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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 new RANZCP guidelines for the treatment of schizophrenia and related disorders highlights what we know works. In this paper, we examine why patients so often fail to benefit from this knowledge and why clinical practice falls so far short of the recommended standard. Instead of the continuous improvement that we expect of health care in general, in psychiatry we face an accelerating decline in systems of care. There has been a sustained underinvestment in public mental health care and a shared failure by State and Federal governments to construct and commit to a governance and funding model that can deliver the standard of care that is available in other major non-communicable diseases, and which we know is equally possible for severe mental illness. This paper sets out some of the reasons for the poor quality of care received by many people with schizophrenia and related disorders in Australia, and describes ways that care could be improved. In particular, we recommend an explicit statement of what constitutes an adequate standard of care, for people at all stages of these illnesses. This would help provide transparency about whether the care provided by mental health services achieves these benchmarks, and enable publication of results comparing the performance of different states and regional services. Patients and families, as well as professional, consumer and carer organizations would then be able to see clearly where the deficits are and demand resources and care that match the recommendations. [ABSTRACT FROM AUTHOR]

Objectives: Reducing or eliminating seclusion from mental health care settings has been a national priority for Australia since 2005. This paper describes Australia's national seclusion data collection, and summarises changes in seclusion rates in Australian public mental health services.Methods: Seclusion events per 1000 patient days were calculated from 2009-2010 to 2014-2015 utilising state and territory administrative data sources. Combined national data were used to calculate results for a number of service characteristics, such as target population and location of the service.Results: The rate of seclusion events decreased by 43% over the 6 years. Child and adolescent services reported consistently higher rates of seclusion, but a shorter duration of seclusion episodes, compared with other service types. There is high variation in seclusion rates between individual services (range 0.0-53.0 seclusion events per 1000 bed days in 2014-2015).Conclusions: Seclusion event rates in Australia's specialised public acute mental health hospital services are declining. The use of existing administrative data was instrumental in establishing a national data source to facilitate the monitoring and reporting of progress of seclusion reduction strategies. [ABSTRACT FROM AUTHOR]

Objective: The term 'missing-middle' has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the 'missing-middle' term, founded on qualitative and quantitative research.Conclusions: Despite the widespread use of the term 'missing-middle' for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the 'missing-middle' care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to 'missing-middle' programmes that may not improve Australian public health outcomes. [ABSTRACT FROM AUTHOR]

Objective: Clinical psychologists are practitioners with expertise in mental health, who apply advanced psychological theory and knowledge to their practice in order to assess and treat complex psychological disorders. Given their robust specialised mental health training, clinical psychology is an integral component of the Australian mental health workforce, but is under-utilised. Recent reviews have identified significant problems with Australia's mental health system, including unequal access to clinical psychology services and fragmentation of service delivery, including convoluted pathways to care.Conclusions: Clinical psychology is well placed to contribute meaningfully to public mental health services (PMHS). We describe what clinical psychologists currently contribute to team-based care in PMHS, how we could further contribute and the barriers to making more extensive contributions. We identify significant historical and organisational factors that have limited the contribution made by clinical psychologists and provide suggestions for cultural change to PMHS. [ABSTRACT FROM AUTHOR]

Objective: To describe key practical knowledge and skill components required for clinicians involved with the assessment of military personnel and veterans.Conclusions: Assessment of military and veterans' mental health issues involves a tailored history-taking process that includes specific aspects of service, transition and reporting requirements. Recommendations for the detailed assessment of military personnel and veterans are provided. Comorbid conditions, chronic pain and the needs of both women and older veterans are also discussed. [ABSTRACT FROM AUTHOR]

This paper examines the process of psychiatric diagnosis in a community mental health center walk-in clinic. The results indicate a great deal of conflict and contradiction in the psychiatric evaluation. This is discussed in light of several tensions: (1) mixed agendas surrounding diagnosis; (2) conflict between training and professional practice; (3) conflict created when a public facility is staffed by an elite medical school; (4) conflict between providing mental health services while serving the needs of other public agencies and mandates; and (5) conflict between an ascendant biopsychiatric model and the daily work of clinical therapeutic service. [ABSTRACT FROM AUTHOR]

