RANZCP Abstracts

Keynote Speaker Abstracts

Tackling Ethnic Inequalities in Severe Mental Illness Experiences and Outcomes

K Bhui

Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK

Background: Ethnic inequalities and severe mental illness experience and outcome have been documented in the United Kingdom (a high-income country) for at least three decades. These include high rates of compulsory admission and treatment, use of crisis and criminal justice agencies on the pathway to care, less use of primary care and arguably more dissatisfaction with services and fear of services. Numerous explanations have been put forward including factors that are patient related, enormous related, service related, or an interaction between service and patient. Despite numerous efforts to collect data and expose inequalities, little has changed. One explanation is that we have not fully understood the causes of inequalities, that causal risk factors are not useful targets for preventive intervention and that there is disagreement about whether inequalities can be understood as socially unjust disparities as opposed to personalized and effective care for a range of populations with differing profiles and types of illness experience. These issues have been the source of much heated debate, often invoking allegations of institutional racism and discrimination, especially salient for populations with long histories of disempowerment and prejudicial treatment in society. In the context of concerns about the scientific basis of psychiatry, such fears reactivate survival schemas and polarized views about how to reduce inequalities.

Objectives:

Methods: I will describe The Synergi Collaborative Centre’s approach to discovering hidden narratives that underlie sources of inequality and how these are being harnessed in partnership with service users and the public to reform national policy in practice. We hope that the emphasis on creativity, progressive and constructive and optimistic processes, grounded firmly in values of respecting patient experience and of co-creation and co-production will offer an attractive, humbling and disarming approach to reconciling divergent, polarized and vexatious ideologies and ways of working that reinforce organizational structures and processes that systemically generate the continuation of inequalities.

Findings: It is too early to provide a comprehensive account of the findings of this 5-year program, which has just launched in the United Kingdom. Not least we are encountering the harsh consequences of austerity measures in public services, potential reform of the mental health act and a growing demand for an awareness of mental health as a basis for a progressive society. However, early indicators based on the working cultural consultation and narrative-based medicine public health models to tackle inequalities, and emerging hidden voices, suggest we are on the right track. Whether such systemic models can ever be tested through randomized trial design is open to question, but total systems change requires significant investment, time, energy, motivation, collaboration and synergy between multiple agencies and actors. Mental health may be better conceived of as a social and public good, in which context-specific specialist mental illness services can operate. There are tensions between targeted interventions and universal population approaches, and in the balance between social justice emphases versus greatest good approaches, given the constraints on budgets. There are risks in the transformational landscape leading to less attention being paid to the most severe mental illnesses and the suffering of those with treatment-resistant conditions. This paper discusses trade-offs and optimistic gains from a systems approach and wider application in other contexts and global health settings.

Building A Healthcare System Response to Borderline Personality Disorder

A Chanen^1,2

¹Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia

²Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia

Background: Borderline personality disorder (BPD) is among the most common disorders seen in clinical practice and its personal, social and economic consequences are comparable with those for severe mood and psychotic disorders.

There is now strong empirical support for timely diagnosis of BPD and for the effectiveness of treatment. Yet, diagnosis of BPD is typically delayed, empirically supported treatments are largely inaccessible, and iatrogenic harm is still a common outcome. Specialized treatments are only offered to a select few, late in the course of the disorder and usually in the form of complex and lengthy individual psychotherapy.

Findings: Evidence suggests that such individual psychotherapy is neither necessary nor sufficient for the treatment of all individuals with BPD and that psychotherapy has little effect upon long-term psychosocial functioning. Such findings need to be integrated into a comprehensive, equitable, accessible and human health system response to BPD, recognizing both its heterogeneity and routine co-occurrence with other psychopathology (‘comorbidity’).

Various treatment options, which are appropriate and proportionate to the phase and stage of the disorder, need support at all levels of the health system. ‘Clinical staging’, similar to disease staging in general medicine, is presented as a pragmatic, heuristic framework to guide prevention of and intervention for BPD.

Clinical staging defines an individual’s location along the evolving and dynamic temporal course of a disorder and sets borderline pathology in the context of other evolving psychopathology. Such staging aids differentiation of early or milder clinical phenomena from those that accompany illness progression, chronicity and poor functional outcomes and suggests the application of sequential, targeted and proportionate intervention strategies.

He Moana Pukepuke E Ekengia E Te Waka – A Rough Sea can be Navigated: Bringing Māori Knowledge Forward in Traumatic Brain Injury Recovery Using Gamification

H Elder

Te Whare Wānanga Ō Awanuiārangi, The University of Auckland, Auckland, New Zealand

Background: The role of ocean-going waka is recognized as a central aspect of hauora (well-being) for Māori (indigenous people in Aotearoa, New Zealand). Waka are a potent symbol of our ocean-going navigational past and of the reclamation of those skills in recent times. Waka remind us of our ancestors’ knowledge and resilience and are the source of powerful whakapapa stories that ground our identity. Waka form essential links for Māori with all peoples of Te Moana nui a Kiwa, the Pacific Ocean.

Waka knowledge systems are a potent resource for enhancing health outcomes and have been used in Te Waka Oranga and Te Waka Kuaka (Elder, 2017), two recently developed evidence-based resources for ensuring that the healing journey from traumatic brain injury (TBI) is culturally salient. These tools are predicated on the theory that an injury to the brain has a cultural component that injures the wairua, the Māori connection to everything in the universe, and therefore requires cultural intervention. These tools are already used in mainstream community services.

Objectives: The next step is to create a free authentic augmented reality game version of Te Waka Oranga and Te Waka Kuaka that takes whānau (extended families) into a waka game format on a device in the palm of their hand. This availability would overcome some difficulties that limit access to services.

Methods: Wānanga (meetings) with traditional waka navigators, game developers and whānau with experience of TBI provide data to ensure the authentic development of the game experience.

Findings: Early findings will be presented.

Conclusions: Gamification of indigenous waka knowledge is a useful addition to available approaches. Although the waka tools have been developed for those with TBI, it is anticipated they will have wider appeal to those with mental health addictions, neurological and neurodegenerative conditions.

Reference

Elder H (2017) Te Waka Kuaka and Te Waka Oranga. Working with whānau (extended families) to improve outcomes. Australian and New Zealand Journal of Family Therapy 38(1): 27–42. doi:10.1002/anzf.1206

Epistemic Trust And Epistemic Injustice, Trying to Understand The Way Psychological Therapies Work For Persistent Mental Health Problems

P Fonagy^1,2

¹University College London, London, UK

²Anna Freud National Centre for Children and Families, London, UK

Background: Recent meta-analyses suggest that several psychological therapies are increasingly but equally effective for treating a variety of personality disorders (PDs), which suggests the involvement of some common mechanism across both disorders and therapies. Psychological therapies for PDs all have a component that facilitates social learning, suggesting that part of the causation of persistent disorders may be an inability to modify current representations in the face of new knowledge.

Objectives: The developmental concepts of mentalizing and the linked concept of epistemic trust may offer a hypothetical framework for explaining persistence and change in these conditions.

Methods: The concept of epistemic trust is reviewed developmentally and in the context of the phenomenology of PDs. Some recent statistical models of the hierarchical structure of mental disorder are examined in relation to the hypothesized association with epistemic hypervigilance and shortcomings in mentalizing processes.

Findings: Preliminary findings indicate an association between limitations of mentalizing and general psychopathology. Further direct and indirect evidence suggests links between epistemic vigilance and hypervigilance and a range of problems normally considered under the heading of PD.

Conclusions: It is argued that persistent mental disorders are best understood not in terms of specific pathologies but in the framework of salutogenesis. Individuals with persistent mental disorder may lack a capacity for wrapping an adaptation for changing social conditions because some optimal social networks weaken by epistemic hypervigilance.

Matching Antidepressant Action to the Pathophysiology of Mood Disorders: A Science-Based Approach to Treatment Discovery

J Mann

Department of Psychiatry, Columbia University, New York, USA

Background: The treatment of depression lacks adequacy. Many patients do not respond to first or second treatment trials. When treatment does work, it takes weeks to provide relief. We have no idea which medication type or psychotherapy or stimulation therapy to match with an individual patient. Treatment selection is based on side effects of the treatment and what the clinician feels most expert in using. Without credible and tractable treatment targets, identifying new and better treatments is so difficult that most major pharmacological companies have abandoned psychiatry.

Objectives: Identified brain pathophysiology in major depression is an obvious target for antidepressant action. The question is: ‘Can treatment selection be tailored to the brain abnormality in the individual patient?’ This presentation will review recent research that illustrates this process and offers a more rational approach to antidepressant treatment selection.

Methods: Brain imaging studies of depressed patients and postmortem studies of depressed patient brain have identified abnormalities related to the serotonin system and brain trophic pathways associated with depression and some potentially causative genomic abnormalities that offer accessible treatment targets.

Findings: Postmortem brain studies have ruled out a deficit in serotonin neurons and serotonin synthesis as a cause of major depression. Yet much evidence suggests that there is less serotonin release despite adequate production and an abundance of serotonin in serotonin neurons. The cause of deficient serotonin neuron firing and release in major depression appears to be a trait consisting of elevated autoreceptor expression on serotonin neurons in many depressed patients. More autoreceptors cause lower levels of serotonin neuron firing and less serotonin release.

There are two causes of this overexpression of these autoreceptors that regulate serotonin neuron firing. The first is a genetic variant in the gene’s regulatory region and the second is that childhood adversity may result in DNA methylation of the site that normally inhibits gene expression, and the result of both causes is overexpression of the autoreceptor.

Selective serotonin reuptake inhibitors (SSRIs), the first-line antidepressant medication class, reduce the number and responsiveness of these autoreceptors and increase serotonin firing and release, over a period of several weeks, as their main mechanism of action. This time frame matches the lag to antidepressant benefit. Identification of this treatment target invites the development of other treatments that can downregulate these receptors faster and have a more rapid antidepressant effect.

Postmortem studies identify deficits in mature granule neurons in the hippocampus and smaller dentate gyrus volume in untreated major depression. The causes of this neuron number loss may be many, including serotonin deficiency, excessive cortisol levels, neuroinflammation and glutamate. Treatment with SSRIs appears to normalize the number of mature granule neurons and reverse the volume loss in the dentate gyrus in major depression. Blocking the neurogenesis effect of SSRIs in mice also blocks their ‘antidepressant’ effect. New treatments that target neurogenesis offer promise.

The fast-acting antidepressant, ketamine, also has a trophic effect in the brain, with a time course comparable to its antidepressant action. Within hours, it causes an increase in mushroom spines on neurons that enhance synapse formation capacity. Blocking this action prevents its ‘antidepressant’ effects in animal models. Modeling drugs on the trophic actions of ketamine offers hope for a new class of antidepressants that work robustly and in only hours.

Conclusions: Preliminary studies link the pathophysiology of major depression to clinical outcome, and identifying treatment targets not only opens the door to personalized treatment of depression but also offers a more rational path forward for new drug development.

A Simple Protocol for the Pharmacological Treatment of Schizophrenia

D Taylor^1,2

¹King’s College London, London, UK

²Maudsley Hospital, London, UK

Background: Worldwide more than 30 antipsychotic drugs are available in a variety of formulations. Debate continues around the optimal sequence of treatments, the use of polypharmacy, the use of long-acting injections, duration of antipsychotic treatment, optimal dose and the possibility that the use of antipsychotics might worsen outcome.

Objectives: To produce an evidence-based protocol for the lifelong treatment of schizophrenia.

Methods: Systematic review of evidence published before December 2017.

Findings: Adherence difficulties with oral antipsychotics, specifically the inability to assure adherence, render them of limited value in schizophrenia. Oral drugs should generally be used only to test efficacy and tolerability before initiating a long-acting formulation. Failure to respond to a long-acting injection should provoke a dose increase to the maximum dose tolerated. Where there is still no response, a second antipsychotic may be added for a short-term trial; limited evidence supports the use of olanzapine as the added drug. After this, only clozapine is likely to be effective. Clozapine should be initiated at the earliest opportunity and the dose determined by plasma concentration determinations. If clozapine fails, augmentation with lamotrigine is the best-supported option.

Conclusions: Treatment should begin with a brief treatment with an oral antipsychotic followed by a long-acting injection at an optimized dose. Where this fails, a brief trial of polypharmacy is supportable. If there is no response, clozapine should be prescribed and the dose optimized. Augmentations strategies are available should clozapine fail.

Invited Speaker Abstracts

Risk and Protective Factors for Mental Health in The Nzdf

C Bennett

New Zealand Defence Force, Wellington, New Zealand

Background: New Zealand’s suicide rate is near the highest it has been since recording. The prevalence of mental health–related issues in the New Zealand (NZ) population is increasing, and it can be expected that this trend may also be reflected in the New Zealand Defence Force (NZDF) community, including our serving personnel, veterans, our families who support us and our new recruits.

As a representative sample of the broader NZ population in many respects, the NZDF can expect similar trends, along with some differences. While our serving personnel are a comparatively younger and healthier subset of the broader population, the nature of service sometimes comes with demands that are not typical of those in the broader community.

Objectives: This presentation presents a summary of the potential stressors associated with military service, risk and protective factors. Key areas of focus for building and maintaining positive mental health in the NZDF are also presented.

Trends in Personality Disorder Research and Treatment

P Cammell

The Royal Melbourne Hospital, Melbourne, Australia

Background: In recent decades, personality disorders have been increasingly associated with research focusing upon certain models of developmental psychopathology and psychotherapy.

Objectives: Trends in personality disorder research will be discussed, focusing upon the widely adopted diagnoses of borderline and narcissistic personality disorder.

Methods: Methods of analysis from philosophical and social theory research will be applied to this domain to explore trends and biases and to highlight dilemmas in applying personality disorder research to real-world situations of individual clinical practice, mental health service provision and public health policy. Research previously outlined in the author’s principal work (Cammell, 2016), and associated literature, will be discussed.

Findings and conclusions: This paper will attempt to emphasize ethical, pragmatic and contextual considerations that are often omitted in the personality disorder research field. The paper will advance some ideas from philosophy and social theory that assist in elucidating the historical nature and culture-boundedness of our understanding of personality disorders.

Reference

Cammell C (2016) Reinterpreting the Borderline: Heidegger and the Psychoanalytic Understanding of Borderline Personality Disorder. Lanham: Rowman and Littlefield.

Keeping The Body in Mind: Integrating Physical and Mental Healthcare in Psychosis

J Curtis^1,2

¹School of Psychiatry, UNSW Sydney, Sydney, Australia

²South Eastern Sydney Local Health District, Sydney, Australia

Background: Higher rates of obesity, tobacco use, cardiovascular disease and diabetes contribute to the 20-year reduced life expectancy of people living with psychosis compared to the general population. International collaboration to tackle this issue created the momentum for the consensus statement Healthy Active Lives (International Physical Health in Youth, 2013) and related consumer and carer resources. The recently released Equally Well national consensus statement also seeks to improve the physical health and well-being of people living with mental illness in Australia (National Mental Health Commission, 2016) and has been widely endorsed.

Objectives: The seeds of this health inequality are planted at the start of treatment, and in youth, with first episode psychosis, antipsychotic medication initiation induces rapid deterioration in metabolic health. The Keeping the Body in Mind (KBIM) program has been developed as an integrated program of care for screening, prevention and intervention to address cardiometabolic health in psychosis. This program commenced in youth and has been extended to adult mental health populations. This presentation will outline the implementation and impact of the KBIM program, including the pivotal role of peer wellness coaches as core members of the multidisciplinary team.

Conclusions: People with psychosis have a right to secure the same life expectancy and expectations of life as their peers who do not have psychosis. Mental health professionals working in partnership with consumers and carers are well placed to support lifestyle management and effective interventions for people with psychosis and can have a substantive role in addressing the health and life expectancy gap in people with psychosis.

References

International Physical Health in Youth (iphYs) Working Group (2013) Healthy Active Lives (HeAL) consensus statement 2013: Keeping the Body in Mind in Youth with Psychosis. Available at: www.iphys.org.au.

National Mental Health Commission (2016) Equally Well Consensus Statement: Improving the Physical Health and Wellbeing of People Living with Mental Illness in Australia. Sydney: NMHC. Available at: http://www.equallywell.org.au.

Diagnosis and Initial Management of Psychogenic Nonepileptic Seizures

R Duncan^1,2

¹Christchurch Hospital, Christchurch, New Zealand

²Department of Neurology, University of Otago, New Zealand

Background: Clinical presentations of psychogenic nonepileptic seizures (PNES) have become better characterized in recent years. Patient history may be limited, but conversational analysis studies have shown that patients are reluctant to describe the experience of their events. Symptoms suggesting hyperventilation may be reported. Patients tend to maximize, report consequences of attacks and concern expressed by others. To the eyewitness, most PNES fall into two main types: convulsive (fall, loss of response, amnesia, variable tremorous movements) and swoon (fall-down-lie-still, loss of response, amnesia). Some PNES are intermediate, or may have phases with and without movements, and some patients may have both types at different times. A minority of patients have absence-like events or events that look like myoclonic jerks.

Better clinical knowledge allows PNES to be suspected earlier, and appropriate tests brought to bear. Video electroencephalography (VEEG) is more widely available and, where an event can be recorded, a clear diagnosis can be arrived at in the great majority of cases. Many patients will have a diagnostic event during short outpatient VEEG recording, especially if simple verbal suggestion is used. Ambulatory EEG can also be useful. Where events cannot be recorded, then criteria for ‘clinically established’ PNES are recognized.

A variable proportion (up to 40%) of patients remit on presentation of the diagnosis, with useful reduction in healthcare utilization, even in some whose seizures persist. Therefore, initial management revolves around good communication of the diagnosis to patient and caregivers, and then withdrawal of anticonvulsant medication where required.

The Role of Psychiatry in The Current Security Environment: Protecting Vulnerable Individuals and Preventing Violent Outcomes

M Pathé^1,2

¹Swinburne University of Technology, Melbourne, Australia

²Victorian Institute of Forensic Mental Health, Melbourne, Australia

Background: Modern terrorism aims to steer vulnerable individuals towards an ideology. There has been a global increase in lone-actor attacks and the morbidity and mortality of those attacks. Traditional policing and counterterrorism methods are more applicable to group extremists. Those who act alone have a different profile, mental illness being a dominant theme.

Objectives:

Methods: Current research findings in relation to lone-actors will be presented, together with the findings from Australian research, with case examples.

Findings: Almost half of lone-actor terrorists, apolitical lone-actor mass murderers and pathologically fixated persons in western nations have a mental illness, many of whom are undiagnosed and untreated.

Joint policing and mental health approaches have demonstrated their effectiveness in mitigating risk and facilitating mental healthcare and other supports for concerning individuals.

Conclusions: Although mental illness is not the primary driver of lone-actor grievance-fuelled violence, it is a contributing factor and one that psychiatry is equipped to address. All mental health practitioners need to be informed and collaborate within the ethical parameters of their profession, to protect their patients and the wider community.

Professional Leadership

K Poutasi^1,2

¹New Zealand Qualifications Authority, Wellington, New Zealand

²Member of the Ministerial Advisory Group for Health, New Zealand

This is a fast changing, global, digital and connected world. The Congress theme Becoming Well Together requires partnerships that will support the recovery journey of mental health clients. That journey will differ for different clients. What does it take to offer professional leadership to such partnerships? We know those partnerships extend from the client themselves, through whanau and community, to other health care professionals and indeed to other government agencies. We know partnerships require a system perspective to ensure quality assurance across the spectrum of care. We know expectations and needs are very personal to clients, so how do we respond? Professional leadership will be explored in this modern complex and changing world.

The Australian Defence Force Mental Health Journey

TL Smart, DC Morton

Joint Health Command, Australian Defence Force, Canberra, Australia

Background: The Australian Defence Force’s mental health journey began in 2002 with the release of our first mental health strategy; experienced a seismic shift following the 2009 Dunt Review; and now stands on the threshold of its next evolution with the Defence Mental Health and Wellbeing Strategy 2018–2023.

This journey has moved us from:

Conclusions: This presentation details highlights and achievements of the journey and ongoing challenges, including how the Royal Australian and New Zealand College of Psychiatrists may assist us on the journey that lies ahead.

Informing Psychiatry with Neuroscience and Philosophy: Becoming Well Through Partnerships

M Wong

School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

Background: A key question for psychiatrists in the 21st century is how we can deliver quality care to our patients in an informed manner. To address that we need good evidence on the nature of mental disorders and their effective treatment and accurate prognosis.

The inconvenient truth of psychiatry is that mental illness is still underdiagnosed and undertreated globally. According to World Bank and the World Health Organization, there are up to 600 million people in the world suffering from mental illness, of whom 50–90% do not get any treatment. In many countries, mental health care attracts less than 1% of the total healthcare budget.

Psychiatry continues to search for a balanced and effective approach to mental illness. During the last couple of centuries, psychiatry has been swinging between ‘brainlessness’ (neglecting neurobiology) and ‘mindlessness’ (overfocusing on brain sciences) and continues to struggle with ambivalence towards culture and spirituality.

This presentation reviews developments over the last three decades in neuropsychiatry, neuroimaging, psychopharmacology, philosophy of psychiatry and related fields, including works by the speaker, to highlight both challenges and opportunities for psychiatry to partner with other disciplines and how these challenges impact on psychiatric research and service delivery.

This lecture argues that psychiatry of the 21st century is going to be an interdisciplinary partnership that puts patients first, supports new models of service delivery, reconnects minds with brains in research, contributes to general skills training in medical education and promotes an open society that understands and supports mental health. The future of mental health is one that is informed by neuroscience, philosophy of science and mind and ethics and is evidence-based, whole-person focused, client-centered and interdisciplinary driven.

Pre-Congress Workshop Abstracts

Approaching the Critical Essay Question and the Modified Essay Questions in the Ranzcp Essay-Style Examination

L Lampe¹, J Reddan²

¹Committee for Examinations, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Written Examination Subcommittee, Committee for Examinations, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: The essay-style questions test capacity for clinical reasoning, critical thinking and the ability to communicate this efficiently and effectively in a professional writing style, in a time-limited situation. These are considered essential skills for psychiatrists.

The essay-style paper includes two components: the critical essay question (CEQ) and modified essay questions (MEQs). The CEQ focusses on the capacity to critically examine a proposition in the context of the practice of psychiatry. MEQs are more clinically focused and aim to test the application of knowledge relevant to clinical practice. Candidates are required to pass the CEQ to be awarded an overall pass in the essay-style paper.

Objectives: This workshop is designed to assist candidates to prepare for the CEQ and the MEQ components of the Royal Australian and New Zealand College of Psychiatrists essay-style examination.

Methods: Members of the Committee for Examinations will discuss the approach to these question types, the required standard and how to demonstrate it (what the examiners are looking for), and highlight skills and strategies for successfully passing these question types. Practical exercises will be used where possible.

Conclusions: Previous workshops have been well attended and have received very positive feedback and response.

Substantial Comparability Assessor Accreditation/Reaccreditation Workshop

L Rose¹, D Fenn¹, B Riethmuller²

¹Substantial Comparability Assessment Review Panel, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Specialist International Medical Graduate Education, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: Specialist international medical graduates who are assessed by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) as substantially comparable are required to complete a 12-month placement of supervised practice to attain Fellowship of the RANZCP. Among other workplace-based assessments, three Case-based Discussion (CbD) assessments are completed during the placement, each conducted by an accredited substantial comparability assessor.

This full-day workshop is aimed at:

Previous accreditation or an approved nomination to become a substantial comparability assessor is required for fellows who wish to attend this workshop.

Fellows who are interested in becoming a substantial comparability assessor and have at least 3 years of post-Fellowship experience should contact the Specialist International Medical Graduate team by emailing comparability@ranzcp.org for details on the approval and accreditation process.

Objectives: To achieve competency and accreditation as a substantial comparability assessor. The workshop will address:

Pharmacological Treatment of Anxiety Disorders

D Taylor^1,2, C Bell^3,4

¹Pharmacy and Pathology, Maudsley Hospital, London, UK

²Institute of Pharmaceutical Science, King’s College, London, UK

³Department of Psychological Medicine, University of Otago, Christchurch, New Zealand

⁴Anxiety Disorders Service, CDHB, Christchurch, New Zealand

Background: Anxiety disorders are some of the most prevalent psychiatric disorders, and anxious patients can present some unique challenges for treatment. This workshop will have a clinical focus covering these issues in an interactive way using case examples and discussion. Participants in the workshop will be invited to submit cases in advance, which can be considered for discussion.

Objectives: The workshop is to cover:

My CPD – Achieving Your Mandatory Continuing Professional Development

W de Beer^1,2, R Harvey², E Moore², L Salmon^2,3, R Dotson², I Goodwin², B Lloyd², J Topp², G Young²

¹Waikato District Health Board, Hamilton, New Zealand

²Committee for Continuing Professional Development, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³Committee for Continuing Professional Development, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: From January 2017, completion of the continuing professional development (CPD) program has become mandatory for members of the Royal Australian and New Zealand College of Psychiatrists. The program has been changed to include elements such as practice development, quality improvement and review that are expected to be required for any future recertification or revalidation regulations that may be introduced. In addition, the online CPD system, My CPD, was launched in April 2017.

Objectives: To increase members’ understanding of the CPD program and the use of the online My CPD system. A particular focus is to explain the audit process and how to achieve a paperless and compliant audit and to explain the requirements of Section 3 – Practice Improvement.

Methods: A combination of didactic presentations, hands-on use of the online My CPD system and question and answer will be used.

Approaching The RANZCP Psychotherapy Written Case Assessment

A Pethebridge

Case History Subcommittee, Committee for Examinations, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: The Psychotherapy Written Case (PWC) provides the opportunity for the trainee to assess their ability to communicate their assessment, formulation and management of a person with psychiatric problems in written professional English and to provide trainees with an opportunity to demonstrate their capacity to reflect on their clinical involvement with a patient, the contribution of supervision and on their role as part of the broader mental health system.

Objectives: To assist candidates to understand the nature and standard of the PWC assessment.

Methods: The workshop will include presentations by members of the Committee for Examinations regarding the common challenges faced by candidates, and it promotes the development of strategies for successfully passing this assessment.

In this workshop, attendees will be introduced to

Approaching The RANZCP Scholarly Project Assessment

J Ferguson

Scholarly Project Subcommittee, Committee for Examinations, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Objectives: To assist candidates to understand the nature and standard of the scholarly project submission and assessment.

Methods: The workshop will include presentations by members of the Committee for Examinations regarding the common challenges faced by candidates, and it promotes the development of strategies for successfully passing this assessment.

In this workshop, attendees will be introduced to

Resilience and Integrity in Becoming Well Together

M Goldner-Vukov¹, LJ Moore², S Mijalkovic³

¹Middlemore Hospital, Auckland, New Zealand

²Loma Linda University, Loma Linda, USA

³University of Belgrade, Belgrade, Serbia

Background: Resilience has been established as an important factor in facing adversity and in the process of recovery. Resilience and integrity on the level of the individual service user (SU), the multidisciplinary team (MDT), the family and the community/culture are essential in achieving coherent relationships that are the foundation of well-being.

Objectives: To provide the participants an opportunity to experience these concepts, understand their necessity in the process of becoming well together and to learn how they can be used in their lives and work.

Methods: The workshop will include a didactic presentation of the concepts of adversity, survival, resilience and integrity and show how all these concepts are integrated and interact with each other. One movie will portray these concepts and engage the participants on a deeper level. Interactive group dialogue and problem-solving sessions will follow each movie. One prominent cultural psychiatrists have been invited as discussants and will engage in the group process of describing how the MDT uses these concepts in the application of resiliency and integrity.

Findings: Participants will have an opportunity to deepen their experience of these concepts and explore their own feelings and how they can empower themselves and implement learning.

Conclusions: Adversity and the need to survive are constant challenges in everyday life and they are often magnified in SUs, their families and communities. Understanding the skills of empowering resilience and integrity and their interactive nature in the MDT, SU, family and community is a significant contribution in the process of becoming well together.

How to Help Your Patients Quit Smoking or Reduce Harm from Tobacco

C Mendelsohn¹, D Castle², H McRobbie^3,4,5, C Bullen⁶

¹School of Public Health and Community Medicine, University of New South Wales, UNSW Sydney, Australia

²St Vincent’s Hospital Melbourne, Melbourne, Australia

³The University of Melbourne, Melbourne, Australia

⁴The Dragon Institute for Innovation, Auckland, New Zealand

⁵Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK

⁶National Institute for Health Innovation, The University of Auckland, Auckland, NZ

Background: Smoking rates in people with mental illness remain high despite substantial declines in the general population. Electronic cigarettes (e-cigarettes) have the potential to reduce smoking prevalence and smoking-related harm in people with mental illness.

Objectives: To provide interactively evidence-based guidelines for psychiatrists to help people with mental illness quit smoking and will give practical information on the use of e-cigarettes for tobacco harm reduction.

Discussion: David Castle will outline the devastating effects of smoking on the physical, mental and financial health of smokers with mental illness. Quitting does not exacerbate pre-existing mental illness and can lead to improved mental well-being, reduced suicide risk and improved substance outcomes. Smoking has important interactions with some psychotropic drugs. Colin Mendelsohn will discuss practical guidelines for helping smokers with mental illness to quit, including counselling, medication and support, based on the 5As framework. The safety of varenicline in smokers with mental illness will be reviewed. Hayden McRobbie and Chris Bullen will discuss the evidence for using e-cigarettes for tobacco harm reduction for smokers who are otherwise unable to quit, including the efficacy, safety and legal status of vaping, with special reference to smokers with mental illness. Hayden McRobbie will describe the devices available and give practical advice on how to counsel smokers on their use. Colin Mendelsohn will present two case studies, one using conventional treatment and another using e-cigarettes.

Conclusions: Psychiatrists have a duty of care to help their patients quit smoking or to reduce the harm from tobacco.

Workshop on Civil Forensic Psychiatry

AH Samuels^1,2,3

¹UNSW Sydney, Rural Clinical School, Wagga Wagga, Australia

²Mental Health, Murrumbidgee Local Health District, Wagga Wagga, Australia

³Consultant Forensic Psychiatrist, Sydney

Background: The purpose of this workshop will be to upskill registrars, trainees in forensic psychiatry, general adult psychiatrists and forensic psychiatrists with regard to current issues in civil forensic practice and the increasing demands and expectations that are being placed on psychiatrists who give expert opinion in civil jurisdictions.

Objectives: To discuss contemporary practice issues in the field as well as future directions and skills needed by those working in the field. Civil forensic psychiatry is an important but somewhat neglected area of forensic psychiatry.

Methods: This will be a 3- to 4-h workshop and ideal numbers would be 20–40 participants.

Findings: The first half will cover theoretical concepts including terminology, legal processes, expert witness codes of conduct, psychiatric injury, impairment, class actions, specific psychiatric issues including trauma, institutional abuse, refugee mental health and medical negligence.

The second half will deal with practical aspects of running a civil forensic practice, including administration, building up a practice, report writing, document management and billing. Some discussion will be devoted to expert conclaves, concurrent evidence and providing expert evidence.

Conclusions: The courts are expecting increasingly high levels of practice from psychiatric experts working in civil forensic psychiatry. This workshop will prepare less-experienced psychiatrists for the challenges they will face in this arena and help those working in the field to refine and review their current approaches to requests for medico-legal opinions.

Perspectives on Trauma-Informed Care

D Backman-Hoyle¹, L Salmon², R McKay^1,2,3

¹Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²HETI (The Higher Education and Training Institute), Sydney, Australia

³UNSW, Sydney, Australia

Background: Trauma-informed care is a term that is being increasingly discussed with regards to how mental healthcare can improve. However, there are differing perspectives regarding what such care does, and should look like. What are the many and various views? The Royal Australian and New Zealand College of Psychiatrists Community Collaboration Committee (CCC) is considering the implication of these issues for psychiatric practice.

Objectives:

Methods: These include

Findings: Consumers, carers and staff describe working in systems that may trigger previous trauma experiences or in systems that are traumatic in themselves. Trauma-informed care must therefore consider the physical and systemic environment within which care is provided, as well as how clinical care is conducted. An awareness of differing perspectives can inform such change and improve outcomes.

Conclusions: This workshop provides an opportunity for participants to both increase their awareness of key issues in trauma-informed care and to inform the development of a Royal Australian and New Zealand College of Psychiatrists statement regarding this important perspective of practice.

Dealing with Domestic Violence in Psychiatric Practice

D Baron, R Parry

Private Practice

Background: Interest and funding tends to focus on the reporting of assault, involvement of police, legalistic remedies, refuge provision and re-educating the public about the nature and extent of the problem.

We focus on people trapped in relationships with varying degrees of physical violence and emotional abuse. Both professional and personal experience inform the workshop.

Objectives: To set out a practical action-orientated approach encouraging the empowerment of victims based on assessment of risk and the careful development of baby steps in a thoughtful and considered fashion.

Methods: A description of both victims and perpetrators, the methods used together with video presentations of personal accounts by both victims and perpetrators during and following group treatment.

Findings: Women can become empowered to tackle these situations without increasing the risk of retaliation or further violence.

Conclusions: Empowerment is a useful and safe way to deal with domestic violence in group and individual settings.

Early Intervention for Borderline Personality Disorder

A Chanen^1,2

¹Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia

²Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia

Background: Although borderline (severe) personality disorder usually has its onset in the period between puberty and emerging adulthood (young people), its diagnosis is often delayed and specific treatment is only offered late in the course of the disorder, to relatively few individuals, and often in the form of inaccessible, highly specialized and expensive services. Accumulating evidence indicates that the seeds of personal, social and economic harm are sown early in borderline personality disorder and such ‘late intervention’ often serves to reinforce functional impairment, disability and therapeutic nihilism. Yet, despite the strong scientific evidence supporting early intervention, the diagnosis remains off-limits among many clinicians and clinical service cultures. Prevention and early intervention for personality disorder requires changing these clinical service cultures and is optimal when integrated with prevention programs for the full range of mental disorders.

Objectives: To cover the current research evidence about borderline/severe personality disorder in young people and present a best practice model for early intervention services.

Approaching The RANZCP Objective Structured Clinical Examination Assessment (Clinical Examination)

G Robinson^1,2, S Luty^1,2

¹OSCE Subcommittee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Committee for Examinations, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Objectives: To assist candidates in understanding the nature and standard of the objective structured clinical examination (OSCE).

Methods: The workshop will include presentations by members of the Committee for Examinations regarding the common challenges faced by candidates and promote the development of strategies for successfully passing this assessment.

Objectives: This workshop will introduce candidates, supervisors and directors of training to

Teach The Teachers Workshop

G Cheung¹, F Sundram¹, M Henning², Y Chen²

¹Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand

²The Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand

Background: Scholarship is a core competency expected of all psychiatrists by the Royal Australian and New Zealand College of Psychiatrists. As scholars, psychiatrists should demonstrate the ability to educate and encourage learning in colleagues, other health professionals, students, patients, families and carers. However, previous research suggests doctors often have had little relevant pedagogical training and they lack knowledge of educational principles and teaching strategies.

Objectives: To present two learning modules: planning a teaching session and small group facilitation.

Methods: The presenters will conduct a 3-h workshop using teaching and learning activities including didactic teaching, small group discussion and experiential learning.

Findings: Attendees will evaluate the workshop by responding to eight questions on a 5-point Likert scale (strongly agree, agree, neither, disagree and strongly disagree). The presenters recently conducted a similar workshop for psychiatrists in Auckland: 60% of the attendees ‘strongly agreed’ and 40% ‘agreed’ that the workshop met all of their learning expectations and needs.

Conclusions: This education workshop is an effective method to improve the skills required for psychiatry teaching.

Setting Up A Ketamine Clinic for Patients With Refractory Major Depression

P Glue

University of Otago, Dunedin, New Zealand

Background: Low-dose ketamine has rapid antidepressant effects in patients with treatment-refractory major depressive disorder (TRD). In the absence of an approved ketamine formulations or dosing guidance for ketamine in TRD, off-label use of ketamine has been relatively uncommon in New Zealand and Australia. This limited use of ketamine may mean that some patients with TRD are disadvantaged. This workshop will describe practical and clinical aspects of treatment for psychiatrists considering setting up ketamine clinics for patients with TRD.

Objectives, methods, findings and conclusions: In this interactive workshop, the following topics will be covered:

Modern Leadership for the Psychiatrist: Culture Change, Getting Buy in and Staying Healthy

J Crawshaw¹, N Gibson²

¹Ministry of Health, Wellington, New Zealand

²Office of the Chief Psychiatrist of Western Australia, Perth, Australia

Background: Psychiatrists frequently step into significant clinical leadership roles with little formal training and variable ongoing leadership mentoring or support. Toxic or problem cultures where services are overwhelmed are not uncommon in mental healthcare settings, and this places patients and staff at risk of poor outcomes. Groups such as The King’s Fund have identified the importance of clinical engagement when leading culture change and change management.

Objectives: To provide a basic platform from which participants can build on their understanding of their personal leadership role in sustainable culture change, clinician engagement (including with more senior clinical colleagues) and self-care.

Methods: Current models around culture change and clinician engagement in mental healthcare settings will be discussed and debated. An interactive, case-based discussion will provide an opportunity for more experiential learning with concepts for sustainable self-care woven through. This presentation will be broken down into some targeted didactic components, followed by case presentation, and the group discussion and debate. There may be opportunity for small group discussion facilitated by an individual senior leader at each group.

Navigating The Minefield: Working With Borderline Personality Disorder In Young People

L McCutcheon^1,2,3

¹Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia

²Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia

³Orygen Youth Health, Melbourne, Australia

Background: Borderline personality disorder (BPD) is a serious mental disorder that is common in clinical practice. Clinicians in both acute and outpatient settings often experience young people with BPD features as challenging to work with, and there continues to be controversy about diagnosis and effectiveness of interventions in youth. There is good evidence that detection and treatment can improve outcomes in young people; however, many frontline and primary care clinicians do not feel skilled enough to work with this population. Despite evidence that structured good clinical care is almost as effective as specialized treatments for BPD in adults and youth, many clinicians continue to believe only specialized treatments for BPD are helpful.

Objectives: To provide principles and strategies to those working clinically with young people presenting with BPD and associated problems.

Methods: This workshop will review the current evidence and discuss best-practice guidelines for working with BPD and associated problems in young people. It will also cover what resources might assist clinicians, young people and families.

Findings: Training in principles of good clinical care has been demonstrated to improve clinicians’ attitudes and confidence in working with young people with BPD.

Conclusions: By the end of the workshop, participants will be familiar with the rationale for early intervention for BPD, will understand the principles of good clinical care and will feel more confident to manage the challenges presented by this patient group.

Combined Symposium Abstracts

Language That Divides, Language That Unites

R McKay^1,2,3, M Kaur¹, B Vickers^1,4, E Lavranos¹, J Liggins^1,5

¹Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²HETI (The Health Education and Training Institute), Sydney, Australia

³University of NSW

⁴Northland DHD, Whangarei, New Zealand

⁵Counties Manukau Health, Auckland, New Zealand

Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) partners with people with lived experience of mental illness through our Community Collaboration Committee (CCC). The CCC is made up of six psychiatrists and eight community members from Australia and New Zealand. In 2017, the CCC was asked to provide advice regarding how the RANZCP should use language within college communications and documents. Responding to this raised significant issues regarding the power of language and its potential to divide or unite people.

Objectives:

Methods:

Findings: Language is powerful, and the same words can evoke either mutual respect or conflict depending upon the context in which they are used and the perspectives of those involved in communication. This poses particular challenges for a binational college, psychiatrists and community members.

Conclusions: Sharing knowledge of the impact of language has the potential to improve the use of language and relationships between psychiatrists and those they work with. It is unclear what form, if any, broader guidance about this important issue should take and the CCC invites Congress attendees’ participation in discussion.

Presenter 1

Use of Language Within Australian Multicultural Communities

M Kaur

Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: Many multicultural communities do not have Western language and terminology to describe mental health conditions and this can hinder a consumer’s recovery. Ensuring that the use of language which is appropriate is vital in assisting consumers to be mentally healthy and proactive in their care.

Objectives: Explore the beliefs and attitudes towards mental health conditions in terms of language for Australian multicultural consumers and carers.

Methods: Experiences of multicultural consumers who have used the mental health system in Australia and examples of methods of how Western language has been modified to assist in gaining insight and improve the therapeutic relationship between the consumer, family/carer and mental health professionals.

Conclusions: Audience questions and discussions.

Presenter 2

A New Zealand Context

B Vickers

Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Whangarei, New Zealand

Background: Language is the principal mechanism by which we convey information to consumer/service user/tangata whai ora. It is important that consumers and whānau are given a framework within which they can begin understanding the processes that may lead to illness and those processes that will enhance recovery (insight). Therefore, getting the language right is particularly important.

Objectives: To explore how the inpatient experience can be modified by communication with consumers and their whānau to make the experience feel more helpful via the use of information and the role language plays within that.

Methods: Utilizing the consumer and whānau experience via a randomly selected panel of consumers and whānau who have experienced admission to the Tumanako inpatient unit (between 1 and 6 months since discharge; 1-year project begun August 2017).

Findings: The panel is still in progress where difficulties have been defined by the panel. The presentation will also include solutions identified, changes in behaviour by staff and systems changes within the unit and community staff to address these issues.

Conclusions: Conclusions and progress to date will be presented along with a discussion of the final aims.

Presenter 3

Existing New Zealand Community Guidance and Carer Context

E Lavranos

Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Whangarei, New Zealand

Background: Families and whānau who become the carer of a loved one who has experienced mental distress take on this role without training and often with little knowledge about mental illness. For many carers, much of what they know about mental health issues is learnt from mass media, and much of that information is based on sensational narratives. The language that is used to interpret life events that depict the experiences and situations that families encounter can reinforce stigmatization or it can support recovery.

Objectives: To explore how language and film images of mental illness have an impact on family, whānau and carers. Research shows that fear of discrimination and stigmatization can frequently prohibit people from seeking professional assistance (Pirkis et al., 2006).

Methods: Using examples from personal experience and film clips, I will discuss how language use and choice of expression can create misunderstanding. As a filmmaker, researching stories about carer relationships to create a documentary resource for families within the multicultural New Zealand context, this was highlighted. I interviewed participants on camera about their experiences and in editing these narratives many instances arose where the language captured raised issues about whether or not it was appropriate or could potentially cause harm.

Findings: The language we use to describe events and situations plays a part and can influence family understanding.

Conclusions: Discussion with the audience could reveal further insights.

Reference

Pirkis J, Blood RW, Francis C and McCallum K (2006). On-screen portrayals of mental illness: extent, nature, and impacts. Journal of Health Communication 11: 523–541. doi: 10.1080/10810730600755889

Presenter 4

Existing Professional Guidance and Context of The Psychiatrist

J Liggins

Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Auckland, New Zealand

Counties Manukau Health, Auckland, New Zealand

Background: During the 1900s, the now historic lunatic asylum became psychiatric hospital or mental health unit; alienist became psychiatrist; and lunatic or inmate became patient. The last 30 years has seen the patient become alternatively client, consumer, survivor or service user; and mental illness or disorder reclaimed as madness, with little agreement on which to use. These terms or labels can represent competing discourses, described by feminist scholars as ‘sites of struggle’ (Church, 1995).

Objectives: To take a journey through the history of language and mental illness and offer reflections on the significance of language from both a personal and professional perspective.

Conclusions: Consideration of history – why and how language has evolved – may offer insight into the potential for language to silence or to enhance relationships.

Reference

Church K (1995) Forbidden Narratives: Critical Autobiography as Social Science. SA, Australia: Gordon and Breach.

Presenter 5

Discussant: Should The College Provide Guidance About Language?

R McKay

Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

HETI (The Health Education and Training Institute), Sydney, Australia

UNSW, Sydney, Australia

Background: As chair of the Community Collaboration Committee, this presentation will focus upon reflections upon the implications of other presenters’ materials for the development of any Royal Australian and New Zealand College of Psychiatrists guidance, and leading discussion from the audience.

Objectives:

Methods:

Findings: To be decided by the audience.

Conclusions: Language is powerful and the perspectives of psychiatrists and differing community perspectives must be understood to use it wisely.

Oranga Hinengaro Oranga Wairua Symposium

R Tapsell

Waikato District Health Board, Hamilton, New Zealand

Background: Kaupapa Māori mental health services were established in the 1980s, with the principal aim of providing a Māori perspective to the clinical mental health services with which increasing numbers of Māori people were engaging (Durie, 2009, 2011). Māori health models, bicultural practices, cultural competency and mental health and addiction workforce development strategies have been some of the implications from this Māori health reform to improve the experience of Māori with mental illness and addiction-related needs.

There are disparities among Māori with mental illness and addiction-related harms. Although now dated Te Rau Hinengaro, the New Zealand Mental Health Survey (2004) completed with 2595 Māori highlighted the degree to which mental disorders were common among Māori, with more than 50% of Māori experiencing a mental health issue in their life time (Baxter et al., 2006).

Anxiety disorder was common in one in three Māori, with substance use disorders and mood disorders experienced by one in four. One in three Māori females and one in four Māori males had experienced a mental illness in the previous year to the survey.

Despite the high prevalence of mental illness and substance use issues contact with mental health and addiction services was considered low in comparison to the high need of Māori (Baxter, 2008).

More recently, the annual New Zealand Health Survey is showing that the psychological distress of Māori is increasing per annum with high rates of anxiety and depression (Ministry of Health, 2016a).

The Māori suicide rates are also the highest in New Zealand. Māori males and Māori females are twice as likely to die by suicide than non-Māori, with the most concerning issue of the highest suicide rates of young Māori people (10–25 years of age) (Ministry of Health, 2016b).

Given there has been a shifting of paradigm in mental health services, of models of care and of cultural competency development: What have we learnt? and what has changed? since these transformational changes to health services over a 30-year span?

We need to do more as mental health professionals in New Zealand and the Congress being held in May 2018, Auckland, provides a prime opportunity for open dialogue.

Conclusions: This symposium is called Oranga Hinengaro Oranga Wairua and the aim is to raise the critical dialogue needed to address Māori mental health and addiction need from a Royal Australian and New Zealand College of Psychiatrists perspective.

References

Baxter J, Kokaua J, Wells JE, McGee MA, and Oakley Browne MA (2006) Ethnic comparisons of the 12-month prevalence of mental disorders and treatment contact. In: Te Rau Hinengaro: The New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry 40(10): 905–913. doi: 10.1111/j./1440-1614.2006.01910.

Baxter J (2008) Māori Mental Health Needs Profile. A Review of the Evidence. Palmerston North, New Zealand: Te Rau Matatini.

Durie MH (2009) Māori knowledge and medical science. In: Incayawar M, Wintrob R, Bouchard L, Bartocci G (eds) Psychiatrists and Traditional Healers: Unwitting Partners in Global Mental Health. Chichester, UK: Wiley, pp. 237–249.

Durie MH (2011) Indigenous mental health 2035: future takers, future makers and transformational potential. Australasian Psychiatry 19(supp 1): S8–S11.

Ministry of Health (2016a) Annual Update of Key Results 2015/16: New Zealand Health Survey. Wellington: Ministry of Health.

Ministry of Health (2016b) Suicide Facts: Deaths and Intentional Self-harm Hospitalisations: 2013. Wellington: Ministry of Health.

Spiritual Therapy: Dawn of A New Modality

N Johri^1,2, E Moore², M Isaac^2,3

¹Armadale Health Service, Perth Australia

²The University of Western Australia, Perth, Australia

³Fremantle Hospital, Perth, Australia

Background: Existing psychotherapies have therapeutic effectiveness with range of disorders but also have limitations. A religious and spiritual dimension of psychotherapy has been proposed with a randomized controlled trial (RCT) to demonstrate effectiveness. Pastoral care and faith-based counselling have been demonstrated to be effective if the target population is appropriately chosen.

Objectives: To propose and discuss this new dimension and approach to psychotherapy.

Methods: Beginning with an overarching review of psychotherapies by the first author, the second author will describe the fundamental philosophical and psychological parameters of the new proposition, followed by in-depth discussion of the therapy process. Case scenarios will be described to augment the theoretical understanding. The third author will invite the audience to critically evaluate the proposed model and conclude by summarizing key features and the role of supervision.

Findings: Spiritual therapy is promising and adds to the effectiveness of the existing range of psychotherapies. It is proposed to be effective with patients who have either not responded to, or only partially improved with, cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) combined with medication-based management. This therapy is not disorder specific and a range of people with mood disorders, personality disorders and anxiety disorders have benefited. Patients are not required to give up their existing beliefs (or lack of it) with regards to religion or spirituality. Similarly, the personal faith of the therapist (or lack of it) is not a factor in conducting this therapy.

Conclusions: The audience will be invited to consider the benefits and limitations of the proposed modality of psychotherapy.

Presenter 1

Is There A Scope of New Psychotherapy in This Biological ERA?

M Isaac^1,2

¹The University of Western Australia, Perth, Australia

²Fremantle Hospital, Perth, Australia Fremantle Hospital

Background: The genesis of psychotherapy as a modality of psychiatric intervention owes much to Janet and Freud and the psychoanalytical movement. Since inception several changes have occurred and a variety of psychodynamic schools have emerged. Behavioural therapies followed and remain effective today. Aaron Beck’s work on the cognitive triad and the subsequent development of cognitive behavioural therapy (CBT) marked the era of the modern psychotherapy movement. There is recent renewed interest in psychiatry in the religious and spiritual dimensions of life and suffering. There have been formal assessments of religious-based CBT since 2007.

Objectives: To review existing therapies and to explore their effectiveness and limitations.

Findings: There is a substantial variety of psychotherapies, which have been refined over time to suit changing paradigms.

Conclusions: There is room for a novel approach to psychotherapy given that a range of patients do not respond, or respond partially, to existing treatment modalities in psychiatry – both biological and psychological.

