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In this paper, we assess the impact of the COVID‐19 pandemic on the Australian visual arts sector. We base our analysis on the responses of over 1500 visual artists and arts workers to a survey conducted by the National Association for the Visual Arts (NAVA), the national peak body for the visual and media arts, craft and design sector in September 2021. NAVA employed this online survey to study the relationship between the pandemic and both the incomes and mental health of artists and arts workers. Using regression analysis, we find that there has been a significant impact for both artists and arts workers, with the severity of the impacts varying by gender, age and the availability of state‐based and Australian Government support programmes. Reduced hours and loss of contracted work and commissions due to the pandemic were both related to declines in income and mental health outcomes for artists and for arts workers. Housing stress was associated with a higher likelihood of a significant or extreme mental health impact for artists and arts workers. In addition, artists' incomes and mental health outcomes were impacted when faced with a reduced ability to sell, although some artists were able to increase their online profiles. [ABSTRACT FROM AUTHOR]

What is known about the topic? Little is known about the state of mental health reform in Australia. This article describes the struggle to develop the systems of accountability necessary to assess national progress. What does this paper add? We provide some historical context regarding mental health reform and consider recent efforts in particular, before then describing current key opportunities. What are the implications for practitioners? Many people working in mental health are struggling to deliver quality services to Australians. This paper considers the broad policy issues which have led to this situation. This is useful for practitioners who can then better respond and participate in processes of systemic reform. Opportunities to engage now in key policy formulation are identified in the article. [ABSTRACT FROM AUTHOR]

Background: The gaps in healthy life expectancy (HLE) between Indigenous and non-Indigenous Australians are significant. Detailed and accurate information is required to develop strategies that will close these health disparities. This paper aims to quantify and compare the causes and their relative contributions to the life expectancy (LE) gaps between the Indigenous and non-Indigenous population in the Northern Territory (NT), Australia. Methods: The age-cause decomposition was used to analyse the differences in HLE and unhealthy life expectancy (ULE), where LE = HLE + ULE. The data was sourced from the burden of disease and injury study in the NT between 2014 and 2018. Results: In 2014–2018, the HLE at birth in the NT Indigenous population was estimated at 43.3 years in males and 41.4 years in females, 26.5 and 33.5 years shorter than the non-Indigenous population. This gap approximately doubled the LE gap (14.0 years in males, 16.6 years in females) at birth. In contrast to LE and HLE, ULE at birth was longer in the Indigenous than non-Indigenous population. The leading causes of the ULE gap at birth were endocrine conditions (explaining 2.9–4.4 years, 23–26%), followed by mental conditions in males and musculoskeletal conditions in females (1.92 and 1.94 years, 15% and 12% respectively), markedly different from the causes of the LE gap (cardiovascular disease, cancers and unintentional injury). Conclusions: The ULE estimates offer valuable insights into the patterns of morbidity particularly useful in terms of primary and secondary prevention. [ABSTRACT FROM AUTHOR]

Background: The Partners in Recovery (PIR) program was implemented by the Australian Government Department of Health. Its overriding aim was to improve the coordination of services for people with severe and persistent mental illness, and who have complex needs that are not being met. The PIR capacity-building project (CBP) was funded to provide capacity building activities to the nationwide network of consortia that were set up in 2013 to deliver PIR over a 3-year period. The purpose of this paper is to describe the design and findings from an evaluation of the PIR CBP. Methods: The evaluation involved collecting feedback from consenting PIR staff via an online survey and follow-up semi-structured interviews. CBP activities included: state and national meetings; a web portal; teleconferences; webinars; a support facilitator mentor program; and tailored support from the CBP team. Results: The CBP made a positive contribution to the implementation and delivery of PIR. Staff highly valued activities that employed face-to-face interaction or provided informative knowledge exchange, and were appreciative of CBP staff being responsive and adaptable to their needs. Conclusions: From this evaluation, we recommend the following: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). This information is informing the mental health workforce capacity building activities that our team is currently undertaking. Capacity-building programs are necessary for advancing new public health initiatives, yet there remains limited evidence to inform best practices for delivering these in the context of mental health. This paper describes the design and findings of a capacity-building program developed to enhance the knowledge and skills of community-based mental health providers. From this evaluation, we recommend the following to ensure effective capacity-building programs: identify relevant functions (e.g. prioritise networking), select the right mode of delivery (e.g. establish an online presence) and abide by key principles (e.g. be responsive to staff needs). [ABSTRACT FROM AUTHOR]

The Melbourne Study of Psychoanalytic Psychotherapy examined the implementation, lived experience, and perceived therapeutic gains of psychoanalytic psychotherapy in a low‐cost, private‐sector community clinic. A first in Australia, this 8‐year demonstration project allowed naturalistic study of the impact and process of intensive, long‐term, time‐limited psychoanalytic psychotherapy delivered to self‐referred adults by clinicians with a common theoretical frame of practice. Presented in three papers, the research employed the RE‐AIM planning and evaluation framework, using complementary quantitative and qualitative methods, to study the psychotherapy service in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance. This first paper reports the Reach of the program to be 67% for those presenting for assessment for psychoanalytic psychotherapy, with Adoption of the full 2‐year treatment program being 60%. Improvements in mental health and life functioning provided quantitative evidence of Effectiveness for those completing the 2‐year treatment program, with Maintenance at 8‐month follow‐up. Patient age, gender and personality characteristics did not modify these improvements. In‐depth qualitative exploration of patient and psychotherapist perspectives regarding the psychotherapy is reported in the second paper highlighting expectations, experience and benefits of the psychotherapy. The third companion paper presents the qualitative findings concerning factors experienced as facilitating or challenging therapeutic progress. Each of the three related papers amplifies understandings of how low‐cost, long‐term but time‐limited psychoanalytic psychotherapy can be implemented in the community with adults otherwise unable to afford such treatment, and discusses lessons learned. [ABSTRACT FROM AUTHOR]

Background: Anxiety and depressive disorders typically emerge in adolescence and can be chronic and disabling if not identified and treated early. School-based universal mental health screening may identify young people in need of mental health support and facilitate access to treatment. However, few studies have assessed the potential harms of this approach. This paper examines some of the potential mental health-related harms associated with the universal screening of anxiety and depression administered in Australian secondary schools. Methods: A total of 1802 adolescent students from 22 secondary schools in New South Wales, Australia, were cluster randomised (at the school level) to receive either an intensive screening procedure (intervention) or a light touch screening procedure (control). Participants in the intensive screening condition received supervised self-report web-based screening questionnaires for anxiety, depression and suicidality with the follow-up care matched to their symptom severity. Participants in the light touch condition received unsupervised web-based screening for anxiety and depression only, followed by generalised advice on help-seeking. No other care was provided in this condition. Study outcomes included the increased risk of anxiety, depression, psychological distress, decreased risk of help-seeking, increased risk of mental health stigma, determined from measures assessed at baseline, 6 weeks post-baseline, and 12 weeks post-baseline. Differences between groups were analysed using mixed effect models. Results: Participants in the intensive screening group were not adversely affected when compared to the light touch screening condition across a range of potential harms. Rather, participants in the intensive screening group were found to have a decreased risk of inhibited help-seeking behaviour compared to the light touch screening condition. Conclusions: The intensive screening procedure did not appear to adversely impact adolescents' mental health relative to the light touch procedure. Future studies should examine other school-based approaches that may be more effective and efficient than universal screening for reducing mental health burden among students. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12618001539224) https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375821. [ABSTRACT FROM AUTHOR]

