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Objective: This paper aims to analyse in a philosophically informed way the recent National Institute of Mental Health proposal for the Research Domain Criteria (RDoC) framework.Conclusion: Current classification systems have helped unify psychiatry and the conditions that it is most concerned with. However, by relying too much on syndromes and symptoms, they too often do not define stable constructs. As a result, inclusions and removals from the manuals are not always backed by sound reasons. The RDoC framework is an important move towards ameliorating matters. This paper argues that it improves the current situation by re-referencing constructs to physical properties (biomarkers for disorders, for example), by allowing theoretical levels within the framework, and by treating psychiatry as a special case of the cognitive sciences. [ABSTRACT FROM AUTHOR]

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Objective: The aim of this paper is to describe the way in which particular Australian and New Zealand mental health services are making use of routine outcome data to foster clinical improvements for consumers. Method: We invited individuals who are responsible for implementing outcome data collection across the two countries to describe exemplary practices occurring within their own services, and present the resultant information in the form of case studies. Results: Outcome measurement is being used to guide clinical decision-making, engage consumers in treatment, foster a collaborative approach to care planning and goal setting, review consumers'' progress with treatment, inform questions about consumers'' eligibility for given programs, assist with discharge planning, improve the evidence-base on which services are founded, and evaluate particular models of service delivery. Conclusions: A number of mental health services are deriving useful information from routine outcome measurement, and using this to guide clinical practice. The examples provided here may offer some lessons for other services wishing to make better use of outcome data, and there may be some opportunities for the sharing of resources or infrastructure. Services that are already using outcome data to inform their clinical activities, and services that are keen to do so, will need ongoing support. [ABSTRACT FROM AUTHOR]

Current Australian Government policy acknowledges that consumers and carers are an integral component of improving all aspects of mental health, from individual service provision to policy development. However, although the ability of consumers and carers to influence mental health programs and services in Australia has increased over the past decade, the theory of partnership for consumer and carer participation has many challenges when put into practice. The Children of Parents with a Mental Illness (COPMI) national initiative has endeavoured to overcome these challenges and integrate consumer and carer participation across the initiative through a range of strategies. This paper explores and describes how consumers and carers have engaged with the initiative and overcome barriers or worked through ways to negotiate them. Examples and consumer and carer reflections are provided specifically in relation to the development of both public information and workforce development resources. The COPMI national initiative's experience adds to the body of knowledge that is increasing as consumer and carer participation becomes more integrated across the mental health sector. [ABSTRACT FROM AUTHOR]

Objective: This paper provides a conceptual, historical and legislative overview of fitness issues. These include fitness to be interrogated or charged, to plead, to be tried and to be sentenced in the context of Australia and New Zealand. Conclusions: Legislation regarding fitness issues needs to strike a balance between protecting the rights of mentally impaired defendants to a fair trial process and recognizing that mental illness in itself does not absolutely preclude participation in a trial process or necessarily diminish criminal responsibility. Although the key determinants of fitness seem to be the ability to cope with court processes and communicate with counsel, the application of clinical judgement to legal criteria is not always straightforward. [ABSTRACT FROM AUTHOR]

Background: The impact of adversity in childhood is well established in clinical populations, but there is little information about adversity in wider populations. The aim of this paper is to report and to explore the distribution of childhood family adversity in an Australian population.Method: A total of 7485 randomly selected subjects in 20-24, 40-44 and 60-64 year age bands were interviewed at the outset of a longitudinal community study of psychological health in the Canberra region of Australia. In the initial cross-sectional interview, subjects answered 17 questions about experience of adversity in the home to age 16 years.Results: In the population, 59.5% had experienced some form of childhood adversity and 37% had experienced more than one adversity. Domestic conflict and parental psychopathology and substance use are the common adversities. Parental sexual abuse was reported by 1.1%. Adversity was highest in the 40-44 year age group and reported more in women in all age groups. The majority of subjects saw their childhood as happy or normal despite adversity, but happiness is affected most by domestic warmth and harmony, and normalcy by abuse and neglect. Severe adversities, physical and sexual abuse and neglect, were uncommon, but were related to multiple and other severe adversities.Conclusion: Some form of adversity is a common experience, although the severest abuses are less common in this population. Multiple adversities are common and only a minority experience single adversities. Physical abuse, sexual abuse and neglect rarely occur alone, but indicate a context of abuse. [ABSTRACT FROM AUTHOR]

