Accepted Abstracts - Sorted by Surname
Dr Julaine Allan
Indigenous Women in Substance Abuse Treatment: Access and equity of outcomes
Abstract
Indigenous Australians are particularly concerned about drug related harm within their communities. Drug use in combination with poverty, poor housing and limited educational attainment is identified as a key reason for the seventeen year gap in life expectancy between Indigenous and non-indigenous Australians (Gray, Saggers, Atkinson & Wilkes 2007). Indigenous drug use, primarily alcohol, is described as the cause of serious health problems, imprisonment for drug related offences and endemic family violence (e.g. Brady 2007, Weatherburn 2006).
Access to treatment has been identified as the most significant factor in reducing drug related harm for high risk populations. A significant gender disparity in access to treatment exists with women underrepresented in treatment populations. An examination of the National Alcohol and Other Drug Minimum data set found that Indigenous women access treatment at significantly higher rates than non-indigenous women. This is in spite of the perception that Indigenous people find access to services difficult and outcomes are generally poor.
This paper reports on the health and social circumstances of a cohort of Indigenous women who accessed substance treatment services in rural NSW. The research found that this group are frequent service users with multiple and chronic life problems unrelieved by health and welfare interventions. The implications of these findings for health services are discussed.
__________________________________________________________________
Ms Candace Bagnall
www.thelowdown.co.nz – young people seeking help for depression online
Abstract
Young New Zealanders have high rates of depression (12-month prevalence for major depressive disorder amongst 16-24 year olds is 8.7%, compared with 5.7% for the total population), and tend not to seek professional help for mental health issues, or use phone help lines. Research indicated that internet-based options might provide a more effective approach for reaching young people.
Young people had significant input to the design of www.thelowdown.co.nz, launched in December 2007. High-profile musicians, sportspeople, media celebrities and other young people with experience of depression gave their time freely to be interviewed on video for the site. Feedback from young people resulted in a new set of online and text-based services being established. Online advertising, together with youth media communications strategies have promoted the site over the first 12 months.
Both the website and Lowdown Team support services, have been well utilised by young people. In the first 12 months, there have been over 100,000 unique visitors to the site. 43,000 text messages and 2,140 emails were received and responded to. The Lowdown Team of trained counsellors made 26 emergency service contacts due to concerns about suicide risk. A new webcam service is being trialled based on structure problem solving.
The Lowdown website and support services appear to be providing a helpful addition to existing youth services. It seems that young people with serious illness are being picked up who might not otherwise be helped. The new services are being evaluated as part of the NDI’s research programme, and results will be discussed.
__________________________________________________________________
Dr Annemaree Bickerton
CONNECTING WITH CARERS IS EVERYBODY’S BUSINESS: a training resource for family friendly mental health services
Abstract
The literature, health policy and, most recently, the amended 2007 NSW Mental Health Act, all stipulate family and carer partnership in the best practice treatment of adults with serious mental illness. Yet many adult mental health services continue to struggle to provide a family-friendly culture.
Our Working with Families Program was established in 1997 in our then small, poorly-resourced, suburban adult mental health service to address such issues. Following the local success of our program, our team was funded to take a lead roll in training public mental health professionals across the state as part of the NSW Family and Carer Mental Health Program. In 2007 we developed the CONNECTING WITH CARERS IS EVERYBODY’S BUSINESS training resource, which comprises a DVD and handbook. It emphasises the key role that all clinicians have in connecting with carers through interviews with clinicians and carers. It proposes a hierarchical intervention framework and models skills in engaging families in helpful partnerships through the journey of a “mock” family through a family-friendly mental health service. 500 copies of this resource have been distributed statewide to date and another print run planned.
This 90 minute workshop utilises the DVD and handbook in delivering a multi-media interactive skills development format. Key learning outcomes for participants will include a richer understanding of:
A Carer’s Perspective
The Pyramid of Family Care
The roles and responsibilities of multi-disciplinary team members in family- friendly service provision
Capacity Building - a useful framework for enhancing family-friendly culture in your mental health service.
___________________________________________________________
Dr Mark Boschen
Treatment of Severe, Treatment-Refractory Obsessive Compulsive Disorder: A Study of Inpatient and Community Treatment
Abstract
Background
This research reports on a prospective outcome study of two cohorts of patients with severe, chronic, resistant obsessive-compulsive disorder (OCD).
Method
One cohort consisted of a total of 52 patients treated in an inpatient setting, while the second group comprised 65 patients treated in a community outpatient setting. Treatment consistent primarily of intensive graded exposure and self-imposed response prevention augmented with cognitive restructuring.
Results
Both groups demonstrated significant improvement over the course of treatment. In both the inpatient and community groups there was significant improvement over the first 12 weeks of treatment, and further improvement between 12 and 24 weeks.
Conclusions
These results suggest that even for patients who have demonstrated treatment-resistance, there may be benefit in intensive behavioural treatment of OCD. In addition it was found that even for those patients with the most profound refractory OCD and complicating factors inpatient stays of up to 24 weeks were effective in reducing symptoms.
__________________________________________________________________
Dr Mark Boschen
Clinical Effectiveness of a Group Treatment Program for Anxiety Disorders: A Benchmarking Study.
Abstract
Previous research has established the efficacy of cognitive behavioural therapy (CBT) for anxiety disorders, yet it has not been widely assessed in routine community clinic practices. Efficacy research sacrifices external validity to achieve maximum internal validity. Recently, effectiveness research has been advocated as more ecological valid for assessing routine clinical work in community clinics. Furthermore, there is a lack of effectiveness research in group CBT. This study therefore, to extend existing research on the effectiveness of CBT from individual therapy into group therapy delivery. It aimed also to examine outcome using not only symptom measures, but also measures of related symptoms, cognitions and life quality and satisfaction. Results from two cohorts of patients with various anxiety disorders demonstrated that treatment was effective in reducing anxiety symptoms in all cases, and to an extent comparable with other effectiveness studies. Despite this, only 16 to 23 percent of individuals were ‘recovered’ from their anxiety symptoms, and the post-treatment measures were still significantly different from the level of anxiety symptoms observed in the general population.
