Mental health recovery and occupational therapy in Australia and New Zealand

Every individual with mental illness has the right to be safe and cared for. Most people will receive the love and care from their families and friends, but they will also expect mental-health professionals, occupational therapists and the community to work together to provide the necessary services to support their recovery from mental illness. This article highlights the development of the recovery approach for people with mental illness in Australia and New Zealand. The implications of recovery concepts for occupational therapy, in the areas of individualized approach, participation of service users and carers, person-centred assessment and intervention, intersectoral links and mental-health promotion, are discussed. There are a number of key areas requiring further research and debate, notably the most effective means of implementing and evaluating recovery-focused interventions.

The International Consortium on Mental Health Policy and Services: objectives, design and project implementation

The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network-the International Consortium on Mental Health Policy and Services-are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a country's current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.

Adult mental health needs and expenditure in Australia

Background Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Method Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. Results In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. Conclusions For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

Australia's National Mental Health Strategy and deinstitutionalization: some empirical results

Objective: To determine the role of the National Mental Health Strategy in the deinstitutionalization of patients in psychiatric hospitals in Queensland. Method: Regression analysis (using the maximum likelihood method) has been applied to relevant time-series datasets on public psychiatric institutions in Queensland. In particular, data on both patients and admissions per 10 000 population are analysed in detail from 1953-54 to the present, although data are presented from 1883-84. Results: These Queensland data indicate that deinstitutionalization was a continuing process from the 1950s to the present. However, it is clear that the experience varied from period to period. For example, the fastest change (in both patients and admissions) took place in the period 1953-54 to 1973-74, followed by the period 1974-75 to 1984-85. Conclusions: In large part, the two policies associated with deinstitutionalization, namely a discharge policy ('opening the back door') and an admission policy ('closing the front door') had been implemented before the advent of the National Mental Health Strategy in January 1993. Deinstitutionalization was most rapid in the 30-year period to the early 1980s: the process continued in the 1990s, but at a much slower rate. Deinstitutionalization was, in large part, over before the Strategy was developed and implemented.

The National Mental Health Strategy and Geographical Access to Mental Health Services: Some empirical results

In 1992 the Australian Government adopted the National Mental Health Strategy in an attempt to improve the provision of mental health services. A component was to improve geographical access to hospital-based mental health services. This paper is concerned with determining if this objective has been achieved. Time-series data on patients (at a regional level) with mental illness in the State of Queensland are available for the years from 1968-69 to 2002-03. A change in regional classification by the Australian Bureau of Statistics complicates the analysis by precluding certain empirical tests such as converging utilisation rates by region. To overcome this problem, it was decided to apply concepts of concentration and equality that are commonly employed in industrial economics to the regional data. The empirical results show no evidence of improving regional access following the National Mental Health Strategy: in fact the statistical results show the opposite, i.e. declining regional access.

Integrating service user and practitioner expertise within a web-based system for collaborative mental-health risk and safety management

Objectives: To develop a decision support system (DSS), myGRaCE, that integrates service user (SU) and practitioner expertise about mental health and associated risks of suicide, self-harm, harm to others, self-neglect, and vulnerability. The intention is to help SUs assess and manage their own mental health collaboratively with practitioners. Methods: An iterative process involving interviews, focus groups, and agile software development with 115 SUs, to elicit and implement myGRaCE requirements. Results: Findings highlight shared understanding of mental health risk between SUs and practitioners that can be integrated within a single model. However, important differences were revealed in SUs' preferred process of assessing risks and safety, which are reflected in the distinctive interface, navigation, tool functionality and language developed for myGRaCE. A challenge was how to provide flexible access without overwhelming and confusing users. Conclusion: The methods show that practitioner expertise can be reformulated in a format that simultaneously captures SU expertise, to provide a tool highly valued by SUs. A stepped process adds necessary structure to the assessment, each step with its own feedback and guidance. Practice Implications: The GRiST web-based DSS (www.egrist.org) links and integrates myGRaCE self-assessments with GRiST practitioner assessments for supporting collaborative and self-managed healthcare.

Young students' use of the internet for mental health information and support

It is recognized that young people experience difficulties in accessing mainstream mental health services particularly because of the stigma that remains associated with mental health problems. One potential solution is to use the many websites available offering information and support for mental health problems, such support and information could be offered by Psychiatric Nurses. However, young peoples' usage and views on using the Internet for this purpose has yet to be examined. This quantitative descriptive study aimed to elicit the views of 922 University students, aged between 18 and 24 years, on using the Internet for mental health information and support. Data were collected using a 30-item self-designed questionnaire and analysed using descriptive statistics. The findings indicated that 72.4% of participants used the Internet several times a day. In addition, 30.8% had previously searched for mental health information online, predominantly on depression. While it was found that 68% of participants indicated that they would use the Internet for mental health support if they needed to, 79.4% would still prefer face to face support. It is concluded that young people are willing to use the Internet for mental health information and that it represents a viable source of support for this age group.

Retail Food Establishments: Guide to HACCP Plans

A Hazard Analysis and Critical Control Point (HACCP) system is a plan to reduce the risk of safety hazards in food. The HACCP System identifies potential biological, chemical and physical hazards from the time the food enters the facility to when it is served. The Hazard Analysis identifies critical control points based on the ingredients, raw materials and processes. Control measures are then identified, implemented and monitored to ensure the ongoing safety of the finished products.

Legislative update

Every week the General Assembly is in session the South Carolina House of Representatives, Office of Research publishes the Legislative Update, a digest of action on the floor of the House and action in full House committees.

Legislative update

Every week the General Assembly is in session the South Carolina House of Representatives, Office of Research publishes the Legislative Update, a digest of action on the floor of the House and action in full House committees.