More people are working into older age, raising questions about how many hours they can work before their health becomes compromised. This paper models work-hour tipping points for mental health and vitality among older Australian workers aged 50–70 years. We use longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, 2005–2016 (about 44,900 observations), and bootstrapping Three Stage Least Squares (3SLS) estimation techniques to adjust for reverse and reciprocal relationships between wages, work hours and health. Our approach corrects for heteroscedasticity in the system equation error terms, and we estimate models on the relatively healthy older adults who have remained employed into older age. Among these older workers we observe weekly thresholds of 39–40 hours beyond which mental health and vitality decline. This average, however, hides variability in work-hour limits linked to overall health and occupation. Thus, weekly tipping points for blue- and pink-collar jobs are 7–9 hours lower compared to white-collar jobs, and even wider gaps (11 hours) are apparent for workers with poorer physical functioning, which becomes common as people age. Our modelling reveals that age is not the biggest limiting factor for how many hours older adults can work, rather their health and the types of jobs are critical, and likely widen the gap in who ages successfully or not. [ABSTRACT FROM AUTHOR]

Issue Addressed: Supporting healthy behaviours (quality diet, physical activity, sleep) through home‐based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale‐up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research‐practice translation. Methods: Stakeholders (n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi‐structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale‐up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale‐up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. Results: Individual‐level: Targeting multiple systems (primary, tertiary, community‐based care) and entry points (early, mid‐postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at‐risk women, was suggested. Provider‐level: Stakeholders identified strategies to enhance future roll‐out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding; online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems‐level: Political support and community champions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. Conclusions: For sustainable implementation and potential scalability of a home‐based multi‐behaviour postnatal intervention, multi‐level implementation and scale‐up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. So What?: This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future. [ABSTRACT FROM AUTHOR]

Intersecting gender and other social inequalities are pertinent to women's mental health across the life course. Gendered violence and other forms of gender inequality in particular play a key role in the higher burden of psychological distress carried by young women. However, the context of gendered violence is often minimised or overlooked entirely when young women seek help or advice around mental health concerns. This is especially the case for young women under the age of 30 years. This paper reports on a research study exploring how young women in Australia understand their mental health, and the scope for new approaches to support that better address their needs. A qualitative survey undertaken with 52 Australian young women was used to explore the nature of their mental health experiences, sought to learn about the strategies they used when experiencing poor mental health and the scope for mental health peer support as an alternative approach to intervention. Responses from a diverse group of young women demonstrated that they understood the role that gendered violence and gender inequality played in their mental health. Findings point to the risk of slippage between young women's understandings of their lived experience and those of traditional service providers, demonstrating the risks associated with minimising or ignoring of the gendered nature of young women's mental health problems. [ABSTRACT FROM AUTHOR]

This paper presents a systematic review that assessed the different types of mental health programs and interventions available for young people from Culturally and Linguistically Diverse (CALD) backgrounds in Australia, and identified core elements of practice for supporting the mental health of CALD youth, and key barriers that preclude CALD youth from engaging with mental health services. A total of 19 articles met inclusion criteria and a total of six distinct practices were identified: (1) personalization, identity and recognition of trauma; (2) creative expression; (3) cultural competence; (4) self-efficacy and empowerment; (5) social connections and relationships; and (6) information and content delivery. Key barriers related to engagement with CALD youth mental health programs included language and literacy barriers, stigma and shame, and service providers' limited cultural competency, and lack of diverse understandings of wellbeing. The findings from this review suggest several avenues for ensuring practice that effectively meets the unique mental health needs of CALD young people and reduces barriers to their access and engagement. [ABSTRACT FROM AUTHOR]

Background: This paper explores the mental health and wellbeing outcomes of a massed community choir program in Australia. Methods: This study employed a mixed methods approach. Data were collected via a survey of choir participants (N = 305), four qualitative interviews and focus groups with facilitators and participants (N = 22), and two workshops with organising staff (N = 5). Questions were derived from a co-designed program logic, and data were triangulated and analysed thematically. Results: Participants reported feeling a sense of connectedness (psychological), but also experiencing connection (social) with their fellow singers. Psychological outcomes included the sensations of affect, arousal, and affirmation. Social outcomes included experiencing belonging, inclusion, and sharing. These positive psycho- social experiences promoted positive mental health and wellbeing outcomes in the large group of participating singers. Conclusions: This paper addresses gaps in our understanding about the mental health and wellbeing outcomes fostered by community choirs at scale. [ABSTRACT FROM AUTHOR]

Emergency situations such as pandemics typically widen inequities, and Australian children and young people with disability already face significant inequities in the education system. In this paper we draw on survey data from over 700 respondents exploring education experiences during the COVID-19 pandemic. Many families reported being left behind, finding it difficult to access education remotely, and that this was having a significant impact on wellbeing and mental health. We find that of all support offered by schools, social supports have a stronger association with learner engagement than educational interventions. This finding indicates the importance of social and emotional supports in learning. The COVID-19 pandemic has significantly disrupted education for most learners; There is good evidence to suggest this impact is felt more keenly by students with disability, because there is disability discrimination in the Australian education system; This paper reports survey responses from over 700 families of students with disability exploring the impact of COVID-19 on education; Many families report being left behind and that students found it difficult to learn away from the school campus, which for many students and families led to poorer wellbeing and mental health; Our results suggest that supporting students to have social contact with peers made the biggest impact on students with disability feeling engaged with learning during this time. This shows it is important for teachers and schools to pay attention to social as well as educational aspects of school life when thinking about how to educate students with disability. [ABSTRACT FROM AUTHOR]

Objectives: The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort. Methods: The FPS is an Australian school‐based prospective cohort study with an embedded cluster‐randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self‐report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5 years. Results: The baseline cohort (N = 6388, M = 13.9 years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps < 0.05). Conclusions: This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence. [ABSTRACT FROM AUTHOR]

