An examination of risk factors for readmission to acute adult mental health services within 28 days of discharge in the Australian setting.

Objective: The aim of this paper was to identify risk factors associated with readmission within 28 days of discharge from eight Australian adult acute mental health inpatient services.

Method: A detailed file audit was conducted comparing 222 patients readmitted within 28 days of discharge with 253 patients not readmitted during the same period.

Results: There was an association between early readmission and having had contact with the service in the previous 12 months (51% vs 21%), having been admitted in the previous 12 months (65% vs 36%), and having been diagnosed with an emotionally unstable personality disorder (14% vs 4%).

Forming and sustaining partnerships to provide integrated services for young people: an overview based on the headspace Geelong experience.

Aim: To discuss critical considerations in the formation and maintenance of agency partnerships designed to provide integrated care for young people.

Methods: Two years after its establishment, an evaluation of the headspace Barwon collaboration and a review of the health-care and management literature on agency collaboration were conducted. The principal findings together with the authors' experience working at establishing and maintaining the partnership are used to discuss critical issues in forming and maintaining inter-agency partnerships.

It's not that bad: the views of consumers and carers about routine outcome measurement in mental health.

The mandatory use of routine outcome measurement (ROM) has been introduced into all public sector mental health services in Australia over the past 6 years. Qualitative processes were used to engage consumers and carers in suggesting how the measures can be used in clinical practice. The project involved an audit by survey, followed by a range of interactive workshops designed to elicit the views of consumers, carers and clinicians, as well as to involve all parties in dialogue about ROM.

A descriptive interview with 64 patients discharged from an acute-psychiatric-inpatient service.

Background: Acute-mental-health services receive hundreds of admissions every year. Some of these patients will continue to be case-managed by community mental-health teams on discharge from the acute unit while others will not remain in contact with the mental-health service. This study compares the findings of comprehensive interviews conducted with current and past patients of the community mental-health service 3 or more years following case closure from the community ambulatory service.

The validity of the CGI severity and improvement scales as measures of clinical effectiveness suitable for routine clinical use.

Objective: The Clinical Global Impression Scale (CGI) is established as a core metric in psychiatric research. This study aims to test the validity of CGI as a clinical outcome measure suitable for routine use in a private inpatient setting.

Methods: The CGI was added to a standard battery of routine outcome measures in a private psychiatric hospital.

Consumer attitudes towards the use of routine outcome measures in a public mental health service: a consumer-driven study.

In this study conducted by consumer consultants, 50 consumers who have a Barwon Health case manager (the majority of whom were nurses) were interviewed using a structured questionnaire to ascertain their attitudes towards the routine use of outcome measures. Forty participants (80% of those interviewed) reported they had been offered the Behaviour and Symptom Identification Scale (BASIS-32) to complete in routine care by their case managers and of those, 95% (n = 38) completed it. On those who completed the BASIS-32, 42% said their case manager had explained what the BASIS-32 would be used for, 45% said that the case manager had discussed their responses with them, 76% stated that completing the BASIS-32 had helped the case manager to understand them better and 66% believed that completing the BASIS-32 had led to them receiving better care.

The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure.

Objective: This study aimed to test the validity of the 21-item Depression Anxiety Stress Scales (DASS-21) as a routine clinical outcome measure in the private in-patient setting. We hypothesized that it would be a suitable routine outcome instrument in this setting.

Method: All in-patients treated at a private psychiatric hospital over a period of 24 months were included in the study.

Monitoring the safe use of clozapine: a consensus view from Victoria, Australia.

Clozapine is an important antipsychotic agent that has a unique profile of clinical benefits, but that has also been associated with several serious and potentially life-threatening safety concerns. In order to minimise the impact of haematological adverse events, health professionals treating patients with clozapine are currently required to register their patients on a centrally administered data network and to conform to strict protocols. The consensus statement documented in this article extends existing protocols by recommending monitoring of patients treated with clozapine for additional adverse effects during treatment.

Routine outcome measurement in public mental health: results of a clinician survey.

This paper explores the attitudes of mental health workers in one public mental health service towards the implementation and use of routine outcome measurement. Two years after their introduction into routine clinical practice, there were equal numbers of positive and negative observations from clinicians about the clinical value of the clinician-rated outcome measures, while more positive observations were made about value of the consumer-rated outcome measure. The most frequent observation from clinicians in relation to making outcome measures more useful to them in clinical practice was that more training, particularly refresher training, is needed.

Providing integrated mental health services: a policy and management perspective.

Objective: To review the challenge of providing integrated mental health services from a policy and health management perspective.

Conclusions: The provision of integrated mental health services involving specialist mental health services, general practitioners, psychiatric disability and rehabilitation services and public community health services is a major challenge in the Australian health care context and is increasingly an expectation of the community. Government, Divisions of General Practice and public community health policy and many Government, State and local initiatives have attempted to address this challenge.

Using continuous quality improvement to implement a clinical governance framework in a mental health service.

Objectives: To outline the principles of continuous quality improvement that can be utilized to develop a clinical governance framework in a mental health service.

Conclusions: The term clinical governance is used to describe the framework through which health organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care. Implementing a clinical governance framework requires clear leadership, particularly clinical leadership, the development of structures and processes to facilitate communication and the development of systems for monitoring and evaluating services.

Interdisciplinary teamwork and leadership: issues for psychiatrists.

Objective: To review the constructs and applications of interdisciplinary teams in mental health services, with a particular view to ascertaining the most effective types of teams and their leadership.

Method: Some of the most challenging questions from a psychiatrist's viewpoint regarding the functions of interdisciplinary teams in the mental health service are addressed.

Results: The effectiveness of the interdisciplinary team in mental health services is supported by an extensive literature that is much more qualitative and descriptive than quantitative and empirically rigorous, except as part of packages of variables subjected to randomized controlled trials.

Organizational change management in mental health.

Objective: To discuss change management as applicable to mental health.

Conclusions: As mental health care grows increasingly complex, and the network of accountability widens, change is both inevitable and necessary. Strategies to introduce change effectively are essential.

Reflections on clinician leadership and management in mental health.

Objective: To review the role of clinician leadership in the management of mental health services.

Conclusions: The literature suggests that clinician leadership is increasingly regarded as an essential element in the effective introduction of innovation and improved quality of clinical care by those who manage mental health services. Psychiatrist leaders have a role to play in ensuring that service change and innovation is based on sound clinical values, is developed in partnership with clinicians and is understood and supported by psychiatrist colleagues.

Quality, risk management and governance in mental health: an overview.

Objective: To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health.

Conclusions: Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement.