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Rural communities have unique mental health needs and challenges which are often related to the uniqueness of the community itself. On a per‐capita basis, the investment in rural mental health research is far less than that in urban communities. Added to this, rural communities are often at risk of researchers, based in large urban universities, visiting, conducting the research with minimal engagement with local stakeholders and limited understanding of the community's social‐service‐environmental context. Often this research leaves no visible benefit to the community with respect to increased knowledge, resources or community capacity. This commentary is based on the insights of a panel of authors from 9 countries, each with extensive experience of rural mental health research and work. And it seeks to stimulate the discourse on responsible rural mental health practice. The aim of this commentary is to provide a reference on research practice for novice and experienced researchers on rural mental health research and practice, to assist policymakers, government and funding bodies to establish appropriate standards and guidelines for rural mental health research, and support rural communities to advocate for equity of funding and sustainable research as they engage with researchers, funders and governments. The 10 standards in this declaration will help guide researchers toward research that is beneficial to rural communities and also help develop the local community's research capability, which ultimately will serve to enhance the mental health and well‐being of rural communities. [ABSTRACT FROM AUTHOR]

Aim: We aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications. Context: This is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals—the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health—recognised that Indigenous peoples' identity could be embedded in authorship details. Approach: An environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is 'nothing about Indigenous people, without Indigenous people' in rural health research publications. Conclusion: Improving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call‐to‐action for research journals and institutions to rigorously improve publication governance that signals "Editing with IndigenUs and for IndigenUs". [ABSTRACT FROM AUTHOR]

In the article, the editors discuss the changes implemented by the journal and its sister publications as of July 2022, including the new editorial rules to include Indigenous peoples as authors and the proposed creation of the Indigenous Cultural Identity of Research Authors Standard (ICIRAS).

Workplace wellbeing is a fast-developing subject in employment relations. This qualitative study examined the workplace wellbeing of police during COVID-19. There has been a significant critique of the narrow focus only on individual resilience and stress as the cause of workers' poor mental health and wellbeing. Research into frontline workers' mental health and wellbeing has mainly focused on the cumulative effect of trauma and operational stress injuries on individual resilience, with insufficient consideration of the impact of organisational culture, systemic and environmental factors. Drawing on a survey of 665 police professionals from all states and territories in Australia, this research investigated individual, the nature of work, organisational and environmental factors that negatively impacted worker wellbeing during the pandemic. The paper concludes that incorporating the full range of factors related to workplace wellbeing would inform an improved, holistic approach to maintaining and enhancing employee wellness. Understanding the influence of these factors during COVID-19 has implications for employment relations theory and the practical management of frontline emergency service workers' workplace wellbeing generally and in times of crisis and disruption. [ABSTRACT FROM AUTHOR]

The article presents the highlights of the 13th virtual Rural and Remote Mental Health Symposium (RRMHS) in Australia in November 2021. Topics include the effects of COVID-19 on rural mental health service reform and the benefits of physical health, vaccination and social well-being as components of a holistic approach to mental health and well-being. Presenters include Doctors Ruth Vine and Leanne Beagley and nurse Jo Rasmussen.

The authors reflect on the position statement of the rural health journals "Canadian Journal of Rural Medicine" (CJRM), "Australian Journal of Rural Health" (AJRH), and "Rural and Remote Health" (RRH) on research and reconciliation with Indigenous peoples in academic journal publishing. Topics include the right of Indigenous Nations to determine, define and name their cultural identity, and the need to end research colonialism.

The article presents the discussion on rural health in Australia. Topics include rural health being prominent in most state and national health plans and workforce strategies; and widely dispersed rural health workforce in pharmacy, allied health, and general practitioner small businesses supported by the Medical Benefits Schedule (MBS).

