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Objective: To study the relationship between aspects of insight and medication adherence and elements of psychopathology. Method: Clients completed insight and adherence measures in interview; doctors and case managers independently completed ratings of adherence and psychopathology. Other client information was obtained from the clinical file. Results: The subscale structure of the insight scale was well reproduced. Clients endorsed items relating to need for treatment more than items relating to relabelling of symptoms and awareness of illness. Selfreported insight was lower in those clients for whom either the treating doctor or the case manager or both thought the client was non-adherent. Insight was related positively to clinician ratings of depressed mood, and negatively to clinician ratings of personal functioning. Conclusion: Our data support the subscale structure of the insight questionnaire used, and previous suggestions that insight is positively related to depressive affect, and inversely related to impaired psychosocial functioning. [ABSTRACT FROM AUTHOR]

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

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

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

Abstract: Context: Family carers of palliative care patients report high levels of psychological distress throughout the caregiving phase and during bereavement. Palliative care providers are required to provide psychosocial support to family carers; however, determining which carers are more likely to develop prolonged grief (PG) is currently unclear. Objectives: To ascertain whether family carers reporting high levels of PG symptoms and those who develop PG disorder (PGD) by six and 13 months postdeath can be predicted from predeath information. Methods: A longitudinal study of 301 carers of patients receiving palliative care was conducted across three palliative care services. Data were collected on entry to palliative care (T1) on a variety of sociodemographic variables, carer-related factors, and psychological distress measures. The measures of psychological distress were then readministered at six (T2; n =167) and 13 months postdeath (T3; n =143). Results: The PG symptoms at T1 were a strong predictor of both PG symptoms and PGD at T2 and T3. Greater bereavement dependency, a spousal relationship to the patient, greater impact of caring on schedule, poor family functioning, and low levels of optimism also were risk factors for PG symptoms. Conclusion: Screening family carers on entry to palliative care seems to be the most effective way of identifying who has a higher risk of developing PG. We recommend screening carers six months after the death of their relative to identify most carers with PG. [Copyright &y& Elsevier]

Abstract: Context: Palliative care services are required to support patients who have advanced, life-threatening, noncurable disease, and their family caregivers. Comprehensive psychological and social support for bereaved family members also is expected. However, recent systematic reviews have demonstrated significant gaps in evidence-based approaches for such support. Furthermore, a comprehensive understanding of the psychological and social response to the family caregiver role is required for support to be optimized. Objectives: We sought to examine the psychological and social profile of family caregivers on commencement of receiving palliative care services. Methods: A self-report questionnaire was administered to primary family caregivers of patients within two weeks of admission to three palliative care services in Melbourne, Australia. The questionnaire incorporated six instruments that measured 11 family caregiver-related psychosocial factors; four instruments that measured caregiver psychological distress factors; 14 mental health lifetime risk factors; and a sociodemographic questionnaire. Results: Three hundred and two family caregivers participated. Nearly half (44%) of the caregivers had a probable anxiety and/or depressive disorder, with 40% scoring more than the cutoff score for probable anxiety and 20% scoring more than the cutoff score for probable depression. Additionally, approximately 15% of caregivers met the criteria for pre-loss grief, and around 10% reported moderate to severe levels of demoralization. Caregivers who had a probable anxiety and/or depressive disorder also reported higher levels of pre-loss grief. Conclusion: This study provides further evidence of the prevalence of poor psychosocial well-being in this population. The results reinforce the need to develop suitable strategies for psychological and social support for family caregivers. [Copyright &y& Elsevier]

This study is one of the activities of a multi-site research program, the Australian Mental Health Initiative (AIMhi), funded by the National Health and Medical Research Council. AIMhi in the Northern Territory collaborated with Aboriginal mental health workers and Northern Territory remote service providers in developing a range of resources and strategies to promote improved Indigenous mental health outcomes. A brief intervention that combines the principles of motivational interviewing, problem solving therapy and chronic disease self-management is described. The intervention has been integrated into a randomised controlled trial. Early findings suggest that the strategy and its components are well received by clients with chronic mental illness, and their carers, in remote communities. [ABSTRACT FROM AUTHOR]

This study was designed to provide important new information about relapse prevention in Indigenous people with chronic mental illness. It aimed to explore Indigenous mental health promotion with Aboriginal mental health workers (AMHW) in order to develop strategies for effective mental health intervention. The research was conducted in three remote Indigenous communities in the top end of the Northern Territory with AMHW. Assessment, psycho-education, and care-planning resources were developed with local AMHW through exploration of local Indigenous perspectives of mental health promotion. Qualitative research methods and an ethnographic approach were used to elicit information, and data included key informant interviews, participant observation, music, photography and story telling. The study confirms that Indigenous people in remote communities prefer to use story telling and local language, local artwork and local music to convey health information. It also confirms that family and local practitioners are key cultural informants and that indirect, holistic and 'two-way' messages are preferred. [ABSTRACT FROM AUTHOR]

Objective: Australian Indigenous peoples in remote and rural settings continue to have limited access to treatment for mental illness. Comorbid disorders complicate presentations in primary care where Indigenous youths and perinatal women are at particular risk. Despite this high comorbidity there are few examples of successful models of integrated treatment. This paper outlines these challenges and provides recommendations for practice that derive from recent developments in the Northern Territory. Conclusions: There is a strong need to develop evidence for the effectiveness of integrated and culturally informed individual and service level interventions. We describe the Best practice in Early intervention Assessment and Treatment of depression and substance misuse study which seeks to address this need. [ABSTRACT FROM AUTHOR]