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Little is known about the experience and impact of intersectional stigma experienced by rural young people (15–25 years) who have a parent with mental health challenges. The StigmaBeat project employed a co-design approach to create short films to identify and challenge mental health stigma from the perspective of young people who have experienced this phenomenon. The aim of this paper is to describe the co-design methodological approach used in StigmaBeat, as an example of a novel participatory project. We describe one way that co-design can be employed by researchers in collaboration with marginalised young people to produce films aimed at reducing mental health stigma in the community. Through describing the processes undertaken in this project, the opportunities, challenges, and tensions of combining community development methods with research methods will be explored. Co-design with young people is a dynamic and engaging method of collaborative research practice capable of harnessing lived experience expertise to intervene in social issues and redesign or redevelop health services and policies. The participatory approach involved trusting and implementing the suggestions of young people in designing and developing the films and involved creating the physical and social environment to enable this, including embedding creativity, a critical element to the project's methodological success. Intensive time and resource investment are needed to engage a population that is often marginalised in relation to stigma discourse. [ABSTRACT FROM AUTHOR]

Epidemiology of mental disorders emerged in the post-1945 era at the intersections of different areas of knowledge. Given its ambitions, the Stirling County Study provides an instructive case study. It is also a good example of how the epidemiology applied methodological skills from social sciences. This paper aims, first, to reconstruct one of the first episodes in the development of psychiatric epidemiology. Its second purpose is to provide a detailed description of interdisciplinarity at work, and to examine its effects. After explaining some of the major features of the Stirling County Study, I emphasize the links between some of the first results, particularly regarding young people as a population at risk, and the job market after the Great Depression. [ABSTRACT FROM AUTHOR]

This paper examines the psychiatric work villages in Israel, which have so far had little historiographic attention. In the 1950s and 1960s, four work villages were established for people with psychiatric disabilities. They were intended to create a long-term rehabilitative alternative to the common hospitalization practice. These villages were organized around employment in various branches of farming and also offered recreational and cultural activities to alleviate the patients' loneliness and to create a community life. The villages echoed central values of the new country: labour, manufacturing, cooperativity, and cultural and community life. I will discuss the similarities between the psychiatric work villages and earlier, mostly Western, psychiatric therapeutic models, such as moral treatment and the therapeutic community model. [ABSTRACT FROM AUTHOR]

This paper points out some problematic aspects of qualitative research based on interviews and uses examples from mental health. The narrative approach is explored while inquiring if the reality of life here is forced into the formula of a chronological story. The hermeneutic approach, in general, is also examined, and we ask if the reality of life in this scenario becomes caught up in a web of interpretations. Inspired by ideas from Bakhtin and phenomenology, we argue for interview-based research that stays with unresolvedness and constantly question the web of interpretations and narratives that determine our experiences. This also chimes with certain dialogical practices in mental health in which tolerance of uncertainty is the guiding principle. Concludingly, we suggest that interview-based research could be a practice of 'un-resolving' in which researchers, together with the participants, look for cracks, contradictions, and complexities to prevent the qualitative fallacies of well-organized meanings and well-composed stories. [ABSTRACT FROM AUTHOR]

Background: In India, mental health rehabilitation centers run income generation programs (IGP) for therapeutic engagement, skills training, and income generation of clients. The centers have evolved IGP models relevant to their settings. There is a paucity of published literature on practices employed by the centers. Methods: This paper compiles data gathered from visits to 13 centers between November 2018 and April 2019. Information was collected through observation and interviews with staff involved in IGP, using a semi-structured pro forma designed for study. Results: Most centers were based in south India (n = 11) and urban areas (n = 12). Each center ran two to seven IGP. Each center involved 20–50 clients in IGP. Clients involved in IGP were aged 20–60 years. The centers ran a range of IGP, including the manufacturing of household consumables, paper products, textile products, handicraft products, food products, and jute products; animal husbandry and horticulture initiatives; and running cafeterias and petty shops. IGP were mostly selected based on market demand and sales value of products (n = 11); ease of doing (n = 5); interests, abilities, exposure, and experience of clients (n = 5); and availability of resources (n = 3). Products were priced primarily to cover input and labor costs (n = 8), and many centers sold products below the market rates (n = 5). Running stalls during public events was a common strategy for the sale of products (n = 9). Personal contacts and "word of mouth" publicity were used for advertisement (n = 6). Four centers involved family members in IGP. Conclusion: The nature of IGP varied in terms of setting, available resources, and profile of clients availing the services. Marketing and sales were a challenge. A supportive framework of policies and schemes is essential to promote IGP at mental health rehabilitation centers. This report may be helpful for professionals and centers planning to set up an IGP. [ABSTRACT FROM AUTHOR]

Migrants, that is people who experience forced displacement or move based on being lesbian, gay, bisexual, trans, two-spirit, queer, and intersex (LGBTQI+), experience increased trauma and stigma when compared to heterosexual and cisgender people. The aim of this paper is to highlight LGBTQI+ migrants' experiences of health and social care encounters in Canada. Gadamerian hermeneutics and an intersectionality lens was used to understand LGBTQI+ migrants' experiences. A total of 16 semi-structured individual interviews were conducted with LGBTQI+ migrants. Themes of stigma and discrimination were identified as (1) "I never went back": Stigma as an exclusionary experience, (2) "Is [your country of birth] really that bad": Fear, safety, and cultural stigma, and (3) "The circle ... is not going to fix my life": LGBTQI+ migrants' call for affirming care. Results suggest that health and social care practices are stigmatizing and discriminatory which negatively impacts LGBTQI+ migrant mental health. Salient practices for promoting mental health included affirming LGBTQI+ identities and orientations through health and social care practices that are culturally safe as well as trauma and violence informed. [ABSTRACT FROM AUTHOR]

