bluuebunny/crossref_metadata_2025 huggingface dataset:
Community Treatment Orders in Victoria: A Clinico-Ethical Perspective
Authors: Patel Gunvant
Published: December 2009

Objective: The aim of this paper is to outline the impact of Community Treatment Orders over a 20-year period on service delivery and clinical practice in Victoria.

Conclusions: Community Treatment Orders, as utilized in Victoria, have undermined optimal service delivery and supported paternalistic, reductionistic clinical practice. The psychiatric profession has failed to advocate adequately for better mental health resourcing and human rights protection of those subject to Community Treatment Orders.
Is There a Role for Music Therapy in the Care of the Severely Mentally Ill?
Authors: Grocke Denise , Bloch Sidney , Castle David
Published: December 2009

Objective: The role of music therapy in psychiatric care in Australia is briefly traced from the early 1990s to the present. With the shift to community-based care, contemporary music therapy practice for the severely mentally ill is reappraised alongside the principles of the recovery model.

Conclusions: Music therapy is a viable option within the creative arts therapies for enhancing quality of life in people with severe and enduring mental illness.
A Prison Mental Health Screening Unit: A First for New South Wales
Authors: Adams Jonathon , Ellis Andrew , Brown Allison , Owens Dale , Halsey Rebecca
Published: December 2009

Objective: The aims of this paper are to provide a description of a newly available service the Mental Health Screening Unit (MHSU), within the NSW prison system and to present the first 12 months in terms of the patients, its adaptations and its limitations.

Methods: The first section of this paper provides a thorough description of the MHSU. The second looks at data collected for the period 1 July 2006 to 30 June 2007. A variety of databases were utilized as sources.

Results: There were a total of 604 admissions. The most common primary diagnoses were schizophrenia-related disorders. There were relatively few adverse incidents, and 18% of the acute unit population were transferred to the Long Bay Prison Hospital.

Conclusion: The MHSU had a considerable throughput of patients and managed a range of severe mental illnesses. The initial objectives of the MHSU have broadly been achieved. There are several future areas of research discussed.
Writing a Letter to Patients
Authors: Restifo Sam
Published: December 2009

Objective: This paper considers the potential utility in clinical practice of writing a letter to patients.

Conclusion: Letters written by psychiatrists to patients may be helpful in some clinical situations.
Clinical Utility of Health of the Nation Outcome Scales for Older Persons in a Memory Clinic
Authors: Cheung Gary , Williams Gwyneth
Published: December 2009

Objective: The aim of this paper is to report the findings from a routine collection of Health of the Nation Outcome Scales for older persons (HoNOS65 +) in a memory clinic and to explore its clinical utility with clinicians working in old age psychiatric services.

Methods: We conducted a retrospective analysis of HoNOS65+ ratings collected during a 12-month period in a newly established memory clinic. Results of this part of the study were presented to 34 clinicians.

Results: The mean total HoNOS65+ score was 6.8 and 7.0 for the initial and follow-up episodes respectively. Between 60 and 65% of the clinicians indicated that they ‘disagree’, ‘strongly disagree’ or were ‘unsure’ whether HoNOS65+ (i) can contribute to clinical decision making; (ii) is useful in monitoring progress; (iii) is useful in supporting consumers to assess their progress; and (iv) is assisting in assessing, planning and evaluating service delivery.

Conclusions: Service users had timely diagnostic assessment and interventions at the memory clinic. The lack of change on the HoNOS65+ suggests the positive effect of the clinic was not captured by this outcome measure. Although HoNOS65+ is routinely collected, its clinical utility as perceived by clinicians is relatively limited.
Liability of Mental Health Services for Injuries Incurred During Community Treatment
Authors: Scott Russ
Published: December 2009

Objectives: The aim of this paper is to examine the recent decision of the NSW Supreme Court, which considered a personal injuries action brought by a patient treated in the community following a 6 day voluntary hospital admission.

Conclusions: The judicial reasoning in Walker v Sydney West Area Health Service provides some comfort to mental health professionals practising in other jurisdictions whose legislative provisions are similar to those contained in the Civil Liability Act (NSW). In applying the Bolam principle, rather than the higher common law standard previously imposed by the High Court in Rogers v Whitaker, the decision is encouraging for mental health professionals whose management accords with accepted current good practice. The infrequent scrutiny by courts and coroners of management practice and systems in mental health is a further incentive to maintain continuous improvement of quality of care (by clinical audits, active risk management, professional development and supervision, and patient/family participation) consistent with the principles of clinical governance.
Merleau-Ponty and Me: Some Phenomenological Reflections Upon my Recent Bone Marrow Transplant
Authors: Morstyn Ron
Published: December 2009

Objective: During my illness and transplant I experienced an overwhelming existential crisis involving a complex intertwining of meaning and body which was often ignored, rejected, or misunderstood by others and at times by myself, which led to painful feelings of alienation. My treatment and my own conceptualizations seemed founded on assumptions of a separation of body and mind that were not true to what I was experiencing. I searched for a more accurate understanding, which I eventually found in the writings of the French existential philosopher Merleau-Ponty.