Presenter 2

Spiritual Therapy: The New Dimension of Psychotherapy

N Johri^1,2

¹Armadale Health Service, Perth, Australia

²The University of Western Australia, Perth, Australia

Objectives and methods:

Findings:

Conclusions: This is an exciting opportunity to share this newly proposed modality of psychotherapy. However, this new modality is in an early phase and well-designed studies are required to undertake formal evaluation of the effectiveness and limitations of this therapy.

Presenter 3

Reflection and Role of Supervision in Spiritual Psychotherapy

E Moore

The University of Western Australia, Perth, Australia

Background: Our understandings of the dimension of psychotherapy are continuously evolving. Self-awareness in both patients and therapist can be a powerful agent of change. There is a growing literature on the trauma that therapists vicariously experience in the process of therapy, which needs to be addressed.

Objectives: To ask the audience to actively participate in considering the following questions:

Methods: Participants will be part of a discussion on the usefulness, relative ease and practical implementation of the proposed therapy.

Conclusions: No ‘one size’ of therapy fits all. No single therapy will suit all patients or therapist. Spiritual therapy requires further consideration and development to join the existing range of therapies.

Autism Spectrum Disorder in Adults: an Update on Diagnosis, Neurological Comorbidities and The Ageing Process

C Franklin^1,2, D Bathgate^3,4, S Starkstein⁵, J Trollor^6,7

¹Queensland Centre for Intellectual and Developmental Disability, MRI–UQ, The University of Queensland, Brisbane, Australia

²Mater Young Adult Health Centre Brisbane, Mater Hospital, Brisbane, Australia

³Southern District Health Board, Dunedin, New Zealand

⁴University of Otago, Dunedin, New Zealand

⁵Department of Psychiatry, School of Medicine, The University of Western Australia, Perth, Australia

⁶Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Australia

⁷The Cooperative Research Centre for Living with Autism, Long Pocket, Brisbane, Australia

Background: Autism spectrum disorder (ASD) has a similar prevalence to schizophrenia, yet psychiatrists are poorly trained in diagnosing ASD. Furthermore, neurological comorbidities have only recently been examined and the ageing process for autistic adults is unknown.

Objectives: To examine ASD in adulthood, looking at key issues of relevance to psychiatrists:

Methods: We will use a wide approach, ranging from literature reviews, analysis of current international guidelines and empirical studies using subjective and objective methodology to examine the current literature and evidence relevant to ASD in adulthood.

Findings: There are issues and challenges relating to the diagnosis of ASD in adulthood but also some tools to assist the psychiatrist in this process. There is a high frequency of parkinsonism in middle-aged autistic adults and various complexities in relation to successful ageing.

Conclusions: Psychiatrists have a definite role in the diagnosis and management of ASD in adulthood. The diagnosis and management of adults with ASD is an area with numerous complexities. At the end of the symposium, we expect the audience to acquire a better understanding of diagnostic problems, the idiosyncratic ageing process of these individuals and relevant neurological comorbidities.

Presenter 1

Autism in Adulthood: What is The Role of Psychiatrist?

C Franklin^1,2

¹Queensland Centre for Intellectual and Developmental Disability, MRI–UQ, The University of Queensland, Brisbane, Australia

²Mater Young Adult Health Centre Brisbane, Mater Hospital, Brisbane, Australia

Background: Autism awareness, diagnosis and research have exploded in the last 10 years. However, there has been correspondingly little (or no) increase in psychiatric training in autism or mental health service development in this area. The recent release of the draft Australian Guidelines for Autism Spectrum Disorder Diagnosis engendered heated discussion in relation to several issues, including the role of psychiatrists in autism.

Objectives: To provoke thought, discussion and greater understanding of the potential role of psychiatry in autism.

Methods: The presentation will begin with an overview of current national and international autism guidelines, focusing on areas of the potential relevance of psychiatrists. This will be followed by a review of recent literature relating to the diagnosis of autism in adulthood and management of comorbidities and other issues associated with autism in adulthood. This will include review of literature relating to the lived experience of autistic adults and their priorities for research and service provision. This literature review will then be related to common issues for clinical practice.

Findings: The last 10 years have seen a flourishing of literature across many different aspects of autism, especially in the areas of genetics, imaging and intervention in early childhood. There continues to be a minority of research that relates to autistic adults. There is a large gap between current guidelines and clinical service provision to autistic adults across much of Australia and New Zealand.

Conclusions: Psychiatrists are potentially well placed to improve the accuracy of autism diagnosis and management of comorbid mental health problems experienced by autistic adults. Current barriers include a lack of training opportunities for psychiatrists and a corresponding lack of mental health service provision for autistic adults.

Presenter 2

Autism Spectrum Disorder in Adults: Training and Capacity Building in Psychiatry

D Bathgate^1,2

¹Southern District Health Board, Dunedin, New Zealand

²University of Otago, Dunedin, New Zealand

Background: There is growing awareness in New Zealand of the impact that autistic spectrum disorder (ASD) has on individuals and their families as well as their ability to engage in health services. Although a relatively rare condition, it is recognized that approximately 1% of the population will have ASD, approximately 40,000 individuals in New Zealand.

Objectives: To review the major limitations in terms of training in the curricula of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and general lack of expertise on how to deal with the psychiatric comorbidities of adults with ASD.

Methods: I shall review the current status regarding training on the diagnosis and management of comorbidities in adults with ASD and psychiatric comorbidities in New Zealand based on a large clinical experience in New Zealand and a recent sabbatical in the United Kingdom working in a medium-secure forensic unit for adult men with ASD.

Findings: My presentation will present a template developed by the Royal College of Psychiatrists (UK) to help general adult psychiatrists with the diagnosis of ASD in adults.

Conclusions: There is an urgent need to develop a specific training program on the diagnosis of ASD as well as diagnosis and management of psychiatric comorbidities by the RANZCP.

Presenter 3

Autism Spectrum Disorders in Adults: A Review of The Most Frequent and Clinically Relevant Movement Disorders

S Starkstein¹, S Miller²

¹Department of Psychiatry, School of Medicine, The University of Western Australia, Perth, Australia

²Autism Association of Western Australia, Perth, Australia

Background: Whereas a variety of motor problems have been described in children with autism spectrum disorders (ASD), little is known about these problems in adults with ASD.

Objectives: To provide a review of the most important movement disorders in adults with ASD and to present a recent proof-of-concept study on the frequency of parkinsonism in these individuals.

Methods: This presentation will review recent findings regarding movement disorders in ASD and present the results from a recently published study into parkinsonian motor signs in older adults with ASD.

Findings: Adults with ASD have a wide variety of movement disorders. Those on neuroleptics carry a high risk of parkinsonism, dyskinesias and dystonias. Our empirical study demonstrated that while adults with ASD have a high rate of atypical antipsychotic use, even those not on medication have a higher incidence of parkinsonian motor signs.

Conclusions: Movement disorders are very common in adults with ASD. The clinician will require relevant neurological skills to assess these disorders, or, preferably, work in conjunction with a neurologist with some specialization in ASD.

Presenter 4

Successful Ageing in Adults with Autism Spectrum Disorders

J Hwang^1,2, J Trollor^1,2, K Foley^1,2

¹Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, Australia

²The Cooperative Research Centre for Living with Autism, Brisbane, Australia

Background: Successful ageing (SA) is a popular concept in gerontology. Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition with a prevalence of 1% and is associated with a variety of health inequalities and challenges in social and community integration. Research has been slow to examine the applicability of the concept of SA to adults ageing with ASD.

Objectives: To explore the applicability of the dominant model of SA to adults on the autism spectrum and to investigate the meaning of SA from the perspectives of autistic adults and their carers.

Methods: A mixed-methods investigation. We applied the Rowe and Kahn 1997 model of SA to data from a sample of autistic adults’ data from the Australian Longitudinal Study of Adults with Autism (ALSAA) (N = 171) and controls (N = 104). We also conducted 24 semi-structured interviews with autistic adults and carers to investigate their perspectives of SA.

Findings: Significant health inequalities were found between autistic adults and controls. A very small proportion of autistic adults were considered to be ageing successfully according to the dominant model. Thematic analysis of the interviews revealed eight themes: ‘myself’, ‘being autistic’, ‘others’, ‘being supported’, ‘lifestyle and living well’, ‘relating to others’, ‘life environment’ and ‘societal attitudes and acceptance’.

Conclusions: Existing conceptualizations of SA are unsuitable and are limited in applicability to autistic adults. Insights will be drawn from these findings to contribute to development of a more inclusive theoretical framework of SA and to direct future research. Key considerations for service and policy development will also be discussed.

Capacity and Consent – Two Sides of The Same Coin? Clinical, Legislative and Human Rights Perspectives On Capacity Assessment

J Hopkins¹, M Fisher², G Young³, G Newton-Howes⁴

¹Psychological Medicine Middlemore Hospital, Auckland, New Zealand

²Mental Health Service for Older People, Counties Manukau Health, Auckland, New Zealand

³Napier Forensic and ID Service, Capital and Coast District Health Board, Napier, New Zealand ⁴Department of Psychological Medicine, University of Otago, Wellington, New Zealand

Background: Soon it is likely that capacity will loom large in legislation changes, human rights considerations and clinical decision-making. It is therefore imperative that the clinical workforce knows what it is doing around capacity. Unfortunately, all too often there is a lack of confidence about how to conduct capacity assessments and manage their outcomes.

Objectives: To highlight three key aspects of capacity and their assessments, legislative contexts and human rights considerations.

Methods: Four presenters draw on critical analyses of the literature, application of relevant law and an individual audit to highlight the clinical assessment, human rights considerations and legislative implications of three key aspects of capacity (residence decision-making, treatment for substance addiction and mental health detention).

Findings: It is vital that capacity is not assessed in the wrong place at the wrong time, but placing the horse back in front of the cart will be challenging. Treating people with impaired capacity without adequate supported or substituted decision-making and detaining people with intact capacity both involve significant breaches of human rights. New legislation is likely to bring both challenges to, and opportunities for, the assessment of capacity. Capacity lies at the heart of the need to reform existing legislation.

Conclusions: Capacity and consent are two sides of the same coin. The need for capacity assessment is ubiquitous in clinical practice and therefore this clinical endeavour, the confidence to use it and the wisdom to know when and how, needs to be in every doctor’s toolbox.

Presenter 1

One-in-100-Year Storm or a Storm in a Teacup? The Impact Baby Boomers will have on Ageing, Lifestyle Choices and The Assessment of Residence Capacity

J Hopkins

Psychological Medicine, Middlemore Hospital, Auckland, New Zealand

Background: The baby boomers are graduating to pensionable age at just the moment in history when birth rates are dropping, older people are living longer, the prevalence of dementia is rising; and ‘ageing in place’ is more rhetoric than reality.

Objectives: To explore the likely impact of the graduation of the baby boomers to the elderly and very elderly age groups, in relation to ageing in place and its alternatives, and the assessment of residence capacity.

Methods: Critical analysis of the contemporary literature on ‘dwellingness’ and sense of place; decision-making and residence capacity assessment, population demographics and change; baby boomers; aged residential care and its alternatives; and the relevant capacity legislation.

Findings: The baby boomers are unlikely to be passive recipients of the major health and social care decisions confronting them as they age further. They are likely to want:

Conclusions: The health and social care sectors and the retirement industry are likely to face significant challenge as the baby boomers graduate to the elderly and very elderly age groups and express their characteristic autonomy over their living arrangements, ageing trajectories and destinies.

Presenter 2

Legal Authorities for Care of Those Without Capacity in Aged Residential Care Facilities: an Audit of Several Facilities

M Fisher

Mental Health Services for Older People, Counties Manukau Health, Auckland, New Zealand

Background: People who lack capacity to consent to care in aged residential care (ARC) should have a substitute decision maker. This requires either enduring powers of attorney (EPOA) or a court order. It is suspected that many incompetent ARC residents lack appropriate legal protection. There are numerous obstacles to arranging legal authorities, including costs, time-delays and the legislation itself.

Objectives: To present an audit of legal authorities for residents of local ARC facilities who lack residence decision-making capacity.

Methods: Data were collected for all residents in five ARC facilities around Auckland, including some locked units. Nursing staff assessed whether residents lacked capacity to decide about their need for residential care. ARC files and electronic hospital records were reviewed to see whether legal authorities for care existed for those lacking capacity.

Findings: The audit included 427 residents across five ARC facilities. Of those, 272 residents were assessed by staff as lacking capacity. Copies of legal authorities existed for about one-third of residents. Another 16% ‘maybe’ had authorities, indicated by comments but no evidence in the file. More than one-half of the residents lacking competency also lacked any legal authority for their care, although about 40% of this group had an inactivated EPOA. Locked facilities were not significantly different from unlocked facilities.

Conclusions: The high number of residents lacking capacity but without legal authority for their care (and detention) is alarming and a significant human rights issue for New Zealand. The legislation in this area needs to be reviewed. However, clinical staff in both ARC facilities and hospitals need to be more aware and confident around capacity issues.

Presenter 3

Assessment of Decision-Making Capacity for Compulsory Assessment and Treatment of People with Severe Substance Addiction

G Young

Napier Forensic and ID Service, Capital and Coast District Health Board, Napier, New Zealand

Background: The Substance Addiction (Compulsory Assessment and Treatment) Act 2017 (SACATA) provides for compulsory treatment of people with severe addictions. A requirement for being subject to the provisions of the act is that the person should lack the capacity to make decisions about their treatment. The criteria for incapacity are laid out in the act but the limits of the applicability to the concept of incapacity, and its threshold, have not been specified.

Objectives: To consider the applicability of the current construct of mental capacity and its assessment to persons with severe addictions.

Methods: A critical analysis of the relevant literature on decision-making capacity, with a particular focus on how the cognitive construct of capacity, and the particular criterion of ‘ability to use and weigh information’, applies to persons with abnormalities of volition.

Findings: The use of capacity assessment as a filter for compulsory treatment of addictions has a clear application to persons with dementia or significant cognitive impairment. However, the literature offers little practical guidance to clinicians assessing the ability to use and weigh information in the context of a disorder characterized by severe compulsion.

Conclusions: Clinicians are likely to be challenged by applications for compulsory detention and treatment of people with severe addictions who do not have dementia or serious cognitive impairment. Further research will be needed as case law develops with the use of the new act.

Presenter 4

Elements of The Need for Capacity In Detention Assessments and The Requirements of The United Nations Convention on The Right of Persons with Disabilities

G Newton-Howes

Department of Psychological Medicine, University of Otago, Wellington, New Zealand

Background: Although there has been a clear shift in the international understanding of the legal position of capacity within the United Nations Convention on the Right of Persons with Disabilities (UNCRPD), not all jurisdictions have taken this into account.

Objectives: To examine the theoretical and practical implications of the UNCRPD in relation to the detention of people suffering from mental distress.

Methods: Critical analysis of the literature and application of mental health law.

Findings: There have been variable efforts internationally and within Australasia to take the needs for capacity into account when redrafting mental health legislation. This is despite the implication that a lack of capacity is the only clear reason for detaining someone in mental distress.

Conclusions: Mental health law needs to consider the requirement for capacity to be the cornerstone for detention. Without this, detention would appear to be in breach of the UNCRPD and natural justice. Although yet to be tested at law, there is a potential legal remedy for those detained without consideration to capacity.

Pacific Mental Health Forum

K Jenkins, J Stratton

The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has held Asia Pacific Mental Health Forums since 2013 and continues to prioritize cementing the RANZCP as a leading collaborator in mental healthcare in Asia and the Pacific. Delegates from more than 20 regional nations have been represented at these forums and discussions have focused on mental health service delivery, legislation, workforce issues and training.

As the RANZCP Congress is held in Auckland, this forum will focus on what can be achieved in the Pacific for mental health.

Regional leaders will be invited to be part of a roundtable discussion to identify and focus on two to three key initiatives that the college can play a significant and meaningful role in developing over the following 12 months. Some examples of strategies to better support mental health practice in the Pacific region may include training, mentoring, networking, educational activities and local information sharing.

Transforming Clinical Safety

B Short^1,2,3,4, M Wright^1,2,5, C Bensemann⁶, R Tapsell^6,7, A Wilson⁸

¹Mental Health Branch, NSW Ministry of Health, Sydney, Australia

²South Eastern Sydney Local Health District, Sydney, Australia

³The University of Newcastle, School of Medicine and Public Health, Newcastle, Australia

⁴HETI (The Health Education and Training Institute), Sydney, Australia

⁵University of New South Wales, Faculty of Medicine, Sydney, Australia

⁶Health Quality and Safety Commission, Wellington, New Zealand

⁷Waikato District Health Board, New Zealand

⁸Medibank Private Ltd, Australia

Background: The World Health Organization identifies patient safety as a serious global public health issue and has estimated that in developed countries as many as one in 10 patients is harmed while receiving hospital care (World Health Organization, 2014). In studies specific to Australia, Wilson et al. (1995) have estimated that 16.6% of all hospital inpatient episodes resulted in adverse events, with at least half of these being preventable. Thus, knowledge and understanding of safety and quality should be recognized as vital competencies and values for all healthcare delivery systems.

Objectives: To explore the opportunities arising from the application of quality improvement approaches in the mental health sector; in particular, how these methodologies can improve patient safety, staff safety and clinical outcomes. The symposium draws upon relevant learning from organizations that have already adopted these approaches, the results they have achieved, and explores what changes are recommended for local health services to cultivate a quality improvement ethos within their jurisdictions.

References

Wilson R, Runciman W, Gibberd R, Harrison B, Newby L and Hamilton J (1995) The quality in Australian Health Care Study. Medical Journal of Australia 163(9): 458–471.

World Health Organization (2014) 10 Facts on Patient Safety. Available at: http://www.who.int/features/factfiles/patient_safety/en/ (accessed 19 July 2016).

Presenter 1

A Proposed Patient Safety Framework

B Short^1,2,3,4

¹Mental Health Branch, NSW Ministry of Health, Sydney, Australia

²South Eastern Sydney Local Health District, Sydney, Australia

³The University of Newcastle, Newcastle, Australia

⁴HETI (The Health Education and Training Institute), Sydney, Australia

Background: An inconsistent safety and quality culture, impaired processes of care and disengaged leadership undermine the ability of mental health systems to ensure the provision of safe and timely care over time. There is also accumulating research indicating that workplace cultures lacking a quality and safety focus endure higher rates of staff injury (Gomaa et al., 2015), staff absenteeism and poorer staff retention levels (World Health Organization, 2006).

Objectives:

Methods: The methods include

Findings: Our consultations indicate that a change in operational strategy and culture is urgently required. We must balance a historically centralized top-down approach to healthcare financing, governance, delivery and change initiatives with a more localized bottom-up approach that embeds a culture of improvement based on science principles and encourages continual innovation, customization and improvement.

Conclusions: Based on the aggregated data, a co-designed framework was developed, which provides guidance for organization preventative maintenance, safety and innovation.

References

Gomaa AE, Tapp LC, Luckhaupt SE, Vanoli K, Sarmiento RF, Raudabaugh WM, Nowlin S, Sprigg SM (2015) Occupational Traumatic Injuries among Workers in Health Care Facilities – United States, 2012–2014. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 64(15): 405–10. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6415a2.htm (accessed 19 September 2017).

World Health Organization (2006) The World Health Report; Working together for Health. Available at: http://www.who.int/whr/2006/en/ (accessed 19 September 2917).

Presenter 2

New Zealand Patient Safety Perspective

C Bensemann¹, R Tapsell^1,2

¹Health Quality and Safety Commission, Wellington, New Zealand

²Waikato District Health Board, New Zealand

Background: The Health Quality Safety Commission (the Commission) is leading a 5-year national program to improve quality and safety in the mental health and addictions services.

Objectives:

Methods:

Findings: Five priority domains are defined:

The work plan will include both national and regional ‘collaboratives’ that use methodology similar to the Institute for Healthcare Improvement Breakthrough Series (Collaborative) and the Scottish Patient Safety Programme (SPSP; Healthcare Improvement Scotland, 2016) with whom a partnership is established. Consumer engagement, co-design, Māori participation and equity are critical to success.

The sector has engaged enthusiastically with the first national training program for improvement facilitators.

Conclusions: This 5-year improvement program provides the opportunity to put quality and safety at the centre of mental health and addictions service delivery.

Reference

Healthcare Improvement Scotland (2016) SPSP Mental Health: End of Phase Report November 2016. Scotland: Healthcare Improvement Scotland. Available at: http://ihub.scot/media/1900/end-of-phase-report.pdf

Presenter 3

Safety and Culture: Restrictive Practices

M Wright^1,2,3

¹Mental Health Branch, NSW Ministry of Health, Sydney, Australia

²South Eastern Sydney Local Health District, Sydney, Australia

³UNSW, Sydney, Sydney, Australia

Background: Following a highly publicized and disturbing incident involving the death of a patient after a period of seclusion in a mental health unit, the NSW Ministers for Health and Mental Health directed that an expert panel conduct a review of seclusion, restraint and observation practices in declared mental health facilities in New South Wales.

Objectives: The panel was asked to consider and report on the existing legislation, policy, clinical governance and oversight, principles and practice standards relating to seclusion, restraint and observations across New South Wales.

Methods:

Findings: The review provided an insight into the current patient safety practices in New South Wales mental health services and raised important questions about how to improve quality and safety, how to improve clinician engagement in safety and improvement initiatives and how to address some of the leadership and cultural deficiencies that were identified.

Conclusions: The report will be completed in December 2017, and the patient safety conclusions and recommendations will be presented and discussed in this session.

Presenter 4

Private Health Safety and Transparency

A Wilson¹

¹Medibank Private Ltd, Sydney, Australia

Background: Medibank is one of Australia’s largest private insurers with nearly 3.8 million policy holders. It funds more than 500,000 hospital separations and pays more than A$5.5 billion in claims annually. It is focused on improving patient outcomes and experiences as well as improving efficiencies in the health system.

Objectives:

Methods:

Findings: Widespread variance was found among surgeons and hospitals across many key measures such as hospital-acquired complication rates, 30-day readmissions, intensive care unit admission rates and out-of-pocket charges to patients.

Conclusions: A successful partnership between a private health insurer and peak professional body is both possible and can lead to the development of a critical practice improvement tool. Next steps include providing individual variance data to surgeons and the use of the data set to define and promote best practice.

God, The Psychiatrist, The Client: What Is ‘Just Right’? – a Symposium

D Davidson¹, F Wilson², W Butcher³, K Brightley¹, Te Puea Winiata⁴, A Blackburn¹, M Wong⁵

¹Waitemata District Health Board, Auckland, New Zealand

²Auckland District Health Board, Auckland, New Zealand

³Canterbury District Health Board, Christchurch, New Zealand

⁴Turuki Health Care, Auckland, New Zealand

⁵School of Clinical Science, New Zealands at Monash Health, Monash University, Melbourne, Australia

Background: Religion/spirituality remains relevant to more than half the population in today’s multicultural, secular, Antipodean society (Australian Bureau of Statistics, 2017; Stats NZ, 2014), particularly in Indigenous cultures (Durie, 1998). They may influence mental illness (Koenig, 2010) and inform recovery. However, there have been concerns about clients being able to raise the issue with their psychiatrists, psychiatrists’ knowledge of these issues in their clients’ lives and using this information in treatment planning for best possible outcome (Philipe Huguelet, 2006). The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has recently drafted a position statement on religion and spirituality to enable psychiatrists to better address this issue.

Objectives: We propose a symposium of six presentations to address through different perspectives the relevance of religion/spirituality to the understanding, treatment, recovery and rehabilitation of mental illness.

Methods: A consumer representative, a cultural representative, a mental health chaplain, a psychiatrist–priest and consultant psychiatrists will make interactive presentations on the influence of religion/psychiatry in mental illness. A survey on the perspectives of trainees, fellows and affiliates of the RANZCP on religion/spirituality in psychiatry was conducted – the results will be critiqued by the panellists from their respective perspectives.

Findings: The results from the survey on the role of religion/spirituality in psychiatric presentations, recovery and rehabilitation will be highlighted with respect to similarities and contrasts with current literature and lived experiences.

Conclusions: Religion/spirituality is relevant to mental illness at many levels in individualized ways, shaped by the lived experiences of both clinicians and patients.

References

Stats NZ (2014) 2013 Census QuickStats About Culture and Identity. Retrieved from http://www.stats.govt.nz/Census/2013-census/profile-and-summary-reports/quickstats-culture-identity/religion.aspx

Australian Bureau of Statistics (2017) Religion in Australia 2016 Census Data Summary. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Religion%20Data%20Summary~70

Durie M (1998). Whaiora: Māori Health Development, 2nd ed. Oxford University Press.

Koenig HG (2010) Spirituality and mental health. International Journal of Applied Psychoanalytic Studies 7(2): 116–122.

Philipe Huguelet SM-Y (2006) Spirituality and religious practices among outpatients with schizophrenia and their clinicians. Psychiatric Services 57(3): 366–372.

Presenter 1

Perspectives of Trainees, Fellows, Affiliates of The RANZCP on Religion/Spirituality in The Practice of Psychiatry

D Davidson¹, F Wilson²,

¹Waitemata District Health Board, Auckland, New Zealand

²Auckland District Health Board, Auckland, New Zealand

Background: Psychiatry stands out among other medical specialties for its inherent nature of being essentially person-centred, with value-based medicine complementing evidence-based medicine. Religion and spirituality are parts of culture that inform person-centredness. The literature, however, indicates there may be an incongruence between religious/spiritual assessments, utilization of religious/spiritual tools in psychiatric practice and client needs (Wyatt Butcher, 2013). There are few studies that explore the perspectives of psychiatrists in this area.

Objectives: To explore the perspectives of trainees, fellows and affiliates of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) on religion/spirituality in the practice of psychiatry.

Methods: The authors are conducting an anonymous online cross-sectional survey of RANZCP trainees, fellows and affiliates. Trainees, fellows and affiliates of the RANZCP who offer informed consent are included. The results will be analysed quantitatively and qualitatively using appropriate statistical methods.

Findings: The survey is designed to look for patterns that may indicate possible psychiatrist or client characteristics that may influence religious/spiritual assessments and use of such interventions in psychiatric practice. It also explores barriers experienced by psychiatrists, including adequacy of training in the area. The final results will be announced at the Congress.

Conclusions: Exploration of religion/spirituality may be variable in psychiatric practice, informed to an extent by psychiatrist/client characteristics and the adequacy of psychiatric training in this area.

Reference

Wyatt Butcher DS (2013) Spirituality, Religion and Psychiatry in New Zealand: A Survey of Psychiatrists in New Zealand. Thesis (Master of Health Sciences). Otago: University of Otago.

Presenter 2

Considering The Spiritual in A Secular Setting

W Butcher^1,2

¹Interchurch Council for Hospital Chaplaincy, Wellington, New Zealand

²Canterbury District Health Board, Canterbury, New Zealand

Background: Religion/spirituality is thought to address essentially the same issues as psychiatry (Hartog and Gow, 2005) and provides an essential context of suffering, mental health and illness (Halasz, 2003), yet the relationship between them has at times been characterized by conflict and mutual disregard (Hartog and Gow, 2005). The role that religion and spirituality can play in health and illness is still a contested issue.

Recent research and personal experience indicate a growing mutual awareness and regard.

Objectives:

Methods: To share from academic research and 14 years of experience as chaplain in an inpatient mental health service. Wyatt will recount situations of positive outcomes from interaction between patient, psychiatrist and chaplain.

Findings: It is not all good news, yet it is apparent that collaboration is better than mutual distrust or dismissal.

Conclusions: Psychiatrists and religious practitioners are, to large extent, interdependent.

References

Halasz G (2003) Can psychiatry reclaim its soul? Psychiatry’s struggle against a dispirited future. Australasian Psychiatry 11(1): 9–11.

Hartog K, Gow KM (2005) Religious attributions pertaining to the causes and cures of mental illness. Mental Health, Religion and Culture 8(4): 263–276.

Presenter 3

The Place of Hope

K Brightley

Waitemata District Health Board, Auckland, New Zealand

Background: Kaye Brightley is a ‘jobbing’ child and adolescent psychiatrist in West Auckland with a particular interest in early intervention in 4- to 12-year olds. She has, since 2010, walked the path towards Anglican priesthood (ordination December 2017) through diocesan training and gained a theology degree from the University of Otago. She works part time as a non-stipendiary priest in the parish of Kohimarama. This is a rich weave of opportunity and joy.

She is passionate about supporting younger colleagues to flourish in a setting not always conducive to growth.

Objectives:

Methods: Kaye proposes to share some thinking from a theological perspective, leaning heavily on the work of John Swinton and William Countryman.

Findings: Are we sitting on a three-cornered stool if we do not consider our own spiritual life (and that of the families who come to see us)?

Conclusions: We have found words to talk about difficult things but the world of faith and grace is rarely explored. This seems odd in the context of so many strength-based approaches. Are we embarrassed to explore lives of faith or have we just lost the words?

Presenter 4

A Cultural Presentation

Te Puea Winiata

Turuki Health Care, Auckland, New Zealand

Background: Te Puea is a chief executive officer at Turuki Health Care, which has managed mental health and addiction services for a number of years that have a focus on culturally appropriate service delivery models for Mhat. Now in primary health, mental health and addiction services continue to feature strongly in the general practitioner health and social services that Turuki delivers in South Auckland.

Te Puea is also Chair of Te Rau Matatini, the national Maori Mental Health and Addiction Workforce Development Centre and a member of Te Kaunihera and What Works Committees with the Royal Australian and New Zealand College of Psychiatrists.

Objectives: Holistic wellness cannot be achieved without being attuned physically, spiritually, mentally and in your relationships with yourself and others.

Methods: Te Puea and her associate propose to share some brief insights from a Maori world view about acknowledging the importance of healing the spirit.

Findings: Being open to the conversation, taking a line of enquiry into spiritual well-being and deep listening can assist the person to explore their ease and dis-ease and how healing may occur.

Conclusions: Practitioners need to understand their own spirituality, be culturally competent to work with Mract and be comfortable in sitting in the world of Te Ao M and to journey with people as they heal themselves and reconnect as they need to with their spiritual selves.

Presenter 5

The Validity of A Truly Holistic Approach

A Blackburn

Waitemata District Health Board, Auckland, New Zealand

Background: When and how do we encourage people to have a truly holistic approach to their healing, not only their social, mental and physical, but also their spiritual.

Andrew has lived with a diagnosis of schizophrenia/schizoaffective disorder (in remission) for more than 25 years, attending several church fellowships in that time and continuing to grow in his Christian faith.

Objectives: To bring personal experience of the healing work that can be achieved by the inclusion of spiritual support in people’s recovery from psychiatric issues.

Methods: Discussing some of the life-stage changes and spiritual development throughout a 35-year time span and how my spiritual experiences have deepened my resilience and resolve.

Findings: People are able to come to a comfort and peace in their lives, with the social and spiritual input of safe church fellowships.

Conclusions: Many people with psychiatric issues find loneliness, exclusion and isolation are major social issues that they deal with. The appropriate and safe use of spiritual and social fellowships can be important and dramatic inroads to recovery, alongside optimal medication, nutrition, sleep and exercise routines.

Presenter 6

Relevance and Integrity: Psychiatry Informed by Religion/Spirituality

M Wong

School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia

Background: There has been increasing interest and endeavour over the last decade in incorporating religion/spirituality into the familiar biopsychosocial model to facilitate a whole-person-focused approach to the practice of psychiatry.

Objectives: To examine the rationale and feasibility of a whole-person-focused approach.

Methods: Literature with special focus on the conceptual and practical aspects of integrating religion/spirituality with the practice of psychiatry was reviewed and critiqued.

Findings: There are both conceptual and methodological evidence that such approach is a valid and warranted one.

Conclusions: When insights from religion/spirituality are applied to the practice of psychiatry with integrity and relevance, the development of a whole-person approach to mental healthcare is achievable and its application potentially beneficial.

Metabolomics Profile of Urine and Serum in Autism Spectrum Disorders

Yujie Liang^1,2,3,4, Jianping Lu^1,2,3,4, Zhou Xiao^1,2,3,4, Xiaolan Cao^1,2,3,4, Xiaoyin Ke^1,2,3,4

¹Shenzhen Kangning Hospital, Shenzhen, China

²Shenzhen Mental Health Center, Shenzhen, China

³Shenzhen Key Laboratory for Psychological Healthcare and Shenzhen Institute of Mental Health, Shenzhen, China

⁴Faculty of Mental Health, Shenzhen University, Shenzhen, China

Background: Autism spectrum disorder (ASD) is a complicated genetic neuropsychopathic disease with heterogeneity. The diagnosis of autism spectrum disorder (ASD) mainly depends on the description of clinical symptoms. There is an urgent need to find a quantitative biological marker for the early detection and diagnosis of autism. Metabolomics is crucially important in the research for pathological mechanisms and the identification of a clinical diagnosis biomarker. Metabolomics can be used potentially to demonstrate a quantitative diagnosis of ASD. However, there are some defects, such as potential biomarkers lacking specificity, which would prevent the biomarker’s clinical application, and difficulties in confirming all the biomarker’s functions.

Objectives: We aim to analyse the urine and serum metabolomics of 20 cases of ASD compared to 20 matched healthy children and then test their diagnostic value in a Han population in China combined with clinical data.

Methods: We will screen the serum and urine for metabolomic markers related to ASD and establish a metabolomic analytical model.

Findings: After differential metabolites were identified using proton nuclear magnetic resonance (¹HNMR) and mass spectrometry, we accurately identified significant changes in the urine and serum metabolites of patients with ASD compared to controls. We also constructed a biological information signal network of ASD.

Conclusions: This research lays the foundation for clinical quantitative biomarkers of ASD, providing the potential of metabolites as biomarkers for the clinical diagnosis and evaluation of ASD.

Presenter 1

Epigenomic-Mediated Gene Regulation in Autism Spectrum Disorders

Yujie Liang^1,2,3,4, Jianping Lu^1,2,3,4, Zhou Xiao^1,2,3,4, Xiaolan Cao^1,2,3,4, Xiaoyin Ke^1,2,3,4

¹Shenzhen Kangning Hospital, Shenzhen, China

²Shenzhen Mental Health Center, Shenzhen, China

³Shenzhen Key Laboratory for Psychological Healthcare and Shenzhen Institute of Mental Health, Shenzhen, China

⁴Faculty of Mental Health, Shenzhen University, Shenzhen, China

Background: Autism spectrum disorder (ASD) is a complicated genetic neuropsychiatric disease, characterized by dysfunctions in social relationships, language and communication, repetitive behaviours and a limited range of interests. ASD thus affects childhood severely. The molecular mechanisms that underlie ASD remain heterogenous, without a shared common pathway or common monogenic. Although a unifying mechanistic explanation has remained elusive, we think that epigenetic regulators of gene expression play an important role in ASD.

Objectives: To investigate the role of epigenetic-mediated regulation of ASDs by determining the genome-wide 5-hydroxymethylcytosine (5-hmC) distribution profiles using multiple mouse models of ASD and human patients with ASD.

Methods: We used an established 5-methylcytosine and 5-hydroxymethylcytosine immunodetection and chemical labelling and affinity purification methods and then used high-throughput sequencing technology to generate a genome-wide profile of striatal 5-hmC in an autism mouse model.

Findings: We provide a genome-wide map of 5-hmC in a mouse model of autism and 5-hmC-mediated epigenetic modulation in ASD.

Conclusions: This study could contribute to the identification of genetic and epigenetic risk factors for autism and may provide insight into the molecular pathogenesis ofASD.

Navigating Risk Management, Recovery and Human Rights in Clinical Practice

A Carroll^1,2,3, B McSherry^4,5

¹Forensicare, Melbourne, Australia

²Our Curious Minds Pty Ltd, Melbourne, Australia

³Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia

⁴Melbourne Social Equity Institute, Melbourne, Australia

⁵Melbourne Law School, The University of Melbourne, Melbourne, Australia

Background: Risk management has become an integral part of mental health service delivery. At the same time, the concept of personal recovery, which emphasizes positive risk-taking, has influenced mental health policy and international human rights law and has influenced reforms to mental health legislation governing compulsory treatment. How then should mental health practitioners navigate the tensions that may exist between risk, recovery and human rights? While courts have placed limitations on the duty of care, which has meant that actions in negligence against mental health practitioners and their employers rarely succeed, mental health practitioners may nevertheless face considerable social pressure to err on the side of being risk averse in treating those within their care.

Objectives: To use case studies to provide a framework for clinical decision-making that respects rights and recovery, while mitigating risk.

Presenter 1

The Values of ‘Recovery’ and The Challenge to Risk Management

A Carroll^1,2,3

¹Forensicare, Melbourne, Australia

²Our Curious Minds Pty Ltd, Melbourne, Australia

³Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia

Background: ‘Recovery’ values are often seen as antithetical to effective management of risk in clinical psychiatry.

Objectives: To demonstrate that effective risk management and recovery-oriented care are complementary rather than clashing.

Methods: The presentation will explore the limitations of ‘one-sided approaches’ that ignore either personal recovery or risk management, by drawing on examples of such approaches in mental health services in Australia. It will then consider the roles of ‘therapeutic risk-taking’ and ‘collaborative safety planning’ as examples of balanced approaches.

Conclusions: Risk management and recovery-centred care need to be integrated for optimal psychiatric practice.

Presenter 2

Human Rights and Mental Health Law

B McSherry^1,2

¹Foundation Director, Melbourne Social Equity Institute and Adjunct Professor, Melbourne Law School, University of Melbourne, Melbourne, Australia

²Adjunct Professor, Faculty of Law, Monash University, Melbourne, Australia

Background: The United Nations Convention on the Rights of Persons with Disabilities has had considerable impact on mental health legislation, leading a profound shift in how the rights and agency of persons diagnosed with mental illness are considered.

Objectives: To explore recent changes to domestic mental health laws that enable compulsory treatment in the light of international human rights law.

Methods: This presentation explores the rights set out in the Convention on the Rights of Persons with Disabilities and how they have been interpreted by United Nations’ bodies. It will consider the effect of such interpretations on domestic mental health laws and the tensions that exist between calls for the complete abolition of mental health laws and arguments that compulsory treatment must still exist as a last resort.

Conclusions: Mental health laws are unlikely to be abolished in Australia and New Zealand and the rights under the Convention can be upheld through trauma-informed, recovery-focused practice.

Presenter 3

The ‘Deep Structure’ of Psychiatric Dilemmas

A Carroll^1,2,3

¹Forensicare, Melbourne, Australia

²Our Curious Minds Pty Ltd, Melbourne, Australia

³Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia

Background: Most clinical dilemmas in psychiatry, whether in acute or rehabilitative contexts, hinge on a choice between risk-averse ‘preventive’ actions and more liberal, recovery-oriented ‘promotional’ actions.

Objectives: To use a range of real-world examples to illustrate how dilemmas tend to share a common ‘deep structure’. These will include dilemmas relevant to suicide risk and to violence risk.

Conclusions: Psychiatrists and other clinicians often feel caught between ‘a rock and a hard place’. Better understanding of the values and evidence-base embedded in decision-making when faced with high-stakes dilemmas can assist with improved decision-making and documentation and preservation of professional confidence even when adverse outcomes occur.

Presenter 4

Achieving The ‘Standard of Care’ While Respecting Recovery and Rights

A Carroll^1,2,3,4, B McSherry^4,5

¹Forensicare, Melbourne, Australia

²Our Curious Minds Pty Ltd, Melbourne, Australia

³Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia

⁴Melbourne Social Equity Institute, Melbourne, Australia

⁵Melbourne Law School, The University of Melbourne, Melbourne, Australia

Background: The fear of lawsuits may discourage the ‘therapeutic risk-taking’ that is part of a recovery approach.

Objectives: To explore whether the Civil Law (Wrongs) Act 2002 legislation in Australia makes respect for recovery and rights more difficult.

Methods: This presentation will consider legislation and landmark cases before presenting a clinically practical framework for reducing medico-legal risk, while respecting rights and recovery.

Conclusions: The contemporary ‘standard of care’ in psychiatry not only ‘permits’ recovery-oriented care and respect of rights but requires a respect for these constructs.

Presenter 5

Practical Application of A Rights and Recovery Approach

A Carroll^1,2,3, B McSherry^4,5,6

¹Forensicare, Melbourne, Australia

²Our Curious Minds Pty Ltd, Melbourne, Australia

³Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia

⁴Melbourne Social Equity Institute, Melbourne, Australia

⁵Melbourne Law School, The University of Melbourne, Melbourne, Australia

⁶Faculty of Law, Monash University, Melbourne, Australia

Background: Abstract concepts from legislation, human rights and recovery discourse need to be ‘grounded’ in real-world clinical practice.

Objectives: To enhance confidence in applying the learnings from this symposium.

Methods: Small-group discussion of real-world dilemmas.

Conclusions: Simple, practical steps can be taken to better grapple with dilemmas thrown up by the ‘rights and recovery’ approach.

Presenter 6

‘Duty of Care’: Legal Versus Clinical Concepts

B McSherry^1,2,3

¹Melbourne Social Equity Institute, Melbourne, Australia

²Melbourne Law School, The University of Melbourne, Melbourne, Australia

³Faculty of Law, Monash University, Melbourne, Australia

Background: There is often confusion about what is meant by the legal duty of care in laws of negligence and what a ‘duty of care’ is considered to mean in clinical practice.

Objectives: To clarify the legal concept of duty of care through an analysis of recent case law.

Methods: Recent cases on the law of negligence will be presented along with an outline of how the findings can be used to drive good clinical practice.

Conclusions: The case law suggests that clinicians who allow patients a degree of risk in decision-making about their mental health treatment will be protected by the law. A duty of care does not mean a duty to care or to make decisions about every aspect of the lives of those diagnosed with mental illness.

Westmead Psychotherapy Program Today: Working with Complex Trauma and Personality Disorder

A Korner^1,2, J Haliburn^1,2, J Stevenson^1,2, S Halovic^1,2, L Mclean^1,2,3, P Graham^1,2, M Williamson^1,2

¹Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

³Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia

Background: Since 2009, the Westmead Psychotherapy Program has undergone substantial change with the introduction of training in short-term dynamic interpersonal psychotherapy and the introduction of group psychotherapy as well as longer term dynamic psychotherapy.

Objectives: To outline the changing demographics as the program has shifted from an exclusive focus on borderline personality disorder and the ways in which the program has adapted to meet the needs of a broader population with trauma-related disorders.

Methods: The adaptation of the conversational model to short-term intervention in adolescents is outlined (J Haliburn). Preliminary results of this intervention are presented including demographic characteristics of the patient population (J Stevenson). The development of an adherence measure also being used in training is described (S Halovic). Finally, the thinking behind the re-orientation of the program towards a broader group of patients with complex trauma and the addition of a group intervention to the program are explained (A Korner).

Findings: A high rate of personality disorder (PD) is recognized in this group, mostly unrecognized in medical records. When analysed, evidence of trauma and dissociation in these inpatients showed that childhood neglect was correlated with the severity of PD and not to individual PD diagnoses. Preliminary results show benefits for short-term intervention in this group. This group has scores well above community norms in relation to trauma.

Conclusions: A mature service needs to offer a range of treatment options to meet the needs of the diverse range of people who present in the public sector with trauma-related disorders.

Presenter 1

Partnerships in Mental Health: Collaboration in Short-Term Dynamic Interpersonal Psychotherapy With Adolescents

J Haliburn^1,2, J Stevenson^1,2, S Halovic^1,2, A Korner^1,2

¹Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia

Background: Adolescence is a time of rapid growth in body and functional capacity, alongside both temporary and enduring changes in the psychology and personality of the young person. Adolescence can be regarded as a time when characteristic ways of thinking, feeling and behaving in relation to oneself and to others (i.e. personality traits) are often quite clear and potentially become a characteristic way of functioning. There is not only an increasing demand on mental health services for adolescents but also increasing pressure placed by adolescents to get better sooner, so that they can go on with the business of living.

Objectives: To demonstrate that short-term dynamic interpersonal psychotherapy meets both these needs. It is time-limited, structured, collaborative and active and suits the average teenager.

Methods: A phasic approach to adolescent crises will be described, incorporating a case study involving self-harm, which demonstrates the effective use of short-term dynamic interpersonal psychotherapy.

Results: Ways of thinking, feeling and behaving are found to change, as the research will attest.

Conclusions: Short-term dynamic therapies are effective in a broad range of conditions, in children and adolescents, including anxiety and depression.

Presenter 2

Trauma, Dissociation and Personality Disorder Severity: A Psychiatric Inpatient Study

J Haliburn^1,2, J Stevenson^1,2, S Halovic^1,2, A Korner^1,2

¹Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

Background: It is more commonly recognized now that childhood trauma predisposes adults to develop psychiatric disorders later in life, especially personality pathology, but the presence of personality pathology in psychiatric inpatients is rarely recognized.

Objectives: To examine consecutive admissions to a psychiatric inpatient facility over a 4-year period and examine the prevalence of personality pathology and compare the outcomes of those with personality disorders (PD) with those without.

Methods: Psychiatric inpatients (240) between the ages of 18 and 100 years were followed, over 4 years, from admission to discharge, 6 and 12 months later. A battery of tests was administered each time, including the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis I disorders (SCID I), SCID II, Symptom Checklist 90 (SCL-90), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) scale, Short form-12 item questionnaire (SF12), Personal Wellbeing Index (PWI), Social and Occupational Functioning Assessment Scale (SOFAS), the COPE inventory, relapse and readmission, the Geriatric Depression Scale (GDS) and the 5-factor inventory. Patients were grouped into three age groups: 18–40 years, 41–65 years and more than 65 years.

Findings: Of the young group, 74% satisfied SCID II criteria for a PD, 72% of the middle group and 59% of the older group. PDs were measured individually and by cluster. In the younger age group, 73 and borderline personality disorder (BPD) were comorbid. BPD reduced in prevalence with age whereas NPD increased. There was a considerable overlap between NPD and BPD. The presence of a PD was not recognized in the hospital notes. Evidence of trauma and dissociation in these inpatients showed that childhood neglect correlated with severity of PD and not to individual PDs. Dissociative experiences were correlated with only physical abuse.

Conclusions: In this cohort, childhood trauma, particularly neglect, was found to result in severe personality pathology, not necessarily specific PDs.

Presenter 3

The Value of Psychotherapy Adherence Scales in Measuring and Developing Psychotherapist Expertise

S Halovic^1,2, A Korner^1,2, L McLean^1,2,3, J Haliburn^1,2, J Stevenson^1,2

¹Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

³Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia

Background: Earlier, in 2017, The Counseling Psychologist published a special issue dedicated to the topic of psychotherapist expertise. The respective authors’ debates about what constitutes psychotherapist expertise and how it can be measured and verified. These collective studies will be reviewed and our own perspectives on the debate will be argued.

Objectives: To argue that psychotherapy adherence scales, like the CoMTAS, have great value in the verification of psychotherapist expertise and in the development of psychotherapeutic expertise in training clinicians.

Methods: The more recent literature on psychotherapist expertise and the measurement of psychotherapist adherence will be reviewed. Additional feedback from training clinicians supporting the value of the CoMTAS in their conversational model therapy training will be described.

Findings: It is difficult to collect quality data for the verification of psychotherapist expertise but not impossible. Psychotherapy adherence scales have the potential to overcome some of the problems highlighted in previous research, as they measure the psychotherapeutic process that corresponds with superior patient outcomes.

Conclusions: Psychotherapy adherence scales afford clinicians access to detailed feedback on their psychotherapeutic performance across different patients with different symptomologies. These adherence scales can be used in peer supervision to assist the psychotherapist’s critical reflections on their continued provision of psychotherapy. Clinicians are then able to continually develop their own psychotherapeutic skills towards psychotherapist expertise.

Presenter 4

The Evolution of The Conversational Model and Its Application to Group Psychotherapy

Anthony Korner^1,2; S Halovic ^1,2, J Haliburn^1,2, J Stevenson^1,2, P Graham^1,2, M Williamson^1,2, L McLean^1,2,3

¹Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

³Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia

Background: The conversational model (CM) was developed as an approach to individual treatment for borderline personality disorder (BPD) by Russell Meares and Robert Hobson. Over the last decade, its use has been expanded from long-term treatment of BPD to short-term intervention for a range of presentations and diagnoses. Most recently, CM has been applied to the situation of group psychotherapy. This draws upon work done in the 1970s when Meares wrote of his experiences with groups in England (Meares, 1977).

Objectives: To highlight ways in which conversational model therapy (CMT) can be adapted to a range of presentations which have in common the need for trauma-informed care and to report on one such application: a pilot group therapy project.

Methods: Data relating to the changing demographics of patients in the Westmead program are used to illustrate the applicability of the model. Preliminary data on the acceptability of the group therapy intervention together with selected literature are used to present a model of group work underpinned by CMT.

Findings: About half of the population currently being seen at the Westmead program meet criteria for BPD. The remainder have diagnoses of mixed personality disorder, treatment resistant depression, somatization and related disorders and anxiety disorders. The group therapy program was mixed from a diagnostic point of view. Although there was a significant drop-out rate, those that completed the 20-week intervention valued it highly.

Conclusions: CMT shows promise in a range of applications, providing a sound theoretical base for trauma-informed care.

Reference

Meares R (1977) The Pursuit of Intimacy. Melbourne: Nelson.

Bodymind: Exploring Stress System Disorder Models in Research and Treatment in Functional Neurological Disorder

L McLean^1,2,3,4, C Chapman^1,2,5, L Xing¹, M Gutkin^4,5, S Halovic^1,2, A Szasz^1,2,3, L Crisante¹, A Korner^1,2, K Kozlowska^2,6

¹Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Hospital, Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

³Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia

⁴Consultation–Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia

⁵HETI (The Heath Education and Training Institute), Sydney, Australia

⁶Department of Psychological Medicine, Children’s Hospital Westmead, Westmead, Australia

Background: Historically conversion disorder, now termed functional neurological disorder (FND), has been associated with unresolved trauma and/or overwhelming stress. Our group and its collaborators have been exploring models of understanding and treating the disorder from an integrative, relational and developmental neuroscience framework, where symptoms are considered to arise from challenges to homeostasis. We have been undertaking studies exploring aetiology and treatment.

