Mental Health In Australia Research Articles

Western Australia's Mental Health Court Liaison Service

This article describes the Western Australian mental health court liaison service. It examines the outcomes that can be measured to assess mental health court liaison services and considers Western Australia's service against criteria described in the literature. The Western Australian mental health court liaison service was reviewed against defined criteria. Published criteria to measure effectiveness of mental health court liaison are helpful. Western Australia's service was developed to be as effective as it could be within the parameters in which it operates. It is important to review the efficacy of a service against criteria over which it has control. Outcomes that have specific utility for court liaison are discussed.

A national approach to perinatal mental health in Australia: exercising caution in the roll‐out of a public health initiative

Perinatal depression is an important public health issue, with major consequences for the mother, child and family. Perinatal depression is often associated with anxiety and other mental health and psychosocial issues. The National Perinatal Depression Plan (NPDP) proposes routine screening during pregnancy and after birth, follow-up support for women assessed to be at risk of or experiencing depression, and training for health professionals. Identifying women at risk of or experiencing perinatal depression is difficult, and there is no standard tool used by all hospitals to assess women’s emotional health and psychosocial comorbidities. The NPDP provides an opportunity to develop and evaluate new approaches to assessing perinatal depression and a range of psychosocial issues, and to test strategies for supporting women and their families before and after birth. Language: en

State of indigenous mental health in Australia - a colonial legacy?

The Aboriginal culture of Australia is one of the oldest cultures on earth, dating back 50 000 years. The Aboriginal and Torres Strait Islander (ATSI) people are the indigenous inhabitants of Australia, constituting 2.4% of the population. The health status of these 'First Australians' has been described as a source of national shame, with the life expectancy approximately 17 years lower than that of other Australians (Eades, 2000). This gap in life expectancy is also significantly larger than that of other countries with indigenous populations and a history of colonisation, such as the USA, Canada and New Zealand (Ring & Firman, 1998). This paper offers an overview of the impact of colonisation and its subsequent influence on the social and emotional well-being of ATSI people.

A national approach to perinatal mental health in Australia: exercising caution in the roll‐out of a public health initiative

Perinatal depression is an important public health issue, with major consequences for the mother, child and family. Perinatal depression is often associated with anxiety and other mental health and psychosocial issues. The National Perinatal Depression Plan (NPDP) proposes routine screening during pregnancy and after birth, follow-up support for women assessed to be at risk of or experiencing depression, and training for health professionals. Identifying women at risk of or experiencing perinatal depression is difficult, and there is no standard tool used by all hospitals to assess women's emotional health and psychosocial comorbidities. The NPDP provides an opportunity to develop and evaluate new approaches to assessing perinatal depression and a range of psychosocial issues, and to test strategies for supporting women and their families before and after birth.

Mental health policy — stumbling in the dark?

Over the past 15 years, governments have agreed to a series of National Mental Health Plans. These national strategies and plans have set goals and discussed the importance of monitoring and evaluation. Despite this ongoing national collaborative framework, Australia's mental health policy lacks real accountability and relies largely on limited mental health service systems data. The lack of outcome data represents a critical gap in knowledge for mental health policy, planning and practice. Resistance from current stakeholders and a lack of investment in research and monitoring capacity are preventing more rigorous ongoing monitoring of mental health policy. The new Rudd Government appears to be shifting the emphasis towards measuring the outcomes of national policy in health, housing and employment. Measuring such outcomes will guide government decision making and ultimately improve mental health services.

A central dilemma in the mental health sector: Structural imbalance

Mental health services provision is persistently criticised regarding resource inadequacy. Services are also subject to another dilemma, “structural imbalance”. This study demonstrates the dimensions of structural imbalance in Australia's mental health sector by recourse to the 1997 Australian Bureau of Statistics national survey of mental health and wellbeing. This study also examines the concept by reference to the Australian Government's announced COAG initiatives (April 2006), and State government responses (July 2006). The two dimensions of structural imbalance are, first, that some people with no clinical mental illness consume mental health services and, second, that other people have clinical manifestations of mental illness and (for various reasons) do not consume mental health services; the present study shows how the situations coexist. “Throwing more money” at the pre-existing structures may do nothing to address the structural imbalance problem. Remedies are discussed by reference to the reforms undertaken in the British National Health Service in recent years.

