Murray Wright

Staffing and funding of consultationliaison psychiatry services in Australia and New Zealand

The aim of the study was to establish the current and desired levels of staffing and funding of the 52 consultation-liaison (C-L) psychiatry training units in Australian and New Zealand general hospitals. Administration of a questionnaire and follow-up verification provided data on referral rates, existing and preferred staffing levels, and staff workloads. The referral rates and staffing levels in most cases fall below those quoted for Europe and the USA, and those considered optimal by the respondents. This, together with the large variation in referral rates and workload, has implications for the type of clinical activity conducted and quality of the training experience in different units.

Improving the mental health of drought-affected communities: an Australian model.

Abstract In recent years there has been increasing recognition of the social impact of drought on rural communities. This paper provides an overview of a major mental health program developed in response to persistent severe drought and longer-term social and economic restructuring in New SouthWales agriculture. Led by government and incorporating close collaboration with rural community agencies and services, the program’s design and implementation was informed by existing evidence regarding mental health promotion, illness prevention, early intervention models, disaster management and a series of core project principles and goals based on community development practice. Improvements in mental health literacy and service collaboration and coordination suggest lessons learnt from the program will have applicability to future projects that aim to address mental health needs and promote the capacity of rural communities to adapt to the continuing impacts of future droughts and longer-term climate change.

The development of a patient satisfaction measure for psychiatric outpatients

Objective: To describe the first stage of development of a patient satisfaction form designed for psychiatric outpatients. Method: An initial 62-item questionnaire was completed by 172 patients, who were asked to assess the importance of a number of practice and practitioner features in contributing to their satisfaction. Results: Mean scores prioritised the psychiatrist respecting the rights of the patient; appointment and billing arrangements were of intermediate importance, while amenity issues were rated as unimportant. When rankings across the several practices were examined, very high levels of agreement were demonstrated, supporting the likely validity of the overall rankings. Four underlying domains were identified by factor analysis, the principal one being defined by respect for confidentiality, by support and adequate communication. The three remaining factors were contributed to more by practice (e.g. billing arrangements, amenities) than by practitioner features. Conclusion: We consider how a refined and modified version of the measure might be developed for use by both individual practitioners and group practices, as well as being used as a formal QA component activity.

To whom do you refer? A referrer satisfaction study

Objective: To report the development of a referrer satisfaction measure. Method: Urban and rural general practitioners, physicians, neurologists, as well as obstetricians and gynaecologists rated 36 items in terms of their judged importance to the respondents satisfaction with a psychiatric service. Responses of the whole sample and component practitioner sub-groups were ranked. Results: We established a high level of agreement across the several subgroups suggesting that we had identified general rather than idiosyncratic variables contributing to referrer satisfaction. Referrers prioritised as most important the immediacy of initial appointment, the psychiatrist reporting at the beginning and end of any treatment course, and ready verbal communication between the referrer and the psychiatrist. Items accorded low priority were the psychiatrists billing arrangements, the psychiatrist being ‘perfect’ (in either having a high ‘cure’ rate or making a definitive diagnosis initially), or the psychiatrist taking complete responsibility for difficult patients. A principal components analysis identified four factors underpinning the item set, and we again established that scores on these factors were not influenced by the particular referrer sub-group. Conclusions: Such findings suggest that only minor modifications would need to be made to the item set in developing a referrer satisfaction measure for quality assurance activities.

Current approaches to enhancing non-metropolitan psychiatrist services

The unequal distribution of psychiatrists between urban and rural areas in Australia and New Zealand is a longstanding and significant service delivery challenge. This article describes some of the current and proposed approaches to the provision of psychiatric expertise outside metropolitan areas in New South Wales, and argues for the improved utilisation of non-resident psychiatrists and technological innovation where resident psychiatrists cannot be recruited or retained.

Structural Characteristics of Australasian Psychiatric Practice

A questionnaire examining structural and basic process characteristics of psychiatric practice was prepared by the RANZCP Quality Assurance Committee and circulated to all Fellows of the College in 1991. There were 830 replies (48%). A one in two sample of the replies was analysed and forms the basis of the descriptive report presented in this paper.

