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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: 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]

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: 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]

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 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]

Creating Futures initiative has established a network of mental health professionals, researchers, and community members from the Pacific Island Nations (PIN), Australia, and New Zealand to address the growing challenges of mental health conditions compounded by the climate change crisis. The enormous amount of work done in Global Mental Health can be particularly helpful to improve population-level mental health. However, translation of this evidence base into practice poses several challenges.This perspective paper discusses the role of local culture and health systems context in determining the feasibility and acceptability of implementing and scaling up evidence-based interventions designed in an American-European context. The paper also advocates development (and evaluation) of mental health interventions in the PIN communities particularly and Global South generally and exporting these interventions to the rest of the world.COVID-19 crisis underlined the role of global cooperation as well as national level ‘self-reliance’. In this post COVID-19 world, it will be desirable for the mental health community to cooperate and collaborate to scale up evidence-based interventions through rigorous contextualization and at the same time main-stream mental health interventions developed in the Global South by incorporating them in the Global Mental Health discourse. [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: 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: 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: 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: 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: 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]

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]

Objective: Describe patterns of substance use and comorbid conditions among clinic attenders in homeless shelters in Sydney. Method: Retrospective cohort study of 2498 people who attended a psychiatric clinic at one of three homeless hostels between February 2008 and May 2020. Multivariable logistic regression was used to identify factors associated with self-reported substance use, psychiatric diagnosis and measures of social function. Results: A total of 2041 of the 2498 (81.7%) reported the harmful use of at least one substance, with alcohol (61.8%), cannabis (50.9%) and stimulant drugs (34.9%) the three most common. Those reporting the regular use of two or more substances (1466, 58.7%) were more likely to have a history of early life and adult trauma, a diagnosis of personality disorder, a criminal conviction, receive the Disability Support Pension, be chronically homeless and sleep in the open. Conclusions: The study found a high rate of polysubstance use among homeless clinic attenders in Sydney, and an increase in the prevalence of substance use compared to previous studies. Substance use is both a cause and a consequence of homelessness, and services to address substance use have to be part of any program to reduce homelessness and sleeping in the open. [ABSTRACT FROM AUTHOR]

Objective: This study explores rates of birth-related symptoms of trauma in a population of parents experiencing severe perinatal mental illness. Method: Birthing-parents admitted to a perinatal inpatient unit completed birth trauma measures on admission which were descriptively analyzed. Results: The population had higher rates of birth-related potentially traumatic events and trauma-related symptoms than the general population. Conclusions: The findings highlight that assessing for and responding to experiences of birth trauma is highly relevant to an inpatient perinatal population. [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: To consider whether research into "motivational postures" can assist the Victorian Government and the forthcoming Mental Health and Wellbeing Commission to regulate and implement forthcoming mental health laws. Conclusion: Although no research explicitly uses a motivational postures framework, there is evidence of a diverse set of postures amongst the mental health workforce. Some practitioners and disciplines reflect positive motivational postures towards mental health laws and consumer rights, while others show resistance, and others disengagement altogether. More research explicitly built on motivational postures is required to inform appropriate regulatory responses. [ABSTRACT FROM AUTHOR]

We discuss the ramifications of the Commonwealth of Australia Budget allocations for mental healthcare for 2024–2025. There is funding for population-based mental health initiatives for milder anxiety and depression but no direct funding of services for the most severe and disabling forms of mental illness, other than pre-existing state/territory disbursements from the Commonwealth for state-based health services. There are substantial concerns that the Commonwealth funding has potentially been misallocated to ineffective interventions that are unlikely to reduce the population prevalence of mild anxiety and depression in Australia. Funds may have been better allocated to provide effective care for those with the most severe and disabling illnesses including schizophrenia, bipolar disorder and severe depression. [ABSTRACT FROM AUTHOR]

Objective: The term 'missing-middle' has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the 'missing-middle' term, founded on qualitative and quantitative research.Conclusions: Despite the widespread use of the term 'missing-middle' for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the 'missing-middle' care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to 'missing-middle' programmes that may not improve Australian public health outcomes. [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]

Objectives: Explore humanity's shifting attachment to the natural world using established attachment theories as a framework. Methods: Investigate the analogy between human-nature connection and caregiver-child attachment styles. Draw on indigenous case studies, sociology and anthropology to highlight contemporary repercussions of this 'detachment'. Results: Factors such as rapid population growth and urbanisation have disrupted the secure attachment with nature, which is evidenced in ancient egalitarian societies. These factors can be mapped onto contemporary attachment domains. Conclusions: There is an urgent need to re-establish a secure attachment to nature. This may be a pivotal strategy in addressing both mental health and environmental challenges, particularly in the context of the escalating climate crisis. [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]

