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Objectives: This paper describes the rationale for and development of an innovative mental health service for people aged over 65 years living in Northern and Eastern Melbourne, Victoria, Australia. Conclusion: The Healthy Ageing Service (HAS) was established in July 2020 to provide care for people aged over 65 years experiencing mild-to-moderate mental health concerns. It embraces a prevention and early intervention model of care. It provides primary consultation and brief intervention, secondary consultation, and capacity building to the primary healthcare sector. This innovative service is a Commonwealth-funded partnership between two tertiary mental health service providers that incorporates the recommendations from two major Royal Commissions. It demonstrates a service that acts as a bridge between primary and specialist mental health care, thereby extending mental health services to target the 'missing middle' and is potentially a model for mental health service provision throughout Victoria and Australia. [ABSTRACT FROM AUTHOR]

Objectives: This narrative paper describes the influences behind the development of, and key components of a specialist younger-onset dementia service located in metropolitan Victoria, Australia.Conclusion: The Melbourne Young-Onset Dementia Service was established in 2013 and provides diagnosis and ongoing care for people with younger-onset dementia and their families, through collaboration with other medical units, allied health and community services. It is potentially a model for other younger-onset dementia services nationally and internationally. [ABSTRACT FROM AUTHOR]

Objective:: The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland.Method:: Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective.Results:: Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care.Conclusions:: Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to describe current approaches in Victoria to the development of perinatal and infant mental health services in regional areas.Method: The paper outlines the significance of perinatal mental disorder for maternal wellbeing and impact on infant development, and describes the model of care at the Agnes Unit.Results: The Agnes Unit has been established as a residential therapeutic unit offering short-term treatment that focusses on promoting parental mental health, parenting sensitivity and the parent-infant relationship.Conclusions: A coordinated and integrated approach with focus on early intervention is needed to deliver perinatal and infant mental health services. Services need to focus on the infant and parent-infant relationship in addition to parental mental health. [ABSTRACT FROM AUTHOR]

Objective: To critically examine a recent decision of the Victorian Supreme Court that found that the Mental Health Tribunal and the Victorian Civil and Administrative Tribunal erred in the application of the capacity test in the Mental Health Act 2014 (Vic) and that compulsory electroconvulsive therapy would infringe upon the human rights of two patients who had no insight into their chronic schizophrenia.Conclusions: After considering the concepts of insight and capacity to consent to treatment, the paper concludes that the decision in NJE and PBU v Mental Health Tribunal [2018] VSC 564 is problematic clinically. [ABSTRACT FROM AUTHOR]

