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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]

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: To describe key practical knowledge and skill components required for clinicians involved with the assessment of military personnel and veterans.Conclusions: Assessment of military and veterans' mental health issues involves a tailored history-taking process that includes specific aspects of service, transition and reporting requirements. Recommendations for the detailed assessment of military personnel and veterans are provided. Comorbid conditions, chronic pain and the needs of both women and older veterans are also discussed. [ABSTRACT FROM AUTHOR]

Objectives: Mental health professionals are particularly susceptible to occupational stress; however, there are limited formal programmes to address the problem. This paper discusses the preliminary results of a brief mindfulness-based stress reduction (MBSR) programme for practising professionals in a public hospital mental health unit.Method: A mixed-group of nine mental health professionals participated in eight weeks of daily 15-minute MBSR training interspersed with three 30-minute education sessions developed by the authors (AD and AT). Levels of psychological distress and mindfulness skill were measured before and immediately after participation.Results: Following the brief MBSR programme, quantitative and qualitative participant feedback revealed a perceived reduction in psychological distress.Conclusions: A brief MBSR programme can be incorporated into the full-time workloads of practicing mental health professionals, potentially addressing a significant unmet workplace need. [ABSTRACT FROM AUTHOR]

Objective: Mental illness is a major contributor to disease burden in China. Guangdong province has a population of over 104 million. This province's health information system is inadequate, especially the mental health workforce and service response. This paper describes a field survey to assess the existing mental health workforce and service capacity in Guangdong.Method: A total of 125 major service providers in Guangdong were identified with the capacity to treat serious mental illness at all levels of the health system. These services were approached to complete a standardised survey based on the WHO Assessment Instrument for Mental Health Systems.Results: The survey identified 8498 mental health workers with 72.5% working in psychiatric hospitals. Service providers reported a treatment rate of 68.8% of a total of 430,000 people registered for treatment of severe mental illness, and only 28.4% of over a million people estimated to be experiencing severe mental illness. An inadequate mental health workforce was cited as a common barrier to treatment access.Conclusion: Guangdong province has a significant treatment gap for severe mental illness and a shortage in the mental health workforce. The distribution of the mental health workforce and facilities is imbalanced towards hospital care rather than community care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to provide further outcome data on a novel consumer-clinician co-taught borderline personality disorder training program. Method: Participants (n=216) who attended consumer-clinician co-taught borderline personality disorder training had their ratings of the training compared to ratings of participants who attended the previous clinician-only borderline personality disorder training. Results: Mean training ratings of the consumer-clinician co-taught borderline personality disorder trainings were 37 percentile points higher (77th vs 40th percentile) than the ratings of the previous clinician-only borderline personality disorder training, which already had evidence of effectiveness. Conclusion: Data confirm preliminary findings that adding a consumer-presenter to training adds considerable value. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the characteristics and outcomes of participants with an Australian physician health program, the Victorian Doctors Health Program (VDHP), for case management of substance use disorder (SUD) and/or significant mental illness. Method: As part of quality assurance, processes data, including demographic information, care plan components and outcomes, were analysed. Results: Between 2001 and 2008, 115 participants undertook case management plans with the VDHP. The majority (n == 71, 62%) had some involvement with the Medical Practitioners Board of Victoria (MPBV). Case management included facilitating referrals to addiction specialists, psychiatrists, counsellors and peer-based support. Ninety (78%) participants reported SUD, the remainder having mental illness (n == 25, 22%). Alcohol was the main drug reported by the SUD group (n == 44, 49%). Most of the SUD participants undertook biochemical monitoring. On commencement with the VDHP, 39 (34%) participants were on leave due to illness. The majority of participants case managed for 5 years were in medical work (n == 31, 84%). Conclusions: Case management by an independent physician health program may protect the health of the doctor and the community, and could be considered in other jurisdictions. [ABSTRACT FROM AUTHOR]

