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As evidence continues to accumulate for the association between childhood trauma and long-term adverse outcomes, Trauma-Informed Care (TIC) approaches are emerging as fundamental to contemporary mental health services. To evaluate a workshop designed to influence mental health practitioners in TIC principles and practices. Nursing, medical and allied health professionals completed pre and post measures of confidence, awareness and attitudes towards TIC practice. The workshop was rated as highly relevant and useful to clinician's practice. Participants' self-reported confidence, awareness and attitudes towards TIC significantly increased (p < .001) and the perceived number of barriers to working within a TIC framework significantly decreased (p < .05). Child and Adolescent Mental Health clinicians routinely screened for trauma and 80% had received training in a trauma specific intervention at follow-up. This brief training provides an important foundation for the development of trauma-informed, evidence-based mental health services.

Objective: The objective of this study was to explore the correlates of a single-item Self-Rated Mental Health Question in people with schizophrenia, in order to achieve a better understanding of what it is measuring., Methods: A cross-sectional survey was conducted exploring the responses of 71 adults with schizophrenia to a single-item Self-Rated Mental Health Question and the relationship with psychological distress, illness perception, and self-rated general health. Measures included the 10-item Kessler Psychological Distress Scale, the Brief Illness Perception Questionnaire, and the single-item Self-Rated Health Question., Results: People with schizophrenia who reported poorer levels of mental health on a single-item Self-Rated Mental Health Question were more likely to have: higher levels of psychological distress; depressive and anxiety symptoms; and negative illness perceptions, especially a lack of perceived personal control over their illness. There was a moderate positive correlation between self-rated mental health and self-rated general health., Conclusion: The single-item Self-Rated Mental Health Question is a predictor of important clinical features in people with schizophrenia. As such, there are implications for health services, with a possible role as a brief, easily administered screening tool for the detection of clinical vulnerability., (© The Royal Australian and New Zealand College of Psychiatrists 2016.)

Objective: To identify the factors associated with 'good' mental health among Aboriginal children living in urban communities in New South Wales, Australia., Design: Cross-sectional survey (phase I of a longitudinal study)., Setting: 4 Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban communities in New South Wales, Australia., Participants: 1005 Aboriginal children aged 4-17 years who participated in phase I of the Study of Environment on Aboriginal Resilience and Child Health (SEARCH)., Primary Outcome Measure: Carer report version of the Strengths and Difficulties Questionnaire. Scores <17 were considered to indicate 'good' mental health for the purposes of this article., Results: The majority (72%) of SEARCH participants were not at high risk for emotional or behavioural problems. After adjusting for the relative contributions of significant demographic, child and carer health factors, the factors associated with good mental health among SEARCH children were having a carer who was not highly psychologically distressed (OR=2.8, 95% CI 1.6 to 5.1); not suffering from frequent chest, gastrointestinal or skin infections (OR=2.8, 95% CI 1.8 to 4.3); and eating two or more servings of vegetables per day (OR=2.1, 95% CI 1.2 to 3.8). Being raised by a foster carer (OR=0.2, 95% CI 0.01 to 0.71) and having lived in 4 or more homes since birth (OR=0.62, 95% CI 0.39 to 1.0) were associated with significantly lower odds of good mental health. Slightly different patterns of results were noted for adolescents than younger children., Conclusions: Most children who participated in SEARCH were not at high risk for emotional or behavioural problems. Promising targets for efforts to promote mental health among urban Aboriginal children may include the timely provision of medical care for children and provision of additional support for parents and carers experiencing mental or physical health problems, for adolescent boys and for young people in the foster care system., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To assess the acceptability and face validity of the Strengths and Difficulties Questionnaire (SDQ) in Aboriginal community controlled health services (ACCHOs) located in the greater Sydney region., Methods: A qualitative study was conducted in three ACCHOs located within the greater Sydney region in 2008-2009. A semi-structured approach was used in focus groups and small group interviews (n = 47) to elicit participants' views on the appropriateness of the SDQ and any additional issues of importance to Aboriginal child and adolescent mental health., Results: The SDQ was found to cover many important aspects of Aboriginal child and adolescent mental health, however, the wording of some questions was considered ambiguous and some critical issues are not explored. The peer relationships subscale did not appear to fit well with Aboriginal concepts of the relative importance of different interpersonal relationships., Conclusion: Overall the SDQ was acceptable in ACCHOs in Sydney; however, changes to the wording of some questions and the response scale may be indicated to improve cultural appropriateness and clarity. A further set of issues which are not covered by any commonly used screening tools but are of critical importance to Aboriginal child and adolescent mental health should also be considered by clinicians.

