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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]

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]

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]

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: 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: 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]

Objective: Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. Following on from a recent review focusing on consumer participation in mental health services, this paper looks at consumer participation in housing. Housing is a critical element in recovery from mental illness. Without suitable housing, people have little chance of maintaining other resources in their lives, such as supportive social relationships and meaningful activities. Conclusions: Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. The importance of appropriate housing to the recovery of people living with mental illness cannot be underestimated. Even well-meaning and well-resourced housing initiatives can fall short of meeting consumers' recovery goals when they do not incorporate the expressed needs of consumers. These expressed needs include keeping units small in size and employing drop-in support models. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to introduce the term 'predicament suicide' and add to the evidence that suicide may occur in the absence of Axis I diagnoses. Method: The term 'predicament suicide' was described as suicide which occurs when the individual without mental disorder is in unacceptable circumstances from which they cannot find an acceptable alternative means of escape. Accounts of suicide that satisfied these criteria, and could be illustrated by images, were sought. Results: Four accounts were identified: Ajax, Brutus, Mayor Freyberg and Commander Donnicke. Conclusions: Predicament suicide appears to be a useful designation. This work added evidence indicating that suicide may occur in the absence of an Axis I mental disorder. [ABSTRACT FROM AUTHOR]

Objective: To consider the contribution of non-clinical factors in the rising rate of mental health presentations and explore the associated silence within the psychiatric profession. Conclusion: Medicalisation, concept creep and group think, alongside societal demand and expectations, have collectively contributed toward a distorted view of mental health and illness. Equitable service provision has been hindered by the silence of important perspectives. [ABSTRACT FROM AUTHOR]

Keywords: video-meeting; overuse; Zoom; mental disorder; medical education EN video-meeting overuse Zoom mental disorder medical education 669 669 1 11/23/20 20201201 NES 201201 Dear Sir, We highlight a new diagnosis of paramount significance during the COVID-19 pandemic public health measures, and which may be included in international diagnostic classifications (e.g. the I Diagnostic and Statistical Manual of Mental Disorders i or I International Classification of Diseases i ) in the future. Our proposed diagnosis is based on clinical observations of an insidious and debilitating video-meeting-mediated disorder afflicting medical students and their clinical academic teachers over the last 6 months, during social distancing for the COVID-19 pandemic in Australia. We consider that this disorder may be usefully classified under the rubric of a trauma or stressor-related disorder; analogous to similar COVID-19 emergent mental disorders (to be discussed in forthcoming papers) such as COVID-19-related Isolated-Academic Logorrhoea (an obsessive-compulsive and related disorder) - the product of which may be exemplified by this letter - or, COVID-19-related Specific Communication Disorder (a bullshit or related disorder). [Extracted from the article]

Objective: This paper aims to explore the concept and determinants of successful ageing as they apply to psychiatrists as a group, and as they can be applied specifically to individuals.Conclusions: Successful ageing is a heterogeneous, inclusive concept that is subjectively defined. No longer constrained by the notion of "super-ageing", successful ageing can still be achieved in the face of physical and/or mental illness. Accordingly, it remains within the reach of most of us. It can, and should be, person-specific and individually defined, specific to one's bio-psycho-social and occupational circumstances, and importantly, reserves. Successful professional ageing is predicated upon insight into signature strengths, with selection of realistic goal setting and substitution of new goals, given the dynamic nature of these constructs as we age. Other essential elements are generativity and self-care. Given that insight is key, taking a regular stock or inventory of our reserves across bio-psycho-social domains might be helpful. Importantly, for successful ageing, this needs to be suitably matched to the professional task and load. This lends itself to a renewable personal ageing plan, which should be systemically adopted with routine expectations of self-care and professional responsibility. [ABSTRACT FROM AUTHOR]

Objectives: A considerable gap exists in health and social emotional well-being between Indigenous people and non-Indigenous Australians. Recent research in stress neurobiology highlights biological pathways that link early adversity and traumas as well as life stresses to ill health. We argue that the neurobiological stress response and its maladaptive changes, termed allostatic load, provide a useful framework to understand how adversity leads to physical and mental illness in Indigenous people. In this paper we review the biology of allostatic load and make links between stress-induced systemic hormonal, metabolic and immunological changes and physical and mental illnesses.Conclusions: Exposure to chronic stress throughout life results in an increased allostatic load that may contribute to a number of metabolic, cardiovascular and mental disorders that shorten life expectancy in Indigenous Australians. [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]