This paper reports a study of the premedical student culture at a major university, based on fieldwork and interviews with 30 premedical students. The paper examines the role of stereotypes in the premedical culture; specifically, the common belief in "cut-throats" among premedical students. Cut-throats are described as excessively competitive, selfish, gradehungry students who cheat, steal books and lab reports, and sabotage lab experiments. Despite the widespread belief, our findings suggest cut-throats are a myth. We found more evidence for cooperative than cut-throat behavior. The myth emerges from the competitive and pressured situation of premedical students and the uncertainty of the medical school admission process, and is in part a manifestation of students' collective anxiety. More significantly, it provides cultural explanations for failure and success for premedical students. We discuss its connection to the general premedical stereotype and its relation to pre-medical education. [ABSTRACT FROM AUTHOR]

Few researchers have explored Canadian migrants' experiences of mental health and service access. We interviewed 10 migrants to Canada from a local settlement organization about mental health and services and 5 organization staff about their experiences supporting migrants' mental health and service access. Our interviews with migrants revealed cultural perceptions of mental health and unmet service needs. Our focus group with staff indicated challenges experienced by migrants and the tension between their openness with mental health difficulties and stigmatization from their cultural communities. A call to restructure existing mental health support for this underserved population is needed. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [ABSTRACT FROM AUTHOR]

The police have underdeveloped links with mental health and social care services despite daily contact with mentally ill individuals. They struggle with identifying and managing the mentally ill in custody, and consistently express a lack of support from partner agencies. In 2010, our research team developed a mental health screening tool and pathway for use by police custody officers, The Police Mental Health Screening Questionnaire (PolQuest). However, due to the large number of agencies with different organisational goals and responsibilities that deal with mentally disordered offenders, the introduction of a screening tool alone was considered insufficient. Thus, an action learning group comprising key professionals from relevant services in one geographical area was tasked with developing a manual and training materials to support the implementation of PolQuest by frontline staff. This paper reflects upon the key themes that emerged from the experience of action learning as a method for engaging multi-agency staff, operating under different occupational goals and cultures, to develop shared practice-oriented outcomes. Data analysed include the facilitator’s reflective notes, meeting minutes and emails. The action learning process was considered a useful method for engaging multi-agency stakeholders in developing materials to support PolQuest’s implementation in vivo. [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]

Objectives: The aim of the study was to identify mental-health-relevant literature accessible to policy makers and healthcare workers in the island nations of the Western Pacific.Methods: Material collated to support the inaugural Leadership in Mental Health: Island Nations course held in Cairns in May 2015 was used as the basis of a "rapid review".Results: The rapid review considered 303 documents identified by a search carried out using James Cook University's OneSearch, Google Scholar, and the authors' knowledge. Search terms included mental health and the like, and terms with Pacific and current Pacific island country names. Findings were classified by region/country, year of release/publication, mental health issue addressed, peer-reviewed or grey literature, and type of study. Almost half of the findings had been released in the previous five years. However, only 36% were peer-reviewed publications and only 3.6% of the findings were intervention studies.Conclusions: There is limited easily accessible documentation to confidently direct practice or policies regarding which strategies are likely to be effective in responding to the high rates of mental ill-health experienced in the Pacific island nations, or to plan for increases as a consequence of rapid social and demographic changes that are transforming Pacific island societies. [ABSTRACT FROM AUTHOR]

Objective: Aboriginal and Torres Strait Islander individuals are overrepresented in mental health services in the state of Queensland (QLD), Australia; indicating greater prevalence and less preventative management of mental illness. This paper describes a project to enhance the model of care to improve mental health, alcohol and other drug outcomes for Aboriginal and Torres Strait Islander Community members in two metropolitan Hospital and Health Services, in Brisbane, Australia.Methods: Individual and focus group consultations were conducted with stakeholders, to determine key themes.Results: The consultative phase of the project revealed three priority areas for action: governance and supervision arrangements for the workforce in the area of Indigenous mental health, alcohol and other drugs; the cultural capability of non-Indigenous clinicians; and consumer access to services.Conclusions: The Way Forward project is a broad workforce redesign approach to address these three key areas. This approach is designed to acknowledge the strengths among the Indigenous Aboriginal and Torres Strait Islander workforce and to utilise their specialised cultural knowledge. This strategy will also include working in relationships with key Community-controlled health and other organisations. The approach will be reviewed and evaluated. [ABSTRACT FROM AUTHOR]

