Public and private psychiatry: Can they work together and is it worth the effort?

Objective: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems. Method: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area. Results: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors. Conclusions: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

Routine measurement of outcomes in Australia's public sector mental health services

OBJECTIVE: This paper describes the Australian experience to date with a national 'roll out' of routine outcome measurement in public sector mental health services. METHODS: Consultations were held with 123 stakeholders representing a range of roles. RESULTS: Australia has made an impressive start to nationally implementing routine outcome measurement in mental health services, although it still has a long way to go. All States/Territories have established data collection systems, although some are more streamlined than others. Significant numbers of clinicians and managers have been trained in the use of routine outcome measures, and thought is now being given to ongoing training strategies. Outcome measurement is now occurring 'on the ground'; all States/Territories will be reporting data for 2003-04, and a number have been doing so for several years. Having said this, there is considerable variability regarding data coverage, completeness and compliance. Some States/Territories have gone to considerable lengths to 'embed' outcome measurement in day-to-day practice. To date, reporting of outcome data has largely been limited to reports profiling individual consumers and/or aggregate reports that focus on compliance and data quality issues, although a few States/Territories have begun to turn their attention to producing aggregate reports of consumers by clinician, team or service. CONCLUSION: Routine outcome measurement is possible if it is supported by a co-ordinated, strategic approach and strong leadership, and there is commitment from clinicians and managers. The Australian experience can provide lessons for other countries.

Association of public support for survival of wildlife species with their likeability

We surveyed 204 individuals from the general public in Brisbane, Australia, to ascertain the extent to which they liked or disliked 24 species of wildlife (belonging to three classes: mammals, birds and reptiles) present in tropical Australia. We calculated likeability indices for each species. We also asked respondents if they favored the survival of each of these species, and were able to calculate the percentage of respondents favoring survival of each. Using linear regression analysis, we could relate the percentage of respondents favoring survival of each of the species to their indices of likeability. In addition, we compared the mean likeability of species in the three classes (mammals, birds and reptiles) with the respondents' allocation of funds (hypothetical 1,000 Australian dollars) between conservation of species and a human charity. From this, we were able to assess how important stated likeability is for preferences to conserve species by animal class, and reconsidered the hypothesis in the literature that there is likely to be more public support for the survival of mammals than for birds, and more support for the survival of birds than for reptiles.

Attitude change and the public-private attitude distinction

In this paper, we highlight the importance of the distinction between public and private attitudes in research on attitude change. First, we clarify the definitions of public and private attitudes by locating the researcher as a potential source of influence. In a test of this definition, we compare participant reports of potentially embarrassing behaviour and the study's importance between participants responding when a researcher has potential access to their reports (public condition), and participants whose reports the researcher has no potential access to (private condition). Participants high in public self-focus or low in defensive self-presentation reported the study to be more important in the public condition than the private condition. Further, participants in the public condition reported less frequency of engaging in embarrassing behaviours than those in the private condition, an effect not moderated by individual differences. We conclude that the public-private distinction is an essential element in attitude change theory.

The evolution of the Global Burden of Disease framework for disease, injury and risk factor quantification: Developing the evidence base for national, regional and global public health action

Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries and risk factors are generally incomplete, fragmented and of uncertain reliability and comparability. Lack of a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and failure to systematically evaluate data quality have impeded comparative analyses of the true public health importance of various conditions and risk factors. As a consequence the impact of major conditions and hazards on population health has been poorly appreciated, often leading to a lack of public health investment. Global disease and risk factor quantification improved dramatically in the early 1990s with the completion of the first Global Burden of Disease Study. For the first time, the comparative importance of over 100 diseases and injuries, and ten major risk factors, for global and regional health status could be assessed using a common metric (Disability-Adjusted Life Years) which simultaneously accounted for both premature mortality and the prevalence, duration and severity of the non-fatal consequences of disease and injury. As a consequence, mental health conditions and injuries, for which non-fatal outcomes are of particular significance, were identified as being among the leading causes of disease/injury burden worldwide, with clear implications for policy, particularly prevention. A major achievement of the Study was the complete global descriptive epidemiology, including incidence, prevalence and mortality, by age, sex and Region, of over 100 diseases and injuries. National applications, further methodological research and an increase in data availability have led to improved national, regional and global estimates for 2000, but substantial uncertainty around the disease burden caused by major conditions, including, HIV, remains. The rapid implementation of cost-effective data collection systems in developing countries is a key priority if global public policy to promote health is to be more effectively informed.

Public opinion of a proposed wind farm situated close to a populated area in New Zealand: Results from a cross-sectional study

In accordance with New Zealand’s Resource Management Act 1991, in 2003, electricity generating company Genesis Energy made public its intention to apply for consent to build the Awhitu wind farm. Several community groups claiming to represent the majority opposed this application and in September 2004 consent was declined. The aim was to investigate the attitudes of local community members to the proposed wind farm. A survey was mailed to 500 Franklin residents, systematically selected from the local 2004/2005 telephone directory. Forty questionnaires were returned undelivered. Of the remaining 460, completed questionnaires were returned from 46% (211). Most, 70% (145), residents supported a wind farm being built in their area, with 17% (35) neutral, and only 13% (28) against the farm. There was no statistical difference in respondents’ attitudes between sex, age, or residential proximity to the farm. Respondents listed renewable resource (83%), suitability (78%), and environmental friendliness (76%) as main advantages. Visual unsightliness (24%) and noise pollution (21%) were listed as main perceived disadvantages. Contrary to the assertions of several lobby groups, the majority of local residents support the construction of the Awhitu wind farm. Scientifically robust methods are essential to measure appropriately community attitudes, particularly on contentious issues.

Health investment, saving, and public policy

This paper develops an overlapping-generations model in which agents invest in health to prolong life in both working and retirement periods. It explores how unfunded social security with or without health subsidies affects life expectancy, economic growth, and welfare. In particular, by extending life at a possible cost of capital accumulation, health subsidies and a pay-as-you-go pension can improve welfare, especially in the short run.

Do Australian public sector employees have the type of culture they want in the era of new public management?

New public management theory proposes that public sector organisations should be managed more like private sector organisations. It is therefore expected that public sector managers will have preferences for an organisational culture that will reflect the culture of private sector organisations, with an external rather than internal orientation. The current research investigated the idea that managers' perceptions of ideal organisational culture would be different to the bureaucratic model of culture (internally oriented), which has traditionally been associated with public sector organisations. Responses to a competing values culture inventory were received from 925 public sector employees. Results indicated that the bureaucratic model is still pervasive; however, managers prefer a culture that is more external, and less control focussed, as expected. Lower level employees expressed a desire for a culture that emphasised human relations values.