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Objectives: This 'Realist Review' aimed to investigate the factors associated with length of stay and outcomes of medium secure care to help inform the development of a local secure care pathway., Method: The searches generated a total of 1570 entries across multiple search engines. Following removal of duplicates, application of inclusion/exclusion criteria and selection of articles, a total of 18 were reviewed in detail, including a further five articles obtained from references and the explored grey literature., Results: Several issues influenced not only admission to medium secure units, but also the outcomes. Many articles were retrospective studies relying on administrative data. The realist synthesis provides contextual data to inform program development., Conclusions: The existing literature, though variable in quality, was limited by the varied jurisdictions and contexts. However it may be useful to inform care pathways for the optimal use of medium secure beds., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Objective: To evaluate forensic and secure mental health services (FSMHS) staff's confidence in managing workplace aggression, identify associated factors, and explore their workplace aggression prevention training needs., Methods: Through an online survey, staff rated their experience of workplace aggression, perceived effectiveness of current training, and confidence in responding to workplace aggression, and described training needs. Stepwise multiple regression was used to identify associated factors with statistical significance. Thematic analysis was used to generate themes describing their training needs., Results: The staff perceived current training as low-to-medium in effectiveness, mirroring their confidence in managing workplace aggression. Nurses experienced more workplace aggression compared to other professions. Staff working at High Security perceived current training as less effective compared to those working at Medium Security or Low Security. Qualitative findings underscored the necessity for improved training content, methods, and supportive strategies., Conclusion: Recommendations for enhancing training include: tailoring training to FSMHS settings; equally focussing on both non-physical and physical intervention techniques; providing more scenario-based hands-on practice opportunities; delivering training in a reasonable trainer-trainee ratio; prioritising nurses and High Security staff and integrating other professions into the training framework; and implementing strategies that support staff, consumers, and environment to ensure training effectiveness and applicability., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Demand for places in postgraduate psychiatry training programmes has increased over recent years. All systems have capacity limits, and concerns have been raised regarding the sustainability of the current intake. This paper presents a modelling exercise to exploring the presence and strategies to resolve bottleneck in the Queensland training programme., Methods: Mathematical modelling based on the RANZCP training regulations and the characteristics of the accredited training programme., Results: A training bottleneck was identified which has been impacted by increased training intake, demand for Advanced Training certificates, and location factors., Conclusions: This investigation raises important questions regarding the future management of postgraduate training in psychiatry in Queensland that may be applicable more widely across Australia and New Zealand. In particular, it highlights the large impact that can result from even small incremental increases in trainees across varying levels of the postgraduate programme and the importance of limiting trainee intake in a manner proportional to the availability of mandatory terms.

Objectives: To examine the prevalence of metabolic syndrome and its association with clinical, demographic and lifestyle factors in patients with mental illness participating in residential rehabilitation., Methods: A physical health audit of all consumers ( n = 364) in publicly funded residential rehabilitation programs in Queensland was carried out in late 2016. Data collection focused on clinical, demographic and lifestyle factors associated with physical health., Results: Central obesity was identified in 80% of males and 89% of females and half of the patients (49.4%) met criteria for metabolic syndrome (MetS). The prevalence of MetS in Indigenous patients (66.1%) was 20% higher than the rate found in non-Indigenous patients (46.1%). Smoking, substance abuse, gender, Indigenous background, length of stay and rarely eating fruit and vegetables were individually associated with MetS., Conclusions: The prevalence of MetS in this cohort is almost double that of the general population, while the rate in Indigenous patients is among the highest reported for those with mental illness. Rehabilitation staff are encouraged to engage more fully in the monitoring of physical health status, sharing this information with consumers and primary care providers, and encouraging consumers to play a greater role in managing their physical health.

