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Background: Suicide in young people is a leading cause of death. Interventions that are reflexive, tailored, and developed in concert with this at-risk population are needed. This study aimed to integrate lived-experience into the design of a suicide prevention intervention delivered by phone to young people post-discharge from an emergency department (ED) for suicide risk or self-harm. Methods: Qualitative study was conducted at the Queensland Children's Hospital, Brisbane Australia. Four focus groups with young people with lived-experience, parents or carers and ED mental health clinicals were conducted. In total 5 young people with lived-experience of suicidality (17–21 years, Mage = 19.20), 3 parents and carers with a lived-experience of caring for a young person with mental illness, and 10 ED mental health clinicians participated in focus groups. The first phase of qualitative analysis involved a phenomenological analysis and second phase included a deductive content analysis. The paper is following the Consolidated Criteria for Reporting Qualitative Research. Results: First phase, a phenomenological analysis identified three foundational themes to structure future follow-up phone interventions: a person-centred focus, the phone-call dynamic, and the phone-call purpose. Second phase, a deductive content analysis found that participants preferred an intervention that was structured, consistent, and finite. Moreover, an intervention that was authentic, able to facilitate and empower growing independence, and achievable of young people after an ED presentation was desired. Conclusions: Participants expressed their desire for a responsive, structured, and clearly focused phone call that would recognise the young person and parent/carer's needs while providing tailored support to ease transition from the ED to available community and family led care. [ABSTRACT FROM AUTHOR]

Background: Improving the rates of, and instruments used in, screening for perinatal depression and anxiety among Aboriginal and Torres Strait Islander women are important public health priorities. The Kimberley Mum's Mood Scale (KMMS) was developed and later validated as an effective and acceptable perinatal depression and anxiety screening tool for the Kimberley region under research conditions. Other regions have expressed interest in using the KMMS with perinatal Aboriginal and Torres Strait Islander women. It is, however, important to re-evaluate the KMMS in a larger Kimberley sample via a real world implementation study, and to test for applicability in other remote and regional environments before recommendations for wider use can be made. This paper outlines the protocol for evaluating the process of implementation and establishing the 'real world' validity and acceptability of the KMMS in the Kimberley, Pilbara and Far North Queensland in northern Australia., Methods: The study will use a range of quantitative and qualitative methods across all sites. KMMS validation/revalidation internal consistency of Part 1 will be determined using Cronbach's alpha. Equivalence for identifying risk of depression and anxiety compared to a standard reference assessment will be determined from receiver operating characteristic curves. Sensitivity and specificity will be determined based on these cut-points. Qualitative methods of phenomenology will be used to explore concepts of KMMS user acceptability (women and health professionals). Additional process evaluation methods will collate, assess and report on KMMS quality review data, consultations with health service administrators and management, field notes, and other documentation from the research team. This information will be reported on using the Dynamic Sustainability Framework., Discussion: This project is contributing to the important public health priority of screening Aboriginal and Torres Strait Islander women for perinatal depression and anxiety with tools that are meaningful and responsive to cultural and clinical needs. Identifying and addressing barriers to implementation contributes to our understanding of the complexity of improving routine clinical practie., Trial Registration: The study was registered retrospectively on 15/05/2019 with the Australian and New Zealand Clinical Trial registry (ACTRN12619000580178).

Sexual minority young people use licit and illicit substances at disproportionate levels. However, little is known about the perceptions of substance use among members of LGBT communities. This paper reports the results of a content analysis of 45 semi-structured interviews about substance use in LGBT communities with sexual minority young people (n = 31) and community stakeholders (n = 14). Results indicated both sexual minority youth and community stakeholders perceived the use and acceptance of substances to be higher in LGBT communities compared to the general population. Participants identified a range of characteristics potentially leading to higher levels of substance use including peer pressure, high exposure to substance use, and the high concentrations of licensed venues in LGBT communities. Marginalisation, discrimination and mental health were also perceived as important reasons for these disparities. Community stakeholders identified a range of potential interventions including legislation to address discrimination and substance use, increased services and activities, advertising in commercial LGBT venues and social media, and reinvigorating community cohesion., Competing Interests: The authors have declared that no competing interests exist.

