Mental health diversion courts : some directions for further development

Recent years have seen a growth in the number of specialist courts operating in Australia, including those which aim to address the needs of mentally disordered offenders. This article describes some of the key characteristics of mental health courts, using case studies from the most established court in Australia, the South Australian Magistrates Court Diversion Program (MCDP). This is followed by a consideration of some factors that may affect the future development of this type of program. It is concluded that there is a need to pay careful attention to issues of risk assessment and risk management if the dual goals of improving both the health of individual and the safety of the community are to be realised.

Association between 5-HTTLPR genotypes and persisting patterns of anxiety and alcohol use : results from a 10-year longitudinal study of adolescent mental health

The serotonin transporter gene (5-HTT) encodes a transmembrane protein that plays an important role in regulating serotonergic neurotransmission and related aspects of mood and behaviour. The short allele of a 44 bp insertion/deletion polymorphism (S-allele) within the promoter region of the 5-HTT gene (5-HTTLPR) confers lower transcriptional activity relative to the long allele (L-allele) and may act to modify the risk of serotonin-mediated outcomes such as anxiety and substance use behaviours. The purpose of this study was to determine whether (or not) 5-HTTLPR genotypes moderate known associations between attachment style and adolescent anxiety and alcohol use outcomes. Participants were drawn from an eight-wave study of the mental and behavioural health of a cohort of young Australians followed from 14 to 24 years of age (Victorian Adolescent Health Cohort Study, 1992 - present). No association was observed within low-risk attachment settings. However, within risk settings for heightened anxiety (ie, insecurely attached young people), the odds of persisting ruminative anxiety (worry) decreased with each additional copy of the S-allele (B30% per allele: OR 0.77, 95% CI 0.62–0.97, P¼0.029). Within risk settings for binge drinking (ie, securely attached young people), the odds of reporting persisting high-dose alcohol consumption (bingeing) decreased with each additional copy of the S-allele (B35% per allele: OR 0.74, 95% CI 0.64–0.86, Po0.001). Our data suggest that the S-allele is likely to be important in psychosocial development, particularly in those settings that increase risk of anxiety and alcohol use problems.

Special interests and mental health in autism spectrum disorders

Special interests (SIs) in autism spectrum disorders are a prevalent though relatively under-researched phenomenon. There was partial support for the hypotheses and factors influencing the relationship between SIs and mental health were identified. Findings contribute to a better understanding of SIs including their importance for individuals with ASD.

Better access to mental health : mapping the evidence supporting participation in meaningful occupations

Introduction: The purpose of this scoping and mapping project is to assess evidence for the use of focused psychological strategies (FPS) under the Better Access to Mental Health (BAMH) scheme to enable people with mental health problems to increase their functional performance and to participate in meaningful occupations. In particular, it aims to provide an accessible summary of evidence for practitioners who use FPS with their clients.

Methods: Evidence scoping and mapping is a relatively new technique, used to provide an overview of key findings in an area of practice. A five stage process of scoping and mapping was used in this project.

Results: A total of 81 studies which addressed the use of focused psychological strategies to promote functional performance and participation in meaningful occupations were found. Surprisingly, only three were published in occupational therapy journals with one further article being authored by occupational therapists. Three maps are provided showing this evidence by diagnosis, intervention and level of evidence.

Conclusion: Clinicians can say with some confidence that cognitive behavioural therapies are effective functional tools, particularly when working with people with depression or schizophrenia. They can also be confident that good quality evidence exists across a range of diagnoses, although there are many gaps where little to no research has been conducted. Suggestions for further research are provided which take into account the findings of these maps.

Mental health-related risk factors for violence : using the evidence to guide mental health triage decision making

Mental health clinicians working in emergency crisis assessment teams or mental health triage roles are required to make rapid and accurate risk assessments. The assessment of violence risk at triage is particularly pertinent to the early identification and prevention of patient violence, and to enhancing the safety of clinical staff and the general public. To date, the evidence base for mental health triage violence risk assessment has been minimal. This study aimed to address this evidence gap by identifying best available evidence for mental health-related risk factors for patientinitiated violence.We conducted a systematic review based on the National Health and Medical Research Council of Australia’s methodology for systematic reviews. A total of 6847 studies were retrieved, of which 326 studies met the study inclusion criteria. Of these studies, 277 met inclusion criteria but failed the quality appraisal process, thus a total of 49 studies were included in the final review. The risk factors that achieved the highest evidence grading were predominantly related to dynamic clinical factors immediately observable in the patient’s general appearance, behaviour and speech. These factors included hostility/anger, agitation, thought disturbance, positive symptoms of schizophrenia, suspiciousness and irritability.

Preventing mental health problems in children : the families in mind population-based cluster randomised controlled trial.

Background

Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care).
Design

Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months. Participants: Families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care. Intervention: (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems. Analysis: Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective.
Discussion

This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed.

He did what? Well that wasn't handed over! Communicating risk in mental health

Mental health inpatient units are dynamic, complex environments that provide care for patients with heterogeneous ages, diagnoses and levels of acuity. These environments commonly expose clinicians and patients to many potential risks. Despite extensive research into risk assessment, prediction and management, no study has investigated how risk information is communicated at handover in acute mental health settings. Given the pivotal role handover plays in informing risk management, this evidence gap is significant. This paper reports on a study that investigated the practices of communicating risk at handover in an Australian acute mental health inpatient unit. The aim of this research was to identify the frequency and type of risk information communicated between nursing shifts, and the methods by which this communication was performed. A secondary aim was to identify effective and ineffective risk communication practices. This study involved an observational design method using a 14-item Clinical Audit Tool derived from handover principles outlined by World Health Organization. Five hundred occasions of patient handover were observed. Few risk information items were observed to be communicated in any method. Risk communication practice was inconsistent, and a key recommendation from the study is the use of standardized handover tools that ensures risk information is adequately reported.

Mental health telephone triage : managing psychiatric crisis and emergency

PURPOSE: The study aims to identify and articulate how mental health telephone triage (MHTT) clinicians manage psychiatric crisis and emergency via the telephone.

DESIGN AND METHODS: An observational design was employed in the study. Wireless headsets were used to observe 197 occasions of MHTT.

FINDINGS: Clinicians use a range of practical strategies, therapeutic skills, and psychosocial interventions to manage psychiatric crises and emergencies via the telephone.

PRACTICE IMPLICATIONS: The evidence base for managing psychiatric crisis/ emergency in MHTT is minimal. These findings contribute to the MHTT knowledge base and provide evidence-based strategies for high-quality emergency mental health care.