Objective: A recovery-based outreach program for people with severe mental illness in regional Victoria is described. The paper covers a description of the program, the services provided and outcomes achieved. The program emphasized active collaboration between patients and clinicians as outlined in the collaborative recovery model and recognized that recovery from mental illness is an individual, personal process. Conclusions: The program provided service to 108 people over 3 years and had a positive impact on clinicians, patients and carers. The benefits of recovery orientation, multidisciplinary teams, collaborative relationships and carer involvement are discussed. The paper highlights the need for a focus on recovery and comprehensive care for people with severe mental illness. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe 'The Tofts', a private psychiatric hospital in the reigns of Edward VII and George V. Conclusions: An addendum to the history of psychiatry, in Australia is the conduct or treatment for the mentally ill in private hospitals during the nineteenth and early twentieth centuries. This paper describes one such small private hospital in Victoria, called The Tofts, and its founder, patients and treatment methods employed. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this paper are to provide an overview of recovery-focused models of care and discuss the implementation of the Strengths Model at St. Vincent's Mental Health Melbourne (SVMH), Victoria, Australia. Conclusions: The implementation of the Strengths Model at SVMH is discussed with particular emphasis on the process of implementation, service implications, practical challenges and dilemmas that have arisen, and proposed evaluation. Recovery-focused care is feasible and can enhance current practice of mental health services. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to outline the impact of Community Treatment Orders over a 20-year period on service delivery and clinical practice in Victoria. Conclusions: Community Treatment Orders, as utilized in Victoria, have undermined optimal service delivery and supported paternalistic, reductionistic clinical practice. The psychiatric profession has failed to advocate adequately for better mental health resourcing and human rights protection of those subject to Community Treatment Orders. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe the use of the Health of the Nation Outcome Scale (HoNOS) in an outreach-based rehabilitation program in regional Victoria, Australia. Method: Routine outcome measures (ROM), including the HoNOS, were introduced in the Stepping Stones Recovery Program (SSRP) in 2002. HoNOS data routinely collected for 122 patients between 2003 and 2006 was examined for sensitivity in capturing clinical changes by using paired t-tests. Results: There was a statistically significant decrease in total HoNOS scores as well as scores on subsets of 'impairment' and 'symptomatic problems'. HoNOS scores reflected positive changes in patients and were useful as a global overview, but did not tap into process issues that are more clinically meaningful. Conclusions: The SSRP provided a wide range of interventions and promoted a structured collaborative approach which could be the main reason for the uptake of ROM in this service. There are significant hurdles in integrating ROM in routine clinical practice, such as feasibility issues and clinician attitudes, along with larger systemic issues that need to be addressed. The introduction of ROM in Australia has resulted in strongly polarized viewpoints. Suggestions for facilitating the administration and use of ROM in routine clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: To describe the introduction of an ongoing professional development programme for clinicians in a rural area mental health service. The programme involved a series of workshops delivered by clinical psychologists. The training component of each workshop focused on discrete cognitive behavioural strategies, targeted at the amelioration of anxiety and mood symptoms.Conclusions: The paper emphasizes contextual aspects of the programme: its setting, the modality of delivery, resourcing issues and maximizing engagement by the participants. Preliminary evaluation data are reviewed, and it is argued that programmes that focus on local capacity building in rural settings are an important component of redressing the urban-rural imbalance in the availability of evidence-based psychological treatments. [ABSTRACT FROM AUTHOR]

This paper aims to provide the context and model of the development of a new, innovative state-wide service for people with a mental illness and intellectual disability (Dual Disability). Preliminary data on referral patterns and assessments are also discussed. [ABSTRACT FROM AUTHOR]

Objective: The paper describes the origin, and establishment of a gender dysphoria clinic at Monash Medical Centre, Melbourne. It aims at describing the various components of the service, especially the triadic notions of assessment, real life experience and surgery for gender identity disorders. Conclusion: This is a unique service offered by a public psychiatric service, and the viability of the service depends upon new resources and renewed interest from psychiatrists. Besides clinical services, the clinic offers enormous research, teaching and training opportunities. [ABSTRACT FROM AUTHOR]

Features the Schizophrenia and Depression Training Workshop developed by the Asia Pacific Forum for International Mental Health Cooperation of the University of Melbourne Department of Psychiatry and the Centre for Cultural Studies in Health in Melbourne, Victoria in July 1999. Background on the Forum; Description of the workshop's design; Overview of activities; Implications to practice.

Presents information on the September 1999 mental health service conference of the Royal Australian and New Zealand College of Psychiatrists in Melbourne, Victoria. Issues addressed by keynote speakers; Description of several convention activities; Topics of the presentations.

Objectives: The aim of this paper is to document the processes towards ensuring that all psychiatrists in training in Victoria have appropriate Indigenous mental health experience and training. Conclusions: This paper describes the process of implementation of the 2004 Indigenous Mental Health Royal Australian and New Zealand College of Psychiatrists (RANZCP) Training By-Laws within Victoria. It is likely that the challenges of ensuring access to this training experience, within the Victorian RANZCP Training Program, have been experienced to varying degrees within other Australian training programs. The vertical integration of Indigenous health curriculum extends work being done in all undergraduate medical schools in Australia and New Zealand, and which the Australian Medical Council have incorporated into their accreditation of medical schools. [ABSTRACT FROM AUTHOR]

