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In most countries, men complete suicide at twice the rate of women; masculinity plays an important role in placing men at a greater risk of suicide. This study identifies and describes trends in the topics discussed within the masculinity and suicide literature and explores changes over time. We retrieved publications relating to masculinity and suicide from eight electronic databases and described origins in the field of research by reference to the first decade of publications. We then explored the subsequent evolution of the field by analysis of the content of article titles/abstracts for all years since the topic first emerged, and then separately by three epochs. We included 452 publications (1954–2021); research output has grown substantially in the last five years. Early publications framed suicide in the context of severe mental illness, masculinity as a risk factor, and suicidality as being aggressive and masculine. We observed some differences in themes over time: Epoch 1 focused on sex differences in suicidality, a common theme in epochs 2 was relationship to work and its effect on men's mental health and suicidality, and epoch 3 had a focus on help-seeking in suicidality. The research field of masculinity and suicide is growing strongly, as evidenced by recent increase in publication volume. The structure, content and direction of the masculinity and suicide research are still evolving. Researchers must work with policymakers and practitioners to ensure that emerging findings are translated for use in programs designed to address suicide in boys and men. Masculinity and suicide as a field is not new, with its origins in the literature dating back to 1954. More than half of the total research output in the field (1954–2021) has been published in the last five years. Early work focused on individual-level risk factors to male suicide (e.g., severe mental illness), while contemporary research focused on social and cultural determinants of male suicide (e.g., help-seeking). [ABSTRACT FROM AUTHOR]

Objectives: The National Suicide Prevention Trial was announced by the Australian Government in 2016 and aimed to prevent suicidal behaviour in 12 trial sites (representing a population of ~8 million). This study investigated the early population-level impact of the National Suicide Prevention Trial activity on rates of suicide and hospital admissions for self-harm in comparison to control areas. Methods: Relative and absolute differences in monthly rates of suicide and hospital admissions for self-harm were compared in the period after the National Suicide Prevention Trial implementation (July 2017–November 2020) to the period prior to implementation (January 2010–June 2017) in (1) 'National Suicide Prevention Trial areas' and (2) 'Control areas', using a difference-in-difference method in a series of negative binomial models. Analyses also investigated whether associations for suicide and self-harm rates differed by key socio-demographic factors, namely sex, age group, area socio-economic status and urban–rural residence. Results: There were no substantial differences between 'National Suicide Prevention Trial areas' and 'Control areas' in rates of suicide (2% relative decrease, relative risk = 0.98, 95% confidence interval = [0.91, 1.06]) or self-harm (1% relative decrease, relative risk = 0.99, 95% confidence interval = [0.96, 1.02]), adjusting for sex, age group and socio-economic status. Stronger relative decreases in self-harm only were evident for those aged 50–64 years, high socio-economic status areas, metropolitan and remote geographic areas. Conclusion: There was limited evidence that the National Suicide Prevention Trial resulted in reductions in suicide or hospital admissions for self-harm during the first 4 years of implementation. Continued monitoring of trends with timely data is imperative over the next 2–3 years to ascertain whether there are any subsequent impacts of National Suicide Prevention Trial activities. [ABSTRACT FROM AUTHOR]

People at risk of suicide frequently communicate suicidal thoughts to professionals and non-professionals. These groups, therefore, need to be aware of how best to respond. We aimed to identify helpful and unhelpful responses to communications of suicide risk from the perspective of those at risk to inform suicide prevention messaging and education. We conducted an online survey (n = 141) of members of an online reference group for an Australian mental health organisation with a history of suicide risk. Most respondents had repeatedly considered and attempted suicide. Indirect suicide communications were more common than direct communications. Listening without judgement was the most common helpful response and "minimizing" responses to suicidal thoughts and feelings, the most common unhelpful responses. We make recommendations for suicide prevention messages and professional education content based on these findings. [ABSTRACT FROM AUTHOR]

It is not known if there are discernible patterns in method lethality over successive episodes of self–harm and, if so, how these may be differentially associated with risks of self–harm repetition and suicide. Latent trajectory modelling estimated variation in patterns of suicide attempt lethality in 1,719 individuals attended by ambulance services on at least three occasions between 2012 and 2016. Cox regression modelling investigated hazards of suicide attempt repetition, all–cause, and suicide mortality as a function of these patterns. Two distinct trajectories provided optimal fit (BIC: –39,464.92). The first (Low/Moderate to Low/Moderate Lethality group; 92.5%) consisted of those consistently using methods associated with low to moderate potential lethality throughout the observation period. The second (High to Low/Moderate Lethality group; 7.5%) consisted of those who initially used methods with higher potential lethality but who switched to methods characterised by lower lethality. There were no significant differences between groups in the hazards of reattempting suicide (Hazard Ratio [HR] = 1.41, 95% CI 0.76 to 2.59) or all–cause mortality (HR = 1.21, 95% CI 0.63 to 2.32). However, those assigned to the High to Low/Moderate Lethality trajectory group may be at greater risk of suicide (Sub–Hazard Ratio [SHR] = 2.82, 95% CI 1.16 to 6.86). There may be discernible sub–groups of patients with important differences in clinical treatment needs and suicide risk profiles. These differences should be considered when undertaking psychosocial risk/needs assessments with those presenting to clinical services following self-harm. [ABSTRACT FROM AUTHOR]

Objective: In the United States, there was an increase in calls to helplines following media reporting of Robin Williams' suicide. We aimed to determine whether this was the case in Australia. Method: The helpline services Lifeline and Beyond Blue provided us with weekly data on calls received for 2013–2015. We conducted interrupted time series regression analyses to determine whether there was an increase in the average weekly number of calls received by each helpline in two periods after the story about Williams' suicide broke (1 week and 4 weeks). Results: We found strong evidence of an increase in calls to Lifeline (incidence rate ratio [IRR] =1.13; 95% confidence interval [CI] =1.02–1.25; p = 0.016) and Beyond Blue (IRR = 1.32; 95% CI = 1.09–1.59; p = 0.004) in the week after Williams' suicide was first reported. We found no evidence of higher than normal call volumes for Lifeline (IRR = 1.04; 95% CI = 0.99–1.10; p = 0.104) or Beyond Blue (IRR = 1.10; 95% CI = 1.00–1.22; p = 0.058) over the four weeks following Williams' death, however, suggesting that calls leveled out over this period. Conclusion: Suicide prevention experts and media professionals must work together to minimize the negative impacts of reports on suicide and maximize their positive ones. In cases where the story is likely to receive extensive international coverage, it may be important for local media to encourage help‐seeking. [ABSTRACT FROM AUTHOR]

