Mental Health Care In Australia Research Articles

A forgotten pioneer in Australian psychiatry: Dr Edward Waldegrave Wardley (1813-1872).

British-born Dr Edward Waldegrave Wardley (MRCSL, 1842) is an unacknowledged pioneer in the history of mental health care in Australia. Between 1857 and 1872, he assisted in the development of a policy of non-restraint across lunatic asylums in New South Wales (NSW). He then went on to extend this approach to the treatment of NSW's criminally insane patients. In addition, he trialled experiments to intellectually engage educated psychiatric patients across the colony. A prolific writer, and sufferer of chronic depression, Dr Wardley serves as a unique example of a nineteenth-century alienist with lived experience of mental illness.

Supporting interdisciplinary mental health professionals through online professional development: eleven years of the MHPN webinar program in Australia

ABSTRACT Objective The Mental Health Professionals’ Network (MHPN) has been delivering webinars for professionals working in primary mental health care in Australia since 2010. This study aimed to investigate changes in engagement in and outcomes of MHPN webinars over 11 years from 2010 to 2020. Method Over 11-years, 75 webinars were delivered by a multi-disciplinary panel of mental health professionals, using a case-study format to stimulate discussion of collaborative care. Attendees were invited to complete a post-webinar online questionnaire to assess webinar effectiveness and impacts on work practice. Change over time was assessed using chi-square tests and analysis of variance. Results From 53,468 webinar attendances, 30,617 (57.3%) questionnaires were collated and analysed. There was a steady and significant increase in webinar attendance over time. The degree to which learning needs were met increased significantly over time, as did the relevance of the webinars and their anticipated impacts on improving work practice. Discussion The findings indicate that practitioner engagement in MHPN webinars and the associated positive impacts on work practice have both increased over the past decade. By improving the knowledge, attitudes and practice of mental health professionals, MHPN plays an important role in improving mental health promotion, prevention, early detection and treatment in Australia.

Women's Experiences Accessing Mental Health Care in Australia After Sexual Violence in Adulthood.

In Australia, at least one in every five women has experienced sexual violence since age 15. Research consistently links sexual violence with poor mental health, persisting long after the crisis period. Trauma-informed mental health support is therefore critical. This article draws on interviews with 29 women who had experienced sexual violence to understand their experiences accessing mental health services in Australia. Our findings suggest that, constrained by a biomedical model of care, mental health practitioners' understanding of trauma generally, and sexual violence particularly, may be lacking. Further, women struggle to navigate a "maze" of services.

Consumer? Views and preferences of people receiving public mental health care in Australia on the terms used to refer to them.

To understand: a) whether adults receiving public mental health care were aware they were officially referred to as 'consumers' and, b) their views and preferences on the terms used to refer to them. Single-page, anonymous survey conducted across two community mental health services in Northern New South Wales (NNSW). Ethics approval obtained from the local research office. 108 people completed the survey with a response rate of approximately 22%. The vast majority (77%) of respondents were not aware that they were officially referred to as 'consumers'. 32% of respondents disliked the term 'consumer' and 11% found it offensive. Half preferred the term 'patient', particularly when consulting a psychiatrist (55%). A small minority (5-7%) preferred the term 'consumer' for any care interaction. Most respondents in this survey wished to be referred to as a 'patient' and a large proportion disliked being referred to as a 'consumer' or found it offensive. Further surveys should include broader sociodemographic and diagnostic/treatment variables. Official terms used to refer to people receiving public mental health care should be person-centred and evidence based.

Patterns of service provision in child and adolescent mental health care in Australia.

Standard description of local care provision is essential for evidence-informed planning. This study aimed to map and compare the availability and diversity of current mental health service provision for children and adolescents in Australia. We used a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE) tool, to describe service availability in eight urban and two rural health districts in Australia. The pattern of care was compared with that available for other age groups in Australia. Outpatient care was found to be the most common type of service provision, comprising 212 (81.2%) of all services identified. Hospital care (acute and non-acute) was more available in urban than in rural areas (20 services [9.7%] vs 1 [1.8%]). The level of diversity in the types of care available for children and adolescents was lower than that for the general adult population, but slightly higher than that for older people in the same areas. Standardised comparison of the pattern of care across regions reduces ambiguity in service description and classification, enables gap analysis and can inform policy and planning.