Objective: There is an emerging consensus that the assessment and management of adverse outcomes in mental health, such as violence and self harm, is best achieved by approaches which incorporate validated tools using “structured professional judgement”. Although several useful tools have emerged from the literature, there is no clear consensus on the best way to integrate these with clinical practice. This paper describes a framework, the Forensicare Risk Assessment and Management Exercise (F.R.A.M.E.), employed by a statewide community forensic mental health service, which incorporates two structured professional judgement tools, and explicitly integrates these into case management and psychiatric treatment. The potential benefits of the framework are discussed in the context of contemporary trends in risk assessment and management. Conclusions: The F.R.A.M.E. appears to assist with the task of integrating risk assessment with clinical management. Formal evaluative research is indicated before it can be recommended for use by other services. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to outline the impact of Community Treatment Orders over a 20-year period on service delivery and clinical practice in Victoria. Conclusions: Community Treatment Orders, as utilized in Victoria, have undermined optimal service delivery and supported paternalistic, reductionistic clinical practice. The psychiatric profession has failed to advocate adequately for better mental health resourcing and human rights protection of those subject to Community Treatment Orders. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to summarize information about the dissemination and implementation of the Royal Australian and New Zealand College of Psychiatrists' clinical practice guidelines (CPGs) since their completion in 2003, and assess the effectiveness of these activities. Method: The dissemination and implementation activities undertaken from 2003 to the present are described. Data regarding the dissemination of the clinician and consumer-carer versions of the CPGs are presented. The results of a series of implementation pilots are summarized. Results: Available data suggest the CPGs have been widely disseminated through both the clinician and consumer-carer communities in Australia and New Zealand, and that the consumer-carer versions in particular continue to be in high demand. Evaluation of CPG implementation pilots, using tools that assist in bringing summary evidence into clinical practice, have suggested that such tools are acceptable, are a useful aid to implementing evidence-based practice, and have a positive impact on practice. Common barriers to implementing the evidence are highlighted. Conclusions: Summary consumer-carer versions of CPGs seem to be acceptable and useful to both consumer-carers and non-government mental health providers. Locally led implementation of CPGs using tools that summarize evidence and support its use in everyday practice has a positive impact, but also highlights system-level barriers to implementing evidence-based practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine the role of consumers as service providers and to describe the successful employment of peer support workers in a public mental health service. Conclusions: The Peer Support Worker program in Adelaide, South Australia is consistent with evidence obtained from previous research in demonstrating the successful training and employment of consumers as peer workers in a public mental health service. [ABSTRACT FROM AUTHOR]

Objective: To provide psychiatrists with a guide to using the Internet.Conclusions: The key to using the Internet is to have the skills to keep the signal-to-noise ratio high. This requires knowledge and practice. The paper contains tips on searching and information about surfing skills, noticeboards, portals and email lists, and lists a range of very useful websites. [ABSTRACT FROM AUTHOR]

Objectives: We argue that mental health-related concepts have become degraded within professional circles and in the wider community. We identify three trends: concept creep, the rise of broad umbrella concepts (e.g. distress and trauma), and the conflation of mental health with well-being, which marginalises serious mental illness. We speculate on the causes of these trends, including cultural shifts towards greater sensitivity to harm and the rise of wellness industries. Contributing factors within psychiatry include overdiagnosis, dimensional models and transdiagnostic perspectives. Conclusions: These trends may lead to inflated demands on services from those at the milder end of the psychopathological spectrum. We set out seven measures that mental health professionals can take to resist trends towards broad concepts of mental illness and limit some of their adverse consequences. [ABSTRACT FROM AUTHOR]

Objective: The aims of this study were to explore the knowledge, attitudes, confidence and practices of Australian psychiatrists and psychiatry registrars with regard to smoking cessation with their patients and to promote clinical practice reflection and re-framing. Methods: A mixed-methods questionnaire was developed. Interviews were conducted via telephone or face-to-face utilising participatory action research principles. Qualitative data were de-identified and analysed following a reflexive thematic approach. Results: The questionnaire was completed with 15 participants. The majority worked in the public health sector and agreed that smoking cessation could be used as a clinical tool across mental health services. However, nearly all of the participants reported being unfamiliar with the latest literature. Only one-third of participants reported having had received formal training in smoking cessation. Overwhelmingly, more training was reported as necessary and welcomed by participants. Conclusion: Our study has identified gaps in psychiatrists' and psychiatry registrars' knowledge and confidence regarding the promotion, initiation and oversight of smoking cessation strategies for patients. It's important that psychiatrists lead the way in re-framing and engaging with this issue, and consider smoking cessation as a tool that can improve mental health outcomes. A review of existing Australian policies, guidelines and training is recommended. [ABSTRACT FROM AUTHOR]

Objective: The aim of this present paper is to highlight some of the issues faced by therapists and sign language interpreters when working with deaf patients. Conclusions: Key issues include linguistic, interpreting and role challenges, and potential threats to the therapeutic alliance. Recommendations are made in relation to preparation strategies and training for sign language interpreters and therapists. [ABSTRACT FROM AUTHOR]

