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Indigenous people are over-represented in inpatient mental health care in Australia. Evidence suggests client-orientated care planning increase client engagement, reduce substance dependence and improve self-management among Indigenous people. The successful uptake and implementation of interventions, however, which promote access and cultural security in primary care practice, remains challenging. The Aboriginal and Islander Mental Health initiative introduced a multi-faceted approach to client-oriented care planning, as part of routine care to the Royal Darwin Hospital inpatient psychiatric unit, to determine whether there was change in the quality of care to Indigenous clients over time. The study used a mixed methods design. It was underpinned by an action-oriented research approach and incorporated stakeholder engagement, interactive training in strengths based recovery approach and psycho-education and a quantitative audit of inpatient files. The results suggest some improvements in quality of care for clients in the inpatient unit with increased attention to social and family history, involvement of translators, and allocation of case managers. Cross-cultural training and tools promoted change in some aspects of clinical practice. Some changes, however, were often not sustained and it did not necessarily promote engagement of AMHWs in routine care. Greater emphases on follow up training and provision of clinician feedback, in conjunction with high-level system change and commitment to introduction of culturally adapted recovery principles, is required for more sustained changes to clinician care and implementation success. [ABSTRACT FROM AUTHOR]

Aim: This study sought to determine factors associated with general practitioner (GP) recognition of emotional distress in Australian general practice. Methods: Twenty eight GPs completed a clinical audit in which they noted their identification of any emotional distress in their patients, while 868 of their patients completed the General Health Questionnaire (GHQ-28). The GHQ was scored with the conventional 4/5 cut-off. GP recognition was determined by a comparison of the GP record of emotional distress and the patient GHQ. Logistic regression was used to examine which patient and GP characteristics influenced correct recognition. Results: The GHQ identified 48% of all patients as probable cases. GPs identified 34% of their patients as having emotional distress, correctly recognizing 43% of GHQ cases. Overall, specificity was high (8 1%), though sensitivity was modest (43%). For individual GPs the rate of correct recognition varied considerably, from 4% to 100%. Correct recognition was associated with years experience as a GP, older age of patient and greater severity of distress. Conclusions: The data raise questions about the possible oversensitivity of the GHQ. The clinical skills associated with the recognition of mental illness and of emotional distress are obviously complex, and take time and experience to develop. Reassuringly, GPs are recognising most of the more severe depressions. [ABSTRACT FROM AUTHOR]

Data from a large field trial were used to test the propositions that the HoNOS is a unidimensional scale and that the original subscale structure fits the data and is valid. Low inter-item correlations suggest that the scale in not unidimensional. Low internal consistencies of the original subscales were also found. Confirmatory factor analysis was used to test the fit of the original subscales, which was found to be poor. An alternative subscale structure is described which fits the data much better, differentiates diagnostic groups better, and accounts for movements between in-patient and out-patient status better. The implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Judgements concerning psychiatric clients' adherence to medication regimes may vary according to whom one asks, but little is known about the agreement between informants. In this study, independent ratings of compliance were obtained from doctors, case managers and clients with serious mental illness in receipt of community psychiatric services. The majority of clients were compliant according to all three information sources. The agreement between doctors and case managers was strong, but much weaker between them and their clients. Rated compliance was not related to age or gender, but clients who were on statutory compulsory treatment orders, and who received their medications by injection, were more likely to be rated as non-compliant. Clients who refused an interview were rated by staff as less compliant, and were more likely to be on compulsory treatment orders. One in eight clients who rated themselves as less than fully compliant were thought by their doctors and case managers to be compliant. [ABSTRACT FROM AUTHOR]