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Objective: We examined the extent to which ethnicity, cannabis and alcohol use could predict prevalence of violence and self-harm in an inpatient psychiatric sample., Method: We collected demographic and clinical data in a series of 141 adult psychiatric inpatients in Hamilton, New Zealand. The Alcohol Use Disorders Identification Test (AUDIT) and Cannabis Use Disorders Identification Test, Revised (CUDIT-R) were used to measure substance use. Clinical assessment and file review were used to verify histories of self-harm and violence., Results: It was found that 66% had a history of violence, 54% of self-harm, and 40% of both; only 20% had neither. Cannabis use was found to significantly predict lifetime history of violence ( p = 0.02); other independent variables (gender, age, ethnicity, alcohol use, psychiatric diagnosis) did not. Self-harm was strikingly predicted by female gender ( p < 0.001), as well as by measures both of cannabis ( p = 0.025) and alcohol use ( p = 0.036); age, ethnicity and diagnosis did not reach significance. Less than 10% of patients were engaged with drug or alcohol services., Conclusions: Cannabis use is a significant predictor of lifetime violence among the severely mentally ill, while both alcohol and cannabis use predict self-harm. Few affected patients receive specific treatment for substance use comorbidity.

Objective: To elucidate patterns of substance misuse, across diagnoses and demographic variables, in patients with severe mental illness., Method: We studied 141 adults admitted to an acute psychiatric unit in Hamilton, New Zealand. Semi-structured interviews, including the Alcohol Use Disorders Identification Test (AUDIT) and Cannabis Use Disorders Identification Test - Revised (CUDIT-R), were used to assess substance use., Results: Seventy-six participants were of European origin (56%), 59 were Maori (42%). Tobacco smoking was noted in 81% overall, with a higher frequency (93%) among Maori. A majority of patients had alcohol use disorder, with greater prevalence in bipolar and schizoaffective disorder compared to schizophrenia. By contrast, cannabis use disorder was strikingly associated with schizophrenia. Younger patients and Maori were disproportionately affected by both alcohol and cannabis use., Conclusions: Substance misuse in New Zealand patients with severe mental illness is common, particularly among younger patients and Maori, and differentially distributed across diagnoses., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

Purpose: People with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting. Design: Single arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention. Method: People with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise. Results: Forty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks. Conclusions: A brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors. Clinical Trial Registration: The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)—U1111-1211-4009. [ABSTRACT FROM AUTHOR]

The article discusses about the views of the author on the report by Australasian College for Emergency Medicine on Australia's mental health system: Nowhere to go: Why Australia's health system results in people with mental illness getting ‘stuck' in emergency department. The author advocates the balanced care at the emergency department length of stay.

The article discusses the advantages offered by the Becker-Drake Individual Placement and Support (IPS) approach as a means to assist people with severe and persistent mental illness to realize their goals of competitive employment. The need for revising existing policies, funding contracts and evaluation frameworks, and to encourage the adoption of the new principles and practices is described. IPS is a program that should be a part of the Australian Disability Employment Service policy.

Accessible summary: What is known on this subject?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally.Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes.No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. What this paper adds to existing knowledge?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care.Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. What are the implications for practice?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring.Guidelines may have a role to play in improved monitoring but need service‐level support in order to be effective. Introduction: People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim: To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method: An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results: Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion: Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness. [ABSTRACT FROM AUTHOR]

Aims: There is very little empirical evidence about the relationship between severe mental illness and the physical health of Indigenous peoples. This paper aims to compare the physical health of Māori and non-Māori with a diagnosis of bipolar disorder in contact with NZ mental health services. Methods: A cohort of Māori and non-Māori with a current bipolar disorder diagnosis at 1 January 2010 were identified from routine mental health services data and followed up for non-psychiatric hospital admissions and deaths over the subsequent 5 years. Results: Māori with bipolar disorder had a higher level of morbidity and a higher risk of death from natural causes compared to non-Māori with the same diagnosis, indicating higher levels of physical health need. The rate of medical and surgical hospitalisation was not higher among Māori compared to non-Māori (as might be expected given increased health needs) which suggests under-treatment of physical health conditions in this group may be a factor in the observed higher risk of mortality from natural causes for Māori. Conclusion: This study provides the first indication that systemic factors which cause health inequities between Māori and non-Māori are compounded for Māori living with severe mental illness. Further exploration of other diagnostic groups and subgroups is needed to understand the best approach to reducing these inequalities. [ABSTRACT FROM AUTHOR]

Background: Serious mental illness (SMI) is common among persons sentenced to life imprisonment for murder, yet little is known about how this affects rehabilitation, prospects of parole, or risk to the community.Aim: The aim of this study is to compare outcomes for a national cohort of offenders charged with murder who were either convicted and sentenced to life in prison or placed on a forensic hospital order.Methods: The 386 cases of murder charges in New Zealand between 1988 and 2000 were divided into three groups: perpetrators without SMI sentenced to life imprisonment (n = 313), perpetrators with SMI but sentenced to life imprisonment (n = 32), or those with such illness and found not guilty by reason of insanity (NGRI) who received a forensic hospital order (n = 41). Access to rehabilitative interventions, time to release, reoffending, and recall to prison or hospital were examined.Results: Being in prison but having severe mental illness delayed release on parole but did not increase the risk of criminal recidivism or recall to prison. Hospital order patients were a demographically different group; they were released to the community earlier and had a lower rate of criminal recidivism.Conclusions: This study provides some evidence that incarceration periods for life-sentenced homicide perpetrators with SMI may be reduced without increasing community risk if hospital transfer and/or more targeted interventions are provided in prison. It also provides further evidence that persons found NGRI after a charge of murder have a relatively low risk of criminal recidivism. The stigma that may sometimes attach to such offenders is unwarranted, if it relies on concerns about risk of reoffending. [ABSTRACT FROM AUTHOR]

