Psychiatry In Australia Research Articles

“A Deed of the Darkest Violence”: Rape and the Emergence of Sadism in Australian Psychiatry, 1920–1950

ABSTRACT This article uses the sadist murder in 1937 of Dorothy May Everett in Newcastle (NSW) to reflect on sexual violence and psychiatry in Australia between the 1920s and the 1950s. Everett’s murder incited debates about Australian masculinity, class, racial degeneration and sex crimes. It led to an unprecedented popular interest in the psychiatric diagnosis of “sadism”. What do these sadistic rape-murders reveal about everyday constructions of the sexual sadist in Australia? How did people gain knowledge of perversions? Did psychiatric classification systems make a difference? Ian Hacking’s concept of “making up” people is productive for reflecting on the spread of knowledge about psychiatric understandings of sexual violence.

Private psychiatry in Australia: reflections on career opportunities, benefits, and challenges.

To provide reflection on career opportunities, benefits and challenges, with regard to commencing private practice psychiatry in Australia. There are varied opportunities for a career in private practice psychiatry. Private practice has benefits and challenges, distinct from public sector psychiatry; with moderately greater professional autonomy, facilitating the provision of expert mental healthcare for the community.

Private practice metropolitan telepsychiatry in larger Australian states during the COVID-19 pandemic: an analysis of the first 2 months of new MBS telehealth item psychiatrist services.

Private practice psychiatry in Australia was largely office-based until the Commonwealth Government introduced new psychiatrist Medicare Benefits Schedule (MBS) telehealth items in response to the first wave of the COVID-19 pandemic. We investigate the uptake of (1) video and telephone telehealth consultations in April-May 2020, and (2) the overall changing rates of consultation, i.e. total telehealth and in-person consultations across the larger states of Australia. MBS item service data were extracted for COVID-19 psychiatrist video- and telephone-telehealth item numbers and compared with a baseline of the 2018-2019-financial-year monthly average of in-person consultations for New South Wales, Queensland, Victoria, and Western Australia. Total psychiatry consultations (telehealth and in-person) rose during the first wave of the pandemic by 10%-20% compared to the previous year. The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations increased from April into May. For large states, there has been a rapid adoption of the MBS telehealth psychiatrist items, followed by a trend back to face-to-face as COVID-19 new case rates reduced. There was an overall increased consultation rate (in-person plus telehealth) for April-May 2020.

To tele- or not to telehealth? Ongoing COVID-19 challenges for private psychiatry in Australia

Objectives:Following a very rapid and significant uptake of metropolitan telepsychiatry in private practice in Australia during COVID-19, practical questions remain: How long should psychiatrists continue telepsychiatry? Are there benefits of continuing: reduced COVID-19 risks to patient and psychiatrist, and flexibility of appointments? Will the Medicare Benefits Schedule (MBS) telehealth items be retained? How does metropolitan telepsychiatry fit into the overall mix of public and private services? This is an important debate.Conclusions:Private psychiatrists may continue to offer the majority of care, where practical, via telepsychiatry to reduce COVID-19 exposure risks, as well as allow for the realities of practice management for pandemic public health measures. However, consideration has to be given to the potential drawbacks for patients with sight, hearing and illness-related disabilities or risks, when in-person consultation is required. There are also risks: some patients may not benefit from telepsychiatry due to the nature of their illness, and will patients feel rapport is lost? However, the retention of COVID-19 MBS telehealth items is needed for ongoing flexible and comprehensive private practice psychiatry.

Indigenous Psychiatry in Australia and New Zealand - an interview with Prof Helen Milroy.

Indigenous Psychiatry in Australia and New Zealand - an interview with Prof Helen Milroy.

Subspecialty training pathways in intellectual and developmental disability psychiatry in Australia and New Zealand: current status and future opportunities.

This study aimed to examine the training experiences of and determine capacity to train future Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health. Australian and New Zealand psychiatrists with expertise or interest in intellectual and developmental disability mental health completed an online survey detailing their training pathway, support for subspecialty training and capacity to provide rotations in this area. Psychiatrists (n=71) indicated the most common reasons they started practicing in intellectual and developmental disability mental health, and these included seeing people with intellectual or developmental disability in a service in which they worked, or personal experience with intellectual or developmental disability. Compared to those trained overseas, psychiatrists trained in Australia or New Zealand had lower ratings of the sufficiency of education received in intellectual and developmental disability mental health. Of the total respondents, 80% supported the development of subspecialty training. Augmentation of intellectual and developmental disability mental health content in the intermediate stage of training was also strongly supported. Participants identified 80 potential six-month training rotations in this area. Psychiatrists working in intellectual and developmental disability mental health strongly support enhancements to intellectual or developmental disability training, including the development of subspecialty training, and can identify potential training capacity if such subspecialty training was developed.

