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The authors highlight study findings that show the scope and resilience of the private sector in meeting the challenge of the COVID-19 pandemic and the previous private-public sector collaborative initiatives that could be revivified. Topics mentioned include the launch of telehealth items in the Medicare Benefits Schedule, the need for health economic and needs analyses to determine where gaps exist between the public and private sectors, and the future of private psychiatry.

Objective: Indigenous suicide prevention is an important focus for national health policies. Indigenous suicide rates in formerly colonial English-speaking countries such as the United States, Australia and New Zealand are considerably higher than the general population, particularly in young males. Given the similarities in their sociocultural history, a time series analysis was conducted to assess recent sex and age trends of suicide in the Indigenous and general populations in the United States, Australia and New Zealand. Methods: Using the number of deaths by intentional self-harm and estimated resident population, suicide incidence rates were calculated for the years 2006–2019 and stratified by Indigenous status, year, time period, sex and age group (above 15 years). Incidence rates were plotted. Using the Poisson regression model, calculated suicide incidence rate ratios were used to make comparisons for sex and age. Results: Across all countries studied, Indigenous suicide rates have increased over time, with Indigenous males having higher suicide rates than Indigenous females. However, the increase in Indigenous female suicides was greater than that for Indigenous males in Australia and New Zealand. Indigenous males aged 15–44 years have the highest suicide rates across all countries. Conclusion: Indigenous suicide rates have remained consistently high in the United States, Australia and New Zealand, with Indigenous males aged 15–44 years showing the highest rate. However, suicide rates for Indigenous females in Australia and New Zealand are increasing more rapidly than males. Given this, it is critical that further research is dedicated to understanding and addressing the issues driving this problem, particularly in youth. [ABSTRACT FROM AUTHOR]

Pandemic mask requirements make face-to-face OSCEs difficult for simulated patient interviews, which are a core component of the summative assessment of clinical skills in Psychiatry and Addiction Medicine. Conduct and evaluation of final-year medical student summative assessments in psychiatry and addiction medicine during COVID-19: an Australian University Medical School experience. Dear Sir, For the 2022 academic year, medical schools still face uncertainty regarding the ongoing impact of the Coronavirus Disease 2019 (COVID-19) pandemic on teaching and summative assessment. [Extracted from the article]

For patients who remain concerned about COVID-19 and vaccination, recommend patients consult their GP. However, our patients are exposed to media regarding vaccine hesitancy and misinformation[1] about COVID-19.[2] Therefore, practical medical advice regarding COVID-19 protective measures and vaccination is crucial. [Extracted from the article]

Objective: We explore telehealth use by private psychiatrists in Victoria during the first 12 months of COVID-19, in the context of: COVID-19 case numbers and restrictions; telehealth use in Victoria compared to national use; telehealth and face-to-face consultations during the first 12 months of COVID-19 compared to face-to-face consultations in the 12 months pre-COVID-19. Method: Outpatient psychiatric face-to-face and telehealth consultations, from March 2020 to February 2021 in Victoria, were analysed using face-to-face consultations from March 2019 to February 2020 as a comparison group, and compared to national telehealth use and trends in COVID-19 case rates. Results: Total psychiatric consultations increased by 16% from March 2020 to February 2021. Telehealth compromised 56% of total, peaking at 70% of consultations in August during the height of COVID-19 cases. Thirty-three percent of total consultations and 59% of telehealth consultations were via telephone. Telehealth consultations per capita in Victoria were consistently lower than the overall Australian level. Conclusion: Telehealth usage during the first 12 months of COVID-19 in Victoria suggests it is a feasible alternative to face-to-face treatment. Telehealth-mediated increases in psychiatric consultations likely indicates an increased psychosocial need for support. [ABSTRACT FROM AUTHOR]

The authors explore the neural circuit basis of neurodegenerative diseases which include Alzheimer's disease, dementias and cerebrovascular disease. They acknowledge significant impact of these conditions on cognition, emotions and movement of afflicted individuals. They also discuss studies which investigated the phenotype of these diseases, the need to map structural changes in the subcortical connectome of the brain, and the use of diffusion tensor imaging for visualizing neural tracts.

