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Up to one third of adults who receive mental health services in Australia are parents. Psychologists in private practice are one of the largest groups within the Australian mental health workforce who support parents experiencing mental ill-health. Parents have specific support needs relating to their parenting role and "treatment as usual" may not address their integrated parenting and mental health concerns. The service experiences of parents in this setting have not been studied. This qualitative study addresses this knowledge gap through investigation of the experiences of Australian mothers who received support from a psychologist in private practice. Semi-structured interviews were conducted with 14 mothers and interviews were analysed using Interpretive Phenomenological Analysis. Three overarching themes were identified in relation to (i) participants' need to feel understood and heard as a parent, (ii) their need for a nonjudgmental therapeutic space and (iii) their desire for practical parental support from psychologists. These findings corroborate the value of family-focused practices when supporting parents with a mental health condition. The results include ways in which family-focused practices have been incorporated by clinicians in private practice settings which may have application in other mental health service contexts. What is already known about this topic: Psychologists in private practice make up a substantial group within the Australian mental health workforce who support parents with a mental health condition. Parents who receive mental health care in tertiary mental health settings report a lack of dedicated parenting support and resources. Family-focused practices are effective in supporting parenting and recovery for parents with a mental health condition who receive mental health care in tertiary mental health settings. What this paper adds: Psychologists who support parents in private practice should collaborate with their clients to identify which aspects of their parenting may be relevant to the therapeutic work and provide targeted support for parenting difficulties. Most participants expected that their psychologist would provide targeted support for parenting difficulties, and they felt disappointed when this did not occur. The lived experiences of parents with mental ill-health in private practice psychology services are highlighted, addressing a key knowledge gap in the literature. [ABSTRACT FROM AUTHOR]

A clear understanding of the nature and extent of suicidal behaviour and other mental health issues in Aboriginal and Torres Strait Islander populations has been limited by the national failure to develop clinically and culturally valid assessments and to ensure the cultural competence of practitioners. The default position for Australian mental health researchers is to continue to adapt existing mainstream assessments. The problem with this approach is it doesn't enable researchers to determine culture-specific symptoms or phenomena that are critical to establishing true cultural validity. The mental health field needs culturally co-designed psychometric tools to capture culture-specific expression and manifestation of symptoms, and to capture culture-specific symptoms. Two such tools exist: the WASC-Y and WASC-A. However, there are few data on their psychometric properties beyond the initial developmental research reported in the test manuals. This needs to be a focus for future research. What is already known about this topic: Aboriginal and Torres Strait Islander people in Australia have suicide rates that are at least twice that of non-Indigenous Australians. Research into Aboriginal and Torres Strait Islander people's mental health is limited by the continued failure to use culturally valid, psychometrically sound, and clinically valid screening tools. For decades researchers have been drawing attention to the need for screening tools and other psychological assessments to be specifically validated for use with Aboriginal and Torres Strait Islander people. What this paper adds: Some attempts have been made to develop culturally valid tools or to validate mainstream instruments for use with Aboriginal and Torres Strait Islander people, but these tools are significantly limited. Attempting to validate mainstream instruments with Aboriginal and Torres Strait Islander people fails to determine unique aetiologies and explain the over-representation of Indigenous people in suicide deaths. The Westerman Aboriginal Symptom Checklists are culturally and clinically valid screening tools that warrant further exploration of their value in addressing the unacceptable gaps in understanding the nature and extent of mental health problems and suicidal behaviour among Aboriginal people. [ABSTRACT FROM AUTHOR]