Accessible Summary: What Is Known on the Subject?: Australia is a commonwealth of federated states and territories with each having unique mental health legislation. Victoria implemented advance statements based on legislation from overseas jurisdictions such as Scotland. The aim of this Victorian legislation was to underpin an individual's autonomy and decision‐making in relation to treatment, particularly compulsory treatment.Advance statements allow individuals within the healthcare setting to document preferences for care and treatment during times of decompensated mental health, including informing nominated persons and preferences for recovery‐oriented care; however, advance statements continue to attract barriers in their implementation and use. What this Study Adds to Existing Knowledge?: This paper focuses on legislation within one jurisdiction, Victoria, highlighting that several barriers to uptake exist, including uncertainty around the legal status of advance statements, the ideal setting to implement advance statements and concern around perceived consumer capacity to contribute to developing advance statements.There are substantial differences of opinion regarding adherence to treatment and recovery preferences contained within the advance statement, especially when decisions are made in the context of decompensated mental health.The Theoretical Domains Framework (TDF) model has been used to formulate recommendations in several other health studies, but to date has not been used to provide recommendations for greater implementation of advance statements.Implementation science is a contemporary research translation movement that seeks to identify factors and strategies that influence the adoption and integration of interventions like advance statements in real world settings. For this study it has been useful to identify barriers, consider implementation strategies and link this with policy frameworks to support practice change. What are the Implications for Practice?: Our study revealed that real challenges exist for mental health clinicians in adopting advance statements despite them having a strong held intention to empower service users to play a greater role in their own treatment and care decisions.The facilitators identified in this study highlight the notion that advance statements, and the concept of supported decision‐making are needed in contemporary mental health care.Implementation science can assist in identifying barriers and suggesting facilitators including enhanced training, incentivization of advance statement creation, and greater awareness of the overarching purpose and principle of advance statement creation.Continued support and training in implementing and maintaining advance statements is required if mental health clinicians are to drive the uptake of this important reform to mental health legislation. Training needs to be provided that will address attitudes, and strongly held beliefs that pose barriers to the use of advance statements. Introduction: Advance statements, also known as advance directives or psychiatric wills, provide individuals the opportunity to document care and recovery preferences during a period of mental ill health. Although the use of advance statements has gained momentum, little research has explored the factors that promote or hinder further uptake. Aim: To determine the factors that promote or hinder the uptake of advance statements. Method: Cross‐sectional online survey of healthcare workers (n = 190). Results: Promoting factors include high perceived value of advance statements, particularly their role in recovery focussed care, while hindering factors include disagreement or responsibility for advance statement creation and legal status. Discussion: This study indicates that several hindering factors or barriers to advance statement uptake remain, and until these factors are addressed future implementation is arguably hindered. In this paper, we have used the Theoretical Domains Framework (TDF) model to outline suggestions to address hindering factors to implementation and guide future implementation strategies for advance statement uptake and practice change. Implications for Practice: The ongoing uptake of advance statements requires tailored implementation strategies address hindering factors. Strong promoting factors, such as the shared belief in the advance statement model and its role in recovery focused care, should be considered a strong foundation for implementation strategies. [ABSTRACT FROM AUTHOR]

Background: A wealth of evidence supports the important role high‐quality parent–child interactions play in children's early language acquisition. However, the impact on later language outcomes remains unclear. Aims: To examine the associations between responsive parental behaviours across the early years and child language outcomes at age 7 years with families from an Australian longitudinal cohort study (N = 1148, 50% female). Methods & Procedures: At child ages 12, 24 and 36 months, parents completed a self‐report measure of responsive parental behaviours. Child language was directly assessed at age 7 using the Clinical Evaluation of Language Fundamentals, 4th edition (CELF‐4), Australian Standardisation. Linear regression was used to examine associations between responsive parental behaviours from 12 to 36 months (consistently high, inconsistent and consistently low responsive parental behaviours at the three time points) and language scores at age 7 years. Adjusted models were run, including the following potential confounders: child sex; birth weight; birth order; maternal education; socio‐economic disadvantage; non‐English‐speaking background; family history of speech–language problems; mother's vocabulary score; maternal mental health score; and mother's age at birth of child. A final adjusted model was run, including the potential confounder variables as well as adjusting for children's earlier language skills. Outcomes & Results: Linear regression results showed children with parents who rated high on responsive parental behaviours at all three time points had higher mean language scores at age 7 than children whose parents reported low responsive parental behaviours across early childhood. This association attenuated after adjusting for earlier child language skills. Conclusions & Implications: Findings support the consistent use of responsive parental behaviours across the very early years of childhood to support long‐term language outcomes. Findings also suggest that models of surveillance and support which monitor and assist families at multiple time‐points over the early years are likely to be most effective for preventing ongoing language difficulties. WHAT THIS PAPER ADDS: What is already known on this subject: There is extensive evidence consistently demonstrating the important contribution of aspects of parent–child interaction, specifically responsive parental behaviours, to children's language development. What this paper adds to the existing knowledge: Understanding the cumulative benefit of responsive parent–child interactions across the very early years may help to inform preventive interventions and service delivery models for supporting young children's language development. This study demonstrates in a large, population‐based cohort the contribution of consistency of responsive parental behaviours during infancy and toddlerhood to school‐age language outcomes, accounting for other child, family and environmental factors. Capturing regular parent behaviours via self‐report during the early years may be a more efficient and less costly method than parent–child interaction observations to monitor the home language‐learning environment during routine developmental checks. What are the potential or actual clinical implications of this work?: Findings support the need for surveillance of children and families in the early years, ensuring that intervention occurs when families need it most, that is, support is responsive to changing needs and that nuanced advice and support strategies are provided to activate positive developmental cascades. Capturing both parent behaviours and child language may assist clinicians to identify those families who may benefit from parent–child interaction intervention. [ABSTRACT FROM AUTHOR]

Background: Doctors with a history of mental health or substance use challenges face barriers accessing treatment and are difficult to recruit for research. This makes understanding their experiences challenging, yet essential. Overcoming barriers to research participation among unwell doctors is critical to advancing their overall health and wellbeing. Methods: A qualitative interview study of 21 allegedly impaired doctors in Australia and Aotearoa New Zealand who were subject to regulatory processes relating to their health. Based in an interpretative phenomenological paradigm, this paper examines participants' motivations for participation in this study and their reactions to participating. It highlights wider implications for sensitive research involving doctors and marginalised groups. Results: Participants were strongly motivated to participate in our research for their own benefit (desire to be heard, catharsis, and empowerment) and to benefit others (to change the system, and to avoid other doctors experiencing what they experienced). Careful planning and communication of unique legal risks fostered a trusting researcher-participant relationship. To assist other researchers undertaking sensitive qualitative research with vulnerable participants, we describe our research protocol, challenges, and successes in detail. Conclusions: Despite ethical concerns about research risk, researchers can and should pursue qualitative research into the experiences of under-represented groups, including allegedly impaired doctors. Without involving them in research that examines issues directly impacting on them, we may be inadvertently perpetuating the barriers and stigma that also hinder them from accessing treatment and support. This also deprives us of knowledge that can be used to improve doctors' health. This paper has broader relevance for anyone doing research with doctors, people in vulnerable positions, people disempowered by institutional or social systems, people who are stigmatised or shamed, and people who have experienced trauma. [ABSTRACT FROM AUTHOR]

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk‐in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof‐of‐concept study investigating the acceptability and short‐term effectiveness of an online walk‐in family therapy service, Walk‐in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk‐in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre‐session, post‐session, and at 6 weeks follow‐up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi‐structured interview data. Post‐session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post‐session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well‐received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk‐in delivery model. This proof‐of‐concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk‐in, telehealth model to meet the rising demand for therapeutic support for families in distress. [ABSTRACT FROM AUTHOR]