Objective: To investigate the impact of COVID‐19 on the mental health and well‐being of rural paramedics, police, community nursing and child protection staff. Method: An online survey was distributed to investigate the sources of stress and support across individual, task and organisational domains. Setting and Participants: The survey was completed by 1542 paramedics, police, community nurses and child protection workers from all states and territories of Australia. This study describes the data for the 632 rural participants. Main outcome measures: The main measures of well‐being were the Public Health Questionnaire (PHQ9), the Generalised Anxiety Disorder (GAD7), the Maslach Burnout Inventory (MBI), workplace engagement, intention to quit and COVID‐19–related stress. Results: The mean depression and anxiety scores were 8.2 (PHQ9) and 6.8 (GAD7). This is 2–3 times that found in the general community. Over half (56.1%) of respondents showed high emotional exhaustion (burnout). The emotional exhaustion, depersonalisation and personal accomplishment mean scores were 28.5, 9.3 and 34.2, respectively. The strongest associations with burnout and psychological distress were workload, provision of practical support, training and organisational communication. A significant proportion of respondents were seriously considering quitting (27.4%) or looking for a new job with a different employer (28.5%) in the next 12 months. Conclusions: COVID‐19 has increased the workload and stress on rural front‐line community staff. The major sources of stress were related to organisations' responses to COVID‐19 and not COVID‐19 per se. The data suggest the most effective mental health interventions are practical and preventive, such as firstly ensuring fair and reasonable workloads. [ABSTRACT FROM AUTHOR]

Urgent action is required to combat rabies in both humans and animals in Myanmar as it is now more common than malaria [[6]]; the WHO target of achieving zero human deaths secondary to dog-mediated rabies in Myanmar is certainly in jeopardy [[7]]. Community engagement and empowerment Democracy signifies "the rule of the people"; the coup d'état has removed the voice of the people of Myanmar and is the strongest form of disempowerment. Strengthening health systems The Myanmar healthcare system has been systematically undermined by the previous military leadership, which leaves it at risk of "profound health system collapse" [[13]]. [Extracted from the article]

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An editorial is presented on the COVID-19, leadership and lessons from physics. Topics include the times of crisis and major disruption bring leadership values into focus, particularly the values of political and public service leaders, the leader needs clarity about their personal and organizational values, and the history of dealing with changing demands, health services have experience in deploying and redeploying staff and resources in response to rapidly changing circumstances.

NewAccess is a low-intensity cognitive behavioural program which was recently trialled for the first time in Australia for clients aged under 18. Given that accessing support earlier tends to result in better outcomes for people with mild-to-moderate mental health issues, having NewAccess available for young people has the potential to reduce the likelihood of mild-to-moderate mental health concerns developing into more serious, or chronic mental illness over time for some clients, while also freeing up resources for those with more severe support needs. This mixed methods approach presents the findings of an independent evaluation of the program delivered out of two regional headspace centres in 2017-2019. From an initial sample of 165 young participants aged between 12 and 25, 109 completed the program. Of those who completed the program 60 were under the age of 18. The standardised assessment and outcome measures indicated a very good response to the program, with the majority showing significant improvements in their depression, anxiety and psychological distress scores. The overall 'reliable improvement' and 'recovery rates' were 64.2% and 72.3% respectively. Overall, the results indicated this program was an acceptable and efficacious intervention for young people in rural settings, when delivered in a 'youth-friendly' service environment. [ABSTRACT FROM AUTHOR]

Objective: This study examines consumer engagement with a social marketing digital media strategy designed to support the implementation of Equally Well--a program to improve the physical health of people living with mental illness. Design: A four-stage strategic analysis and intervention mix were used as the theoretical framework to assess stakeholder needs and to evaluate the effectiveness of the intervention. Setting: Online and digital media. Participants: Mental health consumers, carers, clinicians and service managers. Interventions: A digital media, social marketing intervention to support those seeking to improve the physical health of people living with mental illness. The strategy was developed using a co-design methodology and provided links to self-care resources, access to service providers, clinical tools for health professionals and links to existing successful rural programs. Main outcome measures: The main outcome measures were the number of people from each category accessing the media, making connections and downloading resources. Results: The program has resulted in more than 24 500 website hits per annum, 3500 tweets and 14.5 million Twitter impressions with good bounce and download rates. The analysis suggested the materials were mostly used by clinicians and service managers using desktop computers. Conclusions: Using a co-design approach, the study demonstrated the potential of a social marketing digital media strategy as a health promotion methodology. The paper has provided a framework for implementing and evaluating the effectiveness of digital social media campaigns that can help consumers, carers, clinicians and service planners address the challenges of rural health service delivery and the tyranny of distance. [ABSTRACT FROM AUTHOR]

