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1
Fitzpatrick, Scott J., Tonelle Handley, Nic Powell, Donna Read, Kerry J. Inder, David Perkins, and Bronwyn K. Brew. "Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation." PLOS ONE 16, no. 7 (July 21, 2021): e0245271. http://dx.doi.org/10.1371/journal.pone.0245271.
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Background Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. Methods A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System. Results There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. Conclusions Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
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Peters, A. "Owning the brand of psychiatry." European Psychiatry 41, S1 (April 2017): S740. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1362.
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In Australia and New Zealand, conversations around mental health are playing out in the public space with increasing frequency. Mental health promotion campaigns and organizations are embraced by mainstream and other forms of media, and supported by government. Whilst public knowledge of mental illness is increasing, the profile of psychiatrists as leaders and medical experts in mental illness is a more difficult brand to sell. With a somewhat tarnished history behind us, the modern evidence-based practice of psychiatry is not always at the forefront of public impression. Furthermore, in Australia, more than half of the population (56%) is unaware that psychiatrists have undertaken medical training as a doctor. This presentation will outline Royal Australian and New Zealand college of psychiatrists (RANZCP) action to improve community information about psychiatry, psychiatrists and treatment experiences.Disclosure of interestThe author has not supplied his/her declaration of competing interest.
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Pearson, Mark. "Mental illness, journalism investigation and the law in Australia and New Zealand." Pacific Journalism Review : Te Koakoa 17, no. 1 (May 31, 2011): 90–101. http://dx.doi.org/10.24135/pjr.v17i1.373.
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Mental illness, its terminologies, definitions, voluntary and compulsory treatment regimes, and its interface with the criminal justice system are defined and regulated remarkably differently across the 10 Australian and New Zealand jurisdictions. This presents a legislative and policy nightmare for the investigative journalist attempting to explain the workings of the mental health system or follow a case, particularly if the individual’s life has taken them across state or national borders. This article considers the extent to which legal restrictions on identification and reportage of mental health cases in Australia and New Zealand inhibit the pursuit of ‘bloodhound journalism’—the persistent pursuit of a societal problem and those responsible for it. It recommends the development of resources assisting journalists to navigate the various mental health regulatory regimes. It also calls for the opening of courts and tribunals to greater scrutiny so that the public can be better educated about the people affected by mental illness and the processes involved in dealing with them, and better informed about the decisions that deprive their fellow citizens of their liberty.
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Khairi, Khairil Faizal, Mohamad Subini Abdul Samat, Nur Hidayah Laili, Hisham Sabri, Mohd Yazis Ali Basah, Asmaddy Haris, and Azrul Azlan Iskandar Mirza. "Takaful Protection for Mental Health Illness From the Perspective of Maqasid Shariah." International Journal of Financial Research 11, no. 3 (June 30, 2020): 168. http://dx.doi.org/10.5430/ijfr.v11n3p168.
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Mental health illness becomes one of the major illnesses in Malaysia aside from heart disease. It was recently reported that 29.2% of Malaysians are suffering from mental health illness which increases threefold from the previous year. Majority of the Malaysians suffering from mental health illness comes from the lowest income group. This shows that the lowest income group has less opportunity to seek treatment due to the cost. Even though other countries have started to offer mental health insurance such as the United States of America, United Kingdom, Australia and recently Singapore, Malaysia is still way behind in offering coverage for mental health illness. Therefore, the objective of this paper is to study the mental health takaful from the perspective of Maqasid shariah. The results from this study show that mental health takaful is able to meet the requirement of Maqasid shariah and preserve the benefits of, and prevent harm to human wellbeing. Furthermore, this study will provide an insight to the takaful industry for developing new products that could help mental health disorder patients.
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Mcgorry, Patrick. "‘Every Me and Every You’: Responding to the Hidden Challenge of Mental Illness in Australia." Australasian Psychiatry 13, no. 1 (March 2005): 3–15. http://dx.doi.org/10.1080/j.1440-1665.2004.02143.x.
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Objective: To show that mental illness affects everyone in society, describe some of the main obstacles to better outcomes, and build confidence that they can be overcome. Methods: A review and analysis of relevant evidence and experience combined with personal advocacy. Results: Mental illnesses are common and seriously under-treated, reform of the system of care has completely stalled, and insidious reinstitutionalization of the modernized system is occurring. A number of contributing factors and possible solutions are identified, including mental health literacy and advocacy campaigns, a focus on young people and early intervention, and functional reintegration of the treatment of mental and substance use disorders. Conclusions: A new wave of reform and major financial investment in the treatment of mental and substance use disorders is overdue. This can be best achieved by combining the evidence-based health care (EBHC) paradigm with a direct appeal to the self-interest of members of the general community. A National Institute of Mental Health and Addiction should be a key element of such reform, which must be a continuing process with substantially increased federal and State funding.
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Mueller-Stierlin, Annabel S., Sebastian Cornet, Anna Peisser, Selina Jaeckle, Jutta Lehle, Sabrina Moerkl, and Scott B. Teasdale. "Implications of Dietary Intake and Eating Behaviors for People with Serious Mental Illness: A Qualitative Study." Nutrients 14, no. 13 (June 24, 2022): 2616. http://dx.doi.org/10.3390/nu14132616.
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The impact of poor diet quality and nutritional inadequacies on mental health and mental illness has recently gained considerable attention in science. As the opinions and experiences of people living with serious mental illness on dietary issues are unknown, we aimed to understand the role of nutrition in a biopsychosocial approach. In total, 28 semi-structured interviews were conducted with people living with serious mental illness (SMI) in Australia, Germany and Austria, and a generic thematic analysis approach was applied. Four positive (positive effects on the body and mind, therapeutic effects in treating somatic illnesses, pleasure and opportunity for self-efficacy) and three negative (impairment related to mental illness and its treatment, perceived stigma and negative effects on the body and mind) implications of diet were identified. A key issue for most of the participants was the mental burden arising from their body weight. This might indicate that negative implications, such as guilt and stigma, were of primary importance for people with SMI when talking about their dietary behavior. In conclusion, diet-related support is urgently needed for people with SMI. However, especially participants from Germany and Austria reported that this is not yet widely available in mental health settings, leading to hopelessness and resignation.
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Carroll, Andrew, Jane Pickworth, and David Protheroe. "Service innovations: an Australian approach to community care – the Northern Crisis Assessment and Treatment Team." Psychiatric Bulletin 25, no. 11 (November 2001): 439–41. http://dx.doi.org/10.1192/pb.25.11.439.
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The recent White paper, Modernising Mental Health Services, recommended the provision of home treatment teams for acute mental illness (Department of Health, 1998). Such services are not widespread in the UK and have been the subject of recent debate (Smyth et al, 2000). In Australia, multi-disciplinary teams providing 24–hour community assessment and treatment of psychiatric emergencies have been in place now for over a decade, and form the cornerstone of the public mental health service.
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Harris, Anthony WF, Tanya Kosic, Jean Xu, Chris Walker, William Gye, and Antoinette Redoblado Hodge. "Web-Based Cognitive Remediation Improves Supported Employment Outcomes in Severe Mental Illness: Randomized Controlled Trial." JMIR Mental Health 4, no. 3 (September 20, 2017): e30. http://dx.doi.org/10.2196/mental.6982.
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Background Finding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings. Objective The aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness. Methods A total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment. Results At 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition. Conclusions This study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for severe mental illness. Trial Registration Australian and New Zealand Clinical Trials Registry (ANZCTR) 12611000849998; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12611000849998&isBasic=True (Archived by WebCite at http://www.webcitation.org/6sMKwpeos)
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Bibb, Jennifer. "The role of music therapy in Australian mental health services and the need for increased access to service users." Australasian Psychiatry 29, no. 4 (January 5, 2021): 439–41. http://dx.doi.org/10.1177/1039856220980255.
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Objectives: This opinion paper aims to provide an overview of the current evidence base supporting the use of music therapy in mental health care. It also aims to offer critique on the issue of access to music therapy in Australia. Conclusions: There is a strong evidence base for music therapy to provide symptomatic relief and improve quality of life for people living with mental illness. However, music therapy is underfunded and framed as a supplementary service within mental health services in Australia, which limits its access to consumers. Funding music therapy as an evidence-based treatment option would fill an existing service gap and provide equitable access to a cost-effective and often consumer preferred treatment option for mental health consumers.