Objective: To assess rates of metabolic monitoring in patients prescribed antipsychotic medications in the psychiatric inpatient setting and the impact education can have regarding monitoring compliance.Method: Two identical audits were undertaken at a NSW mental health inpatient service before and after a campaign designed to educate mental health workers about the importance of metabolic monitoring. Results from both audits were compared for statistically significant improvements in monitoring rates.Results: Rates of monitoring plasma lipids increased from 21.7% to 78.8% (p < 0.01) and rates for plasma glucose increased from 20.8% to 73.7% (p < 0.01). There were no statistically significant changes in rates of monitoring body mass index (83.0% and 77.1%, respectively), waist circumference (36.8% and 43.2%, respectively) and blood pressure (99.1% and 100%, respectively).Conclusion: This study has shown that rates of metabolic monitoring in the inpatient setting can be improved with a relatively low-cost education intervention. While absolute rates remain low, outcomes suggest that it may be worthwhile trialling further modes of education and repeating this education in cycles. [ABSTRACT FROM AUTHOR]

Objective: General practitioners (GPs) are key health professionals for referrals to mental health specialists. Youth mental health issues are particularly challenging, requiring a competent assessment and understanding of appropriate referral pathways. We surveyed local GPs about their understanding of youth mental health problems and needs to competently look after young patients. Methods: GPs working in the Hunter region were contacted via email, fax and post over a 6-month period in 2019. Results: Seventy-five GPs participated. They reported 577 of 1698 (34%) of young people seen 2 weeks prior to being surveyed presented with a mental health problem. Predominantly, referrals were to private practice psychologists and Headspace. Almost a third (31%) reported having limited understanding of 'at-risk mental state' and are 'not always comfortable' when facing a young person with a mental health problem. Nearly all (95%) expressed interest in attending specialised training. GPs identified treatment costs, scarce access to psychiatrists and limited patient engagement as the main obstacles to help young people. Conclusions: Effective treatment of a mental health problem relies on early identification. GPs are seeing young people on a regular basis but don't feel well equipped for this task and are keen to up-skill, which needs to be addressed by targeted training. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics and clinical capacity of Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health (IDDMH).Method: Consultant psychiatrists (n=71) with an interest or expertise in IDDMH completed an online survey about their roles, experience and time spent in intellectual developmental disability (IDD)-related activities.Results: Psychiatrists had worked in IDDMH for a median of 11.34 years and half (53.5%) reported expertise in the area. One-fifth of psychiatrists reported IDDMH as their main area of practice. The majority of respondents (85.1%) reported that they were working clinically with people with IDD. Respondents practicing clinically worked a median of 8 hours in clinical and 3 hours in non-clinical IDD-related work per week.Conclusions: Surveyed psychiatrists had considerable experience in IDDMH. However, their work in IDDMH represented a relatively small proportion of their overall work hours, and a minority of respondents were responsible for a large proportion of clinical work. Exploring ways to broaden capacity is crucial to ensuring the mental health needs of people with IDD are met. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the training experiences of and determine capacity to train future Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health.Methods: Australian and New Zealand psychiatrists with expertise or interest in intellectual and developmental disability mental health completed an online survey detailing their training pathway, support for subspecialty training and capacity to provide rotations in this area.Results: Psychiatrists (n=71) indicated the most common reasons they started practicing in intellectual and developmental disability mental health, and these included seeing people with intellectual or developmental disability in a service in which they worked, or personal experience with intellectual or developmental disability. Compared to those trained overseas, psychiatrists trained in Australia or New Zealand had lower ratings of the sufficiency of education received in intellectual and developmental disability mental health. Of the total respondents, 80% supported the development of subspecialty training. Augmentation of intellectual and developmental disability mental health content in the intermediate stage of training was also strongly supported. Participants identified 80 potential six-month training rotations in this area.Conclusions: Psychiatrists working in intellectual and developmental disability mental health strongly support enhancements to intellectual or developmental disability training, including the development of subspecialty training, and can identify potential training capacity if such subspecialty training was developed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to illustrate through poetry that self-directed recovery from mental illness is possible, and that through vigilance and a supportive network of family and mental health workers, life beyond recovery can be full and rewarding for any consumer. Conclusions: Through positive choice, a consumer can break the cycle of admission and realize self-empowerment, which can lead to a full and complete life. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to report the experiences of the author during her Advanced Training Fellowship year in Indigenous mental health and consultation-liaison psychiatry through the Royal Australian and New Zealand College of Psychiatry. The description will include a discussion of how such a Fellowship may complement the key learning objectives of advanced training in psychiatry. Conclusions: A Fellowship in Indigenous mental health can offer a variety of experiences for the psychiatry trainee, including clinical work, research and teaching. The planning and collaboration with Aboriginal health organizations, key clinicians and Ethics committees provides a unique opportunity to learn invaluable communication and consultancy skills. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to demonstrate the benefits of collaboration between Australia and Kiribati, a Pacific island nation, to enhance Kiribati's mental health system.Method: The collaboration involved a training program for a Kiribati senior mental health leader in Melbourne, Australia, and service planning including prioritisation of key areas for development.Results: As well as receiving general training in community-based mental health, the Kiribati mental health leader gained skills in modification of the inpatient environment, with plans for implementation in Kiribati within the current limited resources. Future planning will focus on shifting from an emphasis on acute psychiatric treatment and custodial care to a recovery-oriented approach.Conclusion: The international exchange was a positive experience for both the Kiribati participants and their Australian colleagues. Knowledge transfer was achieved in a short time, and service development appropriate and realistic for the Kiribati environment was planned. [ABSTRACT FROM AUTHOR]