Conclusions: Merleau-Ponty's extensive elaboration of the deep ambiguity of our existence as body-subjects provides an alternative model to those of the mind/body dichotomy currently in vogue in medicine and psychiatry. I found his writings a useful framework within which to comprehend my experiences. I wanted to write about these experiences and how they relate to Merleau-Ponty's insights because I found that those individuals who were able to relate to me at this level of existential ambiguity were invaluable to my recovery.
Differential Effects of GdCl3‐ or MDP Treatment on Rat Liver Microcirculation and Gene Expression in the Hepatic Non‐Parenchymal Cell Fraction in LPS Shock
Authors: Henrich Dirk , Lehnert Mark , Herzog Carsten , Niederlaender Stephan , Relja Borna , Conzelmann Lars , Marzi Ingo
Published: December 2009

Background:Dichloromethylenebisphosphonate (MDP) and gadolinium chloride (GdCl3) are substances frequently used for experimental depletion of Kupffer Cells (KC) in models of endotoxin shock. The aim was to determine whether depletion of KC through pretreatment with GdCl3or MDP alters the hepatic microcirculation during lipopolysaccharide (LPS)‐induced shock in rats and to test if there are substance‐specific differences.Methods:Rats received either MDP or GdCl3or saline prior to induction of LPS shock. Hepatic microcirculation was evaluated by intravital microscopy (sinusoidal diameter, sinusoidal bloodflow, leukocyte adhesion), and the gene expression in the hepatic non‐parenchymal cell fraction was determined by RT‐PCR.Results:GdCl3pretreatment prevented sinusoidal narrowing but did not restore sinusoidal blood flow and did not normalize leukocyte‐endothelial interaction time after LPS. In contrast, MDP pretreatment improved hepatic microcirculation consistently for all parameters measured compared to GdCl3pretreated animals. In the non‐parenchymal cell fraction, eNOS gene expression was preserved and gene expression of TNF‐α was blocked after MDP but not after GdCl3application prior to LPS shock.Conclusions:The results show that GdCl3and MDP cannot be used equivalently for experimental KC depletion in the condition of LPS‐induced shock. These findings should be taken into consideration in studies that evaluate the role of Kupffer cells in models of endotoxin‐induced shock.
Responding to Serious and Complex Mental Health Problems in Youth: The Role of an Interagency Forum
Authors: Lee Erica , Dillon Alana , Dorries Valda , Beech Michael , McDermott Brett
Published: December 2009

Objective: To review the origins, processes, clientele and outcomes of a child and youth interagency forum, a collaborative response to children and youth with severe and complex presentations.

Methods: After a description of the Forum origins, membership and processes, both qualitative and quantitative information is provided on the Forum clientele. The Forum's effectiveness is considered in terms of changes in services provided to this group, as well as changes in agency and interagency work practices.

Results: Forum clients were predominantly boys aged 12 years, with an overrepresentation of indigenous and intellectually disabled children. Few lived with biological parents, and on average had experienced five schools, 11 or more residential placements and were involved with six agencies. Disruptive behaviour symptoms were common, as were suicidal thoughts or actions (43%), history of physical (50%) or sexual abuse (21%), alcohol (29%) and drug use (14%). On average Forum clients were taking three psychotropic medications. Forum client impairment ranged from major impairment to gross impairment across several domains.

Conclusions: While this is not a formal outcome study, evidence suggesting Forum usefulness included qualitative feedback from agencies, altered clinical and interagency practices, and decreased client impairment. Practical interventions for clients with chronic, complex multidomain impairments are discussed in the context of current Australian child and adolescent mental health services.
Policy, Structural Change and Quality of Psychiatric Services in Australia: The Views of Psychiatrists
Authors: Rey Joseph , Walter Garry , Giuffrida Michael
Published: December 2009

Objective: Given that 10 years have elapsed since the implementation of Australia's National Mental Health Strategy, the aim of the paper was to ascertain the views of the country's psychiatrists about changes in mental health services.

Methods: A survey was mailed to all Fellows of the Royal Australian and New Zealand College of Psychiatrists living in Australia; 1039 out of 2059 (50%) returned the questionnaire.

