Mental Health Services In Australia Research Articles

A Feasibility Study of the Translation of Cognitive Behaviour Therapy for Psychosis into an Australian Adult Mental Health Clinical Setting

AbstractThere is evidence that Cognitive Behaviour Therapy for Psychosis (CBTp) is an effective intervention for reducing psychotic symptoms. The recently updated Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines (RANZCP CPG) recommend CBTp for the therapeutic management of schizophrenia and related disorders. Translational research is required to examine how well CBTp can be applied into public mental health services. This feasibility study aimed to provide preliminary evidence on how acceptable, implementable, and adaptable individual or group CBTp may be within a public mental health service in Australia. Twenty-seven participants initially agreed to participate in the study with 16 participants being randomised to either group or individual therapy, 11 starting therapy and 7 completing therapy. The intervention involved approximately 20 h of manualised CBTp. Attendance was higher in the individual therapy. Subjective reports indicated that the therapy was acceptable to all completers. Participants who engaged in individual or group CBTp experienced a similar level of reduction in the severity of hallucinations and delusions. Individual CBTp may be a feasible, acceptable, and effective intervention to include in Australian public mental health services. A pilot trial is now required to provide further evidence for and guidance of how best to translate CBTp protocols to Australian mental health services.

Feasibility of a Consumer Centred Tobacco Management intervention in Community Mental Health Services in Australia.

This study tested a new program for helping smokers with severe mental illness to reduce their tobacco use, together with determining the feasibility of such research in community mental health settings in Australia. Five Neami National sites trialled a Consumer Centred Tobacco Management program called Kick the Habit (n = 34). The intervention included two weeks of free Nicotine Replacement Therapy (patches only) but participants also used a variety of self-funded delivery types in addition or as an alternative to the subsidised nicotine patch. At the 3-month follow-up, Kick the Habit participants had reduced their number of daily cigarettes, dependency levels and average weekly expenditure on tobacco. Although a larger study is required, Kick the Habit represents a promising intervention for tobacco management in community mental health services. The challenges and lessons learnt for scaling up to a larger trial and integration into business-as-usual practice across multiple sites are discussed.

Mapping the prison mental health service workforce in Australia.

The rapidly growing number of people in prison in Australia, combined with the high prevalence of mental disorder in this population, results in high demand for mental health services in prison settings. Despite their critical role as part of a national mental health response, prison mental health services (PMHS) in Australia have been poorly characterised. In this paper, we describe findings of the first national survey of PMHS in Australia. We distributed a survey to key representatives of PMHS in all Australian states and territories in 2016. Our method constitutes a replicable process for quantifying and comparing PMHS in Australia. We describe the structure, governance and staffing models in seven jurisdictions. When compared against international recommendations, only one Australian jurisdiction (the ACT) is funded to provide services at a level equivalent to mental health services provided in the community. Prison mental health services in Australia are delivered by a complex mix of government, private sector and non-government services. Services appear to be severely under-resourced when compared with the available benchmarks.

Commonwealth of common mental health: the need for a comprehensive overhaul of corporate governance in mental healthcare in Australia.

We aim to spark renewed discussion of the need for a more effective corporate governance structure for mental health services in Australia. While acknowledging clinical governance faces challenges, we focus here on corporate governance as the overarching level of administration, which profoundly influences delivery of mental healthcare in Australia. Australia's mental health services are ineffectively governed. Improved corporate governance, including psychiatric expertise, is fundamental to create a comprehensive, effective mental healthcare system in Australia.

Forensic psychiatry and mental health in Australia: an overview.

This article reviews the development of forensic psychiatry and mental health services in Australia for the international reader. It covers the legacy of a series of colonial systems that have contributed to a modern health service that interacts with justice systems. The development of relevant legislation, hospitals, prison services, community, and courts services is reviewed. The training and academic development of professionals is covered. Gaps in service delivery and future directions are considered.

Are current mental health assessment formats consistent with contemporary thinking and practice?

