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Objectives: Dissatisfaction with body image is common in patients seeking corrective plastic surgery. However, surgery may not be suitable for every patient. Surgery can enhance quality of life in mentally healthy patients but those with psychopathology such as body dysmorphic disorder (BDD) tend to have poorer outcomes. For these patients, surgery is not always recommended and psychiatric care can have a useful role. This paper aimed to estimate the rates of psychopathology in a select group of elective plastic surgery candidates and discuss the role of preoperative psychoplastic referral in triaging these candidates. Method: A retrospective cohort study of patients considering elective surgery at Flinders Medical Centre in South Australia referred by their surgeon for psychoplastic evaluation from 2010 to 2016. Medical records were reviewed to determine compliance with psychiatric referral, the number and types of psychiatric diagnosis and rates of subsequent surgery. Results: We found 83 per cent (54/65) of surgical candidates assessed by our psychiatrist had a mental illness. Post-traumatic stress disorder (n=19, 34.5%) and major depressive disorder (n=19, 34.5%) were most common. Nine patients (13.6%) were diagnosed with BDD. A total of 57 (87.7%) patients were considered to need some kind of psychiatric care to improve potential surgery outcomes. Conclusions: In our study, the rate of psychopathology in patients referred for psychiatric evaluation suggests that careful screening is important for clinical decision making. A combined surgical /psychiatric approach is effective in ensuring vulnerable patients are identified and managed appropriately.

Objective: Australian tertiary eating disorder services (EDS) have a divided model of care, where child and adolescent mental health services (CAMHS) support patients until the age of 18 years, and thereafter, adult mental health services (AMHS) provide care. Consumers and carers have criticised this divided model because the age boundary occurs during the peak period of onset and acuity for eating disorders. Most CAMHS patients are lost to specialty follow-up around age 18, increasing the risks of relapse and premature mortality from eating disorders, since young women (aged 15–24) have the highest hospitalisation rates from anorexia nervosa. The current article is a commentary on the transition gap and possible service designs. Conclusions: Eating disorders require access to specialty treatment across the life span. The Australian Federal Government has expanded all-age care through the 2019 Medicare Benefit Schedule (MBS) eating disorder plans. Some new MBS patients require a rapid step-up in care intensity to a tertiary EDS, thereby increasing demand on the public sector. State/Territory Governments should strengthen EDS using the ‘youth reach-down’ model, where AMHS extend EDS to age 12. Vertical service integration from 12 to 64+ facilitates continuity of care for the duration of an eating disorder.

Our sociological knowledge base about plastic surgery has been predominantly constructed in free market contexts, leaving uncertainties as to how sociological theory around agency, identity, and structure apply in the context of publicly funded plastic surgeries. We draw on narratives of Australian women while waiting for abdominoplasty in the public system and recounting their post-surgical realities to understand the relational, dependent and interdependent agency–structure networks in which women's bodies, affects, lives and eligibility requirements are enmeshed. We found women adopted a ‘deserving’ identity to help them claim and enact agency as they felt and navigated the layered structures that govern publicly funded abdominoplasty in Australia, and theorise how this might influence unfolding patterns of social life. We explicate the importance of locating women's lived experiences of medical (dys)function vis-à-vis the sociocultural histories of medicine, health, gender and citizenship that give rise to publicly funded healthcare.

Objective There are three aims of this report. First, to describe how research evidence informed a service development rationale for a new statewide eating disorder service (SEDS) for people aged 15 years and older. Second, to examine the profile of people accessing SEDS in the first 2 years of its operation with respect to the three broad dimensions: illness stage, illness severity, and previous history of treatment. Finally, to examine which patient characteristics resulted in the recommendation of ongoing treatment contact with SEDS. Method Over a 2-year period (July 2014 to July 2016) 292 people were referred to the service, 171 (59%) who consented to have their data used in research. Results Half of the referrals related to anorexia nervosa (AN; 51.2%), with the remainder split between bulimia nervosa (25.3%) and other specified feeding and eating disorders (23.5%); 65.9% had previously received treatment for an eating disorder. The initial information about the service was typically provided by the general practitioner/primary care physician. Compared with any other eating disorder diagnosis, people with AN were three times more likely to be recommended to retain treatment contact with SEDS. Discussion Service development informed by research evidence, clinical expertise, and consideration of patients' characteristics, values, and circumstances, allows for a flexible but accountable development strategy.