Hospitals often perform urine drug screens (UDS) upon inpatient admission to confirm self-reported psychoactive substance use for patients with opioid use disorder (OUD). We sought to evaluate the agreement between UDS and patient self-report for psychoactive substances detected with UDS for adults with OUD admitted to hospital. For 11 substance categories, we evaluated agreement between the UDS and the documented history over a 5-year period for consecutive adults admitted to one academic center with a history of OUD. Among the 153 patients, overall agreement across the 1683 different history/UDS pairs (i.e. either history+/UDS + or history-/UDS-) was high (81.3%) but varied (from lowest to highest) by substance [opiates (56.9%), benzodiazepines (66.0%), 6-acetylmorphine (67.3%), cocaine (81.0%), cannabinoids (81.0%), methadone (83.7%), buprenorphine (85.0%), amphetamine (94.8%), barbiturates (95.4%), and phencyclidine (98.7%)]. History+/UDS- pair mismatches were most frequent for 6-acetylmorphine (32.7%), methadone (14.3%) and oxycodone (12.4%); history-/UDS + pair mismatches were most frequent for opiates (43.1%), benzodiazepines (24.8%) and cannabinoids (18.3%). The change in agreement over time of self-reported heroin use may reflect an increasing number of patients unknowingly using illicit fentanyl products. Among hospitalized patients with OUD, agreement between reported psychoactive substance use history and UDS results is strong with the exception of opiates, heroin, and benzodiazepines. [ABSTRACT FROM AUTHOR]

The author reflects on the strengths and challenges facing rural health research in Australia. Topics discussed include the importance of addressing the inequities of health research funding in the country, advantages of the Australian rural health teaching and research infrastructure, and implications of the proposed open access revisions by the National Health and Medical Research Council (NHMRC) for rural health outcomes.

An available and effective rural mental health workforce is critical to the provision of contemporary mental health care. During the last 5 years new mental health plans and strategies have been released every state and territory of Australia. This policy analysis examines the extent to which workforce, and particularly rural workforce issues are considered in these policies. The analysis revealed that rural workforce issues receive scant attention in state and territory mental health plans. Rural Australians comprise 28% of the total population, yet rural workforce issues are canvased, on average only 6% of the time general workforce issues are addressed. National mental health workforce plans do focus on the rural workforce, but these are not referenced in the state or territory strategies or workforce plans. Given the rural mental health workforce shortages, and consumer challenges in accessing rural mental health services, more planning and consideration to supporting and developing a rural workforce appears warranted. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury in hospital patients is common and associated with reduced survival and higher healthcare costs. The Tackling Acute Kidney Injury (TAKI) quality improvement project aimed to reduce mortality rates in patients with acute kidney injury by implementing a multicomponent intervention comprising of an electronic alert, care bundle and education in five UK hospitals across a variety of wards. A parallel developmental evaluation using a case study approach was conducted to provide the implementation teams with insights into factors that might impact intervention implementation and fidelity. The qualitative element of the evaluation will be reported. Methods: 29 semi-structured interviews with implementation teams across the five hospitals were carried out to identify perceived barriers and enablers to implementation. Interviews were taped and transcribed verbatim and Framework analysis was conducted. Results: Interviews generated four ‘barriers and enablers’ to implementation themes: i) practical/contextual factors, ii) skills and make-up of the TAKI implementation team, iii) design, development and implementation approach, iv) staff knowledge, attitudes, behaviours and support. Enablers included availability of specialist teams (e.g. educational teams), multi-disciplinary implementation teams with strong leadership, team-based package completion and proactive staff. Barriers were frequently the converse of facilitators. Conclusions: Despite diversity of sites, a range of common local factors–contextual, intervention-based and individual–were identified as potential barriers and enablers to fidelity, including intervention structure/design and process of/approach to implementation. Future efforts should focus on early identification and management of barriers and tailored optimisation of known enablers such as leadership and multidisciplinary teams to encourage buy-in. Improved measures of real-time intervention and implementation fidelity would further assist local teams to target their support during such quality improvement initiatives. [ABSTRACT FROM AUTHOR]

