Mental Health Services In Australia Research Articles

Exploration of Perceived Determinants of Disordered Eating Behaviors in People with Mental Illness-A Qualitative Study.

Disordered eating behaviors are common in people with a serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depressive disorder. This study employed qualitative exploration to understand the perceived determinants of eating behaviors, in particular those connected to disordered eating patterns, in people with SMI. In total, 28 semi-structured interviews were conducted in a consecutive sample of people with SMI under treatment in local mental health services in Australia (n = 12), Germany (n = 8) and Austria (n = 8) (mean age: 43.3 years, proportion of female participants: 61%, proportion of participants with ICD-10 F2 diagnosis: 57%, proportion of participants with ICD-10 F3 diagnosis: 64%). A thematic analysis approach, the framework method, was applied using MAXQDA 2020. Three main themes of determinants were derived: (i) impacts to daily functioning, (ii) disrupted physical hunger cues and (iii) emotional hunger. For impacts to daily functioning, the following themes emerged: lack of daily structure, time and drive, and difficulty planning ahead. For physical hunger, themes emerged for disrupted hunger and satiety cues, and mindless eating. All motives listed in the Palatable Eating Motives Scale (PEMS), i.e., coping, reward, social and conformity, have been reported by participants to be drivers for their emotional eating behavior. Subsequent reported behaviors were eating too much or too little, binge eating, night eating and food cravings. We conclude that interprofessional approaches should target daily functioning, disrupted physical hunger cues and emotional eating to reduce disordered eating behaviors in people with SMI.

The Transition From Postgraduate Counselling Student to Working Counsellor: A Qualitative Investigation

With the demand for mental health services in Australia continuing to grow, it is imperative that tertiary trained counsellors continue to enter the profession; yet little is known about the factors that contribute to a successful entry. This qualitative, phenomenological study investigated the transition from postgraduate counselling student to working counsellor by exploring the lived experience of those who have made this transition within the last five years. By focusing on the transitional experience itself, the study aimed to provide useful information for stakeholders holding key roles in such transitions—specifically students, academic institutions, professional bodies, and employers of counsellors within Australia. While results suggest that many factors affected the transitional experience, students’ practicum placement played a disproportionately large role in determining their early career path. Other important factors included the background of the individual, their experiences while studying, and the professional support in place once they had started working. This study also identified that students’ expectations of what it might be like to work as a counsellor in private practice were not always aligned with lived experience. It is hoped that knowledge about what has been valuable to recently transitioned early career counsellors will be of ongoing benefit to all stakeholders.

Helpful encounters with mental health nurses in Australia: A survey of service users and their supporters.

INTRODUCTION: Successive inquiries into mental health services in Australia have identified the need for major reform of services and proposed a return to direct-entry nursing training. To identify what service users, family and supporters have found helpful in their encounters with nurses in mental health settings. A survey of 95 service users and supporters rated the importance of the capabilities and competencies of nurses. They also shared examples of helpful encounters with nurses which were subject to thematic analysis. The most highly rated competencies were around demonstrating caring, empathy and understanding, and responding effectively in crisis situations. Helpful encounters involved enacted values, highly skilful interpersonal and psychotherapeutic engagement and practices that were facilitative and supportive. The process and content of pre-registration nursing training needs to refocus on the nurse meeting the needs of service users and supporters, rather than the instrumental needs of services today. Educational reform may be necessary but insufficient to address anticipated nursing workforce shortages. Policymakers and health service directors need to align services with mental health nursing values and promote practices aligned with what service users and their supporters report as helpful.

The Paradox of Suicide Prevention.