Objective: We aimed to identify Australian adults' current level of confidence and intentions to help a person close to them in distress or at risk of suicide to inform the content and targeting of suicide prevention messages aimed at family and friends of those at risk.Methods: We conducted a nationally representative computer-assisted telephone survey of confidence and intentions to help someone in distress or at risk of suicide (n = 3,002). We used logistic regression to determine whether sociodemographic and exposure variables predicted confidence and intentions to help.Results: Confidence to help was high. About half of the respondents had intentions inconsistent with best practice. Listening and talking, and encouraging the person to seek professional help were the most common types of intended helping actions. Intentions to ask suicide risk assessment questions were least common. Men were more likely than women to have intentions to carry out nonrecommended actions, and less likely to have intentions to carry out recommended actions.Conclusions: Suicide prevention messaging aimed at family and friends could encourage them to ask direct questions about suicide risk and could include messages about "what not to do." Suicide prevention messages aimed specifically at men are indicated. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the extent to which local reporting of Robin Williams' suicide (on 11 August 2014) was associated with suicide in Australia. It followed several studies in the United States which showed that there were significant increases in suicide following media reports of Williams' death and that those media reports were less than optimal in terms of adherence to best-practice guidelines. In a previous study, we demonstrated that Australian media reports of Williams' suicide were largely adherent with our Mindframe guidelines on responsible reporting of suicide, so we speculated that there would be no increase in suicide following the reporting of Williams' suicide in Australia. Method: We extracted data on Australian suicides from the National Coroners Information System for the period 2001 to 2016. We conducted interrupted time series regression analyses to determine whether there were changes in suicides in the 5-month period immediately following Williams' suicide. Results: Our hypothesis that there would be no increase in suicides in Australia following Williams' highly publicised suicide was not supported. There was an 11% increase in suicides in the 5-month period following Williams' death, largely accounted for by men aged 30–64 and by people who died by hanging (the method Williams used). Conclusion: It may be that Australians were exposed to reports that contravened safe reporting recommendations, particularly via overseas media or social media, and/or that some Australian reports may have had unhelpful overarching narratives, despite largely adhering to the Mindframe guidelines. The Mindframe guidelines constitute international best practice but consideration should be given to whether certain recommendations within them should be further reinforced and whether more nuanced information about how stories should be framed could be provided. Future revision and augmentation of the Mindframe guidelines should, as always, involve media professionals. [ABSTRACT FROM AUTHOR]

Objective:Man Up is a three-episode documentary in which Sydney radio personality, Gus Worland, explores the relationship between masculinity and suicide. Our evaluation of Man Up suggested that it changed attitudes, intentions and behaviours that place men at risk. This paper aimed to identify the 'active ingredients' responsible for these outcomes. Method: We analysed comments from those who had participated in a randomised controlled trial (RCT) or an online survey as part of our evaluation or had emailed us via the Man Up website. We also analysed reactions to Twitter and Facebook posts about the show. We ranked the top five themes emerging from each data source. Results: Particular scenes seem to strike a chord with audiences (e.g. a workshop with high school boys, the development/screening of a campaign ad called Man Up, Speak Up). The emphasis on men showing emotion and facts and figures about male suicide also appear important, as do representation by rural men and those who have lost a man to suicide. Discussion: The above segments and topics have credibility as the 'active ingredients' of Man Up and could form the core of a shorter version of the show. Our findings have implications for others developing media-based mental health promotion programs for men too. They suggest that messaging is likely to achieve positive results if it relates to men in meaningful ways, recognises the societal pressures that operate on them, does not simplify complex issues like suicide, and combines heartfelt stories with scientific data. [ABSTRACT FROM AUTHOR]

We sought to compare clusters of suicidal events between two different time periods and examine the extent to which earlier clusters predict later clusters. We included data on suicides and suicide attempts from New South Wales between July 2001 and June 2012 and Western Australia between January 2000 and December 2011. Suicide attempts included admissions to hospital for deliberate self-harm and suicides were deaths due to deliberate self-harm. We combined data on suicides and suicide attempts and grouped them into two equal time periods. We detected clusters in each period using Poisson discrete scan statistics adjusted for socio-economic status. We estimated the predictive values of earlier clusters on later clusters. The results showed that clusters from earlier time period had a moderate power (36%) in predicting later clusters. During the later time period, some additional cluster areas (14%) were found and some earlier cluster areas subsided (64%). Historical clusters predict 36% of the subsequent clusters, which is probably not sufficient for targeting interventions. Our study highlights the need for other strategies to detect emerging clusters, for example, up-to-date data. [ABSTRACT FROM AUTHOR]

Suicide prevention media campaigns are gaining traction as a means of combatting suicide. The current review set out to synthesize information about the effectiveness of these campaigns. We searched four electronic databases for studies that provided evidence on the effectiveness of media campaigns. We focused on studies that described an evaluation of the effectiveness of an entire campaign or a public service announcement explicitly aimed at suicide prevention. We identified 20 studies of varying quality. Studies that looked at whether campaign exposure leads to improved knowledge and awareness of suicide found support for this. Most studies that considered whether campaign materials can achieve improvements in attitudes toward suicide also found this to be the case, although there were some exceptions. Some studies found that media campaigns could boost help-seeking, whereas others suggested that they made no difference or only had an impact when particular sources of help or particular types of help-seeking were considered. Relatively few studies had sufficient statistical power to examine whether media campaigns had an impact on the ultimate behavioral outcome of suicides, but those that did demonstrated significant reductions. Our review indicates that media campaigns should be considered in the suite of interventions that might be used to prevent suicide. Evidence for their effectiveness is still amassing, but there are strong suggestions that they can achieve positive results in terms of certain suicide-related outcomes. Care should be taken to ensure that campaign developers get the messaging of campaigns right, and further work is needed to determine which messages work and which ones do not, and how effective messages should be disseminated. There is an onus on those developing and delivering campaigns to evaluate them carefully and to share the findings with others. There is a need for evaluations that employ rigorous designs assessing the most pertinent outcomes. These evaluations should explore the nature of given campaigns in detail - in particular the messaging contained within them - in order to tease out which messages work well and which do not. They should also take into account the reach of the campaign, in order to determine whether it would be reasonable to expect that they might have their desired effect. [ABSTRACT FROM AUTHOR]

