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Objective: To measure alcohol-related harms to the health of young people presenting to emergency departments (EDs) of Gold Coast public hospitals before and after the increase in the federal government "alcopops" tax in 2008.Design, Setting and Participants: Interrupted time series analysis over 5 years (28 April 2005 to 27 April 2010) of 15-29-year-olds presenting to EDs with alcohol-related harms compared with presentations of selected control groups.Main Outcome Measures: Proportion of 15-29-year-olds presenting to EDs with alcohol-related harms compared with (i) 30-49-year-olds with alcohol-related harms, (ii)15-29-year-olds with asthma or appendicitis, and (iii) 15-29-year-olds with any non-alcohol and non-injury related ED presentation.Results: Over a third of 15-29-year-olds presented to ED with alcohol-related conditions, as opposed to around a quarter for all other age groups. There was no significant decrease in alcohol-related ED presentations of 15-29-year-olds compared with any of the control groups after the increase in the tax. We found similar results for males and females, narrow and broad definitions of alcohol-related harms, under-19s, and visitors to and residents of the Gold Coast.Conclusions: The increase in the tax on alcopops was not associated with any reduction in alcohol-related harms in this population in a unique tourist and holiday region. A more comprehensive approach to reducing alcohol harms in young people is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: There is a well-recognized association between substance use and psychotic disorders, sometimes described as 'dual diagnosis'. The use of substances by people with psychosis has a negative impact in terms of symptoms, longitudinal course of illness and psychosocial adjustment. There are few validated treatments for such individuals, and those that do exist are usually impracticable in routine clinical settings. The present study employs a randomized controlled experimental design to examine the effectiveness of a manualized group-based intervention in helping patients with dual diagnosis reduce their substance use. METHOD: The active intervention consisted of weekly 90-min sessions over 6 weeks. The manualized intervention was tailored to participants' stage of change and motivations for drug use. The control condition was a single educational session. RESULTS: Sixty-three subjects participated, of whom 58 (92%) completed a 3-month follow-up assessment of psychopathology, medication and substance use. Significant reductions in favour of the treatment condition were observed for psychopathology, chlorpromazine equivalent dose of antipsychotics, alcohol and illicit substance use, severity of dependence and hospitalization. CONCLUSIONS: It is possible to reduce substance use in individuals with psychotic disorders, using a targeted group-based approach. This has important implications for clinicians who wish to improve the long-term outcome of their patients. [ABSTRACT FROM AUTHOR]

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. To assess whether the effects of smoking cessation interventions differ according to psychiatric diagnosis or type of intervention or comparator condition., (Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Objective: The recent debate around the College's Clinical Practice Guidelines on mood disorders have highlighted differences in opinion on interpreting evidence from randomised control trials (RCTs) for psychodynamic psychotherapy. This paper discusses new techniques of synthesising research evidence (e.g., umbrella reviews) that may help minimise disagreements in the interpretation of RCTs and foster greater consensus on treatment guidelines., Conclusions: Findings from the latest umbrella review suggest that psychodynamic therapy is an evidence-based approach, among several, for common mental disorders., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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 90 th 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., 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.

Objectives: There are ongoing challenges in workforce sustainability and service delivery due to the COVID-19 pandemic. Recruiting credible clinical leaders can enhance outcomes through mentoring, leading by example, and creating positive work environments. We investigate the anthropology of, and related research on leadership., Conclusions: Clinical and anthropological research provides strong grounds for investing in clinical leadership. The stability of 'prestige-based' leadership can be contrasted with the outcomes of 'dominance-based' leadership that relies on force, control, and threats. Dominance-based leadership increases the risks of bullying in stressed healthcare organisations. In contrast, expert clinical leaders can exert culturally mediated effects on social learning, team cooperation and morale, and patient outcomes.

The COVID-19 pandemic has contributed to longstanding structural shortfalls in the supply of healthcare services in high-income countries, including Australia. These impacts are reflected in Australian public hospital key performance indicators for acute care, elective surgery and hospital exit block. The challenges occur in the context of increased demand following the suspension of a range of healthcare services during the pandemic. The main supply challenge is suitable numbers of skilled healthcare workers. Rebalancing of supply and demand in healthcare is challenging, but needs to be achieved.

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.

