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Objective: The aim of this article was to examine the concept of mental health and the policies that have been advanced to improve the wellbeing of the population. Conclusions: In the last century there have been many changes in the phenomena of psychiatric disorder, the management of those disorders and the outcomes. All of the changes have largely been due to the efforts of those working pragmatically at the coalface. There is little to suggest that the plans and programs advanced in the last half century have achieved more than enhancing the status of those who advance them. Conclusion: It is difficult to define mental health and equally difficult to develop a comprehensive program that will benefit the whole field. [ABSTRACT FROM AUTHOR]

Objective: Diversity in the workforce is a recognised component of highly functioning teams but remains aspirational in the Australian mental health context. There continue to be significant obstacles to true workforce diversity. The objective of this paper is to outline some of the skills and advantages women in established leadership roles have by dint of their lived workforce experience and how these skills may inform leadership approaches and capacity building potential for the benefit of the system. Conclusions: Leaders must synthesise, capacity build, maintain a systems and future focus and hold a vision to harness the skills of others. This paper outlines why women may have some unique capabilities as a consequence of a gender socialised world and describes approaches that contribute to cohesive, diverse and engaged teams. [ABSTRACT FROM AUTHOR]

Objective: Commentary on the debate concerning the effectiveness of headspace, including the most recent independent evaluation of its services. Conclusions: The available evaluations indicate that headspace does not deliver therapy of adequate duration that results in clinically significant improvement. Most evaluations have used either short-term process measures or uncontrolled satisfaction surveys, and where there have been data on outcomes using standardised instruments, findings have been disappointing. Costs are poorly quantified and probably underestimated. Even so, headspace as a primary care intervention costs twice as much as a mental health consultation by a general practitioner and, depending on the assumptions, may not be cost effective. [ABSTRACT FROM AUTHOR]

Objectives: Doctors' mental health has received renewed attention given the epidemic of burnout, high suicide rates and the recent pressures of the COVID-19 pandemic. Internationally, various service designs and primary prevention initiatives have been trialled to address these needs. Systemic barriers such as stigma as well as individual characteristics of doctors have historically prevented access to mental health services. This paper outlines the Australian service context from which a new publicly funded doctors' mental health programme emerged. Methods: A narrative review of current services and a description of the challenges is outlined. Results: A picture of urgency and unmet needs emerged with particular challenges, such as the need for privacy. Conclusions: Doctors' mental health is an urgent priority with direct impacts on patient safety and care. The complex context and the unmet need suggest the focus must go far beyond burnout and has prompted the establishment of a new service model designed to complement existing services in the Australian context, to be described in a sister paper. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. Conclusion: The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses. [ABSTRACT FROM AUTHOR]

Objective: This study examined differences in the types of mental health research that were conducted in the states and territories of Australia in 2008. Differences in both the disorder focus (e.g. depression, psychosis) and goal or methodology (e.g. epidemiological, biological) of published papers were examined. The structural differences underlying research output were examined by comparing output with funding and research infrastructure.Method: A random sample of 1008 Australian-authored mental health research publications and all 126 competitive mental-health related research grants from 2008 were coded in terms of their state or territory of origin, disorder focus and research goal.Results: Victoria and the Australian Capital Territory had the highest per capita rates of mental health research publications in 2008, while Tasmania and the Northern Territory had less per capita output. Research in New South Wales had greater focus on substance use and anxiety disorders, while Victoria was dominant in research on affective disorders and psychosis. Research in Queensland and Western Australia was broader in scope. Research output was more closely linked with number of successful grants than amount of funding.Conclusions: State and territory support for mental health research may have important implications for research output. [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]

Objective: Managing mental health patients during the COVID-19 pandemic has been a global challenge. Current workforce arrangements tend to separate those skilled in caring for highly infectious medical patients from those whose specialism is in managing co-morbid mental health, substance misuse and/or behaviours of concern, including potential non-compliance with community or health care directives. This paper reports an innovative service development through the emergency establishment of a temporary COVID-positive mental health ward in response to a local outbreak in Melbourne. Method: A case study of service reorientation is presented, examining barriers and enablers to effective care of co-morbid mental illness, addiction and COVID-19. Results: Establishing a skilled multidisciplinary workforce across mental health and infectious disease is the most important consideration in optimising care. Other issues included suitable physical space, security arrangements and inter-disciplinary communication. Conclusions: The paper holds insights for managing mental health care during potential future infectious disease outbreaks across the country. [ABSTRACT FROM AUTHOR]