__________________________________________________________________
Prof Philip Burgess
Service use for mental health problems:
Findings from the 2007 National Survey of Mental Health and Wellbeing
Abstract
In 1997 and 2007, National Surveys of Mental Health and Wellbeing (NSMHWB) were conducted. Both Surveys were designed to provide reliable estimates of the prevalence of high prevalence disorders including anxiety, affective and substance use disorders among the Australian adult population. Both Surveys were based on the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). The Surveys were tailored to ensure that information regarding patterns of service utilization properly reflected the Australian practice.
In 2007, approximately 1 in 8 of the general Australian adult population made use of services for mental health problems in a 12-month period. About one third of people meeting criteria for a mental disorder did so. Females with mental disorders were more likely to use services than males. People in the youngest age group made relatively less use of services than older adults. Those with affective disorders were most likely to make use of services, than those with anxiety and substance use disorders. Most persons were likely to consult general practitioners or psychologists. There was a clear dose-response effect between severity of disorders and rates of service use. There was also a relationship between co-morbidity of mental disorders and service use.
Comparisons between 1997 and 2007 suggest that policy efforts can improve rates of service use. Nonetheless, rates of service use for mental health problems among those with mental disorders in Australia are less than optimal. The implications for subsequent policy initiatives and clinical practice are considered as a basis for further discussion.
__________________________________________________________________
Mr Michael Cahill
A Tapestry of Care:An Evolving Person Centred Approach to Mental Health Care
Abstract
The Tapestry of Care has a myriad of threads and by its very nature is a work in progress. This presentation aims to set the framework for further studies that have the potential to evolve into a workable model of care. This is a tripartite model that involves Consumers, Carers and Health Professionals as equal partners in care. Its focus is the wellness of the consumer and their willingness to accept a tripartite care path. Each has a definite role and is supported by the other two, consumers (wellness), carers (coping strategies) and Health Professionals (recognition of their skills and status). Each supports the other in care pathways and in helping the consumer to build on their 'locus of control'. The framework includes Focus groups to draw those who are willing to work towards wellness together with their nominated carer. From the Focus groups Carer/Consumer Support Groups will be formed. The Support Groups will be time limited and will have pre/post and follow up testing to measure Wellness, DASS, and Locus of Control. This program allows consumers and carers to gain control of their lives and work towards wellness. Pilot studies will be completed in 2009.
__________________________________________________________________
Dr John Clarkson
Adult ADHD & Attentional Disorders – Update 2009
Abstract
ADHD is no longer a disorder confined to children and adolescents. It is now recognised that ADHD is major mental health problem for many adults, causing them difficulties in relationships, the workplace and in reaching their full potential – it is as if, “life is just too hard!” for them.
Recent studies confirm approximately 65% to 85% of children and adolescents diagnosed with ADHD will continue to have symptoms into adulthood. Data also points to ADHD becoming one of the most common psychiatric disorders of adulthood and given its association with numerous comorbid conditions such as depression, anxiety and substance abuse, its diagnosis is imperative in achieving better outcomes for our patients .
The Adult ADHD & Attentional Disorders – Update 2009 is a clinically practical and interactive workshop, which will allow attendees to build on their existing knowledge of ADHD. Consideration will be given to how the adult presentation differs from that in childhood and other interesting nuances. Finally, discussion on the advances in the field of attention and functional brain imaging (SPECT and fMRI) will allow attendees to become better equipped to deal with the multifactorial issues involved in the diagnosis and management of adult ADHD in their day-to-day practice.
__________________________________________________________________
Mr Gareth Daniels
Creating Inclusive Mental Health Services in Queensland.
Abstract
The Queensland Association for Healthy Communities (QAHC), with funding from Queensland Health, offered training in Creating Inclusive Services to all Mental Health clinicians statewide.
The six hour/one day training introduces mental health clinicians to the particular mental health and drug and alcohol issues that surround lesbian/gay/bisexual/transgender (L/G/B/T) people.
Drawing on research conducted by the Australian Research Centre for Sex, Health and Society (ARCSHS) at the La Trobe University (2005, 2006, 2007), Roy Morgan Research (2005) and the National Centre in HIV Epidemiology and Clinical Research (2004) it is considered that L/G/B/T people suffer a higher incidence of anxiety, depression and substance abuse than the general population. L/G/B/T young people not only experience suicide ideation and attempts earlier and more often but also start using drugs and alcohol at a younger age than members of the general population. Drug and alcohol use, anxiety and depression for young L/G/B/T people is often associated with the experiences of social isolation, heterosexism and internal and/or external homophobic abuse as well as association with the commercial L/G/B/T scene. One of the other main factors relating to patterns of drug and alcohol use is the prolonged patterns of high usage in the L/G/B/T community. With age, the rates of use do not decline at the same rates as the general population.
This may be influenced by the social lifestyles within the commercial L/G/B/T scene as well as the continuing experiences of being lesbian/gay/bisexual/transgender in a heterosexist society. The session will present some of the factors that influence poor mental health in the L/G/B/T communities and the ways that mental health services can encourage inclusive services and address the common issues of heterosexism. Preliminary findings from the evaluations of this training will be presented.