Videoconferencing and forensic mental health in Australia

Videoconferencing is in common use in Australian forensic mental health services. It provides opportunities to link remote prisons, courts, and psychiatric clinics with distant specialist services, and enables a range of activities including assessment, treatment and feedback, expert testimony, education, and inter-service planning. These functions are acceptable to patients and clinicians, and in Australia videoconferencing minimizes disruption to small services and their patients, who might otherwise face lengthy journeys. In particular, marginalized patient groups, including indigenous people and prisoners, may receive better services. The evidence base supports use of videoconferencing despite a number of practical, legal, and clinical issues that may reduce its effectiveness compared with face-to-face assessments. Videoconferencing technologies are critical to effective forensic mental health services in Australia.

The Australian mental health system: An economic overview and some research issues

This article is concerned with the key economic characteristics of Australia's mental health system. First, some brief conceptual and empirical descriptions are provided of Australia's mental health services, both as a total system, and of its two principal components, viz. public psychiatric institutions and private psychiatry services. Expenditures on public psychiatric hospitals clearly demonstrate the effect of deinstitutionalisation. Data from 1984 on private practice psychiatry indicate that per capita utilisation rates peaked in 1996 and have since fallen. Generally, since 1984 gross fees have not risen. However, for both utilisation and fees, there is evidence (of a statistical kind) that there are significant differences between the states of Australia, in these two variables (utilisation and fees). Emphasis is also placed on the economic incentives that arise from health insurance and the heterogeneous nature of mental illness. The effects of these incentives are regarded as by-products of the health insurance mechanism; and another effect, "unmet need" and "met non-need", is a somewhat unique problem of an informational kind. Discussion of many of these issues concludes on a somewhat negative note, e.g. that no empirical results are available to quantify the particular effect that is discussed. This is a manifestation of the lacunae of economic studies of the mental health sector.

Consumer Participation in Mental Health in Australia: What Progress is Being Made?

Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. This has led to serious negative consequences for their health and wellbeing. Recent public policy has aimed at redressing this situation. This paper sets out to investigate the 'state of play' regarding consumer participation in mental health services. Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. Although the vision of public policy is for consumers to be at the centre of decision making, the changes are understandably slow in coming. The implications for the practice of psychiatry, and therefore mental health services, of the demands for meaningful participation are profound. They challenge some of the social covenants under which mental health services have historically been delivered. Traditionally, people living with a mental illness have not had their rights respected. In recent times, the College has developed policies that aim to ensure that the rights of people living with a mental disorder are respected. These policies also acknowledge that effective health care requires collaboration with consumers.

Asylum, Detention, and Mental Health in Australia

Seeking asylum in the face of persecution is a fundamental human right. The system of arbitrary mandatory detention operating under Australian immigration law since 1992 has impacted on more than 15,000 adults and children, many with traumatic experiences in their country of origin. Restrictions on entry to the mainland, policies of “deterrence”, including prolonged detention in remote camps, and inadequate responses to trauma and mental health needs have contributed to mental deterioration and suffering of asylum-seekers. The responses of mental health professionals, lawyers, human rights advocates, and community groups to the detention system have focused on the need to protect the right to seek asylum and the need for a humane response to asylum-seekers.

An historical account of shell shock during the First World War and reforms in mental health in Australia 1914–1939

The study of the disorders of the mind at the turn of the twentieth century offered useful knowledge about the psyche and the First World War (FWW) provided an avalanche of case studies. Prior to the war the mentally ill were treated with disdain and the social distrust of individuals who did not present as 'normal' was high. The level of diagnostic expertise of psychiatric illness by doctors and nurses was low and as a consequence medicine and nursing was ill-equipped to deal with the phenomenon initially referred to as 'shell shock'. However, the soldiers of the FWW who endured the varied and seemingly unrelated symptoms of shell-shock were respected men - occasional heroes - who were reduced to the status of 'mentals'. There is evidence that civilian trained health professionals altered their views about mental illness during the FWW but initially, the military imperatives inherent in a global conflict perpetuated the notion that mental illness was linked with defective morality. This paper provides an historical account of changes in attitude toward the mentally ill as a consequence of the FWW. The interregnum (1918-39) was a period of advancement in the field of mental health within the civilian sector. However, the imperatives of war negated these developments and there is evidence that the management of soldiers suffering from post-traumatic stress disorders in the Second World War did not benefit from the lessons learnt in the FWW.

