scholarly journals Sustaining evidence-based practice for young people who self-harm: a 4-year follow-up

2004 ◽  
Vol 27 (2) ◽  
pp. 94 ◽  
Author(s):  
Stewart Einfeld ◽  
Margaret Tobin ◽  
John Beard ◽  
Elizabeth Evans ◽  
Richard Buss ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Health Service ◽  
New South ◽  
Evidence Based ◽  
Deliberate Self Harm ◽  
South Wales ◽  
Self Harm ◽  
Northern Rivers

Stewart Einfeld is at the School of Psychiatry, University of New South Wales; the late Margaret Tobin was the Director of Mental Health, South Australia; John Beard is Head of the Northern Rivers University Department of Rural Health, University of Sydney; Elizabeth Evans is a Research Assistant at the School of Psychiatry, University of New South Wales; Richard Buss is the Area Manager, Northern Rivers Area Mental Health Service; Michael Dudley is a child psychiatrist at Prince of Wales Hospital and the School of Psychiatry, University of New South Wales.This report is dedicated to our late co-author Margaret Tobin, to honour her contribution to advancing the quality of mental health services.Objective: In 1998 and 1999, two NSW Area Health Services conducted the Youth At Risk of Deliberate Self Harm (YARDS) project. The YARDS project was designed to implement evidence-based service enhancements for the clinical management of young people with Deliberate Self Harm. This paper examines the extent to which service enhancements implemented during YARDS were maintained 4 years after the conclusion of the project and compares service quality with another NSW Area Health Service that did not participate in the YARDS project.Method: Staff from mental health services and emergency departments completed the Service Activity Scale, a measure developed for the YARDS project to assess the quality of health service response to individuals who present following a suicide attempt.Results: Results indicated that the service improvements made during the YARDS project were maintained 4years after the project ended. Furthermore, a significant difference was found between scores for services that participated in YARDS and services that did not participate in YARDS.Conclusions: These results suggest that projects such as YARDS which support evidence based service nhancements may be useful in improving the management of young people with deliberate self-harm, and that these improvements may be long-lasting.

Systems modelling and simulation to inform strategic decision making for suicide prevention in rural New South Wales (Australia)

2020 ◽  
Vol 54 (9) ◽  
pp. 892-901 ◽  
Author(s):  
Jo-An Atkinson ◽  
Adam Skinner ◽  
Sue Hackney ◽  
Linda Mason ◽  
Mark Heffernan ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Suicide Prevention ◽  
Suicidal Behaviour ◽  
New South ◽  
Decision Makers ◽  
Evidence Based ◽  
South Wales ◽  
Self Harm ◽  
Systems Modelling

Background: The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government’s 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world. Methods: A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period. Results: Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87−6.42%) and 5.45% (4.68−6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23−3.46%; suicide deaths: 4.38%, 95% interval 3.78−5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning. Conclusion: Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources.

scholarly journals Keeping COVID out: a collaborative approach to COVID-19 is associated with a significant reduction in self-harm in young people in custody

2021 ◽  
pp. 103985622110061
Author(s):  
John Kasinathan ◽  
Leigh Haysom ◽  
Helen Andriotis ◽  
Mike Wheaton ◽  
Trisha Lloyd ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
New South ◽  
Positive Interactions ◽  
Youth Justice ◽  
South Wales ◽  
Equivalent Time ◽  
Time Period ◽  
Fold Reduction ◽  
Self Harm

Objective: To describe the collaboration between Youth Justice New South Wales (YJNSW) and Justice Health and Forensic Mental Health Network (JHFMHN) during the early COVID-19 Response (CR) across the six Youth Justice centres in NSW, and the reduced incidence of self-harm noted over this period. Methods: Narrative article with analysis of self-harm incident data during the initial CR period of March to May 2020, compared to the same period in 2019. Results: During the initial CR period (March to May 2020), there was a highly significant, four-fold reduction in self-harming incidents recorded by both YJNSW and JHFMHN compared with the equivalent time period in 2019 ( p < .00001). Conclusion: The greater than four-fold reduction in self-harm by young people during the early CR may relate to the ‘interagency response’, with an increase in positive interactions between staff, and between staff and young people. The reduction in self-harm and improvements in mental health will be further explored through standardised interviews with the young people and staff.