Objectives: As mental health services move towards implementing 'Trauma-informed care', there is a need to consider the challenges posed within services and systems. This paper raises some of the challenges associated with integrating TIC into the current public mental health system.. Conclusion: The lack of clarity about expectations of trauma-informed approaches causes difficulties for its integration into services, but the wider political context of mental health services is also of relevance. Transparent and ongoing debate is required about approaches to mental health care, to ensure the system meets the needs of those who require it, while questioning what other purposes it may be serving at social and political levels. [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]

Objective: Person-centred growth-oriented language and care are considered vital for achieving favourable outcomes in mental health care. Personal testimonies detailed in the Final Report of the Royal Commission into Victoria's Mental Health System (RCVMHS) illustrate the need for a more compassionate and hope filled system, and demonstrate the opportunity to achieve this through embedding best practice person-centred growth-oriented language. A current gap exists in understanding the process and language involved in individuals growing to mental health. Recovery has long been the paradigm for people in the mental health system 'returning to baseline', a stark contrast to our lived experience. We experienced a new beginning post decline, daily personal growth and healing, aiming for constant improvement as we work towards mental health, a status that many may not have even experienced before becoming unwell. Conclusions: Person-centred growth-oriented care includes healing, supportive relationships with the 'caregivers' ideally being transformation specialists; knowing and understanding the process of daily personal growth. While the system is metamorphosing, it is highly recommended to embed person-centred growth-oriented language and care to aid in the transformation of individuals in the service. [ABSTRACT FROM AUTHOR]

Objective: Clinical reasoning in psychiatry may be considered to be more challenging than in other branches of medicine because of its highly subjective nature. The literature on systematic approaches to the teaching of clinical reasoning in psychiatry is lacking, and we propose an approach that may assist educators and learners. Method: A systematic approach with a theoretical underpinning in logical inferences will be proposed as a teaching and learning tool. Conclusion: This paper complements our previous paper on psychiatric case formulation and expands our model of a theoretical framework for diagnostic reasoning and case formulation in psychiatry. Our approach also serves as a tool to assist in integrating the diverse clinical knowledge base in psychiatry. [ABSTRACT FROM AUTHOR]

Objectives: The National Disability Insurance Scheme (NDIS) was introduced in 2013 and offered a new way of providing support to people with permanent and significant disabilities. Despite pilot testing, implementation of the scheme has been challenging, particularly for people with a disability arising from a mental health condition. In 2019, to address the challenge of accessing the NDIS, researchers from Flinders University worked with the National Disability Insurance Agency (NDIA) to develop a streamlined access process for psychosocial disability. The aim of this paper is to provide guidance on the evidence required to demonstrate that a person has a significant and persistent psychosocial disability to access the NDIS. Conclusion: Providing evidence for a psychosocial disability requires knowledge of how to address the disability requirements. The Evidence of Psychosocial Disability (EPD) form has been designed to address these requirements and offers guidance on the evidence that should be provided. A range of resources to accompany the EPD form are freely available online. These resources address a significant knowledge gap that currently exists with the implementation of the NDIS. [ABSTRACT FROM AUTHOR]

Objective: To describe a recent process by which mental health service sector leaders identified key elements of strategic, systemic and structural mental health reform. These elements could guide an incoming Federal government. Method: The paper describes the process undertaken by the Sydney Mental Health Policy Forum between 2019 and 2022. This work generated principles, key domains and finally a set of actions. Results: Five immediate actions were identified that are cost neutral or require minimal investment. Five further actions requiring realignment of existing funds and/or new funds were also identified. Conclusions: The task of mental health reform in Australia is both large and overdue. Continued investment in fragmented or piecemeal programmes and services will not propel desired change. Reform must facilitate new regional control of planning, funding and responding to community mental health needs. The actions identified by the Forum set out a menu of opportunities to guide reform over the life of the next Parliament, starting now. [ABSTRACT FROM AUTHOR]

Objective:: The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland.Method:: Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective.Results:: Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care.Conclusions:: Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS. [ABSTRACT FROM AUTHOR]

Dear Editor, Chanen is highly critical of our paper which heightened awareness of unproven psychotherapies for adolescent borderline personality disorder (BPD).[1],[2] Our aim was to protect traumatised young people from treatments without demonstrated efficacy that might otherwise cause harm. The early detection of BPD is unreliable because the categorical BPD diagnosis produces heterogeneous groups with high comorbidity needing differing approaches. [Extracted from the article]