Young people with severe and complex depression experience substantial social connectedness difficulties. The aim of this qualitative study was to evaluate the role of social connectedness in a novel group therapy (Relate) for youth living with severe and complex depression from clinicians' perspectives. Semi-structured interviews were conducted with 11 clinicians practicing at Orygen's Youth Mood Clinic in Melbourne. Eight of the 11 clinicians were female, with the sample aged 30–42 years (M = 34 years, SD = 3.6 years) and having an average 4.5 years clinical experience at Orygen. Four key themes were identified by codebook thematic analysis. The first theme pertained to clients' difficulties with social engagement, which impacted their attendance of Relate, but were addressed by the intervention. In the second theme, clinicians identified Relate as providing a safe space. In the third theme, clinicians identified opportunities for positive relational experiences. In the fourth theme, clinicians observed social and clinical improvements in Relate clients, but marked recovery did not always occur after attending. Findings provide initial support for the continuation of Relate. Recommendations for future iterations of Relate include refining the intake criteria for referring clients to Relate and potentially lengthening the program's duration. What is already known about this topic: Group interpersonal therapy is an effective intervention for depression and interpersonal functioning in young people. Few studies have evaluated treatments for young people with severe and complex depression and high suicide risk. Few studies have evaluated group programs within early intervention services. What this paper adds: A relationally-focussed group therapy could improve social connectedness and interpersonal functioning for youth living with severe and complex depression. The Relate group emphasises a safe environment for sharing and social risk-taking, providing opportunities for positive relational experiences with similar others which might be particularly useful for youth with complex social difficulties. Identified issues with engagement suggest clients could benefit from an explicit rationale for how their participation in the group benefits their depression treatment. [ABSTRACT FROM AUTHOR]

Objective: Sexual health problems can be pertinent to psychological function/diagnosis and psychologists are key players in treatment and education regarding sexual health. Despite this, little evidence exists to determine if sexual dysfunction is explored during routine client intake interviews, when the client does not present with relationship difficulties, or from a specialist referral for sexual dysfunction. We aimed to explore psychologists' decision-making around questioning of client sexual functioning through the lens of the Dual-Processing Model. Method: This qualitative study assessed 16 registered psychologists working within Australia who answered an online questionnaire around their beliefs and clinical experiences of sexual health practice. Results: Data was analysed using thematic analysis, revealing multiple themes favouring sexual health investigation. Main themes included risk management, relevance to clinical presentations, scope of practice, positive beliefs about asking, and competency beliefs. Primary barriers against sexual health investigation included perceived incompetence, organisational constraints, concerns around damaging rapport, sexual health not being relevant to the client's needs, and perceptions around unethical practice. Conclusions: This paper challenged the applicability of the Dual Processing Model to psychological decision-making, and suggested personal biases influence Australian psychologists' sexual health questioning. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic has had negative mental health impacts. Online psychological interventions can facilitate rapid access to mental health resources. This study examined the outcomes of a 4-lesson, self-help online mindfulness course during the early months of the pandemic in Australia. Methods: 5058 adults commenced the Introduction to Mindfulness course and completed measures of psychological distress (Kessler-10) and wellbeing (Short Warwick-Edinburgh Mental Well-being Scale). 3696 individuals commenced their course between 2016 and 2019 ("pre-COVID" group), while 1362 started their course between 12 March 2020 and 31 July 2020 ("during-COVID" group). Results: Participants in the during-COVID-pandemic group reported slightly lower levels of psychological distress and higher levels of wellbeing compared to the pre-COVID group. In both groups, the mindfulness course was associated with medium effect size reductions in psychological distress (g =.49-.55) and small effect size improvements in wellbeing (g =.27-.41). Conclusions: The mindfulness course was associated with reduced psychological distress before and during the pandemic. Results underscore the generalisability of online mindfulness interventions to pandemic situations. KEY POINTS What is already known about this topic: The mental health impacts associated with the COVID-19 pandemic have been substantial. Mental health service provision has adapted to meet community health needs in the wake of the pandemic. It is unclear if the effectiveness of online mental health interventions will generalise to pandemic conditions. What this paper adds: The outcomes of an online mindfulness course were explored. The course was associated with improved psychological distress and wellbeing both before and during the COVID-19 pandemic in Australia. Results highlight the utility of digital mental health services during COVID-19. [ABSTRACT FROM AUTHOR]

This paper seeks to clarify some of the assertions made by Norton et al. (2022) regarding the accreditation standards of the American Psychological Association (APA) Commission on Accreditation (CoA) and the Canadian Psychological Association (CPA), as well as examines two critical issues raised by the authors. In their editorial, Norton et al. sought to examine accreditation standard similarities and differences between Australia and North America to promote an exploration of effective educational practices. This commentary applauds their effort and after making some clarifying comments about the First Street Accord, Exemplar Institutions, Program Differences and Supervised Experience Requirements and Licensure, this commentary explores competency-based education and assessing competency. The commentary concludes by underscoring Norton et al.'s challenge to the field to develop a clear consensus on what constitutes competent practice and instruments that would allow researchers to measure competence. [ABSTRACT FROM AUTHOR]