Conducting and documenting a mental health assessment is considered a central activity from a clinical and organizational perspective. In recent years, thinking and practice in mental health service delivery has changed considerably to embrace principles of recovery, trauma-informed care, and strengths-based approaches. The aim of the present study was to determine the degree to which these concepts are reflected in the content of assessment formats across mental health services in Australia and New Zealand. Copies of mental health assessments used in each state and territory in Australia, and three District Health Boards in New Zealand were obtained. Assessment formats were compared for similarities and differences, and to determine whether concepts of recovery, trauma-informed care, and strengths-based approaches were incorporated. The assessment formats analysed (n=11) contained many traditional features targeted at identifying harms, problems, risks, and pathology. Some attempts to redress this discrepancy were evident. Overall, assessment formats did not adequately voice the individual's perspective or promote a truly comprehensive assessment through an exploration of individual strengths, skills and abilities, past successes, and future hopes. Assessment formats across Australia and New Zealand are not currently aligned with contemporary thinking and practice in mental health care. Given the heavy influence that mental health assessment has on clinical decision making in particular, a reappraisal of the focus and content of formats used is urgently required.

Surviving the Heart of Darkness: reflections on the experience of psychiatrists working in public mental health services in Australia.

We reflect upon the bleak experiential landscape of psychiatrists working in underfunded, under-resourced and demoralised public mental health services through the metaphorical narrative of Joseph Conrad's Heart of Darkness. It remains difficult to navigate through the Heart of Darkness. We suggest some navigable markers that may stave off metaphorical running aground.

Potemkin redux: the re-disorganisation of public mental health services in Australia.

This paper discusses the phenomenon of re-disorganisation as it applies to publicly-funded mental health services. The term refers to the constant reorganisation of services in the absence of evidence and of unclear benefit. We illustrate the problems of re-disorganisation with some hypothetical examples, as well as discussing the context of these problems. The re-disorganisation of public mental health services may be considered a politically expedient administrative response resulting in the illusion of activity and progress. It may be intentional or unintentional. Re-disorganisation can detract from effective policy, planning and implementation of improvements in provision of public mental health services.

Encounters with difference: Mental health nurses and Indigenous Australian users of mental health services.

This article presents findings from the multi-sited ethnography of mental health nursing practice as it relates to the care of Indigenous users of public mental health services in Australia. It provides an analysis of mental health nurses beliefs and ideas about Aboriginal and Torres Strait Islander people encountered over the course of this research. The Indigenous service user was positioned as Other to the non-Indigenous mental health nurse, and to non-Indigenous service users. Cultural difference and the legacy of colonization, including its impact on the health of Aboriginal and Torres Strait Islander peoples, contributed to these beliefs of alterity. Despite emphasizing the differences with Aboriginal and Torres Strait Islander people in mental health services, nurses did not clearly relate this to Indigenous ways of understanding ill health. While cultural differences were recognized, what they meant for the nurses or their nursing practice was interpreted in different ways. In these circumstances, approaches towards care for Aboriginal and Torres Strait Islander people varied between nurses.

Longitudinal evaluation of a knowledge translation role in occupational therapy

BackgroundIn 2014, a large metropolitan mental health service in Australia developed a senior role (Lead Research Occupational Therapist) to address an identified need for greater research and knowledge translation, and associated capacity building. The aim of this study was to evaluate the impact, in the first 2.5 years, of this role across a range of variables.MethodsMultiple methods were used to gather a comprehensive range of data. Workforce surveys were completed both online and in hard copy in early 2014 (n = 42) and late 2016 (n = 44). Research key performance indicators (academic, research production and cultural) were also identified for measurement over time. The data from these surveys were analysed using descriptive and inductive analysis, and also with social network analysis.ResultsThis role has demonstrated positive outcomes across a range of variables. There was a medium effect on the quantity of participation in quality assurance and knowledge translation activities by the workforce. Most knowledge translation behaviours were occurring regularly, although several were absent. An improving trend in attitudes towards evidence-based practice was recorded, and perceptions of the knowledge translation role were generally positive. The Lead Research Occupational Therapist moved from the periphery to the centre of the evidence based practice social network. Improved awareness of other clinicians deploying evidence based practice was observed, and the frequency of interaction between clinicians increased. The role has met all key performance indicators, across the academic, research production and cultural domains.ConclusionsThe shift in focus of this role from research to knowledge translation has produced tangible outcomes for the occupational therapy workforce. These achievements have had a positive impact on the sustainability of the role, which will be continued for at least another two years. An ongoing challenge is to directly measure the impact of this role on outcomes for people with mental illness and their carers.