The recognition that we cannot use risk stratification (high, medium, low) to predict suicide or to allocate resources has led to a paradigm shift in suicide prevention efforts. There are challenges in adapting to these new paradigms, including reluctance of clinicians and services to move away from traditional risk categorisations; and conversely, the risk of a pendulum swing in which the focus of care swings from one approach to determining service priority and focus (e.g., diagnosis, formulation, risk and clinical care) to a new focus (e.g., suicide specific and non-clinical care), potentially supplanting the previous approach. This paper argues that the Prevention Paradox provides a useful mental model to support a shift in paradigm, whilst maintaining a balanced approach that incorporates new paradigms within the effective aspects of existing ones. The Prevention Paradox highlights the seemingly paradoxical situation where the greatest burden of disease or death is caused by those at low to moderate risk due their larger numbers. Current planning frameworks and resources do not support successful or sustainable adoption of these new approaches, leading to missed opportunities to prevent suicidal behaviours in healthcare. Adopting systems approaches to suicide prevention, such as the Zero Suicide Framework, implemented in a large mental health service in Australia and presented in this paper as a case study, can support a balanced approach of population- and individual-based suicide prevention efforts. Results demonstrate significant reductions in re-presentations with suicide attempts for consumers receiving this model of care; however, the increasing numbers of placements compromise the capacity of clinical teams to complete all components of standardised pathway of care. This highlights the need for review of resource planning frameworks and ongoing evaluations of the critical aspects of the interventions.

High occurrence of food insecurity in young people attending a youth mental health service in regional Australia.

AimDespite the relationship between food insecurity and poor mental health, food insecurity in young people attending mental health services in Australia remains understudied. This study aimed to determine the occurrence and predictors of food insecurity, and the relationship with dietary factors in young people attending a mental health service.MethodsA cross‐sectional online survey was conducted in a sample of young people (15–25 years) who attended a mental health service in Launceston, Australia. The survey utilised a single‐item food insecurity screening tool and eight demographic, health and service use questions. Five questions determined self‐reported intake of fruit, vegetables, breakfast, water, sugar‐sweetened beverages and takeaway foods. Binary logistic regression determined predictors of food insecurity. Cross‐tabulations determined differences in dietary intake according to food security.ResultsOf survey respondents (n = 48; 68% female), 40% (n = 19) were food insecure. Respondents living out of home or in unstable accommodation were at significantly higher risk of food insecurity (odds ratio [OR]: 4.43; SE: 0.696; 95% CI: 1.13–17.34; p = 0.032) compared to those living with their parents. Those receiving government financial assistance (OR: 5.00; SE: 0.676; 95% CI: 1.33–18.81; p = 0.017) were also at significantly higher risk of food insecurity. Regardless of food security status, self‐reported intake of fruits, vegetables and breakfast were low, and respondents regularly consumed takeaway foods and sugar‐sweetened beverages.ConclusionsThere was a high occurrence of food insecurity and poor dietary intake in young people attending a youth mental health service demonstrating that initiatives to support access to healthy food in this group should be a priority, with potential benefits for mental health outcomes.

Working with People Presenting with Symptoms of Borderline Personality Disorder: The Attitudes, Knowledge and Confidence of Mental Health Nurses in Crisis Response Roles in Australia

Many people diagnosed with or presenting with borderline personality disorder (BPD) attend the emergency department (ED) when in crisis, and are often referred to mental health nurses for further assessment, and to arrange appropriate follow-up (MHNs). Little is known about the knowledge, skills, confidence and competence of MHNs working with this group in these specialist roles. This study sought to describe the attitudes of MHNs working in EDs and crisis services towards people who present with symptoms characteristic of BPD and to explore their knowledge of the diagnostic criteria of BPD. A descriptive survey tool comprised of 23 questions was adapted from a previously used survey with clinicians in a mental health service in Australia. Fifty-four nurses who identified as MHNs and were currently employed in EDs or crisis settings completed the survey online. These MHNs were found to hold positive attitudes towards people with BPD including being optimistic about recovery and treatment. The experience and education of MHNs now employed in EDs may have contributed to positive attitudes and self-reported confidence relative to other nurses. Further research ought to focus on how MHNs assist people with a diagnosis of BPD who present in crisis meet immediate needs and facilitate access to effective ongoing care and treatment.

National Mental Health Performance Framework: Descriptive analysis of state and national data for 2019-2020.