Objective: Identification of need for specialist assessment and the use of relevant cultural information to inform mental health assessment and care are two key factors in improving Aboriginal and Torres Strait Islander access to and experience of mental health care. This paper describes the Here and Now Aboriginal Assessment tool (HANAA) and the Cultural Information Gathering Tool (CIGT), two instruments developed to be used respectively by non-mental health clinicians and Aboriginal and Torres Strait Islander mental health workers.Method: Following widespread consultations and feedback, two independent groups of mental health clinicians based in Western Australia and Queensland were involved in developing the HANAA and CIGT.Results: Both the HANAA and CIGT fill unmet needs in terms of instruments that can be used by non-specialists working with Aboriginal and Torres Strait Islander people.Conclusions: Preliminary use of the HANAA and CIGT suggests that they are well received, easy to deploy and effective instruments that promote cultural security and communication with Aboriginal and Torres Strait Islander people. [ABSTRACT FROM AUTHOR]

Introduction: An adequate quantity and quality of sleep is a necessary pre-requisite for optimal occupational performance and participation in everyday life. Occupational therapists in various settings encounter people who are affected by sleep problems, but the contribution occupational therapists can make to help those experiencing sleep problems has not yet been fully defined. Method: This paper reports upon a focus group study designed to elicit the views of occupational therapists working in mental health settings (where sleep disturbances are particularly prevalent) regarding their role in relation to sleep problems. Thematic analysis using a constant comparative approach was used to capture key themes. Findings: Occupational therapists identified sleep as a significant and persistent occupational problem for many of their clients, and acknowledged that sleep was often overlooked. Although they could identify a series of possible strategies to address sleep needs they were uncertain regarding optimal practice. Conclusion: Sleep is a valid and relevant area of concern for the profession. Given the findings of this study and the paucity of literature there is an urgent need to identify, design and evaluate occupational therapy assessments and interventions to address sleep problems in mental health and in other settings. [ABSTRACT FROM AUTHOR]

Until around 1979, ‘confused’ or mentally unwell people over 65 years of age tended to be labelled as having ‘senile dementia’. Senile dementia was usually regarded as a single, inevitably hopeless condition, despite gradually accumulating clinical and pathological evidence to the contrary. Specific psychiatric services for mental illness in older people began to emerge in the 1950s, but by 1969 there were fewer than 10 dedicated services nationally. During the 1970s, ‘old age psychiatrists’ established local services and campaigned nationally for them. By 1979, about 100 old age psychiatrists were leading multi-disciplinary teams in half the health districts in England. This paper explores the tortuous development of these new services, focusing on provision for people with dementia. [ABSTRACT FROM PUBLISHER]

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Objective: The aim of this paper is to assess young people's awareness of mental health organizations supporting their age group. Of particular interest was awareness of headspace, which was created in 2006 to provide youth-oriented mental health services, and of beyondblue, which aims to raise community awareness of depression, anxiety and related disorders. Method: A telephone survey was carried out on a national sample of young people who were part of a 2-year follow-up study of youth mental health literacy. Data were analysed for those aged 13–25 years. Results: Awareness was highest for beyondblue and telephone helplines; headspace had established some awareness, particularly in areas where its services operate. However, awareness was unrelated to the participant's psychological symptoms in the past year. Conclusions: If youth-oriented services are to be successful, young people need to know about them. Awareness campaigns need to be targeted at the sub-group who have greatest need for these services, namely those with mental health problems. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to provide further outcome data on a novel consumer-clinician co-taught borderline personality disorder training program. Method: Participants (n=216) who attended consumer-clinician co-taught borderline personality disorder training had their ratings of the training compared to ratings of participants who attended the previous clinician-only borderline personality disorder training. Results: Mean training ratings of the consumer-clinician co-taught borderline personality disorder trainings were 37 percentile points higher (77th vs 40th percentile) than the ratings of the previous clinician-only borderline personality disorder training, which already had evidence of effectiveness. Conclusion: Data confirm preliminary findings that adding a consumer-presenter to training adds considerable value. [ABSTRACT FROM AUTHOR]