Background: Despite many Australian universities introducing smoke-free policies on campus, there is little information about staff and students understanding of smoking on campus in the context of the implementation of a smoke-free policy. Objective: This research explores the qualitative views of university staff and students about smoking on campus during the implementation of a smoke-free policy. Methods: In 2016, an electronic survey was distributed to all current staff and students of a large university in Queensland, Australia during the implementation of a smoke-free policy. The survey consisted of multiple-choice questions about demographics, tobacco use, attitudes towards smoking, awareness of and attitudes towards the policy, and intentions to quit smoking. The final question asked for a short, open-ended response: "Would you like to comment on the issue of smoking on QUT* campuses?" This question was extracted from the survey and analysed using inductive thematic analysis. This paper reports the findings from this question. *Queensland University of Technology. Results: The survey was completed by 641 staff and students. There were 351 responses to the final question. Five inductive themes emerged about smoking on campus during the implementation of a smoke-free policy: 1) the watering down of the policy, if it is not enforced, 2) the creation of hot spots on campus boundaries affecting those who pass by, 3) concern, especially by those who don't smoke, about the impact on smokers emotional health and welfare, 4) disagreement about the value of designated smoking areas and 5) suggestions about how to better implement the policy. Conclusion: Overall, participants views about smoking on campus during the implementation of a smoke free policy suggest broad agreement but reflect concerns about enforcement, boundaries, non-smokers and designated areas. Consistent and systematic processes for implementation, maintenance and enforcement of policy goals, and cessation support, is needed to create a non-smoking culture on university campuses. [ABSTRACT FROM AUTHOR]

There is a longstanding but sometimes controversial belief that a person is not criminally responsible for a crime if they were suffering from a mental illness at the time of the offence. The Queensland Mental Health Court (QMHC) system, in which assisting clinicians have a central role, is underwritten by this belief. This paper describes the QMHC system. [ABSTRACT FROM AUTHOR]

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Objective: To provide prevalence data on several key mental health indicators for young people aged 15 to 24 years., Methods: A cross-sectional household survey, using telephone recruitment followed by a postal pencil-and-paper questionnaire. The overall response rate was 67.3%., Results: Difficulties with interpersonal relationships are common causes of distress for young people, in particular problems with parents, problems with friends and relationship break-ups. Depressive symptomatology is common among young people with approximately one in eight males and one in four females reporting current depressive symptomatology. One in three young people reported that they had had suicidal thoughts at some time in the past, 1.2% of young people reported that they had made a plan on how to kill themselves in the four-week period prior to completing the survey and 6.9% of young people reported that they had tried to kill themselves at some time during their life time (4.2% of males and 9.0% of females)., Conclusions and Implications: The prevalence figures for the various mental health indicators presented in this paper represent good baseline information upon which to examine the progress over time of interventions designed to improve the mental health of young people.

Men who were sexually abused in childhood are overrepresented in mental health and other clinical populations. There is heterogeneity in outcomes for such men and a substantial number develop coping strategies that minimise negative consequences of abuse. However, little research has been undertaken with abused men to understand the nature of their coping. This paper reports on one arm of a major study of mental health outcomes for Australian men who are survivors of childhood sexual abuse and presents findings from thematic analysis of qualitative interviews with thirty-nine men, exploring how their coping mechanisms have developed and the nature of the advice for coping they would give to professionals or other survivors. The study found that coping strategies developed adaptively through the life course but clustered into two types: those that are concerned with forms of suppression and denial, which are associated with negative mental health outcomes, and those that involve reframing the abuse, which tend to be associated with more positive outcomes. Implications of the study for practice are consistent with the advice suggested by the men themselves, that they were helped by consistent relationships with others who could provide practical support and inspire hope. [ABSTRACT FROM PUBLISHER]

Objective: This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). Methods: This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self‐harm; substance‐use disorder, schizophrenia, mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. Results: A total of 121,203 patients were included, with median follow‐up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0–18.4] restrictive, 10.8 [8.4–13.9] sleeve gastrectomy, 20.4 [9.7–42.8] gastric bypass; p = 0.18). Rates of admission with self‐harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance‐use disorder increased after all surgery types. Conclusions: Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health. [ABSTRACT FROM AUTHOR]