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

The purpose of the present paper was to determine what is currently documented about Indigenous Australians' understandings of mental health and mental disorders through a meta-synthesis of peer-reviewed qualitative empirical research. The following databases were electronically searched (1995-April 2006): AOA-FT and AIATSIS, Blackwell Synergy, CINAHL and Pre CINHAL, Health source: nursing/academic edition, Medline, Proquest health and medical complete, PsycInfo, Science Direct, Synergy and HealthInfoNet. Eligible studies were those written in English and published in peer-reviewed journals, empirical studies that considered Indigenous people's understandings of mental health and provided details on methodology. Five articles from four qualitative studies met these criteria. Meta-ethnography was used to identify common themes emerging from the original studies. Reciprocal translation was used to synthesize the findings to provide new interpretations extending beyond those presented in the original studies. An overarching theme emerged from the synthesis: the dynamic interconnectedness between the multi-factorial components of life circumstances. Reciprocal translations and synthesis regarding Indigenous understandings of mental health and illness resulted in five themes: (i) culture and spirituality; (ii) family and community kinships; (iii) historical, social and economic factors; (iv) fear and education; and (v) loss. The application of a meta-synthesis to these qualitative studies provided a deeper insight into Indigenous people's understandings of mental health and illness. The importance of understanding Indigenous descriptions and perceptions of mental health issues is crucial to enable two-way understandings between Indigenous people's constructs of wellness and Western biomedical diagnostic labels and treatment pathways for mental disorders and mental health problems. [ABSTRACT FROM AUTHOR]

Court diversion schemes have been running for a decade in New Zealand and are increasing in number in Australia. This paper aims to give an international and historical context to these developments, by reference to psychiatric initiatives at courts in the US and in England and Wales. From a review of the specialist literature, an account is given of three forms of psychiatric intervention in courts over the last 90 years: court psychiatric clinics and mental health courts in the US, and court diversion schemes in England and Wales. High levels of psychiatric morbidity among prisoners, coupled with a continuing increase in prisoner numbers, demonstrate the need for systems for dealing with mentally ill people who come before the courts. Court diversion in England and Wales developed as part of a system where the mentally ill who are found guilty are sent to hospital in lieu of any other sentence. Its focus is on a form of psychiatric triage, and its ethos is the health of the patient. Court psychiatric clinics in the US grew up as an alternative to assessment in prison. Their focus has been on full psychiatric evaluation in an insanity and incompetence jurisdiction. The ethos has been that of serving the court. Mental health courts are heavily influenced by ideas of therapeutic jurisprudence, and their emphasis has been on a judge holding minor offenders in community care through the threat of judicial sanction. Experience in England and Wales has shown that court diversion can be a powerful and effective intervention. In order for it to function properly, those running court schemes need direct admission rights to psychiatric beds, both open and locked. Court diversion schemes are best as part of a spectrum of services to police stations, courts and prisons, which involved both general and forensic psychiatrists. [ABSTRACT FROM AUTHOR]

Background: There are few national or cross-cultural studies of the stigma associated with mental disorders. Australia and Japan have different systems of psychiatric health care, and distinct differences in cultural values, but enjoy similar standards of living. This study seeks to compare the nature and extent of stigma among the public in the two countries. Methods: A household survey of the public was conducted in each country using similar methodologies. The Australian study comprised a national survey of 3998 adults aged over 18 years. The Japanese survey involved 2000 adults aged 20 to 69 from 25 regional sites distributed across the country. Interviewees reported their personal attitudes (personal stigma, social distance) and perceptions of the attitudes of others (perceived stigma, perceived discrimination) in the community with respect to four case vignettes. These vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia. Results: Personal stigma and social distance were typically greater among the Japanese than the Australian public whereas the reverse was true with respect to the perception of the attitudes and discriminatory behaviour of others. In both countries, personal stigma was significantly greater than perceived stigma. The public in both countries showed evidence of greater social distance, greater personal stigma and greater perceived stigma for schizophrenia (particularly in its chronic form) than for depression. There was little evidence of a difference in stigma for depression with and without suicide for either country. However, social distance was greater for chronic compared to early schizophrenia for the Australian public. Conclusion: Stigmatising attitudes were common in both countries, but negative attitudes were greater among the Japanese than the Australian public. The results suggest that there is a need to implement national public awareness interventions tailored to the needs of each country. The current results provide a baseline for future tracking of national stigma levels in each country. [ABSTRACT FROM AUTHOR]

