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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]

Objective: To critically examine a recent decision of the Victorian Supreme Court that found that the Mental Health Tribunal and the Victorian Civil and Administrative Tribunal erred in the application of the capacity test in the Mental Health Act 2014 (Vic) and that compulsory electroconvulsive therapy would infringe upon the human rights of two patients who had no insight into their chronic schizophrenia.Conclusions: After considering the concepts of insight and capacity to consent to treatment, the paper concludes that the decision in NJE and PBU v Mental Health Tribunal [2018] VSC 564 is problematic clinically. [ABSTRACT FROM AUTHOR]

Family violence and mental health are pervasive and wicked problems, and the state of Victoria (Australia) has emphasised these areas of focus through two dedicated Royal Commissions. Despite the increased prioritisation of mental health and family violence and recognition of existing systems and policy failures, research into the overlap of these two areas remains limited. This article examines the unique and elevated risk factors of mental health consumers experiencing coercive control and poor system experiences/intervention outcomes as victim-survivors. Utilising lived experience accounts from the Royal Commission into Family Violence and the Royal Commission into Victoria's Mental Health System, this study qualitatively analyses 60 submissions and draws compelling parallels between consumer and victim-survivor experiences, and examines how they intersect at critical junctures to exacerbate risk. The findings suggest that mental health consumers have existing experiences and identity aspects that put them at high risk of being targeted by coercive control and experiencing unique tactics of abuse related to their mental health diagnoses. This article highlights that lived experience expertise is essential for bridging the gap in policy and practice. [ABSTRACT FROM AUTHOR]

Drawing on data from a prospective pregnancy cohort (N = 1,507), this study examines the relationship between exposure to physical and emotional intimate partner violence (IPV) across the first 10 years of motherhood and women's mental and physical health. A measure of IPV (Composite Abuse Scale) was included at 1, 4, and 10 years postpartum. Past year and prior experiences of IPV were associated with mental and physical health issues at 10 years, both for mothers who had experienced combined IPV and emotional IPV alone. Awareness of the health issues associated with different types of IPV can assist in tailoring responses for women who experience IPV. [ABSTRACT FROM AUTHOR]

Objective: A recovery-based outreach program for people with severe mental illness in regional Victoria is described. The paper covers a description of the program, the services provided and outcomes achieved. The program emphasized active collaboration between patients and clinicians as outlined in the collaborative recovery model and recognized that recovery from mental illness is an individual, personal process. Conclusions: The program provided service to 108 people over 3 years and had a positive impact on clinicians, patients and carers. The benefits of recovery orientation, multidisciplinary teams, collaborative relationships and carer involvement are discussed. The paper highlights the need for a focus on recovery and comprehensive care for people with severe mental illness. [ABSTRACT FROM AUTHOR]

The study aimed to document the preferences of fathers in accessing and using parenting supports and to investigate the influence of a range of family contextual factors including paternal mental health, child disability, the co-parenting relationship and parenting sense of efficacy on fathers' help-seeking. Participants included a representative sample of 1,044 fathers of zero- to 18-year-olds. Results suggest that most fathers feel supported in their parenting role and rely on their own efforts (e.g. online searches) for information to support their parenting in preference to in-person interactions with professionals or attendance at groups. The co-parenting relationship and paternal mental health were also identified as important factors impacting on paternal help-seeking behaviours. These results from one of the largest surveys of fathers of its kind provide credible insights into the parenting help-seeking experiences and support needs of fathers, with clear implications for policy makers and service providers. [ABSTRACT FROM AUTHOR]