Through a psychosocial lens, informed by relational psychoanalysis, this article discusses the design, delivery, and impact of The Big Anxiety's 2022 festival in Warwick, Queensland—an arts-based program that engages with lived experiences of trauma, distress, and suicide, and in this case with the devastating impact of youth suicide, disproportionately affecting First Nations communities. It describes the festival's methods of creative engagement, examining how these create conditions for the transformation of trauma and for experiences of growth. [ABSTRACT FROM AUTHOR]

Primary school teachers play a significant role in the support of children with mental health and developmental concerns, which can be comorbid or share similar symptomology. The literature suggests there is a deficiency in teacher mental health literacy (MHL), indicating that teachers often lack the knowledge and confidence to support childhood mental health. This study evaluated the success of the Mental Health Literacy for Educators Training Program for a subset of Queensland (QLD) primary school teachers, with a focus on the developmental areas of Attention Deficit Hyperactivity Disorder, Speech and Language Disorders, and Sensory Processing Disorders. The aim was to evaluate whether knowledge and confidence improved on training completion and to evaluate the satisfaction of the training. This research used a longitudinal design (pre- and post-training) with a sample of 81 QLD primary school teaching staff over a three-year period (2013–2015). The results showed that knowledge and confidence improved on training completion and were strongly correlated. The satisfaction with training was high and positively correlated with knowledge acquisition and confidence attainment. In respect of complex effects, a moderated mediation model showed that confidence mediated the relationship between satisfaction and knowledge, and years of teaching experience as a moderator had no effect directly on confidence or in producing a conditional indirect effect on knowledge. This study considers limitations such as ceiling effects, participant and self-selection biases, and sample representation, which limits the interpretation of the findings. At last, it also recommends additional longitudinal follow-up periods to assess knowledge maintenance, teacher helping behaviours, and benefits to children as key directions for future research. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected university students globally. Our study investigated mental health indicators among higher degree by research (HDR) students at a regional university in Queensland, Australia. A total of 231 HDR students (female = 137, male = 94) completed the Brunel Mood Scale to assess the constructs of Tension, Depression, Anger, Vigor, Fatigue, and Confusion. A subset of 11 students participated in three focus groups to explore their experiences. Results showed that reported mood among HDR students was generally more negative than population norms, although more positive than moods reported previously during the pandemic. A total of 52 participants (22.5%) reported mood profiles that indicated elevated risk of mental ill-health. Mood profiles varied significantly by gender, age, study mode (full-time/part-time), location (on-campus/online), and citizenship (domestic/international). Quantitative data were supported by focus group findings, which identified mental health and wellbeing as key themes of concern to HDR students. Our findings indicate that support mechanisms to safeguard the mental health and wellbeing of HDR students should be a priority for universities. [ABSTRACT FROM AUTHOR]

