Cause and effect in studies on unemployment, mental health and suicide: a meta-analytic and conceptual review

Background There are ongoing questions about whether unemployment has causal effects on suicide as this relationship may be confounded by past experiences of mental illness. The present review quantified the effects of adjustment for mental health on the relationship between unemployment and suicide. Findings were used to develop and interpret likely causal models of unemployment, mental health and suicide. Method A random-effects meta-analysis was conducted on five population-based cohort studies where temporal relationships could be clearly ascertained. Results Results of the meta-analysis showed that unemployment was associated with a significantly higher relative risk (RR) of suicide before adjustment for prior mental health [RR 1.58, 95% confidence interval (CI) 1.33–1.83]. After controlling for mental health, the RR of suicide following unemployment was reduced by approximately 37% (RR 1.15, 95% CI 1.00–1.30). Greater exposure to unemployment was associated with higher RR of suicide, and the pooled RR was higher for males than for females. Conclusions Plausible interpretations of likely pathways between unemployment and suicide are complex and difficult to validate given the poor delineation of associations over time and analytic rationale for confounder adjustment evident in the revised literature. Future research would be strengthened by explicit articulation of temporal relationships and causal assumptions. This would be complemented by longitudinal study designs suitable to assess potential confounders, mediators and effect modifiers influencing the relationship between unemployment and suicide.

Outcome measurement of community based mental health services in Western Australia: literature and concept summary

The paper aims to provide a brief overview of key ideas related to outcome measurement relevant to community based mental health services and their consumers in WA. Due to the breadth of scope of the paper, it is not an extensive or rigorous literature review but provides a scan of the literature that could shape a more thorough literature review in any of the content areas. The paper has been written with the aim of informing the sector of key ideas, issues, concepts and approaches.

Consumer choices about mental health support services

 The implications of psychosocial disability being included in the National Disability Insurance Scheme (NDIS) are not yet fully understood. It is anticipated that approximately 57,000 people with continuous and enduring psychosocial disability across Australia will be eligible for support under Tier 3 of the NDIS. They will be able to make choices about the supports that are “reasonable and necessary” to meet their needs. While there is some work currently being undertaken to prepare staff in the sector for the change, until now there have been few projects focused on the implications of the NDIS from the perspective of people with psychosocial disability.
In response Mind Australia has funded an innovative research project that has sought to:
• provide the CMMHSS and other stakeholders with an understanding of support needs and preferences of people with psychosocial disability and the types of changes needed to develop more responsive services in the transition to NDIS.
• give people with psychosocial disability the opportunity to have a voice in stating their preferences for support.

Improving transfer of mental health care for rural and remote consumers in South Australia

In Australia, it is commonplace for tertiary mental health care to be provided in large regional centres or metropolitan cities. Rural and remote consumers must be transferred long distances, and this inevitably results in difficulties with the integration of their care between primary and tertiary settings. Because of the need to address these issues, and improve the transfer process, a research project was commissioned by a national government department to be conducted in South Australia. The aim of the project was to document the experiences of mental health consumers travelling from the country to the city for acute care and to make policy recommendations to improve transitions of care. Six purposively sampled case studies were conducted collecting data through semistructured interviews with consumers, country professional and occupational groups and tertiary providers. Data were analysed to produce themes for consumers, and country and tertiary mental healthcare providers. The study found that consumers saw transfer to the city for mental health care as beneficial in spite of the challenges of being transferred over long distances, while being very unwell, and of being separated from family and friends. Country care providers noted that the disjointed nature of the mental health system caused problems with key aspects of transfer of care including transport and information flow, and achieving integration between the primary and tertiary settings. Improving transfer of care involves overcoming the systemic barriers to integration and moving to a primary care-led model of care. The distance consultation and liaison model provided by the Rural and Remote Mental Health Services, the major tertiary provider of services for country consumers, uses a primary care-led approach and was highly regarded by research participants. Extending the use of this model to other primary mental healthcare providers and tertiary facilities will improve transfer of care.

Managing risks of violence in a youth mental health service: a service model description

There is a significant relationship between experiencing a severe mental illness, particularly psychosis, and exhibiting violent or offending behaviour. Reducing, if not preventing, the risks of violence among patients of mental health services is clinically warranted, but models to address this are limited

Identification of mental illness in police cells: a comparison of police processes, the brief jail mental health screen and the jail screening assessment tool

The study investigated current police practices employed to identify those with a mental illness in police custody, and to evaluate the predictive utility of the Brief Jail Mental Health Screen (BJMHS) and the Jail Screening Assessment Tool (JSAT). One hundred and fifty detainees were recruited from two police stations in Melbourne, Australia. Measures included the Structured Clinical Interview for DSM-IV-TR, BJMHS and JSAT. Axis-I disorders were compared with police decisions regarding identification of mental illness based on their usual practices. Participants were classified as requiring referral for further mental health evaluation according to the screening tools. Results indicated that current police practices produced high false negatives, with many of those experiencing mental illness not identified. There was no significant difference in performance between BJMHS (AUC =0.722) and JSAT (AUC =0.779) in identifying those with a serious mental illness (p=0.109). However, JSAT performed significantly better at identifying any Axis-I disorder, excluding substance use disorders, as compared with BJMHS (AUC =0.815, vs AUC =0.729; p=0.018). Given the high prevalence of mental illness among detainees, there is a pressing need to introduce standardised screening tools for mental illness in police custody. This can assist the police in managing detainees appropriately and securing mental health services as required.