Enhancing peer support

A useful way to enhance peer support among young people is to provide peer counsellor training programmes. Research has shown, however, that there are problems associated with typical peer counselling programmes for young people. Most rely on teaching young people counselling skills that are commonly used by professional counsellors when counselling adults and these are not compatible with typical conversation behaviours used by young people. Another problem is that they suggest some commonly used communication processes evident in the conversations of young people are unhelpful, whereas research has shown that this is not the case (Geldard, 2006). In order to overcome these problems, a peer counsellor training programme has been developed for young people as an outcome of research into training young people as peer counsellors (Geldard, 2006).

Listening, sharing understanding and facilitating consumer, family and community empowerment through a priority driven partnership in Far North Queensland

Objectives: This paper provides an example of a mental health research partnership underpinned by empowerment principles that seeks to foster strength among community organizations to support better outcomes for consumers, families and communities. It aims to raise awareness among researchers and service providers that empowerment approaches to assist communities to address mental health problems are not too difficult to be practical but require long-term commitment and appropriate support. Methods: A collaborative research strategy that has become known as the Priority Driven Research (PDR) Partnership emerged through literature review,consultations, Family Wellbeing Program delivery with community groups and activities in two discrete Indigenous communities. Progress to date on three of the four components of the strategy is described. Results: The following key needs were identified in a pilot study and are now being addressed in a research-based implementation phase: (i) gaining two-way understanding of perspectives on mental health and promoting universal awareness; (ii) supporting the empowerment of carers, families, consumers and at-risk groups through existing community organizations to gain greater understanding and control of their situation; (iii) developing pathways of care at the primary health centre level to enable support of social and emotional wellbeing as well as more integrated mental health care; (iv) accessing data to enable an ongoing process of analysis/sharing/planning and monitoring to inform future activity. Conclusion: One of the key learnings to emerge in this project so far is that empowerment through partnership becomes possible when there is a concerted effort to strengthen grassroots community organizations. These include social health teams and men’s and women’s groups that can engage local people in an action orientation. Key words: Aboriginal, empowerment, Indigenous, mental health.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.

The ADHD debate and the philosophy of truth

There is ongoing and wide-ranging dispute over the proliferation of childhood behaviour disorders. In particular, the veracity of the category Attention Deficit Hyperactivity Disorder (ADHD), has been the subject of considerable scepticism. With no end to the debate in sight, it will be argued here that the problem might effectively be approached, not by addressing the specific features of ADHD itself, but rather by a philosophical analysis of one of the terms around which this entire problem revolves: that is, the notion of truth. If we state: “It is true that ADHD is a real disorder”, what exactly do we mean? Do we mean that it is an objective fact of nature? Do we mean that it fits seamlessly with other sets of ideas and explanations? Or do we simply mean that it works as an idea in a practical sense? This paper will examine the relationship between some of the dominant models of truth, and the assertions made by those in the field of ADHD. Specifically, the paper will contrast the claim that ADHD is a real disorder, with the claim that ADHD is a product of social governance. The intention is, first, to place some significant qualifications upon the validity of the truth-claims made by ADHD advocates, and second, to re-emphasise the potential and promise of philosophical investigation in providing productive new ways of thinking about some obstinate and seemingly intractable educational problems.

Maternal anxiety and attention problems in children at 5 and 14 years

Objective: This study examines the association between maternal anxiety from pregnancy to 5 years and child attention problems at 5 and 14 years. Method: Birth cohort of 3,982 individuals born in Brisbane between 1981 and 1983 are assessed. Self-reported measures of maternal anxiety are assessed at four time points. Maternal reports of child attention problems using Achenbach’s Child Behavior Checklist are assessed at 5 and 14 years. Results: Children of mothers experiencing anxiety during or after pregnancy are at greater risk of experiencing attention problems at 5 and 14 years. After adjusting for maternal age and child’s gender, antenatal anxiety is strongly associated with persistent attention problems (OR = 3.65, 95% CI = 2.19, 6.07). Children with chronically anxious mothers are 5.67 (95% CI = 3.56, 9.03) times more likely to have persistent attention problems. These associations remain consistent after adjusting for potential confounders. Conclusions: Maternal anxiety appears to increase the rate of child attention problems and identifies a need for treatment programs to have a dual focus—the mother and her child. (J. of Att. Dis. 2009; XX(X) 1-XX)

Fast searching algorithm for candidate satellite-node set in NLMG

The Node-based Local Mesh Generation (NLMG) algorithm, which is free of mesh inconsistency, is one of core algorithms in the Node-based Local Finite Element Method (NLFEM) to achieve the seamless link between mesh generation and stiffness matrix calculation, and the seamless link helps to improve the parallel efficiency of FEM. Furthermore, the key to ensure the efficiency and reliability of NLMG is to determine the candidate satellite-node set of a central node quickly and accurately. This paper develops a Fast Local Search Method based on Uniform Bucket (FLSMUB) and a Fast Local Search Method based on Multilayer Bucket (FLSMMB), and applies them successfully to the decisive problems, i.e. presenting the candidate satellite-node set of any central node in NLMG algorithm. Using FLSMUB or FLSMMB, the NLMG algorithm becomes a practical tool to reduce the parallel computation cost of FEM. Parallel numerical experiments validate that either FLSMUB or FLSMMB is fast, reliable and efficient for their suitable problems and that they are especially effective for computing the large-scale parallel problems.

