Current evidence on integrated treatment for serious mental disorder and substance misuse

Substance misuse in people with serious mental disorders is common and has a wideranging negative impact. The multiplicity of problems suggests that this comorbidity is better conceptualized as a type of complex disorder than by ‘dual diagnosis’. Problems with sequential and parallel treatments have led to the development of integrated approaches, with one practitioner or team addressing both the substance use and mental disorder. These treatments are typically characterized by motivation enhancement, minimizing treatment-related stress, emphasizing harm reduction as well as abstinence, and assertive outreach. A review of published randomized trials demonstrates that superior effects to controls are rarely consistent across treatment foci and over time. While motivational interventions assist engagement, more intervention is usually required for integrated treatment programs to improve long-term outcomes more than control conditions. More intensive case management does not consistently improve impact, but extended cognitive-behavioral therapies have promise. Suggestions for maximizing treatment effects and improving research evidence are provided.

Should mental health issues be addressed in primary care, and can it be done? Views of rural general practitioners in Queensland

Objective: The aim of this paper was to examine self-efficacy and perceived appropriateness among rural general practitioners (GPs) in regards to screening and intervention for physical, lifestyle and mental health issues. ----- Method: Fifty GPs from 25 practices in eight rural Queensland towns completed a written survey designed for the study. ----- Results: General practitioners rated opportunistic screening or assessment for smoking and for detection of relapse of mental disorders as the most appropriate, with even cardiovascular and diabetes risk falling behind these. Self-efficacy was highest for medical disorders for smoking assessment. It was significantly lower for alcohol, mental health issues, and addressing risks of physical disorder in people with mental disorders. ----- Conclusions: High appropriateness ratings suggest that current strategies to boost self-efficacy of GPs in addressing mental health issues are timely.

Challenges faced by general practitioners and allied mental health services in providing mental health services in rural Queensland

Objective: To examine the views of rural practitioners concerning issues and challenges in mental health service delivery and possible solutions. Design: A qualitative study using individual semi-structured interviews. Setting: Eight general practices from eight rural Queensland towns, three rural mental health services and two non-government organisations, with interviews being conducted before recent changes in government-subsidised access to allied health practitioners. Participants: A sample of 37 GPs, 19 Queensland Health mental health staff and 18 participants from community organisations. Main outcome measures: Analysis of qualitative themes from questions about the key mental health issues facing the town, bow they might be addressed and what challenges would be faced in addressing them. Results: There was substantial consensus that there are significant problems with inter-service communication and liaison, and that improved collaboration and shared care will form a critical part of any effective solution. Differences between groups reflected differing organisational contexts and priorities, and limitations to the understanding each had of the challenges that other groups were facing. C onclusions: Improvements to mental health staffing and to access to allied health might increase the ability of GPs to meet the needs of less complex patients, but specific strategies to promote better integrated services are required to address the needs of rural and regional patients with complex mental health problems. The current study provides a baseline against which effects of recent initiatives to improve mental health care can be assessed.

Interpersonal pattern dynamics and adaptive behavior in multiagent neurobiological systems : conceptual model and data

Ecological dynamics characterizes adaptive behavior as an emergent, self-organizing property of interpersonal interactions in complex social systems. The authors conceptualize and investigate constraints on dynamics of decisions and actions in the multiagent system of team sports. They studied coadaptive interpersonal dynamics in rugby union to model potential control parameter and collective variable relations in attacker–defender dyads. A videogrammetry analysis revealed how some agents generated fluctuations by adapting displacement velocity to create phase transitions and destabilize dyadic subsystems near the try line. Agent interpersonal dynamics exhibited characteristics of chaotic attractors and informational constraints of rugby union boxed dyadic systems into a low dimensional attractor. Data suggests that decisions and actions of agents in sports teams may be characterized as emergent, self-organizing properties, governed by laws of dynamical systems at the ecological scale. Further research needs to generalize this conceptual model of adaptive behavior in performance to other multiagent populations.

Challenges in implementing evidence-based practice into mental health services

This paper highlights challenges in implementing mental health policy at a service delivery level. It describes an attempt to foster greater application of recovery-orientated principles and practices within mental health services. Notwithstanding a highly supportive policy environment, strong support from service administrators, and an enthusiastic staff response to training, application of the training and support tools was weaker than anticipated. This paper evaluates the dissemination trial against key elements to promote sustained adoption of innovations. Organisational and procedural changes are required before mental health policies are systematically implemented in practice.

Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders : a qualitative systematic review of randomised controlled trials

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders.

