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Objective: Mental health peer support workers draw on lived experience to provide benefit to people experiencing mental distress. People living in rural areas are less likely than their urban counterparts to seek professional help for psychological distress. The aim of this study was to explore the perceived value of rural peer support workers as facilitators to rural mental health help-seeking., Design: Data were gathered through a cross-sectional survey distributed by a social media boosted post., Setting: A total of 349 "small" rural towns in New South Wales as defined by the Modified Monash Model classification system as MMM5., Participants: A total of 765 adult, rural residents completed the survey., Main Outcome Measure(s): Participants were asked to select, from a list of potential facilitators, those which they felt would make mental health help-seeking easier or harder., Results: Study participants felt that a help provider with lived experience of mental illness or distress would make mental health help-seeking easier. Similarly, rural life experience in a help provider was thought to facilitate help-seeking. Participants also believed that flexible and informal meeting settings would make it easier to seek help for mental distress., Conclusions: Engaging rural mental health peer support workers in a flexible/informal setting, as a complement to conventional health service provision, may increase rural help-seeking for mental distress. Increased mental health help-seeking is likely to have a positive impact on instances of serious mental illness., (© 2020 National Rural Health Alliance Inc.)

Objective: The causal effect of successive population-wide lockdowns in response to increased COVID-19 cases on mental health has yet to be examined using robust methods. A natural experiment design underpinned by objective data can improve our understanding surrounding the definitive impact of social distancing restrictions. Methods: The study employed a natural experiment design underpinned by objective data. Health service cost for visits to general practitioners and psychologists and medication dispensing costs served as objective measures of mental health. Difference-in-difference (DID) estimators, which in this study quantify differences in spending changes between groups over time, were produced based on three comparisons: Victoria 2020 lockdown comparison, Victoria 2021 lockdown comparison, and New South Wales (NSW) 2021 lockdown comparison. Specifically, differences in public health service spending during lockdown periods and the same timeframe in 2019 for Victoria and NSW, and control groups (remaining states and territories), were compared. Results: Positive estimator values indicate that public health service spending for Victoria and NSW increased more during lockdown periods compared to control states and territories. The Victorian lockdowns of 2020 and 2021, but not the NSW lockdown of 2021, resulted in increased public spending for general practitioner mental health consults (2020 DID estimator: $8498.96 [95% CI $4012.84, $12,373.57], 2021 DID estimator: $6630.06 [95% CI $41.27, $13,267.20], all monetary values in AUD$) and short visits to psychologists (2020 DID estimator: $628.82 [95% CI $466.25, $796.00], 2021 DID estimator: $230.11 [95% CI $47.52, $373.98]). The first Victorian lockdown in 2020 and the NSW lockdown in 2021 resulted in greater spending on short visits to clinical psychologists. Spending on long visits to psychologists and clinical psychologists and medication spending did not change. Conclusions: Strict lockdowns can have an adverse impact on population mental health. The impact is particularly evident in those who have a history of previous mental health concerns but does not necessitate extra use of medications, suggesting that psychological care can address the adverse impact of the lockdowns. What is known about the topic? Previous research varied in methodology, using self-reports and healthcare data to understand COVID-19 social distancing public health measures' effects on mental health. What does this paper add? This study introduces robust, objective data via a natural experiment design, examining the impact of successive lockdowns on mental health service usage and medication expenditures in specific Australian regions. What are the implications for practitioners? Findings highlight the need for flexible mental health services that can swiftly respond to increased demands during prolonged restrictions, without necessarily increasing medication use, guiding future policy and resource allocation. [ABSTRACT FROM AUTHOR]

Objective: This paper updates clinicians and service leaders on evidence bases relevant to rehabilitation for older Australians with mental illness. Methods: Narrative review of literature and relevant public domain data supported by reflections on NSW service development. Results: There is a paucity of high-quality evidence regarding mental health rehabilitation in older people. Available evidence supports integrating lessons from physical healthcare with adaptations of 'adult' mental health rehabilitation. Adaptation is required to respond to the specific needs, strengths and service use of older people with mental illness. Challenges for older people include ageism, increased physical and cognitive comorbidities, lower access to mental health services and earlier residential aged care entry. Strengths of older people include an ongoing desire for recovery, ongoing developmental change and often closer connections with carers and GPs. Evidence is consistent with evaluation of relevant NSW service models and initiatives including the Pathways to Community Living Initiative. Integration of recovery-oriented practice and wellness models may provide a framework for future innovative inpatient and community-based models. Conclusions: There is sufficient evidence to guide development of models of rehabilitation with older people, but innovation and evaluation are essential if older people are to have equal opportunities in their recovery journeys. [ABSTRACT FROM AUTHOR]

Personal recovery is central to Australian mental health standards, but promoting recovery-oriented practice remains a wicked problem (ie complex, with definitions and appropriate interventions impacted upon by context and values), with limited evidence regarding effective implementation. This case study re-examines a statewide initiative to enhance recovery-oriented practice in older people's mental health services in New South Wales from the perspective of complex adaptive systems. The initiative consisted of three key strategies: (1) statewide collaborative leadership and practice resources; (2) locally determined and led improvement projects; and (3) evaluating, disseminating and sustaining initiative outcomes. Published outcomes of the initiative, related policy and benchmarking materials and author reflections are used to propose lessons for other services and policy makers. From a systems perspective, a relatively small investment from a state policy unit to enhance a facilitating environment resulted in the emergence of local leaders and voluntary participation of services within 80% of local health districts without funding incentives. Local leaders and activities informed statewide policies and models of care to sustain practice change. Limitations included variability in project scopes and the involvement of people with lived experience, as well as the level of refinement in change management approach. Self-audit and consumer-rated experience suggest resilience of practice and culture change. The outcomes are consistent with conceptualisations of mental health services being complex adaptive systems requiring distributive leadership. Established mechanisms encouraging statewide cooperation between clinicians, service managers and policy makers may have been significant facilitators of engagement in practice change. What is known about this topic? Recovery remains an important concept for older people with mental ill health, with implementation of recovery-oriented practice a wicked problem. What does this paper add? Central policy investment in a collaborative facilitatory environment can stimulate the emergence of local leadership and investment in actions to enhance recovery orientation. As predicted by complex adaptive systems theory, the impact of the leaders developed may be broader than the sum of individual project outcomes. What are the implications for practitioners? A start where you can message can engage and enable leaders in feasible and locally relevant changes consistent with a statewide strategy. This may be a feasible approach to improving recovery orientation in mental health care services for and beyond older people, with potential implications for addressing other wicked problems in health care.