Objective: Child and adolescent mental health (CAMH) disorders are a major public health problem in Australia, especially outside metropolitan areas. The issue is compounded by a shortage of child and adolescent psychiatrists (CAPs). CAMH receives minimal coverage in health professional training, training opportunities are scarce, and support for generalist health professionals, who treat most cases, is lacking. Novel approaches to early medical education and teaching are required to strengthen the available skilled workforce in rural and remote settings. Method: This qualitative study explored the factors influencing medical student engagement in a CAMH videoconferencing workshop as part of the Rural Clinical School of WA. Results: Our results confirm the priority of personal characteristics of medical educators, over clinical and subject matter expertise, on student learning. This research affirms that general practitioners are well-placed to facilitate recognition of learning experiences, especially given that students may not readily recognise exposure to CAMH cases. Conclusion: Our findings support the effectiveness, efficiencies, and benefits of utilising general medical educators in supporting child and adolescent psychiatry expertise in delivering subspecialty training within medical school curricula. [ABSTRACT FROM AUTHOR]

Objective: To report on the rate and causes of mortality, and associations with premature mortality among the homeless in inner city Sydney. Method: Retrospective cohort study of 2,498 people who attended a psychiatric clinic conducted at the three main homeless hostels between 17 February 2008 and 19 May 2020. Cox's proportional hazards regression was used to identify factors associated with mortality. Results: A total of 324 of the 2498 (13.0%) clinic attenders were found to have died in the follow-up period, with a mean age at death of 50.7 years. Unnatural causes of death (119/324, 36.7%) included drug overdose (24.1%), suicide (6.8%) and other injuries (5.9%), at a younger age (44.4 years) than those who died from natural causes (54.4 years). There were 142 (43.8%) deaths from natural causes and 63 (19.4%) in which the cause of death was not determined. Conclusions: The study confirms the high mortality of homeless clinic attenders in Sydney found in a study from 30 years earlier. The lower mortality among regular attenders supports the provision of accessible services to address the physical health needs of homeless people, as well as ready access to mental health and substance use services. [ABSTRACT FROM AUTHOR]

Objective: We report on the extent of veteran homelessness in Australia, what has already been done to address it and what actions are recommended to further improve the response. Conclusions: Work conducted by not-for-profit organisations and the Department of Veterans' Affairs are outlined with positive prospects for significant coordinated action to further address the situation reported. [ABSTRACT FROM AUTHOR]

Dear Sir, The Victorian Royal Commission into Mental Health and Well-being highlighted the prevalence of co-occurring experiences of mental illness and addiction. The Dual Diagnosis team consists of a dual diagnosis clinician and an addiction psychiatrist who work closely with alcohol and drug (AOD) clinicians; local general practitioners (GPs); and other allied health services, including mental health, correctional, child protection, employment, family and housing services. The supported primary consultation model, whereby the client is accompanied/supported by their GP and relevant clinicians during the psychiatrist assessment, has been a powerful component of the program. [Extracted from the article]

Objective: Consider the unique features and challenges of prison psychiatry. Conclusions: A Prison Mental Health Network within the Royal Australian and New Zealand College of Psychiatrists would serve many useful functions including improving the quality of mental health services by promoting high clinical standards and ethical practice by psychiatrists working in prisons. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between self-rated mental health (SRMH) and psychological distress (PD) at multiple periods and subsequently assess the potential of SRMH as a screening tool. Method: Staff working at a designated COVID-19 hospital in Sydney, Australia during March to May 2020 completed the SRMH and Kessler Psychological Distress Scale (K10) within a larger survey examining the pandemic's impact on health and well-being. SRMH was assessed before the pandemic (baseline), during its first peak in 2020 (time 2) and several months later (time 3). K10 was assessed for time 2 and time 3. All assessments took place at time 3. Results: At time 2, 80% of respondents with high PD and 25% with low PD reported poor SRMH (χ2 = 21.3, p <.0001). At time 3, 90% with low PD reported good SRMH. Risk of high PD was greater for respondents with persistently poor SRMH (time 2: OR = 18.2, 95% CI = 7.7–42.8; time 3: OR = 14.4, 95% CI = 6.9–29.9) and, to a lesser extent, for those whose SRMH declined (time 2: OR = 11.6, 95% CI = 6.6–20.4; time 3: OR = 13.8, 95% CI = 2.9–66.9), compared to those with persistently good SRMH. Conclusions: During a crisis SRMH can identify the majority of those most likely to benefit from additional assessment and support. Persistently poor SRMH indicates highest risk, detectable from routine screening. [ABSTRACT FROM AUTHOR]

