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Objectives: Current mental health practices for people living in residential aged care (RAC) facilities are poor. In Australia, there are no mechanisms to monitor and promote mental health for people living in RAC, including those who experience changed behaviours and psychological symptoms. The aim of this study is to improve current practices and mental health outcomes for people living in RAC facilities by codesigning a Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool)., Methods: A two-stage sequential and mixed methods codesign methodology will be used. Stage 1 will include qualitative interviews and focus groups to engage with residents, family/care partners and RAC staff to ascertain mental healthcare practices and outcomes of greatest significance to them. Adapted concept mapping methods will be used to rank identified issues of concern in order of importance and changeability, and to generate draft quality indicators. Stage 2 will comprise a Delphi procedure to gain the wider consensus of expert panel views (aged care industry, academic, clinical) on the performance indicators to be included, resulting in the codesigned MHICare Tool., Ethics and Dissemination: This study has been reviewed and approved by the University of Queensland Human Research Ethics Committee (HREC/2019002096). This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007). The study's findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media., Conclusion: This protocol reports structured methods to codesign and develop a mental health performance indicator tool for use in Australian RAC., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Indigenous Australian young people comprise over 50% of the total Indigenous population (Australian Bureau of Statistics, 2017). Yet, the voices of Indigenous young people are seldom centred in policy or scholarship (Shay & Sarra, 2021). This paper shares findings from a three-year national transdisciplinary, qualitative study that explored the identity and well-being of Indigenous young people in diverse school settings. The data told counter-stories through the lens of Indigenous young people currently absent in mental health and educational wellbeing scholarship. This article illustrates how the theoretical/methodological approach and data provide a strengths-based alternative to trauma-informed and medicalised mental health frameworks that dominate policy and practice approaches. This paper shares key findings from Indigenous young people who articulated their identities as underpinned by respect, pride and collectivism and shaped by culture, where you are from, physicality and role models. These expressions are clearly at odds with broader deficit discourses on Indigenous identity and have implications for health and schooling settings.

Background: Help-seeking provides opportunities for early prevention and intervention of mental health problems. However, little is known about factors that impact help-seeking from a life-course and socioecological perspective. This study aimed to examine factors that impact adolescents' formal and informal help-seeking in three population groups: the whole population, adolescents with depressive symptoms and adolescents with anxiety symptoms., Methods: We drew on data from the Longitudinal Study of Australian Children birth cohort. Participants were followed from birth to 14-15 years. Based on previous literature and life-course and socioecological models, we measured a range of factors at individual and family, interpersonal and community levels at three time points (0-1 year, 4-5 years and 12-13 years). Outcomes at 14-15 years were help-seeking behaviours divided into three categories (formal help from health professionals, close informal help from friends and family members and broad informal help from other sources). Generalised linear models with logit-binomial links were used., Results: There were varying and common patterns of influencing factors across the three population groups and sources of help-seeking. In the whole population, five common factors (female, previous depressive or anxiety symptoms, discrimination and bully victimisation) were associated with all three sources of help-seeking. Among adolescents with depressive or anxiety symptoms, four common barriers to help-seeking were male adolescents, speaking a language other than English, having poor relationships with peers and less social support., Conclusion: Both intrinsic and extrinsic barriers exist for adolescents' mental health help-seeking. There are priority groups of adolescents with mental health problems who are unlikely to seek support and warrant attention. There is a need for multisector collaborations to address barriers to mental health care and promote help-seeking among adolescents., (© 2024 Association for Child and Adolescent Mental Health.)

Schools are an important setting for the early identification, assessment and intervention of mental health problems in children and young people. Internationally, many nurses work in schools, but the role of this group with young people experiencing mental health problems has had only limited investigation. This study explored the activities school nurses undertook with young people experiencing mental health problems in Australia. Reporting was guided by the COREQ checklist. Thirty-one nurses participated in a semi-structured interview. Data were analysed using the constant comparative method of analysis as developed by Glaser and Strauss (1967). The findings identified that nurses working in schools undertake a complex and sophisticated workload to support this cohort. In addition to assessment and referral for treatment, interventions assisted young people to manage challenging life circumstances, cope with intensely difficult emotions and improve their social and occupational functioning. The work of school nurses with young people experiencing mental health problems is hidden and unacknowledged. A better understanding of the mental health work school nurses undertake can inform enhanced service provision for children, young people and their families. The research findings will be of interest to mental health nurses, education professionals, parents, policy makers and governments., (© 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Purpose: This paper aims to provide an overview of a peer-supported writing and wellbeing pilot program for higher degree by research (HDR) students in Australia. It proposes a six-month program is a beneficial service to HDR students that improves not only their productivity and writing confidence but assists with their perceived mental wellbeing as well. Design/methodology/approach: This paper offers a perspective of the piloted writing and wellbeing program for HDR students during the recovery period during the COVID-19 global pandemic. It includes generalized reflections of participation, content, and structure alongside future directions and further implementation. Findings: This research includes generalized, anonymous data regarding the success of the writing and wellbeing pilot program for HDR students and components to improve upon. It suggests that the overwhelming response from participants was positive, especially during various COVID-19 related lockdowns and travel restriction measures. Research limitations/implications: As this paper involves a small cohort of preliminary impressions from the pilot study, results will lack generalizability. Therefore, it is acknowledged that further research will ensue to examine the program further. Practical implications: The success, measured by adherence and wellbeing improvements, of the Write Smarter: Feel Better program can influence the way in which universities address and protect mental wellbeing of their HDR students. Originality/value: This paper fulfills an identified and growing need for mental wellbeing to be strengthened among HDR students.

The mental health Lived Experience workforce (also referred to as peer workforce) is growing rapidly internationally and within Australia. Peer workers are increasingly employed within multi- and inter-disciplinary teams, often directly supervised by mental health professionals such as nurses. Professional supervision has been identified as fundamental for implementing a sustainable peer workforce, but significant gaps in the literature remain, in particular, an understanding of appropriate supervision practices. This scoping review synthesized academic and grey literature on Lived Experience supervision in Australia, exploring current thoughts on best practices. Four electronic databases were searched, and grey literature was located via Google Advanced searches, contacting Lived Experience experts and conducting web-based desktop searches of key mental health organization websites. Thematic analysis identified and described key characteristics in relation to how supervision is conceptualized and operationalized. Eight peer-reviewed and 46 grey literature documents describing supervision and supervisory practices were analysed. Of these studies, 26 were Lived Experience-led. Analysis revealed four key themes: (i) defining peer supervision, (ii) variability in understanding the purpose of supervision, (iii) approaches to supervision and the need for choice and flexibility, and (iv) qualities and skills of the supervisor. Additionally, the establishment of a national professional organization for peer workers was highlighted to protect the authenticity of Lived Experience roles and develop an effective workforce. Clearly, a sustainable Lived Experience workforce cannot develop in isolation, and mental health nurses, as important allies in mental healthcare, need to work alongside, plan and advocate for appropriate supervision practices for this emerging workforce., (© 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