Stemming the tide of mental health problems in young people: Challenges and potential solutions.

One in five people experience clinically relevant mental health problems before the age of 25 years. Furthermore, in Australia, one in seven children are reported to experience a mental health disorder. Consequently, there has been a steady increase in demand for mental health services for children and young people, and this has been compounded by the COVID-19 pandemic. Unfortunately, currently many children and young people with mental health difficulties are not accessing appropriate and/or timely care, with individuals and families finding it increasingly difficult to access and navigate suitable services. In part, this is related to the fragmented and isolated manner in which child mental health services are operating. To address the current issues in access to appropriate child and adolescent mental health care in Australia, a novel Integrated Continuum of Connect and Care model is proposed to integrate relevant services along a tiered care pathway. The aim of this model is to facilitate timely access to mental health services that meet the specific needs of each child/young person and their family. This model will function within co-located service hubs that integrate health care through a comprehensive assessment followed by a link up to relevant services. The Integrated Continuum of Connect and Care has the potential to pave the way for unifying the fragmented child and youth mental health system in Australia.

Population mental health improves with increasing access to treatment: evidence from a dynamic modelling analysis

BackgroundMultiple studies indicate that the prevalence of mental disorders in high-income countries has remained stable or increased despite substantial increases in the provision of care, leading some authors to question the effectiveness of increasing access to current treatments as a means of improving population mental health.MethodsWe developed a system dynamics model of mental disorder incidence and treatment-dependent recovery to assess two potential explanations for the apparent failure of increasing treatment provision to reduce mental disorder prevalence: 1) an increase in the individual-level risk of disorder onset; and 2) declining effectiveness of care resulting from insufficient services capacity growth. Bayesian Markov Chain Monte Carlo (MCMC) methods were used to fit the model to data on the prevalence of high to very high psychological distress in Australia for the period 2008–2019.ResultsEstimates of yearly rates of increase in the per capita incidence of high to very high psychological distress and the proportion of patients recovering when treated indicate that the individual-level risk of developing high to very high levels of distress increased between 2008 and 2019 (posterior probability > 0.999) but provide no evidence for declining treatment effectiveness. Simulation analyses suggest that the prevalence of high to very high psychological distress would have decreased from 14.4% in 2008 to 13.6% in 2019 if per capita incidence had not increased over this period (prevalence difference 0.0079, 95% credible interval 0.0015–0.0176).ConclusionsOur analyses indicate that a modest but significant effect of increasing access to mental health care in Australia between 2008 and 2019 was obscured by a concurrent increase in the incidence of high to very high psychological distress.

Paying the price – out-of-pocket payments for mental health care in Australia.

Objective This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions. Methods We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013-19 and 2019-21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013-21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation.

Is there a missing-middle in Australian mental health care?

The term 'missing-middle' has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the 'missing-middle' term, founded on qualitative and quantitative research. Despite the widespread use of the term 'missing-middle' for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the 'missing-middle' care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to 'missing-middle' programmes that may not improve Australian public health outcomes.

The development of National Safety and Quality Digital Mental Health Standards.

Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm. The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards. The NSQDMH Standards comprise three standards-Clinical and Technical Governance, Partnering with Consumers, and Model of Care-and were launched in November 2020. The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.

Cognitive‐Behaviour Therapy and Psychological Treatments in Australia

In this article, we focus on the various recent healthcare reforms in Australia and their implication for cognitive behavioural therapy (CBT). Specifically, we focus on three areas relevant to CBT in Australia. After discussing the background of mental healthcare in Australia, we highlight the impact that recent health reforms have had on the foregrounding of evidence‐based treatment, with CBT as a focus. Second, we consider the limitations to therapy in this country, in particular the 10‐session limit within the Medicare system acting as a limitation on therapy. Finally, we discuss the impact of the acceptance of psychological treatment, and mental illness more generally in Australia.

Patterns of Service Provision in Older People's Mental Health Care in Australia.

Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.

Portents from Orwell's 1984: Bureaucracies, Ministries of Truth and Plenty - challenges facing the administration of mental healthcare in Australia.

We reflect upon the processes of mental health administration in Australia with reference to George Orwell's novel, 1984. Mental healthcare in Australia is distorted by politicisation, spin and a refusal to acknowledge the reality of the current situation. These challenges for mental healthcare demonstrate some similarities with the Ministries of Truth and Plenty, which conversely performed as their opposites in Orwell's novel. Psychiatrists and their professional bodies should play a greater role in advocacy for clinician-led, evidence-based services in partnership with our communities.

