Join the conversation: evaluating the effectiveness of experienced based co-design in improving the client experience of mental health transition across health sector interfaces

The western region of Melbourne is one of Victoria's fastest growing and most diverse regions. Health demands are on the rise and will continue to grow rapidly, fuelled by a high burden of disease, socioeconomic disadvantage and population diversity. Mental Health issues have been prioritised as a high need area by the health service providers of the region. There is a pressing and regionally supported call for an organised and systemic approach that breaks the cycles of repeated crisis intervention and fragmented care experienced by people with complex mental, medical and social health care needs. The western region experienced based co-design (EBCD) research project, led by Western Health, focuses on working together with consumers of mental health services to improve their experience as they transition from subacute to primary care services and self-management support. The research project gathers the experience of consumers, their families and those who work in the industry and aims to promote service and system integration to improve the consumer experience in the future. This EBCD research methodology does not simply request feedback from consumers but actually involves them and their experience in shaping the design of future services. The methodology has proved successful in making a tangible and sustainable difference to consumers. The research will target consumers with mental health and complex health care needs who are frequent presenters to the emergency department and high users of health care. It will follow their experience as they make the transition from sub-acute care to primary care services and gather 'touch points' (emotionally significant points) or opportunities to improve their experience. The research project will work specifically with the Western Health Mental Health Hospital Admission at Risk Program (MH HARP), which is a step-down service providing intensive care coordination and support to consumers with mental health issues that frequently present to tertiary, and primary care services (principally GPs). The MH HARP service work with consumers, their families/carers, services and primary care providers in the community to transition clients from tertiary! Sub-acute programs to primary care and self-management support.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Znameniti, ali malo poznati biskup rođen u Koprivnici : obljetnica 130. godina od smrti biskupa Angelika Bedenika

Background: Many young migrants and their parents are reluctant to seek help for mental health and substance use problems. Help-seeking delays can result in longer duration of untreated problems and poorer outcomes. In this study, we aimed to identify the help-seeking barriers and facilitators for anxiety, depression and alcohol and drug use problems in young people from recently established sub-Saharan African migrant communities. Methods: A qualitative study, incorporating individual, in-depth interviews and focus group discussions, was undertaken in Melbourne, Australia. Twenty-eight young sub-Saharan African migrants participated in the individual interviews, and 41 sub-Saharan African-born parents and key community leaders participated in 4 focus groups. All participants were aged 16 years or over. A thematic analysis of the data was undertaken. Results: Themes and related sub-themes were abstracted from the data, reflecting the young people’s, parents’ and key community leaders’ beliefs about barriers and facilitators to help-seeking for mental health and substance use problems. Four help-seeking barriers were identified: stigma of mental illness, lack of mental health literacy in parents and young people, lack of cultural competency of formal help sources, and financial costs deterring access. Five help-seeking facilitators were abstracted: being open with friends and family, strong community support systems, trustworthiness and confidentiality of help-sources, perceived expertise of formal help-sources, increasing young people’s and parents’ mental health literacy. Conclusion: Programs that identify and build on help-seeking facilitators while addressing help-seeking barriers are needed to address mental health issues among young sub-Saharan African migrants. Strategies to address help seeking barriers should consider counteracting stigma and increasing mental health literacy in sub-Saharan African communities, increasing health providers’ cultural competency and perceived trustworthiness, and addressing financial barriers to accessing services

Effectiveness of guided self-help in decreasing expressed emotion in family caregivers of people diagnosed with depression in Thailand: a randomised controlled trial