Objective: The Australian headspace model has been proposed as an internationally significant exemplar for reducing the mental health 'treatment gap' amongst young people around the world. We provide a commentary that discusses the conceptualisation and delivery of headspace services within Australia, a predominantly Westernised, Educated, Industrialised, Rich and Democratic (WEIRD) society, as well as examining accessibility and suitability for culturally and linguistically diverse (CALD) communities., Conclusion: headspace was conceptualised, designed, implemented and evaluated according in a WEIRD sociocultural context, and is therefore most applicable to that setting. Australia also has CALD communities, who have not seemed to access headspace in the reported patient and staff demographics. On this basis, there may be questions about the potential generalisability of headspace models outside WEIRD societies.

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.

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.

Objective: This paper provides a commentary on the risk of moral injury amongst psychiatrists and trainees working in the acute psychiatric hospital sector, during the third winter of the COVID-19 pandemic., Conclusions: Moral injuries arise from observing, causing or failing to prevent adverse outcomes that transgress core ethical and moral values. Potentially, morally injurious events (PMIEs) are more prevalent and potent while demand on acute hospitals is heightened with the emergence of highly infectious SARS-CoV-2-Omicron subvariants (BA.4 and BA.5). Acute hospital inpatient services were already facing extraordinary stresses in the context of increasingly depleted infrastructure and staffing related to the pandemic. These stresses have a high potential to be morally injurious. It is essential to immediately fund additional staff and resources and address workplace health and safety, to seek to arrest a spiral of moral injury and burnout amongst psychiatrists and trainees. We discuss recommended support strategies.

Objective: To provide a brief clinical research update and commentary advice on the practical psychiatric care of patients suffering workplace bullying., Conclusions: While there is empirical research on the prevalence and impacts of workplace bullying, there is a relative dearth of clinical research into psychiatric patient care. Accordingly, we provide commentary on practical considerations that assist in psychiatric care planning and delivery.

Objective: To provide a commentary on the implications of the Deed of Settlement in the Honeysuckle Health - nib Australian-Competition-Tribunal Hearing. This hearing has major implications in relation to the potential for a single dominant private-health-insurance buying-group to contract for medical-purchaser-provider-agreements that might limit the clinical autonomy of patients and psychiatrists., Conclusions: The Australian Competition and Consumer Commission (ACCC) authorised the formation of a joint buying-group for private-health-insurers in 2021 to provide collective contracting and related services to private-health-insurers and other healthcare-payers. A consequent legal challenge resulted in a Deed of Settlement on 18 July 2022 that for 5 years preserves doctor-patient autonomy in clinical decision-making, the medical gaps scheme, the transparency of contractual arrangements, and if clinical data of those insured are collected by HH-nib, it must be with the full informed consent of patients. However, there remain options for private-health-insurers to apply for formation of new buying-groups, as well as to collect data and profile the general public and insured patients using online programs. Vigilance on private-health-insurer buying-groups, and the potential for US-style managed-care is warranted.

Objective: To summarise and comment upon research regarding the service delivery impact of the introduction of COVID-19 pandemic Medicare Benefits Schedule (MBS) psychiatrist telehealth services in Australia in 2020-2021. Type of program or service: Privately-billed, MBS-reimbursed, face-to-face and telehealth consultations with a specialist psychiatrist during the first year of the COVID-19 pandemic., Methods: This paper draws on analyses of previously published papers. MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April-September 2020 in Victoria, and compared to face-to-face consultations in the same period of 2019 and for all of Australia. We also extracted MBS-item-consultation data for all of Australia from April 2020-April 2021, and compared this to face-to-face consultations for April 2018-April 2019., Results: Although face-to-face consultations with psychiatrists waned following nationwide lockdowns, the introduction of MBS billing items for video and telephone telehealth meant that overall consultations were 13% higher in April 2020-April 2021, compared to the pre-pandemic year prior. A lockdown restricted to Victoria was associated with a 19% increase in consultations from April-September 2020, compared to the corresponding period in 2019., Lessons Learnt: Telehealth has been an integral component of Australia's relatively successful mental health response to COVID-19. The public availability of MBS data makes it possible to accurately assess change in psychiatric practice. The Australian Federal Government subsidises MBS telepsychiatry care by a patient rebate per consultation, illustrating that government-subsidised services can rapidly provide additional care. Rapid and substantial provision of telepsychiatry in Australia indicates that it may be a useful substitute or adjunct to face-to-face care during future pandemics and natural disasters., Competing Interests: None declared