Informal care can exert adverse effects on the mental health of young people. Bullying victimisation is an important determinant of mental disorders. Young carers are at elevated risk of bullying. We quantify the mental health effects of informal care among Australian adolescents and the extent to which these effects are transmitted through school bullying. We used data from the Longitudinal Study of Australian Children. Participants were classified as non-carers, light carers (caring for < 10 h/week) and moderate-to-heavy carers (caring for 10 + h/week). Mental health was measured using the Kessler Psychological Distress Scale (K10). Using a counterfactual approach to mediation analysis, total effects (TE) of informal care on mental health were decomposed into natural direct effects (NDE-mental health effects not transmitted through school bullying) and natural indirect effects (NIE-mental health effects transmitted through school bullying). The TE of informal caring was 0.71 (95%CI - 0.03, 1.49) for light carers and 1.72 (95%CI 0.45, 3.02) for moderate-to-heavy carers. While school bullying explained 27% of the TE among moderate-to-heavy carers (NIE: 0.46; 95%CI 0.12, 0.91) there was weak evidence of mediation for light carers. Our findings indicate that the mental health effects of moderate-to-heavy caregiving can be reduced by school bullying interventions., (© 2023. Springer Nature Limited.)

Background/aim: Although sensory approaches are recommended to relieve distress and agitation and reduce the use of seclusion and restraint, many Australian psychiatric units have struggled to sustain their practice. The aim of this study was to investigate the barriers and enablers influencing the use of different sensory approaches across one health region in Australia and to obtain recommendations for strategies to improve their use., Method: This cross-sectional survey was informed by the Theoretical Domain Framework. Likert scale questions considered barriers and enablers to the use of non-weighted sensory interventions, weighted modalities, sensory rooms, and sensory assessments/plans. Open-ended questions explored participant concerns and recommendations to improve the use of sensory approaches., Results: Participants (n = 211) were from nursing, allied health, medical, and peer support staff across inpatient psychiatric units. Factors most frequently identified as enablers for using sensory approaches were beliefs of positive benefits to consumers (e.g. decreasing distress and agitation); belief it was within the staff's role; and knowledge of the approaches. Limited time was the most common identified barrier. Factors statistically associated with more frequent use were knowledge, skills, confidence, availability, and easy access to sensory tools/equipment. Only 30% of participants were concerned about potential risks of sensory approaches, with this risk mitigated through adequate supervision and thorough risk assessment. Recommendations to improve practice included improved access to, and maintenance of, equipment, more training, and increased staffing., Conclusion: This study revealed how barriers and enablers vary for different sensory approaches and how these factors impact their frequency of use in psychiatric units. It provides insights into staff recommendations to improve the use of sensory approaches in one health region in Australia. This knowledge will lead to the development of implementation strategies to address identified barriers and improve the use of sensory approaches in psychiatric units., (© 2023 The Authors. Australian Occupational Therapy Journal published by John Wiley & Sons Australia, Ltd on behalf of Occupational Therapy Australia.)

Infant mental health is explicitly relational and strengths based as a field. Ethical dilemmas in infant mental health have received insufficient attention at the level of infant mental health professionals (IMHP) and other professionals caring for infants who must grapple with questions of when caregivers and infants have conflicting interests. We present composite cases drawn from North American and Australian contexts, using three systems in which such conflicts may commonly manifest: child protection, home visiting, and medical settings. The field of infant and early childhood mental health (IECMH) should begin to discuss such dilemmas and how best to balance the needs of caregivers and infants when they are not well aligned., (© 2023 The Authors. Infant Mental Health Journal published by Wiley Periodicals LLC on behalf of Michigan Association for Infant Mental Health.)

Aim: A range of residential supports is available for young people experiencing mental health challenges. One Australian example is the Youth Residential Rehabilitation Service, which provides up to 12 months of intensive psychosocial support in a residential setting to young people aged 16-25 experiencing serious mental health challenges. This paper aimed to add to the scant literature on these services, describing the experiences of young people and staff members across the duration of a stay., Methods: This study drew on collaborative autoethnography to engage and centre the direct lived experience of young people who had lived, and staff who had worked, in a Youth Residential Rehabilitation Service., Results: We identified three phases that young people typically journey through during their stay at the service. The Arriving phase was marked by appropriate referrals, a warm welcome, a period of settling in and the development of trusting relationships. The Discovering phase saw young people identifying and enacting their strengths, hopes and values. Community connections were a focus of the Continuing phase as lives after service exit were envisioned and created., Conclusions: Drawing on collaborative autoethnography methods represents one approach to amplify the voice of young people in service design and evaluation. This paper richly described some of the possibilities and complexities of the Youth Residential Rehabilitation Service experience, which can be used to inform the service's pacing and structure of support., (© 2021 John Wiley & Sons Australia, Ltd.)

This paper reports on a project conducted between July 2020 and March 2021 that was developed within the context of COVID-19 and explored the ways in which Australian universities responded to the pandemic and the gendered effects of these responses. This paper demonstrates that sexist and gender discriminatory practices were amplified by the pandemic and that the gendered division of labour within higher education was made more apparent. We contribute to a growing body of work on gender and the COVID-19 crisis by reporting on a survey conducted in Australia. The survey asked participants to reflect on their experiences qualitatively. It is this qualitative element that has been missing from much of the research in the field thus far. In addition, the diversity of participants means that we bring an intersectional lens to the ongoing effects of the pandemic upon higher education, including exploring the experiences and reflections of academics who identify as culturally and linguistically diverse (CALD), LGBTIQA+, and Aboriginal and Torres Strait Islander experiences and reflections. This paper, therefore, reports on some of the key findings from the survey and focuses upon the gendered dimensions of the pandemic, domestic life and pandemic living-working, and affect, emotion and wellbeing.