____________________________________________________________
Ms Stephanie Deeley
Emotion self-confidence and hopelessness appraisals as predictors of suicidal ideation in adolescents
Abstract
An Emotion Self-Confidence Model of Suicidal Ideation (ESC-SI Model) was examined in naturally occurring suicidal, and non-suicidal, specific negative emotional experiences (SI- & NSI-experiences), in an Australian adolescent sample. Investigation was via a semi-structured interview encompassing the model within a broader Stress-Coping Paradigm (Lazarus & Folkman, 1984) and including Beck and colleagues’ (1974) hopelessness construct. The hypotheses were that emotion self-confidence (coping expectations with respect to negative emotionality) would be lower and hopelessness higher in SI-experiences. In addition, the motivation for suicide was hypothesised to be a desire to escape the aversive experience of negative emotionality. Seven male and 26 female participants described the cognitive-behavioural phenomenology of 21 SI-experiences and 27 NSI-experiences. All hypotheses with respect to the model were supported. However, interpretation remained tentative in recognition of some methodological weaknesses. Results indicate some validity of the ESC-SI Model. Nonetheless, the amount difference in emotion self-confidence across experiences was small. Even when combined with hopelessness, which showed a greater difference, other factors are required to fully explain why suicidal ideation occurs.
__________________________________________________________________
Dr Anthony Dinnen
Posttraumatic Stress Disorder - Fact and Fantasy
Abstract
A recent article in 'Scientific American' entitled 'The Post-Traumatic Stress Trap' focussed on criticisms of the syndrome of posttraumatic stress disorder (PTSD). According to the author, "the defining criteria are too broad leading to rampant overdiagnosis", the concept itself is flawed in that it mistakes natural processes for dysfunction, and the misdiagnosis of soldiers leads to them becoming mired in the Veterans Administration system which encourages chronic disability.
The facts and fallacies of that article, in particular as they apply to the Australian scene, are examined in light of lengthy and extensive experience in treating veterans and others with PTSD, and selective review of the vast research literature on the syndrome which has accumulated over the past 25 years.
__________________________________________________________________
Ms Lois Dugmore & Jackie Channell
Sexual abuse and substance misuse hidden issues for primary mental health services
Abstract
Substance misuse, mental health and sexual abuse are all terms that we find difficult to deal with alone but together require a great deal of skill and expertise to enable the client to develop and change their life. One of the main issues for individuals in access help for these issues is professionals lack of understanding of the content matter. In training staff to deal with sexual abuse as part of an assessment package it can enable the client to accept what has happened and know that it no longer has to be a secret and they are free to explore and move on. When working with drug using populations it is clear that a number of clients have experienced trauma and abuse at a very young age and may not have been able to talk about it or ever been asked and when entering services by asking the question can lead to acceptance by the client and understanding by staff of the clinical presentation. By offering a training package to all staff to develop the clinical skills can make the difference.
__________________________________________________________________
Mr Peter Fleming
E-Health: Australia Moving Forward
Abstract
The National E-Health Transition Authority Limited (NEHTA) is a not-for-profit company established by the Australian Government in 2005. it’s aim is to develop the building blocks for e-health.
In a national public opinion poll (July 2008) on e-health, 80 per cent of Australians said they would use an Individual Electronic Health Record (IEHR), They believe lives – especially those with chronic conditions – will be saved by having important medical information immediately accessible.
NEHTA will discuss the governments commitment to developing a sustainable, national e-health infrastructure that will underpin the success of e-health programs nationally as e-health becomes more visible to patients. NEHTA’s work will not only improve clinical and administrative efficiency but will streamline the care of people with long term illnesses, such as Mental Illness.
NEHTA will outline it’s work which will enable:
-better ways of electronically collecting and securely exchanging health information
-improving clinical and administrative efficiency, by standardizing certain types of healthcare information to be recorded securely in electronic systems
-uniquely identifying patients, healthcare providers and medical products
With e-health, clinicians will have access to a dynamic health summary, being able to access the right information when they need it, where they need it. It means a transition from institution-based care to patient-centric care which, ultimately, leads to better medication and illness management.
By looking back at past healthcare mismanagement, we are moving forward to a future with Electronic Health for all of Australia.
_______________________________________________________________
Prof Kuruvilla George
Depression Training Program for Caregivers of Elderly Care Recipients
Abstract
The prevalence of untreated depression is high among older adults who receive care in residential facilities or in thier own homes and is associated with reduced quality of life and other medical conditions. Research has suggested a number of reasons for the low detection and treatment rates for this problem, including lack of knowledge and efficacy among those who provide direct care and poor communication between these caregivers and senior staff, and between senior staff and general practitioners. In this study, we report on the implementation of a training program for care staff that aims to address these issues and recommendations for the future.
__________________________________________________________________
Dr Trisha Groth
The utility of a school-based cognitive-behavioural intervention for preventing and reducing anxiety in children
Abstract
Aim: Although cognitive behavioural therapy (CBT) is highly effective for treating child anxiety disorders, much of this evidence comes from highly controlled studies. Current research is investigating the effectiveness of CBT for reducing and preventing anxiety problems in children in real-world settings. The purpose of this study was to examine the effectiveness of an 8-week CBT program with children in Grade 5 at a local primary school on the Gold Coast.
Method: It is expected that approximately 80 children will form the active treatment condition, while the control group will consist of 80 children who will complete the program two months later. Anxiety, depression and social skills of children in both conditions are being assessed at pre- and post-treatment, and at a two-month follow-up interval. Children’s interpretation bias towards ambiguous stories will also be assessed at each assessment interval.
Results: Three groups of children are being followed based on their Spence Children’s Anxiety Scale (SCAS) scores at pre-treatment: (1) children scoring within the clinical range (High Anxious; HA); (2) children scoring within the non-clinical and clinical range (High Risk; HR); and (3) children scoring within the non-clinical range (Low Anxious; LA). Results will be discussed in relation to the hypotheses that symptom reduction will be observed in HA children and that increases in anxiety will be offset in HR children, relative to controls whose symptom severity will not change over time. Gender differences and the effects of depression and social skills functioning will also be examined.
