Our Healthy Clarence: A Community-Driven Wellbeing Initiative.

In 2015-2016, the Clarence Valley in Northern New South Wales, Australia, experienced an unexpectedly high number of deaths by suicide, and the resulting distress was exacerbated by unhelpful press coverage. The local response was to adopt a community-wide positive mental health and wellbeing initiative. This paper describes the process and achievements of the initiative called 'Our Healthy Clarence'. Key stakeholders were interviewed at year two and relevant documents reviewed. Data were analysed using document and thematic analysis. Our Healthy Clarence was established following community consultation, including forums, interviews, surveys and workshops. It adopted a strengths-based approach to suicide prevention, encompassing positive health promotion, primary and secondary prevention activities, advocacy, and cross-sectoral collaboration. A stakeholder group formed to develop and enact a community mental health and wellbeing plan. Factors contributing to its successful implementation included a collective commitment to mental health and wellbeing, clarity of purpose, leadership support from key local partners, a paid independent coordinator, and inclusive and transparent governance. Stakeholders reported increased community agency, collaboration, optimism and willingness to discuss mental health, suicide and help-seeking. Our Healthy Clarence draws ideas from mental health care, community development and public health. This initiative could serve as a model for other communities to address suicide, self-harm and improve wellbeing on a whole-of-community scale.

Cost analysis of an integrated aged care program for residential aged care facilities.

Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents. Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District. ACE was implemented in 69 RACFs in the Hunter region of NSW, Australia. Analysis used 14 weeks of ACE and ED service data (June-September 2014). The main outcome measure was the net cost and saving from ACE compared with usual care. It is based on the opportunity cost of implementing ACE and the opportunity savings of ED presentations avoided. Results Our analysis estimated that 981 avoided ED presentations could be attributed to ACE annually. Compared with usual care, ACE saved an estimated A$921214. Conclusions The ACE service supported a reduction in avoidable ED presentations and ambulance transfers among RACF residents. It generated a cost saving to health service providers, allowing reallocation of healthcare resources. What is known about the topic? Residents from RACFs are at risk of further deterioration when admitted to hospital, with high rates of delirium, falls, and medication errors. For this cohort, some conditions can be managed in the RACF without hospital transfer. By addressing avoidable presentations to EDs there is an opportunity to improve ED efficiency as well as providing care that is consistent with the resident's goals of care. RACFs generate some avoidable ED presentations for residents who may be more appropriately treated in situ. What does this paper add? Telephone triaging with nursing support and training is a means by which ED presentations from RACFs can be reduced. One of the consequences of this intervention is 'cost avoided', largely through savings on ambulance costs. What are the implications for practitioners? Unnecessary transfer from RACFs to ED can be avoided through a multicomponent program that includes telephone support with cost-saving implications for EDs and ambulance services.

Feasibility and acceptability of strategies to address mental health and mental ill-health in the Australian coal mining industry.

BACKGROUND: To evaluate the feasibility, acceptability and effectiveness of implementing a peer-based, multi-component mental health program in the Australian coal mining industry. METHODS: The multicomponent program included MATES in mining (a peer-based mental health and suicide prevention program) and supervisor training. Eight Australian coal mines participated in the research, with four mines receiving the mental health program. Primary outcome variables including mental health stigma, help-seeking behaviour and perception of the workplace commitment to mental health were measured prior to program implementation, and then again 10 months following using a paper based survey. Process evaluation of the mental health program was measured using a pre-test/post-test survey. RESULTS: MATES in mining 1275 miners participated in the MATES general awareness and connector training. Participants were more confident that they could identify a workmate experiencing mental ill-health; help a workmate, family member or themselves identify where to get support and were more willing to start a conversation with a workmate about their mental health. Supervisor training 117 supervisors completed the supervisor training and were subsequently more confident that they could: identify someone experiencing mental ill-health in the workplace; identify and recommend support services to a person experiencing mental ill-health; and have an effective conversation about performance issues that may be due to mental ill-health. CONCLUSIONS: Our findings show evidence to support the use of peer-based mental health programs in the mining industry, and for male-dominated industry more broadly.

The Contribution of Individual, Social and Work Characteristics to Employee Mental Health in a Coal Mining Industry Population.