To examine the service characteristics and effectiveness of a segregated employment service assisting young clients with mental illness in New Zealand. The service assisted both youth and adults with severe mental illness to find and keep competitive employment. A retrospective case study method was used to examine service effectiveness with respect to employment outcomes attained by 49 clients aged 16-25 years over a 2-year period (2005-2007). These results were compared with recent national and international benchmarks. As a service segregated from public mental health services, there were no formal arrangements with local mental health teams, limiting coordination of services and reducing fidelity to evidence-based practices in supported employment. Despite an inability to collaborate closely with local community mental health services and a contract not specifically targeting youth, the service was high performing on a range of employment outcome variables. Subject to some study design and benchmarking limitations, these results support the continuing use of evidence-based practices in supported employment and supported education as important early interventions for young people with mental illnesses. [ABSTRACT FROM AUTHOR]

Objectives: Australia and New Zealand have some of the highest rates of compulsory community treatment order use worldwide. There are also concerns that people from culturally and linguistically diverse backgrounds may have higher rates of community treatment orders. We therefore assessed the health service, clinical and psychosocial outcomes of compulsory community treatment and explored if culturally and linguistically diverse, indigenous status or other factors predicted community treatment orders. Methods: We searched the following databases from inception to January 2020: PubMed/Medline, Embase, CINAHL and PsycINFO. We included any study conducted in Australia or New Zealand that compared people on community treatment orders for severe mental illness with controls receiving voluntary psychiatric treatment. Two reviewers independently extracted data, assessing study quality using Joanna Briggs Institute scales. Results: A total of 31 publications from 12 studies met inclusion criteria, of which 24 publications could be included in a meta-analysis. Only one was from New Zealand. People who were male, single and not engaged in work, study or home duties were significantly more likely to be subject to a community treatment order. In addition, those from a culturally and linguistically diverse or migrant background were nearly 40% more likely to be on an order. Indigenous status was not associated with community treatment order use in Australia and there were no New Zealand data. Community treatment orders did not reduce readmission rates or bed-days at 12-month follow-up. There was evidence of increased benefit in the longer-term but only after a minimum of 2 years of use. Finally, people on community treatment orders had a lower mortality rate, possibly related to increased community contacts. Conclusion: People from culturally and linguistically diverse or migrant backgrounds are more likely to be placed on a community treatment order. However, the evidence for effectiveness remains inconclusive and limited to orders of at least 2 years' duration. The restrictive nature of community treatment orders may not be outweighed by the inconclusive evidence for beneficial outcomes. [ABSTRACT FROM AUTHOR]

Aims: The validity of diagnostic classification in early psychosis has important implications for early intervention; however, it is unknown if previously found disparities between Māori (Indigenous people of New Zealand) and non-Māori in first episode diagnoses persist over time, or how these differences impact service use., Methods: We used anonymized routine mental health service data and a previously established cohort of over 2400 13-25-year-old youth diagnosed with FEP between 2009 and 2012, to explore differences in diagnostic stability of psychosis diagnoses, comorbid (non-psychosis) diagnoses, and mental health service contacts between Māori and non-Māori in the five-year period following diagnosis., Results: Differences in schizophrenia and affective psychosis diagnoses between Māori and non-Māori were maintained in the five-year period, with Māori being more likely to be diagnosed with schizophrenia (51% vs. 35%), and non-Māori with bipolar disorder (28% vs. 18%). Stability of diagnosis was similar (schizophrenia 75% Māori vs. 67% non-Maori; bipolar disorder 55% Māori vs. 48% non-Māori) and those with no stable diagnosis at FEP were most likely to move towards a schizophrenia disorder diagnosis in both groups. Māori had a lower rate of diagnosed co-morbid affective and anxiety symptoms and higher rates of continued face to face contact and inpatient admission across all diagnoses., Conclusions: Indigenous differences in schizophrenia and affective psychosis diagnoses could be related to differential exposure to socio-environmental risk or assessor bias. The lower rate of co-morbid affective and anxiety disorders indicates a potential under-appreciation of affective symptoms in Māori youth with first episode psychosis., (© 2022 The Authors. Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.)

People in custody are at high risk of developing depression. Accessing psychological treatments in a prison setting is a particular challenge, in part, due to difficulties accessing specialist mental health workers. Behavioural Activation (BA) may be helpful in improving health outcomes for people in custody experiencing depressive symptoms. The aim of this study is to establish the feasibility and acceptability of custodial health nurses delivering BA to improve depressive symptoms of people in custody. We will conduct a pilot randomised controlled trial with process observation examining the feasibility and acceptability of BA in treating people in custody with depressive symptoms. 60 people in custody presenting with depressive symptoms will be randomised to receive BA plus treatment as usual (TAU) or TAU provided by custodial health nurses. Eight custodial health nurses will be recruited, trained, and deliver BA. BA will be delivered twice a week for six weeks, with sessions lasting up to 30 minutes. Changes in depression and quality of life (QoL) will be assessed at baseline, 6 weeks, and 3 months post-intervention. Participants will be interviewed to understand feasibility and acceptability of BA in prison settings. The findings will inform the design of a randomised controlled trial to test the efficacy of BA for people in custody with depression. Findings will help determine whether BA for depression is suited to prison health care system and services. Improving depressive symptoms in people in custody has benefits beyond prison settings. The Central Adelaide Local Health Network Human Research Ethics Committee and University of South Australia Human Research Ethics Committee have approved the study. The trial results will be disseminated through peer-reviewed journals and scientific conferences and reported to local stakeholders and policy makers. If feasibility and acceptability is demonstrated, we will seek to progress to an effectiveness study. A potential strength of the trial model proposed, is in its scalability, with potential to increase the trial sites and locations. This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry (reference number: ACTRN12623000346673p). Trial registrationACTRN12623000346673p. [ABSTRACT FROM AUTHOR]