Objectives: We compare the prevalence of suicidal thoughts and attempts between Indigenous and non-Indigenous males in urban and regional Australia, and examine the extent to which any disparity between Indigenous and non-Indigenous males varies across age groups. Methods: We used data from the baseline wave of The Australian Longitudinal Study on Male Health (Ten to Men), a large-scale cohort study of Australian males aged 10–55 years residing in urban and regional areas. Indigenous identification was determined through participants self-reporting as Aboriginal, Torres Strait Islander or both. The survey collected data on suicidal thoughts in the preceding 2 weeks and lifetime suicide attempts. Results: A total of 432 participants (2.7%) identified as Indigenous and 15,425 as non-Indigenous (97.3%). Indigenous males were twice as likely as non-Indigenous males to report recent suicidal thoughts (17.6% vs 9.4%; odds ratio = 2.1, p < 0.001) and more than three times as likely to report a suicide attempt in their lifetime (17.0% vs 5.1%; odds ratio = 3.6; p < 0.001). The prevalence of recent suicidal thoughts did not differ between Indigenous and non-Indigenous males in younger age groups, but a significant gap emerged among men aged 30–39 years and was largest among men aged 40–55 years. Similarly, the prevalence of lifetime suicide attempts did not differ between Indigenous and non-Indigenous males in the 14- to 17-years age group, but a disparity emerged in the 18- to 24-years age group and was even larger among males aged 25 years and older. Conclusion: Our paper presents unique data on suicidal thoughts and attempts among a broad age range of Indigenous and non-Indigenous males. The disparity in the prevalence of suicidal thoughts increased across age groups, which is in contrast to the large disparity between the Indigenous and non-Indigenous suicide rates in younger age groups. [ABSTRACT FROM AUTHOR]

Purpose: Males feature prominently in suicide statistics, but relatively little work has been done to date to explore whether endorsement of dominant masculinity norms heightens the risk of or is protective against suicidal thinking. This paper aimed to further knowledge in this area.Methods: We used baseline data from 13,884 men (aged 18-55) in the Australian Longitudinal Study on Male Health (Ten to Men) cohort. These men filled in self-complete questionnaires in 2013/14 which covered a range of topics, including conformity to dominant masculinity norms and suicidal thinking. We conducted logistic regression analyses to estimate the strength of association between these two variables.Results: After controlling for other key predictors of suicidal thinking, one characteristic of dominant masculinity-self-reliance-stood out as a risk factor for suicidal thinking (AOR 1.33; 95% CI 1.25-1.42).Conclusions: It suggests that one particular element of dominant masculinity-being self-reliant-may place men at increased risk of suicidal thinking. This finding resonates with current theories of how suicidal thinking develops and leads to action. It also has implications for the full gamut of suicide prevention approaches that target males in clinical settings and in the general population, and for our broader society. Further work is needed, however, to confirm the direction of the relationship between self-reliance and suicidality, and to unpack the means through which self-reliance may exert an influence. [ABSTRACT FROM AUTHOR]

We are very pleased to introduce Ten to Men, the Australian Longitudinal Study on Male Health. Ten to Men is, to our knowledge, the largest national all-male cohort study in the world. It involves 15,988 males who were aged between 10 and 55 years when we recruited them in 2013/14. Together, the articles in this collection provide an overview of the study's methods, examples of some of the key questions it can answer, and guidance for researchers wishing to use it. Perhaps most importantly, the articles demonstrate the enormous potential Ten to Men has to make a real difference to our understanding of male health and the factors that influence it. [ABSTRACT FROM AUTHOR]

Background: The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development.Methods: Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use.Results: A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %.Conclusion: Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects. [ABSTRACT FROM AUTHOR]

We examined the relationship between frequent use of telephone helplines and health service use over time in a cohort of 789 general practice attendees with depressive symptoms. Telephone helpline use (no use, non-frequent use, frequent use) was measured at 3, 6, 9 and 12 months and analysed using ordered logistic regression. Sixteen participants (2 %) reported frequent use of telephone helplines. Reporting frequent use was associated with visiting multiple general practitioners, using emergency services and visiting mental health specialists in the previous 3 months. Despite this pattern of service use, there was evidence that these services were not meeting the needs of frequent users of telephone helplines, as they were also more likely to report dissatisfaction with their access to health services compared to non-frequent and non-users of telephone helplines. Our findings suggest that a model of care which addresses the complex needs of frequent users of telephone helplines is needed. [ABSTRACT FROM AUTHOR]

Background: This paper describes a program of work designed to inform a service model to address a challenge for telephone helplines, namely frequent callers. Methods: We conducted a systematic literature review and four empirical studies that drew on different data sources-(a) routinely collected calls data from Lifeline, Australia's largest telephone helpline; (b) data from surveys/ interviews with Lifeline frequent callers; (c) data from the Diagnosis, Management and Outcomes of Depression in Primary Care (diamond) study; and (d) data from Australia's National Survey of Mental Health and Wellbeing. Results: Frequent callers represent 3 % of callers but make 60 % of calls. They are isolated and have few social supports but are not "time wasters"; they have major mental and physical health problems and are often in crisis. They make use of other services for their mental health problems. The circumstances under which they use telephone helplines vary, but current service models reinforce their calling behaviour. Conclusions: The findings point to a service model that might better serve the needs of both frequent callers and other callers. The model involves offering frequent callers an integrated, tailored service in which they are allocated a dedicated and specially trained telephone crisis supporter (TCS), and given set calling times. It also involves promoting better linkages between telephone helplines and other services that provide mental health care, particularly general practitioners (GPs) and other primary care providers. The next step is to refine and test the model. [ABSTRACT FROM AUTHOR]

Australia has been implementing routine outcome measurement in its specialized public sector mental health services for over a decade. It uses a range of clinician-rated and consumer-rated measures that are administered at set times during episodes of inpatient, ambulatory and community residential episodes of care. Routine outcome measurement is now embedded in service delivery, and data are made available in a variety of ways to different audiences. These data are used by policy-makers and planners to inform decisions about system-wide reforms, by service managers to monitor quality and effectiveness, and by clinicians to guide clinical decision-making and to promote dialogue with consumers. Consumers, carers and the general community can use these data to ensure that services are accountable for the care they deliver. This paper describes the status quo in Australia with respect to routine outcome measurement, discusses the factors that led to its successful implementation, and considers the steps that are necessary for its continued development. [ABSTRACT FROM AUTHOR]

Summary: This review aimed to evaluate the effects of weight change from childhood to adulthood on depression and/or anxiety risk in adulthood. We systematically searched MEDLINE, PsychINFO, Embase, Cumulative Index to Nursing and Allied Health Literature, and Scopus for longitudinal studies assessing changes in weight status between childhood (≤18 years) and adulthood (≥19 years) in association with outcomes of depression and/or anxiety in adulthood. Study quality was assessed using a modified version of the Newcastle‐Ottawa Scale, and data were narratively synthesized. Seventeen articles met our inclusion criteria: 13 evaluated outcomes of depression, one evaluated outcomes of anxiety, and five evaluated composite measures of depression and anxiety. Evidence was most consistent regarding outcomes of depression, with most finding that persistent and/or increasing adiposity from childhood to adulthood is associated with an increased risk of depression, particularly in women. However, heterogeneity and limitations in the evidence preclude definitive conclusions and inconsistent findings were reported in the few studies that assessed anxiety and composite outcomes. Overall, it appears that early intervention to both prevent or resolve excess weight may aid in reducing the burden of depression, along with mental health support targeting adolescents with persistent and/or increasing adiposity. However, further high‐quality research is needed to address the methodological limitations discussed. [ABSTRACT FROM AUTHOR]

