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Objective: This paper outlines the evolution of mental health rehabilitation in NSW, where allocation of health resources has repeatedly contradicted the policy intention to reorient services from inpatient to community-based services, leaving community rehabilitation the poor and disconnected cousin of inpatient services. The expanding role of community-managed organisations (CMOs) in psychosocial rehabilitation, the introduction of the National Disability Insurance Scheme (NDIS), and emerging service models have helped foster a maturing housing and social care environment, but present reality and the integration of health and social care services remains at a distance from best evidence practice. Conclusion: The challenge of the next decade of mental health reform is to embrace and consolidate greater service diversity and complexity. Understanding what factors influenced present reality is important in providing guardrails for the future, enabling the current wave of renewal and reinvestment in NSW to build on the strengths of past developments and steer a course around their weaknesses. [ABSTRACT FROM AUTHOR]

Objective: Junior doctors have high rates of burnout resulting in downstream impacts on patient care. The aim of this study is to capture cross-sectional data on a cohort of psychiatry trainees. These data will be used to inform a wider project investigating psychiatry trainee mental health and wellbeing. Method: This paper reports on the 2019 baseline data of psychiatry trainees enrolled in a formal education course at the University of Sydney, Australia. The data were collected with an online survey using a range of validated mental health and wellbeing scales. This descriptive study involved psychiatry trainees as co-designers. Results: Our research findings are in keeping with the existing literature on the poor mental health and wellbeing of doctors with significantly higher levels of anxiety and exhaustion found in female trainees and carers. Despite this, the cohort had high scores on the flourishing scale. Conclusions: Concern around the wellbeing of junior doctors in Australia appears justified. We need to move beyond focussing on individual action to systems-based approaches to improving wellbeing and ongoing sustainability of the psychiatry trainee workforce in NSW. [ABSTRACT FROM AUTHOR]

Background: It is well established that First Nations Peoples in Australia are overrepresented within the criminal justice system. However, First Nations Peoples appear to be comparatively underrepresented in the forensic mental health system, and little is known about their outcomes once released from secure care. Objective: To compare the characteristics and rates of repeat criminal justice contact for a criminal charge of First Nations and non-First Nations forensic patients in New South Wales. Methods: Data on the sample were extracted from the New South Wales Mental Health Review Tribunal paper and electronic files matched to the Bureau of Crime Statistics and Research Reoffending Database. Characteristics of First Nations and non-First Nations patients were compared using univariate logistic regression analysis. Univariate and multivariate Cox proportional hazard regression was used to determine predictors of post-release criminal charges. Results: Key differences in the sociodemographic, clinical and forensic characteristics of First Nations compared with non-First Nations forensic patients were identified. The time to first criminal justice contact following release was significantly shorter for First Nations forensic patients (p < 0.01). Conclusion: The findings of this study confirm that First Nations forensic patients have distinct and complex needs that are apparent at entry to the forensic mental health system and that their poorer criminal justice contact rates following release from secure care indicate that these needs are not being adequately met either during treatment or once in the community. Responses to these study findings must consider the complex and continuing impact of colonisation on First Nations Peoples, as well as the need for solutions to be culturally safe. [ABSTRACT FROM AUTHOR]

Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government's 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87−6.42%) and 5.45% (4.68−6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23−3.46%; suicide deaths: 4.38%, 95% interval 3.78−5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources. [ABSTRACT FROM AUTHOR]

Objective: To describe the collaboration between Youth Justice New South Wales (YJNSW) and Justice Health and Forensic Mental Health Network (JHFMHN) during the early COVID-19 Response (CR) across the six Youth Justice centres in NSW, and the reduced incidence of self-harm noted over this period. Methods: Narrative article with analysis of self-harm incident data during the initial CR period of March to May 2020, compared to the same period in 2019. Results: During the initial CR period (March to May 2020), there was a highly significant, four-fold reduction in self-harming incidents recorded by both YJNSW and JHFMHN compared with the equivalent time period in 2019 (p <.00001). Conclusion: The greater than four-fold reduction in self-harm by young people during the early CR may relate to the 'interagency response', with an increase in positive interactions between staff, and between staff and young people. The reduction in self-harm and improvements in mental health will be further explored through standardised interviews with the young people and staff. [ABSTRACT FROM AUTHOR]