Objective: This paper outlines evidence of efficacious outcomes from mixing people living with diverse mental health challenges and/or intellectual disability. The intention was to show how mixing up people who are differently challenged can be efficacious in (re)habilitation terms. Two separate experiences of sharing personal narratives were involved, along with creative expressions in music, art and filming, combined with group gatherings providing discerning feedback for each other on members’ day-to-day progress. After 12 months of ‘open urban tribe’ gatherings in Sydney, where participants formed a community of belonging, the model was adapted for use in Alice Springs. The original group developed a cycle of interactive ritual rhythms, and these became a special feature of their self-help, peer support approach. The Sydney project modelled community-based rehabilitation, and that process then informed the processes initiated in a rural, remote location. Methods: Regular whole tribe gatherings ‘in the circle’ combined with mentoring ‘aunties and uncles’. By sharing stories and giving personal feedback on their progress, participants developed skills and confidence in self expression. Relating to each other and the group, and sharing creative expressions (group craft activities, dancing, small group performing) added depth to the experience of participants... [ABSTRACT FROM AUTHOR]

Objective: The concept of collective trauma has predominantly been applied in the context of natural and human disasters. This paper seeks to explore whether collective trauma offers a respectful way in which to explore and respond to mental health and wellbeing issues for Aboriginal families and communities. Method: A review of the international literature was undertaken in order to determine the elements of collective and mass trauma studies which may have relevance for Indigenous communities in Australia. Results: Findings support the proposition that the patterns of human responses to disasters, particularly in protracted traumas such as war-zones, shows strong parallels to the contemporary patterns of experience and responses articulated by Aboriginal people affected by colonization and its sequelae in Australia. Conclusion: Adopting evidence-informed principles of family and community healing developed internationally in disaster situations may provide helpful ways of conceptualizing and responding in a coordinated way to mental health and wellbeing issues for Indigenous people within Australia. [ABSTRACT FROM AUTHOR]

Objective: Despite recognition of the extremely high rates of mental illness among custodial populations and the fact that Indigenous people represent around one-quarter of Australia's custodial population, little is known about the mental health of Aboriginal and Torres Strait Islander people in custody. Mental health is an important component of social and emotional wellbeing for Indigenous people and this paper considers current evidence regarding the mental health status of Indigenous Australians in custody. Method: A systematic review was undertaken of the quantitative literature relating to the mental health problems of Indigenous people in custody in Australia. Results: Despite high incarceration rates for Indigenous people and evidence that both mental health problems and rates of mental illness are extremely high in this group, studies in this area are few and limited in scope. Conclusion: The first step toward addressing the marked social and mental health problems for Indigenous people in custody is to systematically identify the nature and extent of these problems. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper was to investigate the importance and challenges involved in conducting serial cognitive assessments among healthy Indigenous adolescents. Method: Cognitive assessments were conducted at fortnightly intervals for 2 months and again at 6 and 12 months among a group of Indigenous students from a boarding school in the Northern Territory. These students were to be the healthy control group in a long-term study of substance abuse. Recruitment and attrition rates were reviewed and related challenges for assessing participants were identified. Results: From the recruited sample (n=49), 18% reported heavy or frequent use of alcohol, cannabis or petrol. Males were more likely to have used these substances compared to females. Attrition increased as the follow-up interval increased with 49 recruits reducing to 32 in the first 2 months and only 15 and 13 of the initial group remaining for the 6 and 12 month follow-ups respectively. Conclusions: Main challenges included (i) appropriateness of tests and assessment processes, (ii) high rates of substance abuse and other illness in the control group and (iii) high attrition rates. The importance of assessing cognition appropriately is highlighted by a lack of information regarding mental health issues in Indigenous populations. [ABSTRACT FROM AUTHOR]

