People living with psychosocial disability: Rehabilitation and recovery-informed service provision within the second Australian national survey of psychosis.

Objective: People with psychosocial disability are an important, although often neglected, subgroup of those living with severe and persistent mental illness. Rehabilitation, provided through clinical and non-government organisations in Australia, may contribute to their personal recovery goals. We hypothesised that people with psychoses with the greatest disability and complex needs would receive services from both sectors, reflecting treatment and rehabilitation needs.

Impact of care coordination on Australia's mental health service delivery system.

Care coordination models have developed in response to the recognition that Australia's health and welfare service system can be difficult to access, navigate and is often inefficient in caring for people with severe and persistent mental illness (SPMI) and complex care and support needs. This paper explores how the Australian Government's establishment of the Partners in Recovery (PIR) initiative provides an opportunity for the development of more effective and efficient models of coordinated care for the identified people with SPMI and their families and carers. In conceptualising how the impact of the PIR initiative could be maximised, the paper explores care coordination and what is known about current best practice.

Quality of housing among patients of an area mental health service.

Objectives: The aims of the present study were to (i) assess the quality of housing for patients receiving treatment from an area mental health service; (ii) compare estimates of quality of housing using two different methods: housing type versus housing characteristics; (iii) determine whether either method for assessing quality is more useful that a combination; and (iv) examine the relationship between housing quality and case manager's assessment of the impact of the housing on the patient's mental disorder.

Methods: A survey was developed that included the demographics of the patient; housing type; living arrangements; housing characteristics as assessed by the patient's case manager; and an overall assessment by the case manager of the impact that the housing has on the patient's mental disorder. Case managers were asked to complete the housing survey on all patients they saw in the community during a 2 week period in 2003.

Factors influencing triage decisions in mental health services.

The aim of the study was to identify the factors influencing the timing of an assessment after contact with a triage program in a community-based area mental health service in Australia. Triage decisions apparently were influenced by several groups of factors: patient characteristics; the source and mode of the contact with triage; and to a large extent by mental health service factors including the training, supervision and support of triage workers and the perceived availability of an assessment. While demand factors such as patient characteristics influenced the triage decision, supply factors also played an important role.

Impact and management of dual relationships in metropolitan, regional and rural mental health practice.

Objective: To explore the extent and impact of professional boundary crossings in metropolitan, regional and rural mental health practice in Victoria and identify strategies mental health clinicians use to manage dual relationships.

Method: Nine geographically located focus groups consisting of mental health clinicians: four focus groups in rural settings; three in a regional city and two in a metropolitan mental health service. A total of 52 participants were interviewed.

Economic barriers to better mental health practice and policy.

Mental health systems in many countries are seriously under-developed, yet mental health problems not only have huge consequences for quality of life, but--particularly in low- and middle-income countries--contribute to continued economic burden and reinforce poverty. This paper discusses economic barriers to improving the availability, accessibility, efficiency and equity of mental health care in low- and middle-income countries. Six sets of barriers are identified: an information barrier, resource insufficiency, resource distribution, resource inappropriateness, resource inflexibility and resource timing.

The mental health nurse: a valuable addition to the consultation-liaison team.

Nurses, particularly those working in non-psychiatric settings, report that they do not feel adequately prepared to meet the mental health needs of patients. The psychiatric consultation-liaison nursing role has arisen in part, as a response to these difficulties and aims to facilitate access to mental health nursing expertise for general hospital patients and staff. The impact of the introduction of a nursing position into an established consultation-liaison psychiatry service was evaluated using an activity audit, a staff attitude survey, and staff focus groups.

Identifying marginal housing for people with a mental illness living in rural and regional areas.

Objective: Homelessness among people with a mental illness is a serious issue. Objective: The study aimed to identify the types of housing available for people with a mental illness in the region; to develop an audit tool to assess the housing of patients of the mental health service; and to pilot this audit tool.

Method: Key informants were interviewed to obtain information about the type of housing options available in the Loddon Campaspe Southern Mallee Region.

Identifying marginal housing for people with a mental illness living in rural and regional areas.

Objective: Homelessness among people with a mental illness is a serious issue. The purpose of the present study was to identify the types of housing available for people with a mental illness in the region, to develop an audit tool to assess the housing of patients of the mental health service, and to pilot this audit tool.

Methods: Key informants were interviewed to obtain information about the type of housing options available in the Loddon Campaspe Southern Mallee Region, Victoria, Australia.

Public and private psychiatry: can they work together and is it worth the effort?

Objective: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby.

Dual relationships in mental health practice: issues for clinicians in rural settings.

Objective: This paper aims to provide an overview of the literature on non-sexual dual relationships, and to discuss these in the context of rural mental health practice in Australia.

Method: An internet-driven literature search was undertaken using OVID databases, which include MEDLINE, PsycINFO, CINAHL, and EMBASE: Psychiatry. Ethical codes of practice for the mental health professions of psychiatry, psychology, occupational therapy, social work and nursing were referred to.

An ethnographic study of three mental health triage programs.

Triage processes are commonly used to manage the interface between demand for, and supply of, health services. This dimension of service provision is particularly pertinent for mental health services in Australia, where demand outweighs services available. This paper draws on the experiences of using participant observation to explore mental health triage processes.

Training case managers to deliver focused psychological strategies.

Anxiety and mood disorders are prevalent in the Australian community and can be functionally disabling. Access to treatment for these disorders can be difficult, particularly in rural areas where there is limited availability of specialist mental health practitioners such as psychiatrists and clinical psychologists. One way to address this problem is to improve the skills of local mental health practitioners in recognizing and providing treatment for these disorders.

Improving collaboration between private psychiatrists, the public mental health sector and general practitioners: evaluation of the Partnership Project.

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements.

Postnatal unhappiness: who should direct support?

Depression following childbirth is a common, distressing but frequently underreported disorder. It involves a spectrum of symptoms, some of which may be self-limiting, while others can have major mental health implications in the post partum period. A range of health professionals, including midwives and mental health nurses, come into contact with women who suffer from postnatal depression; however, there is often little attempt made to integrate maternity and mental health care approaches.

What is duty/triage? Understanding the role of duty/triage in an area mental health service.

Objective: To describe the duty/triage system within one urban area mental health service in Australia and to investigate the factors that affect the decision to organize a comprehensive assessment.

Method: Data was collected from 3 months of duty/triage information and key informant interviews. Policies and procedures related to duty/triage were reviewed.