Mental Health Services In Australia Research Articles

Peer work in Open Dialogue: A discussion paper.

Open Dialogue is a resource-oriented approach to mental health care that originated in Finland. As Open Dialogue has been adopted across diverse international healthcare settings, it has been adapted according to contextual factors. One important development in Open Dialogue has been the incorporation of paid, formal peer work. Peer work draws on the knowledge and wisdom gained through lived experience of distress and hardship to establish mutual, reciprocal, and supportive relationships with service users. As Open Dialogue is now being implemented across mental health services in Australia, stakeholders are beginning to consider the role that peer workers might have in this model of care. Open Dialogue was not, initially, conceived to include a specific role for peers, and there is little available literature, and even less empirical research, in this area. This discussion paper aims to surface some of the current debates and ideas about peer work in Open Dialogue. Examples and models of peer work in Open Dialogue are examined, and the potential benefits and challenges of adopting this approach in health services are discussed. Peer work in Open Dialogue could potentially foster democracy and disrupt clinical hierarchies, but could also move peer work from reciprocal to a less symmetrical relationship of 'giver' and 'receiver' of care. Other models of care, such as lived experience practitioners in Open Dialogue, can be conceived. However, it remains uncertain whether the hierarchical structures in healthcare and current models of funding would support any such models.

Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study

ObjectivesMental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning...

The risks, needs and stages of recovery of a complete forensic patient cohort in an Australian state

BackgroundRoutine outcome measures are increasingly being mandated across mental health services in Australia and overseas. This requirement includes forensic mental health services, but their utility in such specialist services and the inter-relationships between the measures remain unclear. This study sought to characterise the risks, needs and stages of recovery of an entire cohort of forensic patients in one jurisdiction in Australia.MethodsLocal expert groups, comprising of members of the forensic patient treating teams, were formed to gather information about the status and needs of all forensic patients in the State of New South Wales, Australia. The expert groups provided demographic information and completed three assessment tools concerning the risks, needs and stages of recovery of each forensic patient.ResultsThe cohort of 327 forensic patients in NSW appears to be typical of forensic mental health service populations internationally when considering factors such as gender, diagnosis, and index offence. A number of important differences across the three structured tools for forensic patients in different levels of secure service provision are presented. The DUNDRUM Quartet demonstrated interesting findings, particularly in terms of the therapeutic security needs, the treatment completion, and the stages of recovery for the forensic patients in the community. The CANFOR highlighted the level of needs across the forensic patient population, whilst the HCR-20 data showed there was no significant difference in the mean clinical and risk management scores between male forensic patients across levels of security.ConclusionsTo the authors’ knowledge this is the first study of its kind in New South Wales, Australia. We have demonstrated the utility of using a suite of measures to evaluate the risks, needs, and stages of recovery for an entire cohort of forensic patients. The data set helps inform service planning and development, together with providing various avenues for future research.

Implementing a family-inclusive practice model in youth mental health services in Australia.

A brief family-inclusive practice model, single session family consultation (SSFC), was introduced at 4 youth mental health service sites to determine the extent to which the model could be implemented in this context and its acceptability as a means of engaging families of young people. Within an action research paradigm, both quantitative and qualitative measures were used for this implementation project with the former reported here. There were 2 components: (1) evaluation of the experiences of young people and their families and (2) evaluation of the extent of implementation of SSFC. Quantitative data were analysed descriptively (item scores, range and any changes over time). Twenty practitioners who were trained and supported in the use of SSFC participated in the 6-month implementation evaluation. In 6 months, 131 SSFC sessions were conducted across the 4 sites and the young people and their families were very satisfied with sessions (overall mean = 5.2, range = 0-6). Six months post-training, there were statistically significant improvements in the practitioners' confidence in providing family interventions (mean improvement = -0.47 (95% confidence interval (CI) = -0.91, -0.04), P = .035) and familiarity with approaches to working with families (mean improvement = -0.61 (95% CI = -1.13, -0.10, P = .023). Practitioners perceived significant improvement in organizational support for working with families. SSFC was acceptable to clients and their families, was adopted by practitioners and was successfully implemented in the participating sites. This suggests that SSFC, when appropriately implemented, is useful to engage families in the treatment of young people facing mental health issues.

Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement.

Restrictive practices are used in response to conflict and aggression in psychiatric inpatient settings. Reducing such practices is the focus internationally of policy and legislative change, many initiatives, and a growing body of research. Safewards is a model and a set of 10 interventions designed to reduce conflict and containment in inpatient services. In the current study, we aimed to assess the impact of implementing Safewards on seclusion in Victorian inpatient mental health services in Australia. The study used a before-and-after design, with a comparison group matched for service type. Thirteen wards opted into a 12-week trial to implement Safewards and 1-year follow up. The comparison group was all other wards (n=31) with seclusion facilities in the jurisdiction, matched to service type. Mandatorily-reported seclusion event data for all 44 wards over a 15-month period were analysed using negative binomial regression. Adherence to Safewards was measured via fidelity checklists at four time points: twice during the trial, post-trial, and at 1-year follow up. Seclusion rates were reduced by 36% in Safewards trial wards by the 12-month follow-up period (incidence rate ratios (IRR)=0.64,) but in the comparison wards seclusion rates did not differ from baseline to post-trial (IRR=1.17) or to follow-up period (IRR=1.35). Fidelity analysis revealed a trajectory of increased use of Safewards interventions after the trial phase to follow up. The findings suggest that Safewards is appropriate for practice change in Victorian inpatient mental health services more broadly than adult acute wards, and is effective in reducing the use of seclusion.

‘Putting your feet in gloves designed for hands’: Horn of Africa Muslim men perspectives in emotional wellbeing and access to mental health services in Australia

ABSTRACTRefugees from the Horn of Africa have often experienced trauma in their country of origin due to prolonged civil wars. Many face emotional difficulties posed by acculturation challenges when settling in a new country. As the Horn of Africa population grows in Australia, there is a need to know how to best promote the wellbeing and mental health of Horn of Africa refugees. This paper examines Horn of Africa Muslim men’s (HAMM) understanding, experiences and views on the causes of emotional difficulties, barriers to seeking help, access to mainstream mental health services and traditional African treatments in the Australian context. Five focus-group interviews of HAMM from the inner-northern suburbs of Melbourne were conducted and ethnographic, qualitative and thematic analysis was used. Emotional difficulties of HAMM in the Australian context were attributed to immigration and settlement-linked stressors such as unemployment, racism, gender role reversal and raising children. Barriers for not seek...

Promoting young people’s musical identities to facilitate recovery from mental illness

ABSTRACTThe new ‘youth mental health paradigm’ (IAYMH. 2015. “International Association for Youth Mental Health.” Accessed February 15, http://www.iaymh.org/) promotes the need for youth-friendly mental health options. Music therapy initiatives offer innovative modes of working towards young people’s recovery in ways that align with the ethos of these services (McCaffrey, Edwards, and Fannon. 2011. “Is There a Role for Music Therapy in the Recovery Approach in Mental Health?” The Arts in Psychotherapy 38 (3): 185–189). This paper details a participatory research project investigating how and why promoting young people’s musical identities can facilitate their recovery from mental illness. Young people accessing a music therapy programme in a youth mental health service in Australia participated in collaborative qualitative interviews that were analysed using constructivist grounded theory techniques. Cycles of action and reflection resulted in a grounded theory explaining the recovery of musical identity, and mapping young people’s community-based music needs for wellbeing. We propose that promoting young people’s musical identities facilitates recovery through: the construction of a health-based identity; facilitating meaning-making; and supporting social participation. Findings are discussed in relation to recovery literature and social justice issues that arise in response to findings about young people’s needs for appropriate music access.