There are three aims of this report. First, to describe how research evidence informed a service development rationale for a new statewide eating disorder service (SEDS) for people aged 15 years and older. Second, to examine the profile of people accessing SEDS in the first 2 years of its operation with respect to the three broad dimensions: illness stage, illness severity, and previous history of treatment. Finally, to examine which patient characteristics resulted in the recommendation of ongoing treatment contact with SEDS.Over a 2-year period (July 2014 to July 2016) 292 people were referred to the service, 171 (59%) who consented to have their data used in research.Half of the referrals related to anorexia nervosa (AN; 51.2%), with the remainder split between bulimia nervosa (25.3%) and other specified feeding and eating disorders (23.5%); 65.9% had previously received treatment for an eating disorder. The initial information about the service was typically provided by the general practitioner/primary care physician. Compared with any other eating disorder diagnosis, people with AN were three times more likely to be recommended to retain treatment contact with SEDS.Service development informed by research evidence, clinical expertise, and consideration of patients' characteristics, values, and circumstances, allows for a flexible but accountable development strategy.

Objectives: The objective of this study was to describe the history of South Australian Government eating disorder service from the perspective of changing leadership, health policies and politics. Conclusions: The history reveals a foundation of early expert academic clinical leadership changing into a centralised managerial bureaucracy correlating with a diminution of services. A threat to the survival of the service led to a solution involving reinvigoration of expert clinical and academic leadership. Expert leadership was shown to be an important part of an eating disorder service.

The role of psychological contributions to common dermatological disease is increasingly recognized. It is often a challenge to find suitable psychological services to complement dermatological treatment. This paper describes the development of a psychological treatment service to reduce scratching behaviour found in common pruritic skin conditions. Our Department of Dermatology together with a consultation-liaison psychiatrist designed a four-session outpatient treatment programme incorporating psychiatric assessment, psychoeducation about the itch-scratch cycle, behavioural analysis, habit reversal techniques and between-session tasks for the patient to complete. This programme is actively modified in consultation with patients and their therapists to suit each patient's individual needs. Formal investigation is required to determine if this psychological treatment adds benefit in overall symptom control beyond dermatological treatment alone.

Habit reversal therapy was originally developed by Azrin and Nunn in 1977 as a multicomponent treatment for nervous tics and habits. Their premise for clinical intervention was that an old habit can be broken by replacing it with a new, more desirable habit. Dermatology nurses trained in habit reversal therapy can enhance system management and quality of life for patients. Recommendations for the evaluation of habit reversal in patients with eczema and prurigo nodularis are made.

The Weight Disorder Unit at Flinders Medical Centre was established in 1977 and in June 2014, the service was expanded under a rebranded name, the South Australian Statewide Eating Disorder Service (SEDS). Now, besides its inpatient unit, SEDS also has outpatient services and an eating disorder Day Program. This is the first Day Program in South Australia and besides providing nutritional support, the Day Program also focuses on helping participants to challenge disordered eating behaviours and thought patterns through group-based therapeutic interventions. To be admitted into the SEDS Day Program, clients need to be at least 15 years of age, have a Body Mass Index (BMI) of 15 and above and be medically stable. In order to gain a better understanding of the profile of clients that get admitted to day programs and the effectiveness of the Day Program, we plan to present the clinical profile of the participants and information collected from the SEDS Day Program. Information presented will include sociodemographic and medical information, information collected from clients' psychological assessments pre, post and 3 months follow-up after completion of the Day Program, and the retention rate of the Day Program participants.