Background: Prior research has documented shared heritable contributions to non-suicidal self-injury (NSSI) and suicidal ideation (SI) as well as NSSI and suicide attempt (SA). In addition, trauma exposure has been implicated in risk for NSSI and suicide. Genetically informative studies are needed to determine common sources of liability to all three self-injurious thoughts and behaviors, and to clarify the nature of their associations with traumatic experiences. Methods: Multivariate biometric modeling was conducted using data from 9526 twins [59% female, mean age = 31.7 years (range 24–42)] from two cohorts of the Australian Twin Registry, some of whom also participated in the Childhood Trauma Study and the Nicotine Addiction Genetics Project. Results: The prevalences of high-risk trauma exposure (HRT), NSSI, SI, and SA were 24.4, 5.6, 27.1, and 4.6%, respectively. All phenotypes were moderately to highly correlated. Genetic influences on self-injurious thoughts and behaviors and HRT were significant and highly correlated among men [ r G = 0.59, 95% confidence interval (CI) (0.37–0.81)] and women [ r G = 0.56 (0.49–0.63)]. Unique environmental influences were modestly correlated in women [ r E = 0.23 (0.01–0.45)], suggesting that high-risk trauma may confer some direct risk for self-injurious thoughts and behaviors among females. Conclusions: Individuals engaging in NSSI are at increased risk for suicide, and common heritable factors contribute to these associations. Preventing trauma exposure may help to mitigate risk for self-harm and suicide, either directly or indirectly via reductions in liability to psychopathology more broadly. In addition, targeting pre-existing vulnerability factors could significantly reduce risk for life-threatening behaviors among those who have experienced trauma. [ABSTRACT FROM AUTHOR]

Aims To identify trajectories of heroin use in Australia, predictors of trajectory group membership and subsequent outcomes among people with heroin dependence over 10-11 years. Design Longitudinal cohort study. Setting Sydney, Australia. Participants A total of 615 participants were recruited between 2001 and 2002 as part of the Australian Treatment Outcome Study (66.2% male; mean age 29 years). The predominance of the cohort (87.0%) was recruited upon entry to treatment (maintenance therapies, detoxification and residential rehabilitation), and the remainder from non-treatment settings (e.g. needle and syringe programmes). This analysis focused upon 428 participants for whom data on heroin use were available over 10-11 years following study entry. Measurements Structured interviews assessed demographics, treatment history, heroin and other drug use, overdose, criminal involvement, physical health and psychopathology. Group-based trajectory modelling was used to: (i) identify trajectory groups based on use of heroin in each year, (ii) examine predictors of group membership and (iii) examine associations between trajectory group membership and 10-11-year outcomes. Findings Six trajectory groups were identified [Bayesian Information Criterion (BIC) = -1927.44 ( n = 4708); −1901.07 ( n = 428)]. One in five (22.1%) were classified as having 'no decrease' in heroin use, with the probability of using remaining high during the 10-11 years (> 0.98 probability of use in each year). One in six (16.1%) were classified as demonstrating a 'rapid decrease to maintained abstinence'. The probability of heroin use among this group declined steeply in the first 2-3 years and continued to be low (< 0.01). The remaining trajectories represented other fluctuating patterns of use. Few baseline variables were found to predict trajectory group membership, but group membership was predictive of demographic, substance use and physical and mental health outcomes at 10-11 years. Conclusions Long-term trajectories of heroin use in Australia appear to show considerable heterogeneity during a decade of follow-up, with few risk factors predicting group membership. Just more than a fifth continued to use at high levels, while fewer than a fifth become abstinent early on and remained abstinent. The remainder showed fluctuating patterns. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to determine whether a 'housing first' permanent supported accommodation was effective in improving housing stability, continuity of care and reducing mental health admissions for persons experiencing chronic homelessness with psychosis.Methods: A quasi prospective cohort study of 42 chronic homeless persons with psychosis accommodated in a new purpose built facility in central Melbourne. Accommodation stability, mental health service contacts and psychiatric admissions were compared across the 2 years prior, the first 2 years of placement and the 2 years after leaving.Results: The mean number of mental health admissions in the first 2 years of accommodation was less (0.56, SD = 1.0) when compared with in the 2 years prior to accommodation (1.0, SD = 1.4, p = 0.05). There was an increase in the mean total number of days admitted in the 2 years after having left the supported accommodation, (33.3 days, SD = 86.7, p = 0.043) Conclusions: The accommodation of chronic homeless persons with psychosis in a 'housing first' permanent supported accommodation lead to increased housing stability and optimism, improved continuity of care and reduced psychiatric admissions. [ABSTRACT FROM AUTHOR]