Prevalence of Mental Disorders in the Elderly: The Australian National Mental Health and Well-Being Survey

To describe the 1- and 12-month prevalence of mental disorders, their demographic correlates, and their impact on service utilization and disability in individuals 65 years of age and over in a comprehensive epidemiological survey of mental health in Australia. A noninstitutionalized national probability sample of elderly Australian residents was interviewed as part of the Australian National Mental Health and Well-being Survey (NMHWS). The prevalence of International Classification of Diseases, Tenth Revision and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders was estimated from the Composite International Diagnostic Interview and other screening instruments. Of 1,792 elderly NMHWS respondents, 13% reported symptoms consistent with a mental disorder in the past 1 month, and 16% reported symptoms consistent with a mental disorder in the past 12 months. Women experienced higher rates of affective disorders and generalized anxiety disorder and had lower rates of substance abuse compared with men. After excluding cognitive disorder, increasing age was associated with less likelihood of having symptoms of any mental disorder. Older age and never having been married were associated with less likelihood of having symptoms of an affective disorder. Those with cognitive impairment were more likely to have had symptoms consistent with an affective disorder. Comorbidity was predictive of increasing disability on the 12-item Short Form but rates of mental health consultation were low, even for those with multiple disorders. Community-dwelling elderly Australians experience substantial rates of mental disorders. Demographic correlates of mental disorder in this elderly population appear to differ from those established in younger populations. Mental disorder in elderly Australians is associated with significant disability, but rates of specialist mental health consultation is low, even for those with multiple comorbidities. The reasons for this must be examined.

Understanding barriers to mental health service utilization for adolescents in rural Australia

There is a general paucity of research in the area of rural adolescent mental health in Australia, and in particular a lack of data regarding the experiences of rural adolescents who seek help for mental health problems. This study used a qualitative approach to data collection and analysis in order to assist understanding of the barriers to mental health service utilization for young people in rural communities. A series of interviews were conducted with each of the study's participants, who ranged in age from 15 to 17 years. All participants were clients of the Child and Adolescent Mental Health Services in the rural cities of Horsham and Ararat, Victoria, Australia. Participants described how the lack of reliable transport to and from the mental health service affected the utilization of the service by rural young people. They also expressed concern regarding a lack of qualified professionals in their region who specialize in child and adolescent mental health. Participants reported frustration at long waiting lists and the lack of an after-hours service. One participant shared her experiences of deliberate self-harm to in order to gain access. Results also revealed that rural gossip networks and social visibility within rural communities compounded the experience of stigma and social exclusion for these young people. Furthermore, participants explained how these experiences negatively impacted on their utilization of the mental health service and their progress towards recovery. There are several barriers to mental health service utilization for rural adolescents which affect both their decision to access help as well as their ability to engage effectively with mental health services over time. Clinicians who work with rural adolescents need to be mindful of the influence of rural culture on mental health service utilization by young people. The co-location of mental health services and general health services is suggested as one way to reduce the fear associated with 'being seen' entering a stand-alone mental health service. It is suggested that treatment programs for adolescents in rural areas address the different types of stigma that these young people are likely to encounter. Furthermore, community and school-based interventions aimed at reducing the social stigma of young people with mental illness in rural areas is recommended.

Benchmarking Australia's mental health services: is it possible and useful?

Benchmarking of performance indicators in the mental health field is gaining currency in Australia as a strategy for improving service quality. To engage mental health service providers in the collection and evaluation of performance data. Three separate rounds of data collection involving high secure, extended treatment, and medium secure services were carried out between 2003 and 2005. Twenty-five core indicators were identified and these were used to assess service inputs, processes, outputs and outcomes. Differences in casemix, clinical practice and local business rules gave rise to variation in service performance. The benchmarking exercise led to the implementation of quality improvement initiatives. It is possible and useful to collect and evaluate performance data for mental health services. While services appear similar enough to benchmark, information related to both casemix and service characteristics needs to be included in benchmarking data to understand the factors that produce differences in service performance.

