Nick O’Connor

The Sydney Mental Health Client Mortality Audit: what does it tell us and what are we to do?

Objectives: To examine the characteristics of those mental health clients of an Australian metropolitan health service who died during a 6 year period, 2005 – 2010. Methods: The medical records, and where available, coronial post-mortem examinations were audited for 109 people with schizophrenia who died while they were clients of the mental health service. Results: The mean age of death for men was 45 years and for women, 47 years, compared to the general population’s male and female life expectancy of 79 and 84 years, respectively. About one-half of the deaths were due to suicide (n = 55), followed by natural causes (n = 42; 39%), undetermined causes (n = 7), and accidents or acts of violence (n = 5). Smoking rates, diagnosed diabetes and hypertension were higher in the group that died from natural causes. Morbid obesity (body mass index (BMI) > 35 kg/m2) rates were higher in the group that died of natural causes (38%), compared with the suicide group (5%). Conclusions: While suicide accounts for the majority of those dying prematurely in this study cohort, it appears that for those who survive the risk of suicide in the earlier period of a chronic psychotic illness, there is yet another threat to life expectancy: death from preventable cardiorespiratory disorders, due to a poor lifestyle and social deprivation.

Reflective accounts of psychiatry in Australasia, 1963–2000:

Objective: To provide reflective accounts of psychiatry through the first four decades of the existence of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Conclusions: The period from the 1960s to the end of the millennium saw significant changes in both the craft of psychiatry and the social and cultural context in which specialist training in psychiatry occurred.

Pharmacological management of acute severe behavioural disturbance: a survey of current protocols

Objectives: The investigators reviewed protocols for the pharmacological management of acute severe behavioural disturbance (ASBD) used in Australasian psychiatric settings. Relevant literature was also examined, with a focus on Australian research. Methods: All Fellows of the RANZCP were emailed on two occasions in 2014 requesting a copy of the guidelines for pharmacological management of the ASBD patient used in their workplace. A literature search was also undertaken. Results: Thirty-six pharmacological management protocols for the ASBD patient were received. Twenty-six of these referred to patients aged 18–65 years and were selected for analysis. A number of recent publications provided new evidence in relation to the safe and effective management of patients with ASBD. Conclusions: ASBD is a heterogeneous, transnosological set of presentations requiring careful assessment and rational clinical decision making. Treatment protocols arising from an evolving evidence base provide safe and effective pathways for the majority of patients. However, sound clinical knowledge and a careful assessment of each presentation is required to enable the clinician to tailor treatment individually.

A substantial peer-worker workforce in a psychiatric service will improve patient outcomes – the case against:

Objectives: The aim of this work was to examine, via narrative review, the evidence supporting the drive for more peer workers to gauge the likely impact on patient outcomes. Conclusions: Despite considerable research into the effectiveness of peer workers in clinical psychiatry, there is insufficient evidence to support the proposition that a substantial peer workforce would improve the outcomes of people living with mental illness.

Time to invest in developing community mental health services.

Objectives: To report on the evaluation of publicly funded community mental health services in two New South Wales health districts. Methods: Qualitative and quantitative data from 28 publicly funded adult community mental health teams in two NSW health districts were gathered using structured interviews, benchmarking surveys, focus groups and online questionnaires. Results: The community mental health services studied lacked a coherent strategic and recovery oriented framework or model of care for service delivery. There was evidence of poor role definition at the team level, resulting in duplication and inefficiency. There were inadequate staffing levels for stated objectives, a lack of training and continuing education in evidence based intervention, poor consumer and family participation in service design, and no development and monitoring of meaningful outcome measures. Conclusions: This review and benchmarking study highlights the need for mental health policy implementation to be further supported with: development of a service delivery framework outlining essential components of a specialist community mental health system; operational guidance to enable effective team specialisation in accordance with research; investment in practitioner training to support the development of evidence based practice; and processes to ensure effective consumer and carer participation in developing recovery oriented services.

Book review: Antipsychotic long-acting injectionsAntipsychotic long-acting injectionsHaddadPeterLambertTimLaurielloJohn, editors. 2011Oxford University Press. Oxford New York. ISBN: 9780199586042 Soft cover. AUD

This book is a must for every mental health service, training program, and any group private practice where long-acting injectable (LAI) antipsychotic medications are prescribed. The authors review the evidence for non-adherence and its impact on patient outcomes. A systematic review of medication nonadherence in schizophrenia found a mean rate of 41.2%.1 In a five year longitudinal study of 104 firstepisode patients, the cumulative first relapse rate was 82% and the second relapse rate was 78%.2 Clearly, non-adherence remains a major barrier to recovery and it would seem that many patients are not receiving sufficient information about LAIs as a sensible and effective treatment option.

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Objectives: This article explores the relevance of gossip and rumour to health organisations and presents what limited empirical research is available specific to the management of gossip and rumour in health organisations. Conclusion: The concept of a sentinel function for gossip and rumour in health organisations is proposed as a topic worthy of further research.

What's to be done when 'foul whisp rings are abroad'? Gossip and rumour in health organisations

Objectives: The study aimed to evaluate the attitudes of patients and staff in relation to the potential benefits and risks of allowing psychiatric inpatients controlled access to personal electronic devices (PEDs), and to document a snapshot audit of practice within the mental health inpatient units of New South Wales, Australia. Methods: Psychiatric inpatients and staff at Royal North Shore Hospital’s Mental Health inpatient units were surveyed, and an audit of the policies of the psychiatric inpatients of New South Wales was undertaken. Results: Access to PEDs is denied in 85% of New South Wales psychiatric inpatient units. While patients and staff appear to concur on the risks of access to PEDs and the need for risk assessment and rules, compared to patients, staff appear to underestimate the importance of PEDs to maintaining social connection and recovery. Conclusions: This study may assist in the formulation of local policy and procedure to allow a more recovery-oriented approach to the question of whether patients should have access to their PEDs while in hospital.

Use of personal electronic devices by psychiatric inpatients: benefits, risks and attitudes of patients and staff

Objectives: To determine the appropriateness and utility of the certificates issued under the New South Wales Mental Health Act (MHA) and compliance with the requirements of the MHA. The analysis also compares MHA documentation by different groups of health professionals and police. Methods: The MHA certificates associated with 100 consecutive involuntary Emergency Department presentations were audited. Results: Considerable variability exists between professional groups in the level of detail, appropriateness, clinical utility and compliance of MHA certificates. Over 10% of Schedule 1s failed to meet the requirements of the MHA, potentially invalidating the involuntary detention of these patients. Information provided by police was typically superior in informing initial risk assessment and emergency management. Conclusions: A number of patients are presently being detained under incomplete MHA certificates. Educational initiatives that aim to improve awareness of the MHA’s requirements, and the potential uses of the information contained in MHA certificates, could encourage professionals to complete these certificates in a more appropriate and clinically useful manner.

Quis custodiet ipsos custodes? An audit of records of involuntary detention

Objectives: To describe the background, method, findings and recommendations of the Royal Australian and New Zealand College of Psychiatrists Board evaluation. Conclusions: An evaluation of the Board in the first half of its initial term indicates that the Board and the new governance processes are developing well. There appears to be a healthy group dynamic and effective working relationships with the Chief Executive Officer and management. A number of priority areas emerged for the Board’s attention. The nature and low level of response from the wider membership indicate a low level of engagement in governance matters. It also seems that there are low levels of ‘governance literacy’ and that a different approach, perhaps facilitated focus groups, may be a more effective method for eliciting effective feedback on Board performance from the membership.