Suicide prevention videos featuring young people's personal narratives of hope and recovery are increasingly used in suicide prevention, but research on their effects is scarce. A double-blind randomized controlled trial was conducted to test the effects of a suicide prevention video featuring an adolescent mastering his suicidal ideation by getting help on 14 to 19-year-olds. N = 299 adolescents were randomly allocated to watch the intervention video (n = 148) or a control video unrelated to mental health (n = 151). Questionnaire data were collected before (T1) and immediately after exposure (T2), and 4 weeks later (T3). Data were analyzed with a repeated-measures ANCOVA. The primary outcome was suicidal ideation, assessed with the Reasons for Living Inventory for Adolescents. Secondary outcomes were help-seeking intentions, attitudes towards suicide, stigmatization of suicidality, and mood. There was an immediate beneficial effect of the intervention on suicidal ideation (T2 mean change from baseline within intervention group MChange = − 0.16 [95% CI − 0.20 to − 0.12], mean difference compared to control group MDiff = − 0.09 [95% CI − 0.15 to − 0.03], ηp2 = 0.03), which was not maintained at T3. Participants reported significantly higher help-seeking intentions, which was maintained at 4-week follow-up. They also reported a sustained reduction of favorable attitudes to suicide. Effects on suicidal ideation were mediated by identification with the featured protagonist. Adolescents appear to benefit from suicide prevention narratives featuring personal stories from peers on coping with suicidal ideation and help-seeking. Trial registration DRKS00017405; 24/09/19; retrospectively registered. [ABSTRACT FROM AUTHOR]

In the original publication there was an error in the calculation of scores for a number of the CMNI subscales and consequently the overall scale score. Recalculating the scores did not alter the substantive finding, and largely resulted in only small adjustments to estimates. Tables 1 and 2 are revised to show the corrected values, and revisions to the text reflecting these changes are noted. [ABSTRACT FROM AUTHOR]

Background: When summary results from studies of counts of events in time contain zeros, the study-specific incidence rate ratio (IRR) and its standard error cannot be calculated because the log of zero is undefined. This poses problems for the widely used inverse-variance method that weights the study-specific IRRs to generate a pooled estimate. Methods: We conducted a simulation study to compare the inverse-variance method of conducting a meta-analysis (with and without the continuity correction) with alternative methods based on either Poisson regression with fixed interventions effects or Poisson regression with random intervention effects. We manipulated the percentage of zeros in the intervention group (from no zeros to approximately 80 percent zeros), the levels of baseline variability and heterogeneity in the intervention effect, and the number of studies that comprise each meta-analysis. We applied these methods to an example from our own work in suicide prevention and to a recent meta-analysis of the effectiveness of condoms in preventing HIV transmission. Results: As the percentage of zeros in the data increased, the inverse-variance method of pooling data shows increased bias and reduced coverage. Estimates from Poisson regression with fixed interventions effects also display evidence of bias and poor coverage, due to their inability to account for heterogeneity. Pooled IRRs from Poisson regression with random intervention effects were unaffected by the percentage of zeros in the data or the amount of heterogeneity. Conclusion: Inverse-variance methods perform poorly when the data contains zeros in either the control or intervention arms. Methods based on Poisson regression with random effect terms for the variance components are very flexible offer substantial improvement. [ABSTRACT FROM AUTHOR]

Abstract: Background: Repetition of hospital-treated deliberate self-harm is common. Several recent studies have used emergency department data to develop clinical tools to assess risk of self-harm or suicide. Longitudinal, linked inpatient data is an alternative source of information. Methods: We identified all individuals admitted to hospital for deliberate self-harm in two Australian states (~350 hospitals). The outcome of interest was a repeated episode of self-harm (non-fatal or fatal) within 6 months. Logistic regression was used to identify a set of predictors of repetition. A risk calculator (RESH: Repeated Episodes of Self-Harm) was derived directly from model coefficients. Results: There were 84,659 episodes of self-harm during the study period. Four variables – number of prior episodes, time between episodes, prior psychiatric diagnoses and recent psychiatric hospital stay – strongly predicted repetition. The RESH score showed good discrimination (AUC=0.75) and had high specificity. Patients with scores of 0–3 had 14% risk of repeat episodes, whereas patients with scores of 20–25 had over 80% risk. We identified five thresholds where the RESH score could be used for prioritising interventions. Limitations: The trade-off of a highly specific test is that the instrument has poor sensitivity. As a consequence, the RESH score cannot be used reliably for “ruling out” those who score below the thresholds. Conclusions: The RESH score could be useful for prioritising patients to interventions to reduce readmission for deliberate self-harm. The five thresholds, representing the continuum from low to high risk, enable a stepped care model of overlapping or sequential interventions to be deployed to patients at risk of self-harm. [Copyright &y& Elsevier]

A telephone-based cognitive behavioural therapy pilot project was trialled from July 2008 to June 2010, via an Australian Government-funded primary mental health care program. A web-based minimum dataset was used to examine level of uptake, sociodemographic and clinical profile of consumers, precise nature of services delivered, and consumer outcomes. Key informant interviews with 22 project officers and 10 mental health professionals elicited lessons learnt from the implementation of the pilot. Overall, 548 general practitioners referred 908 consumers, who received 6607 sessions (33% via telephone). The sessions were delivered by 180 mental health professionals. Consumers were mainly females with an average age of 37 years and had a diagnosis of depressive and/or anxiety disorders. A combination of telephone and face-to-face sessions of 1 h in duration were conducted, delivering behavioural and cognitive interventions, usually with no cost to consumers. Several implementation issues were identified by project officers and mental health professionals. Although face-to-face treatment is preferred by providers and consumers, the option of the telephone modality is valued, particularly for consumers who would not otherwise access psychological services. Evidence in the form of positive consumer outcomes supports the practice of multimodal service delivery. [ABSTRACT FROM AUTHOR]

