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Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone ('face down') restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de‐escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular. [ABSTRACT FROM AUTHOR]

Objective:The aim of this study was to identify, at the time of admission, predictors of aggression in adults admitted to acute mental health care. Method:Adult patients (n = 350) consecutively admitted to the National Institute of Mental Health (NIMH) in Sri Lanka were assessed for a wide range of dispositional, historical, contextual and clinical factors associated with inpatient violence. Clinical factors were assessed using the Brief Psychiatric Rating Scale (BPRS), and risk of aggression using the Brøset Violence Checklist (BVC). All 350 patients were followed for 72 hours post-admission and observed for aggression using the Overt Aggression Scale. Results:Fifty-nine patients (16.8%) met criteria for aggression. Those in the aggressive group were younger, single and had caused harm to others or damaged property in the two weeks prior to admission. Aggressive patients were also more likely to exhibit symptoms of psychopathology (higher scores on the hostility-suspiciousness subscale of BPRS) and to have a higher total score on the BVC at the time of admission, than other patients. Conclusions:Of all of the risk factors considered at the time of admission, the BVC total score was the strongest predictor of aggression following admission. Indeed, the BVC was a more robust predictor of aggression in the post-admission period than a history of aggression preceding admission and psychopathology as measured by the BPRS. The finding supports the use of structured risk assessments for monitoring the risk of aggression in patients during the initial 72 hours post-admission. [ABSTRACT FROM AUTHOR]

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

The article discusses a study on the occurrence of patient absences without authorised leave at a security hospital in Australia. Researchers carried out a retrospective audit covering 10 years of all incidents of leave from the High Security Inpatient Services in Brisbane, Australia. It was found that few absences without permission from leave occurred among patients.

Objective: This paper aims to assess the utility of six measures of consumer outcomes: the Behaviour and Symptom Identification Scale, the Mental Health Inventory (MHI), the Medical Outcomes Study 36-Item Short-Form Survey, the Health of the Nation Outcome Scales, the Life Skills Profile (LSP) and the Role Functioning Scale previously recommended for the routine assessment in Australian mental health services. Method: Consumers and service providers were invited through focus group discussions and surveys to describe the perceived utility of these selected measures. Results: All six measures were rated favourably. The qualitative and quantitative findings suggest that the MHI elicited the most positive results of the consumer measures. No observer-rated scale was clearly preferred. Conclusion: The qualitative feedback obtained indicated that process and context issues may be as important to the successful use of routine instruments for the measurement of consumer outcomes in clinical practice as the choice of instrument. [ABSTRACT FROM AUTHOR]

The article explores the participation of Indigenous Australians in Australian civil society with reference to the legal framework established by the country's constitution. The authors argue that Australia's constitution is based on a European liberal ideology that constructs itself in terms of white, free-market values and explores how various policy objectives have enacted an elision of Indigenous values from Australian civil society. The implications for self-efficacy and political participation for Australia's Indigenous populations are considered in light of this constitutional-legal framework.

In Queensland (Australia), community-based residential mental health rehabilitation services have three distinct staffing profiles. The traditional 'clinical' staffing model has nursing staff occupying most staff roles. The 'partnership' approach involves collaboration between the health service and a Non-Government Organisation. Under the 'integrated' staffing approach, Peer Support Workers reflect the majority staffing component. This study compares the treatment received by consumers (N = 172) under these staffing models using cross-sectional administrative data. Staffing models were generally comparable on demographic, diagnostic, and symptomatic/impairment measures. However, statistically significant differences were present on a range of treatment variables. Differences mainly occurred between the clinical and integrated approaches, with the integrated staffing model having lower rates of involuntary treatment, antipsychotic polypharmacy, depot use, and chlorpromazine dose equivalence levels. These findings indicate the need to carefully examine the impact of staffing configuration on rehabilitation processes to understand whether differences in approaches are likely to impact rehabilitation outcomes., (© 2021. Crown.)

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

Repeat presentations to the emergency department (ED) for non-fatal suicidal behaviour (NFSB) are common in Australia and overseas. The challenges faced by mental health services in managing this sub-group of patients have not been fully explored. In this qualitative study, we consider how case managers view frequent ED use by patients with NFSB. Individual interviews with case managers were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Four main themes emerged: a logical place to go; not a lot of benefit from an ED visit; focus on managing risk; and building a life outside of the ED. The case managers noted that patients with NFSB tend to have complex presentations that are challenging to address in the ED. The focus tends to be on assessment of risk with referral to community support agencies. The findings point to the need to identify more intensive care options that support patients to reduce their dependency on the ED. Insights gleaned from the study have implications for those working with NFSB patients., (© 2020 Australian College of Mental Health Nurses Inc.)

