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Objective Community-based residential rehabilitation for people experiencing severe and persistent mental illness (SPMI) is increasingly available as an alternative to psychiatric inpatient care. Understanding who accesses these services and their outcomes will inform the optimal allocation of limited public mental health resources. Method This retrospective cohort study explored the outcomes of the first 100 consumers supported by a new Australian Community Care Unit (CCU). The primary outcome focus was acute mental health service use (emergency department presentations, acute mental health inpatient admission days), and secondary outcome foci were accommodation independence and substance use. Results When the 365 days before and after CCU support were compared, significant reductions in acute mental health bed days were observed (22 days, W = 3.373, p = .001); greater reductions were noted for those staying >182 days (31 days, W = 3.373, p = .001). Additionally, significant improvements in accommodation independence were found, (W = 3.373, p = .001). Conclusion CCU consumers experienced reductions in acute mental health inpatient service use and improved accommodation independence. These observations are consistent with the intended functioning of the residential rehabilitation service.

Mental health services are increasingly incorporating the views and expertise of people with a lived experience of mental illness in service delivery. A novel approach to this is the 'integrated staffing model' being trialled at two Australian public residential mental health rehabilitation services (Community Care Units, CCUs) where peer support workers (PSWs) occupy the majority of staff roles and work alongside clinicians. Semi-structured interviews were completed with fifteen staff 12-to-18-months after service commencement. Transcripts were analysed following principles of grounded theory analysis. Key emergent themes were: (1) recovery is a deeply personal and non-linear process; (2) The CCU as a transitional learning environment; (3) the integrated staffing model facilitates an effective rehabilitation team; and (4) coming together under the integrated staffing model required a steep learning curve. The findings suggest that the integrated staffing approach may provide a pathway to facilitate the meaningful inclusion of PSWs in rehabilitation settings.

Objective This paper highlights the importance of psychiatric formulation and provides guidance to those learning the art of formulation. To achieve this, we explore the guidance on formulation that has been previously published in Australasian Psychiatry, identify the key components of psychiatric formulation, and outline an approach to comprehensive formulation in routine clinical practice. Conclusion Formulation is the foundation of good psychiatric practice but presents a considerable challenge to the novice practitioner. Understanding the ingredients of formulation and a method for meaningfully putting these together will guide deliberate practice to learn the art of psychiatric formulation.

With ongoing interest in the relationship between videogame and mental health alongside recent focus on gaming's role in coping with stressful life events, we sought to explore the relationship between videogame play and wellbeing among people experiencing their first episode of psychosis. Specifically, we aimed to explore the associations between videogame play and wellbeing among consumers of a first episode psychosis (FEP) service and further to compare their motivations for play, need satisfaction, passion for play and wellbeing to a control group. A sample of 88 people experiencing FEP (57 who played videogames and 31 who did not) and a control sample of 46 (all of whom played videogames) completed a survey containing a range of questionnaires related to the variables of interest. Key findings include that among those experiencing FEP, people who played videogames reported better wellbeing outcomes than those who did not. Among participants who played videogames, the FEP sample reported lower levels of need satisfaction through gaming, lower levels of harmonious passion, higher levels of external types of motivation and lower levels of internal types of motivation for play than the control group. Finally, the relationships between passion orientation (both harmonious and obsessive) and psychological distress were stronger in the control group than the FEP sample, suggesting that passion for gaming may be less influential on wellbeing for those experiencing FEP.

Background: This is the second of two papers that investigated the effectiveness of a group-based program known as ‘Coping with Voices’. The first paper reported on the group facilitators experience of delivering the program. This second paper reports the findings from the participants.Method: Of the 61 participants that gave informed consent to participate in the study 19 did not attend a group, so this provided a natural quasi-control group. The study compared pre and post primary measures for the 42 participants who attended a group. 29 group attendees also provided qualitative data. Secondary measures were measured longitudinally for all 61 participants. Individuals who participated in the program were compared to those individuals who did not.Results: For the 42 voice hearers who attended Coping with Voices, the quantifiable data showed a significant reduction in negative beliefs about voices, voice severity, distress about voices and the perceived power of the voices. Participant feedback was overwhelmingly positive. The secondary measures show a significant reduction in the number of hospital admissions and an improvement in basis life skills for group attendees versus non-attendees at 12 months follow up. Conclusions: Overall, these findings suggest ‘Coping with Voices’ is feasible, acceptable and worthwhile.