Objective: To determine the prevalence of common mental disorders among older Australians included in the Health In Men Data Linkage Study and compare those with the results of the 2020–2021 National Study of Mental Health and Wellbeing (NSMHW). Method: We used longitudinal record linkage to estimate the prevalence of mental disorders from age 65 years in a random sample of 38173 Australian men aged 65–85 years living in the Perth metropolitan region. Outcome was the proportion of participants affected by depressive episodes or dysthymia, bipolar disorder, anxiety disorder, psychotic disorder and alcohol use disorder. Results: Prevalence estimates for participants aged 65–69, 70–74, 75–79, 80–84 and ≥85 years were 0.9%, 2.0%, 3.6%, 5.8% and 12.6% for depressive, 0.2%, 0.3%, 0.4%, 0.4% and 0.7% for bipolar, 0.1%, 0.5%, 1.3%, 2.2%, 6.9% for anxiety, 0.2%, 0.4%, 0.5%, 0.4% and 0.6% for psychotic and 1.2%, 1.7%, 2.1%, 2.2% and 4.2% for alcohol use disorders. Conclusions: In contrast to the NSMHW, our data indicate that the prevalence of depressive and anxiety disorders increases with age, particularly among the older old. We conclude that the NSMHW should not be relied upon to guide planning or policies to address the mental health needs of older Australians. [ABSTRACT FROM AUTHOR]

Objective: To provide some direction for those interested in obtaining funding with the purpose of highlighting opportunities for beginner researchers in the health-care field. Method: Features of a good grant application are described and an audit of seven mental health professional journals was undertaken, the latter to determine, inter alia, whether the paper reported research findings and whether the authors received formal research funding. Result: The audit revealed that many types of papers that are published do not receive formal research funding and describe, for example, services, training issues, clinical practice and education programmes. Conclusion: Innovative and enterprising efforts are required to secure clinical research funding. Submissions must be detailed, comprehensive and relevant, but the onus is also on the researcher to ensure a feasible study, where funding obligations can be fulfilled and findings readily disseminated. Many research studies are conducted without achieving competitive funding, and getting published – and getting started in writing – does not hinge on conducting formal research or receiving research funding. [ABSTRACT FROM AUTHOR]

Objective: There is mixed evidence on the psychological effects of video games. While excessive use can be harmful, moderate use can have emotional, psychological and social benefits, with games successfully used in treating anxiety and depression. More data are required to understand how and for whom these benefits occur. This paper aims to identify correlations between video game genre, player demographics, wellbeing, and the in-play psychological processes for adult players. Method: Adult gamers (n = 2107) completed an anonymous cross-sectional survey canvassing play style, genre, perception of psychological impact and mechanisms (wellbeing, self-determination and flow). A multivariate multiple regression model explored correlations. Results: 88.4% of participants experienced emotional benefits from gaming, with stronger benefits experienced by younger players in all categories. The genres most strongly correlated with psychological benefits were music games, role-playing games and survival horror games. Multiplayer online battle arena games had lower scores for psychological and emotional wellbeing. Conclusions: Certain genres have stronger correlations with beneficial mechanisms, while some may be detrimental to players. These results may guide experimental studies to measure the directionality and strength of these correlations and can also impact practical aspects in development of therapeutic games to treat mental distress. [ABSTRACT FROM AUTHOR]

Objective: Junior doctors have high rates of burnout resulting in downstream impacts on patient care. The aim of this study is to capture cross-sectional data on a cohort of psychiatry trainees. These data will be used to inform a wider project investigating psychiatry trainee mental health and wellbeing. Method: This paper reports on the 2019 baseline data of psychiatry trainees enrolled in a formal education course at the University of Sydney, Australia. The data were collected with an online survey using a range of validated mental health and wellbeing scales. This descriptive study involved psychiatry trainees as co-designers. Results: Our research findings are in keeping with the existing literature on the poor mental health and wellbeing of doctors with significantly higher levels of anxiety and exhaustion found in female trainees and carers. Despite this, the cohort had high scores on the flourishing scale. Conclusions: Concern around the wellbeing of junior doctors in Australia appears justified. We need to move beyond focussing on individual action to systems-based approaches to improving wellbeing and ongoing sustainability of the psychiatry trainee workforce in NSW. [ABSTRACT FROM AUTHOR]