Objectives: To describe process and outcomes to date of two studies in adults exploring FND from a stress regulation framework.

Methods: The first study builds on pilot work in children demonstrating disordered self-regulation from failed homeostasis under overwhelming stress and explores baseline measures and changes with treatment. The adult study also explores responses to psychodynamic psychotherapy, Conversational model therapy (CMT), which aims to build up the regulatory capacity of self, addresses traumatic experience and dissociation. We also offer breathing biofeedback for stress regulation to ground the start of therapy with a stabilizing strategy. The first three papers will examine aspects of the study: conceptual frames, a case study demonstration and early case–control results. The second study, described in the fourth paper, explores treatment in a consultation–liaison context in a new FND clinic that offers psychological assessment, formulation and treatment in a brief frame.

Findings: Early findings show some utility in considering a stress regulation approach to adults with FND.

Conclusions: Further work to assess an integrative relational neuroscience approach to FND may be warranted and is underway.

Presenter 1

Bodymind: The Stress System Disorder Framework for Functional Neurological Disorder

L McLean^1,2,3,4, C Chapman^1,2,5, L Xing¹, M Gutkin^4,5, S Halovic^1,2, A Szasz^1,2,3, L Crisante¹, A Korner^1,2, K Kozlowska^2,6

¹Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Hospital, Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

³Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia

⁴Consultation–Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia

⁵HETI (The Health Education and Training Institute), Sydney, Australia

⁶Department of Psychological Medicine, Children’s Hospital Westmead, Sydney, Australia

Background: Stress and trauma, often consciously undeclared, have been associated with conversion disorder, now termed functional neurological disorder (FND). With contemporary approaches to stress regulation and adaptation, we are being equipped with complex relational, systems approaches to personal and interpersonal stress regulation, but these require testing and evaluation.

Objectives: To explore the current frameworks of interpersonal neurobiology that may offer some help in understanding and treating FND and which underpin the approach in some past and present studies. These include attachment and trauma theory, the hierarchy of consciousness, Porges’ polyvagal theory and the role of implicit and procedural memory and dissociation and understandings that the stress response is aimed at adaptation to contexts of fear, survival and threat to self.

Methods: A brief integrative literature review and then integrative framework will be offered that underpins the studies that follow in the symposium. Questions will be flagged that require empirical investigation.

Findings: An integrative approach to understanding and treating FND is unfolding with hypothesis testing needed.

Conclusions: New approaches to FND require open models that integrate new findings from relational neuroscience and treatment as they emerge.

Presenter 2

Voice, Body and Self Reclaimed: A Case Study of Functional Neurological Disorder Treated with an Integrative Approach and Psychodynamic Psychotherapy in The Conversational Model

L McLean^1,2,3,4, C Chapman^1,2,5, L Xing¹, S Halovic^1,2, A Szasz^1,2,3, L Crisante¹, A Korner^1,2

¹Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Hospital, Western Sydney Local Health District, Sydney, Australia

²Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

³Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, Australia

⁴Consultation–Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia

⁵HETI (The Health Education and Training Institute), Sydney, Australia

Background: Functional neurological disorder (FND) has often been associated with unresolved trauma and unspoken stress. With modern neuroscience, we are putting together a framework of understanding of disordered self-regulation from failed homeostasis under overwhelming stress. Conversational model therapy (CMT), integrating psychodynamic psychotherapy and research in development, neuroscience and linguistics, holds that self emerges in positive relational connections to develop capacities to optimally regulate stress and integrate trauma and support personal coherence. In our local study on FND, building on a study in children, we are assessing patients at baseline from the viewpoint of attachment, emotional, cognitive and autonomic function, teaching breathing biofeedback for stress regulation and then following their progress with other integrative treatment, one arm of which is psychodynamic psychotherapy in the conversational model.

Objectives: To offer a case study demonstration of theory and practice.

Methods: We will present a case study, formulation and some transcript from a baseline adult attachment interview with an account of the symptom emergence, and then early sessions in a therapy to illustrate the entry into illness and then the beginnings of recovery.

Findings: Attachment disorganization, incoherent attachment states of mind and impaired reflective capacities are associated with stress dysregulation and altered mind–body states. FND presentations are open to interventions that foster stress regulation and the integration of experience, including psychotherapeutic approaches

Conclusions: CMT can fit with contemporary conceptions of FND and integrative treatment approaches and give value to the patient’s long journey into illness and support movement towards recovery.

Presenter 3

The Stress Responses of Adults with Conversion Disorder/Functional Neurological Disorder: A Pilot Analysis

C Chapman^1,2,3, L McLean^1,2,4,5, K Kozlowska⁶

¹Western Sydney Local Health District, Sydney, Australia

²Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

³HETI (The Health Education and Training Institute), Sydney, Australia

⁴Brain and Mind Centre, Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia

⁵Department of Consultation–Liaison Psychiatry, Royal North Shore Hospital, Sydney, Australia

⁶Department of Psychological Medicine, Children’s Hospital Westmead, Sydney, Australia

Background: Conversion disorder or functional neurological disorder (FND) has historically been seen to arise as a response to stress or trauma. More recently, in a more integrated neuroscience approach, FND in children has been shown to be associated with dysregulated stress responses. Our pilot case–control study in adults has sought to examine whether this holds in the older group.

Objectives: To explore the baseline stress response in adult patients with FND versus healthy controls.

Methods: Our pilot study is aiming to recruit patients with FND and healthy adults to compare the stress response in the two groups. The baseline stress response is measured via a non-invasive ear-clip measure of heart rate variability (HRV) in the context of a battery of cognitive and emotional testing. Examination of HRV data can be done using mathematical and statistical analysis methods to characterize the functional characteristics of the stress response.

Findings: We present preliminary data from the pilot study comparing HRV in adult conversion disorder patients versus healthy controls in response to a battery of cognitive tests, which highlight the differences and similarities in their stress responses. Tentative explanatory models will be discussed using Porges’ polyvagal theory and attachment and trauma theory.

Conclusions: It is possible to explore and track subtle differences in the way patients with conversion disorder/FND respond to stress when compared to healthy controls in terms of different neurological processes at play during the stress response.

Presenter 4

Functional Neurological Disorders and The Misunderstood Roles of Psychiatry and Stress

M Gutkin^1,2,3, J Streimer¹, L Mclean^1,3,4, R Ilchef^1,3, M Thieben¹, G Herkes^1,3

¹Royal North Shore Hospital, Sydney, Australia

²HETI (The Health Education and Training Institute), Sydney, Australia

³The University of Sydney, Sydney, Australia

⁴Westmead Psychotherapy Program, Cumberland Hospital, Sydney, Australia

Background: It is an uncommon diagnosis in psychiatry; however, neurologists diagnose functional neurological disorder (FND), a new name for conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, in 30% of clinic patients (Stone et al., 2010). FND is a poorly understood group of heterogeneous disorders strongly associated with early trauma and psychiatric comorbidity. Research into other somatoform disorders identified an association with unregulated physiological stress and abnormal illness behaviour (Guthrie, 1991; Kozlowska, 2015) but this has not been established in FND.

Objectives:

Methods: A literature review, correspondence with interested clinicians and site visits, was undertaken. An FND pilot clinic was planned and established at RNSH, Sydney, in collaboration with the coauthors. A mixed-methods approach including case studies was undertaken with ethics approval and consent from participants.

Findings: FND is associated with early trauma, psychiatric comorbidity and stress dysregulation. Abnormal illness behaviour and compensation alleviate anxiety, producing further maintaining feedback loops.

Current treatment focuses on communication of the diagnosis and intervention at many levels of the relational and personal stress system. Psychotherapy fosters psychological integration of difficult affects and trauma to address interrupted dissociation-related seizures.

Conclusions: Physiological stress manifesting as dissociation and disinhibition provides a theoretically consistent aetiological explanation for FND. Aetiology and comorbidity suggest the potential for psychiatry to play a larger role in FND management.

References

Guthrie (1991)

Kozlowska (2015)

Stone et al. (2010)

Enhancing The Status, Role and Utility of Aboriginal and/or Torres Strait Islander Mental Health Professionals in General Mental Health Teams

V Dann^1,2, D Jans^1,3, E McEntyre^1,4, A Rosen^1,5, K Ryan^1,6, D Sabbioni^1,7

¹Aboriginal and Torres Strait Islander Mental Health Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Kimberley Mental Health and Drug Service, Halls Creek, Australia

³Apunipima Cape York Health Council, Cairns, Australia

⁴UNSW Sydney, Sydney, Australia

⁵Far West NSW Local Health District Mental Health Services, Dubbo, Australia

⁶Aboriginal and Torres Strait Islander Mental Health Committee, Pilbara Region of Western Australia, Australia

⁷North Metropolitan Health Service, Perth, Australia

Background: The Aboriginal and Torres Strait Islander Mental Health Committee advises the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in regard to issues relating to mental health in Aboriginal and Torres Strait Islander peoples and communities. The Committee is made up of RANZCP Fellows, a registrar and community members. The RANZCP recognizes the value and skills Aboriginal and Torres Strait Islander mental health professionals bring to the practice of psychiatry and provides leadership in educating the profession and the community about the nature and value of their work.

Objectives: To highlight the importance of the status, role and utility of Aboriginal and Torres Strait Islander Mental Health professionals in enhancing access to holistic and culturally informed and competent mental healthcare for Aboriginal and Torres Strait Islander peoples.

Methods: A panel presentation featuring innovations, research and perspectives derived from lived experience will inform an interactive discussion with the audience

Findings: Aboriginal and/or Torres Strait Islander mental health professionals should be an integral part of any multidisciplinary team caring for Aboriginal and Torres Strait Islander peoples and communities. They have important roles in providing cultural safety and security, supporting the development of cultural competency and optimizing holistic and culturally informed care. Strategies supporting their training, placement and integration into the mental health workforce are available and effective.

Conclusions: Training Aboriginal and Torres Strait Islander mental health professionals, enabling their placement and integration into general mental health teams and valuing their status and roles facilitate the development of robust partnerships that deliver improved and more accessible care to Aboriginal and Torres Strait Islander peoples.

Presenter 1

Integration of Aboriginal Mental Health Workers in Broome Mental Health Service

V Dann^1,2

¹Aboriginal and Torres Strait Islander Mental Health Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Kimberley Mental Health and Drug Service, Broome, Australia

Background: The role of the Aboriginal mental health worker (AMHW) demonstrates a model of care that helps to bridge the gap between mainstream rural and remote mental health services and the Aboriginal community.

Objectives: To ensure that AMHWs provide a whole-of-family, whole-of-life approach to mental health service delivery that is consistent with the cultural needs of Aboriginal people. Our aim is to integrate the AMHW workforce into established multidisciplinary teams located within mental health services across the Kimberley region of Western Australia, to provide culturally and clinically safe care to Aboriginal and Torres Strait Islander peoples who access mental health services.

Methods: This presentation will outline narratives and pictorials to show how this model operates in a localized, grounded and practical manner.

Findings: Partnerships are central to this model, which embodies a collaborative approach to improving the mental health of Aboriginal people, including the use of traditional and spiritual healers, community elders and recovery-focused principles strengthened by connection to culture and country. This way of working, alongside mainstream clinical practice, helps us to recognize the unique knowledge, skills and experience each worker can contribute in building culturally appropriate mental health services within the community.

Conclusions: This model clearly demonstrates its flexibility to adapt across diverse communities and different acute and community mental health settings, while consistently delivering positive results attuned to the local community. By operating in this space, non-Aboriginal and Aboriginal mental health clinicians are able to benefit from a two-way learning process that improves the service provision to the Aboriginal community, family and individuals

Presenter 2

Reflections on Partnerships and Opportunities: Becoming Well Together

D Jans^1,2, E McEntyre^1,3, K Ryan^1,4

¹Aboriginal and Torres Strait Islander Mental Health Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Apunipima Cape York Health Council, Cairns, Australia

³UNSW Sydney, Sydney, Australia

⁴Aboriginal and Torres Strait Islander Mental Health Committee, Pilbara Region of Western Australia, Australia

Background: The authors have extensive lived experience as Aboriginal women working within mental health professional and clinician roles.

Objectives: Aboriginal and Torres Strait Islander mental health workers and clinicians play an important role in the delivery of social, emotional, cultural, spiritual and mental healthcare to Aboriginal and Torres Strait Islander peoples. This presentation provides insights into the varied and broad roles of these professionals and clinicians, and an understanding that their work may extend outside the normal clinical experience of the patient–therapist relationship, including in community development and work outside of the normal geographical and time parameters expected by non-Indigenous practitioners.

Methods: The authors will present on their reflections of partnerships and opportunities from within their experiences as Aboriginal women, family and community members, as well as their roles with drug and alcohol, prison, mental health and child and adolescent settings.

Findings: Aboriginal and Torres Strait Islander mental health workers and clinicians bring additional expertise, knowledge and skills that benefit the care of Aboriginal and Torres Strait Islander people.

Conclusions: Effective and respectful partnerships with Aboriginal and Torres Strait Islander mental health workers and clinicians within multidisciplinary teams, services and organizations are critical for ensuring the delivery of culturally safe and capable services to Aboriginal and Torres Strait Islander peoples.

Presenter 3

Aboriginal Mental Health Clinicians in The Western Australian Metropolitan Youthlink Program in An Interdisciplinary Team: Does it Help Engagement?

D Sabbioni^1,2

¹Aboriginal and Torres Strait Islander Mental Health Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²North Metropolitan Health Service, Perth, Australia

Background: Aboriginal young people are more likely to experience mental health issues and to access mental health services than other young Australians, yet there are few culturally informed mental health programs and services available.

Objectives: To describe the culturally sensitive model within YouthLink, a state-wide mental health service program in Western Australia for young people aged 13–24 years of age, and document its effectiveness.

Methods: A mixed-methods design included a descriptive approach reporting on the YouthLink framework and an empirical research design where 40 Aboriginal clients completed client feedback monitoring measures between 2014 and 2016.

Findings: The YouthLink culturally informed conceptual framework adheres to best practice principles relevant to work with Indigenous people, family and communities (Dudgeon et al., 2014). Aboriginal young people indicated improvement across the treatment period as shown by within-group differences between first and last session scores on feedback measures. Therapeutic alliance (together with lower baseline acuity and female gender) also contributed significantly to positive treatment outcomes.

Conclusions: Through a strong role of Aboriginal practitioners, relationships with Aboriginal communities and greater service flexibility that embraces cultural meaning and knowledge, YouthLink has sought to enhance its response to the needs of Aboriginal youth.

Reference

Dudgeon et al. (2014)

Presenter 4

Effectiveness and Sustainability of An Aboriginal Mental Health Workforce Mentorship Program

A Rosen^1,2, T Brideson

¹Aboriginal and Torres Strait Islander Mental Health Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Far West NSW Local Health District Mental Health Services, Broken Hill, Australia

Background: A mentorship program for the Aboriginal mental health workforce was initiated across Western and Far Western New South Wales. The Aboriginal mental health workforce is comprised of trainees, clinicians through to senior clinicians and managers. The mentoring program was externally evaluated after 5 years in operation.

Objectives:

Methods: Mentoring methods and characteristics of mentors and mentees will be outlined. Qualitative structured interviewing techniques were employed by an independent evaluation team reviewing 5 years of mentoring practice with all mentees, mentors and mentoring coordinators.

Findings: Evaluation results show that the overall benefits are high and include building of mentees’ mental health knowledge, skills and confidence; mentees feeling supported, validated and empowered; increased psychiatrists’ knowledge of Aboriginal culture, community concerns and family; strengthened dynamics and role of the Aboriginal mental health worker; retained Aboriginal mental health workers; and increased status and perceived value of the Aboriginal workforce.

Conclusions: While this evaluation indicates the success of this program, some challenges arising from the evaluation include the need to ensure that a renewed and continuing commitment to this mentoring program is made across the Western and Far West Local Health Districts, with common methods and frameworks across sites.

References

Dudgeon P, Milroy H, Walker R (2014) Community life and development programs – pathways to healing. In: Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 2nd ed. Canberra: Department of the Prime Minister and Cabinet, pp. 419–435.

Leadership, Administration and Management – ‘Stepping Up Beyond The Local Health Service’

A Groves¹, D Riordan², P Brown³, J Allan⁴, J Wilson⁵, M Hopwood⁶, A Wilson⁷, M Cullen⁸, B Kotze⁹

¹Department of Health and Human Services, Hobart, Australia

²Northern Territory Government Department of Health, Darwin, Australia

³National Mental Health Commission, Sydney, Australia

⁴Queensland Health, Brisbane, Australia

⁵Health Quality and Safety Commission, Wellington, New Zealand

⁶Albert Road Clinic, Melbourne, Australia

⁷Medibank Private, Sydney, Australia

⁸Tonic Health Media, Sydney, Australia

⁹Western Sydney Local Health District, Sydney, Australia

Background: This session is part of the leadership and management stream and looks at the potential for psychiatrists to engage in senior leadership roles.

Objectives: To encourage participants to explore leadership opportunities beyond the clinical and service delivery at the state, national and international levels.

Methods: This symposium will be based on the experiential learning of nine senior psychiatrists who have occupied a broad range of senior leadership roles. The examples from their own practice will be supplemented by reference to the broader leadership and management literature.

Findings: The presenters will discuss the breadth of opportunities for psychiatrists to influence policy and health service development at a strategic level and will explore how to develop the skills and attributes required for success at this senior level.

Conclusions: There are many senior leadership opportunities for psychiatrists beyond clinical service delivery. This symposium will highlight some of the potential opportunities and illustrate ways for senior clinicians to pursue their aspiring leadership goals.

Presenter 1

Why, What, How: on Becoming A Chief Psychiatrist

A Groves¹, D Riordan²

¹Department of Health and Human Services, Hobart, Australia

²Northern Territory Government Department of Health, Darwin, Australia,

Background: The role of the chief psychiatrist exists in all jurisdictions in Australia, either as a statutory or a non-statutory appointment, and is responsible for overseeing the administration of mental health legislation and providing clinical advice to government.

Objectives: To provide insights into what the role of the chief psychiatrist entails and the broad leadership opportunities it presents.

Methods: Dr Groves will draw on his experiences as a chief psychiatrist in four jurisdictions to highlight key learnings about the role and what it has taught him about leadership and management more broadly. Dr Riordan will conclude the session with a discussion from the perspective of a first-time appointee.

Findings: Participants will gain insights into the knowledge, skills and ability required to be successful as a chief psychiatrist.

Conclusions: This presentation will synthesize the benefits and challenges of this key leadership role and provide psychiatrists aspiring to a senior leadership role with an understanding of what to expect and what it takes to succeed.

Presenter 2

Winning Hearts and Minds: Leading and Influencing At The National Level

P Brown

National Mental Health Commission, Sydney, Australia,

Background: Leadership and management are not the same. Operating as a senior health administrator generally requires both skill sets, but the ability to influence as a leader often extends well beyond the designated authority of any management role.

Objectives: To explore the differences between leadership and management, the skills and attributes that are needed in each role and how to maximize influence at a national level.

Methods: Dr Brown will draw on her experience in several senior leadership roles to discuss the distinction between leadership and management and describe ways in which psychiatrists can influence health and mental health reform at a national level.

Findings: Participants will hear about ways to exercise influence on health and mental health reform at a national level, including tips about the things you probably didn’t learn during psychiatry training.

Conclusions: This presentation will better equip participants to consider the differences between leadership and management and the spheres of influence of both.

Presenter 3

Thriving in The Hothouse: Dealing with Bureaucracy, Politics and Media

J Allan

Queensland Health, Brisbane, Australia

Background: Working within a central government department presents many new challenges for a psychiatrist, including dealing with bureaucracy, politics and media at close quarters. Learning how to thrive, not just survive, is key to succeeding in this environment.

Objectives: To give insights into the world of the health bureaucracy and its political interface, and the role of media, particularly social media, in influencing policy and decision-making.

Methods: Dr Allan will draw on his experience working as a senior psychiatrist within two state health departments to describe the challenges of operating within a bureaucratic environment and will generously share his tips for surviving it.

Findings: Participants will hear from a senior psychiatrist the truth behind the episodes of Yes, Minister and Utopia, along with how to thrive in the face of adversity and challenge.

Conclusions: This presentation will give aspiring leaders an understanding of the opportunities and challenges of working as a senior psychiatrist in a central government department.

Presenter 4

The Road to Opportunity: A Conversation With Psychiatrists in Leadership Roles

J Wilson¹, M Hopwood², A Wilson³, M Cullen⁴, B Kotze⁵

¹Health Quality and Safety Commission, Wellington, New Zealand

²Albert Road Clinic, Melbourne, Australia

³Medibank Private, Sydney, Australia

⁴Tonic Health Media, Sydney, Australia

⁵Western Sydney Local Health District, Sydney, Australia

Background: Training as a psychiatrist does not limit a practitioner to only clinical roles in their future employment. Rather, the knowledge and skills acquired during psychiatry training can provide a platform for stepping off into a diverse range of important leadership roles.

Objectives: To highlight the diverse roles and opportunities open to psychiatrists who wish to build upon their clinical training.

Methods: This panel of senior psychiatrists with a diverse range of experience in leadership roles will explore what drove each of them to venture beyond clinical service delivery and their secrets to success.

Findings: Participants will hear of the diverse opportunities open to psychiatrists and the interesting and important ways in which psychiatrists can contribute to advancing the health and well-being of our communities.

Conclusions: This presentation will demonstrate that there are opportunities aplenty for any psychiatrist with a penchant for moving beyond clinical practice and doing things differently.

Continuing Professional Development

W de Beer^1,2, R Harvey^2,3, E Moore^2,4, L Salmon^2,5, R Dotson^2,6, I Goodwin^2,7, B Lloyd^2,8, J Topp^2,9, G Young^2,10 M O’Connor^2,11

¹Waikato District Health Board, Hamilton, New Zealand

²Committee for Continuing Professional Development, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³Deakin University, Geelong, Australia

⁴Consultant Psychiatrist, Perth, Australia

⁵Community Representative

⁶The Canberra Hospital, Canberra, Australia

⁷Consultant Psychiatrist, Auckland, New Zealand

⁸Flinders University, Adelaide, Australia

⁹Consultant Psychiatrist, Hobart, Australia

¹⁰Capital and Coast District Health Board, Napier, New Zealand

¹¹The University of Melbourne, Australia

Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) continuing professional development (CPD) program provides a pathway for participants to review and further develop professional practice, maintaining their knowledge, skills and performance and optimizing the provision of adequate and safe medical care. The RANZCP sets the recognized standard for CPD for psychiatrists in Australia and New Zealand, and the program is an essential part of the public assurance of the professionalism of fellows, the quality of the care they provide and the reputation of the College.

Objectives: To present various aspects of CPD, focusing on workplace learning, peer review and changes to the CPD program.

Methods: Presentations are based on data from surveys of membership conducted during 2016–2017, literature reviews and reflection on process change.

Findings: The results of a literature review into how psychiatrists learn in the workplace will be presented. Data from several sources, focusing on peer review groups and the new My CPD online system, will be presented.

Conclusions: CPD is an essential component of psychiatry practice. Key to CPD is a focus on continual quality improvement, and this symposium presents some of the quality improvement work undertaken by the CPD program of the RANZCP.

Presenter 1

How do Psychiatrists Learn in the Workplace? the Role of Continuing Professional Development in Competency Maintenance in the Psychiatrist

W de Beer

Waikato District Health Board, Hamilton, New Zealand

Background: Despite the paucity of scientific and educational literature on how specialists, especially psychiatrists, continue to learn in the workplace, this oral presentation aims to provide best evidence about learning approaches that promote continuing professional development (CPD).

Objectives: To discuss the types of learning that specialists require due to the combinations of factors such as the exponential increase in knowledge and the changes to public perspectives of the expert status of doctors.

Various learning theories including workplace learning will be identified (Billett et al., 2008). The Dreyfus and Dreyfus model of knowledge will be discussed along with other models outlining the theory of expertise status (Dreyfus and Deyfus, 1986). The role of state regulation of specialist competence in New Zealand and Australia through annual recertification and the role of credentialing by the workplace are existing methods of ensuring specialist competence to continue to practice. The session will also briefly focus on the concept of competence-based learning programs and identify how this concept fits within the Royal Australian and New Zealand College of Psychiatrists’ CPD program.

Methods: A literature review (both scientific and grey literature) of workplace learning often extracted from other professions will be presented.

Findings: Limited evidence on how psychiatrists learn in the workplace exists. Everyday work experiences and relationships are a rich area for continuing learning for professionals. Traditional methods for CPD delivery may not be effective in changing practices and hence the promotion of reflective, workplace and peer-related learning activities.

Conclusions: Further research is required to establish how psychiatrists achieve best learning in the workplace and how CPD programs assist this process.

References

Billett S, Harteis C, Eteläpelto C (Eds) (2008) Emerging Perspectives of Workplace Learning. Rotterdam: Sense.

Dreyfus HL, Dreyfus SE 1986 Mind over Machine – The Power of Human Intuition and Expertise in the Era of the Computer. New York: The Free Press.

Presenter 2

Peer Review Groups – 2016 Review

W de Beer^1,2, R Harvey^2,3, E Moore^2,4, L Salmon^2,5, R Dotson^2,6, I Goodwin^2,7, B Lloyd^2,8, J Topp^2,9, G Young^2,10, M O’Connor^2,11

¹Waikato District Health Board, Hamilton, New Zealand

²Committee for Continuing Professional Development, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³Deakin University, Geelong, Australia

⁴Consultant Psychiatrist, Perth, Australia

⁵Committee for Continuing Professional Development, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

⁶The Canberra Hospital, Canberra, Australia

⁷Consultant Psychiatrist, Auckland, New Zealand

⁸Flinders University, Adelaide, Australia

⁹Consultant Psychiatrist, Hobart, Australia

¹⁰Capital and Coast District Health Board, Napier, New Zealand

¹¹The University of Melbourne, Melbourne, Australia

Background: Peer review groups (PRGs) are meetings that have been undertaken by, and with peers within, the Royal Australian and New Zealand College of Psychiatrists since 1996. The aim is improving practice through the presentation of one’s own work to peers with the expectation of open and frank review. It is a requirement that the Royal Australian and New Zealand College of Psychiatrists participants in the continuing professional development (CPD) program undertake at least 10 h of peer review activity each year to achieve Section 2 requirements of the CPD program.

Objectives: To present the PRG review process undertaken in 2016 to obtain data to monitor and report on

Methods: Information on the operation of the PRGs was obtained via an online survey link emailed to PRG coordinators. Of the 904 PRGs operating during 2016, 403 (45%) PRG coordinators accessed and participated in the online survey. The oral presentation provides a summary of the data obtained from the survey.

Findings: This presentation will outline the responses of PRG coordinators to questions about group function, organization and influence on clinical practice outcomes. Meetings during the 2016 year mostly occurred monthly for between 1.5 and 2 h. Clinical management of cases and ethical issues discussions were the major recurring themes addressed by groups. Service provision and individuals’ knowledge and skills are also major recurring themes addressed by the PRGs.

Conclusions: The responses of the coordinators provide a wealth of information on all aspects of group operation and underscore the value of this form of peer review as one that is highly valued by participants and which contributes to improved outcomes in practice and enhanced patient outcomes.

Presenter 3

My CPD – A Review

W de Beer^1,2, R Harvey^2,3, E Moore^2,4, L Salmon², R Dotson^2,5, I Goodwin^2,6, B Lloyd^2,7, J Topp^2,8, G Young^2,9, M O’Connor^2,10

¹Waikato District Health Board, Hamilton, New Zealand

²Committee for Continuing Professional Development, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³Deakin University, Geelong, Australia

⁴Consultant Psychiatrist, Perth, Australia

⁵The Canberra Hospital, Canberra, Australia

⁶Consultant Psychiatrist, Auckland, New Zealand

⁷Flinders University, Adelaide, Australia

⁸Consultant Psychiatrist, Hobart, Australia

⁹Capital and Coast District Health Board, Napier, New Zealand

¹⁰The University of Melbourne, Melbourne, Australia

Background: Changes were implemented in the 2017 continuing professional development (CPD) year, including the introduction of an online portal – My CPD – for the recording of members’ CPD activity. This coincided with the CPD program becoming a mandatory requirement of fellows.

Objectives: A review of the introduction of My CPD was conducted in late 2017, with the aims of

Methods: Two surveys were sent to members in late 2017, one for all members enrolled in the CPD program and one to peer review group (PRG) coordinators.

Findings: This presentation will outline the responses of members and of PRG coordinators to questions around the utility of the My CPD online portal for the maintenance of CPD requirements and will reflect upon the process undertaken to introduce the system and future developments.

Conclusions: My CPD represents a significant change to previously established processes for the recording and maintenance of CPD requirements. This is the first opportunity to review the satisfaction of the users with the system.

Presenter 5

Meeting Section 3 Requirements

W de Beer^1,2, R Harvey^2,3, E Moore^2,4, L Salmon², R Dotson^2,5, I Goodwin^2,6, B Lloyd^2,7, J Topp^2,8, G Young^2,9, M O’Connor^2,10

¹Waikato District Health Board, Hamilton, New Zealand

²Committee for Continuing Professional Development, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³Deakin University, Geelong, Australia

⁴Consultant Psychiatrist, Perth, Australia

⁵The Canberra Hospital, Canberra, Australia

⁶Consultant Psychiatrist, Auckland, New Zealand

⁷Flinders University, Adelaide, Australia

⁸Consultant Psychiatrist, Hobart, Australia

⁹Capital and Coast District Health Board, Napier, New Zealand

¹⁰The University of Melbourne, Melbourne, Australia

Background: In 2017, changes were introduced to the continuing professional development (CPD) program of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). One change was the introduction of mandatory practice development, quality improvement and review activities totalling at least 5 h per annum (Section 3 of the CPD program). This change coincides with the discussion on recertification/revalidation that is occurring in Australia and New Zealand.

Objectives: The presentation aims to

Methods: A review of the CPD activity undertaken in 2017 under this category will be presented. Examples of activities in a range of professional practice settings will be explored.

Findings: The range of activities available will be presented, including

Conclusions: There are a range of activities that can be undertaken to meet Section 3 requirements for the CPD program. No specific activity is mandated, and there is flexibility in how the requirements for this section can be met by psychiatrists in all areas of practice.

Culture Struggle! is Psychiatry Keeping Up with Society?

D Watson^1,2, E Moore³, L Ratnamohan^4,5, T Ahmed^6,7, T Tietze^7,8,9

¹Glenside Health Service, Central Adelaide Local Health Network, Adelaide, Australia

²Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia

³The University of Western Australia, Perth, Australia

⁴Psychiatry Research and Teaching Unit, Liverpool Hospital, Sydney, Australia,

⁵NSW Institute of Psychiatry, Sydney, Australia

⁶Bankstown Hospital, Sydney, New South Wales

⁷UNSW Sydney, New South Wales

⁸St Vincent’s Hospital Sydney, Sydney, Australia

⁹The University of Notre Dame, Sydney, Australia

Background: This symposium is coordinated by the Section of Social and Cultural Psychiatry. It uses clinical examples to observe psychiatry’s response to societal changes and considers these changes against a cultural paradigm. It is intended to be provocative and stimulate debate around how psychiatry must adapt to a changing world.

Objectives: To increase participants’ understanding of the role of culture in presentation, management and healing. Participants may translate this knowledge into more sophisticated formulation and understanding of clinical conditions and treatment plans.

Methods: The symposium starts with a review of paradigms and dialectics in society and culture that inform our clinical practice. Successive papers then consider diagnosis using two examples and the issue of mandated treatment in a society moving to be cigarette free.

Findings: Societal shifts are moving faster than clinical practice. There needs to be a rapid move to catch up with changes from external forces.

Conclusions: It is possible for psychiatric practice to move forward quickly if there is an increased knowledge about societal change.

Presenter 1

The Place of Culture: Paradigms, Margins and Dialectics

L Ratamohan^1,2

¹Psychiatry Research and Teaching Unit, Liverpool Hospital, Sydney, Australia

²NSW Institute of Psychiatry, Sydney, Australia

Background: What do we mean when we talk about ‘culture’ in psychiatry? In this presentation, I consider the place of culture in psychiatric research by tracing a history of paradigm shifts over the past half-century, starting with the so-called ‘old’ cross-cultural psychiatry to the ‘new’ cross-cultural psychiatry (Kleinman, 1977) and yet again to the ‘new-new’ cultural psychiatry (Kirmayer, 2006). Taking child development and Bowlby’s attachment theory as a case in point, I attempt to show how the different conceptualizations of culture advanced by each paradigm produce different notions of normative and at-risk development, health and illness, and race and class. Further, I suggest, by not thinking critically about culture in our everyday practice of psychiatry, we risk reifying a biologized, atomized and racialized understanding of the self, thereby denying ourselves the tools for thinking about subjectivity under post-industrial, neoliberal conditions. I finish by surveying the ‘tools’ the ‘new-new’ cultural psychiatry offers for thinking about the place of culture in psychiatry.

References

Kirmayer (2006)

Kleinman (1977)

Presenter 2

T Ahmed^1,2

¹Bankstown Hospital, Sydney, Australia

²UNSW Sydney, New South Wales

Background: To examine the sociopolitical reasons for the increase in post-traumatic disorder diagnoses and to compare and contrast with increases in Britain, where rates have tripled in the past two decades, with Australia.

Objectives: To assess to what extent the original meaning of trauma, an objectively, unexpected life-threatening event, applies in mainstream clinical practice. Examine differences in how non-psychiatrists may apply the term and its implications.

Methods: The increase in post-traumatic stress disorder (PTSD) diagnosis is consistent with a broader ‘concept creep’, a dilution in the meaning of psychological terms. As the only diagnosis with cause built into the definition, there is an extra significance to the formulation in legal, compensation or political circles.

Findings: The definition of PTSD, beginning in military circles, has filtered down into civilian discourse, but in a diluted form.

Conclusions: The change in definition of PTSD is straining compensation and insurance sectors in a range of arenas but is also affecting our sensitivity to perceiving psychological harm and our relationship to adversity.

Presenter 3

The Breivik Controversy: Politics, Terrorism and Psychiatry

T Tietze^1,2,3

¹UNSW Sydney, Sydney, Australia

²St Vincent’s Hospital Sydney, Sydney, Australia

³University of Notre Dame, Sydney, Australia

Background: On 22 July 2011, the Norwegian-born far-right terrorist Anders Behring Breivik murdered 77 people in Oslo and on the island of Utøya. Despite Breivik having written an explicitly political manifesto and continuing to proclaim the partisan nature of his actions, popular coverage of the case leaned towards depoliticizing the mass killer, usually by locating the killer and his crime within a mental disorder perspective.

Objectives: To examine and analyse the controversy over psychiatric aspects of the Norwegian massacre to consider the implications for the relevance of psychiatry in relation to modern terrorist activity.

Methods: Analysis of media and political responses to the 2011 Norway attacks, focusing on the controversy over the two formal psychiatric assessments of Breivik’s mental state and capacity.

Findings: Mainstream psychiatry is marked by a basic acceptance of methodological individualism and scientific positivism and, therefore, in the case of the Norway massacre, there was a tendency to reduce an overtly political terrorist act to the product of a mentally troubled ‘lone wolf’.

Conclusions: The Breivik controversy illustrates how mainstream psychiatry is currently ill suited to being broadly applied to the spheres of politics and political violence. Rather than jettison psychiatric insights in such cases, the choices facing the profession are either to accept the narrowness of its utility or to work towards a theoretical framework that sees the individual psyche as socially embedded rather than as socially constitutive, and psychiatric science itself as socially constructed and hence inescapably value-laden.

Presenter 4

Should Hospital Smoking Bans Apply To Longer Stay Psychiatry Units?

D Watson^1,2

¹Glenside Health Service, Central Adelaide Local Health Network, Adelaide, Australia

²Discipline of Psychiatry, University of Adelaide, Adelaide, Australia

Background: Social tolerance towards cigarette smoking has shifted radically over recent years. This has occurred with a decline in smoking rates within the general population but ongoing high rates of smoking in those with serious mental illness.

Objectives: To understand societal changes in smoking behaviour. Consider legislative and policy restrictions on places where people can smoke against changes in longer stay psychiatric units.

Methods: Consider issues within the closed long stay ward at Glenside Health Service regarding compliance with the smoking policy of South Australia Health against the actions of other psychiatric inpatient units and correctional service facilities

Findings: There is a problem with compliance despite good evidence supporting the capacity to comply and the general benefits to the target population. The stigmatization of people with serious and enduring mental illness by healthcare staff is likely a factor and requires further research.

Conclusions: Cultural factors impede the ability to comply with societal change. The failure to comply casts psychiatry in a poor light and increases risk involved in care planning.

Best Evidence to Best Practice: Preventing and Managing the Life-Threatening Adverse Effects of Antipsychotic Medication

S Every-Palmer^1,2, R Flanagan³, P Glue⁴, DB Menkes⁵, C Kenedi^6,7

¹Wellington School of Medicine, University of Otago, Wellington, New Zealand

²Central Regional Forensic Service, New Zealand

³King’s College London, London, UK

⁴Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

⁵Waikato School of Medicine, The University of Auckland, Hamilton, New Zealand

⁶Auckland District Health Board, Auckland, New Zealand

⁷Duke University, Durham, USA

Background: Antipsychotics are the most commonly used treatment for psychosis, but come with a significant adverse effect profile affecting multiple organ classes. In the literature, adverse effects are often given second place to the investigation and description of efficacy. However, for many service users, concerns about safety and tolerability exceed considerations of clinical benefit. Psychiatrists, experts in brain and behaviour, may feel less confident managing the effects of medication on different body systems than their effects on mental state.

Objectives: To present the current research on serious adverse effects of antipsychotic medication for a multidisciplinary group of clinical and academic experts. We cover gastrointestinal, cardiac, metabolic and neurological adverse effects and the forensic investigation of antipsychotic-related deaths. We discuss the epidemiology, pathobiology and clinical features for each topic, with particular focus on best-evidence principles of management and prevention in clinical practice.

Methods: A review of the current evidence base on each topic, with reference to each presenter’s own areas of expertise and research insights.

Findings: The adverse effect profile of antipsychotics is significant, and not always well-managed. In line with the conference theme of partnerships in mental health, ways that psychiatrists can work with service users, families and other health professionals to optimize the benefits and reduce the harms of antipsychotic mediation are shared.

Conclusions: Although antipsychotics have potentially life-threatening adverse effects, these can be significantly reduced through collaboration, monitoring and appropriate intervention.

Presenter 1

Preventing And Managing The Life-Threatening Gastrointestinal Effects Of Clozapine

S Every-Palmer^1,2, P Ellis1, R Lentle3, S Inns1

¹Wellington School of Medicine, University of Otago, Wellington, New Zealand

²Central Regional Forensic Service, New Zealand

³School of Health Sciences, Massey University, Auckland, New Zealand

Background: Through anticholinergic and anti-serotonergic mechanisms, antipsychotics, particularly clozapine, may impede gut motility, resulting in a spectrum of presentations, from constipation and delayed gastric emptying at one end, to paralytic ileus, toxic megacolon or bowel perforation at the other.

Objectives: To present a review of current research on antipsychotic-induced gastrointestinal hypomotility or ‘slow gut’ and advice on how to best recognize, prevent and treat this sometimes fatal adverse effect.

Methods: A series of related observational and interventional studies using new technology including translational spatiotemporal mapping, gastrointestinal motility studies using wireless motility capsules and radiopaque markers, and a large Australasian pharmacovigilance study.

Findings: Gastrointestinal hypomotility is very common with clozapine (clozapine-induced gastrointestinal hypomotility, CIGH), but not with other antipsychotics. Radiopaque marker and wireless motility capsule studies show that 50–80% of clozapine-treated patients have significant gastrointestinal hypomotility, with median colonic transit times >4 times normative values. Serious complications, such as bowel obstruction, occur in 0.4% of clozapine users, with a high case fatality rate. We found 160 reports of serious clozapine-induced ‘slow gut’ submitted to Australasian pharmacovigilance agencies with a reported case-fatality rate of 18%. In a pre and post-treatment study using the Porirua protocol, the median colonic transit time improved significantly (p = 0.009) and severe hypomotility reduced from 64% to 21% (p = 0.031). Serious CIGH complications reduced from 8.2 to 1.1 cases per 100 person-years – a highly significant finding.

Conclusions: Although CIGH is a common and potentially serious complication, it can be effectively managed through careful monitoring and the use of prophylactic laxatives.

Presenter 2

The Investigation of Antipsychotic-Related Deaths

R Flanagan

King’s College London, London, UK

Background: After a patient under treatment with an antipsychotic dies, questions that may arise are whether there is any evidence of excessive dosage, which could indicate dose-related toxicity (acute, chronic or acute-on-chronic) or self-poisoning. Even if there is no evidence of excessive dosage, then the possibility of fatal toxicity in normal use may be raised. However, if no drugs are detected, then the question of adequacy of treatment will be raised.

Objective: To outline the problems that may arise when investigating antipsychotic-related deaths and to suggest an appropriate framework for future studies.

Method: Observational study.

Findings: The pharmacology and toxicology, not only of the antipsychotic(s) prescribed but also of other drugs that may have been taken, are important factors in the investigation, which often extends to study of clinical and nursing records, macroscopic post-mortem findings, and post-mortem biochemistry and histology. Common issues are that blood concentrations of centrally acting drugs may change after death (which may not be appreciated by those charged with investigating the death) and that many healthcare professionals, including emergency physicians, intensive care unit specialists and pathologists, have little insight into the complications that surround the use of some of these drugs.

Conclusions: Accurate diagnosis of the cause of antipsychotic-related deaths is important not only for the families of the deceased but also to enable accurate epidemiological data to be gathered with the aim, if possible, of reducing the morbidity and mortality from these drugs.

Presenter 3

Neurological Adverse Effects of Antipsychotics: Focus on NMS and Seizures

P Glue

Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

Background: While neuroleptic malignant syndrome (NMS) is a relatively rare adverse effect of medications acting on the central dopaminergic system, clinicians must remain attuned to its possibility due to its potential severity and lethality. Antipsychotic (AP)-related seizures are more common than NMS and are due to a reduction in seizure threshold. The AP with the greatest risk for seizures is clozapine.

Objectives: To present the current state of research on the neurological adverse events of APs focusing on NMS and seizures; examining epidemiology, pathobiology, clinical features and management.

Methods: A review of the current literature on NMS and AP-related seizures with a focus on prevention and management.

Findings: We will discuss the utility of EEGs and present management guidelines for both conditions. The AP dose appears to be an important predictor of seizures, with greater likelihood occurring at higher dose. Caution should be used when prescribing APs to patients with histories of seizures or other predisposing factors. If it is not possible to substitute APs or dose-reduce an existing AP, an antiepileptic drug such as sodium valproate may be added. For NMS, stopping the AP is of primary importance. Initial treatment is largely supportive and involves rehydration and electrolyte management. Pharmacological interventions will be presented.

Conclusions: NMS and AP-induced seizures are serious adverse effects of this drug class. Recognition, rapid intervention and working in partnership with other specialists are important to reduce morbidity.

Presenter 4

Antipsychotic Drug-Related Metabolic Syndrome

DB Menkes

Waikato School of Medicine, University of Auckland, Hamilton, New Zealand

Background: Metabolic syndrome and related cardiovascular disease is a significant cause of morbidity and mortality among people with severe mental illness. Second-generation antipsychotics are well established as increasing the risk of obesity and other criteria for metabolic syndrome, particularly abnormal glucose and lipid metabolism.

Objectives: To present the current state of research on metabolic adverse events of antipsychotics including epidemiology, pathobiology, clinical features and management. Also, how can psychiatrists best work in partnership with service users and with other specialties, particularly primary care?

Methods: A review of the latest evidence with a particular focus on a New Zealand cross-sectional study of 289 adult patients prescribed antipsychotics for whom metabolic and other clinical factors were quantified. Metabolic syndrome was assessed using standard (National Cholesterol Education Program (NCEP) Adult Treatment Panel–III) criteria.

Findings: We found significantly elevated rates of hypertension, impaired glucose tolerance, abdominal obesity and abnormal lipid profiles in antipsychotic-treated New Zealand adults, with disproportionately high rates of metabolic syndrome in Maori compared to Pakeha (odds ratio: 2.24; 95% confidence interval: 1.38–3.70). Most cases of elevated risk in all domains were found to be untreated, indicating a major unmet need in this population, consistent with other studies.

Conclusions: Antipsychotic drug-related metabolic syndrome (APDAMS) is a significant contributor to premature mortality in various countries. In our New Zealand population sample, we encountered barriers to effective monitoring of risk factors that also impair their effective management. These barriers will need to be addressed if this unmet need and associated mortality are to be effectively managed.

Presenter 5

Cardiac Adverse Effects of Antipsychotics

C Kenedi^1,2

¹Auckland District Health Board, Auckland, New Zealand

²Duke University, Durham, USA

Background: A data mining study of antipsychotics using an international database of adverse reactions found compelling evidence of a causal relationship between clozapine and the cardiac muscle disorders myocarditis and cardiomyopathy in 2001 (Coulter et al., 2001).

Objectives: To present the current state of research on the cardiovascular adverse events of antipsychotics (e.g. sudden cardiac death due to QTc prolongation, myocarditis, cardiomyopathy) including epidemiology, pathobiology and clinical features and to focus on prevention and management.

Methods: A review of the latest evidence with particular reference to our multidisciplinary systematic review of clozapine-induced cardiomyopathy (Alawami et al., 2014) and our review of clozapine-induced myocarditis (Bellissima et al., in-press 2017).

Findings: Key strategies for prevention, identification and management are presented. We discuss the importance of routine reviews of signs and symptoms and the utility of electrocardiograms, biomedical markers such as troponin and C-reactive protein for monitoring myocarditis, and echocardiograms for assessing cardiomyopathy in antipsychotic-treated people. Not all cases of myocarditis in patients taking clozapine are due to the medication and alternative causes (particularly viruses) should be investigated. In general, clozapine-induced myocarditis is not seen after 12 weeks on the medication, and clozapine-induced cardiomyopathy is not seen in the first 12 weeks of administration. There are limited data on the safety of drug re-challenge.

Conclusions: Cardiac adverse effects are uncommon but require close monitoring as they are potentially fatal. Clinicians need to maintain a high level of awareness and include cardiac symptoms in their routine review of patients.

References

Alawami M, Wasywich C, Cicovic A, Kenedi C (2014) A systematic review of clozapine induced cardiomyopathy. International Journal of Cardiology 176(2): 315–320.

Bellissimi et al

Coulter DM, Bate A, Meyboom RH, Lindquist M, Edwards IR (2001) Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study. British Medical Journal 322(7296): 1207–1209.

Every-Palmer S, Nowitz M, Stanley J, Grant E, Mark H, Dunn H, et al. (2016) Clozapine-treated patients have marked gastrointestinal hypomotility, the probable basis of life-threatening gastrointestinal complications: a cross sectional study. EBioMedicine 5: 125–134.

Every-Palmer S, Ellis PM (2017) Clozapine-induced gastrointestinal hypomotility: a 22-year bi-national pharmacovigilance study of serious or fatal ‘slow gut’ reactions, and comparison with international drug safety advice. CNS drugs 2017: 1–11.

Every-Palmer S, Ellis PM, Nowitz M, Stanley J, Grant E, Huthwaite M, et al. (2017) The Porirua Protocol in the treatment of clozapine-Induced gastrointestinal hypomotility and constipation: a pre- and post-treatment study. CNS drugs 31(1): 75–85.

Neuropsychiatry of Younger Onset Dementia: from Neurofilament to Lived Experience

D Velakoulis¹, S Farrand¹, D Griner², A Goh¹, S Sivathamboo³, D Eratne¹, W Kelso¹, S Loi¹, M Walterfang¹, A Evans³, R Marquis Nicholson¹, W Kelso¹, J Bevilacqua¹, P Wibawa¹

¹Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia

²Mental Health Services for Older People, Auckland District Health Board, Auckland, New Zealand

³Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia

Background: The Neuropsychiatry Unit, Royal Melbourne Hospital, has developed a clinical and clinical research program in patients with younger onset dementia (including Alzheimer’s disease, Huntington’s disease, frontotemporal dementia, Niemann Pick Type C). Our clinical program provides diagnostic assessment and continuing care for patients, carers and families. The B_YOND (Biomarkers in Younger Onset Neurodegenerative Disorders) clinical research program is a retrospective and prospective study of patients with younger onset dementia seen in neuropsychiatry since 1995.

Objectives:

Methods: The first four studies report on cerebrospinal fluid, imaging and clinical studies in patients with younger onset dementia. The final study examines pathways to care and models of care for patients with younger onset dementia.

Conclusions: Patients with younger onset dementia have complex diagnostic and management needs. The pathways to care are often delayed and it is important that clinicians are aware of these disorders in younger patients.

Presenter 1

Using Neurofilament Light to Distinguish Patients with Younger Onset Dementia from Patients with Psychiatric Disorders

D Eratne¹, Farrand S¹, S Loi¹, M Walterfang¹, A Evans², D Velakoulis¹

¹Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia

²Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia

Background: The clinical diagnosis of a younger onset neurodegenerative disorder relies on the interpretation of clinical, cognitive, imaging and biochemical markers. Despite extensive investigations, the distinction between a primary psychiatric disorder and a neurodegenerative disorder can be difficult. Cerebrospinal fluid (CSF) studies can be of clinical benefit in excluding neurological disorders and in identifying beta amyloid/tau profiles of Alzheimer’s disease. Neurofilament light (NFL), a marker of neuronal degeneration, is a CSF marker which can potentially help in the distinction.

Objectives: To examine NFL in patients with a primary psychiatric diagnosis (who had been referred with a possible younger onset dementia) and in patients with clinically diagnosed younger onset dementia

Methods: We examined the CSF of 109 patients (primary psychiatric diagnosis (n = 17), neurodegenerative disorder (n = 66) and possible neurodegenerative disorder (n = 26) for NFL levels in the CSF. The patients with a primary psychiatric diagnosis differed in NFL levels from the other two groups. The mean (standard deviation) levels were primary psychiatric disorder, 809 (455); neurodegenerative disorder, 3294 (3059); and possible neurodegenerative disorder, 2019 (2527).