The California Community College (CCC), the largest system of higher education and provider of workforce training in the nation, serves approximately 2.1 million students across its 116 campuses. CCCs work to reduce barriers to academic success by providing mental health services (MHS). However, CCCs provide MHS on a short-term model because of limited staffing and high demand with most campuses placing a restriction of six to eight sessions per academic term. A referral list of local agencies is typically provided for students who need continued care, though students often do not know how to explore options or navigate their health insurance benefits. During the 2020-2021 academic year, an MH navigator program was piloted at four community colleges in a San Francisco Bay Area county. Participants included 10 students with academic/career interests in social work, nursing, and the social sciences. Fall Semester 2020 focused on increasing students' knowledge on mental health topics, while Spring Semester 2021 focused on experiential learning through case management of student clients. The navigator pilot program showed promising results with navigators gaining practical experience and exposure to mental health careers while assisting their peers from campus-based to community-based care. Future efforts will focus on cultivating stronger relationships between navigators and MH liaisons. Doing so will help staff develop greater familiarity of the navigator's role, thus ensuring an increase in usage of its services and allowing the student–client a smoother transitioning experience from campus-based to community-based care. [ABSTRACT FROM AUTHOR]

Black men reportedly have a high prevalence of mental illness with little to no counseling engagement. While there have been studies to determine potential influences on their lack of counseling utilization, the lack of impact toward progress and the scarcity of such literature in the counseling field proves the need for continued exploration. Many of these studies have been conducted by scholars in other social science disciplines with few done by counseling scholars. A review of research concerning Black men and counseling utilization is presented using BlackCrit as a theoretical framework. Racism and masculinity are highlighted as barriers to mental health treatment which require further exploration in counseling literature. Recommendations for improving future research and advocacy efforts are provided for counselors and other mental health professionals. [ABSTRACT FROM AUTHOR]

Introduction: Online mental health services were previously found to be effective in many studies. However, this method was not generally used in Israel. By the end of 2019, the coronavirus disease 2019 pandemic erupted, forcing mental health services to transition to online meetings to maintain the standard of care. In this cross-sectional study, we investigated the attitudes of adolescent patients toward this involuntary new mode of care. Methods: Forty-four adolescents (mean age 14.62 ± 2.12 years, 54.5% females) and 40 of their primary caregivers completed a battery of questionnaires that included the telemedicine satisfaction questionnaire, session evaluation questionnaire, working alliance inventory, and pediatric symptom checklist. Results: Both adolescents and their caregivers reported a reasonable experience with the online medium and a feeling that the meetings were overall powerful, helpful, and comfortable as demonstrated by medium to high scores on the telemedicine satisfaction questionnaire and session evaluation questionnaire questionnaires. A therapeutic alliance was generally maintained according to working alliance inventory scores. However, working alliance inventory scores were negatively correlated with higher levels of internalizing symptoms and parental stress. Discussion: Our findings point to the possibility that anxious/depressed adolescents will have greater difficulties re-establishing therapeutic alliance when transitioned from in-person to online meetings. This may be due to the introduction of an "invisible" third party to the therapeutic setting—the computer. Psychologists and psychiatrists should be aware of these difficulties and respond adequately to maintain the standard of care. [ABSTRACT FROM AUTHOR]

Since the outbreak of COVID-19, there has been a major increase in anxiety and depression. For many, online music fandoms have offered an important platform to combat loneliness and aid well-being. In this study, I use autoethnography, supported by psychosocial theory on recovery and sociological theory on music fandoms, to track my personal journey of recovery (2020–2022) from a mental health crisis through the support of the Rory Gallagher Instagram fan community. Specifically, I investigate how the community acts as a positive support mechanism for well-being, how my relationship with Rory and his music has changed since joining the community, and how knowledge of Rory's own personal struggles, coupled with my own experiences, have empowered me to become a mental health advocate. Overall, the study brings attention to the importance of online music communities as informal, holistic regulating agents for mental health conditions and offers alternative ways for health services to approach mental health care. [ABSTRACT FROM AUTHOR]