‘The government is the cause of the disease and we are stuck with the symptoms’: deinstitutionalisation, mental health advocacy and police shootings in 1990s Victoria

The deinstitutionalization of mental health services in Australia happened first and most rapidly in the state of Victoria. In the final decades of the 20th Century, a period of immense economic and social policy reform accelerated this shift. Policy change appeared to be guided, at least in part, by ideals of human rights and citizenship. However, these same principles could be undermined in the vacuum of services created by deinstitutionalization and the broader restructuring of the welfare state. One expression of this paradox was a reported increase in violent encounters between police and those in states of distress and mental crises. Another example of paradox was rights-based mental health law, which both increased procedural safeguards for involuntary psychiatric intervention but also perpetuated differential treatment of persons with psychosocial disability on the basis of unfounded beliefs. This article will examine the intersections of policing and mental health policy in order to examine how boundaries of normality and disablement were contested during a transitional period of mental health law and policy.

Reallocating Australia’s Scarce Mental Health Resources

IntroductionThe purpose of this paper is to describe a long-standing problem in the provision of mental health services in Australia,2 and to outline a reform that addresses this problem. By way of background, we describe first some 'big picture' financial data that put the health sector, and various components of health expenditure, into a relative, and economic, perspective. The time-period is the 22 years from 1993-94 to 2013-14, the years for which we have comparable and reliable data. The background section highlights two differences that exist between mental health and non-mental health services in Australia. First, government now funds approximately 96 per cent of mental health expenditure, compared to a government share of 66 per cent of non-mental health expenditure. The second major difference between these two parts of the health sector relates to diagnostic information to guide therapy, also referred to as treatment: time-series government expenditure data on diagnostic imaging and pathology services indicate the quantitative importance of diagnostic information to medical therapies. But this expenditure is associated with nonmental health services: the Medicare Benefits Schedule is devoid of item numbers for any diagnostic test applying the numerous psychological tests that exist for schizophrenia, depression, suicidality, narcissistic personality disorder, and so on.The paper then considers an empirical 'puzzle' that exists in Australia's mental health sector. This problem, which we refer to as 'structural imbalance', has two dimensions: first, some people with mental disorders do not consume mental health services, and, at the same time, some people who do not have a diagnosis of a mental disorder do consume mental health services. The evidence that this problem exists is not based on anecdote or adherence to a particular psychological or psychiatric theory: its existence is based on empirical evidence from carefully conducted, population-based epidemiological surveys.The paper concludes with an argument that the structural imbalance problem is connected to the non-use of the large range of psychological tests for diagnosing mental disorders. A necessary reform is to insert diagnostic item numbers in the Medicare Benefits Schedule for psychological tests for mental disorders, and make positive results from these tests a prerequisite to accessing mental health services. Such a structural reform will enable a shift in resources to people who currently have unmet need.BackgroundAustralia's mental health expenditures (funded by Commonwealth, state and territory governments, as well as private sources) were $8,011 million in 2013-14: in the same year total health expenditures were $154,622 million.3 These amounts are not trivial: measured value-added in the health sector constitutes 9.8 per cent of GDP; mental health 0.51 per cent of GDP. Further, mental health expenditure, as a component of total health expenditure, has been steadily rising, from 4.87 per cent in 1992-93 to 5.18 per cent in 2013-14 (see the lowest line graph in Figure 1). This upward trend did not happen by chance. It was a deliberate act of whole-of-government decision-making.Figure 1 also shows the relative size of the health sector compared to the total economy, as measured by GDP: recurrent health expenditure in 1992-93 represented 7.31 per cent of GDP, and was 9.76 per cent in 2013-14. Over this 22-year period, health expenditure increased at a real compound annual growth rate (CAGR) of 3.2 per cent. The mental health sector has increased in relative size compared to the health sector, increasing from 4.87 per cent at the beginning of the period to 5.18 per cent in 2013-14.Consider the two line graphs at the top of Figure 1: both describe shares of government expenditure on components of health - non-mental health expenditure and mental health expenditure. In 1992-93, government funded 64.3 per cent of non-mental health expenditure, and this had risen to 66. …

Stepped Care, System Architecture and Mental Health Services in Australia.