Ross is a mental health patient representative based in Cairns and has been a member of the Cairns CAG for the past eight years. He has played a significant role in the development of consumer participation in Cairns and at a state level. Ross has sat on a range of committees as a consumer representative and has worked as an accreditor with the Institute of Healthy Communities Australia. Currently he sits on the management committee of the Queensland Voice for Mental Health. Ross was a founding member of the Irukandji Pens writers group, based at the Cairns Mental Health Resource Service. [ABSTRACT FROM AUTHOR]

The article reports the participation of Fellows in Australia and New Zealand practicing in their local communities. It features the Mental Health Services conference in Townsville, Queensland, the RANZCP's Section of Social and Cultural Psychiatry in Cairns, and the New Zealand psychiatry conference in Hui at the Bay of Islands at Waitangi.

Objective: To describe a course for trainee psychiatrists, designed to encourage critical thinking within an interdisciplinary framework. Trainees’ responses to the course, and the implications of these for teaching, learning and clinical practice, are considered. Method: Trainees were interviewed, and their responses subjected to content analysis. Results: To some extent, the course appears to have met its objectives. However, some trainees found parts of the course content threatening, and reported negative perceptions of teaching staff and the process of critical appraisal. Conclusions: Challenging taken for granted beliefs in psychiatry is a fundamental skill, which should be fostered in trainee psychiatrists if the profession is to move forwards as an intellectual and clinical discipline. The lessons learned from the course we describe may be useful to others who wish to pursue integrated, interdisciplinary teaching methods. [ABSTRACT FROM AUTHOR]

Objective: To describe how mental health policy is developed and implemented.Methods: A review of the literature on public policy analysis and the experience of the author in the development and implementation of national mental health policy.Results: A five-step process of problem identification, policy development, political decision, policy implementation and evaluation provides a framework for understanding the policy cycle.Conclusion: An understanding of this process is essential for psychiatrists and other mental health professionals in order to influence the process and content of mental health policy. [ABSTRACT FROM AUTHOR]

Objective: To review the role of clinician leadership in the management of mental health services.Conclusions: The literature suggests that clinician leadership is increasingly regarded as an essential element in the effective introduction of innovation and improved quality of clinical care by those who manage mental health services. Psychiatrist leaders have a role to play in ensuring that service change and innovation is based on sound clinical values, is developed in partnership with clinicians and is understood and supported by psychiatrist colleagues. Clinician leaders require clear vision, commitment and courage. The support of their colleagues is essential if the psychiatric profession is to have influence on future development of mental health services. [ABSTRACT FROM AUTHOR]

Objective: Access to beds is a major problem in many psychiatric services and increased waiting times can lead to adverse health outcomes. While there has been a considerable amount of research evaluating bed management systems in public psychiatric services, the private sector has received little attention. This project aimed to determine the time to admission for patients referred to an acute private psychiatric hospital, and to identify factors contributing to time intervals between referral and admission. Method: All staff involved in the admission process engaged in an ongoing, interactive data collection process. Accurate data on waiting times for acute patients was obtained and fed back to credentialed admitting psychiatrists. Results: Determinants of admission were clarified. For urgent admissions, the longest time interval was between the patient being advised that a bed was available and actually presenting themselves at the hospital. Conclusion: The project was effective in clarifying admission flow in a private psychiatric hospital. Some strategies that might reduce time intervals between referral and admission are described. [ABSTRACT FROM AUTHOR]

Objective: To examine the elements of the Aboriginal tea ceremony and its relevance to psychiatric practice. Conclusions: Through the Aboriginal tea ceremony, the mental health professional is able to convey that care and concern balance experience and expertise. These underpinning principles have wide application. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to articles in previous issues including "The Democratization of Psychiatry," by Little et al. and "A Tale of Two Cities: A Neuroimaging Investigation of Melbourne- Sydney Rivalry Comparing Cortical Thickness in Healthy Adults," by Velakoulis et al.

The article presents the acknowledgement from the Honorary Secretary of the contributions and support from the Fellows, trainees and staff for the 2006 issue. It also reports on the COAG mental health strategy, the reprinting of the guidelines of consumer version of the clinical practice in New Zealand, and other issues.