Objective: Managing mental health patients during the COVID-19 pandemic has been a global challenge. Current workforce arrangements tend to separate those skilled in caring for highly infectious medical patients from those whose specialism is in managing co-morbid mental health, substance misuse and/or behaviours of concern, including potential non-compliance with community or health care directives. This paper reports an innovative service development through the emergency establishment of a temporary COVID-positive mental health ward in response to a local outbreak in Melbourne. Method: A case study of service reorientation is presented, examining barriers and enablers to effective care of co-morbid mental illness, addiction and COVID-19. Results: Establishing a skilled multidisciplinary workforce across mental health and infectious disease is the most important consideration in optimising care. Other issues included suitable physical space, security arrangements and inter-disciplinary communication. Conclusions: The paper holds insights for managing mental health care during potential future infectious disease outbreaks across the country. [ABSTRACT FROM AUTHOR]

Objective: Although the prevalence rate of childhood-onset systemic lupus erythematosus (cSLE) is far lower than that of adults, cSLE has a high rate of organ involvement, rapid development and poor prognosis, which is more serious than that in adults. And studies have shown that a wide range of physiological, functional, nerve, and organ damage will have a great impact on the mental health of children. At present, there is no relevant psychological intervention research for cSLE in China. This paper aimed to explore the effect of Sandplay therapy on mental health and disease activity of children with cSLE. Methods: Forty childrens with cSLE were randomly divided into control group (CG) and intervention group (IG); the CG were treated with glucocorticoid, immunosuppressant and other drugs, while the IG were treated with Sandplay therapy in addition to drug therapy, at the time of 0, 2, and 4 weeks after initial diagnosis, respectively. The questionnaire evaluation and related clinical indicators of the two groups were compared and analyzed (before psychotherapy intervention) at 0, 2, 4, and 12 weeks after initial diagnosis. Results: There was no significant difference between the two groups in the evaluation of questionnaire and related clinical indicators at the time 0, 2 weeks after initial diagnosis respectively. At 12 weeks after the intervention, the score of Short version of the Children's Depression Inventory (CDI-S) in the IG was significantly lower than that in the CG, the score of The Screen for Child Anxiety Related Emotional Disorders (SCARED) scale in the IG was significantly lower than that in the CG, and the Pediatric Quality of Life Inventory (PedsQL 4.0) showed that the scores of social function, school performance, and emotional health of the IG were higher than those of the CG (p < 0.05), and the clinical indexes of the IG were better than those of the CG (p < 0.05). Conclusion: Sandplay therapy may help to slow down the occurrence and development of anxiety and depression and reduce disease activity in patients with cSLE. [ABSTRACT FROM AUTHOR]

Objective: Mental Health Acts (MHAs) are important pieces of legislation which include essential definitions of mental illness and mental disorder and are used to guide decision-making regarding treatment, including involuntary admissions. In Australia, responsibility for reviewing this legislation falls under the jurisdiction of State and Territory Governments, resulting in interstate variations of legislative definitions and care requirements. In this paper, we outline some of the main differences between MHAs, and argue that it is time for Australia to enact nationally consistent Mental Health Legislation. Conclusions: Substantial divergence exists between definitions of mental illness and mental disorder, differing criteria for involuntary treatment and discrepancies between treatment requirements for Indigenous Australians. While variations between MHAs are understandable considering the historical context, in an increasingly integrated society, it is time for Australia to enact nationally consistent mental health legislation. [ABSTRACT FROM AUTHOR]

Purpose: Public health campaigns are still relatively rare in mental health. This paper aims to find consensus on the preventive self-management actions (i.e. "healthy behaviors") for common mental health problems (e.g. depression and anxiety) that should be recommended in mental health campaigns directed at the general public.Approach: A 3-round Delphi study.Participants: 23 international experts in mental health and 1447 members of the public, most of whom had lived experience of mental health problems.Method: The modified Delphi study combined quantitative and qualitative data collection: 1) online qualitative survey data collection thematically analyzed, 2) recommendations rated for consensus, 3) consensus items rated by public panel on a Likert scale.Results: Expert consensus was reached on 15 behaviors that individuals can engage in to sustain mental health. Eight were rated as appropriate by more than half (50%) of the public panel, including: avoiding illicit drugs (80%, n = 1154), reducing debt (72%, n = 1043), improving sleep (69%, n = 1000), regulating mood (65%, n = 941), having things to look forward to (60%, n = 869).Conclusions: A series of healthy behaviors for the promotion and protection of mental health received expert and public consensus. To our knowledge, this is the first study to offer a set of actions for public health messaging for the prevention of poor mental health. Future research should focus on evaluating effectiveness of these actions in a universal primary prevention context. [ABSTRACT FROM AUTHOR]

Background: India has the second-largest population of elderly in the world. Serious mental illness (SMI) is a subset of the mental disorders that result in significant functional impairment and is usually long term. Persons with SMI face several challenges in their old age that are different from the issues faced by younger people with SMI. Understanding the problems faced by elderly individuals suffering from SMI is fundamental for planning programs to address them. The SENIOR (Support Systems Evaluation of Neuropsychiatric Illness in Old age) project is a study aimed at evaluating the problems faced in obtaining mental health care by elderly persons having SMI in the Kerala state of India. Aim: To describe the scientific methodology of the SENIOR project. Methods: This study employs mixed-methods cross-sectional design among a minimum sample of 768 SMI patients identified through cluster sampling from three districts, and Focus Group Discussion among mental health program officials. Discussion: This paper presents a methodological model to assist researchers in future field epidemiological studies on mental illness. Assessing service needs and barriers to access for the most vulnerable among the mentally ill will help the policymakers make evidence-based decisions to improve their quality of life. [ABSTRACT FROM AUTHOR]