Background: Conceptualizations of recovery involve more than just symptom amelioration and include the development of hope, meaning and self-identity. Goal attainment increases wellbeing within non-clinical samples and mental health consumers report its facilitative value for psychological recovery. There is a lack of empirical data regarding the impact of goal progress/attainment on mental health outcome for consumers with enduring mental illness. Aims: (i) To examine whether baseline measures of symptoms, functioning and recovery are associated with greater goal progress, and (ii) to examine the impact of goal attainment on improvements in mental health outcome. Method: Seventy-one consumers with enduring mental illness who were receiving case-management support from mental health services in eastern Australia participated in the study. Level of attainment for case-management goals was examined against mental health outcome measures for the corresponding goal-setting period. Results: Path modelling indicated that goal attainment mediated the relationship between baseline (pre-goal setting) levels of symptom distress and progress on recovery constructs; hope, self-confidence, sense of purpose and positive identity. Conclusions: When symptoms are perceived as less distressing consumers are better able to progress toward their case-management goals, which in turn promotes aspects of psychological recovery. [ABSTRACT FROM AUTHOR]

It has been reported that depression and anxiety have overlapping symptoms and are conceptually interrelated. One of the most prominent theoretical developments that explain this association is Clark and Watson’s tripartite model (Journal of Abnormal Psychology, 100:316–336, ) that posits these two disorders and negative emotions share a latent component of negative affect (NA). The current study had two aims, (a) to compare a tripartite factor structure against competing models by Confirmatory Factor Analysis (CFA) of the Depression Anxiety and Stress Scales (DASS-21) (Lovibond and Lovibond ), and (b) explore the psychometric properties of the DASS-21. The DASS-21 was completed by a representative sample of 4039 young Australians, aged 12–18 years, as part of the South Australian Youth Mental Health Survey (SAYMHS), South Australia, Australia. The best fitting model for the data consisted of anhedonic depression, physiological hyperarousal, and general NA. The psychometric properties of the DASS-21 were excellent with a stable and interpretable factor structure and good internal consistency. The results of the current study suggest that the theoretical tripartite structure of depression and anxiety is robust and applicable among Australian youth. The diagnostic, clinical and theoretical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationship between the use of the Internet and the mental health status of older care-givers in Australia. Methods: It utilized data obtained from a national health survey of a stratified random sample from the total population of people with disability, aged 60 years or older and carers of people with chronic health problems or disabilities who lived in a household. Internet usage was assessed by responses to a direct question during a personal structured interview. General mental health of caregivers was assessed using the SF-12v2 Health Survey to obtain the mental health summary scores. Data were analysed using logistic regression analyses with bootstrapping resampling and estimation statistical technique. Results: After adjusting for potential confounders there was a significant association between use of the Internet and better mental health among older care-givers. There was an approximately 60% increase in the odds of better mental health (OR = 1.56, 95% CI = 1.04-2.35) for care-givers who used the Internet in the past 12 months when compared with those who did not. Conclusions: The use of Internet has a beneficial effect on the mental health of care-giver aged 60 years or above. The results have direct implications on the provision of support and care of care-givers. [ABSTRACT FROM AUTHOR]