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [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]

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience-based co-design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma-informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma-informed they required services to: be aware of staff well-being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings., (© 2020 Australian College of Mental Health Nurses Inc.)

Accessible summary Hoarding and squalor are more common among people with chronic mental disorders and can compromise a person's health and safety, be a public health issue and present substantial challenges to family, carers, social service agencies and clinical mental health services., This paper provides a case study outlining the complex challenges experienced by a person exhibiting hoarding and squalor behaviours, and explores the role of a mental health nurse in supporting the person towards recovery., The journey towards mental health recovery for a person with hoarding and squalor behaviours is multidynamic and requires more than clinical expertise or discreet psychotherapeutic modalities., Abstract People with hoarding behaviours acquire a large number of possessions that are often of limited or no monetary value and which they are unable or unwilling to discard. Such behaviours can substantially impair a person's ability to attend to their normal daily activities, cause substantial distress and lead to squalid living conditions. Living in squalor can compromise a person's health and safety, be a public health issue and present substantial challenges to family, carers, social service agencies and clinical mental health services. Hoarding and squalor behaviours are more common among people with co-morbid organic and mental illness, such as developmental delay, schizophrenia, alcohol dependence and/or obsessive-compulsive disorder. This paper provides a narrative that explores the role of one Australian mental health nurse practitioner in the recovery of a person with hoarding behaviours. [ABSTRACT FROM AUTHOR]

This paper examines mental health policies in relation to African communities residing in New South Wales, Australia and the attitudes of African communities toward mental disorders and mental health services. Current mental health policy frameworks have shown an inadequate inclusion of African communities. This may negatively affect the design of mental health interventions and how African communities engage with mental health services. The available mental health literature on African communities showed disjointed and uncoordinated data which focuses on specific community-groups within African communities. Insufficient mental health or suicide data, combined with African community members' perception toward mental disorders and mental health services, makes it very difficult to progress engagement and interventions. There is a need for proper and sizable data on mental health related to people of African descent in NSW and Australia wide, if positive outcomes are to be realised. [ABSTRACT FROM AUTHOR]

Purpose – This article aims to describe the process by which the new NSW Government executed its election promise to establish a Mental Health Commission for NSW. Design/methodology/approach – This case study draws on observations of the author who was expert facilitator to the Taskforce to establish the new NSW Commission. The paper synthesises the work of the Taskforce, the input of a consultation process that engaged more than 2,000 people, through six state-wide community fora, online survey and other means. In describing the nature of the new NSW Commission, the paper will also reflect on key learnings from the Taskforce's interactions with other mental health commissions, including in New Zealand, Western Australia and Canada. Findings – Widespread concern about the lack of access to quality mental health care was reflected in broad support for a new Mental Health Commission. Opinions varied about how such a new body could be effective. Strong bipartisan political support is key. Also critical is ensuring the new body has sufficient legislative power and reach. Research limitations/implications – This paper relies on the observations of a key participant in a reform process. This brings the limitations of potential bias as well as the strength of understanding that is difficult for outsiders to access. The actual impact of the new NSW Mental Health Commission will only become apparent following its 1 July 2012 start-up. Practical implications – Many jurisdictions are turning to specialised governance models, such as a Commission, to drive mental health reform. This paper identifies some of the key issues to consider in pursuing this strategy. Social implications – Commissions need to have strong engagement with consumers, carers, service providers and the general community. This paper highlights some key issues in building these links. Originality/value – The work of the Taskforce to Establish a NSW raised a range of issues relevant to any mental health reform process. Given the level of community concern about mental health care, these are important lessons. [ABSTRACT FROM AUTHOR]

Despite making a substantial contribution to the development of mental health services in colonial Australia, until now the story of Dr Patrick Hill's (1794-1852) life has been overlooked by historians. This paper reviews primary sources including clinical notes, patient lists, letters, government documents and newspaper articles which reveal that Dr Hill was a dedicated physician who played a vital role in the development of Australian mental healthcare. He was held in such esteem that by the time of his sudden death in 1852 he had been elevated to the most senior medical office in New South Wales. Dr Hill's career serves to exemplify how the local practice of individual colonial doctors helped build the reputation of medicine in the modern era.

This paper describes caregiver-reported patterns of mental health service use for 347 pre-adolescent children in foster and kinship care in New South Wales (NSW), Australia. Children’s mean time in care and mean time with their present caregivers were 4.3 and 3.3 years respectively. Forty-four percent of children received individual therapy or counselling, 45% received interventions in the form of clinical guidance for their caregivers, and 31% received both forms of service. Among children scoring in the clinical range on any CBCL sub-scale (N = 191), equivalent rates of mental health service use were 60%, 55% and 41% respectively. Although not directly comparable, these findings describe a higher rate of service use than that reported for children in care elsewhere. While children with more complex and severe difficulties had higher rates of service use, there was no evidence of variable access for treatment of different types of disorder. Predictors of service use are reported and contrasted with previous findings. The paper considers several features of the NSW child welfare, health and education systems that may account for the relatively high rate of service use. [ABSTRACT FROM PUBLISHER]

A university and three area mental health services collaborated in developing a mentorship programme for new graduate nurses in mental health. The programme evolved from initiatives identified by the New South Wales Government to address recruitment and retention problems impacting on the mental health nursing workforce. This mentorship programme was identified as a strategy to potentially contribute to retention of novice nurses within the local mental health nursing workforce. New graduate nurses entering the mental health field were provided the opportunity to engage in a temporary supportive professional mentoring relationship. The present paper describes the background of the programme and provides an overview of how it was developed. It serves as a starting point for others contemplating developing similar programmes. Evaluation of the programme is incomplete, therefore, formal results will be presented in a subsequent paper. [ABSTRACT FROM AUTHOR]

Aim: Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service., Methods: This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making., Results: Eight peer workers were employed to deliver an online shared decision-making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co-design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions., Conclusions: Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health., (© 2017 John Wiley & Sons Australia, Ltd.)