__________________________________________________________________
Dr Maja Hadzic
Application of Data Mining Technology within Mental Health: An Intelligent Tool to Help us Advance with Knowledge Rapidly
Abstract
Mood disorders have emerged as one of the major problems of our society. The World Health Organization predicted that depression would be the world's leading cause of disability by 2020 [1].
Mental health is a complex phenomenon. It is not only influenced by genetical factors but also by physical, social, emotional, financial and spiritual wellbeing of an individual [2]. If we are to examine mental health effectively, we must take into account the multidimensional nature of the mental health. Interesting patterns can emerge in this way.
This multidimensional analysis approach requires powerful data analysis techniques that go beyond statistic analyses. In this work, we explain data mining processes and present a number of data mining algorithms, successfully developed and evaluated at out research centre, which can be applied on mental health knowledge. Data mining algorithms are powerful tools for mental health studies as they help extract information, find hidden patterns and knowledge, and make predictive models [3]. Data mining draws work from areas including database technology, machine learning, statistics, pattern recognition, information retrieval, artificial intelligence, high-performance computing and data visualization.
Data mining is the way how we can truly ‘advance with knowledge’ within mental health domain. We believe that our data mining tools are strongly needed by the mental health community to enable studies of multi-factorial nature. We are excited about collaborations and synergies that will emerge as we make our tools freely available to mental health researchers and practitioners.
[1] Lopez, A.D., Murray, C.C.J.L. 1998, “The global burden of disease, 1990-2020”, Nature Medicine, vol. 4, pp. 1241-1243.
[2] Hadzic, M., Chen, M., Brouwer, R. 2008, ‘A Modern Approach to Total Wellbeing’, Proceedings of the IT Revolutions, Italy.
[3] Hadzic, M., Hadzic, F., Dillon, T. 2009, ‘Domain Driven Tree Mining of Semi-Structured Mental Health Information’, Edited by Yu, P.S., Zhang, C., Zhang, H., Data Mining for Business Applications, pp. 127-141, Springer.
__________________________________________________________________
A/Prof Lynne Harris
Working with Barriers: improving workforce participation for those with mental illness and problematic substance use
Abstract
Mental illness is common, with 18% of adult Australians meeting criteria for a 'mental disorder' within a 12 month period (National Survey of Mental Health and Wellbeing of Adults, 1997). Workforce participation for Australians with mental illness remains low, although improved work status reduces symptoms, improves self-efficacy, and improves life satisfaction (Arns & Linney, 1995; Bryson & Bell, 1999). The Mental Health Council of Australia (2007) described strategies to improve workforce participation among those with mental illness as the "way forward to address one of the most important productivity and health issues in Australia".
Almost half of those with mental illness also have difficulties with substance use (Henderson, Andrew, & Hall, 2000), and for these people workforce participation rates are very low (Crompton et al., 2005). The study aimed to understand the additional barriers to employment resulting from drug and alcohol use among people with mental illness, and to develop strategies to support employment service providers to identify and address the needs of these clients.
This paper presents the perspectives of clients of a specialist Disability Employment Network provider with mental illness and additional drug and alcohol issues, their support persons, and employment consultants concerning personal, social and organizational barriers to joining the workforce. The findings highlight the importance of education and training in achieving improved employment outcomes for those with mental illness and problematic substance use, and for addressing barriers to communication between health and employment service providers to facilitate access to specialist services.
__________________________________________________________________
Dr Sally Hunter
Breaking down the silos - mapping the mental health competencies in order to develop an interprofessional curriculum at a rural university
Abstract
Interprofessional practice is promoted as the way forward in mental health and yet there are few enabling formal educational opportunities at Australian universities. However, mental health practitioners come from various professional backgrounds. The mental health workforce consists of nurses, GPs, social workers, psychologists and psychiatrists, counsellors, and other complementary and allied health practitioners. These clinicians need to work together to support people with mental health issues and their carers. Indeed, one of the guiding principles of the National Mental Health Strategy (2002) is the ‘integration of mental health services to enable access to services, and provide continuity of care through integration and partnerships between service providers’.
At the University of New England (Armidale, Australia) cross-disciplinary practice is encouraged through the development of an interprofessional training program for those entering the mental health workforce. This paper describes the process of mapping mental health competencies in order to develop the curriculum for this interprofessional award. It covers the mental health competencies in the National Practice Standards for the Mental Health Workforce in the National Mental Health Strategy, September 2002, and for GPs (GPMHSC 2008-2010), nurses (MHNET 2008) and social workers (AASW 2008).
The process challenged those involved in the curriculum development process to become more aware of the similarities and difference between the ways in which various health disciplines practice and to break down our silos in order to communicate more effectively. This presentation will outline the lessons learned and the successes involved in working across disciplines to further mental health education.
__________________________________________________________________
Dr Steve Hyde
The use of Cranial Electrotherapy Stimulation in the treatment of anxiety, mood disorders and substance abuse.
Abstract
I have been using Cranial Electrotherapy Stimulation [CES] in the treatment of my patients with psychiatric disorders including anxiety, mood disorders and substance abuse over the past 18 months.
CES involves the passage of very small amounts of electrical current [typically 100-600 microamps] through the brain using earclip electrodes attached to an ipod-sized medical device . CES is FDA approved [since 1977] and has been both TGA and Medsafe listed for the treatment of anxiety, depression, insomnia and pain. Patients initially use their own units for 20-60 minutes a day at home and typically reduce their usage once improved.