The evident and unresolved health disparity between Aboriginal and other Australians is testament to a history of systematic disenfranchisement. Stigma, lack of appropriate services and the expense of delivering services in remote settings make it impossible to adequately address mental health needs, including suicide, solely using a mainstream medical approach. Nor do mainstream approaches accommodate the relationship between Aboriginal health and connectedness to land, whether traditional or new land, remote or metropolitan. This review describes how caring-for-country projects on traditional lands in remote locations may provide a novel way to achieve the linked goals of climate change adaptation with co-benefits for social and emotional wellbeing.

BackgroundBereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction.Methods and findingsA total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment.ConclusionsThe criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.

Objective: To examine the factors associated with psychological distress in parents and carers of Aboriginal children living in urban communities in New South Wales.Design: Cross-sectional survey (phase one of the Study of Environment on Aboriginal Resilience and Child Health [SEARCH], November 2007 - December 2011).Setting and Participants: Primary care; 589 parents and carers of Aboriginal children were recruited when attending one of the four Aboriginal Community Controlled Health Services (ACCHSs) in urban NSW that participated in SEARCH.Main Outcome Measure: Kessler Psychological Distress Scale (K10) scores; a score of 22 or higher was deemed to indicate high levels of psychological distress.Results: High levels of psychological distress were identified in 18% of our sample. The factors most strongly associated with this distress were functional limitations (v those with K10 scores under 22: adjusted odds ratio [aOR], 4.2; 95% CI, 1.3-13.5), previous hospitalisation (aOR, 5.5; 95% CI, 1.5-19.4) or other treatment for social and emotional wellbeing (aOR, 3.3; 95% CI, 1.3-8.4), low satisfaction with feeling part of the community (aOR, 0.83; 95% CI, 0.70-0.98) and low involvement in clubs and groups (aOR, 2.9; 95% CI, 1.2-7.3).Conclusions: Clinicians should note that those with functional limitations or a history of treatment for mental health problems are at higher risk of psychological distress and may require additional support. Increased funding that allows ACCHSs to provide mental health services, and funding and promoting programs and activities that increase social connectedness should remain focuses for ACCHSs and policy makers. [ABSTRACT FROM AUTHOR]

The current study explores the construct validity of the standard Strengths and Difficulties Questionnaire ( SDQ) for Aboriginal children living in urban communities in New South Wales, Australia. Parent report SDQ data from the first 717 Aboriginal children aged 4-17 years who participated in the baseline survey of the Study of Environment on Aboriginal Resilience and Child Health were analysed. The overall construct validity of the SDQ in our sample was acceptable but not 'good.' The internal consistency reliability was excellent overall and good for all subscales with the exception of peer problems, a concept that may have a different significance for urban Aboriginal parents. Removing the peer relationships subscale, however, did not improve the fit of the model. The convergent validity of the SDQ was good. The prosocial behaviours scale and both the peer and conduct problems scales were highly correlated suggesting Aboriginal parents conceptualise these differently and that prosocial behaviours may be considered a key indicator of well-being for Aboriginal children. Overall, the SDQ is a promising tool for urban Aboriginal children in New South Wales. Those working with Aboriginal young people should focus on the SDQ total difficulties score and limit their reliance on the peer relationships subscale. [ABSTRACT FROM AUTHOR]

Background: Indigenous young people are disproportionately exposed to risk factors for poor mental health. Methodologically rigorous research will be critical in the development and evaluation of prevention and treatment programs. Research examining the mental health of Indigenous young people may have been undermined by poor measurement. The extent to which research has used measures with adequate psychometrics is unknown. Methods: MEDLINE, PsychINFO and PUBMED databases, were systematically searched to identify papers published between 1998–2008 measuring the mental health of Indigenous young people from Australia, Canada, New Zealand or the US. Data extracted included type of mental health instrument, psychometric analyses reported and results. Results: Fifty-four relevant studies were identified. Seventy-nine mental health instruments were used, and 18% were bespoke. Only 14% of instruments had been validated for the relevant Indigenous population. Few studies reported assessment of the reliability or validity of instruments. Data about both the reliability and validity of 10 measures were reported. None of the measures met the standards set by the review. Evidence of at least one type of reliability and validity was demonstrated for six measures. Conclusions: From 1998–2008 few studies of mental health in Indigenous young people used measurement instruments with previously determined reliability and validity. [ABSTRACT FROM AUTHOR]

The article presents a study of the perceptions of terrorism by survivors of the 2002 Bali, Indonesia bombing of factors that influence coping and recovery, as well as aimed at determining whether coping supports vary based on demographic, physical and mental health, incident-exposure and bereavement variables. Findings highlight the perceived value of counselling-related services provided to terrorism-affected groups, wherein, male survivors may benefit more from mental health intervention.