The authors comment on the article "Rethinking Psychotropics in Nursing Homes," which raises concern regarding the potential overuse of psychotropic medication in residential aged care facilities (RACF) in Australia. They cite systematic problems behind the high rates of use of psychotropic medication in RACF, such as poorly remunerated staff with limited mental health and behavioural management training. They argue that the mode of delivery of care can impact on RACF residents.

The article presents the discussion on Australia having a largely dehospitalised mental health system where majority of non-acute beds in stand-alone psychiatric hospitals being closed without ready access to food, water or toilets, with heightened risks of clinical deterioration.

Keywords: Academic; medical; mental disorder; logorrhoea; obsessive-compulsive EN Academic medical mental disorder logorrhoea obsessive-compulsive 104 105 2 02/08/21 20210201 NES 210201 Dear Sir, We describe diagnostic criteria for a debilitating new mental disorder emergent during the COVID-19 pandemic: "COVID-19 isolated-academic logorrhoea". This disorder has emerged in the university academic population, but we have noted particular prevalence among medical school academics, possibly as their COVID-19 pandemic clinical duties have impeded their research and teaching. [Extracted from the article]

Objective: We examine whether the recent World Health Organization (WHO) report on global mental health uses severity of illness as a criterion in priority setting for resource allocation. Conclusions: The WHO does not prioritise severity in the recent landmark World Mental Health Report. It recommends instead the insuperable task of scaling-up interventions for broadly defined mental health conditions, including milder distress, amongst over a billion people, with the majority living in low- and middle-income countries. Schizophrenia, the most severe and disabling of all psychiatric illnesses, is relatively neglected in the WHO report, and the disability associated with bipolar disorder is underestimated. This is inconsistent with the ethical principle of vertical equity, where the most severe illnesses should receive the greatest priority. The global mental health movement must refocus on deinstitutionalisation, and ensure adequate community and general hospital treatment for severe illnesses, especially the 24 million people with schizophrenia. [ABSTRACT FROM AUTHOR]

The article reports on data from the Australian Bureau of Statistics which revealed higher suicide rates in rural areas, particularly among Aboriginal and Torres Strait Islander people. Topics discussed include the lowest suicide rates in Sydney, New South Wales and Melbourne, Victoria, the significant gap between the largest conurbations and the rest of the country, and the social indicators that influencing suicide rates.

The article focuses on the required numbers of psychiatric beds in Australia. Topics include policy of reduction of hospital based adult non-acute bed numbers in Western Australia where out-dated beds were closed without commissioning new beds, relation of the Pareto effect in healthcare that is few patients needing disproportionate amounts of hospital care, and extended stays on acute wards for treatment-resistant conditions that are associated with high levels of aggression.

The article discusses the challenges in implement telehealth for patients with schizophrenia and other psychosis during the COVID-19 pandemic. Topics discussed include the significant role of psychiatrists in the shift towards telehealth, responses of patients with schizophrenia or other psychosis to an invitation to a video telehealth, and factors that impede assessment of mood and affect.

Objective: The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation. Methods: Monthly counts of face-to-face and telehealth (videoconferencing and telephone) MBS items for psychiatrists and physicians from January 2017 to December 2022 were compiled from Services Australia MBS Item Reports. Usage levels were compared before and after telehealth item expansion. Usage trends for MBS telepsychiatry and physician telehealth items were compared in time-series plots. Results: Telehealth item expansion resulted in a greater rise of telepsychiatry services from 3.8% beforehand to 43.8% of total services subsequently, compared with physician telehealth services (from 0.6% to 20.0%). More physician telehealth services were by telephone compared with telepsychiatry services. Time-series of both telehealth services displayed similar patterns until mid-2022, when physician telehealth services declined as telephone items were restricted. Telepsychiatry services consistently comprised a greater proportion of total services than physician telehealth services. Conclusions: MBS psychiatrist services showed a more substantial and persistent shift to telehealth than physician services, suggesting a greater preference and use of telepsychiatry. [ABSTRACT FROM AUTHOR]