Results: Private care has not changed much in the last 5 years, but the quality in public psychiatric services has deteriorated. While 67% of private practitioners, 46% of psychiatrists with mixed practice, 39% of exclusively public psychiatrists and 27% of academics believed public practice had deteriorated, only 18% of psychiatrist administrators believed that to be the case. Daily or weekly problems admitting patients to hospital was reported by 40% of psychiatrists working in the public system. Public psychiatrists believed that they now treat more patients who are more disturbed, more acute and more demanding. However, they see their patients less often, provide less psychotherapy and use more medication. Administrative demands have increased.

Conclusions: According to psychiatrists, implementation of the National Mental Health Strategy has not yet resulted in better psychiatric care in the public health system.
The Psychological Impact of Complaints and Negligence Suits on Doctors
Authors: Nash Louise , Tennant Christopher , Walton Merrilyn
Published: December 2009

Objective: To describe the psychological impact of complaints and negligence litigation on doctors.

Methods: A review of the literature from 1966 to 2003 was conducted. Additional sources were obtained from targeted experts and organizations.

Results: Doctors who have been sued or who have had formal complaints made against them describe the process as an extremely stressful experience. Depression and adjustment disorder were relatively common, while drug and alcohol abuse, physical illness and suicidal ideation were reported less frequently. The majority of doctors who have been the subject of a complaint or law suit practice more ‘defensively’.

Conclusions: A complaint or law suit is uncommon in the daily practice of doctors, yet in today's medicolegal environment they pose a constant potential threat. The threat of, or actual, legal process can cause psychological, physical and behavioural practice changes. The obsessional personality of many doctors may make them particularly vulnerable to seeing the process as a challenge to their professional and personal identity.
Antwone Fisher: How Dangerous is ‘Dr Wonderful’?
Authors: Macfarlane Stephen
Published: December 2009

Objective: To describe the style of psychotherapy portrayed in the film Antwone Fisher. The rationale for this examination is that prospective patients often have little idea about what the process of psychotherapy may involve; depictions of therapy in popular films and on television serve to ‘prime’ our patients' expectations in this regard.

Conclusions: The film in question shows a psychiatrist who might be readily perceived as unambiguously good by a lay audience, despite a number of clear therapeutic boundary violations occurring throughout the film. Although such positive depictions might enhance the public image of psychiatry, they have the potential to create unreal expectations within patients and to promote the acceptability of boundary violations.
‘Like Minds, Like Mine’: A New Zealand Project to Counter the Stigma and Discrimination Associated with Mental Illness
Authors: Vaughan Gerard , Hansen Chris
Published: December 2009

Objective: To demonstrate how mass media advertising and community education has been successfully used in New Zealand as part of a comprehensive public health project to reduce stigma and discrimination associated with mental illness.

Conclusions: The involvement of people with experience of mental illness in the campaign has been critical to its success. Advertising involving the stories of well-known and famous people who have experienced mental illness has created significant interest, awareness and improved attitudes among the general public. Local community education and other follow-up activities have also contributed to this success.
Bloomsday 100: The Making of a Literary Legend
Authors: Kaplan Robert M.
Published: December 2009

Objective: As a background to the centenary of Bloomsday, to explore the circumstances in which James Joyce wrote Ulysses, noting the autobiographical elements and unique style, including the stream-of-consciousness technique that depicted the inner life of the characters. Selected quotations are used to illustrate these points. Joyce wanted to show that the epic and the heroic is in our lives every day.

Conclusions: Ulysses defined the literary consciousness of the 20th century. By basing the novel about a day in the life of three ordinary characters on Homer's epic account of an 18 year voyage, Joyce re-established the link between 20th century consciousness and classical times.
Introducing a Professional Development Programme to a Rural Area Mental Health Service: The Importance of Context
Authors: Hodgins Gene , Murray Greg , Donoghue Adrian , Judd Fiona , Petts Alison
Published: December 2009

Objective: To describe the introduction of an ongoing professional development programme for clinicians in a rural area mental health service. The programme involved a series of workshops delivered by clinical psychologists. The training component of each workshop focused on discrete cognitive behavioural strategies, targeted at the amelioration of anxiety and mood symptoms.
Religion, Spirituality and Psychiatry: Steps Towards Rapprochement
Authors: Turbott John
Published: December 2009

Objectives: To consider the claim that there is a fundamental epistemological conflict between religion and psychiatry over what constitutes rational explanation, and what impediment this might be to rapprochement between the two.

