Journal articles on the topic 'Veterans Mental health Australia Case studies'
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Tran, Nam, Jeffrey W. Poss, Christopher Perlman, and John P. Hirdes. "Case-Mix Classification for Mental Health Care in Community Settings: A Scoping Review." Health Services Insights 12 (January 2019): 117863291986224. http://dx.doi.org/10.1177/1178632919862248.
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As mental health care transitions from facility-based care to community-based services, methods to classify patients in terms of their expected health care resource use are an essential tool to balance the health care needs and equitable allocation of health care resources. This study performed a scoping review to summarize the nature, extent, and range of research on case-mix classifications used to predict mental health care resource use in community settings. This study identified 17 eligible studies with 32 case-mix classification systems published since the 1980s. Most of these studies came from the USA Veterans Affairs and Medicare systems, and the most recent studies came from Australia. There were a wide variety of choices of input variables and measures of resource use. However, much of the variance in observed resource use was not accounted for by these case-mix systems. The research activity specific to case-mix classification for community mental health care was modest. More consideration should be given to the appropriateness of the input variables, resource use measure, and evaluation of predictive performance. Future research should take advantage of testing case-mix systems developed in other settings for community mental health care settings, if possible.
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Conn, David K., Ian Ferguson, Krystyna Mandelman, and Carol Ward. "Psychotropic Drug Utilization in Long-Term-Care Facilities for the Elderly in Ontario, Canada." International Psychogeriatrics 11, no. 3 (September 1999): 223–33. http://dx.doi.org/10.1017/s1041610299005797.
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Objective: Despite considerable data from a number of countries regarding psychotropic utilization in long-term-care facilities for the elderly, there has been a lack of similar data from Canada. The purpose of this study was to gather prescription data from a series of institutions in Ontario and to compare the results to those of other international studies. Method: Single-day surveys were carried out in six homes for the aged, four nursing homes, two retirement homes, and a veterans' center. The results were compared to those of recent studies from other countries. Results: The data revealed considerable differences in rates of prescription between different classes of institutions and between similarly classified institutions. The prescription rate of neuroleptics ranged from 11.8% (of patients) in retirement homes to 29.8% in nursing homes. Antidepressant use ranged from 12.2% in nursing homes to 24.6% in homes for the aged, and benzodiazepine use ranged from 22.5% in nursing homes to 36.4% in retirement homes. Conclusions: The overall rate of prescription for psychotropic medications was somewhat lower than in most international studies. The rate of prescription of neuroleptics in nursing homes fell in the midrange of studies, somewhat higher than in recent studies from the United States and an earlier Italian study, but lower than in recent reports from Sweden, Austria, and Australia. The rate of neuroleptic use in homes for the aged was comparable to the rate in the U.S. studies. The overall rate of prescription of antidepressants and benzodiazepines appears to be comparable to that in recent studies from other countries.
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Gray, Gregory C., and Han K. Kang. "Healthcare utilization and mortality among veterans of the Gulf War." Philosophical Transactions of the Royal Society B: Biological Sciences 361, no. 1468 (March 24, 2006): 553–69. http://dx.doi.org/10.1098/rstb.2006.1816.
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The authors conducted an extensive search for published works concerning healthcare utilization and mortality among Gulf War veterans of the Coalition forces who served during the1990–1991 Gulf War. Reports concerning the health experience of US, UK, Canadian, Saudi and Australian veterans were reviewed. This report summarizes 15 years of observations and research in four categories: Gulf War veteran healthcare registry studies, hospitalization studies, outpatient studies and mortality studies. A total of 149 728 (19.8%) of 756 373 US, UK, Canadian and Australian Gulf War veterans received health registry evaluations revealing a vast number of symptoms and clinical conditions but no suggestion that a new unique illness was associated with service during the Gulf War. Additionally, no Gulf War exposure was uniquely implicated as a cause for post-war morbidity. Numerous large, controlled studies of US Gulf War veterans' hospitalizations, often involving more than a million veterans, have been conducted. They revealed an increased post-war risk for mental health diagnoses, multi-symptom conditions and musculoskeletal disorders. Again, these data failed to demonstrate that Gulf War veterans suffered from a unique Gulf War-related illness. The sparsely available ambulatory care reports documented that respiratory and gastrointestinal complaints were quite common during deployment. Using perhaps the most reliable data, controlled mortality studies have revealed that Gulf War veterans were at increased risk of injuries, especially those due to vehicular accidents. In general, healthcare utilization data are now exhausted. These findings have now been incorporated into preventive measures in support of current military forces. With a few diagnostic exceptions such as amyotrophic lateral sclerosis, mental disorders and cancer, it now seems time to cease examining Gulf War veteran morbidity and to direct future research efforts to preventing illness among current and future military personnel.
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Kelsall, Helen, Miranda Van Hooff, Ellie Lawrence-Wood, Alexander McFarlane, Stephanie Hodson, Nicole Sadler, Helen Benassi, Craig Hansen, and Malcolm Sim. "P.1.16 Physical health of transitioned adf and regular adf members in 2015: findings from the transition and wellbeing research programme." Occupational and Environmental Medicine 76, Suppl 1 (April 2019): A81.2—A81. http://dx.doi.org/10.1136/oem-2019-epi.219.
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IntroductionMilitary service can involve exposure to physical and psychological stressors. There has been little systematic research into the health and wellbeing of military personnel after they leave the services.Methods4326 Transitioned ADF (transitioned from regular Australian Defence Force service between Jan 2010–Dec 2014) (18% response) and 8480 Regular 2015 ADF (42%) completed a questionnaire including symptoms, doctor-diagnosed medical conditions, respiratory health, injuries, pain, sleep problems, lifestyle factors, self-perceived health and quality of life and health service use.ResultsTransitioned ADF reported a higher mean number of symptoms (16.4 vs 11.8), similar mean number of medical conditions (1.9 vs 1.5), were more likely to report some medical conditions (a circulatory, musculoskeletal/connective tissue or nervous system condition, high blood pressure, chronic low back pain, and hearing loss), a slightly higher mean number of service-related injury types (1.11 vs 0.96), and poorer self-perceived health and quality of life compared to 2015 Regular ADF. Service-related injuries were more likely to have been sustained during training than on deployment in both groups. The majority of Transitioned ADF and 2015 Regular ADF reported experiencing some pain intensity and disability.In Transitioned ADF, poorer physical health outcomes overall were reported in Department of Veterans’ Affairs (DVA) clients compared with non-DVA clients, in Ex-Serving compared with Active Reservists or Inactive Reservists, and in those who had been medically discharged compared with those discharged for other reasons.ConclusionThis was one of the first studies internationally to investigate a comprehensive range of physical health indicators in recently transitioned military personnel. Overall Transitioned ADF were more likely to report poorer physical health across domains, some subgroups appeared particularly at risk. Findings in DVA clients were consistent with DVA being the conduit for care in veterans who have a service-related injury or mental health condition.
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Kalisch Ellett, Lisa M., Nicole L. Pratt, Mhairi Kerr, and Elizabeth E. Roughead. "Antipsychotic polypharmacy in older Australians." International Psychogeriatrics 30, no. 4 (November 10, 2017): 539–46. http://dx.doi.org/10.1017/s1041610217001934.
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ABSTRACTBackground:Antipsychotics are commonly used, and the rate of use is highest, among those aged 65 years or over, where the risk of adverse events is also high. Up to 20% of younger adults use more than one antipsychotic concurrently; however there are few studies on the prevalence of antipsychotic polypharmacy in older people. We aimed to analyze antipsychotic use in elderly Australians, focusing on the prevalence of antipsychotic polypharmacy and the use of medicines to manage adverse events associated with antipsychotics.Methods:A cross-sectional study was conducted using Australian Department of Veterans’ Affairs (DVA) administrative claims data for the period 1 March 2014 to 30 June 2014. Veterans dispensed at least one antipsychotic medicine during the study period was included. We determined the number of participants dispensed antipsychotic polypharmacy and the number of participants dispensed medicines to manage antipsychotic side effects.Results:There were 7,412 participants with a median age of 86 years. Fifty-one percent (n=3,784) were women and 48% (n=3,569) lived in residential aged-care. Fifty one participants (0.7%) were dispensed anticholinergic medicines indicated for the management of antipsychotic-associated extrapyramidal movement disorders and eight (0.1%) were dispensed medicines for the management of hyperprolactinemia. Five percent of participants (n=365) received dual antipsychotics. Dual antipsychotic users were more likely to be under the care of a psychiatrist or to have had a mental health hospitalization than those using a single antipsychotic.Conclusions:Antipsychotic polypharmacy occurred in one in 20 elderly persons, indicating that there is room for improvement in antipsychotic use in elderly patients.
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Ward, Warren. "Psychiatric Morbidity in Australian Veterans of the United Nations Peacekeeping Force in Somalia." Australian & New Zealand Journal of Psychiatry 31, no. 2 (April 1997): 184–93. http://dx.doi.org/10.3109/00048679709073819.