The Pacific population in Aotearoa New Zealand is youthful, with the majority (55%) being under the age of 25 (Statistics New Zealand, 2014). It is vital that youth mental health for Pacific is understood in relation to their overall wellbeing (Paterson et al., 2018). In parallel to this, the World Health Organization (2022) accentuates the need to protect and promote mental wellbeing for young people globally. Specifically, Pacific youth were far more likely than Aotearoa New Zealand European counterparts to have poorer mental health and higher numbers of suicidality and self-harming behaviours (Ataera-Minster & Trowland, 2018; Fa'alili-Fidow et al., 2016). Moreover, research confirms that Pacific people aged 15–24 years have higher levels of psychological distress of 38% compared to 35% of Pacific adults aged 45–64 years (Ataera-Minster & Trowland, 2018). There is a lack of evidence-based psychological approaches that are culturally appropriate and applicable for Pacific people in Aotearoa New Zealand. Considerably, substantial evidence supports the need to provide more accessible resources and interventions that are flexible, culturally adaptable and cost-effective for Pacific youth. This review aims to (1) provide an insight into Pacific people in Aotearoa New Zealand, (2) have an understanding of Pacific worldview & wellbeing, (3) highlight mental health for Aotearoa New Zealand youth & globally (4) identify therapeutic approaches, including digital mental health globally and in Aotearoa New Zealand. Understanding the perspectives of Pacific youth is a significant first step. Therefore, this article will examine the therapeutic approaches, specifically in the digital space, that are proven effective when promoting wellness for Pacific youth. [ABSTRACT FROM AUTHOR]

Background: The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers. Methods: This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3–4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site's involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site's involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention. Discussion: This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715 [ABSTRACT FROM AUTHOR]

Mental health inpatient units can provide a sanctuary for people to recover from mental illness. To support a therapeutic environment, the safety and well‐being of service users and staff need protection through reduced conflict and containment rates. The Safewards model identifies 10 interventions to prevent conflict and containment. This paper aims to present barriers and enablers to implementing Safewards by analysing current literature on the Safewards model. It will also compare the Safewards model to New Zealand's Six Core Strategies. In a systematic search of 12 electronic databases following the PRISMA flow chart, 22 primary studies were included in this analysis. JBI tools were used for quality appraisal and deductive content analysis was used to organize and interpret data. Four categories were identified: (a) designing the Safewards interventions and implementation; (b) staff participation and perception of Safewards; (c) healthcare system influences on Safewards implementation; (d) service user participation and perception of Safewards. To support successful Safewards implementation in future practice, this review recommends that Safewards implementation is enabled through robust design of the Safewards interventions and implementation methods; staff participation and positive perception of the Safewards model; a resourced healthcare system that prioritizes Safewards implementation; service user awareness and participation in Safewards interventions. Interactionist perspectives may support the implementation of Safewards. This analysis is limited by research settings mostly being inpatient adult services and inadequate capturing of the service user voice. An ongoing review of barriers and enablers is important for supporting future Safewards implementation. [ABSTRACT FROM AUTHOR]

This article discusses various studies and research conducted on mental health and related topics. The studies cover a range of subjects, including the impact of the COVID-19 pandemic on mental health, the relationship between childhood mistreatment and substance use disorders in Latino communities, the challenges faced by caregivers of individuals with intellectual disabilities, the effects of mobile phone dependence on adolescents' mental health, and the validation of a mental health measurement tool in New Zealand. Other studies explore the relationship between temperament and mental illness, the externalizing symptoms of depression in men, the relationship between mental health literacy and quality of life in caregivers, the mental health status of adults with auditory processing disorder, the effectiveness of humor-based interventions for college students, and the mental well-being of family caregivers in dementia care. The studies also examine the relationship between sexual minority status and self-damaging behaviors in college students with borderline personality disorder symptoms. These studies provide valuable insights into various aspects of mental health and highlight the need for support and intervention in different populations. [Extracted from the article]

Separations that occur in the family courts are often characterised by high conflict and lengthy proceedings. For parents with a mental illness, the court can offer additional barriers which may lead to less time with their children and mental distress. This study aimed to (a) identify and critique research relating to parental mental illness in the family courts and (b) understand the experiences of parents with a mental illness who engage with the family courts in parenting matters. This scoping review was conducted on five databases (CINAHL, HeinOnline, ProQuest, PsycInfo and Scopus) following PRISMA-ScR guidelines. The search yielded 5392 unique articles, 12 of which met criteria and were included in this review. These articles included qualitative, quantitative and mixed method studies from family courts located in several countries. Through thematic analysis, four themes were constructed, (1) Actual and perceived influence of parental mental illness on outcomes, (2) Family violence and the courts, (3) The impact of the legal process on parents who have a mental illness, and (4) Supports for parents with a mental illness. The results indicate that parents with a mental illness face many obstacles that impact their ability to engage in the court processes and the outcomes of parenting cases. There were, however, many gaps within the current research. Limitations of the current research and directions for future research in parental mental illness in the family courts are offered. Highlights: Parents with a mental illness involved in parenting disputes perceived that their mental illness negatively impacted their case. Key barriers for parents included the exacerbation of their mental illness during ongoing family law proceedings, the impacts of family violence, and a lack of continuous and sensitive legal representation. Parents indicated that family law professionals and systems need to be informed of the effects of family violence, trauma and mental illness. Further research is needed focusing specifically on the experiences of parents with a mental illness as they navigate family court systems. [ABSTRACT FROM AUTHOR]

The aim of this study is to identify the methods and content of hospital-based serious incident reviews involving mental health related homicide where a service user was the perpetrator between 2007 and 2017. Eleven reports were obtained from mental health services in New Zealand's largest city and thematically analysed. Nine used the London protocol to identify clinical and system factors that may have contributed to the serious incident, but there was considerable variation in the way in which it was applied. Feedback to services was inconsistent. The voices of family members of the victims were largely absent and consideration of cultural context was missing. A structured protocol to specifically address the mental health context in New Zealand and internationally could resolve some of these issues and lead to a process that is more likely to provide comprehensive coverage of relevant matters and produce clear recommendations to effect improvements to services. [ABSTRACT FROM AUTHOR]

Little published research exists on how culture influences mental health service users when they create or use psychiatric advance directives (PADs). This column reports the results of a study (N=38 participants) of cultural factors that might encourage New Zealand Māori who engage in mental health services to make greater use of PADs in their care. The most important factor identified was the inclusion of family and friends in decision making during PAD creation and use. Discussions revealed multiple culturally important themes that were synthesized into a conceptual model, pou herenga (mooring place), which focuses on the importance of reassessing all aspects of one's life journey when creating a PAD. [ABSTRACT FROM AUTHOR]

