The Impact of Allied Health Brief Therapy Clinic Interventions in Consumers in Suicidal Crisis.

Brief interventions increase access to and engagement with care for people who are discharged presentation to emergency departments or inpatient care due to suicidal behavior. This study was to investigate the effectiveness of the Allied Health Brief Therapies (AHBT) clinic interventions on suicide ideation, health service utilization, negative emotional states, and functioning and well-being in consumers in suicidal crisis. This research was designed as pre-post study. Three AHBT clinics were established to provide brief interventions in Queensland Australia. Repeated measures ANOVA and McNemar's test were used to measure the impact of the interventions. Sensitivity analysis was conducted to ensure the robustness and appropriate interpretation of the results. Among the 141 consumers who accepted the referral, 106 (75.2%) attended the AHBT sessions, and 35 (24.8%) did not start the interventions. The AHBT clinic interventions reduced consumers' presence and frequency of suicide ideation, emergency department presentations, and negative emotional states (depression, anxiety, and stress), and increased their functioning and well-being with large effect sizes. Change in the frequency of inpatient admission after the AHBT clinic interventions was statistically non-significant. This study provides evidence that the AHBT clinics can reduce suicidal risk factors, decrease health service utilization, and increase functioning and well-being in consumers in suicidal crisis. Future research should consider the use of a control group to increase confidence in the findings.

Cancer screening in prisons: lessons for health providers.

BACKGROUND: Lifestyle factors place those who experience incarceration at increased risk of morbidity and mortality from a range of preventable diseases, including cancer. METHODS: Two nurses were employed for a period of 6months to facilitate bowel and breast cancer screening of prisoners across four correctional centres in Queensland. We identify factors impacting on cancer screening in prisons and document the outcomes for those screened. RESULTS: Both screening programs produced a positivity rate of ∼17% in those screened, with 23 individuals returning a positive faecal occult blood test and five women requiring further investigations following breast screening. At 3months postscreening, all of the positive cases had been referred for further investigations. It is likely that the screening programs were instrumental in preventing morbidity (and mortality) in the subgroup with positive test results. CONCLUSIONS: Cancer screening within the prison environment presents a number of challenges. Intervention at the individual and systems level is required to ensure prisoners can access a standard of care equal to that provided in the community.

Living with restraint: Reactions of nurses and lived experience workers to restrictions placed on the use of prone restraint.

Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone ('face down') restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de-escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular.

A Shelter in the Storm - Acceptability and Feasibility of a Brief Clinical Intervention for Suicidal Crisis.

Background: People attending the emergency department (ED) for suicidal crisis are at significantly higher risk of taking their own lives in the week following discharge. Aims: We aimed to evaluate the acceptability and feasibility of implementing a brief clinical aftercare intervention provided through Allied Health Brief Therapies (AHBTs) Clinics. Method: Consecutive referrals (n = 149) to the clinics following assessment in the ED for suicidal crisis formed the study group. This article details participant engagement and retention, service provision, therapeutic alliance, and participant satisfaction with the program. Suicidal ideation and ED utilization 3 months pre-/postintervention were used to assess short-term impact. Results: The study supports the feasibility of implementing a brief aftercare intervention for those presenting to the ED for suicidal crisis. High rates of therapeutic alliance and satisfaction with the clinic intervention were reported by participants. Impact assessments pointed to a significant reduction in both suicidal ideation and ED utilization following the intervention. Limitations: A substantial number of participants had missing follow-up data. Given this and the absence of a control group, findings must be interpreted with caution. Conclusion: The study supports the acceptability and feasibility of implementing AHBT Clinics as a potential adjunct in the aftercare of people in suicidal crisis.

COVID-19 pandemic gestational diabetes screening guidelines: A retrospective study in Australian women.

BACKGROUND AND AIMS: Gestational diabetes (GDM) is one of the most common medical complications of pregnancy and associated with significant perinatal and long-term morbidity. Temporary changes to the diagnostic testing for GDM have been recommended for the COVID-19 pandemic. This study aims to identify what proportion of women with GDM would be missed by the COVID-19 GDM screening criteria. Secondly an analysis of the relationship between HbA1c, fasting blood glucose (FBG) and pregnancy outcomes will be completed. METHODS: This was a retrospective analysis of all GDM patients at an Australian secondary hospital between January 2019 and February 2020. The proportion of women with GDM who would have been missed using the COVID-19 guidelines was assessed. Patients were divided into groups according to how their GDM was managed during the pregnancy: Diet, Metformin (MF), Insulin and MF + Insulin groups. Differences between the groups were compared using one-way ANOVA and post-hoc analysis was completed using the Bonferroni test. Logistic regression was employed to further compare the differences between the groups. RESULTS: The study group comprised 237 patients. Sixty patients (25.3%) would not have had GDM detected in their pregnancy using the COVID-19 guidelines. FBG was the most significant predictor for intervention with medication for GDM (p = 0.001). CONCLUSION: HbA1c and FBG are poor screening tests for GDM. During the COVID-19 pandemic, the OGTT should be given clinical priority in high risk patients. Elevated FBG is a significant predictor for needing medical management and could be used in the future to better enable individualised treatment.