Objectives: The aim is to report the operation of the Australian Defence Force Centre for Mental Health (ADFCMH) Second Opinion Clinic (SOC) after its first 10 years of operation. Method: Demographic data and clinical data were recorded and analysed for all Australian Defence Force (ADF) personnel (n =209) seen at the clinic from 2011 to 2021. Results: Assessment at the clinic led to a change in diagnosis from that given at the time of referral in 40.7% (n =85) of members seen. Of the total members assessed at the SOC, 55.9% (n =117) had been on an at least one operational deployment. Mood disorders were the most common mental disorders seen among personnel at the SOC. Conclusions: The ADFCMH SOC is a valuable clinical resource supporting ADF health services nationally and provides an example of an effective mental health tertiary referral service. [ABSTRACT FROM AUTHOR]

Objectives: It has been proposed that legislation for same-sex marriage has a positive mental health benefit. The purpose of this paper is to review and evaluate the empirical and conceptual links between same-sex marriage and mental health.Conclusions: There are substantive methodological issues in the four surveys and comparisons undertaken. Difficulties with the validity of the evidence are discussed. Conceptual difficulties in the arguments relating to victimisation as well as the psychology of marriage are highlighted. It was concluded that it is premature to make claims of causality vis-a-vis same-sex marriage legislation and mental health. [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: The aim of this paper is to evaluate the accuracy of a new genotyping test (Antidepressant PredictAR) in assigning patients as likely 'poor', 'rapid' or 'normal' metabolizers of antidepressant drugs. Method: Eighty-nine patients were clinically assigned (on the basis of their historical response to antidepressant drugs) as 'poor', 'rapid' or 'normal' metabolizers and comparison was then made to their test-based 2D6 and C19 genotyping status reports. Results: The overall capacity of the test to allocate patients to four differing phenotypic categories reporting for the genotyping test was not significant in relation to either C19 or 2D6 analyses. However, the C19 test did appear to have some capacity to identify rapid metabolizers, and we note how we then sought to manage such patients clinically. Conclusions: The test may have some capacity to identify patients with a rapid metabolizing profile. Any further advantages were not identified by this study, whether reflecting methodological and/or assay limitations. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on a brief survey of clinicians' judgements when making treatment decisions in the context of diagnostic uncertainty. Specifically, attitudes and opinions were sought from practising consultant psychiatrists regarding two key areas of clinical decision-making in first episode psychosis (FEP), namely, when to initiate medication and, how long to continue treatment. Method: Interviews were conducted with consultant psychiatrists using a combination of structured and semi-structured questions that examined and explored pharmacological treatment decisions in FEP. Results: Twenty-three consultant psychiatrists participated in the interviews. The threshold to initiate pharmacological treatment was lower when a risk to self or others is present, when symptoms are primarily positive, when the patient is in distress, or where there is a family history of mental illness. Atypical antipsychotics are routinely used as front-line medication in FEP and the choice of medication is determined largely by their likely side effect profile. However, the greater the perceived efficacy, the greater the anticipated tolerability burden. The ideal duration of treatment is considered to be 1–2 years in instances of full remission, and 5 years where only a partial response has been achieved or where recovery has not been sustained. Conclusions: The ‘first episode’ represents a unique period in the management of psychosis where by definition there is no history of pattern of illness, diagnostic certainty is rare, and the patient usually does not have any prior exposure to medications. Therefore, each management decision needs to be considered following a risk benefit analysis which takes into account the context of the individual. [ABSTRACT FROM AUTHOR]