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Walter, Garry, and Joseph M. Rey. "The Relevance of Herbal Treatments for Psychiatric Practice." Australian & New Zealand Journal of Psychiatry 33, no. 4 (August 1999): 482–89. http://dx.doi.org/10.1080/j.1440-1614.1999.00568.x.
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Objective: The aim of this paper is to inform psychiatrists about the basic priniciples, terminology, schools of thought, efficacy, safety and regulatory issues regarding herbal treatments for mental illness. Method: Information was obtained by computerised and manual searching of medical and botanical data bases, and by discussions with experts in herbal medicine and regulatory aspects of the pharmaceutical industry. Results: Herbal medicines are commonly used in developed and developing countries for psychiatric illness. The main schools of herbal medicine in Australia are Western herbal medicine, traditional Chinese medicine and ‘Ayurveda’ (Indian herbal medicine). Herbs used for psychiatric or neurological disorders are termed ‘nervines’. Three nervines which have attracted considerable attention recently are St John's Wort, Gingko biloba and Valeriana officinalis. In Australia, most herbal drugs are classed as ‘listed drugs’ which are required to satisfy less rigorous safety and efficacy criteria than ‘registered drugs’. The popularity of herbal remedies has a number of clinical and research implications for psychiatry. Conclusions: Psychiatrists should not endorse treatments that are unsupported by sound research, nor remain ignorant about alternative approaches to mental illness. The extent of use of herbal treatments for mental illness suggests that psychiatrists should become more knowledgeable about developments in this area.
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Galbally, M., A. Sved-Williams, D. Kristianopulos, K. Mercuri, P. Brown, and A. Buist. "Comparison of public mother–baby psychiatric units in Australia: similarities, strengths and recommendations." Australasian Psychiatry 27, no. 2 (November 8, 2018): 112–16. http://dx.doi.org/10.1177/1039856218810165.
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Background: Mother–baby units are innovative and important models of care that allow inpatient treatment of postpartum maternal mental disorders whilst preserving and promoting the attachment relationship with their young infants. Objectives: To report data across five public mother–baby units in Australia in order to explore similarities and distinguishing features of each model. Method: Each unit also provided 12 months of data on key characteristics of their unit. Results: Despite the geographic differences, the diagnostic profiling, length of stay, and child protection involvement were similar across the units. Conclusions: Acute care for perinatal mental illness offered in public mother–baby units in Australia shows consistency across units, raising concerns for where such treatment is unavailable.
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Coorey, N. J., L. Kensitt, J. Davies, E. Keller, M. Sheel, K. Chani, S. Barry, et al. "Risk factors for TB in Australia and their association with delayed treatment completion." International Journal of Tuberculosis and Lung Disease 26, no. 5 (May 1, 2022): 399–405. http://dx.doi.org/10.5588/ijtld.21.0111.
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BACKGROUND: Australia has a low incidence of TB and has committed to eliminating the disease. Identification of risk factors associated with TB is critical to achieving this goal.METHODS: We undertook a prospective cohort study involving persons receiving TB treatment in four Australian jurisdictions. Risk factors and their association with delayed treatment completion (treatment delayed by at least 1 month) were analysed using univariate analyses and multivariate logistic regression.RESULTS: Baseline surveys were completed for 402 persons with TB. Most (86.1%) were born overseas. Exposure to a person with TB was reported by 19.4%. Diabetes mellitus (10.2%), homelessness (9.2%), cigarette smoking (8.7%), excess alcohol consumption (6.0%) and mental illness (6.2%) were other common risk factors. At follow-up, 24.8% of patients had delayed treatment completion, which was associated with adverse events (34.1%, aOR 6.67, 95% CI 3.36–13.27), excess alcohol consumption (6.0%, aOR 21.94, 95% CI 6.03–79.85) and HIV co-infection (2.7%, aOR 8.10, 95% CI 1.16–56.60).CONCLUSIONS: We identified risk factors for TB and their association with delayed treatment completion, not all of which are routinely collected for surveillance purposes. Recognition of these risk factors should facilitate patient-centred care and assist Australia in reaching TB elimination.
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Hercus, Matthew, Dan I. Lubman, and Margaret Hellard. "Blood-Borne Viral and Sexually Transmissible Infections Among Psychiatric Populations: What are we Doing About Them?" Australian & New Zealand Journal of Psychiatry 39, no. 10 (October 2005): 849–55. http://dx.doi.org/10.1080/j.1440-1614.2005.01696.x.
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Objective: To discuss the prevalence of blood-borne viral and sexually transmissible infections among psychiatric populations, as well as current treatment approaches, both locally and internationally. Method: In this paper, we outline available epidemiological data, as well as interventions designed to target infectious disease risk among those with serious mental illness. Results: Within Australia, the prevalence of blood-borne viral and sexually transmissible infections among at-risk populations remains unacceptably high despite a number of successful harm reduction and prevention strategies. Although the highest rates of new infections occur among young people aged 15–29 years, recent research suggests that psychiatric populations are also at significant risk. However, despite increased rates, there is currently no coordinated strategy to educate, test and reduce disease risk among people suffering with mental illness within Australia. Conclusions: Although further epidemiological research at a local level is needed, interventions specifically targeting psychiatric populations and younger cohorts in particular, are essential. This will require multidisciplinary, collaborative service development, incorporating mental health, substance use and infectious disease specialists.
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Checkley, Gill E., Sandra C. Thompson, Nick Crofts, Anne M. Mijch, and Fiona K. Judd. "HIV in the Mentally Ill." Australian & New Zealand Journal of Psychiatry 30, no. 2 (April 1996): 184–94. http://dx.doi.org/10.3109/00048679609076094.
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Objective: To review the published literature in relation to prevalence of HIV infection and risk behaviours for HIV among the mentally ill to assist in the development of appropriate strategies for public health policy, surveillance and clinical management of HIV and HIV risk in these groups. Method: A search of published literature was carried out using ‘Medline’, in association with following up appropriate papers cited in the References of journals identified. Results: The North American literature shows an increased risk of HIV infection in psychiatric patients receiving treatment in both inpatient or community settings. HIV infection is associated with a number of risk behaviours, particularly male homosexual sex and injecting drug use, and being the sexual partner of a person with a history of these. Impulsivity, high levels of sexual activity during acute exacerbations of psychiatric illness, poor skills at negotiating safe sex, homelessness and drug abuse are all risk behaviours common among those affected by some mental illnesses. The mentally ill also have a comparatively poorer knowledge of HIV/AIDS. There is a dearth of published Australian data addressing the question of HIV seroprevalence or risk in the mentally ill. Although there has been development and implementation of HIV risk-reduction programs overseas, the development and evaluation of any programs in Australia has not been published. Conclusions: Arguably, Australia has developed a comprehensive program of national surveillance for HIV infection and has been relatively successful in its response to the HIV epidemic, with the high rates of infection in the early to mid-1980s substantially reduced to around 600 new diagnoses per year. However, while risk behaviours which exposed those infected with the virus are recorded, underlying conditions which predispose them to these behaviours are not. Nevertheless, there is HIV infection amongst mentally ill and intellectually disabled people in Australia. Examination of the North American experience reveals opportunities to prevent a high rate of HIV infection in those with mental illness in Australia. Such a program would require adequate risk behaviour assessment, appropriate diagnostic testing and management, and development of specific educational interventions which are properly evaluated to ensure their effectiveness.
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Hill, Harry. "Is it time to include people with intellectual disabilities in Royal Australian and New Zealand College of Psychiatrists’ treatment guidelines?" Australasian Psychiatry 27, no. 5 (June 10, 2019): 519–21. http://dx.doi.org/10.1177/1039856219848834.
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Objective: The Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) treatment guidelines set the zeitgeist for psychiatric practice in Australasia. This review conceptualises the current approach to treatment of individuals with an intellectual disability and co-occurring mental illness in RANZCP guidelines, and its potential impact. Conclusions: The enduring omission of people with an intellectual disability and co-occurring mental illness from RANZCP clinical guidelines is a missed opportunity in normalising care and optimising outcomes for people with an intellectual disability. There are substantial cultural, political and historical overlays contributing to the ongoing divide between health and disability. In developing psychiatric guidelines, authors should consider including people with co-occurring intellectual disability as a specific population, that requires distinctive consideration.