Case manager perceptions of emergency department use by patients with non-fatal suicidal behaviour.

Repeat presentations to the emergency department (ED) for non-fatal suicidal behaviour (NFSB) are common in Australia and overseas. The challenges faced by mental health services in managing this sub-group of patients have not been fully explored. In this qualitative study, we consider how case managers view frequent ED use by patients with NFSB. Individual interviews with case managers were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Four main themes emerged: a logical place to go; not a lot of benefit from an ED visit; focus on managing risk; and building a life outside of the ED. The case managers noted that patients with NFSB tend to have complex presentations that are challenging to address in the ED. The focus tends to be on assessment of risk with referral to community support agencies. The findings point to the need to identify more intensive care options that support patients to reduce their dependency on the ED. Insights gleaned from the study have implications for those working with NFSB patients.

Repeat presentations to the emergency department for non-fatal suicidal behaviour: Perceptions of patients.

Presentations to emergency departments (EDs) for non-fatal suicidal behaviour (NFSB) are increasing in Australia and overseas. Our understanding of the factors contributing to this trend remains unclear. In this qualitative phenomenological study, we explored patient perceptions of their ED experience and the interventions provided. The study group comprised 10 adults who had had 3 or more presentations to the ED in a 12-week period for NFSB. Individual interviews were conducted in person with participants and transcribed verbatim. Three broad themes emerged from analysis of the transcripts: ED - a safety net; 'treatment - what treatment!'; and maintaining ED dependence. The findings highlight a failure to understand the needs of those with NFSB and establish better ED treatment strategies and models of aftercare for this sub-group of patients. The findings have implications for mental health nurses working with consumers in the ED and in broader case management roles.

Supporting mental health staff following exposure to occupational violence - staff perceptions of 'peer' support.

Mental health professionals frequently work in environments where stressful, unpredictable, and potentially volatile situations can arise. Staff responses to these, often violent events, can be severe and enduring. Psychological first aid provided by a colleague following exposure to such violence is gaining increasing acceptance as a means of assisting affected individuals. However, there has been little attention to how staff perceive this support. In this study, interviews were conducted with 13 staff employed in a secure facility and thematically analysed using content analysis. Four content themes emerged: responding to emotional distress, empowering staff through practical support, the good provider, and resilience. The results indicate that staff value and benefit from receiving support from peers following exposure to occupational violence. Most would access peer support again and would consider recommending it to others. A small number choose not to engage with the programme and the reasons for this are also discussed. This type of peer support could be applied in other high-risk workplaces as a key element of an integrated and comprehensive workplace violence prevention and management strategy.

Therapeutic drug monitoring (TDM) during maintenance phase treatment at a community mental health centre.

OBJECTIVE: To assess the extent to which therapeutic drug monitoring during maintenance phase treatment with lithium and clozapine was performed according to an agreed protocol and to identify strategies that may support monitoring. METHODS: Data concerning the prescribing and monitoring patterns of lithium for 31 patients and clozapine for 53 patients were collected retrospectively over a period of 2 years. RESULTS: Adherence to clozapine monitoring throughout the study period was 90.5%, while the monitoring of lithium was less likely at 58.1% (P < 0.001). While those prescribed lithium were less likely to adhere to prescribed dosing than those prescribed clozapine (P < 0.007), they were also more likely to have a change of medication (P < 0.005) and require admission to inpatient care (P < 0.002). CONCLUSIONS: Despite the initiatives established to improve adherence to monitoring, there was a significantly lower level of lithium monitoring compared to that of clozapine. Strategies that are likely to support monitoring include the use of labels to clarify tests required, the use of a database to keep track of those requiring pathology tests and allocation of time each week for a nurse to work with medical staff and case managers to support monitoring.

Development of a checklist to aid in the assessment of 'failure to return' from approved leave by acute inpatients.

Better assessment of consumer behaviour and intentions prior to the granting of approved leave may reduce failure to return from such episodes of leave. The aims of this study were (i) to gain consensus on the factors associated with failure to return, and (ii) use these factors to construct a checklist to aid in assessment of consumers prior to being granted leave. Following a review of the literature a pool of 36 factors was identified. These were then assessed for relevance to absconding from approved leave using a modified Delphi approach. After two Delphi rounds, 10 factors were retained and these were collapsed under 6 domains; history of absconding, current substance use, behaviour cues, verbal cues, lack of engagement, and changes in mental state. While staff reactions to the checklist were positive, further testing of its effectiveness in the clinical setting is required.