Objectives: This paper looks to examine the emerging role of carers as essential components in the management of individuals affected by severe mental illness in the context of modern legal and health policy environments. Conclusions: Cultural and legal concepts of confidentiality within the doctor–patient relationship are complex. Increasingly, evidence is recognizing the essential role of carers in the quality management of individuals affected by severe mental illness and this emphasis is being further supported by innovative health policy and legislation. A public health definition for the role of carers may be a more appropriate way to consider their role in mental health management strategies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to explore the relationship between civil commitment under a Community Treatment Order (CTO) and competence to consent to treatment. Method: A purposive convenience sample of 10 service users under CTOs were interviewed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Ratings were compared with the ratings of 10 matched voluntary service users. Results: Seventy percent of the CTO sample were found to be incompetent according to the MacCAT-T, compared to 20% of the comparison group (p = 0.004). The proportion of the CTO sample found to be incompetent reduces to 50% if the subscale of appreciation is excluded (p = 0.004). Most people in each group would elect to continue their current treatment if given the choice. Conclusion: Findings of this study suggest that mental health law reform introducing considerations of competence could lead to a substantially different group of people being subject to CTOs. If the CTO is carefully targeted and not used excessively, it is likely to be accorded qualified acceptance for most service users for whom it is used. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the Child and Family Inclusive Practice program (CFIP), a pilot program implemented in an adult community mental health centre in Newcastle, New South Wales, which aimed to enhance family relationships through child and family inclusive practice. Conclusions: The CFIP used a family-focused, child-sensitive approach in which two clinicians met together with families where there was parental mental illness. Adults and children were seen together and separately. Work with parents was aimed at validating their concerns for the child, and enhancing their confidence as parents/carers. Children had the opportunity to express their concerns in a safe and protective environment and, where appropriate, were supported in their concerns if these were being put to the adult family members. The project was seen to add value to the service provision of the community mental health team, and demonstrated to clinical staff the benefits of an inclusive and whole of family approach to mental health care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine aspects of mental health and mental health care through a gender lens. Conclusion: Gender differences have an impact on mental health and the experience and course of women's mental illness. Comprehensive gender-sensitive mental health care requires the planning, delivery, monitoring and quality improvement initiatives of mental health care to be informed by a knowledge and understanding of gender differences in women and men and their inter-relationship with respect to childhood and adult life experiences (e.g. violence and abuse); day-to-day social, cultural, and family realities; expression and experience of mental ill health and treatment needs and responses. [ABSTRACT FROM AUTHOR]

Objectives: This paper describes the experience and evaluation of a shared care project targeted at marginalized individuals living in the North End of Halifax, Nova Scotia. This population has high rates of psychiatric disorder, often comorbid with chronic medical conditions, and people have difficulty in obtaining the help they need. This primary care liaison service covers all ages and includes outreach to emergency shelters, transitional housing and drop-in centres. Collaborative care improved access, satisfaction and outcomes for marginalized individuals in urban settings. Primary care providers with access to the service reported greater comfort in dealing with mental health problems, and satisfaction with collaborative care, as well as mental health services in general. Results were significantly better than those of control practices when such data were available. The median wait time was 6 days in comparison with 39.5 days for the comparison site. Conclusions: This model can complement other initiatives to improve the health of marginalized populations, and may be relevant to Australia. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to describe the Adolescent Intensive Management (AIM) team at the Austin Child and Adolescent Mental Health Service (CAMHS), a unique model of intensive outreach service with high-risk and difficult-to-engage adolescents, and describe the profile of clients referred to it. Method: This study used a retrospective review of clients' data, collected through file audit, over a 12-month period. Results: The result of the study showed that a 100% retention rate of adolescents with complex social, emotional and mental health needs is possible in a flexible and multi-system approach to service provision. Conclusion: Clients referred to the CAMHS' AIM team displayed a pattern of multiple risk factors and comorbidities. Low caseload of 8-10 clients per clinician allowed flexibility and a level of intensity to make any necessary changes in service provision to better suit the client's needs. The majority of clients showed improvement in functioning following intervention by the team. [ABSTRACT FROM AUTHOR]

Objective: Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. This has led to serious negative consequences for their health and wellbeing. Recent public policy has aimed at redressing this situation. This paper sets out to investigate the 'state of play' regarding consumer participation in mental health services. Conclusions: Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. Although the vision of public policy is for consumers to be at the centre of decision making, the changes are understandably slow in coming. The implications for the practice of psychiatry, and therefore mental health services, of the demands for meaningful participation are profound. They challenge some of the social covenants under which mental health services have historically been delivered. Traditionally, people living with a mental illness have not had their rights respected. In recent times, the College has developed policies that aim to ensure that the rights of people living with a mental disorder are respected. These policies also acknowledge that effective health care requires collaboration with consumers. [ABSTRACT FROM AUTHOR]