Objective: Bullying is common in medical specialist training in Australia. To understand bullying rates across medical specialist training programs, we analyse the recent Medical Training Survey, administered by the Medical Board of Australia to all registered medical practitioners. Methods: Medical Training Survey data were extracted and averaged from 2020 to 2023. Results: Many speciality trainees reported personally experiencing or witnessing bullying. This was lowest in general practice (13% personally experienced and 15% witnessed) and highest in obstetrics and gynaecology (27% and 41%). The highest rate of bullying by supervisors was in surgery: 60% of surgical trainees stated that when they were bullied it was by their supervisor. Within psychiatry, 22% of trainees had personally experienced bullying and 32% of trainees had witnessed bullying. When they were bullied, the perpetrator was less commonly a supervisor (40%). In all specialities, there was a very low percentage of bullying which was reported, and was identified as having a satisfactory outcome: the most satisfactory outcomes (13%) were in general practice. Conclusion: Current rates of bullying for medical specialist trainees, the reluctance to report, as well as the lack of satisfactory outcomes, is of grave concern for Australian healthcare. This requires urgent attention at a systems level. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to the major and minor neurocognitive disorders as discussed in the book "DSM-5: Diagnostic and Statistical Manual of Mental Disorders."

Objective: This study aims to describe the trends in community incidence, community prevalence, mortality, overnight hospital admission rates and average overnight inpatient length of stay (ALOS) for anorexia nervosa (AN) amongst young females aged 15-29 in Australia, between 1998–2018. Methods: Hospitalisation and ALOS data was obtained from the Australian Institute of Health and Welfare principal data cubes. Epidemiological data relating to community-level incidence, community-level prevalence, disability adjusted life years (DALY) and mortality were obtained from the Global Health Data Exchange. We analysed the community and hospital rates for AN in 3 female age groups, 15-19, 20-24 and 25-29. Results: Overnight hospital female admission rates for AN have substantially increased over the past two decades, with a higher rate increase between 2008-2018 for 15-29 age groups. The largest absolute increases were seen in the 15-19 female age group. Community prevalence and DALYs increased slightly, whilst community incidence has remained relatively stable. During the study period, mortality rates and the average hospital inpatient length of stay for AN declined for females 15-29 years. Conclusion: Overnight hospitalisation rates for AN particularly increased amongst young females (15-29) in Australia over the past decade. Less substantial increases in community incidence, community prevalence and DALYs, and declining mortality were also observed. [ABSTRACT FROM AUTHOR]

Objective: Victoria has low numbers of general adult psychiatric beds per capita by Australian and international standards. Hospital key performance indicators (KPIs) such as bed occupancy rates, emergency department waiting times and inpatient lengths of stay are proximal measures of the effects any shortfall in beds. We investigate the real-world performance of Victorian hospitals during the first year of the COVID-19 pandemic and the extended lockdowns in 2020. Conclusions: The Victorian inpatient psychiatric system is characterised by high bed occupancies in many regions, extended stays in emergency departments awaiting a bed, and short inpatient lengths of stay, except for patients with excessively long stays on acute units (over 35 days) who are unable to be admitted to non-acute facilities. At the end of 2020, bed occupancies were high (above 90%) in 10 regions, with three regions having bed occupancies over 100%. However, state-wide average bed occupancy improved between 2019 (94%) and 2020 (88%). Other KPIs remained steady because acute hospitals did not experience the expected pandemic mental health demand-surge. For a more complete picture of the impact of the pandemic, Australia needs interconnected, centralised data systems. [ABSTRACT FROM AUTHOR]