BACKGROUND: Evidence regarding the extent of mental health problems and the associated characteristics within an employee population is necessary to inform appropriate and tailored workplace mental health programs. Mental health within male dominated industries (such as mining) has received recent public attention, chiefly through observations regarding suicide in such populations in Australia and internationally. Currently there is limited empirical evidence regarding the mental health needs in the mining industry as an exemplar of a male dominated workforce, and the relative contribution to such problems of individual, socio-economic and workplace factors. This study aimed to investigate the mental health and associated characteristics among employees in the Australian coal mining industry with a specific focus on identifying modifiable work characteristics. METHODS: A cross-sectional study was conducted among employees (n = 1457) across eight coal mines stratified by key mine characteristics (state, mine type and employee commute arrangements). Participants completed measures of psychological distress (K10+) and key variables across four categories (socio-demographic characteristics, health history, current health behaviours, work attitudes and characteristics). RESULTS: Psychological distress levels within this sample were significantly higher in comparison with a community sample of employed Australians. The following factors contributed significantly to levels of psychological distress using hierarchical linear regression analysis: lower social networks; a past history of depression, anxiety or drug/alcohol problems; high recent alcohol use; work role (managers) and a set of work characteristics (level of satisfaction with work, financial factors and job insecurity; perception of lower workplace support for people with mental health problems. CONCLUSION: This is the first study to examine the characteristics associated with mental health problems in the Australian coal mining industry. The findings indicate the salience of mental health needs in this population, and the associated interplay of personal, social and work characteristics. The work characteristics associated with psychological distress are modifiable and can guide an industry response, as well as help inform the understanding of the role of workplace factors in mental health problems in a male dominated workforce more generally.

Alcohol consumption in the Australian coal mining industry.

OBJECTIVES: To investigate patterns of alcohol use within the coal mining industry, and associations with the personal, social, workplace and employment characteristics. DESIGN: 8 mine sites across 3 eastern Australian states were surveyed, selected to encompass key geographic characteristics (accessibility and remoteness) and mine type (open cut and underground). Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT) to determine: (1) overall risky or hazardous drinking behaviour; and (2) frequency of single-occasion drinking (6 or more drinks on 1 occasion). RESULTS: A total of 1457 employees completed the survey, of which 45.7% of male and 17.0% of female participants reported levels of alcohol use within the range considered as risky or hazardous, considerably higher than the national average. Hierarchical linear regression revealed a significant contribution of many individual level factors associated with AUDIT scores: younger age, male, current smoking status; illicit substance use; previous alcohol and other drug use (AOD) problems; and higher psychological distress. Workplace factors associated with alcohol use included working in mining primarily for the high remuneration, and the type of mining, with underground miners reporting higher alcohol use than open-cut miners. CONCLUSIONS: Our findings provide support for the need to address alcohol use in the coal mining industry over and above routine on-site testing for alcohol use.

A Cluster Randomised Controlled Trial of a Brief Child Health Nurse Intervention to Reduce Infant Secondhand Smoke Exposure.

Background Exposure to secondhand smoke (SHS) is a significant contributor to ill health in children. A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans. Methods This study was a 3 arm, cluster randomised controlled trial. Clusters were 39 community based well child health clinics in one local area health service. Clinics were stratified according to annual number of client appointments and then randomly assigned in a 1:1:1 ratio, (Intervention 1: Intervention 2: Control), with 13 clinics in each cluster. Parents/carers of infants in the intervention groups received a brief multi-strategic intervention from child health nurses during clinic consultations. Treatment condition 1 included computer delivered risk assessment and feedback and nurse brief advice. Treatment condition 2 included all elements of Treatment condition 1 with the addition of biochemical feedback of infant SHS exposure. Results When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 (OR 1.16, 95 % CI 0.73-1.85, p = 0.53) or Treatment condition 2 (OR 1.30, 95 % CI 0.88-1.92, p = 0.19) Similarly, no significant differences were detected in the proportion of parent/carers who reported that they were smokers (T1:OR 0.95, 95 % CI 0.78-1.15, p = 0.58 and T2:OR 0.97, 95 % CI 0.80-1.18, p = 0.77), or in the proportion of households reported to have a complete smoking ban (T1:OR 1.21, 95 % CI 0.89-1.64, p = 0.23 and T2:OR 1.06, 95 % CI 0.79-1.43, p = 0.68). Conclusions Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.

Help-seeking for mental health problems by employees in the Australian Mining Industry.