To compare key performance indicators for public state and territory specialist mental health services in Australia. A descriptive analysis of the publicly-available National Mental Health Performance Framework key performance indicators (KPI), hosted by the Australian Institute of Health and Welfare for 2019-2020, at the national level and for states and territories. The real-world performance of public mental health services varied across the eight states and territories of Australia. Western Australia had the longest acute hospital stays and the lowest rates of involuntary admissions. Queensland (QLD) had the shortest acute hospital stays at the lowest cost. While the Australian Capital Territory had the highest rates of community treatment at the lowest cost, the Northern Territory had highest hospital and community costs with the most involuntary admissions. Victoria (VIC) had the lowest population percentage receiving specialised mental health services, the highest readmission rates after 28 days, and highest physical and mechanical restraint rates. The KPIs indicate that some states and territories show deviations from national benchmarks that may be important for consumers, carers and clinicians. For further improvement in quality and efficiency, more detailed contextual information is required, including detailed mapping of services.

Co-designing consumer and carer peer support principles to assess quality

ABSTRACT Objectives: Peer support has recently been integrated into post-discharge adult mental health services in Australia. This study establishes a consensus on the underpinning, context-specific peer support principles for both consumer and carer peer support and develops and pilot tests a scale to assess the quality of peer support. Methods: A co-design mixed methods approach was taken to iteratively develop peer support principles and to design co-responding survey items. Initial testing of the scale was undertaken with a convenience sample of 33 consumers and 35 carers who received peer support in the preceding nine months. Data were triangulated across multiple data sets for integration across consumers and carers. Scale internal reliability was assessed and comparisons between consumers and carers were investigated. Results: High rates of agreement on scale items measuring five co-designed peer support principles indicated strong service quality. Mann–Whitney U tests demonstrated no difference between consumer and carer responses and scale reliability was α = .93. Open-ended questions were filtered through the five peer support principles and on the whole showed convergence on the peer support principles by the various stakeholders. Discussion: To date, this is the first known development and application of an integrated scale for both consumers and carers in a post-discharge clinical mental health setting. Opportunity exists for further testing fidelity to peer support principles across various post-discharge peer support settings.

Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework.

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a 'tailored blueprint' methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

(Re)Writing Care: Critical Histories of Community Mental Health Services in Australia and New Zealand

(Re)Writing Care: Critical Histories of Community Mental Health Services in Australia and New Zealand

A Snapshot of the Counselling and Psychotherapy Workforce in Australia in 2020: Underutilised and Poorly Remunerated, Yet Highly Qualified and Desperately Needed

The aim of the 2020 workforce survey was to profile professionals affiliated with the Psychotherapy and Counselling Federation of Australia (PACFA) to inform future policy and service planning. PACFA is a national peak body for Australian counsellors and psychotherapists, representing 3,500 members across all states and territories. This study builds on previous workforce studies, the first of which was conducted in 2004. An online questionnaire was circulated to PACFA members covering participants’ demographics, qualifications, employment, sources of client referrals, client groups and presentations, along with the impact of the COVID-19 pandemic. Reflecting previous findings, participants predominantly identified as female, as coming from Australian or English backgrounds, and as being located in or around major cities. Notably, a higher proportion of counsellors and psychotherapists than psychologists and psychiatrists (who also have qualifications as counsellors or psychotherapists) were found in regional and rural Australia. The shortage of mental health services in Australia, especially in remote areas, and the desire for more working hours among over one quarter of registered practitioners, mean this workforce needs to be far better utilised to meet public demand and reduce health inequities for people in regional, rural, and remote Australia. Government recognition of registered counsellors and practitioners through Medicare’s Better Access subsidised sessions would significantly remedy the shortage of mental health services.

Multiple health behaviours and interest in change among people with a mental health condition: A brief report.