Cognitive deficits in schizophrenia are a core feature that often results in functional difficulties and lower quality of life. There is a dearth of literature in India regarding cognitive training interventions. Literature indicates that interventions from the west are not always feasible in low and middle-income countries. Compensatory Cognitive training by Dr Elizabeth Twamley aims to improve functional outcomes and an individual’s subjective experience of impairment and quality of life. The study aimed to culturally adapt and test the feasibility of the English version of the Compensatory Cognitive Training (CCT) manual to suit Indian culture. The study was conducted at Schizophrenia Research Foundation (SCARF) in Chennai, Tamil Nadu. The formative Method for Adapting Psychotherapy (FMAP) approach was used to adapt the manual culturally. Focus Group Discussions (FGD) were conducted with Mental Health Professionals, Caregivers, and Patients. The final version of the manual was piloted as a group intervention on 10 participants. Suggestions from the FGD’s predominantly changed Western names to Indian names and included culturally appropriate activities. The pilot phase was halted after seven sessions due to the pandemic. The sessions delivered were well received by the participants. Cultural adaptation of the Compensatory Cognitive Training Manual (CCT) was made as per the recommendations of the mental health experts and service users. Participant’s engagement and enthusiasm indicate that CCT seems to be a promising intervention to address cognitive deficits in individuals with schizophrenia in Chennai, India.

Background and Hypothesis Clozapine is the most effective antipsychotic for treatment-resistant schizophrenia, yet a significant proportion of individuals on clozapine continue to experience disabling symptoms, despite being treated with an adequate dose. There is a need for adjunct treatments to augment clozapine, notably for negative and cognitive symptoms. One such potential agent is the glutathione precursor N-acetylcysteine (NAC). Study Design A randomized double-blind, multi-center, placebo-controlled trial for clozapine patients with enduring psychotic symptoms (n = 84) was undertaken to investigate the efficacy of adjunctive NAC (2 g daily) for negative symptoms, cognition and quality of life (QoL). Efficacy was assessed at 8, 24, and 52 weeks. Study Results NAC did not significantly improve negative symptoms (P = .62), overall cognition (P = .71) or quality of life (Manchester quality of life: P = .11; Assessment of quality of life: P = .57) at any time point over a 1-year period of treatment. There were no differences in reported side effects between the groups (P = .26). Conclusions NAC did not significantly improve schizophrenia symptoms, cognition, or quality of life in treatment-resistant patients taking clozapine. This trial was registered with “Australian and New Zealand Clinical Trials” on the 30 May, 2016 (Registration Number: ACTRN12615001273572).

Education and work goals are important for people with serious mental illness. For many these goals remain unmet. Increasingly people with serious mental illness are inspired by the stories of people who have been able to meet the challenges of gaining education and stable employment. Two peer workers describe their personal journeys to stable employment. Both authors note the significance of having someone believe in their potential to work. The benefits of stable employment went beyond finances and included improved self-esteem and an altruistic wish to provide a role model for others recovering from mental illness.Functional recovery from serious mental illness (SMI) especially in terms of completed education and employment goals is suboptimal. The clinical evidence base in enhancing functional recovery is increasingly complemented by the growing evidence base developed by the consumer network and by the rise in prominence of peer workers as a significant adjunctive mental health workforce.

Cognitive behavioural therapy for psychosis (CBTp), an effective treatment for people with schizophrenia, may have a role in clozapine refractory schizophrenia.A systematic-review and meta-analysis on the impact of CBTp on psychotic symptoms in people on clozapine.We searched PubMed, Embase, PsycInfo, CINAHL and Cochrane for randomised control trials of CBTp as augmentation in people with treatment-refractory schizophrenia on clozapine and conducted pair-wise meta-analyses.Four studies met inclusion criteria. On pairwise meta-analyses, the primary outcome of total psychotic symptoms was not significantly altered by CBTp at either therapy endpoint or six to twelve months follow-up. Secondary outcomes showed that CBT improved positive symptoms at both therapy endpoint (SMD -0.33, 95%CI -0.50 to -0.16,CBTp may lead to small benefits for positive symptoms refractory to clozapine. Given the low risks associated with CBTp, and the limited alternative options for clozapine refractory schizophrenia, this approach should be considered in this population.