Stepped Care, System Architecture and Mental Health Services in Australia.

Defining the role of a forensic hospital registered nurse using the Delphi method.

A Delphi survey was undertaken to refine the position description of a registered nurse working in a forensic hospital, in New South Wales, Australia. Prior to commencing operation in 2008, position descriptions were developed from a review of legislation, as well as policies and procedures used by existing forensic mental health services in Australia. With an established workforce and an evolving model of care, a review of the initial registered nurse position description was required. An online Delphi survey was undertaken. Eight executive (88.9%) and 12 (58.3%) senior nursing staff participated in the first survey round. A total of four survey rounds were completed. At the final round, there was consensus (70%) that the revised position description was either very or somewhat suitable. There were a total of nine statements, from 31 originally produced in round 1, that did not reach consensus. The Delphi survey enabled a process for refining the Forensic Hospital registered nurse position description. Methods that facilitate executive and senior nursing staff consensus in the development and review of position descriptions should be considered in nursing management.

Out-of-pocket healthcare expenditure and chronic disease - do Australians forgo care because of the cost?

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50-193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33-187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13-14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30-11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia.

Exploring the associated factors of elevated psychological distress in a community residing sample of Australian Chinese migrants

ObjectiveChinese migrants have a low utilisation of mental health services but a high proportion of involuntary admissions to mental health services in Australia. This study aims to screen for psychological distress among Australian Chinese migrants and to understand the potential correlates that contribute to elevated psychological distress in this population.MethodChinese migrants were recruited through several social websites to complete an online health survey. A total of 414 participants (female 55%; male 45%) aged 14–63 years completed a Kessler 6‐item scale and a questionnaire that collected information on demographics as well as health‐related behaviours and perceptions. Bivariate and multiple logistic regression analyses were conducted to assess the associations between demographic, health‐related factors and moderate to high level of psychological distress.ResultsThe findings indicated that Chinese migrants, who are young, single, currently studying, and have stayed in Australia less than 5 years, tended to report significantly higher levels of psychological distress. This study also revealed that the participants' level of satisfaction of primary health services is associated with psychological distress (odds ratio: 0.34; 95% confidence interval: 0.17–0.66).ConclusionsThis exploratory study adds important information about the prevalence and correlates of psychological distress among Australian Chinese migrants. Intervention programmes tailored to improve migrants' level of satisfaction of the Australian primary health‐care services may contribute to the mental health well‐being of Chinese migrants in Australia.

Attending to physical health in mental health services in Australia: aqualitative study of service users' experiences and expectations.

Evidence is unequivocal: the premature death of people with severe mental health problems is attributable primarily to cardiovascular disease, and healthcare provided is often suboptimal. With the overarching aim of improving outcomes, policies and guidelines oblige mental health services and psychiatrists to monitor cardio-metabolic health of patients and intervene as appropriate. Practice is highly variable; however, with ongoing debate about resourcing and responsibilities dominated by clinicians who have identified disinterest among patients as influencing practice. Seeking to balance discussion, we posed the question 'what do patients experience and expect of mental health services in relation to their physical health?' To answer it, we interviewed a convenience sample of 40 service users recruited from a mental health service in Australia, early in 2015. Data were analysed using the framework approach. With few regarding themselves as healthy, participants were commonly concerned about side effects of medication, weight and fitness but rarely mentioned tobacco smoking. Participants' accounts reinforce extensive research demonstrating variability in attention to physical health in mental health services. Reports by some participants of comprehensive care are encouraging, but widespread uncertainty about reasons for various assessments and denial of requests for management of medication side effects, including weight gain, gives cause for concern. Although participants in this study wanted to improve their health and health-related quality of life, they acknowledged that their motivation and ability to do so fluctuated with mental health. They expected clinicians to work proactively, especially when symptoms compromised capacity for self-care, and mental health services to provide or enable access to health-promoting interventions. Attention should be given, as a matter of priority, to creating conditions (culture and infrastructure) needed to support sustained attention to physical health within services and, importantly, to full engagement of service users in management of their physical health.