Results: NFL levels were increased across all younger onset dementia groups but were significantly lowered in patients diagnosed with a primary psychiatric disorder.

Conclusions: NFL may be a valuable marker in the distinction between psychiatric disorder and younger onset dementia.

Presenter 2

Differentiating Features of Major Psychiatric Illnesses that Precede Frontotemporal Dementia

S Farrand¹, A Goh¹, S Sivathamboo², D Eratne¹, W Kelso¹, S Loi¹, M Walterfang¹, A Evans², D Velakoulis¹

¹Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia

²Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia

Background: There is considerable heterogeneity of clinical phenotype in younger onset dementia, including initial presentations with major psychiatric illness such as schizophrenia or bipolar disorder. Of the younger onset dementias, frontotemporal dementia (FTD) is the most likely to present with a psychiatric illness.

Objectives: To examine aspects of clinical presentation and investigations that may assist the general psychiatrist in the differentiation of psychiatric illness from FTD, including the overlap with psychiatric illness and symptoms, and the utility of investigations, imaging and cognitive screening.

Methods: Retrospective review of 2794 inpatient discharge summaries from a neuropsychiatry unit was undertaken, covering the period from 1992 to August 2017. Patients with a diagnosis of FTD with a preceding major psychiatric illness were included.

Findings: Thirty-six patients with a major psychiatric illness identified developed FTD. Twenty-four patients had a schizophrenia spectrum disorder and 12 an affective spectrum disorder. Females were more likely to have neurological signs (p = 0.022) and lower scores on attention (p = 0.027), with lower mean scores across all domains on cognitive screening. There was a high rate of completed suicide and unexplained death in the parents and siblings of this cohort.

Conclusions: FTD presenting with a preceding psychotic illness is important but difficult to differentiate in clinical practice. ‘Red flags’ include abnormal neurological examination, particularly in female and younger patients who are not in keeping with medication effects, and late-onset major psychiatric disorders with cognitive impairment. A significant family history of neurological disorder and or suicide or unexplained death may be suggestive of undisclosed or undiagnosed FTD.

Presenter 3

Utility of A Bespoke Multi-Gene Panel in The Diagnosis of Young-Onset Dementia

D Griner¹, R Marquis Nicholson¹, D Velakoulis²

¹Mental Health Services for Older People, Auckland District Health Board, Auckland, New Zealand

²Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia

Background: The genetic diagnosis of inherited dementia is complicated by locus heterogeneity even when suggestive family history is present. Serial sequencing of multiple potentially causative genes is time-consuming and costly, potentially prohibitively so. Recent advances in genetic testing technology allow for multiple genes from multiple patients to be sequenced simultaneously.

Objectives: To discuss the development and implementation of a multi-gene panel, sequencing 54 genes implicated in inherited dementia.

Methods: We present the results of 11 patients with a diagnosis of dementia and a clinical suspicion of a genetic cause who underwent testing with this panel. We discuss the clinical utility of confirming, or partially excluding, a genetic diagnosis in such cases and explore other recent developments in the field.

Findings: Of 11 patients, 2 had known or probable pathogenic mutations identified on testing, in GBA and PSEN1, respectively. For one patient, the GBA mutation finding resulted in a reviewed diagnosis and change of treatment. Two other patients had more ambiguous findings of variants of unknown significance.

Conclusions: Multi-gene next-generation sequencing-based (NGS) panel testing is a useful, comparatively time and cost-effective means of sequencing many known dementia genes simultaneously. Result interpretation requires in-depth understanding of dementia genetics. Additional testing may be necessary for negative or inconclusive results. Current limitations in knowledge can lead to ongoing diagnostic ambiguity in some cases, and the test is not an effective means of absolutely excluding a genetic cause.

Presenter 4

Assessing Younger Onset Neurodegenerative Disorders: What The General Psychiatrist Needs To Know

S Farrand, P Wibawa, S Loi, D Velakoulis

Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia

Background: There is considerable heterogeneity of clinical phenotype in dementia presenting before 65 years, even within the same disorder. This includes initial presentations with major psychiatric illness such as schizophrenia or bipolar disorder. Diagnostic certainty can be difficult to achieve, given the overlap of symptomatology, with psychiatric illness and within different groups of neurodegenerative disorders. Clinical workup for young-onset dementia is complex and typically includes clinical assessment, neuroimaging and neuropsychology.

Objectives: To examine aspects of clinical presentation and investigations that may assist the general psychiatrist, including the overlap with psychiatric illness and symptoms, and the utility of investigations, imaging and cognitive screening.

Methods and results: The Neuropsychiatry Unit Biomarkers in Younger Onset Neurocognitive Disorders cohort will be described, focusing on aspects of clinical presentation and a discussion of patients who had dementia and psychiatric illness.

Conclusions: Assessing young patients for potential neurodegenerative disorder can be diagnostically challenging. Targeted neurological and cognitive examination is critical, and impairments in these areas should be considered a red flag, particularly in late-onset psychiatric disorders, and more-so in females. Automated volumetric software can be helpful for the general psychiatrist when interpreting neuroimaging.

Presenter 5

Young-onset Dementia: Diagnoses and Dilemmas – What it Means for the Person?

W Kelso, J Bevilacqua

Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia

Background: Dementia is the second leading cause of death in Australia. There are approximately 413,106 Australians living with dementia, with 25,938 having young-onset dementia (under 65 years).

Objectives: To outline the development and growth of specialist diagnostic and treatment services for people with young-onset dementia in Victoria, Australia, and the complex challenges working with this population.

Methods: Data collection included demographics, referral base, dementia incidence, prevalence and subtype, models of assessment and treatment and future care needs. The role of the allied health professional in dementia assessment, treatment, education and training was examined.

Findings: A high proportion of individuals with young-onset dementia were initially misdiagnosed with depression, due to a lack of public awareness of dementia occurring in younger people with a delay of approximately 5 years. The most common cause of dementia was Alzheimer’s disease, followed closely by frontotemporal dementia. Education and counselling were vital to assist the family unit in navigating issues including employment, driving, grief and loss, genetics, financial and legal matters, advanced care planning, respite and residential care. Services were pivotal in providing education, training and capacity building to external service providers.

Conclusions: People with young-onset dementia have complex diagnostic and psychosocial needs that require dedicated specialist multidisciplinary services. Further professional and community education is needed to reduce the delay in diagnosis and allow for earlier treatment and engagement of supports, which are currently lacking.

Power, Paranoia and Partnership

H Kim^1,2, S Suetani²

¹Austin Hospital, Melbourne, Australia

²Trainee Representative Committee, The Royal Australia New Zealand College of Psychiatrists, Melbourne, Australia

Background: Power imbalances exist within many relationships. It is usually discussed within the context of the doctor–patient relationship. However, power imbalances also exist in many other relationships, such as the supervisor–registrar and specialist college–trainee relationships. Paranoia is not only a symptom that can be found in mental illnesses but an experience than can be found in the context of power imbalances. The sense of powerlessness in these relationships may lead to the belief that important outcomes in one’s life are controlled by external forces rather than by ones’ own choice and effort. This provides a fertile backdrop for malign intent to be attributed to the powerful and for paranoia to develop, particularly when the person or people feel out of control or negative events occur. An important question to contemplate is whether partnership is possible in relationships characterized by power imbalances and, if so, how this can be achieved.

Objectives: To explore power, partnership and paranoia in psychiatry from different points of view for registrars and fellows.

Methods: A series of individual presentations will be followed by group discussion with the presenting panel.

Conclusions: Consideration of power imbalances is particularly important in psychiatry and can be manifested in many relationships. Trying to work in partnership is particularly important because of this, and this process needs to start by acknowledging the power differentials first and their possible ramifications.

Presenter 1

Power In Psychiatry

T Muller^1,2

¹Waikato District Health Board, Waikato, New Zealand

²Trainee Representative Committee, The Royal Australia New Zealand College of Psychiatrists, Melbourne, Australia

Background: Power is a co-constructed process that has the potential to exert influence in all interpersonal relationships (Nimmon and Stenfors-Hayes, 2016). It is thus relevant in all human interactions in which a psychiatrist engages and observes. Power imbalances are inherent in the psychiatrist–patient dyad, especially due to the potentially depowering effects that mental illness can have on patients. A psychiatrist may exert power through overt legislated means (such as through Mental Health Acts) or more subtly through possessing expert knowledge and skills that patients rely upon to relieve suffering and/or fulfil care needs. The multidisciplinary team may modulate a psychiatrist’s power and is itself subject to power dynamics. Power is also at play in non-clinical settings, such as in relationships between psychiatrists and trainees, psychiatrists and managers, and psychiatrists and society.

Objectives: To explore the ways that power manifests and is influenced within the field of psychiatry.

Methods: To discuss various examples of power in psychiatry, incorporating multiple viewpoints.

Conclusions: Power is relevant to all interactions within psychiatry and imbalances are inherent in the doctor–patient dyad.

Reference

Nimmon L, Stenfors-Hayes T (2016) The ‘Handling’ of power in the physician-patient encounter: perceptions from experienced physicians. BMC Medical Education 16: 114.

Presenter 2

The Power of Vulnerability

H Kim^1,2

¹Austin Hospital, Melbourne, Australia

²Trainee Representative Committee, The Royal Australia New Zealand College of Psychiatrists, Melbourne, Australia

Background: Traditionally, vulnerability has been considered a sign of weakness. In psychiatry, the term ‘vulnerability’ is usually used to refer to the patient’s risk factors for illness. Contrary to this view, this presentation will argue that vulnerability is a source of strength and the key to empathy and partnership. Empathy is the keystone for people to be able to connect and is the basis of the therapeutic relationship between psychiatrists and patients. Empathy is based on people’s ability to access their own humanity to be able to understand what it might be like for another person, and humanity is vulnerable. Another definition of vulnerability is a state in which people choose to be open and have the ‘courage to be imperfect’ (Brown, 2010). Vulnerability may be particularly difficult to tolerate for doctors (including psychiatrists) due to the perception that doctors need to be strong to heal and to contain distress. Perfectionism may be one way of guarding against vulnerability. It may also be a way to try to maintain a sense of control especially in the face of helplessness, not only in our patients but also as we grieve the limitations of our ability to help our fellow human beings. Perfectionism, however, gets in the way of connection and authenticity.

Objectives: To present vulnerability as a source of strength and the key to empathy and partnership.

Conclusions: To form authentic partnerships, psychiatrists need to have the strength to be vulnerable to be able to relate to the full spectrum of human experience and learn from our patients.

Reference

Brown B (2010, June). The power of vulnerability [Video File]. Available from https://www.ted.com/talks/brene_brown_on_vulnerability#t-535125

Presenter 3

Conflict and Advocacy: Perspectives from the Social Sciences

I Lim^1,2,3

¹Fiona Stanley Hospital, Western Australia, Australia

²Trainee Representative Committee, The Royal Australia New Zealand College of Psychiatrists, Melbourne, Australia

³University of Western Australia, Perth, Australia

Background: The mental health advocate is a relatively new official addition to human infrastructure of mental healthcare services. The advocate’s role is to inform the patient about issues relating to their care, uphold the patient’s human rights and represent the patient in settings such as mental health tribunal reviews. In their representative work, the advocate can come into conflict with the psychiatrist, which can provoke difficult feelings in the psychiatrist.

Objectives: To use concepts from the social sciences to analyse the function of the mental health advocate in patient–psychiatrist power relations, focusing on conflict and conciliation.

Methods and findings: This presentation will outline three perspectives on the advocate’s function, which will highlight the complexities of how the advocate’s approach to conflict serves to organize power:

Conclusions: The presence of the mental health advocate affects the use of power in psychiatry. It is unclear whether advocates serve to correct or reinforce patient–psychiatrist power relations, as evidenced by considering various lenses from the social sciences.

Presenter 4

Public Perception, Paranoia and (Mis)Trust of the Profession of Psychiatry

S Brick^1,2

¹Canterbury District Health Board, Christchurch, Canterbury, New Zealand

²Trainee Representative Committee, The Royal Australia New Zealand College of Psychiatrists, Melbourne, Australia

Background: The history of medicine, particularly the specialty of psychiatry, is fraught with periods of lack of oversight and legislation protecting the individual and societal human rights. There are many examples (such as the psychiatrists who practiced during World War II in Nazi Germany) that provide evidence for the public to regard the specialty of psychiatry with some paranoia and mistrust (Schindler et al., 1987). In practicing psychiatry, one must not forget the historical events that have led to the antipsychiatry movement, contributed to the consumer movement and continue to influence the structure of the profession today.

Objectives: To present a historical perspective of events that contribute to the practice of psychiatry today and consider whether a level of paranoia exists within psychiatry (possibly regarding events of the past) and between society and the profession.

Methods: A presentation and discussion around critical periods in history that have contributed to paranoia towards the profession of psychiatry, the evolution of legislation, consumer movement and the antipsychiatry movement.

Conclusions: To practise in a responsible and holistic way, one needs to have knowledge of the recent and historical events that contribute to varying levels of societal paranoia regarding the psychiatric profession.

Reference

Schindler F, Berren MR, Hannah M, Therese B, Allan S, Jose M (1987). How the public perceives psychiatrists, psychologists, non-psychiatric physicians, and the members of clergy. Professional Psychology: Research and Practice 18(4): 371–376.

Māori Healing and Psychiatry – Developing Partnerships to Augment Indigenous Mental Healthcare with Māori Whaiora and their Whānau

W NiaNia¹, A Bush²

¹Tairawhiti District Health Board, Gisborne, New Zealand

²Capital Coast District Health Board, Porirua, New Zealand

Background: Following the Tohunga Suppression Act (1907), Māori healing practices were outlawed in New Zealand until the 1960s. This, alongside other colonization processes, contributed to the marginalization of Māori world views in mental healthcare. While Māori whānau (families) and communities value wairua (spirituality), modern psychiatry usually does not address this area. The development of kaupapa Māori mental health services from the 1990s has led to opportunities for new bicultural partnerships.

Objectives: To describe the partnership between Māori healer Wiremu NiaNia (NiaNia et al., 2017) and psychiatrist Allister Bush over the last decade and to highlight key concepts and practices that support such a partnership.

Methods: This symposium will outline the sociohistorical backdrop to this partnership. Māori concepts of mana, mauri and tapu will be described and their application to Māori mental and spiritual well-being will be illustrated with a detailed account of Wiremu’s Māori healing work with a young person with a significant mental disorder, which Wiremu formulated as a wairua (spiritual) problem. In addition, psychiatric interview practices that help distinguish spiritual experiences from mental health problems will be described.

Conclusions: Close and sincere collaboration between an indigenous healer and a psychiatrist or other health professional can offer Indigenous people with mental health problems healing possibilities that may not be otherwise available to them.

Reference

NiaNia W, Bush A, Epston D (2017) Collaborative and Indigenous Mental Health Therapy – Tātaihono: Stories of Māori Healing and Psychiatry. New York: Routledge.

Benefits, Harms and Ethical Implications of Sponsored Education in Psychiatry

D Menkes¹, Q Grundy², S Every-Palmer³, A Bates⁴, P Parry^5,6, M Battersby⁶, E Monasterio⁷, A Rae⁷, C Farquhar¹, J Jureidini⁸, G Jarvis⁹, H Souter¹⁰, B Arroll¹, P Glue¹¹, G Newton-Howes³

¹The University of Auckland, Auckland, New Zealand

²The University of Sydney, Sydney, Australia

³University of Otago, Wellington, New Zealand

⁴Wellbeing Wellington, Wellington, New Zealand

⁵The University of Queensland, Brisbane, Australia

⁶Flinders University, Adelaide, Australia

⁷Canterbury DHB, Christchurch, New Zealand

⁸The University of Adelaide, Adelaide, Australia

⁹Medicines New Zealand, Wellington, New Zealand

¹⁰Advertising Standards Authority, Wellington, NZ New Zealand

¹¹University of Otago, Dunedin, New Zealand

Background: In many countries, controversy surrounds the issue of medical education sponsored by commercial interests. Starting in 2014, annual Royal Australian and New Zealand College of Psychiatrists (RANZCP) New Zealand national psychiatry conferences have excluded sponsorship and exhibition by the pharmaceutical industry. While this move has been financially successful and generally well received by New Zealand delegates, not all parties agree, and binational RANZCP Congresses continue to depend on such sponsorship.

Objectives: To consider the implications of sponsorship of medical education in general, including pharmaceutical industry sponsorship of the RANZCP Congress.

Methods: A diversity of views is anticipated from contributors on the benefits, harms and ethics of sponsorship of education in mental health. Attempts will be made to ensure that all relevant stakeholders’ views are considered, with ample opportunity provided for questions and points of discussion from the audience.

Findings: Input will be provided by the RANZCP Board, the current Congress convener, clinical and academic RANZCP psychiatrists, Cochrane experts, clinical academics from other disciplines (general practice, women’s health, nursing), service users, advertising and industry representatives. Perspectives to be considered include implications for educational quality and cost, ethics, effects on research output and knowledge generation, impact on delegates (including medical students, trainee psychiatrists, allied health professionals and service users) and public perception and reputation of the discipline.

Conclusions: The presentations and discussion are intended to inform further consideration of this important issue and ultimately support our shared goal of fostering excellence in mental healthcare based on scientific integrity and best evidence.

Can Partnerships in Research Produce more Usable Knowledge and Attract Increased Support?

S Gordon¹, E Lavranos², S Merry³, W Miles^4,5, T Satyanand⁴

¹University of Otago, Dunedin, New Zealand

²Community Collaboration Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³The University of Auckland, Auckland, New Zealand

⁴Health Research Council, Auckland, New Zealand

⁵RANZCP Scientific Committee Chair, Auckland, New Zealand

Background: Projects such as The Healthier Lives National Science Challenge are promoting research collaboration dedicated to achieving healthier lives for all New Zealanders. This project addresses four of New Zealand’s main non-communicable diseases: cancer, cardiovascular disease, diabetes and obesity.

The project contributes to New Zealand’s commitment to achieving the World Health Organization’s goals of reducing the

The Healthier Lives National Science Challenge project plans to contribute to New Zealand’s commitment in partnership with stakeholders and communities by generating world-class research and translating our research findings into innovative health policy, practice and technology, designed for New Zealand’s unique communities.

The symposium will explore what a project in mental health might look like.

Objectives: To explore partnerships between service users, carers and psychiatrists to promote nationally funded research to promote mental well-being, to prevent mental illness and to minimize the impact of mental health conditions.

Methods:

T Satyanand will outline the expectations of a research funder regarding the kinds of collaboration they consider are most likely to produce research findings that will have significant outcome on disease prevention, early detection and treatment and in the longer term disability reduction.

S Gordon will address the particular contributions to mental health research that utilization of researchers with lived experience of mental issues can bring. She will utilize findings from her own research to demonstrate this.

E Lavranos will describe the particular strengths that including in the collaboration researchers who have experience in the carer role for someone with a mental illness can bring. She will call on her research and lived experience to bring these roles to the audiences’ awareness.

S Merry will describe her own research collaboration that demonstrates not only what a psychiatrist can contribute but will also show how an effective collaboration can produce impactful results. She will introduce some of those who were involved with her.

Is Private Practice In New Zealand A Feasible Work Option?

M Atchison¹, G Galambos¹, S Romans²

¹Section of Private Practice Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Private Practitioner, New Zealand

Background: Approximately half of all psychiatrists in Australia work in private practice, supported by the Australian government’s Medicare scheme. Private practice is a rare beast in New Zealand, with no government subsidy. This symposium looks at the practicalities of working in private practice in New Zealand.

Objectives: To give information to psychiatrists considering working in private practice in New Zealand.

Methods: The symposium will include presentations from private practitioners in Australia and compare and contrast how private practice could work in New Zealand. A private practitioner from New Zealand will discuss her experiences.

Barriers to, and support for, working in private practice in New Zealand will be discussed.

Seeing Through the Haze: Perspectives on Liberalization of Cannabis

N Linzteris¹, R Bell²

¹The University of Sydney, Sydney, Australia

²New Zealand Drug Foundation, New Zealand

Background: Moves to liberalize regulation of cannabis is occurring across Australia and New Zealand. In Australia, the federal parliament has passed amendments to the Narcotics Drugs Act 1967 providing a licensing scheme for cultivation of cannabis for medical or scientific purposes. The newly elected government of New Zealand has as an agreement of coalition which promised a national referendum on the recreational use of cannabis and indicates a more liberal approach to the use of medicinal cannabis. These changes should be seen in the context of international moves to liberalize laws regulating cannabis in the United States, Canada and elsewhere.

Psychiatry has an ambivalent relationship with cannabis. Early cannabis use may have a causative role in the development of schizophrenia, and the impact in the context of existing mental illness is established. However, there is research into the role of cannabinoids as medical treatments including within mental health. In addition, regulation may allow for cannabis use to be addressed as a health issue rather than a crime, providing potential public health interventions to contain the harms associated with recreational use.

Objectives: To provide a range of views on the potential impacts of liberalization of cannabis use, both medicinal and recreational. Regulation of cannabis impacts the community in different ways. The symposium provides a timely opportunity for psychiatry to lead the discussion on regulation of cannabis and influence both public and the Royal Australian and New Zealand College of Psychiatry (RANZCP) policy.

Methods: The symposium will provide a range of perspectives from across the community including those of a clinician and researcher into medicinal cannabis, Executive Director of The New Zealand Drug foundation, consumer of medicinal cannabis and an additional psychiatrist. The symposium will demonstrate contrasting approaches to the use of cannabis including those implementing evidence-based approaches at a regulatory, clinical and scientific level to those of the informed consumer and politician straddling the divide.

Conclusions: The symposium aims to be both entertaining as well as provide a timely opportunity for psychiatry to lead the discussion on regulation of cannabis and influence both public and RANZCP policy.

Women in Leadership: A Presidential Symposium

K Jenkins

The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: In recent years, psychiatry has seen an increase in the number of women becoming psychiatrists. In Australia and New Zealand, this is likely to continue with more women than men entering the psychiatry training program. However, women continue to be under-represented in senior leadership positions.

Methods: This special presidential symposium, hosted by Dr Kym Jenkins, President, Royal Australian and New Zealand College of Psychiatrists, will consist of a panel of female psychiatrists and doctors who hold positions of leadership in prominent organizations, colleges and across academia and clinical settings.

Objectives: To describe some experiences of leadership and to provide career advice for taking up leadership opportunities, particularly in medicine and psychiatry. The panel will discuss how to overcome the unique challenges often in place for women to achieve success and preserve a passion for one’s career.

Building Partnerships in Academic Psychiatry: A Guide for New Investigators and The Scholarly Project

S Clark^1,2, S Kisely^1,3,4, S Parker^1,3,4,5, A Harris^1,6, S Suetani^3,4,5, D Siskind^1,2,3,4

¹Committee for Research, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²The University of Adelaide, Adelaide, Australia

³Metro South Addiction and Mental Health Service, Brisbane, Australia

⁴The University of Queensland, Brisbane, Australia

⁵Queensland Centre for Mental Health Research, Wacol, Australia

⁶The University of Sydney, Sydney, Australia

Background: Evidence-based mental health is the paradigm for the modern professional practice of psychiatry. With this, there is an increasing role for the academic psychiatrist in psychiatry. The skills required to undertake research can be acquired at any stage in a career, from trainee to senior fellow.

Objectives: This symposium is targeted at both registrars and fellows who have an interest in better integration and partnership of research with their clinical practice. The symposium will provide practical information about how to conduct research, including addressing the following questions of how to

Methods: A series of individual presentations will be followed by group discussion with the presenting panel. Each presentation will include three questions at the end for assessment.

Findings: Extensive information and experience will be presented to new investigators in designing, implementing and following a research project through to completion.

Conclusions: Research can be a highly rewarding activity; the provision of information can assist in the process of integrating research into clinical practice.

Presenter 1

Writing a Successful RANZCP Grant

S Clark^1,2

¹Committee for Research, The Royal Australian College of Psychiatrists, Melbourne, Australia

²The University of Adelaide, Adelaide, Australia

Background: The Royal Australian College of Psychiatrists (RANZCP) offers a range of grants on a yearly basis to encourage trainees and fellows who are new to research and require a small amount of funding to conduct a small-scale study. Applicants are required to submit a short, structured proposal considering project context, research plan, synopsis, aims and hypotheses, background and literature review, methodology, data analysis, ethical considerations and budget. Applications are assessed on scientific quality and feasibility, significance of the expected outcomes or innovation of the concept, role of applicant, applicant quality and experience, and research environment. While the overall quality of applications has improved, there is still high variability in submissions.

Objectives: To outline the process of selecting and writing a successful RANZCP research grant.

Methods: This paper will outline available RANZCP research grants and associated application criteria and then step through a standard application, contrasting common errors and desirable characteristics using hypothetical examples.

Findings: Successful grants describe a well-designed and novel study with a realistic small budget and achievable outcomes given the skills of the applicant and strengths of the supporting department. The applicant must play a significant role in the project.

Conclusions: RANZCP grants offer a great opportunity for trainees and early career fellows to explore research interests. Applicants need to follow application guidelines and demonstrate basic skills in grant and budget writing to be successful.

Presenter 2

The Use of Administrative Data in Research: Examples from Australia And New Zealand

S Kisely^1,2,3

¹Committee for Research, The Royal Australian College of Psychiatrists, Melbourne, Australia

²Metro South Addiction and Mental Health Service, Brisbane, Australia

³The University of Queensland, Brisbane, Australia

Background: The Australian Government has provided $20 million to establish the Population Health Research Network (PHRN), with representation from all states and territories to facilitate population health research through data linkage. The Integrated Data Infrastructure (IDI) is the New Zealand equivalent but is more comprehensive with de-identified microdata from a range of government agencies, Stats NZ and non-government organizations. More limited information may also be available through individual health services or boards.

Objectives: To review the potential for using administrative databases in research. Researchers can define cohorts for study within the administrative data or link them to their own data. Robust protocols preserve confidentiality so that researchers only receive anonymized data.

Methods: Individual presentation and facilitated group discussion including the steps involved in gaining the appropriate approvals for access.

Findings: Available data include hospital morbidity, mental health data and mortality. In New Zealand, this is supplemented by criminal justice, education, social services, migration and tax data.

Conclusions: Administrative data provide researchers with accessible, cost-effective information without the intrusion and cost of additional data collection. These techniques are especially useful in studying regional, rural and remote populations where access may be difficult.

Presenter 3

Making Supervision Work: Practical Recommendations for Supervisees

S Parker^1,2,3, S Suetani^1,2,3, B Motamarri¹, D Siskind^1,2,3

¹Metro South Addiction and Mental Health Service, Brisbane, Australia

²School of Medicine, University of Queensland, Brisbane, Australia

³Committee for Research, The Royal Australian College of Psychiatrists, Melbourne, Australia

Background: Supervision is a critical component underlying the pedagogy of the Competency-based Fellowship Program (CBFP) of the Royal Australian and New Zealand College of Psychiatrists. However, there is limited literature to guide supervisors and supervisees as to how to best manage the process of supervision.

Objectives: To review the literature relating to supervision under the CBFP and make several practical recommendations about how a supervisee can actively work to get value from supervision. Guidance as to how a supervisee can best work to maintain the supervisory relationship when the process breaks down is also provided.

Methods: Narrative review of the literature and opinion derived from the perspectives of multiple stakeholders (trainee, junior consultant, scholarly project supervisor and senior administrator).

Findings: Supervisees may benefit in taking an active role in seeking feedback, finding value in criticism and building autonomy. It is also important for them to consider what value a supervisor can offer and maintain realistic expectations.

Conclusions: Trainees can benefit from taking an active role in planning and managing their supervision to maximize their learning.

Presenter 4

Does that Treatment Really Work? Sticking your Toe into The Pool of Clinical Trial Research

A Harris^1,2

¹Westmead Institute for Medical Research, Westmead, Australia

²Discipline of Psychiatry, Westmead Clinical School, The University of Sydney, Sydney, Australia

Background: As psychiatrists we are reliant on good quality evidence to tell us what treatment works best. However, the process of obtaining that evidence is complex and much effort is spent doing research of relatively little use while many important questions remain unanswered. Good quality evidence requires good quality research design.

Objectives: To review important steps in developing a good clinical trial.

Methods: Presentation of basic guidelines informing trial design, ethics and governance. Discussion of common pitfalls in the process of clinical trial design and possible resources available to clinicians wanting to develop an idea.

Findings: Good clinical design improves the chance of obtaining good quality evidence about treatment effectiveness.

Conclusions: Understanding the context of research and the resources available to clinicians wanting to embark upon a clinical trial helps in designing the best possible trial. Protocol development and adequate resourcing maximize the likelihood that the effort involved in running the trial will result in a useful outcome.

Presenter 5

Making Most Out of Research as a Registrar

S Suetani^1,2,3

¹Metro South Addiction and Mental Health Service, Brisbane, Australia

²School of Medicine, The University of Queensland, Brisbane, Australia

³Committee for Research, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: The competency-based Fellowship Program (CBFP) of the Royal Australian and New Zealand College of Psychiatrists includes a scholarly project as a mandatory training requirement. However, this training requirement often needs to be met in the context of having little time or money as a registrar.

Objectives: To share ideas and experiences that may be useful in guiding registrars through the research requirement of training and beyond.

Methods: In this presentation, different and creative ways in which ‘research’ can be incorporated into psychiatry training are explored. This is done through both personal and shared experiences with registrar and junior consultant colleagues.

Findings: There are many ways in which clinical curiosity can be transformed into research output.

Conclusions: Research within training can be very useful in terms of both training progression and professional development.

Presenter 6

Tips for Consultants when Supervising Research Projects with Registrars and Medical Students

D Siskind^1,2,3, S Kisely^1,2,3, S Parker^1,2,3, S Suetani^1,2

¹Metro South Addiction and Mental Health Service, Brisbane, Australia

²School of Medicine, The University of Queensland, Brisbane, Australia

³Committee for Research, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: The advent of the scholarly project provides an opportunity to collaborate with registrars to build research capacity. Trainees in the 2012 program are required to complete a scholarly project to meet training requirements. As such, clinical academics can partner with registrars to design and provide supervision for discrete and achievable research projects. Medical students are increasingly realizing the training advantages associated with being involved with research while in medical school and are enthusiastic about volunteering for research experiences.

Objectives: To outline the mutual advantages of research partnerships between clinical academics, trainees and medical students.

Methods: We will outline partnership projects between clinical academics, trainees and medical students and describe how to build a suitable discrete and achievable project. We will also describe the mutual obligations of supervision.

Findings: In the past 2 years at the Metro South Addiction and Mental Health Service in Brisbane, we have supervised six medical students and seven trainees to project completion and in 2018 have 16 registrars and eight medical students working on active projects. These projects include systematic reviews, meta-analyses, clinical trial protocols, retrospective de-identified administrative data set analysis and clinical chart reviews.

Conclusions: Supervising trainees and medical students can be a mutually beneficial undertaking within the public sector.

Partnering with Mental Health Carers: Changing Practice and Improving Outcomes

S Lawn¹, S Pollock², J McMahon³, Ramsay Health Care Representative⁴, Jenny Branton⁵

¹Flinders University, Adelaide, Australia

²Mind Australia, Melbourne, Australia

³Private Mental Health Consumer and Carer Network, Australia

⁴Ramsey Health Care South Australia, Australia

⁵Mental Health Carers Australia, Melbourne, Australia

Background: This symposium will provide an overview of A Practical Guide for Working with Carers of People with a Mental Illness and demonstrate resources aimed at supporting guide implementation in clinical settings.

Objectives: The guide recognizes carers are a crucial component of any partnership approach to service delivery. It and the supporting implementation resources have been developed to assist psychiatrists, other clinicians and service providers working in mental health service settings to work more effectively with carers, thus enhancing outcomes for consumers.

Methods: Since the publication of the guide in 2016, projects have developed practical resources to support guide implementation. These include an online clearing house of resources for family/carer engagement; online professional development modules; a real-time self-assessment app and a series of demonstration projects, trialling the use of the guide in different mental health service settings. These resources will be of significant assistance to psychiatrists in public and private settings and as clinical leads in mental health.

Findings: This symposium will provide

Conclusions: The guide provides a framework for partnership working that enables services to meet their compliance obligations under national quality standards and enables psychiatrists and clinicians to establish effective working relationships with families and carers as partners in care.

Presenter 1

The Evidence Base For Partnering With Families And Carers

S Lawn

Flinders University, Adelaide, Australia

Background: International research has established that most people with mental illness experience better health outcomes when they are supported by family and/or informal carers.

Objectives: The first phase of development for A Practical Guide for Working with Carers of People with a Mental Illness set out to establish the evidence base for partnership working between psychiatrists and clinicians and mental health carers, drawing on empirical research and lived experience.

Methods: A literature review and consultations with families and carers provided this evidence base. It also examined the application of the approach taken in the UK ‘Triangle of Care’ model to the Australian context.

Findings: Historically, the training of mental health professionals has focused on an individual treatment model. The evidence review and consultation process found that a partnership way of working supported better outcomes for consumers. However, staff training in partnership approaches to service delivery is severely limited. Concerns regarding issues such as confidentiality are flagged as a barrier to using a partnership approach.

Conclusions: It is possible to develop effective ways for psychiatrists and clinicians to work in partnership with mental health carers, to the benefit of all concerned, at the same time as remaining within the professional and ethical boundaries that prescribe practice. The lived experiences of mental health carers provide a unique and important knowledge base for improved practice in psychiatry and across mental health services generally.

Presenter 3

Partnering with Mental Health Carers: Changing Workplace Practice

S Pollock

Mind Australia, Melbourne, Australia

Background: National, state and territory legislation, standards and policy clearly articulate the obligation of mental health service providers to respect, engage and partner with carers. Yet the experience of families and carers of people with mental illness is that the policy does not generally translate into practice. This presents both a challenge to and an opportunity for services.

Objectives: A Practical Guide for Working with Carers of People with a Mental Illness is a hands-on, standards-based tool designed to help mental health services engage more effectively with family and carers, comply with legislative and accreditation obligations and improve recovery for consumers and carers.

Methods: The guide was developed following an extensive literature review and consultations with system stakeholders including a representative from the Royal Australian and New Zealand College of Psychiatrists, families, carers and consumers.

Findings: The guide is based on six partnership standards that can be applied across all settings and incorporate age-related, cultural and other needs. Each partnership standard is accompanied by an easy-to-use self-assessment tool, and practical examples and suggestions about how to implement each one.

Conclusions: By implementing the guide, mental health services are better able to meet their obligations under various national standards governing service provision, offering an enhanced experience of service for carers, consumers and clinicians and improved outcomes for consumers through shared approaches to treatment, care and support.

We are developing a national implementation plan, working in collaboration with key stakeholders in the mental health system and with consumers and carers throughout our networks.

Presenter 3

Using Self-Assessment to Change Individual Practice

Representative

Ramsey Health Care South Australia, Australia

Objectives: Working in partnership with the Private Mental Health Consumers and Carers Network (PMHCCN), Ramsay Health is implementing A Practical Guide for Working with Carers of People with a Mental Illness in all of its mental health services as a means of enhancing carers’ experiences of service and improving outcomes for consumers. The guide is as applicable to private office-based practice as it is to public mental health service settings.

Methods: PMHCCN have developed a self-assessment smart phone app that psychiatrists and clinicians can use to rate their own practice against the six partnership standards in the guide. This gives individual clinicians a real-time picture of their effectiveness as partners with carers of the consumers they are treating and supporting. Baseline measurement of carer experience of service, self-assessment, online training and re-measurement of carer experience will provide an evidence base that will help us understand the efficacy of the guide in combination with the self-assessment and online training as a means of changing individual practice.

Findings: The demonstration project will be completed in the first quarter of 2018. The presentation will focus on the outcomes from the project. It will pay particular attention to issues and challenges that psychiatrists and clinicians faced in orienting their practice towards partnership working, and strategies that Ramsay Health put in place to deal with these.

Conclusions: We anticipate that working within the framework provided by the guide, with different kinds of measurement and assessment and supported through online training, that psychiatrists and clinicians will be able to take steps towards partnership working.

Presenter 4

Carers and Consumers as Educators

J McMahon

Private Mental Health Consumers and Carers Network, Australia

Background: The concept of carers and consumers as educators has a long way to go towards integration into formal education curricula of mental health clinicians in a meaningful way. Carers and consumers are in the unique position of being able to provide valuable information, experiences, views and recommendations into training and education for mental health service providers.

Objectives: The Consumers and Carers as Educators project aimed to provide practical guidance on how to involve consumers and carers in meaningful ways into patient-centred care models, as well as providing key information around the areas of collaboration, communication and cooperation between multiple health providers that a consumer can have concurrently. It was critical to include the voices of consumers, carers and health professionals in this project to support best practice approaches.

Methods: The Private Mental Health Consumers and Carers Network developed a series of online modules that explore consumer and carer involvement, continuity of care, communication, cooperation (roles and responsibilities) and collaboration.

Findings: The modules include videos with consumers, carers, a general practitioner and a psychiatrist, case studies, reflective questions exploring the lived experiences of consumers and carers and suggestions for practice provided by health professionals.

Conclusions: Support for the project from the Royal Australian and New Zealand College of Psychiatrists (including approved continuing professional development (CPD) points) is strong and demonstrates the value of this self-paced approach to improving clinical practice by partnership working between psychiatrists, clinicians, consumers and carers.

Presenter 5

Demonstrating Effectiveness, Planning and Implementing Together

J Branton

Mental Health Carers Australia, Melbourne, Australia

Background: Mental Health Carers Australia is the only national peak body representing mental health carers. As part of our advocacy agenda, we are taking a systematic approach to implementing A Practical Guide for Working with Carers of People with a Mental Illness across Australia.

Objectives: Our planned approach to guide implementation aims to understand the challenges to guide implementation in different parts of the mental health service delivery system and to work with stakeholders to develop strategies and resources to overcome barriers.

Methods: Four funded demonstration projects in different mental health settings (including clinical, non-government organizations and youth) have trialled and evaluated different approaches to implementation. We have combined these with a national implementation process, partly a stakeholder engagement exercise and partly a planning process. These will enable us to develop an evidence-based, practical and realistic framework for national implementation.

Findings: The demonstration projects have identified particular challenges in implementation at leadership, service provision and individual clinician levels. They have also generated a range of resources that can be used in other settings. We will outline some of the challenges and strategies for moving forward and the outcomes from the national implementation planning process.

Conclusions: We believe that a coordinated, national approach to implementation, shared by key system stakeholders, including the Royal Australian and New Zealand College of Psychiatrists, will facilitate use of the guide across Australia, gradually changing practice and enhancing partnership working between psychiatrists, clinicians and carers. Alignment with the implementation of the Carer Experience Survey in public mental health services in some jurisdictions will help evidence the guide’s impact in changing practice.

Dementia in AOTEAROA: Multicultural Views on the Lived Experience of Dementia in New Zealand

S Cullum¹, M Dudley¹, G Cheung¹, F Fa’alau¹, R Krishnamurthi², S Kautoke³, M Boyd¹, C Perkins⁴, D Wilson², O Menzies⁵, H Elder⁶, D Addis¹, N Kerse¹

¹The University of Auckland, Auckland, New Zealand

²Auckland University of Technology, Auckland, New Zealand

³Counties Manukau District Health Board, Auckland, New Zealand

⁴NZ Dementia Cooperative, Auckland, New Zealand

⁵Auckland District Health Board, Auckland, New Zealand

⁶Te Whare Wānanga Ō Awanuiārangi, Whakatane, New Zealand

Background: Very little is known about the lived experience of dementia in the major New Zealand ethnic groups. Culturally appropriate and responsive services for dementia prevention, diagnosis and management for the New Zealand population can only be developed if the true extent of dementia is fully described both overall and in major ethnic groups.

Objectives: To understand the lived experience of dementia in the major communities living in New Zealand.

Methods: We used qualitative research methods including focus groups and individual interviews with people with dementia, their care partners and healthcare professionals from four different communities (Māori, Pacific, Chinese and Indian) to identify common and ethnic-specific themes that describe their lived experience of dementia.

Findings: The background and general methods of the research will be presented in the first session. The findings from each community will be described in the next four presentations and the final presentation will consist of a panel of the speakers who will further discuss the common and ethnic-specific themes, taking questions from the audience.

Conclusions: Our aim is to share experiences and reduce stigma for people and their families living with dementia from all major New Zealand ethnic groups. We will do this by raising public awareness and encouraging the exchange of ideas about this common disease. We will use our findings to inform the development of a national prevalence study of dementia and culturally appropriate services in New Zealand.

Presenter 1

Living with Dementia in AOTEAROA: Background and Methods

S Cullum¹, M Dudley¹, G Cheung¹, F Fa’alau¹, R Krishnamurthi², S Kautoke³, M Boyd¹, C Perkins⁴, D Wilson², O Menzies⁵, H Elder⁶, D Addis¹, N Kerse¹

¹The University of Auckland, Auckland, New Zealand

²Auckland University of Technology, Auckland, New Zealand

³Counties Manukau District Health Board, Auckland, New Zealand

⁴NZ Dementia Cooperative, Auckland, New Zealand

⁵Auckland District Health Board, Auckland, New Zealand

⁶Te Whare Wānanga Ō Awanuiārangi, Whakatane, New Zealand

Background: There are reported to be more than 60,000 people living with dementia in New Zealand (at a cost of NZ$1700 million), and this number is projected to triple by 2050. These figures are extrapolated from other countries’ statistics as there has never been a New Zealand dementia prevalence study. Local memory clinic data from South Auckland suggest that dementia is more common among Māori and Pacific peoples and that dementia is highly stigmatized in Asian communities. We need to explore the lived experiences of dementia in more detail to understand the needs of each population and develop culturally appropriate services.

Objectives: To describe the background and methods for our research exploring the experience of living with dementia within different communities in New Zealand.

Methods: We held community events to discuss the issues of dementia and dementia research in specific communities. We also worked in partnership with different community organizations to identify potential participants for our research. We interviewed individuals and held focus groups in the following languages: English, Te Reo Māori, Samoan, Tongan, Cantonese, Mandarin and Hindi. The recorded data were analysed using a grounded theory approach to identify themes that describe the lived experience of dementia in different communities. Where possible, data were analysed by bilingual researchers to avoid material being distorted by translation into English.

Findings: The logistics and challenges of conducting multicultural research in several different languages will be discussed.

Conclusions: The lived experience of dementia within different New Zealand communities will be presented in the following sessions.

Presenter 2

The Lived Experience of Dementia in Māori Communities

M Dudley¹, D Wilson², O Menzies³, H Elder⁴

¹The University of Auckland, Auckland, New Zealand

²Auckland University of Technology, Auckland, New Zealand

³Auckland District Health Board, Auckland, New Zealand

⁴Te Whare Wānanga Ō Awanuiārangi, Whakatane, New Zealand

Background: The number of Māori, the Indigenous people of New Zealand, living beyond 65 years of age has nearly doubled in the last decade. In accordance with this increased life expectancy, the prevalence of dementia is also predicted to increase. However, the literature regarding Māori and dementia is almost non-existent.

Objectives: To explore the experience and understanding of dementia from a Māori world view.

Methods: A qualitative interview approach within a Kaupapa Māori framework was used. Eight whānau interviews were conducted in the Waikato region and 13 semi-structured focus groups with Māori elders at 7 different locations were conducted throughout New Zealand. The design included representation of all major tribal groups. The data were analysed using rangahau kaupapa Māori methods and a grounded theory approach of comparative analysis whereby we compare transcripts for similarities and differences.

Findings: The initial findings have identified seven major themes that describe the experience and understanding of dementia for Māori. Some universal aspects of dementia were identified, although there were points of difference that are particular to Māori, such as cultural expectations of whānau caregiving, the importance of wairua, the role of bilingualism on cognition, the need for culturally competent clinicians, education and advocacy and a tolerance by Māori towards unwellness.

Conclusions: Māori understandings and experiences of dementia are both culturally unique yet similar to western constructs of this condition. The findings of this research will assist in improving existing approaches to the assessment and management of dementia for Māori.

Presenter 3

The Lived Experience of Dementia in New Zealand Pacific Communities

F Fa’alau¹, S Kautoke², M Havea², D Addis¹, N Kerse¹, S Cullum¹

¹The University of Auckland, Auckland, New Zealand

²Counties Manukau District Health Board, Auckland, New Zealand

Background: Pacific peoples make up 7% of the New Zealand population. Those that immigrated to New Zealand between the 1960s and 1980s are now elderly and at risk of developing dementia. There is very little research evidence about dementia in New Zealand Pacific communities, but local memory service data suggest that Pacific people are presenting with dementia at a younger age and with more severe cognitive symptoms.

Objectives: To explore and describe the lived experience of dementia in Samoan and Tongan communities in South Auckland.

Methods: Collaborating with a local non-government organization to identify Pacific families who were willing to discuss their experiences, we conducted talanoa sessions with 10 people with mild dementia, 10 care partners of people with mild dementia and 10 caregivers of people with more severe dementia. Talanoa sessions were conducted in English, Samoan or Tongan depending on the participants’ preferences. Appropriate cross-cultural research methodologies, frameworks and models for investigation developed by Tongan and Samoan scholars were used to translate and analyse data for this study. Recurring themes and concepts were identified for further analysis and discussion with bilingual researchers and members of the advisory group.

Findings: A sociocultural understanding of Pacific concepts and themes provides knowledge of how these groups conceptualize and cope with dementia.

Conclusions: Samoan and Tongan understandings and experiences of dementia are both culturally and socially unique. The knowledge of Samoan and Tongan families will assist in improving education, services and management of dementia for Pacific peoples in New Zealand.

Presenter 4

The Lived Experience of Dementia in New Zealand Indian Communities

R Krishnamurthi¹, S Cullum², M Havea², N Kerse²

¹Auckland University of Technology, Auckland, New Zealand

²The University of Auckland, Auckland, New Zealand

Background: The impact of dementia, awareness and knowledge of dementia signs and symptoms, prevention as well as barriers or facilitators of access to services is unknown in the New Zealand Indian community.

Objectives: To conduct in-depth individual interviews and focus groups with older members of the Indian community to explore their lived experience of dementia.

Methods: Semi-structured individual interviews and 2–3 focus groups will be conducted in Hindi and English. Data will be transcribed and analysed thematically using a grounded theory approach.

Findings: We will present the main themes from the semi-structured interviews: How is the diagnosis of dementia perceived by the Indian community? What are the cultural issues that arise? How is dementia recognized by older Indians and their families? What are the barriers and facilitators of accessing dementia clinical and support services? How can the Indian community access cultural and language-specific information on dementia?

Conclusions: The findings will be used to develop culturally appropriate dementia prevention and awareness strategies, and clinical and support services for the New Zealand Indian community.

Presenter 5

Engaging Asians in Dementia Care and Research: The Clinicians’ Perspectives

G Cheung¹, M Boyd¹, C Perkins², S Cullum¹

¹The University of Auckland, Auckland, New Zealand

²NZ Dementia Cooperative, Auckland, New Zealand

Background: Asian people comprise the third largest ethnic group (11.1%) in New Zealand. Dementia is often difficult to diagnose in people whose first language is not English.

Objectives: To explore the views of healthcare professionals (HCPs) who have experience and/or an interest in working with Asian people on dementia care and research.

Methods: The first stage involved four focus groups of a convenience sample of HCPs. Each focus group had six to eight participants discussing three broad questions: ‘What dementia research is important to New Zealand Asian people?’ ‘Where do Asian communities get their information about dementia?’ and ‘Which is the best avenue to engage the Asian community?’ The focus groups were videotaped. Four researchers independently searched for themes in the data and agreed on the final themes following an iterative process. The second stage involved a focus group of 11 Asian HCPs with the aim of clarifying and refining the main themes.

Findings: A total of 30 HCPs (female 63.3%; Chinese 63.3%, European 20.0%, Korean 10.0%, Indian 6.7%) participated in four focus groups in the first stage. Their professional backgrounds included nursing (23.3%), social work (20.0%), medical (10.0%) and occupational therapy (10.0%). Three main themes emerged: the lack of availability of culturally appropriate clinical pathways and support services; education for healthcare professionals, older Asians and their families; culturally specific communication and dissemination of education.

Conclusions: Engaging Asians in dementia care and research requires a whole-systems inter-generational approach starting from the community and the provision of culturally appropriate services.

Presenter 6

Panel Discussion and Future Directions for Research

N Kerse¹ (Chair), S Cullum¹, M Dudley¹, G Cheung¹, F Fa’alau¹, R Krishnamurthi², S Kautoke³, D Wilson²

¹The University of Auckland, Auckland, New Zealand

²Auckland University of Technology, Auckland, New Zealand

³Counties Manukau District Health Board, South Auckland, New Zealand

Background: Very little research has been conducted regarding the epidemiology or experience of people and families living with dementia in New Zealand.

Objectives: To present the findings of our qualitative research exploring the perspectives of people with dementia, their care partners and healthcare professionals regarding the lived experience of dementia in four major New Zealand communities (Māori, Pacific, Chinese and Indian).

Methods: This final 15-min session will consist of a panel of the presenters who will discuss the common and ethnic-specific themes arising from our research. The panel will be chaired by Professor Ngaire Kerse, who will also take questions from the audience.

Mental Health Integration Partnerships With Primary Care: Four Snapshots From Metro Auckland

D Codyre¹, O Campbell², M Fisher³, C Bensemann³

¹East Tamaki Healthcare/Nirvana Health Group, Auckland, New Zealand

²Auckland District Health Board, Auckland, New Zealand

³Counties Manukau Health, Auckland, New Zealand

Background: In response to recognition of the prevalence and disability associated with the common mental health and addiction conditions, and the lack of historic support for primary care to effectively recognize and address these conditions, health policy in New Zealand, as in most Western countries, has over the past decade called for improved collaboration and integration of mental healthcare with primary care.