Asian Americans (AA) in the United States, and throughout the world, commonly hold a negative connotation or stigma regarding seeking mental health services. Unique cultural stigmas and beliefs of AA play an important role when examining why this population group is less likely to engage in therapy. This article explains why these cultural stigmas and beliefs contribute to the lack of mental health help seeking. Through examining these stigmas, perception of therapy, loss of face, and parental control among AA will allow therapists to have a better understanding when they are working with this population. Also, the consideration is given of how the increase of Anti-Asian racism due to the COVID-19 pandemic affects AA and the challenges it creates. This article includes a case example that provides information on how stigmas impact an AA family who have differing cultural values and expectations while experiencing discrimination from COVID-19. [ABSTRACT FROM AUTHOR]

Research related to military spouses accessing community-based mental health care is limited. Evaluations identifying outcomes of anxiety, depressive symptoms, and resilience are scant. In this study, 71 military partners and spouses (age M = 39.79, SD = 11.32; 97.2% women) receiving counseling services at a nonprofit agency completed self-report measures of anxiety, depressive symptoms, and resilience pre–post a 6-week intervention. Less depressive symptoms predicted higher resilience at intake of services, with medium statistical significance. In pre–post analysis, no statistically significant changes were noted to anxiety, depressive symptoms, or resilience, with small to medium effect sizes and unimproved conditions with no clinical significance. This study represents an evaluation of services from a single site utilizing individual counseling services. [ABSTRACT FROM AUTHOR]

This exploratory study examined the intersections of Middle Eastern and North African (MENA) American cultural identity and attitudes towards mental health and mental health services. Fifteen in-depth narrative interviews with participants of MENA descent in the United States were analyzed using qualitative thematic content analysis, revealing five primary themes within these data: denial, lack of awareness, stigma/shame, collective identity, and resistance. These results indicate cultural identity plays a unique and significant role in how this population understands and responds to mental health and substance use challenges, in a way that often creates barriers to social service provision and success. Implications and suggestions for how these findings might be used to develop more culturally competent and effective social work interventions for MENA communities are discussed. [ABSTRACT FROM AUTHOR]

Young people leaving foster- and residential care more often indicate having mental health problems than their peers from the general population. International research has extensively studied these mental health outcomes of care leavers. However, in Flanders (the Dutch speaking part of Belgium), no previous quantitative studies are known. This longitudinal study explores outcomes of depression, anxiety, sleep and general mental health of care leavers in Flanders and investigates if these outcomes improve in the years after leaving care. Associations with placement factors are explored to support recommendations to the clinical field. The current study involves 175 care-leavers. The participants of the study are between 18 and 27 years old at the start of the study and have all left care. Data was collected using a self-reporting questionnaire touching multiple domains. On all domains, no significant differences between foster- and residential care leavers are found. Residential care leavers more often indicate depressive symptoms than their peers from the general population. Foster care leavers more often indicate sleeping problems. Regarding anxiety, no differences are found. In all conducted analyses, the number of years in care, the age of starting and leaving care, the different types of support during care and whether aftercare was offered were included. However, none of these factors provide a sufficient explanation for the outcomes found. On all scales, the effect of gender, the number of placements and the reason of placement do recur. This indicates the importance of these factors. Policy makers should focus on improving placement stability and extra support for children who were placed due to own emotional or behavioral problems or maltreatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to inform mental health professionals about Activity-based funding (ABF) and the implications for data collection and clinical practice, in particular for consultation-liaison (CL) psychiatry.Conclusions: Activity-based funding may provide an opportunity for mental health services to be more equitably resourced, but much needs to be done to demonstrate that the funding model works in mental health. It is important to ensure that data collected is meaningful and accurate and reflects the diverse roles of mental health clinicians, including in CL. Inpatient and community services should be integrated in the model, as well as safeguards against potential abuse. Clinicians, in partnership with initiatives such as the Australian Mental Health Outcomes and Classification Network, are best placed to guide the development of an ABF system for mental health which appropriately recognises the complexity and variability between patients in different settings. [ABSTRACT FROM AUTHOR]