This paper describes the older people's mental health workforce development, policy development and implementation process and quantifies the rural service delivery and access impacts over a 15‐year period in New South Wales. It highlights the factors that are considered to be critical to successful rural service development such as commitment to funding parity, investment in strong local service leadership, and development of innovative, locally adapted rural service models. Building on these foundations, the Older People's Mental Health Program in New South Wales was able to address key challenges relating to service access in rural health and develop new, sustainable specialist older people's mental health service networks. A sustained focus on policy and implementation which explicitly supports rural older people's mental health service enhancement, and development of evidence‐based models of care, has significantly improved access to specialist mental health care for older people in rural areas. It has delivered 23 new rural older people's mental health community teams and a 440% increase in the number of people accessing these teams. It has also doubled the number of acute inpatient units and established new specialist mental health‐residential aged care partnership services in rural New South Wales. It has resulted in increased access to services for the "older old," while not diminishing older people's rates of access to general adult mental health services. It has also supported innovative, sustainable rural service models such as "hub and spoke" models and step‐up step‐down inpatient services that build on existing health and hospital infrastructure and link geographically dispersed specialist clinicians and services together in rural service delivery. [ABSTRACT FROM AUTHOR]

The aim of the project was to evaluate the use of telehealth equipment in the homes of older community-dwelling people, and to review its social and economic impact. A mixed methods approach was adopted, involving interviews, observation and Depression Anxiety Stress Scales. Overall, the greatest benefit was apparent in those participants with a low familiarity with technology and low digital literacy, where changes in behaviours to prevent an exacerbation of their condition was possible. The user interface design reduced concern about using the technology. Changes achieved were through better compliance with medication and associated understanding of the impact on their vital signs and hence daily activities. This represented an improved health literacy and the economic benefits appear to be linked to that. Less benefit was observed by those who had been self-monitoring previously. A greater focus on specific conditions and improved self-management could strengthen the evidence for targeted economic benefits. [ABSTRACT FROM AUTHOR]

An editorial is presented on the public health policy and leadership matters. The article discusses that the extraordinary situation of COVID-19 has mobilized health experts in concert with our political leaders, whose duty it is to convert expert advice to regulation and action; and COVID-19 has been the catalyst for (mostly) rapid and decisive public health action.

The article focuses on the 11th Australian Rural and Remote Mental Health Symposium that was held between 28 and 30 October 2019 at the Adelaide Convention Centre, South Australia (SA) to discuss mental health. It mentions that the rate of suicide is much higher in rural communities; and also mentions that to be effective, mental health policy development must include stakeholders from rural communities.

People diagnosed with mental illness have relatively poor physical health and die earlier than their counterparts in the general population. People living with mental illness in rural Australia have three times the risk of premature death than the total population. This article reviews recent international, Australian and New Zealand research, identifies the increased risk of early death of people living with mental health issues in rural settings and looks at the need for policy and practice responses. The 'Equally Well' national initiatives are described in Australia and New Zealand, which seek to systematically address this inequity as a matter of priority. Finally, it argues for co‐design and consumer participation in policy development, program implementation and research. Improved understanding of the perspectives and priorities of people with experience of mental illness is vital if change is to be fully realised. [ABSTRACT FROM AUTHOR]

Introduction: People living with mental illness have poorer physical health and die on average 20 years younger than the general population. Most of this poor health and early death is due to preventable chronic health conditions. Using a collective impact model, Equally Well, provides examples of, how with the support of a backbone organisation, leadership is distributed to enable the development of new collaborative initiatives that are 'fit-for-purpose' and not imposed by a central agency. This presentation provides examples from Australia, New Zealand and UK on how the collective impact approach has been adapted and implemented. Aims, Objectives, Theory or Methods: The aim of Equally Well is to facilitate increased coordination and integration between a diverse range of partner organisations toward a common goal. Based on the theory and methods of the collective impact model, Equally Well looks to enhance the way organisations work together towards the ultimate objective of improving the physical health and reducing the life expectancy gap for people living with mental illness. A variety of methods were used, such as a national audit to identify and share best practice; and continuous communication to increase awareness of the issue, initiatives and opportunities to address this problem. Highlights or Results or Key Findings: A comprehensive national environmental scan and audit revealed 387 projects and initiatives underway to implement the recommendations of the Equally Well National Consensus Statement. The most effective and sustainable initiatives were then identified and highlighted through webinars, symposia, and social media. This served as a catalyst for partners to network, collaborate and share learnings and resources. In addition, policy, implementation and clinical delivery communities of practice were established as a forum to discuss these projects and their associated processes and challenges. As a result, new crossjurisdictional and inter-sectorial partnerships were established across the government, nongovernment, and research sectors. This distributed leadership and light-touch governance model means that contextually appropriate new partnerships can form according the context and capability of each organisation at the time. This presentation will outline case examples illustrating how this process facilitated collaborative partnerships to provide integrated holistic care. Conclusions: Supported by a strong policy framework, this experience demonstrated the capability of agencies to self-organise to form strong integrative partnerships. Further, this light-touch approach, means partnerships can develop to best suit their unique situational context, and combined with a shared, agreed goal, this results in better and sustainable 'fit-for-purpose' solutions. Implications for applicability/transferability, sustainability, and limitations: The processes and methods of a collective impact approach can be applied to a range of care scenarios to facilitate enhanced integration and collaboration. Working through local place-based leaders results in a more sustainable approach that works to focus, mobilize and coordinate existing capacity towards a common agenda. [ABSTRACT FROM AUTHOR]