Purpose: To explore the experiences of mental health workers and perceptions of their role and the scope of their work., Design and Methods: Qualitative design. Twenty interviews were conducted with mental health workers. Interviews were analyzed using thematic analysis., Findings: Three overarching themes were identified. In this paper the overarching theme of "dimensions of my role" is discussed. Subthemes were (a) information and education, (b) person-centered care, and (c) networking and partnerships., Practice Implications: Professional development, networking, and partnerships underpin the provision of coordinated services and ultimately person-centered care. Enhancing staff capacity building may also enable sustainability of appropriate quality services., (© 2016 Wiley Periodicals, Inc.)

Infant well-being is intrinsically linked to maternal physical and emotional well-being. Internationally health services have implemented policies to identify women at risk of mental health problems and developed effective care pathways. The aim of this paper is to describe how perinatal and infant mental health clinicians perceive their role and the attachment-based interventions they use in their work. The study comes from a larger mixed methods study, which examined two specialist perinatal and infant mental health services in New South Wales (Australia). Two hundred and forty-four medical records were reviewed, and six perinatal and infant mental health clinicians participated in in-depth semi-structured interviews. Data were analysed by content and thematic analysis. One overarching theme, modelling a secure base and three supporting themes, enhancing reflective capacity, enhancing emotional regulation and enhancing empathy emerged from the analysis. These findings demonstrate how perinatal and infant mental health clinicians use attachment theory to inform practice by modelling "holding" and being a secure-base for women. They also provide a clearer understanding of perinatal mental health practice and can be used to inform educational programs for multidisciplinary mental health professionals particularly those working with women and infants. [ABSTRACT FROM AUTHOR]

This study aimed to explore, from peer workers' perspectives, the supports and strategies they use to optimise their wellbeing and effectiveness in their roles. A qualitative descriptive study was conducted using semi-structured interviews with nine peer workers from a community managed organisation in New South Wales, Australia in 2022. Data were analysed using qualitative content analysis. Peer workers described four types of personal strategies: looking after myself; increasing my peer-related skills; recognising and using my skills; and advocating for and promoting peer work. They described five types of organisational support that helped them to use these strategies and influenced their wellbeing and performance: professional development opportunities; a mental health friendly environment; place of peer work in the organisation; team dynamics and support; and logistical support. This research can help stakeholders recognise the strategies and supports that are beneficial to peer workers and facilitate understanding and support between mental health staff. While a small, contextualised study, it could provide strategies for peer workers new to the industry and for organisations seeking to ensure the sustainability of their peer workforce and the quality of services supplied to consumers. [ABSTRACT FROM AUTHOR]

In Australia and around the world, people with disability and their carers living in rural areas face additional challenges compared to their urban-dwelling counterparts. This cross-sectional study explored current access to therapy services for people with disability living in western New South Wales as reported by their primary carers. Data were collected using an online and paper survey distributed to carers, from December 2012 until June 2013. Information was sought about the carers, the person they care for, access to physiotherapy, speech pathology, occupational therapy and psychology services. A total of 166 carers participated. Respondents were mostly the carers of a son or daughter (83.6%) , the person they care for had an average age of 17.6 years (range 1-69 years) and more than half were males (56%). The majority of people with disability (73.5%) had received therapy services in the last 2 years. Waiting time and distance travelled to access physiotherapy, speech and occupational therapy services varied. People with disability had to wait an average of 6.6 months to receive speech pathology and had to travel an average of 2.6 hours to receive physiotherapy. The main provider of all services was the specialist disability government department, except for psychology, which is mainly provided in the private sector. From the carers' perspective, availability and accessibility to services are limited. Carers noted that availability of services was more restricted once people with disability reached adulthood. Lack of choice and frustration with the lack of availability of specialist disability services was reported frequently. Carers believed that timely allied health intervention prevented the development of more severe or complicated conditions that had a greater impact on carers, families, communities and the person with disabilities. [ABSTRACT FROM AUTHOR]

This paper summarises the major findings from the Quake Impact Study (QIS), a four-phase longitudinal project that was conducted in the aftermath of the 1989 Newcastle (Australia) earthquake. A total of 3,484 subjects participated in at least one component of the QIS, comprising a stratified sample of 3,007 drawn from community electoral rolls and 477 from specially targeted supplementary samples (the injured, the displaced, the owners of damaged businesses, and the helpers). Subjects' initial earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured at each phase using the General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES). Selected findings and key conclusions are presented for each of six areas of investigation: service utilisation during the first 6 months post-disaster; patterns of earthquake experience and short-term (6-month) psychosocial outcome; earthquake exposure and medium term (2-year) psychosocial outcome; vulnerability factors and medium-term psychosocial outcome; specific community groups at increased risk (e.g., the elderly and immigrants from non-English-speaking backgrounds); the effects of stress debriefing for helpers. Threshold morbidity (i.e., likely caseness) rates are also presented for a broad range of subgroups. In addition to presenting an overview of the QIS, this paper synthesises the major findings and discusses their implications for future disaster management and research from a mental health perspective. [ABSTRACT FROM AUTHOR]