Objective. Suicide prevention, including among youth, has been a national priority in Australia for some time. Yet despite this, rates of suicide, and related behaviour, remain high. The aim of this study was to review all suicide-prevention research that had been conducted in Australia between January 2007 and December 2011, with a specific emphasis on studies relating to young people, in order to determine whether or not we are prioritising the sort of research that can adequately inform policy development and guide 'best practice'. Methods. Data were collected from two sources. First, several electronic databases were searched in October 2012 in order to identify published journal articles relating to suicide, written by Australian authors. Second, summary data obtained from the National Health and Medical Research Council, the Australian Rotary Health Research Fund and the Australian Research Council were examined in order to identify currently funded studies that relate to suicide. Studies were then classified according to whether or not they had a focus on youth, and according to research type, type of suicide-related behaviour under investigation and method of suicide. Results. There were 224 articles published and 12 grants funded that specifically focussed on suicide-related behaviour over the period January 2007 to December 2011. Of these, 47 articles (21%) and five funded grants (42%) focussed on young people. Youth studies, in particular those reported in the published articles, tended to be epidemiological in nature and only six of the published articles (13%) and two of the funded grants related to intervention studies. Conclusions. Although the focus on youth is welcome, the lack of intervention studies is disappointing. Given that rates of suicide and related behaviour remain high, there is a clear need for a stronger body of intervention research that can inform national policy, if we are to successfully develop effective approaches to reducing suicide risk. [ABSTRACT FROM AUTHOR]

Background Certain sites have gained notoriety as ‘hotspots’ for suicide by jumping. Structural interventions (e.g. barriers and safety nets) have been installed at some of these sites. Individual studies examining the effectiveness of these interventions have been underpowered.Method We conducted a meta-analysis, pooling data from nine studies.Results Following the interventions, there was an 86% reduction in jumping suicides per year at the sites in question (95% CI 79% to 91%). There was a 44% increase in jumping suicides per year at nearby sites (95% CI 15% to 81%), but the net gain was a 28% reduction in all jumping suicides per year in the study cities (95% CI 13% to 40%).Conclusions Structural interventions at ‘hotspots’ avert suicide at these sites. Some increases in suicide are evident at neighbouring sites, but there is an overall gain in terms of a reduction in all suicides by jumping. [ABSTRACT FROM AUTHOR]

Background: To investigate the epidemiology of a steep decrease in the incidence of suicide deaths in Australia. Methods: National data on suicide deaths and deliberate self-harm for the period 1994-2007 were obtained from the Australian Institute of Health and Welfare. We calculated attempt and death rates for five major methods and the lethality of these methods. Negative binomial regression was used to estimate the size and significance of method-specific time-trends in attempts and lethality. Results: Hanging, motor vehicle exhaust and firearms were the most lethal methods, and together accounted for 72% of all deaths. The lethality of motor vehicle exhaust attempts decreased sharply (RR = 0.94 per year, 95% Cl 0.93-0.95) while the motor vehicle exhaust attempt rate changed little; this combination of motor vehicle exhaust trends explained nearly half of the overall decline in suicide deaths. Hanging lethality also decreased sharply (RR = 0.96 per year, 95% Cl 0.956-0.965) but large increases in hanging attempts negated the effect on death rates. Firearm lethality changed little while attempts decreased. Conclusion: Declines in the lethality of suicide attempts-especially attempts by motor vehicle exhaust and hanging-explain the remarkable decline in deaths by suicide in Australia since 1997. [ABSTRACT FROM AUTHOR]

The article presents a study that aims to identify the possible contribution of the educational intervention of general practitioners on the reduction of depression and self-harm behavior in older primary care patients. It notes that 373 Australian general practitioners and 21,762 of their patients aged 60 years or older took part of the study. Results unveiled that the educational intervention has no effect on the recovery of the patients, yet it prevented the onset of new cases.

Abstract: Background: Depression is more frequent in socioeconomically disadvantaged than affluent neighbourhoods, but this association may be due to confounding. This study aimed to determine the independent association between socioeconomic disadvantage and depression. Methods: We recruited 21,417 older adults via their general practitioners (GPs) and used the Patient Health Questionnaire (PHQ-9) to assess clinically significant depression (PHQ-9≥10) and major depressive symptoms. We divided the Index of Relative Socioeconomic Disadvantage into quintiles. Other measures included age, gender, place of birth, marital status, physical activity, smoking, alcohol use, height and weight, living arrangements, early life adversity, financial strain, number of medical conditions, and education of treating GPs about depression and self-harm behaviour. After 2years participants completed the PHQ-9 and reported their use of antidepressants and health services. Results: Depression affected 6% and 10% of participants in the least and the most disadvantaged quintiles. The proportion of participants with major depressive symptoms was 2% and 4%. The adjusted odds of depression and major depression were 1.4 (95% confidence interval, 95%CI=1.1–1.6) and 1.8 (95%CI=1.3–2.5) for the most disadvantaged. The adjusted odds of persistent major depression were 2.4 (95%CI=1.3–4.5) for the most disadvantaged group. There was no association between disadvantage and service use. Antidepressant use was greatest in the most disadvantaged groups. Conclusions: The higher prevalence and persistence of depression amongst disadvantaged older adults cannot be easily explained by confounding. Management of depression in disadvantaged areas may need to extend beyond traditional medical and psychological approaches. [Copyright &y& Elsevier]

The authors reflects on the editorials by A. F. Jorm, N. Allen and H. Jackson, and I. Hickie and colleagues which commented on their study of patient outcomes associated with the Better Access programme. The authors clarify some of the issues highlighted by the said authors on topics including methodology, the size and representativeness of the sample, and allowing providers to enter data for patients. The authors note that their study's results contribute in the debate about Better Access.

Background: Australia's Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule (Better Access) initiative involves a series of Medicare Benefits Schedule (MBS) item numbers which offer a rebate for selected services delivered by eligible clinicians. There has been considerable debate about the appropriateness and effectiveness of Better Access, much of which has been based on limited evidence. The current paper contributes to this debate by presenting the findings of a study which profiled the clinical and treatment characteristics of Better Access patients and examined the outcomes of their care. Method: We approached a stratified random sample of providers who had billed for at least 100 occasions of service under the Better Access item numbers in 2008 (509 clinical psychologists, 640 registered psychologists, 1280 GPs) and invited them to participate. Those who agreed were asked to recruit 5-10 Better Access patients according to a specific protocol. We collected data that enabled us to profile providers, patients and sessions. We also collected pre- and post-treatment patient outcome data, using the Kessler-10 (K-10) and the Depression Anxiety Stress Scales (DASS-21). Results: In total, 883 patients were recruited into the study (289 by 41 clinical psychologists, 317 by 49 registered psychologists and 277 by 39 GPs). More than 90% of participating patients had diagnoses of depression and/or anxiety (compared with 13% of the general population). More than 80% were experiencing high or very high levels of psychological distress (compared with 10% of the general population). Around half of all participating patients had no previous history of mental health care. Patients experienced statistically significant improvements in average K-10 and DASS-21 scores from pre- to post-treatment. Conclusions: The findings suggest that Better Access is playing an important part in meeting the community's previously unmet need for mental health care. [ABSTRACT FROM AUTHOR]