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Objective: Since World War II, an increasing number of soldiers have been deployed in United Nations (UN) peacekeeping forces. However, little is known about the psychiatric impact of such deployments. The present study investigated the nature, prevalence, aetiology and natural history of psychiatric morbidity in Australian veterans of the United Nations peacekeeping force in Somalia. Method: Fifteen months after their return from Somalia, 117 Somalian veterans completed the 28-item version of the General Health Questionnaire (GHQ-28), the Impact of Events Scale (IES), the Combat Exposure Scale (CES), and a checklist of posttraumatic stress disorder symptoms, completed by veterans 12 months previously as part of an evaluation by the Department of Defence. Seventy-seven non-veteran controls also completed the GHQ-28. Results: Veterans scored significantly higher on the GHQ-28 than controls. Twenty-four-point-eight per cent (24.8%) of veterans were GHQ cases (using 4/5 as a cut-off point) compared to 13.0% of controls. Psychiatric morbidity in veterans was associated with combat exposure and a past psychiatric history. Levels of morbidity reduced over time, although they remained substantial at 15 months following soldiers' return to Australia, with posttraumatic stress disorder symptoms being reported by approximately 20% of veterans. Conclusions: At least one-fifth of Australian soldiers who served in Somalia had significant levels of psychiatric morbidity 15 months following their return. This was almost twice that of their non-veteran peers. Risk factors for the development of psychiatric morbidity included combat exposure and past psychiatric history. Levels of psychiatric morbidity were much higher than those reported in previous studies on UN soldiers.
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Skodol, Andrew E., Sharon Schwartz, Bruce P. Dohrenwend, Itzhak Levav, Patrick E. Shrout, and Marian Reiff. "PTSD Symptoms and Comorbid Mental Disorders in Israeli War Veterans." British Journal of Psychiatry 169, no. 6 (December 1996): 717–25. http://dx.doi.org/10.1192/bjp.169.6.717.
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BackgroundThe purpose of this study was to investigate patterns of mental disorders comorbid with PTSD symptoms in young Israeli men exposed to combat.MethodSix hundred and seventeen subjects were selected via a general population sample and evaluated in a two-phase case-identification procedure, culminating in a modified SADS–L interview, administered by psychiatrists.ResultsMajor depressive disorder (OR=3.2), substance use disorders (OR=1.9) and personality disorders (OR=3.0) occurred more frequently in men reporting symptoms of PTSD than in men who had been under fire who did not report symptoms. With the possible exception of personality disorders, comorbid disorders did not constitute risk factors for PTSD. Comorbid PTSD and RDC disorders were associated with increased help-seeking.ConclusionsThe results suggest similar rates and types of PTSD comorbidity in Israeli war veterans as in veterans in the US assessed in general population studies, and are consistent with shared risk factors for PTSD and comorbid disorders.
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O'Donnell, Renee, Melissa Savaglio, Dave Vicary, and Helen Skouteris. "Effect of community mental health care programs in Australia: a systematic review." Australian Journal of Primary Health 26, no. 6 (2020): 443. http://dx.doi.org/10.1071/py20147.
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Although numerous studies have examined the effects of community-based mental health care programs in Australia, no synthesis of this literature exists. This systematic review of peer-reviewed and grey literature described the types of community-based mental health care programs delivered and evaluated in Australia in the past 20 years, and evaluated their impact in improving outcomes for those with a serious mental illness (SMI). Articles were included if they evaluated the extent to which the programs delivered in Australia improved individual outcomes, including hospitalisations, psychiatric symptoms, substance misuse or psychosocial outcomes, for individuals with an SMI. Forty studies were included. Community-based mental health care programs were categorised into three types: case management (n=23), therapeutic (n=11) and lifestyle (n=6). Therapeutic programs were most effective in reducing psychiatric symptoms. Case management approaches yielded significant improvements in psychosocial outcomes. Lifestyle programs were inconclusive in improving individual outcomes. This review provides support for the implementation of community-based mental health care programs that are informed by both therapeutic and case management principles. A multidisciplinary team that can facilitate the provision of therapeutic and psychosocial support may be most beneficial for those with an SMI within the Australian community.
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McIngvale, Elizabeth, Nathaniel Van Kirk, Amber B. Amspoker, Melinda A. Stanley, and Terri L. Fletcher. "Prevalence and Treatment of Obsessive-Compulsive Disorder in Veterans and Active-Duty Service Members: A Systematic Review." Journal of Cognitive Psychotherapy 33, no. 1 (February 1, 2019): 11–22. http://dx.doi.org/10.1891/0889-8391.33.1.11.
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The prevalence and treatment of obsessive-compulsive disorder (OCD) in veterans and active-duty military remains unclear. We systematically reviewed literature on OCD diagnosis and treatment in U.S. Veterans and active-duty military to obtain a prevalence estimate, describe treatment approaches for OCD in veterans, and evaluate use of Exposure and Response Prevention (ERP). Eight terms were used to identify studies in PubMed, PsychINFO and SCOPUS up to March 13, 2018; additional articles were identified from reference lists of 19 included studies, 16 addressing prevalence, and 3 addressing treatment. OCD prevalence is lower in studies employing electronic medical records databases than in studies using OCD assessments, suggesting underrecognition of OCD in clinical settings. Higher prevalence was seen with OCD screening tools than with diagnostic interviews. Lower OCD prevalence was seen in active-duty individuals than in veterans. Two case studies showed a decrease in OCD symptoms following ERP. Additional studies with larger samples and controlled designs examining ERP are needed.
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Kalek, Sally, Anita S. Mak, and Nigar G. Khawaja. "Intergroup Relations and Muslims’ Mental Health in Western Societies: Australia as a Case Study." Journal of Muslim Mental Health 5, no. 2 (June 21, 2010): 160–93. http://dx.doi.org/10.1080/15564908.2010.487722.
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Armour, Cherie, Eric Spikol, Emily McGlinchey, Rachael Gribble, Nicola T. Fear, and Dominic Murphy. "Identifying psychological outcomes in families of Five Eyes alliance armed forces Veterans: A systematic review." Journal of Military, Veteran and Family Health 8, no. 1 (February 1, 2022): 7–27. http://dx.doi.org/10.3138/jmvfh-2021-0025.
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LAY SUMMARY Military service can affect the psychological health and well-being of ex-service members and their families. Most research prioritizes active duty families or Veterans, with spouses/intimate partners and adult children of Veterans often overlooked. This study reviewed all previous research on the psychological health of Veteran families within the Five Eyes alliance countries of Australia, Canada, New Zealand, the United Kingdom, and the United States. It found spouses/intimate partners had higher rates of anxiety, depression, and posttraumatic stress disorder (PTSD) compared to national rates and were more likely to feel distress when their Veteran partner had mental health issues. Adult children were at higher risk for anxiety, depression, alcohol/substance misuse, and PTSD compared to national rates. Four themes identified were: personal feelings and internal emotions, Veteran-oriented, help and support, and acting as a unit. Due to the scarce available research, further studies are needed to address psychological outcomes among military Veteran families.
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Rafferty, L. A., P. E. Cawkill, S. A. M. Stevelink, K. Greenberg, and N. Greenberg. "Dementia, post-traumatic stress disorder and major depressive disorder: a review of the mental health risk factors for dementia in the military veteran population." Psychological Medicine 48, no. 9 (March 8, 2018): 1400–1409. http://dx.doi.org/10.1017/s0033291717001386.
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AbstractBackgroundDementia is currently incurable, irreversible and a major cause of disability for the world's older population. The association between mental health difficulties, such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), and dementia has a long history within the civilian population. Despite the increased importance of this link within the military veteran population, who suffer a greater propensity of mental health difficulties and consist largely of over 65s, attention is only recently being paid to the salience of such an association for this group. This paper aims to explore the relationship between PTSD and MDD with dementia within the military veteran population.MethodA systematic review was conducted on articles from 1990 to July 2016 on MEDLINE, EMBASE, EBSCO and Web of Science electronic databases with an update conducted in February 2017.ResultsSix empirical studies were identified from the review, the majority of which originated from the USA. Five of the studies asserted that veterans with a diagnosis of either PTSD or MDD are at a significantly greater risk of developing dementia than ‘healthy’ controls. The final study, conducted in Australia, found only a small, but non-significant, correlation between earlier MDD and future dementia, but no concurrent correlation.ConclusionsWhile causality cannot be determined, it is likely that PTSD and depressive disorders are related to an increased risk of dementia in military veterans. Potential pathological explanations and risk factors are reviewed and the clinical and neuroscience implications of these findings are explored.
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Thériault, François L., William Gardner, Franco Momoli, Bryan G. Garber, Mila Kingsbury, Zahra Clayborne, Daniel Y. Cousineau-Short, Hugues Sampasa-Kanyinga, Hannah Landry, and Ian Colman. "Mental Health Service Use in Depressed Military Personnel: A Systematic Review." Military Medicine 185, no. 7-8 (February 17, 2020): e1255-e1262. http://dx.doi.org/10.1093/milmed/usaa015.