There is growing national and international concern about the mental health of children and young people, and in countries such as England there is now a political and policy commitment to developing whole-school approaches to mental health. This paper presents new evidence on how pupils' mental health is being addressed in schools using learning activities associated with physical education, sport and physical activity, as part of a school-based sport- and mental health-themed programme ('Tackling the Blues') for pupils aged 6–16 years old in north-west England. In particular, we examine how pupil-centred learning activities have been used in weekly multi-sport activity sessions and related classroom-based workshops, and draw upon insight from 29 focus groups to explore pupils' (n = 116) mental health awareness and associated socio-emotional learning (SEL). The learning activities led pupils to focus on the impact personal relationships with family and friends, feelings and emotions, and experiences of stress, anger and entrapment can have on mental health. It is argued that embedding socially relevant learning activities into the content, organisation and delivery of school curricula may help improve pupils' sense of enjoyment, participation and achievement which are important for enhancing their knowledge and awareness of mental health, and developing SEL. However, we conclude that the effectiveness of whole-school approaches also depends, perhaps to a greater degree, on the wider educational systems in which schools are located and especially the widening social, economic and health inequalities which have profound impacts on child development, educational and other outcomes, and mental health. [ABSTRACT FROM AUTHOR]

Objectives: This paper reviews the major findings of the Victorian Psychiatry Attraction, Recruitment and Retention Needs Analysis Project and considers some of the implications for the psychiatrist workforce working in public sector psychiatry.Conclusions: The report provides a snapshot of the issues that are impairing the ability of Victorian psychiatrists to comprehensively treat those in our community who have severe mental illness. As the report shows, the issues impacting the profession are multi-faceted and complex, yet surmountable. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to evaluate the effectiveness of ongoing physical health monitoring for Indigenous Australians with mental health issues in the Kimberley region of Western Australia.Method: This longitudinal, within-groups investigation assessed physical health parameters such as blood pressure and blood glucose levels at baseline and at 18 months for the same cohort. No standardised intervention was in place, but action was taken if results were found to be abnormal.Results: Most measures of physical health remained stable, with mean lipid and fasting glucose levels remaining abnormal over the entire assessment period. Systolic blood pressure showed a significant improvement.Conclusions: More needs to be done to improve the physical health of Indigenous mental health patients - culturally appropriate and secure interventions incorporating holistic models of care are needed. [ABSTRACT FROM AUTHOR]

In the United States, the National Institute of Mental Health (NIMH) is seeking to encourage researchers to move away from diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders (the DSM). A key mechanism for this is the "Research Domain Criteria" (RDoC) initiative, closely associated with former NIMH Director Thomas Insel. This article examines how key figures in US (and UK) psychiatry construct the purpose, nature, and implications of the ambiguous RDoC project; that is, how its novelty is constituted through discourse. In this paper, I explore and analyze these actors' accounts of what is new, important, or (un)desirable about RDoC, demonstrating how they are constituted through institutional context and personal affects. In my interviews with mental health opinion leaders, RDoC is presented as overly reliant on neurobiological epistemologies, distant from clinical imaginaries and imperatives, and introduced in a top-down manner inconsistent with the professional norms of scientific research. Ultimately, the article aims to add empirical depth to current understandings about the epistemological and ontological politics of contemporary (US) psychiatry and to contribute to science and technology studies (STS) debates about "the new" in technoscience. Accordingly, I use discussions about RDoC as a case study in the sociology of novelty. [ABSTRACT FROM AUTHOR]

Objective:: The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland.Method:: Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective.Results:: Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care.Conclusions:: Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS. [ABSTRACT FROM AUTHOR]

The past one decade has witnessed a boom in the availability of Internet-based self-help apps in the field of mental health. Several apps have emerged that aim to provide information and strategies to empower individuals with self-help approaches to deal with issues and concerns related to mental health. A large number of these apps in developing countries are likely to be those which depend entirely on the users to go over the self-help program on their own (unguided internet-based self-help). Only a few apps add a component of periodic professional contact/technical support through phone/email or other means to supplement the self-help strategies suggested in the app that the user is expected to utilize. This scenario poses several challenges in use of unguided self-help apps for mental health. This paper enumerates some of these challenges for potential users of the apps from the perspective of clinicians. These range from difficulties in choosing the right app, limited scope for contextualization, and motivation management to awareness about when to step up to a higher intensity intervention. Despite these challenges, unguided self-help apps can serve important purposes, and hence we propose a few recommendations to address such challenges. [ABSTRACT FROM AUTHOR]

The notion of recovery has been embraced by key stakeholders across Canada and elsewhere. This has led to a proliferation of definitions, models, and research on recovery, making it vitally important to examine the data to disentangle the evidence from the rhetoric. In this paper, first we ask, what do people living with severe mental illness (SMI) say about recovery in autobiographical accounts? Second, what do they say about recovery in qualitative studies? Third, from what we have uncovered about recovery, can we learn anything from quantitative studies about proportions of people leading lives of recovery? Finally, can we identify interventions and approaches that may be consistent or inconsistent with the grounded notions of recovery unearthed in this paper? We found that people with mental illness frequently state that recovery is a journey, characterized by a growing sense of agency and autonomy, as well as greater participation in normative activities, such as employment, education, and community life. However, the evidence suggests that most people with SMI still live in a manner inconsistent with recovery; for example, their unemployment rate is over 80%, and they are disproportionately vulnerable to homelessness, stigma, and victimization. Research stemming from rehabilitation science suggests that recovery can be enhanced by various evidence-based services, such as supported employment, as well as by clinical approaches, such as shared decision making and peer support. But these are not routinely available. As such, significant systemic changes are necessary to truly create a recovery-oriented mental health system. [ABSTRACT FROM AUTHOR]