Objective: To provide a rapid clinical review and commentary for psychiatrists on the population mental health consequences of the COVID-19 pandemic in Australia, including evidence-based findings and interventions., Conclusions: Whilst there was evidence of collective psychological resilience during the first 2 years of the COVID-19 pandemic, younger women, carers for those with COVID-19, and those with more household chores, childcare needs and higher economic strain, were at more risk. Interventions should therefore target people with these socio-demographic risk factors, as well as severe COVID-19 survivors, their relatives and frontline workers. However, the rapid spread of the Omicron SARS-CoV-2 variant has the potential for greater impacts on population mental health. Innovations in telehealth and online therapy should be incorporated into standard care. Ongoing research is needed to assess who remains most vulnerable to negative mental health impacts of the current pandemic, and especially the longer term outcomes of mental ill health. Further research should also investigate evidence-based approaches to resilience and well-being. Prospective risk/benefit analyses of infection control measures, economic effects and mental health consequences are needed.

Objective: A commentary on the usefulness of the concepts of organisational culture, organisational climate and justice on the quality and safety of mental health services and how conditions may be improved., Conclusions: Organisational culture, organisational climate and justice impact upon the quality and safety of care, as well as well-being of staff, in mental health services. Psychiatrists and trainees, should consider, act and advocate for improved organisational culture, climate and justice. Improvement in these organisational domains can be achieved, through a coordinated framework that acts across all levels of administration, mid-level management and frontline clinical staff.

Objective: To comment upon the evidence-base regarding psychiatrist and trainee burnout and provide recommendations on management., Conclusions: Burnout has been conceptualised as a specific stress-related response, primarily related to work. There is a high prevalence of burnout amongst both trainees and psychiatrists internationally, with substantial consequences for personal and family wellbeing, organisational efficiency and patient care. We summarise the evidence on organisational and individual approaches to addressing burnout.

Objective: To compare key performance indicators for public state and territory specialist mental health services in Australia., Methods: A descriptive analysis of the publicly-available National Mental Health Performance Framework key performance indicators (KPI), hosted by the Australian Institute of Health and Welfare for 2019-2020, at the national level and for states and territories., Results: The real-world performance of public mental health services varied across the eight states and territories of Australia. Western Australia had the longest acute hospital stays and the lowest rates of involuntary admissions. Queensland (QLD) had the shortest acute hospital stays at the lowest cost. While the Australian Capital Territory had the highest rates of community treatment at the lowest cost, the Northern Territory had highest hospital and community costs with the most involuntary admissions. Victoria (VIC) had the lowest population percentage receiving specialised mental health services, the highest readmission rates after 28 days, and highest physical and mechanical restraint rates., Conclusions: The KPIs indicate that some states and territories show deviations from national benchmarks that may be important for consumers, carers and clinicians. For further improvement in quality and efficiency, more detailed contextual information is required, including detailed mapping of services.

Objective: This opinion paper discusses certain recommendations of the House of Representatives Select Committee on Mental Health and Suicide Prevention pertaining to psychology, GP and psychiatric professions., Conclusions: The Committee's recommendations may compromise patient care by undermining the ability of private sector medical specialists in providing direct clinical treatment and their role in the coordination of multidisciplinary teams. Expanding private psychological therapies without GP and private psychiatry support might increase the reliance on public hospital emergency departments and public sector mental health services for severe disorders and suicidal crises. Psychiatrists and GPs need to engage in more effective policy advocacy with the Australian Government, in order to maintain their roles in leading private sector collaborative multidisciplinary care.

Objective: To discuss concerns about the Australian federal government announcement of further funding expansion of the Adult Mental Health Centres (AMHCs), now known as Head-to-Health centres., Conclusions: The expansion of AMHCs prior to evaluation recapitulates the policy predicaments and perils of the headspace federal-infrastructure allied-health private-practice model. Comprehensive evidence-based mental healthcare planning and practice is needed, rather than stand-alone services of unclear efficacy. We describe the principles of such an approach based upon an evidence-based Health Needs Assessment.

Objective: We describe an independent model of clinical academic mental health services research that is able to provide synthesised views for medico-political organisations that are engaged in advocacy for national and state evidence-based policy and planning of mental healthcare., Conclusions: CAPIPRA focuses on independent research and policy analysis using publicly available datasets on population mental health at national and state/territory levels, published in international and national peer-reviewed journals (>50 papers since 2019). We partner with medico-political organisations in evidence-based advocacy across a wide range of issues.