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Abstract Introduction Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public health priority. However, the scientific literature on the major depression treatment gap in military organizations has never been systematically reviewed. Methods We systematically searched the EMBASE, MEDLINE, and PsychINFO databases for studies measuring recent mental health service use in personnel serving in the armed forces of a Five-Eye country (Australia, Canada, New Zealand, the United Kingdom, or the United States). We excluded studies conducted with retired veterans. Because of the substantial heterogeneity in included studies, we did not pool their results. Instead, we computed median period prevalence of mental health service use. Results Twenty-eight studies were included in the systematic review; 12 had estimated mental health service use in personnel with depression, and another 16 had estimated mental health service use in personnel with depression or another mental health disorder. The period prevalence of mental health service use in depressed military personnel ranged from 20 to 75% in 12 included studies, with a median of 48%, over 2–12 months. The other 16 studies yielded similar conclusions; they reported period prevalence of mental health service use in personnel with any mental health disorder ranging from 14 to 75%, with a median of 36%, over 1–12 months. The median was higher in studies relying on diagnostic interviews to identify depressed personnel, compared to studies relying on screening tools (60% vs. 44%). Conclusions There is a large treatment gap for major depression in particular, and for mental health disorders in general, among military personnel. However, our results highlight the association between the use of measurement tools and treatment gaps: estimated treatment gaps were larger when depressed patients were identified by screening tools instead of diagnostic interviews. Researchers should be wary of overestimating the mental health treatment gap when using screening tools in future studies.
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King, Robert. "Caseload Management, Work-Related Stress and Case Manager Self-Efficacy Among Victorian Mental Health Case Managers." Australian & New Zealand Journal of Psychiatry 43, no. 5 (January 1, 2009): 453–59. http://dx.doi.org/10.1080/00048670902817661.
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Objective: In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. Method: A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. Results: The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Conclusion: Routine monitoring of caseload, especially by a workplace supervisor, may be effective in reducing work-related stress and enhancing case manager personal efficacy.
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Bigdeli, Tim, Ayman Fanous, Nallakkandi Rajeevan, Frederick Sayward, Yuli Li, Mary Brophy, Saiju Pyarajan, et al. "S173. GENOME-WIDE ASSOCIATION STUDIES OF SCHIZOPHRENIA AND BIPOLAR DISORDER IN A DIVERSE COHORT OF US VETERANS." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S103. http://dx.doi.org/10.1093/schbul/sbaa031.239.
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Abstract Background Schizophrenia and bipolar disorder are debilitating neuropsychiatric illnesses collectively affecting 2% of the world’s population, and which cause tremendous human suffering that impacts patients, their families and their communities. Recognizing the major impact of these disorders on the psychosocial function of more than 200,000 US Veterans, the Department of Veterans Affairs (VA) recently genotyping of nearly 9,000 veterans with schizophrenia or bipolar I disorder in Cooperative Studies Program (CSP) #572: “Genetics of Functional Disability in Schizophrenia and Bipolar Illness”, all of whom were extensively assessed for neurocognitive function and disability, and genotyped using a custom Affymetrix Axiom Biobank array. Methods Primary genome-wide association studies (GWAS) of schizophrenia and bipolar disorder were performed across and within ancestry goups, with attempted replication in matched subjects from the PGC and Genomic Psychiatry Cohort (GPC). We combined results for CSP#572 with available summary statistics from the PGC, Indonesia Schizophrenia Consortium and Genetic REsearch on schizophreniA neTwork-China and Netherland (GREAT-CN) study, and multi-ethnic GPC cohorts, achieving among the largest and most diverse studies of these disorders to date. Results Polygenic risk scores based on published PGC summary statistics for schizophrenia or bipolar disorder were significantly associated with case status among EA (P<10–30) and AA (P<0.0005) participants in CSP#572. Our primary analyses of schizophrenia yielded a single genome-wide significant association with variants in CHD7 at 8q12.2 for European-American (EA) participants, which remained significant in a joint analysis of EA and African-American (AA) subjects (P=4.62e-08). While no genome-wide significant associations were detected by our within-ancestry analyses of bipolar disorder, a cross-ancestry meta-analysis of CSP#572 participants yielded a significant finding at 10q25 with variants in SORCS3 (P=2.62e-08). Among loci attaining P<0.0001 in our within-ancestry analyses, 4 and 8 subsequently achieved genome-wide significance, respectively, when jointly analyzed with matched subjects from the PGC and GPC. Combining our results with published summary statistics, we performed a cross-ancestry GWAS meta-analysis of 69,280 schizophrenia cases and 138,379 controls, identifying 200 genome-wide significant loci of which 76 are newly reported here. Cross-ancestry analysis of 28,326 bipolar cases and 90,570 controls identified 24 genome-wide significant loci, including novel associations with common variants in PAX5, DOCK2, MACROD2, BRE, KCNG1, and LINC01378. Discussion We newly describe genome-wide analyses in a diverse cohort of US Veterans with schizophrenia or bipolar disorder, benchmarking the predictive value of polygenic risk scores based on published GWAS findings. Leveraging available summary statistics from studies of global populations, we add to burgeoning lists of genomic loci implicated in the etiologies of these disorders.
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Dwyer, Judith, and Sandra Leggat. "Australian Health Review call for papers." Australian Health Review 29, no. 4 (2005): 377. http://dx.doi.org/10.1071/ah050377.
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The editors of Australian Health Review are seeking articles for an upcoming issue on mental health services in Australia and New Zealand. It is estimated that mental health problems and mental illness will affect more than 20% of the adult population in their lifetime and between 10%?15% of young people in any one year. In Australia, through the National Mental Health Strategy, all levels of Australian government have recognised the need to work together to reform services and policy to ensure that, wherever possible, people with a mental illness are able to enjoy the same opportunities as other Australians. In New Zealand, the Mental Health Commission envisions a place where people with mental illness have personal power, full participation in their communities and access to a fully developed range of recovery-oriented services. To help inform policy and practice, Australian Health Review is looking to publish research papers, case studies and commentaries related to mental health. Some potential topic areas include: � Governance and management � Consumer and community perspectives � Program evaluation and economic analysis � Impact of policy. Submissions related to international programs with lessons for Australia and New Zealand will also be welcomed. Submissions can be short commentaries of 1000 to 2000 words, or a more comprehensive review of the topic of 2000 to 3000 words. The deadline for submission is 15 February 2006.
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Appleby, Michael, and Judy Bourke. "Promoting Law Student Mental Health Literacy and Wellbeing: A Case Study from The College of Law, Australia." International Journal of Clinical Legal Education 20, no. 1 (July 8, 2014): 461. http://dx.doi.org/10.19164/ijcle.v20i1.18.
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<p>A number of studies have been undertaken about the mental health of law students and the reports as to the findings of those studies have all expressed concern about the high levels of psychological distress suffered by them. Australian studies indicate that while university students suffer from emotional distress at a rate greater than that of the general population and at a higher rate than their non-student (age group) peers, law students are more distressed than their university peers. This has led to many calls for action.</p><p><br />Most law students undertake their degree with a view to practising law. It is now also accepted that legal practitioners suffer depression or emotional distress at higher rates than other professionals, other workers more generally and the general population. Research shows that there is a strong correlation between high levels of emotional distress and the incidence of mental illness. Law students suffering high or very high distress levels are therefore at an increased risk of suffering a mental illness, most commonly anxiety and/or depression.</p><p>Faced with this problem, the question arises: how should legal education institutions respond? This article describes the approach taken by one legal education institution, The College of Law, Australia (the College), in answering this question. The College identified the value in improving students’ mental health literacy and stress management and now trains its lecturers to deliver an educational workshop (the workshop) in these areas. The workshop forms part of the core curriculum for the College’s practical legal training program (PLT).</p><p>Part 2 of the article reviews some of the literature about health promotion, health literacy, mental health literacy and promoting student wellbeing, providing the underpinnings for the intervention. Part 3 describes the development of the workshop for pre-admission graduate law students. Part 4 outlines the content of the workshop and delivery methods. Part 5 considers evaluations of the workshop, from both the student and teacher perspective and student learning outcomes, and Part 6 contains recommendations based on our experience in designing and delivering the workshop.</p>
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Liddelow, Caitlin, Matthew J. Schweickle, Jordan T. Sutcliffe, Christian Swann, Richard Keegan, Simon Rice, Anthony David Okely, and Stewart A. Vella. "Protocol for national mental health guidelines for community sport in Australia." BMJ Open Sport & Exercise Medicine 8, no. 4 (November 2022): e001426. http://dx.doi.org/10.1136/bmjsem-2022-001426.
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Organised sports are the most common settings for sports participation. Despite a range of documented benefits from participation, these positive outcomes are not always guaranteed. Emotional distress from pressure and injuries can mean some participants experience negative outcomes. To ensure organised sports are well equipped to promote the mental health of their members, evidence-based guidelines for them are required. Using a Community-Based Participatory Research framework, mental health guidelines for community sport will be developed. In Phase One, community sport stakeholders will participate in focus groups. The aim is to understand their preferences of the content, purpose and scope of the guidelines. In Phase Two, an e-Delphi study will be conducted with experts in mental health and sport in Australia to gather recommendations on the purpose and scope of the guidelines. In Phase Three, a national consensus meeting with an Expert Guideline Development Committee will be held to draft the guidelines. In Phase Four, follow-up focus groups will be held with community sport stakeholders to understand the usability and acceptability of the draft guidelines. In Phase Five, a second e-Delphi study will be conducted to provide feedback on the revised guidelines after community stakeholder review. In Phase Six, implementation case studies will assess the implementation of the guidelines in community sport clubs. These mental health guidelines will answer an urgent call for action by experts. The guidelines will be based on sector needs and preferences, be acceptable and useable, and be able to be implemented by community sport clubs globally by 2025.
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Davidson, Jonathan, J. Ingram Walker, and Clinton Kilts. "A Pilot Study of Phenelzine in the Treatment of Post-traumatic Stress Disorder." British Journal of Psychiatry 150, no. 2 (February 1987): 252–55. http://dx.doi.org/10.1192/bjp.150.2.252.
