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Objective: The majority of people with gambling problems contact helplines when they are in crisis, hampering their capacity to explore suitable treatment options. To date, there has been limited research identifying the best way to support individuals to reduce distress and maximise further treatment-seeking. In this paper, we describe the development and piloting of the resulting six-step brief intervention.Method: A six-step brief intervention was developed based on a literature review of existing interventions for crisis management, semi-structured interviews with 19 participants comprising gambling and crisis support counsellors and consumers, as well as experts in the addiction field.Results: The resulting six-step brief-intervention focusses on (1) acknowledging and measuring distress; (2) normalising and reducing distress; (3) optimising motivation for change; (4) providing a sense of hope; (5) re-measuring distress and, if reduced; (6) exploring options for treatment and support.Conclusion: Whilst developed primarily for helpline counsellors, the intervention has potential application for health practitioners working across telephone, online and face-to-face services. Further research is required to determine its effectiveness in improving treatment engagement amongst people with gambling problems. [ABSTRACT FROM AUTHOR]

The article focuses on the implementation of the new assessment procedures for the fellowship examination at the Australian Medical College. The most recent review of the curriculum for psychiatrists in training led to substantial changes to the training programs, which came into force at the beginning of the year. The Committee for Examinations has also reviewed the assessment procedures. The written exam is now vastly different from the written paper. An Observed Clinical Interview (OCI) replaces the clinical exam. Two examiners now observe the trainee conducting a comprehensive psychiatric assessment of a patient.

Professor Allan Schore's distinguished career as a pioneer theoretician ''scientist of the brain'' surprisingly began with the publication of his first volume, Affect Regulation and the Origin of the Self. The Neurobiology of Emotional Development (1994), after having published only one paper. The rest, as they say, is history. In this conversation recorded in December 2009, Allan provides intimate insights into the major influences on his intellectual odyssey, from his engineer father's work on thermostats, to his later collaboration with his wife Judy on the centrality of shame in emotional development, eventually to formulate his theory of the development of emotional regulation through the life-cycle. Offering insights into the workings of his own creative mind, Allan traces key links between his personal and professional experiences to provide a deeper understanding into how his model of human behaviour leads to the controversial view that current brain science is in a ''paradigm shift''. His influential work promotes the view that the previously neglected right brain functions are critical to a full understanding of both normal and dysregulated human behaviour. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to understand the barriers and resulting solutions encountered by mental health service staff during the implementation of a metabolic risk assessment programme. Method: Semi-structured qualitative interviews were held with key programme staff. Thematic analysis was performed on the resulting data. Results: Barriers identified included an existing mindset that care of service users’ physical health is not part of Mental Health Service ‘core business’; the lack of processes that ensure consistent implementation of risk assessment; and lack of resources in terms of equipment and staff time/manpower. Solutions identified were categorized as: systems and process issues; staff training or education issues; issues requiring attention at an organizational level; and issues relating to service users, their family and communities. Conclusions: A valuable programme that contributes to the improved physical health of service users has been developed and implemented. However, a number of barriers to wider adoption were identified. Solutions to a number of these barriers were identified during implementation. [ABSTRACT FROM AUTHOR]

Objective: To identify and understand the linguistic expertise of psychiatrists in clinical interviews with patients experiencing thought disorder (TD).Method: Qualitative analysis of 24 routine clinical interviews between psychiatrists and inpatients with TD.Results: Psychiatrists demonstrated the expertise with which they navigated clinical interviews and accomplished shared goals with patients experiencing TD. These findings highlight the need to rethink the notion that such patients are incapable of productive communication. Capturing and describing psychiatrists' tacit expertise provides a foundation for documenting an under-recognised skill set.Conclusions: Understanding such expertise could enhance the care of patients with TD, repositioning them as active participants in the accomplishment of shared therapeutic goals. Teaching these skills to mental health clinicians during their training would improve their ability to establish effective therapeutic relationships with these patients. [ABSTRACT FROM AUTHOR]