Understanding the drivers of student dropout from higher education has been a policy concern for several decades. However, the contributing role of certain factors—including student mental health—remains poorly understood. Furthermore, existing studies linking student mental health and university dropout are limited in both methodology and scope—for example, they often rely on small and/or non-representative samples or subjective measures, and focus almost exclusively on main effects. This paper overcomes many of these shortcomings by leveraging unique linked administrative data on the full population of domestic students commencing undergraduate studies at Australian universities between 2012 and 2015 (n = 652,139). Using these data, we document that approximately 15% of students drop out of university within their first academic year. Critically, students receiving treatment for mental health problems are 4.3 (adjusted) to 8.3 (unadjusted) percentage points more likely to drop out of higher education. This association remains in the presence of an encompassing set of potential confounds, and is remarkably uniform across segments of the student population determined by individual, family, and programme characteristics. Altogether, our findings call for increased policy efforts to improve student mental health and to buffer against its deleterious effects on retention. [ABSTRACT FROM AUTHOR]

This paper considers the role of academic training programs in the integration of family therapy and infant mental health (IMH) curricula. It takes the form of a conversation between senior academic staff of the Bouverie Centre in Australia and the special issue editors. Robyn Elliott and Colleen Cousins are family therapists, trauma specialists, and academics at the Bouverie Centre, La Trobe University. Robyn supervises the development and delivery of the Master of Clinical Family Therapy, accredited by the Australian Association of Family Therapy. Colleen is a psychologist and family therapist and coordinates the Graduate Certificate of Family Therapy program. They are in dialogue here with the special issue co‐editors, Jessica Opie and Jennifer McIntosh. We consider the degree to which current family therapy training holds the infant in mind, and approaches to deepening the future training nexus between IMH and family therapy. [ABSTRACT FROM AUTHOR]

Objective: Cross-sectional studies have demonstrated that people with disability have substantial inequalities in mental health compared to people without disability. However, it is not known if these inequalities have changed over time. This study compared the mental health of people with and without disability annually from 2003 to 2020 to investigate time trends in disability-related mental health inequalities. Methods: We use annual data (2003–2020) of the Household, Income and Labour Dynamics in Australia Survey. Mental health was measured using the five-item Mental Health Inventory. For each wave, we calculated population-weighted age-standardised estimates of mean Mental Health Inventory scores for people with and without disability and calculated the mean difference in Mental Health Inventory score to determine inequalities. Analyses were stratified by age, sex and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). Results: From 2003 to 2020, people with disability had worse mental health than people without disability, with average Mental Health Inventory scores 9.8 to 12.1 points lower than for people without disability. For both people with and without disability, Mental Health Inventory scores decreased, indicating worsening mental health, reaching the lowest point for both groups in 2020. For some subpopulations, including young females and people with intellectual disability, brain injury or stroke, mental health inequalities worsened. Conclusion: This paper confirms that people with disability experience worse mental health than people without disability. We add to previous findings by demonstrating that disability-related inequalities in mental health have been sustained for a long period and are worsening in some subpopulations. [ABSTRACT FROM AUTHOR]

This review aimed to inform a deeper understanding of the varied experiences of ageing in place for older adults in Australia and New Zealand. Ageing in place involves older adults remaining in their own home or community as they age rather than moving into residential care. Our focus was on how ageing in place relates to older adults' mental health, life satisfaction, wellbeing, and overall ability to adapt well to ageing. This paper followed PRISMA‐ScR guidelines. Of the initial 210 papers identified, 20 met inclusion criteria and were retained. Four key themes related to experiences of ageing in place and the skills and strategies utilised to age in place were extracted from these studies. Themes encompassed older adults' individual characteristics and strategies, their connections to community, their home environment, and the appropriateness of support and services. We conclude that ageing in place should not be considered a "one size fits all" approach to ageing. Policymakers, researchers, and governments should acknowledge that older adults are a diverse group. Future ageing policy should strive to accommodate all older adults regardless of their circumstances or ageing preferences and researchers should include older adults from diverse populations and circumstances. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Background: Communities of practice (CoPs) are frequently used in health settings to enhance knowledge and support action around public health issues. Yet, most are ineffective and often at risk of not delivering on this promise. To prevent loss of time and resources by organisations, facilitators, and members, this paper argues for a reliable assessment of the needs of people who intend to join and to set realistic expectations to assure effective communities of practice. This research proposes a valid and reliable needs assessment and analysis tool for starting communities of practice, by presenting the results of using such a tool. Methods: Inception needs assessments were developed, tested and administered to 246 respondents entering five communities of practice that focused on one of three public health issues: health literacy, mental health literacy and trauma-informed care. One community of practice had a global audience, four were based in Australia. Data from the needs assessments were analysed qualitatively and supplemented with descriptive statistics. Results were used to develop an analysis tool to support future communities of practice. Results: The short-term expectations of respondents included seeking to increase their knowledge and getting to know other members of the community of practice. Long-term expectations shifted towards undertaking action, collaborating and improving health outcomes. While respondents learning expectations included a wide range of topics, they articulated very specific knowledge they expected to share with others. There were high expectations of receiving practical support from the facilitator and a strong preference for meetings with synchronous interaction. Most respondents who planned to join focused initially on the direct and individual benefits and participation they expected from others, whereas they indicated limited intention to actively contribute to the learning needs of other community members. Respondents appeared to need to take time to build self-confidence and trust, and frequently applied a wait-and-see attitude. Conclusions: The findings of this study suggest that an inception needs assessment allows members to express their needs and expectations, which directly informs the direction and structure of a community of practice, gives voice to members, and supports facilitators in managing expectations. [ABSTRACT FROM AUTHOR]

This paper presents findings from an investigation of nature-based practices, from the perspectives of 10 academics/educators from six nations. Participants engaged in a focus group exploring the prevalence and inclusion of nature in social work practice and education. While the study focused on individual members' experiences and perspectives, the findings highlight important context-specific factors for including nature within social work to reconnect humans with nature for health, well-being, healing, and justice. An Integrative Environmental Model for social work is proposed to assist future practice and education. [ABSTRACT FROM AUTHOR]

Up to one third of adults who receive mental health services in Australia are parents. Psychologists in private practice are one of the largest groups within the Australian mental health workforce who support parents experiencing mental ill-health. Parents have specific support needs relating to their parenting role and "treatment as usual" may not address their integrated parenting and mental health concerns. The service experiences of parents in this setting have not been studied. This qualitative study addresses this knowledge gap through investigation of the experiences of Australian mothers who received support from a psychologist in private practice. Semi-structured interviews were conducted with 14 mothers and interviews were analysed using Interpretive Phenomenological Analysis. Three overarching themes were identified in relation to (i) participants' need to feel understood and heard as a parent, (ii) their need for a nonjudgmental therapeutic space and (iii) their desire for practical parental support from psychologists. These findings corroborate the value of family-focused practices when supporting parents with a mental health condition. The results include ways in which family-focused practices have been incorporated by clinicians in private practice settings which may have application in other mental health service contexts. What is already known about this topic: Psychologists in private practice make up a substantial group within the Australian mental health workforce who support parents with a mental health condition. Parents who receive mental health care in tertiary mental health settings report a lack of dedicated parenting support and resources. Family-focused practices are effective in supporting parenting and recovery for parents with a mental health condition who receive mental health care in tertiary mental health settings. What this paper adds: Psychologists who support parents in private practice should collaborate with their clients to identify which aspects of their parenting may be relevant to the therapeutic work and provide targeted support for parenting difficulties. Most participants expected that their psychologist would provide targeted support for parenting difficulties, and they felt disappointed when this did not occur. The lived experiences of parents with mental ill-health in private practice psychology services are highlighted, addressing a key knowledge gap in the literature. [ABSTRACT FROM AUTHOR]

