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Introduction Founded at the beginning of the COVID-19 pandemic, Hand-n-Hand Peer Support (HnH) offers free, confidential peer support to healthcare workers (HCWs) across Australia and New Zealand. This survey aimed to evaluate HCWs experiences of peer support and collect demographic data about what groups of HCWs were seeking support. Methods An online survey was conducted in November 2021 of HCWs who were either active or past HnH participants ( n = 158). Questions included 5-point Likert scales, multiple choice and free text responses. Results We received 66 responses (42% response rate). The median age range of respondents was 41–45 years and most were female (87.9%). Most respondents (57.4%) reported experiencing no barriers to accessing peer support. The vast majority (81.4%) of HCWs reported a ‘good’ or ‘very good’ peer support experience. Respondents felt peer support helped in multiple ways, particularly in feeling less alone and having a safe space to discuss issues. Conclusion Australian HCWs accessing peer support tended to be female and more senior clinicians. Most HCWs engaged in HnH reported overall very positive experiences. Our survey helped to identify several areas for improvement in HnH, including clearer marketing about peer support and more targeted triage assessments.

Objective: Classification systems and their practical implications have become increasingly important in child and adolescent psychiatry. This paper presents the evolution and practical applications of a multiaxial classification system for children and adolescents presenting to mental health services. Included are some worked examples demonstrating both the complexity of many presentations and how broadening the use of the multiaxial system can help in identifying appropriate interventions. Conclusions: Classification systems in child and adolescent psychiatry have largely remained uniaxial in nature. A multiaxial system encapsulates the broader biopsychosocial aspects of the presenting child or adolescent, and orders complex data in a concise manner. This approach can be used to concisely communicate with other treating clinicians, and assist with case reviews, formulation and teaching.

Objective: To investigate the rate of attendance at Alcohol Tobacco and Other Drug Services (ATODS) for patients discharged from an acute mental health unit with a primary/secondary diagnosis of substance use disorder (SUD); and describe factors, demographics, diagnoses and service provision that relate to their attendance. Method: All inpatients between 1 November 2016 and 31 October 2017 with a diagnosis of SUD were compared for their attendance at ATODS within 30 days of discharge. Other measures included their admission data (e.g. demographics, diagnosis), and indices of their illness severity. Results: Of 1295 admissions for a total of 900 patients, 32.4% of patients had an SUD diagnosis. Only 10.3% of these patients attended ATODS. There were no significant differences by gender, age, indigenous status, illness severity or dual diagnosis intervention during their inpatient stay on attendance. Relative to the SUD-only group, individuals with any psychiatric comorbidity were three–four times less likely to attend ATODS. Conclusion: Despite the ongoing emphasis on dual diagnosis treatment, the rate of engagement with ATODS remains low. Further review is needed to determine whether enhanced information sharing or case management models may improve attendance rates.

Objective Building upon the tripartite model of anxiety and depression, the current study aims to examine mechanisms of comorbidity between anxiety and depression using the ProQOL (Professional Quality of Life; including the constructs of burnout, secondary traumatic stress, and compassion satisfaction) in a sample of Chinese health-care clinicians. Method A randomized cross-sectional survey was distributed to 1620 participants who were recruited from eight state-owned hospitals in a city in southern China between January and May 2017. A total of 1562 questionnaires were returned (a response rate of 96.4%). After the cases with more than 10% missing variables and multivariate outliers being removed, 1423 valid cases remained. Multiple mediator models were used for mediation analysis that was conducted using the PROCESS v3.1 macro for SPSS. Results The indirect effects of anxiety upon depression through burnout (a1 = . 601 (95% confidence interval (CI): .552, .650), p Conclusions In the current sample, burnout and compassion satisfaction mediated the effect of anxiety upon depression and secondary traumatic stress mediated the effect of depression upon anxiety. The findings of the current study offer support to the tripartite model.

Objective: The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. Method: Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. Results: After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but had less confidence in other key clinicians. Many registrars did not discuss after-hours work during supervision. Conclusions: The after-hours experience of psychiatry registrars at a university hospital is arduous and includes a wide range of clinical tasks. This activity is an essential service provision undertaking as well as a training activity. This must be weighed against the impact of after-hours work on registrar well-being.

The purpose of this study was to identify the risk factors associated with paternal perinatal mental distress in a sample of Australian men. A mixed-methods design was used. The qualitative component ( N = 13) using thematic analysis identified maternal depression, marital distress, masculine gender role stress, unplanned pregnancy, work–family conflict, and sleep disturbance as risk factors for paternal perinatal mental distress. The quantitative component ( N = 525) expanded on the qualitative findings and examined the associations between the identified risk factors and mental distress of fathers in the perinatal period measured by Edinburgh postnatal depression scale. Hierarchical multiple regression analysis revealed six significant predictors of paternal perinatal mental distress with masculine gender role stress being the most significant risk factor for paternal perinatal mental distress. The results from this study provide an insight into how masculine gender role may affect the expression and experience of mental distress in fathers within the perinatal period. Implications of research findings are discussed.