Objectives: Assertive community treatment (ACT) teams are increasingly being adapted to suit the needs of consumers who have never experienced long-term institutional care yet struggle to retain community tenure and quality of life due to residual functional disabilities associated with severe mental illness. Support needs can be provided by the growing disability support sector but recovery-orientated rehabilitation services delivered by specialist rehabilitation clinicians are also required. The Mobile Intensive Rehabilitation Team (MIRT) within the Metro South Addiction and Mental Health Service has adapted the ACT model to deliver assertive outreach that aims to work collaboratively with the person and their chosen supports to improve their function and their sense of self-efficacy in illness self-management. We described the characteristics of the consumers referred to MIRT over a 20-month time period, and reported on on their discharge location. Conclusion: After two years with MIRT, half the participants were discharged out of case-management. Being on clozapine was a barrier to discharge from case-management despite functional improvement. Psychiatric hospitalisations predicted longer duration working with MIRT.

There is evidence that Cognitive Behaviour Therapy for Psychosis (CBTp) is an effective intervention for reducing psychotic symptoms. The recently updated Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines (RANZCP CPG) recommend CBTp for the therapeutic management of schizophrenia and related disorders. Translational research is required to examine how well CBTp can be applied into public mental health services. This feasibility study aimed to provide preliminary evidence on how acceptable, implementable, and adaptable individual or group CBTp may be within a public mental health service in Australia. Twenty-seven participants initially agreed to participate in the study with 16 participants being randomised to either group or individual therapy, 11 starting therapy and 7 completing therapy. The intervention involved approximately 20 h of manualised CBTp. Attendance was higher in the individual therapy. Subjective reports indicated that the therapy was acceptable to all completers. Participants who engaged in individual or group CBTp experienced a similar level of reduction in the severity of hallucinations and delusions. Individual CBTp may be a feasible, acceptable, and effective intervention to include in Australian public mental health services. A pilot trial is now required to provide further evidence for and guidance of how best to translate CBTp protocols to Australian mental health services.

Background: While there have been increased calls for mental health consumers to be involved in mental health services research, there is limited research exploring the research interests of this g...

The COVID 19 pandemic has required major changes in healthcare delivery. This study sought to understand the impact of the mental healthcare changes associated with COVID-19 on people living with severe and persisting mental illness (SPMI) and staff working in rehabilitation teams in Queensland in Australia. Telephone interviews were completed with participants diagnosed with SPMI who were supported by the rehabilitation teams of a public mental health service (n = 18). Additionally, an anonymous survey was completed with staff from these teams (n = 20, 17.5% of staff). Both datasets were analysed separately using thematic analysis. Four themes were identified through the analysis of the patient interviews: wishing the whole thing would go away; [COVID-19 has] delayed my recovery; being more socially aware; and (you've) got to be clean (which is a) good thing. Four themes emerged through the analysis of the staff survey data: needing to change the model of care; impact on patients, the impact on staff, positive impact. The perceived impact on participant's mental health was like that which was reported in the general population. Participants' emphasised anxiety, loneliness, boredom, and depression rather than a relapse of their primary psychotic illness. Participants noted the pandemic slowed the pace of personal recovery and limited the delivery of specialised rehabilitation programs.The online version contains supplementary material available at 10.1007/s40737-022-00320-5.