Conclusions: An epistemological gap most certainly exists, but there is a growing acceptance of the importance of religion and spirituality to psychiatry. Rapprochement may best be achieved by increasing psychiatric awareness and knowledge of the issues, and by a willingness to embrace intellectual, cultural and religious pluralism.
Spiritually Augmented Cognitive Behavioural Therapy
Authors: D'Souza Russell F , Rodrigo Angelo
Published: December 2009

Objective: To describe spiritually augmented cognitive behaviour therapy (SACBT) and its applications.

Methods: The background for the need to incorporate spirituality into therapy is considered, and SACBT as a therapy for sustaining mental health and functional recovery is described. Cognitive and behavioural components are considered, including the use of existential techniques in discovering meaning. The use of meditation and the validation and incorporation of the appropriate belief system of patients into their treatment are described.

Results: Controlled studies have demonstrated 16-session SACBT to be beneficial in extinguishing hopelessness and despair, improving treatment collaboration, reducing relapse rates and enhancing functional recovery.

Conclusion: SACBT can aid therapists in providing ‘whole person’ care and achieving better global outcomes for patients with psychological illness.
The Psychological Impact of September 11 Terrorism on Australian Inpatients
Authors: Taylor Mark , Jenkins Kym
Published: December 2009

Objective: To investigate the psychological impact on Australian hospital patients of the media coverage of the September 11 (9/11) terrorist attack.

Methods: Thirty psychiatry and 26 matched medical and surgical inpatients were assessed.

Results: Both reported and observed distress was common. Women reported significantly more distress than men. Individuals with psychiatric illness were significantly more varied in their attribution of cause for 9/11. Seven patients (29%) with pre-existing psychosis became delusional surrounding the events, but there were no significant differences between the psychiatry and the medical and surgical inpatients.

Conclusions: Clinical impressions were confirmed, namely, that a large proportion of hospital inpatients were adversely affected by TV footage of the 9/11 terrorist attack. Most vulnerable were those already with a mental disorder, particularly those with a pre-existing psychotic illness.
Audit of Antipsychotic Prescribing in a Private Psychiatric Hospital
Authors: Botvinik Lev , Ng Chee , Schweitzer Isaac
Published: December 2009

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.
Epidemiology of Depression in the Asia Pacific Region
Authors: Chiu Edmond
Published: December 2009

Objective: To summarise studies reporting rates of depression (for the general population and older samples) and suicide in the Asia Pacific region.

Methods: Information on local data was collected from the members of the SEBoD International Advisory Board on known epidemiological studies. Additionally, online searches were conducted using Medline and PsycInfo for the period 1994–2004.

Results: Across the Asia Pacific region, rates of current or 1-month major depression ranged from 1.3% to 5.5%, rates of major depression in the previous year ranged from 1.7% to 6.7%, and lifetime rates ranged from 1.1% to 19.9%, with a median of 3.7%. Rates of suicide in the Asia Pacific region are now similar to those in Europe and the Americas. The exceptions include China and South Korea.

Conclusions: Epidemiological studies in Asian populations are rare and use various diagnostic criteria. However, studies indicate that rates of depression in Asia Pacific, whilst lower, are comparable to other western countries. As such, depression as a health issue in Asia Pacific demands greater recognition. It is important that Asian countries should have the human and financial resources to conduct large scale epidemiological surveys not only in the area of depression, but also in the broader field of mental disorders.
The Economic Burden of Depression and Reimbursement Policy in the Asia Pacific Region
Authors: Hu Teh-wei
Published: December 2009

Objective: To determine the economic burden of depression in the Asia Pacific region, review the negative economic consequences attributable to depression, and describe the reimbursement policies for health-care services throughout the Asia Pacific region.

Methods: Both direct and indirect costs were obtained via a literature review of international mental health journals. Disability adjusted life year (DALYs) estimates were obtained from the World Health Organization. Reimbursement policy data were obtained from personal communication with the SEBoD International Advisory Board.

Results: There are only two studies of the economic costs of depression in the Asia Pacific region. From these, the total cost of depression in Australia for 1997–98 was estimated as US$1.8 billion (22% direct costs), and in Taiwan for 1994 as US$1.4 billion (25% direct costs). In the year 2000, it was estimated that unipolar major depression accounted for 14.2 million DALYs in China and 22.7 million DALYs for all other Asia Pacific countries. The majority of Asia Pacific health-care systems have extensive insurance coverage, but not specific provisions for depression. However, relatively low overall fee schedules diminish financial barriers for outpatient treatment of depression.