Objective: The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists' uptake of telehealth, and face-to-face consultations for April–September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019. Method: MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April–September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia. Results: Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April–September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria's increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April–September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April–September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations. Conclusions: During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019. [ABSTRACT FROM AUTHOR]

Objective: A spreadsheet-based model for supporting equitable mental health resource distribution in Australia was developed, based on the Australian Health Survey (AHS) psychological distress findings associated with area socio-economic disadvantage (SED). An illustrative application is presented.Method: Stratum-specific psychological-distress rates for area SED quintiles are applied to local government areas, catchment areas and local health networks (LHNs). A case study applies the model to Victoria, including examining recommendations in the Royal Commission into Victoria's Mental Health Services (RCVMHS) 2019 interim report for increases to bed stock in two LHNs.Results: Need-adjusted demand estimates considered as a ratio of raw population proportions for catchments range between 0.6 to 1.4 in Victoria. Applying the formula to the Royal Commission recommendations suggests the proposed distribution of beds is a reasonable correction for these two LHNs and indicates next expansion priorities for more equitable distribution to other LHNs.Conclusions: The spreadsheet, adaptable for other states and territories, could complement National Mental Health Services Planning Framework outputs and assist in evaluation, for instance, determining potential supply shortages in the tele-mental-health response to COVID-19. We outline research directions including consideration of the moral bases of value judgements and identification of other variables including their use in parameterisation and calibration. [ABSTRACT FROM AUTHOR]

Objective: The shortage of addiction psychiatrists in Australia results in poor access to specialist care. This is most evident in rural Australia, a population experiencing significant issues related to drugs, alcohol and mental illness. This problem is exacerbated by the lack of addiction psychiatry training in rural Australia. Purposeful and well-coordinated educational opportunities for health professionals in rural settings can assist in recruitment and retention. This report will describe the establishment of an addiction psychiatry training programme in regional Victoria.Conclusion: Rural addiction psychiatry training programmes that ensure trainees meet the competencies required of an addiction psychiatrist can be established. Key components in establishing programmes are: collaboration between a breadth of local services; provision of quality supervision; support of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), senior psychiatrists and managers; provision of assistance to trainees and their families; and appropriate selection of trainees. [ABSTRACT FROM AUTHOR]

Objective: 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. Method: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Objective: The aim of the project was to identify changes in the practice of electroconvulsive therapy (ECT) in a metropolitan mental health service before and after the Mental Health Act 2014 (2014 Act) in Victoria.Method: Retrospective clinical file audit of ECT administration across all three sites at Eastern Health (EH) two years before and two years after introduction of the 2014 Act.Results: There was a statistically significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT across the three hospitals at EH in the two years following the 2014 Act compared to the two years prior to the 2014 Act. There was no significant difference in the number of voluntary ECT treatments and in the number of patients who had voluntary ECT.Conclusion: The review showed that there has been a significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT after the introduction of the 2014 Act. Potential reasons for the changes are discussed. [ABSTRACT FROM AUTHOR]

Objectives: This study examined (i) the demographic and illness profiles of mothers admitted to Werribee Mercy MBU in Victoria, Australia and (ii) the severity of maternal depressive symptoms over the course of admission.Method: A retrospective audit was conducted on consecutively admitted mother-baby dyads between January 2011 and June 2015. Routinely collected maternal Beck Depression Inventory, second edition (BDI-II) scores were analysed for severity and change.Results: A total of 307 mother-baby dyads were admitted during the study period. The majority of mothers was partnered and educated young adults. The average length of stay was 4.4 weeks. The mean age of babies was 3.3 months. One-third of mothers met International Classification of Diseases, 10th edition criteria for two or more psychiatric diagnoses. Unipolar major depression was the commonest diagnosis. Of the 307 mothers, 125 mothers completed BDI-II on admission and on discharge, which showed a mean reduction of 16 points (p < 0.001) on discharge.Conclusions: This study notes the similarities between the clinical profiles of the study population with mother-baby admissions to MBUs worldwide. Maternal depressive symptoms improved by 16 points on the BDI-II over the course of MBU admission, which shows the utility of MBU admission on maternal depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: To examine laws in three Australian jurisdictions that prohibit therapy to change or suppress a person's sexual orientation or gender identity.Conclusions: The laws in Victoria and the ACT provide inadequate protection for clinically appropriate psychiatric practice and may deprive patients of mental health care. [ABSTRACT FROM AUTHOR]

