It's all about risk, isn't it? Science, politics, public opinion and regulatory reform

Like most Western democracies, Australia has seen constant business complaints about the regulatory burden and the need for reform. Governments have been sympathetic to these concerns and initiated numerous enquiries into ways to reduce red tape. One, published by the Regulation Taskforce in 2006, argues that a key problem is that Australians are becoming 'risk averse'. Drawing on research into the regulatory aftermath of major disasters, this paper argues that the Taskforce's approach is over-simplistic. Risk has at least three dimensions: actuarial, social and political. Proliferation of rules and regulations in the aftermath of a major disaster can be as much, if not more, the product of political risk aversion as it is of social and actuarial assessments. 'Smart' regulation, which aims to reduce risk while avoiding an excess of rules, must address all three dimensions. The paper explores when and how there can be a 'smart' response to major disaster

Use of an electronic metabolic monitoring form in a mental health service - A retrospective file audit

Background: People with severe mental illness have poorer physical health, experience disparities in physical health care, and lead significantly shorter lives, compared to the general population. Routine metabolic monitoring is proposed as a method of identifying risk factors for metabolic abnormalities. Efforts to date suggest routine metabolic monitoring is both incomplete and ad-hoc, however. This present study reports on the recent implementation of a routine metabolic monitoring form at a mental health service in regional Australia. Methods: A retrospective file audit was undertaken on 721 consumers with electronic health records at the mental health service. Descriptive statistics were used to report the frequency of use of the metabolic monitoring form and the range of metabolic parameters that had been recorded. Results: Consumers had an average age of 41.4 years (SD = 14.6), over half were male (58.4 %), and the most common psychiatric diagnosis was schizophrenia (42.3 %). The metabolic monitoring forms of 36 % of consumers contained data. Measurements were most commonly recorded for weight (87.4 % of forms), height (85.4 %), blood pressure (83.5 %), and body mass index (73.6 %). Data were less frequently recorded for lipids (cholesterol, 56.3 %; low density lipoprotein, 48.7 %; high density lipoprotein, 51.7 %; triglycerides, 55.2 %), liver function (alanineaminotransferase, 66.3 %; aspartate aminotransferase, 65.5 %; gamma-glutamyl transpeptidase, 64.8 %), renal function (urea, 66.3 %; creatinine, 65.9 %), fasting blood glucose (60.2 %), and waist circumference (54.4 %). Conclusions: The metabolic monitoring forms in consumer electronic health records are not utilised in a mannerthat maximises their potential. The extent of the missing data suggests that the metabolic health of most consumers may not have been adequately monitored. Addressing the possible reasons for the low completion rate has the potential to improve the provision of physical health care for people with mental illness

Improving the cardiometabolic health of people with psychosis: A protocol for a randomised controlled trial of the Physical Health Nurse Consultant service

Background: Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. Objectives: To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. Design/Methods: In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the ‘Access’, ‘Acceptability’ and ‘Shared Decision Making’ dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. Results: Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. Conclusions: The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health car

Experts by experience in mental health nursing education: What have we learned from the COMMUNE project?

The COMMUNE (co-produced mental health nursing education) was an international project established to embed EBE perspectives in mental health nursing education by developing and delivering a specific mental health nursing module. The underlying intention of this project was to go well beyond ad hoc implementation and tokenistic approaches to EBE involvement. Standards for co-production of Education (Mental Health Nursing) (SCo-PE [MHN]) was developed to provide guidance to the increasing number of academics seeking genuine and meaningful involvement of Experts by Experience in the education of health professionals. These standards were recently published in the Journal of Mental Health and Psychiatric Nursing (Horgan et al., 2020): https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12605 and prompted this Editorial to discuss the COMMUNE project more fully, including the lessons learned

Practice Guidelines for Co-Production of Mental Health Nursing Education

COMMUNE (Co-production of Mental Health Nursing Education) is an Erasmus+ Strategic Partnership Project based on the collaboration of experts by experience (EBE) and mental health nursing academics from six European universities and the University of Canberra in Australia. Its purpose was to advance the involvement of those who have experiences of mental health service use (EBE) in mental health nursing education. The project combined experiential and academic knowledge, with the aim of co-producing a module on ‘mental health recovery’ for undergraduate nursing students; a module that was taught to the students by EBE. Principles of co-production where followed as much as possible, involving EBE in all stages of the process, from grant application to dissemination. The project tried to move beyond typical service user involvement and towards co-creation of knowledge, where power differentials are acknowledged and equity issues addressed. Barriers to meeting these goals were experienced and will be discussed in this Guidelines. We hope that these Practice Guidelines will be useful for those who intend to co-produce learning programs or modules in mental health nursing and inspire others to follow similar paths and learn from our experiences, positive or otherwise. These Guidelines provide an overview of our experiences, learnings, limitations and barriers.The Commune team decided on the term ‘Expert by Experience’ (EBE) to describe the members of the team and other collaborators who has lived experience of mental distress. Other more commonly used terms are ‘service user’, ‘consumer’ and ‘people with mental illness.’ As not all experts by experience are mental health care users, and what constitutes an illness is highly debated, the team decided on a term that more correctly describes and value lived experience.Erasmus