Social innovation to solve homelessness : wicked solutions for wicked problems

Homelessness is a complex problem that manifests in all societies. This intractable and ‘wicked’ issue resists single-agency solutions and its resolution and requires a large, on-going investment of financial and professional resources that few organisations can sustain. This paper adopts a social innovation framework to examine government and community sector responses to homelessness. While recent evaluations and policy prescriptions have suggested better integrated and more co-ordinated service delivery models for addressing homelessness, there is little understanding of the innovation framework in which alternative service system paradigms emerge. A framework that identifies/distils and explains different innovation levels is put forward. The framework highlights that while government may lead strategic level innovations, community organisations are active in developing innovation at the service and client level. Moreover, community organisations may be unaware of the innovative capacity that resides in their creative responses to resolving social crisis and marginalisation through being without shelter.

Schizophrenia : an overview and practical handbook

Schizophrenia is a serious mental disorder currently undergoing a renaissance of scientific interest. This book summarizes current knowledge and details some of the recent developments. Divided into three sections, it presents an overview of the disorder, including its features, social impact and aetiology; reviews methods of assessing the symptoms and disabilities of schizophrenia and examining the sufferer's social environment; and discusses a range of interventions, from pharmacological treatment to skill training for individuals and families. Issues that arise in planning services for sufferers and their families are also reviewed. All of the chapters focus on clinical practice and many include guides to assessment and practice. This handbook should be particularly useful in training health professionals in psychiatric/mental health services and general practice. It also aims to offer practitioners and researchers a comprehensive update on schizophrenia that is both easy to read and practical in its focus.

Developing a quick and practical screen to improve the identification of poor hydration in geriatric and rehabilitative care

Dehydration has been associated with increased morbidity and mortality. Dehydration risk increases with advancing age, and will progressively become an issue as the aging population increases. Worldwide, those aged 60 years and over are the fastest growing segment of the population. The study aimed to develop a clinically practical means to identify dehydration amongst older people in the clinical care setting. Older people aged 60 years or over admitted to the Geriatric and Rehabilitation Unit (GARU) of two tertiary teaching hospitals were eligible for participation in the study. Ninety potential screening questions and 38 clinical parameters were initially tested on a single sample (n=33) with the most promising 11 parameters selected to undergo further testing in an independent group (n=86). Of the almost 130 variables explored, tongue dryness was most strongly associated with poor hydration status, demonstrating 64% sensitivity and 62% specificity within the study participants. The result was not confounded by age, gender or body mass index. With minimal training, inter-rater repeatability was over 90%. This study identified tongue dryness as a potentially practical tool to identify dehydration risk amongst older people in the clinical care setting. Further studies to validate the potential screen in larger and varied populations of older people are required

Randomized controlled trial of cognitive-behavioural therapy for coexisting depression and alcohol problems : short-term outcome

AIMS: Alcohol use disorders and depression co-occur frequently and are associated with poorer outcomes than when either condition occurs alone. The present study (Depression and Alcohol Integrated and Single-focused Interventions; DAISI) aimed to compare the effectiveness of brief intervention, single-focused and integrated psychological interventions for treatment of coexisting depression and alcohol use problems. METHODS: Participants (n = 284) with current depressive symptoms and hazardous alcohol use were assessed and randomly allocated to one of four individually delivered interventions: (i) a brief intervention only (single 90-minute session) with an integrated focus on depression and alcohol, or followed by a further nine 1-hour sessions with (ii) an alcohol focus; (iii) a depression focus; or (iv) an integrated focus. Follow-up assessments occurred 18 weeks after baseline. RESULTS: Compared with the brief intervention, 10 sessions were associated with greater reductions in average drinks per week, average drinking days per week and maximum consumption on 1 day. No difference in duration of treatment was found for depression outcomes. Compared with single-focused interventions, integrated treatment was associated with a greater reduction in drinking days and level of depression. For men, the alcohol-focused rather than depression-focused intervention was associated with a greater reduction in average drinks per day and drinks per week and an increased level of general functioning. Women showed greater improvements on each of these variables when they received depression-focused rather than alcohol-focused treatment. CONCLUSIONS: Integrated treatment may be superior to single-focused treatment for coexisting depression and alcohol problems, at least in the short term. Gender differences between single-focused depression and alcohol treatments warrant further study.