Objective: This study determined the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people.Methods: De-identified qualitative feedback from participants and psychologists regarding the cultural appropriateness of the SCID-I for Indigenous people using open-ended anonymous questionnaires was gathered. Aboriginal Medial Service staff and Indigenous Support Workers participated in a focus group.Results: A total of 95.6% of participants felt comfortable during the 498 questionnaires completed. Psychologists also provided qualitative feedback for 502 (92.3%) interviews, of whom 40.4% established a good rapport with participants. Of the participants, 77.7% understood the SCID-I questions well, while 72.5% did not require any cultural allowances to reach a clinical diagnosis.Conclusion: When administered by a culturally safe trained psychologist, SCID-I is well tolerated in this group. [ABSTRACT FROM AUTHOR]

Objective: A 'cancer care observation' (CCO) empathy training is described. This study examined psychiatry trainees' experience of CCO and cancer patients' experience of being observed.Method: Trainees were paired with consenting patients undergoing cancer treatment; they observed a number of cancer treatment sessions and chronicled their experiences. The observations were discussed in supervision. Semi-structured interviews were conducted with trainees and observed patients. Observation journals and transcribed interviews were analysed using qualitative description.Results: Seven trainees participated. Three themes emerged: patients used trainees to support themselves while trainees struggled with role identities; CCO extends trainees' professional awareness and can benefit patients; and staff reactions were mixed. Trainees developed wide-ranging, empathic insights into cancer and hospital care experiences. No patient regarded CCO as intrusive.Conclusions: Trainees garnered insights from CCO as they generated clinical hypotheses, learnt about professional boundaries and gained first-hand experience of unconscious mental processes based on their empathic connections. CCO lends itself to psychiatry and, potentially, other medical trainees. [ABSTRACT FROM AUTHOR]

Objective: This study describes the impact of Motivational Aftercare Planning (MAP) - an intervention to increase consumer/clinician collaboration on the content of mental health recovery plans. The intervention focussed on enhancing existing discharge processes in psychiatric inpatient wards and supporting nursing staff in using motivational interviewing techniques to facilitate the completion of these plans.Methods: We conducted a qualitative thematic content analysis of the recovery plans completed throughout the study ( n = 110). Chi-squared tests were then used to compare the occurrence of themes and content identified in recovery plans pre and post the intervention ( n = 55).Results: The thematic content of the recovery plans shifted in focus following the intervention, with a change from third to first person language. Those completed prior to the intervention generally mentioned: decreasing symptoms of mental illness; acceptance of the illness; achieving clinical stability; risk management and treatment compliance. The recovery plans completed after the intervention focussed on: general wellness; participate in meaningful activities; community life; social roles and connections with others.Conclusions: This study demonstrated that a simple time-limited, facilitated intervention resulted in a change of thematic content in recovery plans. The use of these plans and its effect on care planning will need further evaluation. [ABSTRACT FROM AUTHOR]

Objectives: To report on the evaluation of publicly funded community mental health services in two New South Wales health districts.Methods: Qualitative and quantitative data from 28 publicly funded adult community mental health teams in two NSW health districts were gathered using structured interviews, benchmarking surveys, focus groups and online questionnaires.Results: The community mental health services studied lacked a coherent strategic and recovery oriented framework or model of care for service delivery. There was evidence of poor role definition at the team level, resulting in duplication and inefficiency. There were inadequate staffing levels for stated objectives, a lack of training and continuing education in evidence based intervention, poor consumer and family participation in service design, and no development and monitoring of meaningful outcome measures.Conclusions: This review and benchmarking study highlights the need for mental health policy implementation to be further supported with: development of a service delivery framework outlining essential components of a specialist community mental health system; operational guidance to enable effective team specialisation in accordance with research; investment in practitioner training to support the development of evidence based practice; and processes to ensure effective consumer and carer participation in developing recovery oriented services. [ABSTRACT FROM AUTHOR]

Objective: The 'hypothesis-driven interview' was articulated by George Engel as a method of raising and testing hypotheses in the process of building a biopsychosocial formulation and determining the most likely diagnosis. This interview was a forerunner of the modern medical interview as well as the contemporary psychiatric assessment. The objective of this article is to describe the hypothesis-driven interview and to explore its relationship with the contemporary medical interview. Method: The literature on the medical and hypothesis-driven interview was reviewed. Key features of each were identified. Results: The hypothesis-driven interview shares much with the contemporary medical interview. In addition, it enhances the application of communication skills and allows the interviewer to develop a formulation during the course of the assessment. Conclusion: The hypothesis-driven interview is well suited to the aims of a contemporary psychiatric assessment. [ABSTRACT FROM AUTHOR]