Aim: This paper uses the public record to explore the relationship between reputation damage and suicide. Method: The public record of the last 20 years was examined for examples of individuals without evidence of mental disorder who suffered actual or threatened reputation damage and suicided shortly thereafter. Results: Fifteen individual cases were identified; 18 additional cases, less comprehensively detailed, were mentioned in reports of The Wood Royal Commission and Operation Auxin. All cases were male. Of the 15 individual cases, the average age was 55 years, with a range of 40 to 76 years. The available details of the 18 additional cases were consistent with these findings. Conclusion: Middle-aged males without clear evidence of mental disorder, who suffer actual or threatened reputation damage, may be at increased risk of suicide. Naming and shaming needs to be conducted with caution. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine the background to the emblematic psychiatric term, schizophrenia, the historical, cultural and social factors affecting the two men who defined modern psychiatric practice, and anticipate what lies ahead in the next century. Conclusions: The term schizophrenia was created by Swiss psychiatrist Eugene Bleuler and first used on 24 April 1908. The condition was first described by German psychiatrist Emil Kraepelin and called dementia praecox. After a century, it is impossible to think of the practice of psychiatry without schizophrenia. [ABSTRACT FROM AUTHOR]

Objective: This paper provides a conceptual, historical and legislative overview of fitness issues. These include fitness to be interrogated or charged, to plead, to be tried and to be sentenced in the context of Australia and New Zealand. Conclusions: Legislation regarding fitness issues needs to strike a balance between protecting the rights of mentally impaired defendants to a fair trial process and recognizing that mental illness in itself does not absolutely preclude participation in a trial process or necessarily diminish criminal responsibility. Although the key determinants of fitness seem to be the ability to cope with court processes and communicate with counsel, the application of clinical judgement to legal criteria is not always straightforward. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to examine self-efficacy and perceived appropriateness among rural general practitioners (GPs) in regards to screening and intervention for physical, lifestyle and mental health issues. Method: Fifty GPs from 25 practices in eight rural Queensland towns completed a written survey designed for the study. Results: General practitioners rated opportunistic screening or assessment for smoking and for detection of relapse of mental disorders as the most appropriate, with even cardiovascular and diabetes risk falling behind these. Self-efficacy was highest for medical disorders for smoking assessment. It was significantly lower for alcohol, mental health issues, and addressing risks of physical disorder in people with mental disorders. Conclusions: High appropriateness ratings suggest that current strategies to boost self-efficacy of GPs in addressing mental health issues are timely. [ABSTRACT FROM AUTHOR]

Objective: Some groups of young people experience elevated rates of mental disorders and low rates of uptake of mental health services. Because an association between staff competence and uptake of services has been demonstrated a key objective of this paper is to identify relevant staff learning needs. Method: A learning needs analysis was undertaken of adolescent mental health workers employed in the health and education sectors in NSW, Australia, to explore their learning needs regarding Aboriginal, same-sex attracted and culturally and linguistically diverse young people. Results: Significant differences were found between learning needs in relation to location but no significant differences were found in relation to agency or experience. Participants ranked their learning needs as high and their knowledge and skills in working with depression and related disorders in these young people as low. Conclusion: This article highlights issues that may be of interest to clinicians and their managers regarding training, policy and service delivery. [ABSTRACT FROM AUTHOR]

Objective: Insufficient understanding of the reciprocal interactions between health and human rights, mental health and human rights and the realization of all human rights by Indigenous peoples constitute a triple jeopardy in how these topics are currently being addressed and/or openly antagonized. This paper will attempt to show how a combined health and human rights approach to mental health in Indigenous peoples can transform a triple jeopardy into a triple opportunity. Methods: The vast and growing body of literature on mental health, health as a whole, and human rights as these relate to health and to Indigenous peoples will be used to frame the discussion. Results: Attention to the complex interactions of health and human rights can guide policy formulation and action by offering a method of analysis, a process of participatory decision and a framework for accountability. In addition, mental health can find its rightful place in the health and human rights discourse through efforts to help policymakers and practitioners broaden their vision of mental illness to holistically encompass aspects of physical, social, emotional and cultural wellbeing. Finally, connecting the role that rights realization plays in determining health and wellbeing will add power to the rightful claims by Indigenous peoples to the promotion and protection of all their human rights - civil, political, economic, social and cultural. Broadening the research agenda by applying systematically a health and human rights analytical framework to the understanding of social determinants of health would minimize the risk of assigning health outcome merely to behaviours, practices and lifestyles, uncovering structural determinants of holistic health entrenched in policies and governmental conduct. Conclusions: Building the evidence of the negative impact of human rights violation on health and the negative impact of ill-health on the fulfilment of other human rights can help in designing comprehensive interventions, building on the synergy between the promotion of health and the promotion of rights. A way forward is proposed for which it is essential that work be carried out across ethnic lines and professional boundaries to further advance the claim of Indigenous peoples for better health and greater enjoyment of human rights. [ABSTRACT FROM AUTHOR]