Forensic Patients and Forensic Mental Health in Victoria: Legal Context, Clinical Pathways, and Practice Challenges

ABSTRACTForensic mental health services in Australia have evolved and developed considerably over the past two decades. To clinicians unfamiliar with them, the contemporary practice environments in which professionals deliver specialised forensic mental health services and the legislation governing offenders with a mental illness can appear extremely complex. This article outlines the legislation applying to individuals found not guilty of a serious offence on the grounds of mental impairment in the State of Victoria, describes the characteristics of the forensic patient population, and delineates the clinical pathway forensic patients typically take, using an illustrative case example. The competencies and attributes required by forensic practitioners are highlighted, along with the clinical challenges they face, including the inherent need to address risk in a service that has become recovery-focused in orientation. A central theme of the discussion is how social workers adapt their practice within these highly regulated settings to effectively meet forensic patients' needs.

Back … this time with keys: the perspective of a peer support worker embedding peer support in a hospital setting

Purpose – Peer support workers are becoming more involved in mental health services in Australia. Peer support workers have had to overcome challenges and dilemmas whilst embedding their role within mental health settings. This includes coping with scrutiny from fellow colleagues, supporting consumers and managing their own mental health. The paper aims to discuss these issues. Design/methodology/approach – This paper will explore the author’s perspective and experience of working as a peer support worker in a psychiatric hospital and how the skills, knowledge and values she has developed during her recovery from mental illness have been essential in undertaking the daily activities with consumers and clinicians, overcoming the challenges and dilemmas, and managing her own wellness. Findings – The paper provides insight into the experience of a peer support worker at a psychiatric hospital for adults. Originality/value – The author’s personal experience of being a peer support worker in a mental health facility.

Symptoms, functioning and quality of life after treatment in a residential sub-acute mental health service in Australia.

The aim of this study was to assess clients' and service providers' perspectives on changes in mental health after an admission to a residential recovery-focused, sub-acute service, in Australia. Clients were either step-up clients, entering the service directly from the community, or step-down clients who were transitioning from an inpatient unit to home. During the 30-month period of data collection (August 2011 to January 2014) all clients (N=102) were invited to participate in the longitudinal study and 41 clients consented to be involved (38% response rate). At admission and exit, participants completed the Behaviour and Symptom Identification Scale (Basis-32) and service providers completed the Life Skills Profile-16 and Health of the Nations Outcome Scales. Follow-up data 3months after exit were available for 12 clients, including the Basis-32 and a self-report measure of quality of life (Assessment of Quality of Life 8-dimension). Both client groups reported positive improvements between admission and exit in the areas of relation to self and others, psychosis, daily living and presence of depression or anxiety symptoms. Service providers reported gains for clients in the areas of self-care, level of symptoms and presence of social problems. At 3months, clients generally reported positive quality of life, although there was no significant change in symptoms and functioning. This study demonstrates that after an admission to a sub-acute service, step-up clients experience an improvement in their symptoms and functioning, have avoided a hospital admission and are well enough to return home. Step-down clients also experience further improvements in their symptoms and functioning, indicating that the service has assisted them in their transition to independent living after a hospital admission. Sub-acute residential units provide a continuation of care for inpatients preparing to return home, and people with a mental health problem living in the community who experience an escalation in symptoms and prefer an alternative to hospital.

Incidence and risk factors for clozapine-induced myocarditis and cardiomyopathy at a regional mental health service in Australia.

To determine the incidence of clozapine-induced myocarditis and cardiomyopathy and identify risk factors. A cohort of 129 patients initiated on clozapine at Toowoomba Mental Health Service from year 2000 until 2011 was examined to evaluate cases of myocarditis and cardiomyopathy. Risk factors were analysed using multivariable logistic regression. The incidence of clozapine-induced myocarditis and cardiomyopathy was 3.88% and 4.65% (or 2.26 per 100 patient years), respectively. A significant association was identified between clozapine-induced myocarditis and SSRI use (p = 0.043). Subclinical cardiomyopathy was identified in the absence of symptoms in the majority of cases. These results illustrate a high incidence of clozapine-induced myocarditis as well as cardiomyopathy, reinforcing the need for a standardised, mandatory monitoring scheme. Concomitant SSRI use as one such potential predictor merits further study.