Objectives: To provide a brief biography of Dr Richard Greenup and to explore the legacy he has left to one of Australia's longest operating psychiatric services. Methods: This history was obtained by consulting staff working within Cumberland Hospital, New South Wales and by examining primary and secondary sources. Results: Greenup was the second surgeon superintendent of 'The Parramatta Lunatic Asylum' from 1852 until 1866 when he was fatally stabbed with a pair of scissors by a patient. Greenup was involved in establishing The University of Sydney and advocated for expanded and improved services for people diagnosed with mental disorders. Conclusions: Greenup recognised the needs of the mentally ill and sought to address similar social and demographic determinants of health to those that we face today. The challenges he faced, and his tragic end remind us of the importance of delivering patient-centred care whilst being mindful of associated risks. [ABSTRACT FROM AUTHOR]

Objective: Short term psychodynamic psychotherapies have been markedly phased out of Australia's mental health services. This paper aims to describe the successful introduction of a Conversational Model of Short Term Intensive Psychodynamic Psychotherapy into a public health service in an attempt to revive its practice., Method: A brief review of relevant papers in the Royal Australian & New Zealand College of Psychiatrists journals since 1980 gives a background to the decline of dynamic psychotherapy in Australia. The development of a Conversational Model of Short Term Intensive Psychodynamic Psychotherapy in the author's private practice over 20 years, and its introduction into a hospital-based training programme are described., Results: A structured programme by scholarship has been offered yearly since 2011 to 10 multidisciplinary mental health clinicians of the Western Sydney Health District. Trainees see two patients from their own service. Over three years, 29 trainees have treated 57 patients with weekly supervision provided., Conclusions: The model has been easily learned. Trainees report a sense of re-invigoration, refinement of existing skills and acquisition of new skills. Resolution of problems in a significant number of patients is noted and improvement and satisfaction reported by others. A valuable service is provided and research is underway., (© The Royal Australian and New Zealand College of Psychiatrists 2014.)

Aims: Historically, the Australian health system has failed to meet the needs of young people with mental health problems and mental illness. In 2006, New South Wales (NSW) Health allocated considerable funds to the reform agenda of mental health services in NSW to address this inadequacy. Children and Young People's Mental Health (CYPMH), a service that provides mental health care for young people aged 12-24 years, with moderate to severe mental health problems, was chosen to establish a prototype Youth Mental Health (YMH) Service Model for NSW. This paper describes nine key principles developed by CYPMH to guide the development of YMH Service Models in NSW., Methods: A literature review, numerous stakeholder consultations and consideration of clinical best practice were utilized to inform the development of the key principles., Results: Subsequent to their development, the nine key principles were formally endorsed by the Mental Health Program Council to ensure consistency and monitor the progress of YMH services across NSW. As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service., Conclusions: The nine key principles provide mental health services a framework for how to reorient services to accommodate YMH and provide a high-quality model of care. [Corrections added on 29 November 2013, after first online publication: The last two sentences of the Results section have been replaced with "As a result, between 2008 and 2012 YMH Services across NSW regularly reported on their activities against each of the nine key principles demonstrating how each principle was addressed within their service."]., (© 2013 Wiley Publishing Asia Pty Ltd.)

Background: People with a mental health condition are more likely to engage in risk behaviours compared to people without. Delivery of preventive care to improve such behaviours is recommended for community mental health services, but inadequately implemented. This study assessed the effectiveness of an implementation support package on clinicians' delivery of preventive care (assessment, advice, referral) for four risk behaviours (tobacco smoking, harmful alcohol consumption, physical inactivity, inadequate fruit and vegetable intake) compared to no implementation support. The participatory approach to developing the support package, and fidelity of the implementation strategies, are also described. Methods: A non-randomised controlled trial was undertaken in 2019–2020 with two community mental health services (control and target) in one health district in New South Wales, Australia. A 4-month support package consisting of multiple implementation strategies was delivered to one site following a two-phase participatory design process. Five implementation strategies were proposed to service managers by researchers. After consultation with managers and clinicians, the final implementation support package included four strategies: training and education materials, enabling resources and prompts, client activation material, and audit and feedback. Client-reported receipt of the three elements of preventive care for the four risk behaviours was collected from a cross-sectional sample of clients who had recently attended the service at baseline (6 months) and follow-up (5 months). Logistic regression models examined change in receipt of preventive care to assess effectiveness. Results: A total of 860 client surveys were completed (control baseline n = 168; target baseline n = 261; control follow-up n = 164; and target follow-up n = 267). Analyses revealed no significant differential changes in preventive care receipt between the target and control sites from baseline to follow-up, including across the four primary outcomes: assessed for all behaviours (OR = 1.19; 95% CI 0.55, 2.57; p = 0.65); advised for all relevant risk behaviours (OR = 1.18; 95% CI 0.39, 3.61; p = 0.77); referred for any relevant risk behaviour (OR = 0.80; 95% CI 0.40, 1.63; p = 0.55); and complete care (OR = 3.11; 95% CI 0.62, 15.63; p = 0.17). Fidelity of the implementation strategies was limited as one of the four strategies (audit and feedback) was not delivered, components of two strategies (enabling resources and prompts, and client activation material) were not delivered as intended, and one strategy (education and training) was delivered as intended although some components were offered late in the implementation period. Conclusions: The implementation support package was ineffective at increasing preventive care delivery. Further investigation is required to determine optimal participatory design methods to develop effective implementation strategies, including those that support delivery of care in community mental health settings within the ongoing context of uncertain environmental challenges. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12619001379101. [ABSTRACT FROM AUTHOR]

There has been much recent literature on the technical parameters of electroconvulsive therapy (ECT) with regard to improving efficacy and minimizing adverse effects, but relatively little on ECT service delivery. This paper will discuss the development and characteristics of an ECT service at a teaching hospital in metropolitan Sydney, New South Wales, Australia. A mixture of qualitative and quantitative methods, including a selective literature review and audit of ECT use were used. The results of the audit were compared with the 2007 revision of the Royal Australian and New Zealand College of Psychiatrists' clinical memorandum on ECT. We discuss issues, such as the optimal site for ECT delivery, ECT mental health nurse coordinator role, credentialing of psychiatrists, registrar supervision, and the development of an ECT committee. A significant finding of the audit was that the majority of patients were treated under the New South Wales Mental Health Act, and voluntary patients were more likely to have a diagnosis of a depressive disorder, whereas involuntary patients were more likely to have a non-mood disorder diagnosis. This study has shown that auditing of ECT practices and services by mental health nurses is essential for quality improvement processes. The audit highlighted areas of service delivery that should be subject to review and evaluation against professional standards., (© 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.)