New technologies have afforded increased access to genetic testing providing valuable information for individuals and those biologically related. However, the management of such information is challenging for psychologists given the ethical issues that may arise. This paper aims to review the utility of existing ethical standards and current legislation for psychologists when encountering genetic information. Current legislation and guidelines involved in the management of genetic information applicable for psychologists is critically reviewed in light of relevant ethical principles. While knowledge of information that has arisen from genetic testing may guide psychological therapy, intervention, and education, psychologists have a responsibility to uphold their ethical obligations in order to meet the needs of their clients and their families and to prevent harm. Outside the domain of ethically approved human research, and specific guidance for trained genetic counsellors in Australia, ethical guidance on the management of human genetic information is not readily available for psychologists. Technological advances can be expected to continue to present epistemic dilemmas about the use of genetic material. The implications for future psychological practice is discussed. : What is already known about this topic: (1) Increased access to genetic testing can provide valuable information for individuals and those biologically related. (2) Genetic testing poses new and significant challenges for psychologists, especially in respect to the ethical issues that can occur. (3) Given that findings from genetic testing may guide therapy goals, interventions, and psychoeducation, psychologists have a responsibility to uphold ethical obligations in order to meet the needs of their clients and their families and to prevent harm. Yet, clear guidelines for ethical obligations regarding the handling of genetic testing are not readily available. What this topic adds: (1) Within the framework of current legislation, the four core ethical standards of beneficence, autonomy, justice, and non-maleficence work together with the APS Code of Ethics and ethical guidelines for psychologists. (2) While the use of genetic information has the potential to affect whole communities, it should be used in such a way that maintains ethical principles, meeting the needs of the individual and family. (3) It is important that ethical guidelines for genetic information in the field of psychology remain cohesive to meet the needs of rapid technological advances and changing legislation. [ABSTRACT FROM AUTHOR]

Recent changes to clinical psychology training and supervision in Australia have been driven by a deliberate endeavour by regulatory authorities and professional bodies to align education and training with competency-based models of training, a development that is apparent internationally across health disciplines. A critical question is: how do reforms in Clinical Psychology training standards match international benchmarks for competency-based pedagogies? Objective: To outline key principles of competency-based pedagogies and to critically examine whether Australia's new standards and guidelines for accreditation of coursework, practicum requirements, and supervision are consistent with competency principles, and match similar guidelines proposed in the U.K. and the U.S.A. Method: Following a critical analysis of the extant literature, the authors highlight progress achieved, discuss major gaps and challenges, and examine the extent to which current accreditation changes constitute a reliable blueprint for the development of a competent psychology workforce for the country. Results and Conclusions: The current review indicates that in an overall sense, practitioner training in Australia is tracking well in comparison to international developments. Specifically, the decreased emphasis on the regulation of inputs (e.g., nature and type of coursework and practicum) is pedagogically sound and has the potential to promote training innovation and efficiencies. However, a revision of the current competency framework is required to underpin future progress. Also, the lack of reliable and valid competence instruments in combination with less than rigorous adherence to systematic, timely, and ecologically valid assessments constitute a major challenge and a serious threat to ensuring safe and competent psychology practice. What is already known about this topic: (1) Competency-based education and clinical training play important coordinated roles in ensuring the competence of clinical psychologists, consistent with the accreditation standards and registration requirements of the Psychology Board of Australia. (2) The Australian Psychology Accreditation Council (APAC, 2019) have recently published new accreditation standards for psychology programs that are based on competency principles. (3) The shift to the new paradigm is both exciting and challenging. It is exciting because it provides opportunities for innovation; it is challenging because it demands systemic change. What this topic adds: (1) The current paper compares and contrasts current standards and guidelines for accreditation in Australia with their counterparts in the U.K. and the U.S.A. (2) Although significant progress has been made in Australia, additional implementation efforts should be taken to establish a comprehensive and authoritative competency framework, incorporating empirically-supported means of assessment. Such a framework should be fit-for-purpose providing a grid that maps shared and unique aspects of competencies across registration levels and specialised endorsements. (3) The progressive relaxing of input criteria has the potential to seriously compromise the commitment to safe and competent psychological practice if training institutions do not adopt a re-designed system of ecologically valid assessments both during training and at the point of entry to the profession. (4) The need to ensure competence is maintained throughout a psychologist's career will remain a major challenge, given the ongoing and rapid advance of science. A commitment to the competency-based approach provides the necessary scaffolding for ongoing professional development. [ABSTRACT FROM AUTHOR]