Purpose: Although the international education sector is one of the significant contributors to the Australian economy, international students continue to experience various forms of social inequalities. This paper aims to focus on overseas doctoral researchers (ODRs) -- candidates and graduates -- and capture their experiences. Design/methodology/approach: Drawing on the adaptive capacity framework, an exploratory qualitative study was carried out based on interviews with doctoral candidates (n = 6), doctoral graduates (n = 5) and supervisors (n = 4) in various Business Schools in Australian universities. Given this study's exploratory and interpretive nature, the research question was deliberately broad: what insights can be generated for key stakeholders by capturing the experiences of ODRs in Australia through the lens of adaptive capacity? Findings: Findings indicate that financial pressure, social exclusion and cultural bias were the three main challenges ODRs had to overcome; female ODRs perceived that supervisors and faculties often overlooked the mental health aspects; and better pedagogy of research supervision, institutional support and national policies are needed to develop adaptive ODRs. Research limitations/implications: If ODRs are to become an integral part of the knowledge economy, key stakeholders need to focus on support mechanisms for these researchers. That way, Australian universities can not only improve their image of treating international students only as a part of the revenue flow but also enhance the educational experiences of ODRs and set them up for future success. Originality/value: The contribution of this paper is twofold. First, it demonstrates the utility of the adaptive capacity lens to capture the experiences of ODRs. Second, it discusses research implications for the three key stakeholders: supervisors, higher education institutions and the government.

Recent years have seen an increasing emphasis on the role of teachers in promoting and supporting student mental health. It is thus important to understand how teachers' attitudes towards mental health impacts the efficacy of school mental health programs. The aim of this paper was to evaluate, based on a comprehensive review of existing literature, the relationship between teachers' attitudes and the success of school-based mental health interventions. Results indicated that teachers' attitudes towards mental health is a critical moderator of the success of related programs in schools. When teachers are supportive of, engaged in, and understand the importance of, mental health programs, students are more likely to participate in these programs and experience positive outcomes. The specific type of efforts that should be made to educate teachers about the importance of mental health and to provide them with the tools and resources necessary to effectively support student mental health in the classroom are discussed. The paper also highlights the importance of careful selection in terms of the mental health initiatives introduced within schools, and how this choice may impact teacher attitudes.

This scoping review explores the role of school leadership in the improvement of teacher well-being by utilizing the Locus of Control (LOC) Framework identified by psychologist Julian Rotter in 1954. The internal and external environments impacting teacher well-being were explored, and the specific responsibilities of school leadership were identified. The literature reports that while teachers are responsible for many aspects of their well-being, school leaders can improve a teacher's mental health and create a positive school culture by taking responsibility for factors external to the teacher's LOC. This paper outlines school leadership responsibilities in actively implementing strategies to improve staff well-being in the school environment.

Background: Mental health concerns prevent positive well-being and are key challenges for Australian children and young people. Arts organisations play a role in enhancing the positive mental health of children and young people. This paper describes the involvement of young people and their parents in the development of a resource for arts organisation's intentional support of social and emotional well-being. Methods: Six focus groups were conducted with 19 young people who participate in dance, drama, and circus programs, and 17 of their parents. Questions explored how the arts currently, and potentially, support their social and emotional well-being. Results: Three overarching themes: "Connecting with Others;" "Being Myself;" and "Teaching Methods," plus 14 sub-themes were identified. Conclusion: A framework of well-being factors and pedagogies was developed to guide the creation of a resource to help support the social and emotional well-being of young people participating in arts programs.

In recent years, interest in the therapeutic potential of yoga for people recovering from trauma has flourished. To date, much of this research on yoga for trauma adopts a quantitative methodology that positions yoga as a medicalised intervention to understand if yoga is 'effective' for trauma recovery for adults. This paper seeks to contribute to an emerging body of qualitative literature by drawing on the voices of eight Iyengar yoga teachers with experience teaching adult students with trauma. It reveals that the teachers do not hold themselves out to be specialists in trauma, nor do they rely on formulistic principles or knowing a person's trauma narrative. Rather, they draw on the pedagogic skills they have developed more generally through their considerable experience of teaching yoga as an embodied practice to tailor their approach for their students. Of central interest is the way the teachers use their own bodies, particularly their sensory perceptions, to 'read' the bodies and emotional capacities of their students within each teaching session. The teachers also reflect on the way they use adjustments as part of their embodied pedagogic skills in nuanced ways that challenge the dominant no-touch discourse on teaching students with trauma. These pedagogic approaches offer important insights for movement teachers more generally, particularly those teaching vulnerable students.

Background: There is little research comparatively assessing prevalence of pain between older people either with or without intellectual disability. This paper explores health and social factors associated with chronic pain in these two groups. Method: A cross-sectional survey was undertaken in New South Wales and Queensland, Australia. Inclusion criteria were adults either with or without intellectual disability, aged 60 years and older, and currently living in community-settings. Univariate and multivariable analyses were undertaken on a sample of 391 adults with intellectual disability and 920 adults without intellectual disability. Results: Key findings included higher prevalence of pain in the intellectual disability group, along with higher rates of osteoarthritis, falls, oral health problems, and mood disorders. Conclusions: Mitigating risk factors for conditions that cause chronic pain in older adults is crucial. As longevity increases, the healthcare sector needs to prioritise chronic pain management for people with intellectual disabilities through appropriate treatment strategies.

Understanding the drivers of student dropout from higher education has been a policy concern for several decades. However, the contributing role of certain factors--including student mental health--remains poorly understood. Furthermore, existing studies linking student mental health and university dropout are limited in both methodology and scope--for example, they often rely on small and/or non-representative samples or subjective measures, and focus almost exclusively on main effects. This paper overcomes many of these shortcomings by leveraging unique linked administrative data on the full population of domestic students commencing undergraduate studies at Australian universities between 2012 and 2015 (n = 652,139). Using these data, we document that approximately 15% of students drop out of university within their first academic year. Critically, students receiving treatment for mental health problems are 4.3 (adjusted) to 8.3 (unadjusted) percentage points more likely to drop out of higher education. This association remains in the presence of an encompassing set of potential confounds, and is remarkably uniform across segments of the student population determined by individual, family, and programme characteristics. Altogether, our findings call for increased policy efforts to improve student mental health and to buffer against its deleterious effects on retention.

Purpose: This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW)., Design/methodology/approach: By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee's success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group's audit were drawn by critically appraising the JHFMHN/CSNSW HRRG's Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature., Findings: The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings., Social Implications: Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large., Originality/value: Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives., (© Emerald Publishing Limited.)