There is limited published evidence about how psychosocial services should be organised or routinely integrated into cancer services to ensure that cancer patients receive appropriate psychological, social and emotional support during periods of diagnosis, treatment and follow-up. This paper reports on a survey of 26 oncology services in New South Wales, Australia, to examine the current provision of psychosocial oncology services. The aim of the study was to gather baseline data and information about the provision of services and to identify significant challenges associated with the development and implementation of psychosocial oncology services. A total of 42% of staff at psycho-oncology services reported they could provide adequate psycho-oncology services, but 58% of sites said they could provide either only limited (27%) or very limited (31%) services. We found that services frequently identified challenges such as insufficient funding to employ skilled staff to provide psychosocial interventions, inadequate data to demonstrate the effectiveness of psychosocial interventions and, at times, lack of space to allow privacy for patient consultations. Future needs identified were strategic planning of psychosocial oncology services as part of broader cancer service plans, leadership of psychosocial oncology services, cohesive teams using agreed patient pathways or tools and integration into multi-disciplinary cancer teams.

The Mental Health Intervention Team (MHIT) programme was developed by New South Wales Police Force (NSWPF) to improve police capacity to respond efficiently and safely to incidents involving persons with a mental illness (PWMI). The programme was initiated in 2008 in three Local Area Commands, wherein 111 officers received enhanced training. It has since been funded for roll-out across the Force. In this paper, we evaluate the success of the MHIT against its key aims: to reduce injury to police and people with a mental illness during their interactions, to enhance awareness amongst police of issues relating to mental illness and how best to mitigate these, to improve interagency collaboration in responding to PWMI and to reduce the amount ofunnecessarytime police spend on mental health events. We conclude that the MHIT led to increased confidence among police in dealing with mental health-related events, reduced police involvement in transportation of PWMI and improved handover between police and mental health care services. Despite such positive findings, difficulties with interagency cooperation remained, which – we argue – reflects differences in organisational and accountability structures, and concern among NSWPF's partners about the flow-on implications for their own resources. One remedy, we conclude, may lie in a fundamental reconfiguration of public sector responses to PWMI. [ABSTRACT FROM AUTHOR]

Objective: The aims of this paper are to provide a description of a newly available service the Mental Health Screening Unit (MHSU), within the NSW prison system and to present the first 12 months in terms of the patients, its adaptations and its limitations., Methods: The first section of this paper provides a thorough description of the MHSU. The second looks at data collected for the period 1 July 2006 to 30 June 2007. A variety of databases were utilized as sources., Results: There were a total of 604 admissions. The most common primary diagnoses were schizophrenia-related disorders. There were relatively few adverse incidents, and 18% of the acute unit population were transferred to the Long Bay Prison Hospital., Conclusion: The MHSU had a considerable throughput of patients and managed a range of severe mental illnesses. The initial objectives of the MHSU have broadly been achieved. There are several future areas of research discussed.

Increasingly, consumers and carers are involving themselves in many aspects and levels of mental health services. However, one area in which active involvement has been less prominent is research. This paper describes an educational initiative that sought to increase consumers' and carers' understanding of the way research is conducted and its role in evidence-based practice. Information regarding participants' attitudes towards research, knowledge about research practice and participation was also examined. The findings provide evidence that workshop attendance increases knowledge and encourages participation in future research projects, particularly when participants have confidence in the researcher.

Objective: In order to implement and sustain family intervention programmes in clinical settings, there is a need for an organizational change within routine clinical practice. The objective of this paper is to outline the idea behind the development of a programme for working with families of patients within an adult mental health service., Methods: Capacity building, project management and action research frameworks were the three theoretical frameworks used to inform the implementation of the programme within the mental health service. Extensive literature in the area of working with families informed the programme's content. Sutherland Mental Health Service in New South Wales is used as a model to show that organizational changes are needed to implement a 'family friendly' service., Results: The programme included two main components: (i) a service development component, (ii) a family engagement and support component. Description of the programme plan has been based on key objectives, strategies and activities for implementation at the service delivery level. Individual activities within the programme have achieved their goals. The rate of family contact within the service has doubled., Conclusions: Issues regarding the effectiveness of such a programme, its limitations, as well as the nature of examining and evaluating such work were discussed. Becoming more 'family friendly' is a realistic goal for adult mental health services.

Collaborative research activities are increasingly being used across health-care settings and are viewed as a positive way to achieve mutual outcomes. However, interagency or intersectoral research programmes are not without problems. They are, at best, challenging and complex activities that require enormous commitment of resources, expertise and insight from all stakeholders. This paper uses the example of an actual collaborative research project to illustrate factors that can impair collaboration and in turn negatively impact on intersectoral research outcomes. It is anticipated that an honest description of those events and issues that adversely affected the programme presented here, and examination of the associated literature, will serve as a guide to others embarking on similar collaborative endeavours. This paper does not attempt to provide a full review of the comprehensive range of literature about collaboration and collaborative research; rather, it presents some key themes identified as having the potential to impact on the success of collaborative research projects. Key themes acknowledged by the authors as influencing the progress of the research project highlighted here are communication, environment, politics and power, and organizational culture.