Objective: This study outlines the service issues and adjustments associated with the implementation of Choice and Partnership Approach (CAPA) into a rural Child and Adolescent Mental Health Service (CAMHS).Method: A mixed-methods approach examined the impacts of the CAPA implementation. A qualitative review of the minutes from team and implementation group meetings illustrated themes according to 11 key CAPA components. Quantitative internal audit data illustrated waiting list times.Results: Findings showed that inclusive language has replaced the traditional, pathology-driven psychiatric discourse, though this has been met with mixed response from CAMHS clinicians, service users and referrers. Data also showed that a waiting list for clinician allocation has been eliminated, and the waiting time between the referral date and the first face-to-face contact has decreased from 63.9 days to 10.7 days.Conclusion: A modified CAPA Choice appointment system has allowed quick access without a waiting list, in line with government guidelines. A full-booking system and focussed, goal-oriented interventions has led to lower caseloads and optimum use of CAMHS clinician skillsets. [ABSTRACT FROM AUTHOR]

The article discusses the perspectives and revisions of the New Mental Health Act 2014 (MHA) of Victoria. Included in the perspectives and revisions discussed are the promotion of collaborative decision making, new conditions for the management of involuntary treatment, and the role of the Mental Health Tribunal in the protection of consumers' rights. Also discussed are consumer rights involving restrictive interventions and the right of a consumer to communicate.

Objective: The study aimed to characterize the demographics, diagnostic makeup and aspects of patient management for the inpatient population of a large aged psychiatry service. Method: Sociodemographic and clinical variables were retrospectively collated from inpatient files and discharge summaries over a 3-year period. Age, gender, country of birth, diagnostic group, length of stay, involuntary care status and number of admissions were described and analysed. A total of 604 patients were included in the study, with complete data available for 516. Results: Approximately half of the patients were aged 65–75 years and 59.3% were female. More than half had been born outside of Australia. The primary diagnosis was an affective disorder in 39.0% of admissions, dementia in 27.5% and psychotic illnesses in 25.8%. The median length of stay was 28 days; 60.8% had a period of involuntary care and 79.8% had only one admission. Conclusion: In the near future, aged psychiatry services will face increased numbers of patients and rising expectations. To best respond to these challenges, we need to have an understanding of current patient and service profiles. The findings of this study illustrate a range of patient, diagnostic and management variables in aged psychiatry practice. This information can be used for comparison with other services and in planning for future development of services. [ABSTRACT FROM AUTHOR]

Information about the 2008 Royal Australian and New Zealand College of Psychiatrists Congress held on May 25-29 in Melbourne, Victoria is presented. Professor James Angus officially opened the Congress with a speech about working in partnerships and the development of the teaching of psychiatry at the University of Melbourne. Professor Ken Kirkby talked about education and learning in psychiatry and opportunities that the College provides in these areas.