Presentations to emergency departments (EDs) for non-fatal suicidal behaviour (NFSB) are increasing in Australia and overseas. Our understanding of the factors contributing to this trend remains unclear. In this qualitative phenomenological study, we explored patient perceptions of their ED experience and the interventions provided. The study group comprised 10 adults who had had 3 or more presentations to the ED in a 12-week period for NFSB. Individual interviews were conducted in person with participants and transcribed verbatim. Three broad themes emerged from analysis of the transcripts: ED - a safety net; 'treatment - what treatment!'; and maintaining ED dependence. The findings highlight a failure to understand the needs of those with NFSB and establish better ED treatment strategies and models of aftercare for this sub-group of patients. The findings have implications for mental health nurses working with consumers in the ED and in broader case management roles., (© 2020 Australian College of Mental Health Nurses Inc.)

Objective: Because comorbidity between mental and physical disorders is commonly found in patients, it would be expected that this pattern would also be reflected at the family level. During a recent population-based survey of common mental disorders, respondents were asked about the presence of selected mental and physical disorders in their relatives. The aim of this research was to describe the within-family co-occurrence of selected common physical and mental disorders in a population-based sample., Methods: Subjects were drawn from the Australian National Survey of Mental Health and Wellbeing 2007. A modified version of the World Mental Health Survey Initiative of the Composite International Diagnostic Interview (WMH-CIDI 3.0, henceforth CIDI) was used to identify lifetime-ever common psychiatric disorders (anxiety disorders, depression, drug or alcohol disorders). The respondents were asked if any of their relatives had one of a list of psychiatric (anxiety, bipolar disorder, depression, drug or alcohol problem, schizophrenia) or general physical disorders (cancer, heart problems, intellectual disability, memory problems). We examined the relationship between the variables of interest using logistic regression, adjusting for potential confounding factors., Results: Compared to otherwise-well respondents, those who had a CIDI diagnosis of major depressive disorders, anxiety disorders, or drug or alcohol abuse/dependence were significantly more likely to have first-degree relatives with (a) the same diagnosis as the respondent, (b) other mental disorders not identified in the respondent, and (c) a broad range of general physical conditions., Conclusions: Individuals with common mental disorders report greater familial co-occurrence for a range of mental and physical disorders. When eliciting family histories, clinicians should remain mindful that both mental and physical disorders can co-occur within families.

Objective: The present study was designed to investigate the clinical and social outcomes for a group of individuals (n = 181) discharged into supported accommodation from three long-stay facilities in Queensland., Method: Data were collected prospectively using a battery of standardized measures and individual interviews at 6 weeks pre-discharge and again at 6, 18, 36, and 84 months post-discharge., Results: While there was little functional gain at follow up, the clients, as a group, did not deteriorate. Sixty per cent of the clients were engaged in some form of structured community activity and the need for hospitalization decreased significantly in the follow-up period. The ongoing costs of the programme, while remaining high, were significantly less than inpatient alternatives., Conclusion: The provision of community accommodation with adequate clinical and non-clinical support is a suitable option for a large proportion of individuals with serious mental illness.

Background: Benchmarking of performance indicators in the mental health field is gaining currency in Australia as a strategy for improving service quality., Aim: To engage mental health service providers in the collection and evaluation of performance data., Methods: Three separate rounds of data collection involving high secure, extended treatment, and medium secure services were carried out between 2003 and 2005. Twenty-five core indicators were identified and these were used to assess service inputs, processes, outputs and outcomes., Results: Differences in casemix, clinical practice and local business rules gave rise to variation in service performance. The benchmarking exercise led to the implementation of quality improvement initiatives., Conclusions: It is possible and useful to collect and evaluate performance data for mental health services. While services appear similar enough to benchmark, information related to both casemix and service characteristics needs to be included in benchmarking data to understand the factors that produce differences in service performance.

Objective: To assess the outcomes for a group of elderly patients with mental illness following their discharge from a stand-alone psychiatric facility to seven extended care units (ECUs)., Method: All patients (n=60) who were relocated to the ECUs were assessed using a number of standardized clinical and general functioning instruments at 6 months and 6 weeks pre-move, and again at 6 weeks, 6 months and 18 months post-move., Results: By 18 months post-discharge, 13 of the 60 patients (21.7%) had died and seven others had been transferred to nursing homes. Those who died were older and had significantly higher levels of physical ill health when compared to those who did not die. Changes on measures of clinical and behavioural functioning in those who remained in the study did not reach statistical significance by 18 months post-move. However, participants did demonstrate improvements in quality of life with significantly higher scores on measures of social contact and community access., Conclusions: The mortality observed in the follow-up period is likely to be related to physical ill health and old age rather than the trauma associated with relocation. While overall functioning did not improve following relocation, patients had more independence and greater access to community-based activities.