Objective: The term 'missing-middle' has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the 'missing-middle' term, founded on qualitative and quantitative research., Conclusions: Despite the widespread use of the term 'missing-middle' for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the 'missing-middle' care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to 'missing-middle' programmes that may not improve Australian public health outcomes.

Objective: To provide a rapid clinical update on casemix, average length of stay, and the effectiveness of Australian private psychiatric hospitals., Methods: We conducted a descriptive analysis of the publicly available patient data from the Australian Private Hospitals Association Private Psychiatric Hospitals Data Reporting and Analysis Service website, from 2015-2016 to 2019-2020. This was compared with corresponding reporting on public and private hospitals from the Australian Institute of Health and Welfare, and Australian Mental Health Outcomes and Classification Network., Results: In 2019-2020, there were 72 private psychiatric hospitals in Australia with 3582 acute beds. There were 42,942 inpatients with 1,286,470 days of care, and a mean length of stay 19.6 days (SD 13.9) for the financial year 2019-2020. The main diagnoses were major affective and other mood disorders (49%), and alcohol and other substance abuse disorders (21%). Clinician-rated outcome measures, that is, the HoNOS, showed an improvement effect size of 1.64, while the patient-rated MHQ-14 showed an improvement effect size of 1.18. Results are similar for previous years., Conclusions: Private psychiatric hospitals provide substantial, effective psychiatric care.

Objective: The Australian federal government introduced additional Medicare Benefits Schedule (MBS) telehealth-items to facilitate care by private psychiatrists during the COVID-19 pandemic., Method: We analysed private psychiatrists' uptake of video and telephone-telehealth, as well as total (telehealth and face-to-face) consultations for April 2020-April 2021. We compare these to face-to-face consultations for April 2018-April 2019. MBS-Item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with face-to-face consultations for the whole of Australia., Results: Psychiatric consultation numbers (telehealth and face-to-face) were 13% higher during the first year of the pandemic compared with 2018-2019, with telehealth accounting for 40% of this total. Face-to-face consultations were 65% of the comparative number of 2018-2019 consultations. There was substantial usage of telehealth consultations during 2020-2021. The majority of telehealth involved short telephone consultations of ⩽15-30 min, while video was used more, in longer consultations., Conclusions: Private psychiatrists and patients continued using the new telehealth-items during 2020-2021. This compensated for decreases in face-to-face consultations and resulted in an overall increase in the total patient contacts compared to 2018-2019.

Objective: To provide a clinical update on private health insurance in Australia and outline developments in US-style managed care that are likely to affect psychiatric and other specialist healthcare. We explain aspects of the US health system, which has resulted in a powerful and profitable private health insurance sector, and one of the most expensive and inefficient health systems in the world, with limited patient choice in psychiatric treatment., Conclusions: Australian psychiatrists should be aware of changes to private health insurance that emphasise aspects of managed care such as selective contracting, cost-cutting or capitation of services. These approaches may limit access to private hospital care and diminish the autonomy of patients and practitioners in choosing the most appropriate treatment. Australian patients, carers and practitioners need to be informed about the potential impact of private managed care on patient-centred evidence-based treatment.

Objective: To discuss relevant factors affecting the effectiveness and membership engagement of medico-political professional organisations, for example, medical colleges, societies and associations., Conclusions: Medico-political professional organisations face perils from corporatisation, bureaucratisation and concentration of power that diminish membership engagement and influence. Actions to address these challenges are necessary to ensure the future viability of these organisations.

Objective To quantify the introduction of new, temporary telehealth Medicare Benefits Schedule (MBS) items delivered by allied mental health professionals (AMHPs) through the Better Access initiative during the COVID-19 pandemic in Australia. Methods MBS-item service data for clinical psychologists, registered psychologists, social workers, and occupational therapists were extracted for existing face-to-face, remote videoconferencing and new, temporary telehealth items for the study period April-December 2020. The total number of services in Australia were compared with the baseline period of 2019. Given the second wave of increased COVID-19 infections and prolonged lockdowns in the state of Victoria, we compared the per capita rate of services for Victoria versus other states and territories. Results During the study period, there was an overall 11% increase in all allied mental health consultations. Telehealth use was substantial with 37% of all sessions conducted by videoconferencing or telephone consultations. The peak month was April 2020, during the first wave of increasing COVID-19 cases, when 53% of consultations were via telehealth. In terms of Victoria, there was an overall 15% increase in all consultations compared with the same period in 2019. Conclusions Allied mental health services via MBS-subsidised telehealth items greatly increased during 2020. Telehealth is an effective, flexible option for receiving psychological care which should be made available beyond the pandemic. What is known about the topic? Little is known about the transition to and delivery of new, temporary Better Access telehealth services by AMHPs during the COVID-19 pandemic. What does this paper add? This paper provides valuable data on the rapid transition to telehealth by AMHPs to provide levels of psychological care commensurate to 2019. Data extends from April to December 2020 and includes the overall number of services provided for each profession, and the proportion of services delivered via face-to-face and telehealth. We highlight the impact of the new, additional items which temporarily raised the cap on sessions. We also illustrate the substantial use of the scheme by those living in Victoria who experienced greater COVID-19-related hardships. What are the implications for practitioners? The continuation of Better Access telehealth services by AMHPs has the potential to extend the reach of mental health care beyond the pandemic.