Objectives: To present an overview of four different integration initiatives which have evolved in Metro Auckland, three specialist mental health services and one primary care.

Methods: Each presentation will provide an overview of the approach taken to integrating services, the focus for the initiative and the data gathered. The initiatives will be then compared and contrasted.

Findings: Data presented will show that these initiatives have increased access to effective mental healthcare and improved outcomes for patients.

Conclusions: Despite their different approaches to planning and implementation, each of these initiatives has demonstrated collaboration and partnership in action, has upskilled the primary care workforce and has increased access to specialist care and improved patient outcomes.

Presenter 1

Integrating Holistic Mental Health And Self Management Support Into Primary Care

D Codyre

East Tamaki Healthcare/Nirvana Health Group, Auckland, New Zealand

Abstract: East Tamaki Healthcare is a primary care network comprising 35 clinics, providing both general practice and after-hours accident and medical services, to a population of 200,000 people across high needs communities of metro Auckland, including large Maori, Pacific and immigrant/refugee populations. The ‘Wellness Support Team’ within the network comprises a psychiatrist/clinical lead, general practitioners (GPs) with advanced training in primary mental health (MH), psychologists/therapists and peer ‘health coaches’, providing a range of individual and group-based mental health programs provided in the GP clinics. In recognition of the high prevalence of comorbidity of MH and medical long-term conditions (LTCs), and the poorer health outcomes and much higher service utilization that results, the team has increasingly focused on development of an array of ‘self-management support’ programs to address wider LTC needs. Throughout, the focus of program development has been translation of evidence-based programs into routine practice. Routine use of co-design with patients/families, and improvement science methodologies, has been key to successful implementation. One key learning of this co-design approach has been that culture- and language-matched peer engagement and support can greatly improve outcomes. This presentation will provide an overview of the evolution of this service, the role of co-design and improvement science, the development of a peer-professional partnership model, the range of services provided and outcomes achieved. Examples of MH and LTC program implementation will be given, with data from each program presented.

Presenter 2

Relationships Count: Person-Centred Well-Being Support In General Practice

O Campbell

Auckland District Health Board, Auckland, New Zealand

Abstract: As part of a localities approach to developing new experiences of mental health and well-being support in Tāmaki (East Auckland), the Auckland District Health Board and partners are co-designing new approaches to service development in primary care and the community. The focus of the work is to understand and capture peoples’ experiences to enable person-centred service development. Co-design and a facilitated action-learning process provides all stakeholders with a ‘trial and refine’ learning agenda and an inclusive way of working together to building understanding and collaboration. The collaborative want to showcase two pieces of work that have emerged from this program. Awhi Ora: Supporting Well-being is a walk-alongside community-based support service. Awhi Ora providers have been building connections with general practices to provide integrated social well-being support to their enrolled populations. Fit for the Future aims to upscale Awhi Ora and develop an extended integrated general practice team that outreaches to the community and provides timely and holistic support.

Presenter 3

Primary Care Dementia Pathways

M Fisher

Counties Manukau Health, Auckland, New Zealand

Abstract: One of the central aspirations under the New Zealand Framework for Dementia Care was the early identification of those suffering from dementia. Referrals to secondary care often occur late in the illness. However, experience in other countries suggests that people with dementia are not usually diagnosed as such in primary care, possibly due to the time-consuming process of assessment. To improve diagnosis and management of dementia in a primary care setting, there have been three projects undertaken in Auckland, where secondary and primary care clinicians have collaborated on setting up a dementia care pathway in primary care. The elements have included a clear assessment and treatment algorithm to be followed, training for primary care clinicians, support and back-up, and involvement of local dementia Auckland keyworkers as well. Research results and clinical experience with the pathways have shown that people are identified in primary care at an early stage, including while suffering from mild cognitive impairment. Confidence of primary care clinicians was also shown to improve through the project. This primary–secondary collaboration has been successfully introduced into Auckland, and it offers people with dementia earlier identification with the potential for better clinical outcomes, and family caregivers who have been supported through more of the journey.

Presenter 4

A Mental Health and Addiction Service Integration Transformation: Progress and Challenges

C Bensemann

Counties Manukau Health, Auckland, New Zealand

Abstract: In 2016, Counties Manukau Health began a Mental Health and Addiction service transformation to integrate vertically with primary care and horizontally with general health services.

Specialist mental and addiction clinicians and non-government organization (NGO) staff utilizing a liaison model have been devolved into locality teams embedded within primary care and community care providers. The integration focuses on ensuring people with a serious mental illness are well engaged with primary care to address their physical health needs and on supporting primary care in the routine screening and treatment of people with long-term conditions and mental health comorbidity.

Part of the integration is the re-design of core support services provided by the NGO sector. A Maori -led integration initiative is under development to address the issues for Maori in Counties Manukau. Co-design, improvement science and cultural capability have been used to inform and support the process.

The challenges in large-scale service change are described, and early data presented.

Its a Drug and Alcohol Problem, not a Mental Health Problem: Reflections on Treatment Pathways for Co-Occurring Disorders

J Lappin^1,2, S Arunogiri^3,4, J Foulds^5,6, G Newton-Howes^7,8

¹National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia

²Bondi Junction Early Psychosis Program, South Eastern Sydney Local Health District, Sydney, Australia

³Turning Point, Eastern Health, Melbourne, Australia

⁴Monash University, Melbourne, Australia

⁵Department of Psychological Medicine, University of Otago, Christchurch, New Zealand

⁶Canterbury Regional Forensic Psychiatric Service, Christchurch, New Zealand

⁷Department of Psychological Medicine, University of Otago, Wellington, New Zealand

⁸Te-Upoko-me-te-Whatu-o-Te-Ika, Wellington, New Zealand

Background: The co-occurrence of alcohol and other drug (AOD) and mental health disorders are the rule rather than the exception in most mental health and AOD treatment settings. While many jurisdictions have formulated policies adopting a ‘no wrong door’ approach towards integrated provision of treatment, in reality, many individuals continue to fall through the gaps between AOD and mental health services.

Objectives: To examine the key gaps in service provision for individuals with co-occurring disorders from the perspective of different service models.

Methods: This will be an interactive symposium inviting active audience participation. We will discuss how a case study (‘Matthew’), an individual with a substance-associated psychotic episode, might receive care in a first episode psychosis service, an alcohol and other drug treatment service, a forensic service and a specialist personality disorder service.

Findings: Each presentation will provide an overview of the prevalence of co-occurring disorders in the treatment setting, and how this is screened for, assessed and managed. We will highlight the main gaps in service provision, and what needs to change to address these gaps.

Conclusions: There are a range of gaps in current treatment pathways for individuals with co-occurring disorders. Innovative approaches to service delivery need to be adequately resourced to provide integrated care.

Presenter 1

Methamphetamine-Related Psychosis: How Do We Treat It?

J Lappin^1,2, G Sara^3,4, M Farrell¹

¹National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia

²Bondi Junction Early Psychosis Program, South Eastern Sydney Local Health District, Sydney, Australia

³Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia

⁴InforMH, Health System Information and Reporting Branch, NSW Ministry of Health, Sydney, Australia

Background: Methamphetamine-related psychosis is increasing in prevalence in Australia and New Zealand. There is limited evidence to guide clinicians in appropriate management of methamphetamine-related psychoses.

Objectives: The session will provide opportunity for debate on the following issues:

Methods: Several case examples of young people presenting with comorbid methamphetamine misuse and first-episode psychosis will be presented to facilitate debate among the symposium audience.

Findings: Some key issues to be addressed include evidence that transient psychotic symptoms are often seen as self-limiting or benign by individuals and by clinicians. Many individuals experiencing such symptoms do not seek help. Only a minority of methamphetamine users ever receive substance use treatment. Many delay help-seeking for health issues and may not receive ongoing specialist care from mental health or addiction services.

Conclusions: We hope that the audience shares examples from across Australia and New Zealand of effective approaches to working with people with methamphetamine-related psychosis to progress towards a model of best practice.

Presenter 2

Treatment Pathways for Recovery in the AOD Sector

S Arunogiri^1,2

¹Turning Point, Eastern Health, Melbourne, Australia

²Monash University, Melbourne, Australia

Background: A substantial proportion of individuals presenting for alcohol and other drug (AOD) treatment have co-occurring mental health disorders. Australian population estimates suggest a third of individuals in the community with an AOD have a co-occurring mental health disorder; this is higher in treatment settings, particularly if including individuals with mental health symptoms and no formal diagnosis.

Objectives: To discuss current models of care of co-occurring disorders in AOD treatment settings and to comprehensively examine gaps in service provision and workforce capacity.

Methods: A review of evidence relating to service delivery for care of co-occurring disorders will be presented. Using the case study of ‘Matthew’ as an example, an interactive discussion will explore key challenges and barriers to providing evidence-based treatment within AOD treatment settings.

Findings: While co-occurring disorders are common in AOD treatment settings, workforce capacity to screen, assess and provide evidence-based management of mental health problems is lacking. Although several training initiatives and guidelines have been developed, it is unclear whether this translates to improved outcomes for consumers, in the absence of sustainable models of care incorporating clinical leadership and governance.

Conclusions: The capacity of the AOD sector to effectively manage complex mental health disorders is limited. There is potential for enhancing the recovery of consumers by providing more holistic and integrated models of care.

Presenter 3

Treatment Pathways for Co-Occurring Disorders in the Prison Setting

J Foulds^1,2

¹Department of Psychological Medicine, University of Otago, Christchurch, New Zealand

²Canterbury Regional Forensic Psychiatric Service, Christchurch, New Zealand

Background: Most referrals to forensic mental health services involve people with co-occurring mental health and alcohol or other drug (AOD) problems.

Objectives: To describe patterns of co-occurring disorders among people referred to prison psychiatry services in New Zealand and Australia and, using the case study of ‘Matthew’ as an example, to describe current treatment models and identify potential gaps in service provision.

Methods: This will be an interactive discussion highlighting the state of current clinical practice in service provision for offenders with mental health and AOD comorbidity. Symposium participants will have the opportunity to report on quality improvement initiatives from their local jurisdiction and to suggest ways to overcome barriers to service improvement.

Findings: While AOD comorbidity is common among prisoners referred to forensic mental health services in Australasia, we anticipate that service delivery models for treating prisoners with co-occurring disorders vary greatly.

Conclusions: It is hoped the symposium will promote awareness of alternative service delivery models that can improve outcomes for this vulnerable group.

Presenter 4

The Influence of Personality in those with an Alcohol Problem: Do We Need to Care, What Do We Do?

G Newton-Howes^1,2

¹Department of Psychological Medicine, University of Otago, Wellington, New Zealand

²Te-Upoko-me-te-Whatu-o-Te-Ika, Wellington, New Zealand

Background: Clinically, alcohol use disorder (AUD) and personality disorder (PD) commonly coexist, although a degree of therapeutic nihilism exists as to how to best approach a patient with both conditions. No service in Australasia has a specialist coexisting PD AUD service although co-existing services (related to AUD) have been developed, and specialist personality disorder services exist in many regions.

Objectives: To examine, using the case study as an example, how clinical services can implement findings from the literature to assist ‘Matthew’ in his recovery.

Methods: Systematic review of the literature will be presented to consider prevalence and the personality factors that may be clinically at play in considering Matthew’s presentation. Narrative review of the literature and clinical experience will inform a discussion of how services could respond and how services could be developed to support the management of Matthew.

Findings: AUD is common in PD, particularly in antisocial personality disorder (ASPD) a diagnosis Matthew may likely carry. This presents treatment challenges that need to be considered from the outset. If services recognize the optimal skill mix for the management of Matthew, despite the lack of clear evidence-based treatment, an appropriate idiosyncratic management plan can be developed.

Conclusions: There are significant challenges in managing comorbid PD and AUD. The literature supports the importance of recognizing this comorbidity, albeit the treatment focus remains unclear. Despite this, and possible service limitations, co-working can assist in finding an appropriate path forward.

Psychiatry and Family Violence: from Theory to Policy and Practice

M O’Connor^1,2, S, Patel^2,3, M Eisenbruch^2,4, N Coventry⁵, S Fernbacher⁵

¹University of Melbourne, Parkville, Australia

²Family Violence Working Group, Victorian Branch, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³Royal Children’s Hospital, Melbourne, Australia

⁴Monash University, Melbourne, Australia

⁵Department of Human and Health Services, Melbourne, Victoria

Background: Domestic and family violence (FV) is a complex problem requiring interdisciplinary collaboration to prevent and ameliorate the impact of abuse on the next generation. The World Health Organization highlights mental healthcare as suitable settings for early intervention in FV. Mental healthcare professionals and services often see both women experiencing abuse and the perpetrator. Estimates are that up to 30% of psychiatric inpatients and outpatients have experienced family violence. Research suggests that many women will disclose family violence and sexual assault to a trusted health professional in the context of seeking care for themselves or their children. The Victorian Royal Commission into Family Violence identified the need to improve Victoria’s response to family violence, including mental health services.

Objectives: To provide information on background, processes, products and outcomes through partnership approaches.

Methods: To undertake this work, a range of partnerships have been formed between government, the Royal Australian and New Zealand College of Psychiatrists (RANZCP), the Australian Psychological Society, the Royal Australian College of General Practitioners, The University of Melbourne, Monash University and sector experts in mental health and family violence.

Findings: The presentations will provide information on findings of specific areas of work. These include a study of the knowledge, opinions and practices of psychiatrists towards family violence (presentation 1); an agreement on Family Violence Learning Agendas for professional bodies including the RANZCP (presentation 2); development of the Chief Psychiatrist Guideline on Family Violence (presentation 3); and cultural aspects of FV (presentation 4).

Conclusions: FV is a complex issue with significant mental health implications. This work contributes towards ongoing professional development for psychiatrists and other mental health professionals, guidance on responding to family violence to ultimately increase responsiveness to mental health clients experiencing or perpetrating family violence.

Presenter 1

Find Study: Exploring Psychiatrists’ Knowledge, Opinions and Practices in Relation to Domestic and Family Violence

M O’Connor^1,2, K Forsdike¹, K Hegarty¹, D Castle¹

¹The University of Melbourne, Melbourne, Australia

²Family Violence Working Group, Victorian Branch, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: There is a need to understand the supports psychiatrists may require and, in particular, provide a basis for the development of education and training for working with patients experiencing family violence.

Objectives: To determine the knowledge, opinions (attitudes and beliefs) and practices of Australian psychiatrists in relation to domestic and family violence.

Methods: The FIND study surveyed online 216 psychiatrists from the Royal Australian and New Zealand College of Psychiatrists (RANZCP) membership, which constitutes the largest survey of the profession in Australia.

Findings: This survey is the first in Australia. Almost half of responding psychiatrists (47%) were trained for fewer than 2 h: trainees received fewer than consultants; using PREMIS (Physician Readiness to Manage Intimate Partner Violence Survey), findings showed moderate knowledge of family violence in responding psychiatrists’ clinical work and moderate preparedness to deal with family violence. Consultants with greater years of clinical experience and more training were significantly more prepared to deal with family violence.

Conclusions: Psychiatrists’ comfort to ask and their preparedness to deal with family violence is associated with greater hours of training; it is recommended that RANZCP provides support regarding the need for more training for psychiatrists.

Presenter 2

Developing a Family Violence Learning Agenda

N Coventry¹, S Patel^2,3, M O’Connor^3,4, S Fernbacher¹

¹Department of Human and Health Services, Melbourne, Australia

²Royal Children’s Hospital, Melbourne, Australia

³Family Violence Working Group, Victorian Branch, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

⁴University of Melbourne, Melbourne, Australia

Background: The Victorian Royal Commission into Family Violence identified the need for professional bodies to develop family violence learning agendas to ensure access to ongoing professional development. Guidance on appropriate responses to family violence is attended to in a range of ways, including enacting family violence learning agendas and a chief psychiatrist guideline supporting clinical practice.

Objectives: To present the process of bringing various key stakeholders and professional bodies together. We will discuss challenges and ways we have overcome these to ultimately work towards a shared goal with enough commonality while allowing organizational flexibility.

Methods: The response to this recommendation included a Project Advisory Group with representatives of both government and professional bodies who came together to work through identifying: what it means to set a learning agenda; to advocate for a learning agenda to be adopted; and the process that was employed to achieve this goal.

Findings: The Office of the Chief Psychiatrist partnered with the Royal Australian and New Zealand College of Psychiatrists, Royal Australian College of General Practitioners, the Australian Psychological Society, experts in workforce development and family violence to undertake this work. Working across and between organizations demands high-level commitment to work towards a common goal while appreciating organizational differences. The work of the Project Advisory Group evidences good inter-organizational engagement and thoughtful ways to develop a shared vision and ultimately a shared outcome.

Conclusions: While the task of creating a learning agenda that maintains its currency beyond policy cycles is challenging, it has been collaboration and partnerships between key stakeholders that have contributed to this work. Sensitive response to family violence requires thoughtful collaboration across various domains including government, professions, mental health services, people with lived experience and clinicians.

Presenter 3

Developing Family Violence Policy Guidance

S Fernbacher, N Coventry

Department of Human and Health Services, Melbourne, Australia

Background: The intention of the work by the Department of Health and Human Services/Mental Health Branch in response to the Commission’s recommendations aims to move towards a more consistent, strategic and systemic response to family violence by mental health services.

Objectives: To facilitate work across different systems and organizational cultures to provide a more connected service response between mental health and family violence services.

Methods: Literature at the intersection of family violence and mental health provides the context for the development of a situational analysis seeking clarification on current issues. Focus groups and key informant interviews with mental health professionals, people with lived experience, carers and family violence specialists provide insight into current practice, gaps and potential solutions.

Findings: Mental health clinicians are indeed in a good position to contribute to an increased response to family violence. Approaches to increase a more systemic and consistent response to family violence require support, guidance and access to ongoing professional development opportunities.

Conclusions: In this presentation, we will provide an overview of the major findings from the literature review and the situational analysis. We will provide an outline of the Chief Psychiatrist Guideline and its application to clinical practice.

Presenter 4

Towards Cultural Responsiveness in Family Violence

M Eisenbruch^1,2

¹Monash University, Melbourne, Victoria

²Family Violence Working Group, Victorian Branch, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: There is increasing awareness about the importance of cultural issues associated with family violence (FV), with most attention given to factors ‘in the culture’ that prompt FV. One prevailing view seems to be that immigrants need to be ‘educated’ that FV is against the law so that they will change their ways.

Objectives: To apply ethnographic methods to identify in greater depth how culture shapes violence by exploring ‘cultural attractors’, those mutually reinforcing mechanisms that lead abusers or victims along their trajectories, and underpin the landscape of violence.

Methods: Examples are drawn from the author’s clinical ethnographic research with Cambodians affected by domestic violence, acid attack and child sexual abuse.

Findings: ‘Cultural attractors’ push and pull violence: blighted endowment, explaining child rape; seeds of bad temperament, leading to adult impunity; misfortune that predestines victim or perpetrator; incompatibility between a couple; craving or anger leading to sexual crimes; entering the ‘road to ruin’; and shameless moral blindness.

Conclusions: Culture is never a justification for FV. Effective prevention programs, beyond seeking to educate culturally and linguistically diverse (CALD) background groups to observe Australian mainstream practices, need to harness the cultural logic (e.g. the male hegemonies of the CALD background communities). Programs and multilateral agencies worldwide are challenged to re-examine Theory of Change, so that culture, rather than being a stigma, is seen as a pathway to the solution, in which we induce change within rather than outside the cultural norms on gender and family life.

Joint RANZCP/JSPN Symposium: Partnering with Consumers and Carers

K Jenkins¹, Members of the Japanese Society of Psychiatry and Neurology²

¹The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Japanese Society of Psychiatry and Neurology, Tokyo, Japan

Background: People with experiences of mental illness (also referred to as consumers) and their carers and families have unique expertise to help shape mental health policy and practice, and their needs, perspectives, concerns and values can play an important role in mental health service development.

Objectives: This joint symposium between the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Japanese Society of Psychiatry and Neurology (JSPN) will outline the range of models for consumer and carer involvement in the mental health services of the respective countries.

Methods: Representatives from the RANZCP and the JSPN will give a presentation, which will be followed by a roundtable discussion to identify opportunities for further collaboration.

Findings: There are a range of current models for consumer and carer engagement that are applicable to differing cultures and countries and interactions with health systems.

Conclusions: Consumers of mental health services and their carers have a great deal of experience and expertise that clinicians, psychiatric colleges, mental health service providers and policymakers can draw upon. Consumer and carer participation is increasingly regarded as a valuable facet in the healthcare system, and understanding of different modalities of consumer and carer engagement is helpful in promoting consumer and carer involvement in decisions.

Thinking Around Leadership: Caesar’s Red Cloak and Bandwagons

N O’Connor^1,2, R Parker³, S Clark^4,5

¹Northern Sydney Local Health District, Sydney, Australia

²Department of Psychiatry, The University of Sydney, Sydney, Australia

³Northern Territory Medical Program, Darwin, Australia

⁴Western NSW Local Health District, Orange, Australia

⁵Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia

Background: The authors are senior psychiatrists involved in various leadership roles. This symposium examines some important aspects of leadership: what history can tell us about leadership and the role of symbolism in leadership; and the literature on ‘bandwagons’ and its relevance to psychiatry, medicine and health management.

Objectives: To stimulate thought and discussion in relation to thinking around leadership.

Methods: Presentation of the literature on the role of symbolism in leadership. Presentation on the medical and management literature on bandwagons.

Findings: Identifying, understanding and managing the bandwagon effect.

Conclusions: The symbolism of leadership is an important issue for psychiatrists working in complex organizations. Understanding the bandwagon effect is important for all psychiatrists but particularly those in leadership roles.

Presenter 1

Caesar’s Red Cloak: Enhancing the Value of Psychiatrists as Leaders

R Parker

Northern Territory Medical Program, Darwin, Australia,

Background: Examine the social and psychological background to symbols of leadership.

Objectives: To review how such symbolic factors may enhance the role of psychiatrists as leaders within complex health organizations.

Methods: Review of management theory and any relevant studies.

Findings: Psychiatrists as leaders may need to have a greater awareness of their symbolic value as an adjunct to effective leadership.

Conclusions: The recognition of the value symbols in management would be an additional tool that may be of value for psychiatrists as managers.

Presenter 2

Beware Bandwagons! The Bandwagon Phenomenon in Medicine, Psychiatry and Health Management

N O’Connor^1,2, S Clark^3,4

¹Northern Sydney Local Health District, Sydney, Australia

²Department of Psychiatry, The University of Sydney, Sydney, Australia

³Western NSW Local Health District, Orange, Australia

⁴Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia

Background: The bandwagon effect is evident in medicine, psychiatry and health management but despite its huge potential for distorting decision-making in health practice and policy, bandwagons often go unrecognized and unchallenged.

Objectives: To describe the bandwagon effect, its relevance to practice and policy in medicine, psychiatry and management.

Methods: We examined the literature on bandwagons, fashions and fads in the fields of medicine, psychiatry and management.

Conclusions: The bandwagon effect appears to operate across medicine, psychiatry and management, often to the detriment of patients and health organizations. The authors provide advice on recognizing and managing this phenomenon.

Presenter 3

Panel and Audience Discussion

N O’Connor^1,2, R Parker³, S Clark^4,5

¹Northern Sydney Local Health District, Sydney, Australia

²Department of Psychiatry, The University of Sydney, Sydney, Australia

³Northern Territory Medical Program, Darwin, Australia

⁴Western NSW Local Health District, Orange, Australia

⁵Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia

It Takes a Village to Create and Sustain Children’s Mental Health and Well-Being

N Kowalenko^1,2, S Merry^3,4, H Thabrew^3,4, P Robinson¹, B Morgan¹

¹Emerging Minds, Adelaide, Australia

²Faculty of Child and Adolescent Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³School of Medicine, The University of Auckland, Auckland, New Zealand

⁴Starship Children’s Hospital, Auckland, New Zealand

⁵Werry Centre for Infant, Child and Adolescent Mental Health, Auckland, New Zealand

Background: From a public policy perspective, the prevention and early treatment of mental health problems depend on community partnerships. Community participation, workforce development, active engagement of key partners, strategic research and aligning parent mental health with general health services are some of the components required for effective implementation. Over the past decade, local, state-wide and national initiatives have been undertaken in New Zealand and Australia to further develop mental health services for children. These include workforce development, teaching and research in New Zealand and the Australian government funding of Emerging Minds to develop a National Workforce Centre for Children’s Mental Health.

Objectives: To discuss national partnership initiatives, particularly in primary and specialist care, that have been undertaken in New Zealand and Australia to further develop mental health services for children.

Methods: This symposium will

Findings: Participants will learn about the current initiatives and research informing mental health reform in New Zealand and Australia.

Conclusions: Improving the mental health of infants, children and adolescents can only be done in partnership.

Making Sense of Chaos – A Brave Foray into Helping the Most Disadvantaged: A Joint Mental Health, Drug Health and Family and Community Services Initiative

R Jairam^1,2,3, R Devlin³, N Medel³, R Jairam³, G Barton³, V Eapen^1,3

¹UNSW Sydney, Sydney, Australia

²University of Western Sydney, Sydney, Australia

³South Western Sydney Local Health District, Sydney, Australia

Background: Children in out-of-home care (OOHC) have poor health outcomes (Tarren-Sweeney, 2008). The mental health (MH) needs of families with child protection concerns have been long neglected. Historically, MH services have had limited success in providing appropriate care for these children and families. The South-West Sydney Local Health District (SWSLHD) received enhancements to establish a new MH team that aims to bridge this gap.

Objectives: To discuss the trials and tribulations of setting up this new MH team with a unique model of care to address the mental health needs of the most disadvantaged children and families in our community along with preliminary clinical outcomes will be discussed.

Methods: The symposium will spotlight the current challenges faced by these children and families and focus on the processes involved in setting up the novel hybrid team; care provided and outcome of the first 30 referrals to both streams (OOHC and WFT), concluding with lessons learned and future directions.

Findings: Responding to a dire need within SWSLHD, this ambitious service required multi-agency collaboration at several levels to commission. Despite adversities, the service is providing MH care for those most in need with the average scores on admission of the Children’s Global Assessment Scale (CGAS)/Global Assessment of Functioning (GAF) ( American Psychiatric Association, 2000; Shaffer et al., 1983) of 45.4; and Health of the Nation Outcome Scales (HONOS)/Health of the Nation Outcome Scales for Children and Adolescents (HONOSCA) (Speak and Muncer, 2015), 19.8.

Conclusions: The OOHC/Whole-Family Team is a purpose-established unique mobile tier-four community MH service that has so far met the lofty aspirations for which it was established and may provide a model that could be replicated in other settings. Systemic challenges remain and the nurturance and sustenance while inherently challenging is vitally important to ensure that the most disadvantaged population within our community continues to receive the care it so badly needs.

References

American Psychiatric Association (2000) Global assessment of functioning scale (GAFS). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington DC: APA.

Shaffer D, Gould MSBrasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Archives of General Psychiatry 40: 1228–1231.

Speak B, Muncer S (2015) The structure and reliability of the Health of the Nation Outcome Scales. Australasian Psychiatry 23(1): 66–68.

Tarren-Sweeney M (2008) The mental health of children in out-of-home care. Current Opinion in Psychiatry 21: 345–349.

Presenter 1

What’s the Problem? Are Mental Health Needs of Children in OOHC and Significantly Disadvantaged Families not Being Met?

R Jairam^1,2,3, R Devlin³, N Medel³, R Jairam³, G Barton³, V Eapen^1,3

¹UNSW Sydney, Sydney, Australia

²University of Western Sydney, Sydney, Australia

³South Western Sydney Local Health District, Sydney, Australia

Background: Numbers of Australian children in out-of-home care (OOHC) is increasing; 37,648 (2010–11) to 46,448 (2015–16); with disproportionate indigenous representation – 56.6/1000 compared to 5.8/1000 for non-Indigenous (Australian Institute of Health and Welfare, 2017a). Similar increases in the risk-of-significant-harm (ROSH) reports are noted (Australian Institute of Health and Welfare, 2017b). Current research highlights complex needs of children in OOHC and families where significant child protection concerns exist, consequently highlighting a deficit with current health systems, necessitating a rethink of strategies.

Objectives: To outline the mental health issues faced by children in OOHC and families where ROSH exists. Review current systems and explore alternative strategies adopted both within Australia and worldwide to address this.

Methods: The complex health/mental health needs of children in OOHC including Indigenous children and families where ROSH exists have sparked a new, shared approach between child protection agencies and health (Australian Institute of Health and Welfare, 2017b; Wood, 2008). Novel strategies worldwide include assertive trauma-informed approaches given the high prevalence of complex trauma and adversity.

Findings: Current research highlights the complex needs of children in OOHC and disadvantaged families, which frequently fall through gaps in current traditional health systems. An assertive, culturally sensitive, multifaceted approach, underpinned by a trauma-informed model of care is essential.

Conclusions: Scant available research highlights the need to review our approach to providing care to these significantly disadvantaged families and children. Our experience affirms observations that traditional models of care do not adequately cater for this clinical population, prompting the development of a novel service aimed at improving access to mental healthcare to reduce the social and health inequalities that exist for this disadvantaged group.

References

Australian Institute of Health and Welfare (2017a) Child Protection Australia 2015–16. Canberra.

Australian Institute of Health and Welfare (2017b) Supplementary Data Tables 2015–16. Canberra.

Tarren-Sweeney M (2008) The mental health of children in out-of-home care. Current Opinion in Psychiatry 21: 345–349.

Wood J (2008) Report of the Special commission of Inquiry into Child Protection Services in NSW. State of NSW through the special commission of inquiry into child protection services in NSW, published by the Government of NSW.

Presenter 2

A Welcome Response! The Establishment of A Brand-Spanking-New Hybrid out of Home Care Mental Health and Whole Family Team: Is it as Easy as it Sounds?

R Jairam^1,2,3, R Devlin³, N Medel³, R Jairam³, G Barton³, V Eapen^1,3

¹U\Dept of Medicine, University of New South Wales, UNSW Sydney, Australia

²University of Western Sydney, Sydney, Australia

³South Western Sydney Local Health District, Sydney, Australia

Background: The South West Sydney Local Health District (SWSLHD) has the highest number of children (>2100 in 2015) in out-of-home care (OOHC) in New South Wales (NSW Family and Community Services, 2016). This population has a high prevalence of mental health issues and associated comorbidities. The severity and complexity of their presentations necessitates the establishment of a new service that moves away from the traditional model of mental health services.

Objectives: To discuss the establishment of a hybrid team, with a novel model of care, which aims to service the most disadvantaged/vulnerable families, whose children are at-risk of being assumed into care, in addition to those children in OOHC, who have the most serious and complex mental health issues.

Methods: An overview of the establishment of this hybrid team; from developing a unique model of care, to canvassing existing teams/services, to equipping staff with resources and finally to the ongoing collaboration between partners.

Findings: Despite the challenges that exist with bringing together the three unique systems of mental health, drug health and child protection, there is perseverance in creating a well-oiled system that services children who are at risk of becoming the most disadvantaged group in the developed world, and with those children who already fall into that category. What has been shown to be most useful is the cross-pollination of mental health, drug health and child protection skills of clinicians, along with creative approaches to engaging the disengaged.

Conclusions: The establishment of a new hybrid OOHC/Whole-Family Team requires a complementary skill mix alongside patience, persistence and passion to meet the needs of this very complex population.

Reference

NSW Family and Community Services, Community Services, Improving the lives of children and young people 2015–16. FACS Statistics, published by FACS NSW Government

Presenter 3

What we have Learnt Working with the First Few Children in The Out-Of-Home Care Mental Health Team?

R Jairam^1,2,3, R Devlin³, N Medel³, R Jairam³, G Barton³, V Eapen^1,3

¹UNSW Sydney, Sydney, Australia

²University of Western Sydney, Sydney, Australia

³South Western Sydney Local Health District, Sydney, Australia

Background: The out-of-home care (OOHC) mental health service (MHS) is a new, tier-four community-based mobile team set up to provide mental healthcare for those children in OOHC whose needs cannot be met by traditional MHSs.

Objectives: To evaluate sociodemographic and clinical variables and monitor change in functioning and psychopathology of the first 30 children seen by the OOHC MHS, which commenced in March 2017.

Methods: Clinical files were the main source of information. Individual psychopathology and functioning and family psychopathology and functioning was measured at admission, every 3 months and at discharge from the service via the Health of Nations Outcome Scale Children and Adolescents (HONOSCA), Children’s Global Assessment Scale (CGAS) and the North Carolina Family Assessment Scale (NCFAS) (Reed-Ashcraft et al., 2001), respectively. Descriptive statistics will be presented as will correlation of change of measures with relevant variables.

Findings: On admission, there were 46.7% male, mean age of 10.8 years, with an average of six placement breakdowns, 100% having significant abuse; mean HONOSCA was 28.3; CGAS, 34.9; and NCFAS score, 57.8. Individual psychological interventions, psychopharmacotherapy and systems interventions and recommendations are delivered in a trauma-informed, consistent, empathic and predictable manner. The mobile nature of the team was a significant factor.

Conclusions: The OOHC MHS is providing services to a very impaired, ill and disadvantaged group of children. Significant early abusive experiences, frequent placement breakdowns and inconsistent care-taking experiences meant that these children often had fragmented mental healthcare which worsened their difficulties. The OOHC MHS provides an appropriate model of care to meet their complex needs. Further sustenance and continuity of care provided by this team is critical for this challenging population.

Reference

Reed-Ashcraft K, Kirk RS, Fraser MW (2001) The reliability and validity of the North Carolina family assessment scale. Research on Social Work Practice 11(4): 503–520.

Presenter 4

What we have Learnt Working with The First Few Families in the Whole-Family Team?

R Jairam^1,2,3, R Devlin³, N Medel³, R Jairam³, G Barton³, V Eapen^1,3

¹University of New South Wales, Sydney, Australia

²University of Western Sydney, Sydney, Australia

³South Western Sydney Local Health District, Sydney, Australia

Background: The Whole-Family Team (WFT) is a new mobile team set up to provide mental healthcare for families where a child or children are at risk of being assumed into care and their parent/s are affected by mental health or drug health problems.

Objectives: To evaluate sociodemographic and clinical variables and monitor change in functioning and psychopathology of the first 30 families seen by the WFT mental health service (MHS), which commenced in March 2017.

Methods: Clinical files were the main source of information. Individual psychopathology and functioning and family psychopathology and functioning were measured at admission, every 3 months and at discharge from the service via the Health of Nations Outcome Scale (HONOS), Global Assessment of Functioning (GAF) and North Carolina Family Assessment Scale (NCFAS), respectively.

Findings: On admission, the mother was the index parent in 88% of instance, with a mean age of 36.2 years, with the mean number of three dependent children, with emotional abuse and neglect being the commonest risk-of-significant-harm (ROSH) concern. Their mean HONOS was 15.3; GAF, 51.08; and NCFAS, −54.6. Individual/family interventions, psychopharmacotherapy and systems interventions/recommendations are delivered in a trauma-informed, consistent, empathic and predictable manner. The mobile nature of the team was critical to their success.

Conclusions: The WFT MHS is providing services to impaired, traumatized and disadvantaged families. This team provides the appropriate model of care to meet complex needs of these families; however, it is one of the many services needed. Further sustenance and continuity of care provided by this team together with effective partnership with other agencies is critical to improve safety and well-being of children in these families.

Presenter 5

One Year on: The Good, The Bad and The Future

R Jairam^1,2,3, R Devlin³, N Medel³, R Jairam³, G Barton³, V Eapen^1,3

¹University of New South Wales, Sydney, Australia

²University of Western Sydney, Sydney, Australia

³South Western Sydney Local Health District, Sydney, Australia

Background: South-West-Sydney has the highest population of children in out-of-home care (OOHC) and 14 of 20 of the most disadvantaged suburbs in Greater Sydney. This, together with having a well-functioning Infant–Child–Adolescent Mental Health-Service (ICAMHS) with prior successful partnerships with Family and Community-Services (FACS) meant that we were considered a natural site for this initiative. OOHC and the Whole-Family Team (WFT) MHS are specific purpose teams that have been commissioned in March 2017.

Objectives: Intra-agency collaboration, facility and staff recruitment were the initial challenges. Developing and implementing suitable models of care together with adequate and appropriate training and supervision for staff formed the thrust for service provision.

Methods: To describe the administrative and clinical controls together with challenges that contributed to the functioning of these teams one year on.

Findings: Having regular steering committee oversight, maintaining regular and close linkages with FACS and other parts of MHS and drug health services were the administrative necessitates. Clinician care including appropriate training, supervision, case load reviews and self-care opportunities were other important aspects. Lessons were learnt from an initial high staff turnover. All these together ensured appropriate referrals being accepted and effective care delivered while keeping clinician morale up and turnover and burnout low.

Conclusions: Working as part of OOHC/WFT MHS is quite stressful with a significant amount of secondary or vicarious trauma. Taking good care of the team is paramount to ensuring appropriate care continues to be delivered to the most disadvantaged children and families in our society.

Reference

South Western Sydney Local Health District (2016) Year in Review 2014–15. Published by SWSLHD, Department of Health, NSW Government.

Diet And Exercise As Key Drivers Of Better Physical And Mental Health For People Living With Mental Illness: A Status Report

SB Teasdale^1,2, N Korman³, PB Ward², G Latimer⁴, A Byron⁵, V Schuldt⁵, L Czosnek⁶, S Rosenbaum²

¹South Eastern Sydney Local Health District, Sydney, Australia

²UNSW Sydney, Sydney, Australia

³Metro South Addiction and Mental Health Services, Brisbane, Australia

⁴cohealth, Melbourne, Australia

⁵Dietitians Association of Australia, Melbourne, Australia

⁶Exercise and Sports Science Australia, Brisbane, Australia

⁷Australian Catholic University, Melbourne, Australia

⁸Black Dog Institute, Sydney, Australia

Background: Poor dietary habits and physical inactivity are key modifiable risk factors contributing to the overall burden of disease. Despite the established physical and mental health benefits of consuming a healthy diet and engaging in regular physical activity, people living with mental illness have poorer dietary habits, engage in less moderate-to-vigorous, and leisure time physical activity and have worse fitness levels compared to the general population. Further, evidence regarding the preventative and treatment effects of maintaining a healthy lifestyle with regard to mental health is becoming increasingly clear. Accredited Practicing Dietitians (APDs) and Accredited Exercise Physiologists (AEPs) represent allied health practitioners with expertise in lifestyle modification. Increasingly APDs and AEPs are gaining employment within mental health facilities.

Objectives: To present the latest evidence regarding the role of APD and AEP-led interventions in improving mental and physical health outcomes for people living with mental illness. Pathways to care, referral processes and examples of successful models of care will be presented.

Presenter 1

Addressing the Scandal of Premature Mortality in People Living With Mental Illness: The Role of Lifestyle Interventions

PB Ward

UNSW Sydney, Sydney, Australia

Background: People with mental illness represent a vulnerable population that continues to experience a substantial life expectancy gap. The magnitude of this life expectancy gap would be expected to lead to significant public health action to redress this health inequality if a different group of patients were similarly impacted.

Findings: Cardiovascular disease remains a major driver of increased mortality risk among people with mental illness. Modifiable risk factors are prevalent in this population – high rates of tobacco use, lack of exercise and high levels of sedentary behaviour, poor diet and barriers to evidence-based treatment of chronic disease. Weight-enhancing medications are often a key component of treatment. Thankfully, there is growing evidence that these risk factors can be successfully addressed.

There is growing evidence from randomized controlled trials that behavioural interventions can achieve significant weight loss in people with schizophrenia who have already experienced significant weight gain. We recently demonstrated that the substantial weight gain typically experienced by those commencing treatment with antipsychotics and mood stabilizers can be prevented by implementing intensive diet and exercise interventions in youth with first episode psychosis, which have now been implemented as routine care. Weight gain prevention means that future cardiometabolic disease may be prevented, with important benefits in terms of increased fitness and improved diet quality.

Conclusions: Regular reporting of the physical health outcomes of people living with mental illness by those charged with the responsibility for overseeing comprehensive health systems would enable benchmarking against outcomes achieved for those not experiencing mental illness.

Presenter 2

Expanding Collaborative Care: The Role of Nutritional Interventions and Dietitians in Mental Health and Mental Illness

S Teasdale^1,2, G Latimer³, V Schuldt⁴, A Byron⁴

¹South Eastern Sydney Local Health District, Sydney, Australia

²University of New South Wales, Sydney, Australia

³cohealth, Melbourne, Australia

⁴Dietitians Association of Australia, Melbourne, Australia

Background: Unhealthy diet is one of the greatest contributors to morbidity and mortality worldwide. In western countries, this is predominantly due to its relationship with obesity, cardiovascular disease and diabetes. People with mental illness (MI) experience these comorbidities at unacceptable rates suggesting dietary practices as a key target. Mental health programs are now evolving to include dietitians as routine care.

Objectives: To describe the current literature linking nutrition, mental health and MI including the

Methods: Selective literature review and viewpoint from the Dietitians Association of Australia.

Findings: People with MI have unhealthier dietary practices compared to the general population, a key contributor to the poor physical health in this vulnerable group. Antipsychotic medications, particularly, appear to exacerbate these unhealthy dietary practices. Dietary interventions, as part of more comprehensive lifestyle programs, are effective in improving the physical health of people with mental illness. Epidemiological evidence demonstrates that nutrients and dietary patterns impact on mental health. A preliminary trial found that improving diet quality can improve symptoms of depression, suggesting a further role for dietitians in collaborative care.

Conclusions: Dietitians providing medical nutrition therapy offer an effective adjunctive method for improving the physical, and potentially the mental, health of people living with mental illness.

Presenter 3

Research to Practice: Delivering Clinical Exercise Programs for People Living with Mental Illness

S Rosenbaum^1,2,3, L Czosnek^1,4

¹Exercise & Sports Science Australia, Brisbane, Australia

²UNSW Sydney, Sydney, Australia

³Black Dog institute, Sydney, Australia

⁴Australian Catholic University, Melbourne, Australia

Background: Exercise is a highly acceptable and efficacious adjunct to standard care for people experiencing mental illness. Nonetheless, people living with mental illness face considerable barriers to being physically active and, as such, engage in significantly less structured exercise and have a significantly reduced cardiorespiratory fitness in comparison to the general population. Accredited exercise physiologists (AEPs) are allied health practitioners specializing in exercise prescription for clinical populations.

Objectives: To outline emerging evidence regarding both the preventative and treatment effects of physical activity for people living with mental illness. Referral pathways and models of care incorporating AEPs will also be presented.

Findings: Appropriately targeted exercise interventions can improve both the mental and physical health outcomes for people living with MI.

Conclusions: AEPs are increasingly recognized as important members of the multidisciplinary mental health team. Existing evidence suggests that AEP-led interventions are cost-effective and efficacious in improving outcomes.

Mental Health in Adults with Intellectual Disabilities

T Abuelroos¹, J Trollor², C Bennett¹

¹Victorian Dual Disability Service, Melbourne, Australia

²School of Psychiatry, UNSW Sydney, Sydney, Australia

Background: People with intellectual disabilities (ID) represent 1% of the general population (Maulik et al., 2011) and suffer from a high rate (14–75%) of comorbid mental illness (Buckles et al., 2013). However, the process of assessing and treating psychiatric symptoms in this population is very challenging and may result in inappropriate use of psychotropic medication.

Objectives: In this symposium, we aim to

Methods: A series of presentations will examine the provided data and review the relevant literature.

Findings: A specific ID mental health service is an economically viable option for service delivery in this population. Using the data from a specialist Victorian mental health service for people with ID confirmed that the number of recommendations implemented was significantly associated with positive outcomes for this population. Evidence based use of psychotropic medications is vital for this group.

Conclusions: Further investment is needed in ID specific services to ensure the mental health needs of people with intellectual disability are appropriately met.

References

Buckles J, Luckasson R, Keefe E (2013) A systematic review of the prevalence of psychiatric disorders in adults with intellectual disability, 2003–2010. Journal of Mental Health Research in Intellectual Disabilities 6: 181–207.

Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S (2011) Prevalence of intellectual disability: a meta-analysis of population-based studies. Research in Developmental Disabilities 32(2): 419–436.

Presenter 1

Factors Associated with Health and Social Functioning Outcomes Following the Assessment of A Specialist Mental Health Service for Adults with Developmental Disabilities

T Abuelroos

Victorian Dual Disability Service, Melbourne, Australia

Background: In a previous paper by the same author (Abuelroos, 2017), we illustrated that patients who received an assessment by the Victorian Dual Disability Service (VDDS) had a better improvement in health and social functioning as measured by the Health of the Nation Outcome Scale (HONOS) and Life Skills Profile (LSP) scores after 3 months of the assessment compared to the average improvement in the mainstream mental health service in Victoria. However, the reasons behind this improvement needed further exploration.

Objectives: To investigate the potential factors associated with the improvement in HONOS and LSP scores following 3 months of the VDDS assessment.

Methods: All adult patients who were referred to the VDDS from 1 July 2010 to 30 June 2015 and who received an assessment by the VDDS were included. The HONOS and LSP scores at the point of assessment and on 3-month follow-up were compared. We analysed some of the potential factors implicated in the functional outcome.

Findings: Out of the 439 assessments, the mean change in HONOS scores was 4 points over 3 months and 3 points in LSP scores over the same period. The number of the recommendations implemented, particularly the biological recommendations, showed consistent significant association with the improvement in HONOS and LSP scores.

Conclusions: Executing the recommendations of a specialist dual disability service was associated with better outcomes for this population.

Reference

Abuelroos T (2017) Can a specialist mental health service for adults with developmental disabilities make a difference? The Royal Australian and New Zealand College of Psychiatrists 2017 Congress.

Presenter 2

Building Capacity in Intellectual Disability Mental Health in Local Health Districts: A Cost–Benefit Analysis

J Trollor¹, P Srasuebkul¹, R Reeve², T Heintze¹, S Reppermund¹, NHMRC Partnership Team³

¹School of Psychiatry, UNSW Sydney, Sydney, Australia

²School of Social Sciences, UNSW Sydney, Sydney, Australia

³NHMRC Partnership for Better Health Grant: Improving the Mental Health Outcomes of People with Intellectual Disability, Sydney, Australia

Background: Compared to the general population, people with intellectual disability (ID) experience a range of health disparities, including higher rates of mental ill health and barriers accessing mainstream mental health services. Big Data research from our group documents higher ambulatory, emergency department and inpatient mental health service use in people with ID. Services development for this population must be informed by data on economic feasibility.

Objectives: To propose a service model for delivery of mental health services for people with ID within local health districts (LHDs) in Australia and to model its economic feasibility using Big Data.

Methods: Stakeholders in a National Health and Medical Research Council (NHMRC) Partnerships for Better Heath Grant (ID 1056128) undertook mixed-methods research which analysed inclusion in Australian mental health policy, examined barriers and enablers to access to mental health services and used Big Data to examine mental health profiles and service use of people with ID. Using the project’s knowledge translation framework, a capacity building response for LHDs was formulated and subjected to a health economic analysis.

Findings: The needs of people with ID are beginning to be acknowledged in mainstream mental health policy, but services development lags. Linked administrative data and the experiences of people with ID indicate high service needs, yet services are not appropriately tailored and are inefficient. Economic modelling of proposed service models indicates economic viability of investment in specific ID mental health services.

Conclusions: Improving mental health service provision for people with ID is achievable and affordable in most LHDs.

Presenter 3

Prescribing Psychotropic Medication to People with Intellectual Disability

C Bennett

Victorian Dual Disability Service, Melbourne, Australia

Background: People with intellectual disability (ID) are prescribed psychotropic medication at much higher rates than the general population and in excess of the predicted prevalence of mental illness in this population. The reasons for this are explored including high rates of comorbidity and difficulties in assessment and management. Ethical, legal and governance issues are also identified that could be contributing to the high rates of prescription

Objectives: To review the prescription of psychotropic medication to people with ID.

Methods: Review of the relevant literature.

Findings: That there are factors leading to the over-prescription of psychotropic medication in people with ID.

Conclusions: Principles for the prescription of medication in this population are identified and discussed.

Janssen Neuroscience: Partnering with The Mental Health Community

L Naylor

Janssen-Cilag Pty Ltd, Pharmaceutical Companies of Johnson & Johnson, Auckland, New Zealand

Background: For more than 50 years, since the development of the first breakthrough treatment for schizophrenia, haloperidol, in the 1950s, Janssen’s commitment to mental health has led to innovative products to treat schizophrenia, schizoaffective disorder and bipolar disorder. The legacy in neuroscience is now extending to bring forward new products for Alzheimer’s disease and severe mood disorders. However, the science is only part of the story. Janssen’s commitment to patients extends beyond the medicine. Today’s medical challenges are far more complex than ever. As such, Janssen as a health organization is collaborating with researchers, community organizations, service users, carers and healthcare professionals on initiatives aimed at improving outcomes for people living with serious mental illness.

Objectives: To develop and implement initiatives aimed at improving outcomes for people living with serious mental illness.

Methods: Janssen is working with the mental health community to better understand and drive improvements in mental health service delivery. Our aim is to give patients a voice in their treatment and identify opportunities for improved patient outcomes. Several key initiatives are underway to better understand and raise awareness of the issues in delivering better, more coordinated care for people living with complex mental illnesses.

Findings: Some of the initiatives in partnership with the mental health community will be highlighted in this session.

Conclusions: Innovative products and access to medication must be complemented with initiatives in partnership with the mental health community aimed at improving outcomes for people living with serious mental illness.