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]

Objectives: The aims of this paper are to quantify the effect of an innovative perinatal mental health program, the Early Motherhood Service, to identify factors contributing to its success, and to make recommendations as to its general applicability across other rural services. Method: The study involved stakeholder evaluation, analysis of available outcome data and analysis of consumer feedback data. Results: Service functions were grouped into four key areas: increasing awareness of perinatal mental health problems; providing information and advice; providing treatment and support; and education, training and capacity building. Women accessing the service showed significant improvement in outcomes as measured by change over time in the Edinburgh Postnatal Depression Scale and the Health of the Nation Outcome Scale. Consumer feedback demonstrated that the service was highly valued. Key factors identified as contributing to the service's success were broad coverage of perinatal mental health problems; inclusion of early intervention and prevention; outreach capacity; partnership with, support for and capacity building of other health providers; a location which is accessible and non-stigmatizing; and staff comprising senior and skilled clinicians. Conclusions: The Early Motherhood Service is an innovative perinatal mental health service. It provides a useful model for the development of such services in rural communities. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to identify risk factors associated with readmission within 28 days of discharge from eight Australian adult acute mental health inpatient services. Method: A detailed file audit was conducted comparing 222 patients readmitted within 28 days of discharge with 253 patients not readmitted during the same period. Results: There was an association between early readmission and having had contact with the service in the previous 12 months (51% vs 21%), having been admitted in the previous 12 months (65% vs 36%), and having been diagnosed with an emotionally unstable personality disorder (14% vs 4%). Those who were not readmitted had a significantly higher score in the Health of the Nation Outcome Scales on index admission than those who were readmitted. Those who had community team contact on the day of discharge and those who received follow up by the mental health team within 7 days of discharge were more likely to be readmitted (55% vs 45% and 29% vs 19% respectively). Conclusions: Significant determinants of early readmission identified were a history of recent previous admissions and a diagnosis of unstable personality disorder. The usefulness of this performance measure to Area Mental Health Services and clinicians is discussed. [ABSTRACT FROM AUTHOR]

Objective: This paper describes the adult mental health forums that were conducted as part of the National Mental Health Benchmarking Project (NMHBP). Method: Eight adult mental health forums were attended by staff from eight adult mental health services from around the country. The forums provided an avenue for these participants to document their organizations'' performances against previously agreed key performance indicators (KPIs), and to compare this performance with that of their peers. The forums also encouraged discussion about appropriate targets. Results: Forum participants found that the inter-organizational range for many of the KPIs was substantial, and they used this to inform practice change within their own organizations. They also found that they could set ''alert targets'' and ''good practice targets'' for some KPIs but not others. The discussion that ensued informed participants'' understanding of factors that were within the control of their organizations that could be modified to improve service quality. Conclusions: Benchmarking in adult mental health services is not only possible but also likely to be extremely worthwhile as an exercise in improving service quality. For benchmarking to realize its potential, it requires strong national and local leadership, and a spirit of openness on the part of participating organizations. [ABSTRACT FROM AUTHOR]

This research concerns mental health workers who treat the victims of sexual abuse. The health workers were all part of a forum composed of doctors, counsellors and a community psychiatric nurse, who met to discuss issues of best practice in their everyday work. The research examined how these workers make sense of their work, particularly in terms of how they understand the concept of care and the kinds of knowledge that they use in their work, professional and otherwise. A great deal of scepticism was expressed concerning the traditional medical approaches to caring for the victims of abuse, and as a consequence these practitioners developed pragmatic and exploratory approaches to caring in order to help their clients. Many important similarities exist between the accounts given by the medical and voluntary practitioners of this forum and the insights of Michel Foucault’s genealogical studies of medicine, particularly his analysis of processes of normalization and his later work on the care of the self. This paper provides a re-evaluation of the concept of mental health care in terms of Foucault’s concept of ‘the care of the self’. [ABSTRACT FROM AUTHOR]

