Snapshot of Australian primary health care research 2010

This snapshot of recent Australian research projects demonstrates the potential for primary health care research to improve the health of Australians. Snapshot of Australian primary health care research 2010 is a collaborative venture involving representatives from PHC RIS, the Australian Government Department of Health and Ageing, Australian Primary Health Care Research Institute, Australian Association for Academic General Practice, Royal Australian College of General Practitioners. View Snapshot on-line: Foreword Introduction Understanding barriers to hypertension treatment Tapping into social workers\u27 skills for primary mental health care Measuring the right things - indicators for remote Aboriginal mothers and infants in the Northern Territory Health literacy for change in behavioural risk factors The roles of Australian General Practice Nurses Work intentions of Australian general practitioners Quality outcomes in general practice - how do we compare? Rural community perceptions of the determinants of health Primary care management of chronic heart failure in rural communities Effective alternatives to treat chronic achilles tendon pain Sexuality, sexual abuse and protection skills in women with intellectual disability   Editorial and review team: Belinda Lunnay, Ellen McIntyre, Libby Kalucy, Fiona Thomas and Petra BywoodWriter: Edwina Ligh

The First into the Dark

"Under the Nazi regime a secret program of ‘euthanasia’ was undertaken against the sick and disabled. Known as the Krankenmorde (the murder of the sick) 300,000 people were killed. A further 400,000 were sterilised against their will. Many complicit doctors, nurses, soldiers and bureaucrats would then perpetrate the Holocaust. From eyewitness accounts, records and case files, The First into the Dark narrates a history of the victims, perpetrators, opponents to and witnesses of the Krankenmorde, and reveals deeper implications for contemporary society: moral values and ethical challenges in end of life decisions, reproduction and contemporary genetics, disability and human rights, and in remembrance and atonement for the past.

The First into the Dark

"Under the Nazi regime a secret program of ‘euthanasia’ was undertaken against the sick and disabled. Known as the Krankenmorde (the murder of the sick) 300,000 people were killed. A further 400,000 were sterilised against their will. Many complicit doctors, nurses, soldiers and bureaucrats would then perpetrate the Holocaust. From eyewitness accounts, records and case files, The First into the Dark narrates a history of the victims, perpetrators, opponents to and witnesses of the Krankenmorde, and reveals deeper implications for contemporary society: moral values and ethical challenges in end of life decisions, reproduction and contemporary genetics, disability and human rights, and in remembrance and atonement for the past.

Psychiatry and the ‘gay holocaust’ – the lessons of Jill Soloway’s Transparent

Objective: We aim to consider issues relevant to psychiatry raised by the television series, Transparent. Conclusions: Psychiatry’s disturbing history regarding the lesbian, gay, bisexual, transgender and intersex (LGBTI) community shares many aspects with the group’s persecution by the National Socialist regime in Germany. The medicalised ‘otherness’ conferred on LGBTI patients, latent homophobia and transphobia, and lack of culturally sensitive clinical services for these people represent a major ethical challenge for modern Australasian psychiatry.4 page(s

Reconceptualizing involuntary outpatient psychiatric treatment from capacity to capability

Justifying involuntary psychiatric treatment on the basis of a judgment that a person lacks capacity is controversial because there are questions about the meaning and utility of the concept in this context. There are complexities to using capacity in this way, which are further amplified in the community outpatient setting compared with acute inpatient care. A richer account of capacity, its meanings, and practical applications in context, is required. This qualitative study sought to build inductively a model of capacity in the context of involuntary outpatient psychiatric treatment, based on 38 interviews with stakeholders from New South Wales, Australia. The emergent model incorporates multiple capacities : to manage illness, for self-care, and to maintain social roles. It identifies core values that correspond with the capabilities approach, elaborating the justifications and processes of involuntary outpatient psychiatric treatment. This proposed model of capability may have a range of benefits to sound and ethical practice and scrutiny of systems of involuntary outpatient treatment

Beyond platitudes: A qualitative study of Australian Aboriginal people's perspectives on biobanking

Background Biobanks are vital resources for genetics and genomics, and it is broadly recognised that for maximal benefit it is essential that they include samples and data from diverse ancestral groups. The inclusion of First Nations people, in particular, is important to prevent biobanking research from exacerbating existing health inequities, and to ensure that these communities share in the benefits arising from research. Aims To explore the perspectives of Australian Aboriginal people whose tissue—or that of their family members—has been stored in the biobank of the National Centre for Indigenous Genomics (NCIG). Methods Semi‐structured interviews with 42 Aboriginal people from the Titjikala, Galiwinku, Tiwi Islands, Yarrabah, Fitzroy Crossing, Derby, One Arm Point, and Mulan communities, as well as a formal discussion with AH, an Indigenous Community Engagement Coordinator at the NCIG who had conducted the interviews. The interviews and the structured discussion were double coded using a procedure informed by Charmaz’s outline of grounded theory analysis and Morse’s outline of the cognitive basis of qualitative research. Results In this article, we report on AH’s interviews with members from the above Aboriginal communities, as well as on her personal views, experiences, views and her interpretations of the interviews she conducted with other community members. We found that participation in the NCIG biobank raised issues around broken trust, grief and loss, but also—somewhat unexpectedly—was perceived as a source of empowerment, hope and reconnection. Conclusions This research reminds us (again) of the need to engage deeply with communities in order to respond appropriately with respect for their cultural values and norms, and to develop culturally relevant policies and processes that enhance the benefits of biobank participation and minimise potential harms

The Urgent Need to Review the use of CTOs and Compliance with the UNCRPD Across Australian Jurisdictions

In every Australian jurisdiction, legislation permits mental health service providers and/or mental health tribunals to force people with mental illness to engage in treatment, under Community Treatment Orders (CTOs). Despite considerable efforts made by every Australian state and territory to meet human rights obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (2008; Maylea & Hirsch, 2017), Australia has rates of CTO usage that are very high by world standards (Light, 2019). Even within Australia, rates of CTO usage vary considerably between and within jurisdictions in spite of the legislation being very similar (Light, 2019; Adult mental health quarterly KPI report, 2019). This occurs in the context of mixed evidence about the efficacy of CTOs and a lack of clear understanding of their purpose (Segal et al., 2017; Kisely et al., 2017). The use of CTOs remains one of the most contentious issues in mental health service delivery. Not only is their efficacy unresolved, they also raise serious ethical and human rights concerns. The current debates, and attempts at reform, must be informed by valid and reliable data. This brief commentary will make the case for a research agenda that addresses the minimal research that has been undertaken to address the variations of CTO use across Australian jurisdictions