The objective of the present paper was to identify factors associated with job satisfaction and burnout among staff working in mental health services for older people. A postal survey was distributed to staff members from eight mental health services for older people in Western Australia. Staff focus groups identified causes of work stress. The response rate was 33% (116/349). Teamwork, social support and clear roles had a positive effect on job satisfaction. Community staff members had higher job satisfaction than ward staff. Nurses reported higher burnout and lower job satisfaction than other mental health professionals. Staff members working in newer models of service delivery had higher job satisfaction than those working in more traditional models. Surveys and focus groups were an effective means of identifying factors associated with job satisfaction in mental health staff members. Newer models of service delivery with team building and supportive management may improve the workplace for staff. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including the complex interactions of culture, personhood and illness, of the need for caution in generalizations across culture and of the potential richness of interdisciplinarity for the psychiatric field, and the different vantages on the scale and nature of the mental health challenges in the island nations.

Objective: Young people affected by mental health disorders have greater sexual health needs compared to their peers. Less is known about this need across illness severity. Method: A cross-sectional survey of the sexual health of those attending outpatients or inpatients within a youth mental health service was conducted. Statistical differences between groups were explored. Results: One hundred and seven young people (18–25 years) participated and of these, 37.7% were inpatients who had more severe psychiatric symptoms than outpatients. While inpatients were as likely to be sexually active as outpatients, they were significantly less likely to have a regular sexual partner (25% vs 64.5%). Additionally, they used amphetamines more frequently during sex (28.6% vs 5.8%). Sexual dysfunction was experienced by 55.6% of inpatients and 37.9% of outpatients. Conclusions: High-risk sexual behaviours and sexual dysfunction were highly prevalent in both groups. For some behaviours and dysfunction, this prevalence was higher in the inpatient population. Holistic clinical services that address the mental, physical and sexual health needs of consumers are needed both within inpatient and outpatient settings. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to gain an understanding of the mental health needs and services in Vanuatu, and examine the importance of the Church in the lives of the local people and the part that the Church can play in mental health service delivery. Method: The author visited Vanuatu to gain an understanding of the mental health needs and services in Vanuatu. This was followed by interaction with a number of churches to find out the views of church leaders about mental illness and their interest to learn about mental illness. A questionnaire was completed by 80 individuals who were also involved in some training. Results: There was a widely held view that mental illness was due to a weak faith, sin or demon possession. However, there is a desire and an interest among churches to have a better understanding about mental illness. Conclusion: Churches in Vanuatu can and need to be mobilized to make mental health service delivery successful in the country. [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]

The article explores the use of recovery orientation, medication, and shared responsibility in contemporary mental health services in Australia. It highlights the importance of improving the relationships between psychiatrists, other clinicians and consumers as well as the influence of the personal recovery paradigm in mental health. Challenges in clinical practice are mentioned.

Objectives: People with mental illness may be vulnerable to psychological distress and reduced well-being during the COVID-19 pandemic. The aim of this study was to assess psychosocial and lifestyle predictors of distress and well-being in people with mental illness during the pandemic. Method: People with mental illness who participated in an exercise programme prior to the pandemic were invited to complete surveys about mental health and lifestyle corresponding to before and during the pandemic. Results: Social support reduced, alcohol intake increased, and sleep quality and diet worsened during the pandemic, contributing to distress. Psychological distress was associated with the two or more mental illnesses, and negatively associated with having a physical disease. Better diet appeared to protect against increases in distress; loneliness hindered improvements in well-being. Conclusions: Healthy lifestyle programmes designed to improve social connection may improve health for people with mental illnesses during and after the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: Inspire and partners have built an evidence base examining the role technology can play in supporting the mental health and wellbeing of young people at increased risk of developing mental health difficulties. This paper explores these findings collectively and considers how to best use information communication technologies (ICT) to meet the mental health needs of diverse young people aged 14-25. Conclusions: ICT offers relevant and innovative strategies for young people at increased risk of developing mental health difficulties. Whilst many young people experience social isolation and stigma, the manifestation of these issues and the strategies required to address them vary. ICT-based programs will benefit from identifying which protective factors can be most positively influenced through the unique properties of ICT, amongst whom and how. Challenges to ICT-based health services include inadequate access and training, lower literacy levels and the need for specialized technologies for people with disabilities. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to advance and enrich innovative thinking about mental health issues from an Indigenous perspective, through consideration of the gap between Indigenous mental health research and Indigenous mental health practice. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the articles in previous issues including "Side Effects of Second Generation Antipsychotics: The Experience, Views, and Monitoring Practices of Australian Child Psychiatrists," the importance of clinical governance with respect to mental health services, clinical teams and clinicians, and the problem of psychiatrists.