Conclusions: Untreated depression is a very costly disorder across the Asia Pacific region, with indirect costs constituting a substantial proportion. Consequently, treatment of depression should be the focus of policy makers to avoid major negative cost repercussions. It is encouraging that most Asia Pacific health service reimbursement policies enable the treatment of depression (especially outpatient treatment) to be relatively affordable. To advance this issue, the paucity of specific information on the epidemiology of depression, as well as service use and cost, needs to be addressed.
A Guide to the Internet for Psychiatrists
Authors: Straton David
Published: December 2009

Objective: To provide psychiatrists with a guide to using the Internet.

Conclusions: The key to using the Internet is to have the skills to keep the signal-to-noise ratio high. This requires knowledge and practice. The paper contains tips on searching and information about surfing skills, noticeboards, portals and email lists, and lists a range of very useful websites.
A Tale of Three Pathways: The Experience of RBWH Mental Health
Authors: Emmerson Brett , Fawcett Lisa , Frost Aaron , Lacey Maree , Todd Cathy , Powell Jacinta
Published: December 2009

Objectives: Australian research has identified that there are significant variations between service providers in terms of clinical management of patients with comparable presenting problems. Internal audits within the facility at Royal Brisbane and Women's Hospital revealed that these variations occurred between wards, treating teams and psychiatric consultants. Given the increasing emphasis on evidence-based practice, it was decided that the literature should be reviewed to determine what the standard of care should be. The paper then examines how clinical pathways for psychosis and for depression were developed and how they eventually evolved into an acute inpatient pathway. It identifies the framework used and examines important aspects relating to the adaptation of these frameworks to mental health issues. The process for the development and implementation of the clinical pathway is discussed. Recommendations for their future use in a mental health setting are also presented.

Conclusions: Mental Health care is complex. For this reason, mental health clinical pathways have to remain flexible and innovative. With the present project, it was found that the pathways were not suited for specific diagnoses so that they evolved into a single acute inpatient pathway.
Description and Evaluation of an Up-Skilling Workshop for Rural and Remote Mental Health Practitioners in South Australia
Authors: Chur-Hansen Anna , Todd Elizabeth , Koopowitz Leslie
Published: December 2009

Objective: In response to the identified need for up-skilling in psychiatry for rural and remote general practitioners, a series of workshops has been designed and delivered to medical and nursing staff in South Australia. In this paper one such workshop is described, dealing with acute psychiatric care. Quantitative and qualitative evaluations of the workshop are reported on, and recommendations are made for future training programmes.

Conclusions: The workshop was well received and increased participants’ knowledge about the management of acute psychiatric presentations. Qualitative data indicate that the pharmacological management and neurobiology of psychiatric illness was interesting but difficult for some participants, and further training in these areas may be appropriate in future workshops. Inclusion of all professional stakeholders in future training is recommended, including students, to promote interest in working in rural and remote health. Participants considered networking with colleagues as an important benefit of the workshop. Targeted training in psychiatry may be needed for overseas-trained doctors. Further, rigorous research is needed to evaluate the long-term benefits of up-skilling workshops, and to inform funding bodies as to where resources might be most effectively channelled.
Establishing and Running a Trauma and Dissociation Unit: A Contemporary Experience
Authors: Middleton Warwick , Higson David
Published: December 2009

Objective: To evaluate the functioning of a trauma and dissociation unit that has run for the past 8 years in a private hospital, with particular regard to operating philosophy, operating parameters, challenges encountered, research and educational initiatives, and the applicability of the treatment model to other settings.

Conclusions: Despite the challenges associated with significant difficulties in the corporate management of a private health-care system, it has been possible to operate an inpatient and day hospital programme tailored to the needs of patients in the dissociative spectrum, and the lessons learnt from this experience are valid considerations in the future planning of mental health services overall
Changeability, Confidence, Common Sense and Corroboration: Comprehensive Suicide Risk Assessment
Authors: O'Connor Nick , Warby Monica , Raphael Beverley , Vassallo Tony
Published: December 2009

Objective: The authors, in collaboration with NSW Health, have recently developed a comprehensive suicide risk assessment framework. The present paper describes key concepts in the assessment of suicide risk by mental health professionals.

Methods: A framework for conducting a comprehensive suicide risk assessment was derived from the literature, incident analysis and clinical experience. The framework underwent a consultation process involving clinicians in NSW area mental health services. The aim was to provide clinicians with a standardized conceptual map for the assessment of suicide risk. A MEDLINE search was conducted for publications dealing with ‘suicide’ and ‘suicide risk assessment’ from 1980 to 2002. The recommendations from sentinel event reviews conducted in a NSW area mental health service in the period 1999-2002 were reviewed. The lessons from a visit to a coroner's relatives support group for people who had been bereaved by suicide also informed the development of the guidelines.

