I. Harry Minas

Pathways to the first contact with specialist mental health care

Objective: To examine the pathways to mental health care followed by patients presenting for the first time to community- and hospital-based services and the degree to which individual characteristics, cultural background, illness type, severity and service-related variables influence the time and pathways taken to reach care. Method: One hundred and forty-six consecutive Australian-born, Asian and Arabicspeaking patients making their first lifetime contact with mental health services in two area health regions were included. Symptom severity was assessed using the Health of the Nations Outcome Scales. Illness explanatory models, social support, English-language proficiency and acculturation were also assessed. Results: An average of three professional consultations were made prior to first contact with public mental health services. Family physicians occupied a pivotal role in the helpseeking pathway with 53% of patients consulting a general practitioner. The median time taken to reach specialist mental health services was 6 months, with significantly shorter time for patients with psychotic disorders. Individual variables such as gender, social support, ethnicity and English flency were not associated with delays in receiving public mental health care. Ethnicity was associated with lower utilization of allied health professionals. Conclusions: The data suggest that social and cultural factors influence the range of professionals consulted by those with a mental illness but do not delay their presentation to public mental health services.

A case study in the globalization of medical education: assisting overseas-born students at the University of Melbourne

Over the past decade there has been a remarkable increase in ethnic diversity among Australian medical students. This phenomenon has been driven by two forces: the disproportionate school-level academic success achieved by first-generation migrant and refugee-origin youth, and the rapid globalization of Australias tertiary education system, in a context where reduced government funding has accelerated the development of ‘academic capitalism’ (Slaughter & Leslie, 1997). This paper briefly examines each trend, prior to exploring select pedagogical implications of these changes for the University of Melbourne, the destination of choice by 2001 for 30% of all international students electing to study medicine in Australia. Two key questions are addressed: (1) What are the potential problems in delivering Western-style medical education to culturally and linguistically disparate groups?; (2) What model of international student support has been developed by the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne? The paper suggests the model may have potential relevance for other universities, in the context of the accelerating globalization of medical education.

Illness Behaviour as a Determinant of Referral to a Psychiatric Consultation/Liaison Service

Recognition of psychiatric disturbance and rate of referral to psychiatric units in general hospitals falls far short of the prevalence of psychiatric morbidity in such hospitals. This study has sought to determine whether particular patterns of “illness behaviour” contribute to the decision to refer. A group of patients referred to a psychiatric service was compared to a group of non-referred patients using the General Health Questionnaire (GHQ) as a general measure of morbidity, the Inventory to Diagnose Depression (IDD), the State-Trait Anxiety Inventory (STAI) and the Illness Behaviour Questionnaire (IBQ). The rate of referral to the service was 2.9%. The estimated prevalence of psychiatric morbidity was 30%. Referred patients scored more highly on all measures of morbidity (GHQ, IDD, STAI) and on the IBQ scale Affective Disturbance, and scored lower on the Denial Scale. Data are reported which suggest that patients with a strong somatic focus are less likely to be referred for psychiatric assessment despite the presence of significant psychiatric morbidity. The implications for health care delivery and identification of psychiatric morbidity are discussed.

Which employment interview skills best predict the employability of schizophrenic patients

To examine the effects of verbal and nonverbal interview microbehaviors and interview characteristics on employability, Simulated Employment Interviews were conducted with 46 psychiatric inpatients who each met the DSM-III criteria for a diagnosis of schizophrenia. Each interview was videotaped and shown to two raters, who generated independent ratings for six microbehaviors (eye-contact, facial gestures, body posture, verbal content, voice volume, and length of speech) and six subject characteristics (motivation, self-confidence, ability to communicate, manifest adjustment, manifest intelligence and overall interview skill). A panel of three Commonwealth Employment Service psychologists viewed the same videotaped interviews and generated employability ratings. Verbal and nonverbal microbehaviors were relatively independent while subject characteristics were highly interdependent. Microbehaviors and characteristics correlated at a high level. Of the 12 interview microbehaviors and characteristics, manifest adjustment and ability to communicate accounted for 64% of the total variance in predicting employability. Interviewees who were perceived as behaving in an adjusted manner and as being good communicators were rated as more employable.