Objective: The rapidly growing number of people in prison in Australia, combined with the high prevalence of mental disorder in this population, results in high demand for mental health services in prison settings. Despite their critical role as part of a national mental health response, prison mental health services (PMHS) in Australia have been poorly characterised. In this paper, we describe findings of the first national survey of PMHS in Australia.Methods: We distributed a survey to key representatives of PMHS in all Australian states and territories in 2016.Results: Our method constitutes a replicable process for quantifying and comparing PMHS in Australia. We describe the structure, governance and staffing models in seven jurisdictions. When compared against international recommendations, only one Australian jurisdiction (the ACT) is funded to provide services at a level equivalent to mental health services provided in the community.Conclusion: Prison mental health services in Australia are delivered by a complex mix of government, private sector and non-government services. Services appear to be severely under-resourced when compared with the available benchmarks. [ABSTRACT FROM AUTHOR]

Objectives: This paper reviews the major findings of the Victorian Psychiatry Attraction, Recruitment and Retention Needs Analysis Project and considers some of the implications for the psychiatrist workforce working in public sector psychiatry.Conclusions: The report provides a snapshot of the issues that are impairing the ability of Victorian psychiatrists to comprehensively treat those in our community who have severe mental illness. As the report shows, the issues impacting the profession are multi-faceted and complex, yet surmountable. [ABSTRACT FROM AUTHOR]

Objective: Mental Health Acts (MHAs) are important pieces of legislation which include essential definitions of mental illness and mental disorder and are used to guide decision-making regarding treatment, including involuntary admissions. In Australia, responsibility for reviewing this legislation falls under the jurisdiction of State and Territory Governments, resulting in interstate variations of legislative definitions and care requirements. In this paper, we outline some of the main differences between MHAs, and argue that it is time for Australia to enact nationally consistent Mental Health Legislation. Conclusions: Substantial divergence exists between definitions of mental illness and mental disorder, differing criteria for involuntary treatment and discrepancies between treatment requirements for Indigenous Australians. While variations between MHAs are understandable considering the historical context, in an increasingly integrated society, it is time for Australia to enact nationally consistent mental health legislation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to evaluate the effectiveness of ongoing physical health monitoring for Indigenous Australians with mental health issues in the Kimberley region of Western Australia.Method: This longitudinal, within-groups investigation assessed physical health parameters such as blood pressure and blood glucose levels at baseline and at 18 months for the same cohort. No standardised intervention was in place, but action was taken if results were found to be abnormal.Results: Most measures of physical health remained stable, with mean lipid and fasting glucose levels remaining abnormal over the entire assessment period. Systolic blood pressure showed a significant improvement.Conclusions: More needs to be done to improve the physical health of Indigenous mental health patients - culturally appropriate and secure interventions incorporating holistic models of care are needed. [ABSTRACT FROM AUTHOR]

Objective: An expert reference group met on four occasions to consider ways forward in terms of Indigenous mental health. This paper summarises the discussion and recommendations.Conclusion: While the negative effects of colonisation and trans-generational trauma continue, we propose renewed emphasis on improving access, cultural orientation and trauma-informed care, and a focus on the needs of young Indigenous Australians. [ABSTRACT FROM AUTHOR]

Objective: This paper identifies publicly available data about the use of involuntary treatment orders within Australia and considers whether this reporting is sufficient given the gravity of the intervention.Method: A search of mental health tribunal, health department and justice department annual reports was conducted to determine the use of involuntary treatment orders in Australia.Results: Reporting of involuntary treatment orders varied significantly across jurisdictions; for example, South Australia reported 11,570 distinct orders made during a 12-month period while the Australian Capital Territory reported 627 for the same period.Conclusion: The publicly available data for involuntary treatment orders in Australia is inadequate for jurisdictional comparisons. This concern should be addressed to enable transparent public reporting and facilitate benchmarking. [ABSTRACT FROM AUTHOR]