Summary This article reports research that aimed to identify and evaluate potential resilience benefits of visual arts interventions for young people with complex needs. The study involved a review of the ‘arts for resilience’ literature and a case study of 10 weekly resilience-building arts workshops for 10 young people experiencing mental health complexities and/or learning difficulties. Findings We found a significant existing evidence-base linking visual arts practice to individual and community resilience, across disciplinary fields including art therapy, social work, community health, visual arts practice and geographies of health. Visual art activities were utilised to both educate young people about resilience and enhance young people’s overall resilience. Qualitative research material developed from the case study shows that even short-term visual arts interventions can impact on young people’s resilience – crucially, participation was extremely beneficial to young people’s sense of belonging and ability to cope with difficult feelings (topics which arose repeatedly during interview, focus group discussion and observation). Applications Our review and findings from this small case study provide some initial insights into the resilience benefits of participation in visual arts activities. This, combined with the resilience-based practice framework presented here, could aid the effective targeting of interventions for social workers and others working with young people with complex needs. Alongside this research paper, an arts for resilience practice guide has been produced by the project team (including young people). It contains instructions on how to conduct a range of practical visual arts activities that we identified as being resilience-promoting. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper are to provide a description of a newly available service the Mental Health Screening Unit (MHSU), within the NSW prison system and to present the first 12 months in terms of the patients, its adaptations and its limitations. Methods: The first section of this paper provides a thorough description of the MHSU. The second looks at data collected for the period 1 July 2006 to 30 June 2007. A variety of databases were utilized as sources. Results: There were a total of 604 admissions. The most common primary diagnoses were schizophrenia-related disorders. There were relatively few adverse incidents, and 18% of the acute unit population were transferred to the Long Bay Prison Hospital. Conclusion: The MHSU had a considerable throughput of patients and managed a range of severe mental illnesses. The initial objectives of the MHSU have broadly been achieved. There are several future areas of research discussed. [ABSTRACT FROM AUTHOR]

Objective: Recognizing the prodrome of a first psychotic episode prospectively creates the opportunity of intervention, which could delay, ameliorate or even prevent onset. Valid criteria and a reliable methodology for identifying possible prodromes are needed. This paper describes an instrument, the Comprehensive Assessment of At-Risk Mental States (CAARMS), which has been designed for such a purpose. It has two functions: (i) to assess psychopathology thought to indicate imminent development of a first-episode psychotic disorder; and (ii) to determine if an individual meets criteria for being at ultra high risk (UHR) for onset of first psychotic disorder. This paper describes the pilot evaluation of the CAARMS. Method: Several methodologies were used to test the CAARMS. First, CAARMS scores in a group of UHR young people and the association between CAARMS scores and the risk of transition to psychotic disorder, were analysed. Second, CAARMS scores in a UHR group were compared to a control group. To assess concurrent validity, CAARMS-defined UHR criteria were compared to the existing criteria for identifying the UHR cohort. To assess predictive validity, the CAARMS-defined UHR criteria were applied to a sample of 150 non-psychotic help-seekers and rates of onset of psychotic disorder at 6-month follow-up determined for the CAARMS-positive (i.e. met UHR criteria) group and the CAARMS-negative (i.e. did not meet UHR criteria) group. The inter-rater reliability of the CAARMS was assessed by using pairs of raters. Results: High CAARMS score in the UHR group was significantly associated with onset of psychotic disorder. The control group had significantly lower CAARMS scores than the UHR group. The UHR criteria assessed by the CAARMS identified a similar group to the criteria measured by existing methodology. In the sample of non-psychotic help-seekers those who were CAARMS-positive were at significantly increased risk of onset of psychotic disorder compared to those who were CAARMS-negative (relative risk of 12.44 (95% CI = 1.5–103.41, p = 0.0025)). The CAARMS had good to excellent reliability. Conclusions: In these preliminary investigations, the CAARMS displayed good to excellent concurrent, discriminant and predictive validity and excellent inter-rater reliability. The CAARMS instrument provides a useful platform for monitoring subthreshold psychotic symptoms for worsening into full-threshold psychotic disorder. [ABSTRACT FROM AUTHOR]

This paper identifies rates of common mental disorders among Māori and non-Māori consulting a general practitioner (GP), and explores the association between ethnicity and social and material deprivation.Survey of GPs and their patients. Participants were randomly selected GPs (n = 70), and their patients (n = 3414, of whom a subset of 786 form the basis of this paper). The main comparison is between self-identified ethnicity, mental disorder assessed by the Composite International Diagnostic Interview, and social and material deprivation measured by NZDep2001 (an area based measure), and an individualized index of deprivation.Rates of mental disorder among Māori general practice attenders were higher than among non-Māori. Overall, Māori women attenders were twice as likely as non-Māori women attenders to have a diagnosable mental disorder. The rates of anxiety, depressive and substance use disorders were all higher for Māori than for others attending GPs. Treatment for psychological problems was offered by the GP at similar rates to both Māori and non-Māori. Although there were differences between Māori and non-Māori in terms of social and material deprivation, higher rates of mental disorder among Māori attending GPs compared to non-Māori cannot be accounted for by these differences alone.These findings support the view that whilst social and material deprivation may play a role in the high rates of mental disorders among Māori general practice attenders, there are additional ethnicity-specific factors involved. Interventions to address Māori mental health (whether by reducing risk factors for mental disorder, by promoting disclosure, early recognition and intervention, or by ensuring access to acceptable and effective treatments) may need to explicitly take those factors into account. [ABSTRACT FROM AUTHOR]