This paper reports on the Perinatal Mental Health and Wellness Project which aimed to develop and evaluate a collaborative model for mental health promotion, illness prevention and early intervention in the perinatal period. The project took on a place-based action research approach, developing and trialling the model with expectant parents (n=537) engaged with Redcliffe Hospital Maternity Services in the Metro North Hospital and Health Service in Queensland, Australia, from 2015 - 2017. In Australia, at least 16% of expecting and new mothers and 10% of expecting and new fathers experience depression and/or anxiety to a clinically significant degree1. Supporting and protecting the mental health and emotional wellbeing of expectant and new parents not only benefits the parents but has lifelong benefits for the infant, reducing demand for social and health services across the lifespan. Based on this evidence and the identified need for more effective models of promotion, prevention and early intervention in perinatal mental health, a collaborative project was developed. The project was jointly funded by the Queensland Mental Health Commission and the Statewide Maternity and Neonatal Clinical Network, Clinical Excellence Division, with inkind support from participating organisations including Children's Health Queensland Hospital and Health Service, Metro North Hospital and Health Service, Hope's Room Incorporated, and Women's Health Queensland Wide. A key component of the model included closer collaboration among public health services, nongovernment services and peer-led services, to provide information and resources to support the emotional health and wellbeing of expectant and new parents and their infants and families. This was achieved by the establishment of new relationships between project partner organisations and the First 5 Forever Program, Moreton Bay Regional Council, Playgroup Queensland and Brisbane North Primary Health Network, which resulted in their collaborative contribution to the model of service. Project findings support the premise that partnerships and collaborations have the benefit of bringing together varied skills and resources for more successful outcomes. Collaborative partnerships require a clear purpose, add value to the work of partners and have a bigger im pact than if partners were working alone. Our project was mindful of these factors in creating a successful collaboration3. Feedback received from members of the collaboration indicates that the establishment and strengthening of relationships has resulted in increased connectedness of the community sector with the health sector, co-production and co-branding of resources, review and improvement to referral processes and increased opportunities to engage with fathers which otherwise would have been limited. Cross-sectoral collaboration, especially the initial building of relationships, requires considerable time and effort. While such an innovative project presented challenges at many levels, evaluation has been overwhelmingly positive and the model is seen as holding considerable promise for implementation in other areas. [ABSTRACT FROM AUTHOR]

Following a series of consultations throughout 2014 and 2015, the Queensland Centre for Perinatal and Infant Mental Health (QCPIMH) identified a significant gap in provision of perinatal and infant mental health (PIMH) services to families living in rural and remote areas of Queensland. Challenges to health service provision in rural and remote areas are well known and include geographically-dispersed populations, the transient nature of some populations (including fly-in/fly-out workers and defence personnel), culturally diverse communities, extreme environments and natural disasters, economic disadvantage, the difficulty of recruiting to service positions, and a generally sparse service environment. Using a cross-sectoral approach over a seven month period, the e-PIMH pilot aimed to strengthen relationships with public, private and non-government providers of health and education services. This includes engaging with Indigenous organisations, to support the work done with parents/carers in building strong, positive, and enjoyable relationships with their infant and/or young child. e-PIMH sought to develop awareness, knowledge, and skills among healthcare professionals and other workers in rural and remote communities, to identify perinatal and infant mental health issues early, intervene effectively, and refer appropriately. Evaluation of the pilot (N = 41) reflected improved awareness of PIMH issues due to engagement with e-PIMH. The average weighted score for improved awareness was 8.49 (out of 10) for both perinatal mental health and infant mental health respectively. Respondents believed this improved outcomes for clients. Respondents also reported that the pilot improved their skills in detecting problems with mental health and wellbeing of clients, and provided useful resources as well as increased knowledge on where to find relevant resources. Three respondents commented on the value of e-PIMH in reducing the gap in service delivery by upskilling health professionals outside the mental health field. When asked, 94% of the respondents (n = 32) felt that the e-PIMH pilot was easy to access and supported by their organisation. While 72% agreed that it fit well within their organisation and complemented existing programs (n = 33). However the evaluation identified a need for clinical support in this area of work. As a consequence, QCPIMH has been developing a state-wide model of telehealth for perinatal and infant mental health incorporating clinical support, such as consultation and liaison, clinical supervision and mentorship, in addition to the non-clinical support and advice. This paper will present information on the evaluation of the effectiveness of the pilot, lessons learned and progress of the collaborative e-PIMH telehealth model. [ABSTRACT FROM AUTHOR]