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: To describe the development of a Youth Psychiatry specialty within the College. Conclusion: Progress has been frustratingly slow. The recognition of a specialty will enable the development of an appropriately trained workforce to best meet the mental health needs of young people aged 12–25. We are hopeful Advanced Training in Youth Psychiatry will become available from February 2024. [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: We aimed to explore young peoples' lived experiences of multidisciplinary mental health assessment in an intensive mental health day program. Method: Interpretative phenomenological analysis (IPA) was applied to data from semi-structured interviews with six males, aged 13–16 years. Member-checking interviews were conducted to ensure the trustworthiness of findings. Results: Analysis revealed three themes, 'therapy fatigue', '360 supports' and 'experiential assessment'. Participants had either attended many years of psychological therapy without significant change or had failed to engage with therapy. Participants' attitudes changed at the day program with intensive support and their own determination. Participants valued experiential elements of assessment such as music therapy and art therapy which helped them understand the service, get to know others and experience positive emotions. Conclusions: Unsuccessful psychological treatment can leave young people feeling jaded and reluctant to engage with services. The potential for iatrogenic harm should be monitored and alternative approaches, such as intensive, multidisciplinary treatment including music therapy and art therapy considered to help young people overcome therapy fatigue, regain hope and reengage with mental health services. [ABSTRACT FROM AUTHOR]

Objective: We explore the previous research and current context regarding opportunities for shared-care partnerships between public and private psychiatric practice. Conclusions: Since the early 2000s, when there was impetus for the development of public-private psychiatric shared-care models as part of a previous National Mental Health Strategy, there has been surprisingly little research and policy development. Given an apparent exodus of psychiatrists to private practice due to current challenges facing the public health sector, it is timely to reconsider models of private and public sector shared-care that may improve the quality of public mental healthcare. [ABSTRACT FROM AUTHOR]

Preparing for the future Despite a third of Australians living in regional, rural, and remote locations, there remains a relative dearth of research and guidance in considering, recognising, and understanding the implications of remoteness within mental health service design and system performance. Remoteness and socioeconomic status reduce access to specialist mental health care across Australia. [Extracted from the article]

Objective: The COVID-19 pandemic may cause a major mental health impact. We aimed to identify demographic or clinical factors associated with psychiatric admissions where COVID-19 was attributed to contribute to mental state, compared to admissions which did not. Methods: A retrospective cohort study was undertaken of inpatients admitted to Northern Psychiatric Unit 1, Northern Hospital in Melbourne, Victoria, Australia during 27/02/2020 to 08/07/2020. Data were extracted for participants who identified COVID-19 as a stressor compared to participants who did not. Fisher's exact test and Mann-Whitley rank sum test were used. Results: Thirty six of 242 inpatients reported the COVID-19 pandemic contributed to mental ill health and subsequent admission. Reasons given included social isolation, generalized distress about the pandemic, barriers to support services, disruption to daily routine, impact on employment, media coverage, re-traumatization, cancelled ECT sessions, loss of loved ones, and increased drug use during the lockdown. Chronic medical conditions or psychiatric multimorbidity were positively associated and smoking status was negatively associated with reporting the COVID-19 pandemic as a contributor to mental ill health. Conclusion: Screening and identifying vulnerable populations during and after the global disaster is vital for timely and appropriate interventions to reduce the impact of the pandemic worldwide. [ABSTRACT FROM AUTHOR]

Objective: To guide the efficient and effective provision of mental health services to clients in Central West and Far North Queensland, we surveyed preferences for face-to-face or in-person contact. Methods: A clinician-designed survey of contact preferences was offered to 248 clients of mental health services in Far North and Central West Queensland in mid-2020. With the onset of COVID-19, the survey was modified to measure the impact of the pandemic. Results: Just over half of the services' clients participated in the survey (50.4%), of whom more were female (63.2%). Of the participants, 46.3% in Far North and 8.6% in Central West Queensland identified as Indigenous. Strong resistance to telehealth before the pandemic across groups (76%) was moderated during COVID-19 (42.4%), an effect that appeared likely to continue past the pandemic for Central West clients (34.5%). Far North clients indicated their telehealth reluctance would return after the pandemic (77.6%). Conclusions: Our results suggest that remote Australians strongly prefer in-person mental health care to telehealth. Although the COVID-19 pandemic increased acceptance of telehealth across regions while social distancing continued, there was evidence that Indigenous Australians were more likely to prefer in-person contact after the pandemic. [ABSTRACT FROM AUTHOR]