People with a mental illness experience a disproportionate burden of chronic disease morbidity and mortality; contributed to by a higher prevalence of health risk behaviours that increase the risk of chronic disease development. Amongst this population there is little understanding of multiple risk behaviour co-occurrence and client interest in improving multiple such risks. A cross-sectional survey was undertaken with a random selection of 557 clients of 12 community mental health services in Australia. Participants reported their engagement in health risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity), and those deemed 'at risk' reported whether they were seriously considering improving their risk behaviours. Almost all participants engaged in at least one risk behaviour (96.1%), with 78.4% of participants engaging in two or more risk behaviours. Of those with two risks, the most frequently paired behaviours were inadequate fruit and vegetable consumption and inadequate physical activity (39.7%); of those with three risks the most common combination was inadequate fruit and vegetable consumption, tobacco smoking and harmful alcohol consumption (42.5%). Of those at risk for all behaviours, 68.4% were interested in improving multiple behaviours, and 14% were interested in improving all; with these participants being most frequently interested in changing smoking, nutrition, and physical activity (19.3%), followed by all risk behaviours (14.0%). The findings strengthen the evidence that people with a mental illness are interested in improving their health risk behaviours and indicate a need to address the multiple health risks in this population group.

Mental health attendances in Australia during the COVID-19 pandemic: A telehealth success story?

IntroductionThe COVID-19 pandemic has significantly impacted the delivery of mental health services globally. Within Australia, the COVID-19 pandemic and subsequent containment measures have led to reduced face-to-face attendances. To maintain access to mental health consultations, new telehealth services were introduced by the Australian Government in late March 2020.ObjectivesWe aimed to quantify the impact of the COVID-19 pandemic on patterns of mental health attendances in Australia using an interrupted time series model.MethodsTo characterise patterns of mental health service utilisation, monthly mental health attendances between January 2016 and June 2020 were extracted from the Medicare database, stratified by clinician type: general practitioner (GP), psychiatrist, and allied health. We used triple exponential smoothing to model attendances between January 2017 and December 2019. Observed and predicted attendances between January and June 2020 were compared with 95% confidence (p<0.05).Results Our models showed decreased mental health attendances in March and April, consistent with all healthcare services during this time. While uptake of telehealth was significant, it only partially covered the reduction in mental health attendances.Conclusions Our modelling highlights the significant impacts of the COVID-19 pandemic on mental health services in Australia, with telehealth only partially compensating for the reduction in face-to-face attendances. These results suggest that telehealth services may not be suitable for all individuals (e.g. those without reliable internet access). Given that telehealth will likely remain a feature of mental health service provision, outreach and face-to-face services should be considered for vulnerable groupsDisclosureNo significant relationships.

The role of music therapy in Australian mental health services and the need for increased access to service users.

This opinion paper aims to provide an overview of the current evidence base supporting the use of music therapy in mental health care. It also aims to offer critique on the issue of access to music therapy in Australia. There is a strong evidence base for music therapy to provide symptomatic relief and improve quality of life for people living with mental illness. However, music therapy is underfunded and framed as a supplementary service within mental health services in Australia, which limits its access to consumers. Funding music therapy as an evidence-based treatment option would fill an existing service gap and provide equitable access to a cost-effective and often consumer preferred treatment option for mental health consumers.

Doing and being occupation centred in challenging settings: reflections on implementation strategies and professional rewards

Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach – a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond “knowing that” occupation centred practice is important, to “knowing how” to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.

Predicting self-harm within six months after initial presentation to youth mental health services: A machine learning study.

BackgroundA priority for health services is to reduce self-harm in young people. Predicting self-harm is challenging due to their rarity and complexity, however this does not preclude the utility of prediction models to improve decision-making regarding a service response in terms of more detailed assessments and/or intervention. The aim of this study was to predict self-harm within six-months after initial presentation.MethodThe study included 1962 young people (12–30 years) presenting to youth mental health services in Australia. Six machine learning algorithms were trained and tested with ten repeats of ten-fold cross-validation. The net benefit of these models were evaluated using decision curve analysis.ResultsOut of 1962 young people, 320 (16%) engaged in self-harm in the six months after first assessment and 1642 (84%) did not. The top 25% of young people as ranked by mean predicted probability accounted for 51.6% - 56.2% of all who engaged in self-harm. By the top 50%, this increased to 82.1%-84.4%. Models demonstrated fair overall prediction (AUROCs; 0.744–0.755) and calibration which indicates that predicted probabilities were close to the true probabilities (brier scores; 0.185–0.196). The net benefit of these models were positive and superior to the ‘treat everyone’ strategy. The strongest predictors were (in ranked order); a history of self-harm, age, social and occupational functioning, sex, bipolar disorder, psychosis-like experiences, treatment with antipsychotics, and a history of suicide ideation.ConclusionPrediction models for self-harm may have utility to identify a large sub population who would benefit from further assessment and targeted (low intensity) interventions. Such models could enhance health service approaches to identify and reduce self-harm, a considerable source of distress, morbidity, ongoing health care utilisation and mortality.