I will present results and follow-up from an observational study on my first 10 patients and expand the results to include some 50 patients who have now used the device, most with measurable benefit. I will explore the experiences of other Australian Medical Professionals with CES.
I will review the history of CES focussing on the body of research which has become available over the past 40 years over which time there have been more than 130 trials carried out in humans with 40 being double-blind placebo controlled studies.
I will conclude by discussing how CES fits with our standard therapies and also where it stands amongst the range of Electrical treatments such as DBS,VNS,TMS and ECT which are the subject of increasing interest and study in present day Psychiatry.
__________________________________________________________________
Ms Diane Keesman
Factors Influencing Vocational Outcomes for Anxiety Disorders: Clients' Perspectives
Abstract
Qualitative interviews were conducted with eight previous Australian vocational rehabilitation agency clients with an anxiety disorder to gain an understanding of their perceptions and experiences of the vocational rehabilitation process after they obtained employment.
Some themes identified were that withdrawal from society and relationship breakdown, both prior and after diagnosis, were extremely common. Most of the interviewees also identified a specific point in time when they decided to turn their lives around and seek treatment or return to work. The vast majority of participants had received psychiatric treatment for their anxiety prior to coming to the vocational rehabilitation agency. Very limited psychological treatment was accessed both before and during the participants’ programs.
Three of eight interviewees believed that their vocational program could be improved with the majority of interviewees reporting they found the interactions with their case managers to be helpful. Most participants felt they did not need support once they had started employment. While over half of the interviewees had discussed their disorder with a colleague, most participants had not disclosed information about their disability to their employer, except when specifically asked to provide information about any conditions they may have. The majority of participants reported no longer taking medication for their anxiety, however, over half continued to avoid certain places and situations which they believe would trigger an anxiety response.
The study has implications for practitioners and vocational rehabilitation agencies, raising a number of issues which could be useful to consider when working with people with anxiety disorders.
__________________________________________________________________
Prof Justin Kenardy
Paediatric medical traumatic stress: Prevalence, risk, and prevention
Abstract
Paediatric medical traumatic stress is a term used to describe a set of psychological and physiological responses of children and their families to pain, injury, medical procedures, and invasive or frightening treatment experiences. Many aspects of illness and injury are stressful and may be painful or difficult to deal with, and may place strain on an individual’s and family’s coping resources. Some aspects are also potentially traumatic, and are extremely frightening or horrifying for the child and their parent, are potentially life-threatening and can be sudden, painful, or overwhelming.
This paper explores the prevalence, risk, and prevention of paediatric medical traumatic stress in children and their parents presenting data from a number of Australian and international paediatric studies including accidental injury and admission to hospital, oncology, and head injury. Perceptions of what is traumatic in children and their parents are compared. Diagnostic criteria for post traumatic stress for children is presented and discussed in relation to proposed changes for the DSM-V.
Current literature and statistics on the prevalence of PTSD and associated symptoms in children and their parents following medical trauma are presented. Risk factors for the development of post traumatic stress and the course of symptoms are also explored using latest data. Advances in the early detection and treatment of post traumatic stress symptoms in the paediatric population within the family context are also discussed.
________________________________________________________________
Ms Andrea Kincade
Putting LIFE into practice: national direction in suicide prevention
Abstract
The purpose of this presentation is to look at the Action Areas of the Living Is For Everyone (LIFE) Framework and how the livingisforeveryone.com.au website can support suicide prevention activities.
Delegates will also be introduced to the professional development forum and interactive features of the redeveloped LIFE website, where all people who play a role in suicide prevention can connect, share news, debate issues, access the latest research, and support one another in their work.
The release of the updated Living is for Everyone (LIFE) Framework, produced by the Commonwealth Department of Health and Ageing, provides a national strategy for action based on the best available evidence to guide activities aimed at reducing the rate at which people take their lives. The LIFE Framework, Research and Evidence document, and set of 24 fact sheets aim to support population health approaches and prevention activities that assist in reducing the loss of life through suicide in Australia.
__________________________________________________________________
Ms Nemu Lallu
Future Development of Primary Mental Health in New Zealand and Implementation of Mental Health Guidelines for Primary Care
Abstract
This paper describes the New Zealand primary mental health initiatives targeting patients with mild to moderate mental health problems primarily depression, anxiety disorders and alcohol and other drugs. Service delivery models that are funded by Government ($19.1m) include: (1) extended GP consultations (2) primary mental health co-ordinators (3) primary mental health practitioner supervision (4) practice staff training and (5) packages of care (eg brief talking therapies). An evaluation (Dowell et al 2008) showed the initiatives were very successful, 80% of service users improved with benefits maintained at 6 month follow-up.
The Ministry of Health is implementing the recently published Guideline for identification of Common Mental Disorders and Management of Depression in Primary Care. It emphasises the “stepped care” approach for managing depression, choosing the least intensive intervention required to achieve clinical change for patients. It guides treatment using a combination of evidence-based principles and continuous clinical assessment. Progression through levels of care is determined on the basis of patient response, with support for self-management.
Four implementation components include: an electronic Decision Support Tool (DST) for all general practices that is fully integrated into practice computer systems and provides easy access to management pathways in the Guideline. It will include advanced technological features to support better patient outcomes. Four journals will be published over 2 years to support guideline implementation, workforce development, and monitoring and evaluation to measure impact at practice level and tracking utilisation patterns.
__________________________________________________________________
Ms Jodie Landstra
Acceptance and Commitment Therapy (ACT) applied to patients with chronic health issues and anxiety: A case study
Abstract
ACT has been growing in use over the last 5 years in Australia. The data from ACT outcome studies are showing promising results. ACT aims to enhance psychological flexibility in order for individuals to live meaningful and vibrant lives even in the presence of distressing thoughts, feelings, memories or body sensations.
