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.

The Gravely Inadequate Definition of a “Mentally Ill Person” in the Mental Health Act (New South Wales) 1983

1988 ◽  
Vol 22 (1) ◽  
pp. 43-68 ◽  
Author(s):  
James Durham
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Mentally Ill ◽  
New South ◽  
Involuntary Hospitalization ◽  
Main Structure ◽  
Working Definition ◽  
South Wales ◽  
Definition Of

The definition, given in Section 5 of the new Act, of a “mentally ill person” is examined. It is argued that this “definition” is cumbersome, logically incoherent, and impractical. It is predicted that if given effect it will have very unwelcome consequences. Various sources of inherent misunderstanding and uncertainty are noted. Arguments are presented for allowing severe mental illness itself rather than its consequences to be the ground for involuntary hospitalization in certain circumstances. Various suggestions are proposed for the Section's amendment. These fall into two categories, depending upon alternative assumptions: (1) minor improvements, upon the pessimistic assumption that the main structure and content of the definition will be retained; (2) more radical amendment, involving the abandonment of the entire present structure of the section, and the adoption of a working definition of “mental illness” with clear safeguards against error and abuse. The nature and requirements of such a definition are discussed.

scholarly journals Protocol for the Data-Linkage Alcohol Cohort Study (DACS): investigating mortality, morbidity and offending among people with an alcohol-related problem using linked administrative data

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030605
Author(s):  
Amy Peacock ◽  
Vivian Chiu ◽  
Janni Leung ◽  
Timothy Dobbins ◽  
Sarah Larney ◽  
...  
Keyword(s):  
Law Enforcement ◽  
Alcohol Use ◽  
Health Service ◽  
New South ◽  
Healthcare Services ◽  
Health Service Utilisation ◽  
Service Utilisation ◽  
Problematic Alcohol ◽  
South Wales ◽  
Problematic Alcohol Use

IntroductionThe aims of this program of research are to use linked health and law enforcement data to describe individuals presenting to emergency and inpatient healthcare services with an acute alcohol harm or problematic alcohol use; measure their health service utilisation and law enforcement engagement; and quantify morbidity, mortality, offending and incarceration.Methods and analysisWe will assemble a retrospective cohort of people presenting to emergency departments and/or admitted to hospitals between 1 January 2005 and 31 December 2014 in New South Wales, Australia with a diagnosis denoting an acute alcohol harm or problematic alcohol use. We will link these data with records from other healthcare services (eg, community-based mental healthcare data, cancer registry), mortality, offending and incarceration data sets. The four overarching areas for analysis comprise: (1) describing the characteristics of the cohort at their first point of contact with emergency and inpatient hospital services in the study period with a diagnosis indicating an acute alcohol harm and/or problematic alcohol use; (2) quantifying health service utilisation and law enforcement engagement; (3) quantifying rates of mortality, morbidity, offending and incarceration; and (4) assessing predictors (eg, age, sex) of mortality, morbidity, offending and incarceration among this cohort.Ethics and disseminationEthics approval has been provided by the New South Wales Population and Health Services Research Ethics Committee. We will report our findings in accordance with the REporting of studies Conducted using Observational Routinely collected health Data (RECORD) statement and Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) where appropriate. We will publish data in tabular, aggregate forms only. We will not disclose individual results. We will disseminate project findings at scientific conferences and in peer-reviewed journals. We will aim to present findings to relevant stakeholders (eg, addiction medicine and emergency medicine specialists, policy makers) to maximise translational impact of research findings.

Metabolic Syndrome Screening in People With Severe Mental Illness: Results From Two Spanish Community Mental Health Centers

2019 ◽  
Vol 26 (2) ◽  
pp. 162-171 ◽  
Author(s):  
Sara Fernández Guijarro ◽  
Carolina Miguel García ◽  
Edith Pomarol-Clotet ◽  
Elena Nunilón Egea López ◽  
Maria Dolors Burjales Martí ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Metabolic Syndrome ◽  
Mental Illness ◽  
Community Mental Health ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Health Centers ◽  
Community Mental Health Centers ◽  
Mental Health Centers

BACKGROUND: The excess of mortality in people with severe mental illness is due to unnatural causes such as accidents or suicides and natural causes such as metabolic syndrome. The presence of modifiable risk factors like tobacco consumption increases cardiovascular and metabolic risk. AIMS: The purpose of this study was to identify the prevalence of metabolic syndrome and other cardiovascular risk factors in people with severe mental illness. This study also aimed to identify the prevalence of patients receiving treatment for any metabolic syndrome risk factor. METHOD: A cross-sectional descriptive study was performed. A total of 125 participants from two community mental health centers in Spain were recruited. RESULTS: More than half of the participants (58.4%) were active smokers. The prevalence of metabolic syndrome was 60%. A total of 16.8% received previous treatment for hypertension, 17.6% for hypertriglyceridemia, and 11.2% for diabetes. No differences were found between centers (22.7% vs. 18.7%, p = .9). CONCLUSIONS: The findings underscore the importance of monitoring the physical health of patients on antipsychotic therapy. The identification and management of cardiovascular and metabolic risks factors is an essential part of nursing care for people with severe mental illness. Mental health nurses are ideally positioned to carry out this task by performing physical health screening, health education, and lifestyle interventions.

Acute mental health service use by patients with severe mental illness after discharge to primary care in South London

2015 ◽  
Vol 24 (4) ◽  
pp. 208-213 ◽  
Author(s):  
Parashar P Ramanuj ◽  
Carlos FA Carvalho ◽  
Robert Harland ◽  
Philippa A Garety ◽  
Tom KJ Craig ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Service ◽  
Health Service ◽  
Severe Mental Illness ◽  
Service Use ◽  
Mental Health Service Use ◽  
Health Service Use

Are people with severe mental illness ready for online interventions? Access and use of the Internet in Australian mental health service users

2017 ◽  
Vol 25 (3) ◽  
pp. 257-261 ◽  
Author(s):  
Neil Thomas ◽  
Fiona Foley ◽  
Katrina Lindblom ◽  
Stuart Lee
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Health Service ◽  
Severe Mental Illness ◽  
Social Networking Sites ◽  
Internet Access ◽  
Health Service Delivery ◽  
The Internet ◽  
Mental Health Service Delivery

Objectives: The Internet is increasingly used in mental health service delivery, but there are significant potential barriers to Internet access for persons with severe mental illness (SMI). There is a need to understand this group’s access to, and confidence with using, the Internet, and current views on using online resources as part of mental healthcare. Method: A survey was conducted of 100 consumers attending a specialist mental health service in Melbourne, Australia. Results: Approximately three-quarters of participants had regular access to the Internet, and two-thirds used the Internet weekly or more. Half of the sample used email at least weekly, and a third were regular users of social networking sites. Internet access was often via mobile devices. Only a minority of participants used the Internet for mental health information, with video streaming and general websites accessed more often than peer forums for mental health content. Most participants were positive about their mental health worker using tablet computers with them in appointments for delivery of mental health materials. Conclusion: Most people with SMI are active Internet users and, therefore, able to use interventions online.

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.

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.

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