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Abuhammad, Sawsan, and Heyam Dalky. "Ethical Implications of Mental Health Stigma: Primary Health Care Providers’ Perspectives." Global Journal of Health Science 11, no. 12 (October 15, 2019): 165. http://dx.doi.org/10.5539/gjhs.v11n12p165.
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Stigma towards mental illness is a widespread phenomenon not just in the developing world, but also in developed countries. Unfortunately, this stigma is not only restricted to the general population, but is also prevalent among professional health care providers. Research from developing countries is scarce. Thus, the aim of this paper was to explore health care providers’ attitudes toward mental illness stigma in the primary health care settings. The review sheds light on the ethical implications of mental health stigma as perceived by primary health care providers, and the proposed recommendations for responsible conduct of research and policy initiative in the context of mental health research. Utilizing CINAHL, Medline and Scopus electronic data bases, results are reported for the 41 studies that are grouped according to being from USA, Europe, Australia, Africa, and Asia and Arab World. The results from this review confirmed that stigma associated with mental illness have many ethical implications in the context of research including use of consent form, fair treatment, and good respect for individual rights concerning treatment choices. To counter stigma and prevent the ethical implications of such stigma, interventions in the form of awareness and training programs would be the best way to minimize and stop it. Further, govermnetal and political are needed to initiate a national code of ethics for mental health research in their respective coutries.
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Nielssen, Olav B., and Matthew M. Large. "Potentially Lethal Suicide Attempts Using Sharp Objects During Psychotic Illness." Crisis 32, no. 1 (January 1, 2011): 37–42. http://dx.doi.org/10.1027/0227-5910/a000058.
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Background: Recent studies have reported that serious violence toward self and others is more common in the first episode of psychosis than after treatment. Aims: To estimate the proportion of survivors of potentially lethal suicide attempts with sharp objects who have a diagnosis of psychotic illness, and the proportion of those patients who had never received treatment for psychosis with antipsychotic medication. Methods: An audit of the medical records of patients from three major teaching hospitals in Sydney, Australia, who survived a self inflicted stab wound to the abdomen, torso, or a laceration to the neck. Results: The files of 95 survivors of self-inflicted wounds by cutting or stabbing who met the inclusion criteria for the study were examined. A psychotic illness was diagnosed in 46 cases (48%), of which 26 (57%) had never received treatment with antipsychotic medication and, hence, were in the first episode of psychosis. Conclusions: Psychosis is strongly associated with potentially lethal suicide attempts using sharp objects and patients who have never received treatment for psychosis appear to be at particular risk.
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Siskind, D. J., M. Harris, A. Phillipou, V. A. Morgan, A. Waterreus, C. Galletly, V. J. Carr, C. Harvey, and D. Castle. "Clozapine users in Australia: their characteristics and experiences of care based on data from the 2010 National Survey of High Impact Psychosis." Epidemiology and Psychiatric Sciences 26, no. 3 (July 18, 2016): 325–37. http://dx.doi.org/10.1017/s2045796016000305.
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Aims.Clozapine is the most effective medication for treatment refractory schizophrenia. However, descriptions of the mental health and comorbidity profile and care experiences of people on clozapine in routine clinical settings are scarce. Using data from the 2010 Australian Survey of High Impact Psychosis, we aimed to examine the proportion of people using clozapine, and to compare clozapine users with other antipsychotic users on demographic, mental health, adverse drug reaction, polypharmacy and treatment satisfaction variables.Methods.Data describing 1049 people with a diagnosis of schizophrenia or schizoaffective disorder, who reported taking any antipsychotic medication in the previous 4 weeks, were drawn from a representative Australian survey of people with psychotic disorders in contact with mental health services in the previous 12 months. We compared participants taking clozapine (n= 257, 22.4%) with those taking other antipsychotic medications, on a range of demographic, clinical and treatment-related indicators.Results.One quarter of participants were on clozapine. Of participants with a chronic course of illness, only one third were on clozapine. After adjusting for diagnosis and illness chronicity, participants taking clozapine had significantly lower odds of current alcohol, cannabis and other drug use despite similar lifetime odds. Metabolic syndrome and diabetes were more common among people taking clozapine; chronic pain was less common. Psychotropic polypharmacy did not differ between groups.Conclusions.Consistent with international evidence of clozapine underutilisation, a large number of participants with chronic illness and high symptom burden were not taking clozapine. The lower probabilities of current substance use and chronic pain among clozapine users warrant further study.
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Lyndon, R. William. "The Role of Specialised Units in the Treatment of Affective Disorders." Australian & New Zealand Journal of Psychiatry 25, no. 4 (December 1991): 491–98. http://dx.doi.org/10.3109/00048679109064442.
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Units which specialise in the treatment of affective (mood) disorders are gaining popularity in Australia and overseas. This paper examines the history, role and function of these units with particular reference to their benefits and disadvantages. Specialised units can offer advantages in the assessment and management of depression and bipolar illness, as well as being centres for research and education. Further research into their effectiveness is needed to enable their rational integration into existing psychiatric services.
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Hickie, Ian, and Grace Groom. "Primary Care-Led Mental Health Service Reform: An Outline of the Better Outcomes in Mental Health Care Initiative." Australasian Psychiatry 10, no. 4 (August 2002): 376–82. http://dx.doi.org/10.1046/j.1440-1665.2002.00498.x.
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Objective: To describe the key features of the ‘Better Outcomes in Mental Health Care’ initiative (2001-2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content. Conclusions: The ‘Better Outcomes in Mental Health Care’ initiative represents a major development in mental health care in Australia. It recognises the central role of primary care, promotes integrated medical and psychological care, rewards treatments that occur over an episode of illness, promotes active purchasing of non-pharmacological interventions earlier in the course of illness, and attempts to better link general practitioners, non-medical mental health specialists and psychiatrists to meet population-based mental health needs. Central to its development has been a commitment by general practitioners to develop progressively better mental health skills and measure both individual consumer and system-related outcomes.
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Bailey, Jacqueline M., Paula M. Wye, Emily A. Stockings, Kate M. Bartlem, Alexandra P. Metse, John H. Wiggers, and Jennifer A. Bowman. "Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services." Journal of Smoking Cessation 12, no. 4 (November 22, 2016): 221–30. http://dx.doi.org/10.1017/jsc.2016.23.
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Introduction: Smoking prevalence remains high among people with a mental illness, contributing to higher levels of morbidity and mortality. Health and community services are an opportune setting for the provision of smoking cessation care. Although family carers are acknowledged to play a critical role in supporting the care and assistance provided by such services to people with a mental illness, their expectations regarding the delivery of smoking cessation care have not been examined.Aims: To explore family carer expectations of smoking cessation care provision by four types of health services, to clients with a mental illness, and factors associated with expectations.Methods: A cross-sectional survey was conducted with carers of a person with a mental illness residing in New South Wales, Australia. Carers were surveyed regarding their expectations of smoking cessation care provision from four types of health services. Possible associations between carer expectation of smoking cessation care provision and socio-demographic and attitudinal variables were explored.Results: Of 144 carers, the majority of carers considered that smoking cessation care should be provided by: mental health hospitals (71.4%), community mental health services (78.0%), general practice (82.7%), and non-government organisations (56.6%). The factor most consistently related to expectation of care was a belief that smoking cessation could positively impact mental health.Conclusions: The majority of carers expected smoking cessation treatment to be provided by all services catering for people with a mental illness, reinforcing the appropriateness for such services to provide smoking cessation care for clients in an effective and systematic manner.
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Hambridge, John A., and Alan Rosen. "Assertive Community Treatment for the Seriously Mentally Ill in Suburban Sydney: A Programme Description and Evaluation." Australian & New Zealand Journal of Psychiatry 28, no. 3 (September 1994): 438–45. http://dx.doi.org/10.3109/00048679409075871.