Transgender Experience of Mental Healthcare in Australia

Emerging global research suggests that transgender people experience poorer physical and mental health outcomes, as well as higher rates of discrimination in healthcare settings. To explore this in an Australian context, a qualitative research project was undertaken to explore the helpful and unhelpful therapy experiences of six transgender Australians. Using interpretative phenomenological analysis, four master themes emerged from the interview data, two of which are explored in depth. The research brings valuable insight into working towards positive outcomes with transgender clients with suggestions for changes in clinical practice for mental healthcare providers, education, training and future research.

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.

Enhancing the Capacity of the Australian Health Care Workforce to Support Veterans’ Mental Health: A Collaborative Interdisciplinary Approach

Abstract Introduction Military personnel and veterans can have higher rates of mental health problems than the general population, but are no more likely to receive appropriate mental health care. A lack of experience among Australia’s mental health workforce in treating veteran-specific issues has been identified, pointing to a need for strategies to strengthen the workforce capacity. To this end, the Department of Veteran’s Affairs joined with the Mental Health Professionals Network (MHPN) to produce and deliver a series of veteran-specific webinars for health professionals working with military personnel, veterans and their families. Materials and Method Five webinars were produced and delivered between August 2016 and July 2017. Each involved a panel of health professionals with content expertise and was facilitated by a nationally recognized expert in veteran mental health. Each webinar was evaluated using an online survey to address whether learning needs were achieved, likely improvements to work practice, and improvements in knowledge of and confidence in treating veteran mental health issues. Results Of the 5,127 attendees across the five webinars, registration data was collected for 4,809 (94%) and post-webinar data for 3,334 (70%) of registrants. Of these, over 90% indicated that their learning objectives were achieved, that the content was relevant to their practice, and that their work practices would be improved as a result of their participation. Further, almost three quarters reported increased knowledge and skills, and two-thirds increased confidence in treating veterans’ mental health needs. Conclusions The Veterans’ webinar series was effective in engaging a large number and a wide range of professionals working in mental health care in Australia, underscoring the strength of MHPN’s initiatives in terms of scale and reach. With its emphasis on interdisciplinary practice and collaborative care, MHPN is well-placed to continue to support Australia’s mental health workforce.

Stepped care mental health service in Australian primary care: codesign and feasibility study.

Objective In 2015, the Australian Government introduced several mental health reforms, including the requirement that Primary Health Networks (PHNs) provide stepped care services for Australians with mental health needs such as anxiety and depression. This paper reports on the development and feasibility study of StepCare, an online stepped mental healthcare service in general practice that screens patients, provides immediate feedback to patients and general practitioners (GPs), transmits stepped treatment recommendations to GPs and monitors patients' progress, including notification of deterioration. Methods The present codesign and feasibility study in one PHN examined: (1) the acceptability and feasibility of StepCare to GPs, practice staff and patients; (2) the impact of StepCare on clinical practice; and (3) the barriers to and facilitators of implementation. Results Thirty-two GPs, 22 practice staff and 418 patients participated in the study. Overall, patients, practice staff and GPs found StepCare acceptable and feasible, commending its privacy, the mental health screening, monitoring and feedback. They also made suggestions for service improvements. GPs reported that StepCare helped with their identification and management of patients with common mental health issues. Conclusions Preliminary data suggest that StepCare may be acceptable and feasible in Australian general practice, helping GPs identify and manage common mental health problems in their patients. The study provides implications for policy and practice, and points the way to future translational research into stepped mental health care. What is known about the topic? Depression and anxiety are common illnesses in primary care and GPs are ideally placed to implement stepped care approaches enabling early detection and accessible, effective care. What does this paper add? Developed in and for general practice, StepCare is the first fully integrated stepped approach to primary mental health care in Australia. As a first step in a translational research program evaluating the effectiveness of StepCare, this paper reports data regarding the feasibility and acceptability of the service. What are the implications for practitioners? Integrated into the workflow of general practice, StepCare is an online service that helps GPs detect new cases of depression and anxiety, provide evidence-based stepped care treatments and monitor patients' progress.

Service availability and capacity in rural mental health in Australia: Analysing gaps using an Integrated Mental Health Atlas.