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]

Discrimination against people with mental health and substance use conditions (MHSUC) by health professionals contributes to the poor physical health outcomes this group experiences. We surveyed people with MHSUC in Aotearoa New Zealand to explore how they experienced and responded to discrimination from physical health services. Participants identified 6 strategies used to avoid or minimize the impact of discrimination. Avoidance strategies included not seeking help, not disclosing MHSUC diagnoses and changing or seeking out health professionals who did not behave in discriminatory ways. Minimizing strategies were being a "model patient," taking a support person to consultations or advocating for what they needed, even in the face of discrimination. Physical health services must focus on providing non-discriminatory care to reduce the need for compensatory strategies and improve care of physical illness for people with MHSUC. [ABSTRACT FROM AUTHOR]

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Background: ‘Paediatric bipolar disorder’ (PBD) is a controversial diagnosis where often prepubertal children as well as adolescents, who may have a range of psychiatric disorders or symptoms, are diagnosed with a severe mental illness requiring lifelong medication. Clinically, it has often been applied in the United States but rarely in most other countries. A meta‐analysis (Van Meter et al., Journal of Clinical Psychiatry, , 72, 1250) claimed that the prevalence of PBD was similar to adults at 1.8% with no difference between the United States and other countries. This conclusion has been highly cited. Methods: The heterogeneous nature of the original 12 epidemiological surveys warrants a qualitative analysis, rather than statistical meta‐analysis as performed by Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250). Thus, the meta‐analysis and each of the 12 studies (six from the United States; six from other countries) were reexamined. Results: Most of the 12 surveys predated the emergence of the PBD hypothesis. The 12 surveys were mainly of adolescents and at times young adults with few prepubertal children. Prevalence rates in the 12 studies suggest a lower rate of bipolar disorder, especially in non‐US samples. For example, the Van Meter et al. (Journal of Clinical Psychiatry, 2011, 72, 1250) meta‐analysis chose a rate of 2.8% by summation of adolescent and parent responses in a Dutch survey, however the rate fell to 0% if requiring concordance of adolescent and parent responses. Indeed, it could be argued that four of the non‐US studies show 0% rates of PBD. Conclusions: Rates of PBD were generally substantially lower than 1.8%, particularly in non‐US surveys, and if both parent and adolescent reports were required to meet the diagnostic threshold they fell to close to zero. The reanalysis suggests that bipolar disorder is rare before the expected age of onset in later adolescence. [ABSTRACT FROM AUTHOR]

Objectives: Individuals with schizophrenia develop dementia in late life at higher rates than the general population. This is arguably explained by high rates of chronic medical conditions and exposure to antipsychotic medications. This risk has implications for public health. We aimed to test this in a large New Zealand database. Methods: Participants in this study were New Zealanders aged 65 years or older who had an interRAI assessment completed during the study period (July 2013–June 2020). This cohort study analysed data from 168,780 individuals. The majority were European (87%), and mostly assessment was for home care (86%). Results: There were 2103 individuals with schizophrenia, 1.25% of the total sample, mean age of 75 years (±1.9) and 61% female. A minority of individuals with schizophrenia, 23%, also had a dementia diagnosis. At 82 years of age (±1.7) and 60% female, 25% of individuals without schizophrenia had a dementia diagnosis; the difference from rate of dementia in individuals with schizophrenia was not statistically significant. Conclusions: These findings suggest that further study is needed about the processes that lead to dementia diagnoses in older individuals with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: People living with borderline personality disorder (BPD) face high levels of prejudice and discrimination from both the community and medical professionals, but no measure of prejudice toward people living with BPD exists. Aims: The current study aimed to adapt an existing Prejudice toward People with Mental Illness (PPMI) scale and investigate the structure and nomological network of prejudice toward people with BPD. Methods: The original 28-item PPMI scale was adapted to create the Prejudice toward People with Borderline Personality Disorder (PPBPD) scale. The scale and related measures were completed by three samples: 217 medical or clinical psychology students, 303 psychology undergraduate students, and 314 adults from the general population. Results: The original four-factor structure of the PPMI was supported in the PPBPD scale. Reported prejudice toward people with BPD was more negative than prejudice toward people with mental illness in general. The association of the PPBPD scale with antecedents and consequences was assessed, including social dominance orientation, right-wing authoritarianism, ethnocentrism, personality traits, empathy, prior contact, and feelings toward other stigmatized groups and mental illnesses. Conclusions: This study provided evidence for the validity and psychometric properties of the PPBPD scale across three samples and investigated anticipated relationships with theoretically related antecedents and consequences. This research will help improve understanding of the expressions underlying prejudice toward people with BPD. [ABSTRACT FROM AUTHOR]

Summary: This article reviews the risk equations recommended for use in international cardiovascular disease (CVD) primary prevention guidelines and assesses their suitability for use in Australia against a set of a priori defined selection criteria.The review and assessment were commissioned by the National Heart Foundation of Australia on behalf of the Australian Chronic Disease Prevention Alliance to inform recommendations on CVD risk estimation as part of the 2023 update of the Australian CVD risk assessment and management guidelines.Selected international risk equations were assessed against eight selection criteria: development using contemporary data; inclusion of established cardiovascular risk factors; inclusion of ethnicity and deprivation measures; prediction of a broad selection of fatal and non‐fatal CVD outcomes; population representativeness; model performance; external validation in an Australian dataset; and the ability to be recalibrated or modified.Of the ten risk prediction equations reviewed, the New Zealand PREDICT equation met seven of the eight selection criteria, and met additional usability criteria aimed at assessing the ability to apply the risk equation in practice in Australia. [ABSTRACT FROM AUTHOR]