Results: A framework is proposed for the assessment of suicide risk. The framework promotes a reflective style of practice, encouraging clinicians to evaluate their assessment and its limitations. Risk assessment is always undertaken as part of a full clinical assessment and an evaluation of the person's current predicament and psychosocio-cultural context. The concepts of changeability, assessment confidence, common sense and the importance of corroboration are incorporated in the framework.

Conclusions: Mental health clinicians can be guided by a framework in suicide risk assessment and documentation. The assessment of suicide risk can generate a suicide risk rating for which minimum standards of care can be mandated.
Use of the Psychiatric Consultation Letter as a Therapeutic Tool
Authors: Couper Jeremy , Harari Edwin
Published: December 2009

Objective: Carefully crafted medical consultation letters can serve the dual purpose of transmitting the consulted psychiatrist's opinion to the referring doctor and enhancing the quality of the doctor-patient therapeutic relationship. Using the same document for both purposes simultaneously can enhance the consultation letter's overall effectiveness, as illustrated by three case examples.

Conclusions: Future teaching programmes for undergraduate and postgraduate psychiatry students should incorporate consultation letter writing workshops to improve students’ skills in clearly expressing their opinions and management recommendations in written form.
Towards a Needs Based Mental Health Resource Allocation and Service Development in Rural and Remote Australia
Authors: O'Kane Ann , Tsey Komla
Published: December 2009

Objective: To develop a transparent, needs-based mental health resource allocation framework to guide area level service planning in rural and remote settings.

Methods: Using the Central Australian mental health service region as a case study, a five-step approach was used to analyse and gather relevant data as follows: (i) mapping a regional sociodemographic profile; (ii) estimating the expected level of mental illness within the regional population; (iii) estimating the expected level of specialist mental health service usage; (iv) estimating the expected categories of specialist mental health care required for the regional population; (v) making adjustments to the costs of providing specialist mental health care on the basis of demographic features of the region. These data were then matched with the availability, access and cost of specialist mental health care currently provided at the regional level.

Results: The capacity of specialist mental health care in Central Australia was below the expected benchmark for the population residing in this region. The region required approximately double the existing funding allocation to provide an adequate and equitable level of care that meets the needs of the diverse population groups. Children and adolescents were the group most in need, as were adult Aboriginal people living in remote settings.

Conclusion: The framework described provides the beginnings of more open and transparent evidence-based decision-making regarding mental health resource allocation and service development for rural and remote residents.
Acute Psychosis Following Ingestion of ‘Rapture’
Authors: Austin Helen , Monasterio Erik
Published: December 2009

Objectives: To describe a brief psychotic episode associated with ingestion of a dietary supplement containing piperazine.

Methods: A case report was undertaken.

Results: A 20-year-old man developed a brief psychotic episode associated with persecutory delusional beliefs and auditory and visual hallucinations, leading him to commit the offence of arson. This episode occurred 12 h following the ingestion of ‘Rapture’ in addition to small quantities of cannabis and nitrous oxide, in a young man with no prior psychiatric history. This episode resolved with the use of benzodiazepines and 6 months later he has had no recurrence of psychiatric symptoms.

Conclusions: Given the reported mechanism of action of the ‘herbal high’ dietary supplements, it would seem possible that they may be able to precipitate a psychotic episode in vulnerable individuals. With the increasing use of these substances, it is important for clinicians to be alert to this possibility.
Leadership in Mental Health Policy: The National Context
Authors: Whiteford Harvey
Published: December 2009

Objective: To describe how mental health policy is developed and implemented.

Methods: A review of the literature on public policy analysis and the experience of the author in the development and implementation of national mental health policy.

Results: A five-step process of problem identification, policy development, political decision, policy implementation and evaluation provides a framework for understanding the policy cycle.

Conclusion: An understanding of this process is essential for psychiatrists and other mental health professionals in order to influence the process and content of mental health policy.
Development of an Inner Urban Homeless Mental Health Service
Authors: Holmes Alex , Hodge Mark , Newton Richard , Bradley Gail , Bluhm Alan , Hodges Jane , Didio Louise , Doidge Graeme
Published: December 2009

Objectives: The aim is to describe the development, principles and practices of the Waratah Area Homeless Outreach Psychiatric Service (WAHOPS) and place these in the context of international developments in homeless psychiatric services.

Methods: Information on the development of the service was collected from current and past staff. Reference is made to the relevant literature.

Results: WAHOPS has developed a unique model of practice based on local and international experience.