Background: Research on registered psychologists' knowledge of and attitudes toward Animal-Assisted Therapy (AAT) is virtually nonexistent. Aim: To explore Australian psychologists' knowledge of and attitudes toward AAT. Materials and Methods: This paper presents a thematic analysis of qualitative data collected from 9 psychologists speaking about AAT during individual interviews. Results: The first research question explored psychologists' knowledge of AAT and identified 3 key themes: AAT use across the client lifespan in various health settings; training is inadequate; and efficacy studies are lacking. The second question exploring psychologists' attitudes towards AAT identified further themes: AAT enhances therapeutic relationships; AAT used purposefully or incidentally is effective; and there are barriers to AAT implementation. Conclusion: Whilst AAT is deemed to be a useful intervention by some psychologists, its evidence base and training in such interventions are lacking. [ABSTRACT FROM AUTHOR]

This paper provides a background to the mental health policy changes introduced by the Council of Australian Governments (COAG) in 2006. It then considers a major Australian Government COAG reform, the revision of the Medicare Benefits Schedule (MBS), by analysing the month-by-month utilisation of the available time-series data for the 17-month period (1 November 2006-31 March 2008) when new items for psychologists, social workers and occupational therapists were introduced. There are a number of unique problems associated with monthly time-series data. Essentially, there is a problem of heterogeneity that arises from the non-uniformity of the temporal unit of a 'month'. Second, there is an issue of the population covered by Medicare altering through time. Both of these problems are addressed in the present analysis of the time-series data. The two groups of psychologists created by the MBS changes dominate the provision of the new services, providing 96.4% of the new services. Psychologists, who are not deemed clinical psychologists in the MBS changes, are the group providing most of the services. Virtually all services are individual, not group, and are provided in a consulting room. The temporal adoption of the new items was continuing to grow by March 2008. Implications of this analysis for psychologists are discussed. [ABSTRACT FROM AUTHOR]

This paper provides an overview of current trends in the mental health problems of Australia's youth and adolescents. It presents information derived from the most recent and comprehensive Australian surveys of youth mental health, and provides international comparisons and views from professional practice where relevant. An update of trends for the most common and significant mental health problems is required to understand the mental health issues most likely to be encountered when working with young people, and as justification of the focus on intervening early for this age group. [ABSTRACT FROM AUTHOR]

This article presents the authors' response to a comment made by O'Kearney and Wilmoth on their article. The authors mention that O'Kearney and Wilmoth's rejoinder contained many positive features and supported the common aim of delivering best practice, improved access and equity, and cost efficiency in psychological therapies. They added that it was particularly encouraging to read their observation that a "preoccupation with within-profession distinctions is counterproductive." Nevertheless, two areas require clarification. The first is the difference between the psychological therapies and the focused psychological strategies described in the Medicare Benefits Schedule (MBS). O'Kearney and Wilmoth maintain that these items are different types of services, with the psychological therapies requiring "more independent clinical decision making" and "more expertise." If this is the case, it is not expressed in the MBS. The other difficulty in the O'Kearney and Wilmoth paper concerns international standards of training. There is clearly an argument for making Australian standards of training compatible with those in other countries, but this is a separate issue to the one highlighted in the Medicare context. The two-tier Medicare system does not differentiate between university-trained and industry-trained psychologists, as singled out by O'Kearney and Wilmoth. Rather, it separates those psychologists eligible for membership of the Clinical College of the Australian Psychological Society (APS) from all other registered psychologists, including those that are members of the other eight specialist colleges of the APS. The authors conclude that it is an exciting time for psychology in Australia and, to ensure that they do not look back on this period as an opportunity lost, it is imperative that they move forward in an atmosphere of collaborative openness and transparency.

