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While there has been a significant increase in investment in community mental health in Australia since the advent of the National Mental Health Strategy in the early 1990s, there has been little guidance on service design and delivery. This has led to a growing diversity of approaches and concern about the adequacy of care with repeated calls for a system overhaul. Consumers and carers have very largely been absent from decision‐making about service design and development which has led to a system primarily designed by healthcare professionals. However, with the emergence of recovery as a core principle in mental health, it is time for consumers and carers to be centrally engaged in co‐designing services with service providers. This raises the question of whether dominant service delivery models – such as the growth of specialist teams/services, the changing balance between profession‐specific and generic case management roles in multidisciplinary teams, and the separation of inpatient from community care – will prevail. Contentious issues in these three service delivery areas are outlined to stimulate debate and highlight the pressing need for national guidance on the configuration of community mental health services. Building on the lessons learned from the first National Mental Health Strategy, we outline a proposal for a co‐designed National Framework for Community Mental Health Services to guide the delivery of care in a way which satisfies the aspirations of consumers, carers, and mental health professionals alike. [ABSTRACT FROM AUTHOR]

Background: Proximal humeral fractures are common in older patients. The majority are minimally displaced and are associated with good outcomes after nonoperative treatment. Poorer outcomes are associated with displaced, multipart fractures. There is no clear benefit from surgical fracture fixation compared to nonoperative treatment. Replacement of the fractured humeral head with a hemiarthroplasty is another treatment option, but has not been shown to be clearly superior to nonoperative treatment or internal fixation. Recently, reverse total shoulder arthroplasty has been used to treat these fractures, particularly in the older population with several case series demonstrating good outcomes. No comparative trial has been performed to test the effectiveness of reverse total shoulder arthroplasty against nonoperative treatment.Methods/design: ReShAPE (Reverse Shoulder Arthroplasty for the treatment of Proximal humeral fractures in the Elderly) is a multicenter combined randomized and observational study. The primary objective is to compare pain and function 12 months post fracture using the American Shoulder and Elbow Society (ASES) score in patients aged 70 years or older with three- and four-part proximal humeral fractures treated by either reverse shoulder arthroplasty or nonoperative treatment. Secondary outcome measures will include the DASH (Disability of the Arm, Shoulder and Hand) score, the EQ-5D (EuroQol Health Survey), the EQ-VAS, pain, radiological parameters and complications.Discussion: The study will assess the effectiveness of reverse shoulder arthroplasty for complex proximal humeral fractures and thereby guide treatment of a common injury in the older population.Trial Registration: World Health Organization Universal Trial Number (WHO UTN): U1111-1180-5452 . Registered on 10 March 2016. Australian and New Zealand Clinical Trials Registry (ANZCTR): 12616000345482 . Registered on 16 March 2016. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzed the implementation of joint crisis plans (JCP) into routine clinical practice in community mental health services in Western Australia. The Crisis Awareness Plans (CAP) aim to improve collaboration between mental health services, community-managed organisations (CMO) and general practitioners (GP). Among the key themes identified in the study are support for CAP, purpose and ownership, and collaborative partnerships.

The authors discuss potential benefits of the Australian government healthcare program, the National Disability Insurance Scheme (NDIS), to the mental health sector. They acknowledge established goals of the NDIS for the public and the inclusion of psychiatric disability in its coverage. They also explore the possible implementation of self-directed support for the mental health services industry and the involvement of carer organizations, consumers, and stakeholders in the NDIS.

This article addresses a number of issues regarding post-sentence detention order regimes in the context of an analysis of a collection of publicly available judgments made under the Dangerous Prisoners (Sexual Offenders) Act 2003 (Qid). The article raises concerns regarding the accuracy of the psychiatric evidence presented to the court. However, it suggests that the way in which the psychiatrists conduct their prisoner assessments, and the way in which judges have applied the main rules of expert evidence, have combined to ensure that the potential for unjust outcomes has been minimised. The article also suggests that judges have struck a fine balance between community protection and prisoner liberty, by in most cases making supervision orders which allow prisoners to be released into the community under strict conditions, rather than making detention orders. As no prisoner released under a supervision order is known to have committed a further sex offence, it is the conclusion of this article that the judges' approach to cases under the Dangerous Prisoners (Sexual Offenders) Act 2003 (Qid) has been highly successful, and may represent a solution to the serious problem of recidivist sex offenders within the community. [ABSTRACT FROM AUTHOR]

Objectives: To describe the process adopted by the Committee for Professional Practice (CPP) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in devising the 5th edition of its code of ethics and to outline principal changes.Methods: CPP members planned, scrutinised and documented the steps taken in preparing the new edition.Results: The process, following that used in all previous updates of the code and which had proved effective and productive on each occasion, comprised consultations with RANZCP committees and relevant external stakeholders. Canvasing the views of so many groups was regarded as essential to ensure that multiple perspectives were considered and any bias of the CPP avoided. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) was examined with two aims: promoting a robust clinician and patient partnership, and acknowledging the psychiatrist's advocacy role. The psychiatrist's duty to be alert to colleagues' wellbeing and to safeguard respectful professional relationships was highlighted.Conclusions: A comprehensive, rigorous and established review process occurred and was carefully documented resulting in a sound and contemporary revision of the code of ethics. RANZCP members will be duty-bound to adhere to, and apply, the code to optimise their ethical standards. [ABSTRACT FROM AUTHOR]