Objective: To discuss and reflect upon the role of medical practitioners, including psychiatrists, as health advocates on behalf of patients, carers and staff., Conclusions: Health advocacy is a key professional competency of medical practitioners, and is part of the RANZCP framework for training and continuing professional development. Since advocacy is often a team activity, there is much that is gained experientially from volunteering and working with other more experienced health advocates within structurally and financially independent (of health systems and governments) representative groups (RANZCP, AMA, unions). Doctors may begin with clinically proximate advocacy for improved healthcare in health systems, across the public and private sectors. Health advocacy requires skill and courage, but can ultimately influence systemic outcomes, sway policy decisions, and improve resource allocation.

Objective: The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists' uptake of telehealth, and face-to-face consultations for April-September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019., Method: MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April-September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia., Results: Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April-September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria's increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April-September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April-September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations., Conclusions: During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019.

Objective: To describe political advocacy and scientific debate about headspace, a non-governmental organisational (NGO) substantially funded by the Australian federal government that has significantly impacted the youth mental healthcare landscape. Access Open Minds is a Canadian clinical research initiative for youth mental health partially based on headspace. Lessons from the Australian experience may thus prove useful for Canadian stakeholders., Method: The Australian healthcare system, mental health policy and governance for youth mental healthcare are contextually described. The structure and promulgation of the headspace NGO is detailed, as a parallel provider of primary mental healthcare outside of existing public and private mental health services. A review of the existing research on the evaluation of headspace was conducted., Results: Headspace has expanded rapidly due to successful political advocacy on behalf of the youth early intervention model, with limited coordination in terms of governance, planning and implementation with existing mental health services. In spite of consuming considerable resources, there has been limited evidence of effectiveness., Conclusions: Canadians should be wary of large youth programs that operate outside mainstream mental healthcare because of similar dangers such as poor co-ordination with existing government-funded services, duplication of care, the substantial consumption of resources, and limited evaluation of outcomes. As Access Open Minds is a clinical research project, there is the opportunity for Canada to evaluate the efficacy of the model before further adoption by governments., Competing Interests: Conflicts of Interest The authors have no financial relationships to disclose., (Copyright © 2021 Canadian Academy of Child and Adolescent Psychiatry.)

Objective: We reflect upon the processes of mental health administration in Australia with reference to George Orwell's novel, 1984 ., Conclusions: Mental healthcare in Australia is distorted by politicisation, spin and a refusal to acknowledge the reality of the current situation. These challenges for mental healthcare demonstrate some similarities with the Ministries of Truth and Plenty, which conversely performed as their opposites in Orwell's novel. Psychiatrists and their professional bodies should play a greater role in advocacy for clinician-led, evidence-based services in partnership with our communities.

Objective: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists' uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July-September), 2020. We compare these to the same quarter in 2019., Method: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July-September), 2019, of face-to-face consultations for the whole of Australia., Results: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15-30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations., Conclusions: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.

Objectives: This paper discusses the phenomenon of re-disorganisation as it applies to publicly-funded mental health services. The term refers to the constant reorganisation of services in the absence of evidence and of unclear benefit. We illustrate the problems of re-disorganisation with some hypothetical examples, as well as discussing the context of these problems., Conclusions: The re-disorganisation of public mental health services may be considered a politically expedient administrative response resulting in the illusion of activity and progress. It may be intentional or unintentional. Re-disorganisation can detract from effective policy, planning and implementation of improvements in provision of public mental health services.