Objective: Classification systems and their practical implications have become increasingly important in child and adolescent psychiatry. This paper presents the evolution and practical applications of a multiaxial classification system for children and adolescents presenting to mental health services. Included are some worked examples demonstrating both the complexity of many presentations and how broadening the use of the multiaxial system can help in identifying appropriate interventions. Conclusions: Classification systems in child and adolescent psychiatry have largely remained uniaxial in nature. A multiaxial system encapsulates the broader biopsychosocial aspects of the presenting child or adolescent, and orders complex data in a concise manner. This approach can be used to concisely communicate with other treating clinicians, and assist with case reviews, formulation and teaching. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to summarise the new psychiatry Fellowship programme and its rationale, highlighting the new inclusions, revised assessment structure, the benefits and structure of the programme.Conclusions: The 2012 Fellowship programme is based on the CanMEDs educational framework. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) underwent a comprehensive process, adapting the CanMEDs competencies to a psychiatric framework and mapping the curriculum to Fellowship competencies, learning outcomes and developmental descriptors of the various stages of training. The 2012 Fellowship programme introduced summative entrustable professional activities (EPAs), formative workplace-based assessments (WBAs) and revised external assessments. [ABSTRACT FROM AUTHOR]

Objective: This opinion paper discusses certain recommendations of the House of Representatives Select Committee on Mental Health and Suicide Prevention pertaining to psychology, GP and psychiatric professions. Conclusions: The Committee's recommendations may compromise patient care by undermining the ability of private sector medical specialists in providing direct clinical treatment and their role in the coordination of multidisciplinary teams. Expanding private psychological therapies without GP and private psychiatry support might increase the reliance on public hospital emergency departments and public sector mental health services for severe disorders and suicidal crises. Psychiatrists and GPs need to engage in more effective policy advocacy with the Australian Government, in order to maintain their roles in leading private sector collaborative multidisciplinary care. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to describe the development and technical specifications of a framework and national key performance indicators (KPIs) for Australian mental health Court Liaison Services (CLSs) by the National Mental Health Court Liaison Performance Working Group (Working Group).Methods: Representatives from each Australian State and Territory were invited to form a Working Group. Through a series of national workshops and meetings, a framework and set of performance indicators were developed using a review of literature and expert opinion.Results: A total of six KPIs for CLSs have been identified and a set of technical specifications have been formed.Conclusions: This paper describes the process and outcomes of a national collaboration to develop a framework and KPIs. The measures have been developed to support future benchmarking activities and to assist services to identify best practice in this area of mental health service delivery. [ABSTRACT FROM AUTHOR]

Objective: This article explores how the concept of 'recovery' has been much debated and often sits at odds with our notion of rehabilitation. Method: This article provides a Lived Experience and post-structural commentary on the ever-changing meaning of recovery and rehabilitation. Results: Building on the contemporary Consumer Movement's use of the term recovery, this article explores how constructions of recovery try to create a boundary which stops people being invalidated based on their experience, or perceived experience, of mental distress. The concept of recovery has insufficiently influenced rehabilitation practices. Recovery is also frequently reappropriated, often with no or minimal consumer input, and reconstructed in line with notions of progress and improvement. Conclusion: People with Lived Experience have challenged the concept of rehabilitation; however, rehabilitation may still have relevance if it is redefined according to Lived Experience values and recovery-oriented practice. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic poses significant risks to the vulnerable patient population supported by community mental health (CMH) teams in South Australia. This paper describes a plan developed to understand and mitigate these risks.Methods: Public health and psychiatric literature was reviewed and clinicians in CMH teams and infectious disease were consulted. Key risks posed by COVID-19 to CMH patients were identified and mitigation plans were prepared.Results: A public health response plan for CMH teams was developed to support vulnerable individuals and respond to the COVID-19 pandemic. This plan will be reviewed regularly to respond to changes in public health recommendations, research findings and feedback from patients and clinicians.Conclusions: The strategic response plan developed to address risks to vulnerable patients from COVID-19 can assist other CMH services in managing the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify promising elements of best practice relevant to mainstream mental health service (MHS) delivery of early psychosis intervention (EPI) to Indigenous communities. In a companion paper, a comprehensive literature review identified a promising service model with potential for delivering EPI: an Indigenous sub-team embedded within a mainstream health service. Method: This paper describes a consultation process with Indigenous Mental Health Workers (IMHWs) in south eastern Queensland. A case study of the Sunshine Coast Cultural Healing Program (CHP-SC) was carried out during the consultation process. Results: IMHWs agreed that the Australian clinical guidelines for early psychosis were relevant to improving outcomes for Indigenous patients. IMHWs unanimously identified the CHP-SC as a best practice mainstream MHS for delivering EPI. The CHP-SC, which represented an Indigenous sub-team model, was found to be associated with substantially improved engagement of Indigenous young people. Conclusions: We provisionally conclude that specialist EPI could be delivered by specialist Indigenous sub-teams (rather than specialist EPI teams) embedded in mainstream MHSs that incorporate culturally safe practice and are fully integrated with Indigenous primary care services, and recommend that the model be formally evaluated. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper are to provide a description of a newly available service the Mental Health Screening Unit (MHSU), within the NSW prison system and to present the first 12 months in terms of the patients, its adaptations and its limitations. Methods: The first section of this paper provides a thorough description of the MHSU. The second looks at data collected for the period 1 July 2006 to 30 June 2007. A variety of databases were utilized as sources. Results: There were a total of 604 admissions. The most common primary diagnoses were schizophrenia-related disorders. There were relatively few adverse incidents, and 18% of the acute unit population were transferred to the Long Bay Prison Hospital. Conclusion: The MHSU had a considerable throughput of patients and managed a range of severe mental illnesses. The initial objectives of the MHSU have broadly been achieved. There are several future areas of research discussed. [ABSTRACT FROM AUTHOR]