Supervision practices in allied mental health : relationships of supervision characteristics to perceived impact and job satisfaction

This study examined whether supervision characteristics impacted on mental health practice and morale, and developed a new Supervision Attitude Scale (SAS). Telephone surveys were conducted with a representative sample of 272 staff from public mental health services across Queensland. Although supervision was widely received and positively rated, it had low average intensity, and assessment and training of skills was rarely incorporated. Perceived impact on practice was associated with acquisition of skills and positive attitudes to supervisors, but extent of supervision was related to impact only if it was from within the profession. Intention to resign was unrelated to extent of supervision, but was associated with positive attitudes to supervisors, accessibility, high impact, and empathy or praise in supervision sessions. The SAS had high internal consistency, and its intercorrelations were consistent with it being a measure of relationship positivity. The study supported the role of supervision in retention and in improving practice. It also highlighted supervision characteristics that might be targeted in training, and provided preliminary data on a new measure.

Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders

Objectives: To determine opinions and experiences of health professionals concerning the management of people with comorbid substance misuse and mental health disorders. Method: We conducted a survey of staff from mental health services and alcohol and drug services across Queensland. Survey items on problems and potential solutions had been generated by focus groups. Results: We analysed responses from 112 staff of alcohol and drug services and 380 mental health staff, representing a return of 79% and 42% respectively of the distributed surveys. One or more issues presented a substantial clinical management problem for 98% of respondents. Needs for increased facilities or services for dual disorder clients figured prominently. These included accommodation or respite care, work and rehabilitation programs, and support groups and resource materials for families. Needs for adolescent dual diagnosis services and after-hours alcohol and drug consultations were also reported. Each of these issues raised substantial problems for over 70% of staff. Another set of problems involved coordination of client care across mental health and alcohol and drug services, including disputes over duty of care. Difficulties with intersectoral liaison were more pronounced for alcohol and drug staff than for mental health. A majority of survey respondents identified 13 solutions as practical. These included routine screening for dual diagnosis at intake, and a range of proposals for closer intersectoral communication such as exchanging client information, developing shared treatment plans, conducting joint case conferences and offering consultation facilities. Conclusions: A wide range of problems for the management of comorbid disorders were identified. While solution of some problems will require resource allocation, many may be addressed by closer liaison between existing services.

The explicit hazard model – part 1: theoretical development

Modern Engineering Asset Management (EAM) requires the accurate assessment of current and the prediction of future asset health condition. Appropriate mathematical models that are capable of estimating times to failures and the probability of failures in the future are essential in EAM. In most real-life situations, the lifetime of an engineering asset is influenced and/or indicated by different factors that are termed as covariates. Hazard prediction with covariates is an elemental notion in the reliability theory to estimate the tendency of an engineering asset failing instantaneously beyond the current time assumed that it has already survived up to the current time. A number of statistical covariate-based hazard models have been developed. However, none of them has explicitly incorporated both external and internal covariates into one model. This paper introduces a novel covariate-based hazard model to address this concern. This model is named as Explicit Hazard Model (EHM). Both the semi-parametric and non-parametric forms of this model are presented in the paper. The major purpose of this paper is to illustrate the theoretical development of EHM. Due to page limitation, a case study with the reliability field data is presented in the applications part of this study.

Mechanisms of improvement in treatment for depression : test of a self-efficacy and performance model

Tested D. J. Kavanagh's (1983) depression model's explanation of response to cognitive-behavioral treatment among 19 20–60 yr old Ss who received treatment and 24 age-matched Ss who were assigned to a waiting list. Measures included the Beck Depression Inventory and self-efficacy (SE) and self-monitoring scales. Rises in SE and self-monitored performance of targeted skills were closely associated with the improved depression scores of treated Ss. Improvements in the depression of waiting list Ss occurred through random, uncontrolled events rather than via a systematic increase in specific skills targeted in treatment. SE regarding assertion also predicted depression scores over a 12-wk follow-up.

The Explicit Hazard Model – Part 2 : Applications

Hazard and reliability prediction of an engineering asset is one of the significant fields of research in Engineering Asset Health Management (EAHM). In real-life situations where an engineering asset operates under dynamic operational and environmental conditions, the lifetime of an engineering asset can be influenced and/or indicated by different factors that are termed as covariates. The Explicit Hazard Model (EHM) as a covariate-based hazard model is a new approach for hazard prediction which explicitly incorporates both internal and external covariates into one model. EHM is an appropriate model to use in the analysis of lifetime data in presence of both internal and external covariates in the reliability field. This paper presents applications of the methodology which is introduced and illustrated in the theory part of this study. In this paper, the semi-parametric EHM is applied to a case study so as to predict the hazard and reliability of resistance elements on a Resistance Corrosion Sensor Board (RCSB).

A model of project complexity : distinguishing dimensions of complexity from severity

There is increasing agreement that understanding complexity is important for project management because of difficulties associated with decision-making and goal attainment which appear to stem from complexity. However the current operational definitions of complex projects, based upon size and budget, have been challenged and questions have been raised about how complexity can be measured in a robust manner that takes account of structural, dynamic and interaction elements. Thematic analysis of data from 25 in-depth interviews of project managers involved with complex projects, together with an exploration of the literature reveals a wide range of factors that may contribute to project complexity. We argue that these factors contributing to project complexity may define in terms of dimensions, or source characteristics, which are in turn subject to a range of severity factors. In addition to investigating definitions and models of complexity from the literature and in the field, this study also explores the problematic issues of ‘measuring’ or assessing complexity. A research agenda is proposed to further the investigation of phenomena reported in this initial study.