The authors present a position statement regarding the publication of articles about Indigenous people or communities in rural health journals, particularly "Australian Journal of Rural Health," "Canadian Journal of Rural Health" and "Rural and Remote Health." The move is aimed at showing respect to Indigenous cultural identity and to enhance all aspects of academic publishing. Also cited is the effort to promote and support Indigenous authors and rural research.

The article presents the discussion on Peter Brown, a Commonwealth public servant organising major Australian cultural events such as ballet, orchestral performances, and film showings in China and analysing cultural and social developments in the country.

Hospital emergency departments (EDs) are common providers of emergency mental health care. Access to specialist expertise can affect and improve patient outcomes. The Mental Health Emergency Care-Rural Access Programme (MHEC) provides access to mental health specialists for rural and remote communities in western New South Wales. In 2011, 46 of the 48 EDs used the MHEC programme, which provided 1487 clinical services, an average of 29 services per week. This represented 60% of all MHEC activity. A video assessment was conducted during 571 (38%) of these MHEC contacts. Patients attending a non-base hospital (<50 beds) were twice as likely to receive a video assessment as those attending the larger base hospitals, and video was used more with increasing remoteness. Patients from non-base hospitals were also more likely to be admitted locally after a video assessment. When a decision to admit was made, patients from non-base hospital EDs assessed by video were less likely to be transferred out of their community to a mental health inpatient unit than those assessed by telephone triage only (46% vs 62%; P = 0.016). The MHEC programme is a practical, relevant and responsive solution that was designed for the Australian health system, but the same model could be adapted for implementation in other countries. [ABSTRACT FROM AUTHOR]

Objective. To evaluate a rural emergency telepsychiatry program, the Mental Health Emergency Care-Rural Access Program (MHEC-RAP), which aims to improve access to emergency mental health care for communities throughout western New South Wales (NSW). Methods. A descriptive analysis of service activity data from the introduction of the MHEC- RAP in 2008 to 2011 using Chi-squared tests and linear regression modelling to assess change and trends over time. Result. There were 55 959 calls to the MHEC-RAP, 9678 (17%) of these calls initiated an MHEC-RAP service (~2500 each year). The use of video assessment increased over 18 months, then levelled off to an average of 65 each month. Health care provider use increased from 54% to 75% of all contacts, and 49% of MHEC-RAP patients were triaged 'urgent'. Most (71%) were referred from the MHEC-RAP for outpatient care with a local provider. The proportion of MHEC-RAP patients admitted to hospital initially increased by 12%, then declined over the next 2 years by 7% (by 28% for admissions to a mental health inpatient unit (MHIPU)). Conclusion. The MHEC-RAP is well established. It has achieved acceptable levels of service activity and continues to be as used as intended. Further research is required to confirm how the MHEC-RAP works in terms of process and capacity, how it has changed access to mental health care and to document its costs and benefits. [ABSTRACT FROM AUTHOR]

The article focuses on the goals of the Australian Journal of Rural Health (AJRH) which is to promote scholarly discourse on research, policy and rural health projects and through this promote and improve the health of rural communities. It mentions that the Original research often has a larger sample size and a series of controls that are important to the accurate reporting of reliable, valid and meaningful results.