Prior research has established that childhood adversities are potentially associated with a range of subsequent difficulties in childhood, adolescence and adulthood, including depression, suicide, behaviour problems, anxiety and physical health conditions. It has also been generally accepted that adversities do not occur in isolation, with multiple adversities being the norm. However, whether the experience of combinations of adversities during childhood forms a consistent pattern has not been established. The aim of this study was to systematically review prior research which has investigated whether childhood adversities occur in predictable clusters. A systematic search of published research investigating this issue was completed using 10 library databases for the period of January 1980 through February 2011. Eleven of the 12 studies included in the review found that childhood adversities did cluster in predictable ways. However, the revealed clusters were highly inconsistent across the studies. This may be due to variation in the number and type of adversities examined, in the definition of “childhood”, in the methodologies and criteria used to identify childhood adversities and in the analyses applied to the data. It was suggested in several of the studies that adversities centring on family functioning were most salient in predicting future mental health and behavioural difficulties. Research in this area needs to maximise the comprehensiveness of the measurement of childhood adversities within available resources while minimising the subjective qualities of extensive questionnaires. Practitioners and interventions should not focus on a single adversity but consider those that commonly co-occur and address them as a collective whole. [ABSTRACT FROM PUBLISHER]

The author reflects on the threat of major and complex health disasters known in the Asia-Pacific region. The author discusses the initiatives that targets to extenuate the hazards and their effects which requires the knowledge of threats and its prevention as well as the strategies to help people in communities. She also asserts that mental health problems are a leading and prevalent component of health burden of disease worldwide.

This paper examines the concept of catastrophic experience, its relationship to the range of acute and prolonged stressors to which women may be exposed and the broad impacts on their mental health and well-being. It identifies catastrophe in terms of multiple accumulated stresses including death, loss, victimization, demoralization, shame, stigmatization, helplessness and identity. Catastrophic experiences include personal violence in domestic circumstances of intimate partner abuse, sexual assault and child physical and sexual abuse. Women's experiences of loss through the violent deaths of children and loved ones may also have such enduring impacts. Terrorism victimizes men and women in this way, with the enduring impacts for women in terms of threat of ongoing attacks as well as acute effects and their aftermath. The catastrophes of war, conflict, genocide, sexual exploitation and refugee status differentially affect large numbers of women, directly and through their concerns for the care of their children and loved ones. Ultimate catastrophes such as Hiroshima and the Holocaust are discussed but with recognition of the very large numbers of women currently experiencing catastrophe in ongoing ways that may be silent and unrecognized. This is significant for clinical care and population impacts, and in the losses for women across such contexts. [ABSTRACT FROM AUTHOR]

Over the past 2-3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis. [ABSTRACT FROM AUTHOR]

The Indian Ocean Tsunami of December 2004 was one of the most significant natural disasters in modern history. The response that it drew was unprecedented at both local and international levels. While a range of specific impacts and losses may be predicted within the affected populations, there is substantial evidence that adverse impacts upon mental health may represent one of the most significant outcomes of such events. People from poorer countries are disproportionately exposed to such emergencies and may experience greater psychosocial burden in the aftermath, as well as a range of adaptations. This raises important questions regarding the current capacity of response agencies to mitigate negative impacts but also concerning the cultural context in which such mental health effects are defined. It also calls into question whether "'indicated" interventions are both realistic and ecologically valid in non-Western settings. The science of Disaster Mental Health is a relatively new field, currently engaged in a number of such debates. However, there is some emerging consensus about what constitutes good public mental health practice throughout the phases of emergency response and across diverse cultural settings. Existing data and practice guidelines provide frameworks that may be adapted to allow health and recovery workers to identify and reduce mental health morbidity, support healing and harness the agency of those affected for the recovery process. [ABSTRACT FROM AUTHOR]

The vulnerability of children has long been recognized in terms of their development needs and the importance of protecting their physical health. The extent, severity and impact of their mental health problems, including the particular vulnerabilities associated with such problems in both childhood and through to adult life, have been less of a public health priority. Vulnerabilities come in many forms, all of which may impact on the mental health and wellbeing of children and may do so in complex ways. These include the diversity of family structures, of cultures, of childrearing practices, the influence of developmental trajectories, experiences of illness and disability in child or parent and multiple strengths, resilience and protective factors. In understanding the patterns and sources of vulnerability, several themes need to be taken into account. Advocacy is also a central issue. Children do not have a political voice. The most vulnerable children from the most vulnerable families are rarely heard. This brings a responsibility for all, in terms of advocacy, engagement with their issues and recognition and building of their strengths and hearing their voices in all these matters. [ABSTRACT FROM AUTHOR]