Background: High expressed emotion (EE) can extend the duration of illness and precipitate relapse; however, little evidence-based information is available to assist family caregivers of individuals with depression. In the present exploratory study, we examined the effectiveness of a cognitive behaviour therapy (CBT) based guided self-help (GSH) manual in decreasing EE in caregivers of people with depression, in Thailand. Method: A parallel group randomised controlled trial was conducted, following CONSORT guidelines, with 54 caregivers who were allocated equally to GSH or control group (standard outpatient department support). In addition, both groups were contacted weekly by telephone. EE was assessed, using the Family Questionnaire (FQ), at baseline, post-test (Week 8) and follow-up (Week 12). Results: FQ scores at baseline indicated that both groups had similar, though moderately high level of EE. However, between baseline and post-test EE scores decreased markedly in the intervention group, but in contrast, they increased slightly in the control group. Between post-test and follow-up, little change took place in the EE scores of either group. Overall, the intervention group recipients of GSH showed a significant decrease in EE whereas the control group recipients of standard outpatient department support reported a slight increase in EE. Conclusion: These findings provide preliminary evidence that GSH is beneficial in reducing EE in caregivers, which is advantageous to family members with depression and caregivers. The approach may be used as an adjunct to the limited outpatient department support given to caregivers by mental health professionals and, perhaps, to caregivers who do not attend these departments

Effectiveness of a guided self-help manual in strengthening resilience in people diagnosed with moderate depression and their family caregivers in Thailand: a randomised controlled trial

The growing incidence of depression in developing countries, such as Thailand, is placing increasing pressure on public mental health services, and those living in rural areas have limited access to mental health services and specialised support. Resilience is integral to the recovery of people with depression and to caregivers. This parallel group randomised controlled trial evaluated the effectiveness of a guided self-help manual in improving resilience in adults diagnosed with moderate depression and their primary caregivers in Thailand. Our findings indicate that the approach is an accessible and low-cost approach to increasing resilience in adults with depression and their caregivers

Alcohol consumption in tertiary education students

Background Heavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC) guidelines for alcohol consumption and intentions to seek help for alcohol problems. Methods Students of an Australian metropolitan university (with staff as a comparison group) participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed. Results Of the completed interviews, 774 (65%) were students and 422 (35%) were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students. Conclusions Our findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among young men

Social problem solving in carers of young people with a first episode of psychosis:A randomized controlled trial

AIM: Caring for young people with first-episode psychosis is difficult and demanding, and has detrimental effects on carers' well-being, with few evidence-based resources available to assist carers to deal with the problems they are confronted with in this situation. We aimed to examine if completion of a self-directed problem-solving bibliotherapy by first-time carers of young people with first-episode psychosis improved their social problem solving compared with carers who only received treatment as usual. METHODS: A randomized controlled trial was carried out through two early intervention psychosis services in Melbourne, Australia. A sample of 124 carers were randomized to problem-solving bibliotherapy or treatment as usual. Participants were assessed at baseline, 6- and 16-week follow-up. RESULTS: Intent-to-treat analyses were used and showed that recipients of bibliotherapy had greater social problem-solving abilities than those receiving treatment as usual, and these effects were maintained at both follow-up time points. CONCLUSIONS: Our findings affirm that bibliotherapy, as a low-cost complement to treatment as usual for carers, had some effects in improving their problem-solving skills when addressing problems related to the care and support of young people with first-episode psychosis

Mental health content of Australian pre-registration nursing curricula: Summary report and critical commentary

'Background:' Concerns have been expressed about inadequate mental health content in generic pre-registration nursing curricula in Australia. These have led to claims new graduates are inadequately prepared to care for patients with mental health issues. The Mental Health Nurse Education Taskforce set up for the purpose of the project by the Australian Health Ministers' Advisory Council, carried out a national exploration of mental health content in pre-registration nursing curricula in order to develop a framework for including mental health in future pre-registration courses. This paper summarises the Taskforce's report, and presents a critical commentary on several aspects, of the Taskforce's report. 'Methods:' The project comprised a literature review, a national survey, national consultations, and advice from an Expert Reference Group. 'Results:' The report sets out a framework, which included the core values underpinning learning and teaching, learning outcomes, learning and teaching principles, and benchmarks for inclusion of mental health content in curricula. It recommended that a national approach needed to be taken to accreditation of curricula. This, together with greater collaboration between universities and clinical agencies, and the adoption of innovative strategies to secure clinical places, will help ensure a consistent adoption of the framework in each state and territory