Objective: To assess depression literacy, help-seeking and help-offering to others in members of the police force in the state of Victoria, Australia. Methods: All staff in police stations involved in a cluster randomised controlled trial of an integrated workplace mental health intervention were invited to participate. Survey questions covered sociodemographic and employment information, recognition of depression in a vignette, stigma, treatment beliefs, willingness to assist co-workers with mental health problems, help-giving and help-seeking behaviours, and intentions to seek help. Using the baseline dataset associated with the trial, the paper presents a descriptive analysis of mental health literacy and helping behaviours, comparing police station leaders and lower ranks. Results: Respondents were 806 staff, comprising 618 lower-ranked staff and 188 leaders. Almost 84% of respondents were able to correctly label the problem described in the vignette. Among those who had helped someone with a mental health problem, both lower ranks and leaders most commonly reported ‘talking to the person’ although leaders were more likely to facilitate professional help. Leaders’ willingness to assist the person and confidence in doing so was very high, and over 80% of leaders appropriately rated police psychologists, general practitioners, psychologists, talking to a peer and contacting welfare as helpful. However, among both leaders and lower ranks with mental health problems, the proportion of those unlikely to seek professional help was greater than those who were likely to seek it. Conclusion: Knowledge about evidence-based interventions for depression was lower in this police sample than surveys in the general population, pointing to the need for education and training to improve mental health literacy. Such education should also aim to overcome barriers to professional help-seeking. Interventions that aim to improve mental health literacy and help-seeking behaviour appear to be suitable targets for better protecting police member mental health. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this paper are to provide an overview of recovery-focused models of care and discuss the implementation of the Strengths Model at St. Vincent's Mental Health Melbourne (SVMH), Victoria, Australia. Conclusions: The implementation of the Strengths Model at SVMH is discussed with particular emphasis on the process of implementation, service implications, practical challenges and dilemmas that have arisen, and proposed evaluation. Recovery-focused care is feasible and can enhance current practice of mental health services. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to outline the impact of Community Treatment Orders over a 20-year period on service delivery and clinical practice in Victoria. Conclusions: Community Treatment Orders, as utilized in Victoria, have undermined optimal service delivery and supported paternalistic, reductionistic clinical practice. The psychiatric profession has failed to advocate adequately for better mental health resourcing and human rights protection of those subject to Community Treatment Orders. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a profound psychological impact on our frontline healthcare workers. Throughout the entire second COVID-19 wave at one major tertiary hospital in Melbourne Australia, longitudinal qualitative data between perioperative staff members, and analyses of intrapersonal changes were reported. Inductive analysis of three open-ended questions generated four major themes: Organisational Response to the Pandemic, Psychological Impact, Changes in Feelings of Support Over Time and Suggestions for Changes. Understanding the challenges, perception and suggestions from this longitudinal study allows us to provide a range of support services and interventions to minimise the long-term negative psychological impact and be better prepared should another similar situation arises again. [ABSTRACT FROM AUTHOR]

Introduction: Family violence (FV) is one of the most urgent health issues of our generation. While nurses play a vital role in identifying and supporting victim/survivors of violence, little is known about nursing readiness to respond across clinical areas. Objective: This study aimed to compare and contrast the knowledge, confidence, clinical skills, and perceived barriers of nurses across three clinical areas of a tertiary trauma hospital in Melbourne, Australia, in responding to FV. Method: A prospective, mixed methods design was used. The nursing staff at a large trauma hospital were approached to participate. Participants completed a brief online survey to quantify clinician-reported knowledge, clinical skills, and barriers to managing FV. Results: Two hundred and forty-two nursing staff electronically completed a brief survey to capture self-reported confidence, knowledge, clinical skills, and barriers to working effectively in the area. The descriptive analysis reflected service-wide deficits in knowledge, confidence, and self-reported clinical skills, irrespective of the work area. Deficits were identified on a background of limited structured training for FV among this cohort. Significantly higher rates of FV confidence and knowledge were identified among emergency department nurses relative to acute and subacute clinical counterparts. Conclusion: Nurse respondents overall reported low rates of confidence, knowledge, and clinical skills in responding to disclosures of FV. Findings reinforce the need for imbedded training programs to support frontline responses. [ABSTRACT FROM AUTHOR]

Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults (n = 9) and primary caregivers of autistic adults (n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to document the processes towards ensuring that all psychiatrists in training in Victoria have appropriate Indigenous mental health experience and training. Conclusions: This paper describes the process of implementation of the 2004 Indigenous Mental Health Royal Australian and New Zealand College of Psychiatrists (RANZCP) Training By-Laws within Victoria. It is likely that the challenges of ensuring access to this training experience, within the Victorian RANZCP Training Program, have been experienced to varying degrees within other Australian training programs. The vertical integration of Indigenous health curriculum extends work being done in all undergraduate medical schools in Australia and New Zealand, and which the Australian Medical Council have incorporated into their accreditation of medical schools. [ABSTRACT FROM AUTHOR]