Objective: This paper describes a training program in mood disorders for senior mental health clinicians in the Pacific region and presents the qualitative evaluation findings. Method: The program, which incorporated a 2-week intensive course in Sydney and follow-up in-country, was undertaken by 13 clinicians from the Ministries of Health in seven Pacific Island countries. Evaluation data were gathered throughout the program. Participating individuals and their respective Ministries also completed an activity completion report. Results: The evaluation was very positive. Individual and organizational reports documented immediate and expected ongoing benefits and expressed a desire for continuing collaboration. Conclusions: The program has resulted in a major boost to regional expertise and leadership in mood disorders. Furthermore, it has made an important contribution to the implementation of individual country mental health policies, one which strengthens the regional mental health network and builds new connections with Australian institutions. Success was based on a collaborative approach, high levels of institutional and individual commitment, and careful attention to both content and process issues. Sustainability will be enhanced through ongoing collaborative in-country and regional activities. [ABSTRACT FROM AUTHOR]

Objective: Suicide is a global health priority. It is important to analyse the effects of investment in mental health services on suicide rates. This paper presents and discusses recent changes in suicide rates and diagnostic mix among clients of the mental health service in Auckland during a time of service growth. Method: Details of suicides among current clients were analysed for the years 1993 to 2006, comparing the periods 1993-1999 and 2000-2006. These periods were compared with the local population and national figures. Results: The local population suicide rate decreased significantly with the rate among clients increasing slightly so the proportion occurring among clients increased (up to 31%). There was an increase in non-psychotic diagnoses. Conclusions: As access to services expands the proportion of suicides that occur in known clients will paradoxically increase. Service expansion may have contributed to the falling population suicide rate in Auckland. [ABSTRACT FROM AUTHOR]

Objective: Psychiatric disorders commonly occur during pregnancy and in the postpartum period, posing substantial risks to both mother and unborn child. Consequently, screening for maternal psychiatric disorder during pregnancy and in the postnatal period has been advocated. In this paper, we describe the development and evaluation of a screening tool for use with a ‘high risk’ demographic group – adolescent women seeking maternity care. Conclusions: The tool was developed to identify women with, or at risk of, psychiatric disorders requiring specialist assessment and/or treatment, rather than only those with psychosocial concerns and/or distress, or with depressive symptoms alone. The tool was administered by midwives and used during discussion at the maternity team multidisciplinary meeting to facilitate referral or seek advice through secondary consultation. The tool was well accepted by the women attending the clinic. All women in the group who received psychiatric care later – either during confinement or during the 6-week postnatal period of follow-up – had already been identified by the tool in the antenatal period. Arguably, the tool enabled early intervention, treatment planning and effective care. We suggest that rather than adopting a ‘one size fits all’ approach, any screening should be tailored to the population of interest. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the establishment of an integrated young person's mental health service and the findings of a qualitative evaluation conducted 2 years after its establishment. Method: A qualitative evaluation of the service was undertaken using a semi-structured interview, a service satisfaction survey and partnership analysis tool. Results: The major problems encountered in establishing the service were insufficient recognition of the cultural challenges in working together, difficulty in recruiting general practitioners, establishing a youth friendly environment and maintaining the quality of the relationship between partners. Conclusion: Despite almost 3 years of preparation, many important aspects of change management were underestimated or inadequately attended to. [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 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: This paper outlines the development of the Resource Team, an innovative service delivery model supporting clinical services at the Inner North Brisbane Mental Health Service, Royal Brisbane and Women's Hospital Health Service District. The team aims to provide a base for specialist mental health support staff, improve knowledge management and support the development of meaningful community partnerships. Method: Development of the team included a literature review and consultation with internal and external stakeholders. From this, the objectives, roles and functions of the team were clarified and disseminated to stakeholders. Results: The team currently encompasses 12 positions and has initiated a number of programs and service developments. These include improved IT management of clinical resources and the development of partnerships with the community and non-government sectors. Conclusions: The Resource Team effectively coordinates specialist clinical support positions, addresses knowledge management issues and facilitates meaningful engagement with the community and non-government sectors. The model could easily be applied in other mental health and general health services. [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]

