Australian community and inpatient general public sector mental health services between 2017-18 and 2021-22: Relative stasis in bed capacity, increasing outpatient demand, and stunted expenditure.

Objective: To descriptively analyse Australian public sector General Mental Health Services (GMHS) expenditure, ambulatory, and inpatient services, including key performance indicators (KPIs) in comparison with other subspeciality mental health services (MHS).

Method: We descriptively analysed data published by the Australian Institute of Health and Welfare (AIHW), including inpatient, ambulatory services, expenditure, and KPIs.

Results: From 2017-18 to 2021-22, per capita expenditure for Australian GMHS (18-64) rose by an average annual inflation-adjusted change of 2%.

Unpeeling the onion: Digital triage and monitoring of general practice, private psychiatry, and psychology.

Objective: The Australian federal government is considering a 'digital front door' to mental healthcare. The Brain and Mind Centre at the University of Sydney has published a discussion paper advocating that the government should adopt a comprehensive model of digital triage and monitoring (DTM) based on a government-funded initiative Project Synergy ($30 million). We critically examine the final report on Project Synergy, which is now available under a Freedom of Information request.

Can new approaches to synthesising evidence help achieve a consensus in psychotherapy research?

Objective: The recent debate around the College's Clinical Practice Guidelines on mood disorders have highlighted differences in opinion on interpreting evidence from randomised control trials (RCTs) for psychodynamic psychotherapy. This paper discusses new techniques of synthesising research evidence (e.g.

Patients languishing in emergency departments: A descriptive analysis of mental health-related emergency department presentations in Australia between 2016-17 and 2020-21.

Objective: In the context of concerns regarding hospital access block, this paper provides a descriptive longitudinal analysis of mental health-related ED episodes in Australian public hospitals between 2016-17 and 2020-21.

Method: We descriptively analysed Australian Institute of Health and Welfare data for mental health-related ED presentations, outcomes and 5-year trends for Australian public hospitals.

Results: There were more than 300,000 Australian mental health-related ED presentations in 2020-21.

Supply and demand - a health economic perspective on the Australian hospital and elective surgery crisis.

The COVID-19 pandemic has contributed to longstanding structural shortfalls in the supply of healthcare services in high-income countries, including Australia. These impacts are reflected in Australian public hospital key performance indicators for acute care, elective surgery and hospital exit block. The challenges occur in the context of increased demand following the suspension of a range of healthcare services during the pandemic.

Child and Adolescent Mental Health Services in Australia: A descriptive analysis between 2015-16 and 2019-20.

Objective: To provide analysis and commentary on Australian state/territory child and adolescent mental health service (CAMHS) expenditure, inpatient and ambulatory structure and key performance indicators.

Method: Data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics were descriptively analysed.

Results: Between 2015-16 and 2019-20, overall CAMHS expenditure increased by an average annual rate of 3.

More smoke and mirrors: Fifteen further reasons to doubt the effectiveness of headspace.

Objective: Commentary on the debate concerning the effectiveness of headspace, including the most recent independent evaluation of its services.

Conclusions: The available evaluations indicate that headspace does not deliver therapy of adequate duration that results in clinically significant improvement. Most evaluations have used either short-term process measures or uncontrolled satisfaction surveys, and where there have been data on outcomes using standardised instruments, findings have been disappointing.

Physician leadership during the current crisis in healthcare: A perspective drawn from anthropological and clinical leadership research.

Objectives: There are ongoing challenges in workforce sustainability and service delivery due to the COVID-19 pandemic. Recruiting credible clinical leaders can enhance outcomes through mentoring, leading by example, and creating positive work environments. We investigate the anthropology of, and related research on leadership.

The new World Mental Health Report: Believing impossible things.

Objective: We examine whether the recent World Health Organization (WHO) report on global mental health uses severity of illness as a criterion in priority setting for resource allocation.

Conclusions: The WHO does not prioritise severity in the recent landmark World Mental Health Report. It recommends instead the insuperable task of scaling-up interventions for broadly defined mental health conditions, including milder distress, amongst over a billion people, with the majority living in low- and middle-income countries.

Commentary: Is Australian headspace socioculturally westernised, educated, industrialised, rich and democratic in conceptualisation and accessibility?

Objective: The Australian headspace model has been proposed as an internationally significant exemplar for reducing the mental health 'treatment gap' amongst young people around the world. We provide a commentary that discusses the conceptualisation and delivery of headspace services within Australia, a predominantly Westernised, Educated, Industrialised, Rich and Democratic (WEIRD) society, as well as examining accessibility and suitability for culturally and linguistically diverse (CALD) communities.

Conclusion: headspace was conceptualised, designed, implemented and evaluated according in a WEIRD sociocultural context, and is therefore most applicable to that setting.

Clinical update and commentary on psychiatric care for patients experiencing workplace bullying.

Objective: To provide a brief clinical research update and commentary advice on the practical psychiatric care of patients suffering workplace bullying.