Profiles of Emotion Regulation in Young People Accessing Youth Mental Health and Drug Treatment

Deficits regulating emotions are a core process underlying both substance use and mental health disorders. Research has focused on identifying one-to-one associations between individual emotion regulation (ER) strategies and mental health symptoms. Consequently, little is known about how patterns of ER relate to a broad range of psychopathology, in treatment seeking young people. Latent class analysis was used to examine patterns of ER strategies and their relationship with symptoms of depression, anxiety, eating disorders, substance use and borderline personality disorder, in a sample of young treatment seekers. Participants were young people (N = 306, M = 20.8 years) accessing youth advocacy and support or mental health services in Australia. Participants recalled an emotionally-arousing event experienced when on their own and indicated their use of 14 possible ER responses in an online questionnaire. Symptoms of mental health and substance use were measured. The LCA identified three distinct classes of ER responses: Ruminators/avoiders (n = 76), active regulators (n = 81), and low regulators (n = 129). The ruminators/avoiders endorsed the most severe symptom picture across all disorders except alcohol use. Within this cohort, distinct patterns of ER responding had unique relationships with symptoms of psychopathology. The deleterious impact of heightened maladaptive ER strategies (rumination and avoidance) in the absence of adaptive strategies was highlighted.

Utilisation patterns of privately funded mental health services in Australia.

The purpose of this paper is twofold: first, to present patient-level utilisation patterns of hospital-based mental health services funded by private health insurers; and second, to examine the implications of the findings for planning and delivering private mental health services in Australia. Analysing private health insurance claims data, this study compares differences in demographic and hospital utilisation characteristics of 3,209 patients from 13 private health insurance funds with claims for mental health-related hospitalisations and 233,701 patients with claims for other types of hospitalisations for the period May 2014 to April 2016. Average number of overnight admissions, length of stay and per patient insurer costs are presented for each group, along with overnight admissions vs same-day visits and repeat services within a 28-day period following hospitalisation. Challenges in analysing and interpreting insurance claims data to better understand private mental health service utilisation are discussed. Patients with claims for mental health-related hospitalisations are more likely to be female (62.0 per cent compared to 55.8 per cent), and are significantly younger than patients with claims for other types of hospitalisations (32.6 per cent of patients aged 55 years and over compared to 57.1 per cent). Patients with claims for mental health-related hospitalisations have significantly higher levels of service utilisation than the group with claims for other types of hospitalisations with a mean length of stay per overnight admission of 15.0 days (SD=14.1), a mean of 1.3 overnight admissions annually (SD=1.2) and mean hospital costs paid by the insurer of $13,192 per patient (SD=13,457) compared to 4.6 days (SD=7.3), 0.8 admissions (SD=0.6) and $2,065 per patient (SD=4,346), respectively, for patients with claims for other types of hospitalisations. More than half of patients with claims for mental health-related hospitalisations only claim for overnight admissions. However, the findings are difficult to interpret due to the limited information collected in insurance claims data. This study shows the challenges of understanding utilisation patterns with one data source. Analysing insurance claims reveals information on mental health-related hospitalisations but information on community-based care is lacking due to the regulated role of the private health insurance sector in Australia. For mental health conditions, and other chronic health conditions, multiple data sources need to be integrated to build a comprehensive picture of health service use as care tends to be provided in multiple settings by different medical and allied health professionals. This study contributes in two areas: patient-level trends in hospital-based mental health service utilisation claimed on private health insurance in Australia have not been previously reported. Additionally, as the amount of data routinely collected in health care settings increases, the study findings demonstrate that it is important to assess the quality of these data sources for understanding service utilisation.