Explaining International new venture internationalisation: an innovation adoption model

The increasing prevalence of International New Ventures (INVs) during the past twenty years has been highlighted by numerous studies (Knight and Cavusgil, 1996, Moen, 2002). International New Ventures are firms, typically small to medium enterprises, that internationalise within six years of inception (Oviatt and McDougall, 1997). To date there has been no general consensus within the literature on a theoretical framework of internationalisation to explain the internationalisation process of INVs (Madsen and Servais, 1997). However, some researchers have suggested that the innovation diffusion model may provide a suitable theoretical framework (Chetty & Hamilton, 1996, Fan & Phan, 2007).The proposed model was based on the existing and well-established innovation diffusion theories drawn from consumer behaviour and internationalisation literature to explain the internationalisation process of INVs (Lim, Sharkey, and Kim, 1991, Reid, 1981, Robertson, 1971, Rogers, 1962, Wickramasekera and Oczkowski, 2006). The results of this analysis indicated that the synthesied model of export adoption was effective in explaining the internationalisation process of INVs within the Queensland Food and Beverage Industry. Significantly the results of the analysis also indicated that features of the original I-models developed in the consumer behaviour literature, that had limited examination within the internationalisation literature were confirmed. This includes the ability of firms, or specifically decision-makers, to skip stages based om previous experience.

Towards a model of the institutional logics of climate change

The proliferation of innovative schemes to address climate change at international, national and local levels signals a fundamental shift in the priority and role of the natural environment to society, organizations and individuals. This shift in shared priorities invites academics and practitioners to consider the role of institutions in shaping and constraining responses to climate change at multiple levels of organisations and society. Institutional theory provides an approach to conceptualising and addressing climate change challenges by focusing on the central logics that guide society, organizations and individuals and their material and symbolic relationship to the environment. For example, framing a response to climate change in the form of an emission trading scheme evidences a practice informed by a capitalist market logic (Friedland and Alford 1991). However, not all responses need necessarily align with a market logic. Indeed, Thornton (2004) identifies six broad societal sectors each with its own logic (markets, corporations, professions, states, families, religions). Hence, understanding the logics that underpin successful –and unsuccessful– climate change initiatives contributes to revealing how institutions shape and constrain practices, and provides valuable insights for policy makers and organizations. This paper develops models and propositions to consider the construction of, and challenges to, climate change initiatives based on institutional logics (Thornton and Ocasio 2008). We propose that the challenge of understanding and explaining how climate change initiatives are successfully adopted be examined in terms of their institutional logics, and how these logics evolve over time. To achieve this, a multi-level framework of analysis that encompasses society, organizations and individuals is necessary (Friedland and Alford 1991). However, to date most extant studies of institutional logics have tended to emphasize one level over the others (Thornton and Ocasio 2008: 104). In addition, existing studies related to climate change initiatives have largely been descriptive (e.g. Braun 2008) or prescriptive (e.g. Boiral 2006) in terms of the suitability of particular practices. This paper contributes to the literature on logics by examining multiple levels: the proliferation of the climate change agenda provides a site in which to study how institutional logics are played out across multiple, yet embedded levels within society through institutional forums in which change takes place. Secondly, the paper specifically examines how institutional logics provide society with organising principles –material practices and symbolic constructions– which enable and constrain their actions and help define their motives and identity. Based on this model, we develop a series of propositions of the conditions required for the successful introduction of climate change initiatives. The paper proceeds as follows. We present a review of literature related to institutional logics and develop a generic model of the process of the operation of institutional logics. We then consider how this is applied to key initiatives related to climate change. Finally, we develop a series of propositions which might guide insights into the successful implementation of climate change practices.

Integrated Diagnosis and Prognosis Model for High Pressure LNG Pump

In condition-based maintenance (CBM), effective diagnostics and prognostics are essential tools for maintenance engineers to identify imminent fault and to predict the remaining useful life before the components finally fail. This enables remedial actions to be taken in advance and reschedules production if necessary. This paper presents a technique for accurate assessment of the remnant life of machines based on historical failure knowledge embedded in the closed loop diagnostic and prognostic system. The technique uses the Support Vector Machine (SVM) classifier for both fault diagnosis and evaluation of health stages of machine degradation. To validate the feasibility of the proposed model, the five different level data of typical four faults from High Pressure Liquefied Natural Gas (HP-LNG) pumps were used for multi-class fault diagnosis. In addition, two sets of impeller-rub data were analysed and employed to predict the remnant life of pump based on estimation of health state. The results obtained were very encouraging and showed that the proposed prognosis system has the potential to be used as an estimation tool for machine remnant life prediction in real life industrial applications.