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Assertive and intensive community treatment for the seriously mentally ill is becoming a widely accepted approach internationally. This type of service is, however, still relatively new in Australia and New Zealand, and it has rarely been fully integrated into a comprehensive catchment area community and hospital mental health service. This paper has two aims. Firstly, it describes an innovative assertive community mental health service in suburban Sydney. This service was initially provided to 64 clients with a serious mental illness, who had previously experienced repeated hospitalisations and were unable to benefit from existing high quality services. Secondly, it presents the results of the ongoing evaluation of this service. Following the implementation of the service, the number of psychiatric bed days occupied by these clients decreased by 62%; the number of clients admitted decreased, client functioning improved and symptom severity decreased, all to a significant degree.
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Thomas, Laura A., Eleanor Milligan, Holly Tibble, Lay S. Too, David M. Studdert, Matthew J. Spittal, and Marie M. Bismark. "Health, performance and conduct concerns among older doctors: A retrospective cohort study of notifications received by medical regulators in Australia." Journal of Patient Safety and Risk Management 23, no. 2 (March 21, 2018): 54–62. http://dx.doi.org/10.1177/2516043518763181.
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Objectives To determine whether ‘older doctors’ (aged over 65) are at higher risk of notifications to the medical regulator than ‘younger doctors’ (aged 36–60 years) regarding their health, performance and/or conduct. Design Retrospective cohort study. Setting National dataset of 12,878 notifications lodged with medical regulators in Australia between 1 January 2011 and 31 December 2014. Participants All registered doctors in Australia aged 36–60 and >65 years during the study period. Main outcome measures Incidence rates of notifications and incidence rate ratios of notifications (older versus younger doctors). Results Older doctors had higher notification rates (90.9 compared with 66.6 per 1000 practitioner years, p < 0.001). Sex-adjusted incidence rate ratios showed that older doctors had a higher risk of notifications relating to physical illness or cognitive decline (incidence rate ratio = 15.54), inadequate record keeping (incidence rate ratio = 1.98), unlawful use or supply of medications (incidence rate ratio = 2.26), substandard certificates/reports (incidence rate ratio = 2.02), inappropriate prescribing (incidence rate ratio = 1.99), disruptive behaviours (incidence rate ratio = 1.37) and substandard treatment (incidence rate ratio = 1.24). Older doctors had lower notification rates relating to mental illness and substance misuse (incidence rate ratio = 0.58) and for performance issues relating to problems with procedures (incidence rate ratio = 0.61). Conclusions Older doctors were at higher risk for notifications relating to physical or cognitive impairment, records and reports, prescribing or supply of medicines, disruptive behaviour and treatment. They were at lower risk for notifications about mental illness or substance misuse. Incorporating knowledge of these patterns into regulatory practices, workplace adjustments and continuing education/assessment could enhance patient care.
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Burvill, P. W., W. D. Hall, H. G. Stampfer, and J. P. Emmerson. "The Prognosis of Depression in Old Age." British Journal of Psychiatry 158, no. 1 (January 1991): 64–71. http://dx.doi.org/10.1192/bjp.158.1.64.
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The 12–month outcome of 103 elderly depressed patients treated by psychiatrists in Perth, Western Australia, was good in 32–47% of cases, depending upon the stringency of the outcome criteria used. A higher than expected mortality was found, especially in men. No clear association was found between 12–month outcome and a variety of clinical variables at index admission, including chronic physical illness, severity of depression, and severe life events during follow-up. As the statistical power of this and other studies is small, it would be unwise at present to draw definite conclusions about the role of possible risk factors in the prognosis of depressed elderly. Vigorous treatment of the depressive illness and adequate after-care are important.
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Rose, Grenville, Elena Cama, Loren Brener, and Carla Treloar. "Knowledge and attitudes towards hepatitis C and injecting drug use among mental-health support workers of a community managed organisation." Australian Health Review 37, no. 5 (2013): 654. http://dx.doi.org/10.1071/ah13134.
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Objectives People with mental illness are at significantly higher risk of acquiring hepatitis C virus (HCV) compared with the general population. This study assessed knowledge of and attitudes towards people with HCV and people who inject drugs (PWID) among support workers of clients with mental illness. Methods Support workers from a community managed organisation (CMO) in Australia were recruited to complete an online cross-sectional survey. The survey collected data about their knowledge of HCV and attitudes towards PWID and people with HCV. Results Valid responses were received from 117 support workers. Although HCV knowledge was moderate, there were significant knowledge gaps around transmission and treatment of HCV. Higher HCV knowledge was significantly associated with more positive attitudes towards PWID, but not with attitudes towards people with HCV. Participants had more positive attitudes towards people with HCV than towards PWID. Additionally, those with more positive attitudes towards HCV tended to also have more positive attitudes towards PWID. Conclusions Given that people with mental illness are at higher risk of acquiring HCV, these results point to the need for education targeted at support workers of clients with mental illness to increase HCV knowledge and promote positive attitudes towards PWID and people with HCV. What is known about this topic? The limited research available suggests that there are gaps in HCV knowledge among mental-health-service providers, although such research has generally targeted physicians. What does this paper add? This paper is the first to assess HCV knowledge, attitudes towards PWID and HCV among mental-health support workers. The findings suggest that although HCV knowledge is moderate, significant gaps exist, which are related to negative attitudes towards PWID. What are the implications for practitioners? Supportive and non-judgemental care is essential for people with mental illness and HCV, due to the potential for a double stigma arising from negative attitudes towards both mental illness and injecting drug use. This paper highlights the importance of targeted education for workers in the mental-health sector, to increase HCV knowledge and promote positive attitudes towards people with co-occurring mental-health, substance use problems and HCV.
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Bird, Jennifer, Darlene Rotumah, James Bennett-Levy, and Judy Singer. "Diversity in eMental Health Practice: An Exploratory Qualitative Study of Aboriginal and Torres Strait Islander Service Providers." JMIR Mental Health 4, no. 2 (May 29, 2017): e17. http://dx.doi.org/10.2196/mental.7878.
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Background In Australia, mental health services are undergoing major systemic reform with eMental Health (eMH) embedded in proposed service models for all but those with severe mental illness. Aboriginal and Torres Strait Islander service providers have been targeted as a national priority for training and implementation of eMH into service delivery. Implementation studies on technology uptake in health workforces identify complex and interconnected variables that influence how individual practitioners integrate new technologies into their practice. To date there are only two implementation studies that focus on eMH and Aboriginal and Torres Strait Islander service providers. They suggest that the implementation of eMH in the context of Aboriginal and Torres Strait Islander populations may be different from the implementation of eMH with allied health professionals and mainstream health services. Objective The objective of this study is to investigate how Aboriginal and Torres Strait Islander service providers in one regional area of Australia used eMH resources in their practice following an eMH training program and to determine what types of eMH resources they used. Methods Individual semistructured qualitative interviews were conducted with a purposive sample of 16 Aboriginal and Torres Strait Islander service providers. Interviews were co-conducted by one indigenous and one non-indigenous interviewer. A sample of transcripts were coded and thematically analyzed by each interviewer and then peer reviewed. Consensus codes were then applied to all transcripts and themes identified. Results It was found that 9 of the 16 service providers were implementing eMH resources into their routine practice. The findings demonstrate that participants used eMH resources for supporting social inclusion, informing and educating, assessment, case planning and management, referral, responding to crises, and self and family care. They chose a variety of types of eMH resources to use with their clients, both culturally specific and mainstream. While they referred clients to online treatment programs, they used only eMH resources designed for mobile devices in their face-to-face contact with clients. Conclusions This paper provides Aboriginal and Torres Strait islander service providers and the eMH field with findings that may inform and guide the implementation of eMH resources. It may help policy developers locate this workforce within broader service provision planning for eMH. The findings could, with adaptation, have wider application to other workforces who work with Aboriginal and Torres Strait Islander clients. The findings highlight the importance of identifying and addressing the particular needs of minority groups for eMH services and resources.
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O'Donnell, Renée, Melissa Savaglio, Debra Fast, Ash Vincent, Dave Vicary, and Helen Skouteris. "MyCare study: protocol for a controlled trial evaluating the effect of a community-based intervention on psychosocial, clinical outcomes and hospital admission rates for adults with severe mental illness." BMJ Open 10, no. 11 (November 2020): e040610. http://dx.doi.org/10.1136/bmjopen-2020-040610.