Objective: Patients admitted to mental health services may exhibit behaviours of concern (BOCs) such as aggression, self-harm, absconding and sexual harm. BOCs can lead to restrictive interventions, which have adverse effects on patients, carers and staff. This paper aims to explore the nature and outcome of BOCs within an adult inpatient mental health setting.Methods: A retrospective audit was conducted at a metropolitan inpatient service between 1 August 2016 and 31 July 2017. The frequency, nature and outcomes of BOC episodes were described and thematic analysis was used to summarise BOC antecedents.Results: A BOC was documented for 179 (18.2%) patients who also showed high rates of drug abuse, homelessness and longer admission. Most self-harm and sexual harm events occurred outside of normal business hours. Medications and verbal de-escalation were commonly used interventions. Episodes of deliberate self-harm were likely to result in patient and staff injury or mechanical restraint, whereas aggression was associated with seclusion. Mental state, care engagement, physiological stress and situational stressor were identified as BOC antecedents.Conclusion: Multiple forms of BOCs were experienced with mental state, physical and interpersonal contributors identified. Improving multidisciplinary input into early assessment and treatment of BOC causes is needed to improve safety. [ABSTRACT FROM AUTHOR]

Objective: Borderline personality disorder (BPD) is frequently accompanied by low mood, the features of which may satisfy the diagnostic criteria for major depressive disorder (MDD). Treatment of depressive symptoms in the absence of BPD-appropriate treatment is less effective and may cause iatrogenic harm. This paper briefly reviews the co-occurrence of BPD and depressive disorder and suggests ways of differentiating these disorders and optimising treatment within the Australian Mental Health context.Conclusions: Depressive symptoms are present in the majority of people with BPD. To address the difficulty differentiating clinically distinct MDD from depressive symptoms that are integral to BPD psychopathology, it is suggested that depressive symptoms arising from a primary diagnosis of BPD (i) may exhibit transience and be stress reactive, (ii) lack a robust clinical response to antidepressant medication and/or electroconvulsive treatment and (iii) are responsive to BPD-appropriate psychotherapy. [ABSTRACT FROM AUTHOR]

Objective: To critically examine a recent decision of the Victorian Supreme Court that found that the Mental Health Tribunal and the Victorian Civil and Administrative Tribunal erred in the application of the capacity test in the Mental Health Act 2014 (Vic) and that compulsory electroconvulsive therapy would infringe upon the human rights of two patients who had no insight into their chronic schizophrenia.Conclusions: After considering the concepts of insight and capacity to consent to treatment, the paper concludes that the decision in NJE and PBU v Mental Health Tribunal [2018] VSC 564 is problematic clinically. [ABSTRACT FROM AUTHOR]

Objective: This paper highlights the significant mental health vulnerabilities of people who have sought asylum in Australia and their additional adversities as a result of the Covid-19 pandemic. Conclusions: Australia's policies in relation to asylum seekers result in multiple human rights violations and add significantly to mental health vulnerabilities. Despite a majority being identified as refugees, people spend years in personal and administrative limbo and are denied resettlement in Australia. Social isolation and other restrictions associated with Covid-19 and recent reductions in welfare and housing support compound their difficulties. The clinical challenges in working with people impacted by these circumstances and the role of psychiatrists and the RANZCP in advocacy are identified. [ABSTRACT FROM AUTHOR]