The article presents a reprint of the article "Austerity Versus Stimulus" by Russell Roberts, which appeared in the "European." The author discusses the impact of the government spending on the military sector on private consumption and economy in the country. He also mentions the analysis of several economists regarding the outcome of U.S. President Barack Obama's stimulus package on the economic condition in the country.

Background: The patterns of health service use by rural and remote residents are poorly understood and under-represented in national surveys. This paper examines professional and non-professional service use for mental health problems in rural and remote communities in Australia. Methods: A stratified random sample of adults was drawn from non-metropolitan regions of New South Wales, Australia as part of a longitudinal population-based cohort. One-quarter (27.7%) of the respondents were from remote or very remote regions. The socio-demographic, health status and service utilization (professional and non-professional) characteristics of 2150 community dwelling residents are described. Hierarchical logistic regressions were used to identify cross-sectional associations between socio-demographic, health status and professional and non-professional health service utilization variables. Results: The overall rate of professional contacts for mental health problems during the previous 12 months (17%) in this rural population exceeded the national rate (11.9%). Rates for psychologists and psychiatrists were similar but rates for GPs were higher (12% vs. 8.1%). Non-professional contact rates were 12%. Higher levels of help seeking were associated with the absence of a partner, poorer finances, severity of mental health problems, and higher levels of adversity. Remoteness was associated with lower utilization of non-professional support. A Provisional Service Need Index was devised, and it demonstrated a broad dose-response relationship between severity of mental health problems and the likelihood of seeking any professional or non-professional help. Nevertheless, 47% of those with estimated high service need had no contact with professional services. Conclusions: An examination of self-reported patterns of professional and non-professional service use for mental health problems in a rural community cohort revealed relatively higher rates of general practitioner attendance for such problems compared with data from metropolitan centres. Using a measure of Provisional Service Need those with greater needs were more likely to access specialist services, even in remote regions, although a substantial proportion of those with the highest service need sought no professional help. Geographic and financial barriers to service use were identified and perception of service adequacy was relatively low, especially among those with the highest levels of distress and greatest adversity. [ABSTRACT FROM AUTHOR]

An interview with professor Russell Roberts of George Mason University is presented. He says that the YouTube videos featuring Billy Scafuri as John Maynard Keynes and Adam Lustik as F. A. Hayek in "Fear the Boom and Bust," and its sequel "Fight of the Century" in which the characters argue their sides in a rap music, is the idea of John Pola. He added that knowing teachers are using the video in teaching economics is very satisfying.

Background: With the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy. Within existing health system structures the active strategies that facilitate effective partnership linkages are not clear. The objective of this study was to examine the evidence from peer reviewed literature regarding the effectiveness of service linkages in primary mental health care. Methods: A narrative and thematic review of English language papers published between 1998 and 2009. Studies of analytic, descriptive and qualitative designs from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted to examine what service linkages have been used in studies of collaboration in primary mental health care. Findings from the randomised trials were tabulated to show the proportion that demonstrated clinical, service delivery and economic benefits. Results: A review of 119 studies found ten linkage types. Most studies used a combination of linkage types and so the 42 RCTs were grouped into four broad linkage categories for meaningful descriptive analysis of outcomes. Studies that used multiple linkage strategies from the suite of "direct collaborative activities" plus "agreed guidelines" plus "communication systems" showed positive clinical (81%), service (78%) and economic (75%) outcomes. Most evidence of effectiveness came from studies of depression. Long term benefits were attributed to medication concordance and the use of case managers with a professional background who received expert supervision. There were fewer randomised trials related to collaborative care of people with psychosis and there were almost none related to collaboration with the wider human service sectors. Because of the variability of study types we did not exclude on quality or attempt to weight findings according to power or effect size. Conclusion: There is strong evidence to support collaborative primary mental health care for people with depression when linkages involve "direct collaborative activity", plus "agreed guidelines" and "communication systems". [ABSTRACT FROM AUTHOR]

Background: Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. Methods: A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. Results: A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. Conclusion: The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback. [ABSTRACT FROM AUTHOR]

In recent years there has been increasing recognition of the social impact of drought on rural communities. This paper provides an overview of a major mental health program developed in response to persistent severe drought and longer-term social and economic restructuring in New South Wales agriculture. Led by government and incorporating close collaboration with rural community agencies and services, the program's design and implementation was informed by existing evidence regarding mental health promotion, illness prevention, early intervention models, disaster management and a series of core project principles and goals based on community development practice. Improvements in mental health literacy and service collaboration and coordination suggest lessons learnt from the program will have applicability to future projects that aim to address mental health needs and promote the capacity of rural communities to adapt to the continuing impacts of future droughts and longer-term climate change. [ABSTRACT FROM AUTHOR]