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IntroductionPeople with serious mental illness (SMI) often fail to receive adequate treatment. To provide a higher level of support, mental health systems have been reformed substantially to integrate mental healthcare into the community. MyCare is one such community-based mental health model of care. This paper describes the study protocol of a controlled trial examining the effect of MyCare on psychosocial and clinical outcomes and hospital admission and duration rates for adults with SMI.Methods and analysisThis is a multisite non-randomised controlled trial with a 3, 6 and 12-month follow-up period. The study participants will be adults (18–64 years of age) with SMI recruited from Hobart, Launceston and the North-West of Tasmania. The treatment group will include adults who receive both the MyCare intervention and standard mental health support; the control group will include adults who receive only standard mental health support. The primary outcome includes psychosocial and clinical functioning and the secondary outcome will examine hospital admission rates and duration of stay. Mixed-effects models will be used to examine outcome improvements between intake and follow-up. This trial will generate the evidence needed to evaluate the effect of a community mental health support programme delivered in Tasmania, Australia. If MyCare results in sustained positive outcomes for adults with SMI, it could potentially be scaled up more broadly across Australia, addressing the inequity and lack of comprehensive treatment that many individuals with SMI experience.Ethics and disseminationThis study has been approved by the Tasmanian Health and Medical Human Research Ethics Committee. The findings will be disseminated to participants and staff who delivered the intervention, submitted for publication in a peer-reviewed journal and shared at academic conferences.Trial registration numberACTRN12620000673943.
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Daws, Tessa. "Obtaining consent for non-psychiatric treatment of persons detained under mental health legislation in Australia and New Zealand: is there cross-jurisdictional consistency?" Australasian Psychiatry 26, no. 5 (September 18, 2018): 486–90. http://dx.doi.org/10.1177/1039856218797444.
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Objective: It is increasingly recognised that persons with mental illness experience physical health issues at greater rates than the general population and that there are significant barriers to accessing appropriate treatment. One less obvious barrier to appropriate care may be the law. This review examines the legal regimes within Australia and New Zealand that regulate consent for medical and surgical treatment for persons detained under mental health legislation. The review begins with a brief overview of concepts of consent and capacity then examines the law with regards to consent for non-psychiatric treatment for persons detained in psychiatric facilities. The complexity and cross-jurisdictional consistency is considered and potential future directions and possibilities for reform are discussed. Conclusion: Examination of the different laws regarding consent for medical or surgical treatment for persons admitted to psychiatric facilities are complex and demonstrate lack of consistency across jurisdictions. Reform in this area might be considered to achieve greater consistency and clarity for both health professionals and consumers.
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Battersby, Malcolm W., John J. O'mahoney, Andrew R. Beckwith, and Justin L. Hunt. "Antidepressant Deaths by Overdose." Australian & New Zealand Journal of Psychiatry 30, no. 2 (April 1996): 223–28. http://dx.doi.org/10.3109/00048679609076098.
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Objective: To determine the prevalence of antidepressant deaths in South Australia, the relative frequency of each antidepressant used and demographic data of those who died. Method: This was a retrospective, case note study of all cases where death was caused by lethal levels of antidepressants in South Australia for the period from 1986 to 1990. The study occurred at the South Australian coroner's office. Subjects were selected from toxicology data, where serum or liver levels of one or more antidepressant were in the lethal range. Results: Seventy-one cases were identified and information was obtained on 68 of these cases from the coroner's files. Amitriptyline, Doxepin and Dothiepin accounted for the majority of antidepressant deaths. Women were 2.5 times more likely to use antidepressants to suicide than men. At least 63% had a known psychiatric illness and 45% had previously attempted suicide. Conclusions: The older tricyclic antidepressants are a significant cause of suicide. It is recommended that the newer antidepressants, which are as efficacious yet safer in overdose, be prescribed in preference to the older tricyclic antidepressants, as the first line of treatment in newly diagnosed depressed outpatients.
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Teresa Dawson, Maria, Paul Grech, Brendan Hyland, Fiona Judd, John Lloyd, Anne M. Mijch, Jennifer Hoy, and Alan C Street. "A Qualitative Approach to the Mental Health Care Needs of People Living with HIV/AIDS in Victoria." Australian Journal of Primary Health 8, no. 3 (2002): 30. http://dx.doi.org/10.1071/py02041.
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This article reports on the findings of the qualitative stage of a larger project on the mental care needs of people with HIV/AIDS and mental illness (Tender T1176 Department of Human Services, Mental Health Branch, Victoria - Research on the Mental Health Care Needs of People with HIV/AIDS and Mental Illness). The purpose of the larger research was to evaluate the needs and treatment requirements of persons with HIV/AIDS, who also suffer from mental health problems, with a view to developing proposals for improving existing service delivery in Victoria, Australia. The qualitative stage was designed to complement and elucidate data obtained through the quantitative stages of the project. Thirty in-depth open-ended interviews were carried out with service providers including HIV physicians, general practitioners, psychiatrists, clinical and managerial staff of Area Mental Health Services, Contact Tracers and forensic mental health services staff, as well as representatives of community groups such as People Living with HIV/AIDS and Positive Women and carers. The interviews explored the perspective of both service providers and users of such services with respect to needs for psychiatric care and service delivery, ease of access or barriers to mental health services, and the perceived strengths and weaknesses in current service provision. This paper presents the main findings and recommendations submitted to the funding body.
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Bairami, Kemalie, Benjamin L. Spivak, Lisa M. Burke, and Stephane M. Shepherd. "Exploring mental illness attributions and treatment-seeking beliefs in a diverse Muslim-Australian sample." Clinical Psychologist 25, no. 1 (January 2, 2021): 44–54. http://dx.doi.org/10.1080/13284207.2021.1929143.
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Bell, Maureen. "From the 1870s to the 1970s: the Changing Face of Public Psychiatry in South Australia." Australasian Psychiatry 11, no. 1 (March 2003): 79–86. http://dx.doi.org/10.1046/j.1440-1665.2003.00513.x.
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Objective: To give an overview of the development of psychiatric services in South Australia from the 1870s to the 1970s, to describe some of the milestones in their progress, and to demonstrate that many of the guiding principles of contemporary services can be found to have their roots in this period. Conclusions: Psychiatric services in South Australia progressed in fits and starts, but not for want of commitment and concern by those responsible for the care of the mentally ill. While in broad outline the development of services followed the course taken in other states, it is clear that the individual efforts of staff of the hospitals and a number of members of the public played an important role in improving the conditions and treatment of those with a mental illness, and laying the foundations for the movement of psychiatric services from their early isolationist position into the general health arena.
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Gwinner, Karleen, and Louise Ward. "Storytelling, Safeguarding, Treatment, and Responsibility: attributes of recovery in psychiatric intensive care units." Journal of Psychiatric Intensive Care 11, no. 02 (December 19, 2014): 105–18. http://dx.doi.org/10.1017/s1742646414000181.
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AbstractBackground and aimIn recent years, policy in Australia has endorsed recovery-oriented mental health services underpinned by the needs, rights and values of people with lived experience of mental illness. This paper critically reviews the idea of recovery as understood by nurses at the frontline of services for people experiencing acute psychiatric distress.MethodData gathered from focus groups held with nurses from two hospitals were used to ascertain their use of terminology, understanding of attributes and current practices that support recovery for people experiencing acute psychiatric distress. A review of literature further examined current nurse-based evidence and nurse knowledge of recovery approaches specific to psychiatric intensive care settings.ResultsFour defining attributes of recovery based on nurses’ perspectives are shared to identify and describe strategies that may help underpin recovery specific to psychiatric intensive care settings.ConclusionThe four attributes described in this paper provide a pragmatic framework with which nurses can reinforce their clinical decision-making and negotiate the dynamic and often incongruous challenges they experience to embed recovery-oriented culture in acute psychiatric settings.
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Hopkins, Liza. "Schools and adolescent mental health: education providers or health care providers?" Journal of Public Mental Health 13, no. 1 (March 12, 2014): 20–24. http://dx.doi.org/10.1108/jpmh-07-2013-0050.