A clear understanding of the nature and extent of suicidal behaviour and other mental health issues in Aboriginal and Torres Strait Islander populations has been limited by the national failure to develop clinically and culturally valid assessments and to ensure the cultural competence of practitioners. The default position for Australian mental health researchers is to continue to adapt existing mainstream assessments. The problem with this approach is it doesn't enable researchers to determine culture-specific symptoms or phenomena that are critical to establishing true cultural validity. The mental health field needs culturally co-designed psychometric tools to capture culture-specific expression and manifestation of symptoms, and to capture culture-specific symptoms. Two such tools exist: the WASC-Y and WASC-A. However, there are few data on their psychometric properties beyond the initial developmental research reported in the test manuals. This needs to be a focus for future research. What is already known about this topic: Aboriginal and Torres Strait Islander people in Australia have suicide rates that are at least twice that of non-Indigenous Australians. Research into Aboriginal and Torres Strait Islander people's mental health is limited by the continued failure to use culturally valid, psychometrically sound, and clinically valid screening tools. For decades researchers have been drawing attention to the need for screening tools and other psychological assessments to be specifically validated for use with Aboriginal and Torres Strait Islander people. What this paper adds: Some attempts have been made to develop culturally valid tools or to validate mainstream instruments for use with Aboriginal and Torres Strait Islander people, but these tools are significantly limited. Attempting to validate mainstream instruments with Aboriginal and Torres Strait Islander people fails to determine unique aetiologies and explain the over-representation of Indigenous people in suicide deaths. The Westerman Aboriginal Symptom Checklists are culturally and clinically valid screening tools that warrant further exploration of their value in addressing the unacceptable gaps in understanding the nature and extent of mental health problems and suicidal behaviour among Aboriginal people. [ABSTRACT FROM AUTHOR]

Purpose: Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. Methods: Young people (12–25 years old) were recruited from five youth-specific primary mental health ("headspace") services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. Results: 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. Conclusions: Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles. [ABSTRACT FROM AUTHOR]

Background: Early career medical professionals experience stress and burnout at higher levels than the wider community. Burnout can arise with competing demands of life and career, which is evident in early career development, where family planning can coincide with specialty training. General practice may be seen as a family friendly career option; however, few studies examine the experience of general practice trainees with stress and burnout and the impact that parenting has on their experience. This study aims to explore the experience of stress and burnout in general practice registrars and the exacerbating and protective factors, with a focus on the experiences of two groups of registrars, those that have children, and those that do not. Methods: A qualitative study was conducted with 14 participants, who were interviewed with questions exploring experiences of stress and burnout. Participants were grouped into those with children and those without children. The transcripts were thematically analysed. Results: Themes were identified as those that contributed to stress and burnout (such as time, financial concerns and isolation) and those factors that reduced stress and burnout (such as support from others and being respected and valued within the workplace). Parenting was identified as both a factor that could contribute to and reduce stress and burnout. Conclusions: Stress and burnout are important foci for future research and policy to ensure the sustainability of general practice. System based and individual focused policies, including individualising training to support parenting, are required to ensure that registrars are supported through their training years and beyond. General practice needs to work to increase recruitment of doctors, reduce early career burnout and to retain GPs in the long term. Early career medical professionals experience stress and burnout at higher levels than the wider community. General practice may have traditionally been seen as a family friendly career option, however, unfortunately it may be no longer. This paper examines the experience of GP trainees with stress and burnout and the impact that parenting has on their experience and looks at solutions to improve conditions for early to mid career GPs, and hopefully make general practice more attractive for future doctors. [ABSTRACT FROM AUTHOR]

Objective: In the context of concerns regarding hospital access block, this paper provides a descriptive longitudinal analysis of mental health–related ED episodes in Australian public hospitals between 2016-17 and 2020-21. Method: We descriptively analysed Australian Institute of Health and Welfare data for mental health–related ED presentations, outcomes and 5-year trends for Australian public hospitals. Results: There were more than 300,000 Australian mental health–related ED presentations in 2020-21. Presentations increased by an average annual rate of 2.8% between 2016-17 and 2020-21, commonly involving first responder (police, paramedic) attendance. From 2016-17 to 2020-21, the average annual rate of mental health–related ED presentations receiving a triage category of resuscitation increased by 13.7%, emergency by 9.4% and urgent by 4.7%. 90% of MH-related ED presentations were completed within 14 h, which was longer than the 90th percentile for all ED presentations (up to 8 h). Conclusions: Current mental health policies have not stemmed the rising tide of ED presentations. Mental health–related ED presentations are increasing in number and severity, likely due to health systemic and societal factors. Psychiatry patients stay longer in EDs than other patients. Healthcare reforms should be targeted to provide the best outcome based on principles of equity of access. [ABSTRACT FROM AUTHOR]

Student evaluation of teaching (SET) has become a ubiquitous feature of higher education. The attainment and maintenance of positive SET is essential for most teaching staff to obtain and maintain tenure. It is not uncommon for teachers to receive offensive and non-constructive commentary unrelated to teaching quality. Regular exposure to SET contributes to stress and adversely impacts mental health and well-being. We surveyed Australian teaching academics in 2021, and in this paper, we explore the perceived impacts of SET on the teaching and learning experience, academic standards and quality. Many respondents perceived that SET contributes to an erosion of standards and inflation of grades. A thematic analysis of open-ended questions revealed potential mechanisms for these impacts. These include enabling a culture of incivility, elevating stress and anxiety in teaching staff, and pressure to change approaches to teaching and assessment to achieve the highest scores. Playing the SET game involves balancing a commitment to quality and standards with concessions to ensure optimal student satisfaction. Anonymous SET is overvalued, erodes standards and contributes to incivility. The process of SET needs urgent reform. [ABSTRACT FROM AUTHOR]

Background: Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. Methods: Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. Results: Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. Conclusion: There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth. [ABSTRACT FROM AUTHOR]