This paper reports on the outcomes of an intensive collaborative community-based perinatal and infant mental health (PIMH) Day Program designed to improve the emotional-social wellbeing of mothers with a moderate to severe mental illness and attachment to their infant. Coordinated by the Queensland Centre for Perinatal and Infant Mental Health, Child and Youth Mental Health, Children's Health Queensland Hospital and Health Service, the program was delivered in 2016 to twenty six mother-infant dyads through an interagency partnership between adult mental health, child and youth mental health and community child health across two Hospital and Health Service sites in Queensland, Australia. The study resulted from recommendations of a pilot project conducted in Brisbane in 2009. An infant's developmental outcomes are predicated by their earliest attachment to their caregivers. It is estimated 40% to 60% of children whose parent has a mental illness are at risk to their mental wellbeing. With more than 16% of Australian women and 10% of fathers developing a perinatal mental illness, there is an identified gap in both the availability and flexibility of services to this vulnerable population. Evidence suggests that service delivery to perinatal mothers with complex mental health issues is typically 'siloed' and that treating maternal mental health alone does not improve outcomes for infants. The unique feature of the PIMH Day Program is the collaboration of three separate health services delivering one program to mothers and infants together. Cairns and Hinterland Hospital and Health Service (HHS) and Townsville HHS are two large regional cities located in north Queensland. Clinicians from adult mental health, child and youth mental health and child health from each HHS delivered three (3) six week (one day per week) perinatal and infant mental health programs between May to November 2016 through a collaborative and integrative methodology. Multidisciplinary clinicians from the three services worked together to deliver the program using a dedicated program manual. The intervention resulted in statistically significant improvements in pre-post quantitative measures relating to mother's emotional-social wellbeing and infant attachment, positive feedback from selfreport surveys on program elements, and engagement in post referral pathways. Clinicians reported high level satisfaction with the collaborative process, resource sharing and transfer of knowledge and skills. They support the intervention as a sustainable, effective and efficient model of service. The findings support the premise that interagency collaboration between health services brings about improved mental health outcomes for mothers with a mental illness and enhanced understanding and sensitivity to their infants. The study resulted in statistically significant results in both sites supporting the results of the 2009 study. This program demonstrates that collaboration, partnerships and integration across service boundaries and professional disciplines offers a promising opportunity to deliver a service that supports parenting and an infant's emotional-social development. The Day Program translates across settings while building workforce capacity in perinatal and infant mental health. [ABSTRACT FROM AUTHOR]

In 2016, Queensland introduced changes to mental health legislation, providing additional powers to Magistrates in relation to soundness of mind and fitness for trial. This article explores the application of fitness for trial to young people in the Magistrate's Court. It begins with a discussion of fitness for trial broadly, exploring issues with the current legal test, and discusses the unique application of the test in Queensland. By highlighting the inherent vulnerabilities of young people involved in the legal system, we identify the gaps and challenges of assessing fitness for trial with this population. In conclusion we recommend further exploration of alternative models for resolving questions of fitness for trial for young people involved in the criminal justice system. [ABSTRACT FROM AUTHOR]

Mental health review tribunals face the difficult task of balancing an obligation to be efficient and accessible against the obligation to provide procedural fairness. We conducted focus groups with lawyers and advocates who support people with matters before the Queensland Mental Health Review Tribunal to ascertain their views on issues relating to procedural fairness in this particular forum. Consistent with similar studies in other jurisdictions, our participants expressed concerns about how well informed their clients were about the proceedings, the probative value of the evidence relied upon and the extent to which medical evidence is effectively challenged. We analyse the concerns raised by our participants in light of the limited Australian case law on procedural fairness in mental health review tribunals. [ABSTRACT FROM AUTHOR]