Do police-mental health co-responder programmes reduce emergency department presentations or simply delay the inevitable?

OBJECTIVE:: The aim of this study was to assess the outcomes for people following intervention by a police-mental health co-responder team. METHOD:: Individuals seen by the co-responder team were followed for 2 weeks to monitor subsequent emergency department presentations and inpatient admissions. RESULTS:: Of the 122 people who had direct contact with the co-responder team, 82 (67.2%) remained at their residence, 35 (28.7%) were transported to the emergency department (ED) and 5 (4.1%) were taken into custody by police. The 82 people who remained at home following initial assessment were followed-up for 2 weeks. During this time 10 (12.2%) presented to ED and 3 of these (3.7%) were subsequently admitted to hospital. CONCLUSIONS:: Interventions provided through the co-responder team were capable not only of resolving the immediate crisis for the majority of people, but were also likely to divert people away from ED and inpatient treatment in the immediate term.

Metabolic risk in patients participating in residential rehabilitation programs: how are we doing?

OBJECTIVES: To examine the prevalence of metabolic syndrome and its association with clinical, demographic and lifestyle factors in patients with mental illness participating in residential rehabilitation. METHODS: A physical health audit of all consumers ( n = 364) in publicly funded residential rehabilitation programs in Queensland was carried out in late 2016. Data collection focused on clinical, demographic and lifestyle factors associated with physical health. RESULTS: Central obesity was identified in 80% of males and 89% of females and half of the patients (49.4%) met criteria for metabolic syndrome (MetS). The prevalence of MetS in Indigenous patients (66.1%) was 20% higher than the rate found in non-Indigenous patients (46.1%). Smoking, substance abuse, gender, Indigenous background, length of stay and rarely eating fruit and vegetables were individually associated with MetS. CONCLUSIONS: The prevalence of MetS in this cohort is almost double that of the general population, while the rate in Indigenous patients is among the highest reported for those with mental illness. Rehabilitation staff are encouraged to engage more fully in the monitoring of physical health status, sharing this information with consumers and primary care providers, and encouraging consumers to play a greater role in managing their physical health.

Australian mental health nurses' perspectives about the identification and management of antipsychotic medication side effects: a cross-sectional survey.

BACKGROUND: Currently, little is known about mental health nurses' management of antipsychotic medication side effects. AIMS: This study examined how Australian mental health nurses' attitudes and service processes influence the assessment of antipsychotic medication side effects. METHODS: Participants were included if they were registered nurses in Australian mental health settings. An online questionnaire was distributed via email. Multivariate logistic regression was used to examine associations between attitudes and awareness, and use of antipsychotic medication assessment tools. RESULTS: Only one quarter of the respondents were currently using a tool. In cases where the service had a clear system for agreeing responsibility about monitoring consumers between primary and secondary care, respondents were three times more likely to still be using one or more tool. When the service had reliable systems in place to remind staff that side effect assessments were due, respondents were five times more likely to continue using assessment tools. CONCLUSION: Australian mental nurses are not routinely using antipsychotic medication side effect assessment tools. The routine use of assessment tools would improve if systems were implemented to enhance their use.

Inter-agency collaboration between mental health services and police in Queensland.

OBJECTIVE: The objective of this study was to consider the collaboration between mental health services and police in Queensland. CONCLUSION: Queensland has developed a number of initiatives for intervention and response to incidents involving police and persons with mental illness. Future research should focus on identifying interventions that promote effective resolution of incidents involving police.

Critical Incidents During Leave From an Australian Security Hospital - A 12 Year Audit.

All critical incidents between 2003 and 2015 relating to leave episodes from the High Security Inpatient Services, Brisbane, Australia were audited. The audit found that since March 2003, when the High Security Inpatient Service opened, there was a very small number of critical incidents related to over 46,000 leave episodes. Of the 17 patients who went absent without permission over the 12-year study period, only 2 patients re-offended and 1 patient deliberately self-harmed during a leave episode. One patient assaulted his escort nurse during a leave and four patients attempted unsuccessfully to flee their escort nurses during escorted off-ground leave. No patient committed a serious violent offence and no patient committed suicide during an absence from leave. Only 4 of the 17 patients who went absent during leave between 2003 and 2015 remain as inpatients in the High Security Inpatient Service.

The physical health of Indigenous and non-Indigenous patients participating in residential rehabilitation programs: a comparison study.