This presentation will outline an ACT approach to anxiety, highlighting the six core processes of therapy; Acceptance, Cognitive Defusion, Being Present, Self as Context, Values, Committed Action and the skills taught to enable patients to live with their anxiety and have active, meaningful lives. Two case studies will be used to demonstrate this treatment model.
______________________________________________________________
Ms Teresa Lulan & Dr Charles Alpren
The GP Clinic - Two Years On
Abstract
Both international and local studies conclude that mortality rates from physical illnesses for those with mental health issues is significantly higher than the general population. Clinicians would agree that often routine health checks, follow up of tests results and monitoring of medications are often overlooked whilst mental health workers and GPs concentrate on crisis management and mental health checks. This situation is often exacerbated in rural areas where there is less acess to clinical services. The GP clinic was set up in order to rectify these issues. The objectives of the clinic were to:
1. Improve the general medical care of people with mental disorders
2. Address acess and equity issues
3. Use standardised measures to track mental and physical health issues
4. Empower clients in the maitenance of their own health.
Clients are seen with both the GP and clinic nurse present. 110 clients were seen in the first year - 71% of these had no previous engagement with a GP. Attendence was 95%. Physical health issues treated included abnormal ECGs, hypertension, hypercholesterolaemia and osteopenia. Seasonal checks such as skin checks, influenza shots were offered as well as tobacco cessation. Drug and alcohol issues and lifestly issues such as obesity were also identified. Results continue to indicate that there are a number of benefits for clientele, mental health workers and the GP in conducting a clinic
__________________________________________________________________
Ms Tahlee Marian
The course of posttraumatic stress disorder: An exploration of recovery trajectories of children and their parents following accidental injury
Abstract
Objective: Trajectory analyses were used to empirically differentiate patterns of posttraumatic stress symptoms (PTSS) in parents following child accidental injury and to explore the relationship between parent and child recovery patterns.
Method: Parent (n=189) self reported symptoms from acute to 2 years post child injury were examined to i) identify distinct parent symptom trajectories; ii) identify risk factors affecting trajectory group membership; and iii) explore the patterns of children and parents together.
Results: Analysis predicted three distinct symptom trajectory groups for parents: Resilient (78%); recovery (8%) with clinical level acute symptoms that declined to below clinical level by 6 months; and chronic subclinical (14%). Child serious injury and pre-injury internalizing behaviour predicted parent symptom group. Children of resilient parents were most likely to also be resilient. Children of chronic subclinical parents were most likely to have chronic trajectory patterns.
Conclusion: Parents with subclinical level symptoms and their child are at risk for ongoing PTSS following child accidental injury. The ability to identify distinct PTSD trajectories post child trauma and the correlates of these trajectory groups has critical clinical implications for the early identification of individuals who may be at risk.
__________________________________________________________________
Ms Etty Matalon
Guidelines on the management of cannabis use disorder
Abstract
As the demand for cannabis interventions increases internationally, and specialist cannabis clinics are being made available in Europe and Australia, there is a need for evidence-based guidelines to inform best practice.
This workshop will introduce participants to the recently developed guidelines for the management of cannabis related problems (Copeland, Frewen & Elkins). These aim to provide a range of clinicians with a reference point for the range of skills required to intervene with cannabis related problems. Healthcare practitioners may be confronted with a range of presentations of cannabis use disorder including sometimes complex clinical profiles which include mental health symptoms and acute behavioural disturbances such as psychosis and aggression. This workshop is suitable for health care practitioners who work in a variety of settings where clients present with cannabis use disorders. Participants will be made familiar with the various aspects of the guidelines including assessment, withdrawal, psycho-education and interventions.
________________________________________________________________
Ms Kristine McConnell
The Cloak of Invisibility – The Challenge of Identifying ans Supporting Young Carers
Abstract
From the limited research undertaken in Australia to date, it is estimated that there are between 350,000 and 1.2 million young Carers under the age of 25 years. Children as young as 5 years old, have been acknowledged as being Carers. The vast majority of these young Carers remain unidentified and without services supporting them.
Identifying young Carers is challenging for many reasons including the fact that this is ‘normal’ for them; they are concerned about possible ramifications of any intervention if they are identified; and sometimes their care recipient does not acknowledge their level support.
The Young Carers Program is an Australian-wide program which provides support to young Carers, who might be at risk of not completing their secondary education or vocational equivalent, by providing them with access to respite services. The program can help young Carers who provide significant care and support for a parent, child, partner, relative or friend who has a disability, is frail aged, or who has a severe mental or physical condition.
Approximately 80% of the young Carers we are currently supporting are caring for a parent with a mental health issue. Many of these young Carers also either have or develop their own mental health issues.
This presentation highlights case studies demonstrating how to identify young Carers, the types of support provided by the Young Carers Program and the level of care coordination often required to appropriately support young Carers.
______________________________________________________________
Dr Arun Naik
Group CBT approach to treatment of anxiety and depression in rural mental health settings.
Abstract
Dr. Arun Naik and Dr. Anthony O’Brien
This paper will present data gathered from CBT anxiety depression groups in a rural mental health outpatient setting. Patients were invited by letter to voluntarily participate in the anxiety depression groups after identification by their case manager. The group structure follows 8 closed sessions where participants meet in a health service owned house used as a rehab facility once a week for 8 weeks. Topics involved in the groups are learning about anxiety and depression, learning CBT techniques and stress management strategies, self esteem and communication, medication mindfulness and relapse drills. Each participant in recent times has been scored pre group and post group using the DASS and K10. This data will be presented in the context of a discussion around the need to educate consumers using self monitoring strategies which they can use as interventions, rather than relying predominately on medication and case management.