Conclusions: Specialized mental health services for the homeless, by working in close collaboration with existing homeless services, can successfully engage and manage patients. The application of homeless practices may need to become more widespread in public mental health services as patterns of accommodation change within the Australian population.
Assertive Community Treatment of the Mentally Ill: Service Model and Effectiveness
Authors: Udechuku Adaobi , Olver James , Hallam Karen , Blyth Frances , Leslie Melissa , Nasso Marina , Schlesinger Paul , Warren Lorraine , Turner Miles , Burrows Graham
Published: December 2009

Objective: To provide a description of the service delivery model of an assertive community treatment (ACT) team in the management of a group of severely mentally ill patients and examine the effectiveness of this team in reducing readmissions to a psychiatric inpatient service.

Method: A clinical case audit was performed on a single day in September 2001. Admission episodes and duration were collected for patients registered with the team in the 12 month period prior to ACT and for a period of 12 months ending on the day of the audit. Forty-three patients were registered with the team at the time of data collection. The majority (79%) were diagnosed with schizophrenia and there were high rates of comorbidity (76%) and disability (mean Global Assessment of Functioning score 45.9). The main outcome measures were the number of readmissions and readmission days before and after the institution of ACT.

Results: The mean number of readmission days reduced from 70.9 to 10.2 (p < 0.05) following the institution of ACT.

Conclusion: Assertive community treatment conducted in a naturalistic clinical environment is effective in signi?cantly reducing the number of readmission days in a group of patients suffering from long-term and persistent severe mental illness.
Building an ECT Service: An Outcomes-Equivalent Approach
Authors: Little John , Munday Jo , Atkins Martin
Published: December 2009

Objective: Specific guidelines, ongoing controversies in technique and audit reviews have made clinicians wary about continuing in electroconvulsive therapy (ECT). This paper attempts to reassure practitioners by incorporating such changes into a simple approach to ECT based on outcomes equivalence.

Method: A selected compilation of the recent literature was used to describe a model for starting and/or continuing an effective ECT service.

Results: It was suggested that a useful way of approaching ECT service delivery is to focus on what is actually important, getting patients better, and to do so within the context and capability of each hospital.

Conclusions: ECT is a changing field. Remaining true to the core principles of clinical practice, patient selection and technique, provides a basis for beginning, continuing and further developing an effective ECT service.
Combining Clinical and Actuarial Methods to Assess Andmanage Risk in a New South Wales Forensic Psychiatric Setting
Authors: Samuels Anthony , O'driscoll Colman , Bazaley Michael
Published: December 2009

Objective: This paper describes the risk assessment (RA) approach in a maximum security forensic psychiatric unit in New South Wales, Australia. The literature in relation to violence and mental illness is briefly reviewed and discussed and the process of RA is described. Emphasis is placed on the importance of combining clinical and actuarial methods to engage in comprehensive RA.

Conclusion: It is concluded that a combination of actuarial and clinical assessment completed by a multidisciplinary team of mental health professionals with clinical knowledge of the patient being assessed is proving to be an efficient and effective method. Further directions are highlighted and a cautionary note in relation to the potential for unintended outcomes is made.
Primary Care Psychiatry: Taking Consultation–Liaison Psychiatry to the Community
Authors: Blashki Grant , Selzer Rob , Judd Fiona , Hodgins Gene , Ciechomski Lisa
Published: December 2009

Objective: To assist psychiatrists who work closely with general practitioners (GPs) at the primary/secondary care interface.

Conclusion: The role of primary care psychiatrists can be enhanced by a sound appreciation of the general practice context, knowledge of the local mental health services and an understanding of the educational and clinical support needs of GPs.
Postcards from Psyberspace
Authors: Straton David
Published: December 2009

Objective: To recommend websites of interest to psychiatrists.

Method: Regular perusal of the Internet and discussion with the members of the auspsyc email list for Australian and New Zealand psychiatrists.

Results: A list of websites is presented.

Conclusions: The Internet provides a useful way for psychiatrists to keep their knowledge up to date.
Power and Knowledge in Psychiatry and the Troubling Case of Dr Osheroff
Authors: Robertson Michael
Published: December 2009

Objective: To consider the state of knowledge in psychiatry with reference to the ‘Osheroff debate’ about the treatment of depression.

Method: A review of the key philosophical issues regarding the nature of knowledge applied to the Osheroff case.

Results: There is an apparent dichotomy between knowledge derived from a reductionist scientific method, as manifest in evidence-based medicine, and that of a narrative form of knowledge derived from clinical experience. The Focauldian notion of knowledge/power and knowledge as discourse suggests that scientific knowledge dominates over narrative knowledge in psychiatry. The implication of this applied to the Osheroff case is the potential annihilation of all forms of knowledge other than science.