Introducing a competency based Fellowship programme for psychiatry in Australia and New Zealand.

The aim of this paper is to summarise the new psychiatry Fellowship programme and its rationale, highlighting the new inclusions, revised assessment structure, the benefits and structure of the programme. The 2012 Fellowship programme is based on the CanMEDs educational framework. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) underwent a comprehensive process, adapting the CanMEDs competencies to a psychiatric framework and mapping the curriculum to Fellowship competencies, learning outcomes and developmental descriptors of the various stages of training. The 2012 Fellowship programme introduced summative entrustable professional activities (EPAs), formative workplace-based assessments (WBAs) and revised external assessments.

Helen Herrman: president elect of the World Psychiatric Association

Helen Herrman: president elect of the World Psychiatric Association

Culture and Stigma of Mental Illness: Path Analysis Conducted with Amos in Transcultural Psychiatry in Australia

Aim: The study was designed to elucidate the relationships between cultural values, contact level, differential nursing practices and stigma towards mental illness among General and Psychiatric Nurses (N = 208) from Anglo and Chinese backgrounds in Australia. The study results aimed at informing education disciplines, health care providers and policy makers to examine strategies that seek to diminish stigma of mental illness and to reflect on cultural sensitive issues associated with mental illness. This paper reports analyses conducted with AMOS-5 within the Chinese sample (n = 84). Method: A cross-sectional survey explored a number of factors such as contact factor, cultural values (Individualism (IND), In group Role Concern (IRC) and In group Interdependence (INT)), “General Stigma” measured by the Social Distancing (STPP) and Negative Stereotyped (DISL) Scales and how these factors might translate into nurses’ endorsement of differential care practices between two vignettes (diabetes versus mental illness), which was termed “Practice Stigma”. “Practice Stigma” was measured by Caring Approach (CARE), Nursing Satisfaction (SATI), Authoritarian Stance (AUTH) and Negativity (NEGA) Scales. Differential practices (DIF_CARE, DIF_SATI, DIF_AUTH and DIF_NEGA) were obtained by subtracting the diabetes case from the mental illness case. Findings: Chinese nurses endorsed more highly collectivist values measured by the variables “In group Interdependence” and “In group Role Concern” when compared with Anglo-Australian nurses, but there was no difference in individualist values measured by “Individualism”. Chinese nurses endorsed more highly general stigma towards mental illness than Anglo nurses when statistically controlled for differences in background demographics and contact factors. Chinese nurses endorsed more care/support and authoritarianism in their clinical approaches than Anglo-Australian nurses, although there was no significant interaction effect between ethnicity and patient type on care and authoritarianism. Chinese nurses endorsed more highly differential negativity than Anglo nurses for the mental illness case than the diabetes case, an effect mediated by differences in general stigma between these two ethnic groups. Within the Chinese sample, higher contact was related to lower differential negativity for the mental illness case than the diabetes case. Several path analyses suggested that Chinese values influenced differential negativity, mediated by general stigma and prior diversified contact with people having a mental illness.

From theory to practice: making entrustable professional activities come to life in the context of milestones.

Entrustable professional activities (EPAs) are gaining traction across the globe as a practical way to teach and assess competencies in the clinical setting. Full-scale implementation, though, has only taken place in obstetrics-gynecology in the Netherlands and in psychiatry in Australia and New Zealand. As with any conceptual framework, implementation in different contexts will require adaptations. For example, implementation in the United States will need to incorporate the Accreditation Council for Graduate Medical Education's competencies and the recently completed milestones for each of the specialties. In this issue, an article by Aylward and colleagues describes the process for implementing a handoff communication EPA, using milestones as the basis for the assessment tool. The explicit linkage of the milestones with the EPA assessment allows a more definitive "picture" of the learner to emerge at each advancing level of performance of the EPA. This "picture" can be shared with those directly observing the learner and thus provides a potential model for a more reliable assessment of learners performing EPAs and perhaps a more consistent approach to entrustment decisions. The authors hope that Aylward and colleagues' article will be one of many that aim to help the medical education community understand how to implement EPAs as a framework for competency demonstration, as educators try to determine what works, under what conditions and in what settings. Only through a committed effort to share lessons learned can the promise of the theory be translated to practice in the field.