BACKGROUND: The current study examined help-seeking behavior for mental health problems of employees in the mining industry. METHODS: The research involved a paper-based survey completed by a cross-section of employees from eight coalmine sites. The research aimed to investigate the frequency of contact with professional and non-professional sources of support, and to determine the socio-demographic and workplace factors associated. RESULTS: A total of 1,457 employees participated, of which, 46.6 % of participants reported contact with support to discuss their own mental health within the preceding 12 months. Hierarchical logistic regression revealed a significant contribution of workplace variables, with job security and satisfaction with work significantly associated with help-seeking behavior. CONCLUSIONS: The results provide an insight into the help-seeking behaviour of mining employees, providing useful information to guide mental health workplace program development for the mining industry, and male-dominated industry more broadly.

The Economic Impact of Psychological Distress in the Australian Coal Mining Industry.

OBJECTIVE: The aim of this study was to estimate the economic impact of psychological distress among employees of the Australian Coal Mining Industry. METHODS: Sample data were gathered from 1456 coal mining staff across eight sites in two Australian states. Two measures were taken of work time lost over four weeks due to psychological distress: (1) full-day absences; (2) presenteeism. Lost work time was valued using hourly wages. Sample data was modeled to estimate annual monetary losses for the Australian Coal Mining Industry. RESULTS: For the sample, estimated annual value of time lost due to psychological distress was $4.9 million ($AUS2015) ($0.61 million per mine), and for the Australian Coal Mining Industry, $153.8 million ($AUS2015). CONCLUSION: Psychological distress is a significant cost for the Australian Coal Mining Industry. Relevant intervention programs are potentially cost-effective.

Strategies and outcomes in translating alcohol harm reduction research into practice: the Alcohol Linking Program.

Harm associated with consumption of alcohol on licensed premises is an issue of community concern. Interventions to reinforce responsible sale of alcohol such as server training and accords between licensees, police and health advocates are well known. However, while generally supported by police and licensees as 'a good thing', evaluations demonstrating that they reduce alcohol-related harm are rare. Lack of enforcement is often an issue. This paper reports on system intervention to enhance police enforcement of liquor laws by providing data-based feedback to police and licensees about alcohol-related crime following drinking on specific licensed premises. The system has been shown to contribute to a reduction of alcohol-related crime and has been adopted into routine practice by NSW police state-wide. It is a good example of how research can be conducted in a way that bridges the gap between policy research and policy practice.

Monitoring and educational feedback to improve the compliance of tattooists and body piercers with infection control standards: a randomized controlled trial.

OBJECTIVES: Blood-borne viruses, which present a grim health and economic burden for both developed and developing countries, can be transmitted through tattooing and piercing. Limited data exist concerning intervention strategies for increasing skin penetration operators' compliance with infection control standards. We evaluated the efficacy and acceptability of an educational feedback intervention for tattooists and piercers. METHODS: A randomized controlled trial was conducted in Sydney, NSW, Australia, among 37 tattooing and body-piercing premises in 2002. RESULTS: No effects were found in terms of improved knowledge. There was a significantly greater increase in the experimental group in the perceived risk of being detected and penalized for noncompliance. There was a significantly greater improvement in the demonstration of 2 of 3 infection control procedures and a nonsignificant trend toward greater improvement in inspection scores in the experimental group. The odds of compliance were significantly higher in the experimental group for 2 of the 3 demonstration practices and in 2 of 5 observed infection control practices. CONCLUSION: The findings contribute new information concerning alternative approaches to increasing tattooists and piercers' infection control compliance with regulations/guidelines.

Skin penetration operators' knowledge and attitudes towards infection control.

OBJECTIVES: To assess the knowledge and attitudes of owners/managers of commercial skin-penetration premises regarding infection control. METHODS: A telephone survey was conducted with a randomly selected sample of 874 owners/managers. RESULTS: Participants appeared to lack knowledge of essential infection-control practices. Less than 39% correctly identified recommended disinfection procedures, and between 12% to 67% were not aware of inappropriate sterlization procedures. Almost all participants accepted the need for guidelines. Half acknowledged a need to improve their infection-control compliance, and most accepted having their premises regularly checked by the councils. CONCLUSIONS: There is a considerable opportunity to increase infection-control compliance among skin-penetration operators.

