Kerry Dawes

Updating medical school psychiatry curricula to meet projected mental health needs

Objective: In view of the growing disease burden of mental disorders, we consider the pressing need to update medical school psychiatry education to better equip doctors to recognise and treat these conditions. Key challenges to the delivery of medical school mental health curricula, and possible directions for reform, are reviewed with the aims of stimulating collaboration and enhancing the efficiency across schools. Conclusions: In Australia, medical school expansion provides opportunities to prepare many training doctors to meet growing mental health care needs. Despite this, published reviews of practice and curriculum models are notably lacking. Australia, unlike other countries, has yet to agree on a core curriculum in medical school psychiatry, with practices varying widely between schools. Curricula should equip doctors to better recognise and treat common mental disorders during early stages, as well as preparing some for specialist psychiatry training. High-quality, multidisciplinary teaching in varied clinical settings may boost teaching resources. Additionally, medical education provides opportunities to better equip doctors to take care of their own mental health. Key challenges are to achieve a consensus on core curricula across Australian medical schools, and an appropriate proportion of medical school curriculum time for mental disorders, relative to their complexity and large disease burden.

It's time to examine the status of our undergraduate mental health curricula

To the Editor: Review of undergraduate mental health education is timely, given the growing disease burden of mental disorders and the need to better equip doctors for their central role in treatment. Curricula should prepare all doctors with competencies in recognising and treating mental health problems,1 because these occur frequently in patients across all branches of medicine, leading to poorer outcomes.2 Curricula should also prepare a minority of doctors for specialist psychiatry training.

The relationship between environment and mental health: how does geographic information systems (GIS) help?

The role of physical and social environment on mental health cannot be ignored. While this relationship is adequately explored in mental health research, analysing and assimilating them in mental health planning still remains a road less travelled. Computer-based mapping technology called geographic information systems (GIS) has presented mental health researchers with many new possibilities in this direction. GIS-based spatial mapping and analysis can provide a better insight into illness patterns, causes, interactions and service needs. This can in turn help in evaluating interventions and guide evidence-based health care policies. The aim of this letter is to inform us of the opportunities and usefulness of GIS in mental health research, planning and delivery.

The clinical assessment of impulsivity

The term impulsivity is often used to describe behavior that is both spontaneous and detrimental. Impulsivity is multidimensional and derives from personality, general psychopathology as well as specific mental disorders. Thus, the construct of impulsivity is important as it is associated with numerous mental disorders as well as socially deviant behaviors ranging from behaviors targeted towards others such as aggression, to behaviors targeted toward oneself, for example, self-harm and suicide. As a clinical construct impulsivity is highly predictive of poor prognosis thus further emphasizing its clinical relevance. Therefore, the need exists for impulsivity to be clinically assessed and this assessment should take place at the same time as the assessment of risk. As risk and impulsivity are interrelated and interact. Although there are existing self-report rating scales for trait-based impulsivity, a dearth exists in regards to assessment of impulsivity in clinical practice that is focused and pragmatic. Thus, a pragmatic rubric to guide the individualized assessment of impulsivity in a clinical population is proposed. The quadrants espoused will assist both with the formulation of questions and categorization of responses to determine the most appropriate interventions for the client.

A qualitative analysis of medical students' concerns and perceptions of their safety on mental health clinical placements

Background: Problem drinking is a worldwide concern and is often a comorbid health problem for psychiatric illness. With the rising trend in e-mental health interventions, the advancement of smartphone technology has ushered in an era where smartphone applications can be used for behavioural intervention in problem drinking. Objectives: The aim of the study is to contribute towards the development of a novel smartphone application for use with problem drinkers based on behavioural modification principles. Methods: Seven postgraduate students in the School of Health Professions at Murdoch University were interviewed about the use of a novel smartphone application for behavioural intervention with problem drinking and the interview transcripts were subjected to thematic analysis. Findings: Themes that emerged include: accessibility, milestones and commitment. Conclusions: These findings shed light on the development of a novel e-mental health intervention for problem drinking. The implications for clients from diverse cultures and various age groups are discussed.Background: The last 10 years has seen considerable progress in relation to seclusion data development and reduction initiatives in Australia. Part of the success has been the use of a standardized definition and national collection of data for benchmarking and quality improvement. The National Seclusion and Restraint Reduction Project has encouraged services and individuals to reconsider their practices, and there has been a flurry of activity at local, state and national levels. Objectives: This paper describes that journey presents data from the national collection and looks at the future intentions of the Project. Findings: The acute mental health units have progressively reduced their use of seclusion in the last 6 years from 13.8 episodes per 1000 bed days in 2009–2010 to 8.0 in 2013–2014. Despite this, an average of 5% of people admitted to specialized services still experience an episode of seclusion, and there are considerable variations across sites and age ranges. There have also been some remarkable successes, particularly when consumers have been actively involved in the response. Conclusions: The call for ‘recovery’ challenges us to think about many other forms of restrictive practice. We are at various stages in the development of national measures of physical and mechanical restraints, continuing involuntary treatment and acute injectable medications. As seclusion once was, much of this has been considered necessary for safety or to get a good outcome. Is this true and what does the future hold?