Background: It is controversial whether compulsory community treatment (CCT) for people with severe mental illness (SMI) reduces health service use, or improves clinical outcome and social functioning., Objectives: To examine the effectiveness of compulsory community treatment (CCT) for people with severe mental illness (SMI)., Search Methods: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials (2003, 2008, 2012, 8 November 2013, 3 June 2016). We obtained all references of identified studies and contacted authors where necessary., Selection Criteria: All relevant randomised controlled clinical trials (RCTs) of CCT compared with standard care for people with SMI (mainly schizophrenia and schizophrenia-like disorders, bipolar disorder, or depression with psychotic features). Standard care could be voluntary treatment in the community or another pre-existing form of CCT such as supervised discharge., Data Collection and Analysis: Authors independently selected studies, assessed their quality and extracted data. We used Cochrane's tool for assessing risk of bias. For binary outcomes, we calculated a fixed-effect risk ratio (RR), its 95% confidence interval (95% CI) and, where possible, the number needed to treat for an additional beneficial outcome (NNTB). For continuous outcomes, we calculated a fixed-effect mean difference (MD) and its 95% CI. We used the GRADE approach to create 'Summary of findings' tables for key outcomes and assessed the risk of bias of these findings., Main Results: The review included three studies (n = 749). Two were based in the USA and one in England. The English study had the least bias, meeting three out of the seven criteria of Cochrane's tool for assessing risk of bias. The two other studies met only one criterion, the majority being rated unclear.Two trials from the USA (n = 416) compared court-ordered 'outpatient commitment' (OPC) with entirely voluntary community treatment. There were no significant differences between OPC and voluntary treatment by 11 to 12 months in any of the main health service or participant level outcome indices: service use - readmission to hospital (2 RCTs, n= 416, RR 0.98, 95% CI 0.79 to 1.21, low-quality evidence); service use - compliance with medication (2 RCTs, n = 416, RR 0.99, 95% CI 0.83 to 1.19, low-quality evidence); social functioning - arrested at least once (2 RCTs, n = 416, RR 0.97, 95% CI 0.62 to 1.52, low-quality evidence); social functioning - homelessness (2 RCTs, n = 416, RR 0.67, 95% CI 0.39 to 1.15, low-quality evidence); or satisfaction with care - perceived coercion (2 RCTs, n = 416, RR 1.36, 95% CI 0.97 to 1.89, low-quality evidence). However, one trial found the risk of victimisation decreased with OPC (1 RCT, n = 264, RR 0.50, 95% CI 0.31 to 0.80, low-quality evidence).The other RCT compared community treatment orders (CTOs) with less intensive and briefer supervised discharge (Section 17) in England. The study found no difference between the two groups for either the main health service outcomes including readmission to hospital by 12 months (1 RCT, n = 333, RR 0.99, 95% CI 0.74 to 1.32, moderate-quality evidence), or any of the participant level outcomes. The lack of any difference between the two groups persisted at 36 months' follow-up.Combining the results of all three trials did not alter these results. For instance, participants on any form of CCT were no less likely to be readmitted than participants in the control groups whether on entirely voluntary treatment or subject to intermittent supervised discharge (3 RCTs, n = 749, RR for readmission to hospital by 12 months 0.98, 95% CI 0.82 to 1.16 moderate-quality evidence). In terms of NNTB, it would take 142 orders to prevent one readmission. There was no clear difference between groups for perceived coercion by 12 months (3 RCTs, n = 645, RR 1.30, 95% CI 0.98 to 1.71, moderate-quality evidence).There were no data for adverse effects., Authors' Conclusions: These review data show CCT results in no clear difference in service use, social functioning or quality of life compared with voluntary care or brief supervised discharge. People receiving CCT were, however, less likely to be victims of violent or non-violent crime. It is unclear whether this benefit is due to the intensity of treatment or its compulsory nature. Short periods of conditional leave may be as effective (or non-effective) as formal compulsory treatment in the community. Evaluation of a wide range of outcomes should be considered when this legislation is introduced. However, conclusions are based on three relatively small trials, with high or unclear risk of blinding bias, and low- to moderate-quality evidence. In addition, clinical trials may not fully reflect the potential benefits of this complex intervention.