The new RANZCP guidelines for the treatment of schizophrenia and related disorders highlights what we know works. In this paper, we examine why patients so often fail to benefit from this knowledge and why clinical practice falls so far short of the recommended standard. Instead of the continuous improvement that we expect of health care in general, in psychiatry we face an accelerating decline in systems of care. There has been a sustained underinvestment in public mental health care and a shared failure by State and Federal governments to construct and commit to a governance and funding model that can deliver the standard of care that is available in other major non-communicable diseases, and which we know is equally possible for severe mental illness. This paper sets out some of the reasons for the poor quality of care received by many people with schizophrenia and related disorders in Australia, and describes ways that care could be improved. In particular, we recommend an explicit statement of what constitutes an adequate standard of care, for people at all stages of these illnesses. This would help provide transparency about whether the care provided by mental health services achieves these benchmarks, and enable publication of results comparing the performance of different states and regional services. Patients and families, as well as professional, consumer and carer organizations would then be able to see clearly where the deficits are and demand resources and care that match the recommendations. [ABSTRACT FROM AUTHOR]

Introduction. Quality of health care contributes to poor physical health outcomes for people with mental health and substance use conditions (MHSUC). AIM. This study investigated experiences of people with MHSUC who sought help for a physical health condition in primary healthcare services, examining quality of care attributes. Methods. An online survey of adults currently or recently accessing services for MHSUC was fielded in 2022. Respondents were recruited nationally through mental health, addiction and lived experience networks and social media. The attributes of service quality assessed were relationships (respect and being listened to), discrimination due to MHSUC, and diagnostic overshadowing (MHSUC diagnosis distracted from physical health care). Results. Respondents who had used primary care services were included (n = 335). The majority of respondents reported both being treated with respect (81%) and being listened to (79%) always or most of the time. A minority of respondents reported diagnostic overshadowing (20%) or discrimination due to MHSUC (10%). People with four or more diagnoses or a diagnosis of bipolar disorder or schizophrenia had significantly worse experiences across all quality measures. Those with a diagnosis of substance use disorders had worse experiences for diagnostic overshadowing. Māori had worse experiences for respect and diagnostic overshadowing. Conclusions. Although many respondents reported good experiences in primary care, this was not the case for everyone. Quality of care was affected by type and number of diagnoses and the person's ethnicity. Interventions to reduce stigma and diagnostic overshadowing for people with MHSUC are needed in primary care services in New Zealand. [ABSTRACT FROM AUTHOR]

Objective: To report rates of Compulsory Community Treatment Order (CTO) use by District Health Boards (DHBs) in New Zealand and analyse whether socio-demographic factors explain any variability. Methods: The annualised rate of CTO use per 100,000 population was calculated for the years 2009–2018 using national databases. Rates were adjusted for age, gender, ethnicity, and deprivation and are reported according to DHBs to allow comparisons between regions. Results: The annualised rate of CTO use for New Zealand was 95.5 per 100,000 population. CTO use varied between DHBs from 53 to 184 per 100,000 population. Standardising for demographic variables and deprivation made little difference to this variation. CTO use was higher in males and young adults. Rates for Māori were more than three times that of Caucasian people. CTO use increased as deprivation became more severe. Conclusions: CTO use increases with Maori ethnicity, young adulthood, and deprivation. Adjusting for socio-demographic factors does not explain the wide variation in CTO use between DHBs in New Zealand. Other regional factors appear to be the major driver of variation in CTO use. [ABSTRACT FROM AUTHOR]

Background: To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention.Methods: The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National.Results: Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable.Conclusions: Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted.Study Registration: Australian New Zealand Clinical Trials Registry (ANZCTR; Trial ID ACTRN123615000564550). [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the location of acute mental health inpatient units in general hospitals by mapping their location relative to hospital facilities and community facilities and to compare their proximity to hospital facilities with that of general medical acute units. Methods: We obtained Google maps and hospital site maps for all New Zealand public hospitals. Geographic data were analysed and mental health units' locations in relation to hospital facilities and public amenities were mapped. Radar plots were constructed comparing acute medical and mental health units' locations in relation to hospital facilities. Results: Twenty-two mental health units were identified. They were located predominantly at the periphery of hospital campuses, but also at a distance from community facilities. Compared to acute medical units, mental health units were almost universally located further from shared hospital facilities – with distances approximately three times further to reach the main hospital entrance (2.7 times distance), the nearest public café (3.4 times), the emergency department (2.4 times), and medical imaging (3.3 times). Conclusion: Despite the reforms of the 20th Century, mental health units still appear to occupy a liminal space; neither fully integrated into the hospital, nor part of the community. The findings warrant further investigation to understand the impact of these structural factors on parity of health care provision between mental and physical health care and the ability of mental health care services to support recovery. [ABSTRACT FROM AUTHOR]

For people with autism spectrum disorder (ASD), the risk of mental illness, including suicidality, has a higher prevalence than the general population. This scoping review explored how people with ASD access suicide hotlines/crisis support services; and current approaches to delivering mental health services (MHS) to people with ASD. A search identified 28 studies meeting the selection criteria with analysis revealing four key findings. The support received by the person with ASD influenced how they accessed MHS; people often encounter barriers to accessing MHS; a separation exists between autism and MHS; and no studies on accessing or delivering MHS through crisis hotlines. The presence of such autism-specific crisis hotlines and the dearth of studies suggest a void in the existing research. [ABSTRACT FROM AUTHOR]

This study aimed to compare the Kessler Psychological Distress Scale (K10) and Short-Form 12-Item Health Survey Mental Component Score (SF-12 MCS) for the effectiveness as screening tools for depression in Asian New Zealanders. A national, representative New Zealand Health Survey (NZHS) data set was used. In total, 1,277 participants were included in the analyses. The sensitivity and specificity values, as well as the areas under the receiver operating characteristics curves (AUROC), for the K10 and the SF-12 MCS scores were examined. The AUROCs for K10 and SF-12 MCS were 0.787 (95% CI [0.736, 0.837]) and 0.725 (95% CI [0.656, 0.793]), respectively. A less than optimal sensitivity and positive predictive value of K10 support the need to reexamine the optimal cut-off point according to the results of the Youden index. Strengthening the K10 predictive accuracy will increase the practical application among Asian populations. [ABSTRACT FROM AUTHOR]