Objective: To explore the rates and characteristics of self-harm across the Kimberley region of Western Australia. Method: Retrospective, cross-sectional audit. We obtained and descriptively analysed routinely collected self-harm data from the Kimberley District of the Western Australia Police Force (2014–2018) and the Emergency Department Data Collection (June 2017–December 2018). Variables included age, sex, Indigenous status, time of incident, and alcohol and drug use. Results: The rate of emergency department attendance for self-harm was three times higher in the Kimberley than the rest of Western Australia. Both emergency department and police data showed a disproportionately high percentage of incidents involving Aboriginal people, with highest rates in the 15–19 and 20–24 year age groups. Almost 80% of self-harm events recorded by police involving individuals aged 25–50 years involved alcohol. Many self-harm incidents occurred in the evening and at night. Conclusions: The rates of self-harm across the Kimberley region from 2014–2018 are unacceptably high. Increased funding and alignment of services to meet regional need are required as part of a holistic effort to reduce regional rates of self-harm. [ABSTRACT FROM AUTHOR]

Objective: Borderline personality disorder (BPD) and schizophrenia are both serious and chronic mental health conditions of similar prevalence. This study was designed to assess trainees' confidence in the assessment, management and treatment of BPD in comparison with schizophrenia.Methods: A survey was used to assess psychiatry trainees' confidence and experience of training with regard to managing BPD and schizophrenia.Results: Eighty-two psychiatry trainees completed the survey. Overall, confidence scores of respondents with respect to BPD were significantly lower in comparison with schizophrenia. Trainees reported a preference for working with patients with schizophrenia compared with BPD. Respondents reported receiving less adequate supervision and training in the assessment, management and treatment of BPD than for schizophrenia.Conclusions: The results suggest an urgent need to enhance training and supervision in skills related to the diagnosis, management and treatment of BPD, with a greater focus on psychotherapy to improve trainee psychiatrists' confidence in working with people diagnosed with BPD. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the effectiveness of a short-term outpatient DBT (DBT-S) skills group for individuals experiencing pervasive emotion dysregulation (PED). Method: Pre-and post-group outcome data consisted of self-report measures and six-month Mental Health admissions and Emergency Department presentations. Results: Group completers reported significant improvements in psychological distress, depression, borderline symptomatology and functional impairment, increases in 'skills use' and decreases in 'dysfunctional coping', associated with symptomatic improvement. There were reduced numbers of Mental Health presentations and admissions between six months pre- and post-group. Conclusion: Findings support emerging evidence for DBT-S as an effective, viable treatment for PED. [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: This study aimed to understand perceived social support (PSS) among women with personality disorder (PD). We also investigated potential differences in PSS according to PD clusters (clusters A, B, C). Methods: Women (n = 718) from the Geelong Osteoporosis Study completed the Multidimensional Scale of Perceived Social Support (MPSS) and Structured Clinical Interview for DSM-IV Axis II Disorders. Multivariable regression and analyses of covariance were employed, controlling for psychiatric and sociodemographic confounders. Results: After age-adjustment, PD (any) and the PD clusters were negatively associated with PSS across all subscales. Bonferroni-adjusted pairwise comparisons revealed lower: significant other PSS for cluster A; family PSS for cluster C, friend PSS for clusters B and C; and total PSS for clusters B and C. Conclusion: Aspects of PSS were predominantly lower among women with cluster B and C PDs. [ABSTRACT FROM AUTHOR]

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]

Objectives: To ascertain whether doctors were experiencing higher rates of distress during Covid-19 and whether this was impacted by demographic factors. Our hypotheses were that being a junior doctor, having a previous mental health diagnosis and treating Covid-19 positive patients would predict higher rates of distress. Methods: Cross-sectional survey conducted via Survey Monkey. Voluntary participants were recruited from the mailing list of a national-based referral service for doctors to psychiatrists. Distress was measured using the Kessler Psychological Distress Scale (K10). Demographic factors were analysed for predictive value of a higher rating on the K10. Areas of concern in relation to Covid-19 and preference for support services were measured on a Likert scale and compared to levels of distress. Results: The rate of very high distress was 15%. Being a junior doctor and having a previous mental health diagnosis were predictive factors of a higher K10 score. K10 was not affected by likelihood of contact with Covid-19-positive patients. Social isolation had a larger impact on mental health in the context of a previous psychiatric diagnosis. Face-to-face assessments were preferred. Conclusions: Rates of distress in doctors have been higher than baseline during Covid-19. Some groups have been particularly vulnerable. [ABSTRACT FROM AUTHOR]