A new bottom-up method for the standard analysis and comparison of workforce capacity in mental healthcare planning: Demonstration study in the Australian Capital Territory

The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument—the Description and Evaluation of Services and Directories—DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.

Download Full-text

A comparison of the reported use of involuntary treatment orders within Australian jurisdictions

Australasian Psychiatry ◽

10.1177/1039856218789787 ◽

2018 ◽

Vol 26 (5) ◽

pp. 482-485 ◽

Cited By ~ 1

Author(s):

Bobbie Clugston ◽

Amy Young ◽

Edward B Heffernan

Keyword(s):

Mental Health ◽

South Australia ◽

Health Department ◽

Public Reporting ◽

Annual Reports ◽

Involuntary Treatment ◽

Justice Department ◽

Australian Capital Territory ◽

Australian Capital

Objective: This paper identifies publicly available data about the use of involuntary treatment orders within Australia and considers whether this reporting is sufficient given the gravity of the intervention. Method: A search of mental health tribunal, health department and justice department annual reports was conducted to determine the use of involuntary treatment orders in Australia. Results: Reporting of involuntary treatment orders varied significantly across jurisdictions; for example, South Australia reported 11,570 distinct orders made during a 12-month period while the Australian Capital Territory reported 627 for the same period. Conclusion: The publicly available data for involuntary treatment orders in Australia is inadequate for jurisdictional comparisons. This concern should be addressed to enable transparent public reporting and facilitate benchmarking.

Download Full-text

Patterns of use of the Mental Health Act 1983, from 2007–2008 to 2016–2017, in two major London secondary mental healthcare providers

BJPsych Open ◽

10.1192/bjo.2019.84 ◽

2019 ◽

Vol 5 (6) ◽

Author(s):

Sian Oram ◽

Craig Colling ◽

Megan Pritchard ◽

Mizanur Khondoker ◽

Daniela Fonseca de Freitas ◽

...

Keyword(s):

Mental Health ◽

Healthcare Providers ◽

Mental Healthcare ◽

Fiscal Year ◽

Historical Cohort ◽

Patient Level ◽

Mental Health Act ◽

Patterns Of Use ◽

Level Data ◽

Active Patients

Summary Trends in detention under the Mental Health Act 1983 in two major London secondary mental healthcare providers were explored using patient-level data in a historical cohort study between 2007–2008 and 2016–2017. An increase in the number of detention episodes initiated per fiscal year was observed at both sites. The rise was accompanied by an increase in the number of active patients; the proportion of active patients detained per year remained relatively stable. Findings suggest that the rise in the number of detentions reflects the rise of the number of people receiving secondary mental healthcare.

Download Full-text

The effect of changes to Australian Capital Territory mental health legislation on rates of emergency detention

Australasian Psychiatry ◽

10.1177/1039856221992637 ◽

2021 ◽

pp. 103985622199263

Author(s):

Miriam Saffron ◽

Deepa Singhal

Keyword(s):

Mental Health ◽

Mental Health Treatment ◽

Psychiatric Treatment ◽

Cross Sectional Study ◽

Australian Capital Territory ◽

Cross Sectional ◽

Australian Capital ◽

Period 2 ◽

Mental Health Legislation ◽

Health Legislation

Objectives: The Australian Capital Territory (ACT) changed from the Mental Health (Treatment and Care) Act 1994 (ACT) to the Mental Health Act 2015 (ACT) on 1 March 2016. The objective was to find the association between legislative changes and detention rates. Methods: A cross-sectional study of involuntary order rates in the period 3 years before the legislative change was undertaken. Chi-squared analysis was performed to compare proportions. Results: There was a statistically significant decrease in the proportion of Psychiatric Treatment Orders (PTOs) over the two periods, which could be impacted by the change from a period of detention for 7 days to a period of detention of 11 days in Period 2. On the other hand, the total number of Emergency Actions (EAs) increased in Period 2, where ambulance officers could detain patients. Conclusion: The change in mental health legislation in the ACT was associated with a change in detention rates, in particular a decrease in the proportion of PTOs and an increase in EAs. Further study needs to be undertaken, given changes to frontline supports since the study period ended.