Dialectical Behaviour Therapy (DBT) is an intensive and multi-modal intervention developed for individuals with multiple comorbidities and high-risk behaviours. During pandemic-related lockdowns, many DBT services transitioned to delivering treatment via telehealth, but some did not. The current study sought to explore the experience of DBT teams in Australia and New Zealand who did and did not transition to telehealth during the early stages of the COVID19 pandemic, as the majority of research on DBT via telehealth has originated from North America, and focussed on therapists who did make this transition. DBT team leaders in Australia and New Zealand completed a survey with open-ended questions about the barriers they encountered to delivering DBT via telehealth, and for those teams that implemented telehealth, the solutions to those barriers. Respondents were also asked about specific barriers encountered by Indigenous and Pacific people service users. Of the 73 team leaders who took part, 56 reported providing either individual therapy, skills training or both modalities via video-call during lockdown. Themes emerging from perceived barriers affecting just DBT providers included the assessment & management of emotions and high-risk behaviours, threats to privacy and information security posed by telehealth, logistical issues related to remote sessions, and the remote management of therapy-interfering behaviour. Themes emerging from perceived barriers affecting both providers and service users included disruptions to therapeutic alliance, lack of willingness, lack of technical knowledge, lack of private spaces to do DBT via telehealth, and lack of resources. The solutions most frequently cited were the provision of education and training for therapists and service users in the use of telehealth, and the provision of resources to access telehealth. These findings are relevant to clinical delivery of DBT, as well as planning and funding for DBT telehealth services. [ABSTRACT FROM AUTHOR]

Background: An international systematic review concluded that individuals with poor social health (social isolation, lack of social support or loneliness) are 30% more likely to develop coronary heart disease (CHD) and stroke. Notably, the two included Australian papers reported no association between social health and CHD or stroke. Objective: We undertook a systematic review and meta‐analysis to investigate the association between social isolation, lack of social support and loneliness and cardiovascular disease (CVD) incidence among people living in Australia and New Zealand. Methods: Four electronic databases were systematically searched for longitudinal studies published until June 2020. Two reviewers undertook title/abstract screen and one reviewer undertook full‐text screen and data extraction. Quality was assessed using the Newcastle – Ottawa Quality Assessment Scale. Results: Of the 725 unique records retrieved, five papers met our inclusion criteria. These papers reported data from three Australian longitudinal datasets, with a total of 2137 CHD and 590 stroke events recorded over follow‐up periods ranging from 3 to 16 years. Reports of two CHD and two stroke outcomes were suitable for meta‐analysis. The included papers reported no association between social health and incidence of CVD in all fully adjusted models and most unadjusted models. Conclusions: Our systematic review is inconclusive as it identified only a few studies, which relied heavily on self‐reported CVD. Further studies using medical diagnosis of CVD, and assessing the potential influence of residential remoteness, are needed to better understand the relationship between social health and CVD incidence in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation is considered the ideal treatment for most people with kidney failure, conferring both survival and quality of life advantages, and is more cost effective than dialysis. Yet, current health systems may serve some people better than others, creating inequities in access to kidney failure treatments and health outcomes. AcceSS and Equity in Transplantation (ASSET) investigators aim to create a linked data platform to facilitate research enquiry into equity of health service delivery for people with kidney failure in New Zealand. Methods: The New Zealand Ministry of Health will use patients' National Health Index (NHI) numbers to deterministically link individual records held in existing registry and administrative health databases in New Zealand to create the data platform. The initial data linkage will include a study population of incident patients captured in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), New Zealand Blood Service Database and the Australia and New Zealand Living Kidney Donor Registry (ANZLKD) from 2006 to 2019 and their linked health data. Health data sources will include National Non-Admitted Patient Collection Data, National Minimum Dataset, Cancer Registry, Programme for the Integration of Mental Health Data (PRIMHD), Pharmaceutical Claims Database and Mortality Collection Database. Initial exemplar studies include 1) kidney waitlist dynamics and pathway to transplantation; 2) impact of mental illness on accessing kidney waitlist and transplantation; 3) health service use of living donors following donation. Conclusion: The AcceSS and Equity in Transplantation (ASSET) linked data platform will provide opportunity for population-based health services research to examine equity in health care delivery and health outcomes in New Zealand. It also offers potential to inform future service planning by identifying where improvements can be made in the current health system to promote equity in access to health services for those in New Zealand. [ABSTRACT FROM AUTHOR]

On 16 March 2020 the District Court in Auckland, New Zealand, had its first sitting as a court dedicated exclusively to cases where issues of fitness to stand trial or insanity had been raised. The impetus for these court sittings, called 'the CPMIP Court' [after the Criminal Procedure (Mentally Impaired Persons) Act 2003], was to reduce delays for mentally impaired defendants, and improve the coverage and efficiency of mental health advice to the Court from both Court Liaison Nurses and Health Assessors (Psychiatrists and Psychologists). This article looks at the model in operation and reflects on some early outcome data, as the possibility of further expansion of this model is contemplated in other regions. We also consider broader challenges currently facing mentally impaired defendants in New Zealand's criminal justice system, and argue that other innovative judicial approaches such as the establishment of problem-solving mental health courts should be considered. [ABSTRACT FROM AUTHOR]

Objective: With longer life expectancies, cardiovascular diseases are increasingly common among older adults, which also leads to functional changes that severely impact their quality of life. This study aimed to identify the predictors of health‐related quality of life (HRQOL) among older New Zealanders with cardiovascular health problems. Methods: A cross‐sectional data analysis of the 2015/16 New Zealand Health Survey was performed. In total, 2203 older New Zealanders with cardiovascular health problems were identified and included in the final analyses. The association between demographics, physical activity, health measurements, and HRQOL was examined using a multiple linear regression model. Results: Significant differences in HRQOL were identified between the demographics and cardiovascular risk factors. Predictors of higher HRQOL among older New Zealanders with cardiovascular conditions were increased physical activity (β = 0.218), age (β = −0.067), employed (β = 0.137), lower waist circumference (β = −0.261), male (β = 0.127), and being without a history of diabetes (β = −0.071). Conclusions: Physical activity is the strongest predictor of HRQOL in older adults with cardiovascular problems. Older female New Zealanders with cardiovascular health problems have lower perceptions of their health status. These predictors should be considered while designing and developing intervention and health education that aims to improve the HRQOL of older adults. [ABSTRACT FROM AUTHOR]