This commentary speaks to several issues that arise from the papers in this special issue. Two articles--Kessler (2002) and Mirowsky and Ross (2002)--focus on a major measurement issue: dimensional versus diagnostic-type assessments. One topic requires greater attention: the correspondence of these measures with the underlying states they supposedly measure--constructs in the psychometric tradition and empirically defined illnesses in the medical or psychiatric tradition. Conclusions about the nature of these unobserved states remain tentative at this time. Three articles--Keyes (2002), Schwartz (2002), and Umberson, Williams, and Anderson (2002)--address the expansion of mental health outcomes. The existing reliance on emotional distress is problematic for sociological research because a single disorder is not a good proxy for estimates of the overall mental health consequences of social arrangements. Although these papers present diverse and sometimes conflicting perspectives, collectively they demonstrate that no one approach to outcomes is best for all research questions. [ABSTRACT FROM AUTHOR]

Objective: This paper provides an overview of the Christchurch Health and Development Study (CHDS) and a summary of findings relating to child and adolescent mental health. Method: The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (New Zealand) urban region during mid 1977. This cohort has now been studied from birth to age 21. Results: The paper examines the ways in which the study has been able to examine a wide range of issues. Key issues examined include: (i) measurement of disorder (respondent effects; dimensionality; scales vs categories); (ii) prevalence and treatment of disorder; (iii) stability and continuity of disorders; (iv) the contribution of risk and aetiological factors (e.g. lead exposure, parental divorce, child abuse, family adversity, sexual orientation) to psychosocial adjustment; and (v) the psychosocial consequences of mental health problems in adolescence. Conclusions: The study findings illustrate the many advantages of a longitudinal study, such as the CHDS, in providing methodologically sound, theoretically relevant and cost effective research that caters for the interests of multiple end-users including the scientific community, clinicians and applied policy makers. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to explore the concept and determinants of successful ageing as they apply to psychiatrists as a group, and as they can be applied specifically to individuals.Conclusions: Successful ageing is a heterogeneous, inclusive concept that is subjectively defined. No longer constrained by the notion of "super-ageing", successful ageing can still be achieved in the face of physical and/or mental illness. Accordingly, it remains within the reach of most of us. It can, and should be, person-specific and individually defined, specific to one's bio-psycho-social and occupational circumstances, and importantly, reserves. Successful professional ageing is predicated upon insight into signature strengths, with selection of realistic goal setting and substitution of new goals, given the dynamic nature of these constructs as we age. Other essential elements are generativity and self-care. Given that insight is key, taking a regular stock or inventory of our reserves across bio-psycho-social domains might be helpful. Importantly, for successful ageing, this needs to be suitably matched to the professional task and load. This lends itself to a renewable personal ageing plan, which should be systemically adopted with routine expectations of self-care and professional responsibility. [ABSTRACT FROM AUTHOR]

Objectives: A considerable gap exists in health and social emotional well-being between Indigenous people and non-Indigenous Australians. Recent research in stress neurobiology highlights biological pathways that link early adversity and traumas as well as life stresses to ill health. We argue that the neurobiological stress response and its maladaptive changes, termed allostatic load, provide a useful framework to understand how adversity leads to physical and mental illness in Indigenous people. In this paper we review the biology of allostatic load and make links between stress-induced systemic hormonal, metabolic and immunological changes and physical and mental illnesses.Conclusions: Exposure to chronic stress throughout life results in an increased allostatic load that may contribute to a number of metabolic, cardiovascular and mental disorders that shorten life expectancy in Indigenous Australians. [ABSTRACT FROM AUTHOR]

There is a need for qualitative studies on motherhood and mental distress. Many mothers have a diagnosis of mental illness, and their motherhood exists in constant tension with their distress. This paper focuses on 10 mothers’ stories about motherhood in relation to being admitted as mental health service users in three different Norwegian community mental health centers. The study has a narrative approach, and through a thematic analysis of personal stories, we emphasize how the 10 women make sense of their experiences of admittance to mental health services in relation to dominant Discourses of good motherhood. Themes identified were: (1) being able to put oneself in the child’s shoes; (2) the emotional impact of being admitted; (3) being open with the children about the admission; and (4) being an emotionally available and present mother. Based on the results of our analysis, we suggest the mothers experienced their distress as a natural reaction to life strains over time, and that they relate to the admissions as interruptions. This underlines the necessity of a more holistic approach, with a support system that focuses on both personal and social aspects of motherhood and mental distress. [ABSTRACT FROM AUTHOR]

Objective: Mental illness is a major contributor to disease burden in China. Guangdong province has a population of over 104 million. This province's health information system is inadequate, especially the mental health workforce and service response. This paper describes a field survey to assess the existing mental health workforce and service capacity in Guangdong.Method: A total of 125 major service providers in Guangdong were identified with the capacity to treat serious mental illness at all levels of the health system. These services were approached to complete a standardised survey based on the WHO Assessment Instrument for Mental Health Systems.Results: The survey identified 8498 mental health workers with 72.5% working in psychiatric hospitals. Service providers reported a treatment rate of 68.8% of a total of 430,000 people registered for treatment of severe mental illness, and only 28.4% of over a million people estimated to be experiencing severe mental illness. An inadequate mental health workforce was cited as a common barrier to treatment access.Conclusion: Guangdong province has a significant treatment gap for severe mental illness and a shortage in the mental health workforce. The distribution of the mental health workforce and facilities is imbalanced towards hospital care rather than community care. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to describe two methods of qualitative analysis - thematic analysis and content analysis - and to examine their use in a mental health context. Method: A description of the processes of thematic analysis and content analysis is provided. These processes are then illustrated by conducting two analyses of the same qualitative data. Transcripts of qualitative interviews are analysed using each method to illustrate these processes. Results: The illustration of the processes highlights the different outcomes from the same set of data. Conclusion: Thematic and content analyses are qualitative methods that serve different research purposes. Thematic analysis provides an interpretation of participants' meanings, while content analysis is a direct representation of participants' responses. These methods provide two ways of understanding meanings and experiences and provide important knowledge in a mental health context. [ABSTRACT FROM AUTHOR]