Implementing cognitive therapies into routine psychosis care: organisational foundations.

BackgroundTreatment outcomes for people diagnosed with psychosis remain suboptimal due in part to the limited systematic application of evidence based practice (Adm Policy Ment Health, 36: 1-7, 2009) [1]. The Implementation science literature identifies a number of factors organisationally that need to be considered when planning to introduce a particular EBP. Profiling these organisational characteristics at baseline, prior to commencement of service reform can determine the focus of a subsequent implementation plan. This study examined the organisational baseline factors existing in two services promoting the routine use of cognitive interventions for psychosis. One of the services studied has since undertaken organisational structural reform to facilitate the greater uptake of Evidence Based Practice (EBP). The results of this study were used to design an implementation strategy to make cognitive therapies a part of routine psychosis care.MethodsOne hundred-and-six mental health staff from two metropolitan mental health services in Australia was surveyed to ascertain their attitudes, competencies and interest in Cognitive Behavioural Therapy for psychosis (CBTp) and Cognitive Remediation Therapy (CRT). In addition perceptions of organisational values were profiled using the Organisational Culture Profile (OCP). Fifty five participants were excluded because they completed less than 50 % of the survey. The final sample consisted of 51 participants.Results48.1 % of surveys were completed. Over 50 % of staff were interested in CBTp and CRT approaches to psychosis. Staff were aware of existing CBTp and CRT programs but these were not uniformly available throughout the services. Fourteen percent of staff identified as CBT therapist and 35 % were trained CRT facilitators. Only 12 % of staff were receiving therapy specific supervision. The Organisational Culture Profile (OCP) at baseline revealed highest scores amongst leadership, planning, and humanistic workplace domains, with communication receiving the lowest rating indicative of organisational weakness.ConclusionProfiling the factors associated with successful implementation of service reform informed the implementation planning and the efficient deployment of resources in a mental health service introducing cognitive therapies for psychosis into routine clinical care. The majority of staff had positive attitudes to the evidence based cognitive therapies allowing a focus on training and supervision and the development of supporting organisational elements.

Have you got what it takes? Nursing in a Psychiatric Intensive Care Unit

Purpose – A Psychiatric Intensive Care Unit (PICU) and or High Dependency Unit (HDU) is a locked, intensive treatment facility available to people experiencing acute psychiatric distress. For many people who access public mental health services in Australia, the PICU/HDU is the primary point of admission, and should represent and facilitate timely assessment and an optimum treatment plan under a recovery framework. Nurses are the largest health discipline working in this specialty area of care. The paper aims to discuss these issues. Design/methodology/approach – A qualitative study aimed to investigate the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. Identifying how nurses provide care in the PICU/HDU will inform a clinical practice guideline to further support this specialty area of care. Four focus groups were facilitated with 52 registered nurses attending. Findings – The nurse participants identified specific skills under four distinct themes; Storytelling, Treatment and recovery, Taking responsibility, and Safeguarding. The skills highlight the expertise and clinical standard required to support a recovery model of care in the PICU. Research limitations/implications – The research findings highlight urgency for a National PICU/HDU clinical practice guideline. Practical implications – A PICU/HDU practice guideline will promote the standard of nursing care required in the PICU/HDU. The PICU/HDU needs to be recognised as a patient centred, therapeutic opportunity as opposed to a restrictive and custodial clinical area. Social implications – Providing transparency of practice in the PICU/HDU and educating nurses to this specialty area of care will improve client outcome and recovery. Originality/value – Very few studies have explored the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. A dearth of research exists on what is required to work in this specialty area of care.