The health service contact patterns of people with psychotic and non-psychotic forms of severe mental illness in New South Wales, Australia: A record-linkage study

2021 ◽  
pp. 000486742110314
Author(s):  
Rachael C Cvejic ◽  
Preeyaporn Srasuebkul ◽  
Adrian R Walker ◽  
Simone Reppermund ◽  
Julia M Lappin ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Illness ◽  
Health Service ◽  
Confidence Interval ◽  
Physical Health ◽  
Severe Mental Illness ◽  
New South ◽  
Service Utilisation ◽  
South Wales

Objective: To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. Methods: We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. Results: People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. Conclusion: Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.

scholarly journals Managing organisational change to improve health services for young people with deliberate self harm behaviour

2001 ◽  
Vol 24 (2) ◽  
pp. 143 ◽  
Author(s):  
Margaret J Tobin ◽  
Adam R Clarke ◽  
Richard Buss ◽  
Stewart L Einfeld ◽  
John Beard ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factor ◽  
Young People ◽  
Organisational Change ◽  
Change Strategies ◽  
Deliberate Self Harm ◽  
Completed Suicide ◽  
Service Engagement ◽  
Self Harm ◽  
Improve Health

Repeat Deliberate Self Harm is a recognised risk factor for completed suicide and therefore reduction by effective healthservice response represents a valid contribution to suicide prevention. However, only a small fraction of people withdeliberate self harm presentations to general health settings actually reach specialist mental health follow-upappointments. Therefore, even if responses at that point are known to be effective they do not make a significantcontribution to reducing repeat self-harm overall. We describe health system organisational change strategies to improvehealth service engagement for the target group, and present data demonstrating the effectiveness of these strategies.

The Relationship Between Evidence-Based Practices and Emergency Department Managers’ Perceptions on Quality of Care for Self-Harm Patients

2019 ◽  
Vol 26 (3) ◽  
pp. 288-292
Author(s):  
Amaya H. Diana ◽  
Mark Olfson ◽  
Sara Wiesel Cullen ◽  
Steven C. Marcus
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Teaching Hospitals ◽  
Health Staff ◽  
Evidence Based ◽  
Mental Health Staff ◽  
Evidence Based Practices ◽  
Deliberate Self Harm ◽  
Self Harm

OBJECTIVE: To understand the extent to which implementation of evidence-based practices affects emergency department (ED) nurse managers’ perceptions of quality of care provided to deliberate self-harm patients. METHODS: ED nursing leadership from a nationally representative sample of 513 hospitals completed a survey on the ED management of deliberate self-harm patients, including the quality of care for deliberate self-harm patients on a 1 to 5 point Likert-type scale. Unadjusted and adjusted analyses, controlling for relevant hospital characteristics, examined associations between the provision of evidence-based practices and quality of care. RESULTS: The overall mean quality rating was 3.09. Adjusted quality ratings were higher for EDs that routinely engaged in discharge planning (β = 0.488) and safety planning (β = 0.736) processes. Ratings were also higher for hospitals with higher levels of mental health staff (β = 0.368) and for teaching hospitals (β = 0.319). CONCLUSION: Preliminary findings suggest a national institutional readiness for further implementation of evidence-based practices for deliberate self-harm patients.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (07) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and Method To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis. Results Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P &lt; 0.01) and in older patients (P &lt; 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P &lt; 0.001). Clinical Implications Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

Case Study

2011 ◽  
pp. 191-203
Author(s):  
E. Saurman ◽  
D. Perkins ◽  
D. Lyle ◽  
M. Patfield ◽  
R. Roberts
Keyword(s):  
Mental Health ◽  
Health Service ◽  
New South ◽  
New South Wales ◽  
Health Staff ◽  
Local Health ◽  
Rural And Remote ◽  
South Wales ◽  
Western Area ◽  
Area Health

The MHEC-RAP project involves the innovative application of video conferencing to mental health assessment in rural NSW. The preliminary evaluation findings of the project are presented. Mental health emergencies in rural and remote settings cause particular problems and are not amenable to conventional health service solutions. Patients and local health care staff may be isolated from specialist mental health staff and from acute inpatient services. Decisions to transport patients for specialist assessments or treatment may be required at night or at weekends and may involve families, police, ambulance services and local health staff. Such decisions need to be made promptly but carefully and the ability to obtain a specialist assessment may assist in making a decision about how best to care for the patient bearing in mind the need to provide a responsive, high quality and safe service to patients and local clinicians. In this chapter we examine a novel approach which uses audio-visual technology to conduct remote emergency mental health patient assessment interviews and provide consultations to local clinicians in rural communities in western NSW. The Mental Health Emergency Care – Rural Access Project or ‘MHEC-RAP’ was developed in 2007 following a series of consultations held in rural towns and implemented in 2008 within the Greater Western Area Health Service (GWAHS), New South Wales, Australia. GWAHS is a primary example of a rural and remote health service. It serves 287,481 people (8.3% of whom are Indigenous Australians) in an area that is 445,197sq km or 55% of the state of New South Wales (Australian Bureau of Statistics, 2001; Greater Western Area Health Service, 2007, 2009). The communities within GWAHS are mostly small, the towns are widely dispersed and local services are “limited by distance, expense, transport, and the difficulty of recruiting health professionals to these areas” (Dunbar, 2007 page 587). The chapter focuses on the design of the service, its implementation and its performance in the first year. We conclude with a discussion about the service, its broader relevance, transferability and its sustainability.