Background: Australian policy reports recommended schools to be leveraged to better support student mental health, with a focus on regional and rural areas where students have poorer mental health outcomes. In designing solutions to address this systemic gap, decision-makers require an understanding of the barriers and facilitators experienced by regional and rural schools. However, current literature has focused on metropolitan schools and neglected to explore facilitators., Objective: To review the evidence on barriers and facilitators in delivering student mental health support experienced by regional and rural schools in Organisation for Economic Co-operation and Development nations., Design: A mixed-methods systematic review of peer-reviewed and grey literature., Findings: The search identified 4819 studies. A full-text review by 2 reviewers resulted in 5 papers, which met the inclusion criteria and were assessed using methodological appraisal. One study used qualitative data, 2 studies used quantitative data, and 2 studies were a mixed-methods design., Discussion: While there was a paucity of studies, this review draws together the most up-to-date research. The barriers and facilitators were categorised into 3 themes: access to services and resources; mental health literacy of staff and parents; and communication and collaboration between stakeholders., Conclusion: This review presents a comprehensive synthesis of the literature and highlights opportunities to leverage rural and regional schools to support student mental health, focusing on the quality of communication and collaboration, and increasing access to services and resources, and mental health literacy. Research should explore the unique advantages of rural and regional areas to inform policy, including a focus on strengths., (© 2021 National Rural Health Alliance Ltd.)

A caring school community can enhance whole-school wellbeing including the wellbeing of school staff, which directly impacts on student academic, social and emotional wellbeing. This study firstly examines the validity and reliability of a proposed wholeschool staff wellbeing evaluation tool which uses a set of whole-school wellbeing indicators to identify strengths and areas for improvement within the school environment which may be impacting on staff wellbeing. Secondly, the association between factors found within the whole-school staff wellbeing tool with staff self-reported mental health are examined, and finally, the influence of person characteristics and role of factors on perceived whole-school staff wellbeing are determined. Cross-sectional data were collected from 801 school staff from six non-government schools in Australia as part of the School Staff Wellbeing Project. Results confirmed and validated the hypothesised structure of the whole-school staff wellbeing evaluation tool with staff relationships (leadership, staff), staff engagement (active, supported), staff emotional wellbeing (supported through policies and opportunities) and school climate (culture and values) found to be significant predictors of mental health. Prioritising resources to building supportive staff relationships, school climate, and providing opportunities to promote staff emotional wellbeing, were found to have the greatest impact on staff mental health. Characteristics such as age, gender, education, role, and length of time working in schools predicted perceptions of the whole-school's general wellbeing. The whole-school staff wellbeing evaluation tool provides a useful screening and self-evaluation measure to identify whole-school staff wellbeing strengths and areas for improvement in staff wellbeing.

International students from culturally and linguistically diverse countries travel to Australia because of the opportunity to study courses in the English language with some coming to this country just to study the language itself. Such desires moreover create students to engage in creative strategies to improve their language skills. This paper, however, suggests that the desire to be skilled in English through immersion in an English-speaking country like Australia creates challenges to the mental wellbeing of international students. Reporting on interview data with 47 international students of Asian descent in the Australian city of Melbourne, this paper reveals these challenges to include lived and perceived notions of self and belonging, as well as loneliness.

WHAT IS KNOWN ON THE SUBJECT?: Australia is a commonwealth of federated states and territories with each having unique mental health legislation. Victoria implemented advance statements based on legislation from overseas jurisdictions such as Scotland. The aim of this Victorian legislation was to underpin an individual's autonomy and decision-making in relation to treatment, particularly compulsory treatment. Advance statements allow individuals within the healthcare setting to document preferences for care and treatment during times of decompensated mental health, including informing nominated persons and preferences for recovery-oriented care; however, advance statements continue to attract barriers in their implementation and use. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: This paper focuses on legislation within one jurisdiction, Victoria, highlighting that several barriers to uptake exist, including uncertainty around the legal status of advance statements, the ideal setting to implement advance statements and concern around perceived consumer capacity to contribute to developing advance statements. There are substantial differences of opinion regarding adherence to treatment and recovery preferences contained within the advance statement, especially when decisions are made in the context of decompensated mental health. The Theoretical Domains Framework (TDF) model has been used to formulate recommendations in several other health studies, but to date has not been used to provide recommendations for greater implementation of advance statements. Implementation science is a contemporary research translation movement that seeks to identify factors and strategies that influence the adoption and integration of interventions like advance statements in real world settings. For this study it has been useful to identify barriers, consider implementation strategies and link this with policy frameworks to support practice change. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our study revealed that real challenges exist for mental health clinicians in adopting advance statements despite them having a strong held intention to empower service users to play a greater role in their own treatment and care decisions. The facilitators identified in this study highlight the notion that advance statements, and the concept of supported decision-making are needed in contemporary mental health care. Implementation science can assist in identifying barriers and suggesting facilitators including enhanced training, incentivization of advance statement creation, and greater awareness of the overarching purpose and principle of advance statement creation. Continued support and training in implementing and maintaining advance statements is required if mental health clinicians are to drive the uptake of this important reform to mental health legislation. Training needs to be provided that will address attitudes, and strongly held beliefs that pose barriers to the use of advance statements., Abstract: INTRODUCTION: Advance statements, also known as advance directives or psychiatric wills, provide individuals the opportunity to document care and recovery preferences during a period of mental ill health. Although the use of advance statements has gained momentum, little research has explored the factors that promote or hinder further uptake., Aim: To determine the factors that promote or hinder the uptake of advance statements., Method: Cross-sectional online survey of healthcare workers (n = 190)., Results: Promoting factors include high perceived value of advance statements, particularly their role in recovery focussed care, while hindering factors include disagreement or responsibility for advance statement creation and legal status., Discussion: This study indicates that several hindering factors or barriers to advance statement uptake remain, and until these factors are addressed future implementation is arguably hindered. In this paper, we have used the Theoretical Domains Framework (TDF) model to outline suggestions to address hindering factors to implementation and guide future implementation strategies for advance statement uptake and practice change., Implications for Practice: The ongoing uptake of advance statements requires tailored implementation strategies address hindering factors. Strong promoting factors, such as the shared belief in the advance statement model and its role in recovery focused care, should be considered a strong foundation for implementation strategies., (© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Aim: The adverse impacts of exposure to work intensity on mental health have been widely studied. However, there is a lack of research examining who is most vulnerable in terms of position on the mental health distribution. The current study aims to: (a) initially estimate the average impacts of work intensity on workers' mental health in Australia, and then (b) estimate the extent to which this effect varies across the mental health distribution., Materials and Methods: The current study uses data from waves 2005--2017 of the Household Income and Labour Dynamics in Australia (HILDA) survey. It first employs Average Treatment Effect (ATE) to provide a baseline/average treatment effect for the whole population, and then applies Quantile Regression fixed effects models for various quantiles on the mental health distribution., Discussion and Conclusion: The baseline estimates show that there are significantly negative effects of work intensity on mental health for the whole population, but importantly the quantile fixed effect estimates show that these adverse effects are substantially stronger for those with the poorest mental health (i.e. at the bottom of the distribution). When ATE alone is estimated, the significant effect is averaged over the mental health distribution, missing important information regarding the heterogeneity of the effect. The findings have important implications for understanding and reducing mental health inequality, particularly inequality driven by workplace stress. First, they align with existing research demonstrating the importance of reducing psychosocial job stressors. Second, given workers with mental health problems were most susceptible to the adverse effects of work intensity, there is a need to offer additional support (and be sensitive of workloads) for this group in particular., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: This study investigates the sex, ethnic and socioeconomic inequalities in emotional difficulties over childhood and adolescence using longitudinal cohort studies in the UK and Australia. Estimating cross-national differences contributes to understanding of the consistency of inequalities in mental health across contexts., Methods: Data from 19,748 participants in two contemporary representative samples in Australia (Growing Up in Australia: The Longitudinal Study of Australian Children, n = 4,975) and UK (Millennium Cohort Study, n = 14,773) were used. Emotional difficulties were assessed using the parent-reported Strengths and Difficulties Questionnaire at ages 4/5, 6/7, 11/12 and 14/15 years and the self-reported Short Moods and Feelings Questionnaire at age 14/15. Latent Growth Curve Modelling was used to examine mental health over time., Results: There were significant increases in emotional difficulties in both countries over time. Emotional difficulties were higher in Australian children at all ages. The gender gap in self-reported depressive symptoms at age 14/15 was larger in the UK (8% of UK and 13% of Australian boys were above the depression cut-off, compared with 23% of girls). Ethnic minority children had higher emotional difficulties at age 4/5 years in both countries, but over time this difference was no longer observed in Australia. In the UK, this reversed whereby at ages 11/12 and 14/15 ethnic minority children had lower symptoms than their White majority peers. Socioeconomic differences were more marked based on parent education and employment status in Australia and by parent income in the UK. UK children, children from White majority ethnicity and girls evidenced steeper worsening of symptoms from age 4/5 to 14/15 years., Conclusions: Even in two fairly similar countries (i.e. English-speaking, high-income, industrialised), the observed patterns of inequalities in mental health symptoms based on sociodemographics are not the same. Understanding country and context-specific drivers of different inequalities provides important insights to help reduce disparities in child and adolescent mental health., (© 2021 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Purpose: Compared to men, older women have poorer mental health and are more vulnerable to poverty, especially when living alone. However, few studies have examined how gender, marital status and poverty are inter-related and are associated with mental health. This study examines the gendered associations between relative poverty, marital status and mental health in older Australians., Methods: Drawing on 17 waves of the HILDA Survey, fixed-effects longitudinal regression analysis was utilised to examine the association between: (1) relative poverty (< 50% median household income) and mental health (MHI-5); (2) marital status and poverty, in a cohort of Australians aged 65 + years. We then examined effect modification of the association between relative poverty and mental health by marital status., Results: Within-person associations, stratified by gender, showed that women in relative poverty reported poorer mental health than when not in relative poverty, however no association was observed for men. Being divorced/separated was associated with increased odds of relative poverty for women, but not men. Widowhood was strongly associated with relative poverty in women, and also among men, albeit a smaller estimate was observed for men. There was no evidence of effect modification of the relationship between relative poverty and mental health by marital status for either men or women., Conclusion: This study provides evidence that relative poverty is a major determinant of mental health in older Australian women. Addressing gender inequities in lifetime savings, as well as in division of acquired wealth post marital loss, may help reduce these disparities.