This paper explores the dilemmas encountered by mental health nurses when working with mental health legislation. The concerns and considerations of an expert mental health nurse, complemented by the opinion of an expert in health-care and legal issues are presented. It is argued that there is currently a distorted perception with regard to the function and sentiment of mental health legislation, and this paper aims to restore balance in interpreting and working with such law. Viewing mental health legislation primarily as a mechanism for involuntary hospitalization effectively removes any power or recourse given to mental health consumers by the law. Principles of mental health care and legislation are examined as well as the relationship the law has with dangerousness to self or others and mental ill health. A dialogue is established between the two authors to assist the exploration of these legal and clinical issues. The continued relevance of specific mental health legislation is brought into question. It is proposed that the existence of such legislation constitutes discrimination and contributes to stigma associated with mental illness. An alternative legislation for all circumstances where an individual is deemed incompetent is proposed as the most significant step towards mainstreaming of mental health care and an end to discrimination.

Introduction: The Access to Allied Psychological Services program was introduced as part of the Better Outcomes in Mental Health Care initiative in 2001-2002. Divisions of General Practice are funded to establish programs that allow GPs to refer patients for psychological treatments. The University of New South Wales evaluated programs run by the Southern Highlands and Illawarra Divisions of General Practice. This paper presents the findings of these evaluations., Method: Both evaluations analysed process and patient outcomes. This was obtained from a combination of program data and qualitative satisfaction data., Results: The two program models differed in the mechanism of retention of the psychologists and the method of referral of patients. Anxiety and depression were the main reasons for referral, and clinical data showed there was improvement in patient outcomes. Patients, GPs and psychologists expressed satisfaction with the programs., Discussion: The Access to Allied Psychological Services programs in both Divisions have proven popular. Flexibility in the program structure allows Divisions to develop a model which suits their local circumstances. There is support for ongoing Commonwealth funding and the challenge is to find the most effective and financially sustainable model of delivery for psychological services in primary care.

Objective: Drought is a serious and recurring problem for rural and remote Australia. This paper reports the proceedings of a consultative conference concerning the mental health effects of drought held at the Centre for Rural and Remote Mental Health, Orange, in December 2003. The conference objective was to record the collective experience of government and non-government agencies dealing with the effects of drought in rural areas and to collate information for the development of a mental health strategy for future drought., Design: Participants were recruited in consultation with rural mental health organisations. Questions about mental health service strategies to minimise and respond to the mental health impact of the drought were posed to participants. Qualitative data were collected using a Nominal Group Technique., Setting: The Centre for Rural and Remote Mental Health, Bloomfield Hospital, Orange, New South Wales., Participants: Twenty-three professionals participated, including representatives from New South Wales Health, Mental Health, and Agriculture; the Department of Community Services, and Rural Financial Counsellors., Main Outcome Measure: Qualitative analysis of participant responses., Results: Three general strategies emerged as the most beneficial in minimising adverse mental health outcomes in times of drought: community-building and education about the physical, financial and mental health effects of drought; co-operation between and co-ordination of agencies in delivering mental health and other drought support; and continuity and planning of improved mental health services., Conclusions: Drought has a serious effect on the mental health of communities. It is important to plan a response beyond the end of the drought, bringing together different government and non-government agencies to build community capacity to address common mental health needs.

Abstract: Objective: Children aged 0 to 5years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes. Method: The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered. Conclusions: Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children. [Copyright &y& Elsevier]

The relationship between mental health services and police and people who have mental health problems, are suicidal or are drug- and/or alcohol-affected is examined in this paper. A survey of 131 police officers in Sydney, Australia, revealed that more than 10% of police time is spent dealing with people with mental health problems. Nevertheless, police felt unsupported in this role, unprepared for it and torn between the competing demands experienced in their work. A lack of confidence in dealing with suicidal people and a belief that work with mentally disturbed people does not constitute valid police work are also reported. Managing people with mental disturbance is a major concern for police. Specifically, there are difficulties relating to: inadequate training and education; deficiencies in services/resources; time and resource over-utilization; communication, liaison and feedback problems, and frustration related to accessing mental health facilities/services. It is argued that police work involving mentally disturbed people is a valid and necessary role that complements law enforcement. In order to facilitate this aspect of police work, recommendations are made regarding education and collaborative working relationships between police and mental health professionals, which, in turn, could improve the care of mentally disturbed people in the community.

It is increasingly common for mental health nurses to develop and implement quality improvement and/or research projects. The requirement that these activities be conducted in accordance with local, state and national policy; organizational accreditation frameworks; and within ethical frameworks is daunting. This paper aims to define relevant terms, relate some of the competing demands to each other and outline a pathway for developing nurse-based quality-related projects. When a specific exemplar is required, protocols from Central Sydney Area Mental Health Service will be drawn upon as it is likely that policy developed in this health area will not be significantly different to that of other health areas in New South Wales and other Australian States.

Objective: Concern over the high rate of suicide among Aboriginal people on the south coast of NSW led to the development of a project aimed at preventing youth suicide in the Aboriginal communities of the Shoalhaven. This paper describes the development, implementation and evaluation of the project., Method: Following extensive consultation with the Aboriginal community, a range of culturally appropriate interventions were developed. The main focus was a series of community gatekeeper training workshops, which aimed to increase the potential of members of the Aboriginal community to identify and support people at risk of suicide and to facilitate their access to helping services., Results: Evaluation of the workshops demonstrated an increase in participants' knowledge about suicide, greater confidence in identification of people who are suicidal, and high levels of intentions to provide help. Attitudes, subjective norms and barriers predicted intentions to help., Conclusions: The project indicated community members could be successfully trained in the recognition of individuals at risk of suicidal behaviour. Gatekeepers' attitudes and perceived barriers to helping predicted intentions to help those in need. There is a need for longer-term follow-up to assess the extent to which new knowledge and skills are used in practice., Implications: Suicide awareness and skills training have been demonstrated to be an effective early intervention strategy. Gatekeeper training empowers Aboriginal communities and is generally accepted. There is demand for such programs outside the Shoalhaven. The project has a methodological framework that can be easily adapted by other communities.