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Purpose – The issue of mental health amongst students in the senior years of secondary schooling is one which has recently gained traction in mainstream media and public discourse across Australia. The purpose of this paper is to uncover the ways in which schools and other education providers are responding to mental health issues amongst their students both proactively (for prevention) and reactively (for referral and treatment). Design/methodology/approach – The project took a qualitative research approach to gathering data from student support staff based in schools and out-of-school learning settings, through a focus group methodology. Findings – The project found that despite policy rhetoric and research evidence supporting pro-active, curriculum integrated, early intervention to prevent and avoid mental illness and mental distress amongst secondary school students, most schools still take a reactive, piecemeal approach to prevention of mental illness and provision of mental health care. Individual schools and learning providers are responding to issues in a variety of ways, along a continuum of care. Research limitations/implications – The project had a small sample size and restricted geographic area. The divergence in findings between staff from schools in this area and staff from other education providers suggests much more work needs to be done in establishing the implications of bureaucratic sector and school governance on health and wellbeing outcomes. Originality/value – This paper begins to explore an under-researched area of school and other education provider responses to rising concern about student mental health.
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Thomas, Trang. "Health Issues for Women of Non-English Speaking Backgrounds." Australian Journal of Primary Health 4, no. 3 (1998): 93. http://dx.doi.org/10.1071/py98035.
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The shift away from focusing only on physical factors in health to more on psycho-social factors means that, in a multicultural society like Australia, we have to pay attention to the influence of cultural factors in health and health promotion. Living healthily in a culturally diverse society is a challenge. Issues concerning cultural factors in maintaining and promoting the health of women of non-English speaking backgrounds are discussed here. Cultural differences and knowledge gaps create difficulties not only for the people in need of service, but for service providers as well. There is a need for bilingual and culturally sensitive trained professionals. Access to health care, especially preventive measures, and the role of ethnic women as carers are discussed. Another issue for attention is mental health. Risk factors in developing mental illness, and barriers to effective diagnosis and treatment are identified. Difficulties in handling health crises bring serious problems. Many women came from countries with traditional ways of handling crises which may not be possible or appropriate in Australia.
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Bains, Jatinder J. S., and Olav B. Nielssen. "Combining depot antipsychotic medications with novel antipsychotics in forensic patients: a practice in search of a principle." Psychiatric Bulletin 27, no. 1 (January 2003): 14–16. http://dx.doi.org/10.1192/pb.27.1.14.
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OBJECTIVEWe observed a pattern of combining depot antipsychotic medication with the newer ‘atypical’ antipsychotics in forensic patients. We aimed to determine the prevalence and rationale for such ‘combination therapy’.METHODThe medical records of forensic patients in 3 forensic hospitals in New South Wales, Australia, were reviewed and the responsible psychiatrists asked to explain the rationale for treatment of those patients on combination therapy.ResultsTwenty-two per cent of the forensic patient population were receiving combination therapy. The reasons given for combination therapy were the presence of treatment-resistant illness, to ensure adherence to at least part of the treatment and to assist transfer to lower security units.CONCLUSIONSSuch a high prevalence of a practice that is discouraged and without theoretical justification is a cause for concern. It appeared to reflect the practical difficulties of managing forensic patients.
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James, Norman McI. "On the Perception of Madness." Australian & New Zealand Journal of Psychiatry 27, no. 2 (June 1993): 192–99. http://dx.doi.org/10.1080/00048679309075768.
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Since the beginning of recorded history, mental illness has been recognised as being primarily in the province of the healing profession. This view has continued, despite the fact that psychiatry left the mainstream of medicine with the development of asylums during the 19th century. With the advent of deinstitutionalisation however, psychiatrists, particularly in Australia, have increasingly left public practice. As result, the treatment of the severely and chronically mentally ill, especially those with behavioural disorder, has become neglected. It is argued that moves toward the mainstreaming of acute psychiatry to general hospitals offer new opportunity for the profession to reassert itself in this essential but difficult area of psychiatric practice.
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SIMON, JUDIT, ULRIKE SCHMIDT, and STEPHEN PILLING. "The health service use and cost of eating disorders." Psychological Medicine 35, no. 11 (April 1, 2005): 1543–51. http://dx.doi.org/10.1017/s0033291705004708.
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Background. The economic burden and health service use of eating disorders have received little attention, although such data are necessary to estimate the implications of any changes in clinical practice for patient care and health care resource requirements. This systematic review reports the current international evidence on the resource use and cost of eating disorders.Method. Relevant literature (1980–2002) was identified from searches of electronic databases and expert contacts.Results. Two cost-of-illness studies from the UK and Germany, one burden-of-disease study from Australia and 14 other publications with relevant data from the UK, USA, Austria, Denmark and The Netherlands could be identified. In the UK, the health care cost of anorexia nervosa was estimated to be £4·2 million in 1990. In Germany, the health care cost was €65 million for anorexia nervosa and €10 million for bulimia nervosa during 1998. The Australian study reported the health care costs of eating disorders to be Aus$22 million for year 1993/1994. Other costing studies focused mostly on in-patient care reporting highly variable estimates. There is a dearth of research on non-health care costs.Conclusions. The limited available evidence reflects a general under-detection and under-treatment of eating disorders. Although both cost-of-illness studies may significantly underestimate the costs of eating disorders because of important omitted cost items, other evidence suggests that the economic burden is likely to be substantial. Comprehensive data on the resource use of patients with eating disorders are urgently needed for better estimations, and to be able to determine cost-effective treatment options.
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Moore, Elizabeth, Serafino G. Mancuso, Tim Slade, Cherrie Galletly, and David J. Castle. "The impact of alcohol and illicit drugs on people with psychosis: The second Australian national survey of psychosis." Australian & New Zealand Journal of Psychiatry 46, no. 9 (April 3, 2012): 864–78. http://dx.doi.org/10.1177/0004867412443900.
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Objective: To provide the most up-to-date prevalence estimates of alcohol and illicit drug use among individuals with psychosis in Australia, and explore correlates associated with a lifetime diagnosis of both alcohol abuse/dependence and cannabis abuse/dependence. Method: This paper uses data from the Survey of High Impact Psychosis (SHIP), conducted as a follow-up to the first Australian National Low Prevalence (Psychotic) Disorders Study (1997–1998). The SHIP was a national study, carried out across five states, in which a sample of 1825 individuals was recruited through a two-phase sampling framework. Results: Alcohol and illicit drug use was highly prevalent for the entire sample. There were few significant differences in the prevalence or frequency of use across the diagnostic categories examined. Substantial increases in substance abuse/dependence were noted since the 1997–1998 survey (51% diagnosed with alcohol abuse/dependence, 51% with cannabis abuse/dependence and 32% with other illicit drug abuse/dependence, compared to 28%, 23% and 12% respectively, in the 1997–1998 survey by Kavanagh et al., 2004). Factors significantly associated with both lifetime alcohol and cannabis dependence included male gender, younger age, single marital status, lower educational attainment, shorter duration of illness, lifetime presence of hallucinations, higher negative syndrome score and lower body mass index (BMI). A number of other factors were found to be differentially associated with either lifetime alcohol or cannabis dependence. Conclusions: The use of alcohol and illicit substances is common among people with a psychotic illness, with a concerning upward trend in rates of substance abuse/dependence since the 1997–1998 survey. Clinicians should be aware of the potential impact of concurrent substance use and provide integrated treatment for individuals presenting with psychotic illnesses. More research and investment in new intervention programs is required.
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Neil, Amanda L., Terry J. Lewin, and Vaughan J. Carr. "Allocation of Resources and Psychosis." Australian & New Zealand Journal of Psychiatry 37, no. 1 (February 2003): 15–23. http://dx.doi.org/10.1046/j.1440-1614.2003.01117.x.
