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.

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.

Conservation cornerstones : capitalising on the endeavours of long-term monitoring projects

Ecological monitoring is widely used to measure change through time in ecosystems. The current extinction crisis has resulted in a wealth of monitoring programs focussed on tracking the status of threatened species, and the perceived importance of monitoring has seen it become the cornerstone of many biodiversity conservation programs. However, many monitoring programs fail to produce useful outcomes due to inherent flaws. Here we use a monitoring program from south-eastern Australia as a case study to illustrate the potential of such endeavours. The threatened carnivorous marsupial, the brush-tailed phascogale (Phascogale tapoatafa), has been monitored at various locations between 2000 and 2010. We present strong evidence for a decline in relative abundance during this period, and also describe relationships with environmental variables. These results provide insights likely to be valuable in guiding future management of the species. In the absence of the monitoring program, informed management would not be possible. While early detection of population declines is important, knowledge of the processes driving such declines is required for effective intervention. We argue that monitoring programs will be most effective as a tool for enhanced conservation management if they test specific hypotheses relating to changes in population trajectories. Greater emphasis should be placed on rigorous statistical analysis of monitoring datasets in order to capitalise on the resources devoted to monitoring activities. Many datasets are likely to exist for which careful analysis of results would have benefits for determining management directions.

Invertebrate food sources for waterbirds provided by the reconstructed wetland of Nyirkai-Hany, northwestern Hungary

The Nyirkai-Hany wetland reconstruction area in northwestern Hungary is now designated as a Ramsar and a Natura 2000 site. It was created in 2001–2002 by the Fertő-Hanság National Park Directorate to restore a part of the formerly drained large wetland called Hanság and to offer waterbirds a suitable habitat for feeding and breeding. We focused on this aim of the restoration project and studied the temporal and spatial variation in abundance of birds and their invertebrate prey in this newly created wetland. From April 2007 until May 2008, we sampled plankton, nekton and benthos of different habitats monthly and monitored waterbirds weekly on the three different areas of the Nyirkai-Hany. During our investigations, 135 invertebrate and 53 waterbird species were recorded. Benthos and macrophyte decomposition accelerating guilds were the most abundant waterbird guilds—besides the dominant grazing importer material transporter guild, represented primarily by geese—in the Nyirkai-Hany. Zooplankton assemblages primarily consisted of small species not easily used as a food by planktivorous waterbirds. The low density of zoobenthic biomass and the small extent of shallow water mudflats probably accounted for the scarcity of the bioturbing guild group of birds. Nektonic biomass varied greatly among locations having different vegetation types, was greatest in the shallow water areas dominated by Typha, Carex and Phragmites species and lowest at offshore vegetation-free sites. Chironomids, mayflies and odonates were especially abundant and their biomass significantly correlated with several waterbird species, mainly belonging to the macrophyte decomposition accelerating guild (e.g. Anas platyrynchos, Fulica atra). This guild itself, which has increased in abundance in recent years, showed an exceptionally strong correlation with odonate abundance. These results indicate the growing importance of the Nyirkai-Hany wetland area as a foraging site for waterbirds.

Australia's defence policy : a market-state approach?

In 2002, Professor Philip Bobbitt published 'The Shield of Achilles', in which he postulates that the nation-state is evolving into a fundamentally new form - the market state. It is my contention that Australia is evolving into something approximating Bobbitt's market-state and therefore its defence policy shuld be informed by market-state strategy.

Recovering the hidden through found-footage films

In the early nineteen seventies materialist experimental film was cogently rejected by feminist theorists for its inability to deliver a feminist counter-cinema addressing its political agenda. The concomitant development of feminist psychoanalytic readings of “dominant cinema” against its grain also discounted such work. This split is marked by Peter Wollen’s formulation of “two avant-gardes”, one narrative and explicit about its political position and the other non-narrative and focusing directly on implicit perceptual processes. Materialist film’s fixation on structure jettisoned content, and extended post-war painting’s essentialist move to pure abstraction manifest in abstract expressionism and minimalism. The emergence of trauma theory and the recent explosion of moving image digital media with its non-linear bias and the complex layering of “technical images” have created a new situation opening up alternate readings of such discounted materialist practices. As well as a historic precursor for digital media, it is suggested that a materialist cinema, represented here by the found footage films: Alone: Life Wastes Andy Hardy (Arnold 1998) and Dreamwork (Tscherkassky 2001), signposts a belated return for materialist film within the context of trauma studies. This materialist turn rescues such experimental film from its traumatic excision and extends an understanding of what has been termed a “trauma cinema” by Janet Walker. Rather than pure, abstract or visionary such practice is read here through trauma theory as performing implicit mechanisms of denial and erasure.

Found footage: recycling historic material a-historically

The digital has speeded up multi-platform image delivery, to impose sampling and collagic strategies into the way we process information. This is a trauma inducing situation. During an earlier period of technological change reading the moving landscape similarly overwhelmed the early train traveller. Wolfgang Schivelbusch noted that ‘The inability to acquire a mode of perception adequate to technological travel crossed all political, ideological and aesthetic lines.’ (1983) New perceptual strategies had to be developed that contextualized the blur and the streak produced by looking out the train window without overwhelming the viewer. Utilizing Chris Brewin’s (2001) model of two parallel memory systems, this paper argues that, as another round of unprecedented technological change impacts on our senses, another ‘re-alignment’ of the senses is required. Chris Brewin’s (2001) model of two parallel memory systems, of Verbally Accessible Memory (VAM) and Situational Accessible Memory (SAM), suggests that the current information explosion requires a greater emphasis on the SAM system for processing information and critical thinking. Processed through the amygdala, SAM is implicit, situationally triggered, information intensive and conveys no sense of time. Found footage films, like those of Martin Arnold and Peter Tscherkassky that cut up, layer, repeat and recycle historic imagery perform the sampling and collagic strategies that characterize this SAM memory system to demonstrate a more visually based mode of critical thinking.

Modulation of putative mirror neuron activity by both positively and negatively valenced affective stimuli: a TMS study

Research indicates that mirror neurons are important for social cognition, including emotion processing. Emerging evidence, however, also reveals that emotional stimuli might be capable of modulating human mirror neuron system (MNS) activity.

The current study used transcranial magnetic stimulation (TMS) to assess putative mirror neuron function following emotionally evocative images in twenty healthy adults.

Participants observed videos of either a transitive hand action or a static hand while undergoing TMS of the primary motor cortex. In order to examine the effect of emotion on the MNS, each video was preceded by an image of either a positive, negative or neutral valence.

MNS activity was found to be augmented by both the positive and negative (relative to neutral) stimuli, thus providing empirical support for a bi-directional link between emotion and the MNS, whereby both positively and negatively valenced stimuli are capable of facilitating mirror neuron activity. The potential adaptive significance of this finding is discussed.