Working with consumers who hear voices: The experience of early career nurses in mental health services in Australia.

Mental health consumers who hear voices frequently experience distress and express a desire to discuss their voice-hearing experience. Nurses do not regularly demonstrate a willingness to engage in such discussions. With the introduction of educational strategies that develop empathy and an understanding of voice-hearing experiences, it is anticipated that early career nurses will be able to translate such understanding into their professional nursing practice. To explore early career nurses' understanding of providing care to mental health consumers who hear voices, a qualitative exploratory descriptive study was conducted in which nine early career Registered Nurses were interviewed regarding their experiences of caring for people who hear voices. Thematic analysis was employed to analyse the data and generate themes. Participants reported difficulty in developing relationships with consumers who hear voices, due to a workplace culture that was focussed on risk and lacking professional support. Nurses need specific education to develop the skills necessary to respond to consumers who hear voices and engage in dialogue that assists consumers to relate to the voices in a meaningful way. However, for this to succeed in practice, changes need to be supported by addressing the cultural barriers, such as risk-focussed environments, that prevent nurses implementing best practice.

A benchmarking study of father involvement in Australian child mental health services.

Fathers are underrepresented in interventions focussing on child well-being, yet research suggests their involvement may be critical to enhancing intervention effectiveness. This study aimed to provide the first Australian benchmark of rates of father attendance across several child mental health services. Retrospective casefile reviews were conducted to obtain data on father and mother attendance at 10 Australian child mental health services. A total of 2128 casefile records were retrospectively examined to extract family-level data. The main outcome measures were rates of father and mother attendance at sessions involving parents, and rates of father- and mother-instigated referral to services. Across services, fathers attended on average 48.2% (range 39.7% to 72.0%) of total parent sessions, with an average of 68.4% (range 53.1% to 88.1%) of fathers attending at least one session. Mothers attended sessions at significantly higher rates; an average of 92.8% of total parent sessions and 96.9% attendance for at least one session. For self-referred families, on average 12.6% of referrals were from fathers, and 87.4% were from mothers. These results indicate that rates of father attendance at Australian child mental health services vary, but are significantly lower than attendance rates for mothers. This may compromise the quality and outcomes of child mental health services in Australia. Routine monitoring of rates of father attendance is needed, as are strategies to enhance father engagement.

Adult mental health clinicians\u2019 perspectives of parents with a mental illness and their children: single and dual focus approaches

BackgroundWhen clinicians in the adult mental health sector work with clients who are parents with dependent children, it is critical they are able to acknowledge and respond to the needs of the parents and their children. However, little is known about clinicians’ personal perspectives and reactions towards these parents and children or if/how they balance the needs of both.MethodsSemi structured interviews were conducted with eleven clinicians from adult mental health services in Australia. Interviews focused on clinicians’ experiences when working with parents who have mental illness. Transcripts were analysed within an Interpretative Phenomenological Analysis framework to examine participants’ perspectives and personal reactions to parents and children.ResultsThere was considerable divergence in participants’ reactions towards parents and children and the focus of their perspectives when working with parental mental illness. Feelings of sympathy and responsibility made it difficult for some participants to maintain a dual focus on parents and children and contributed to some adopting practices that focused on the needs of parents (n = 3) or children (n = 1) exclusively. Other participants (n = 7) described strategies and supports that allowed them to manage these feelings and sustain a dual focus that incorporated the experiences and needs of both parents and children.ConclusionsIt is difficult for some mental health clinicians to maintain a dual focus that incorporates the needs and experiences of parents and their children. However, findings suggest that the challenges of a dual focus may be mitigated through adequate workplace support and a strengths-based practice framework that emphasises parental empowerment.