People with schizophrenia frequently have cognitive dysfunction, which does not respond to pharmacological interventions. Varenicline has been identified as a potential treatment option for nicotinic receptor dysfunction with a potential to treat cognitive impairment in schizophrenia. We conducted a systematic review of Pubmed, Embase, Psycinfo, CINAHL and the Cochrane Schizophrenia Trial Registry for randomised controlled trials of varenicline in people with schizophrenia for cognitive dysfunction. We excluded trials among people with dementia. We then undertook a meta-analysis with the primary outcome of difference in change of cognitive measures between varenicline and placebo as well as secondary outcomes of difference in rates of adverse events. We conducted a sensitivity analysis on smoking status and study duration. We included four papers in the meta-analysis (n = 339). Varenicline was not superior to placebo for overall cognition (SMD = −0.022, 95% CI −0.154–0.110; Z = −0.333; p = 0.739), attention (SMD = −0.047, 95% CI −0.199–0.104; Z = −0.613; p = 0.540), executive function (SMD = −0.060, 95% CI −0.469–0.348; Z =− 0.290; p = 0.772) or processing speed (SMD = 0.038, 95% CI −0.232–0.308; Z = 0.279; p = 0.780). There was no difference in psychotic symptoms, but varenicline was associated with higher rates of nausea. Sensitivity analyses for smoking status and study duration did not alter the results. Within the present literature, varenicline does not appear to be a useful target compound for improving cognitive impairment in schizophrenia. Based on these results, a trial would need over 2500 participants to be powered to show statistically significant findings.

Cognitive impairment which impacts on functioning in everyday tasks and quality of life affects many people diagnosed with schizophrenia. Cognitive remediation therapy (CRT) is recommended in the current Australian and New Zealand clinical practice guidelines for Schizophrenia and related disorders. An implementation trial of the Computerised Interactive Remediation of Cognition-Interactive Training for Schizophrenia (CIRCuiTS) program was undertaken in Orange, NSW, Australia. As an important component of the evaluation of the CIRCuiTS program in our local context, this study explored the meanings clinicians placed on their experiences as CIRCuiTS therapists. Seven CIRCuiTS therapists who were each involved in the implementation trial agreed to present platform papers at the CIRCuiTS Expo held in May 2018. A thematic analysis was undertaken on the transcripts of these presentations. Analyses showed therapists valued their involvement in delivering the CIRCuiTS program and pointed to many instances in which they felt their practice was enhanced. The three major themes identified from the data included (1) appreciation of the lived experience of schizophrenia, (2) the centrality of the therapeutic relationship, and (3) increased professional satisfaction and “Joy in work”. CIRCuiTS therapists’ language was consistent with recovery-focused practice. This was the first study to explore CIRCuiTS therapists’ experiences and occurred within a broader implementation trial. Overall, the findings supported the feasibility and acceptability of the CIRCuiTS program from the therapists’ perspective. Further research is required into the dynamics of the therapeutic relationship and contribution of CRT to the work-life experiences of clinicians providing psychiatric rehabilitation.

BACKGROUND: CADENCE-BZ is a multi-centre, parallel-group, double-blind randomized controlled trial designed to examine the clinical efficacy and safety of an accessible food preservative, sodium benzoate, as an add-on treatment for patients with early psychosis. The original study protocol was published in 2017. Here, we describe the updated protocol along with the Statistical Analysis Plan (SAP) for the CADENCE-BZ trial prior to study completion.METHODS AND MATERIALS: Two important changes were made to the original protocol: (1) improvements to our statistical analysis plan permitted a reduction in sample size; and (2) a revision in the secondary outcomes with the intent of reducing redundancy and excluding those measures that were not appropriate as outcomes.CONCLUSIONS: We provide the updated SAP prior to the completion of the study with the intent of increasing the transparency of the data analyses for CADENCE-BZ. The final participants are currently completing the study and the results will be published in the near future.TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN12615000187549 ). Registered on 26th February 2015.

AIM This study aimed to introduce a set of administrative key performance indicators (KPIs) for Early Psychosis Services. METHODS The study design was longitudinal with data retrieved from a 4-year period between January 2009 and December 2013 included in the study. Descriptive statistics and t tests were used to evaluate the KPIs. RESULTS Results in the 1 year before early psychosis (EP) intervention and 1-year postintervention were calculated for most items, and entry and exit scores were calculated for involuntary treatment orders (ITOs) and Health of the Nation Outcome Scale (HoNOS) scores. There was a 54% reduction in mental health emergency department presentations representing a cost saving of $62 524.00 (AUD). There was also an improvement in the number and duration of mental health admissions with a financial saving of $1 653 534.00 (AUD). Patients improved on all HoNOS scores from entry to exit from the services. ITOs were reduced by approximately 29% on discharge from the service. CONCLUSIONS Administrative data can provide useful KPIs to measure the effectiveness of EP teams and allow benchmarking with similar services.