Objectives: We aimed to report substance use across a five-year period in individuals admitted to an acute mental health unit, utilizing data from a routine clinical measure, diagnoses, and findings related to gender, ethnicity and the implementation of a new dual-diagnosis policy. Methods: Data was extracted from the electronic records of 2118 individuals who had consecutive admissions to the acute inpatient unit. Analysis focused on demographic and diagnosis variables and the drug and alcohol question in the Health of the Nations Outcome Scale. Results: Some 57.6% of the sample was in the at-risk drug and alcohol category. Male and indigenous inpatients were most at risk. More than 50% of patients with schizophrenia, anxiety and personality disorders were deemed at-risk. Following implementation of the dual-diagnosis policy, recorded primary and secondary substance use disorder (SUD) diagnoses significantly increased. Conclusions: The study replicated previous findings of a high proportion of patients with co-morbid drug and alcohol use. In this sample it seems likely that the dual-diagnosis policy and related activities increased the rate of SUD diagnoses recorded, although it is likely to still be under-reported.

There is a critical need for evaluation of the pharmacotherapies used in conduct disorder (CD), due to the high incidence of off-label prescribing. The aim of this review was to identify concerns associated with the safety, efficacy and impact on quality of life (QOL) that pharmacotherapy has in children and adolescents with CD. A systematic review was undertaken using pre-defined search criteria and four databases, including reference searches. We assessed these studies using the Strength of Recommendation Taxonomy, Grading of Recommendations Assessment, Development and Evaluation, and Review Manager Risk of Bias (RevMan®) tools. There were 12 randomised controlled trials that met our inclusion criteria. Studies included: antipsychotics, atomoxetine, lithium, clonidine, divalproex sodium and psychostimulants. The antipsychotics demonstrated efficacy, but were associated with adverse effects. Other agents demonstrated mixed responses, highlighting the lack of clinical significance and increased incidence of adverse effects. The management of related adverse effects was addressed to assist with clinical gaps. Overall, there is limited evidence regarding the role of pharmacotherapy in CD. More research is needed that takes into account the heterogeneity of CD and analysis of pharmacotherapy in pure CD.

Objective: This study investigates if the routine use of the urine drug screen offers any diagnostic or management benefit in the assessment and treatment of psychiatry patients in a suburban psychiatry emergency service. Methods: Data was collected retrospectively from consecutive patients 18 years and above, who presented to a large suburban hospital emergency department and had a urine drug screen ordered in the emergency department. A total of 111 patients, (with mean age of participants being 34.9 years, SD 10.2 years, minimum 18 – maximum 62 years, 62.2% (69/111) were male) met the inclusion criteria. Results: The most common drug group identified was benzodiazepines (59.5%; 66/111), followed by cannabis (40.5%; 45/111). Other drugs were identified at much lower levels, including amphetamines (9.0%; 10/111), opiates (4.5%; 5/111) and methadone (0%; 0/111). For most individuals only one drug was detected (55.9%; 62/111), with equal numbers (18.9%) with either zero or two drugs identified by a urine drug screen. Fewer patients had three drugs on a urine drug screen (5.4%; 6/111) or four (0.9%; 1/111). Conclusions: Qualitative urine drug screens provide limited additional information compared to history taking and has minimal impact on clinical management decisions in a psychiatry emergency service.

Objective: The aim of this study was to investigate a new social connectedness factor and Posttraumatic Stress Disorder (PTSD) in children who experienced a cyclone disaster. Method: Three months post-disaster school-based screening for PTSD was conducted. 804 children (mean age=10.22 years, SD=1.24) participated. 12.0% of children reported severe or very severe PTSD symptoms. Results: Low connected children, adjusted for age, gender and independent of cyclone exposure and threat perception, were 3.96 times more likely to experience severe to very severe PTSD. A structural model of child PTSD indicated that connectedness was the most important factor explaining variance in children’s symptomatology. The final model accounted for 60% of the variance of child PTSD scores. Conclusions: We conclude that child connectedness is a new, significant, independent factor in a model of post-disaster child PTSD. Connectedness may represent a vulnerability factor that can be targeted preventatively in children in disaster-prone regions. Conversely, a pre-disaster intervention that helps children develop high connectedness may have the potential to confer resilience.

Objective: To identify services supporting the well-being of infants and their families in an area of South Brisbane, Australia, highlight problems of accessing these services and recommend strategies to make them more readily available. Method: Semistructured interviews were conducted with staff from 18 service providers offering antenatal services, or programmes primarily focused on children under the age of 2 years and/or their families. The interview aimed to identify the precise nature of the services offered, problems encountered in providing those services, perceived gaps in services and potential strategies for improvement. Results: Services were diverse, provided by a range of different professionals, in varying locations (home, community, hospital) and with funding from various sources. The major findings were:(i) the fragmentation of services, lack of communication between them, and lack of continuity in services from one stage of family formation to another; (ii) the shortage of services working with the parents and infant together; and (iii) the difficulty ofproviding services for some at-risk populations. Conclusions: Recommendations included: (i) maintaining a range of different services networked through a centralized resource/referral centre; (ii) expandingjoint mother–infant services and providing training for such services; and (iii) supporting outreach services for difficult to engage populations.

Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Ministry of Health. This CPG covers anorexia nervosa (AN).Method: The CGP team consulted with scientists, clinicians, carers and consumer groups in meetings of over 200 participants and conducted a systematic review of meta-analyses, randomized controlled trials and other studies.Treatment recommendations: It is extremely difficult to draw general conclusions about the efficacy of specific treatment options for AN. There are few controlled clinical trials and their quality is generally poor. These guidelines necessarily rely largely upon expert opinion and uncontrolled trials. A multidimensional approach is recommended. Medical manifestations of the illness need to be addressed and any physical harm halted and reversed. Weight restoration is essential in treatment, but insufficient evidence is available for any single approach. A lenient approach is likely to be more acceptable to patients than a punitive one and less likely to impair self-esteem. Dealing with the psychiatric problems is not simple and much controversy remains. For patients with less severe AN who do not require in-patient treatment, out-patient or day-patient treatment may be suitable, but this decision will depend on availability of such services. Family therapy is a valuable part of treatment, particularly for children and adolescents, but no particular approach emerges as superior to any other. Dietary advice should be included in all treatment programs. Cognitive behaviour therapy or other psychotherapies are likely to be helpful. Antidepressants have a role in patients with depressive symptoms and olanzapine may be useful in attenuating hyperactivity.

Objective: To review the origins, processes, clientele and outcomes of a child and youth interagency forum, a collaborative response to children and youth with severe and complex presentations. Methods: After a description of the Forum origins, membership and processes, both qualitative and quantitative information is provided on the Forum clientele. The Forum's effectiveness is considered in terms of changes in services provided to this group, as well as changes in agency and interagency work practices. Results: Forum clients were predominantly boys aged 12 years, with an overrepresentation of indigenous and intellectually disabled children. Few lived with biological parents, and on average had experienced five schools, 11 or more residential placements and were involved with six agencies. Disruptive behaviour symptoms were common, as were suicidal thoughts or actions (43%), history of physical (50%) or sexual abuse (21%), alcohol (29%) and drug use (14%). On average Forum clients were taking three psychotropic medications. Forum client impairment ranged from major impairment to gross impairment across several domains. Conclusions: While this is not a formal outcome study, evidence suggesting Forum usefulness included qualitative feedback from agencies, altered clinical and interagency practices, and decreased client impairment. Practical interventions for clients with chronic, complex multidomain impairments are discussed in the context of current Australian child and adolescent mental health services.

Objectives: To describe from an academic and practical perspective the process of organisational change associated with the introduction of an innovative child and adolescent mental health service. Method: The project consultation process is described. Process redesign literature is reviewed and the application of the principles to the project process is discussed. Results: The project successfully produced a unified, inter-sector recommendation for a new service which had achieved wide endorsement. Understanding and utilising process redesign principles was confirmed to be advantageous. Further, an evidence based approach was found to be helpful in uniting the sectors and in accelerating change. Obstacles to innovation were identified and specifically addressed by the planning process. Conclusions: Restructuring of services or the introduction of new services in response to policy changes or to changes in available resources is commonplace. Often it is assumed that the benefits expected from proposed changes will automatically flow and little effort is made to employ current knowledge from the literature regarding the successful implementation of organisational change. A rigorous planning process is required for service change, particularly when innovative treatments are being considered.

Objective: To report the burden of care and financial cost of a new Eating Disorders service within a paediatric teaching hospital.Method: A 39-month period before and after the inception of a child and adolescent Eating Disorders service was studied. Medical records were analysed to compare the burden of care, including number of admissions and bed-days, during the comparison period. The financial implications of the new service were also investigated.Results: The number of individuals referred, assessed and offered treatment was significantly greater following the inception of the ED Team. The number of admissions and total bed-days utilised significantly increased. The burden of care was shifted to the medical ward. The overall service cost increased by 108% from baseline. However, the cost per-admission and per-inpatient decreased by 40% and 48% respectively.Conclusions: There are compelling psychological and medical arguments why children and adolescents with Eating Disorders warrant a coordinated team approach. The inception of such a team is likely to create significant financial economies. However, the overall hospital burden of care will significantly rise.

[Extract] Attention Deficit Hyperactivity Disorder (ADHD) is a controversial diagnosis. There are several reasons for this, including potential difficulties in acknowledging that children can develop mental health disorders, professional and lay concern over diagnostic criteria and defining boundaries with normal functioning, and concern relating to prescribing psychoactive medication. Nevertheless, Australian research using a representative community sample has enshrined a one year ADHD prevalence of 11% in 6 to 17 year olds, more than three times the rate of either Depressive or Conduct Disorder [1], and a figure dissonant with prescribing rates [2]. We will consider assessment and management from the perspective that ADHD is now out of step with conceptual thinking in the child and adolescent mental health field.

Jack P Shonkoff, Deborah A Phillips (eds)Washington, DC: National Academy PressISBN 0 30906 988 2 pp.588 $US40.00This text is the report of the Committee on Integrating the Science of Early Childho...