Objective: Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. Methods: out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021–2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. Results: Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. Conclusions: Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations. [ABSTRACT FROM AUTHOR]

Objective: The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (BPD) proposed a major change for youth mental health services. The Alliance recommended that early detection and specialised treatment for youth BPD becomes a major focus of their clinical activities. Since structured psychotherapies for BPD are complex and lengthy, this proposal has significant implications for youth policy, planning and resource allocation. Our commentary addresses whether BPD is diagnosable and treatable in youth, and whether early intervention results in longer-term benefits. Conclusion: People diagnosed with BPD are highly heterogeneous and experience high levels of comorbidity. The low quality of the evidence for the treatment of BPD in adolescence limits our ability to develop evidence-based guidelines. Accordingly, there is no clear case for BPD early intervention as a major component of youth mental health services. The introduction of ICD-11 classification system may facilitate further empirical studies of personality disorders in adolescence and emerging adulthood. [ABSTRACT FROM AUTHOR]

The author discusses the interaction between the dimensional level of research domain criteria in Australia and classification tools such as "Diagnostic and Statistical Manual of Mental Disorders" and "International Classification of Diseases" (DSM-5/ICD-II). Topics include the failure of Australian psychiatrists to adhere to DSM-5/ICD-II, why DSM-5 may be considered passing due to lack of neuroimaging markers, and the need to refine the descriptions of neuropsychiatric disorders.

Objective: The Australian federal government is considering a 'digital front door' to mental healthcare. The Brain and Mind Centre at the University of Sydney has published a discussion paper advocating that the government should adopt a comprehensive model of digital triage and monitoring (DTM) based on a government-funded initiative Project Synergy ($30 million). We critically examine the final report on Project Synergy, which is now available under a Freedom of Information request. Conclusion: The DTM model is disruptive. Non-government organisations would replace general practitioners as care coordinators. Patients, private psychiatrists, and psychologists would be subjected to additional layers of administration, assessment, and digital compliance, which may decrease efficiency, and lengthen the duration of untreated illness. Only one patient was deemed eligible for DTM, however, during the 8-month regional trial of Project Synergy (recruitment rate = 1/500,000 across the region). Instead of an unproven DTM model, the proposed 'digital front door' to Australian mental healthcare should emphasise technology-enabled shared care (general practitioners and mental health professionals) for the treatment of moderate-to-severe illness. [ABSTRACT FROM AUTHOR]

Objective: In the context of concerns regarding hospital access block, this paper provides a descriptive longitudinal analysis of mental health–related ED episodes in Australian public hospitals between 2016-17 and 2020-21. Method: We descriptively analysed Australian Institute of Health and Welfare data for mental health–related ED presentations, outcomes and 5-year trends for Australian public hospitals. Results: There were more than 300,000 Australian mental health–related ED presentations in 2020-21. Presentations increased by an average annual rate of 2.8% between 2016-17 and 2020-21, commonly involving first responder (police, paramedic) attendance. From 2016-17 to 2020-21, the average annual rate of mental health–related ED presentations receiving a triage category of resuscitation increased by 13.7%, emergency by 9.4% and urgent by 4.7%. 90% of MH-related ED presentations were completed within 14 h, which was longer than the 90th percentile for all ED presentations (up to 8 h). Conclusions: Current mental health policies have not stemmed the rising tide of ED presentations. Mental health–related ED presentations are increasing in number and severity, likely due to health systemic and societal factors. Psychiatry patients stay longer in EDs than other patients. Healthcare reforms should be targeted to provide the best outcome based on principles of equity of access. [ABSTRACT FROM AUTHOR]