Presenter 1

WAKA: Digital Self-Management Tool for Service Users who Experience Schizophrenia

R Tapsell¹, L Mathews², L Toi³

¹Waikato District Health Board, Hamilton, New Zealand

²National Telehealth Service, Homecare Medical New Zealand, LJ Psych Ltd, New Zealand

³Independant Health Consultant, Northland, New Zealand

Background: A key gap, as identified in earlier research, is the provision of relevant and useful self-management support that is engaging and accessible when consumers need it and via a channel that suits them. Another gap is the lack of a safe, secure and moderated peer community where consumers can share, support and learn more about how others have coped and managed their condition. A secondary goal is to improve service users’ engagement with their treatment plans.

Objectives: To develop a digital self-management platform, WAKA tool, that offers moderated peer connection, with engaging and health-literate tips and tools to improve self-management for service users who are prescribed paliperidone palmitate (INVEGA SUSTENNA^®) for schizophrenia management.

Methods: The design and development of the WAKA tool, funded by Janssen, has been led by digital health company Melon Health Ltd with advice from a multi-stakeholder steering group comprising of District Health Board clinicians, service users, pharmacists, mental health nurses, consumer groups and supporting families. The design has also been informed and shaped by research conducted both locally (Janssen and Auckland District Health Board) and internationally at University of California, San Francisco in California. The research outcomes seek to demonstrate the value consumers see in access to social and peer connections (with others who are going through, or have been through, similar experiences) and the need for engaging self-management education and tools online.

Findings: Details of the program and preliminary outcomes, including level of engagement, usability and patient satisfaction with the tool will be presented.

Conclusions: It is anticipated that use of the WAKA program will lead to improvement in recovery experience, reflected by improvement in self-management behaviours and adherence to treatment plans.

Presenter 2

Te Tauoko NGA Tangata – Mental Health Employment Social Impact Bond

C Bakker¹, K Came²

¹Acuo Ltd, Wellington, Auckland, New Zealand

²Advanced Personnel Management, Christchurch, New Zealand

Background: Being out of work can have highly negative psychological and social effects. The rate of suicide for a person out of work is up to six times higher than for someone working. Among many benefits, employment can assist in improving mental health outcomes.

Objectives: New Zealand’s first Social Bond (SB) provides the financial backing for Advanced Personnel Management (APM), which aims to get more people with mental health issues returned into sustained employment with vocational rehabilitation. SBs are a way for governments to utilize private sector funding and skills to drive innovation in delivery of services.

Methods: APM Workcare places jobseekers referred from the Ministry of Social Development (MSD) with diagnosed mental health conditions into sustained employment. The MSD oversees the outcomes to contract employment into six Auckland suburbs (Manukau, Manurewa, Clevedon, Papakura, Pukekohe, and Waiuku). The Bond will gather data about the employment and health outcomes achieved to inform analysis of its cost-effectiveness and allow comparisons with alternative models of service provision. The Bond has four investors: Janssen, a Johnson & Johnson family healthcare company, along with two philanthropic funders and APM Workcare, the service provider.

Findings: New Zealand’s first pilot SB became operational on 1 February 2017. Details of this initiative and preliminary outcomes will be presented.

Conclusions: SB, an innovative funding model, may provide an alternative funding structure that absorbs some of the risks and challenges faced with providing service provision to people with mental health conditions who are out of work.

Presenter 3

KANEKE: A Johnson & Johnson Aotearoa Māori Responsiveness Strategy

M Henare¹, L Naylor²

¹Mira Szászy Business School, The University of Auckland, Auckland, New Zealand

²Janssen-Cilag Pty Ltd, Pharmaceutical Companies of Johnson & Johnson, Auckland, New Zealand

Background: Today, as a population group, Māori have on average the poorest health status of any ethnic group in Aotearoa–New Zealand, with a life expectancy of 7.1 years lower than the non-Māori population. Given the higher proportion of Māori with acute and chronic illnesses, there is a need to develop knowledge and understanding of Māori culture, capabilities and values, which will assist in identifying and developing solutions to Māori health inequities. There is an opportunity for health organizations such as Johnson & Johnson (J&J) to show leadership in taking an innovative approach to the issue.

Objectives: For J&J to work with and through Māori to make a meaningful, measurable contribution to improving Māori health outcomes.

Methods: J&J are pursuing five initiatives: connect and consult with Māori; establish relationships and partnerships with key Māori health sector and community thought leaders; build our understanding of and internal capability in te ao Māori; deepen our knowledge of Māori health needs and the drivers of disparities in Māori health outcomes in the areas we specialize in, and through research to identify, develop and implement new and innovative solutions in these areas to improve health outcomes for Māori.

Findings: In this presentation, Professor Henare will present the Maori Health disparities report commissioned by Janssen and identify opportunities for the private sector to partner and contribute to improving Maori Health.

Conclusions: Understanding the cultural drivers will enable the support and development of culturally sensitive interventions to address causative elements that contribute to poor health outcomes for Aotearoa–New Zealand Māori.

Presenter 4

ATLAS: Working with Community Mental Health and General Practice

V Moudgil¹, F Nolan-Isles², A Stockwell²

¹Metro North Mental Health – Royal Brisbane and Women’s Hospital, Brisbane, Australia

²Innovation and Partnership, Janssen-Cilag Pty Ltd, Sydney, Australia

Background: The healthcare system for people living with schizophrenia is highly fragmented with regular transitioning between acute, community and primary care settings. Coordination of medical appointments and medication management within this complexity was identified as a barrier to improving healthcare outcomes.

Objectives: The ATLAS program was co-created with mental health clinicians to help connect community mental health and general practice and to identify what resources were required to support people living with schizophrenia remain engaged in their treatment and attend appointments.

Methods: Psychiatrists, general practitioners (GPs) and consumers/carers were consulted to provide insights around the health systems communication gaps, and what was required to improve transition from acute/community mental health to primary healthcare and shared care arrangements.

Findings: ATLAS was developed following the consultation process. ATLAS consists of an online clinician dashboard and system of alerts, GP appointment reminders (SMS or phone call), and an optional pharmacy dispensary and delivery service. ATLAS has been running since 2015. The program is being received positively, with high rates of satisfaction from people living with schizophrenia, carers and healthcare providers. GP appointment attendance is 98.5% among consumers enrolled in ATLAS.

Conclusions: Schizophrenia is a debilitating and lifelong chronic disease. ATLAS supports the medical care coordination for people living with schizophrenia as they transition to the primary healthcare setting. The high levels of program satisfaction of program users and the 98.5% GP appointment attendance are successful outcomes for the program.

Faculty of Child and Adolescent Psychiatry Global Mental Health Initiatives: Partnerships in the Asia–Pacific Region

P Robertson¹, A Bush², N Kowalenko³, E Hunter⁴

¹University of Melbourne, Melbourne, Australia

²Health Pasifika Mental Health Service, Capital Coast District Health Board, Porirua, New Zealand

³University of Sydney, Sydney, Australia

⁴James Cook University, Cairns, Australia

Background: The Faculty of Child and Adolescent Psychiatry (FCAP) has actively sought to engage and form partnerships in global child and adolescent mental health (CAMH) predominantly in the Asia–Pacific region.

Objectives: Since 2012, the FCAP has actively supported CAMH in the Asia–Pacific region resulting in a series of projects in Vanuatu, Fiji, Papa New Guinea (PNG) and Sri Lanka. The flagship of this work is the Pasifika Study Group (PSG) facilitated in Melbourne in 2013. Subsequent PSGs were held in Vanuatu (2015) and Noumea (2017). The PSG aims to support and develop CAMH through educational networking activities for mental health practitioners in the Pacific Islands. Doctors from PNG, Fiji, Solomon Islands, Vanuatu, Cook Islands, Tonga, Kiribati and CAMH psychiatrists from New Zealand (NZ) and Australia have attended. The possibility of supporting greater volunteerism to support CAMH in Asia Pacific is being discussed.

Methods: Descriptions of projects, activities and ideas relating to global CAMH in the region are provided. The FCAP PSG planning and process is described including details of the program, tools and case studies. The program evaluation is presented. The development of additional projects is discussed.

Findings: There is increasing activity in partnerships and engagement between Australian and New Zealand child and adolescent psychiatrists with regional partners in CAMH.

Conclusions: The FCAP through the PSG is successful in developing an educational networking project resulting in greater CAMH partnerships and participation in the Pacific region. The PSG has created a platform for ongoing collaborations and seeks to further develop key affiliations in the region.

Member Welfare Symposium

Background: This symposium is an official presentation of the Member Welfare Committee.

Objectives: To provide opportunities for trainees to discuss a range of issues such as burnout, resilience and self-care.

Methods: Presenters will discuss the current literature, share experiences and identify resources that may be helpful for trainees.

Findings: Will be evident on the day.

Overseas Trained Doctors’ Journey on the RANZCP Specialist Pathway

M Fogarty¹, L Rose², A Bhatt³

¹Committee for Specialist International Medical Graduate Education (CSIMGE), The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Substantial Comparability Assessment Review Panel (SCARP), The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

³Assessments and Specialist International Medical Graduate Education (SIMGE), The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: This symposium will provide an overview of the specialist assessment process undertaken by The Royal Australian and New Zealand College of Psychiatrists (RANZCP).

The Australian Health Practitioner Regulation Agency (AHPRA) has appointed each Australian Medical Council (AMC) accredited specialist medical college to undertake assessment of specialist international medical graduates (SIMGs).

In 2013, about 40% of those members who were admitted to the RANZCP Fellowship had received their medical training in a country outside Australia and New Zealand. While some of these overseas trained doctors had gone through the Training pathway, there are a substantial number who had taken the Specialist Pathway process to become fellows of the RANZCP.

The symposium will comprise three presentations:

This symposium will explain the processes for the assessment of comparability that an overseas-trained doctor has to undertake on the RANZCP Specialist Pathway before they can become fellows of the RANZCP. SIMGs who wish to work in New Zealand and obtain the RANZCP Fellowship follow the same assessment processes.

Objectives: To provide information about

Methods: PowerPoint presentation followed by a question and answer session.

Presenter 1

Applying for the Specialist Assessment (Specialist Pathway)

M Fogarty

Committee for Specialist International Medical Graduate Education (CSIMGE), The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: The specialist pathway is for international medical graduates (IMGs) who are overseas-trained specialists seeking specialist registration in Australia (specialist recognition) and/or are applying for an area of need specialist level position in Australia.

The Committee for Specialist International Medical Graduate Education (CSIMGE) is responsible for developing the policies and the assessments and evaluation of specialist international medical graduate (SIMG) qualification equivalencies. This then determines the further training and assessment pathway. Progress through the pathways is monitored by CSIMGE.

The specialist assessment conducted by the Committee and its delegates (State Assessment Panels) is a robust, fair and objective process ensuring a consistent outcome for applicants. Depending on the level of comparability to Australian and New Zealand training, the assessment outcomes can comprise ‘substantially comparable’, ‘partially comparable’ or ‘not comparable’. Not comparable candidates can seek an alternative pathway (such as training), while substantial and partially comparable candidates are required to complete the requirements on their designated pathway.

Objectives: To provide information about

Methods: PowerPoint presentation followed by a question and answer session.

Findings: The specialist assessment of overseas-trained doctors is undertaken within a specified framework which ensures a consistent and objective outcome for all IMG applicants.

Conclusions: The CSIMGE has developed clear and objective processes for the assessment in Specialist Pathways for specialist recognition and Area of Need, ensuring that SIMGs are assessed in accordance with the Medical Board of Australia’s approved definitions for assessment of comparability.

Presenter 2

Requirements of the Substantially Comparable Specialist Pathway

L Rose

Substantial Comparability Assessment Review Panel (SCARP), The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: Candidates whose qualifications, training and experience are deemed to be substantially equivalent to the Royal Australian and New Zealand College of Psychiatrists (RANZCP) training and qualifications are assessed as ‘substantially comparable’. The substantially comparable candidates are required to complete 12 months of workplace-based assessments. The assessment requirements include supervisor reports, multi-source feedback and three case-based discussions (CbDs). The CbDs are assessed by external accredited assessors. Specialist international medical graduate (SIMG) candidates must successfully complete all their requirements before they are eligible to apply for RANZCP Fellowship.

Substantially comparable candidates are required to be employed as consultant specialists and are able to work in areas of need.

The progress of substantially comparable candidates is closely monitored by the Substantially Comparable Assessment Review Panel (SCARP), which reports directly to CSIMGE.

Objectives: To provide information about

Methods: PowerPoint presentation and DVD followed by a question and answer session.

Findings: Almost all candidates assessed as substantially comparable complete this pathway successfully. Data on this will be presented, together with results of a survey of candidates who have completed the pathway, and of the supervisors and assessors who are involved with this pathway.

Conclusions: This substantial comparability Specialist Pathway offers an opportunity to overseas qualified psychiatrists to pursue a 12-month clinical pathway to RANZCP Fellowship.

Presenter 3

Requirements of the Partially Comparable Specialist Pathway

M Fogarty

Committee for Specialist International Medical Graduate Education (CSIMGE), The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

Background: Candidates, whose qualifications, training and experience are deemed to be partially equivalent to the Australian training and qualifications, are assessed to be ‘partially comparable’. The candidates are required to complete 24 months of workplace-based assessments and Royal Australian and New Zealand College of Psychiatrists examination (Essay Style and Objective Structured Clinical Exam, OSCE). The partially comparable requirements for specialist international medical graduates (SIMGs) are aligned to that of the 2012 Fellowship program for trainees at the stage 3 level. This includes two entrustable professional activities (EPAs), one of the observed clinical activities (OCAs) and one of the in-training assessments (ITAs) to be completed in each 6-month period. Candidates must successfully complete their ITAs for each 6-month period before their term can be accredited.

Depending on gaps in a SIMGs overseas training, some candidates may be required to take additional training to satisfy the gaps in their training.

Objectives: To provide information about

Methods: PowerPoint presentation followed by a question and answer session.

Findings: Some SIMG candidates in the previous program have seamlessly transitioned to the new program, which is aligned to the 2012 Fellowship Program for trainees, of whom a number have successfully completed the partial comparability requirements.

Conclusions: The partial comparability Specialist Pathway offers opportunity for IMGs to pursue the partial comparability program and complete any deficits in their training as compared with the local Australian and New Zealand trainees. Once partially comparable candidates successfully complete the Specialist Pathway, they are eligible to apply for the Royal Australian and New Zealand College of Psychiatrists Fellowship.

Social Media: Risks, Rewards and Opportunities for the RANZCP

Background: This symposium is an official presentation of the Membership Engagement Committee (MEC), focusing on the risks, rewards and opportunities for the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to engage with social media platforms. The MEC has broad high-level oversight of membership engagement activities and feedback mechanisms, including providing advice on appropriate strategies to communicate more effectively with RANZCP members. This symposium will explore how social media platforms can provide members with new ways to engage with the college, complementing the existing communication channels. It will discuss how two different platforms, in particular Facebook and Twitter, could be utilized to expand communication and engagement with members.

Objectives: To focus on the advantages and benefits of social media platforms such as Facebook and Twitter, as well as risk-minimization strategies and education for members on the safe use of social media.

Methods: Presenters will discuss the opportunities for the RANZCP to engage with members and facilitate members’ connections with each other via popular social media platforms Facebook and Twitter. An overview of risk-minimization strategies inherent in each platform, along with external guidance, will be presented.

Findings: Will be evident on the day.

Panel Presentation Abstracts

God, the Psychiatrist, the Client – What is ‘Just Right’? A Panel Debate

D Davidson¹, F Wilson²

¹Waitemata District Health Board, Auckland, New Zealand

²Auckland District Health Board, Auckland, New Zealand

Background: Religion/spirituality may influence mental illness (Koenig, 2010), help-seeking, compliance, recovery and rehabilitation (Philipe Huguelet, 2006). Psychiatrists need to be able to assess when these issues are significant in clinical presentations and when religious/spiritual tools may be used for best possible outcomes. Towards this end, the Section of History, Philosophy and Ethics of Psychiatry, of the Royal Australian and New Zealand College of Psychiatrists (RANZCP), has recently drafted a Position Statement on religion and spirituality.

Objectives: To propose a panel debate on when religion/spirituality is relevant in psychiatric presentations, taking into account issues raised in the proposed symposium preceding the panel debate.

Methods: A 10-member panel consisting of consumer representatives, cultural representatives, mental-health chaplain and psychiatrists will debate ‘God, The Psychiatrist, The Client – What is “Just Right?”’ using the proposed RANZCP Position Statement in clinical scenarios encasing cultural presentation, psychosis, depression and anxiety.

Topics will include (subject to some modifications)

Direct audience participation will be encouraged in the debate and by live poll.

Findings: Participant and audience views will emerge from the debate.

Conclusions: Religion/spirituality may inform outcomes in mental illness. Their exploration and use may vary between providers. A Position Statement on religion and spirituality by the RANZCP will provide guidance in incorporating it appropriately into psychiatric practice.

References

Koenig HG (2010) Spirituality and mental health. International Journal of Applied Psychoanalytic Studies 7(2): 116–122.

Philipe Huguelet SM-Y (2006) Spirituality and religious practices among outpatients with schizophrenia and their clinicians. Psychiatric Services 57(3): 366–372.

Curing Mental Illness: Can we? Should We?

GS Malhi¹, JJ Mann²

¹The University of Sydney, Sydney, Australia

²Department of Psychiatry, Columbia University, New York, USA

Background: This debate will address whether mental illness can be cured. The discussants will first debate whether a cure for various mental illnesses is possible, arguing both for and against, and then discuss what a cure might look like. The debate will also delve into the ethical issue of whether a cure for mental illness is desirable and, in particular, how this might change us, both individually and as a society.

Methods: The debate will be interactive – concluding with comments and questions from the audience.

Oral Presentation Abstracts (including PIF Presentation and Rapid Fire Presentations)

Personality Characteristics of Elite Extreme Athletes and Psychopathic Offenders

E Monasterio¹, O Mei-Dan², CR Cloninger³

¹Canterbury District Health Board, Christchurch, New Zealand

²University of Colorado, Boulder, USA

³Washington University School of Medicine, St Louis, USA

Background: Extreme, risk-taking sportspeople, such as elite mountaineers and BASE (building, antenna, span and Earth (cliff)) jumpers frequently engage in sports associated with considerable risk of serious morbidity and mortality. Psychopathic offenders engage in frequent antisocial criminal behaviour associated with considerable risk of harm to others. Elite extreme athletes and psychopathic offenders appear to be psychologically resilient to the effects of trauma and present with low anxiety propensity.

Objectives: To compare and contrast the personality characteristics of elite extreme athletes and psychopathic offenders.

Methods: Elite mountaineers and BASE jumpers completed the Temperament and Character Inventory (TCI-240), which is based on Cloninger’s psychobiological model of personality. The TCI-240 findings of the extreme athletes are compared to TCI-240 findings of psychopathic and non-psychopathic offender populations.

Findings: Two-hundred and fifty-one elite extreme athletes enrolled in the study. TCI-240 findings revealed statistically significant differences between the ‘risk-taking’ sports population and an age-matched control population. The study populations scored higher on measures of novelty seeking and self-directedness and lower on measures of harm-avoidance, reward-dependence and self-transcendence. There are considerable temperamental similarities between extreme athletes and psychopathic offender populations, as they both present with an ‘adventurous temperament’ profile characterized by higher scores on novelty-seeking and lower scores on harm-avoidance and reward-dependence. There are considerable character differences as elite athletes score high on self-directedness, cooperativeness and low on self-transcendence, whereas psychopathic offenders score low on self-directedness, cooperativeness and self-transcendence.

Conclusions: Based on the findings of the TCI, character development differentiates the expression of the ‘adventurous temperament’ profile.

Current Evidence and Use of Physical Activity in the Treatment of Mental Illness: A Literature Review

M Rahman¹, F Lehmann-Waldau¹, R Werfalli²

¹University of Queensland, Brisbane, Australia

²McMaster University, Hamilton, Canada

Background: There is a plethora of literature that discusses the use of physical exercise in the treatment of mental illness. The discussion in the literature goes back to as early as 1979, when a trial was conducted that examined the effectiveness of aerobic exercise in patients diagnosed with depression. The investigators found promising initial results and called for more robust studies to replicate the positive findings.

Objectives: To explore the role of physical exercise in the treatment of mental illness by examining its evidence base through a literature review conducted in March 2016 and updated on August 2017. Additionally, the study includes a discussion regarding its current use in clinical practice along with the necessary partnerships with exercise physiologists.

Methods: Using the search terms ‘physical exercise’ and ‘mental health’ while applying filters for clinical trials, literature reviews, systematic reviews between 2011 and 2016, 574 articles matching the filtered criteria were elicited from PubMed. Exclusion and inclusion criteria were used to extract relevant and robust studies.

Findings: The results revealed that there were systematic reviews of randomized controlled trials (RCTs) which provided evidence for therapeutic benefit of physical exercise in depression, schizophrenia, anxiety and post-traumatic stress disorder. There was also an RCT that showed preliminary evidence for physical exercise as a treatment for attention-deficit hyperactivity disorder.

Conclusions: There is a growing body of evidence that supports incorporating exercise into treatment regimens for a variety of mental illnesses. There is a need for more robust trials focused on optimizing exercise parameters.

A Tale of Two Teenage Pregnancies: Medico-Legal and Ethical Complexities Around Termination of Pregnancy for Under 14s

A Kothari^1,2, S Ghosh³, G Bruxner³

¹Redcliffe Hospital, Redcliffe, Australia

²University of Queensland, Brisbane, Australia

³Caboolture Hospital, Caboolture, Australia

Background: Almost half of the women in Australia have an unplanned pregnancy and the laws governing termination of pregnancy vary between states. In Queensland, under the Criminal Code Act 1899, those that provide termination and the patient may be liable to up to 14 years of imprisonment. With minors, each situation is unique, ethically and emotionally challenging and no course of action is obviated.

Objectives: To discuss the particular challenges related to young women, under 14 years of age, seeking termination of pregnancy.

Methods: Two hypothetical cases are presented and challenges discussed.

Findings: Deciding on the fate of a teenage pregnancy is a complex individual decision-making process. Factors, such as timing of assessment, variation in the gestation period, choice of clinic setting (paediatric versus psychiatric or perinatal clinic), and simultaneous legal, and child safety investigations impact the young patient’s ability to make decisions freely and voluntarily. Legal constraints limit the person’s right to autonomy. Clinical assessment of capacity is based on informed probabilities whereas law requires capacity to be an absolute state. This raises issues around fairness and equality, with more deprived, less able individuals not getting access to safe interventions. Legally defined communal best interest could preclude the patient’s best interest. Particularly, in Queensland, it is uncertain whether economic and social issues can be considered when determining legality of termination of pregnancy.

Conclusions: Clinicians determining legality of a request for termination of pregnancy for a young woman under 14 years of age should use a multidisciplinary approach and professional recommendations of the Royal Australian and New Zealand College of Psychiatrists to aid decision-making.

Medication Error Minimization Project

M Anand^1,2, C Dong^3,4, V Totev⁴, L Stewart^3,4

¹Adult Mental Health Unit, Toowoomba Hospital, Queensland, Australia

²Darling Downs Health, Queensland, Australia

³The Research and Audit in Mental Health Services (REAMS), Queensland, Australia

⁴Counties Manukau Health, Auckland, New Zealand

Background: The authors will present the summary of a 5-year ‘medication error minimization’ project at Acute Adult Mental Health Unit, Counties Manukau Health. A pilot audit tool was devised by the authors to categorize medication errors in an acute inpatient setting. Over 300 charts were analysed and three categories of errors were identified: prescription puzzles, administration muddles and inconsistencies between prescriptions and administration of medications. The pilot audit compared the percentage of errors before and after the introduction of the National Medication Chart in New Zealand (2010 and 2012).

A survey was sent to managers, charge nurses and clinical heads to seek approval for an ongoing audit on a quarterly basis and rate the level of clinical significance with errors and classify them as high, medium, low or clinically irrelevant.

The quarterly audit was set up in a quality improvement ‘plan–do–study–act’ (PDSA) cycle with a focus on minimization of high-risk errors. The audit was linked to organizational policy and procedures and involved a multidisciplinary approach.

The author will present the outcome of an ongoing quarterly audit, raising awareness among registrars, house officers and new graduate nurses by including a presentation as a part of the orientation and involving medication error-free champions in each of the wards. Photographs demonstrating the three types of errors will be presented.

Objectives:

Methods: A pilot audit tool was designed and over 300 medication charts analysed in a busy acute adult inpatient unit in Auckland. The medication errors were carefully documented and categorized into three categories: prescription puzzles, administration muddles and inconsistencies between prescription and administration.

A survey was sent to clinical heads, charge nurses and managers to seek endorsement of an ongoing audit and suggestions for improvement.

A quarterly audit within the quality improvement PDSA framework was implemented. Medication champions were identified in all the wards. Orientation for registrars, house officers and new graduate nurses were improved and medication error discussion included.

Twenty random medication charts were analysed in 2015 following the implementation of the quality improvement activity.

Findings: Following the implementation of the National Medication Chart, errors in all the three categories reduced in certain areas but persisted in others (e.g. wrong or incomplete prescription date, re-charted prescription error, administration illegibility, inconsistent frequency between administration and prescription).

Following a three-pronged quality improvement approach, the medication errors were significantly reduced in all the categories by 2015.

Conclusions: Medication error-free rates can be enhanced by a systematic evaluation of medication errors and implementation of a regular audit, involvement of medication-free champions and improving orientation for registrars, house officers and new graduate nurses.

Quality Improvement in a Child and Adolescent Psychiatric Practice: The Use of Systematic Measures to Rationalize Prescribing

C Yong

South Western Sydney Local Health District, Liverpool, Australia

Background: Prescribing in child and adolescent psychiatric practice is relatively underdeveloped compared to adult psychiatric practice. Fewer guidelines and practice models exist and there is a lack of clinical trials to support the broad use of psychotropic medication. The relative lack of an evidence base was impetus to develop a systematic program of outcome measures to support and inform treatment decisions.

Objectives: To outline the development of routine clinical measures in a community child and adolescent mental health team. Discussion of the barriers to adoption and implementation of suitable measures. Presentation of initial results from the use of measures.

Methods: The implementation of the measures has followed established improvement science methods.

Findings: Choice of validated, simple measures of outcome and to establish symptom baselines have been in use in child and adolescent practice for several years, but mostly to support national funding requirements. Their use to support treatment decisions has been less evident in the literature, outside of specialist research clinics.

Conclusions: The experience in our team is that systematic measures have been helpful in assisting treatment decisions, but establishing the infrastructure for administering the measures has been challenging in the public mental health service context.

Prescribing Antidepressants and Anxiolytic Medication to Pregnant Women: The Perception of Risk of Foetal Teratogenicity Among Australian Specialists and Trainees

A Kothari^1,2, S Williams^1,3, E Ballard⁴, G Bruxner²

¹University of Queensland, Brisbane, Australia

²Redcliffe Hospital, Redcliffe, Australia

³Queensland Health (Gold Coast University Hospital), Southport, Australia

⁴QIMR Berghofer, Herston, Australia

Background: The decision of whether to prescribe antidepressants (AD) and anxiolytics (AX) to pregnant women is a complex one, with serious potential ramifications. Clinicians’ perception of the risk of teratogenicity forms a significant influence on their own prescribing decisions and, in turn, impacts maternal decision-making.

Objective: To discern differences in perceived risk between obstetricians (O&Gs) and general practitioners (GPs) of prescribing these medications in pregnancy. Furthermore, we investigated factors impacting perception, clinicians’ willingness to prescribe and their approach to provision of patient information.

Methods: This study was conducted via a nation-wide online Survey Monkey questionnaire utilizing the database of Royal Australian and New Zealand College of Psychiatrists (RANZCP)-affiliated GP diplomats, fellows and trainees (5409 survey invitations: 545 valid respondents). The responses were then analysed to determine trends.

Findings: Results confirmed a statistically significant difference between O&Gs and GPs, with the latter reporting higher rates of being up to date with the latest medication prescription recommendations (57.6% versus 44.2%). GPs felt more adequately trained to prescribe psychotropic medication (56.1% versus 29.0%). Their levels of confidence in knowledge base, initiation and prescription of antidepressants and anxiolytics consistently exceeded those of O&G. Similar perceptions of likelihood of patient compliance were found, but GPs perceived the extent of patient anxiety as higher (73.7%) compared to O&G (63.1%).

Conclusions: Both clinician groups showed a strong preference for improved training rather than patient-focused technology (>70% for both). Up to 22.3% of clinicians incorrectly ascribed teratogenicity to AD and AXs. Further development of clinician training is warranted.

Outside the Box: How can Psychiatrists be open to Involvement in New Models of Care for Complex Families? An Mst-Can Experience

K Watson

Ozchild MST-CAN Program, Sydney, Australia

Background: Psychiatrists have skills and experience working with clients and families who have a range of complex mental health and psychosocial comorbidities. New models of care are emerging in the health and child protection spheres incorporating wrap around care, with a focus on being trauma-informed, client-centred and strengths-based in treatment models. Psychiatrists face the challenge of establishing our key role in this changing environment.

Objectives: To explore the issues arising for a psychiatrist working in a non-government organization (NGO), as a new model of care and treatment team are established, in partnership with child protection services.

Methods: This presentation explores the process of establishing a Multi-Systemic Therapy for Child Abuse and Neglect (MST-CAN) team in outer urban Sydney, from the perspective of the team psychiatrist.

Findings: There are a range of skills, knowledge and experience that psychiatrists bring to complex care teams. MST-CAN is a structural family treatment model that recognizes this and incorporates a psychiatrist within the model. This partnership can provide both challenges and opportunities for all the participants in establishing such a collaboration.

Conclusions: Psychiatrists have an opportunity to be part of innovative new treatment models and collaborative partnerships, provided we can remain reflective and flexible in our approach. The expertise we bring in complex cases and comorbidity improves the capacity of such models to be successful.

Treatment and Service Issues in Managing Comorbid Substance Use Disorders and Personality Disorders

K Watson

South Western Sydney Drug Health Services, Sydney, Australia

Background: The literature regarding prevalence of personality disorders (PD) among clients with substance use disorders (SUD) describes high rates of comorbidity, over 50% in some studies. The presence of PD comorbidity is associated with higher rates of symptom severity, psychosocial morbidity and risk. Higher levels of distress from PD symptoms have been correlated with more treatment episodes and treatment instability.

PD treatment is evolving with the main focus being a range of deliverable psychosocial treatments. The literature and clinical experience has developed in mental health services (MHS), often excluding clients with comorbid SUD. Some models have been further developed to integrate SUD-specific treatment aspects within the model.

Methods: An exploration of contemporary treatments for PD has identified core elements which are key aspects of providing quality treatment for clients with PD.

Findings: This presentation will review the literature regarding comorbid PD and SUD. It will incorporate an overview of contemporary treatments for PD and the core features of quality treatment for PD.

Conclusions: Discussion will explore the utility and application of evidence-based treatments for PD, and their core elements, in addiction treatment services.

Identifying the Predictors for Risk of Absconding from an Inpatient Psychiatric Unit: A Retrospective Audit Study

S Cabarkapa¹, R Sadhu², J King^3,4

¹St Vincent’s Hospital Melbourne, Melbourne, Australia

²Western Hospital, Melbourne, Australia

³The Melbourne Clinic, Melbourne, Australia

⁴University of Melbourne, Melbourne, Australia

Background: A significant issue faced across acute psychiatric inpatient units is the risk of patients absconding. The implications of this vary in severity, ranging from nil consequences to death. A substantial proportion of inpatient suicides, reported to be up to 21% (Appleby et al., 2016), occur among patients who are absent from wards without staff agreement. Furthermore, absconding also poses a risk to the staff involved in their care, the police and members of the community.

Objectives: To identify the predictors of absconding from a cohort of inpatients at a tertiary psychiatric facility, to help stratify the risk of patients on an individual basis.

Methods: Data were gathered across two psychiatric facilities in South West Victoria to identify the number of patients (approximately 100) who absconded during inpatient stay over a 2-year period (2015–2016). The data were collated in an Excel spreadsheet including patient demographics, length of stay and other parameters to identify the potential predictors. Basic statistical analysis was applied to the data to find statistical significance.

Findings: Findings were consistent with the literature in terms of the greatest risk of absconding found among male patients with a previous history of absconding. Statistical analyses are still in the final stages of processing.

Conclusions: Factors have been identified to predict the likelihood of absconding and could lead to the development of strategies to minimize the chance of absconding. Further research is needed to delineate potential modalities for the screening and identification of high-risk patients.

Reference

Appleby LA, Kapur, N, Shaw, J et al. (2016) The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Making mental health care safer: annual report and 20-year review. University of Manchester. Available at: http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/nci/reports/2016-report.pdf (accessed 10 October 2017)

Psychotropic Medication Profile in Youth Mental Health Settings in Australia

A Dharni¹, D Coates², S Padencheri²

¹Wyong Public Hospital, Hamlyn Terrace, Australia

²Gosford Hospital, Central Coast Local Health District, Gosford, Australia

Objectives: There is a trend towards a rapid increase in prescriptions of psychotropic medications dispensed in the child and adolescent population. Widespread and unchecked use of psychotropic medication in children and adolescents is a matter of concern as they often cause endocrine and metabolic side effects. This study sought to identify psychotropic prescribing pattern in a public mental health service for young people who experience non-psychotic mental health problems.

Method: We conducted a retrospective chart review of all young people aged 12–17 years who received care from a youth mental health service in 2016 (N = 191) who presented with a range of mental health issues excluding psychosis. We documented psychotropic medications, prescribed medications, prescriber, reason and side effects.

Results: More than 60% of young people (62.2%, n = 117, N = 191) were prescribed psychotropic medication. Of these, nearly one-quarter (24%, n = 46) were prescribed antipsychotics (for non-psychotic conditions), 51.8% (n = 99) antidepressants, 17.8% (n = 34) both antipsychotics and antidepressants and 6.2% (n = 12) were on attention-deficit hyperactivity disorder (ADHD) medications. Among those on antipsychotics, quetiapine was the most prescribed (71.74%, n = 33) predominantly for the treatment of insomnia (76%, n = 26). The majority of prescribers for all medications were public psychiatrists (64.6%, n = 75) followed by general practitioners (26.7%, n = 31) and paediatricians (8.6%, n = 10).

Conclusions: A high proportion of young adults are being prescribed psychotropic medication, including antipsychotic medication for the treatment of non-psychotic conditions. Given the side effect profile of psychotropic medication, particularly for antipsychotic medication, this is of concern.

Innovative Collaboration (Nurse Practitioners and Psychiatrists in Private Practice)

J Seymour, M Walker

Nepean Blue Mountains Local Health District, Penrith, Australia

Background: For the past 2 years, the Blue Mountains Psychiatry Practice has employed an experienced Mental Health Nurse Practitioner (NP) to complement consumer care. This is a part-time appointment allowing for treatment variety for consumers extending from crisis interventions to psychotherapies and collaborative information exchange with other agencies. Many consumers are psychogeriatric patients with complex medical comorbidities.

Objectives: To showcase the psychiatrist’s vision for the collaboration and strategic direction in the practicalities of setting up the service. The NP will showcase the consumer demographics in relation to diagnosis, interventions, prescribing and follow-up.

Methods: Patient statistics on demographics will be displayed graphically and discussed. Patient files will be reviewed as to therapeutic interventions provided. Medical director prescriptions will be reviewed as to prescribing practices, and consumer perspectives of the NP role will be reviewed.

Findings: Demonstrated effectiveness of the collaborative practices will be discussed in relation to patient care and positive outcomes. Limitations of the NP role will also be discussed with respect to suggested changes. Consumers’ perspectives of the collaboration will be presented.

Conclusions: A psychiatrist’s view of the collaborative efforts made to improve consumer outcomes. Where to from here? Further visionary changes to practice.

Brief Psychodynamic Psychotherapy

N Jeyasingam

The University of Sydney, Sydney, Australia

Background: Psychodynamic psychotherapy is enjoying a resurgence, with increased awareness of its benefits when provided in a session-limited form. With reformations in the Better Access scheme, there is an excellent opportunity to see a wider range of patients being able to receive its benefits. With this novel opportunity comes both unrealistic expectations as well as a higher risk of therapeutic nihilism.

A Systematic Review and Meta-Analysis of the Efficacy of Internet-Delivered Behavioural Activation

S Kisely^1,2,3, A Huguet^3,4, A Miller^3,4, P McGrath^3,4, S Rao⁵, N Saadat⁶

¹School of Medicine, University of Queensland, Brisbane, Australia

²Metro South Addiction and Mental Health Service, Brisbane, Australia

³Dalhousie University, Halifax, Canada

⁴IWK Health Centre, Halifax, Canada

⁵Ottawa University, Ottawa, Canada

⁶Royal Ottawa Mental Health Centre, Ottawa, Canada

Background: There is growing evidence for behavioural activation (BA) in a range of disorders both delivered in person and via the internet.

Objective: To determine the conditions in which the efficacy of internet-based BA has been evaluated and to assess its efficacy along with the quality of evidence.

Method: Studies were identified from electronic databases (EMBASE, ISI Web of Knowledge, Medline, CINAHL, PsychINFO, Cochrane) and reference lists of included studies. Two reviewers independently screened articles for inclusion and extracted data and assessed the quality of evidence for each outcome for which a pooled effect could be estimated by using The Grading of Recommendations Assessment, Development and Evaluation framework.

Findings: We found nine randomized controlled trials (RCTs) of 2152 adult participants, all of whom had depression. Random effects meta-analyses showed that internet-based BA was non-inferior to other forms of behavioural therapy and mindfulness that were delivered in person and was superior to physical activity, psychoeducation or treatment as usual and waitlist in reducing both depressive and anxious symptoms post-treatment and at follow-up. Study quality was low to moderate.

Conclusions: Evidence for the efficacy of internet-based BA for depression is promising and this may be a cost-effective alternative to treatment that is delivered in person. Further research is needed to determine its use efficacy in other diagnoses.

Electroconvulsive Therapy for Borderline Personality Disorder: The Potential Slippery Slope

T Mohan

Flinders University, Adelaide, Australia

Background: Clinician responses (e.g. electroconvulsive therapy, ECT) to manage depressive symptoms in borderline personality disorder (BPD) may evoke specific transference/countertransference dynamics – and withdrawal of such responses may precipitate an abandonment crisis (Rasmussen, 2015). ECT’s symbolism as an external cure for a personality problem may further complicate future expectations by the patient placed on the treating team – and transfers the responsibility to recover – from the self to the other.

Objectives: To discuss the role of ECT in BPD, accounting for the personality dynamics at play.

Methods: A comprehensive search of the literature pertaining to ECT in BPD would be conducted.

Findings: Literature about ECT in borderline and other personality disorders supports the role of this intervention irrespective of the personality style. However, the symbolic meaning of ECT within a personality disorder construct should be given due consideration. The therapeutic value of ECT in personality disorders should be understood within a context – rather than as a straightforward external remedy.

Conclusions: ECT is a valuable intervention in BPD – provided the psychiatric formulation clearly identifies the proportion of psychopathology that is likely to be managed by a robust biological intervention. Practice of ECT in personality disorders as a ‘just in case’, ‘last resort’, ‘risk aversion’ or ‘rescue’ type of intervention – without a clear understanding of the intricate dynamics involved – is likely to end up in a slippery slope of the psychiatrist taking on responsibility for the patient’s behaviour.

Reference

Rasmussen KG (2015) Do patients with personality disorders respond differentially to electroconvulsive therapy? A review of the literature and consideration of conceptual issues. Journal of ECT 31(1): 6–12.

Predictors of Repetition of Suicidal Behaviour and Deliberate Self-Harm in a Population of Help-Seeking Young People

C McHugh, N Glozier, I Hickie

Brain and Mind Centre, University of Sydney, Sydney, Australia

Background: A move to early intervention in psychosis and mood disorders in Australia has led to the development of primary mental healthcare centres, headspace, for young people aged 12–30 years old. Longitudinal population studies have suggested suicidal behaviours in young people without major mental illness will spontaneously resolve without specialist care with transition into adulthood. It is not clear whether the suicidal behaviour of young people in this new cohort is in keeping with our knowledge of such behaviour in the population.

Objectives: To determine rates of repetition of suicidal behaviour at 12-month follow-up and whether baseline demographic, clinical or health service use variables predicted repetition.

Methods: The current study included 802 participants, of whom 511 (69% females, mean age 18.33 years) completed follow-up assessment at 12 months.

Findings: Of 187 young people who had made a suicide attempt or deliberately self-harmed at baseline, 51% had repeated the behaviour by follow-up at 12 months. Rates of repetition were higher in females than males. Of the sociodemographic variable measures, only sexual orientation predicted repetition.

Suicidal ideation at baseline was associated with greatly increased risk of repeating suicidal behaviour. Transdiagnostic clinical staging showed rates of repetition increased significantly from stage 1A (non-specific symptoms) to stage 1B (attenuated syndrome).

Conclusions: The high rate of repetition in this cohort suggests continuing suicidal and distress over the study period. Although it is not possible to determine whether engaging with youth-focused primary mental healthcare is preventing repeat episodes of suicidal behaviour, it would appear provision of these clinical services is warranted given the burden of disease.

Is Anxiety and Depression Research in Adults with Cancer Dominated by a Single Cancer Type?

B Bravery¹, T Richardson^1,2, M Murphy^2,3

¹University of Notre Dame Australia, Sydney, Australia

²St Vincent’s Hospital Sydney, Sydney, Australia

³University of New South Wales, Sydney Australia.

Background: Cancer patients and survivors are four times more likely to suffer from anxiety and/or depression than the general population (Linden et al., 2012; Mitchell et al., 2011). Rapid growth in psycho-oncology research has occurred; however, its generalizablity remains unclear, with some positing that oncological research across the board has been breast-cancerized and remains dominated by experiences in breast cancer (Bell, 2014, 2015).

Objectives: The applicability of this perceived bias in research on anxiety and/or depression in people with cancer remains unknown. This study will quantify anxiety and/or depression research in adults with cancer according to tumour type and compare this to population-wide tumour burden and psychiatric burden within tumour types.

Methods: By early 2018, a systematic review of anxiety and/or depression research in adults living with cancer published from 2011 to 2016 will have been undertaken. Studies will be quantitatively described and classified according to study design, tumour site and participant characteristics. Statistical analyses and summary graphics will be used to determine parity between research effort and disease burden. Ethics approval is complete.

Findings and conclusions: Psychiatrists in both public and private practice should be aware of trends in psycho-oncology and their practical use or limitations. This study will examine a concern that psycho-oncology research is dominated by a particular tumour stream (i.e. breast cancer). Should disparity exist, researchers and funders will be prompted to examine psychiatric burden in underexplored cancer types; should disparity not exist, arguments for an improved distribution of psycho-oncology research will cease.

References

Bell K (2014) The breast-cancer-ization of cancer survivorship: implications for experiences of the disease. Social Science & Medicine 110: 56–63.

Bell K (2015) Breast vs. the rest: a response to Koczwara and Ward. Social Science & Medicine 128: 344–346.

Linden W, Vodermaier A, Mackenzie R, Greig D (2012) Anxiety and depression after cancer diagnosis: prevalence rates by cancer type, gender, and age. Journal of Affective Disorders 141(2–3): 343–351.

Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncology 12(2):160–174.

Experience of New Mothers with Borderline Personality Disorder Completing a Mother–Infant Dialectical Behaviour Therapy Group: An Interpretative Phenomenological Analysis

E Jureidini¹, A Sved-Williams², C Yelland²

¹Women’s and Children’s Health Network, Adelaide, Australia

²Helen Mayo House, Adelaide, Australia

Background: Borderline personality disorder (BPD) can have a profound impact on maternal functioning and the outcomes of offspring (Eyden et al., 2016; Petfield et al., 2015), with high rates of intergenerational transmission (Eyden et al., 2016). There are no specific treatments that reduce this impact on the mother–infant dyad (Kowalenko et al., 2013). A public mother–baby unit in South Australia has created a novel form of dialectical behaviour therapy (DBT), which aims to address symptomatic burden and improve parenting capacity, with a view to reducing distress and improving outcomes.

Objectives: To determine how women perceived their experience of participating in mother–infant DBT and its impact on their symptom burden, parenting skills and children.

Methods: Interpretative phenomenological analysis of semi-structured interviews of 10 women who had completed the pre-intervention interview, 26 weeks of treatment and post-intervention interview was conducted.

Findings: The women who completed mother–infant DBT were motivated to seek treatment to improve the experience of their children and disrupt the intergenerational transmission of BPD. They reported a reduction in their symptom burden (particularly anger and difficulties with self-esteem and interpersonal effectiveness) and increased parenting skills (namely the capacity to tolerate their child’s distress and increased mentalizing capacity).

Conclusions: Mother–infant DBT is a novel treatment showing positive impacts on a new mother’s skills, confidence in, and enjoyment of, parenting. Given the reported improvement in mentalizing capacity and capacity to tolerate their child’s distress, it has further significant potential impacts on the well-being of children and a reduction in the intergenerational transmission of this distressing illness.

References

Eyden J, Winsper C, Wolke, Broome MR, MacCallum F. (2016) A systematic review of the parenting and outcomes experienced by offspring of mothers with borderline personality pathology: potential mechanisms and clinical implications. Clinical Psychology Review 47: 85–105.

Kowalenko NM, Mares SP, Newman LK, Sved Williams AE, Powrie RM, van Doesum KT. (2013) Family matters: infants, toddlers and preschoolers of parents affected by mental illness Medical Journal of Australia 199(3 suppl): S14–S17.

Petfield L, Startup H, Droscher H, Cartwright-Hatton S. (2015) Parenting in mothers with borderline personality disorder and impact on child outcomes. Evidence Based Mental Health 18(3): 67–75.

‘3PR’ of Risk Assessment – A Visual Record of Assessed Risk for Suicide and Homicide

A Djurkov

Te Rawhiti CMHC, Counties Manukau Health, Auckland, New Zealand

Background: Assessing safety risk has become a necessary part of psychiatric and primary care clinical practice. It is a skill scrutinized by management and public in cases of suicide and homicide. There are many algorithms and scales to assess that risk which have been used variably, creating inconsistency and confusion.

Objectives: To suggest a tool that has been helpful for me. Using a simple memory and visual tool might make safety risk assessment easier, simpler and unified.

Methods: Over the years, I have worked a simple memory tool to remind me what not to miss when assessing safety risk using the ‘3PR’ acronym. That memory tool could be recorded as a diagram on a written document including on a referral form or on a safety risk assessment form.

Findings: The 3PR has been a helpful personal reminder of what to assess when exploring safety risk and might be useful for others, including primary care health professionals who refer their patients to a mental health service.

Conclusions: Given the lack of universal approach to quickly assessing and recording safety risk, this simple tool is worth considering but it needs testing on a larger scale than an individual psychiatrist’s clinical practice.

Psycho-Dialysis? The Holding Potential of the Renal Dialysis Unit

D Brass

St Vincent’s Hospital Melbourne, Melbourne, Australia

Background: Depression and anxiety are common in chronic kidney disease and particularly in dialysis patients. Psychological therapies are central to treatment for depression. This paper seeks to consider the concept of the dialysis unit (suite and staff) as a ‘holding’ environment.

Objectives:

Methods: This is a qualitative paper based on an extensive review of theoretical and creative literature discussing dialysis, psychiatry and psychotherapy. It will test how certain concepts from that literature can usefully be applied to the dialysis setting and can offer novel ways of thinking about the role of the dialysis staff.

Findings: Dialysis nurses have frequent and long-term contact with dialysis patients. A priority for liaison psychiatry services is to engage dialysis staff as partners not only in treating mental illness in dialysis patients but also in maintaining mental health by increasing awareness of their psychological function. Whether this includes direct consultation with the patient or not, dialysis staff have a fundamental role in prevention of mental illness among dialysis patients.

Conclusions: A challenge for both nephrology and psychiatry is to consider alternatives to a narrow focus on direct psychiatric consultation as a response to a perceived mental health ‘problem’. This consultation-based approach only benefits a small proportion of dialysis patients and tends to be requested only after significant problems have developed.

Liaison psychiatry has a vital role in recognizing and developing the psychotherapeutic potential of the dialysis unit. This concept of the dialysis unit as a ‘holding’ environment opens possibilities that could benefit both patients and staff, including in the prevention of mental illness.

Psychiatry and the Accident Compensation Corporation – Opportunities and Developments

K Fernando, S Dominguez

Accident Compensation Corporation (ACC), Wellington, New Zealand

Background: The Accident Compensation Corporation (ACC) is a Crown entity set up to deliver New Zealand’s accident insurance scheme as set out in the Accident Compensation Act 2001 (the Act). The Act sets out three core functions for the Scheme: injury prevention, rehabilitation and compensation.

The ACC provides comprehensive, 24-h, no-fault personal injury cover for New Zealand residents and visitors to New Zealand. The ACC’s role is to prevent injury, treat it when it occurs and rehabilitate people back to productive life as soon as is practicable and at a reasonable cost.

The rate of mental health problems among ACC clients is being increasingly recognized with a greater emphasis on early identification of mental health difficulties and early intervention.

Objectives:

This is not a research presentation but rather is focused on providing education regarding the ACC and outlining roles and opportunities for psychiatrists. Some basic research findings will be presented in terms of outcome data for ACC’s sensitive claim services.

Early Career Matters: Mindset, Mentor and Meaning

L Ng¹, R Steane², N Scollay³

¹The University of Auckland, Auckland, New Zealand

²Canterbury District Health Board, Christchurch, New Zealand

³Auckland and Waitemata District Health Boards, Auckland, New Zealand

Background: Amid a constant grind of pressure in our professional lives, we pose the question: ‘How do we rise effectively to meet systemic challenges within complex organizations, rather than merely surviving them as individual professionals?’

Objective: To explore how mindset, mentoring and sustainable working practices matter at the early career stage of a psychiatrist.

Methods: We report on ideas generated from specific training opportunities created by early career psychiatrists to support leadership development, mentoring and work–life balance (Ng et al, 2017; Ng et al, 2018).

Findings: Early career psychiatrists identified the importance of developing a platform for their career as a basis for realizing their leadership potential.

