The recovery journey : employment support for people with depression and other mental illnesses

This paper presents the qualitative findings of a larger mixed method study aimed to articulate factors that clients and staff of the Disability Employment Network (DEN) identify in relation to re-engagement into the workforce. The DEN is a supported job training and employment program funded by the Australian Federal Government, established to assist clients with health disabilities, including mental health diagnoses, to seek and retain employment. Two DEN sites participated in the study (one regional and one metropolitan). Semi structured interviews and focus groups were undertaken with seven employment counsellors and 16 clients until data saturation occurred. Analysis of the narrative data identified two overarching emergent concepts articulated by clients and employment counsellors: employment enablers and employment barriers. The notion of recovery and re-engagement in the workforce in the context of mental illness is complex. The qualitative results of this study highlight the essential nature of supporting clients’ mental health and vocational needs concurrently through such means as service collaboration, vocational peer support and, importantly, provision of employment support congruent with phase of recovery.

Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future

This review summarises nutrition and mental health research in Australia and New Zealand between 1986 and 2006. The method used to identify papers for inclusion was a search of computerised databases: Medline, Cinahl and Meditext 1986–2006, with subsequent bibliographical review. Key search words were nutrition, diet, mental disorder, mental illness, weight, physical health, Australia and New Zealand. Inclusion criteria included: English language, original data in peer reviewed journals, and examination of some component of nutrition in people with a mental illness. The review of thirteen papers found that the evidence base for dietetic practice in mental health has developed through small assessment and interventional research, often with multidisciplinary collaboration. Future research should include quality and outcome measures with intersectoral partnerships. Dietitians are well positioned to lead and participate in mental health research and to implement research findings to improve the nutritional status of this vulnerable group.

Socio-economic explanators of mental morbidity differences between Australian men and women

This study aimed to investigate differences in reporting rates for mental morbidity between Australian men and women aged 25-54. Data for the study was obtained from the 1983 Australian Health Survey.

Do GPs use electronic mental health resources? A qualitative study

BACKGROUND
The Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance. However, there is little data on GPs’ acceptance and use of EMHRs.

METHOD
Semistructured interviews were conducted with 27 GPs to determine their attitude toward EMHRs, and their use during consultation with patients.

RESULTS
Few GPs reported frequently using EMHRs in consultation. Identified barriers to use included lack of familiarity with information technology, and insufficient knowledge of available resources. Identified advantages of electronic resources included high patient acceptance, time efficiency, and improved quality of information.

DISCUSSION
General practitioners recognise several advantages of utilising electronic resources for managing patients with mental illness. However, GPs are not sufficiently familiar with electronic resources to use them effectively. This could be overcome by education.

Identifying the core competencies of mental health telephone triage

Aims and objectives. The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage.
Background. Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice.
Design. An observational design was employed to address the research aims.
Methods. Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011.
Results. The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation.
Conclusions. The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. Relevance to clinical practice. The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.

The arts and mental wellbeing : opportunities and challenges

Strategies to combat the many effects of mental illness on individuals and families need to go beyond psychopharmacology and institutional care. Evidence has been mounting for the healing and treatment role of art in clinical and health care settings. Art, in its many forms, has also been suggested as one valuable tool in addressing social exclusion in people with many forms of disability including mental illness.
This paper draws on Masters Research findings to present a discussion of the historical and the current landscape of Art for Health Programs with special emphasis on art programs targeting people with chronic mental illness. Recent studies in the UK and Scotland indicate that participation in the arts can enhance recovery, social connectedness and cultural inclusivity.

Providing quality mental health nursing in primary health care settings in Kenya : A discussion paper.

Kenya, a country of 38 million people in East Africa has about 75 Psychiatrists and 500 Psychiatric Nurses, the majority work in the private sector and mainly in urban areas. Mental illness is common in Kenya, however, specialist services are sparse and primary care struggles to cope, and this has been worsened by general health programs which have been slow to appreciate the significance of mental health. The World Health Organisation recommends that provision of good quality mental health care does not only involve increasing the number of health workers but changing the skill mix and developing new competencies among existing workers. Successful implementation of mental, neurological and substance abuse disorder services in Kenya will depend on nurses, who constitute majority of the workforce located in provinces, districts and community clinics.

This discussion paper will address s key workforce issues affecting the up-scaling of mental health services, and the delivery of quality mental health nursing care in primary health care settings in Kenya. Strategies to develop skills and competencies of new and existing personnel will be discussed.