Using the Internet to Enhance the Treatment of Depression

Deficiencies in Australia's mental health systems persist despite over a decade of mental health reform. Recent developments in e-health provide the opportunity to facilitate health reform and improve services. This paper presents preliminary findings from the implementation of a comprehensive e-health system, called RecoveryRoad, which was designed to augment the routine clinical treatment of depression. Depressed patients (n = 144) were referred to RecoveryRoad from a public hospital and public and private clinics in Perth, Western Australia. Online features included secure e-consultations, progress monitoring questionnaires, psychoeducation and evidence-based therapy. Treating clinicians had online access to patients' progress monitoring outcomes and e-consultations. There were two types of adherence reminders: automated email reminders and personalized case management delivered by email and telephone. Adherence to the system was high (from 53% to 84%, depending on the modality of reminder), and self-reported medication adherence was over 90%. Average depression severity declined from severe to mild by the eighth session, a large effect (d = 1.0). Both clinicians and patients were generally satisfied with the programme and reported that it improved clinician-patient relationships. Clinicians also reported that it helped patients to better manage depression. Preliminary findings support the feasibility of comprehensive e-health systems in enhancing the delivery of mental health care.

A central dilemma in the mental health sector: structural imbalance.

Mental health services provision is persistently criticised regarding resource inadequacy. Services are also subject to another dilemma, “structural imbalance”. This study demonstrates the dimensions of structural imbalance in Australia's mental health sector by recourse to the 1997 Australian Bureau of Statistics national survey of mental health and wellbeing. This study also examines the concept by reference to the Australian Government's announced COAG initiatives (April 2006), and State government responses (July 2006). The two dimensions of structural imbalance are, first, that some people with no clinical mental illness consume mental health services and, second, that other people have clinical manifestations of mental illness and (for various reasons) do not consume mental health services; the present study shows how the situations coexist. “Throwing more money” at the pre-existing structures may do nothing to address the structural imbalance problem. Remedies are discussed by reference to the reforms undertaken in the British National Health Service in recent years.

A Report on Economic Studies of Australian Mental Health Issues

To report on economic studies of Australian mental health issues. Although the international literature on the economics of mental health issues is increasing, and although many Australian studies exist on one comorbid condition of mental illness, namely substance abuse, there are very few empirical studies by economists of Australia's mental health issues.

Examining geographical and household variation in mental health in Australia

Objective: International research has failed to demonstrate area effects in the distribution of common mental disorders. In contrast, strong and robust household effects are evident, though relatively rarely examined. This study investigated household and area effects in the distribution of mental health scores using Australian data.Method: Analysis of data from the first wave of the Household, Income and Labour Dynamics in Australia Survey: a large representative survey of 13 969 Australian adults. Multilevel regression methods were used to model variance in the mental health scale and mental component summary scale of the Short-Form 36 at the individual, household and area (Census Collection District) levels. A number of risk factors at various levels of the model were also examined.Results: Very little variance in mental health scores occurred at the area level (1.5%), whereas significant and substantial variance occurred at the household level (23.0%). The variance at the household level remained highly significant following the inclusion of a range of risk factors at the individual, household and area levels.Conclusions: The results confirm the absence of substantial area-level variation in mental health using Australian data. The findings highlight the importance of focusing on household-level characteristics in future research.

Examining Geographical and Household Variation in Mental Health in Australia

International research has failed to demonstrate area effects in the distribution of common mental disorders. In contrast, strong and robust household effects are evident, though relatively rarely examined. This study investigated household and area effects in the distribution of mental health scores using Australian data. Analysis of data from the first wave of the Household, Income and Labour Dynamics in Australia Survey: a large representative survey of 13 969 Australian adults. Multilevel regression methods were used to model variance in the mental health scale and mental component summary scale of the Short-Form 36 at the individual, household and area (Census Collection District) levels. A number of risk factors at various levels of the model were also examined. Very little variance in mental health scores occurred at the area level (1.5%), whereas significant and substantial variance occurred at the household level (23.0%). The variance at the household level remained highly significant following the inclusion of a range of risk factors at the individual, household and area levels. The results confirm the absence of substantial area-level variation in mental health using Australian data. The findings highlight the importance of focusing on household-level characteristics in future research.

Issues in rural adolescent mental health in Australia

The mental health of adolescents living in rural Australia has received little research attention. In this article, the extant literature on rural adolescent mental health in Australia is reviewed. Given the lack of literature on this topic, the review is centered on a vignette presented at the beginning of the article. The case represented by the vignette is that of a young Australian growing up in a rural area. The issues raised--including the nature of mental health issues for rural adolescents and barriers to seeking professional help--are then discussed in terms of the available literature. The article concludes with a future focus for research efforts in the area of rural adolescent mental health.