The Australian Government's Better Access initiative was introduced in late 2006 to increase treatment rates for people with mental disorders. It provides for reimbursement of psychologists' services through Medicare. The current pilot study examines the experiences of psychologists with this initiative. A random sample of 204 of 4,235 psychologists in private practice was approached and 73 psychologists (36%) were interviewed. The current study suggests that psychologists have had positive experiences with Better Access. They have appreciated the greater security of income and greater variety of work afforded by the initiative, and they have observed flow-on benefits in terms of increased access and reduced stigma for their clients. Additional research is required to corroborate these findings with a larger sample of psychologists, but the current findings provide indicative evidence that Better Access is assisting psychologists to meet a previously unmet community need for mental health care. [ABSTRACT FROM AUTHOR]

Objective: Australia's Better Outcomes in Mental Health Care (BOiMHC) programme enables GPs to refer patients with common mental disorders to allied health professionals for time-limited treatment, through its Access to Allied Psychological Services (ATAPS) projects. This paper considers whether patients who receive care through the ATAPS projects make clinical gains, if so, whether particular patient-related and treatment-related variables are predictive of these outcomes. Method: Divisions of General Practice (Divisions), which run the ATAPS projects, are required to enter de-identified data into a minimum dataset, including data on patients'' socio-demographic and clinical characteristics, the sessions of care they receive, and their clinical outcomes. We extracted data from January 2006 to June 2010, and examined the difference between mean pre- and post-treatment scores on the range of outcome measures being used by Divisions. We then conducted a linear regression analysis using scores on the most commonly-used outcome measure as the outcome of interest. Results: Pre- and post-treatment outcome data were available for 16 700 patients from nine different outcome measures. Across all measures, the mean difference was statistically significant and indicative of clinical improvement. The most commonly-used measure was the Kessler-10 (K-10), and pre- and post-treatment K-10 data were available for 7747 patients. After adjusting for clustering by Division, outcome on the K-10 was associated with age, levels of income and education, previous receipt of mental health care, number of sessions, treatment received and pre-treatment K-10 score. The benchmark was sufficiently high, however, that even the groups that fared relatively less well still showed strong improvement in absolute terms. Conclusions: Patients who receive care through the ATAPS projects are making considerable clinical gains. A range of socio-demographic, clinical and treatment-based variables are associated with the levels of outcomes achieved, but improvements are still substantial even for those in the relatively disadvantaged groups. [ABSTRACT FROM AUTHOR]

Object: The concept of recovery has been recognized as important in the treatment of mental illness. A number of specific instruments exist which are designed to: (i) measure recovery at an individual level; and (ii) assess the recovery orientation of services. The current review aimed to identify these and evaluate their potential for routine use in Australian public sector mental health services. Method: We identified potential instruments by drawing on existing reviews, searching MEDLINE and PsycINFO, and consulting with experts. We used a hierarchical criterion-based approach to assess whether given instruments might be candidates for measuring recovery in the Australian context. Results: We identified 33 instruments: 22 designed to measure individuals'' recovery and 11 designed to assess the recovery orientation of services (or providers). Four of the former (Recovery Assessment Scale; Illness Management and Recovery Scales; Stages of Recovery Instrument; Recovery Process Inventory) and four of the latter (Recovery Oriented Systems Indicators Measure; Recovery Self Assessment; Recovery Oriented Practices Index; Recovery Promotion Fidelity Scale) were identified as promising candidates for routine use in Australian public sector mental health services. Conclusions: Further work is required, however, to determine which, if any, might best be used for this purpose; the possibility that modifications to existing instruments or the development of new instruments might be required should not be ruled out. It might be desirable to invest in two instruments: one designed to measure individuals'' recovery and one designed to measure the recovery orientation of services. If Australia were to go down this path, it would make sense to align indicators in each as far as possible, and to ensure that they were consistent with existing endeavours aimed at monitoring and improving recovery-focused aspects of service quality. [ABSTRACT FROM AUTHOR]

Objective: Two pivotal Australian Government primary mental health reforms are the Access to Allied Psychological Services (ATAPS) projects, introduced in July 2001 and implemented by Divisions of General Practice, and the Better Access to Psychiatrists, Psychologists and GPs through the Medicare Benefits Schedule (Better Access) programme, introduced in November 2006. This research explores the reciprocal impact of the uptake of psychological treatment delivered by these two initiatives and the impact of location (rurality and socioeconomic profile) on the uptake of both programmes since the inception of the Better Access programme. ATAPS session delivery, before and after the introduction of the Better Access program, is also examined. Method: General Practice Division-level data sources included a minimum dataset containing uptake data of ATAPS services, Medicare Benefits Schedule uptake data supplied by the Medicare Benefits Branch of the Department of Health and Ageing, a Rural, Remote and Metropolitan Area classification, and Indices for Relative Socio Economic Disadvantage (IRSD). Regression analyses were conducted to examine the reciprocal impact of the two programmes and the impact of rurality and socioeconomic status up to December 2008. Results: A dramatic uptake of Better Access sessions, particularly in urban areas, coincided with a temporary reduction in sessions provided under ATAPS, with an overall small positive relationship detected between the two programmes. A greater proportion of ATAPS sessions (45%) have been delivered in rural areas compared with Better Access (18%). The combination of socioeconomic profile, rurality, and Better Access sessions accounted for a small but significant percentage of variance (7%) in the number of ATAPS sessions delivered, with a non-significant independent contribution of Better Access sessions to the prediction of ATAPS sessions. Weak but significant relationships between ATAPS sessions and each of socioeconomic profile ( r = 0.22) and rurality ( r = −0.24), respectively, were identified. In comparison, socioeconomic profile, rurality, and ATAPS sessions accounted for a much larger and significant percentage of variance (46%) in number of Better Access sessions delivered, with a non-significant independent contribution of ATAPS sessions to the prediction of Better Access sessions. Moderate significant relationships between Better Access sessions and each of socioeconomic profile ( r = 0.46) and rurality ( r = −0.66), respectively, were identified. The introduction of Better Access appears to have halted the steady increase in the number of ATAPS sessions previously observed. This finding should be interpreted alongside the fact that ATAPS funding is capped. Conclusions: The findings are policy relevant. ATAPS projects have been successfully providing equity of geographic and socioeconomic access for consumers most in need of subsidized psychological treatment. The uptake of psychological treatment under Better Access has been dramatic, suggesting that the programme is addressing an unmet need. [ABSTRACT FROM AUTHOR]