Objective: To provide analysis and commentary on Australian state/territory child and adolescent mental health service (CAMHS) expenditure, inpatient and ambulatory structure and key performance indicators. Method: Data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics were descriptively analysed. Results: Between 2015–16 and 2019–20, overall CAMHS expenditure increased by an average annual rate of 3.6%. Per capita expenditure increased at a higher rate than for other subspeciality services. CAMHS admissions had a higher cost per patient day, shorter length of stay, higher readmission rate and lower rates of significant improvement. Adolescents aged 12–17 had high community CAMHS utilisation, based on proportion of population coverage and number of service contacts. CAMHS outpatient outcomes were similar to other age-groups. There were high rates of 'Mental disorder not otherwise specified', depression and adjustment/stress-related disorders as principal diagnoses in community CAMHS episodes. Conclusions: CAMHS inpatient admissions had lower rates of significant improvement and higher 14-day readmission rates than other ages. Australia's young population had a high outpatient CAMHS contact rate. Evidence-based modelling of CAMHS providers and outcomes may inform future service improvement. [ABSTRACT FROM AUTHOR]

Objective: Commentary on the debate concerning the effectiveness of headspace, including the most recent independent evaluation of its services. Conclusions: The available evaluations indicate that headspace does not deliver therapy of adequate duration that results in clinically significant improvement. Most evaluations have used either short-term process measures or uncontrolled satisfaction surveys, and where there have been data on outcomes using standardised instruments, findings have been disappointing. Costs are poorly quantified and probably underestimated. Even so, headspace as a primary care intervention costs twice as much as a mental health consultation by a general practitioner and, depending on the assumptions, may not be cost effective. [ABSTRACT FROM AUTHOR]

Objective: To provide a commentary on Australian state/territory older persons mental health service (OPMHS) expenditure, inpatient and outpatient services and key performance indicators (KPIs). Method: Descriptive analysis of data from the Australian Institute of Health and Welfare (AIHW), the Australian Bureau of Statistics and the World Health Organisation. Results: Between 2015–16 and 2019–20, annual expenditure on OPMHS in Australia increased by an average of only 2.3%, compared to 2.9% for all population groups, despite an increase in the number of over 65 year olds. Per capita recurrent expenditure on OPMHS decreased by an average of 1% annually. Australia's total mental health beds increased, whereas OPMHS beds decreased, mainly due to a reduction in non-acute beds. Outcomes for OPMHS admissions were similar to other age groups, except for a longer length of stay and reduced readmission rate. Older Australians accessed ambulatory mental health care at a lower rate and had a lower rate of improvement after a completed episode. Conclusions: OPMHS expenditure has not increased at commensurate levels compared to other populations. The mental health of people aged over 65 appears to be a neglected policy priority in Australia. The Royal Commission into Aged Care Quality and Safety may herald service and expenditure changes. [ABSTRACT FROM AUTHOR]

Objectives: Australia is piloting a stand-alone early intervention programme for psychosis, based on the Early Psychosis Prevention and Intervention Centre (EPPIC) model that was developed within mainstream Victorian State Government psychiatric services. The Australian early intervention programme is located in primary care, and badged as ' headspace Early Psychosis Youth Services'. There are currently six metropolitan early intervention services with two further services planned for the 2023 Financial Year. We discuss key findings from an external evaluation of the first six services, released by the Australian Government Department of Health under a Freedom of Information request. Conclusions: headspace Early Psychosis Youth Services received high ratings for patient satisfaction and engagement, which was associated with symptomatic improvement and functional recovery. However, governance was complicated, costs were relatively high, and caseload targets were not met. The cost for an additional year of good quality life was estimated at AUD 318,954, which exceeds the usual thresholds for defining a 'good buy'. Integrated models should be investigated, as they seem in principle to offer efficiencies and improved continuity of care. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore whether the single-item Self-Rated Mental Health Question (SRMHQ) may be an indicator of the need for further mental health assessment and investigation in women with gestational diabetes mellitus (GDM). Method: Women with GDM (n = 159) were recruited from outpatient clinics in the Australian Capital Territory prior to a GDM information session (mean gestational age = 26, SD = 4.5). Participants were aged 20–45 (mean = 33, SD = 4.2) and completed a single-item Self-Rated Health Question (SRHQ), single-item Self-Rated Mental Health Question (SRMHQ), Kessler 10-item Psychological Distress Scale (K-10), and Edinburgh Depression Scale (EDS), as well as demographic, psychiatric, and general health items. Multiple regression was used to explore whether there was an association between SRMHQ responses and K-10 or EDS total scores. Results: Regression analysis revealed that the SRMHQ was a statistically significant predictor of K-10 and EDS total scores, while controlling for key potential confounders. When mental health was rated as "poor" compared to "excellent," this was associated with an additional 12 and 9 points on K-10 and EDS total scores, respectively. Conclusion: The SRMHQ may have a role as an indicator of the need for further mental health assessment and investigation in women with gestational diabetes mellitus. [ABSTRACT FROM AUTHOR]