Semi-structured interviews were used to explore the consumer experience of community-based residential mental health rehabilitation support at Community Care Units in Australia. These clinical services provide recovery-oriented residential rehabilitation to people affected by severe and persistent mental illness. Typically, nurses occupy the majority of staff roles. However, two of the three sites in the study were trialling a novel integrated staffing model where the majority of staff were people with a lived experience of mental illness employed as peer support workers (PSWs). The interviews explored consumers' experiences of care 12-18 months after admission. Fifteen interviews were completed with an independent interviewer. Most participants were diagnosed with schizophrenia or a related psychotic disorder. The analysis followed a pragmatic approach to grounded theory. Consumers viewed the CCU favourably, emphasizing the value of the relationships formed with staff and co-residents. No major differences in consumers' experience under the traditional versus integrated staffing models were identified; however, those from the integrated staffing model sites valued the contributions of the peer support workers. The understanding of the consumer experience emerging through this study aligned with their expectations of the service at the time of commencement.

Introduction: The importance of peer support workers in mental health care delivery has been extensively advocated for in mental health policy frameworks. However, there has been limited research examining the implementation of paid peer workers in clinical settings. This study explores the experience of paid peer support workers integrated within a clinically-operated community-based residential rehabilitation service for people diagnosed with a mental health disorder experiencing challenges living independently in the community.Methods: A general inductive approach was taken in the analysis of diaries completed by a newly employed peer workforce. These diaries focussed on what they viewed as significant interactions in fulfilling their role. Composite vignettes were generated to illustrate key themes.Findings: Thirty-six diaries were provided; these reported unplanned and spontaneously occurring interactions. Peer workers emphasized the importance of connecting with people while they were engaging in everyday activities as an opportunity for personal growth of the residents. The diaries also focussed on the peer workers' ability to connect and establish trust by sharing similar experiences with residents or family members. Peer workers also believed that they brought a different perspective than clinical staff and were able to refocus attention from clinical diagnoses and symptoms to other aspects of the resident's lives.Discussion: Peer support workers described their work as flexible, responsive, and adaptable to the resident's needs. They believed that their roles brought a different lens to interactions on the unit and fostered a more inclusive and personal way of working for the team.Conclusion: To ensure that peer workers can engage authentically with residents and family members, it is critical that the role and principles of peer work are valued and understood by all.

Objective: Coronavirus disease 2019 and the consequent public health and social distancing measures significantly impacted on service continuity for mental health patients. This article reports on contingency planning initiative in the Australian public sector. Methods: Ninety-word care synopses were developed for each patient. These formed the basis for guided conversations between case managers and consultant psychiatrists to ensure safe service provision and retain a person-centred focus amidst the threat of major staffing shortfalls. Results: This process identified vulnerable patient groups with specific communication needs and those most at risk through service contraction. The challenges and opportunities for promoting safety and self-management through proactive telehealth came up repeatedly. The guided conversations also raised awareness of the shared experience between patients and professionals of coronavirus disease 2019. Conclusion: There is a parallel pandemic of anxiety which creates a unique opportunity to connect at a human level.

Little is known about what predicts disengagement from rehabilitation treatment for people affected by severe and persistent mental illness (SPMI).To identify predictors of unplanned discharge among consumers admitted to community-based residential rehabilitation units in Australia.Secondary analysis of data from a prospective cohort study of consumers admitted to three Community Care Units (CCUs) between 2014 and 2017 (38.8% of consumers experienced unplanned discharge. Significant predictors of unplanned discharge were younger age, higher alcohol consumption and disability associated with mental illness, as well as recovery stage indicating a sense of growth and higher competence in daily task performance. 63.0% of unplanned discharges were initiated by staff, mostly for substance-related reasons (55.9%). History of trauma was more likely among consumers with self-initiated discharge than those with staff-initiated unplanned and planned discharge.Assertive intervention to address alcohol-use, and ensuring care is trauma-informed, may assist in reducing rates of unplanned discharge from rehabilitation care.

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.

Background Deficits in social cognition are common in people with schizophrenia and are associated with impaired functioning. Finding effective interventions to address these deficits is a priority. Social Cognition Interaction Training (SCIT) is a psychosocial intervention that has demonstrated acceptability and feasibility in various health care settings. Larger, well-designed randomized controlled trials are needed to examine the effectiveness of this intervention. Design A randomized controlled trial. Methods One hundred and twenty adults diagnosed with schizophrenia spectrum disorder were randomized to receive SCIT (n = 61) or Befriending Therapy (BT) (n = 59). Both intervention groups were delivered weekly for 2 hr over 12 weeks. Neurocognitive assessment was completed at baseline. Participants completed assessments of social cognition, social functioning, and meta-cognition at baseline, post-intervention, and 3-month follow-up. Results There were no clinically significant differences between group outcomes on any measure of social cognition or social functioning. There was a trend for both groups to improve over time but not at a level of statistical significance. Conclusions SCIT did not show any additional benefits on measures of social cognition compared to Befriending Therapy for people with schizophrenia spectrum disorder. The findings are discussed in terms of potential improvements to the programme. Practitioner points ◾ Effective interventions for the social cognitive deficits of schizophrenia spectrum disorders are still being refined. ◾ Social Cognition Interaction Training is a promising therapy but requires further modifications to improve its effectiveness.

Aims Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. Methods Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. Results Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (β = 1.12) and longer episodes of CCU care (β = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. Conclusions CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.

Aims.Incorporating consumer perspectives into mental health services design is important in working to deliver recovery-oriented care. One of the challenges faced in mental health rehabilitation services is limited consumer engagement with the available support. Listening to consumers’ expectations of mental health services, and what they hope to achieve, provides an opportunity to examine the alignment between existing services and the priorities and preferences of the people who use them. We explored consumer understandings and expectations of three recovery-oriented community-based residential mental-health rehabilitation units using semi-structured interviews; two of these units were trialling a staffing model integrating peer support with clinical care.Methods.Twenty-four consumers completed semi-structured interviews with an independent interviewer during the first 6 weeks of their stay at the rehabilitation unit. Most participants had a primary diagnosis of schizophrenia or a related psychotic disorder (87%). A pragmatic approach to grounded theory guided the analysis, facilitating identification of content and themes, and the development of an overarching conceptual map.Results.The rehabilitation units were considered to provide a transformational space and a transitional place. The most common reason given for engagement was housing insecurity or homelessness rather than the opportunity for rehabilitation engagement. Differences in expectations did not emerge between consumers entering the clinical and integrated staffing model sites.Conclusions.Consumers understand the function of the rehabilitation service they are entering. However, receiving rehabilitation support may not be the key driver of their attendance. This finding has implications for promoting consumer engagement with rehabilitation services. The absence of differences between the integrated and clinical staffing models may reflect the novelty of the rehabilitation context. The study highlights the need for staff to find better ways to increase consumer awareness of the potential relevance of evidence-based rehabilitation support to facilitating their recovery.

Aim: This investigation aims to identify if correlates of not working or studying were also correlated with part‐time vocational participation. Methods: Demographic and vocational engagement information was collected from 226 participant clinical charts aged 15 to 25 years accessing a primary youth health clinic. Multinomial logistic regressions were used to examine potential correlates no and part‐time vocational engagement compared to those full‐time. Results: A total of 33% were not working or studying and 19% were part‐time. Not working or studying was associated with secondary school dropout and a history of drug use. These associations were not observed in those participating part‐time. Conclusions: This result suggests that the markers of disadvantage observed in those not working or studying do not carry over to those who are part‐time. Potentially, those who are part‐time are less vulnerable to long‐term disadvantage compared to their unemployed counterparts as they do not share the same indicators of disadvantage.

The most extensively evaluated intervention for auditory hallucinations is Cognitive Behavioural Therapy for Psychosis (CBTp), which is usually delivered in statutory settings by experienced clinicians. In contrast, peer support networks, such as the Hearing Voices Network (HVN), operate informally using peers to normalise and manage voices. This article compares these two approaches to identify points of synergy and difference. Its analysis suggests the two approaches share many features, but also deviate in important ways that could compensate for each other. Instead of competing with each other as might first be thought, they may actually be complementary. Further, HVN may align comfortably with the values and principles of social work. Social workers seeking to engage with voice hearers may be advised to study the underlying principles of each approach to guide the way in which they can capitalise on intervention opportunities to better assist voice hearers.