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Objective: This commentary reviews current expenditure on psychosis in Australia, identifies discretionary expenditure that could be used more efficiently, discusses the factors influencing resource allocation and intervention selection decisions, and suggests priorities for change. Method: Cost-of-illness findings from the Low Prevalence Disorders Study (LPDS), and related service use and psychosocial data, are used to highlight patterns of expenditure on psychosis and potential resource allocation issues. Arguments are also presented suggesting that mental health resource allocation in Australia should be informed primarily by treatment efficiency, equity and humanitarian considerations, not differences in the global burden of disease. However, our evidence-base about the effectiveness and costs associated with individual treatments, programmes, and organizational structures is also shown to be limited. Conclusions: The patterns of service use and expenditure on psychosis suggest certain imbalances, including an over-reliance on hospitalization, low levels of supported community accommodation, and inadequate provision of evidence-based psychosocial treatments, rehabilitation and supported employment programmes. We need to identify and develop efficient interventions and programmes, re-orientate our services to better utilize those interventions, increase community awareness, improve monitoring of outcomes and costs, and undertake timely evaluations at multiple levels, from the individual to the societal perspective.
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Beumont, Pierre, Phillipa Hay, and Rochelle Beumont. "Summary Australian and New Zealand Clinical Practice Guideline for the Management of Anorexia Nervosa(2003)." Australasian Psychiatry 11, no. 2 (June 2003): 129–33. http://dx.doi.org/10.1046/j.1039-8562.2003.00534.x.
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Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the Management of Anorexia Nervosa (AN). Conclusions: Anorexia nervosa affects only a small proportion of the Australian and New Zealand population but it is important because it is a serious and potentially life-threatening illness. Sufferers often struggle with AN for many years, if not for life, and the damage done to their minds and bodies may be irreversible. Anorexia nervosa is characterized by a deliberate loss of weight and refusal to eat. Overactivity is common. Approximately 50% of patients also use unhealthy purging and vomiting behaviours to lose weight. There are two main areas of physical interest: the undernutrition and mal-nutrition of the illness and the various detrimental weight-losing behaviours themselves. Basic psychopathology ranges from an over-valued idea of high salience concerning body shape through to total preoccupation and eventually to firmly held ideas that resemble delusions. Comorbid features are frequent, especially depression and obsessionality. It is inadvisable in clinical practice to apply too strict a definition of AN because to do so excludes patients in the early stage of the illness in whom prompt intervention is most likely to be effective. The best treatment appears to be multidimensional/multidisciplinary care, using a range of settings as required. Obviously, the medical manifestations of the illness need to be addressed and any physical harm halted and reversed. It is difficult to draw conclusions about the efficacy of further treatments. There is a paucity of clinical trials, and their quality is poor. Furthermore, the stimuli for developing AN are varied, and the psychotherapy options to address these problems need to be tailored to suit the individual patient. Because there is no known ‘chemical imbalance’ that causes the illness, no one drug offers relief. There is a high rate of relapse, and some patients are unable to recover fully. Because AN is a psychiatric illness, a psychiatrist should always be involved in its treatment. All psychiatrists should be capable of assuming this responsibility. Because cognitive behavioural methods are generally accepted as the best mode of therapy, a clinical psychologist should also be involved in treatment. Because medical manifestations are important, someone competent in general medicine should always be consulted. The optimal approach is multidisciplinary or at least multiskilled, with important contributions from psychologists, general practitioners, psychiatric nurses, paediatricians, dietitians and social workers.
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Morgan, Matthew. "Police Responses to Persons with Mental Illness: The Policy and Procedures Manual of One Australian Police Agency and ‘Procedural Justice Policy’." Social Sciences 10, no. 2 (January 27, 2021): 42. http://dx.doi.org/10.3390/socsci10020042.
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Persons with mental illness (PWMI) often report negative perceptions of police treatment following receiving criminalising and heavy-handed police responses. To appropriately control officer discretion and to harness ethical, legal, and efficient police practice when encountering vulnerable and diverse individuals, police agencies across the world issue policy documents to their officers. These documents serve as a reflection regarding how police agencies aspire to manage PWMI in the community. Using a procedural justice framework, this research measures how a large police agency in Australia aspires to manage PWMI and whether the police policy document provides sufficient detail in advocating the appropriate and just police treatment of PWMI. A content analysis of the policy document revealed a lack of sufficient procedural guidelines in effectively controlling police officer discretion when encountering PWMI in the community. This article argues that without further consolidation to embed appropriate procedural guidelines into the policy document, the procedural policy gaps may have a negative effect on the experiences of PWMI when encountering the police.
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Adams, Nicholas H. S., and R. Julian Hafner. "Attitudes of Psychiatric Patients and their Relatives to Involuntary Treatment." Australian & New Zealand Journal of Psychiatry 25, no. 2 (June 1991): 231–37. http://dx.doi.org/10.1080/00048679109077739.
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In 1979 a Guardianship Board assumed responsibility in South Australia for the welfare of those mentally ill or handicapped people unable to look after their own health or safety, or to manage their own affairs. This study examines the attitudes to guardianship and involuntary treatment of 79 patients referred to the Board from a psychiatric hospital, all of whom were under guardianship at the time of the study. Forty-seven of their relatives took part in the project, which included measures of patients' psychiatric symptoms and relatives' punitiveness. Although almost 70% of patients objected to Guardianship in principle, they made more positive than negative statements about it. Nearly 60% rated involuntary treatment, including medication, as helpful. Patients reported a level of psychiatric symptoms less than half of that of a psychiatric outpatient sample. Relatives were strongly in favour of Guardianship, stating frequently that it allowed an improved relationship between themselves and the patient. Patients who believed that they were suffering from a mental illness were comparatively happy about being under Guardianship, and a belief that the patient was mentally ill was significantly associated with reduced ex-trapunitiveness in relatives.
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Wijesinghe, C. P., and D. J. Clancy. "Schizophrenia in Migrants Living in the Western Region of Melbourne." Australian & New Zealand Journal of Psychiatry 25, no. 3 (September 1991): 350–57. http://dx.doi.org/10.3109/00048679109062636.
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Comparison is made between migrant (n = 332) and Australian-born (n = 242) schizophrenic outpatients attending a regional psychiatric hospital. Age-corrected rates show that migrants are over-represented. The migrant patient-group was older, developed the illness later, and had a higher proportion of females. More female migrant patients had developed the illness before arrival and in the first five years after migration compared to males whose peak incidence was between 11 and 15 years after arrival. Migrant patients showed greater family cohesion. On broad socio-economic indices, illness characteristics and treatment received, no significant differences emerged. In many respects patients born in U.K. and Ireland resembled the Australian-born.
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Butler, Tony, Stephen Allnutt, Azar Kariminia, and David Cain. "Mental Health Status of Aboriginal and Non-Aboriginal Australian Prisoners." Australian & New Zealand Journal of Psychiatry 41, no. 5 (May 2007): 429–35. http://dx.doi.org/10.1080/00048670701261210.
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Objective: To compare the mental health of Aboriginal and non-Aboriginal prisoners in New South Wales. Methods: The sample consisted of a cross-sectional random sample of sentenced prisoners, and a consecutive sample of reception prisoners. The sample was drawn from 29 correctional centres (27 male, two female) across New South Wales. Overall, 1208 men (226 Aboriginal), and 262 women (51 Aboriginal) participated in the study. Mental illness was detected using the Composite International Diagnostic Interview (CIDI-A) and a number of other screening measures incorporated into the programme. Results: No differences were detected in mental illness between Aboriginal and non-Aboriginal men, apart from depression, which was lower in the latter group. Aboriginal woman were more likely than non-Aboriginal women to screen positive for symptoms of psychosis in the prior 12 months and have a higher 1 month and 12 month prevalence of affective disorder; they also had higher psychological distress scores. Suicidal thoughts and attempts were the same in both groups. Conclusions: These findings confirm that the demand for mental health services in prisons is considerable, and that Aboriginal women are one of the most vulnerable groups. Services and programmes providing an alternative to incarceration are needed, as are culturally sensitive approaches to treatment.
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Teesson, Maree, and Neil Buhrich. "Prevalence of schizophrenia in a refuge for homeless men: a five year follow-up." Psychiatric Bulletin 14, no. 10 (October 1990): 597–600. http://dx.doi.org/10.1192/pb.14.10.597.
