Patterns of Service Provision in Older People's Mental Health Care in Australia.

Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.

Mental Health Commissions: making the critical difference to the development and reform of mental health services.

PURPOSE OF REVIEW: Several Mental Health Commissions (MHCs) have emerged in developed countries over recent years, often in connection with mental health reform strategies. It is timely to consider the types of MHC which exist in different countries, their characteristics which may contribute to making them more effective, and any possible limitations and concerns raised about them. RECENT FINDINGS: The emerging literature on MHCs indicates, particularly with the wider types of MHCs, that they may contribute to the substantial enhancement of mental health resources and sustainability of services; mental health reform is much more likely to be implemented properly with an independent monitor such as a MHC which has official influence at the highest levels of government; and they can encourage, champion and monitor the transformation of services into more evidence-based, community-centred, recovery-oriented, consumer, family and human rights-focused mental health services. SUMMARY: The advent of MHCs may enhance the resourcing, quality and consistency of distribution of effective clinical practices and crucial support services, and foster more relevant practice-based research. MHC variants can work in different countries and the model can be adapted to state jurisdictions, single state nations and federated systems of government, without duplicating bureaucracies. Achievements and possible limitations are considered.

Psychiatrically impaired medical practitioners: better care to reduce harm and life impact, with special reference to impaired psychiatrists.

OBJECTIVE: The aims are to briefly review treatment outcomes for impaired practitioners, and to explore how preventive and early intervention, and the accessing of and retention within treatment systems for impaired medical practitioners, and particularly psychiatrists, could be improved to maximize the doctors' chances of full recovery and to minimize danger to self and others. METHODS: The literature on the treatment and care of medical practitioner impairment due to mental illness, and substance use, with special reference to impaired psychiatrists is briefly reviewed. The implications of deficiencies of usual clinical management of doctors impaired by mental illness and opportunities for improvement in services for them are explored, including the impact of the experience of being an impaired medical practitioner under psychiatric treatment. The roles of medical boards and advisory services are examined. RESULTS: Medical practitioner impairment due to mental illness has a severe impact on doctors' lives and the lives of their families due to both the effects of the disorder and the experience of communal, professional and self stigma and discrimination. Deficiencies in usual practice in the treatment and rehabilitation of such individuals are identified, and alternatives explored. CONCLUSIONS: Prevention, early detection, intervention, and treatment programs that are more continuous more sensitive to the needs of impaired practitioners, that are more continuous, better structured, and rehabilitation and recovery focused, may be more likely to produce a positive outcome.

General Practice care of enduring mental health problems: an evaluation of the Wellington Mental Health Liaison Service.

AIMS: To describe the development and evaluation of a primary care service for a population of mental health consumers who had previously been predominantly cared for by a specialist service. METHODS: Consumers were interviewed at regular intervals after entry to the programme. The Health of the Nation Outcomes Scale (HoNOS) and the Life Skills Profile (LSP) outcomes measures were used with consumers at intervals of 0,3,6,12 and 18 months after entry to the programme. A cost comparison was made between services provided to consumers in the year before entry to the programme, and after entry. RESULTS: Consumers reported no deterioration in their clinical condition while under the care of general practitioners, and they were largely satisfied with general practitioner care. Consumers' LSP scores were stable after entry to the programme. General practitioners were initially ambivalent about the programme, but were more supportive after 12 months had elapsed. The education provided to general practitioners, nurses, and receptionists was strongly welcomed. CONCLUSIONS: With carefully designed training and support, general practice can provide high-quality community-based mental healthcare for consumers with enduring mental health disorders, and it can support the introduction of integrated mental health care initiatives.