Objective:: The aim of this study was to assess the outcomes for people following intervention by a police-mental health co-responder team., Method:: Individuals seen by the co-responder team were followed for 2 weeks to monitor subsequent emergency department presentations and inpatient admissions., Results:: Of the 122 people who had direct contact with the co-responder team, 82 (67.2%) remained at their residence, 35 (28.7%) were transported to the emergency department (ED) and 5 (4.1%) were taken into custody by police. The 82 people who remained at home following initial assessment were followed-up for 2 weeks. During this time 10 (12.2%) presented to ED and 3 of these (3.7%) were subsequently admitted to hospital., Conclusions:: Interventions provided through the co-responder team were capable not only of resolving the immediate crisis for the majority of people, but were also likely to divert people away from ED and inpatient treatment in the immediate term.

Objective: To examine the differences in the physical health of Indigenous and non-Indigenous patients with severe mental illness (SMI) undergoing psychiatric rehabilitation., Methods: An audit of the physical health of patients ( n = 361) in all publicly funded residential rehabilitation programs in Queensland was carried out in late 2014. Data collection focused on clinical and lifestyle factors associated with physical health., Results: The prevalence of smoking, substance use and type 2 diabetes in Indigenous patients was significantly higher than rates found in non-Indigenous patients. Metabolic syndrome was also significantly higher in indigenous patients, with 66% of Indigenous patients compared to 46% of non-Indigenous patients meeting criteria for metabolic syndrome., Conclusions: Patients with SMI in residential rehabilitation programs have poor physical health. Our findings underscore the need for clinicians to develop and evaluate interventions aimed at improving the metabolic profile of those with SMI in residential rehabilitation programs. Historical factors and cultural traditions need to be considered when designing lifestyle interventions for Indigenous patients.

Objective: To consider incidents relating to absences without permission from authorised leave from a security hospital., Method: A retrospective audit over a 10-year period of all critical incidents relating to leave from the High Security Inpatient Services, Brisbane, Australia., Results: There has been a low incidence of patients absenting themselves without permission from leave. Of the 12 patients who went absent without permission over the 10-year study period, only one patient was reported to have committed an offence and no patient seriously self-harmed., Conclusions: Attention to patient selection and risk management strategies have been effective in minimising the risk to patients and to the community as a direct result of absences without permission from authorised leave.

Objective: The Mental Health Intervention Project (MHIP) was established in Queensland in 2005 to improve interagency collaboration in the management of mental health crisis situations. The aim of this present study was to assess changes in the use of Emergency Examination Orders (EEOs) by police and ambulance officers since the commencement of the MHIP., Method: Information concerning the use of EEOs was analysed to highlight changes that have occurred since the inception of the MHIP., Results: The use of EEOs by police and ambulance officers increased by 262% since 2002. The proportion of EEOs completed by ambulance officers has increased from 14.5% in 2004 to 38% in 2010. Involuntary assessment was deemed necessary for less than half of the individuals presented by police and ambulance officers., Conclusions: Police continue to generate two-thirds of all EEOs completed. Police and ambulance officers may benefit from additional training in the use of EEOs. Providing alternative accommodation/treatment options for those under the influence of alcohol and other drugs may help to reduce the inappropriate use of EEOs and subsequent demand for Emergency Department services.

Objective: This study was designed to investigate the strategies employed by consumers to manage the common side effects associated with antipsychotic medication use., Method: Focus group discussions and individual interviews involving 238 consumers, 25 carers and 16 mental health staff were employed to identify key side effects and a range of consumer coping strategies for managing these adverse effects., Results: Nine side effects were selected from a total pool of 32 proposed in the group discussions. Strategies that were perceived by the participants to be useful in coping with the selected side effects were then identified., Conclusions: While the strategies proposed for each side effect differed, common themes included the maintenance of a balanced lifestyle, healthy eating and sleeping routines, and fostering a positive outlook on life. Understanding the strategies employed by consumers to deal with the adverse effects of their medications may help clinicians to engage more effectively with consumers in the discussion and management of side effects.