• Thalamic morphology differentiates symptomatic from presymptomatic HD. • Thalamic morphology differentiates symptomatic HD from controls. • Thalamic morphology is associated with neurocognitive dysfunction in symptomatic HD. • Thalamic morphology is associated with motor dysfunction in symptomatic HD. In Huntington's disease (HD), neurodegeneration causes progressive atrophy to the striatum, cortical areas, and white matter tracts - components of corticostriatal circuitry. Such processes may affect the thalamus, a key circuit node. We investigated whether differences in dorsal thalamic morphology were detectable in HD, and whether thalamic atrophy was associated with neurocognitive, neuropsychiatric and motor dysfunction. Magnetic resonance imaging scans and clinical outcome measures were obtained from 34 presymptomatic HD (pre-HD), 29 early symptomatic HD (symp-HD), and 26 healthy control individuals who participated in the IMAGE-HD study. Manual region of interest (ROI) segmentation was conducted to measure dorsal thalamic volume, and thalamic ROI underwent shape analysis using the spherical harmonic point distribution method. The symp-HD group had significant thalamic volumetric reduction and global shape deflation, indicative of atrophy, compared to pre-HD and control groups. Thalamic atrophy significantly predicted neurocognitive and motor dysfunction within the symp-HD group only. Thalamic morphology differentiates symp-HD from pre-HD and healthy individuals. Thalamic changes may be one of the structural bases (endomorphotypes), of the endophenotypic neurocognitive and motor manifestations of disease. Future research should continue to investigate the thalamus as a potential in vivo biomarker of disease progression in HD. [ABSTRACT FROM AUTHOR]

Objective: The Vastaamo psychotherapy data breach in Finland is perhaps the largest cybersecurity incident in mental healthcare to date, resulting in significant patient harm. There are specific lessons for mental healthcare providers from an analysis of the incident., Method: Case study of this specific electronic health record data breach, based on detailed media reporting., Results: The issues raised include: the importance of governance of the cybersecurity of sensitive personal patient data, such as compliance with legislative requirements on privacy and data security; specific security measures such as de-identification of data, data protection via passwords, multi-factor authentication, firewalls and encryption; and timely and effective communication, and support of those who have been affected., Conclusions: The implications for mental healthcare providers, including psychiatrists and trainees, are that, within their capability, providers need to assess the efficacy and robustness of cybersecurity of electronic health record systems they use, and carefully consider the information that is recorded to minimise exposures such as in the Vastaamo breach., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare that JCLL, SA, TB, PAM, SK and SR are editorial team members for the journal – they were not involved in the independent peer review process.

Objective: Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions., Conclusions: The mental healthcare labour market has a number of features that make it prone to shortages and other distortions. These include: the labour-intensive nature of healthcare work;, long-training periods; that traditional policy levers like pay are only partially effective; as well as other challenges in retaining and recruiting mental health nurses and psychiatrists, especially in public mental health services. Further research is needed to develop and evaluate effective interventions., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JL, SA, TB and SK are editorial team members for the journal – they were not involved in the independent peer review process.