Download Full-text

The Indonesian Mental Health Act: psychiatrists’ views on the act and its implementation

Health Policy and Planning ◽

10.1093/heapol/czaa139 ◽

2020 ◽

Author(s):

Annemieke P Bikker ◽

Cokorda Bagus Jaya Lesmana ◽

Niko Tiliopoulos

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Local Level ◽

Healthcare Providers ◽

Mental Healthcare ◽

Implementation Process ◽

Structured Interview ◽

Evidence Base ◽

Political Issue ◽

Mental Health Act

Abstract In 2014, the Indonesian government passed the Mental Health Act (MHA) to address the country’s complex mental health situation. The implementation of the MHA has been slow, and little is known about how the MHA is perceived by mental healthcare providers within local settings. This study aimed to obtain insight into psychiatrists’ views on the MHA, including on how it affected their clinical practice and on challenges of translating the MHA into practice. The study was conducted in Bali, and 27 psychiatrists (15 men and 12 women) participated in a semi-structured interview. Thematic analysis indicated four overarching themes: raising the profile of mental health, developing a shared understanding of mental illness, integrating psychiatric practice with other services and views on implementation of the MHA into practice. Overall, the psychiatrists viewed the MHA as a step in the right direction to improve mental health services and to create awareness at local and national levels. However, there was consensus that the meaning of the MHA’s concepts of mental problems and disorders were not compatible with psychiatric everyday practice or their patients’ understandings. As a result, many assumed that the MHA was targeted at government and policy officials. Furthermore, there was a perceived lack of clarity on issues relating to collaborating with other services and unequal access to resources among regencies that impacted on their clinical practice in a negative way. Moreover, a few psychiatrists raised concerns that local beliefs and practices were not acknowledged in the MHA. According to the participants, mental health remained a highly political issue and without national support, mental health would remain a low priority. In conclusion, insights into providers’ perspectives contribute to developing an evidence-base that can inform the implementation process of the MHA in Indonesia, and possibly elsewhere, into local level guidelines and regulations.

Download Full-text

Scaling up mental healthcare in the Republic of Niger: priorities for and barriers to service improvement

BJPsych International ◽

10.1192/s2056474000000763 ◽

2015 ◽

Vol 12 (S1) ◽

pp. S-6-S-9

Author(s):

Alison Hwong ◽

Djibo Maiga Douma ◽

Soumana Zamo ◽

Julian Eaton

Keyword(s):

Mental Health ◽

Health Workers ◽

Health Centre ◽

National Level ◽

Scale Up ◽

Mental Healthcare ◽

Traditional Healers ◽

World Health ◽

Service Improvement ◽

Local Health

As part of a pilot programme to scale up community mental health services, local health centre directors, community health workers and key informants were interviewed in two neighbouring political districts of Niger. Major priorities for improving services included training staff on the diagnosis and treatment of mental illness, collaborating with traditional healers, educating the community about the origins of psychiatric illness and building infrastructure for medication delivery. Barriers to care included long distances for travel to the nearest hospital and lack of funding for home-based visits by health workers. This study was the first step in Niger's plan to implement the World Health Organization's Mental Health Gap Action Programme (mhGAP) at a national level.

Download Full-text

The role of regional planning and management strategies in the transformation of the healthcare system

Health Services Management Research ◽

10.1258/095148403762539149 ◽

2003 ◽

Vol 16 (1) ◽

pp. 56-69 ◽

Cited By ~ 5

Author(s):

Marie-Josée Fleury ◽

Jean-Louis Denis ◽

Claude Sicotte

Keyword(s):

Mental Health ◽

Healthcare System ◽

Regional Planning ◽

Local Level ◽

Management Strategies ◽

Health Sector ◽

Mental Healthcare ◽

Public Healthcare ◽

Planning And Management

Drawing on a case study, this article questions the role of planning and management strategies in the process of transforming a regional public healthcare system that involves a number of organizations and is characterized by fluidity in its functions and division of power. It examines the efficacy of the Regional Plan for the Organization of Health Services (PROS) in reforming the mental health sector in a health and social service district in Quebec, in terms of integrated regional management of mental healthcare and activities at the local level. The regional planning procedure involves a major transformation in management of the mental health system, organizational roles and clinical and professional practices. Our assessment of PROS highlights the importance of taking into account the context of implementation and the instrumental value of planning, before judging its efficacy. To transform a complex healthcare system at the regional and local level, the study suggests a revised conception of the main roles played by planning and of the process shaping its implementation. Our study concludes in favour of developing management strategies at the operational, clinical and professional levels, and integrating them as a planning aid that allows a more corporate and matrix-based system to be set up.