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In recent years, there has been renewed appreciation of the morbidity which can result from unusual or overwhelming stress and while many situations can give rise to post-traumatic disorder, the most frequently studied of these is probably military combat. Psychiatric disorder pursuant to combat experience can not only become chronic, but may intensify with advancing age, decades after the original trauma (Archibald & Tuddenbaum, 1965; Wilmer, 1982). Moreover, a high percentage of combat veterans are believed ultimately to develop chronic psychiatric morbidity (Walker & Cavenar, 1982). The drug treatment of such post-traumatic states remains an important question, largely over looked until the last 2 years but recent case reports suggest that doxepin and imipramine (White, 1983; Burstein, 1984) are beneficial in treating post traumatic stress disorder (PTSD), which may be either combat or non-combat related. Hogben & Cornfield (1981) described five veterans whose PTSD improved when treated with phenelzine, while Van der Kolk (1983) has described beneficial results with antidepressants, lithium, benzodiazepines, beta blockers, and neuroleptics in uncontrolled studies of PTSD.
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Due, Clemence, Kathleen Connellan, and Damien W. Riggs. "Surveillance, Security and Violence in a Mental Health Ward: An Ethnographic Case-Study of a Purpose-Built Unit in Australia." Surveillance & Society 10, no. 3/4 (November 28, 2012): 292–302. http://dx.doi.org/10.24908/ss.v10i3/4.4276.
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This paper discusses the potential relationship between surveillance techniques, the enactment of security measures, and patient violence in mental health wards. The paper draws upon data from an ethnographic study conducted in a purpose-built mental health unit containing two wards (one locked and one open) in South Australia, and argues that acts of violence observed in the unit were typically preceded by an incident within the unit that was related to the implementation of security measures aimed at controlling non-compliant behaviours. The paper argues that if a relationship between security measures and violence does exist in mental health wards, then close attention must be paid to the ways in which forms of surveillance may arguably exacerbate, rather than prevent, the need for security measures.
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Gaudig, Trisha. "Rolling Out Behavioral Recovery Outreach (BRO) Teams: Perspectives From an Inaugural Partner Site." Innovation in Aging 5, Supplement_1 (December 1, 2021): 46. http://dx.doi.org/10.1093/geroni/igab046.175.
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Abstract The Sioux Falls VA Community Living Center (CLC) is a partner site for the Behavioral Recovery Outreach (BRO) Team dissemination. This CLC is home to over 55 Veterans requiring a variety of specialty needs such as dementia care, short-term rehabilitation, respite, hospice, and/or psychosocial needs. Many of the Veterans followed by the BRO Team on the CLC experienced frequent rehospitalizations and difficult placement in the community due to behavioral concerns. Local leadership encouraged participation in the BRO Team dissemination due to the growing need in this VA system to open access to dementia and mental health care, successfully discharge Veterans to appropriate community settings, and reduce unnecessary rehospitalizations. This presentation will discuss BRO Team development, including several factors facilitating successful BRO Team implementation (e.g., leadership support, community outreach approaches, staff partner buy-in), and identify barriers impacting successful implementation with a case example to illustrate strategies to overcome such barriers.
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Spooner, Heather, Jenny B. Lee, Diane G. Langston, Jill Sonke, Keith J. Myers, and Charles E. Levy. "Using distance technology to deliver the creative arts therapies to veterans: Case studies in art, dance/movement and music therapy." Arts in Psychotherapy 62 (February 2019): 12–18. http://dx.doi.org/10.1016/j.aip.2018.11.012.
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Rossi, Alberto, Vera Morgan, Francesco Amaddeo, Marco Sandri, Michele Tansella, and Assen Jablensky. "Psychiatric Out-Patients Seen Once Only in South Verona and Western Australia: A Comparative Case-Register Study." Australian & New Zealand Journal of Psychiatry 39, no. 5 (May 2005): 414–22. http://dx.doi.org/10.1080/j.1440-1614.2005.01590.x.
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Objective: This study examined variables associated with having a once-only contact with the out-patient department of two community mental health services in Italy and Australia. Method: Two 8-year cohorts of patients, who had a new episode of care with out-patient psychiatric departments in South Verona and in Western Australia, were followed-up for 3 months after the first contact, to identify those patients who had no further contact with services. Potential determinants of once-only contact were analysed. Results: Thirty percent of new episodes of care for persons who met the inclusion criteria of the study were once-only contacts with the service in South Verona. In Western Australia, the figure was 24%. Moreover, the proportion of once-only contact patients has increased over time in South Verona whereas, in Western Australia, it has remained stable. In Western Australia, once-only contact patients were younger whereas in South Verona they tended to be older. At both research sites, patients who had a once-only contact were more likely to be male and to have a less severe mental illness. Conclusions: The results of this study suggest that only clinical characteristics were significant determinants of this pattern of contact with services consistently at both sites: the less severe the patient's diagnosis, the more likely the patient is to have a once-only contact. This may well indicate good screening at the initial point of contact by both sets of mental health service providers. Prospective studies are necessary to clarify the problem of ‘onceonly contact’ and to organize a proper psychiatric care.
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Edward, Karen-leigh, Rhonda Nelson Hearity, and Boyce Felstead. "Service integration for the dually diagnosed." Australian Journal of Primary Health 18, no. 1 (2012): 17. http://dx.doi.org/10.1071/py11031.
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The needs of dually diagnosed clients in mental health services have been and remain a focus for service development and improvement in Australia. The Council of Australian Governments committed to a five-year National Action Plan on Mental Health with a $1.8 billion injection into mental health services. In Australia there have been great advances in the service initiatives and service deliverables to those clients who experience a dual diagnosis. These advances include that dual diagnosis is systematically identified and responded to in a timely, evidence-based manner as a core business in mental health and alcohol and other drug services. These advances are brought to life by specialist mental health and alcohol and other drug services that establish effective partnerships and agreed mechanisms to support integrated care and collaborative practice. Here, four case studies are offered as a means of illustrating the ways in which projects undertaken in local community health services have approached dual diagnosis treatment for clients. These case studies reflect how cooperation and cross-referral between services, as well as effective management of dual diagnosis clients by suitably qualified staff can produce benefits to clients who use the service.
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Bower, Emily S., Kelsey Simons, Patrick G. Walsh, Lisham Ashrafioun, Kimberly A. Van Orden, and Todd M. Bishop. "PHYSICAL CONDITIONS ASSOCIATED WITH SUICIDE ATTEMPTS: DO RISKS DIFFER AMONG OUR OLDER VETERANS?" Innovation in Aging 3, Supplement_1 (November 2019): S824. http://dx.doi.org/10.1093/geroni/igz038.3038.
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Abstract Physical illness confers risk for late-life suicide, yet few studies report whether risks differ with older age and among Veterans. We examined age-stratified associations between physical illness and suicide attempt among Veterans 65+ years (n=8452, 97% male) from a larger retrospective case-control study that utilized secondary data from the Veterans Affairs Corporate Data Warehouse and Suicide Prevention Applications Network. Controls were matched by age, sex, and mental health treatment utilization. Risk estimates for 15 conditions and a combined comorbidity score were stratified by young-old (65-74), middle-old (75-84), and oldest-old (85+), adjusting for age and sex within strata. Neurodegenerative disorder (ORs=4.5, 6.0, 6.5) or dementia (ORs=5.0, 5.7, 4.4) diagnosis within 180 days conferred the highest risks across young-, middle-, and oldest-old. Cerebrovascular disorder was associated with higher risk among the oldest-old versus young-old (ORs=6.1 vs 2.2). Findings differ from reported risks for suicide death. Illness may be experienced differently across later-life.
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Tan, Eric J., Denny Meyer, Erica Neill, Andrea Phillipou, Wei Lin Toh, Tamsyn E. Van Rheenen, and Susan L. Rossell. "Considerations for assessing the impact of the COVID-19 pandemic on mental health in Australia." Australian & New Zealand Journal of Psychiatry 54, no. 11 (August 3, 2020): 1067–71. http://dx.doi.org/10.1177/0004867420947815.
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During this unprecedented novel coronavirus (COVID-19) pandemic, there is an urgent need for empirical data to characterise its impact on the mental health and well-being of Australians. In this viewpoint, we outline a number of considerations for research on this topic, highlighting areas necessitating special attention, consideration of particular vulnerable groups and the need for longitudinal studies to track mental health fluctuations in the general population. We conclude by introducing the COLLATE (COvid-19 and you: mentaL heaLth in AusTralia now survEy) project, outlining its aims, addressing some considerations raised herein and detailing avenues for future research. Since the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 (WHO, 2020), the COVID-19 pandemic has caused major upheaval both in Australia and globally. While the search for a vaccine continues, current efforts towards tackling the virus and limiting contagion in several nations have focused on social distancing and the shutdown of non-essential services. In Australia, the first case was reported on 13 January 2020 (COVID-19 National Incident Room Surveillance Team, 2020), the first death occurred on 24 February and a spate of progressive restrictions were enforced throughout the 2 weeks leading up to 31 March 2020 (COVID-19 National Incident Room Surveillance Team, 2020a).
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Tran, Dai Binh, and Hanh Thi My Tran. "Women’s health: a benefit of education in Australia." Health Education 119, no. 4 (June 3, 2019): 259–76. http://dx.doi.org/10.1108/he-11-2018-0053.
