Excess mortality from chronic physical disease in psychiatric patients - The forgotten problem

The article discusses various reports published within the issue, including one by David Lawrence and Joanne Pais on the mortality rate of mentally ill, another by Chris J. Busche and Richard Hodgson on cancer complexities, and on the incidence of chronic disorders among Canadians

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

Lessons for life

The short film Lessons for Life, shows real-life stories from people who have experienced suicidal thoughts as a powerful way to increase empathy and understanding. The Lessons for Life video shares incredible stories of resilience; stories that underpin SANE’s research into attempted suicide. As participant Evan says, accepting and learning from people who have had suicidal thoughts is essential for improving support in Australia. ‘We shouldn’t have negative attitudes towards people who are vulnerable, we should try to encourage and care for them as a community. The film is an accessible way to inform the community about the insights people have about recovering from a suicide attempt. Lessons for Life aims to reduce the stigma associated with suicide, increase help-seeking, and give hope to thousands of others who may be in a similar situation.     &nbsp

Vocational rehabilitation in psychiatry: A re-evaluation

Objective: To highlight the vocational gap in the provision of psychiatric rehabilitation, to outline the goals and conceptual framework of psychiatric rehabilitation, and to discuss rehabilitation interventions with specific reference to vocational rehabilitation and the evidence base for supported employment. Conclusions and service implications: Vocational psychiatric rehabilitation has been a neglected area of practice in Australian psychiatry. Psychiatric treatment needs to adopt a more balanced approach in the provision of a range of services, including vocational rehabilitation, in order to improve long-term outcomes for people suffering from psychiatric disability. A vocational focus should be included in psychiatric rehabilitation and better integration between mental health services and vocational services needs to take place. Supported employment is an evidence-based practice that is designed to help people with psychiatric disabilities participate as much as possible in the competitive job market

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of \u27second filter\u27 criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.Conclusions: All three interventions are considered \u27value-for-money\u27 within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.<br /

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