Background. Unlike the widely used self rated health, the self rated mental health was found unsuitable as a proxy for mental illness. This paper analyses the relationships between the self ratings of physical health, mental health and overall health, and their association of with the objective indicators for physical and mental health. Design and methods. The study is a secondary analysis of data from a nationwide representative sample of the non-institutionalized adult residents of Israel in 2003 that was collected via computer-assisted personal interview methods [n=4859]. Results. The self rated physical health and the self rated mental health were strongly related to each other yet the self rated mental health was not related to chronic physical conditions and the self rated physical health was not related to mental disorders. In a multiple logistic regression analysis, those with positive self rated mental health had 93 times the odds of reporting positive overall health whereas those with positive self rated physical health had 40 times the odds of reporting positive overall health. Conclusions. The self rating of mental health presents a qualitatively different dimension from mental illness. The self rated mental health is two times more important than the self rated physical health in predicting the self rated overall health [ABSTRACT FROM AUTHOR]

Objective: This paper provides a descriptive statistical overview of Mental Health Review Tribunal outcomes from 1992 to 2011.Method: A database used by administrators of the Mental Health Review Tribunal to store information on applicants and their hearing outcomes was subjected to basic descriptive analysis.Results: A total of 3117 applications were received, with most applications received from males (n=2039, 65%) of New Zealand European ethnicity and a mean age of 49 years. A similar number of applications were received from inpatient and community patients (35%, 28% respectively). There was only a small percentage (7%) of applicants who were released and the number of applications withdrawn before a hearing took place was high, at 45%.Conclusion: The success rates of New Zealand Mental Health Review Tribunal applicants is low compared with some international jurisdictions, while at the same time withdrawals are high, warranting further investigation. Applicants in the community are underrepresented, which is of concern in the context of rising use of community treatment orders. Future research focused on service users' experiences of using the Mental Health Review Tribunal and improvements to the existing data stored on applicants are also suggested. [ABSTRACT FROM AUTHOR]

Objectives: It has been proposed that legislation for same-sex marriage has a positive mental health benefit. The purpose of this paper is to review and evaluate the empirical and conceptual links between same-sex marriage and mental health.Conclusions: There are substantive methodological issues in the four surveys and comparisons undertaken. Difficulties with the validity of the evidence are discussed. Conceptual difficulties in the arguments relating to victimisation as well as the psychology of marriage are highlighted. It was concluded that it is premature to make claims of causality vis-a-vis same-sex marriage legislation and mental health. [ABSTRACT FROM AUTHOR]

Objective: To explore basic requirements for a stigma program to produce sufficient savings to pay for itself (that is, break even). Methods: A simple economic model was developed to compare reductions in total short- term disability (SDIS) cost relative to a stigma program's costs. A 2-way sensitivity analysis is used to illustrate conditions under which this break-even scenario occurs. Results: Using estimates from the literature for the SDIS costs, this analysis shows that a stigma program can provide value added even if there is no reduction in the length of an SDIS leave. To break even, a stigma program with no reduction in the length of an SDIS leave would need to prevent at least 2.5 SDIS claims in an organization of 1000 workers. Similarly, a stigma program can break even with no reduction in the number of SDIS claims if it is able to reduce SDIS episodes by at least 7 days in an organization of 1000 employees. Conclusions: Modelling results, such as those presented in our paper, provide information to help occupational health payers become prudent buyers in the mental health market place. While in most cases, the required reductions seem modest, the real test of both the model and the program occurs once a stigma program is piloted and evaluated in a real-world selling. [ABSTRACT FROM AUTHOR]

Based on an extended period of qualitative research with mental health service-users in north-east England, this article considers the various forms of 'magical work' and 'recovery work' that emerge in the lives of people living with severe mental health problems. Given the now sizeable body of literature which seeks to problematize traditional conceptual boundaries of work, the article asks to what extent these hidden and unusual work-forms might also be considered legitimate members of the category. Rather than argue for the expansion of the construct to accommodate these activities, the paper attempts simply to problematize the extent to which so-called 'mad' forms of work are irresolvably different to more conventional forms of occupation. In challenging notions of the psychiatric patient as inevitably inactive, new vocabularies for service-user work are explored. Concluding remarks are also directed to recent policy debates concerning 'back-to-work' welfare reform for long-term out of work service-users. [ABSTRACT FROM AUTHOR]