OBJECTIVE: To examine the differences in the physical health of Indigenous and non-Indigenous patients with severe mental illness (SMI) undergoing psychiatric rehabilitation. METHODS: An audit of the physical health of patients ( n = 361) in all publicly funded residential rehabilitation programs in Queensland was carried out in late 2014. Data collection focused on clinical and lifestyle factors associated with physical health. RESULTS: The prevalence of smoking, substance use and type 2 diabetes in Indigenous patients was significantly higher than rates found in non-Indigenous patients. Metabolic syndrome was also significantly higher in indigenous patients, with 66% of Indigenous patients compared to 46% of non-Indigenous patients meeting criteria for metabolic syndrome. CONCLUSIONS: Patients with SMI in residential rehabilitation programs have poor physical health. Our findings underscore the need for clinicians to develop and evaluate interventions aimed at improving the metabolic profile of those with SMI in residential rehabilitation programs. Historical factors and cultural traditions need to be considered when designing lifestyle interventions for Indigenous patients.

Comparing clinical and demographic characteristics of people with mental illness in hospital- and community-based residential rehabilitation units in Queensland.

Objective The aim of the present study was to examine care pathways and characteristics of mental health consumers participating in both hospital- and community-based residential rehabilitation programs. Methods An audit of consumers (n=240) in all publicly funded residential rehabilitation units in Queensland was performed on the same day in 2013. Data collection focused on demographic characteristics, clinical information and measures of consumer functioning. Results Significant differences emerged for consumers in community- and hospital-based services with regard to age, length of stay, functioning, Mental Health Act status, guardianship status, family contact and risk of violence. Consumers in hospital-based programs have more severe and complex problems. Conclusions Consumers in residential rehabilitation units have high levels of disability, poor physical health and high levels of vulnerability. Nonetheless, it is likely that a sizeable proportion of consumers occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options to move patients on were available. What is known about the topic? A small subgroup of people with severe and complex mental health problems is likely to require time in a residential rehabilitation program. This group is characterised by failure to respond to treatment, severe negative symptoms and some degree of cognitive impairment. What does this paper add? Patients currently occupying residential rehabilitation beds in Queensland have high levels of disability, poor physical health and high levels of vulnerability. Patients in hospital-based programs are more severely disabled than those in community-based programs. What are the implications for practitioners? It is likely that a sizeable proportion of patients occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options were available. Future planning initiatives need to focus on developing a greater array of community support options to facilitate the discharge of people from residential services.

Assessing clinicians' perspectives about the identification and management of antipsychotic medication side-effects: Psychometric evaluation of a survey questionnaire.

Eliciting clinicians' views about antipsychotic medication side-effects may assist in understanding strategies that could enhance the identification and management of these side-effects. The present paper details the development and psychometric evaluation of a questionnaire that captures clinicians' perceptions about these issues. An initial item set was derived from a literature review, and then refined by an expert content validity panel that assessed the relevance of the items. The online questionnaire was distributed to Australian mental health nurses and 140 fully completed questionnaires were returned. Principal components analysis yielded two robust scales that conceptually tapped "system responsibility" and "personal confidence". These scales may be used to advance knowledge about how mental health nurses' attitudes towards the assessment and management of antipsychotic medication side-effects influences their clinical behaviour.

Australian case managers' views about the impact of antipsychotic medication on mental health consumers.

This study examined case managers' views about antipsychotic medications and the impact of side-effects on mental health consumers in a community setting. Nine case managers were purposively sampled and interviewed. Content analysis was used to generate a series of themes. The findings indicated that case managers perceived that a lack of consumer insight was one of the main reasons for wanting to reduce, or altogether cease, antipsychotic medication. However, case managers lacked an adequate level of knowledge about antipsychotic medication side-effects. Without a sufficient level of knowledge, case managers may be unable to fully address consumers' concerns.

Australian case managers' perceptions of mental health consumers use of antipsychotic medications and associated side-effects.

The present study explores Australian case managers' perceptions of mental health consumers' use of antipsychotic medications and the side-effects resulting from these medications. Semistructured interviews were used to elicit material from nine case managers in a community care setting in South-East Queensland, Australia. Content analysis was used to examine the transcripts, and the audio-recordings were replayed to identify important contextual cues. The analysis identified several main themes, including perceptions of the use of antipsychotic medications and associated side-effects, the provision of information about antipsychotic medication side-effects; the assessment of antipsychotic medication side-effects; and the promotion of effective management of antipsychotic medication side-effects. The participants believed that antipsychotic medication provided clear benefits to mental health consumers. Most participants believed that consumers adapted to side-effects and came to accept them. The case managers themselves often felt poorly informed about antipsychotic medication side-effects, leading them to request more succinct types of information. It was notable to find that there was a lack of systematic approach to the assessment of side-effects. This finding highlighted the need to incorporate the routine structured assessment of antipsychotic medication side-effects in providing care to mental health consumers in the community.