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Objective: To assess depression literacy, help-seeking and help-offering to others in members of the police force in the state of Victoria, Australia. Methods: All staff in police stations involved in a cluster randomised controlled trial of an integrated workplace mental health intervention were invited to participate. Survey questions covered sociodemographic and employment information, recognition of depression in a vignette, stigma, treatment beliefs, willingness to assist co-workers with mental health problems, help-giving and help-seeking behaviours, and intentions to seek help. Using the baseline dataset associated with the trial, the paper presents a descriptive analysis of mental health literacy and helping behaviours, comparing police station leaders and lower ranks. Results: Respondents were 806 staff, comprising 618 lower-ranked staff and 188 leaders. Almost 84% of respondents were able to correctly label the problem described in the vignette. Among those who had helped someone with a mental health problem, both lower ranks and leaders most commonly reported ‘talking to the person’ although leaders were more likely to facilitate professional help. Leaders’ willingness to assist the person and confidence in doing so was very high, and over 80% of leaders appropriately rated police psychologists, general practitioners, psychologists, talking to a peer and contacting welfare as helpful. However, among both leaders and lower ranks with mental health problems, the proportion of those unlikely to seek professional help was greater than those who were likely to seek it. Conclusion: Knowledge about evidence-based interventions for depression was lower in this police sample than surveys in the general population, pointing to the need for education and training to improve mental health literacy. Such education should also aim to overcome barriers to professional help-seeking. Interventions that aim to improve mental health literacy and help-seeking behaviour appear to be suitable targets for better protecting police member mental health. [ABSTRACT FROM AUTHOR]

This is the introductory paper to the special issue on ethics in psychiatry. We introduce the other papers that follow and set them in a context. Inevitably, they represent only a thin slice of the work going on in psychiatric ethics. But they serve to show two unique features of this discipline. First, it has a tendency to dig deep and to make connections with other philosophical concepts. So, for example, in a number of ways the papers that follow touch on the nature of personhood. We examine this notion. Second, psychiatric ethics, because of its content and its embededness in the real world, tends to hit upon diverse and sometimes conflicting values. We introduce the idea of values-based medicine, which provides both a theoretical framework and a practical approach to the common dilemmas of psychiatric practice. The need to think deeply, but also clearly and coherently, combined with the need to engage with the hurly-burly of the world of patients, users and carers, suggests the reasons why psychiatric ethics offers a paradigm for practical ethics generally. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic trends herald what many describe as the Asian Century, whereby Asian economic, political and cultural influence is in global ascendency. Broadening relevant ties between Australia and Asia is evident and logical and may include strengthening alliances in mental health systems. Aim: We argue the importance of strengthening Asian mental health systems and some of the roles Australian mental health workers could have in promoting strengthening the Asian mental health system. Methods: This paper is a narrative review which sources data from reputable search databases. Results: A well-articulated Australian strategy to support strengthening the mental health system in Asia is lacking. While there are active initiatives operating in this space, these remain fragmented and underdeveloped. Coordinated, collaborative and culturally respectful efforts to enhance health education, research, policy, leadership and development assistance are key opportunities. Conclusion: Psychiatrists and other mental health professionals have a unique opportunity to contribute to improved mental health outcomes in Asia. [ABSTRACT FROM AUTHOR]

Objective: In Australia it has been estimated that mental health symptoms result in a loss of $ AU2.7 billion in employee productivity. To date, however, there has been only one study quantifying employee productivity decrements due to mental disorders when treatment-seeking behaviours are considered. The aim of the current paper was to estimate employee work productivity by mental health symptoms while considering different treatment-seeking behaviours. Method: A total of 60 556 full-time employees responded to the World Health Organization Health and Work Performance Questionnaire. This questionnaire is designed to monitor the work productivity of employees for chronic and acute physical and mental health conditions. Contained within the questionnaire is the Kessler 6, a scale measuring psychological distress along with an evaluation of employee treatment-seeking behaviours for depression, anxiety and any other emotional problems. A univariate analysis of variance was performed for employee productivity using the interaction between Kessler 6 severity categories and treatment-seeking behaviours. Results: A total of 9.6% of employees have moderate psychological distress and a further 4.5% have high psychological distress. Increasing psychological distress from low to moderate then to high levels is associated with increasing productivity decrements (6.4%, 9.4% and 20.9% decrements, respectively) for employees in current treatment. Combining the prevalence of Kessler 6 categories with treatment-seeking behaviours, mean 2009 salaries and number of Australian employees in 2009, it is estimated that psychological distress produces an $ AU5.9 billion reduction in Australian employee productivity per annum. Conclusions: The estimated loss of $ AU5.9 billion in employee productivity due to mental health problems is substantially higher than previous estimates. This finding is especially pertinent given the global economic crisis, when psychological distress among employees is likely to be increasing. Effective treatment for mental health problems yields substantial increases in employee productivity and would be a sound economic investment for employers. [ABSTRACT FROM AUTHOR]

Objective: Patients with mental health disorders frequently have difficulties with their cognitive functioning. Assessment of cognition in this population can be complicated by psychiatric symptomatology, making standard written and verbal assessment methods difficult. In these situations, observations by nursing and allied staff of patients' routine activities provide an important source of information about cognitive ability. The Behavioural Assessment Tool for Cognition and Higher Function (BATCH) was developed to record observations of patients' daily functioning under subheadings that reflect cognitive domains. Its capacity to provide a measure of cognitive function through observational means was assessed in a neuropsychiatric unit. Method: A consecutive sample of 76 adult neuropsychiatry inpatients were assessed over 6 months using BATCH. BATCH measures the frequency of given behaviours grouped under 10 functional and cognitive domains: orientation, attention/concentration, personal responsibility, volition, adaptation, problem-solving/judgement, executive function, memory, language, and visuospatial function. Data from routine standardized cognitive (Mini-Mental Status Examination, MMSE; Neuropsychiatry Unit Cognitive Screening Tool, NUCOG), psychiatric (Neuropsychiatric Inventory; Health of the Nation Outcome Scale) and functional (Bristol Activities of Daily Living Scale; Barthel Index) instruments were collected to determine the relative contribution of cognitive function to scores on the BATCH. Results: A strong correlation was found between total BATCH scores and total NUCOG and MMSE scores. BATCH and NUCOG subdomains correlated significantly in all subscales. BATCH demonstrated very high internal consistency. Linear regression analysis showed that the strongest determinant of BATCH scores was cognitive function as measured on the NUCOG. A significant subscale×group effect showed lower BATCH scores in memory, orientation, attention, executive function and language in dementia sufferers compared to psychiatric and neurological patient groups. Conclusion: BATCH scores correlated strongly with pencil-and-paper measures of cognitive function. BATCH provides clinicians with a means of assessing cognitive function through behavioural observation, thus enabling assessment of patients with behavioural disturbance or severe psychopathology. This tool has practical application for adult and aged clients across all observational mental health settings. [ABSTRACT FROM AUTHOR]

Objective: The present accepted classificatory systems (ICD-10 and DSM-IV) represent the culmination of 100 years of post-Kraepelinian evolution. The present paper reports on a study to ascertain the views of New Zealand psychiatrists on their requirements of a classificatory system, and their opinions on those currently in use. Method: An anonymous postal survey of 542 psychiatrists and trainees was undertaken in New Zealand. Results: A total of 235 questionnaires were returned, completed. New Zealand psychiatrists primarily use DSM-IV and do so because that is what they were taught on. They make relatively limited use of the multiaxiality. The purposes of classificatory systems that they value most highly are reliable interclinician communication, and to inform patient management planning. The two purposes they valued least were usefulness for a national statistical base, or to indicate prognosis. Conclusions: New Zealand psychiatrists' views are consistent with some of the stated objectives of ICD-10 and DSM-IV, but there is significant diversity in the former and over-ambition in the latter, with much to be resolved. [ABSTRACT FROM AUTHOR]

Objective: This is the second part of a study of posttraumatic amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of dissociative amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse). Method: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation–integration and repression–abreaction models are contrasted. Results: Descriptive evidence is cited in support of preferring Myers’ and McDougalls’ dissociation–integration treatment approach over Brown’s repression–abreaction model. Conclusion: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the dissociative–integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while emotional release is secondary. [ABSTRACT FROM AUTHOR]