Conclusions: While there is empirical research on the prevalence and impacts of workplace bullying, there is a relative dearth of clinical research into psychiatric patient care. Accordingly, we provide commentary on practical considerations that assist in psychiatric care planning and delivery.

Lessons from billed telepsychiatry in Australia during the COVID-19 pandemic: rapid adaptation to increase specialist psychiatric care.

Objective: To summarise and comment upon research regarding the service delivery impact of the introduction of COVID-19 pandemic Medicare Benefits Schedule (MBS) psychiatrist telehealth services in Australia in 2020-2021. Type of program or service: Privately-billed, MBS-reimbursed, face-to-face and telehealth consultations with a specialist psychiatrist during the first year of the COVID-19 pandemic.

Methods: This paper draws on analyses of previously published papers.

Commentary on the private practice implications of the Deed of Settlement in the Honeysuckle Health - NIB Australian-Competition-Tribunal-hearing.

Objective: To provide a commentary on the implications of the Deed of Settlement in the Honeysuckle Health - nib Australian-Competition-Tribunal Hearing. This hearing has major implications in relation to the potential for a single dominant private-health-insurance buying-group to contract for medical-purchaser-provider-agreements that might limit the clinical autonomy of patients and psychiatrists.

Conclusions: The Australian Competition and Consumer Commission (ACCC) authorised the formation of a joint buying-group for private-health-insurers in 2021 to provide collective contracting and related services to private-health-insurers and other healthcare-payers.

Psychiatrist and trainee moral injury during the organisational long COVID of Australian acute psychiatric inpatient services.

Objective: This paper provides a commentary on the risk of moral injury amongst psychiatrists and trainees working in the acute psychiatric hospital sector, during the third winter of the COVID-19 pandemic.

Conclusions: Moral injuries arise from observing, causing or failing to prevent adverse outcomes that transgress core ethical and moral values. Potentially, morally injurious events (PMIEs) are more prevalent and potent while demand on acute hospitals is heightened with the emergence of highly infectious SARS-CoV-2-Omicron subvariants (BA.

Australian older persons mental health inpatient and ambulatory services in 2015-2020 - A descriptive analysis and commentary.

Objective: To provide a commentary on Australian state/territory older persons mental health service (OPMHS) expenditure, inpatient and outpatient services and key performance indicators (KPIs).

Method: Descriptive analysis of data from the Australian Institute of Health and Welfare (AIHW), the Australian Bureau of Statistics and the World Health Organisation.

Results: Between 2015-16 and 2019-20, annual expenditure on OPMHS in Australia increased by an average of only 2.

Psychiatrist and trainee burnout: Commentary and recommendations on management.

Objective: To comment upon the evidence-base regarding psychiatrist and trainee burnout and provide recommendations on management.

Conclusions: Burnout has been conceptualised as a specific stress-related response, primarily related to work. There is a high prevalence of burnout amongst both trainees and psychiatrists internationally, with substantial consequences for personal and family wellbeing, organisational efficiency and patient care.

Mental health services need action on organisational culture and justice.

Objective: A commentary on the usefulness of the concepts of organisational culture, organisational climate and justice on the quality and safety of mental health services and how conditions may be improved.

Conclusions: Organisational culture, organisational climate and justice impact upon the quality and safety of care, as well as well-being of staff, in mental health services. Psychiatrists and trainees, should consider, act and advocate for improved organisational culture, climate and justice.

National Mental Health Performance Framework: Descriptive analysis of state and national data for 2019-2020.

Objective: To compare key performance indicators for public state and territory specialist mental health services in Australia.

Methods: A descriptive analysis of the publicly-available National Mental Health Performance Framework key performance indicators (KPI), hosted by the Australian Institute of Health and Welfare for 2019-2020, at the national level and for states and territories.

Results: The real-world performance of public mental health services varied across the eight states and territories of Australia.

Self-reported child maltreatment and cardiometabolic risk in 30-year-old adults.

Background: Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect.

Aims: To assess the association between five types of self-reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort.

Rapid review and commentary on the clinical implications of the population mental health consequences of the COVID-19 pandemic in Australia.

Objective: To provide a rapid clinical review and commentary for psychiatrists on the population mental health consequences of the COVID-19 pandemic in Australia, including evidence-based findings and interventions.

Conclusions: Whilst there was evidence of collective psychological resilience during the first 2 years of the COVID-19 pandemic, younger women, carers for those with COVID-19, and those with more household chores, childcare needs and higher economic strain, were at more risk. Interventions should therefore target people with these socio-demographic risk factors, as well as severe COVID-19 survivors, their relatives and frontline workers.

Is there a missing-middle in Australian mental health care?

Objective: The term 'missing-middle' has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the 'missing-middle' term, founded on qualitative and quantitative research.

Conclusions: Despite the widespread use of the term 'missing-middle' for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group.