Do adults in contact with Australia's public sector mental health services get better?

This paper describes the outcomes of episodes of care for adults in public sector mental health services across Australia, with a view to informing the debate on service quality. Health of the Nation Outcome Scales (HoNOS) change scores and effect sizes were calculated for 14,659 acute inpatient episodes and 23,692 community episodes. The results showed that people in contact with public sector mental health services generally do get better, although the magnitude of improvement depends on the setting and episode type. This confirmatory finding is particularly positive, given current community concerns about the quality and effectiveness of mental health services

Factors associated with length of stay and the risk of readmission in an acute psychiatric inpatient facility: a retrospective study

OBJECTIVE: This study was to investigate factors influencing the length of stay and predictors for the risk of readmission at an acute psychiatric inpatient unit. METHOD: Two comparative studies were embedded in a retrospective cross-sectional clinical file audit. A randomly selected 226 episodes of admissions including 178 patients during a twelve-month period were reviewed. A total of 286 variables were collected and analysed. A case control study was employed in the study of length of stay. A retrospective cohort study was used to investigate the predictors for the risk of readmission. RESULTS: Logistic regression analyses showed that 10 variables were associated with length of stay. Seclusion during the index admission, accommodation problems and living in an area lacking community services predicted longer stay. During the follow-up period 82 patients (46%) were readmitted. Cox regression analyses showed 9 variables were related to the risk of readmission. Six of these variables increased the risk of readmission, including history of previous frequent admission, risk to others at the time of the index admission and alcohol intoxication. More active and assertive treatment in the community post-discharge decreased the risk of readmission. CONCLUSIONS: Length of stay is multifactorially determined. Behavioural manifestations of illness and lack of social support structures predicted prolonged length of stay. Good clinical practice did not necessarily translate to a shorter length of stay. Therefore, length of stay is predictable, but not readily modifiable within the clinical domain. Good clinical practice within the community following discharge likely reduces the risk of readmission. Quality of inpatient care does not influence the risk of readmission, which therefore raises a question about the validity of using the rate of readmission as an outcome measure of psychiatric inpatient care

Mental health consumer and caregiver perceptions of stigma in Australian community pharmacies

Background: The stigma of mental illness can be a barrier to effective medication management in the community pharmacy setting. This article explored mental health consumers’ or caregivers’ experiences of stigma in Australian community pharmacies. Materials: Semi-structured interviews and focus groups were conducted with a purposive sample of consumers or caregivers (n = 74). Interview transcripts were analysed using a general inductive approach. Discussion: Stigma presented a barrier to effective mental health management. Self-stigma impeded consumers’ community pharmacy engagement. Positive relationships with knowledgeable staff are fundamental to reducing stigma. Conclusions: Findings provide insight into the stigma of mental illness in community pharmacies

The personal and national costs of mental health conditions: impacts on income, taxes, government support payments due to lost labour force participation

<p>Abstract</p> <p>Background</p> <p>Mental health conditions have the ability to interrupt an individual's ability to participate in the labour force, and this can have considerable follow on impacts to both the individual and the state.</p> <p>Method</p> <p>Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model built on data from the Australian Bureau of Statistics' <it>Survey of Disability, Ageing and Carers </it>and STINMOD, an income and savings microsimulation model was used to quantify the personal cost of lost income and the cost to the state from lost income taxation, increased benefits payments and lost GDP as a result of early retirement due to mental health conditions in Australians aged 45-64 in 2009.</p> <p>Results</p> <p>Individuals aged 45 to 64 years who have retired early due to depression personally have 73% lower income then their full time employed counterparts and those retired early due to other mental health conditions have 78% lower incomes. The national aggregate cost to government due to early retirement from these conditions equated to $278 million (£152.9 million) in lost income taxation revenue,$407 million (£223.9 million) in additional transfer payments and around $1.7 billion in GDP in 2009 alone.</p> <p>Conclusions</p> <p>The costs of mental health conditions to the individuals and the state are considerable. While individuals has to bear the economic costs of lost income in addition to the burden of the conditions itself, the impact on the state is loss of productivity from reduced workforce participation, lost income taxation revenue, and increased government support payments - in addition to direct health care costs.</p

Building effective service linkages in primary mental health care: a narrative review part 2

<p>Abstract</p> <p>Background</p> <p>Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care.</p> <p>Methods</p> <p>A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored.</p> <p>Results</p> <p>A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings.</p> <p>Conclusion</p> <p>The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback.</p

Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach.

BACKGROUND: Eating Disorders (ED) are mental health disorders that typically effect women of childbearing age and are associated with adverse maternal and infant outcomes. UK healthcare guidance recommends routine enquiry for current and past mental illness in antenatal and postnatal care for all women, and that pregnant women with a known ED are offered enhanced monitoring and support. Midwives and health visitors are ideally placed to identify and support women with ED as they are often the primary point of contact during the antenatal and postnatal periods. However, research on the barriers to identifying ED in the perinatal period is limited. This study aimed to understand the barriers to disclosure and identification of ED in pregnancy and postnatally as perceived by women with past or current ED, and midwives and health visitors working in the UK National Health Service. METHODS: Two studies were undertaken: mixed-measures survey of pregnant and postnatal women with current or past ED; focus groups with student and qualified midwives and health visitors. RESULTS: Five themes emerged on the barriers to disclosure in pregnancy as perceived by women: stigma, lack of opportunity, preference for self-management, current ED symptomatology and illness awareness. Four themes were identified on the barriers to identification of ED in pregnancy and in the postnatal period as perceived by health professionals: system constraints, recognition of role, personal attitudes, and stigma and taboo. CONCLUSIONS: Several barriers to the identification of ED during and after pregnancy were described, the main factors were stigma and poor professional training. Perinatal mental health is becoming increasingly prioritised within national policy initiatives; however, ED continue to be neglected and increased awareness is needed. Similarly, clinical guidance aimed at responding to the rising prevalence of obesity focus on changing nutrition but not on assessing for the presence of ED behaviours that might be affecting nutrition. Improving education and training for health professionals may contribute to reducing stigma and increase confidence in identifying ED. The barriers identified in this research need to be addressed if recognition and response to women with ED during the perinatal period is to improve

Consumer and carer participation in mental health services

Objective; To clarify the meaning of consumer and carer participation in mental health services, to identify reasons why consumer participation is important both to consumers and to services, and to discuss barriers to participation and ways of overcoming these barriers. Conclusions: Consumer and carer participation has been promoted as part of the National Mental Health Strategy and has the potential to empower consumers and their carers and to improve mental health services. Barriers to consumer participation include professional staff attitudes and resource allocation. Guidelines are provided to assist services to address these barriers and increase the level of consumer and carer participation in both clinical decision-making and service development