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The development of positive workplace culture is important for health services, with implications for patient experience, staff wellbeing and service outcomes. The Oakden Report identified dysfunctional culture in the South Australian state-wide older persons' mental health service and established an agenda for change through a codesigned culture framework. An innovative culture change project was undertaken at Northgate House, a specialist service commissioned following the Oakden Report. The project built on the culture framework, with emphasis on developing psychological safety and employed principles from the deliberately developmental organisation model. The project resulted in positive outcomes for patients and staff and valuable organisational learning. Insights from the project may inform culture change journeys in a range of healthcare settings. [ABSTRACT FROM AUTHOR]

The Oakden Report documented failures in governance, clinical practice and organisational culture occurring at the Oakden Older Persons' Mental Health Service and drew national attention to the care of older people with complex clinical needs. Responding to the recommendations of the Report, a working group brought together stakeholders to engage in a codesign process involving literature review, gallery walks and focus groups, under the governance of the Oakden Response Oversight Committee. The working group developed a framework as a blueprint for organisational culture reform built around a central philosophy of compassionate relationship-centred care, supported by four priorities: developing a values-based workforce, cultivating psychological safety, facilitating excellence in care and providing transparent accountability. The purpose of the framework was to provide a way forward for South Australian older persons' mental health services after The Oakden Report, and it may provide insight into similar processes of codesign and culture change in other service contexts. [ABSTRACT FROM AUTHOR]

Objective: A mentoring programme was established in South Australia in 2014 by psychiatry trainees, with the goal of reducing stress and burnout amongst first-year trainees. All first-year trainees are offered the opportunity to have a senior trainee as a mentor. This article describes the mentoring programme, presents feedback from participants and identifies areas for further development.Method: The majority (72/76) of first-year trainees entering psychiatry training in South Australia from 2014-2018 were allocated a mentor. Surveys were sent out in 2014, 2015 and 2017. Twenty of 42 (48%) mentors and 17 of 42 (40%) of mentees completed a 10-item questionnaire, with free text responses.Results: Mentee feedback was mostly positive, reporting that mentors offered them reassurance and support. The most common challenges were advice about training, managing work-life balance and issues with supervision. The main barrier to the mentoring programme was lack of time to meet. Mentors identified that they would have liked more training in mentoring.Conclusion: The trainee mentoring programme has been a useful initiative. As consultant psychiatrists are likely to provide mentoring for more junior colleagues, the authors propose that training in mentoring should be part of the Royal Australian and New Zealand College of Psychiatrists education programme. [ABSTRACT FROM AUTHOR]

Objective: To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. Methods: A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. Results: From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons’ mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. Conclusions and implications: The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years. Methods: Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18–65 years with a psychotic disorder. We compared those aged 50–65 years (N = 347) with those aged 18–49 years (N = 1478) across a range of measures. Results: The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher. Conclusion: Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis. [ABSTRACT FROM AUTHOR]

The article discusses the management and use of high-dose haloperidol for severe aggression in a man with early onset frontotemporal dementia (FTD). It cites the case of a 60 year old man with a history of rapidly progressive FTD complicated by extreme aggression and the perpetrator of domestic violence before diagnosis. It notes that the risk of mortality in elderly nursing home residents increased with higher doses of antipsyhotic medications and was greatest for haloperidol.