An Exploration of the Quality of Peer Review Group Activities within Australasia

Objective: To describe a two-phase study of the structure of Australasian psychiatrist peer review groups. Method (Phase one): Initially, information was sought from chairskoordinators of psychiatrist peer review groups regarding the nature and organisation of their group. Results (Phase one): One hundred and three questionnaires were returned describing a number of models of peer review. Three principal models were identified: a teaching hospital model, a private practice model, and a private institution model. Method (Phase two): The second-phase questionnaire sought information on the quality of the review, using six proposed standards developed by the Quality Assurance Committee of the Royal Australian and New Zealand College of Psychiatrists. Results (Phase two): Many groups indicated that four of the proposed standards (those relating to documentation, having clear goals, reviewing actual clinical cases, and rigorous protection of confidentiality) were either already being followed or would be relatively easy to implement. The remaining two proposed standards (including structure, process and outcome dimensions of health care in the case discussion, and the use of explicit criteria) presented more difficulty. Conclusion: The application of such standards to peer review group meetings should assist groups to provide a forum for presentation and evaluation of clinical work where participants know they will be challenged in an environment which is both supportive and educational.

Measuring the distribution of the length of stay in acute psychiatric units

Objective: To examine the distribution of length of stay (LOS) in acute psychiatric units. Method: Analysis of one year of LOS data from twelve acute psychiatric units in New South Wales, Australia. Main findings: LOS had a complex distribution, with a ‘head’ of discharges within a day, a ‘body’ of discharges that approximated an exponential distribution and a ‘tail’ made up of a small group of patients discharged after very long admissions. There were substantial differences between units in the proportions of discharges classified as being in the head and the tail of the LOS distribution. With regards to the traditional measures of central tendency, the median LOS was affected by the proportion of patients discharged within a day, and the mean LOS was strongly influenced by small numbers of very long stay patients. Conclusions: A graphic representation of logarithmically transformed LOS values might assist in understanding the LOS of individual acute psychiatric units. A modified median LOS, calculated after the removal of patients staying less than a day, was found to be a simple and reliable measure that can potentially provide a more meaningful measure of LOS than the mean or the median LOS.

Clinical Practice Issues in Consultation-Liaison Psychiatry:

Objective: To overview and highlight the issues currently challenging and confronting consultation-liaison (C-L) psychiatry and to present them for discussion in a wider forum. Method: Following preliminary discussions, the authors (members of the New South Wales C-L Interest Group) undertook to selectively review a number of issues relevant to C-L psychiatry. A preliminary paper was prepared and then presented to the membership of the interest group. Feedback from this meeting was incorporated into the final version of the paper. Results: Issues selected as a nidus for further discussion include economic issues, changing models of C–L practice, service issues as well as ethical issues. In addition, recognition of C–L psychiatry as a true subspeciality is foreshadowed. Conclusion: This paper highlights some of the challenges for C–L psychiatry both now and in the future. Intuitive beliefs in our efficacy will not suffice in this era of economic rationalisation. Disciplined and focused research substantiating our value is imperative. Subspecialty recognition is likely to ensure uniformity of standards as well as providing the structure and direction required to consolidate C–L psychiatrys future.

Practice visits: a pilot study

Objective: The aim of the paper is to report a pilot study of practice visits. Method: The study involved 35 psychiatrists as hosts and/or visitors, as well as four non-psychiatrist visitors, with the model and subsequent design changes described. Results: The Quality Assurance Committees rationale for practice visits is detailed, together with several focal concerns raised by committee members and other Fellows of the College. Conclusions: Feedback was highly positive, with visitors being generally more positive and enthusiastic than hosts. A follow-up questionnaire indicated ongoing enthusiasm for such an activity and provided evidence of participants making changes to their practices. Identified concerns and some suggested modifications to the pilot study design are noted.