Objective: To determine how donor health status affects the risk of infection after corneal transplant. Methods: An adverse reaction surveillance registry was used to conduct a matched case-control study among transplanted donor corneas from January 1, 1994, to December 31, 2003. Cases comprised 162 reports of endophthalmitis after penetrating keratoplasty including 121 with microbial recovery, of which 59 had concordant donor and recipient microbial isolates. Two controls were matched to each case by surgery date. Conditional logistic regression estimated adjusted odds ratios with 95% confidence intervals according to the premortem status of decedent donors. Results: Postkeratoplasty endophthalmitis was associated with recent hospitalization (odds ratio, 2.84; 95% confidence interval, 1.61-4.98) and fatal cancer (odds ratio, 2.46; 95%confidence interval, 1.53-3.97) among donors. Endophthalmitis appeared more likely with tissues transplanted longer than 5 days after donation (odds ratio, 1.55; 95% confidence interval, 1.02-2.35). The prevalence of concordant microbial isolates from donors and recipients was greater among fungal endophthalmitis than among bacterial endophthalmitis (P < .001). Conclusions: Corneal grafts with eye tissue obtained from donors dying in the hospital or with cancer may have an increased risk of postsurgical endophthalmitis, possibly due to donor-to-host microbial transmission. Together with donor screening and processing, improvements in microbiological control may reduce infection associated with corneal transplant. [ABSTRACT FROM AUTHOR]

Background: Prevention of falls in the elderly is a major health care target. There are theoretical reasons why older dialysis patients may be at high risk of falls: co-morbidity, medication, and post-dialysis hypotension, which have not been well tested. Dialysis patients are also at higher risk of fracture if they do fall. Methods: We prospectively interviewed all our centre haemodialysis patients over a 6 month period to see if they reported falls, syncope, pre-syncope or dizziness. Routine blood pressure (BP) and other clinical data were recorded. Results: A total of 78 patients completed the study. There was a high incidence of all four symptoms but only falls was age-related. About 38% of patients aged >65 reported 1 or more fall compared to 4% of younger patients (p < 0.001). There were no significant differences in pre-dialysis, post-dialysis or standing BP between young and older patients or between fallers and non-fallers although the older patients did have a greater magnitude in change between pre-dialysis BP and post-dialysis standing BP. Conclusions: Older haemodialysis patients have a high incidence of falls. Falls can be prevented by addressing modifiable risk factors. Whether existing guidelines are applicable to this specialised population is uncertain. There is a high incidence of syncope in dialysis patients of all ages and the cause of this needs further exploration. [ABSTRACT FROM AUTHOR]

Objective: To see if a new model of service delivery ensures that individuals with a mental illness in rural and remote settings could be assessed, treated and cared for in a more appropriate way. Design: Community mental health teams (CMHTs), general practitioners (GP) and other agencies were provided with clinical and broader support services by consultant psychiatrists from public and private sectors. The occasions of service were logged, audited and relevant provider groups were interviewed. Ethics approval was provided by Human Research Ethics Community of University of New South Wales. Setting: Far West Area Health Service (FWAHS), remote New South Wales. Participants: An enhanced service was provided for residents, specialist mental health and other healthcare providers. Results: • Regular access to psychiatrists for primary and secondary care was achieved in remote communities in FWAHS. • 3908 new patients were seen by CMHTs between July 2002 and December 2003 and 380 by visiting psychiatrists between January 2002 and July 2003. • Secondary consultation, mentoring and education opportunities were made available by tele-conference and face-to-face for CMHTs and others in FWAHS. • GPs and CMHTs in remote settings were satisfied with improved access to psychiatrist care. Conclusions: This model appears to be sustainable with reasonable levels of funding in FWAHS and may be applicable to other remote contexts. [ABSTRACT FROM AUTHOR]

An editorial is presented on an editorial is presented on researching for better health for regional and rural Australians. Topic include effective use of the personnel, infrastructure and clinical expertise; and developing new medicines and innovative treatments, the health of communities is about control.