Increases in youth mental health services in Australia: Have they had an impact on youth population mental health?

Mental disorders often have their first onset during youth, which justifies targeting treatment services at this age group. Australia has had a substantial increase in youth mental health services since the introduction of the Medicare Better Access scheme and headspace services in 2006-2007. This paper examines trends in the mental health of Australian youth before and after this time using available national and state datasets. The following data were examined for age groups available in the age range of 12-25 years: use of mental health services per 100,000 population provided under Medicare by GPs, psychiatrists, clinical psychologists, other psychologists and allied health professionals; per capita accessing of headspace services; and prevalence of high and very high psychological distress (using the K10) in youth age groups in the National Health Survey, the Victorian Population Health Survey and the New South Wales Population Health Survey between 2001 and 2018. There has been a large increase in use of mental health services since the introduction of Better Access and headspace. No significant improvement in youth mental health was evident following the introduction of these schemes. Rather, there appeared to be a worsening of youth mental health from around 2015 onwards. Despite a large increase in the provision of mental health services to Australian youth, there has not been a detectable reduction in the prevalence of psychological distress. There may be other factors that have worsened youth mental health in recent years.

'What would a trauma-informed mental health service look like?' Perspectives of people who access services.

Trauma-informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re-traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma-informed. However, how Australian mental health services should deliver trauma-informed care is not well documented. Efforts towards trauma-informed care in any setting require engagement with those who receive care. This qualitative study used an experience-based co-design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question 'what would a trauma-informed mental health service look like?' Focus groups were held with consumers (n=10) and carers (n=10). Thematic analysis of transcripts identified that consumers and carers consider that trauma-informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma-informed care across settings.

Efficacy of the Zero Suicide framework in reducing recurrent suicide attempts: cross-sectional and time-to-recurrent-event analyses.

The Zero Suicide framework is a system-wide approach to prevent suicides in health services. It has been implemented worldwide but has a poor evidence-base of effectiveness. To evaluate the effectiveness of the Zero Suicide framework, implemented in a clinical suicide prevention pathway (SPP) by a large public mental health service in Australia, in reducing repeated suicide attempts after an index attempt. A total of 604 persons with 737 suicide attempt presentations were identified between 1 July and 31 December 2017. Relative risk for a subsequent suicide attempt within various time periods was calculated using cross-sectional analysis. Subsequently, a 10-year suicide attempt history (2009-2018) for the cohort was used in time-to-recurrent-event analyses. Placement on the SPP reduced risk for a repeated suicide attempt within 7 days (RR = 0.29; 95% CI 0.11-0.75), 14 days (RR = 0.38; 95% CI 0.18-0.78), 30 days (RR = 0.55; 95% CI 0.33-0.94) and 90 days (RR = 0.62; 95% CI 0.41-0.95). Time-to-recurrent event analysis showed that SPP placement extended time to re-presentation (HR = 0.65; 95% CI 0.57-0.67). A diagnosis of personality disorder (HR = 2.70; 95% CI 2.03-3.58), previous suicide attempt (HR = 1.78; 95% CI 1.46-2.17) and Indigenous status (HR = 1.46; 95% CI 0.98-2.25) increased the hazard for re-presentation, whereas older age decreased it (HR = 0.92; 95% CI 0.86-0.98). The effect of the SPP was similar across all groups, reducing the risk of re-presentation to about 65% of that seen in those not placed on the SPP. This paper demonstrates a reduction in repeated suicide attempts after an index attempt and a longer time to a subsequent attempt for those receiving multilevel care based on the Zero Suicide framework.

What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers.

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience-based co-design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n=64) and senior managers (n=9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma-informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma-informed they required services to: be aware of staff well-being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings.