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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: In New Zealand and Australia, a renewed emphasis on equity and efficiency in the provision of mental health care has seen outcomes-focused, culturally appropriate clinical practice become essential within mental health services. Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes, however, is hindered by the difficulty of measuring the process of quality care delivery. Method: This paper argues that it is the process of care delivery (i.e. what clinicians do to, and for, patients) that is critical to the effectiveness of treatment and the degree to which treatment either inhibits or promotes an improvement in mental health recovery. Identification of the underlying causes of poor achievement of process factors is likely to positively impact on things such as readmission rates, shared care initiatives, and ultimately patient recovery. Such attention could be the difference between low-quality service provision and a high-quality service provision with positive recovery outcomes for patients. Results: Ascertaining the degree to which quality improvement and monitoring systems are enhancing professional practice and patient outcomes for indigenous people, however, is hindered by the difficulty of measuring such concepts. Australia has indeed embraced 'culturally appropriate' practice in recent years, but this appears to be piecemeal when compared with New Zealand. Certainly, there are inconsistent and variable approaches to cultural practices with indigenous people when comparing the two countries. Conclusions: Using evidence from a bicultural mental health nursing study that developed and validated generic and Maori-specific (indigenous) clinical indicators for mental health nursing standards of practice in New Zealand, it is argued that the process of care delivery is equally as important as outcome measures when ascertaining the effectiveness of nursing care. Second, this paper contends that accurate process measures must be culturally responsive to indigenous and other ethnic groups. [ABSTRACT FROM AUTHOR]

Objectives: The present paper aims to: (i) describe how the Mental Health Commission in New Zealand works and has contributed to the substantial enhancement of mental health resources and services; (ii) determine whether mental health reform policies will ever be implemented properly without an independent monitor with official influence at the highest levels of government; and (iii) demonstrate how variants on this model work in other Western countries and how it can be adapted to the Federated system in Australia.Conclusions: It is recommended that the Australian National Mental Health Plan 2003-2008 should be complemented by a long-standing national mental health commission (or similarly constituted body), which is also able to report independently from and to the government, with direct access to the Prime Minister, Premiers and Australian Health Ministers. Its aims would be to monitor service effectiveness and identify gaps in service provision, training and performance of the work force, management and government. It would be informed by consumer, carer and provider experience, and by reviews of evidence-based research regarding health needs and cost-effective services. It should accurately cost such service gaps, and advise government on a strategy for implementing them. It could also promote and advise formally on enhancing community awareness, decreasing stigma and discrimination and improving workforce recruitment and retention. [ABSTRACT FROM AUTHOR]

Objectives: To describe some of the policy implications of the Australian National Survey of Mental Health and Wellbeing. Methods: A review of the initial findings from the Survey published by the Australian Bureau of Statistics and the five papers in this issue of the Journal, was done. Results: Mental disorders are highly prevalent with the prevalence essentially unchanged since Australia's 1997 mental health survey. Mental disorders are often comorbid with each other and with physical disorders. Despite the disability they cause, most people with disorders do not seek treatment. This is largely because they do not perceive a need for treatment. Conclusions: National epidemiological surveys are important for service planning. They are especially important in gaining an understanding of the population not accessing services. Innovative strategies, including action on mental health literacy, will be necessary to increase the treatment rates for common mental disorders. [ABSTRACT FROM AUTHOR]

Objective: The present paper applies Goldberg and Huxley's Pathways to Care (PTC) model to the Australian health-care system to ask: who is treated in each sector and what does this tell us about the performance of the health-care system? It examines the factors associated with reaching primary care, outpatient and inpatient sectors, as well as private and public mental health services. Method: Data from the Australian National Survey of Mental Health and Wellbeing were used to determine the proportion of the population treated in each sector. Sociodemographic and clinical characteristics were examined and logistic regression was used to determine which factors were associated with use of different sectors of care. Results: Of the total population, 80.5% reached primary care, 8.2% primary care for mental health problems, 6.5% outpatient care and 0.4% reached the mental health inpatient sector. Clinical severity increased across these sectors and was an important determinant of access to care. Those consulting private practitioners were clinically similar to those consulting in the public sector. Sociodemographic characteristics were important determinants of access to primary, specialist and private mental health care. Being aged over 55 years or living in a rural area was associated with lower access to several sectors. Conclusions: Although at a broad level the health-care system is performing as expected, limited access among some groups is cause for concern. Applying the PTC model to a population sample offered useful insights into the performance of the Australian health-care system. [ABSTRACT FROM AUTHOR]