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Purpose The purpose of this paper is to examine the relationship between education and health amongst Australian women. Design/methodology/approach This study uses the Household, Income and Labour Dynamics in Australia data set. Spouse’s education is employed as an instrument to solve the potential endogeneity of educational attainment. Findings The results indicate that an additional year of schooling can lead to an increase in self-reported health, physical health, mental health and a reduced likelihood of having long-term health conditions. Women who are not in the labour force are likely to enjoy higher benefits of education compared to their employed counterparts. The findings also suggest that the relationship between education and health can be explained by the extent of positive health behaviours and social capital as mediators. Research limitations/implications The conclusion from the results might be different in the case of men, reducing the generalisability of the results. Several objective health variables should be used to provide further aspects of health on which education has an impact. Practical implications As the positive effect of education on women’s health is empirically found, investment in women’s education should be seriously considered and reevaluated. Originality/value This paper focuses on Australian women which not only reduces the heterogeneity between genders but also adds to the rare number of studies on this topic in Australia. This paper also employs a formal mediation analysis to examine what are the mechanisms explaining the relationship between education and health.
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Austern, David J. "Beyond Binary Thinking: Providing Best Practice Treatment to Veterans with PTSD." Pragmatic Case Studies in Psychotherapy 13, no. 2 (July 20, 2017): 154. http://dx.doi.org/10.14713/pcsp.v13i2.2006.
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In "Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex,' 'Bruno,' and 'Charles'"(Austern, 2017), I presented three composite case study examples of how veterans suffering from PTSD may benefit from written exposure to their trauma memories. For one case (Bruno), Written Exposure Therapy (WET) was the initial treatment in a stepped-care approach that culminated in Prolonged Exposure therapy. However, for the two others, WET became a standalone treatment. In two commentaries on the cases, Cigrang and Peterson (2017) and Sloan and Marx (2017) discuss the development and efficacy of WET, WET implementation strategies, and practice implications of WET (e.g., the potential to reduce clinician burnout). In my response to these commentaries, I aim to contribute to the bourgeoning discussion of how mental health providers can best incorporate this promising writing-based treatment (WET) into their existing approaches to working with veterans suffering from Post-Traumatic Stress Disorder (PTSD). My response will address themes raised by my composite case studies and by the commentaries, including how stepped-care service delivery models may have the potential to make PTSD care more efficient.
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Meadows, Graham, Philip Burgess, and Irene Bobevski. "Distributing Mental Health Care Resources: Strategic Implications from The National Survey of Mental Health and Wellbeing." Australian & New Zealand Journal of Psychiatry 36, no. 2 (April 2002): 217–23. http://dx.doi.org/10.1046/j.1440-1614.2002.01011.x.
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Objective: This paper considers mental health services resource distribution under the Australian second national mental health plan, with its direction to mental health services to be more inclusive of people with higher prevalence psychiatric disorders. We consider inequalities in mental health in Australia, and describe the performance of the composite census variable employed in the Victorian mental health funding distribution formula, the index of relative socioeconomic disadvantage (IRSED), in predicting disorder rates and perceived needs for care. Method: We review data sets generated through the National Survey of Mental Health and Wellbeing (NSMHWB) for their utility in development of resource distribution formulae. We present analyses from the 10 641 cases examined in the household survey to explore the role of the IRSED in predicting prevalence rates of anxiety, affective, substance misuse and other disorders, as well as perceived need for care. Results: Recent epidemiological studies provide some additional sources of data to guide resource distribution, although the available data sets are found not to be optimized for examination of this issue. Greater levels of socioeconomic disadvantage of areas are associated with increased rates of morbidity in metropolitan areas, with different patterns for different disorder groups. The influence of the IRSED is more complex outside the major cities. Conclusions: The descriptive epidemiological data now available, despite significant investment, are relatively crude instruments for this current purpose. The findings support the case for using the IRSED as a proxy indicator for morbidity for the high prevalence disorders, but only within metropolitan areas. This examination confirms the existence of significant inequalities in mental health between Australian urban areas with different socioeconomic characteristics.
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Formosa, Marvin, Roberta Chetcuti Galea, and Rosette Farrugia Bonello. "Older men learning through religious and political affiliations: case studies from Malta." Andragoška spoznanja 20, no. 3 (November 1, 2014): 57–69. http://dx.doi.org/10.4312/as.20.3.57-69.
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This article examines two case studies from Malta that focus on older men learning through informal channels. The first case study investigated the role of a community-based organisation - namely, a religious confraternity dedicated to 'Our Lady of Immaculate Conception' of the village of Mqabba - as an avenue for informal learning activities for older men. The second case study investigated the connection between affiliation in the Labour Party Veterans' branch of the Labour Party (Malta) and informal learning. The case studies were carried out by employing a qualitative-methodological framework whereby data was collected through semi-structured interviews. The intent was to reveal the perceived interests and expectations regarding what would be considered a satisfying lifestyle in the context of membership of older men in both organisations. Findings reveal the benefits that older men enjoy through participation in such organisations, including increased levels of independence, improved social participation, and positive effects on participants' self-esteem and personal confidence. Informants report that membership also contributed to their mental and physical health and to increased activity. Many underlined how participation aided them in escaping boredom and keeping in touch with the outside world. Findings also reveal that only a few informants were simultaneously involved in organisations and activities not related to their religious and political affiliations, which highlights the importance of both informal learning channels in helping older men lead successful and active lives.
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Skerrett, Delaney Michael, Kairi Kõlves, and Diego De Leo. "Factors Related to Suicide in LGBT Populations." Crisis 37, no. 5 (September 2016): 361–69. http://dx.doi.org/10.1027/0227-5910/a000423.
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Abstract. Background: There is evidence of heightened vulnerability to nonfatal suicidal behaviors among LGBT populations yet a paucity of studies into fatal behaviors. Aim: The specific aim of this article was to identify factors related to suicide in LGBT individuals in Australia. Method: The psychological autopsy (PA) method with a matched case-control study design was used. PA interviews were conducted with 27 next-of-kin of an LGBT person that had died by suicide. Three living LGBT controls per suicide case, matched by age and gender, were also interviewed. Results: The key factors relating to suicide in LGBT people were a lack of acceptance by family and self (reflected in higher internalized homophobia and shame), negative feelings about own sexuality/gender, and dissatisfaction with appearance. LGBT people who died by suicide also tended to go through coming out milestones 2 years earlier than controls. There was a higher prevalence of aggressive behaviors and a more predominant history of physical and sexual abuse. Additionally, there was greater incidence of depression and anxiety and alcohol and substance use disorders. Conclusion: Specific predictive factors for suicide in LGBT populations in Australia were identified, including significantly poorer mental health outcomes and more violence across an array of measures.
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Siskind, Dan, Ashneet Sidhu, John Cross, Yee-Tat Chua, Nicholas Myles, Dan Cohen, and Steve Kisely. "Systematic review and meta-analysis of rates of clozapine-associated myocarditis and cardiomyopathy." Australian & New Zealand Journal of Psychiatry 54, no. 5 (January 20, 2020): 467–81. http://dx.doi.org/10.1177/0004867419898760.
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Background: Clozapine is the most effective medication for treatment refractory schizophrenia, but is associated with cardiac adverse drug reactions. Myocarditis and cardiomyopathy are the most serious cardiac adverse drug reactions although reported rates of these conditions vary in the literature. We systematically reviewed and meta-analysed the event rates, the absolute death rates and case fatality rates of myocarditis and cardiomyopathy associated with clozapine. Methods: PubMed, EMBASE and PsycINFO were searched for studies that reported on the incidence of cardiomyopathy or myocarditis in people exposed to clozapine. Data were meta-analysed using a random effects model, with subgroup analysis on study size, time frame, region, quality, retrospective vs prospective, and diagnostic criteria of myocarditis or cardiomyopathy. Results: 28 studies of 258,961 people exposed to clozapine were included. The event rate of myocarditis was 0.007 (95% confidence interval [CI] = [0.003, 0.016]), absolute death rate was 0.0004 (95% CI = [0.0002, 0.0009]) and case fatality rate was 0.127 (95% CI = [0.034, 0.377]). The cardiomyopathy event rate was 0.006 (95% CI = [0.002, 0.023]), absolute death rate was 0.0003 (95% CI = [0.0001, 0.0012]) and case fatality rate was 0.078 (95% CI = [0.018, 0.285]). Few included studies provided information on criteria for diagnosis of myocarditis and cardiomyopathy. Event rates of cardiomyopathy and myocarditis were higher in Australia. Conclusion: Clarity of diagnostic criteria for myocarditis remains a challenge. Observation bias may, in part, influence higher reported rates in Australia. Monitoring for myocarditis is warranted in the first 4 weeks, and treatment of comorbid metabolic syndrome and diabetes may reduce the risk of cardiomyopathy. The risks of myocarditis and cardiomyopathy are low and should not present a barrier to people with treatment refractory schizophrenia being offered a monitored trial of clozapine.
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Kalantidou, Eleni. "Design interventions to repair migrants’ mental well-being: The ‘Culture in Mind’ healing space." Crossings: Journal of Migration & Culture 9, no. 2 (October 1, 2018): 133–53. http://dx.doi.org/10.1386/cjmc.9.2.133_1.