Novel strategy to stop cigarette smoking by surgical patients: pilot study in a preadmission clinic.

BACKGROUND: Evidence-based guidelines suggest that all services, wards and clinics within hospitals consider smoking status a vital sign and routinely provide cessation care. Despite this, such opportunities are currently under-utilized. The aim of the present pilot study was to determine the potential effectiveness, feasibility and acceptability of computer delivery of smoking cessation advice to surgical preadmission patients. METHODS: All smokers attending a non-cardiac surgical preadmission clinic at the John Hunter Hospital, New South Wales, completed a brief computerized smoking cessation intervention programme. Nine months following completion of the programme, patients completed a follow-up telephone interview that assessed their smoking status and the acceptability of the programme. RESULTS: At follow up, 22 of the 37 participants (60.0%) reported that they had stopped smoking prior to their surgery 9 months previously. Of the 37 participants at follow up, five reported that they were no longer smokers at that time, a cessation rate of 13.5%. Among those patients still smoking, a trend toward smoking fewer cigarettes was evident. Of the 56 smokers at baseline, all completed the computerized smoking cessation programme, with an average completion time of 21 min. A large majority of the smokers (80%) and non-smokers (88%) found that the provision of smoking cessation advice by the computer was appropriate and acceptable. Extrapolation of the results to a full year suggests a cost per quitter of $443. CONCLUSIONS: An interactive computerized smoking cessation programme is an acceptable and feasible method of routinely encouraging surgical preadmission clinic patients to stop or reduce their smoking. Further development and testing of the efficacy of this approach is required.

Prevalence of responsible hospitality policies in licensed premises that are associated with alcohol-related harm.

This study aimed to determine the prevalence of responsible hospitality policies in a group of licensed premises associated with alcohol-related harm. During March 1999, 108 licensed premises with one or more police-identified alcohol-related incidents in the previous 3 months received a visit from a police officer. A 30-item audit checklist was used to determine the responsible hospitality policies being undertaken by each premises within eight policy domains: display required signage (three items); responsible host practices to prevent intoxication and under-age drinking (five items); written policies and guidelines for responsible service (three items); discouraging inappropriate promotions (three items); safe transport (two items); responsible management issues (seven items); physical environment (three items) and entry conditions (four items). No premises were undertaking all 30 items. Eighty per cent of the premises were undertaking 20 of the 30 items. All premises were undertaking at least 17 of the items. The proportion of premises undertaking individual items ranged from 16% to 100%. Premises were less likely to report having and providing written responsible hospitality documentation to staff, using door charges and having entry/re-entry rules. Significant differences between rural and urban premises were evident for four policies. Clubs were significantly more likely than hotels to have a written responsible service of alcohol policy and to clearly display codes of dress and conditions of entry. This study provides an indication of the extent and nature of responsible hospitality policies in a sample of licensed premises that are associated with a broad range of alcohol related harms. The finding that a large majority of such premises appear to adopt responsible hospitality policies suggests a need to assess the validity and reliability of tools used in the routine assessment of such policies, and of the potential for harm from licensed premises.

Contrasting views of staff and patients regarding psychosocial care for Australian women who miscarry: a hospital based study.

OBJECTIVES: The objectives of this study were to assess the psychosocial needs of women following miscarriage and to describe what changes should be made to improve their hospital care. METHODS: One hundred and nine women were asked to complete a survey within one month of discharge from hospital following a miscarriage. The women were asked to describe their psychosocial needs, satisfaction with hospital care and type of follow-up care provided. The women also completed the Edinburgh Depression Scale and the General Health Questionnaire-12. Forty-three staff were asked questions relating to the psychosocial effects of miscarriage on these women, how the hospital experience could be improved for women, and barriers to providing adequate psychosocial care. RESULTS: Seventy-five per cent of the women felt that their hospital experience could have been improved, particularly by a more considerate and sensitive attitude from staff. While staff agreed that the hospital experience could be better for women, they considered this would be best achieved by the provision of counselling, more privacy and additional staff. Results of the Edinburgh Depression Scale indicated that 44% of the women were either possibly or probably depressed, while the General Health Questionnaire-12 indicated that 57% were suffering some psychological distress. CONCLUSION: It is clear that women and their hospital care givers want to see improvements in the care given to women who miscarry However, disagreement exists as to how this improvement can be best achieved.