To examine the likely utility of the recently published Australian and New Zealand clinical practice guidelines for the treatment of depression.The guidelines are critiqued for their intrinsic logic and their success in extracting potentially valid and useful management templates.This paper provides examples of key limitations to many specific interpretations and conclusions.It is argued that these guidelines are far less precise and informative for clinical practice than they appear and with a disturbing lack of rigour for a document promulgated by a professional college. [ABSTRACT FROM AUTHOR]

This paper aims to provide an overview of the literature on non-sexual dual relationships, and to discuss these in the context of rural mental health practice in Australia.An internet-driven literature search was undertaken using OVID databases, which include MEDLINE, PsycINFO, CINAHL, and EMBASE: Psychiatry. Ethical codes of practice for the mental health professions of psychiatry, psychology, occupational therapy, social work and nursing were referred to. Searches were not limited by year of publication. Other unpublished material or information was included where relevant.Dual relationships are common in rural mental health practice. However, research on non-sexual dual relationship boundary issues in rural mental health is limited. Ethical codes of practice of mental health professional bodies provide little guidance regarding non-sexual dual relationships. Decision-making models addressing the ethics of dual relationships are restricted to considerations of whether to enter a dual relationship rather than how to manage such a relationship.‘Everyday’ dual relationships are a predictable part of rural mental health practice. Further research is required to identify the benefits and/or problems in clinical practice resulting from non-sexual dual relationships. Responsibility for identifying and implementing ways of appropriately managing such relationships should be shared by the patient, the clinician, mental health services and professional organizations. [ABSTRACT FROM AUTHOR]

Objective: We reflect upon the processes of mental health administration in Australia with reference to George Orwell's novel, 1984.Conclusions: Mental healthcare in Australia is distorted by politicisation, spin and a refusal to acknowledge the reality of the current situation. These challenges for mental healthcare demonstrate some similarities with the Ministries of Truth and Plenty, which conversely performed as their opposites in Orwell's novel. Psychiatrists and their professional bodies should play a greater role in advocacy for clinician-led, evidence-based services in partnership with our communities. [ABSTRACT FROM AUTHOR]

Objective: We aim to spark renewed discussion of the need for a more effective corporate governance structure for mental health services in Australia. While acknowledging clinical governance faces challenges, we focus here on corporate governance as the overarching level of administration, which profoundly influences delivery of mental healthcare in Australia.Conclusion: Australia's mental health services are ineffectively governed. Improved corporate governance, including psychiatric expertise, is fundamental to create a comprehensive, effective mental healthcare system in Australia. [ABSTRACT FROM AUTHOR]

Objectives: The Mental Health Act 2007 (NSW) ( MHA) was recently reformed in light of the recovery movement and the United Nations Convention on the Rights of Persons with Disabilities. We analyse the changes and describe the impact that these reforms should have upon clinical practice.Conclusions: The principles of care and treatment added to the MHA place a strong onus on clinicians to monitor patients' decision-making capacity, institute a supported decision-making model and obtain consent to any treatment proposed. Patients competently refusing treatment should only be subject to involuntary treatment in extraordinary circumstances. Even when patients incompetently refuse treatment, clinicians must make every effort reasonably practicable to tailor management plans to take account of any views and preferences expressed by them or made known via friends, family or advance statements. [ABSTRACT FROM AUTHOR]

The article explores the role of risk assessment in clinical practice as well as in clinical decision-making in the public mental health services in Australia. It mentions a little evidence supporting the existing form of risk assessment applied in the Australian public mental health services. An overview regarding the development and use of actuarial risk assessment instruments is provided.