Objective: There is an emerging consensus that the assessment and management of adverse outcomes in mental health, such as violence and self harm, is best achieved by approaches which incorporate validated tools using “structured professional judgement”. Although several useful tools have emerged from the literature, there is no clear consensus on the best way to integrate these with clinical practice. This paper describes a framework, the Forensicare Risk Assessment and Management Exercise (F.R.A.M.E.), employed by a statewide community forensic mental health service, which incorporates two structured professional judgement tools, and explicitly integrates these into case management and psychiatric treatment. The potential benefits of the framework are discussed in the context of contemporary trends in risk assessment and management. Conclusions: The F.R.A.M.E. appears to assist with the task of integrating risk assessment with clinical management. Formal evaluative research is indicated before it can be recommended for use by other services. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to examine the effect of changes to a consultation-liaison (C-L) service at Maroondah Hospital on referral and service delivery patterns across a period of 7 years. There is no national benchmarking of C-L service. Local services respond to local political and service demands. There have been significant changes to the C-L service at Maroondah Hospital between 1999 and 2006. During the intervening years, psychogeriatric referrals have been included and gazetting of general hospital beds has resulted in detention of patients under the Mental Health Act (MHA). Method: Clinical audit data from assessments by the C-L service during the above period were entered into a database and analysed. Results: The annual referral rate increased as did the mean age of referred patients. The main reason for referral changed from suicide evaluation and history of psychotic symptoms to depression. Referral lag time did not change significantly. A higher proportion of patients received a single consultation and a greater number required psychiatric inpatient care. Conclusion: The nature of referral changed towards older, sicker patients and away from younger, suicidal patients which, together with an increased referral rate, significantly increased demand on available resources. [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 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]

Objective: The aim of this paper is to describe a model for consultation with Aboriginal stakeholders used in the development of a training course, by the NSW Institute of Psychiatry, about young people's mental health and wellbeing. Historical, social and political factors contribute to the elevated rates of mental distress and disorder experienced by many Aboriginal young people. However, these young people often do not receive the help they need. Knowledge, skills and attitudes of clinicians are associated with the uptake of services. Therefore, a training course for clinicians was developed utilizing a detailed consultation process with Aboriginal stakeholders. Conclusions: The course was delivered as part of an ongoing comprehensive interagency training program for 2000 clinicians. The course was positively evaluated by participants and stakeholders, suggesting that the course development, including the consultation process with Aboriginal stakeholders, was effective in meeting participant and stakeholder needs. Agencies may be interested in the application of this model to consultation processes with Aboriginal communities and with other populations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine the role of consumers as service providers and to describe the successful employment of peer support workers in a public mental health service. Conclusions: The Peer Support Worker program in Adelaide, South Australia is consistent with evidence obtained from previous research in demonstrating the successful training and employment of consumers as peer workers in a public mental health service. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to present the findings of a survey of consumers of mental health services who are working (in either paid or unpaid positions) in NSW Health and in the Non Government Organisation sector in NSW. Method: A survey was distributed through the NSW Consumer Advisory Group newsletter to elicit the roles and assess the training needs of consumer employees, as well as those who were working in voluntary capacities as consumer representatives, within the mental health system in NSW. Results: Many mental health consumers have been placed in the untenable position of being engaged in representation and/or advocacy roles with unclear job descriptions and no training. The majority of consumers want a code of ethics and performance standards for consumer workers. Conclusions: The rhetoric of consumer participation is not matched by effective and timely strategies that ensure that consumer involvement is underpinned by relevant training and supportive infrastructure. The goal of meaningful consumer participation in mental health services, as outlined in policy, is yet to be achieved. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe an initiative in Victoria, Australia, aimed at improving the detection and management of co-occurring mental health issues within the youth Alcohol and Other Drug (AOD) sector. Conclusions: Over the past 4 years, in partnership with local youth AOD services, we have developed a successful service model that addresses co-occurring mental health issues within the youth AOD sector. However, such capacity-building requires the full support of workers and senior management, and a cultural shift whereby the assessment and management of mental health issues are seen as a priority and core service issue. The capacity-building process was facilitated by embedding experienced mental health clinicians within each service to support and implement the initiative. This model offered learning opportunities through the modelling of relevant skills and the provision of 'on-the-job' training. Such approaches demonstrate that integrated models of care can be delivered within youth AOD services, although further research is needed to determine their effectiveness. [ABSTRACT FROM AUTHOR]