Data specifically comparing outcomes for people with and without intellectual disability is limited. This paper reports perceived health and wellbeing of older Australians resident in metropolitan and rural locations in New South Wales and Queensland. Respondents were community-residing individuals with intellectual disability and mainstream age peers [age = 60]. Measures included SF12; Cummings well-being scales; DSSI; Adverse Life Events; and financial hardship status. The sample was composed of 391 adults with intellectual disability and 920 age peers. Adults with intellectual disability were significantly more likely to note adverse life events, worse mental health, and lower levels of social support, but reported higher mean wellbeing scores and had higher scores for physical health. Results indicated higher likelihood of adults with intellectual disability reporting comparative disadvantage across multiple key areas when compared to age peers.

Issues Addressed: To explore adolescents' experiences of access to and continued use of mental health services, and identify factors influencing their perceived satisfaction with their care. This paper focusses on the role of organisational and policy-level factors in the mental health system., Method: Qualitative semi-structured face-to-face interviews with 22 adolescents aged 14-18 years living in Perth, Western Australia., Results: Adolescents identified key policy, systemic and service-based factors which influenced their access to and continued use of mental health services. These were strongly related to the processes of service intake, level of orientation towards person-centred care and adequacy of service resourcing and funding. Areas of concern for adolescents included, complex service intake procedures, suboptimal mental health service environments, lack of client-centred care and the quality of mental health support provided in school settings., Conclusions: Our research has identified a wide spectrum of factors influencing mental health service access and use amongst adolescents. The findings further support the growing national consensus for major reform to address the mental health needs of this age group. The current strengths within mental health services and the system identified by adolescents need to be supported and extended. SO WHAT?: Although there have been numerous recommendations on ways to improve mental health service access and ongoing engagement for Australian adolescents, a number of the major challenges faced by this high-risk population have shown little improvement. The findings of this research indicate the importance of now moving towards implementing meaningful plans for action., (© 2020 Australian Health Promotion Association.)

Purpose: Many parents struggle to balance their work and family responsibilities. Yet, little research in the field of social psychiatry has explored the emergence of work-family conflict (WFC) as an important social determinant of mental health, particularly for children. The current study used longitudinal Australian population-based data to investigate the impact of parents' accumulated experiences of work-family conflict on children's mental health. Levels of parent psychological distress, marital satisfaction and parenting irritability were examined as potential explanatory factors within the family environment., Methods: The study used five waves of data from the Australian Longitudinal Study of Australian Children (LSAC), a representative community sample of Australian children and their parents. Analyses were restricted to coupled, employed mothers (1903) and fathers (1584) who reported their WFC levels in all five waves. Structural Equation Modelling (SEM) was used to examine the association between accumulated experiences of work-family conflict across all time-points (AWFC) and children's mental health at wave 5. Family environment factors were assessed as possible explanatory mediators., Results: There was a significant association between AWFC and children's mental health at wave 5. Parent psychological distress, marital satisfaction and parenting irritability were all found to significantly explain this association (accounting for 66% of the total effect)., Conclusions: Children whose parents have ongoing or accumulated difficulties managing their work and family responsibilities are more likely to have poorer mental health. This has important implications for family-friendly work arrangements and demonstrates the need to further understand the intergenerational impacts of parents' jobs on their children's psychological wellbeing.