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The intention of this article is to present the transformation of a space that houses a migrant-oriented community service with a focus on mental health and well-being (Culture in Mind) into an inviting milieu, which fosters healing processes, intercultural understanding and community empowerment in Brisbane, Australia. This project, which was formed as a case study, is described through its ideation phase, the installation methods, the sourcing and use of reclaimed materials as well as the methods employed for the collection of data, including interviews conducted for the evaluation of the design interventions. In like manner, the outcomes of the data analysis are discussed in conjunction with evidence provided by relevant studies and photos collected through the documentation process. The final part of the article is dedicated to arguing the necessity of different understandings of mental health according to non-western cultural backgrounds so as to inform the design of mental health services and physical settings and enhance sentiments of privacy, safety and dignity for migrant patients.
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Fatima Zahra, C., I. Katir, A. Korchi, S. Belbachir, and A. Ouanass. "blind or schizophrenic but not both." European Psychiatry 65, S1 (June 2022): S791. http://dx.doi.org/10.1192/j.eurpsy.2022.2043.
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Introduction Although visual impairment appears to be a risk factor for schizophrenia, early blindness may be protective , It’s a phenomenon that has puzzled even the smartest scientific brains for decades. It might surprise you: no person born blind has ever been diagnosed with schizophrenia. Objectives The objective of this research is to discover the relationship between schizophrenia and congenital blindness is there a protective gene ! is that visual perception constitutes an essential stage in the onset of the disease itself ! Methods Case study of a family consisting of thirteen brothers and sisters, three of whom were blind at birth, three with schizophrenia. the study of the files of schizophrenic patients hospitalized in our structure since it opened in the 1970s Results Case study of a family consisting of thirteen brothers and sisters, three of whom were blind at birth, three with schizophrenia, but there is none with blindness at birth and schizophrenia. PLus on the basis of medicals files there is no case of schizophrenia with blindness at birth. Preliminary observational analysis of this clinical case suggests the following hypothesis: the presumed protective role of congenital blindness against schizophrenia. The bibliographic research has objectified three recent studies in this direction in Australia, Denmark, and the USA. Conclusions The relationship between schizophrenia and congenital blindness is still unrecognized and controversial Several studies are done in this direction, but so far there is no assertion or confirmation of the hypothesis Disclosure No significant relationships.
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Smelson, David A., Vera Yakovchenko, Thomas Byrne, Megan B. McCullough, Jeffrey L. Smith, Kathryn E. Bruzios, and Sonya Gabrielian. "Testing implementation facilitation for uptake of an evidence-based psychosocial intervention in VA homeless programs: A hybrid type III trial." PLOS ONE 17, no. 3 (March 17, 2022): e0265396. http://dx.doi.org/10.1371/journal.pone.0265396.
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Background Healthcare systems face difficulty implementing evidence-based practices, particularly multicomponent interventions. Additional challenges occur in settings serving vulnerable populations such as homeless Veterans, given the population’s acuity, multiple service needs, and organizational barriers. Implementation Facilitation (IF) is a strategy to support the uptake of evidence-based practices. This study’s aim was to simultaneously examine IF on the uptake of Maintaining Independence and Sobriety Through Systems Integration, Outreach and Networking-Veterans Edition (MISSION-Vet), an evidence-based multicomponent treatment engagement intervention for homeless Veterans with co-occurring mental health and substance abuse, and clinical outcomes among Veterans receiving MISSION-Vet. Methods This multi-site hybrid III modified stepped-wedge trial involved seven programs at two Veterans Affairs Medical Centers comparing Implementation as Usual (IU; training and educational materials) to IF (IU + internal and external facilitation). Results A total of 110 facilitation events averaging 27 minutes were conducted, of which 85% were virtual. Staff (case managers and peer specialists; n = 108) were trained in MISSION-Vet and completed organizational readiness assessments (n = 77). Although both sites reported being willing to innovate and a desire to improve outcomes, implementation climate significantly differed. Following IU, no staff at either site conducted MISSION-Vet. Following IF, there was a significant MISSION-Vet implementation difference between sites (53% vs. 14%, p = .002). Among the 93 Veterans that received any MISSION-Vet services, they received an average of six sessions. Significant positive associations were found between number of MISSION-Vet sessions and outpatient treatment engagement measured by the number of outpatient visits attended. Conclusions While staff were interested in improving patient outcomes, MISSION-Vet was not implemented with IU. IF supported MISSION-Vet uptake and increased outpatient service utilization, but MISSION-Vet still proved difficult to implement particularly in the larger healthcare system. Future studies might tailor implementation strategies to organizational readiness. Trial registration ClinicalTrials.gov, NCT02942979.
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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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Siffert, Veronica, Colette Riahi, Melinda A. Stanley, and Terri L. Fletcher. "Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Case Study of a Veteran With Violent Intrusive Thoughts." Journal of Cognitive Psychotherapy 33, no. 1 (February 1, 2019): 71–81. http://dx.doi.org/10.1891/0889-8391.33.1.71.
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Exposure and Response Prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD); however, few studies have evaluated the use of ERP with veterans. This case study describes ERP and medication treatment of a veteran who experienced violent sexual thoughts, countered by compulsions of focusing on the distressing thought to ensure a negative emotion or reversing the thought to a nonviolent thought or image. The veteran had previously received supportive psychotherapy and medication for depression, anxiety, and sleep difficulties, with poor treatment adherence. Upon reengagement in treatment, the therapist provided ERP in 34 sessions over 14 months, with 15 sessions via video telehealth to home. The patient used the OCD Workbook as a resource throughout treatment. The patient developed a hierarchy of target obsessions and rituals with associated subjective units of distress; completed exposures, beginning with lower-level items; and wrote imaginal scripts. He also received zolpidem for insomnia and venlafaxine for anxiety and depression. His scores on the nine-item Patient Health Questionnaire and Yale Brown Obsessive-Compulsive Scale decreased significantly.
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Marotta, Phillip L. "A Systematic Review of Behavioral Health Interventions for Sex Offenders With Intellectual Disabilities." Sexual Abuse 29, no. 2 (August 2, 2016): 148–85. http://dx.doi.org/10.1177/1079063215569546.
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This article reviews evaluation studies of programs designed to treat sex offenders with intellectual and developmental disabilities (IDD) published in peer-reviewed journals between 1994 and 2014. The design of this study is mirrored after PRISMA (Preferred Reporting of Items for Systematic Reviews and Meta-Analyses) recommendations for conducting a systematic literature review. The study design, study setting, characteristics of participants, type of treatment, and intervention procedures comprise areas of focus for evaluating the implementation of treatment programs. Therapeutic outcomes include changes in attitudes consistent with sex offending, victim empathy, sexual knowledge, cognitive distortions, and problem sexual behaviors. Eighteen treatment evaluation studies were identified from the United States, the United Kingdom, Australia, and New Zealand. Cognitive-behavioral treatments were the most commonly delivered treatment modality to sex offenders with IDD. Other less common treatments were dialectical behavioral therapy, problem solving therapy, mindfulness, and relapse prevention. No randomized controlled trials were identified. The most common designs were multiple case studies and pre- and post-treatment assessments with no control and repeated measures follow-up. Small sample sizes, no control groups, and wide variation in treatment length and follow-up time complicate the qualitative synthesis of study findings. Short follow-up times introduce the potential for bias in conclusions surrounding treatment efficacy for many of the studies reviewed in this analysis. The overall quality of studies examining treatments for sex offenders with IDD is poor and requires further development before rendering firm conclusions about the effectiveness of interventions for this population.
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Angermeyer, M. C., and G. Schomerus. "State of the art of population-based attitude research on mental health: a systematic review." Epidemiology and Psychiatric Sciences 26, no. 3 (August 30, 2016): 252–64. http://dx.doi.org/10.1017/s2045796016000627.
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Aims.Population surveys have become a frequently used method to explore stigma, help-seeking and illness beliefs related to mental illness. Methodological quality however differs greatly between studies, and our current knowledge seems heavily biased towards high-income countries. A critical appraisal of advances and shortcomings of psychiatric attitude research is missing. This review summarises and appraises the state of the art in population-based attitude research on mental health.Methods.Systematic review of all peer-reviewed papers reporting representative population studies on beliefs and attitudes about mental disorders published between January 2005 and December 2014 (n = 478).Results.Over the decade covered by this review considerably more papers on psychiatric attitude research have been published than over the whole time period before. Most papers originated in Europe (36.3%), North America (23.2%) and Australia (22.6%), only 14.6% of all papers included data from low- or middle income countries. The vast majority of papers (80.1%) used correlational cross-sectional analyses, only 4% used experimental or quasi-experimental designs. Data in 45.9% of all papers were obtained with face-to-face interviews, followed by telephone (34.5%), mail (7.3%) and online surveys (4.0%). In almost half of papers (44.6%) case-vignettes served as stimulus for eliciting responses from interviewees. In 20.7% instruments meeting established psychometric criteria were used. The most frequently studied disorder was depression (44.6% of all paper), followed by schizophrenia (33%). 11.7% of papers reported time trend analyses of attitudes and beliefs, 7.5% cross-cultural comparisons. The most common focus of research was on mental health literacy (in total 63.4% of all papers, followed by various forms of stigma (48.3%).There was a scarcity of papers (12.1%) based on established theoretical frameworks.Conclusions.In the current boom of attitude research, an avant-garde of studies uses profound and innovative methodology, but there are still blind spots and a large proportion of conventional studies. We discuss current and future methodological challenges that psychiatric attitude research needs to embrace. More innovative and methodologically sound studies are needed to provide an empirical basis for evidence-based interventions aimed at reducing misconceptions about mental disorders and improve attitudes towards those afflicted.