Objective: The authors, in collaboration with NSW Health, have recently developed a comprehensive suicide risk assessment framework. The present paper describes key concepts in the assessment of suicide risk by mental health professionals.Methods: A framework for conducting a comprehensive suicide risk assessment was derived from the literature, incident analysis and clinical experience. The framework underwent a consultation process involving clinicians in NSW area mental health services. The aim was to provide clinicians with a standardized conceptual map for the assessment of suicide risk. A MEDLINE search was conducted for publications dealing with 'suicide' and 'suicide risk assessment' from 1980 to 2002. The recommendations from sentinel event reviews conducted in a NSW area mental health service in the period 1999-2002 were reviewed. The lessons from a visit to a coroner's relatives support group for people who had been bereaved by suicide also informed the development of the guidelines.Results: A framework is proposed for the assessment of suicide risk. The framework promotes a reflective style of practice, encouraging clinicians to evaluate their assessment and its limitations. Risk assessment is always undertaken as part of a full clinical assessment and an evaluation of the person's current predicament and psychosocio-cultural context. The concepts of changeability, assessment confidence, common sense and the importance of corroboration are incorporated in the framework.Conclusions: Mental health clinicians can be guided by a framework in suicide risk assessment and documentation. The assessment of suicide risk can generate a suicide risk rating for which minimum standards of care can be mandated. [ABSTRACT FROM AUTHOR]

On October 12, 2002, the island of Bali experienced a horrific terrorist attack in which 202 people, 88 of them Australian, died; many of the victims were young people on holiday. This article chronicles the authors' experience as policy makers, administrators, and clinicians responding to the bombing. It focuses on the immediate and continuing needs of those involved and the complex challenges faced by a systems response in the acute and ongoing phases. Survivors' narratives, reflecting the enduring difficulties experienced by both individuals and systems, are included. The article highlights issues of mental health aspects of disaster victim identification and responses to the variously affected groups. [ABSTRACT FROM AUTHOR]

Background: There is concern in the community about increasing cannabis use and its potential effect on health.Aims: To ascertain the prevalence of cannabis use among Australian adolescents, associations with mental health problems, risk behaviours and service use.Method: Examination of data from a national representative sample of households comprising 1261 adolescents aged 13-17 years. Parents completed a psychiatric interview and questionnaires while adolescents completed questionnaires.Results: One-quarter of the adolescents in the sample had used cannabis. There were no gender differences. Use increased rapidly with age, was more common in adolescents living with a sole parent and was associated with increased depression, conduct problems and health risk behaviours (smoking, drinking) but not with higher use of services.Conclusions: Cannabis use is very prevalent. The association with depression, conduct problems, excessive drinking and use of other drugs shows a malignant pattern of comorbidity that may lead to negative outcomes. [ABSTRACT FROM AUTHOR]

This article states that there are many opportunities for improving mental health in family settings. Programs supporting couples to build better relationships, specific parenting interventions through the period of childbirth and child rearing, and early childhood interventions have all been shown to have significant benefits. A multitude of prevention initiatives may target the family, from family formation, child bearing and child rearing stages, through family loss and breakdown, to the family issues of adult generations in the later period of life. These need to be included in a life span development framework. However, all these must be understood and interpreted in terms of the different meaning and nature of family life in different cultures, and the significance such broader issues will have for the mental health and well being of family members. Key amongst these is the place of women, the nature of role delineation, and the significance of children. Although the structure of families may vary considerably across cultures and with societal changes core emotional attachments linking family, kith and kin and community are apparent universally.

This paper overviews the development of Australian mental health services during disasters as well as recording research conducted and outcomes published. A comprehensive review of disaster research conducted on the Australian continent over the past 15 years has been undertaken. This includes ‘natural disasters’ of flood, bush fire, cyclone, and earthquake; as well as ‘man-made’ disasters of rail accident, bus crash, shipwreck, and mass shootings. The Australian mental health response to disasters has evolved progressively through a changing focus from broad evaluations in early studies to systematic exploration of the mental health impact. Ongoing research should consider prevention at every level, further exploration of etiology, and the issues of service provision across the diverse nature of Australian society. [ABSTRACT FROM AUTHOR]

Background: Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction. Methods and Findings: A total of 291 bereaved respondents were interviewed three times, grouped as 0–6, 6–12, and 12–24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment. Conclusions: The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11.

The article discusses a study on the emerging mental health themes for children and adolescents in several Aboriginal community-controlled health organisations (ACCHOs) in Sydney, New South Wales. The study participants were interviewed to gather data characterizing the mental health conditions of Aboriginal young people concerned. Several mental health themes were identified and categorized including issues related to kinship relationships and identity.

The article discusses the highlights of a workshop offered by Australia in an effort to support China's response to mental health problems. A team, composed of core members of the National Mental Health Disaster Response Taskforce, collaborated with Chinese officials to tackle mental health-related concepts such as psychological first aid, resilience building and evidence-based strategies for trauma. The workshop was held in Chengdu in Sichuan Province in July 2009, and was funded by AusAID.