ARE EMPLOYMENT-INTERVIEW SKILLS A CORRELATE OF SUBTYPES OF SCHIZOPHRENIA?

46 inpatients with a DSM-III diagnosis of schizophrenia were assessed in the week prior to discharge from hospital on measures of positive and negative symptoms and on 12 measures of employment interview skills (i.e., eye contact, facial gestures, body posture, verbal content, voice volume, length of speech, motivation, self-confidence, ability to communicate, manifest adjustment, manifest intelligence, over-all interview skill), and a global measure of employability. A cluster analysis based on the total positive and negative symptom scores produced two groups. The group with the lower mean negative symptom score exhibited better employment-interview skills and higher ratings on employability.

Mental health research, ethics and multiculturalism.

AbstractIn this paper we examine ethical issues relevant to conducting mental health research with refugees and immigrant communities that have cultural orientations and social organisation that are substantially different to those of the broader Australian community, and we relate these issues to NH&MRC Guidelines. We describe the development and conduct of a mental health research project carried out recently in Melbourne with the Somali community, focusing on ethical principles involved, and relating these to the NH&MRC National Statement on Ethical Conduct in Research Involving Humans, and the NH&MRC document Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research.The experience of conducting mental health research with the Somali community highlights the fact that the principles of inclusion and benefit enunciated in the NH&MRC document Values and Ethics are particularly pertinent when conducting research with refugees and immigrant communities that are culturally distant to those of the broader Australian community. These principles inform issues of research design and consent, as well as guiding respectful engagement with the participating community and communication of the research findings.

Brief functional English proficiency measure for health survey research

Through three studies we develop a brief measure of functional English proficiency intended for use in health survey research and particularly with older adults. The samples involved in these studies included adults aged 18 to 93 years whose language of origin was Turkish (n = 497, 53% women); Macedonian (n = 209, 49% women); Spanish (n = 205, 68% women); Italian (n = 212, 52% women); Turkish (n = 201, 51% women), and Greek (n = 150, 53% women). The resulting instrument, comprising four items is a good brief measure of English proficiency, with capacity to discriminate between high and low levels of proficiency in all language groups.

Schizophrenia: An Overview

An overview of schizophrenia is presented. The epidemiology and clinical features of this common but serious psychiatric disorder are outlined. Four case vignettes illustrate different presentations and, to some extent, the varying course of the disorder. Diagnostic issues are discussed and the heterogeneity of the disorder highlighted. The major aetiological hypotheses are outlined, including evidence for genetic and biochemical involvement, the role of family, social and personality factors, psychological mechanisms and life events. A diathesis-stress view is presented, in which biological vulnerability and psychological and environmental factors are necessary for the development of the clinical disorder. Somatic and psychosocial treatments are briefly discussed as are the course, possible outcomes and factors affecting prognosis. Finally some future research directions in both the biological and psychosocial areas are considered.

Asia-Pacific Forum for International Mental Health Co-Operation

a high priority on the national social and economic development agendas of countries in the region. legislation, policies and strategic plans that are consistent with national culture and national priorities for social and economic development mental health, consistent with strategies developed by international organisations (e.g. World Health Organization, World Psychiatric Association).

Culture and psychiatric education

Our current training programs prepare graduates to work in a society that no longer exists and to work in ways that are no longer acceptable to those for whose benefit we work. One would think, by looking at our training programs, that there is a remarkable uniformity and consensus concerning what constitutes a life worth living and how such a life should be lived. One would also think that our ideas about health and illness, and what should be done in the presence of suffering, were universally applicable and uncontroversial. One would be justified in assuming that communication is not a problem worthy of much consideration. Further, it would seem, from what we choose to teach, that issues such as the politics of knowledge and of practice, privilege, and the distribution and proper use of power, were settled long ago. And finally, one would have to concede that psychiatry is essentially a technical discipline, no different really to any other occupation that requires some identifiable body of specialised knowledge and a range of technical skills, the application of which can repair dysfunctional brains or minds.1