The purpose of this review study was to conduct a thematic exploration of prior studies related to the transition between primary and secondary school. The aim of the paper was to discover (1) the extent of earlier research, (2) how earlier research thematises social and emotional issues, and (3) suggestions of those studies concerning how to improve schools. Searches were conducted across four international databases of peer-reviewed research to identify articles published in the last decade on the topic 'transition between primary and secondary school'. Articles related to social and emotional issues were further selected, and thematic analysis was conducted on the selected 29 articles to identify the topical focus. This review study draws attention to the importance of understanding challenges related to the transition between primary and secondary school. Overall, the analysed studies indicate that this is an important focus for educational research. Key issues related to support and wellbeing/bullying have emerged, which clarify the importance of further research in this field. The present study may also contribute to increasing awareness among policy makers and school leaders of the challenges related to the transition between primary and secondary school.

Parents are a critical resource in supporting young people who live with mental health problems. Qualitative research has identified that parents use a wide range of strategies to provide support. However, parents report being unsure which strategies are likely to be helpful, so often struggle in this role. Presently, little empirical evidence exists to assist parents to decide which strategies are likely to be most helpful. This study aimed to explore the parent-perceived helpfulness of parental strategies to support young people living with mental health problems. Data were collected from February to July of 2018, using a cross-sectional, online, anonymous, self-report survey of participants who identified as parenting a young person (15-24 years) diagnosed with a mental health problem (n = 70). Overall, the strategies perceived as most helpful were practical assistance and personal interactions aimed at promoting positive thoughts and feelings and obtaining appropriate treatment. Least helpful strategies tended to be control-type strategies, aimed at behaviour change. Overall, there was good alignment between strategies' helpfulness and frequency of use, however, there were exceptions. These exceptions are likely reflections of the specific context of particular situations as well as parental uncertainty regarding alternative strategies. Generally, perceptions of strategies' helpfulness were unrelated to parent or child characteristics. However, helpfulness of strategies was associated with parents' satisfaction with their relationship with the young person. Parents' collective experience-based perceptions about the helpfulness of strategies used to support young people experiencing mental health problems can be harnessed to inform mental health practitioners' advice to parents and contribute to better mental health outcomes for young people., (© 2020 John Wiley & Sons Ltd.)

A substantial amount of research has documented the negative impact technology has on young people's lives: particularly cyberbullying and the negative mental health outcomes associated with it. Research examining how technology could promote mental health and wellbeing in young people however, needs further investigation. This paper reports on a mixed methods study, which involved quantitative online surveys (N=229), and face to face interviews (N=30), across eight South Australian high schools. This paper will only address the quantitative results. The study involved young people aged 12 to 17 years. This paper discusses the importance of social connectedness and the use of technology to promote social connectedness among young people. A key finding was that young people who were more socially connected, were more likely to cope actively in response to frequent cyber victimisation. They were more likely to seek help and have positive mental health as a consequence. Findings from this study could aid policy development, social media campaigns, and the education of health professionals, teachers, and parents about the benefits of technology and the importance of staying connected.

Migrants from areas affected by war, especially refugee migrants, are susceptible to mental health issues. In addition to recognising trauma, health professionals, such as mental health nurses, need to be aware of the strength and resilience of refugees and migrants. The capacity to provide trauma-informed care that is shaped by the recognition of clients' strength and resilience is required/paramount to meet the current demand of multiculturalism emanating from an increased global migration. To facilitate increased awareness about West African women's resilience prior to migration and support trauma-informed care, we used a qualitative strength-based storytelling approach with 22 West African women residing in Sydney, Australia. Thematic analysis of the women's stories identified two major themes: When the World Falls Apart and Battered but Strong. Findings revealed that past personal experiences significantly influenced participants' strength and resilience and contributed to their mental health. Mental health professionals such as nurses can play an important role by incorporating knowledge about the resilience of migrants and refugees into providing appropriate trauma-informed care., (© 2019 Australian College of Mental Health Nurses Inc.)

Boarding schools, by definition, house students in residence either on campus or close by in residential facilities - where the sleep environment is likely to differ from their home environment. For boarders, being in the boarding environment occurs alongside a convergence of psychosocial and physiological factors likely to impact adolescent sleep. This paper comprises a review of the literature on sleep and boarding students in the Australian context. We also propose recommendations aligned with the scientific evidence base that can be used to promote healthy sleep in Australian boarding school students, focusing on staff training and sleep knowledge, daily routines, sleeping arrangements, and student mental health and wellbeing. It must be noted that these recommendations should be considered interim recommendations until further research is performed in the area. Further, we suggest the development of standardised practice guidelines, to ensure that student sleep is supported appropriately within the Australian boarding context.

This paper explores schools' new role in promoting children's mental health, as a key focus for policy makers across the global north. An education policy analysis is conducted for England and Australia, two nations advocating a 'bottom-up' approach to mental health promotion, granting flexibility to schools and municipal authorities. Here it is argued that a common policy lexicon is evident where key concepts--wellbeing, resilience, character--are constructed on taken-for-granted assumptions. These are argued to be limited by an emphasis upon the individual constituents of mental health, which is contrasted against a broader conception of wellbeing, evident in recent non-governmental international policy. Empirical data is then presented from two separate studies in England and Australia, where young peoples' perspectives are used to arbitrate the efficacy of the policy construction of wellbeing, in canvassing a relational and social identity approach as a viable alternative. Both studies privilege the voices of young people on wellbeing and identity, with findings from England highlighting that the dominant schooling narrative of resilience perceived by students, misses the ontological and social dimensions of their wellbeing. Research with Indigenous young people in Australia is then evaluated for the affordances generated by identity building and affirming programmes in schools. Notwithstanding cultural differences, common aspects were evident across both datasets, revealing the centrality to young people of self-authenticity, relatedness, and connectedness to nature, as key to their wellbeing. The paper concludes in advancing a set of principles to underpin a relational and social identity approach to schools' wellbeing promotion strategy.

Purpose: From 2018, the Schools Up North (SUN) programme worked with three remote Australian schools to enhance their capability and resilience to support the wellbeing and mental health of Aboriginal and Torres Strait Islander students and staff. This paper explores the implementation of SUN during the first two years of COVID-19 (2020-2021). Method: Using grounded theory methods, school staff, other service providers and SUN facilitators were interviewed, with transcripts and programme documents coded and interrelationships between codes identified. An implementation model was developed. Results: The SUN approach was place-based, locally informed and relational, fostering school resilience through staff reflection on and response to emerging contextual challenges. Challenges were the: community lockdowns and school closures; (un)availability of other services; community uncertainty and anxiety; school staff capability and wellbeing; and risk of educational slippage. SUN strategies were: enhancing teachers' capabilities and resources, facilitating public health discussions, and advocating at regional level. Outcomes were: enhanced capability of school staff; greater school-community engagement; student belonging and engagement; a voice for advocacy; and continuity of SUN's momentum. Conclusions: The resilience approach (rather than specific strategies) was critical for building schools' capabilities for promoting students and staff wellbeing and provides an exemplar for remote schools globally.

Background: Mass gatherings are well-documented for their public health risks; however, little research has examined their impact on mental health or focused on young people specifically. This study explores risk and protective factors for mental health at mass gatherings, with a particular focus on characterising attendees with high levels of psychological distress and risk taking., Method: Data collection was conducted in situ at "Schoolies", an annual informal week-long mass gathering of approximately 30,000 Australian school leavers. Participants were 812 attendees of Schoolies on the Gold Coast in 2015 or 2016 (74% aged 17 years old)., Results: In both years, attendee mental health was found to be significantly better than population norms for their age peers. Identification with the mass gathering predicted better mental health, and this relationship became stronger across the course of the mass gathering. Attendees with high levels of psychological distress were more likely to be male, socially isolated, impulsive, and in a friendship group where risk taking was normative., Conclusions: Mass gatherings may have a net benefit for attendee mental health, especially for those attendees who are subjectively committed to the event. However, a vulnerable subgroup of attendees requires targeted mental health support.

Chinese international students represent a significant social, economic and cultural force in Australian society. Research has demonstrated that Chinese students enrich Australia not only through their economic contribution, but through soft diplomacy and cultural links. Despite this, and the recent rapid growth in the number of Chinese international students to the country, only a small number of studies have focused specifically on understanding the health and employment experiences of Chinese students in Australia. This paper examines interview data from an ethnographic study involving ten Chinese international students pursuing higher education in New South Wales, Australia. Topics concerning work rights and exploitation, migration, and cultural differences are touched upon within their health and employment experiences. This paper provides insights for those working with Chinese international students in the areas of health education and promotion, diversity and inclusion, employment and mobility studies. The results contribute to broader insights into the inward/outward mobility of higher education students and Australia's "National Strategy for International Education 2025."

Over the last 18 months, the pandemic of coronavirus disease 2019 (COVID-19) has had dramatic implications for education systems across the globe. In Australia, state and territory governments have worked in consultation with one another and the federal government to respond to outbreaks. State-level policymakers have introduced the measures and policy directives that determine how schools operate during the pandemic. At the school level, Australian principals and school leaders were responsible for dealing with the disruption brought about by the pandemic and ensuring that policy directives were effectively implemented. The new circumstances presented school leaders with new challenges and in some cases radically transformed the school leadership role. In this article, the authors consider how Australian school leaders' work roles and health and wellbeing may have been impacted during 2020- the year that the COVID-19 pandemic wrought major disruption to Australian school systems. To achieve this, they draw on a pool of ten years of data from the Australian Principal Health, Safety and Wellbeing Survey (APHSWS). This analysis is intended to provide a broad overview of general patterns in school leaders' work environments. Given the breadth of the data, the findings of this paper should be read with caution as key factors that would shape school leaders' experiences and outcomes (e.g. gender, role, location and sector) are beyond the scope of this paper.

Decades of reports and policy have drawn attention to the significant social and occupational impairment of many young Aboriginal men in Central Australia. However, the role of mental ill-health as a contributing factor to this impairment, and culturally appropriate intervention targets have received insufficient attention in the psychiatry literature. Despite having the worst health outcomes of any population in Australia, Aboriginal men chronically underuse primary health care services. It's proposed that interventions ensuring cultural continuity through Identity-strengthening with a particular focus on positive Aboriginal masculinities will address a critical mental health gap for young men. In Central Australian and broader Indigenous populations, tangible and measurable kinship, language, religious and economic (KLRE) activities are catalytic vehicles for restoring traditional knowledge that suffer ongoing pressures as a result of colonization and assimilationist Government policy. By transforming KLRE knowledge content from ethnographic archives, these culturally rich repositories may be utilized to create education and engagement materials that will support young Aboriginal men's efforts to obtain and maintain positive mental health. This proposal focuses on building resilience through the acquisition of KLRE knowledge which young Aboriginal men can utilize as resources for enhancing positive identity and mental health outcomes., (© 2021 John Wiley & Sons Australia, Ltd.)

During COVID-19, rates of mental health issues, particularly anxiety, rose significantly in university students. In the scramble to adapt to online learning, university professors were overwhelmed with material aimed at facilitating a supportive learning experience and preserving student academic performance in online contexts yet were ill-equipped to cope with the increased volume of mental health issues encountered. Many studies attest to the association between poor mental health and academic performance. It has been shown that students often report their mental health issues to university professors who are called upon to cope with these issues as best they can. This paper outlines strategies undertaken, in the context of a novel undergraduate mental health program, to address emergent mental health issues during COVID-19 student isolation. These practical, cost effective interventions can be used to successfully give voice to ongoing student mental health issues in a post-COVID world and to help professors feel equipped and empowered enough to contribute to stemming the tide of rising rates of mental illness meaningfully, appropriately and professionally. [Note: The page range (69-81) shown on the PDF is incorrect. The correct page range is 69-79.]

Trans and non-binary youth (TNBY) face high levels of interpersonal and social adversity as well as disproportionate rates of mental health issues such as depression, self-harm and suicidal ideation. Among protective factors, context plays a key role. In addition to parental support, access to gender-affirming medical care begins to emerge as crucial for young people needed them. This paper compares, through thematic analysis, the experiences of TNBY with regard to access and experiences to care in Canada, Switzerland, England, and Australia. It identifies similarities and differences in barriers to access to care, as well as impacts of gender affirming care on young people and their well-being. The article concludes with a discussion on the importance of prompt and easier access to gender-affirming medical care, of training of professionals, and a hypothesis about the role of context in TNBY well-being.

The COVID-19 pandemic has been a major disrupter in the Australian early childhood education (ECE) sector. ECE educators had to respond quickly to frequent surprises and risky challenges. Their stressful, exhausting experiences as they constantly managed change are explored in this paper. The study used an interpretive social constructionist approach to interview six ECE leaders in order to construct a shared understanding of their beliefs and experiences during this time. The results indicate an increased risk of mental and physical health problems, and some impaired service quality. Although the results are indicative of historical treatment, the consequences of government neglect have resulted in a staffing crisis and closed services. Lessons need to be learned in how we treat educators and services if we want future generations of children educated and cared for by resilient educators who are not at risk of feeling they are in "burnout central."