Objective: To describe the processes undertaken to maximise cultural competence in a complex research project and illustrate how this enhanced the quality of the research and impact of the research outcomes.Methods: An epidemiological survey of the mental health of Indigenous people in custody in Queensland was conducted using culturally informed research processes.Results: The research process that enhanced cultural competence is described. The research outcomes were positive in terms of participant and community experiences, participation rates, publications and other research outputs, capacity building and translation of research findings.Conclusions: This paper describes in practical terms how to conduct culturally informed research and how this approach enhanced the scientific rigour of a complex Indigenous health research project. Indigenous health research should be conducted using a culturally competent method. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this qualitative study was to explore the subjective experiences of consumers and staff members regarding the availability of electronic nicotine delivery systems (ENDS) in inpatient mental health units. Methods: Mental health consumers and staff members (n = 16) from rehabilitation and forensic inpatient units were interviewed in 2022. Thematic analysis of the transcripts was undertaken. Results: Our study identified four themes: The high salience of nicotine use in inpatient units, delivering nicotine in a resource scarce environment, weighing up the harms of ENDS as a smoking cessation tool, and a need for fair and consistent policy. Conclusions: The main positive aspects identified were recognition of rights of consumers, a relative harm reduction compared to tobacco use, and ENDS as a positive factor in the therapeutic relationship. The main challenges identified were resourcing issues, ENDS being a potential source of tension and conflict and a lack of overarching policy guiding their use. [ABSTRACT FROM AUTHOR]

Objective: This paper is based on a case report, describing a protocol to help practitioners communicate mental-health diagnosis to patients from culturally and linguistically diverse (CALD) backgrounds. The protocol was presented by integrating the DSM-5 Cultural Formulation Interview (CFI) and the SPIKES protocol for communicating the diagnosis of cancer, yielding a modified CFI-SPIKES protocol (i.e. S, Support; P, Perception using CFI; I, Invitation; K, Knowledge; E, Emotions). The protocol was demonstrated using a case report with a patient of a Middle-Eastern background experiencing generalised anxiety disorder.Conclusions: The CFI-SPIKES protocol for communicating mental-health diagnosis allows for a collaborative process, whereby the CALD patient and practitioner can address the stigma associated with communicating a mental-health diagnosis, ensuring patient engagement and informed shared decision making. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper are to describe a Māori approach to assessment and intervention planning using the Māori creation narrative Te Ara a Tāne (The Journey of Tāne) and to outline an evaluation one year after the model was implemented.Conclusions: Te Ara Waiora a Tāne is a kaupapa Māori (Māori-centred) mental-health engagement, assessment, goal setting and planning approach designed to enhance the mana (spiritual and personal authority) of whānau (individuals and family/families) at the point they enter a Māori service and during ongoing mental-health work. Preliminary evaluation indicated that staff considered the model user-friendly and helpful for whānau. Further evaluation is needed to assess the impact of this approach on Māori whānau engagement with services. [ABSTRACT FROM AUTHOR]

Objectives: This paper reports a pilot study exploring the benefits of offering sensory modulation within a mental health emergency setting for consumers experiencing distress during a psychiatric presentation.Methods: Seventy-four consumers with a mental health presentation reported on their sensory modulation use experiences during their stay in a South Australian tertiary teaching hospital emergency department. An evaluation form was used to document use of items, self-reported distress pre and post sensory modulation use, and other consumer experiences.Results: Consumers used between one and six sensory items for a median duration of 45 min. There was a statistically significant reduction ( t(73) = 15.83, p < .001) in self-reported distress post sensory modulation use, and consumers also reported that use was helpful, distracting, calming and assisted in managing negative emotions and thoughts.Conclusions: The results demonstrate the potential value of sensory-based interventions in reducing behavioural and emotional dysregulation in an emergency setting whilst also promoting consumer self-management strategies. [ABSTRACT FROM AUTHOR]

Objective: Mental Health Act 2016 (Qld) (MHA 2016) includes many 'less restrictive ways' to minimise involuntary/compulsory treatment. One such measure, the statutory health attorney, has been adopted from the Powers of Attorney Act 1998 (Qld). This paper analyses the statutory health attorney provision against the human rights framework adopted by the United Nations Convention on the Rights of Persons with Disabilities (CRPD). Method: The statutory health attorney provision was analysed against the CRPD article 12 (equal recognition before the law). Results: The statutory health attorney provision is not based on the will and preferences of the individual, is not free from conflict of interest and is not subject to the required safeguards. Conclusion: The use of a statutory health attorney brings mental health and physical health under the same provision (the fusion law/proposal). However, the statutory health attorney provision is not compatible with the contemporary human rights framework adopted by the CRPD. [ABSTRACT FROM AUTHOR]