Undergraduate Teaching of Child and Adolescent Psychiatry in Australia: Survey of Current Practice

To identify the goals, content, and time allocated for undergraduate child psychiatry teaching programmes in Australian medical schools. A structured questionnaire designed specifically for the present study was used to identify the goals, content, and time allocated to child psychiatry teaching for undergraduate medical students. Staff responsible for child psychiatry teaching programmes at all 15 medical schools in Australia were contacted and those in 12 schools (80%) agreed to participate. All 12 medical schools provided some teaching relevant to child psychiatry. Teaching was commonly provided as part of general psychiatry and/or paediatric teaching programmes. Between 4 and 12 h were allocated for child psychiatry teaching, with the exception of one school, which assigned 46 h. Ten schools (83%) offered clinical placements in child psychiatry to some or all students, with placements ranging in length from 0.5 days to 8 weeks. However, only four schools (33%) offered clinical placements to all students. Two schools (17%) offered no clinical placements or electives in child psychiatry. The skills required to assess children and families, and knowledge about normal child development were identified as key teaching goals. Barriers to teaching child psychiatry included the lack of academic child psychiatrists in Australia, and the limited time allocated for this teaching in medical school curricula. The amount of time allocated for teaching child psychiatry in Australian medical schools is relatively small and not consistent with the size of the public health problem posed by child and adolescent mental disorders. Staff responsible for teaching child psychiatry need to coordinate their activities more effectively at a national level to identify teaching goals, design curricula, and advocate for high-quality child psychiatry teaching programmes in medical schools.

A Survey of Combination Antidepressant Use in Australia

The aim of this study was to survey doctors working in psychiatry in Australia about the practice of using two antidepressants simultaneously. A postal survey was sent to all doctors in psychiatry in Australia enquiring about their prescribing history and their attitudes to combination antidepressants and related issues. Seventy-nine percent of respondents had used combination antidepressants. The most frequently reported combination was a selective serotonin reuptake inhibitor combined with a tricyclic antidepressant. Combinations of mirtazepine with venlafaxine and other antidepressants were the next most frequently used. Seventeen percent of respondents reported having seen a complication from combination antidepressants, 75% believed that Australian GPs should be given information on the use of combination antidepressants, 89% wished for more information on this topic, and 88% believed patients had a right to be informed of this option in their treatment. Use of combination antidepressants was more frequent than exceeding the recommended maximum dose of an individual antidepressant. Combination antidepressants are used far more frequently in Australia than suspected previously. Research into safe and evidence-based practice is strongly indicated.

What psychiatry means to me.

Moving in early career from public health physician to psychiatrist gives me a public health view of psychiatry and an interest in pursuing the goals of widening access to community-based services for people with mental disorders and promoting mental health in communities. Training in social medicine in the UK and psychiatry in Australia lead to studies of homelessness in people living with psychotic disorders, the health of family caregivers, assessing quality of life and mental health promotion.Work with the World Health Organization (WHO) in the Western Pacific Region and the World Psychiatric Association (WPA) worldwide has given me opportunities to work with psychiatrists, mental health workers, service users and others in governments and non-government organisations implementing the recommendations of the World Health Report 2001 in countries with limited resources. My work as WPA Secretary for Publications seeks to improve information exchange in countries irrespective of their wealth. This is an exciting time to be working in a global village with technical capacity to reach into its furthest corners. Psychiatrists supported by WPA can help ensure that vulnerable people and communities and people living with mental disorders are well served in this new environment and no longer left out and left behind.

The Royal Australian and New Zealand College of Psychiatrists

The vision of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) is of 'a fellowship of psychiatrists working with and for the general community to achieve the best attainable quality of psychiatric care and mental health'. It is the principal organisation representing the specialty of psychiatry in Australia and New Zealand; it currently has around 2600 Fellows, who account for approximately 85% of psychiatrists in Australia and 50% of psychiatrists in New Zealand. The RANZCP sets the curriculum, accredits training and training programmes, and assesses trainee psychiatrists. In addition, it administers a continuing professional development programme for practising psychiatrists, has a role in policy development, publishes two scientific journals - the Australian and New Zealand Journal of Psychiatry and Australasian Psychiatry - and holds an annual scientific congress.