The management of young people who self-harm by New Zealand Infant, Child and Adolescent Mental Health Services: cutting-edge or cutting corners?

2018 ◽  
Vol 26 (2) ◽  
pp. 152-159
Author(s):  
Hiran Thabrew ◽  
Ernest Gandeza ◽  
Giselle Bahr ◽  
David Bettany ◽  
Chris Bampton ◽  
...  
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Evidence Based ◽  
Behaviour Therapy ◽  
Self Harm

Objectives: Self-harm is common in New Zealand (NZ) young people and can have short-term and long-term consequences, including suicide. This study was undertaken to examine the extent to which evidence-based approaches for addressing self-harm are offered by Infant, Child and Adolescent Mental Health Services (ICAMHS). Methods: A national survey of ICAMHS practitioners working with young people who self-harm was undertaken between May and July 2016. Results: Responses from 23 out of 30 ICAMHS confirmed self-harm was a familiar presentation and most commonly associated with diagnoses of depression, anxiety and borderline personality disorder. Cognitive behavioural therapy (47.1%, n = 8), dialectical behaviour therapy (47.1%, n = 8) and acceptance and commitment therapy (5.9%, n = 1) were the treatments of choice, but variably delivered. There were significant training gaps for all types of therapy. Conclusions: Although it is reassuring that many ICAMHS are using evidence-based approaches to address self-harm in young people, there is concerning variability in the way these therapies are delivered. Improvement in training in key modalities, further research into therapist performance and continuous evaluation of workforce development are needed to maximise the effectiveness of proven interventions and provide NZ young people with the state-of-the-art service they deserve.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (7) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and MethodTo compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.ResultsFive-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).Clinical ImplicationsPrescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

scholarly journals Health and wellbeing of people with intellectual disability in New South Wales, Australia: a data linkage cohort

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e031624 ◽  
Author(s):  
Simone Reppermund ◽  
Theresa Heintze ◽  
Preeyaporn Srasuebkul ◽  
Rebecca Reeve ◽  
Kimberlie Dean ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Health Service ◽  
Service Use ◽  
New South ◽  
New South Wales ◽  
Data Sets ◽  
Psychiatric Admission ◽  
South Wales ◽  
Wide Range

PurposePeople with intellectual disability (ID) experience high rates of physical and mental health problems, while access to appropriate healthcare is often poor. This cohort was established to develop an epidemiological profile related to the health, health service use, disability services, mortality and corrective services records of people with ID.ParticipantsThe cohort contains 92 542 people with ID (40% females) with a median age of 23 years (IQR: 12–43 years) and 2 004 475 people with a neuropsychiatric or developmental disorder diagnosis (50% females) with a median age of 51 years (IQR: 29–73 years) from New South Wales, Australia. The whole sample contains records for 2 097 017 individuals with most data sets spanning financial years 1 July 2001 to 30 June 2016. A wide range of data from linked population data sets are included in the areas of disability, health, corrective services and targeted specialist support services in public schools, Public Guardian and Ombudsman services.Findings to dateThis study includes one of the largest cohorts of people with ID internationally. Our data have shown that the presence of ID is significantly associated with emergency department presentations and psychiatric readmissions after the first psychiatric admission based on a subcohort of people with a psychiatric admission. Adults with ID experience premature mortality and over-representation of potentially avoidable deaths compared with the general population.Future plansWithin the health service system, we will examine different components, that is, inpatient, emergency adult services, children and younger people services and costs associated with healthcare as well as mortality, cause and predictors of death. The neuropsychiatric and developmental disorders comparison cohort allows comparisons of the physical health, mental health and service use profiles of people with ID and those with other neuropsychiatric disorders.

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