The inclusion of evidence-based psychological interventions within Medicare through Better Access addresses an inequity within the Australian health system against people with mental disorders. The question of "Who is qualified to provide these services" is the overriding focus of many commentaries on Better Access within psychology. Carey et al. (2009) argue for examination of the Medicare data to answer this question. We show that Carey et al. (2009) fail to clarify if and how the Medicare data could be used to answer the questions they put and that the reasons for the current eligibility requirements within the Medicare Benefits Schedule are transparent, justifiable and responsible. The preoccupation with within-profession distinctions is counterproductive because it distracts from a proper examination of the impact of Better Access on mental health care in Australia. Research dollars need to be directed to questions that most directly affect the quality of care, such as how can interventions under Better Access be delivered appropriately according to best practice, improve access and equity for everyone and be most cost efficient? Given the current policy agenda in primary care favouring integrated, multidisciplinary models of care, these questions are the critical ones for the future direction of Better Access.

This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline personality disorder. The current study examines how clinical indicators used to screen for this complex disorder differ across service settings, professions, specialised training and years of clinical experience. A purpose-designed survey was administered to 108 mental and emergency medicine health practitioners across an Australian health service and a New Zealand health service to record the level of significance placed on different clinical indicators in the application of the diagnosis of borderline personality disorder. A heavy reliance was placed on observable behavioural symptoms, such as self-mutilation and impulsive behaviours that are self-damaging, in the screening of borderline personality disorder as a psychiatric diagnosis. Statistically significant differences were found between emergency medical staff and mental health clinicians in their use of diagnostic indicators of borderline personality disorder, [chi][superscript 2](4) = 17.248, p = 0.002. Implications of these findings for the screening, assessment and diagnosis of patients with borderline personality disorder are discussed. (Contains 5 tables and 1 figure.)

Since its introduction on 1 November 2006 the Better Access initiative has improved the access and affordability to psychological services. The enthusiastic response by Australians has resulted in the production of a large and growing dataset about the way in which psychological treatments are delivered by different professionals in routine clinical practice. Given the importance of evidence-based decisions in psychological treatment service delivery there is now an opportunity to use the Better Access data to make a significant and sustained contribution to the evidence base. In this paper the features of the Better Access initiative and the Australian context that potentially place Australia as a unique and key contributor to the evidence-base movement on a global scale, are described. Areas are then suggested in which improvements to the evidence base are needed, and some of the ways in which the Better Access data might clarify these issues are outlined (including the evidence to support the $AUD27,650,523.80 of higher Medicare rebate to clinical psychologists) as well as the research opportunities the Better Access initiative has created through the rapid growth in services.

The present paper outlines the development and evaluation of an allocation committee to distribute community placements on an equitable basis between universities. Although based on our experience in South Australia with the University Placement Allocation Committee (UPAC), the primary goal is to outline the steps that would be useful if placement coordinators at other universities in Australia decided to establish and maintain an allocation committee. A survey of field supervisors was also conducted and field supervisors endorsed UPAC as a constructive mechanism for allocating community placements. (Contains 2 tables.)

Much of the psychosocial morbidity experienced by cancer patients goes undetected and therefore untreated. This paper describes infrastructure to routinely screen patients for psychosocial problems and provide targeted intervention in the cancer care setting. Cancer patients will complete a psychosocial screening survey via touchscreen computer at three outpatient visits. A report containing a summary of their responses, score interpretation and recommended management strategies will be printed immediately and placed in their file for follow-up by their health care team. Centres will be able to track changes in their patients psychosocial outcomes over time, and in response to changes in service delivery. Benchmarking reports will be produced annually to feed back performance data to individual centres on their patients' psychosocial outcomes.

Twenty-nine years ago Minnesota Longitudinal Study of Parents and Children (MLSPC) was launched at the Institute of Child Development, University of Minnesota. It was one of the first prospective longitudinal studies of how parent-infant attachment develops, how it changes over time, and how the quality of attachment in infancy influences long-term development. Findings from this study have been published widely in journals, books, and conference papers (a complete list of publications is available from the authors or on the web at www.cyfc.umn.edu). In this article the authors discuss the theory that has guided the research, summarise critical findings from the 29 years and illustrate how this research has been used to inform and shape preventive intervention for parents and infants in high-risk circumstances.