Objective: To profile the Australian adults who are caring for a relative with a mental disorder. Method: Data came from the 2007 National Survey of Mental Health and Wellbeing 2007 (NSMHWB), a nationally representative household survey of 8841 individuals aged between 16 and 85 years. Results: Many people act as carers: 15% of the Australian adult population, or nearly 2.4 million individuals. The strongest predictors of being a carer are being female and being in a relatively older age bracket. Carers provide a range of emotional and practical supports to close relatives with a range of mental disorders, most notably high prevalence disorders. Their relatives' health problems cause them considerable worry, anxiety and depression, and their caring role can be associated with high financial costs. Conclusions: Carers are significant stakeholders in the mental health system. Providing support for carers is crucial, particularly because their own mental health and well-being may be affected by their care-giving role. The nature of this support should take into account their large numbers, their profile and the role they perform. [ABSTRACT FROM AUTHOR]

The progressive achievements over time of the Access to Allied Psychological Services (ATAPS) component of the Better Outcomes in Mental Health Care program are examined using a web-based, purposedesigned minimum dataset that collects provider-, consumer- and session-level data on the projects. Findings indicate that the ATAPS projects have established themselves over time as a cornerstone of mental health service provision in Australia. Despite the more recent introduction of the complementary Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule program, the ATAPS projects have continued, since 2001, to attract substantial numbers of general practitioners and allied health professionals and deliver services to significant numbers of consumers. The profile of consumers being referred to the projects is now very consistent, with the majority being women with high prevalence disorders who may have had difficulty accessing mental health care in the past. The nature of sessions being delivered through the projects has also reached a point of consistency, with the majority being individual-level, cognitive behavioural therapy-based sessions of around 1 h in length. The only variation in session delivery is related to the charging of a co-payment. There is good evidence that the projects are achieving positive outcomes for consumers. [ABSTRACT FROM AUTHOR]

Objectives: To provide an overview of 12 month rates of service use for mental health problems and mental disorders by the general Australian adult population. Method: Data came from the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB), a nationally representative household survey of 8841 individuals aged between 16 and 85 years. Results: Overall, 11.9% of the general Australian adult population made use of any services for mental health problems in a 12 month period. Approximately one-third of people (34.9%) meeting criteria for a mental disorder did so. Female subjects with mental disorders were more likely to use services than male subjects (40.7% vs 27.5%). People in the youngest age group made relatively less use of services than older adults. Those with affective disorders were most likely to make use of services (58.6%), followed by those with anxiety (37.8%) and substance use disorders (24.0%), respectively. Mental health hospitalizations were less common than consultations with community-based providers (2.6%), whereas 34.6% consulted a community-based provider - particularly general practitioners (24.7%) and psychologists (13.2%). There was a clear dose-response effect between severity of disorders and rates of community-based service use: 63.5% of those with severe mental disorders used community-based services, compared with 40.2% and 17.7% of those with moderate and mild mental disorders, respectively. There was also a relationship between comorbidity of mental disorders and service use. Conclusions: Rates of service use for mental health problems among those with mental disorders in Australia are less than optimal. Little international guidance is available regarding appropriate levels of treatment coverage and other comparable countries face similar difficulties. Further work is required to determine what an appropriate rate of service use is, and to set targets to reach that rate. Australia has demonstrated that concerted policy efforts can improve rates of service use. These efforts should be expanded. [ABSTRACT FROM AUTHOR]

Objectives: To provide an overview of the lifetime and 12 month prevalence of suicidal ideation, suicide plans and suicide attempts for Australian adults as a whole and for particular sociodemographic and clinical population subgroups, and to explore the health service use of people with suicidality. Method: Data came from the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB), a nationally, representative household survey of 8841 individuals aged 16-85 years. Results: A total of 13.3% of respondents had suicidal ideation during their lifetime, 4.0% had made a suicide plan and 3.2% had made a suicide attempt. The equivalent 12 month prevalence rates were 2.3%, 0.6% and 0.4%, for ideation, plans and attempts, respectively. In general, suicidality in the previous 12 months tended to be relatively more common in women, younger people, those outside the labour force, and those with mental disorders; and less common in those who were married or in de facto relationships, and those with moderate levels of education. A number of the differences in prevalence rates between sociodemographic and clinical subgroups did not reach statistical significance due to data availability constraints and the conservative tests of significance that were used by necessity. These patterns warrant further exploration. Service use for mental health problems was higher among people with suicidality than it was among the general population, but significant numbers of those experiencing suicidality did not receive treatment. Conclusions: Suicidal thoughts and behaviours are not uncommon among the Australian adult population. These thoughts and behaviours are not only predictive of subsequent fatal suicidal acts, but are significant public health problems in their own right. They are associated with high levels of burden at an individual and societal level. Further analysis is required to assess the effectiveness of the national policy frameworks in reducing the spectrum of suicidal thoughts and behaviours. [ABSTRACT FROM AUTHOR]

Objective: Although Australia and the UK have both made efforts to systematize outcome measurement in mental health services, surprisingly little attention has been paid to how best to analyse routine outcome data in order to determine how services are performing. Methods: Outcome data collected in acute inpatient and ambulatory mental health services across Australia during the 2006-2007 financial year were used. three approaches to measuring effectiveness were explored: effect size (ES); the reliable change index (RCI); and standard error of measurement (SEM). Results: The most conservative results were produced by the RCI and the least conservative by the medium ES statistic and the SEM. By way of example, only 38.0% of inpatient admission-discharge periods of care showed significant improvement for adults when the RCI was used, whereas 67.4% and 72.9% did so when the medium ES and the SEM statistics were used, respectively. Conclusions: In any routine outcome measurement exercise, the degree of effectiveness demonstrated by services will depend on the specific statistical indicator used to judge effectiveness. Routine outcome measurement has the potential to answer a range of crucial performance-related questions, but only if the same metric is used. Discussion of the appropriate statistical approach to take to facilitate cross-service, cross-area and even cross-national comparisons warrants attention. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To estimate the prevalence of depression among older adults in Australia. Method: All general practitioners in Australia''s five most populous states who satisfied certain eligibility criteria (e.g., sufficient weekly working hours, sufficient numbers of elderly patients) were invited to participate. Those who consented were asked to identify all of their patients aged 60+ and invite them (either directly or via the study team) to complete a questionnaire. The questionnaire identified those who had experienced ‘clinically significant depression’ and those who had experienced a ‘major depressive episode’ in the past two weeks, via the Patient Health Questionnaire (PHQ-9). Consenting patients completed the questionnaire and returned it to the study team in a reply-paid envelope. Results: In total, 22,251 patients returned questionnaires. Overall, the age-adjusted rate of clinically significant depression was 8.2% (95%CI=7.8%–8.6%), with the age-adjusted rates for males being 8.6% (95%CI=7.9%–9.2%) and for females being 7.9% (95%CI=7.4%–8.4%). The overall, male and female age-adjusted rates for a major depressive episode were 1.8% (95%CI=1.6%–2.0%), 1.9% (95%CI=1.6%–2.2%) and 1.7% (95%CI=1.5%–2.0%), respectively. Discussion: Our study suggests that depression among older people is a major public health problem. The above estimates provide guidance for efficient planning of services, and establish a baseline against which preventive and treatment interventions can be assessed. Armed with this information, we can progress efforts at reducing this major health problem and its consequences. [Copyright &y& Elsevier]