Objective: To assess rates of metabolic monitoring in patients prescribed antipsychotic medications in the psychiatric inpatient setting and the impact education can have regarding monitoring compliance.Method: Two identical audits were undertaken at a NSW mental health inpatient service before and after a campaign designed to educate mental health workers about the importance of metabolic monitoring. Results from both audits were compared for statistically significant improvements in monitoring rates.Results: Rates of monitoring plasma lipids increased from 21.7% to 78.8% (p < 0.01) and rates for plasma glucose increased from 20.8% to 73.7% (p < 0.01). There were no statistically significant changes in rates of monitoring body mass index (83.0% and 77.1%, respectively), waist circumference (36.8% and 43.2%, respectively) and blood pressure (99.1% and 100%, respectively).Conclusion: This study has shown that rates of metabolic monitoring in the inpatient setting can be improved with a relatively low-cost education intervention. While absolute rates remain low, outcomes suggest that it may be worthwhile trialling further modes of education and repeating this education in cycles. [ABSTRACT FROM AUTHOR]

The objective was to explore the efficacy of a dual diagnosis resource—the Reasons For Use Package (RFUP)—to build staff capacity to work with service users and explore service user experiences. A two-state case comparison evaluation was conducted employing a mixed methods action research design, utilizing staff and service user surveys combined with focus groups involving staff trained and mentored in use of the RFUP. Results were that both staff and service users responded positively to the RFUP. Staff self-reported improvements in knowledge and confidence, and service users reported the RFUP assisted them with reflecting on interactions between their mental health and substance use; this assisted them with goal planning and improved their working relationship with staff. Implications were that training and mentoring in the RFUP can contribute to building staff knowledge and confidence in dual diagnosis interventions in mental health community services, and benefit service users. [ABSTRACT FROM AUTHOR]

Working with individuals with dual disabilities can be a complex process in the presence of limited evidence base to guide clinical practice. The aims of this qualitative study were to investigate perceptions of best practices of Australian psychologists who work with this specialist population. Thirty-eight Australian psychologists working in the intellectual disability field participated in eight semistructured focus groups. Perceptions of evidence-based practice for individuals with intellectual disabilities and in relation to mental health assessment were explored. Psychologists demonstrated resourcefulness in adapting to limits in available evidence-based practice and in modifying mainstream practice to suit the needs of individuals with dual disabilities. Findings suggest the necessity of practice-based evidence in contributing to the evidence base, and person-centered approaches in relation to best practice for people with intellectual disabilities. Implications for strengthening psychologists' clinical competency and bridging the research and practice gap are discussed. [ABSTRACT FROM AUTHOR]

Objective:: Development of a Mental Health Quality and Safety Framework with co-designed priority areas for improvement.Method:: A qualitative and inductive approach was utilised, including a literature search, consultations with staff and focus groups with consumers and carers.Results:: Thematic analysis resulted in 32 categories, grouped into seven key themes. Combined with the evidence base, these were distilled into component parts of the Framework.Conclusions:: A change in strategy and culture is required, balancing a traditionally centralised top-down approach to health care governance and improvement, with a complementary localised bottom-up model that embeds improvement science principles involving frontline staff, consumers and carers. This Framework, that centres on patient safety and quality improvement, in combination with a corresponding cultural change, can enhance clinical outcomes, service efficiency, staff morale and staff retention rates. [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 Mental Health Emergency Care-Rural Access Programme (MHEC) aims to improve access to specialist emergency mental health care in rural and remote communities in New South Wales. It provides a range of services including emergency telephone triage and video assessment. The present report provides a detailed description of the structure and function of the MHEC model, and identifies matters concerning adaptation and transferability. Structure: the MHEC can be contacted 24 hours/day, every day of the year; no caller is refused assistance. Function: the MHEC provides information services, clinical services and other programme activities. Adaptation of the model and implementation elsewhere (transferability) should be informed by local needs, existing practices and the components of access. The programme has already attracted the attention of two other regions in Australia interested in implementing emergency telepsychiatry programmes. The MHEC model is a practical solution for improving access to specialist emergency mental health care in underserved areas. [ABSTRACT FROM PUBLISHER]

Objective: In this study we aimed to examine the characteristics of Mental Health Act (MHA) usage in the Emergency Department (ED) of an urban teaching hospital in Sydney.Methods: All MHA certificates written on individuals in the ED over a 12-week period in 2013 were collected. The medical record of each individual was reviewed by a member of the research team using an audit tool developed for the study. Any uncertainty over individual cases was addressed through research team consensus.Results: A total of 172 MHA certificates were collected; 67 were written by police, 45 by ambulance, 54 by medical officers and three by accredited persons. Three magistrate orders for assessment were also received. Seventy percent of police and 60% of ambulance MHA certificates did not result in admission. Over a third were revoked by ED physicians. Forty-five people (32.4%) who presented voluntarily were subsequently detained.Conclusions: Police and ambulance MHA certification was a poor predictor of admission. Least restrictive measures were predominantly the outcome. Delegating ED physicians with authorised medical officer status assisted in facilitating this process. Formalised education and training on the principles and practicalities of MHA legislation should be ongoing for all professionals involved. [ABSTRACT FROM AUTHOR]