Background: Doctors with a history of mental health or substance use challenges face barriers accessing treatment and are difficult to recruit for research. This makes understanding their experiences challenging, yet essential. Overcoming barriers to research participation among unwell doctors is critical to advancing their overall health and wellbeing. Methods: A qualitative interview study of 21 allegedly impaired doctors in Australia and Aotearoa New Zealand who were subject to regulatory processes relating to their health. Based in an interpretative phenomenological paradigm, this paper examines participants' motivations for participation in this study and their reactions to participating. It highlights wider implications for sensitive research involving doctors and marginalised groups. Results: Participants were strongly motivated to participate in our research for their own benefit (desire to be heard, catharsis, and empowerment) and to benefit others (to change the system, and to avoid other doctors experiencing what they experienced). Careful planning and communication of unique legal risks fostered a trusting researcher-participant relationship. To assist other researchers undertaking sensitive qualitative research with vulnerable participants, we describe our research protocol, challenges, and successes in detail. Conclusions: Despite ethical concerns about research risk, researchers can and should pursue qualitative research into the experiences of underrepresented groups, including allegedly impaired doctors. Without involving them in research that examines issues directly impacting on them, we may be inadvertently perpetuating the barriers and stigma that also hinder them from accessing treatment and support. This also deprives us of knowledge that can be used to improve doctors' health. This paper has broader relevance for anyone doing research with doctors, people in vulnerable positions, people disempowered by institutional or social systems, people who are stigmatised or shamed, and people who have experienced trauma. [ABSTRACT FROM AUTHOR]

Objective: This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions. Methods: We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013–19 and 2019–21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results: Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013–21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions: The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation. What is known about the topic? A$35 m is spent on Medicare mental health services every week but there has been little research on the out-of-pocket payments charged to Australians. What does this paper add? Looking at Medicare data from 2013 to 2021, this paper answers three main questions: how much are out-of-pocket payments for mental health in Australia; what trends can be seen; and what variations exist? What are the implications for practitioners? Medicare's Better Access Program is under current review and this research can help practitioners, funders and policy-makers understand the significant investment made in mental health services. [ABSTRACT FROM AUTHOR]

This study seeks to assess the health, social and economic outcomes associated with rough sleeping among women and compare those outcomes with those of (1) men sleeping rough, and (2) women experiencing other forms of homelessness (such as being housed in temporary supported accommodation due to family and domestic violence). The paper analyses survey data using the Vulnerability Index‐Service Prioritization Decision Analysis Tool (VI‐SPDAT) collected from 2735 women experiencing homelessness and 3124 men sleeping rough in Australian cities from 2010 to 2017. We find that women sleeping rough report poorer physical and mental health outcomes and greater problematic drug and or alcohol use relative to both men sleeping rough and women experiencing other types of homelessness (all p < 0.5). Women sleeping rough report significantly higher levels of crisis service utilisation (Β = 17.9, SE = 3.9, p < 0.001) and interactions with police in the previous 6 months (Β = 1.9, SE = 0.3, p < 0.001) than women experiencing homelessness not sleeping rough. Women sleeping rough also report greater healthcare utilisation, and, therefore, healthcare costs, than women experiencing homelessness not sleeping rough and men sleeping rough (all p < 0.05). From a policy perspective, the evidence presented in this paper supports a social determinants approach that moves from addressing symptoms of poor health outcomes associated with homelessness to preventing and ending homelessness with a particular focus on the life trajectories of women. Integrated services and homelessness strategies need to be developed through a gender lens, providing women sleeping rough with tailored permanent housing with wrap‐around supportive housing to address poor health outcomes. [ABSTRACT FROM AUTHOR]

Under the Victorian 2014 Mental Health Act (MHA14), Victorians have a right to advance statements. While there have been initiatives to support uptake, under 3% of consumers have done so. In March 2021, the Royal Commission into Victoria's Mental Health System (the Commission) released its report, including a call to repeal MHA14 and enact a new Act no later than mid-2022. In this paper, we discuss the role of advance planning documentation and instruments used in Australian legislation. Drawing on the Commission's recommendations, models of advance planning in Australia and the Victorian legislative context, this paper proposes a model of both binding and non-binding advance directives. This model would bring the rights of Victorian consumers into alignment with rights provided under the Medical Treatment, Planning and Decisions Act 2016 (Vic) and assist in bringing the new Act into compatibility with the Charter of Human Rights and Responsibilities Act 2006 (Vic). [ABSTRACT FROM AUTHOR]

Objective: To identify what legal workplace protections are available for the mental health consumer workforce in Australia. Methods: Review the available common law and legislative protections to identify the general workforce rights and employer responsibilities in Australia. Results: Consumer workforce members enjoy protections under employment law, anti-discrimination law, tort law and work health and safety law. Conclusions: Consumer workforce members would benefit from understanding and exercising their rights, whereas employers should have better regard to their obligations under common law and legislation. However, further empirical research is needed to assess whether these legislative and policy frameworks sufficiently protect the rights of consumer workers. What is known about the topic? Australia's mental health consumer workforce is expanding. Traditional roles such as consumer consultants and peer support workers are multiplying, as are newer roles such as systemic advocacy, supervision and executive roles. However, the consumer workforce continues to face low pay conditions, stigma, discrimination and unsafe work conditions. What does this paper add? This paper clarifies how these unsatisfactory workplace conditions interface with existing employment-, anti-discrimination- and occupational health and safety-law rights and obligations. In doing so, it signals the key protections in place for the consumer workforce. What are the implications for practitioners? Consumer workers can better understand and exercise their rights. Equally, employers can better understand their obligations to mental health consumer workers, and how they may meet them. Policymakers can consider whether these frameworks are sufficiently protecting mental health consumer workforce rights. [ABSTRACT FROM AUTHOR]

Objectives: This paper compares the evolution of the psychosocial sector in two Australian regions pre and post introduction of the National Disability Insurance Scheme – a major reform to the financing, planning and provision of disability services in Australia, intended to create greater competition and efficiency in the market, and more choice for service users. Methods: We used a standardised service classification instrument based on a health ecosystems approach to assess service availability and diversity of psychosocial services provided by non-government organisations in two Primary Health Network regions. Results: We identified very different evolutionary pathways in the two regions. Service availability increased in Western Sydney but decreased in the Australian Capital Territory. The diversity of services available did not increase in either Primary Health Network 4 years after the reform. Many services were experiencing ongoing funding uncertainty. Conclusion: Assumptions of increased efficiency through organisational scaling up, and a greater diversity in range of service availability were not borne out. Implications: This study shows the urgent need for evaluation of the effects of the NDIS on the provision of psychosocial care in Australia. Four years after the implementation of the NDIS at vast expense key objectives not been met for consumers or for the system as a whole, and an environment of uncertainty has been created for providers. It demonstrates the importance of standardised service mapping to monitor the effects of major reforms on mental health care as well as the need for a focus at the local level. [ABSTRACT FROM AUTHOR]

Analysing survey data from 1,304 LGBTQ + young people in Australia collected in 2016, this paper considers key distinctions between the experiences of bisexual and pansexual participants, and lesbian and gay participants in relation to social media use and aspects of connection, harassment and mental health. Presenting quantitative data, illustrated by qualitative extracts, we found broad similarities in motivations for using social media and how participants connected to peers and communities. There were some statistically significant differences, however, in respondents' motivations for using social media and who they connected with on these platforms. Importantly, bisexual and pansexual participants reported more negative experiences of harassment and exclusion across all major social media platforms when compared to their lesbian and gay peers. Bisexual and pansexual respondents also reported poorer mental health experiences. These findings speak to the different impacts of discrimination and oppression that young people experience in everyday life. There is a need for focused attention on bisexual and pansexual young people in academic, policy and youth-work domains. Young people will benefit from more substantial school-based education on LGBTQ + identities - beyond the experiences of gay and lesbian people - to 'usualise' varieties of difference in gender and sexual identity. [ABSTRACT FROM AUTHOR]