__________________________________________________________________
Ms Kim Ryan
The Mental Health Nurse Incentive Program - a primary mental health care success.
Abstract
As a part of the COAG reform agenda in 2006 the then Prime Minster announced a significant boost to support mental health care in Australia. $1.9 billion over 5 years was committed. Part of this reform was the allocation of $191.6 million of new funding for providing services by credentialed mental health nurses in collaboration with general practitioners and psychiatrists. An incentive payment was established so that general practices, private psychiatrists, and other appropriate organizations (eligible organisations) would be able to engage or retain mental health nurses to assist in the provision of coordinated care for people with severe mental disorders.
The Mental Health Nurse Incentive Program (MHNIP) was implemented 1 July 2007. While initially there was slow take up of the program, many mental health nurses persevered in promoting the program to potential eligible organisations as they saw the benefit to clients. Using information from focus groups, surveys and conferences conducted by the Australian College of Mental Health Nurses, this paper will highlight developments and outcomes since implementation of the MHNIP, and propose improvements for its continuing success.
__________________________________________________________________
Dr Catherine Segan
Evaluation of a tailored Quitline callback service for smokers with a depression history
Abstract
Background
Smokers have a high incidence of lifetime depression. The Quitline callback service in Victoria, Australia offers an additional tailored service for smokers with a depression history that involves Quitline-doctor comanagement (QL-Dr CoMx) of smoking cessation and depression, and tailored counselling that promotes strategies that assist with both smoking cessation and mood control.
Objectives
To test whether the tailored service for depression-history smokers produces comparable quit rates compared to the standard callback service (2 pre-quit and 4 post-quit calls using cognitive-behavioural counselling tailored to stage of change) for smokers without mental health concerns.
Methods
Prospective study of 3 groups of smokers using the Quitline (N=798) i). Disclosed current depression to Quitline n=199; ii). Disclosed past depression n=118; iii) No depression history n=481. Ethical considerations led to use of non-random comparisons. Telephone interviews conducted at baseline, 2 months ie post-treatment (71% response rate) and 6 months (data pending).
Results
Overall 84% made a quit attempt and 50% were quit post-treatment. Currently depressed were significantly less likely to make a quit attempt (72%) and to be quit post-treatment (37%). 74% of currently depressed discussed quitting with Dr, but about half did not proceed to QL-Dr CoMx. Using QL-Dr CoMx predicted making a quit attempt for the currently depressed. Among the currently depressed 2+ weeks of feeling depressed during treatment period was associated with post-treatment smoking.
Conclusions
These preliminary findings show good but not comparable quit rates among the currently depressed and suggest that the additional service for depression history smokers is helpful.
__________________________________________________________________
Ms Andree Sellars
An evaluation of the Dual Diagnosis Reciprocal Rotations Project
Abstract
A.L. Sellars,1., Dr.P. Hasking, 2., G. Logan, 3.
1.Goulburn Valley area Mental Health Dual Diagnosis Service; 2. Monash University, Caulfield; 3.Victorian
Dual Diagnosis Initiative Education and Training Unit.
Aims: The current study sought to evaluate the efficacy of the Dual Diagnosis Reciprocal Rotations Project. It was hypothesised that the program would increase knowledge, skills and confidence in working with clients with dual diagnoses. The sample consisted of 73 practicing clinicians from Victoria (29 rotatees; 21 managers of host organisations; 23 managers of parent organisations).
Results. Results revealed significant increases in all outcome measures over the course of the study. In addition, while workers from the alcohol and other drug sector reported the greatest increase in mental health knowledge, skills and confidence, the greatest gains in dual diagnosis measures were reported by rotatees and managers of the organisations hosting them.
Discussion. Clients with both mental illness and substance use issues often experience sub-standard treatment as they are referred between the mental health and alcohol and other drug service sectors. In an effort to train staff to operate within a dual diagnosis capable framework, the Victorian Dual Diagnosis Initiative introduced the Dual Diagnosis Reciprocal Rotations Project. This project involves staff from the mental health and alcohol and other drug sectors engaging in a work placement in the opposite sector for a three month period. Positive, significant improvement in knowledge, skill and confidence levels in dual diagnosis were found as a result of Rotations.
Implications for policy, delivery or practice: As the Reciprocal Rotations Project improves dual diagnosis knowledge skill and confidence in clinicians, it may be concluded in line with much past research into integrated treatment, that the project will also improve treatment outcomes for consumers by encouraging information sharing, collaborative treatment and a no-wrong-door philosophy in dual diagnosis service providers
__________________________________________________________________
Dr Tim Slade
Trends in the prevalence of mental disorders in Australia, 1997 to 2007: Results of the National Mental Health and Wellbeing Surveys
Abstract
It has been over ten years since the 1997 Australian National Survey of Mental Health and Wellbeing (NSMHWB) was carried out. The findings of the 1997 NSMHWB have contributed greatly to mental health policy and practice in Australia. A second Australian NSMHWB was carried out in 2007 to gain a more detailed understanding of the epidemiology of mental disorders with a particular focus on the issue of health service utilisation. The aim of this talk is to present descriptive epidemiological findings from the 2007 NSMWHB. This will include data on the prevalence and correlates of the major DSM-IV mental and substance use disorders as well as a detailed examination of the feasibility and outcome of comparing estimates of prevalence over time. The 2007 Australian NSMHWB was carried out by the Australian Bureau of Statistics between August and December 2007. Data were collected via computerised personal interview using the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). At the time of writing this abstract the data files for the 2007 NSMHWB had not been released by the ABS. Preliminary results obtained through negotiated extract tables indicate that around one in five Australians experience DSM-IV mental disorder in the 12 months prior to interview. The results of the 2007 NSMHWB will be discussed both as a snapshot of the mental health of Australians circa 2007 as well as in the context of the findings from the 1997 survey.