MindMatters Plus is a mental health promotion initiative in Australia which aims to improve the capacity of secondary schools to cater for students who have high support needs in the area of mental health. The development of effective school case management was one of the projects associated with this initiative. The aim of this project was to produce a practical resource on the principles and practices of effective school case management for staff who work with secondary school students who have high support needs in the area of mental health (e.g. student support personnel, school administrators, school psychologists, school counsellors and mental health workers). This article briefly outlines the school case management initiative — its rationale, and research and development process. This is followed by a description of the resource itself, namely the framework for effective school case management, and the kit for developing effective school case management practices. Feedback on the resource is invited from readers following access to and utilization of the kit from the website provided. [ABSTRACT FROM AUTHOR]

In Australian emergency departments, the triage of people with physical illness and injury is well developed and supported by the Australasian Triage Scale. The Australasian Triage Scale contains brief descriptors of mental illness and it is unknown if these provide the same reliability in triage decision-making for emergency triage nurses assessing people with a mental illness. Specialist mental health triage scales have been developed to cater for this deficit and to aid emergency staff who have lacked training in the assessment and management of people with a mental illness. A review of the development of mental health triage scales and their use in Australia identifies that using a mental health triage scale improves the competence and confidence of emergency department staff in triaging people with mental illness. Despite this, there is no consistent national approach to the emergency triage of people with a mental illness. There is ad hoc use of mental health triage scales and there are few reports of improvements in service provision to this client group as a result of the use of a mental health triage scale. These findings suggest that despite the intentions of the National Mental Health Strategy, a lack of equity remains in emergency departments in the provision of care to people with a mental illness who make up one in five of adult Australians. Consideration should be given to the introduction of a national approach to the use of a mental health triage scale in Australian emergency departments. [ABSTRACT FROM AUTHOR]

In relation to mental health, it is clear that medicalized underpinnings, the provision of a clin- ically orientated evidence base for practice and the need to contain `risk' continue to be prior- itized, particularly when compulsory intervention is considered. This is despite the increasing influence of a citizenship and social justice agenda which is being promoted by psychiatrists involved in the development of `postpsychiatry', as well as by service users/survivors. These drivers are not mutually exclusive, but in the context of compulsory treatment, there are clear tensions. In this article, the policy surrounding mental health and compulsory intervention in Australia and in England and Wales is explored. In the context of this discussion, three ways in which current government policy can be interpreted are examined and links made between these interpretations and different ways of viewing the relationship between mental health and community capacity building. With regard to social work practice, it is argued that a response to mental ill health which concentrates on an individualized `diagnose and treat' approach, which particularly comes to the fore at times of compulsory intervention, has limited capacity to facilitate community engagement, foster social inclusion and generate reciprocal dynamics between positive mental health and community capacity building. [ABSTRACT FROM AUTHOR]

Background: Only a limited number of population-based studies have been able to prospectively follow the mental health of their participants. We aimed to describe diagnostic changes in a population based cohort over a two year period, and to explore associations between a range of individual factors and recovery from, or onset of, disorders.Methods: Two year, face-to-face follow-up of a community-based cohort drawn from random telephone screening using the CIDI as diagnostic instrument. Unlike most similar research we did not exclude individuals with prior history from analysis.Results: 1407 participants were administered face-to-face interviews and 968 were re-interviewed. In multivariate analysis, recent adverse life events, poor physical health, and high neuroticism score were significant predictors of developing a mental disorder in participants who were disorder free at baseline. Higher baseline levels of physical activity were protective of new disorders in univariate analysis. Most participants with a baseline disorder and not lost to follow-up were disorder-free two years later. For participants with a disorder at both interviews, there was marked lability in diagnoses, with only a small minority having an unchanged diagnosis at both baseline and follow-up. Factors predicting a poor outcome in participants with a disorder included the number of baseline diagnoses, high neuroticism score and adverse life events.Conclusions: These findings suggest that the diagnosis of common mental disorders is complex and that diagnoses are relatively unstable. The factors that influence the emergence of mental disorders in individuals who may, or may not, have had a disorder in the past, are similar to those associated with the development of new disorders in subjects without a lifetime history. [ABSTRACT FROM AUTHOR]

