Kindness in Australia: an empirical critique of moral decline sociology.

A new sociological agenda is emerging that interrogates how morality can be established in the absence of the moral certainties of the past but there is a shortage of empirical work on this topic. This article establishes a theoretical framework for the empirical analysis of everyday morality drawing on the work of theorists including Ahmed, Bauman and Taylor. It uses the Australian Survey of Social Attitudes to assess the state and shape of contemporary moralities by asking how kind are Australians, how is its expression socially distributed, and what are the motivations for kindness. The findings demonstrate that Australians exhibit a strong attachment and commitment to kindness as a moral value that is primarily motivated by interiorized sources of moral authority. We argue these findings support the work of theorists such as Ahmed and Taylor who argue authenticity and embodied emotion are legitimate sources of morality in today's secular societies. The research also provides new evidence that generational changes are shaping understandings and practices of kindness in unexpected ways.

Balancing hospital and community treatment: effectiveness of an extended-hours community mental health team in a semi-rural region of australia.

OBJECTIVE: To examine the effectiveness of the introduction of a community mental health team on consumer psychosocial outcomes. DESIGN: Longitudinal panel design. SETTING: District general hospital in a semi-rural region of Australia. NUMBERS: Two matched groups (n = 37 in each group) MAIN OUTCOME MEASURE: These included: Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Rosenberg Self-Esteem, Life Skills Profile as well as self-report. RESULTS: The study found that the introduction of the new service resulted in few significant differences in consumer outcomes. CONCLUSIONS: The paper argues that because the state was the only specialist mental health service provider and it was unable to offer assertive community treatment, hospital care remained central. Evidence that a substantial proportion of consumers and carers preferred hospital to community care is placed against this background. The paper argues that in regions like these, where community-based services are likely to remain underdeveloped, it may be best to maintain quality hospital services and to target community services more precisely on what is achievable rather than developing community services at the expense of hospital care. WHAT IS ALREADY KNOWN: Studies on the efficacy of assertive community treatment suggest that it can lead to improved consumer outcomes. However, these studies are usually in urban settings and involve experimental teams. In many rural and regional areas community treatment teams offer standard rather than assertive community care. It is therefore important to investigate the effectiveness of community treatment teams in rural and regional Australia. WHAT THIS STUDY ADDS: This study suggests that in rural and regional areas characterised by limited resources, it is too much to expect community treatment teams to have a measurable impact on consumer outcomes. In these settings hospital care remains at the heart of the service. This means that regions such as these need to focus their community services on what is achievable given the level of resources and social ecology. For example, they may need to consider offering either crisis intervention or rehabilitation services and to rely on innovations, such as telehealth or strategic alliances with other service providers to fill the gap.

A comparison of patient clinical and social outcomes before and after the introduction of an extended-hours community mental health team.

OBJECTIVE: The aim of this study was to assess the effectiveness of the addition of standard community treatment to a hospital-based service in a regional district of Australia. METHOD: The study was a naturalistic investigation of a routine clinical service and utilized a longitudinal panel design. Two matched groups of seriously mentally ill patients were recruited,one before the addition of the community mental health team (CMHT)and one after. Each sample was followed up for one year using a semistructured questionnaire and instruments including the Brief Psychiatric Rating Scale, the Global Assessment Scale, the Life Skills Profile and the Rosenberg Self-Esteem Scale as well as hospital records. RESULTS: Patients in both groups showed similar patterns of improvements. Although the aims of the new service included reducing in-patient utilization and improving social functioning,there were few significant differences between the two groups. While the number of admissions and length of stay were lower in the post-CMHTsample most were admitted rather than treated in their homes by the CMHT. CONCLUSION: The study concludes that better outcomes might have been achieved if the aims of the CMHT had been limited to either crisis or rehabilitation interventions, but not both. More attention needs to be paid to the service context in which model programmes are introduced so that new developments can be more closely tailored to the realities of what is likely to be achievable.

Psychiatric and social outcomes of a rural district general hospital in the 1990s.

This study investigates the psychiatric and social outcomes of treatment by the psychiatric unit of a district general hospital in a semirural region of Australia. The study is a naturalistic investigation of a routine clinical service, and utilizes a longitudinal panel design. Repeat interviews at admission, 1 month and 1 year later were conducted with all consenting respondents (n = 57) with a diagnosis of schizophrenia, bipolar disorder or related condition, as well as with their nominated relatives. Patients showed significant improvements on clinical measures (P < 0.001) and a high rate of continuation of medication. Most measures of social functioning showed improvement although few were statistically significant. Patients and relative satisfaction was high. Relative worry showed significant improvement in the first month (P < 0.05). There was a high rate of readmission (31 patients) and mean days in hospital were also high at 43 days. These results suggest that basic district general hospital care, operating under both budgetary restrictions and the difficulties associated with recruiting staff can nonetheless provide a credible service. However, the results fall short of what research tells us can be achieved when services are adequately funded and more specifically targeted to meet patient needs.