Objectives: The aim is to present information which may be useful to those who scrutinize mental health professionals and systems in the aftermath of completed suicide. Conclusion: Suicide has been known in all cultures, throughout history, and may be committed in the absence of mental disorder. Risk factors for suicide are known but they are of limited clinical utility. Prediction and prevention of suicide are beyond current abilities. Criticism of mental health professionals and systems in the aftermath of suicide may be destructive and work to the disadvantage of patients. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines a rationale for expanding research and clinical innovations focused upon relapse prevention following a first episode of psychosis. Some general principles for further progress are extracted from an overview of the first-episode psychosis (FEP) relapse literature. A cognitive behaviour therapy intervention for relapse prevention for FEP, that has been developed at the Early Psychosis Prevention and Intervention Centre, is described to illustrate these principles. Conclusions: Further progress is needed in refining interventions specific to the prevention of relapse following FEP. Future progress is dependent upon improved understanding of the interaction of biological, interpersonal and psychological processes underpinning relapse. [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]

The author comments on the effort of Australia to facilitate early intervention for young people with mental ill health. Topics discussed include a collaborative translational research effort in which national and international partnerships have been critical, a brief history of mental health intervention and the underfunded mental health research.

Objective: During the perinatal period, partners of mothers with severe mental illness (SMI) play an important role in managing the new baby and supporting the mothers' wellbeing. Providing information via mobile phone on infant care, partner support and self-care may assist partners in their support role.Method: Partners (n = 23) of mothers with SMI were enrolled in a partner-focused SMS service sending brief texts 14 times per month for a maximum of 10 months. Partners (n = 16) were interviewed on exit and their responses analysed for acceptability and perceived usefulness of the texts.Results: Partners remained with the programme and expressed high acceptability of the texts. Participants identified effects such as increased knowledge of and interaction with their baby; effective support for their partner; and reassurance that 'things were normal'. Few partners sought support for their own mental health.Conclusions: Texts supplied to mobile phones of partners of new mothers with SMI may increase partners' support. The texts in this study were acceptable to partners and were reported to enhance a partner's focus on the mother's needs, raise the partner's awareness of the infant's needs, and support the partner's confidence and competence in infant care. [ABSTRACT FROM AUTHOR]

Objective: A key challenge facing justice health service providers is addressing and treating the high rates of mental illness among offenders. It is well documented that rates of mental illness are substantially higher within prison populations compared to the general population. As such, the need to provide ongoing treatment to prisoners experiencing mental health issues is of fundamental importance. Prisoners experiencing mental health disorders are more likely to have poorer social outcomes on release, including a greater likelihood of recidivism and poorer health outcomes. The growing numbers of justice-involved individuals from culturally and linguistically diverse (CALD) backgrounds signal the need for justice systems to adapt to the changing demographic.Conclusions: In this commentary, we argue that greater efforts to explore the nature and prevalence of mental illness among CALD groups in custody, where such concerns are often intertwined with additional complex personal, environmental and historical criminogenic risk factors, are desperately needed to improve system responses and reduce recidivism. [ABSTRACT FROM AUTHOR]

Objective: A pilot art-making and mental health recovery project addressed consumer and carer mental health and well-being in Suva, Fiji. Method: Using feedback surveys, the project evaluated initial training, and a 12-month art programme for consumers, carers and staff across several mental health services. Results: First person and stakeholder group reports from the project reflected broad-scale approval for the novel modality and its potential for continued application in keeping with local cultural values. A broad stakeholder base was involved in planning and participation, aligned with the values of inclusive recovery-oriented mental health service approaches. Conclusions: These results suggest that the programme can add value to mental health care being provided for people with a mental illness in Fiji. [ABSTRACT FROM AUTHOR]