Objective: To compare the acceptability of three distinct physical activity measurement tools in people with psychosis: an objective measurement tool, a self-report measure, and an exercise capacity test. Methods: We measured the completion rate for each measurement tool. Participants rated the ease/difficulty of each measure using a 7-point Likert scale. Participants were also asked to rank the three tools in order of the ease of use. Results: Sixty-six per cent (46/69) of participants completed all three assessment tools, and 60.9% (42/69) completed the acceptability questionnaire. The majority of the participants found it easy to complete all three measurement tools. The majority (52.8%) of the participants ranked the objective measurement tool as the easiest to use. Conclusion: All three measures were acceptable to people with psychosis, but objective measurement tools may be easier to use.

Background Compensation and adaptation therapies have been developed to improve community functioning via improving neurocognitive abilities in people with schizophrenia. Various modes of delivering compensation and adaptation therapies have been found to be effective. The aim of this trial is to compare two different cognitive interventions, Compensatory Cognitive Training (CCT) and Computerised Interactive Remediation of Cognition–Training for Schizophrenia (CIRCuiTS). The trial also aims to identify if mismatch negativity (MMN) can predict an individual’s response to the compensation and adaptation programmes. Methods This study will use a randomised, controlled trial of two cognitive interventions to compare the impact of these programmes on measures of neurocognition and function. One hundred clinically stable patients aged between 18 and 65 years with a diagnosis of a schizophrenia spectrum disorder will be recruited. Participants will be randomised to either the CCT or the CIRCuiTS therapy groups. The outcome measures are neurocognition (BACS), subjective sense of cognitive impairment (SSTICS), social functioning (SFS), and MMN (measured by EEG) in people with schizophrenia spectrum disorders. Discussion This trial will determine whether different approaches to addressing the cognitive deficits found in schizophrenia spectrum disorders are of comparable benefit using the outcome measures chosen. This has implications for services where cost and lack of computer technology limit the implementation and dissemination of interventions to address cognitive impairment in routine practice. The trial will contribute to the emerging evidence of MMN as a predictor of response to cognitive interventions. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000161224. Registered on 2 February 2018. Protocol version: 4.0, 18 June 2018.

Background Clinically operated community-based residential rehabilitation units (Community Rehabilitation Units) are resource intensive services supporting a small proportion of the people with severe and persisting mental illness who experience difficulties living in the community. Most consumers who engage with these services will be diagnosed with schizophrenia or a related disorder. This review seeks to: generate a typology of service models, describe the characteristics of the consumers accessing these services, and synthesise available evidence about consumers’ service experiences and outcomes. Method A systematic review was undertaken to identify studies describing Community Rehabilitation Units in Australia, consumer characteristics, and evidence about consumer experiences and outcomes. Search strings were applied to multiple databases; additional records were identified through snowballing. Records presenting unique empirical research were subject to quality appraisal. Results The typology defined two service types, Community-Based Residential Care (C-BRC), which emerged in the context of de-institutionalisation, and the more recent Transitional Residential Rehabilitation (TRR) approach. Key differentiating features were the focus on transitional care and ‘recovery’ under TRR. Schizophrenia spectrum disorders were the most common primary diagnosis under both service types. TRR consumers were more likely to be male, referred from community settings, and less likely to be subject to involuntary treatment. Regarding outcomes, the limited quantitative evidence (4 records, 2 poor quality) indicated C-BRC was successful in supporting the majority of consumers transferred from long-term inpatient care to remain out of hospital. All qualitative research conducted in C-BRC settings was assessed to be of poor quality (3 records). No methodologically sound quantitative evidence on the outcomes of TRR was identified. Qualitative research undertaken in these settings was of mixed quality (9 records), and the four records exploring consumer perspectives identified them as valuing the service provided. Conclusions While there is qualitative evidence to suggest consumers value the support provided by Community Rehabilitation Units, there is an absence of methodologically sound quantitative research about the consumer outcomes achieved by these services. Given the ongoing and increasing investment in these facilities within the Australian context, there is an urgent need for high-quality research examining their efficiency and effectiveness. Trial registration PROSPERO (CRD42018097326). Electronic supplementary material The online version of this article (10.1186/s12888-019-2019-5) contains supplementary material, which is available to authorized users.