Our paper provides an overview of current stigma discourse, the origins and nature of the stigma associated with mental illnesses, stigmatization by health providers, and approaches to stigma reduction. This is a narrative review focusing on seminal works from the social and psychological literature, with selected qualitative and quantitative studies and international policy documents to highlight key points. Stigma discourse has increasingly moved toward a human rights model that views stigma as a form of social oppression resulting from a complex sociopolitical process that exploits and entrenches the power imbalance between people who stigmatize and those who are stigmatized. People who have a mental illness have identified mental health and health providers as key contributors to the stigmatization process and worthy targets of antistigma interventions. Six approaches to stigma reduction are described: education, protest, contact-based education, legislative reform, advocacy, and stigma self-management. Stigma denigrates the value of people who have a mental illness and the social and professional support systems designed to support them. It creates inequities in funding and service delivery that undermine recovery and full social participation. Mental health professionals have often been identified as part of the problem, but they can redress this situation by becoming important partners in antistigma work. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the characteristics and outcomes of participants with an Australian physician health program, the Victorian Doctors Health Program (VDHP), for case management of substance use disorder (SUD) and/or significant mental illness. Method: As part of quality assurance, processes data, including demographic information, care plan components and outcomes, were analysed. Results: Between 2001 and 2008, 115 participants undertook case management plans with the VDHP. The majority (n == 71, 62%) had some involvement with the Medical Practitioners Board of Victoria (MPBV). Case management included facilitating referrals to addiction specialists, psychiatrists, counsellors and peer-based support. Ninety (78%) participants reported SUD, the remainder having mental illness (n == 25, 22%). Alcohol was the main drug reported by the SUD group (n == 44, 49%). Most of the SUD participants undertook biochemical monitoring. On commencement with the VDHP, 39 (34%) participants were on leave due to illness. The majority of participants case managed for 5 years were in medical work (n == 31, 84%). Conclusions: Case management by an independent physician health program may protect the health of the doctor and the community, and could be considered in other jurisdictions. [ABSTRACT FROM AUTHOR]

Objective: Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. Following on from a recent review focusing on consumer participation in mental health services, this paper looks at consumer participation in housing. Housing is a critical element in recovery from mental illness. Without suitable housing, people have little chance of maintaining other resources in their lives, such as supportive social relationships and meaningful activities. Conclusions: Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. The importance of appropriate housing to the recovery of people living with mental illness cannot be underestimated. Even well-meaning and well-resourced housing initiatives can fall short of meeting consumers' recovery goals when they do not incorporate the expressed needs of consumers. These expressed needs include keeping units small in size and employing drop-in support models. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to evaluate the accuracy of a new genotyping test (Antidepressant PredictAR) in assigning patients as likely 'poor', 'rapid' or 'normal' metabolizers of antidepressant drugs. Method: Eighty-nine patients were clinically assigned (on the basis of their historical response to antidepressant drugs) as 'poor', 'rapid' or 'normal' metabolizers and comparison was then made to their test-based 2D6 and C19 genotyping status reports. Results: The overall capacity of the test to allocate patients to four differing phenotypic categories reporting for the genotyping test was not significant in relation to either C19 or 2D6 analyses. However, the C19 test did appear to have some capacity to identify rapid metabolizers, and we note how we then sought to manage such patients clinically. Conclusions: The test may have some capacity to identify patients with a rapid metabolizing profile. Any further advantages were not identified by this study, whether reflecting methodological and/or assay limitations. [ABSTRACT FROM AUTHOR]

Objective: This paper reports on a brief survey of clinicians' judgements when making treatment decisions in the context of diagnostic uncertainty. Specifically, attitudes and opinions were sought from practising consultant psychiatrists regarding two key areas of clinical decision-making in first episode psychosis (FEP), namely, when to initiate medication and, how long to continue treatment. Method: Interviews were conducted with consultant psychiatrists using a combination of structured and semi-structured questions that examined and explored pharmacological treatment decisions in FEP. Results: Twenty-three consultant psychiatrists participated in the interviews. The threshold to initiate pharmacological treatment was lower when a risk to self or others is present, when symptoms are primarily positive, when the patient is in distress, or where there is a family history of mental illness. Atypical antipsychotics are routinely used as front-line medication in FEP and the choice of medication is determined largely by their likely side effect profile. However, the greater the perceived efficacy, the greater the anticipated tolerability burden. The ideal duration of treatment is considered to be 1–2 years in instances of full remission, and 5 years where only a partial response has been achieved or where recovery has not been sustained. Conclusions: The ‘first episode’ represents a unique period in the management of psychosis where by definition there is no history of pattern of illness, diagnostic certainty is rare, and the patient usually does not have any prior exposure to medications. Therefore, each management decision needs to be considered following a risk benefit analysis which takes into account the context of the individual. [ABSTRACT FROM AUTHOR]

Objectives: This paper looks to examine the emerging role of carers as essential components in the management of individuals affected by severe mental illness in the context of modern legal and health policy environments. Conclusions: Cultural and legal concepts of confidentiality within the doctor–patient relationship are complex. Increasingly, evidence is recognizing the essential role of carers in the quality management of individuals affected by severe mental illness and this emphasis is being further supported by innovative health policy and legislation. A public health definition for the role of carers may be a more appropriate way to consider their role in mental health management strategies. [ABSTRACT FROM AUTHOR]