We discuss the ramifications of the Commonwealth of Australia Budget allocations for mental healthcare for 2024-2025. There is funding for population-based mental health initiatives for milder anxiety and depression but no direct funding of services for the most severe and disabling forms of mental illness, other than pre-existing state/territory disbursements from the Commonwealth for state-based health services. There are substantial concerns that the Commonwealth funding has potentially been misallocated to ineffective interventions that are unlikely to reduce the population prevalence of mild anxiety and depression in Australia. Funds may have been better allocated to provide effective care for those with the most severe and disabling illnesses including schizophrenia, bipolar disorder and severe depression., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Women with severe mental illness and pregnancy suffer substantial travails in accessing care for mental and perinatal health. Women with psychotic illnesses such as schizophrenia face higher risks of pregnancy and postnatal complications. Similarly, lack of access to holistic psychiatric care presents particular perils for these women and their children. Tailored care for these mothers-to-be and their babies is needed to prevent and ameliorate health complications, mental and physical. This will require targeted funding of services that connect women with and provide continuity of care., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The process of medical scientific journal publishing merits further explanation for authors and readers. Prospective authors need to understand the scope of the journal and the article types that are published. We give an overview of the editorial process, including selection of reviewers, peer review and decisions regarding revision, acceptance and rejection of papers for Australasian Psychiatry . We encourage authors and readers to submit papers, and volunteer as peer reviewers, working together with the journal editorial team., Competing Interests: DisclosureThis paper is not peer-reviewed as it is an expression of the views of the Editorial team co-authors.

Objectives: Psychosocially unsafe workplaces are related to burnout, especially amongst trainees and psychiatrists. Burgeoning research on psychosocial workplace safety indicates the importance of organisational governance to reduce adverse professional, and consequently patient, outcomes in healthcare by balancing job demands and resources. We provide a brief commentary on the relevance of the concept of the Psychosocial Safety Climate model for mental health services and healthcare workers, and considerations for action., Conclusions: Based on the Extended Job Demand-Resource model, the Psychosocial Safety Climate model has been developed and validated in community and healthcare environments. Psychosocial safety is also an Australian workplace safety requirement. An important direction to improve working conditions, reduce adverse outcomes, and improve recruitment and retention of healthcare workers, may be to adopt and formalise psychosocial workplace safety as a key performance indicator of equal importance to productivity for mental healthcare services., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: he authors declare the following: JCLL, PAM, SK, SA & TB are all members of the journal editorial team and were not involved in the peer review process. The paper was independently peer-reviewed.

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines on mood disorders recommend psychotherapy as foundational care for patients with acute depression with minimal discussion of any potential adverse effects. Randomised controlled trial evidence on psychotherapy adverse effects is limited. This is problematic because clinicians must balance the benefits of treatment against the harms, and clinical decisions become skewed without data on adverse effects. We suggest that clinical practice guidelines should be more guarded about recommending psychotherapy and add consensus statements on adverse effects for informed consent and clinical decision-making., Competing Interests: DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: TB has received Honoraria from CSL Sequirus for a lecture. Authors are editorial board members for this journal – they had no involvement in the editorial and peer review process.

Objective: In this perspective, we investigate how the Royal Australian and New Zealand College of Psychiatrists' (RANZCP) position statement on psychotherapy takes the potential for adverse effects into account., Conclusions: Psychotherapy has two critical outcomes - efficacy and adverse effects. Evidence-based psychotherapy is significantly more effective than care-as-usual for about one in 10 psychotherapy patients. However, a similar proportion also reports adverse effects. Despite this, the RANZCP position statement on psychotherapy focuses on efficacy with minimal discussion of the adverse effects. This is an oversight because psychiatrists have legal and ethical obligations to consider the adverse effects as well as the benefits of any treatment. We therefore reflect on the RANZCP's six recommendations in light of the adverse effects of psychotherapy., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.