Mind the gap! : A discussion on the disparity between low and high income countries in the provision of mental health care and the implications for capacity building in Kenya’s nursing workforce.

About fourteen per cent of the global burden of disease has been attributed to mental, neurological and substance use disorders. A number of initiatives have been launched in recent years to respond to this, the World Health Organisation (WHO) introduced the Mental Health Gap Action Programme (mhGAP) to address the widening gap between what is needed to provide adequate mental health services and what is currently available, especially in low and middle income countries where the gap is widest.
This discussion paper will focus on mental health nursing in Kenya, a country in East Africa with a population of 42 million people. Mental illness is common in Kenya with up to twenty five per cent prevalence rates, yet mental health services are sparse at the tertiary and primary care level and mental health remains a low budget and policy priority for the government. The aim of this paper is to raise participants’ awareness of the challenges of delivering mental health nursing care in low-income countries such as Kenya, and to explore possible solutions to the problem.

Mercy health mental health nurse practitioner project report

The Nurse Practitioner – Mental Health model investigates the options for providing a service to a group of clients who present at Werribee and Western Emergency Departments (ED) and currently receive either limited mental health service or have an undiagnosed mental illness. This group comprises at risk young adults who do not meet the criteria for ongoing treatment in public mental health services at present. At risk young adults are those who fit known demographic variables for risk and have a risk catalyst (eg relationship break up) and a situational response to this (self harm). Mercy Mental Health Program service survey indicates gaps in services to this group using current referral pathway with potentially 40-70% lost to follow-up and a significant increase in risk for suicide.

Socio-demographic and work setting correlates of poor mental health in a population sample of working Victorians: application in evidence-based intervention priority setting

Interventions to promote mental health in the workplace are rapidly gaining acceptability as a means to prevent, screen, treat and effectively manage the growing disease burden of depression and anxiety among working people. The objective of this study was to identify socio-demographic and work setting correlates of poor mental health to consider alongside other evidence in priority setting for workplace mental health promotion (MHP). Multiple logistic regression was used to model the probability of poor mental health (SF-12) in relation to socio-demographic (gender, age, education, marital status and occupational skill level) and employment factors (workplace size and type, industrial sector, employment arrangement and working hours) in a population-based cross-sectional survey of 1051 working Victorians. As a result, poor mental health was (21% prevalence overall) higher in working females than in males and decreased with increasing age. Only one employment factor was significant in demographically adjusted multivariate analyses, showing an increase in the odds of poor mental health with increasing working hours. It is concluded that based on the prevalence of poor mental health, Victorian work settings with high proportions of younger workers, and younger working women in particular, should be prioritized for workplace MHP. Thus, together with other research demonstrating particularly poor psychosocial working conditions for young working women, sectors with an over-representation of this group (e.g. service sector) could be prioritized for workplace MHP alongside young and blue-collar males (also a priority due to low mental healthcare service use).

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.

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

A qualitative evaluation of an intervention for parents of adolescents with mental disorders: the parenting challenging adolescents seminar

This qualitative study describes parents’ responses to a targeted and brief educational seminar (known as ‘Parenting Challenging Adolescents’), and provides recommendations for brief parenting interventions designed to engage adolescents in mental health treatment. The 2-h intervention was designed to assist parents who were concerned about their adolescents and in the identification of mental disorders. Participants were invited to attend the seminars conducted in a community setting on the basis of local advertising and promotion of the event with community health services and schools. Any parent of a young person aged 12–25 interested in the seminar material was eligible to attend. Sixteen parents completed measures of parent and youth mental health and family satisfaction and were also interviewed using semi-structured telephone interviews 4 weeks after the seminar. Interpretational phenomenological analysis of interviews suggested that most parents valued the chance to connect with others in similar situations and appreciated knowing about local services available for mental health disorders. Many parents also reported positive changes to communication and family dynamics following the seminar. Another common theme was an increased knowledge of mental disorders and appropriate treatments, along with the desire to receive more specific, targeted information. Overall the findings suggest that even a single session of educational material designed for parents may be useful, engaging and potentially encourage improved service usage for adolescents with mental disorders.

Emergency department mental health triage scales improve outcomes.

The assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses* without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. This paper examines the need for such guidelines and reviews a number of mental health triage scales that have been evaluated for use in emergency departments. Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients' reactions to the impact of this change to service delivery in future evaluations.