Aim: To understand violence on acute mental health units according to staff and service user perspectives and experiences. Background: The collateral damage of violence in acute inpatient mental health settings is wide-ranging, impacting on the health and wellbeing of staff and service users, and detrimental to public perceptions of people who are mentally unwell. Despite international research on the topic, few studies have examined psychiatric unit violence from both staff and service user perspectives. Methods: We conducted in-depth interviews with 85 people (42 staff, 43 service users) in four adult acute mental health inpatient units in New Zealand. We undertook a thematic analysis of perspectives on the contributing factors and consequences of violence on the unit. Results: Both staff and service users indicated violence was a frequent problem in acute inpatient units. Four themes regarding the causes of violence emerged: individual service user factors, the built environment, organisational factors, and the overall social milieu of the unit. Staff often highlighted complexities of the system as causal factors. These included the difficulties of managing diverse service user illnesses within an inadequate and unsafe built environment whilst having to contend with staffing issues and idiosyncrasies relating to rule enforcement. In contrast, service users talked of their needs for care and autonomy not being met in an atmosphere of paternalism, boredom due to restrictions and lack of meaningful activities, enforced medication, and physical confinement as precipitants to violence. Two broader themes also emerged, both relating to empathy. Both staff and service users exhibited 'othering' (characterised by a profound lack of empathy) in relation to acutely unwell individuals. Explanations for violent behaviour on the unit differed between groups, with service users being more likely to attribute unwanted behaviour to contextual factors and staff more likely to 'blame' mental illness. The consequences of violence included stress, physical injury, and a culture of fear and stigma. Conclusion: Violence in acute inpatient mental health units in New Zealand is a significant, complex, and unresolved problem negatively impacting the therapeutic mission of these settings. Further in-depth qualitative investigations are urgently required into what is experienced as violence by service users, their view of how violence occurs, the role of fear and power relations, and the contributions of the built and organisational environment to all forms of violence to all unit users. A core function of the acute mental health unit is to offer a therapeutic environment for individuals at their most vulnerable. For this to happen, the unit must be a rewarding place to work, and a safe place to be. [ABSTRACT FROM AUTHOR]

Trauma involving violation of trust, or betrayal trauma, plays a significant role in the lifetime trajectories of homeless adults. This study investigates this type of trauma and posttraumatic stress disorder (PTSD) symptom severity in the chronically homeless population. The sample consisted of 77 adults with a history of trauma and chronic homelessness in Melbourne, Australia. Using the Composite International Diagnostic Interview Traumatic Events Questionnaire, participants nominated their worst traumatic event and self-reported if their trust was violated as a result of that trauma. PTSD symptom severity was assessed by the 6-item PTSD Checklist. Forty percent of the sample reported violation of trust occurred in their worst trauma. Within this group, 80.6% screened positive for PTSD, compared to 50.0% of those whose worst trauma had not involved a trust violation (p =.006). The violation of trust group presented with significantly more severe PTSD symptoms, in comparison to the group without violation of trust during their worst trauma, controlling for gender, age of worst trauma, cumulative trauma, and psychological distress (p =.020). The findings highlight the importance of providing trauma-informed care and trauma-specific treatment for chronically homeless adults. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12616000162415. [ABSTRACT FROM AUTHOR]

Objective: We aim to determine psychiatrists' identified factors associated with suitability of discharging patients on long-acting injectable antipsychotics (LAI) from specialist to primary care.Method: We undertook a retrospective observational study utilising case file reviews. A questionnaire was developed specifically for this including sociodemographic information, clinical characteristics of the patients and clinical opinion on suitability of discharge to primary care.Results: In total, 72 case files (51 men, 21 women) were included in the study. The most common diagnosis was schizophrenia (71%) and Risperidone was the most often used LAI (71%). Fourteen (19%) of the patients were deemed suitable for discharge to primary care. A minimum period of 1 year of stability, having good cognitive function and insight, and absence of high-risk history were associated with suitability for discharge.Conclusions: Treating psychiatrists consider only a minority of patients on long-acting injection antipsychotics as suitable for discharge to primary care. [ABSTRACT FROM AUTHOR]

This paper will look at the appropriateness of the management of mental illness for Maori in general. It is also the beginning of a study about the impact that 'mental illness' has on Maori women during pregnancy and childbirth. As a matter of course in New Zealand, the management of severe mental illness is accessed by way of Western treatment service, typically in a state funded and managed hospital environment. Discussion will revolve around the appropriateness of these Western treatment approaches, and whether they serve the wellbeing, cultural values and beliefs of Maori in health settings. [ABSTRACT FROM AUTHOR]

Background: Patients with depressive symptoms are common in primary care. Brief, simple therapies are needed. Aim: Is a focussed acceptance and commitment therapy (FACT) intervention more effective than the control group for patients with depressive symptoms in primary care at one week follow up? Design and setting: A randomised, blinded controlled trial at a single primary care clinic in Auckland, New Zealand. Methods: Patients presenting to their primary care practice for any reason were recruited from the clinic waiting room. Eligible patients who scored ≥2 on the PHQ-2 indicating potential depressive symptoms were randomised using a remote computer to intervention or control groups. Both groups received a psychosocial assessment using the "work-love-play" questionnaire. The intervention group received additional FACT-based behavioural activation activities. The primary outcome was the mean PHQ-8 score at one week. Results: 57 participants entered the trial and 52 had complete outcome data after one week. Baseline PHQ-8 scores were similar for intervention (11.0) and control (11.7). After one week, the mean PHQ-8 score was significantly lower in the intervention group (7.4 vs 10.1 for control; p<0.039 one sided and 0.078 two sided). The number needed to treat to achieve a PHQ-8 score ≤6 was 4.0 on intention to treat analysis (p = 0.043 two sided). There were no significant differences observed on the secondary outcomes. Conclusion: This is the first effectiveness study to examine FACT in any population. The results suggest that it is effective compared with control, at one week, for patients with depressive symptoms in primary care. [ABSTRACT FROM AUTHOR]

