The contribution of psychological assessment to community mental health services

Specialist psychological assessment plays a potentially important role in multidisciplinary community mental health settings. This portfolio describes and evaluates this psychological assessment and provides four case studies.

Dialectical behavior therapy in community mental health settings : an evaluation

Borderline personality disorder causes extreme and enduring suffering. Dialectical Behavior Therapy is a psychological intervention that has been developed to treat the disorder. Two studies were conducted to test the effectiveness of the treatment. Results showed that borderline personality disorder can be treated effectively in the public mental health system. The portfolio presents four case studies to examine the notion that Cognitive Behavior Therapy (CBT) is efficacious in the treatment of anxiety as a comorbid condition.

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.

The acceptability and efficacy of a group cognitive behavioural therapy programme in a community mental health setting

This paper presents data on a patient evaluation of a group cognitive behavioural therapy programme in an applied setting and its efficacy for reducing generalised anxiety and or depression, and distress. Patients (n=14) participated in one of two 8-week group cognitive behavioural therapy programmes for generalised anxiety or depression, within a mental health service. Patients’ perceptions of the programme were collected via an evaluation questionnaire, and data on clinical outcomes were sourced from patients’ case notes. Most patients who were invited to participate in the programme (n=14 of 17), and their evaluations were generally favourable. Almost all participants (93%) indicated that the programme either met or exceeded their expectations. The clinical outcomes of the intervention were similar to those found in efficacy studies reported in the published literature (approximately half to threequarters of one standard deviation improvement in anxiety, depression, and distress scores).

Evaluation of outcome in child and adolescent mental health services: children with persistent conduct problems

This article focuses on the evaluation of outcome in child and adolescent mental health services. We examined the outcomes of 46 children with persistent conduct problems by gathering at baseline and six months information from multiple informants on multiple domains including the functioning of the child, risk factors, and parents’ and children’s perceptions of the treatment process. A statistically significant reduction in oppositional/conduct symptoms was reported six months after the initial clinical contact. However, the majority of the group still scored within the clinical range. The various outcome measures are correlated to only a mild to moderate degree. Teachers did not notice the same degree of change at school, despite the changes noticed by parents. Symptom improvement and satisfaction with a service are two separate issues. Parents’ satisfaction was related to their perception of the therapist and the therapy offered. Their satisfaction was high if they perceived that the therapist was able to communicate well, show care and concern, and if the therapy was perceived as organized. Much can be learned from a comprehensive outcome measurement system within a mental health service.

Differences in dropout between diagnoses in child and adolescent mental health services

Dropout from treatment is a significant problem in child and adolescent mental health services, and findings regarding the role of possible contributing factors are inconsistent. It is argued that this inconsistency may be the result of the confounding effects of different definitions of dropout, and different dropout rates for different diagnoses. A file review of 520 new cases over a 12-month period in a large Child and Adolescent Mental Health Service in Melbourne, Australia was performed. Information was collected about the intake, parents, family, child, diagnoses and treatment. A significant relationship was found between diagnosis and dropout rate, with clients experiencing family problems or conduct disorder and ADHD being more likely to dropout, and those experiencing negative life events, anxiety disorders or those not having a diagnosis being less likely to dropout. These findings offer potential directions for services to consider specific strategies for retaining their clients. Possible reasons for these findings, methodological issues and future research directions are discussed.

Factors associated with dropout and diagnosis in child and adolescent mental health services

Objective: Dropout from child and adolescent mental health services has ramifications for children, families and the services themselves. Understanding the factors that are associated with dropout for different diagnoses has the potential to assist with tailoring of services to reduce dropout. The aim of the current study was to identify such factors.

Method: A file audit was conducted for all referrals to a child and adolescent mental health service over a 12 month period, yielding 520 subjects for analysis (264 male, 256 female, mean age = 12.6 years). Parent, child and service variables of interest were recorded as were diagnoses, which were categorized into 25 superordinate categories.

Results: Almost 50% of subjects dropped out of treatment. Factors associated with dropout varied across diagnosis, and no factor was associated with dropout for all diagnoses.

Conclusion: There are differences in the factors that were associated with dropout for different disorders. This is a useful finding in terms of understanding and preventing dropout in child and adolescent mental health settings, but more research is needed.

Enablers and barriers to accessing mental health services for adults with high prevalence psychological disorders in South West Victoria

Knowing what services are available and how to access them can be challenging in rural areas. The aim of the South West Mental Health Mapping project was to identify the level, accessibility and effectiveness of mental health services for high prevalence psychological disorders amongst the adult population in the South West region of Victoria. This study includes data from a number of sources: regional records of the number and location of health professionals; a telephone survey of 1297 people in five Local Government Areas in the region; and a social network analysis of contact points. Additional qualitative interviews and surveys were conducted with 25 service recipients and 37 health professionals to identify issues from different perspective. This paper will focus on the social network analysis of the project. It highlights the relative prominence of each type of service provider within the overall network. The social network map shows the centrality of the General Practitioner and the wide range of agencies that become involved in supporting people with mental health issues. The discussion identifies primary contact points for people seeking help and places of referral. The main barrier acknowledged by people requiring assistance was lack of knowledge about where to go for help. Enablers included Medicare Better Access funded schemes. The findings show that there is a reasonable range of mental health professionals across the region, although there are challenges with recruitment and retention of staff. Even with available services, a major problem is communicating this information to potential consumers

Primary mental health care reform in Australia : the vision and the reality

Reports on primary mental health care reform in Australia 1991-2001 and the involvement of general practioners as the key providers. Investigates the degree to which the vision of policy makers and key stakeholders for a more integrated and effective system had been achieved. Findings suggested there is a considerable mismatch between the policy vision and the implementation reality and that the current system falls short of providing the support and systemic changes necessary for GPs to provide effective mental health care.