This paper draws on a multi-year Australian collaborative study of mental health review tribunals (‘MHTs’) in three jurisdictions (Victoria, New South Wales and the Australian Capital Territory) undertaken in conjunction with the NSW Law and Justice Foundation, using qualitative and quantitative methods to examine the role of MHTs in advancing goals such as fairness, legality and access to treatment. Study findings regarding stakeholder and client concerns – about access to quality treatment and associated support services, review of treatment adequacy and drug regimes, and their ‘participation’ or dignity of engagement in review processes – are presented as variants of the need for adequate hearing ‘space’: temporal, jurisdictional, cognate/relational, physical and symbolic, and ‘connective’. Building on earlier arguments for MHTs to engage not only legal, but also clinical and social domains, and for adopting some processes more characteristic of case-conferencing, this paper examines the implications of tribunal ‘flexibility’ and a wider overall ‘governance’ jurisdiction in mental health. [Copyright &y& Elsevier]

Objective Most mental health outcome and satisfaction measures have been developed by academic researchers or service providers. Consumers have been limited to the role of participant or advisor. The validity and reliability of these satisfaction measures have been challenged. This paper reports the development of a consumer satisfaction questionnaire in which consumers work as collaborative researchers to increase its face validity and relevance. Method Eleven themes from a previous participatory study were used by consumer researchers and university-based researchers to generate questionnaire items, with four items reflecting each theme. The internal consistency and factor structure were examined in public and non-government mental health service centres based on data of 202 mental health consumers. Results Principal Components Analysis with oblique rotation yielded a two-factor structure: Empowerment and Dehumanization. The two factors together explained 36.7% of the total variance. The scale demonstrated high internal consistency, with Cronbach's alpha for the total scale at 0.92, and for the two factors at 0.92 and 0.80. Conclusions The questionnaire was developed in accordance with an evaluation framework of consumer directed evaluation of mental health services. The final questionnaire consists of 26 items. It has satisfactory internal consistency and appeared to be useful with inpatients and outpatients. Further research will be performed to establish its test-retest reliability and criterion validity. [ABSTRACT FROM AUTHOR]

Students who transition from high school to college are often excited by the new phase of their lives. However, they are exposed to circumstances and expectations which place them at risk for psychiatric disorders or that may exacerbate pre-existing problems. In this paper, we discuss risk factors and other issues associated with students transitioning to college or university life, identify challenges for health professionals, and suggest possible strategies to improve the mental health of young adults on college campuses. Academic staff and health care providers need to be aware of how best to engage and assist students during an important phase of their life. Processes and care pathways also need to be easily understood, user friendly, and appropriately resourced. It is anticipated that staff, students, and industry health care providers will benefit from a greater awareness of some of the mental health issues that may occur in higher education. [ABSTRACT FROM AUTHOR]

Issue addressed: Unemployment is detrimental to health. The Unemployment and Health Project in South Western Sydney sought to work with labour market programs to improve the health, particularly, mental health, of unemployed people. This paper describes the experiences of the Project. Methods: Phase one commenced in 1995 and involved consultation with the majority of Skillshares (labour market programs under the Labor government) in south-western Sydney to identify potential areas of action. Phase two commenced in 1998 and involved the development of a brief cognitive behaviour therapy intervention that was delivered in Job Network Settings (the next generation of labour market programs under the Liberal government). Results: The cognitive behaviour therapy intervention has been successful in improving mental health in five small scale trials but the intervention has proved difficult to scale up and evaluate comprehensively. Generating more general interest in improving the health of unemployed people through the Job Network has also been difficult. This is related to different understanding and valuing of evidence, a highly volatile context, lack of shared core business by the health and employment sectors, and the changing nature of work in Australia. Conclusions: There are theoretical and practical reasons why it is difficult for labour market programs to be a setting for improving the health of unemployed people. However, the reach of labour market programs into the high risk groups warrants more attention by mental health promotion programs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this paper is to examine the recent decision of the NSW Supreme Court, which considered a personal injuries action brought by a patient treated in the community following a 6 day voluntary hospital admission. Conclusions: The judicial reasoning in Walker v Sydney West Area Health Service provides some comfort to mental health professionals practising in other jurisdictions whose legislative provisions are similar to those contained in the Civil Liability Act (NSW). In applying the Bolam principle, rather than the higher common law standard previously imposed by the High Court in Rogers v Whitaker, the decision is encouraging for mental health professionals whose management accords with accepted current good practice. The infrequent scrutiny by courts and coroners of management practice and systems in mental health is a further incentive to maintain continuous improvement of quality of care (by clinical audits, active risk management, professional development and supervision, and patient/family participation) consistent with the principles of clinical governance. [ABSTRACT FROM AUTHOR]