Psychiatry in Australia

Psychiatry has been practised in Australia in one form or another since the peopling of the continent, originally with the practices of the Aboriginal shamans, and later with the psychiatric treatment necessitated by convict transportation.Over most of the last half-century psychiatry has been administered by the Royal Australian and New Zealand College of Psychiatrists.There are over 2 000 psychiatrists in Australia, and num- bers are expected to increase in future.As in many other countries, there is ongoing pressure between the private and public sectors, with endemic under- funding of public and community services.Despite its small number of practitioners and relative isola- tion from major centres, Australian psychiatry has a distin- guished record in the field of research. The most famous dis- covery, by John Cade, was the use of lithium for treatment of mania.Recently governments at state and federal level have acknowledged the effect of psychiatric illness on patients and their families. This has led to the development of pro- grammes to improve public information and eliminate preju- dice.It is anticipated that the practice of psychiatry will flourish in Australia and that the country will remain a leading centre of excellence in psychiatric research and training.

Academic Departments of Psychiatry in Australia: A Need for Reinvention

Objective: To give an overview of academic departments of psychiatry in Australia, emphasising the contribution they have made to the development of psychiatry in this country and the current pressures on them. Method: Review of the literature, historical perspective and personal observation. Results: University departments of psychiatry are under considerable stress in Australia because of pressure on both the health and education budgets. Conclusion: In the current climate, university departments need to reconsider their core goals and review their sources of funding if they are to survive and prosper.

Impressions of Psychiatry in Australia

The last two months (August and September, 2000) have been spent as the Meigunyah Visiting Fellow at the University of Melbourne. My main duty was to deliver a public lecture on the future of menta...

Focus on psychiatry in Australia

Humankind has been present on the Australian continent for at least 40 000, some say 60 000 years, remarkably adapted to the environment and having a cultural tradition appreciated by few Caucasians. White people have been here for only 200 years; and psychiatry for about half of that. We know nothing about the mental health of pre-contact indigenous peoples; but we now know a little about the ways in which mental disorders are explained and treated by traditional methods. In two centuries, the Aboriginal and Torres Strait Islands communities, which are very diverse, have been steadily reduced to become only 1.5% of the population. From settlement in 1788 until the 1950s, most non-aboriginal Australians were of Anglo-Saxon or Celtic origin. Since the Second World War, the pattern of immigration has greatly enriched Australian life, first through large numbers of people from the Mediterranean littoral, Western Europe and the Balkans, and more recently from south-east Asia. Ethnic diversity is now evident in most peoples' daily lives – whom you see in the street, whom you work alongside, who your friends are, what you eat and who you have as patients. So the present Australian population of 18 million has undergone a marked change in demography and lifestyle within only two generations. Like the people, psychiatry is also changing rapidly. Where are the changes taking place? What is it like to be a psychiatrist here at present? Where has there been success and where has there been failure? Where is there lots of action?

A focus on empirically supported outcomes: A commentary on search for empirically supported treatments.

Psychiatry in Australia has prepared clinical practice guidelines, and in doing so identified empirically supported treatments, but has been loath to implement those guidelines. Clinical psychology, excluded from being reimbursed by health insurance, has shown less interest in systematically identifying such treatments. There is considerable official interest in how to make science inform practice, with comments from the payers that routine outcome assessment would be used in setting reimbursement schedules. Efficacy, effectiveness, and efficiency are popular words, evidence-based medicine is to be adopted by all, but no one is clear about how this will be achieved. Does all this sound familiar?

Educational Aims and Objectives for Registrar Training in Rural Psychiatry in Australia and New Zealand

RANZCP trainees in psychiatry are required to have at least three months experience in a rural area, or with populations who are socially or economically disadvantaged. This requirement was introduced in the College by-laws in 1996 [ 1 ] and applies prospectively to all trainees who commenced training after 1 December 1997. In some training programs relatively few trainees have completed experience in rural areas since this time, for a variety of reasons [ 2 ]. Firstly, the alternative to rural experience (a rotation involving working with economically or socially disadvantaged populations) can be done in many metropolitan areas, thus alleviating the need for temporary relocation to the country. Secondly, the low availability of suitably accredited rural posts may prompt the arrangement of an alternative training experience. Thirdly, the educational value of a rural training experience may not be readily apparent.