Aims: Limited information exists about the prevalence of psychiatric illness for Indigenous Australians. This study examines the prevalence of diagnosed psychiatric disorders in Indigenous Australians and compares this to non-Indigenous Australians. The aims were to: (1) determine prevalence rates for psychiatric diagnoses for Indigenous Australians admitted to hospital; and (2) examine whether the profile of psychiatric diagnoses for Indigenous Australians was different compared with non-Indigenous Australians. Methods: A birth cohort design was adopted, with the population consisting of 45 141 individuals born in the Australian State of Queensland in 1990 (6.3% Indigenous). Linked administrative data from Queensland Health hospital admissions were used to identify psychiatric diagnoses from age 4/5 to 23/24 years. Crude lifetime prevalence rates of psychiatric diagnoses for Indigenous and non-Indigenous individuals were derived from the hospital admissions data. The cumulative incidence of psychiatric diagnoses was modelled separately for Indigenous and non-Indigenous individuals. Logistic regression was used to model differences between Indigenous and non-Indigenous psychiatric presentations while controlling for sociodemographic characteristics. Results: There were 2783 (6.2%) individuals in the cohort with a diagnosed psychiatric disorder from a hospital admission. The prevalence of any psychiatric diagnosis at age 23/24 years was 17.2% (491) for Indigenous Australians compared with 5.4% (2292) for non-Indigenous Australians. Indigenous individuals were diagnosed earlier, with overrepresentation in psychiatric illness becoming more pronounced with age. Indigenous individuals were overrepresented in almost all categories of psychiatric disorder and this was most pronounced for substance use disorders (SUDs) (12.2 v. 2.6% of Indigenous and non-Indigenous individuals, respectively). Differences between Indigenous and non-Indigenous Australians in the likelihood of psychiatric disorders were not statistically significant after controlling for sociodemographic characteristics, except for SUDs. Conclusions: There is significant inequality in psychiatric morbidity between Indigenous and non-Indigenous Australians across most forms of psychiatric illness that is evident from an early age and becomes more pronounced with age. SUDs are particularly prevalent, highlighting the importance of appropriate interventions to prevent and address these problems. Inequalities in mental health may be driven by socioeconomic disadvantage experienced by Indigenous individuals. [ABSTRACT FROM AUTHOR]

This study aimed to establish the proportion of women seeking information regarding unintended pregnancy in the context of domestic violence (DV) and/or sexual assault (SA) experiences in Queensland. Mental health, sociodemographic variables, and gestation at first and repeated contacts were examined for 6249 women primarily seeking information regarding abortion options during an unintended pregnancy over the 5-year period from July 2012 to June 2017. Reports of DV and SA and associations with mental health issues increased significantly across the 5 years. First contact rates of disclosure were 12.2% for DV and 3% for SA, and higher among repeat contacts (38.1% for DV and 14.1% for SA), with recurring contact facilitating violence disclosure. Restricting access to abortions in the context of violence impedes a woman's agency in attempts to separate from violence and highlights the need for safe, supportive, and accessible services, to assist in screening and assisting with violence. [ABSTRACT FROM AUTHOR]

Previous research has shown an association between children's development of psychosocial and motor skills. This study evaluated the development of these skills in 301 three-year-old deaf and hard of hearing children (M: 37.8 months) and considered a range of possible predictors including gender, birth weight, age at first fitting with hearing devices, hearing device used, presence of additional disabilities, severity of hearing loss, maternal education, socio-economic status (SES), language ability, and communication mode. Caregivers reported on children's development using the Child Development Inventory (CDI). On average, both psychosocial and motor development quotients were within the typical range for hearing children, with large individual differences. There was a positive correlation between language ability and both social and motor development, and also between social and motor development. Age at first fitting of hearing aids (as an indicator of age at identification of hearing loss), SES, degree of hearing loss, and maternal education were not significant predictors of social skill or motor development, whereas presence of additional disabilities and birth weight were. Girls performed better than boys on all but the Gross Motor subscale of the CDI. Children with hearing aids tended to perform better than those with cochlear implants on the Gross Motor subscale. [ABSTRACT FROM AUTHOR]

Information about the 18th Annual Australian Military Medicine Association and Controversies in Civilian and Military Trauma Group Joint Conference in Gold Coast Convention and Exhibition Centre on the Gold Coast in Queensland on October 31 to November 1, 2009 is presented. Topics include the mental and veterans health, ability and capability, and army medical training. The conference also featured key speakers including Major General Paul Alexander, Dr. Fiona Woods, and Michael Groom.

Background: The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a 'one-stop' mental health service hub.Methods: We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale - Domains and Stages (RAS-DS) scores at intake and review (n = 108); (2) RAS-DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation.Results: Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS-DS measurements, averaging 5 months apart. RAS-DS 'total recovery' scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS-DS domains ('Looking forward', p < 0.001; 'Mastering my illness', p < 0.001; and 'Connecting and belonging', p = 0.001). Corresponding improvements, except in 'Connecting and belonging', were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant.Conclusions: Despite the lack of a control group and small follow-up sample size, Floresco's integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services. [ABSTRACT FROM AUTHOR]