Background: People with a mental health condition have a shorter life expectancy than the general population. This is largely attributable to higher rates of chronic disease and a higher prevalence of modifiable health risk behaviours including tobacco smoking, alcohol consumption, poor nutrition, and physical inactivity. Telephone support services offer a viable option to provide support to reduce these health risk behaviours at a population-level; however, whilst there is some research pertaining to Quitlines, there is limited other research investigating whether telephone services may offer effective support for people with a mental health condition. This protocol describes a randomised controlled trial that aims to evaluate the referral of people with a mental health condition to a population-level telephone coaching service to increase physical activity, healthy eating, or weight management, and increase attempts to do so.Methods: A parallel-group randomised controlled trial will be conducted recruiting participants with a mental health condition through community mental health services and advertisement on social media. Participants will be randomly assigned to receive either a health information pack only (control) or a health information pack and a proactive referral to a free, government-funded telephone coaching service, the NSW Get Healthy Coaching and Information Service® (intervention), which offers up to 13 telephone coaching calls with a University Qualified Health Coach to assist with client-identified goals relating to physical activity, healthy eating, weight management, or alcohol reduction. Data will be collected via telephone surveys at baseline and 6 months post-recruitment. Primary outcomes are as follows: (1) minutes of moderate to vigorous physical activity per week, (2) serves of fruit consumed per day, (3) serves of vegetables consumed per day, and (4) a composite measure assessing attempts to change at least one health risk behaviour (any attempts to change physical activity, fruit consumption, vegetable consumption, or other parts of nutrition). Secondary outcomes include weight and body mass index.Discussion: This study is the first to evaluate the effectiveness of referral to a population-level telephone support service for reducing health risk behaviours relating to physical activity, healthy eating, and weight in people with a mental health condition. Results will inform future policy and practice regarding the delivery of telephone-based behaviour change coaching services and the management of physical health for this population to reduce health inequity and the burden of chronic disease.Trial Registration: The Australian New Zealand Clinical Trials Registry ACTRN12620000351910 . Retrospectively registered on 12 March 2020. [ABSTRACT FROM AUTHOR]

Background: People who smoke with serious mental illness carry disproportionate costs from smoking, including poor health and premature death from tobacco-related illnesses. Hospitals in New Zealand are ostensibly smoke-free; however, some mental health wards have resisted implementing this policy. Aim: This study explored smoking in acute metal health wards using data emerging from a large sociological study on modern acute psychiatric units. Methods: Eighty-five in-depth, semi-structured interviews were conducted with staff and service users from four units. Data were analysed using a social constructionist problem representation approach. Results: Although high-level smoke-free policies were mandatory, most participants disregarded these policies and smoking occurred in internal courtyards. Staff reasoned that acute admissions were not the time to quit smoking, citing the sceptres of distress and possibly violence; further, they found smoking challenging to combat. Inconsistent enforcement of smoke-free policies was common and problematic. Many service users also rejected smoke-free policies; they considered smoking facilitated social connections, alleviated boredom, and helped them feel calm in a distressing environment – some started or increased smoking following admission. A minority viewed smoking as a problem; a fire hazard, or pollutant. No one mentioned its health risks. Conclusion: Psychiatric wards remain overlooked corners where hospital smoke-free policies are inconsistently applied or ignored. Well-meaning staff hold strong but anachronistic views about smoking. To neglect smoking cessation support for people with serious mental illness is discriminatory and perpetuates health and socioeconomic inequities. However, blanket applications of generic policy are unlikely to succeed. Solutions may include myth-busting education for service users and staff, local champions, and strong managerial support and leadership, with additional resourcing during transition phases. Smoke-free policies need consistent application with non-judgemental NRT and, potentially, other treatments. Smoking cessation would be supported by better designed facilities with more options for alleviating boredom, expressing autonomy, facilitating social connections, and reducing distress. [ABSTRACT FROM AUTHOR]

Background: Changes in pharmacy models of care, services and funding have been occurring internationally, moving away from the traditional dispensing role to more extended patient-facing roles utilising pharmacists' clinical skills. This study aimed to identify the extended services offered by community pharmacy in Aotearoa New Zealand and the barriers and facilitators to extended services provision. The study is unique in that it includes intern (pre-registration) pharmacists.Methods: An online survey, conducted in 2018, of all pharmacists and intern (pre-registration) pharmacists working in a community pharmacy. Data were analysed using descriptive statistics and regression analyses.Results: The results are based on replies from 553 community pharmacists and 59 intern pharmacists (response rate: 19 and 26% respectively). Both pharmacists (83%) and interns (85%) want to work at the top of their scope of practice. Wide variation exists in the specific services individual pharmacists offer. Most pharmacists were accredited to supply the emergency contraceptive pill (95%), sildenafil for erectile dysfunction (86%) and trimethoprim for uncomplicated urinary tract infection (85%). Fewer were able to immunise (34%) or to supply selected oral contraceptives (44%). Just under a quarter could provide a Medicines Use Review (MUR) or Community Pharmacy Anticoagulation Management Service (CPAMS). Of the pharmacists not already accredited, 85% intended to gain accreditation to supply selected oral contraceptives, 40% to become vaccinators, 37% to offer CPAMS and 30% MUR. Interns expressed strong interest in becoming accredited for all extended services. Poisson regression analyses showed key factors supporting the likelihood of providing extended services were owner and management support and appropriate space and equipment. Being excited about the opportunities in community pharmacy, having employer funding and time for training and sufficient support staff were also statistically significant.Conclusions: Pharmacists need time and a supportive management structure to enable them to deliver extended services. Health policy with a greater strategic emphasis on funding services and pharmacist training, and developing technician support roles, will help to minimise or eliminate some of the barriers to role expansion both in Aotearoa New Zealand and internationally. [ABSTRACT FROM AUTHOR]