bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
Tools and Methodologies for Investigating the Mental Health Needs of Indigenous Patients: It's about Communication
Authors: Eley Diann , Hunter Keith , Young Louise , Baker Peter , Hunter Ernest , Hannah Dominique 
Published: December 2009

Objective: To undertake a needs analysis to determine the quality and effectiveness of current mental health services to Indigenous patients within a health district of Southern Queensland. The present study focused on identifying gaps in the service provision for Indigenous patients. Tools and methodologies were developed to achieve this. Method: Before commencement of the needs analysis, a review of related national projects was completed. The needs analysis entailed the develop ment and distribution of two separate questionnaires. A major priority of the questionnaire for Indigenous patients was ensuring that effective com munication and cultural respect was achieved. A steering committee of both Indigenous and non-Indigenous experts collaborated on this. The second questionnaire was for employees of the mental health service. Both questionnaires were designed to provide a balanced perspective of current mental health service needs for Indigenous people within the mental health service. Results: The predominant issue that emerged and underpinned all the results was communication. Conclusions: The present study has developed and used procedures for undertaking research involving Indigenous people. It has shown the impor tance of involving Indigenous people to help ensure successful communication, compliance and cooperation by Indigenous mental health patients.
Video-Linked Court Liaison Services: Forging New Frontiers in Psychiatry in Western Australia
Authors: Brett Adam , Blumberg Lawrence 
Published: December 2009

Objective: To describe the use of videoconferencing that is providing a specialist forensic service to remote parts of Western Australia. Conclusions: Court liaison has been shown to be an effective intervention for people with mental illness within the justice system. Most such programmes occur within metropolitan areas in Australia. Videoconferencing facilitates the provision of specialized forensic services to courts in remote parts of Australia.
The RANZCP Australian Private Practitioners' Network
Authors: Middleton Warwick , Lammersma Johanna 
Published: December 2009

Objective: To provide an overview of the challenges and opportunities afforded by the practice of psychiatry in the private sector, and in so doing build a rationale for the formation of a formally established network of Australian psychiatrists who meet to advance constructive proposals concerning the private practice of psychiatry, encourage mutual support, and promote this area of psychiatric endeavour. Conclusions: Private psychiatry has dangers, challenges and many responsibilities, but it also has the potential for relative independence and creative fulfilment. It is desirable that its practitioners support each other and work constructively together in addressing the sorts of issues delineated in the Private Practitioners’ Network's mission statement and objectives.
Selecting Patients for Long-acting Novel Antipsychotic Therapy
Authors: Lambert Tim 
Published: December 2009

Objective: As new psychopharmacological agents for the management of schizophrenia are introduced into clinical practice, inappropriate patient selection may often lead to disappointing outcomes for the patient, the family and services. Recently, the first and only long-acting novel antipsy chotic was made available in Australia. Based on criteria used in a large clinical network in Victoria, this paper sets out to present six selection profiles for patients with schizophrenia who may be suitable candidates for treatment with this class of medication. Conclusions: Optimizing outcome for patients with enduring psychotic disorders involves enabling a stable psychopharmacological platform upon which to build a psychosocial therapies programme. Too often, problems with adherence undermine the recovery process. Long-acting novel anti psychotics ensure adherence, with all the advantages inherent in second generation antipsychotics. Identifying patients a priori who might best respond to the long-acting novel antipsychotics may lead to improving the efficiency of the recovery process.
Evaluation of a Short Course in Psychiatry for General Practitioners
Authors: Clarke David , Smith Graeme , Peake Julie-Anne , Trauer Tom , McCall Louise , Blashki Grant , Piterman Leon 
Published: December 2009

Objective: To assess the acceptability and benefits to general practitioners (GPs) of a short course on the management of depression and anxiety. Method: One hundred and twenty-two GPs from southeast metropolitan Melbourne participated in a five-session short course. Pre- and postmeasures of knowledge, attitude and self-evaluated clinical practice and a post-measure of participant satisfaction were completed. Results: The course was overwhelmingly appreciated by participating GPs. In the group as a whole, knowledge, attitude and certain elements of clinical practice changed in a positive and predicted direction. General practitioners affirmed the use of an interpersonal and problem-solving framework for patients more commonly than a cognitive-behavioural one. Conclusions: Brief educational interventions are useful and, through improving GP knowledge, attitude and clinical practice, have an important role to play in enhancing the capacity of GPs to assist people with depression and anxiety.
Education System Discrimination Against Children with Mental Disorders
Authors: Bor William , Dakin Jean 
Published: December 2009

Objective: To describe the conceptual confusion, inconsistency and discrimination within some state and territory education systems towards children with mental disorders. Conclusions: Reforms are required to achieve a consistent Australia wide framework for the classification of childhood mental disorders as disabilities. The mental health diagnostic assessment to qualify for disability status needs to be simplified when participation in complex evaluation procedures is not possible.
Working with Families of Patients within an Adult Mental Health Service: Development of a Programme Model
Authors: Mottaghipour Yasaman , Woodland Lisa , Bickerton Annemaree , Sara Grant 
Published: December 2009

Objective: In order to implement and sustain family intervention programmes in clinical settings, there is a need for an organizational change within routine clinical practice. The objective of this paper is to outline the idea behind the development of a programme for working with families of patients within an adult mental health service. Methods: Capacity building, project management and action research frameworks were the three theoretical frameworks used to inform the implementation of the programme within the mental health service. Extensive literature in the area of working with families informed the programme's content. Sutherland Mental Health Service in New South Wales is used as a model to show that organizational changes are needed to implement a ‘family friendly’ service. Results: The programme included two main components: (i) a service development component, (ii) a family engagement and support component. Description of the programme plan has been based on key objectives, strategies and activities for implementation at the service delivery level. Individual activities within the programme have achieved their goals. The rate of family contact within the service has doubled. Conclusions: Issues regarding the effectiveness of such a programme, its limitations, as well as the nature of examining and evaluating such work were discussed. Becoming more ‘family friendly’ is a realistic goal for adult mental health services.