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Rock, Daniel Joseph, and Joachim Franz Hallmayer. "The Seasonal Risk for Deliberate Self-Harm." Crisis 29, no. 4 (July 2008): 191–201. http://dx.doi.org/10.1027/0227-5910.29.4.191.
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Groups at seasonal risk for deliberate self-harm (DSH) vary according to their geographic location. It is unknown, however, if seasonal risk factors for DSH are associated with place of birth or place of residence as these are confounded in all studies to date. In order to disaggregate place of birth from place of residence we examined general and seasonal risk factors for DSH in three different population birth groups living in Western Australia: Australian Aborigines, Australian born non-Aborigines, and UK migrants. We found Aborigines are at much higher general risk for DSH than non-Aborigines, but are not at seasonal risk, whereas non-Aboriginal Australians and UK migrants are. For UK migrants, this is only found for females. For all groups at seasonal risk this peaks during the austral (southern hemisphere) spring/summer. Furthermore, non-Aboriginal Australians and UK migrants show a consistent pattern of increased case fatality with increasing age. In contrast, case fatality does not increase with age among Australian Aborigines. Overall, despite living in the same environment, the three birth groups show different patterns of seasonal risk for DSH. In particular, the sex difference found between UK migrants and non-Aboriginal Australian birth groups suggests that predisposition toward seasonal risk for DSH is established early in life, but when present this is expressed according to local conditions.
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Lamontagne-Godwin, Frédérique, Caroline Burgess, Sarah Clement, Melanie Gasston-Hales, Carolynn Greene, Anne Manyande, Deborah Taylor, Paul Walters, and Elizabeth Barley. "Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review." BMJ Open 8, no. 2 (February 2018): e019412. http://dx.doi.org/10.1136/bmjopen-2017-019412.
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ObjectivesTo identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work.DesignRealist review.SettingPrimary, secondary and tertiary care.ResultsA systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre–post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward.ConclusionsA range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.
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To, Quyen G., Mitch J. Duncan, Anetta Van Itallie, and Corneel Vandelanotte. "Impact of COVID-19 on Physical Activity Among 10,000 Steps Members and Engagement With the Program in Australia: Prospective Study." Journal of Medical Internet Research 23, no. 1 (January 25, 2021): e23946. http://dx.doi.org/10.2196/23946.
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Background Physical activity is an important health behavior, due to its association with many physical and mental health conditions. During distressing events, such as the COVID-19 pandemic, there is a concern that physical activity levels may be negatively impacted. However, recent studies have shown inconsistent results. Additionally, there is a lack of studies in Australia on this topic. Objective The aim of this study is to investigate changes in physical activity reported through the 10,000 Steps program and changes in engagement with the program during the COVID-19 pandemic. Methods Data between January 1, 2018, and June 30, 2020, from registered members of the 10,000 Steps program, which included 3,548,825 days with step data, were used. The number of daily steps were logged manually by the members or synced automatically from their activity trackers connected to the program. Measures on program usage were the number of new registered members per day, the number of newly registered organizations per day, the number of steps logged per day, and the number of step entries per day. Key dates used for comparison were as follows: the first case with symptoms in Wuhan, China; the first case reported in Australia; the implementation of a 14-day ban for noncitizens arriving in Australia from China; the start of the lockdown in Australia; and the relaxing of restrictions by the Australian Government. Wilcoxon signed-rank tests were used to test for significant differences in number of steps between subgroups, between engagement measures in 2019 versus 2020, and before and after an event. Results A decrease in steps was observed after the first case in Australia was reported (1.5%; P=.02) and after the start of the lockdown (3.4%; P<.001). At the time that the relaxing of restrictions started, the steps had already recovered from the lockdown. Additionally, the trends were consistent across genders and age groups. New South Wales, Australian Capital Territory, and Victoria had the greatest step reductions, with decreases of 7.0% (P<.001), 6.2% (P=.02), and 4.7% (P<.001), respectively. During the lockdown, the use of the program increased steeply. On the peak day, there were more than 9000 step entries per day, with nearly 100 million steps logged per day; in addition, more than 450 new users and more than 15 new organizations registered per day, although the numbers decreased quickly when restrictions were relaxed. On average per day, there were about 55 new registered users (P<.001), 2 new organizations (P<.001), 25.6 million steps (P<.001), and 2672 log entries (P<.001) more in 2020 compared to the same period in 2019. Conclusions The pandemic has had negative effects on steps among Australians across age groups and genders. However, the effect was relatively small, with steps recovering quickly after the lockdown. There was a large increase in program usage during the pandemic, which might help minimize the health impact of the lockdown and confirms the important role of physical activity programs during times of distress and lockdowns.
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Tarren-Sweeney, Michael, Anouk Goemans, Anna Sophie Hahne, and Matthew Gieve. "Mental health screening for children in care using the Strengths and Difficulties Questionnaire and the Brief Assessment Checklists: Guidance from three national studies." Developmental Child Welfare 1, no. 2 (March 28, 2019): 177–96. http://dx.doi.org/10.1177/2516103219829756.
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Although children residing in statutory out-of-home care and those adopted from care are more likely than not to have mental health difficulties requiring clinical intervention or support, their difficulties often remain undetected. Children’s agencies have a duty of care to identify those child clients who require therapeutic and other support services, without regard to the availability of such services. The present article proposes a first-stage mental health screening procedure (calibrated for high sensitivity) for children and adolescents (ages 4–17) in alternative care, which children’s agencies can implement without clinical oversight using the Strengths and Difficulties Questionnaire (SDQ) and Brief Assessment Checklists (BAC). The screening procedure was derived from analyses of BAC, SDQ, and “proxy SDQ” scores obtained in three national studies of children and adolescents residing in alternative care (Australia, the Netherlands, and England). The SDQ and BAC demonstrated moderate to high screening accuracy across a range of clinical case criteria—the SDQ being slightly better at predicting general mental health problems and the BAC slightly better at predicting attachment- and trauma-related problems. Accurate first-stage screening is achieved using either the SDQ or the BAC alone, with recommended cut points of 10 (i.e., positive screen is 10 or higher) for the SDQ and 7 for the BAC. Greater accuracy is gained from using the SDQ and BAC in parallel, with positive screens defined by an SDQ score of 11 or higher or a BAC score of 8 or higher. Agencies and post-adoption support services should refer positive screens for comprehensive mental health assessment by clinical services.
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Apolinário-Hagen, Jennifer, Jessica Kemper, and Carolina Stürmer. "Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review." JMIR Mental Health 4, no. 2 (April 3, 2017): e10. http://dx.doi.org/10.2196/mental.6186.
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Background Over the past decades, the deficient provision of evidence-based interventions for the prevention and treatment of mental health problems has become a global challenge across health care systems. In view of the ongoing diffusion of new media and mobile technologies into everyday life, Web-delivered electronic mental health (e-mental health) treatment services have been suggested to expand the access to professional help. However, the large-scale dissemination and adoption of innovative e-mental health services is progressing slowly. This discrepancy between potential and actual impact in public health makes it essential to explore public acceptability of e-mental health treatment services across health care systems. Objective This scoping review aimed to identify and evaluate recent empirical evidence for public acceptability, service preferences, and attitudes toward e-mental health treatments. On the basis of both frameworks for technology adoption and previous research, we defined (1) perceived helpfulness and (2) intentions to use e-mental health treatment services as indicators for public acceptability in the respective general population of reviewed studies. This mapping should reduce heterogeneity and help derive implications for systematic reviews and public health strategies. Methods We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library, using reference management software for parallel searches) to identify surveys published in English in peer-reviewed journals between January 2010 and December 2015, focusing on public perceptions about e-mental health treatments outside the context of clinical, psychosocial, or diagnostic interventions. Both indicators were obtained from previous review. Exclusion criteria further involved studies targeting specific groups or programs. Results The simultaneous database search identified 76 nonduplicate records. Four articles from Europe and Australia were included in this scoping review. Sample sizes ranged from 217 to 2411 participants of ages 14-95 years. All included studies used cross-sectional designs and self-developed measures for outcomes related to both defined indicators of public acceptability. Three surveys used observational study designs, whereas one study was conducted as an experiment investigating the impact of brief educational information on attitudes. Taken together, the findings of included surveys suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions. Additionally, intentions to future use e-mental health treatments were overall smaller in comparison to face-to-face services. Professional support was essential for help-seeking intentions in case of psychological distress. Therapist-assisted e-mental health services were preferred over unguided programs. Unexpectedly, assumed associations between familiarity with Web-based self-help for health purposes or “e-awareness” and intentions to use e-mental health services were weak or inconsistent. Conclusions Considering the marginal amount and heterogeneity of pilot studies focusing on public acceptability of e-mental health treatments, further research using theory-led approaches and validated measures is required to understand psychological facilitator and barriers for the implementation of innovative services into health care.
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Coombe, Paul. "The Cassel Hospital, London." Australian & New Zealand Journal of Psychiatry 30, no. 5 (October 1996): 672–80. http://dx.doi.org/10.3109/00048679609062664.