International students leave their countries to pursue their educational goals in a different country and must adapt to succeed. However, they may face challenges when adapting to and learning a new culture. This study investigates the challenges common to international students in their host countries and summarizes the publishing trends. A literature search of peer-reviewed articles published in Scopus, Taylor & Francis, EBSCO Host, Web of Science, Springer, PubMed, and Wiley Online over 21 years (2002-2022) was done for data collection. After the screening, a total of 175 articles were included in this review and analyzed with content analysis. The findings show that the top four destinations for international students (USA, UK, Australia, and Canada) produced the most articles about international students' challenges. Additionally, most papers investigated more than one challenge, and sociocultural (82.9%) and academic challenges (82.3%) were the most researched, with language issues as the primary cause. The results also show no changes or improvement in the challenges of international students in 21 years, and areas such as psychological and economic challenges need more research. These challenges and other trends found in the articles are discussed and directions for future research are suggested.

Objective: The Bridging the Gap Between Physical and Mental Illness in Community Pharmacy ("PharMIbridge") randomised controlled trial (RCT) aims to test the effectiveness of a pharmacist-led support service in improving medication adherence, and the physical and mental health of people living with severe and persistent mental illness compared to a standard medication review service. Method: Using the six-step intervention mapping (IM) framework, this paper describes the development and content of the "PharMIbridge" pharmacist training programme, an integral part of the RCT implementation, and continuous adaptations made to the process to keep pace with the evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Australia. A Training Working Group comprising health educators, practitioners, mental health consumers and researchers, refined the programme objectives and assisted with developing content and troubleshooting issues related to training delivery for pharmacists randomised to the RCT intervention arm. Results: A 2-day training programme was developed, which included Mental Health First Aid, simulated patient role-plays, and four pre-recorded modules using lectures, demonstration case vignettes, role-play activities and discussion. The programme, co-facilitated by project team members and mentors (pharmacist and consumer educators), aims to enhance pharmacists' mental health literacy, skills and confidence and empower them to engage with this vulnerable population using a strengths-based approach. Pre- and post-training questionnaires and interviews will be used to evaluate the impact of the "PharMIbridge" training programme. Conclusion: The systematic stepwise method provided by the IM framework highlights the solution-focused approach adopted by the project team and characteristics including adaptability and resilience which enabled training development and implementation across four Australian regions during the SARS-CoV-2 pandemic.

Prior research shows that economic downturns are associated with increases in mental illness. However, we know little about whose mental health is most negatively affected. Is it the young or old, men or women, employed or non-employed, rich or poor? Using an 18-year panel dataset of Australians, we contribute to this understanding by estimating the impact of changes in unemployment on mental health, separately by population subgroups. Our mental health measure captures psychological distress and emotional difficulties, which are often missed by infrequent event indicators such as suicides. We find that young women suffer most during economic downturns. Men and women of older ages are not significantly affected. The effects for young women are driven by those in insecure employment, and those from low socioeconomic backgrounds. Our results suggest that public health programs should emphasize the mental health of young women during economic downturns., (© 2021 John Wiley & Sons Ltd.)

Aim: Late teens and early adulthood is the peak age of onset for mental disorders. Currently, there is a gap between primary mental health care and more intensive mental health services for young people in New South Wales (NSW), Australia. Two headspace Early Intervention Teams (hEITs) were developed to bridge this gap in Sydney Local Health District (SLHD), in Sydney, Australia. This study aims to explore clinician experiences of hEIT after the first 2 years of implementation., Methods: Semistructured interviews were conducted with key clinicians working within hEIT or closely associated with hEIT. Nine interviews were conducted, transcribed and analysed using qualitative thematic analysis., Results: Four themes were identified: (1) building a bridge between services, (2) filling a clinical gap, (3) service collaborations and their challenges and (4) difficulties of small team size., Conclusions: There is evidence that clinicians value the service provided by hEIT. There are difficulties such as referral confusion, staff turnover and suggestions to increase staffing to improve the stability, skill diversity and viability of the service. Findings have implications for other collaborative youth mental health models., (© 2021 John Wiley & Sons Australia, Ltd.)

Faced with broad scale cancellation of allied health student placements due to COVID-19, placement coordinators at The University of Melbourne Department of Rural Health established remote, online work-integrated learning placements across a range of settings, including a primary school, specialist school, kindergarten association and a homelessness sector organization. To ensure safe and high-quality placements, the evidence for telepractice and placement innovation was reviewed and integrated with existing knowledge of developing quality service-learning placements and COVID-safe guidelines from professional associations. This paper describes how placements were established, how student learning needs were aligned with host site objectives, and critically analyses the benefits and challenges of the online placement format. Partnerships, communication, and planning with all stakeholders were critical in placement redesign. The outcome is that students have enhanced their clinical and professional skills and provided community services to clients that would otherwise not have been provided during a pandemic.

This study aimed to assess the accessibility, usability, reliability and readability of those websites most likely encountered by Australian mental health consumers when using the internet to find information regarding the National Disability Insurance Scheme (NDIS). Websites were systematically identified with 127 deemed relevant for assessment in 2018. The LIDA instrument, the Simple Measure of Gobbledygook and Flesch-Kincaid Grade Level were used to evaluate the quality of information provided to mental health consumers. The study identified mediocre results for the accessibility, usability, reliability and readability of websites as they pertain to the needs of mental health consumers. Furthermore, it was identified that mental health support websites did not provide a more appropriate online experience for mental health consumers than general information websites, despite their focus on this demographic. These findings suggest a lack of understanding regarding the needs of mental health consumers and their experience of the online environment, which may in turn affect their access to information, agency and, ultimately, their uptake of the NDIS. The establishment of guidelines around enhancements to the online environment for mental health consumers would provide an experience that instils confidence, returns dignity and aids this group in realising their personal recovery journey., (© 2020 John Wiley & Sons Ltd.)

Objective: To generate outcomes for the development of a culturally appropriate mental health treatment model for Indigenous Australians with depression., Methods: Three focus group sessions and two semi-structured interviews were undertaken over six months across regional and rural locations in South West Queensland. Data were transcribed verbatim and coded using manual thematic analyses. Transcripts were thematically analysed and substantiated. Findings were presented back to participants for authenticity and verification., Results: Three focus group discussions (n=24), and two interviews with Elders (n=2) were conducted, from which six themes were generated. The most common themes from the focus groups included Indigenous autonomy, wellbeing and identity. The three most common themes from the Elder interviews included culture retention and connection to Country, cultural spiritual beliefs embedded in the mental health system, and autonomy over funding decisions., Conclusions: A treatment model for depression must include concepts of Indigenous autonomy, identity and wellbeing. Further, treatment approaches need to incorporate Indigenous social and emotional wellbeing concepts alongside clinical treatment approaches. Implications for public health: Any systematic approach to address the social and cultural wellbeing of Indigenous peoples must have a community-led design and delivery., (© 2021 The Authors.)