Does clinical placement location affect medical student exam performance in psychiatry

Background: Natural disasters affect the health and wellbeing of adults throughout the world. There is some debate in the literature as to whether older persons have increased risk of mental health outcomes after exposure to natural disasters when compared to younger adults. To date, no systematic review has evaluated this. Objectives: We aimed to synthesise the available evidence on the impact of natural disasters on the mental health and psychological distress experienced by older adults. Methods: A meta-analysis was conducted on papers identified through a systematic review. The primary outcomes measured were post-traumatic stress disorder (PTSD), depression, anxiety disorders, and adjustment disorder. Findings: We identified six papers with sufficient data for a random effects meta-analysis. Older adults were 2.11 times more likely to experience PTSD symptoms when exposed to natural disasters when compared to younger adults. Conclusions: Recent decades have seen a global rise in the numbers of older adults affected by natural disasters, implying that an increasing number of the older adults will find themselves “in harm’s way” amid community disruption and distress. Mental health service providers need to be prepared to meet the mental health needs of older persons, and be particularly vigilant after natural disasters to ensure, in particular, early detection and management of PTSD.Abstract of a poster presentation at the RANZCP 2015 Congress, Brisbane, Australia, 3-7 May 2015. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Dawes, K., Lethbridge, A. & Pai, N. (2015). Does clinical placement location affect medical student exam performance in psychiatry?. Australian and New Zealand Journal of Psychiatry, 49 (Suppl. 1), 107-108. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/2780 Poster Presentations RANZCP 2015 CONGRESs, Brisbane Convention and Exhibition Centre, 3–7 May 2015 Does Clinical Placement Location Affect Medical Student Exam Performance in Psychiatry? K Dawes, A Lethbridge, N Pai University of Wollongong, Wollongong, Australia Background: One of the many challenges in managing student clinical placements is trying to ensure equity of opportunity and experience in regards to meeting the curriculum objectives. Students often complain that they have been disadvantaged by their clinical placement due to variations in patient population and acuity, the availability of consultants, registrars and other health care staff to guide learning, and the presence of other students from all disciplines who compete for opportunities. Objectives: To identify if there is a relationship between psychiatry placement location in the Illawarra Shoalhaven Local Health District (ISLHD) and end of year psychiatry exam results for medical students from the University of Wollongong. Methods: We compared psychiatry oral and written exam results for six cohorts of students, from 2009 to 2014, across four different placement locations in the ISLHD (N = 450) using one-way multivariate analysis of variance. Findings: The multivariate effect of placement location was not significant (Pillai’s Trace = .013, F(6,892) = .994, p = .428). Univariate ANOVAs on the individual outcome variables were also non-significant (written exam scores, F(3, 446) = 1.373, p = .250; oral exam scores F(3,446) = .789, p = .501). Conclusions: Maintaining the quality and consistency of clinical placements will always be a challenge due to limited and varied opportunities, student numbers, and the dynamic nature of both the workforce and the patient populations. However, based on our findings, within our region there is no difference in placement location in regards to end of year psychiatry exam results.Background Australia and New Zealand both have mandated systems for routine outcome measurement within public mental health services. A comprehensive 2014 review of the Australian system highlighted both support for routine outcome measurement and a need to spread good practice in the use of the mandated measures in practice. At the same time, the mandated measures are under evaluation in Australia for inclusion within activity based funding processes. The RANZCP has completed two online modules to assist trainees in improving their knowledge and skills in this important area of practice.