Objective: Youth mental health disorders are rising across the world. Mindful Parenting could be a potential tool to promote youth mental health. The primary distinction between Mindful Parenting programs and other behavioral parenting programs is the focus on emotional literacy and compassion. However, this emerging field has gaps in its theory and evidence. In order to objectively evaluate the impact of Mindful Parenting, it is important to identify how it promotes change. This theoretical paper aims to articulate the key change processes of Mindful Parenting that promote positive outcomes.Method: A literature review was conducted to synthesize the change processes outlined by different authors in the field.Results: Key processes argued to promote Mindful Parenting were aligned with five main categories, namely attention, intention, attitude, attachment and emotion. More specifically the change processes were listening, emotional awareness, emotional regulation, attentional regulation, attunement, attention to variability, intentionality, reperceiving, compassion and non-judgmental acceptance.Conclusions: This preliminary analysis attempted to understand how Mindful Parenting fosters change and transformation. Whilst there are numerous change processes, the essence of Mindful Parenting appears to be the ability to be responsive to a child's needs. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to analyse in a philosophically informed way the recent National Institute of Mental Health proposal for the Research Domain Criteria (RDoC) framework.Conclusion: Current classification systems have helped unify psychiatry and the conditions that it is most concerned with. However, by relying too much on syndromes and symptoms, they too often do not define stable constructs. As a result, inclusions and removals from the manuals are not always backed by sound reasons. The RDoC framework is an important move towards ameliorating matters. This paper argues that it improves the current situation by re-referencing constructs to physical properties (biomarkers for disorders, for example), by allowing theoretical levels within the framework, and by treating psychiatry as a special case of the cognitive sciences. [ABSTRACT FROM AUTHOR]

Objective: This paper provides a descriptive statistical overview of Mental Health Review Tribunal outcomes from 1992 to 2011.Method: A database used by administrators of the Mental Health Review Tribunal to store information on applicants and their hearing outcomes was subjected to basic descriptive analysis.Results: A total of 3117 applications were received, with most applications received from males (n=2039, 65%) of New Zealand European ethnicity and a mean age of 49 years. A similar number of applications were received from inpatient and community patients (35%, 28% respectively). There was only a small percentage (7%) of applicants who were released and the number of applications withdrawn before a hearing took place was high, at 45%.Conclusion: The success rates of New Zealand Mental Health Review Tribunal applicants is low compared with some international jurisdictions, while at the same time withdrawals are high, warranting further investigation. Applicants in the community are underrepresented, which is of concern in the context of rising use of community treatment orders. Future research focused on service users' experiences of using the Mental Health Review Tribunal and improvements to the existing data stored on applicants are also suggested. [ABSTRACT FROM AUTHOR]

Objectives: Despite the high prevalence of mental health problems for young Australians, many do not have ready access to treatment or are reluctant to seek help. Until recently there was a tendency for young Australians to fall between the gap of Child and Adolescent Mental Health Services and Adult Mental Health Services, and this has contributed to low rates of service use for young people. In 2006, the Australian Government sought to redress this gap in service delivery with its establishment of the Australian National Youth Mental Health Foundation, headspace. This paper presents demographic data collected at headspace Gosford over a 5.5-year period.Conclusions: The data presented indicates that headspace Gosford has been successful in improving early access to mental health treatment for young people on the Central Coast, in particular for young people aged 14-18. Headspace Gosford has attracted young people of both sexes, with a higher proportion of females. The majority of young people access headspace for mental health problems, predominantly depression and anxiety; however, a significant proportion report physical health or alcohol and drug-related reasons. The likelihood of these referral reasons is informed by gender and age. [ABSTRACT FROM AUTHOR]

The article aims to complement a previous paper on clinical reasoning and provides an actual clinical case that was de-identified but the substrate of the case was used as an exemplar of pattern-based formulation (PBF). It cites the case of a young female who worked in healthcare and was very passionate about her career. The case presented was complex and challenging due to the ongoing high acute suicidal risk, non-response to treatments and challenging behaviour causing team splitting.