Social capital, generally observed in Chinese cultures, can be considered as the glue that holds together all the norms, trust and social networks that enhance mutual benefit of a collectivistic society. The aim of this paper is to explore the best way to tap into these social resources in mental health promotion. A mixed-method study, consisting of 16 community focus groups and a quantitative survey (n = 528), was conducted among Chinese Australians (recruited from general practices) in metropolitan Sydney. Although the focus groups explored help-seeking behaviours during emotional distress, the survey assessed the prevalence of such episodes. Chinese informants identified 'family and friends', 'cultural values', 'spirituality' and 'self' as common 'helpers' for managing depressive episodes before professionals were consulted. These 'helpers' function as the 'social capital' within the Chinese community. Focus group narratives of the low-acculturated Chinese revealed that they turned to close friends and family for help during crises. Highly acculturated Chinese found 'family values' most helpful when facing adversity. Survey findings indicated that the self-report rate of lifetime depression in low-acculturated Chinese was significantly lower than that of Australians. These results resonate with Cullen and Whiteford's (2001) proposition that a higher level of social capital decreases the incidence of depression. Although the links between social capital and mental health require further investigation, the current findings support its role in counteracting emotional distress. There are implications of the current research findings to wider culturally and linguistically diverse communities. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe a model for consultation with Aboriginal stakeholders used in the development of a training course, by the NSW Institute of Psychiatry, about young people's mental health and wellbeing. Historical, social and political factors contribute to the elevated rates of mental distress and disorder experienced by many Aboriginal young people. However, these young people often do not receive the help they need. Knowledge, skills and attitudes of clinicians are associated with the uptake of services. Therefore, a training course for clinicians was developed utilizing a detailed consultation process with Aboriginal stakeholders. Conclusions: The course was delivered as part of an ongoing comprehensive interagency training program for 2000 clinicians. The course was positively evaluated by participants and stakeholders, suggesting that the course development, including the consultation process with Aboriginal stakeholders, was effective in meeting participant and stakeholder needs. Agencies may be interested in the application of this model to consultation processes with Aboriginal communities and with other populations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to present the findings of a survey of consumers of mental health services who are working (in either paid or unpaid positions) in NSW Health and in the Non Government Organisation sector in NSW. Method: A survey was distributed through the NSW Consumer Advisory Group newsletter to elicit the roles and assess the training needs of consumer employees, as well as those who were working in voluntary capacities as consumer representatives, within the mental health system in NSW. Results: Many mental health consumers have been placed in the untenable position of being engaged in representation and/or advocacy roles with unclear job descriptions and no training. The majority of consumers want a code of ethics and performance standards for consumer workers. Conclusions: The rhetoric of consumer participation is not matched by effective and timely strategies that ensure that consumer involvement is underpinned by relevant training and supportive infrastructure. The goal of meaningful consumer participation in mental health services, as outlined in policy, is yet to be achieved. [ABSTRACT FROM AUTHOR]

This paper presents data on the experiences and recommendations of providers of supported accommodation services concerning the needs of people with co-morbid mental health and substance use issues. Forty-two service providers were surveyed in New South Wales, Australia. Their responses highlight discrepancies between current services and ideal service. Half of the participants believed that their services did not effectively meet the needs of those with a dual diagnosis; this was the case particularly among services that offered shared accommodation facilities and limited supervision. The service providers recognized a need for accommodation services that simultaneously offer treatment, as well as greater interagency networking. Given the dearth of research specifically on the accommodation needs of people with a dual diagnosis, these insights have the potential to aid policy development and increase the effectiveness of service provision in the accommodation sector. [ABSTRACT FROM AUTHOR]

In the context of health services, decisions regarding priorities for social work intervention and, hence, the allocation of social work expertise and resources have traditionally been based on an interaction between social work knowledge, principles and skills, historical precedence, health policy, multidisciplinary team requirements, and manager opinion. In the current context of health services, traditional practices are questioned and it has become essential for social work as a profession to clarify its role, its choice of interventions, and to state clearly and strongly, on the basis of social work knowledge, its core priorities for practice and, hence, the allocation of resources. This paper presents the findings of an exploratory study, undertaken by joint university and practice collaboration, designed to develop a set of priorities for social work practice in health. The study was undertaken in the Hunter Health region of New South Wales, Australia, where social workers are employed across a range of hospital, mental health, specialist, and community services. The resulting set of clinical priorities for social work practice in health has implications for the allocation of social work resources and expertise to the social issues central in individual family and community health status, and for the profession's capacity to strengthen the role of social work in health. [ABSTRACT FROM AUTHOR]

Objective: The new Black Dog Institute Depression Clinic adopts a novel clinical service model that argues for the importance of clinically defining separate mood disorders in order to apply specific management strategies. This paper describes clinic nuances and the impact on diagnosis and management for the first 100 patients assessed. Method: Patients are assessed via a computerized structured self-report program, a semistructured interview undertaken by a psychiatrist and a colloquium involving several practitioners where diagnostic decisions are formulated. A detailed report with treatment recommendations, incorporating psychiatric and psychological perspectives, is sent to the referring clinician. Such data are examined in this report. Results: We offered a differing diagnostic and treatment paradigm for nearly 90% of those diagnosed with a primary mood disorder. Difficulties encountered by referring practitioners are highlighted and the need for an alternative diagnostic and management model is discussed. Conclusions: A subtyping diagnostic management model has the capacity to advance treatment outcome, but requires validation. Our future research will assess the comparative utility of the subtyping model in clinical and research arenas. [ABSTRACT FROM AUTHOR]

Objectives: This paper outlines a proposed framework including values, principles and steps, developed by consumers, to evaluate mental health services from a consumer’s perspective. Method: A research team consisting of consumer researchers, established academics and students developed the framework. The team had already conducted qualitative research with consumers of mental health services. Using these experiences and the evaluation literature, the proposed framework was developed over a series of 13 meetings. Results: An evaluation framework, which describes the values underpinning consumer-directed evaluation of mental health services and the principles and steps to follow in conducting this type of evaluation, is presented. Conclusions: The evaluation framework will guide consumers and services in conducting consumer-directed evaluation of mental health services, and assist in developing more genuine consumer participation in services. [ABSTRACT FROM AUTHOR]

In the public sector mental health service setting, accountability for quality has often been considered the responsibility of the individual clinician. This presents a particular challenge for introducing an organization-wide quality improvement culture in this setting. The introduction of a systemic view of quality may encounter resistance from individual clinicians reluctant to accept that some clinical autonomy must be subsumed within more standardized patterns of intervention and evaluation. Services must firstly tackle the issue of clinicians' readiness to embrace such a culture, which requires strong direction from the executive level. The area of recently diagnosed psychosis was selected in one public sector mental health service as a starting point for initiating the quality improvement culture. The eventual outcome for the organization has been a positive commitment to improvement, but the journey was long and hard. This paper describes the beginning of this ultimately rewarding journey.