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

The group-based latent trajectory model allows investigators to identify distinctive trajectory groups based on relevant outcomes. Dual trajectory analysis enables examination of the interrelationship between two outcomes simultaneously. This paper describes the application of the group-based dual trajectory model in mental health and substance abuse research. We analyzed two related recovery outcomes: 1) social contact with non-substance abusing friends and 2) stage of substance abuse treatment. We identified four groups for social contact and four groups for substance abuse treatment. We then examined the interrelationship between the two outcomes across the trajectory groups over 10 years. The two outcomes are positively associated longitudinally and evolve in the same direction, although for specific groups, the two outcomes do not covary. By examining dynamic linkages across all trajectory groups between two longitudinal outcomes, the dual model provides a more comprehensive and realistic understanding of the underlying relationships between the two outcomes under investigation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to explore the relationship between civil commitment under a Community Treatment Order (CTO) and competence to consent to treatment. Method: A purposive convenience sample of 10 service users under CTOs were interviewed using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Ratings were compared with the ratings of 10 matched voluntary service users. Results: Seventy percent of the CTO sample were found to be incompetent according to the MacCAT-T, compared to 20% of the comparison group (p = 0.004). The proportion of the CTO sample found to be incompetent reduces to 50% if the subscale of appreciation is excluded (p = 0.004). Most people in each group would elect to continue their current treatment if given the choice. Conclusion: Findings of this study suggest that mental health law reform introducing considerations of competence could lead to a substantially different group of people being subject to CTOs. If the CTO is carefully targeted and not used excessively, it is likely to be accorded qualified acceptance for most service users for whom it is used. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the Child and Family Inclusive Practice program (CFIP), a pilot program implemented in an adult community mental health centre in Newcastle, New South Wales, which aimed to enhance family relationships through child and family inclusive practice. Conclusions: The CFIP used a family-focused, child-sensitive approach in which two clinicians met together with families where there was parental mental illness. Adults and children were seen together and separately. Work with parents was aimed at validating their concerns for the child, and enhancing their confidence as parents/carers. Children had the opportunity to express their concerns in a safe and protective environment and, where appropriate, were supported in their concerns if these were being put to the adult family members. The project was seen to add value to the service provision of the community mental health team, and demonstrated to clinical staff the benefits of an inclusive and whole of family approach to mental health care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine aspects of mental health and mental health care through a gender lens. Conclusion: Gender differences have an impact on mental health and the experience and course of women's mental illness. Comprehensive gender-sensitive mental health care requires the planning, delivery, monitoring and quality improvement initiatives of mental health care to be informed by a knowledge and understanding of gender differences in women and men and their inter-relationship with respect to childhood and adult life experiences (e.g. violence and abuse); day-to-day social, cultural, and family realities; expression and experience of mental ill health and treatment needs and responses. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to introduce the term 'predicament suicide' and add to the evidence that suicide may occur in the absence of Axis I diagnoses. Method: The term 'predicament suicide' was described as suicide which occurs when the individual without mental disorder is in unacceptable circumstances from which they cannot find an acceptable alternative means of escape. Accounts of suicide that satisfied these criteria, and could be illustrated by images, were sought. Results: Four accounts were identified: Ajax, Brutus, Mayor Freyberg and Commander Donnicke. Conclusions: Predicament suicide appears to be a useful designation. This work added evidence indicating that suicide may occur in the absence of an Axis I mental disorder. [ABSTRACT FROM AUTHOR]

Objectives: This paper describes the experience and evaluation of a shared care project targeted at marginalized individuals living in the North End of Halifax, Nova Scotia. This population has high rates of psychiatric disorder, often comorbid with chronic medical conditions, and people have difficulty in obtaining the help they need. This primary care liaison service covers all ages and includes outreach to emergency shelters, transitional housing and drop-in centres. Collaborative care improved access, satisfaction and outcomes for marginalized individuals in urban settings. Primary care providers with access to the service reported greater comfort in dealing with mental health problems, and satisfaction with collaborative care, as well as mental health services in general. Results were significantly better than those of control practices when such data were available. The median wait time was 6 days in comparison with 39.5 days for the comparison site. Conclusions: This model can complement other initiatives to improve the health of marginalized populations, and may be relevant to Australia. [ABSTRACT FROM AUTHOR]

Objective: Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. This has led to serious negative consequences for their health and wellbeing. Recent public policy has aimed at redressing this situation. This paper sets out to investigate the 'state of play' regarding consumer participation in mental health services. Conclusions: Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. Although the vision of public policy is for consumers to be at the centre of decision making, the changes are understandably slow in coming. The implications for the practice of psychiatry, and therefore mental health services, of the demands for meaningful participation are profound. They challenge some of the social covenants under which mental health services have historically been delivered. Traditionally, people living with a mental illness have not had their rights respected. In recent times, the College has developed policies that aim to ensure that the rights of people living with a mental disorder are respected. These policies also acknowledge that effective health care requires collaboration with consumers. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to describe the Adolescent Intensive Management (AIM) team at the Austin Child and Adolescent Mental Health Service (CAMHS), a unique model of intensive outreach service with high-risk and difficult-to-engage adolescents, and describe the profile of clients referred to it. Method: This study used a retrospective review of clients' data, collected through file audit, over a 12-month period. Results: The result of the study showed that a 100% retention rate of adolescents with complex social, emotional and mental health needs is possible in a flexible and multi-system approach to service provision. Conclusion: Clients referred to the CAMHS' AIM team displayed a pattern of multiple risk factors and comorbidities. Low caseload of 8-10 clients per clinician allowed flexibility and a level of intensity to make any necessary changes in service provision to better suit the client's needs. The majority of clients showed improvement in functioning following intervention by the team. [ABSTRACT FROM AUTHOR]

A systematic overview of the literature on palliative care for people with severe persistent mental illness (SPMI) was conducted to inform clinical practice, research, and education. Empirical studies and nonempirical papers were included. Few empirical studies exist. There is even less information about the palliative care needs of, or the nature of palliative care provided to, people with SPMI. Mental health, primary care, and palliative care providers need to partner with people who have SPMI in developing and providing palliative care. The field of palliative care for people with SPMI is wide open and in need of methodologically sound studies that will help define the issues that exist for this vulnerable population. Recognizing the similarities between mental health and palliative care should lead to collaborative ventures and discussions in an attempt to address common and parallel issues. [ABSTRACT FROM AUTHOR]