Conclusions: In transitioning from trainee to specialist, shifts in professional identity occur as early career psychiatrists develop awareness of broader systemic factors in clinical care. A mindset, distinct from a skill set of knowledge, may be an emergent quality for those seeking to make the leap into leadership.

References

Ng L, Steane R, Chacko E, Scollay N (2017) Things I wish I’d known: desiderata for early career psychiatrists. Australasian Psychiatry 25(1): 75–81.

Ng L, Steane R, Scollay N (2018) Leadership mindset in mental health. Australasian Psychiatry 26(1): 95–97.

‘Partnerships with Peers’: The Development of the 2017 Trainee Report for the Australian Medical Council Review of the RANZCP

R Graham^1,2,3, M Renzenbrink^1,4

¹Trainee Representative Committee, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²University of Tasmania, Hobart, Australia

³Royal Hobart Hospital, Hobart, Australia

⁴Sydney Local Health District, Sydney, Australia

Background: The Australian Medical Council (AMC) is the national body that oversees the process of assessment and accreditation of specialist medical programs. In 2017, the AMC undertook a comprehensive review of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP’s) training program and, as part of this process, requested that the Trainee Representative Committee (TRC) submit a comprehensive trainee report.

Objectives: To explore the process (not the content contained within) of completing the comprehensive trainee report. Collaboration with peers was a vital component of creating a report that reflected the experience of all Australian trainees.

Methods: Many trainees contributed to the report. In addition to the TRC, independent trainee groups (Association of Psychiatry Trainees (APTs)) were invited to submit a combined response and individual non-TRC representative trainees made further contributions. The process of supporting these trainees to provide meaningful feedback will be explored in addition to discussing the general AMC standards against which the report was written.

Findings: The TRC had to balance fostering partnerships with non-TRC peers against maintaining confidentiality when developing the report. The TRC also had to balance their trainee advocacy role with their relationship as part of the broader RANZCP structure. The final comprehensive trainee report (content will not be discussed) was 24 pages long and was submitted to the AMC on 31 August 2017.

Conclusions: This was the first comprehensive AMC review where trainees were invited to submit a comprehensive report. Lessons learnt through this process will be discussed, along with an update of subsequent processes that occurred after the submission of the report.

What Should ‘Co-design’ Mean for Formal Education Courses?

R McKay^1,2

¹HETI (The Health Education and Training Institute), Sydney, Australia

²UNSW Sydney, Sydney, Australia

Background: Mental health policy in Australia and New Zealand strongly promotes ‘co-design’ as essential to improving mental healthcare, with statements such as the following: ‘Governments are committed to equitable, practical, authentic co-design with consumers and carers in the implementation of Fifth Plan actions. Collaborative partnerships with consumers and carers are integral to successfully implementing changes that improve outcomes for people …’ (Commonwealth of Australia, 2017).

Objectives:

Methods: Semi-structured literature review, reflection upon experience in developing the Health Education and Training Institute (HETI) Formal Education Course and related engagement with trainees, consumers and carers.

Findings: Co-design is an approach to design in which all stakeholder are involved in the design of products or services. Relevant mental health literature focuses upon increasing consumer and carer involvement in the design (and delivery) of services. Educational literature explores the benefits and challenges of involving students and teachers in the design and delivery of learning but rarely focuses on postgraduate education. Both areas of research report increased satisfaction by a range of stakeholders through co-design and, at least, the potential for improved outcomes.

Conclusions: Formal education courses must consider trainees their primary ‘users’ and increase their involvement in course design and delivery; while also preparing trainees for working with, and learning from, consumers and carers. The methods by which this can happen probably will vary with stage of training and the context within which formal education courses are delivered.

Reference

Commonwealth of Australia (2017) The Fifth National Mental Health and Suicide Prevention Plan. Canberra: Department of Health.

Fronto-Limbic Dysconnectivity Leads to Impaired Brain Network Controllability in Young People with Bipolar Disorder and Those at High Genetic Risk

J Jeganathan^1,2, A Perry^2,3, D Bassett^4,5, G Roberts^3,6, P Mitchell^3,6, M Breakspear^2,7

¹Western Sydney Local Health District, Sydney, Australia

²QIMR Berghofer Medical Research Institute, Brisbane, Australia

³School of Psychiatry, UNSW Sydney, Sydney, Australia

⁴Department of Bioengineering, University of Pennsylvania, Philadelphia, USA

⁵Department of Electrical and Systems Engineering, University of Pennsylvania, Philadelphia, USA

⁶Black Dog Institute, Prince of Wales Hospital, Sydney, Australia

⁷Metro North Mental Health Service, Brisbane, Australia

Background: Recent investigations have revealed disturbances in the neurocircuitry that underlies cognitive–emotional control in bipolar disorder (BD) and those at familial high risk (HR). It has been difficult to quantify how structural changes lead to the emotional lability that characterizes BD. Average controllability is a concept from network control theory that estimates how local neuronal fluctuations spread to alter the state of the rest of the brain

Objectives: To use theory to ask whether structural connectivity deficits observed in HR and BD translated to differences in the ability of brain systems to be manipulated between states.

Methods: Diffusion-weighted magnetic resonance imaging was used to generate structural networks for 38 patients with BD, 84 HR participants and 96 matched controls. For each subject, average controllability was measured over three granularity levels: nodes, subnetworks and modules.

Findings: Localized impairments in network controllability were seen in the left parahippocampal, middle occipital, superior frontal and right inferior frontal and precentral gyri. Subjects with BD had distributed deficits in a subnetwork containing the left superior and inferior frontal gyri, postcentral gyrus, and insula (p = 0.004). HR subjects had controllability deficits in a right-lateralized subnetwork involving the dorsomedial and ventrolateral prefrontal cortex, superior temporal pole, putamen and caudate nucleus (p = 0.008). Some previously reported differences in network connectivity were not associated with differences in controllability, likely reflecting the contribution of complex network properties.

Conclusions: These analyses highlight the potential functional consequences of altered connectivity in bipolar disorder and may guide future clinical interventions.

An Attempt to Explore the Mental Struggles of the Suicidal Patient with the help of Linehan and Joiner

A Djurkov

Counties Manukau Health, Auckland, New Zealand

Background: Suicidal patients have barriers sharing their wish to die and their suicidal thoughts. Using the Reasons for Living Inventory (Linehan et al., 1983) promotes introspection and discussion and could stimulate a partnership between the patient and the clinician to deal with suicidal risk. There are multiple ways to assess suicidal risk but not many are based on a meaningful and well-researched theory (Interpersonal Theory of Suicide; Joiner et al., 2009) that looks at both sides of suicidal risk – not only a wish to die but also an ability to kill yourself.

Objectives: Realizing that the statements in the Reason for Living Inventory directly explore both sides of patients’ suicidal risk as identified by Joiner’s theory, I aimed to use that combination when assessing suicidal risk.

Methods: I identified the statements in the Reason for Living Inventory closely linked to the suicidal dichotomy between wish to die and ability to suicide as defined by Joiner’s interpersonal theory and then used the Inventory to promote discussion with suicidal patients about their risk to act.

Findings: I found that using the Reasons for Living Inventory helps my suicidal patients to open up about their suicidal struggles and helps create a partnership in exploring and managing suicidal risk.

The combination of Linehan’s Reasons for Living Inventory and Joiner’s interpersonal theory gives valuable information about suicidal risk.

Conclusions: With help from Linehan and Joiner, we could develop a successful partnership with the suicidal person to assess and manage suicidal risk. That idea needs testing on a wider scale.

References

Joiner TE Jr, Van Orden KA, Witte TK, Rudd MD (2009) The Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients. doi:10.1037/11869-000

Linehan MM, Goodstein JL, Nielsen SL, Chiles JA (1983) Reasons for staying alive when you are thinking of killing yourself: the reasons for living inventory. Journal of Consulting and Clinical Psychology 51: 276–286.

Epilepsy and Psychogenic Non-Epileptic Seizures – Different but the Same: Mortality, Neuropsychiatric and Sleep Morbidity in Video EEG Monitoring Units

D Velakoulis¹, L McCartney¹, R Nightscales², S Adams^3,4, S Sivathamboo^2,5, B Johnstone², A McIntosh², C Malpas⁶, S Farrand¹, Z Chen⁵, A Pattichis^2,5,7, E White², C Roberts^2,5, C Hollis², J Carino², N Jones⁵, R Yerra², C French^2,5, P Perucca^2,5, P Kwan^2,5, J Goldin⁷, T O’Brien^2,5

¹Neuropsychiatry Unit, The Royal Melbourne Hospital, Melbourne, Australia

²Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia

³Orygen Youth Health, Melbourne, Australia

⁴headspace, Melbourne, Australia

⁵Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia

⁶Murdoch Children’s Research Institute, Melbourne, Australia

⁷Department of Respiratory and Sleep Disorders Medicine, The Royal Melbourne Hospital, Melbourne, Australia

Background: The study of neuropsychiatric aspects of epilepsy has a long and rich literature. Many studies were undertaken prior to the advent of video electroencephalogram (EEG) monitoring (VEM) (now recognized as the gold standard for the diagnosis of epilepsy and psychogenic non-epileptic seizures).

Objectives: To describe a series of studies examining large, well-characterized cohorts of VEM patients from Melbourne, Australia, who have had comprehensive neurological, neuropsychiatric, polysomnographic, cognitive and psychosocial assessments.

Methods: Retrospective and prospective investigations of patients undergoing VEM at Royal Melbourne Hospital and St Vincent’s Hospitals’ VEM units.

Findings: Patients with psychogenic non-epileptic seizures (PNES) exhibit rates of mortality, sleep and neuropsychiatric morbidity equivalent to those seen in patients with epilepsy.

Conclusions: These findings highlight the need for greater awareness and assessment of comorbid neuropsychiatric and sleep disorders in patients with epilepsy and PNES.

Bipolar Spectrum Disorders and Associated Factors Among Adults Attending Anti-Retroviral Therapy Clinic in Gedeo Zone Health Centres, Southern Ethiopia, 2017

Z Belayneh^1,2

¹Dilla University, College of Medical and Health Science, Dilla, Ethiopia

²Dilla University Referral Hospital Psychiatric Clinic, Dilla, Ethiopia

Background: Bipolar spectrum disorders are more common among human immunodeficiency virus (HIV)-positive individuals than the general population. Although bipolar disorders have such diverse and devastating consequences (e.g. immune suppression, cognitive impairment and poor medication adherence), little is known about bipolar spectrum disorders among HIV-positive individuals in Ethiopia.

Objective: To assess the prevalence and associated factors of bipolar spectrum disorders among adult patients attending an anti-retroviral therapy(ART) clinic in Gedeo zone health centres, Southern Ethiopia.

Methods: A cross-sectional analytical study was conducted by screening 412 randomly selected HIV-positive individuals using the Mood Disorder Questionnaire (MDQ). Data analysis was conducted using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to identify factors associated with bipolar spectrum disorders. Odds ratio (AOR) was computed to determine the level of significance with a 95% confidence interval (CI).

Results: Of a total of 412 participants, 11.2% screened positive for bipolar spectrum disorders. Lower CD4 count (AOR = 2.975; 95% CI: 1.119, 7.908), past history of a bipolar-related mental health problem (AOR = 3.35; 95% CI: 1.576, 7.144), poor social support (AOR = 2.65; 95% CI 1.063, 6.639) and poor ART drug adherence (AOR = 3.591; 95% CI: 1.788, 7.21) had a statistically significant association with bipolar spectrum disorders.

Conclusions: The result of this study showed that bipolar spectrum disorders are more frequent among patients attending ART clinics, which demonstrates a need for integration of mental health with HIV/AIDS care.

A Developing Model for Rural Mental Healthcare in India

R Gupta

Pandit Bhagwat Dayal Sharma, University of Health Sciences, Rohtak, India

Background: Despite more than 80% of the population of India lives in rural areas, most psychiatrists and the tertiary healthcare centres are located in urban areas. In developing countries like India, the psychiatry teaching and care models are largely following those in the West. This may be successful in urban areas with enough specialists and infrastructure; however, in rural areas where both are deficient, we need to think of innovative ways that are culturally appropriate, relevant, acceptable and penetrate well into previously unreached and remote areas.

Objectives:

Methods: The Society for Rural Mental Health was raised by dedicated professionals working in the field of mental health. We organized workshops to develop Information, Education and Communication (IEC) materials and awareness camps in the villages where our teams stayed and could thoroughly evaluate their understanding of mental health and needs.

Findings: Stigma, lack of knowledge, poor health practices, lack of health services and trained staff, poverty, faith healers and exploitation by religious and spiritual gurus are important impediments to service delivery.

Conclusions: There is an urgent need to develop rural psychiatry and learn from the experience of professionals working in different countries in this area. Evolving a model which links rural with tertiary and urban centres and incorporating interactive activities using modern technology is required.

The Challenges and Rewards of Building and Supporting Psychiatric Services in the Solomon Islands – The Need for Multiple Partnerships

F Hawker¹, P Orotaloa², R Maukera³

¹Solomon Island Project 2017, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

²Psychiatrist National Psychiatric Unit, National Referral Hospital, Honiara, Solomon Island

³Psychiatrist National Psychiatric Unit, Kilu’ufu Hospital Malaita Province, Solomon Island

Background: Two Solomon Island (SI) psychiatrists are working in this tropical island nation with a population of nearly 600,000 people. It is a nation with broad and complex mental health needs, a dispersed, largely subsistence agrarian society. Although rich in lush, fertile flora and plentiful fishing, they contend with severely limited resources, problems accessing many isolated small communities and professional isolation.

There has been an established practice of the Solomon Island Health Services accessing surgical support through the Department of Foreign Affairs and Trade funded Pacific Island Program (PIP) and, in November 2017, the first requested PIP-facilitated visit from psychiatrists occurred, and for a week the Royal Australian and New Zealand College of Psychiatrists Fellows Dr Peter Norrie and Dr Fiona Hawker worked alongside the SI psychiatrists Dr Paul Orotaloa and Dr Rex Maukera.

Objectives: To outline the pertinent history, culture and the current challenges that confront the development of mental health services in the Solomon Islands, in addition to special strengths and qualities within their people and culture. There is a strong, supportive family and community connectedness, an apparent predisposition to happiness and a well-established willingness to seek and work in partnership with a wide range of supports.

Conclusions: In developing the partnerships that are likely to be most constructive in the ongoing development of mental health services in these beautiful tropical islands, it is important to understand and build on the unique strengths of the Solomon Islands, while adapting what is most appropriate from our first world resources and knowledge base.

RANZCP Peer Review Groups: Literature Review and Future Research Directions

S Prager¹, J Lancaster¹, L Nash², A Karageorge²

¹Consultant Psychiatrist, Melbourne, Australia

²Brain and Mind Centre, University of Sydney, Sydney, Australia

Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Peer Review Groups (PRGs) were pioneered by College Fellows in the 1990s, including evidence-based research. Today, they are a popular choice of continuing professional development (CPD) activity. The RANZCP model of PRGs has been adopted internationally and by other medical specialties within Australia; however, little research has been undertaken on the topic since the 1990s.

Objectives: To present a review of the international literature regarding Peer Review Groups, as well as to outline a broader research project being undertaken to explore the use of PRGs within psychiatry in Australia and New Zealand.

Methods: An international literature review of the use of PRGs, both within medicine and more broadly.

Results: Findings from the literature review will be presented, with a particular emphasis on the use of PRGs and small-group learning for ongoing education of doctors and the potential for building resilience in this population. Ongoing methods for the next phase of a larger research project will also be canvassed.

Conclusions: This research will clarify the existent evidence base for the ways in which PRGs are used, both within Australia and New Zealand and internationally. This is a particularly important issue in view of the planned coming revalidation of medical practitioners.

Developing a Model of Care for Older People, with Older People

R McKay^1,2

¹HETI (The Health Education and Training Institute), Sydney, Australia

²UNSW Sydney, Sydney, Australia.

Background: Mental health policy in Australia and New Zealand and the Royal Australian and New Zealand College of Psychiatrists strongly promote recovery and recovery-oriented care. In 2017, the Specialist Mental Health Services for Older People (SMHSOP) Community Model of Care Guideline (NSW Ministry of Health, 2017) was released in New South Wales.

Objectives:

Methods: Highlighting aspects of the model, its development and the associated literature review. Reflection upon experience in developing the model.

Findings: The project commenced with consultations focused upon obtaining input from consumers, carers and the broader community, as well as clinicians. These consultations, consumer involvement in the reference group and the development of a parallel project to improve recovery orientation of care markedly influenced the Model of Care. Although previous standards developed by clinicians through benchmarking influenced the Model of Care, the model developed to ensure a clear articulation between the role of services and the requirements of consumers to support their broader recovery journey. This enabled productive discussions and decisions regarding prioritization of functions within teams, clinician roles and how they relate to non-clinical services.

Conclusions: The involvement of consumers and carers in the development of this Model of Care influenced its development. The benefits appear likely to be not only more appropriate care, but a more satisfying model of care for clinicians to work within.

Reference

NSW Ministry of Health (2017) Specialist Mental Health Services for Older People (SMHSOP) Community Model of Care Guideline. GL2017_003. Sydney: Mental Health Branch.

Understanding Existing Community Networks: Preliminary Findings from Trainees Undertaking an Indigenous Suicide Intervention Training Program Developed in Partnership with Indigenous Communities

B Nasir¹, M Toombs¹, S Kondalsamy-Chennakesavan¹, S Kisely², L Hides³, N Gil¹, N Hayman¹, G Ranmuthugala¹, S Brennan-Olsen^4,5, GC Nicholson¹

¹Rural Clinical School, The University of Queensland, Brisbane, Australia

²Princess Alexandra Hospital South-side Clinical Unit, The University of Queensland, Brisbane, Australia

³School of Psychology, The University of Queensland, Brisbane, Australia

⁴Australian Institute for Musculoskeletal Science, The University of Melbourne, Melbourne, Australia

⁵Western Health, Melbourne, Australia

Background: To determine the acceptance and effectiveness of a community-led Indigenous suicide-intervention training program, it is essential to identify which people or organizations are being used to seek support or help for an Indigenous person at-risk of suicide.

Objectives: To identify existing social networks among volunteer suicide intervention trainees.

Methods: We conducted social network surveys to identify existing networks between trainees and at-risk youth, communities and support agencies, before they commenced our suicide intervention training program. Qualitative feedback about the training program was also collected.

Findings: Preliminary findings from 50 participants indicate that 44% were Aboriginal, 28% worked for government organizations, 74% had previous personal suicide experiences, 72% had provided support or help to an Indigenous person in the community who was at-risk of suicide and 48% had no previous prevention training. Most frequent contacts used were non-government agencies and mental health professionals: Both were contacted more than six times in the past 6 months by 16% of the participants. Friends (12%) or parents/guardians (12%) contacted participants for help or support more than six times in the last 6 months. Most-likely contact for future support or help were parents/guardians (44%), emergency services (40%) or doctors (40%). Feedback indicated a strong need for a tailored, community-developed approach to suicide prevention training.

Conclusions: Preliminary findings indicate that our community-led program will be beneficial in developing connectedness within communities. Future research will evaluate the effectiveness of the training program after a period of time and will determine the change in connectedness and information flow within participants’ social networks.

Nuancing the Role of Psychiatrists in Doctors’ Health

W Pring

Expert Advisory Committee of the Doctors Health Services Company, Australian Medical Association, Canberra, Australia

Background: Major changes have occurred in the organization of Doctors’ Health Advisory Services in Australia, and there is agitation for similar changes in New Zealand. There is also a greater awareness in the medical community of doctor suicide and mental health. How should psychiatrists best respond to these changes?

Objectives: To briefly outline the changes and suggest psychiatrist responses.

Methods: Historical analysis of the recent record.

Findings: Psychiatrists have always been participant activists in doctors’ health. We can have an enhanced role under recent changes, but what should we do in terms of preparation, training and capacity?

Conclusions: Psychiatrists can assist our medical community if we are better prepared to engage with individual doctor–patients and by multi-level engagement in doctors’ health advisory services.

Do Clinicians Assess Patients’ Religiousness? An Audit of an Aged Psychiatry Community Team

V Payman¹, ZJ Lim²

¹Peter James Centre, Eastern Health, Melbourne, Australia

²Monash University, Melbourne, Australia

Background: The role of religion in mortality, coping and recovery has been well documented. However, the quality of religious histories has not been evaluated.

Objectives: To determine the frequency and quality of religious history-taking of patients by clinicians working in an old age psychiatry service in Middlemore Hospital, Auckland, New Zealand.

Methods: A retrospective audit of 80 randomized patient files from the Koropiko Mental Health Services for Older People in Middlemore Hospital, Auckland, New Zealand. Progress notes from August 2016 to October 2016 were evaluated using a 3-step questionnaire (Q1–Q3). Religious histories identified from these questions were evaluated using the FICA (Faith or Beliefs, Importance or influence, Community and Address assessment tool) (Q4–Q7).

Findings: A total of 66 clinical records were available for analysis. A religious history was taken in 33/66 (50%) patients. However, when such histories were evaluated using the FICA assessment tool, only 10/33 (30.3%) histories contained detailed information regarding the patient’s religiosity.

Conclusions: The infrequency and low quality of religious histories discovered in this audit suggest that clinicians need more training in taking a religious history from patients.

The Unexplored Value of Verbatim

D Brunskill

PUAWAI: Midland Regional Forensic Psychiatric Service, Hamilton, New Zealand

Background: ‘Verbatim’ is a term which originates from Medieval Latin, and means, ‘word for word’, or ‘recorded exactly as said’. Example forms can include both the written and the spoken. Despite being among the richest of data sources in psychiatry, examples of verbatim are often improperly recorded, or overlooked rather than preserved, despite having clear potential to be tapped for clinical information. This situation is likely to represent a missed opportunity.

Objectives: To demonstrate this potential, a selection of verbatim examples will be considered (published and unpublished). These include written verbatim (letters from stalkers/erotomanics, other descriptive clinical writings) and spoken verbatim (transcriptions from the last statement of a death-row inmate, the final communication of a mass murderer – ‘final messages have great personal meaning’ – Knoll, 2012).

Methods: The verbatim source will be shown, analysed and discussed, to reveal its potential import.

Findings: The value of verbatim can only be unlocked if it is properly valued in the first instance. Such a shift in focus would promote better recording of what is said, in order to better ascertain what is meant – ‘The limits of my language mean the limits of my world’ (Wittgenstein, 1921).

Conclusions: Verbatim is a valuable data source which is undervalued in psychiatry, despite the potential to be tapped into as a ‘mainline to the mind, or by providing a gateway into elusive personal worlds of interest’ (Brunskill, 2015).

References

Knoll, J. (2012) Mass murder: causes, classification, and prevention. Psychiatric Clinics of North America 35: 757–.80

Wittgenstein L (1921) Tractatus Logico-Philosophicus. Revised edition paperback, 1981, Taylor & Francis Ltd.

Brunskill D (2015) Verbatim – 100 Words. The British Journal of Psychiatry 207: 543. doi: 10.1192/bjp.bp.115.174094.

Screening for Obstructive Sleep Apnea in a Public Mental Health Service Clozapine Clinic

H Foung¹, A Watkins², R Morell², PB Ward³, J Curtis², M Barclay⁴, C Omana⁴, M Kalucy²

¹Faculty of Medicine, UNSW Sydney, Sydney, Australia

²Keeping the Body in Mind Program, Mental Health, South Eastern Sydney Local Health District, Sydney, Australia

³School of Psychiatry, UNSW Sydney, Sydney, Australia

⁴Euroa Centre Prince of Wales Hospital, Sydney, Australia

Background: Patients with schizophrenia have a two to threefold increase in standard mortality ratio for all causes. One often overlooked condition is obstructive sleep apnoea (OSA), which exacerbates both mental and physical comorbidities. However, daytime somnolence and cognitive impairment can be misattributed to the negative symptoms of schizophrenia or to treatment side effects. Snoring is also often not detected as most individuals sleep alone. Therefore, OSA may be underdiagnosed and undertreated in this population.

Objectives: To examine the rates of OSA in the schizophrenia population attending a clozapine clinic and to examine the utility and feasibility of the screening tools available to clinicians.

Methods: We screened patients attending a clozapine clinic located at Prince of Wales Hospital (POWH) using six sleep assessment tools validated in other patient groups: the Berlin Questionnaire; STOPBANG; OSA50; Epworth Sleepiness Scale; Pittsburgh Sleep Quality Index; and the Flinders Fatigue Scale. Those screening positive by any of the first four tools were referred to the POWH Sleep Clinic. Physical measures, metabolic data and sociodemographic data were also collected.

Findings: So far, 53 patients (55.8% male and 47.2% female) have been screened, with 39 (73.5%) screening positive on at least one of the screening tools and with 34 (64.2%) referred to the Sleep Clinic.

Conclusions: There is a high prevalence of positive screening for OSA in patients attending a clozapine clinic. This study highlights the importance of searching for OSA and encourages a greater comprehensive approach to managing physical health factors.

Polypharmacy and Guidelines: An Audit of Prescribing Patterns of Psychotropics in a Major Australian Mental Health Service District

C Perera¹, S Patterson², D Debattista¹, U Wijayatunga³, G Bruxner¹

¹Redcliffe-Caboolture Mental Health Service, Metro North Mental Health Service, Brisbane, Australia

²Metro North Mental Health Service, Brisbane, Australia

³University of Queensland, Brisbane, Australia

Background: Antipsychotics and mood stabilizers are both commonly used in the treatment of bipolar affective disorder (BPAD). Concomitant prescribing of an antipsychotic and mood stabilizer or two mood stabilizers is supported by the Royal Australian and New Zealand College of Psychiatrists and National Institute for Health and Care Excellence (NICE) guidelines. Antipsychotic polypharmacy, however, is discouraged due to risk of QT prolongation and sudden cardiac death.

Objectives: To ascertain the extent of antipsychotic polypharmacy and concomitant prescribing of mood stabilizers and in managing BPAD.

Methods: An audit of records of all patients (n = 383) with a diagnosis of BPAD open to a public mental health service on a census date. Data pertaining to demographics and prescribing patterns of antipsychotics, mood stabilizers, antidepressants, hypnotics and non-psychotropics were collected. Data were tabulated and analysed using simple descriptives.

Findings: The majority (73%) of patients were prescribed any mood stabilizer; two-thirds (n = 254; 66%) were prescribed antipsychotics, with antipsychotic polypharmacy noted in 41 (16%). Three-quarters of those prescribed any antipsychotic were also prescribed a mood stabilizer. Mood stabilizer–polypharmacy was observed in 42 of 279 (15%) patients prescribed any mood stabilizer.

Conclusions: Polypharmacy of antipsychotics remains a notable practice in managing BPAD in routine care despite being discouraged by guidelines, which is of concern. Further understanding and knowledge among doctors with regard to prescribing practices and guidelines will enhance safe prescribing knowledge.

The Convention on the Rights of Persons with Disabilities, Legal Coercion and Mental Health

S Gordon, G Newton-Howes

University of Otago, Wellington, New Zealand

Both New Zealand and Australia have signed and ratified the Convention on the Rights of Persons with Disabilities (CRPD), thereby taking an obligation under international law to implement it. This presentation will explore the implications of that in relation to the existence and application of Mental Health (Compulsory Assessment and Treatment) Acts. Somewhat radically, and perhaps even inconceivably to some, the United Nations has devised and interpreted Article 12 of the CRPD to prohibit substitute decision-making regimes, such as mental health laws that permit forced treatment. States parties are obliged to replace substitute decision-making regimes by supported decision-making alternatives. Through this presentation, the implications of this obligation on mental health practitioners and services will be explored. Although radical, this change will not happen overnight, but with the weight of the United Nations and the World Health Organization in support, it will happen … so, best to start getting to grips now.

Cultural and Linguistic Diversity Increases the Likelihood of Compulsory Community Treatment but does not Improve Outcomes in an Analysis of Western Australian Administrative Data

S Kisely^1,2,3, J Xiao⁴

¹Metro South Addiction and Mental Health Service, Brisbane, Australia

²School of Medicine, University of Queensland, Brisbane, Australia

³Dalhousie University, Halifax, Canada

⁴Health Department of Western Australia, Perth, Australia

Background: People from culturally and linguistically diverse (CALD) backgrounds are over-represented in compulsory admissions to hospital but little is known about whether this also applies to community treatment orders (CTOs).

Objective: To investigate any differences between Australian and overseas-born patients in the likelihood of CTO placement using state-wide databases from Western Australia.

Method: Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Logistic regression was then used to identify potential predictors of a CTO. We also assessed if any differences in CTO placement between Australian and overseas-born patients affected bed-days or community contacts in the subsequent year.

Findings: We identified 2958 CTO cases and controls from November 1997 to December 2008 (total n = 5916). Of these, 74% had schizophrenia or other non-affective psychoses. Patients who were born in New Zealand, the United Kingdom or Ireland had very similar rates of CTO placement compared to those who were Australian-born. By contrast, there was a gradient of increasing risk of CTO placement for people born in Continental Europe (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) = 1.06–1.70, p = 0.01) and then the ‘rest of the world’ (AOR = 1.64; 95% CI = 1.30–1.96, p < 0.001). However, there was no evidence of additional benefit in terms of health service use in the following year.

Conclusions: In common with other coercive treatments, people from CALD backgrounds are more likely to be placed on CTOs. Further research is needed to establish if this is for similar reasons.

Role of Professional Associations to Facilitate Reconciliation, Strengthen Advocacy and Promote Human Rights of People Living with Mental Illness

B Janse van Rensburg

South African Society of Psychiatrists, Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa

Background: Thematic papers on reconciliation were published in the BJPsych International (2015), including reports from Australia/New Zealand and South Africa, while symposia on human rights were included in both the World Psychiatric Association International Congress (2016) in Cape Town and the World Psychiatric Congress (2018) in Berlin. During the same period, rapid deinstitutionalization in Gauteng Province occurred following a political decision to discharge 1700 long-term psychiatric patients to poorly capacitated non-government organizations in the community. As a result, 144 patients died within 6 months. The national outcry and the damning report by the health ombudsperson on this incident were widely reported (Office of Health Standard Compliance, 2017).

Objectives: To explore and report on these events, in the context of the role of professional associations to protect the human rights of patients.

Methods: Literature review on psychiatry and human rights in Australia and New Zealand, South Africa, Germany and Brazil.

Findings: With reference to the role of the South African Society of Psychiatrists in recent local events.

Conclusions: Despite the common problem of dual loyalties, professional associations have an indispensable role to play in the protection of the human rights of people living with mental illness in various settings.

References

Cox J, Lee JBL, Janse van Rensburg B, Hewston M & Huges J. (2015) Thematic papers: reconciliation and conflict resolution. BJPsych International 12(3): 58–66.

Office of Health Standard Compliance (2017) Health Ombudsperson Report into the ‘Circumstances surrounding the death of mentally ill patients: Gauteng Province’. Available at: http://www.ohsc.org.za/index.php/publications/ohsc-documents (accessed 26 February 2017).

World Psychiatric Association International Congress (2016) Symposium S062 Human rights abuses in psychiatry. Cape Town, South Africa, 18–22 November 2016.

World Psychiatric Congress (2017) Symposium 13 Human Rights Abuses: Remembrance and Responsibility. Berlin, Germany, 8–12 October 2017.

Experiences of Choice in Service Delivery: Psychosocial Disability and NDIS

S Pollock

Mind Australia, Melbourne, Australia

Background: Choice and control are central to human services policies in Australia. In policy, choice is assumed to be a public good and as such represents a pathway to citizenship. However, choice in service systems can be problematic for people with psychosocial disability. Understanding people’s lived experiences will help develop practical strategies to support choice-making in service delivery systems.

Objectives: To present findings from a study that examines how people with psychosocial disability make choices in the context of the National Disability Insurance Scheme (NDIS), including how they understand themselves as choice-makers and the supports they draw on in making choices.

Methods: Interviews with 30 NDIS participants with psychosocial disability were completed in three NDIS trial sites (Barwon, Hunter and Perth). Using narrative interviews, respondents explored their experiences of choice-making in the NDIS, comparing these to their experience of making choices in other areas of their lives. Undertaken in partnership with Deakin and Melbourne Universities, the research team includes people with a lived experience of mental ill-health and recovery.

Findings: The research design and initial findings from pre-field work interviews were presented at the 2017 Congress. This presentation will report on findings from the main study and consider practical strategies to support enhanced choice-making at everyday, lifestyle and pervasive (existential) levels.

Conclusions: Having a choice in service provision can be a powerful mechanism for achieving a preferred life. However, this is not a straightforward process. Understanding choice as problematic, developmental and relational will facilitate new ways of supporting choice-making that is oriented towards citizenship and empowerment.

Capacity Assessment in the New South Wales Mental Health Act 2007: Are we Doing it Right?

T Foley¹, C Ryan^1,2

¹RANZCP Advanced Trainee, Westmead Hospital, Sydney, Australia

²Sydney Health Ethics, University of Sydney, Sydney, Australia

Background: In 2015, reforms to the New South Wales Mental Health Act 2007 saw the introduction of s 68(h1) to better align the legislation with Recovery Principles and Consumer Rights. It states: ‘Every effort that is reasonably practicable should be made to obtain the consent of people with a mental illness or mental disorder …’. NSW Health, through the Health Education and Training Institute (HETI) and the New South Wales Institute of Psychiatry (NSWIOP), has conducted an education drive through an online module and face-to-face workshops. However, it is unclear whether this has changed the way the Act is being used in clinical practice.

Objectives: To examine to what degree authorized medical officer reports to the Mental Health Review Tribunal refer to specific aspects of the ss 12 and 14 treatment criteria and elements laid out in s 68(h1) in the Act. We believe that by auditing the reports, we may gain an insight into the minds of clinicians who are using the Act on a day-to-day basis.

Methods: To audit and compare samples of written reports and recommendations of the authorized medical officer submitted for the purposes of a Mental Health Inquiry both before and after the 2015 reforms and subsequent education drive.

Findings and conclusions: Research is planned to be completed before presentation at the Royal Australian and New Zealand College of Psychiatrists Congress 2018.

What Happens in the Brain when we Deliver TMS Pulse?

N Smirnov

Department of TMS Systems Development, Neurosoft, Ivanovo, Russia

Background: In this talk and live demonstration, some basic questions about physics and physiology of transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS) will be discussed. What is motor evoked potential (MEP)? How is it generated? And what does MEP tell us about excitation processes in the brain and descending volley? Why does the size of the MEP reflect the excitability of the motor cortex?

A typical paradigm of a neuromodulation experiment comprises a baseline MEP measurement followed by neuromodulation and then modulated MEP measurement. What does the silent period (SP) tell you about inhibition processes in the brain? What are short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI)? What happens if we do TMS repetitively?

The two main paradigms of rTMS are that high-frequency results in an excitability increase and low-frequency ones lead to an excitability decrease. Is this always true? What is theta-burst stimulation (TBS)? The two main paradigms of TBS are intermittent (iTBS) and continuous (cTBS). The TMS and electromyograph machines will be on the stage and MEP, SP and neuromodulation techniques will be demonstrated live to illustrate the talk.

Psychodynamic Psychotherapy for Older Adults – A Workshop

N Jeyasingam

The University of Sydney, Sydney, Australia

Background: Psychodynamic psychotherapy is gradually being offered to more older persons despite previous reservations regarding its role. With this novel exploration comes both unrealistic expectations as well as a higher risk of therapeutic nihilism.

Methods: This workshop will begin with consideration of the brief psychodynamic psychotherapy model as a whole. Two case studies of patients will be used as instructional opportunities, who both had radically different interventions, both informed by psychodynamic principles, and showed significant gains as a result despite both patients having long previous histories of multiple failures with different therapeutic interventions. Models of ageing and understanding the older person will be explored, as well as cohort and context issues when adapting psychotherapy for the older person.

Appearances Matter: Why the Congress should not Take Place in A Casino

S McBride^1,2

¹Capital Coast District Health Board, Wellington, New Zealand

²New Zealand Branch of Faculty of Addiction Psychiatry, Wellington, New Zealand

Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) position statement on problem gambling was published in September 2017. This outlines the RANZCP’s position on problem gambling and associated risks. Associated harms include high rates of problem gambling, association with community harms, mental health problems including in a causative manner and differential impact on the young. The RANZCP committed to being cognizant of its association with the gambling industry, including ‘being mindful when selecting venues’.

That the 2018 RANZCP Congress, its public showpiece, is held in a casino illustrates the manner in which the gambling industry has been shown to degrade democratic institutions. Parallels can be found in other harmful industries including tobacco and alcohol or in the manner in which industry has influenced debate on public health issues such as climate change.

In aiming to engage with communities and talk with authority on matters of public health, it is important that the RANZCP can do so with authority. Holding the Congress in a casino undermines its role in this regard. This talk provides an opportunity for the RANZCP to consider which communities it represents and the values to which it holds.

Mandatory Drug and Alcohol Testing of Health Professionals: Time to Revisit the Issue

A Samuels¹, T Meade²

¹University of New South Wales Rural Clinical School, Wagga Wagga, Australia

²School of Social Sciences and Psychology, University of Western Sydney, Sydney, Australia

Background: Drug and alcohol testing of the workforce is now routine in many industries. The issue of illicit and prescription drug abuse among health professionals have recently been highlighted in the media. Targeted drug and alcohol testing of health professionals working in higher risk areas may confer safety and deterrence benefits and bolster public confidence.

Objectives: To highlight the issue of mandatory drug testing of health professionals in the workplace.

Methods: A brief review of the literature is outlined and possible options for implementing such a process are discussed.

Findings: Targeted drug and alcohol testing of health professionals working in higher risk areas may confer safety and deterrence benefits and bolster public confidence. It is time to revisit this issue.

Conclusions: The arguments against the mandatory drug testing of health professionals are becoming harder to sustain in this era of increasing scrutiny and accountability.

Civil liberties of doctors need to be balanced by the rights of patients. Mandatory drug testing is not a solution in itself but may also aid early identification of problems and lead to appropriate support services and review of workplace practices.

Dual Disabilities – are We Equipped?

S Naveed

Sunshine Coast University Hospital, Kawana Waters, Australia

Background: As a final year Psychiatry trainee, and as I draw closer to the commencement of specialist work, I am naturally apprehensive about this transition and my preparedness. One of the areas where I feel lacking is intellectual disabilities and their interplay with psychiatric ailments.

Objectives: To highlight the connected nature of intellectual disability and psychiatric ailments via a case series.

Methods: Case series of five patients out of many that I have treated in the last 5 years who present with a psychiatric ailment on a background of intellectual impairment.

Findings: The Royal Australian and New Zealand College of Psychiatrists’ curriculum has only one entrustable professional activity (EPA) in the third stage (not compulsory) involving attaining skills specific to dual disability: ‘Assessment and management of adults with a comorbid intellectual/developmental disability and mental illness’.

During my training, I have assessed at least 2–3% of my patient load as having comorbid intellectual impairment. During the time in CL and in rural settings, it becomes more pertinent.

Conclusions: There perhaps needs to be more focus on training of skills about intellectual impairment assessment and its links with psychiatric ailment so that future psychiatrists can be well versed with the treatment of dual disability.

Physician Don’t Examine Thyself

Rob Selzer^1,2,3, Fiona Foley⁴, Dragan Ilic⁵, Laila Rotstein^1,3

¹Monash University Central Clinical School, Melbourne, Australia

²Monash Alfred Psychiatry Research Centre, Melbourne, Australia

³Alfred Health, Melbourne, Australia

⁴Swinburne University of Technology, Melbourne, Australia

⁵Monash University School of Public Health & Preventive Medicine, Melbourne, Australia

Background: A candidate’s state of mind is an important determinant in succeeding in face-to-face exams, such as the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP’s) Observed Structured Clinical Examinations (OSCEs). Contributing to this state of mind may be the fraction devoted towards self-assessing one’s own performance in real-time.

Objectives: To investigate the phenomenon of self-assessment in specialist trainees and to determine whether a candidate’s self-assessment impacts upon their performance in a multi-part exam.

Methods: A cross-sectional study of candidates sitting a mock Royal Australasian College of Physicians multi-case examination was undertaken. Participants self-assessed their mark after each patient case. Parametric and non-parametric analyses were used to examine the relationship between the self-assessed mark and the actual mark.

Findings: Correlation between self-assessed and actual marks varied between a Pearson’s r of 0.32 (p = 0.006) and 0.36 (p = 0.04), depending on case type (physical examination only or history and physical examination). Underestimating one’s performance was associated with worse performance in the subsequent case: from first to second case (χ² = 7.05, p = 0.03), from second to third (χ² = 15.31, p < 0.001). When self-assessed marks were pooled to yield a total mark for each candidate, those who underestimated their total mark were likely to score higher than others (mean difference 3.11, 95% confidence interval (CI), 1.85–4.37).

Conclusions: Self-assessment in this specialist examination is only weakly or, at best, moderately accurate. Underestimation may predispose candidates to defocus in a subsequent case; however, some underestimators may counterbalance this by better preparing for the examination. These findings may help candidates better prepare for the OSCEs of the RANZCP.

Training Mental Health Professionals in Low-Resource Settings to Deliver Lifestyle Interventions for People With Mental Illness: Butabika Hospital, Uganda Pilot Project

PB Ward^1,2, S Rosenbaum^1,3, J Richards⁴

¹UNSW Sydney, Sydney, Australia

²Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, Australia

³Black Dog Institute, Prince of Wales Hospital, Sydney, Australia

⁴University of Sydney, Sydney, Australia

Background: The prevalence of non-communicable diseases (NCDs) is rapidly rising in low-income countries (LICs). People with mental illness living in LICs represent a particularly vulnerable population at risk of developing NCDs secondary to mental illness. Physical inactivity, poor diet quality and smoking are key modifiable risk factors and targeting these modifiable risk factors is feasible in high-income settings. There is a dearth of literature examining adaptation of programs to LIC settings.

Objectives: To present the training of mental health professionals from a psychiatric hospital in Uganda in the principles of lifestyle interventions and evaluate the impact of training on knowledge, confidence and attitudes to metabolic monitoring.

Methods: A one-day workshop for mental health staff was conducted in July 2017, which covered the rising prevalence of NCDs, cardiometabolic health of people with mental illness, staff culture, assessing and reporting on physical health outcomes, principles of exercise and dietary prescription and medical management of mental disorders. Outcomes assessed included the Metabolic Barriers, Attitudes, Knowledge and Confidence questionnaire (M-BACK).

Findings: In total, 39 clinical psychologists attended the workshop and 29 completed pre- and post-session questionnaires. Total M-BACK scores increased from 56.1 (standard deviation (SD) = 5.6) to 65.1 (SD = 7.3) (p < 0.001, η² = 0.64). All respondents (100%) reported that the workshop was effective in increasing understanding of the importance of addressing the physical health of patients.

Conclusions: A one-day training workshop was feasible, acceptable and effective in improving the knowledge and confidence of mental health professionals regarding the physical health and delivery of lifestyle interventions for people with a mental illness in a LIC setting.

Trends and Patterns in Unplanned Readmissions to ISLHD Hospitals Following Admissions for Mental Diseases and Disorders

N Pai^1,2 V Westley-Wise², L Lago¹, F Facci², R Zingel² J Mullan¹, K Eagar¹

¹University of Wollongong, Wollongong, Australia

²Illawarra Shoalhaven Local Health District, Wollongong, Australia

Background: Reducing early (<30 days) hospital readmissions is a policy priority aimed at improving healthcare quality. Unplanned readmissions are generally considered undesirable events that often indicate relapse. Although not necessarily a reflection of healthcare, they may reflect on the effectiveness of the system of mental healthcare as a whole.

Objectives: To describe trends in unplanned readmissions to Illawarra Shoalhaven Local Health District (ISLHD) hospitals following mental health admissions and examine how these vary by service factors, specific conditions and patient groups.

Methods: Retrospective longitudinal study of patients attending ISLHD hospitals between 2002 and 2015 whose major diagnostic category (MDC) was Mental Diseases and Disorders (MDC 19) who have at least one unplanned readmission within 6 months of discharge.

Findings: We found that 27% of patients admitted in the MDC 19 category have at least one unplanned readmission within 6 months of discharge – a higher readmission rate than for other inpatients (20%). Trends in the percentage readmitted since 2002 show an approximately 40% decrease across all age groups within 30 days of discharge. An increased risk of unplanned readmission is associated with older age, Aboriginal and Torres Strait Islander peoples, speaking English as an additional language, no health insurance, low socioeconomic status, an Index admission via the emergency department, an emergency and with length of stay (short stay ⩽2 days).

Conclusions: Readmission risk prediction remains a poorly understood and complex endeavour. Factors such as medical comorbidities, basic demographic data and clinical variables are much better able to predict mortality than readmission risk. Broader social, environmental and medical factors such as access to care, social support, substance abuse and functional status contribute to readmission risk. Readmission risk prediction is a complex endeavour with many inherent limitations.

Adolescents with Treatment Resistant Mental Illness; Does Quaternary Inpatient care Make a Difference?

R Jairam¹, J Starling^2,3

¹South West Sydney Local Health District, Sydney, Australia

²Sydney Local Health District, Sydney, Australia

³University of Sydney, Sydney, Australia

Background: Some information is available on adolescents in acute mental health units (Edwards et al., 2015). Little is known about adolescents admitted to quaternary medium-stay mental health units.

Methods: The clinical profile and outcome of adolescents admitted to Walker Unit (WU), the only unit in New South Wales, Australia, which admits adolescents with severe treatment-resistant mental illness was mapped by retrospective chart review. Sociodemographic and clinical variables were analysed and predictor variables were evaluated. The degree of psychopathology and functioning were assessed using Health of Nations Outcome Scale Children Adolescents (HONOSCA) (Speak and Muncer, 2015) and the Children Global Assessment Scale (CGAS) (Shaffer et al., 1983), respectively, at admission, 3-monthly and at discharge.

Results: Sixty-two adolescents (42% male) were included. The mean age at admission was 16 years and mean length of stay (LOS) was 193 days. Of the 62 adolescents, 84% received antipsychotics; psychotic disorders were most common diagnoses (63%), one-third needed clozapine with these adolescents having greater LOS. More than 60% had a history of abuse, notably more in girls, and 29% had autistic spectrum disorder (ASD), which was more in boys and associated with greater LOS. Despite data quality issues, the sample showed improvement in CGAS and a reduction in HONOSCA scores at discharge with 80% of adolescents returning to school or work.

Conclusions: The WU provides high-quality care to a subgroup of adolescents with severe treatment-resistant chronic mental illness and helps significantly reduce psychopathology and improve functioning. Those with ASD had significantly greater LOS and those with non-psychotic illnesses had significantly better functional outcomes. Data quality issues need attention, as does in-depth study of variables affecting course and outcome of this group of challenging adolescents.

References

Edwards D, Evans N, Gillen E, Longo M, Pryjmachuk S, Trainor G, Hannigan B (2015) What do we know about the risks for young people moving into, through and out of inpatient mental health care? Findings from an evidence synthesis. Child and Adolescent Psychiatry and Mental Health 9: 55.

Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Archives of General Psychiatry 40: 1228–1231.

Speak B, Muncer S (2015) The structure and reliability of the Health of the Nation Outcome Scales. Australasian Psychiatry 23(1): 66–68.

Female-Only Areas Improve Patient Safety in Inpatient Psychiatric Services

J Hauptman¹ J Ginnane¹, J Kulkarni²

¹Alfred Hospital, Melbourne, Australia

²Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia

Background: It is standard practice for inpatient psychiatric services to have mixed-gender wards. Female inpatients are particularly vulnerable to sexual assault and harassment in this setting. Female-only areas have been demonstrated to be an effective way to improve patient safety. In 2013, the Alfred hospital reconfigured one of its two psychiatry wards to include a female-only area, and there was a reduction in the number of sexual assaults in the 6 months following this change.

Objectives: To determine if creating a female only area within a mixed-gender inpatient psychiatric service has reduced the number of incidents compromising patient safety among female inpatients during a 6-month period at 2 years following its establishment.

Methods: Documented incidents compromising the safety of women admitted to the inpatient psychiatry service within a 6-month period from January 2017 to June 2017 were reviewed. These were compared with a similar review which was concerned with incidents occurring within the 6-month period immediately following the establishment of a female-only area.

Findings: As previously demonstrated, the occurrence of documented incidents compromising female patients’ safety was significantly lower on the ward containing a female-only area.

Conclusions: Female-only areas in inpatient psychiatric wards may reduce the number of incidents involving female inpatients and make the ward a safer place for women.

Factors Related to Hospital Readmissions in an Acute Inpatient Unit for Mental Health in a Rural Multicultural Community

Subhash Das¹, Raju Laksmana^1,3, Saji Joseph¹, Vivek Phutane¹, Md Rafiqul Islam^2,3,4,5

¹Goulburn Valley Area Mental Health, Goulburn Valley Health, Shepparton, Australia

²Research and Ethics, Goulburn Valley Health, Shepparton, Australia

³Department of Rural Health, The University of Melbourne, Shepparton, Australia

⁴School of Health and Social Development, Deakin University, Melbourne, Australia

⁵Rumbalara Aboriginal Cooperative Limited, Shepparton, Australia

Background: Hospital readmission for any reason including mental health conditions can increase the years of lost life and may compromise the quality of life. Mental health system performance can be monitored by the rate of early return or readmissions to the hospital. Whether readmission can be an indicator for evaluating the quality of inpatient care and the issues related to mental health readmissions in a multicultural regional Australian setting are yet to be determined.

Objectives: The study is aimed to determine the

Methods: A retrospective review of medical records will be conducted for the patients readmitted between July 2012 and June 2017 to the acute inpatient unit of Goulburn Valley Area Mental Health Services, Shepparton, Victoria. In this study, readmission is considered if the patient is admitted again to an acute inpatient unit as unplanned within 4 weeks of discharge. All adult psychiatric patients readmitted in this unit for any reason within 4 weeks of discharge will be included in the review. Clinical records with number of readmissions during this period including sociodemographic characteristics, ethnicity and other related background information will be collected. All data will be coded and entered in Microsoft Excel. The data will be cleaned and transferred to STATA 11 for analysis. A scientific paper will be written for full publication and the findings will be disseminated in local, national or international conferences.