Conclusions: Knowledge in psychiatry is a pluralist, rather than singularly scientific enterprise. In the Osheroff case, the potential for scientific knowledge to abolish other forms of knowledge posed a serious threat of weakening the profession. In the light of the current debate about best practice, there is a need for reconsideration of the implications of Osheroff.
Enabling Clinicians to Become the Quality Leaders in Amental Health Service
Authors: O'connor Nick , Ward Denise , Newton Liz , Warby Monica
Published: December 2009

Objective: To show how clinicians can become the leaders of ‘quality’ in a mental health services, using the example of developments within Northern Sydney Health (NSH) Area Mental Health Services (AMHS).

Method: In the absence of an existing integrated area quality programme, NSH AMHS implemented a quality improvement programme whereby staff at the coalface would become the leaders in ‘quality’ guided and supported by the newly established Quality Unit. This innovative approach is consistent with evidence that suggests that clinicians need to ‘own’ quality improvement initiatives and embed them into everyday practice, rather than see them as the role of a designated ‘quality’ person/s.

Results: Within 12 months the service trained over 100 clinicians in Clinical Practice Improvement (CPI) methodology and currently has over 20 CPI projects with an identified measurable outcome. As well, it has provided over 200 staff with in-services on quality improvement approaches and trained 45 staff in root cause analysis. Training of eight clinicians in the use of the Minitab statistical package has allowed data analysis and charting to identify opportunities for improvement.

Conclusion: The handing of ‘quality’ back to clinicians of the AMHS has provided a framework for improved outcomes for patients and carers. This approach to service improvement is transferable to other mental health services.
The Role of the Consumer in the Leadership and Management of Mental Health Services
Authors: Gordon Sarah
Published: December 2009

Objective: To reflect on consumer involvement in the leadership and management of mental health services through consideration of relevant policy directives, pertinent literature and current practice, and to consider the role of psychiatrists in promoting consumer involvement.

Conclusions: Both Australia and New Zealand have significant policy directives in relation to consumer involvement in mental health services. The actual realization of consumer involvement within the mental health sector is extremely variable and the extent of genuine participation highly questionable, particularly in regard to leadership and management roles. It is important that the rationale for consumer involvement is continually highlighted and understood by all mental health professionals, including psychiatrists, so as to discourage the practice of including consumers solely for the sake of adhering to political policies. The attitudes of health professionals have been identified as having the most significant impact on consumer involvement. It is questionable whether the critical contribution of consumer involvement in mental health services should remain dependant on the attitudes of non-consumers within the sector. In New Zealand, a paradigm shift is occurring with consumer involvement moving from a construct of ‘participation’ to one of ‘leadership’. Psychiatristscan, and should, play a significant role in advocating for the development of mental health services in directions which support and promote consumer involvement at all levels.
Heroes and Villains: Making Sense of the History of Psychiatry
Authors: Berks John
Published: December 2009

Objective: To review two seemingly contradictory accounts of the history of psychiatrists and psychiatry and outline some thoughts on integrating these differing views.

Method: The context of these two accounts is given in a brief overview of the historiography of medicine and psychiatry in the nineteenth and twentieth centuries with illustrative examples, in particular looking at the practically useful distinction between the traditional and social history of psychiatry.

Conclusions: nderstanding how and why these two currents of psychiatric history differ allows one to derive and integrate useful insights from both.
Issues in the Pharmacological Treatment of Anxiety Disorders
Authors: Starcevic Vladan
Published: December 2009

Objective: To review the most salient issues in the pharmacotherapy of anxiety disorders. These pertain to means of achieving greater efficacy, accelerating the onset of therapeutic action, improving side-effect profile and tolerability, decreasing the propensity to induce therapeutic dependence and achieving better long-term outcome.

Conclusions: By and large, pharmacological agents with greater efficacy in anxiety disorders have yet to be developed. Several strategies have been used with some success to make medications for anxiety disorders work faster and to lessen their side-effect burden. The field of psychopharmacology has yet to find ways of lessening or eliminating the problem of therapeutic drug dependence and, even more so, of minimizing the risk of relapse following the cessation of medication.
Identifying and Communicating Clinical Risk
Authors: Arya Dinesh , Nicholls Denise
Published: December 2009

Objective: To develop a simple and easy-to-complete tool to communicate identified clinical risks.

Conclusions: Literature and Internet searching did not yield a simple and easy-to-use method of identifying and communicating risks. A Risk Identification Form was developed and may be of interest to mental health services wishing to implement a similar tool to document and communicate clinical risk identified during assessment of mental health consumers.