There are worldwide concerns that pro-suicide web sites may trigger suicidal behaviors among vulnerable individuals. In 2006, Australia became the first country to criminalize such sites, sparking heated debate. Concerns were expressed that the law casts the criminal net too widely; inappropriately interferes with the autonomy of those who wish to die; and has jurisdictional limitations, with off-shore web sites remaining largely immune. Conversely, proponents point out that the law may limit access to domestic pro-suicide web sites, raise awareness of Internet-related suicide, mobilize community efforts to combat it, and serve as a powerful expression of societal norms about the promotion of suicidal behavior. [ABSTRACT FROM AUTHOR]

Within the health services research community there is a growing strength of feeling that ongoing partnerships between researchers and decision-makers are critically important to effective transfer and exchange of knowledge generated from health services research. A body of literature is emerging around this idea that favours a particular model of partnership based on decision-maker involvement in research. This model is also gaining favour among health research funding bodies internationally. We argue that it is premature for the health services community to privilege any particular model of partnership between researchers and decision-makers. Rather a diversity of models should be conceptualized, explored in theory and practice, and evaluated. We identify seven dimensions that could be used to describe and differentiate models of partnerships for knowledge exchange and illustrate how these dimensions could be applied to analysing partnerships, using three case studies from recent and ongoing health services research partnerships in Australia. [ABSTRACT FROM AUTHOR]

Background The fifth leading cause of death for Aboriginal people in Australia is suicide. These deaths are preventable, and their impact is significant for family and the wider community. This work aims to increase understanding of suicide deaths among Aboriginal people by describing these deaths by a range of factors, and identifying similarities and differences between Aboriginal and non-Aboriginal deaths by suicide. Methods Suicide deaths in Australia from 2001 to 2019 will be identified from the National Coronial Information System database. Demographic factors, details of the deaths and geographic factors will be described, and comparisons will be made between Aboriginal and non-Aboriginal deaths by suicide. Overall suicide rates by Aboriginal status and age- and sex-standardised rates per 100,000 person-years will be calculated using mid-year estimated resident population and death counts stratified by year, age, sex, and Aboriginal status from the Australian Bureau of Statistics. Results The analysis for this work is currently underway and will be finalised prior to the conference. Conclusions The results of this research will provide information about sub-groups of the Aboriginal population and areas of Australia with heightened and reduced risks and rates of suicide. The findings will be interpreted with guidance from the Aboriginal Advisory Committee involved in this work. Findings will be shared with service providers, policymakers, communities, and researchers to enable improved targeting of interventions. Key messages Better understanding of Aboriginal deaths by suicide is critical to inform and improve the much-needed targeting of services and interventions. [ABSTRACT FROM AUTHOR]

Rural Australians face particular difficulties in accessing mental health care. This paper explores whether 51 rural Access to Allied Psychological Services projects, funded under the Better Outcomes in Mental Health Care program, are improving such access, and, if so, whether this is translating to positive consumer outcomes. Design and method: The paper draws on three data sources (a survey of models of service delivery, a minimum dataset and three case studies) to examine the operation and achievements of these projects, and makes comparisons with their 57 urban equivalents as relevant. Results: Proportionally, uptake of the projects in rural areas has been higher than in urban areas: more GPs and allied health professionals are involved, and more consumers have received care. There is also evidence that the models of service delivery used in these projects have specifically been designed to resolve issues particular to rural areas, such as difficulties recruiting and retaining providers. The projects are being delivered at no or low cost to consumers, and are achieving positive outcomes as assessed by standardised measures. Conclusion: The findings suggest that the rural projects have the potential to improve access to mental health care for rural residents with depression and anxiety, by enabling GPs to refer them to allied health professionals. The findings are discussed with reference to recent reforms to mental health care delivery in Australia. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates international planning directions of mental healthcare service plans in various countries. The World Health Organization (WHO) administered the study by conducting web search on the health plans of different countries through information and full reference identification and classified them in different types. The study revealed that WHO initiative in reforming and creating unified health plan services is commendable.

There is a paucity of studies examining which suicides are considered newsworthy. By combining data on media reports of individuals' suicides with routinely collected suicide data, it was found that 1% of Australian suicides were reported over a 1-year period. There was evidence of over-reporting of suicides by older people and females, and those involving dramatic methods. Reported suicides fell into three groups: suicides reported in a broader context; suicides by celebrities; and suicides involving unusual circumstances/methods. The data suggest a need for media professionals and suicide experts to work together to balance newsworthiness against the risk of copycat behavior. [ABSTRACT FROM AUTHOR]

Objective: One hundred and eight Access to Allied Psychological Services projects have been funded under Australia's Better Outcomes in Mental Health Care programme since July 2001. All projects are run by Divisions of General Practice and enable general practitioners (GPs) to refer patients to allied health professionals for evidence-based care. They differ in the models they use to retain, locate and direct referrals to their allied health professionals. This paper examines the extent to which the projects are achieving positive patient outcomes, and explores the association between different models of service delivery and varying levels of patient outcomes. Method: The paper draws on two data sources (a purpose-designed minimum dataset and a survey of models of service delivery) to examine the level of patient outcomes within and across projects, and variations in the level of patient outcomes by models of service delivery. Results: The projects are achieving positive effects and these are mostly of large or medium magnitude. The projects do not differ markedly in terms of the patient outcomes they are achieving, despite differences in the models of service delivery they are using. However, those projects implementing a direct referral model, where the GP refers the patient directly to the allied health professional, have significantly greater effect sizes, indicating that they are achieving greater improvements in patient outcomes. In addition, there are non-significant trends toward direct employment of allied health professionals by Divisions being predictive of greater improvements in patient outcomes, and delivery of services from allied health professionals' own rooms being predictive of weaker patient outcomes. Conclusions: Overwhelmingly, the Access to Allied Psychological Services projects are having a positive impact for patients in terms of their level of functioning, severity of symptoms and/or quality of life. Preliminary indications suggest that a service delivery model incorporating the use of a direct referral system may be associated with superior outcomes. The findings are discussed in the light of the imminent listing of psychologists' services on the Medicare Benefits Schedule. [ABSTRACT FROM AUTHOR]