Many countries, including Australia, have laws that enable criminal prosecution of an individual based on reckless or intentional transmission of HIV to another person. Previous research has suggested that criminalisation of HIV may serve to hamper public health efforts by inhibiting HIV status disclosure or testing. Limited research to date has sought to examine the broader impact of criminalisation on the health and wellbeing of people living with HIV, which this paper aims to address. Drawing on cross-sectional data from 895 people living with HIV in Australia, this paper describes associations between standard measures of mental health and resilience with a newly devised scale measuring anxiety about HIV criminalisation. Findings suggest that laws criminalising HIV transmission have a broadly negative impact on wellbeing of people living with HIV, a situation that is exacerbated for gay and bisexual men, and other people living with HIV who may face intersecting forms of marginalisation based on race, gender or class. There is little justification for these laws being applied in Australia and the findings add weight to advocacy seeking to overturn criminalisation across the world. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the initial development of a mental health rehabilitation curriculum for Australian mental health settings and for psychiatrists and trainees wishing to develop specialist skills in mental health rehabilitation. Method: Members of the Section of Social Cultural and Rehabilitation Psychiatry (SSCRP) established an expert working group under the auspices of the RANZCP. Existing college training resources were reviewed, and a gap analysis was conducted to guide development of new training modules. Results: A tiered curriculum structure was created that allows a staged development of rehabilitation knowledge, skills and attitudes required to be a specialist in mental health rehabilitation. An introductory module was developed to establish the principles of modern mental health rehabilitation. Most of the curriculum was based on existing resources that are relevant to rehabilitation practice. Finalisation of a draft for review was undertaken with the assistance of the RANZCP education project advisors and curriculum experts. Conclusions: As a national body responsible for training psychiatric registrars and maintenance of training for psychiatrists, the RANZCP is well situated to train the specialist medical mental health workforce required to lead rehabilitation services in Australia. The RANZCP mental health rehabilitation curriculum will provide a platform to train the skilled workforce that will enable these services to be fully realised. [ABSTRACT FROM AUTHOR]

This paper reports an Australian project designed to simultaneously explore and capacity build professional practice when working at the intersection of parental mental health and/or problematic substance use and domestic violence (DV). Data from this paper are derived from two main sources: observations and ethnographic notes obtained during 28 Community of Practice (CoP) meetings and semi‐structured interviews with 28 CoP participants. Participants were front‐line workers from a range of government and non‐government organizations providing services to families experiencing DV across three Australian states who participated in The STACY Project: Safe and Together Addressing ComplexitY. Thematic analysis was employed to examine the research questions: How do professionals and organizations understand and respond to families experiencing DV, parental mental health difficulties and problematic substance use issues? How did practitioners report participation in the STACY Project reorienting professional practice with families experiencing DV, parental mental health difficulties, and substance misuse issues? This paper reports workers' exploration of practice implications. The research found that 'domestic violence blind' practice has become entrenched at the intersections of child protection, substance misuse and mental health problems, but a shared framework could bring practitioners from diverse sectors together to generate new ways of working with these complex problems. [ABSTRACT FROM AUTHOR]

Post-traumatic stress disorder (PTSD) is characterised by a range of symptoms including acute stress, flashbacks and avoidance of situations that trigger trauma. Women from Arabic-speaking backgrounds have been shown to have a higher likelihood of developing PTSD due to life stressors experienced. This paper aimed to provide an overview of the experiences and social circumstances of Arab women experiencing PTSD in Australia. Family, gender roles, religion, mental health stigma, trauma, re-settlement challenges, acculturation and discrimination were some of the factors explored in this review. The paper also aimed to review evidence-based treatment for PTSD such as cognitive behavioural therapy, narrative exposure and eye movement desensitisation therapy and whether these westernised approaches can extend to women from Arab backgrounds. Directions for culturally appropriate interventions and how to adapt treatments to suit the needs of individuals from the Arab community experiencing PTSD are discussed as well as considerations for specifically supporting women from Arab backgrounds who need treatment. Future avenues for research are canvassed and discussed within. KEY POINTS What is already known about this topic: (1) Women from Arabic speaking backgrounds in Western countries have been shown to have a higher likelihood of developing PTSD due to the life stressors that they have experienced. (2) Particular life stressors include migration and acculturation stressors, marginalisation, financial concerns, family responsibilities and for some, family violence which can exacerbate distress and contribute to the expression of PTSD symptoms. (3) No effective PTSD treatments for Arab populations in general, let alone Arab women have been identified in research. What this topic adds: (1) Effective mental health treatment for Arab women must take into consideration certain cultural values such as family, women's role/status and stigmas around mental health. (2) Some of the main factors to consider include beliefs and values, communication and language, shame, strict gender roles and religious healing. (3) There is a significant need for immediate future research to be conducted for this community. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal.●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. What the paper adds to existing knowledge: ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking.●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. What are the implications for practice: ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues.●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. Introduction: Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim: To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods: Qualitative exploratory research methods were employed. In‐depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results: Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions: These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice: Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier. [ABSTRACT FROM AUTHOR]

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020–2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally. [ABSTRACT FROM AUTHOR]

Issues Addressed: Well‐being intervention frameworks may help improve well‐being. The Wheel of Well‐being (WoW) is designed to empower individuals to understand and use the WoW framework for themselves, their communities and in workplaces. This paper evaluates the well‐being impacts on participants of a well‐being capacity building programme using WoW, in Australia. Methods: The programme collected quantitative data from participants at two time points, once at the beginning of the programme (Time 1) and on the final session (Time 2). Surveys assessed well‐being outcomes as well as life satisfaction, knowledge and understanding of well‐being and behavioural changes. Results: Results of a total of 162 participants were included in this evaluation of the programme across nine cohorts. Between Time 1 and Time 2 the participants saw a small, but significant increase in well‐being scores, with no difference between age groups. The number of participants regarded as having a "High" well‐being score increased from 11% to 24%. Increases in knowledge, understanding and the implementation of actions and behaviours to improve well‐being were also observed. Conclusion: This evaluation provides evidence that participation in a short, intensive WoW programme can positively impact well‐being, behaviour and knowledge and understanding regarding well‐being. This suggests WoW may be an effective framework around which individuals can improve their well‐being. So What?: Consideration should be given to the implementation of comprehensive health promotion frameworks, including WoW, to improve the well‐being of individuals. Further evaluation is needed to see if improved well‐being is maintained over longer time periods. [ABSTRACT FROM AUTHOR]