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Until the mid 1950s, the management of persons suffering from chronic mental illness in Australia was the responsibility of the large mental hospital. With the advent of psychotropic drugs and concern about the ‘negative’ influence of the institutional environment on patients there was a shift to shorter but more frequent periods of hospital admission. As the pattern of shorter admissions increased, community services for the mentally ill were expanded in the early 1970s. Between 1950 and 1985 in the state of New South Wales, the numbers of patients in large mental hospitals decreased from 256 to 55 per 100 000 population. However, no special arrangements for accommodation, as distinct from treatment, were made for these ex-mental hospital patients. The decline in hospital numbers can be attributed to a general reduction in the length of hospital stays. Initially, there seemed to be no pressing need for extra accommodation in the community as the provision of social security benefits was adequate to allow patients without homes to afford basic accommodation, a situation different to that in the United States (Lamb, 1984).
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Waterreus, Anna, and Vera A. Morgan. "Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners – Findings from the Australian National Survey of High Impact Psychosis." Australian & New Zealand Journal of Psychiatry 52, no. 6 (September 9, 2017): 561–72. http://dx.doi.org/10.1177/0004867417728806.
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Objectives: To describe from the perspective of people living with psychotic illness their use of general practitioner services over a 12-month period and the experiences, attitudes and challenges general practitioners face providing health care to this population. Methods: A two-phase design was used. Phase 1, screening for psychosis, occurred in public specialised mental health services and non-government organisations within seven catchment sites across Australia. In Phase 2, 1825 people who were screened positive for psychosis were randomly selected for interview which included questions about frequency and reason for general practitioner contact in the 12 months prior to interview. General practitioners (1473) of consenting participants were also surveyed. Results: Almost all (90.3%) survey participants had consulted a general practitioner in the 12-month period, on average 8.9 times, and 28.8% of attenders had consulted 12 times or more. The majority (83.5%) attended one general practitioner practice. Most (77.6%) general practitioners wanted to be involved in the mental health care of their patient. Although 69.1% said the management of their patient was not problematic for their practice, one in five general practitioners reported issues related to patient non-compliance with treatment and non-attendance at scheduled appointments; time constraints; and lack of feedback from treating mental health services. Conclusion: People with psychotic disorders consult general practitioners, some very frequently. Most Australian general practitioners believe they have a responsibility to review the physical and mental health of their patients. Improved communication between general practitioners and mental health services, and easier access to mental health support, may help general practitioners manage the complex mental, physical and social problems of their patients.
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Brophy, Lisa, Craig Hodges, Kieran Halloran, Margaret Grigg, and Mary Swift. "Impact of care coordination on Australia's mental health service delivery system." Australian Health Review 38, no. 4 (2014): 396. http://dx.doi.org/10.1071/ah13181.
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Care coordination models have developed in response to the recognition that Australia’s health and welfare service system can be difficult to access, navigate and is often inefficient in caring for people with severe and persistent mental illness (SPMI) and complex care and support needs. This paper explores how the Australian Government’s establishment of the Partners in Recovery (PIR) initiative provides an opportunity for the development of more effective and efficient models of coordinated care for the identified people with SPMI and their families and carers. In conceptualising how the impact of the PIR initiative could be maximised, the paper explores care coordination and what is known about current best practice. The key findings are the importance of having care coordinators who are well prepared for the role, can demonstrate competent practice and achieve better systemic responses focused on the needs of the client, thus addressing the barriers to effective care and treatment across complex service delivery systems. What is known about the topic? Care coordination, as an area of mental health practice in Australia, has not been well defined and the evidence available about its effectiveness is uneven. Even so, care coordination is increasingly identified as having the potential to deliver a more person-centred response to the health and social needs of people with severe and persistent mental illness (SPMI), as well as enhance the responsiveness of Australia’s mental health service delivery system. The introduction of Partners in Recovery (PIR), a new Australian Government initiative based on coordinated care approaches, provides the impetus to investigate the hoped for mental health system enhancements and related improved client outcomes. What does this paper add? This paper offers a rationale for care coordination, referred to in the PIR model as support facilitation, as a primary enabler for enhanced person-centred, cost-effective and sustainable mental health service delivery. The paper discusses support facilitation as an integral practice platform for supporting the successful implementation and sustainability of the PIR initiative. It also addresses issues that may be encountered in establishing the roles and functions of various components of the initiative’s care coordination model. What are the implications for practitioners? The key implications for PIR support facilitation practitioners are to reconsider their function and roles within a mental health service delivery system that places care coordination at its centre. This paper establishes that any model of care coordination requires well-trained and enthusiastic practitioners with a sophisticated appreciation of current barriers to care. Practitioners will be required to value partnerships as a means of addressing barriers that impact on the establishment and maintenance of robust, system-wide responses that are genuinely consumer focused.
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Mueller-Stierlin, Annabel S., Anna Peisser, Sebastian Cornet, Selina Jaeckle, Jutta Lehle, Sabrina Moerkl, and Scott B. Teasdale. "Exploration of Perceived Determinants of Disordered Eating Behaviors in People with Mental Illness—A Qualitative Study." International Journal of Environmental Research and Public Health 20, no. 1 (December 27, 2022): 442. http://dx.doi.org/10.3390/ijerph20010442.
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Disordered eating behaviors are common in people with a serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depressive disorder. This study employed qualitative exploration to understand the perceived determinants of eating behaviors, in particular those connected to disordered eating patterns, in people with SMI. In total, 28 semi-structured interviews were conducted in a consecutive sample of people with SMI under treatment in local mental health services in Australia (n = 12), Germany (n = 8) and Austria (n = 8) (mean age: 43.3 years, proportion of female participants: 61%, proportion of participants with ICD-10 F2 diagnosis: 57%, proportion of participants with ICD-10 F3 diagnosis: 64%). A thematic analysis approach, the framework method, was applied using MAXQDA 2020. Three main themes of determinants were derived: (i) impacts to daily functioning, (ii) disrupted physical hunger cues and (iii) emotional hunger. For impacts to daily functioning, the following themes emerged: lack of daily structure, time and drive, and difficulty planning ahead. For physical hunger, themes emerged for disrupted hunger and satiety cues, and mindless eating. All motives listed in the Palatable Eating Motives Scale (PEMS), i.e., coping, reward, social and conformity, have been reported by participants to be drivers for their emotional eating behavior. Subsequent reported behaviors were eating too much or too little, binge eating, night eating and food cravings. We conclude that interprofessional approaches should target daily functioning, disrupted physical hunger cues and emotional eating to reduce disordered eating behaviors in people with SMI.
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Vaughan, Kevin, Neil McConaghy, Cherry Wolf, Craig Myhr, and Terry Black. "Community Treatment Orders: Relationship to Clinical Care, Medication Compliance, Behavioural Disturbance and Readmission." Australian & New Zealand Journal of Psychiatry 34, no. 5 (October 2000): 801–8. http://dx.doi.org/10.1080/j.1440-1614.2000.00813.x.
Full textAbstract:
Objective: The objective of this study was to investigate the readmission rate, and the level of patient disturbance and community care associated with readmission following Community Treatment Orders (CTOs) in New South Wales, Australia. Method: The readmission rates of all patients given CTOs within a 4-year period and a matched comparison group were investigated. The following factors were compared before, during and following a CTO: medication non-compliance, number of clinical services and duration of disturbed behaviour preceding hospitalisations. Results: Of 123 patients on CTOs (mean length, 288 days; SD, 210 days), 38 were readmitted during the CTO, the majority in the first 3 months and a further 21 patients were readmitted following termination of the CTO. Evidence of lower severity of illness in the comparison patients prevented meaningful evaluation of the readmission rates of the two groups. While on CTOs, patients receiving depot medications showed high compliance and a significantly reduced readmission rate compared with that of patients receiving oral medications. In the 2 months prior to hospitalisations during CTOs, compared with those before or after CTOs, patients received more frequent consultations and showed a shorter duration of medication non-compliance and disturbed behaviour. The level of services in the 3 months following discharge were comparable for patients on CTOs and the comparison group. Conclusions: CTOs may reduce rehospitalisations by use of depot medication. Earlier and possibly more frequent readmissions in the CTO group shortened the disturbance associated with illness recurrence. It would appear that to establish a control group with equivalent severity of disorder necessary to evaluate the impact of CTOs requires a random allocation design.