Download Full-text

Physical and Mental Health Effects of Bushfire and Smoke in the Australian Capital Territory 2019–20

Frontiers in Public Health ◽

10.3389/fpubh.2021.682402 ◽

2021 ◽

Vol 9 ◽

Author(s):

Rachael M. Rodney ◽

Ashwin Swaminathan ◽

Alison L. Calear ◽

Bruce K. Christensen ◽

Aparna Lal ◽

...

Keyword(s):

Mental Health ◽

Physical Health ◽

Health Effects ◽

Online Survey ◽

Prolonged Exposure ◽

Health Practitioner ◽

Australian Capital Territory ◽

Physical And Mental Health ◽

Australian Capital ◽

Eastern Australia

The 2019–20 bushfire season in south-eastern Australia was one of the most severe in recorded history. Bushfire smoke-related air pollution reached hazardous levels in major metropolitan areas, including the Australian Capital Territory (ACT), for prolonged periods of time. Bushfire smoke directly challenges human health through effects on respiratory and cardiac function, but can also indirectly affect health, wellbeing and quality of life. Few studies have examined the specific health effects of bushfire smoke, separate from direct effects of fire, and looked beyond physical health symptoms to consider effects on mental health and lifestyle in Australian communities. This paper describes an assessment of the health impacts of this prolonged exposure to hazardous levels of bushfire smoke in the ACT and surrounding area during the 2019–20 bushfire season. An online survey captured information on demographics, health (physical and mental health, sleep) and medical advice seeking from 2,084 adult participants (40% male, median age 45 years). Almost all participants (97%) experienced at least one physical health symptom that they attributed to smoke, most commonly eye or throat irritation, and cough. Over half of responders self-reported symptoms of anxiety and/or feeling depressed and approximately half reported poorer sleep. Women reported all symptoms more frequently than men. Participants with existing medical conditions or poorer self-rated health, parents and those directly affected by fire (in either the current or previous fire seasons) also experienced poorer physical, mental health and/or sleep symptoms. Approximately 17% of people sought advice from a medical health practitioner, most commonly a general practitioner, to manage their symptoms. This study demonstrated that prolonged exposure to bushfire smoke can have substantial effects on health. Holistic approaches to understanding, preventing and mitigating the effects of smoke, not just on physical health but on mental health, and the intersection of these, is important. Improved public health messaging is needed to address uncertainty about how individuals can protect their and their families health for future events. This should be informed by identifying subgroups of the population, such as those with existing health conditions, parents, or those directly exposed to fire who may be at a greater risk.

Download Full-text

The EPA Guidance Project: Guidance for Mental Healthcare in Europe

Die Psychiatrie ◽

10.1055/s-0038-1669868 ◽

2015 ◽

Vol 12 (01) ◽

pp. 5-11

Author(s):

I. Großimlinghaus ◽

J. Zielasek ◽

W. Gaebel

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Graduate Training ◽

Action Plan ◽

Stakeholder Involvement ◽

Mental Healthcare ◽

World Health ◽

Post Graduate Training ◽

Health Organization

Summary Background: The development of guidelines is an important and common method to assure and improve quality in mental healthcare in European countries. While guidelines have to fulfill predefined criteria such as methodological accuracy of evidence retrieval and assessment, and stakeholder involvement, the development of guidance was not standardized yet. Aim: In 2008, the European Psychiatric Association (EPA) initiated the EPA Guidance project in order to provide guidance in the field of European psychiatry and related fields for topics that are not dealt with by guideline developers – for instance due to lack of evidence or lack of funding. The first three series of EPA Guidance deal with diverse topics that are relevant to European mental healthcare, such as quality assurance for mental health services, post-graduate training in mental healthcare, trust in mental health services and mental health promotion. Results: EPA Guidance recommendations address current and future challenges for European psychiatry. They are developed in accordance with the World Health Organization (WHO) European Mental Health Action Plan.

Download Full-text