COVID‐19 brings increased risk to the mental health of asylum seekers and refugees in Australia on temporary visas. Rapid government changes due to the COVID‐19 pandemic are resulting in significant and sustained hardship on this already vulnerable group. This discursive paper is both an explainer and a resource for mental health nurses and health professionals with scope of practice in primary care and emergency departments responding to this population. The aim of this paper is to alert clinicians to the drivers of mental and suicide related distress and to provide recommendations as to how to therapeutically engage and support this group. Drivers include complex intersections between legal uncertainty, economic, social and mental health stress as drivers of entrapment, acute mental distress and suicidal ideation. Information about the COVID‐19 related factors as drivers contributing to worsening states of distress may help guide clinicians to consider protective factors designed to mitigate the onset or worsening of mental distress, plus aid in the development of health policy and service‐delivery arrangements of support and therapeutic engagement. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 has led to disruptions to the lives of Australian families through social distancing, school closures, a temporary move to home-based online learning, and effective lockdown. Understanding the effects on child and adolescent mental health is important to inform policies to support communities as they continue to face the pandemic and future crises. This paper sought to report on mental health symptoms in Australian children and adolescents during the initial stages of the pandemic (May to November 2020) and to examine their association with child/family characteristics and exposure to the broad COVID-19 environment. Methods: An online baseline survey was completed by 1327 parents and carers of Australian children aged 4 to 17 years. Parents/carers reported on their child's mental health using five measures, including emotional symptoms, conduct problems, hyperactivity/inattention, anxiety symptoms and depressive symptoms. Child/family characteristics and COVID-related variables were measured. Results: Overall, 30.5%, 26.3% and 9.5% of our sample scored in the high to very high range for emotional symptoms, conduct problems and hyperactivity/inattention, respectively. Similarly, 20.2% and 20.4% of our sample scored in the clinical range for anxiety symptoms and depressive symptoms, respectively. A child's pre-existing mental health diagnosis, neurodevelopmental condition and chronic illness significantly predicted parent-reported child and adolescent mental health symptoms. Parental mental health symptoms, having a close contact with COVID-19 and applying for government financial assistance during COVID-19, were significantly associated with child and adolescent mental health symptoms. Conclusion: Our findings show that Australian children and adolescents experienced considerable levels of mental health symptoms during the initial phase of COVID-19. This highlights the need for targeted and effective support for affected youth, particularly for those with pre-existing vulnerabilities. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic continues to exert a significant toll on the Australian primary healthcare system. Although wellbeing challenges faced by hospital-based healthcare workers are widely discussed, less is known about the experiences of general practitioners (GPs) during the initial phases of the pandemic. This paper reports qualitative survey data from Australian GPs, examining their workplace and psychosocial experiences during the initial months of the pandemic. Methods: An Australia-wide, cross-sectional, online survey of frontline healthcare workers was conducted in 2020. A qualitative approach using content analysis was utilised to examine responses to four free-text questions from GPs. Results: A total of 299 GPs provided 888 free-text responses. The findings reveal that general practice was overlooked and undervalued within the pandemic response, resulting in negative impacts on GP wellbeing. Four themes were identified: (1) marginalisation of GPs; (2) uncertainty, undersupported and undervalued in the workplace; (3) isolation and disrupted personal lives; and (4) strategies to support GPs during times of crises. Key concerns included poor access to personal protective equipment, occupational burnout and poor wellbeing, insufficient workplace support, and conflicting or confusing medical guidelines. Conclusions: Primary healthcare constitutes an essential pillar of the Australian healthcare system. This study presents the many factors that impacted on GP wellbeing during the COVID-19 pandemic. Enabling GP voices to be heard and including GPs in decision-making in preparation for future crises will enhance the delivery of primary care, reducing the burden on hospital services, and help sustain a safe and effective health workforce long term. The COVID-19 pandemic caused significant challenges and wellbeing issues for healthcare workers such as general practitioners (GPs), especially during the initial months in 2020. A large nationwide survey of Australian healthcare workers was undertaken in 2020 to understand their experiences, from which 299 GPs provided free-text survey responses for qualitative analysis. This analysis showed GPs felt marginalised, undervalued and under-supported while working in risky work conditions, pointing to a need for GP voices to be heard to safeguard their wellbeing. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Little is known about adolescent inpatient units, key features which define them, and how these essential services operate and deliver care. What the paper adds to existing knowledge?: Adolescent inpatient unit studies are limited in their descriptions of settings in terms of how they operate and key features.The proposed preliminary checklist is a practical tool to assist clinicians, policy makers, and researchers when reporting to ensure comprehensive descriptions of adolescent inpatient settings. What are the implications for practice?: This could be used to inform service design processes for inpatient and other mental health service models which is of critical importance in the context of reforms and implementation of these in Australia currently.Greater attention to operational models, services, and philosophies of practice will improve reporting and allow for the advancement of knowledge, comparison of study results, and a clearer direction for mental health nursing clinicians and researchers. Introduction: Adolescent inpatient units care for vulnerable population groups; however, little is known about how these essential services operate and deliver care. Aims: To examine the descriptions of adolescent mental health inpatient units in Australian and international research publications and to identify key features which were used to define them. A secondary aim was to develop a checklist to improve consistency when reporting on the operations and services delivered within adolescent mental health inpatient units (both public and private). Methods: Five electronic databases (CINAHL, MEDLINE, ERIC, EMBASE, and PsycINFO) were systematically searched. We included studies that provided descriptions of operations and services within adolescent inpatient units where participants had a mean age between 12 and 25. Narrative synthesis was used to explore the similarities and differences between descriptions of settings. Results: Twenty‐eight studies were identified, which varied in their descriptions of adolescent inpatient units, providing inconsistent information to inform best practice. Discussion: Studies lack consistency and comprehensive detail when describing the operational models within inpatient units, making interpretation challenging. Consequently, a preliminary checklist is proposed to improve reporting of adolescent inpatient units. [ABSTRACT FROM AUTHOR]

This paper explores the environmental, interpersonal, and personal outcomes of music performance in a hospital oncology setting. An original, qualitative research study examined the impact of live music for staff, patients, and carers. Data were collected using a multi-method approach of observations and semi-structured interviews and were analysed using inductive and theory-driven theming that was shaped by a determinants of health framework. The research found that live music promoted stronger relationships and calmer environments, among other environmental, social and individual outcomes. Improved communication between staff through the creation of a more supportive environment was a pertinent finding of the research. No negative effects were reported. We discuss research findings in the context of relevant literature and suggest recommendations for future hospital-based live music programs. Results of this study indicate that live music interventions impacted individual, interpersonal, social and environment factors that led to health and wellbeing outcomes for participants. [ABSTRACT FROM AUTHOR]

This paper examines the reflections of a cohort of Australian children who lived through the 2020–21 COVID‐19 pandemic and experienced being in 'lockdown'; a state of largely being confined to the home for long periods daily. We report how children reflect on their experiences and illustrate how reflections draw on similar topics focused on localised child concerns regarding health, education, family, digital engagement, mealtimes and food. Further, we argue for the importance of including children's own voices of lived experience in reports regarding life during the pandemic since these perspectives may differ from those reported by adults on children's behalf. [ABSTRACT FROM AUTHOR]