A cross-national survey was conducted among 358 recently homeless young people in Melbourne and Los Angeles. Drug dependence and mental illness were assessed at baseline, 6 and 12 months. At each time point, participants were classified as no condition, drug dependent, having a mental illness or dual condition. Low levels of drug dependence or mental illness or both were reported at each data point. Most young people were classified as neither drug dependent nor having mental illness at baseline and remained so for the 12-month period and few remained drug dependent, or had continuing mental illness or both. Half to two-thirds of young people classified as having one or both conditions were subsequently reclassified as “no condition”. There was no evidence of a consistent pathway from either drug dependence or mental illness to co-morbidity. Most young people reported an absence of mental illness and/or drug dependence at each time point. Improvement from one or both conditions at each transition suggests it may be more effective to provide interventions to address drug dependence and mental health problems to young people early in their experience of homelessness. [ABSTRACT FROM AUTHOR]

This study explored gambling among Australian veterans entering posttraumatic stress treatment programs (n = 153). Twenty-eight percent reached the South Oaks Gambling Screen (SOGS) criteria for probable problem gambling, as did 17% on the DSM-IV gambling scale (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; American Psychiatric Association, 1994). Almost all problem gamblers reported gambling to escape problems in other areas of their lives. The strongest independent predictor of problem gambling was gambling weekly or more often on electronic gaming machines. There was no significant relationship between problem gambling, posttraumatic stress disorder (PTSD), anxiety, depression, or alcohol use. The study identified an entrenched gambling culture among PTSD treatment-seeking veterans, finding these veterans indulge in many different forms of gambling and that these forms are mediated by situational factors that provide both casual and formal gambling opportunities. [ABSTRACT FROM AUTHOR]

Objective: To show that mental illness affects everyone in society, describe some of the main obstacles to better outcomes, and build confidence that they can be overcome.Methods: A review and analysis of relevant evidence and experience combined with personal advocacy.Results: Mental illnesses are common and seriously under-treated, reform of the system of care has completely stalled, and insidious reinstitutionalization of the modernized system is occurring. A number of contributing factors and possible solutions are identified, including mental health literacy and advocacy campaigns, a focus on young people and early intervention, and functional reintegration of the treatment of mental and substance use disorders.Conclusions: A new wave of reform and major financial investment in the treatment of mental and substance use disorders is overdue. This can be best achieved by combining the evidence-based health care (EBHC) paradigm with a direct appeal to the self-interest of members of the general community. A National Institute of Mental Health and Addiction should be a key element of such reform, which must be a continuing process with substantially increased federal and State funding. [ABSTRACT FROM AUTHOR]

Background: The prevalence of mental disorders is so high that members of the public will commonly have contact with someone affected. How they respond to that person (the mental health first aid response) may affect outcomes. However, there is no information on what members of the public might do in such circumstances. Methods: In a national survey of 3998 Australian adults, respondents were presented with one of four case vignettes and asked what they would do if that person was someone they had known for a long time and cared about. There were four types of vignette: depression, depression with suicidal thoughts, early schizophrenia, and chronic schizophrenia. Verbatim responses to the open-ended question were coded into categories. Results: The most common responses to all vignettes were to encourage professional help-seeking and to listen to and support the person. However, a significant minority did not give these responses. Much less common responses were to assess the problem or risk of harm, to give or seek information, to encourage self-help, or to support the family. Few respondents mentioned contacting a professional on the person's behalf or accompanying them to a professional. First aid responses were generally more appropriate in women, those with less stigmatizing attitudes, and those who correctly identified the disorder in the vignette. Conclusions: There is room for improving the range of mental health first aid responses in the community. Lack of knowledge of mental disorders and stigmatizing attitudes are important barriers to effective first aid. [ABSTRACT FROM AUTHOR]

The article comments on healthcare research to describe the trials and tribulations of performing within the research arena for mental health nursing in the Australia. An effective starting tactic is ignoring the instructions on ethics forms. If the researcher is lucky enough to have secured funding for the research, liaising with the Health Service Finance Department can provide ample distraction from the work at hand.