__________________________________________________________________
Ms Liz Temple
The Cannabis Experience & Everyday Functioning: Who needs treatment?
Abstract
With approximately 159 million users, cannabis is widely cited as the most commonly used illicit substance in the world. Although the vast majority of cannabis users are non-treatment-seeking, this group of users is relatively under researched. It is probable that the disparate cannabis use-related effects seen in society are in some way related to the heterogeneity of these users and their divergent patterns of cannabis use. To investigate this premise, 989 participants (62% male; age range: 18-73 years) were recruited to complete an Internet-based questionnaire assessing everyday functioning, with a specific focus on mental health and cognitive function. Participants were 16 years old on average when they first used cannabis and had been using for a mean of 13 years, 42% were current daily users, and 13% met criteria for proxy cannabis dependence. High levels of psychopathology and cognitive failures were evident in the sample population (i.e., 19% depression, 6% high psychotic symptomology, 14% high cognitive failures); with 28% of participants likely to experience some level of impairment in their everyday functioning. Five cannabis user types were identified and found to differ in relation to patterns of cannabis use, demographics, current and childhood lifestyles, and, everyday functioning. The high level of impairment evident in the sample population indicates that these individuals would benefit from psychological treatment. However, the detailed user typology developed in this study suggests that such treatment should be tailored to the type of cannabis user.
__________________________________________________________________
Dr Allison Waters
Predictors of treatment success in a CBT program for child anxiety disorders
Abstract
Aim: Considerable evidence has accumulated to support the use of cognitive-behavioural therapy (CBT) in the treatment of child anxiety disorders. However, less research has been conducted on the potential factors that predict treatment success. The purpose of this study was to identify the predictors of treatment outcome in a 10-week group CBT program.
Method: 188 children aged between 4 and 12 years who met DSM-IV diagnostic criteria for an anxiety disorder completed the Take ACTION Program at Griffith University, Gold Coast Campus. The program comprised of 10 child and parent sessions, followed by one booster session. Treatment included the core components of CBT (i.e., psycho-education, relaxation techniques, positive thinking, graded exposure), in addition to social skills training (i.e., assertiveness). Children and parents completed a diagnostic interview and a number of self-report measures at post-treatment, 6-month and 12-month follow-up.
Results: Predictors of treatment outcome were examined across the post-treatment and follow-up assessment intervals. The child’s age at pre-treatment was found to be a significant predictor of principal diagnosis severity at post-treatment and 6-month follow-up, with younger children (4 to 7 years) experiencing greater reductions in anxiety in comparison to older children (8 to 12 years). Children’s gender was found to predict the severity of parental depression scores at post-treatment, with parents of male children reporting lower depression scores than parents of female children.
Conclusions: The present study will add to the literature on child anxiety CBT programs, and may help identify those families who would most benefit from this form of treatment.
__________________________________________________________________
Ms Lorraine Waters & Dr Jennifer Wells
Self-reported Substance Use
among Police Detainees
Abstract
This paper explores self-reported substance use, mental ill-health and
offending behaviour in a sample of police-detained adults. It is based
on data collected by Court Liaison officers of Queensland Health's
Community Forensic Mental Health Service at Magistrate's Courts and
watch houses in S.E.Queensland over a 3 month period, July - September,
in 2008.
The assessment tool and procedures routinely employed by Court Liaison
officers are briefly described. Preliminary findings with a special
focus on the 73% of detainees who reported recent consumption of any
psychoactive substance are then outlined. The type and nature of
reported substance use among this group is summarized, providing
evidence of a trend for cannabis, often used in conjunction with other
substances including alcohol, to continue as the latest drug-of-choice
among detainees. In addition, analyses exploring more complex patterns
of consumption in relation to the current charges, the diagnoses, and
treatment-seeking behaviours of the detainees are reported.
Despite the limitations of this study, the paper concludes that the
findings confirm the widespread use of psychoactive substances among
those confronting the criminal justice system as police detainees, and
that the link between the nature of the charges faced by police
detainees and their current consumptive habits warrants further, more
rigorous investigation. The paper also highlights the need for special
handling of this potential client group, especially to ensure their
equal access to interventions designed to encourage initial
acknowledgement and subsequent successful management of any mental
health or drug and alcohol issues.
__________________________________________________________________
Mr Paul Zdrojewski
Development of a Therapy Program working alongside an Emergency Mental Health Service
Abstract
In 2006 Noarlunga Emergency Mental Health Service (NEMHS), developed the Brief Therapy Program (BTP). This program works along side NEMHS (an emergency/crisis response mental health service) and pulls clients from the service that are experiencing depression, anxiety or stress due to life circumstances.
While engaged with the BTP, clients have full access to the NEMHS services, including after hours support and access to a consultant psychiatrist/mental health medical officer.
The Brief Therapy Program provides a service to clients who are experiencing emotional/psychological crisis. The clinicians within this service offer a client centred, time limited therapeutic approach which enhances the clients’ ability to cope with their crisis and develop techniques to better mange such situations in the future.
This program prevents attendance at hospital emergency departments or the seeking of mental health inpatient admissions.
The program has proven useful to clients that require more long term therapy by way of an introduction as to what can be achieved and the benefits of the therapy process.
Other outcomes have been to assist in the development of improved quality of life, linking in with appropriate community services and assisting the client to take control of managing crisis situations or areas of their life that causes them distress.
The service is a Regional program that accepts referrals from both the Inner and Outer Southern Adelaide Health Service catchment areas. Referral sources have also included the local hospital emergency departments, GP’s and Community Health Centres.
Since inception, 70% of clients registered have completed the program.
__________________________________________________________________