Access to services and workforce shortages are major challenges in rural areas worldwide. In order to improve access to mental health care, it is imperative to understand what services are available, what their capacity is and where existing funds might be spent to increase availability and accessibility. The aim of this study is to investigate mental health service provision in a selection of rural and remote areas across Australia by analysing service availability, placement capacity and diversity. This research studies the health regions of Western New South Wales and Country Western Australia and their nine health areas. Service provision was analysed using the DESDE-LTC system for long-term care service description and classification that allows international comparison. Rates per 100,000 inhabitants were calculated to compare the care availability and placement capacity for children and adolescents, adults and older adults. The lowest diversity was found in northern Western Australia. Overall, Western New South Wales had a higher availability of non-acute outpatient services for adults, but hardly any acute outpatient services. In Country Western Australia, substantially fewer non-acute outpatient services were found, while acute services were much more common. Acute inpatient care services were more common in Western New South Wales, while sub-acute inpatient services and non-acute day care services were only found in Western New South Wales. The number and span of services in the two regions showed discrepancies both within and between regions, raising issues on the equity of access to mental health care in Australia. The standard description of the local pattern of rural mental health care and its comparison across jurisdictions is critical for evidence-informed policy planning and resource allocation.

Book review: Humanising Mental Health Care in Australia: A Guide to Trauma-informed Approaches

Book review: <i>Humanising Mental Health Care in Australia: A Guide to Trauma-informed Approaches</i>

Improving collaborative mental health care across Australia: development and evaluation of the Mental Health Professionals Network (MHPN) initiative

Introduction : The Mental Health Professionals Network (MHPN) was established in 2008 to improve consumer outcomes in the primary care sector by fostering a collaborative clinical approach to the provision of mental health care in Australia. MHPN is a not-for-profit organization funded by the Australian Government Department of Health. This presentation will describe the development of MHPN and present results of evaluations of MHPN’s two key programs. Short description of practice change implemented : The MHPN national platform has two key programs by which it promotes collaborative mental health care: network meetings and webinars. MHPN interdisciplinary networks comprise groups of practitioners who meet face-to-face on a regular and voluntary basis. While networks are self-directed in determining membership and content covered, MHPN provides strategic and planning advice, and manages meeting logistics, communications, and administration tasks. At 30 June 2016 there were 380 networks across Australia with a total of over 10,000 participants. During 2015-16 there were 1,171 network meetings and 14,835 network meeting attendances. MHPN professional development webinars feature case-based discussions by leading experts, modelling interdisciplinary practice and collaborative care. From December 2010 to 30 June 2016, MHPN produced 52 webinars. Overall, there have been more than 160,000 individual views of the live webinars or downloadable podcasts. Aim and theory of change : Collaborative practice is recognised as a necessary element for an integrated health delivery system. MHPN’s activities are based on the premise that if practitioners from different disciplines connect and communicate on a regular basis, clinical pathways will be more effective, referrals better informed and service-delivery improved. Targeted population and stakeholders: MHPN targets psychiatrists, general practitioners, psychologists, mental health nurses, social workers, pediatricians, occupational therapists and other mental health practitioners. Timeline : MHPN was established in 2008 and continues to grow and evolve. Highlights : During 2015-16, evaluations of MHPN’s two key programs were undertaken: Study 1 surveyed network meeting attendees and assessed change across seven areas relating to increased awareness of and interaction with professionals from other disciplines. More than 75% respondents had made each practice change, with those who attended more meetings significantly more likely to have made changes. Study 2 surveyed webinar attendees. Three months post-webinar, 80% respondents had made practice changes, including increased confidence in providing mental health care, increased discussions about other disciplines and improved targeting of referrals. Comments on sustainability : MHPN continues to monitor its structure, policy and practice in order to maintain sustainability of the initiative. Comments on transferability : The MHPN initiative is potentially transferable to other settings and countries. Discussion and Conclusions : The two studies demonstrate that MHPN interdisciplinary network meetings and professional development webinars have impacted positively on health professionals’ attitudes and practices towards a more collaborative approach to mental health care, highlighting the success of the MHPN initiative. Evaluation findings will be published in the Journal of Integrated Care in 2018. Lessons learned : The high attendance at both network meetings and live webinars underscores the strong interest and desire amongst Australia’s mental health workforce for interdisciplinary networking and professional development opportunities.