The NSW Emergency Psychiatry Network.

Emergency Psychiatry is evolving. In an environment that lacks a clear evidence base, and where a constellation of factors is driving up Emergency Department presentation rates and lengths of stay, several stakeholders are working towards and clamouring for change. With the goal of collaborating with such parties, we believe Emergency Psychiatrists should position themselves to establish and advocate for best-practice change in culture, research, clinical care and training, and funding in the provision of mental health crisis care. To this end, we have formed the NSW Emergency Psychiatry Network, a group of Emergency Psychiatrists with a broad experience in a range of settings, from tertiary metropolitan emergency facilities with access to subspecialty psychiatric services, to rural and remote emergency settings with sporadic in-reach from local mental health services and telehealth. We unanimously recognise the need to upskill both Emergency Department and Mental Health clinicians in crisis care, and the need for committed, evidence-based Mental Health resourcing within Emergency Departments.

Clinical pathways for suicidality in emergency settings: a public health priority.

Rates of self-harm in Australia are increasing and constitute a concerning public health issue. Although there are standard treatment pathways for physical complaints, such as headache, abdominal pain and chest pain, in Emergency Medicine, there is no national pathway for self-harm or other psychiatric conditions that present to the emergency department. Herein we outline the difference between clinical practice guidelines and clinical pathways, discuss pathways we have identified on self-harm in Australia and overseas and discuss their applicability to the Australian context and the next steps forward in addressing this public health issue.

Assessing and managing suicidal patients in the emergency department.

OBJECTIVE: The objective of this article is to set out consensus guidelines for the assessment and management of "suicidal patients" in the emergency department. CONCLUSIONS: Clinicians should be respectful and reassuring. They should review old notes, conduct a full history and examination, and talk to friends, family and any practitioners already involved in the patient's care. Management should be guided, where possible, by the patient's preferences, not by notions of risk. Every negotiated management plan and its rationale should be carefully documented.

The Breivik controversy: politics, terrorism and psychiatry.

OBJECTIVES: To examine and analyse the controversy over psychiatric aspects of the case of Norwegian far right mass murderer Anders Behring Breivik. CONCLUSIONS: Because of a basic acceptance of methodological individualism and scientific positivism, mainstream psychiatry is currently ill suited to being broadly applied to the spheres of politics and political violence. Rather than jettison psychiatric insights in such cases, the choices facing the profession are either to accept the narrowness of its utility or to work towards a theoretical framework that sees the individual psyche as socially embedded rather than as socially constitutive, and psychiatric science itself as socially constructed and hence inescapably value-laden.

What makes a hospital-based psychiatry training program successful? The experience of St Vincent's Hospital, Sydney.

OBJECTIVES: The purpose of this paper is to describe those features that have contributed to the popularity and success of the psychiatry training program at St Vincent's Hospital, Sydney, and to discuss the factors that potentially weaken the program and how these might be addressed. CONCLUSIONS: The strengths of the psychiatry training program at St Vincent's Hospital are the high rate of recruitment of junior medical officers to psychiatry training, the provision of quality in-house teaching, the in-house provision of psychotherapy supervision and exam preparation, the positive influence of the chief psychiatry registrar, having enough trainees to alleviate the tension between training and service delivery, and the availability of a variety of 'extra', high-quality, professional development opportunities.