The little red flying‐fox (Pteropus scapulatus, Pteropodidae) is the most widely distributed of the four Australian mainland flying‐fox (Pteropus) species. They move very large distances following foraging resources and congregate in large numbers which often causes human‐animal conflict. To better understand the resources that drive these movements and aggregations, we investigated the diet of the little red flying‐fox using data from five sources: (i) faecal eDNA metabarcoding of field sampled little red flying‐foxes; (ii) identification of foraging locations through satellite tracking; (iii) a literature search; (iv) a search of online databases; and (v) an expert survey. Our sources revealed a specialist nectarivore diet containing 204 species, dominated by floral products from the plant family Myrtaceae. We consider a small number of widely occurring and structurally dominant Myrtaceae, particularly from the genera Corymbia, Eucalyptus and Melaleuca, as major diet species that regularly drive mass aggregations. In addition, we consider a moderate number of species dominated by the Myrtaceae as important diet species and a large number of species from diverse taxa as supplementary diet species. Fruit represents approximately 5% of the diet suggesting that the little red flying‐fox is unlikely to be a major pest of horticultural crops or disperser of weeds. The combination of long‐distance movement and a wide range of diet species results in a long‐distance pollination service to many plant species which likely promotes genetic mixing between isolated populations of plants. Our understanding of the little red flying‐fox diet allows us to better predict mass migrations and aggregations at a continental scale and allows us to clearly identify key foraging habitat so that informed management decisions can be made. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction. There is a lack of recent data on the extent to which gay men engage in insertive anal intercourse (IAI) and receptive anal intercourse (RAI). Accurate assessments of the overall risk of infection from HIV and other sexually transmitted infections (STIs) require such data because versatile men who engage in both roles have heightened vulnerability for becoming infected and infecting others. Aim. To investigate the extent to which gay men are versatile with regard to having IAI and RAI. Main Outcome Measures. Percentages of gay men who reported engaging in IAI, RAI, or both during the past 12 months and in their most recent sexual encounter. Methods. Eight hundred fifty-six Australian gay men completed an online survey to retrospectively report on their sexual practices over the past 12 months. Results. Of men who had anal intercourse in the past 12 months, 83% had both IAI and RAI, of whom 57% were highly versatile in that they had approximately equal numbers of partners for IAI and RAI. Of men who had anal intercourse in their most recent sexual encounter, as many as one in five (20%) had reciprocal anal intercourse, having both IAI and RAI with the same partner in a single encounter. Condom use was significantly less likely with reciprocal (38%) than nonreciprocal anal intercourse (50%; P = 0.04). While highly versatile men were less likely to know their HIV status, practices at most recent sexual encounter such as reciprocal anal intercourse and condom use were not significantly related to either their HIV status or that of their partner. Conclusions. Engaging in both IAI and RAI appears to be common among gay men. HIV/STI prevention strategies would benefit from paying attention to the implications of high rates of versatile sexual practices, particularly the tendency for condoms to be used less often when having reciprocal anal intercourse. Lyons A, Pitts M, Smith G, Grierson J, Smith A, McNally S, and Couch M. Versatility and HIV vulnerability: Investigating the proportion of Australian gay men having both insertive and receptive anal intercourse. J Sex Med 2011;8:2164-2171. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Thresholds often exist in the relationship between species richness and the area of remaining habitat in human-modified landscapes, prompting debate about the mechanisms responsible. We hypothesize that if species-area relationships differ with underlying factors such as landscape productivity, and such factors correlate with patterns of habitat clearance, then spurious thresholds can arise where the separate species-area relationships intersect. We assessed whether this phenomenon could explain landscape-level species-area relationships for birds occupying 31 landscapes of 100 km2 in eastern Australia. Location Eastern Australia. Methods Landscape-level species richness estimates were modelled as a function of the percentage of native vegetation remaining in the study landscapes. The performance of traditional species-area curves and continuous and discontinuous piecewise models was compared using an information theoretic approach. Separate models for high- and low-productivity and high- and low-fragmentation landscapes were examined to determine whether they implied different species-area relationships. Results The species-area relationship exhibited a rapid change-point at approximately 40% vegetation cover, but this was most parsimoniously explained by two disjunct slopes rather than a continuous threshold model or a classic species-area curve. Exploration of models fitted separately to high- and low-productivity landscapes suggested that such landscapes may differ in their characteristic species-area relationships. Main conclusions The observed pattern is consistent with the spurious threshold hypothesis, and opens a new avenue of enquiry into the processes behind apparent ecological thresholds. This hypothesis may be valid in other regions where clearing history is confounded by underlying factors such as landscape productivity, and demands further research. In such systems, real thresholds for different landscape types may occur at different levels of cover, or might not exist at all. If so, a simple space-for-time substitution may not be valid, and management prescriptions based on threshold values (e.g. 40%) will be flawed. [ABSTRACT FROM AUTHOR]