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

Objective: The aim of the project was to identify changes in the practice of electroconvulsive therapy (ECT) in a metropolitan mental health service before and after the Mental Health Act 2014 (2014 Act) in Victoria.Method: Retrospective clinical file audit of ECT administration across all three sites at Eastern Health (EH) two years before and two years after introduction of the 2014 Act.Results: There was a statistically significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT across the three hospitals at EH in the two years following the 2014 Act compared to the two years prior to the 2014 Act. There was no significant difference in the number of voluntary ECT treatments and in the number of patients who had voluntary ECT.Conclusion: The review showed that there has been a significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT after the introduction of the 2014 Act. Potential reasons for the changes are discussed. [ABSTRACT FROM AUTHOR]

Background: Up to two-thirds of athletes may not return to their preinjury level of sport by 12 months after anterior cruciate ligament (ACL) reconstruction surgery, despite being physically recovered. This has led to questions about what other factors may influence return to sport. Purpose: To determine whether psychological factors predicted return to preinjury level of sport by 12 months after ACL reconstruction surgery. Study Design: Case control study; Level of evidence, 3. Methods: Recreational and competitive-level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. The primary outcome was return to the preinjury level of sports participation. The psychological factors evaluated were psychological readiness to return to sport, fear of reinjury, mood, emotions, sport locus of control, and recovery expectations. Participants were followed up preoperatively and at 4 and 12 months postoperatively. Results: In total, 187 athletes participated. At 12 months, 56 athletes (31%) had returned to their preinjury level of sports participation. Significant independent contributions to returning to the preinjury level by 12 months after surgery were made by psychological readiness to return to sport, fear of reinjury, sport locus of control, and the athlete's estimate of the number of months it would take to return to sport, as measured preoperatively (x2 2 = 18.3, P\.001, classification accuracy = 70%) and at 4 months postoperatively (x2 4 = 38.7, P\.001, classification accuracy = 86%). Conclusion: Psychological responses before surgery and in early recovery were associated with returning to preinjury level of sport at 12 months, suggesting that attention to psychological recovery in addition to physical recovery after ACL injury and reconstruction surgery may be warranted. Clinical screening for maladaptive psychological responses in athletes before and soon after surgery may help clinicians identify athletes at risk of not returning to their preinjury level of sport by 12 months. [ABSTRACT FROM AUTHOR]

Information about the 2008 Royal Australian and New Zealand College of Psychiatrists Congress held on May 25-29 in Melbourne, Victoria is presented. Professor James Angus officially opened the Congress with a speech about working in partnerships and the development of the teaching of psychiatry at the University of Melbourne. Professor Ken Kirkby talked about education and learning in psychiatry and opportunities that the College provides in these areas.

• Summary: What characterizes the practice of expert mental health social workers? An observational study of social workers in a public mental health network in Melbourne, Australia sought to answer this question and the findings are reported in this article. As part of a larger study of mental health social work expertise, direct observation was done of the work of six practitioners engaged in a range of activities about which they were subsequently interviewed. • Findings: In the first stage based on group interviews, six themes were identified. These were termed: 1) 'The Knowledge'; 2) 'A lot of hard grind'; 3) 'We are here for the clients'; 4) 'The complicated and the difficult'; 5) 'The stone in the shoe'; and 6) 'Going ten rounds with the system'. In this second stage observational study, evidence was found for all of these six themes, plus two additional ones relating to supervision and the emotive content of the work. • Applications: Development of expertise consists of three elements: 1) a personality predisposition and personal capacity; 2) education; and 3) a conducive workplace environment. The application of the findings lies in developing the conditions for these elements to emerge. [ABSTRACT FROM AUTHOR]

In 1995, the Royal Children's Hospital Mental Health Service in Melbourne developed the first telepsychiatry programme in child and adolescent mental health services (CAMHS) in Australia. A survey of 25 CAMHS clinicians in five rural regions who had used videoconferencing showed that 64% had used the technology for more than 18 months, and 20% had used it for 7–12 months. Also, 60% had used the technology on over 30 occasions, and 24% had used it on 20–29 occasions. Respondents clearly recognized its benefits in terms of their increased knowledge and skills (96%), strengthening of relationships with colleagues (92%) and decreased sense of isolation (92%). To build on the success of telepsychiatry there are a number of challenges that health service managers will need to address. Telepsychiatry works most effectively as a tool to complement face-to-face contact. It cannot be promoted as the total solution to the issue of isolation from mainstream services. [ABSTRACT FROM AUTHOR]