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This paper is an account of the principles and practices of treatment offered at the Cassel Hospital, London, with a particular focus on the Inpatient Families Unit. The Cassel Hospital is an internationally renowned therapeutic community, the operation of which is based on psychoanalytic principles and which has operated within the British National Health Service for nearly 50 years. An account of the historical development of the hospital is given as well as a description of its structure and function. The following three innovative structures are elaborated: a complex network within which patients can develop, Cassel-style nursing care, and nurse-therapist supervision. Theoretical underpinnings are outlined, which together with two case studies facilitate an appreciation of the capacity of the therapeutic network to foster the successful treatment of a range of severely disordered individuals and families. Such treatment may approach a level perhaps otherwise unattainable and which is widely applicable in the public hospital and clinic settings in Australia.
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Whatman, Susan, Roberta Thompson, and Katherine Main. "The recontextualisation of youth wellbeing in Australian schools." Health Education 119, no. 5/6 (July 5, 2019): 321–40. http://dx.doi.org/10.1108/he-01-2019-0003.
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Purpose The purpose of this paper is to suggest how well-being messages are recontextualized into school-based contexts from an analysis of national policy and state curricular approaches to health education as reported in the findings of two selected case studies as well as community concerns about young people’s well-being. Design/methodology/approach A cross-sectional review of Australian federal and state-level student well-being policy documents was undertaken. Using two case examples of school-based in-curricular well-being programs, the paper explores how discourses from these well-being policy documents are recontextualized through progressive fields of translation and pedagogic decision making into local forms of curriculum. Findings Pedagogic messages about well-being in Australia are often extra-curricular, in that they are rarely integrated into one or across existing subject areas. Such messages are increasingly focused on mental health, around phenomena such as bullying. Both case examples clearly demonstrate how understandings of well-being respond to various power relations and pressures emanating from stakeholders within and across official pedagogic fields and other contexts such as local communities. Originality/value The paper focusses on presenting an adaptation of Bernstein’s (1990) model of social reproduction of pedagogic discourse. The adapted model demonstrates how “top-down” knowledge production from the international disciplines shaping curriculum development and pedagogic approaches can be replaced by community context-driven political pressure and perceived community crises. It offers contemporary insight into youth-at-risk discourses, well-being approaches and student mental health.
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Botvinik, Lev, Chee Ng, and Isaac Schweitzer. "Audit of Antipsychotic Prescribing in a Private Psychiatric Hospital." Australasian Psychiatry 12, no. 3 (September 2004): 227–33. http://dx.doi.org/10.1080/j.1039-8562.2004.02099.x.
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Objectives: There exists a substantial and growing body of evidence suggesting that antipsychotic medications are efficacious in the treatment of many non-psychotic psychiatric disorders. Although indications for the use of antipsychotics (particularly the atypicals) remain relatively narrow in Australia, psychiatrists seem to be using them for an expanding range of disorders in a variety of clinical settings. This has raised issues of costeffectiveness and methods of funding of these medications. The present study aimed to quantify and describe the patterns of prescribing of antipsychotic medications in a large private psychiatric hospital. Another aim was to compare the findings with other published evidence, and consider the implications of antipsychotic use for current clinical practice in Australia. Methods: A retrospective review of the medical records of 100 consecutive patients admitted to a private psychiatric hospital was conducted. The data collected included demographic details, major psychiatric diagnoses, all medications prescribed during the admission and their doses and, in the case of antipsychotics, the target symptoms/conditions for which they were prescribed. Results: Fifty-nine per cent of inpatients received at least one dose of an antipsychotic during their admission. While all patients with psychotic illnesses were treated with antipsychotics, 57% of patients with primary mood disorders and 40% of patients with a primary anxiety disorder also received an antipsychotic. The most common indications for use of antipsychotics included the treatment of psychotic symptoms, augmentation of antidepressants, relief of anxiety symptoms and lessening of agitation, and control of difficult behaviours (including self-harm and aggression) associated with personality disorders. The most frequently used antipsychotic was olanzapine (22%), followed by chlorpromazine (20%), and quetiapine (14%). Eleven per cent of patients received a combination of two antipsychotics. Conclusions: Antipsychotic medications were widely used in a private psychiatric inpatient setting for the treatment of non-psychotic disorders. This finding parallels those from other Australian studies of psychotropic prescribing patterns. The issues of clinical utility, cost-effectiveness and benefits of funding of these medications for such wider indications require further study and evaluation.
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Comans, Tracy, Victoria Visser, and Paul Scuffham. "Cost Effectiveness of a Community-Based Crisis Intervention Program for People Bereaved by Suicide." Crisis 34, no. 6 (November 1, 2013): 390–97. http://dx.doi.org/10.1027/0227-5910/a000210.
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Background: Postvention services aim to ameliorate distress and reduce future incidences of suicide. The StandBy Response Service is one such service operating in Australia for those bereaved through suicide. Few previous studies have reported estimates or evaluations of the economic impact and outcomes associated with the implementation of bereavement/grief interventions. Aims: To estimate the cost-effectiveness of a postvention service from a societal perspective. Method: A Markov model was constructed to estimate the health outcomes, quality-adjusted life years, and associated costs such as medical costs and time off work. Data were obtained from a prospective cross-sectional study comparing previous clients of the StandBy service with a control group of people bereaved by suicide who had not had contact with StandBy. Costs and outcomes were measured at 1 year after suicide bereavement and an incremental cost-effectiveness ratio was calculated. Results: The base case found that the StandBy service dominated usual care with a cost saving from providing the StandBy service of AUS $803 and an increase in quality-adjusted life years of 0.02. Probabilistic sensitivity analysis indicates there is an 81% chance the service would be cost-effective given a range of possible scenarios. Conclusion: Postvention services are a cost-effective strategy and may even be cost-saving if all costs to society from suicide are taken into account.
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Johnson, Hilary, Barbara Solarsh, Karen Bloomberg, and Denise West. "Supporting people with complex communication needs through community capacity building: the Communication Access Network." Tizard Learning Disability Review 21, no. 3 (July 4, 2016): 130–39. http://dx.doi.org/10.1108/tldr-10-2015-0044.
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Purpose – The purpose of this paper is to describe specific features of a Victorian (Australia) state-wide hub and spoke model of speech pathology provision established for adults with complex communication needs (CCN). Two case studies highlighting successful examples of services developed to enhance community inclusion will be described and the challenges discussed. Design/methodology/approach – The route to community inclusion is described through a case study illustration of one communication accessible community site and one disability service study. The disability service research involved focus groups, survey and interview data and demonstrated the efficacy and sustainability of a support worker training model. Findings – Sustainable change in the community and in disability services can occur through partnerships, training, and long-term commitment. Support workers who can facilitate interactions for people who have cognitive and communicative disabilities are an essential component of building the capacity of communities to include people with CCN. Collaboration between community members, specialised supports and people with disabilities enhances active community participation. Originality/value – This innovative, state-wide model has the capacity to be replicated elsewhere. On-going speech pathology services are integral to support adults with CCN providing both short-term individualised services, sustainable staff training and community engagement.
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Kacic, Viktor, Frank Zimmerman, Ben Milbourn, Sonya Girdler, Melissa Black, Sven Bölte, and Maya Hayden-Evans. "Developing resilience and promoting positive mental health strategies in university students." BJPsych Open 7, S1 (June 2021): S142—S143. http://dx.doi.org/10.1192/bjo.2021.403.
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AimsSuicide is one of the leading causes of death in young people living in Australia, accounting for 7.3% of all deaths among individuals aged 15–19 years. Historically, high levels of suicide have been recorded in Australian university students. This project aims to develop and test a massive online course-program (MOOC) for university students, underpinned by literature and strength-based suicide prevention principles, building resilience and awareness of mental health promoting activities.MethodA scoping review of the literature was undertaken to explore the effectiveness of current suicide prevention programs for undergraduate university students, and the effective elements contributing to the success of these programs. Six electronic databases were searched to identify relevant literature. Further, mental health consumers and university students were involved in co-producing the content of the six modules of the ‘Talk-to-me' MOOC.ResultNine articles were included in the review, discussing four types of programs including; gatekeeping, education, promotional messaging and online consultation. It was apparent from this review that there is a significant dearth of interventions and programs currently available to reduce the risk of suicide among undergraduate students, with many of the programs having limited efficacy. Despite this, a number of program elements were identified as beneficial to preventing suicide among post-secondary students including upskilling of students, and improving resilience, and self-management. These findings and further consultation with mental health consumers and undergraduate university students underpinned the development of the content of the ‘Talk-to-me' MOOC which is tailored to meet the needs of university students. The MOOC contains six modules: Mental fitness; strategies to increase mental fitness; self-harm; suicidal behaviour in young adults; interventions for suicidal behaviour; and, gatekeeper interventions. Two case study senarios depicting mental health challenges commonly experienced by yound adults portraying appropriate crisis communication skills were developed and filmed complementing the six ‘Talk-to-me' modules.ConclusionOverall, studies included in the review provide evidence to suggest that preventative programs, incorporating an educational component may be effective to be used in the MOOC to improving help-seeking behaviours among post-secondary education students. Findings from this review have underpinned the development of the ‘Talk-to-Me' MOOC which was launched in March 2020. To date this MOOC has enrolled over 45,000 participants from over 150 countries, with the average age of users being 24 years. Collectively, this line of work highlights that MOOCs are an effective means of mental health promotion to young adults.