Family and carer mental health program: reflections on gaps in educational needs (poster)

Abstract of paper that presented at the Australian College of Mental Health Nursing 39th International Mental Health Nursing Conference, 22-24 October, 2013, Perth, Australia.Climate change is causing more frequent and severe adverse weather events that impact large numbers of people and leave a path of destruction leading to long-term consequences. Psychosocial distress including symptoms such as anxiety, sleep disruption, recurring intrusive thoughts of the events and mood changes may affect survivors even though they may not have experienced any form of physical harm (Simpson et al., 2011). The link between extreme weather events such as floods, cyclones and hurricanes resulting from climate change, and psychosocial distress is well established (Friedman & McEwen, 2004; Reser et al., 2011; Sattler et al. 1995; Sattler et al., 2002; Salcioglu et al., 2007; Simpson et al., 2011). Tropical cyclone (TC) Yasi struck North Queensland on Thursday February 3, 2011 between midnight and 1am and made landfall on the southern tropical coast near Mission Beach. The cyclone wreaked havoc across the region; never before has a cyclone of that intensity crossed the coast of North Queensland. A survey of community members, undertaken with assistance from local community organisations, collected data using an electronic and paper based questionnaire. The results indicate those with signs of psychosocial distress were more likely to be older (60.6%) and reside in the area worst affected by the cyclone, were more likely to have been without essential services for an extended period of time, more likely to have inadequate levels of insurance, and more likely to have had experienced moderate or major loss of sentimental possessions, money for living expenses and personal transportation. Community support is one of the major factors in community resilience. Therefore, working with the community to help members better understand the level of current distress is important for the development of response interventions. Feedback to the community thus formed a pivotal component of the study.engage or disengage from the early intervention service. OUTCOMES AND PRACTICE CHANGE Clinicians can have an increased awareness of what influences levels of engagement and this will allow for appropriate changes to be made to individual practice and services in order to enhance engagement for this population. LEARNING OBJECTIVES 1. To understand the impact of disengagement from early intervention services. 2. To hear young people’s stories of engagement and reflect on one’s own clinical engagement with consumers. 3. To understand the factors influencing engagement or disengagement from community mental health teams.

Solution based teaching methods in a problem based curriculum: the role of a mental health nurse in addressing the challenges of curriculum delivery in a regional medical school

Abstract of paper that presented at the Australian College of Mental Health Nursing 39th International Mental Health Nursing Conference, 22-24 October, 2013, Perth, Australia.Climate change is causing more frequent and severe adverse weather events that impact large numbers of people and leave a path of destruction leading to long-term consequences. Psychosocial distress including symptoms such as anxiety, sleep disruption, recurring intrusive thoughts of the events and mood changes may affect survivors even though they may not have experienced any form of physical harm (Simpson et al., 2011). The link between extreme weather events such as floods, cyclones and hurricanes resulting from climate change, and psychosocial distress is well established (Friedman & McEwen, 2004; Reser et al., 2011; Sattler et al. 1995; Sattler et al., 2002; Salcioglu et al., 2007; Simpson et al., 2011). Tropical cyclone (TC) Yasi struck North Queensland on Thursday February 3, 2011 between midnight and 1am and made landfall on the southern tropical coast near Mission Beach. The cyclone wreaked havoc across the region; never before has a cyclone of that intensity crossed the coast of North Queensland. A survey of community members, undertaken with assistance from local community organisations, collected data using an electronic and paper based questionnaire. The results indicate those with signs of psychosocial distress were more likely to be older (60.6%) and reside in the area worst affected by the cyclone, were more likely to have been without essential services for an extended period of time, more likely to have inadequate levels of insurance, and more likely to have had experienced moderate or major loss of sentimental possessions, money for living expenses and personal transportation. Community support is one of the major factors in community resilience. Therefore, working with the community to help members better understand the level of current distress is important for the development of response interventions. Feedback to the community thus formed a pivotal component of the study.engage or disengage from the early intervention service. OUTCOMES AND PRACTICE CHANGE Clinicians can have an increased awareness of what influences levels of engagement and this will allow for appropriate changes to be made to individual practice and services in order to enhance engagement for this population. LEARNING OBJECTIVES 1. To understand the impact of disengagement from early intervention services. 2. To hear young people’s stories of engagement and reflect on one’s own clinical engagement with consumers. 3. To understand the factors influencing engagement or disengagement from community mental health teams.