Objective: To describe an aged persons mental health service in the Sunraysia district in remote Victoria. Conclusion: The aged persons mental health community team undertakes the bulk of the service’s work. The data for 2 years are presented and demonstrate how effective the team is. Good relationships and linkages have been built with the local hospital, general practitioners, aged residential care services and the local aged care assessment service. During the 2 year period, very few elderly patients were admitted to the inpatient psychiatric facility and patients suffering from dementia were rarely admitted. [ABSTRACT FROM AUTHOR]

Objective: To describe the nature of psychiatry work within a general medical hospital and to compare and contrast the nature of that work between emergency department and inpatient settings. Method: The data from the Royal Melbourne Hospital (RMH) consultation-liaison service database relating to referral, patient demographics, psychiatric diagnosis service use, management and discharge arrangements was recorded for all referrals to the RMH C-L service in 1999. The inpatient and emergency department arms of the service were compared. Results: The referral rate for inpatients and the emergency department was 2.9% and 2.1% respectively. The reasons for referral and frequency of psychiatric diagnosis differed significantly between the two settings. Conclusions: The provision of C-L services to inpatients and the emergency department needs to be tailored to the different patient populations. [ABSTRACT FROM AUTHOR]

Highlights the insufficient integration of community treatment orders into clinical management in Victoria. Scope of psychiatric treatment; Community treatment disorders; Model for integrating community treatment orders into clinical practice.

The article discusses advance statements in the area of mental health under the Victorian Mental Health Act. Topics covered include the definition of advance statements and procedure for making and varying advance statements, its implications for psychiatrists and mental health tribunals, and the value of the legislation for recovery-oriented service provision for persons with mental illness.

Objectives: To examine (1) perceived roles and functions of psychiatry medical staff in two multidisciplinary teams at two state-funded health services, a community mental health clinic at a general public psychiatry service and an alcohol and drug service, and (2) factors influencing these roles and functions. Method: Data were obtained from focus groups, key informant interviews, participant observation and document review. Results: Clinical roles were well conceptualised in both services, with good concordance between medical and non-medical staff. Team and leadership roles, however, were not well conceptualised. Service-related factors influenced clinical and many other roles. Power and professional cultural differences between medical and non-medical staff influenced team and leadership roles. Conclusions: Addressing lack of role clarity and teaching interpersonal and team leadership skills to psychiatry medical staff are likely to improve multidisciplinary team functioning for psychiatrists in these settings. [ABSTRACT FROM AUTHOR]

Focuses on the closure of the long-stay ward at a psychiatric hospital in rural Victoria. Review of related studies; Capacity of the hospital; Discussion on the consultative processes and staff retraining prior to closure; Description of the closure process.

Presents an overview of the General Council meeting of The Royal Australian and New Zealand College of Psychiatrists held in Melbourne, Victoria from October 26-27, 2002. Issues concerning the strategic policies to be developed for the year 2003; Plans of the education and training department of the council; Topics discussed by the college affairs department of the council.

Comments on the neglect of mental health problems of the elderly in health care facilities in Australia. Government policies introduced to mask the problem; Information on the psychogeriatric nursing homes developed in Victoria.

Summarizes the decisions made at the meeting of the Royal Australian and New Zealand College of Psychiatrists in Melbourne, Victoria on October 2 and 3, 1999. Ratification of by-laws; Appointment and resignation in the organization; Approval of policies and standards.

Presents information on a study which described the state of the Registrar Psychotherapy Program in Victoria as of April 1999. Overview of Victorian registrars' experiences of psychotherapy program; Attitude toward psychotherapy on the part of teaching hospitals and registrars; Access to patients who are suitable for psychotherapy.

Objective: Australia adopted a national mental health strategyin the early 1990s and each State has had to go through its ownimplementation process in the intervening years. The present paperdescribes the process of reform in services in Victoria, and venturesexplanations as to why the process may have been more comprehensiveand successful than in other States. Conclusions: Victoria adopted a Statewide ‘framework’,defining structural elements of area-based services, with rationalresource distribution. A transitional process involvinga population health approach and relatively rigid implementationof a tightly specified service framework, within a pol­iticalenvironment that favoured strong health services management, was ­successfulin achieving desired structural reforms in this State. This was undoubtedlyat the cost of promoting a model of public mental health service deliverythat is generally rationed so as to accept only a restricted rangeof types of referral. New initiatives from the current State governmentare explicitly targeted to correcting this situation. [ABSTRACT FROM AUTHOR]