Background: Recurrent chest pain in the absence of coronary artery disease is a common problem which sometimes leads to excess use of medical care. Although many studies have examined the causes of pain in these patients, few clinical trials have evaluated treatment. This is an update of a Cochrane review originally published in 2005 and last updated in 2010. The studies reviewed in this paper provide an insight into the effectiveness of psychological interventions for this group of patients., Objectives: To assess the effects of psychological interventions for chest pain, quality of life and psychological parameters in people with non-specific chest pain., Search Methods: We searched the Cochrane Library (CENTRAL, Issue 4 of 12, 2014 and DARE Issue 2 of 4, 2014), MEDLINE (OVID, 1966 to April week 4 2014), EMBASE (OVID, 1980 to week 18 2014), CINAHL (EBSCO, 1982 to April 2014), PsycINFO (OVID, 1887 to April week 5 2014) and BIOSIS Previews (Web of Knowledge, 1969 to 2 May 2014). We also searched citation lists and contacted study authors., Selection Criteria: Randomised controlled trials (RCTs) with standardised outcome methodology that tested any form of psychotherapy for chest pain with normal anatomy. Diagnoses included non-specific chest pain (NSCP), atypical chest pain, syndrome X or chest pain with normal coronary anatomy (as either inpatients or outpatients)., Data Collection and Analysis: Two review authors independently selected studies for inclusion, extracted data and assessed quality of studies. We contacted trial authors for further information about the included RCTs., Main Results: We included two new papers, one of which was an update of a previously included study. Therefore, a total of 17 RCTs with 1006 randomised participants met the inclusion criteria, with the one new study contributing an additional 113 participants. There was a significant reduction in reports of chest pain in the first three months following the intervention: random-effects relative risk = 0.70 (95% CI 0.53 to 0.92). This was maintained from three to nine months afterwards: relative risk 0.59 (95% CI 0.45 to 0.76). There was also a significant increase in the number of chest pain-free days up to three months following the intervention: mean difference (MD) 3.00 (95% CI 0.23 to 5.77). This was associated with reduced chest pain frequency (random-effects MD -2.26, 95% CI -4.41 to -0.12) but there was no evidence of effect of treatment on chest pain frequency from three to twelve months (random-effects MD -0.81, 95% CI -2.35 to 0.74). There was no effect on severity (random-effects MD -4.64 (95% CI -12.18 to 2.89) up to three months after the intervention. Due to the nature of the main interventions of interest, it was impossible to blind the therapists as to whether the participant was in the intervention or control arm. In addition, in three studies the blinding of participants was expressly forbidden by the local ethics committee because of issues in obtaining fully informed consent . For this reason, all studies had a high risk of performance bias. In addition, three studies were thought to have a high risk of outcome bias. In general, there was a low risk of bias in the other domains. However, there was high heterogeneity and caution is required in interpreting these results. The wide variability in secondary outcome measures made it difficult to integrate findings from studies., Authors' Conclusions: This Cochrane review suggests a modest to moderate benefit for psychological interventions, particularly those using a cognitive-behavioural framework, which was largely restricted to the first three months after the intervention. Hypnotherapy is also a possible alternative. However, these conclusions are limited by high heterogeneity in many of the results and low numbers of participants in individual studies. The evidence for other brief interventions was less clear. Further RCTs of psychological interventions for NSCP with follow-up periods of at least 12 months are needed.

There is controversy as to whether compulsory community treatment (CCT) for people with severe mental illness (SMI) reduces health service use or improves clinical outcome and social functioning. To examine the effectiveness of CCT for people with SMI. We searched the Cochrane Schizophrenia Group's Trials Register and Science Citation Index (2003, 2008, 2012, and 2013). We obtained all references of identified studies and contacted authors where necessary. All relevant randomized controlled clinical trials (RCTs) of CCT compared with standard care for people with SMI (mainly schizophrenia and schizophrenia-like disorders, bipolar disorder, or depression with psychotic features). Standard care could be voluntary treatment in the community or another preexisting form of compulsory community treatment such as supervised discharge. We found 3 trials with a total of 752 people. Two trials compared a form of CCT called 'Outpatient Commitment' (OPC) versus standard voluntary care, whereas the third compared Community Treatment Orders with intermittent supervised discharge. CCT was no more likely to result in better service use, social functioning, mental state, or quality of life compared with either standard voluntary or supervised care. However, people receiving CCT were less likely to be victims of crime than those on voluntary care. Further research is indicated into the effects of different types of CCT as these results are based on 3 relatively small trials., (© The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy. , Methods: 26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias. , Results: Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy., Conclusions: Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved., (© The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)