Distress, emotional clarity, and disordered eating in young people with complex emotional and behavioural difficulties

BackgroundDisordered eating frequently co‐occurs in young people seeking treatment for mental health and substance use difficulties. High levels of psychological distress and a lack of emotional clarity (LEC) are two constructs that have received recent attention as important constructs underlying this harmful behaviour; however how they interact to precipitate and maintain disordered eating still remains unclear. This study sought to address this gap by examining whether psychological distress moderates the relationship between LEC and disordered eating in a sample of young people with complex emotional and behavioural difficulties.MethodsParticipants were young people (N = 306, M = 20.8 years) accessing youth specific alcohol and other drugs and/or primary mental health services in Australia who completed an online questionnaire which examined their level of emotional clarity, degree of distress, and engagement in disordered eating behaviours.ResultsModeration analysis was employed to examine if psychological distress (i.e., anxiety and depression) significantly moderates the relationship between LEC and disordered eating. A small, significant interactive effect of high levels of depressive symptoms on the relationship between LEC and disordered eating was found. Whereas, anxious affect did not significantly interact with LEC to predict disordered eating.ConclusionsYoung people who struggle to identify and articulate their emotions are more likely to engage in disordered eating in the presence of high distress relating to depressive symptomatology. Addressing LEC through increasing emotional literacy, while treating depressive symptomatology, are key intervention strategies that may assist young people with complex emotional and behavioural difficulties manage disordered eating.

Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service

BackgroundMental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees. MethodsClinical and functional data from 1143 individuals (aged 12–30) attending a primary care-based mental health service in Australia were collected over 3–60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders). ResultsPrior suicide attempts were common (n = 164; 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) individuals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm; recurrent attempts were associated with being older and comorbid alcohol/substance use disorder. LimitationsThe cohort includes only individuals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time). ConclusionsYoung people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.

Psychotropic medication profile in a community youth mental health service in Australia

AimThere has been a rise in the use of psychotropic medication in young people, despite limited risk-benefit profile of psychotropic medication for this population. Given their side effect profile, the use of psychotropic medications should occur with caution. This study investigated psychotropic prescribing pattern in a public youth community mental health service and gives an estimate of general level of psychotropic medication use in this setting. MethodsA retrospective file review was undertaken of all young people aged 12–17 who received care from the service in 2016 (N = 189) for a range of mental health problems, excluding psychosis. Files were reviewed for demographical information (age, gender), diagnosis/presenting issues, prescribed medications, indications of medications, and prescriber type (e.g. psychiatrist, general practitioners (GPs), paediatrician). The data was analysed descriptively. ResultsOver 60% (60.8%, n = 115) of young people were prescribed psychotropic medications. Over half of the entire sample were on antidepressants (51.32%, n = 97), nearly a quarter (n = 46, 24%) on antipsychotics, 6% on ADHD medications (6.35%, n = 12), and a fifth (19.58%, n = 37) on polypharmacy. Antidepressants and antipsychotics were mostly used off-label, prescribed by public psychiatric staff. Quetiapine was the most prescribed antipsychotic predominantly for insomnia. Fluoxetine and fluvoxamine were the most prescribed antidepressants predominantly for anxiety disorders. Girls are more likely to be prescribed psychotropic medications than boys, specifically antipsychotic medication. ConclusionsA high proportion of young people were prescribed psychotropic medication, including antipsychotic medication, mostly for the treatment of anxiety and depressive disorders. There is little evidence around how psychotropic medication is used in youth mental health settings, and this study contributes to this gap.

2.2-O5Help-seeking for mental health services in Australia among Afghan women with refugee backgrounds

2.2-O5Help-seeking for mental health services in Australia among Afghan women with refugee backgrounds

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.