The effects of education, self-regulation, social support and cultural participation on physical activity variety in the Baby Boomer generation

© 2013 Dr. Chris Platania-PhungIf there is one principle for well-being, it is that recreational physical activities, such as walking and sports, have wide-ranging health benefits. However, most people are not active enough to realise the benefits, such as the baby boomer generation. A major public health issue is how to develop better ways to encourage the ‘boomers’ to live physically active lives. Research has identified a tendency for the boomers to participate in variety, such as a range of recreational activities (Alderson, Junisbai, & Heacock, 2007). In addition, adult education level is connected to more variety (e.g. van Eijck, 1999). If the boomers have an appetite for variety, it may be a focus for physical activity promotion. However, the potential effects of education on activity variety of this generation is unclear, and it has not been directly investigated whether forms of self-agency such as self-regulation, and seeking social support, intervene education and physical activity variety. By drawing on social-cultural psychology to integrate insights from health psychology, public health, and sociology, the current thesis investigated the potential role of formal education and self-agency in current participation in physical activity variety by the boomer generation. The aim was to establish whether education is a determinant of physical activity variety, and in particular, as a potential precursor to day-to-day agency (e.g. seeking social support to be active). A model of the effects of education on physical activity variety was developed, and investigated through a field study of boomer adults (n = 217) in the general community of Melbourne, Australia. The Model proposed that education leads to activity variety via self-regulation, seeking social support and cultural participation (e.g. visiting museums and cultural festivals). Research participants completed a detailed survey of social and life background, lifestyle patterns, and health, and a measure of cognitive ability – a potentially important capacity for self-regulation and active living. Before the main field study, the survey was developed through two pilot studies (n1 = 218, and n2 = 106), and the ability measure evaluated in the latter pilot. As anticipated, education was found to effect physical activity variety, positively and indirectly, and primarily via: (1) self-regulation and attaining social support, and (2) cultural participation. The strongest direct effect on activity variety was via social support elicitation, and the multiple indirect effects of education on variety took place via this form of adult self-agency. Cognitive ability had a negative effect on self-regulation, and a positive direct effect on social support elicitation. Women were more engaged in cultural participation than men, and less engaged in physical activity variety. The findings of this thesis suggest that physical activity promotion strategies that are focused on increasing multiple types of activity may be a promising public health approach, and may be particularly effective for boomers with higher education. Furthermore, forms of self-agency that are not normally the ‘target’ of public health, such as cultural participation, may foster more health-enhancing physical activity. The baby boomers gravitate to variety in life, and efforts to support this proclivity in the generation may confer additional benefits to their well-being

A psychometric analysis of the mental health consumer participation questionnaire

If consumer participation is to be translated from rhetoric into reality, the attitudes of health professionals need to be addressed. Educational strategies can play an important role, but measures of attitudes are needed to determine the effectiveness of these strategies. This paper seeks to establish the Mental Health Consumer Participation Questionnaire (MHCPQ) on psychometric grounds, and explore attitude levels. Overall, the 150 nursing students who participated saw consumer participation in a favourable light, although this varied with the nature and extent of involvement. Psychometric properties, attitude structure, and attitude differences are reported. The MHCPQ displays good face validity and can be further developed and used in mental health-care settings

Thoughts, feelings, action: survey of Victorian major hazard facility managers

This article reports on a survey of Victorian major hazard facility (MHF) managers as a follow-up to earlier comparative case study research on major hazard, counterterrorism and financial regulation. The case study research suggested that the Victorian MHF safety case regime could be viewed as a "best case scenario" among the three regulatory regimes studied. The results of the survey support this positive assessment of the Victorian safety case regime and the critical role that the regulator plays in making regulations more effective. The survey also provides an important window into understanding what assists in compliance with safety case requirements and how managers deal with business pressures and competing regulatory demands that may threaten safety levels at their respective sites

Mental health issues within the general health care system : implications for the nursing profession

Aim: The aim of this paper is to briefly describe the prevalence of mental illness within the general healthcare population and the implications for the nursing profession. Primary argument: The nursing profession espouses holism as its philosophy of care. This philosophy embraces the essential interaction between the biological, psychological and social aspects of each individual. The mainstreaming of mental health services within the general health care system has increased the level of contact nurses have with people experiencing mental health problems, yet the research evidence suggests they are not confident or competent in meeting the associated needs. Conclusion: There is an urgent need for education of the current and future nursing workforce if the challenges presented by mental health issues are to be addressed