Expected outcomes: This study will demonstrate the readmission rate with most likely reasons along with other associated factors. Taking care of these associated factors may improve the quality of inpatient care including quality of life and help to reduce the burden of health systems by reducing the in-patient bed occupancies.

A Multidisciplinary Partnership Implementing a Solution-Focused Therapy Approach into an Acute Mental Health Unit

A Baas, H Newton

Noarlunga Hospital, Noarlunga Centre, Australia

Background: In Australia, the 4th National Mental Health Plan 2009–2014 dictated implementation of a consumer-led, strengths-based recovery model. Despite this, acute mental health units seem to have limited focus on such models or a clear therapeutic stance. Discussions in 2016 identified the need for more therapy and strengths-focus in our acute unit, with the multidisciplinary team deciding to implement solution-focused therapy.

Objectives: To reflect on early stages of implementing solution-focused, strengths-based therapy and approach in an acute mental health unit, and the roles of the psychiatrist within this project.

Methods: Following initial training, multidisciplinary team members formed an interest group which met regularly. Additional staff were supported to attend training and then encouraged to practice and discuss their experience of using the therapy in both individual and group settings. Links have been developed with an international centre of excellence, and a weekly supervision group has commenced.

Findings: The therapy has been well supported by staff from all disciplines, with more than half of all ward staff undertaking training and increasing use of the therapy with patients in a range of interactions. Active partnership with ward psychiatrists has been important in maintaining momentum for the project.

Conclusions: Initial implementation of the approach has increased focus on strengths and recovery for inpatients. We anticipate continuing growth of the project and integration into our model of care and have begun developing additional resources for patients. Expansion to partnership with other parts of the local mental health service would offer continuity of the solution-focused approach.

Formation of Carers and Consumer Action Network Mental Health Sri Lanka

J Mendis, N Fernando, P Gunrathne

Consumer Action Network Forum Sri Lanka (CANMH), Mulleriyawa, Sri Lanka

Background: The number of psychiatrists and the other multidisciplinary team members have been increasing over the last decade. However, power among the mentally ill patients and their carers was not a strong force in Sri Lanka during the pre-Tsunami period.

Objectives: To form a strong consumer action forum, to eradicate stigma and discrimination, to alleviate the economic burden affecting development and to promote mental health well-being, the Consumer Action Network Forum Sri Lanka (CANMH) was commenced countrywide in 2006.

Methods: A small consumer group was formed initially with the help of consumers, carers, resource persons from the national institute of mental health, universities, nurses training schools and the Royal Australian and New Zealand College of Psychiatrists. An initial 12 consultation workshops were held to form six consumer groups mainly in the southern part of Sri Lanka. Thereafter, each consumer group was formed at at least one per district in the whole of Sri Lanka by 2011.

In 2014, the legislative framework, policy and the structures for ensuring implementation were formed. Thereafter, various national and international links were formed to strengthen the consumers and carers.

National Mental Health Awareness Butterfly campaign has been a well-known activity of mental health day, and this has been commenced with the aim of educating all policy makers in Sri Lanka.

Conclusions: Since the formation of CANMH, decision-making regarding policy changes, the Ministry of Health and other policy makers obtain advocacy from the CANMH Sri Lanka. This supports the theme of this years’ conference, ‘becoming well together in partnership in mental health’.

The Courage to Collaborate: A Co-Production Approach to Inpatient Discharge Summaries

R Waller, J Haitana

Waitemata District Health Board, Auckland, New Zealand

Background: Inpatient admissions are followed by communication with the general practitioner (GP). Increasingly, information is provided to service users too, sometimes as copies of the GP letter; however, this is often technical or delayed and is rarely recovery-based.

Objectives: To co-produce a discharge summary written primarily for service users, including information they thought relevant for the immediate discharge period, but also meeting standards for communication with GPs, and for this summary to be available on the day of discharge.

Methods: Using quality improvement methodology, the discharge summary process was first improved to 100% of discharges having a summary and then to this being available on the day of discharge. Content was derived from current and recent service users and GP guidelines. Recovery language was used. A first draft was made available in the regional electronic record and piloted, before being extended to all adult inpatient discharges. Adherence to the process was monitored using an automated weekly report.

Findings: Inpatient discharge summaries can be developed using co-production approaches to meet the needs of both service users and GPs. Quality improvement methodology can improve adherence to the process and allow ongoing automated monitoring.

Conclusions: Core communications such as around the transition from hospital to home should be supported by immediately available information. Ideally, this should be the same information for both service user and GP.

Indigenous Populations and the Use of Inpatient Treatment Authorities

G Pasternak, N Wijesekera, A Rana

Department of Mental Health, Mackay Base Hospital, Mackay, Australia

Background: Under the Mental Health Act 2016, it is assumed that diagnostic criteria and assessment of risk and capacity leads to the decision of whether a patient is treated under involuntary circumstances. Health services around the world^1–3 have shown that particular minorities are compulsorily detained under the mental health act more than other groups. To our knowledge, no study to date has examined what factors may contribute to being admitted under the Mental Health Act 2016 in Queensland, Australia.

Objectives: To examine if Indigenous populations are over-represented in admissions to mental health units and investigate what, if any, sociodemographic factors contribute to the use of the mental health act.

Methods: Twelve months of patient admissions and relevant sociodemographic factors from Mackay Base Hospital were collected. We compared these admission data with a recent census date from the Mackay Hospital and Health service catchment area. Additionally, sociodemographic factors such as indigenous status were assessed through a linear regression model to determine what factors influence whether an involuntary admission occurs.

Findings: Of the 1642 admissions to the mental health ward, 16% of patients identified as having an Indigenous background, making this group over-represented compared to the health service population. Additionally, identifying as Indigenous makes it significantly more likely to being treated under involuntary circumstances.

Conclusions: Given the over-representation of this population in mental health units and the increased likelihood of being admitted involuntarily, further studies are required to ascertain what factors make Indigenous populations more likely to be treated under involuntary status.

References

¹Audini B and Lelliott P (2001) Age, gender and ethnicity of those detained under Part II of the Mental Health Act 1983. British Journal of Psychiatry, 180: 222–226.

²Archie S, Akhtar-Dinesh N, Norman R, et al. (2010) Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophrenia Bull 36: 688–701.

³Farhana M, Fisher H, Johnson S (2014) A systematic review of ethnic variations in hospital admission and compulsory detention in first-episode psychosis. Journal of Mental Health 23: 205–211.

The Rise of Substance-Related Acute Inpatient Psychiatric Admissions: An Attempt to Look for Causes

N Wijesekera, G Pasternak, B Bui, A Rana

Mackay Base Hospital, Mackay, Australia

Background: Systematic reviews of Queensland government data have revealed a dramatic rise in hospital admissions due to psychostimulant use disorders in the past 5 years due to increase in purity and availability. Local mental health services data reflect this, and a major contributing factor may be economic downturn in the region.

Objectives: To determine whether the economic downturn is associated with increased substance misuse-related hospital admissions. The two hypotheses are

Methods: Data were drawn from a central Queensland hospital from all psychiatric inpatient admissions looking at sociodemographic identifiers and clinical data with regards to diagnosis from January 2012 to December 2016.

Sociodemographic, socioeconomic and clinical correlates of stimulant use disorders were identified using binary logistic regression models.

Findings:

Conclusions: There has been an increase in hospital admissions due to stimulant use over the past 5 years. Many factors were related to this rising trend as well as economic downturn.

The Impact of Intoxication on Emergency Department Length of Stay for Mental Health Presentations

J Jose¹, V Ip², A Chitakunye², D Long², H Zhao², L Lampe³

¹Central Coast Mental Health Services, Gosford, Australia

²Hornsby Ku-Ring-Gai Mental Health Services, Sydney, Australia

³University of Newcastle, Newcastle, Australia

Background: Previous Australian studies estimated that one-third of mental health presentations to the emergency department (ED) is associated with intoxication and increased length of stay (LOS). Increasing pressure for timely disposition of patients from ED led to the implementation of Emergency Performance Targets (EPT) requiring discharge within 4 h. Anecdotally, mental health presentations with comorbid intoxication are associated with higher rates of failure to meet EPT targets.

Objectives: Primarily, to investigate associations between intoxication and ED LOS for mental health presentations since EPT implementation. Secondarily, to facilitate future research by estimating the reliability of various indicators of intoxication available from the patient medical record.

Methods: File review of metropolitan hospital ED mental health referrals over 6 months. Patient triage, toxicology results and discharge documentation were examined for documentation of intoxication, and LOS was compared between intoxicated (where any one of the above three markers suggest intoxication on patient arrival) and non-intoxicated (where none of the markers suggest intoxication) groups.

Findings: Of 782 referrals identified, 26.7% were likely intoxicated. In the intoxicated group, 58.8% exceeded the 4-h EPT LOS target, compared to 31.4% of the non-intoxicated group. The intoxicated group’s average LOS was longer compared to that of the non-intoxicated group (363 versus 250 min). Within the intoxicated group, 84.7% were identified by ED triage, 56.9% by discharge documentation and 42.1% had a positive toxicology result.

Conclusions: Mental health presentations with intoxication are associated with increased ED LOS. Intoxication can be reliably identified at triage.

Does Training Change Practice: A Survey of Clinicians and Managers One Year on from Training in Trauma-Informed Care

G Smith^1,2

¹Office of the Chief Psychiatrist Western Australia, Perth, Australia

²School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia

Background: Despite the growing body of evidence highlighting the limitation of stand-alone training and the critical importance of contextual factors in the successful implementation of new practices, many organizations continue to provide one-off training workshops for their clinical workforce with the apparent belief that ‘train and they will do’.

Objectives:

Methods: A total of 271 clinicians and middle-managers from public mental health and drug and alcohol services in Western Australia who had undertaken TIC training were invited to complete an online survey at 12 months after training. Individual survey items were based on a 5-point Likert scale with opportunity provided for additional comments.

Findings: One-year post training, both clinicians and middle-managers reported that training had increased their awareness and knowledge and had had a positive impact on their attitudes towards TIC. Clinicians reported a moderate increase on their individual practice, and both groups reported very limited success in bringing about changes in their workplaces. Workplace development and organizational factors were identified by both clinicians and managers as being barriers to implementation.

Conclusions: Stand-alone training is not sufficient to bring about practice change. Theories of motivation and organizational readiness for change offer promising directions for rethinking the role of training in workplace change.

Revisiting Counter-Transference and Vicarious Traumatization in the Age of Trauma-Informed Care, Intervention and Treatment

G Halasz

Department of Psychiatry, Monash University, Melbourne, Australia

Background: The ongoing century-long debate centred on the nature and experience of real trauma and ‘psychic trauma’ in therapy took a major turn as McCann and Pearlman (1990) introduced the term ‘vicarious traumatization’. Major advances have continued in the field of trauma studies, notably Schore’s (2001) ‘relational trauma’. This presentation updates the relationship between counter-transference and vicarious trauma.

Objectives: To update the TIC paradigm (Halasz, 2017) as applied to the principles of care, intervention and treatment (TICIT) in psychiatric psychotherapy.

Methods: A brief overview of the key components of the TIC paradigm change: ‘relational trauma’ to distinguish it from the related but distinct phenomena: ‘burnout’, ‘compassion fatigue’, ‘heart-sink patients’, counter-transference and ‘psychic trauma’ in a clinical case.

Findings: Many reports use these terms interchangeably resulting in confusion and exposure to risks of vicarious trauma for patient and therapist.

Conclusions: The evidence-based trauma-informed care should be introduced as core curriculum teaching in all mental health courses.

References

Halasz G (2017). Introduction. Massive trauma: attachment ruptured, attachment repaired. In: Salberg J, Grand S (eds) Wounds of History. Repair and Resilience in the Trans-Generational Transmission of Trauma. London: Routledge, pp. 9–17.

McCann IL Pearlman LA (1990) Vicarious traumatization: a framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress 3(1): 131–149.

Schore AN (2001) The effects of relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal 22: 201–269.

Evidence for Yoga as a Treatment Intervention for Depression, Anxiety and PTSD – Navigating Heterogeneity

M de Manincor^1,2,3,4,5

¹Australian Health Practitioners Registration Australia, Sydney, Australia

²The Yoga Institute, Sydney, Australia

³The Yoga Foundation, Sydney, Australia

⁴Yoga Australia, Melbourne, Australia

⁵National Institute of Complementary Medicine (NICM), Western Sydney University, Sydney, Australia

Background: Growing evidence suggests potential benefits of yoga as a treatment for depression, anxiety and post-traumatic stress disorder (PTSD). Systematic reviews and meta-analyses of clinical trials have found positive results (Balasubramaniam et al., 2013; Cramer et al., 2013, 2017). However, heterogeneity of yoga interventions makes it difficult to draw conclusions and formulate clinical intervention guidelines.

Objectives: To present a summary of evidence from systematic reviews and meta-analyses for treatment of depression, anxiety and PTSD, including intervention characteristics, and identification of differences and commonalities across heterogeneity of approaches.

Methods: A systematic review of RCTs was conducted on the effectiveness of yoga for reducing depression and/or anxiety (de Manincor, 2017). The review identifies, describes and assesses clinical research from RCTs that include any type of yoga-based intervention as a treatment for depression or anxiety. Identification of trial and intervention characteristics, summary of outcome efficacy, and findings of related previous systematic reviews are included in the review. Related research for PTSD is also summarized.

Findings: Results indicate that several types of yoga interventions were effective in reduction of depression, anxiety and PTSD. Heterogeneity was identified among yoga interventions.

Conclusions: Yoga was effective in reducing depression, anxiety and PTSD. Heterogeneity of yoga interventions makes it difficult to formulate recommendations and clinical intervention guidelines. Further investigation and clarification of the variety of approaches is warranted.

References

Balasubramaniam M, Telles S, Doraiswamy P (2013) Yoga on our minds: a systematic review of yoga for neuropsychiatric disorders. Frontiers in Psychiatry 3: 117.

Cramer H, Lauche R, Langhorst J, Dobos G (2013) Yoga for depression: a systematic review and meta-analysis. Depression and Anxiety 30 (11): 1068–1083.

Cramer H, Lauche R, Anheyer D, Pilkington K, de Manincor M, Dobos G, Ward L (2017) Yoga for anxiety: a systematic review and meta-analysis. Under Review.

de Manincor M (2017) Yoga for Mental Health: evaluation of yoga interventions for reducing depression and anxiety, and improving well-being. PhD Thesis.

The Cultural Psychiatry of Violence Against Women – Lessons from the Cambodian Case

M Eisenbruch

Monash University, Melbourne, Australia

Background: Violence against women in Cambodia is alarming, with one in four women a victim of it.

Objectives: To provide a comprehensive understanding of the ways in which Cambodians see the causes and effects of violence against women and to identify and analyse the cultural forces that underpin and shape its landscape.

Methods: An ethnographic study was carried out with 102 perpetrators and survivors of emotional, physical and sexual violence against women and 228 key informants from the Buddhist and healing sectors. Their views and experiences of it were recorded – the popular idioms expressed and the symptoms of distress experienced by survivors and perpetrators. From these results, the eight cultural forces, or cultural attractors, that propel a person to violence were identified.

Findings: Eight cultural attractors shaped the landscape of violence against women:

Conclusions: The cultural epigenesis of violence against women in Cambodia can be used to build culturally responsive mental health interventions and strengthen the primary prevention of violence against women.

Holistic Care in Action-When Health and Law Unite

T Ewais^1,2, C Banks¹

¹University of Queensland, Brisbane, Australia

²Mater Young Adult Health Centre, Brisbane, Australia

Background: The issues of health and law are closely connected in people with chronic illness, and yet there is little emphasis in the current health services funding and planning on establishing formal links between these two important areas.

Increasing evidence indicates that the relationship between chronic ill health and social adversity is bidirectional, as well as the relationship between chronic illness and unmet legal needs. The evidence strongly suggests that one predisposes to the other and they are mutually reinforcing (Coumarelos et al., 2012).

The Mater Young Adult Health Centre and Health Advocacy Legal Clinic partnership is an example of an innovative and effective health–justice or medical–law partnership. It is the first of its kind; being a co-located health and legal service but also providing a space for collaborative interdisciplinary work.

Objectives: Young people’s health and well-being are explored in a contemporary context of holistic care provided within a health–justice partnership in a tertiary hospital for young adults with chronic illness.

Methods: We describe the collaborative treatment model involving health and law professionals working in an interdisciplinary clinic.

Findings: We provide examples of treatment, coordinated actions and successful outcomes in the well-being of three complex young people, their families and the community.

Conclusions: The paper concludes by offering future visions of service expansion both in availability on site as well as increased support.

Reference

Coumarelos et al. (2012)

Barriers and Burdens: Forensic Patient Exposure to Stigma and Discrimination

C Matthews, EN McVie

Hunter New England Mental Health Service, Newcastle, Australia

Background: Forensic patients are often distinguished from other health consumers by their severe psychiatric morbidity as well as the seriousness of their criminal history. These factors may be viewed as reasons for greater accessibility to health and community services. There are suggestions, however, that forensic patients encounter certain barriers on their recovery journey that prevent the attainment of optimal well-being.

Objectives: To provide an understanding of how service provision is limited for forensic patients. Compared to their civilian counterparts and other consumer groups, we hypothesize that forensic patients encounter greater discriminative practices and stigma throughout their healthcare journey that prevent full access to programs and services.

Methods: A review of the scholarly literature was conducted with reference to the topic question. The information collected was supplemented by a series of relevant case reports.

Findings: Forensic patients appear to experience significant issues associated with stigma and discrimination in various domains. Areas of particular note include stigma by health and legal professionals and discrimination by government and non-government organizations responsible for community services. These barriers may, in turn, potentiate an experience of self-stigmatization.

Conclusions: The results support the notion that forensic patients experience significant levels of stigma and discrimination during their recovery journey. The authors suggest that health networks and government sectors work with patients and clinicians to address management inadequacies. In particular, vocational accessibility and clinician education should be optimized to improve outcomes for this patient group.

Non-Violent Resistance: Changing Culture Together in the Child and Adolescent Inpatient Setting

C de Vries

Hunter New England Mental Health, Newcastle, Australia

Background: Non-violent resistance (NVR), a method well known in a social political context, has been adapted to the psychiatric clinical practice. Developed in Israel by Haim Omer and colleagues, NVR was first used in outpatient settings for parents of violent children, regaining parental authority and reducing (self) destructive behaviour. De Bascule, an academic child and adolescent mental health setting in Amsterdam, the Netherlands, adapted this model in 2008, to be used in the inpatient setting with the initial aim of reducing seclusion and restraint. The benefits exceeded expectations and almost 10 years later it has created a change of culture which has not only reduced seclusion but also has had multiple flow-on benefits. Teams are more cohesive, patients and families more involved and empowered and overall satisfaction with services improved. De Bascule now provides training and is instrumental in implementing this method in other clinical settings including the forensic setting.

Objectives: To outline the origins and adaptation of NVR. It will outline the principles, the challenges and future of this method.

Methods: A 20-min oral presentation to introduce NVR.

Conclusions: NVR is a versatile method to reduce violence and destructive behaviour. It has been adapted to the clinical setting and is built on a collaborative network around the identified patient, empowering them and their systems, including our own

Youth and Family Well-Being Team: A Different Approach

T Tijhof

Metro South Addiction and Mental Health Services (Logan Hospital), Brisbane, Australia

Background: The Logan Beaudesert Wellbeing Program has been implemented by Metro South Addiction and Mental Health Service to reduce hospital-based care.

The Youth and Family Wellbeing Team (YFBT) is an evidence-informed (Flexible Assertive Community Treatment, Balanced Care Approach, Adolescent Mentalization-Based Integrative Therapy) service delivery program. The team works with young people aged 12–21 years with complex and severe mental health and/or behavioural presentations. The target population is hard to engage – young people who are (or who are at high risk of becoming) high utilizers of hospital services and who are likely to benefit from intensive, client-centred, family-focused, outreaching mental health services within a 6- to 12-month timeframe.

At the YFWBT, youth and carer-specific peer-support-workers are a part of the integrated care treating team.

Objectives: The aim of the program is to maintain and/or improve the patient’s quality of life leading to less occupied bed days and less emergency department attendance by reducing the symptom impact and associated distress and address individual’s healthcare needs, whole-of-life needs and personal goals.

Methods: We obtained data from electronic medical records to evaluate hospital utilization. We used routine outcome measures (Health of the Nation Outcome Scales, Burden Assessment Scale, Recovery Assessment Scale) to evaluate symptomatology, symptom impact and associated distress.

Findings: There was a significant reduction in hospital utilization and improvement on the outcome measures.

Conclusions: The YFBT achieved the targeted primary objectives: addressed the needs for the target population, reduced hospital utilization and demonstrated statistically significant outcomes.

Innovations in Youth Early Psychosis

P Denborough^1,2

¹Alfred CYMHS (Child and Youth Mental Health Services), Melbourne, Australia

²headspace, Melbourne, Australia

Background: headspace Youth Early Psychosis Program (hYEPP) in South East Melbourne takes an innovative approach to caring for young people with serious mental illness. Recent innovations in practice at hYEPP have led to the trialling and implementation of a range of new opportunities for young people, their families and carers, and service staff.

Objectives: To report on two important innovations in practice now being rolled out across hYEPP in South East Melbourne. These are the development and implementation of a youth-focused Discovery College and the adoption of an open dialogue-based approach to early psychosis treatment.

Methods: We have undertaken qualitative research on the service change implications of these two significant shifts in our service delivery model. We report on the experiences of both staff and young people in the design, delivery and implementation of both Discovery College and open dialogue.

Findings: Both Discovery College and open dialogue require investment in a service change process and a willingness by staff across the entire organization to commit to recovery principles embedded in a new way of working. Managing service change on this scale requires support from senior management, tolerance of uncertainty, respect for the wisdom of lived experience and a willingness to experiment.

Conclusions: Implementing service-wide change to deliver innovative ways of working with young people is both feasible and effective given sufficient support, resources and time. These new ways of working are welcomed by young people and families and can be transformative.

Habits – an App-Based Self-Help Intervention for Youth: Proof of Concept Testing

K Stasiak, G Christie, T Fleming, M Shepherd, S Hopkins, S Merry

Department of Psychological Medicine, University of Auckland, Auckland, New Zealand

Introduction: mHealth interventions have promise as a means of delivering evidence-based treatment to hard-to-reach populations. Few are designed for adolescents, nor do many have evidence of efficacy. HABITs is a large New Zealand project to develop modular behavioural intervention technologies (BITs) to support adolescents with common mental health concerns. We used co-design principles with school students to design a prototype app. This paper presents results from a trial to evaluate its acceptability, usage and estimate its efficacy.

Methods: We conducted a proof-of-concept pilot with young people aged 13–16 years wanting help to manage stress. Participants were given access to the HABITs app and encouraged to use it over a 3-week period. The app is linked to the HABITs IT platform which collects information about usage and administers screening and outcome measurement instruments. We collected pre and post measures of depressed mood (Patient Health Questionnaire for Adolescents (PHQ-A)) and anxiety (Generalized Anxiety Disorder Scale (GAD-7)). A satisfaction questionnaire and brief semi-structured interviews were also administered.

Results and conclusions: This is an ongoing study. Results from the pilot will be presented along with discussion about the research process involving collecting data across an electronic platform.

Is Deep Brain Stimulation a Pacemaker for the Brain? A Systematic Review and Meta-Analysis of its Efficacy In Depression

S Kisely^1,2,3, A Li¹, N Warren², D Siskind^1,2

¹School of Medicine, University of Queensland, Brisbane, Australia

²Metro South Addiction and Mental Health Service, Brisbane, Australia

³Dalhousie University, Halifax, Canada

Background: Deep brain stimulation (DBS) is increasingly being used for treatment-resistant depression. Blinded, randomized controlled trials of active versus sham treatment have been limited to small numbers.

Objective: To conduct a systematic review and meta-analysis on the effectiveness of DBS in depression.

Method: The Cochrane Central Register of Controlled Trials, PubMed/Medline, Embase and PsycINFO, Chinese Biomedical Literature Service System and China Knowledge Resource Integrated Database were searched for single- or double placebo-controlled, cross-over and parallel-group trials in which DBS was compared with sham treatment using validated scales.

Findings: Eight papers from seven studies met inclusion criteria, all but one of which were double-blinded RCTs. We were unable to obtain data for a further unpublished study that was discontinued following a futility analysis. The main outcome was a reduction in depressive symptoms. It was possible to combine data for 96 participants. Patients on active, as opposed to sham, treatment had a significantly higher response (odds ratio (OR) = 6.73; 95% confidence interval (CI) = 2.91, 15.59; p < 0.0001) and reductions in mean depression score (standardized mean difference (SMD) = −0.54; 95% CI = −1.02, −0.07; p = 0.03). There were no differences for most other outcomes. Publication bias was possible.

Conclusions: DBS may show promise for treatment-resistant depression but remains an experimental treatment till further data are available.

Structural and Functional Neuroimaging Brain Correlates of Violence in Schizophrenia and Personality Disorder

M Das^1,2

¹Top End Mental Health Service, Darwin, Australia

²West London Mental Health Trust, Broadmoor Hospital, London, UK

Background: The vast majority of the mentally disordered are not violent. Unfortunately, a small minority can be responsible for serious acts of violence. There are a range of factors that can contribute to violence in the mentally disordered. However, the brain origins of violence in this group have remained poorly understood.

Objectives: To discuss research using various techniques in this subgroup of psychiatric patients; specially focusing on structural and functional magnetic resonance imaging (MRI). The talk will detail how these non-invasive techniques can be used to explore the key brain areas and circuits that are responsible for aggression and violence. The brain circuits that govern emotional processing are the ones that are aberrant in the violent mentally disordered.

Methods: The talk will detail results from a major study from Broadmoor high security Hospital and the Institute of Psychiatry, London, in patients with schizophrenia and personality disorder (PD) wherein functional and structural MRI and other measures were used to understand the brain origins of violence.

Findings: The findings have been reported in several peer-reviewed publications. The findings focus on executive function deficits, volume reduction in whole brain, hippocampal, frontal lobe areas; functional impairment in brain areas related to threat perception, facial emotion recognition and motor inhibition. A significant difference in brain abnormalities between violent schizophrenia and patients with PD is noted.

Conclusions: The presentation will pull together strands of evidence to formulate an integrative hypothesis of the brain origins of violence in schizophrenia and PD.

Bibliographic Review in Neuroimaging in Obsessive–Compulsive Disorder: Alterations in Structural and Functional Brain Magnetic Resonance Imaging

T O Domingos, V Muoio

Universidade Nove de Julho, São Paulo, Brazil

Background: Obsessive–compulsive disorder (OCD) is present in 1.2% of the population in the United States and is classified in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) within OCD and related disorders. It is characterized by the presence of depressive and intensive thoughts, images, impulses and behavioral or mental rituals, which alleviate the anxiety caused by obsessions. With the advancement of neuroimaging, different studies with different conclusions have been conducted to define the neurologic alterations in this disorder.

Objectives: To reunite data from different studies published after 2013 about functional and structural magnetic resonance imaging (MRI) in OCD to define the major alterations in this disorder.

Methods: Twenty-seven different articles found in Google Scholar, published after 2013 about experimental research on functional and structural alterations in MRI, were analysed. The articles were found under the following key words: neuroimaging in OCD, functional MRI in OCD, neuroimaging obsessive compulsive, epidemiology in OCD, OCD imaging, abnormal functional connectivity ‘MRI study’ OCD, structural MRI OCD, brain abnormalities in OCD, obsessive compulsive disorder brain scans.

Findings: Diverse studies found an elevation connectivity and activity in the orbifrontal cortex, striatum, caudate nucleus, anterior cingulate cortex, thalamus, cerebellum, putamen and amygdala, which explains the impulses and the compulsions. In addition, there were reductions in the activities of the prefrontal and frontal cortex and the insula.

Conclusions: These findings support the theory of an altered cortical–striatal–thalamic–cortical circuit in addition to a disturbed cortical–striatal–cerebellar circuit and the participation of the limbic system in the pathophysiology of OCD.

‘The Child is the Father of the Man’: Effects of Childhood Abuse on Later Life Brain Structure and Violence – Insights from Neuroimaging

M Das^1,2

¹Top End Mental Health Service, Darwin, Australia

²West London Mental Health Trust, Broadmoor Hospital, London, UK

Background: Adverse early life experiences shape personality formation and mental functioning as an adult, and there is ample evidence for mental disorders arising from experiences such as abuse and deprivation during childhood. Offenders with schizophrenia or personality disorders (PDs) with serious violence have histories of, for example, significant childhood abuse, neglect or deprivation.

Objectives: To examine the literature on morphological variations in various brain structures in individuals with a history of violence and childhood abuse. The role of childhood abuse on brain structure in forensic psychiatric populations was investigated.

Methods: The speaker will report on his research conducted in seriously violent men with antisocial PD or schizophrenia and a history of childhood abuse and other deprivation using structural magnetic resonance imaging.

Findings: The findings focus on volume loss in two specific areas of the brain affected by childhood abuse in these violent subjects: the thalamus (which affects sensory processing) and the anterior cingulate (regulates executive functioning).

Conclusions: The aetiology and clinical implications of these findings are discussed with a focus on the pathoplastic effects of childhood abuse on later-life brain structure and functioning.

References

Kumari V, Gudjonsson GH, Das M (2013) Reduced thalamic volume in men with antisocial personality disorder or schizophrenia and a history of serious violence and childhood abuse. European Psychiatry 28(4): 225–234.

Kumari V, Uddin SS, Das M (2014) Lower anterior cingulate volume in seriously violent men with antisocial personality disorder or schizophrenia and a history of childhood abuse. Australian & New Zealand Journal of Psychiatry 48(2): 153–161.

Changing Characteristics of a Psychiatric Emergency Care Centre: An Eight-Year Follow-Up Study

J Seymour, V Brakoulias

Nepean Blue Mountains Local Health District, Penrith, Australia

Background: Psychiatric Emergency Care Centres (PECCs) have become common modes of acute service delivery throughout Australia. It is important to understand the characteristics of PECCs and whether PECCs can positively influence outcomes for patients.

Objectives: To report changes in characteristics of the first PECC to open in New South Wales after 8 years of operation.

Methods: Retrospective data collated from consumer files were compared with data from 8 years previously in respect to presenting problems, diagnosis, medications prescribed, treatment of aggression and length of stay.

Findings: Innovative changes to practice after the first study in 2007 led to a decreased length of stay, reduction in aggressive incidents, reduced use of PRN (as needed) medications and positive changes to practice, particularly in relation to diagnostic practice.

Conclusions: The significant reduction in aggression, the use of PRN medication and the number of people with longer stays within the PECC support the usefulness of PECCs over the long term. These factors may be considered as indicators of the efficiency of a PECC.

Leave Incidents: How Frequent and How Serious?

D Wettasinghe¹, N O’Connor^1,2, K Walkley¹

¹Northern Sydney Local Health District, Sydney, Australia

²Department of Psychiatry, University of Sydney, Sydney, Australia

Background: Allowing leave for patients in mental health units is a complex issue. Most Australasian psychiatrists regard leave as a vital component of a patient’s gradual transition from the hospital to the community environment. However, when leave goes wrong, there can be societal, political and media implications. Internationally practices vary.

Objectives: To investigate the frequency, type and consequences of incidents occurring when psychiatric patients are on authorized and unauthorized leave.

Methods: The leave incidents occurring in six psychiatric hospitals between 2010 and 2017 were analysed.

Findings: There were 1370 incidents of unauthorized leave between 1 January 2010 and 31 December 2017. Most incidents were of low severity and consequence. The frequency of serious incidents, whether calculated per number of leave events or per 1000 bed days, is very rare. A significant proportion of leave incidents occur on authorized leave following failure to return.

Conclusions: Our study provides evidence for the hypothesis that leave incidents are rare and serious leave incidents are extremely rare. Failure to return from authorized leave is worthy of more consideration when thinking about prevention of harm.

How the Redesign of an Emergency Department Psychiatry Model of Care Led to Reduced Waiting Times Despite Increased Patient Demand and No Change in the Availability of Inpatient Beds

S Stafrace, S Lee, P Thomas, K Henderson, E Symons, de Villiers Smit, R Atkins, B Hobbs, A Reynolds, S Keppich-Arnold

Background: The Alfred is a major metropolitan hospital in Melbourne, Victoria. It operates an Emergency and Trauma Centre (E&TC) that responded to 63,242 presentations in 2014–2015. Although anecdotal reports indicated that presentations involving mental health or alcohol and other drug (AOD) issues were common, little data were available to demonstrate the prevalence, pathways of care through the hospital and whether the current model was meeting patient needs. This project aimed to improve the E&TC response for people experiencing AOD and/or mental health issues by improving access to specialist assessment, earlier commencement of specialist treatment, reduced time in E&TC and reduced harm during the E&TC episode of care.

Intervention: A steering group was established with representation from clinical, re-design and performance monitoring units. A current state analysis examined the frequency of AOD or mental health presentations over a 14-month period in the emergency department. Consultation was undertaken with consumer, clinician and management stakeholders to identify the current process of responding to this target population and to test potential solutions. An improved response was highlighted as being needed for patients who were exhibiting behaviours of concern, frequent presenters and likely to undergo short-term (<48 h) adult psychiatry admissions. A dedicated E&TC psychiatry team (the emergency psychiatry service (EPS)) was established to provide enhanced specialist interventions from Monday to Friday, with the restricted hours reflecting limitations of funding. The team was managed within a single program stream structure that included the liaison psychiatry and outreach crisis assessment and treatment teams, both of which supported the activity of the EPS. Collaboration with the Adult Psychiatry Inpatient Unit was also central to the outcomes. The model provided for assessment and brief intervention from specialist staff including a dually qualified nurse (mental health and AOD), a mental health nurse practitioner, a psychiatry registrar and a psychiatrist. Patients were admitted under EPS bed cards to the E&TC short-stay unit as required. EPS staff undertook training of non-psychiatric staff to develop their expertise in AOD and mental health assessment and treatment and management of acute behavioural disturbance.

Outcome: Following implementation, there was a 6% increase in the number of mental health and/or AOD assessments undertaken in the E&TC in the first year (pre-implementation 12 months = 2110 episodes vs. post-implementation 12 months = 2239 episodes). In the 3-year post-implementation, the numbers of mental health and/or AOD assessments undertaken in the E&TC increased by 64% (2012–2013 = 1980 episodes vs. 2015–2016 = 3240).

Despite this increase in activity, the time spent by patients presenting with mental health and/or AOD issues in the E&TC was reduced by 20% (pre-implementation 12 month mean = 4.3 h vs. post-implementation 12 months mean = 3.4 h). In the 3-year post-implementation, the National Emergency Access Target of 4 h to admission increased from 58% in 2012–2013 to 72% in 2015–2016, indicating that the gains in this component of performance were sustained.

Patient safety indicators in the first 12-month post-implementation included a 12% reduction in time spent by security responding to events within the E&TC and a 40% reduction in the number of patients transferred from the inpatient psychiatry unit to medical wards in the first 24 h following admission. Patient feedback was positive and will be included in the presentation.

Conclusions: This initiative demonstrated that an approach to service redesign that integrated emergency and hospital consultation–liaison, outreach crisis assessment and inpatient services can reduce emergency department waiting times safely and can sustain that reduction even in the setting of increased emergency demand and no change in the number of hospital beds.

NSW Health ‘Pathways to Community Living Initiative’: Deinstitutionalizing Options for New And Ultra-Long Stay Patients in Long-Term Inpatient Care

A McGeorge¹, R Murray²

¹UNSW Sydney, Sydney, Australia

²NSW Health, Sydney, Australia

Background: The process of deinsitutionalization in New South Wales has been a long-term endeavour with frequent lapses of momentum.

Objectives:

Methods: A cohort of 380 long-stay patients has been identified utilizing a battery of ‘transition readiness’ screening tools, existing NSW Health patient data and additional evidence-based measures of functioning, capacity and need. Person-centred processes are being employed to engage consumers and their families in defining and determining what services and supports would enable consumers to have a place and community they can call ‘home’. An external evaluation of the initiative has been commissioned to determine challenges to, and changing attitudes towards, the process, consumer experience and clinical outcomes.

Findings: Each hospital has presented its own specific challenges, relating to its history, staff and staffing and the functions that it serves in the community. Availability of existing community services and lack of planning for models of rehabilitation figure in outcomes thus far achieved.

Conclusions: The negative aspects of institutionalization still exist in New South Wales. However, with high-level government support, capable project management, clinical leadership and consumer involvement, positive change is proving possible. Some of the lessons being learnt can be applied in more contemporary services to ensure that they remain person-centred and innovative.

MASQUERADE: Covert Internet Addictive Behaviours and Mental Health Symptoms in a Youth Cohort

A McDonald^1,2

¹Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, Australia

²Curtin University Health Centre, Curtin University, Perth, Australia

Background: Addiction problems cause serious impairments and functional compromise. Clinical assessment by a psychiatrist in a new consultation service at a University Health Centre identified covert internet addictive behaviours with other commonalities noted.

Objectives: To identify characteristics and indicators of clinical presentation to inform other health practitioners in this busy, subspecialized clinical service treating a diverse and highly intelligent youth patient cohort.

Methods: A clinical audit of referred students who completed an initial psychiatric assessment within a defined time period was completed. A qualitative study of each identified case was completed using a retrospective patient file analysis and case discussion with the referring general practitioner.

Findings: A small group of patients (approximately 10%) were identified, all of whom had presented over a long time (1–8 years) with a range of mental health disorders without disclosure of their associated addictive behaviours. All had received treatment from other health professionals. All had demonstrated academic failure. All were in personal situations where their behaviours were enabled, with a history of internet overuse since mid-adolescence, and displayed features of developmental arrest in living and social skills.

Conclusions: University students may present with mental health symptoms and not reveal the comorbid and impairing internet dependency. There are indicators in the history which may assist in the identification. There are enabling factors in their lives that allow the perpetuation of this problem. Health professionals and services need to be informed to allow identification, promote treatment and to prevent their own inclusion within the individual’s enablement systems.

A Life Worth Living

D Davidson

Waitemata District Health Board, Auckland, New Zealand

Background: When there is seemingly no purpose or meaning to life, one might find purpose and meaning in death. Even if it is an escape from pain, purposelessness and meaninglessness.

Despite systems working intensely on suicide prevention, New Zealand retains the dubious distinction of the country with the highest adolescent suicide rate in the developed world (UNICEF Office of Research, 2017). What makes New Zealand’s children lack purpose and meaning in life and find something worth living for? What can we do to help them find it?

Objectives: To have an interactive, philosophical discussion on what makes life worth living, especially for young people in New Zealand.

Methods: This presentation will be a collation of various philosophical schools of thought about meaning and purpose in life. It incorporates case vignettes and anecdotes from published articles, reports, online media and clinical experience, of people’s perception of meaning and purpose or the lack of it. The focus will be on what might help young people find meaning and purpose in life, thus building resilience.

Findings: Multiple factors contribute to youth suicide including childhood neglect, abuse or poverty, family dysfunction, peer pressure and alcohol abuse. Vulnerable social systems contribute to individual vulnerability. However, finding something worth living for may build resilience and perhaps ‘what doesn’t kill you makes you stronger’ (Jörgen Elofsson, 2011), taken from an English translation of the 19th century German philosopher, Friedrich Nietzsche.

Conclusions: System changes are necessary, important but tedious and time-consuming processes. Finding individual meaning and purpose in life, despite life circumstances, can help build individual resilience.

References

UNICEF Office of Research (2017). Building the Future: Children and the Sustainable Development Goals in Rich Countries. Innocenti Report Card 14, UNICEF Office of Research – Innocenti, Florence. Available at: Innocenti Report Card 14: https://daks2k3a4ib2z.cloudfront.net/57fecca33488e33246faeb20/5941c32ca086816fc5a850f2_Building%20the%20Future%20-%20Children%20and%20the%20Sustainable%20Development%20Goals%20in%20Rich%20Countries%20(English).pdf

Jörgen Elofsson AT, Gamson D, Kurstin G, Tamposi A (2011). Stronger (What Doesn’t Kill You). [Recorded by K. Clarkson]. United States of America.

The Importance of Process and Outcome Measurement in the Effective Implementation of Evidence-Based Practices in Vocational Rehabilitation

H Lockett^1,2, G Waghorn^3,4, R Kydd¹

¹The University of Auckland, Auckland, New Zealand

²The Wise Group, Hamilton, New Zealand

³Queensland Centre for Mental Health Research (QCMHR), Brisbane, Australia,

⁴School of Applied Psychology, Brisbane, Australia

Background: The quality of program implementation influences program effectiveness. Therefore, a critical stage in developing any evidence-based psychosocial program is to develop a measure of implementation quality so that, for any previously demonstrated program, efficacy is not eroded through poor implementation. An example of such a quality (fidelity) measure is found in the Individual Placement and Support (IPS) approach to vocational rehabilitation, a specialized form of supported employment for people with mental illness. IPS is a well-defined and extensively researched program.

Objectives: To explore the predictive validity of the two measures of fidelity in international studies of IPS implementation. The secondary research questions were specified to explore other potential influences on the strength of the relationship between program quality, as measured through fidelity and employment commencements.

Methods: A systematic review was conducted to identify both natural observational studies and controlled trials of IPS programs, reporting IPS fidelity scores. More than 60 defined cohorts were identified. After grouping the studies by differentiating characteristics, meta-analyses were conducted to determine the relationship between fidelity score and employment commencements, and the potential covariates.

Findings: Fidelity scores less than 80% of full fidelity predicted poor outcomes, defined as 43% or less of participants commencing employment. While fidelity score was found to be a robust predictor of program performance, it did not guarantee high performance.

Conclusions: Program implementation leaders should first focus on attaining good fidelity. A wider implementation framework is needed to identify promising factors, outside implementation fidelity, to improve program performance.

Islamic Spirituality and Mental Well-Being

M Rahman

Yaqeen Institute, Dallas, USA

Background: Modern science has recently taken a keen interest in the wisdoms found in the ancient eastern traditions such as Buddhism, Confucianism, Taoism and Hinduism. For instance, a browse through the literature will reveal an abundance of studies that have investigated neurobiological effects and therapeutic benefits of Buddhist mindfulness meditation. Subsequently, this practice has been incorporated into a wide variety of treatment protocols. However, the tradition of spirituality within Islam remains unexamined. Historically, Muslim civilization had developed strong psychospiritual theories that resulted in innovative psychotherapeutic practices that included cognitive behavioural therapies from as early as the ninth century.

Objectives: To uncover some of the lost Islamic heritage to demonstrate its relevance to modern discussions in mental health. It is divided into two sections:

Methods: Integrating neuropsychology and spirituality research from scientific journals with Islamic spiritual literature to explore universal therapeutic benefits achieved from Islamic practices.

Findings: Neuroimaging reveals profound therapeutic effects on the brain of individuals engaged in different forms of Islamic spiritual practices (Newberg et al., 2015).

Conclusions: Clinicians and allied mental health professionals can serve to benefit from gaining cultural literacy in the Islamic perspective of mental health to provide care to Muslim populations and to provide fresh insights to potentially incorporate into their own current therapeutic repertoire.

References

Chiesa A, Serretti A (2010) A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine 40(8): 1239–1252.

Badri MB (2013) Abu Zayd al-Balkhi’s Sustenance of the Soul: The Cognitive Behavior Therapy of a Ninth Century Physician. Herndon, VA: The International Institute of Islamic Thought.

Newberg AB, Wintering NA, Yaden DB, Waldman MR, Reddin J, Alavi A (2015) A case series study of the neurophysiological effects of altered states of mind during intense Islamic prayer. Journal of Physiology – Paris 109: 214–220.

Congress at the Movies: The Snowman (A Cinemeducation)

D Brunskill

PUAWAI, Midland Regional Forensic Psychiatric Service, Hamilton, New Zealand

Background: There are no rules as to where psychiatric learning and understanding might originate from. Non-traditional sources of education (e.g. literature, television, radio and film) may offer added value. The art form with the most vaunted potential is probably film.

Objectives: To demonstrate how ‘Cinemeducation’ can add significant value to clinical practice (Dave and Tandon, 2011), Congress will go to the movies.

Methods: The value of film to psychiatry (and vice versa – Byrne, 2009) will be described. The Snowman (Lamont, 2008) won the Sydney Film Festival Doco Prize, 2010, and was reviewed as ‘fascinating, heartbreaking and very brave’. Curated scenes will be shown.

Findings: Psychiatric education and development can be enjoyable, and learning from film can apply to all levels of clinical experience. Given the diverse learning objectives of students, trainees and psychiatrists, the ‘doco’ genre should be added to ‘the modern clinical educators’ armamentarium’ (Dave & Tandon, 2011).

Conclusions: Traditional forms of continuing medical education (CME) – online credits, journal subscriptions, peer review, conferences – can be enhanced by exposure to the arts also. Films/movies allow for a vicarious experience and reflection and, in this example, can promote a deeper understanding of how mental illness affects individuals and their whānau (family), as well as professionals of all grades – ‘lighting up parts of ourselves that have been dark for a while’ (Tsapas, 2017).

References

Byrne P (2009) Why psychiatrists should watch films (or What has cinema ever done for psychiatry). Advances in Psychiatric Treatment 15: 286–296.

Dave S, Tandon K (2011) Cinemeducation in psychiatry. Advances in Psychiatric Treatment 17: 301–308.

Lamont J (2008) The Snowman, Antidote Films.

Tsapas T (2017) Removing obstacles to make better doctors through the use of films in Medical Education. Available at: https://www.rcpsych.ac.uk/pdf/4-Films_Psych_eSSC.pdf (accessed on 11 August 2017).

Never had so Many been Treated with so Little by so Few

A Virgona^1,2,3,4

¹Northside Macarthur Clinic, Sydney, Australia

²Clinical Governance Committee, One Door Mental Health, Sydney, Australia

³NSW Branch, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia

⁴Western Sydney University, School of Psychiatry, Sydney, Australia

Background: Borderline personality disorder (BPD) and complex trauma disorders are common. The National Health and Medical Research Council (NHMRC) Guidelines provide guidance about effective treatments. Effective treatments are unavailable to most sufferers due to cost/availability of skilled practitioners.

Objectives: To determine the numbers of patients being treated for BPD/complex post-traumatic stress disorder (PTSD), the frequency of contact, the limitations on frequency and intensity of treatment, a survey of all non-government organizations (NGO) and private sector clinicians was conducted. Data were also collected regarding the professional background of clinicians, their specific skill sets and specific training in evidenced-based treatments for these disorders. Obstacles to effective service delivery were explored.

Methods: Survey Monkey was distributed to all relevant clinicians) and NGOs (difficult to be precise regarding N as unclear it was distributed to all individuals within organizations, but minimum reach was 65) in a population catchment of 430,000 (outer-metro Sydney/semi-rural, with few psychiatrists in the private sector and only two part-time psychiatrists conducting psychotherapy); 38 respondents.

Findings: Most respondent clinicians had the requisite skills to deliver evidence-based therapies; however, multiple obstacles were encountered in delivering the appropriate level of therapy, but there were mainly funding limitations.

Conclusions: The Clinical Practice Guideline for the Management of Borderline Personality Disorder (NHMRC) recommends specific evidence-based therapies, of specific frequency and duration. Clinicians skilled in delivery of evidence-based therapies are not uncommon. Public sector services and Medicare-funded services are not designed to provide therapy of sufficient frequency and duration. Possible funding and partnership models are explored.

Mental Health and Indigenous Connection to Land and Community

M Toombs¹, S Kondalsamy-Chennakesavan¹, S Kisely¹, N Gill¹, N Hayman¹, G Ranmuthugala¹, G Beccaria², R Ostini¹, GC Nicholson¹, B Nasir¹

¹Faculty of Medicine, The University of Queensland, Brisbane, Australia

²Faculty of Psychology and Counselling, University of Southern Queensland, Toowoomba, Australia

Background: Although rates of common mental disorders (CMD) are acknowledged to be high among community-living Indigenous Australians, the data are derived from self-report. Rates among remote residents are half of those living elsewhere. Community-based prevalence rates of CMD derived from diagnostic interviews have not been available.

Objectives: To determine whether Indigenous Australians living as majorities on traditional lands (‘Reserve’ populations) or in remote areas have lower rates of current CMD than those living as minorities in mainstream communities.

Methods: Cross-sectional study (July 2014 to November 2016) involving Aboriginal Medical Service (AMS) clients (n = 420), community residents (n = 54) and Reserve residents (n =70). Psychologists conducted a Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) assessments.

Findings: The standardized rates (95% confidence interval (CI)) of current CMD were 45.9% (38.8, 47.7) among AMS clients and 37.5% (32.2, 42.8) among community residents, 4.6-fold and 3.7-fold higher, respectively, than those of the Australian population (2007 National Survey of Mental Health and Well Being). Among Reserve residents, the rate was 25.4% (20.7, 30.2). Only 5.5% (3.0, 8.0) of Reserve residents had a mood disorder, one-third the rate of the other two groups. Among a small subgroup (n = 25) of the n = 544 cohort who resided in remote areas, the rate of current CMD was 7.5% (4.6, 10.3).

Conclusions: The prevalence of current mental disorders in this Indigenous population is substantially higher than previous estimates. The much lower rates among reserve and remote residents point to the importance of Indigenous peoples’ connection to their traditional lands and culture and a potentially important protective factor.

The Cultural Appropriateness of the Structured Clinical Interview for DSM-IV Tr, Axis I for Indigenous Populations

M Toombs¹, B Nasir¹, S Kisely¹, S Kondalsamy-Chennakesavan¹, N Gill¹, E Black, N Hayman¹, G Ranmuthugala¹, G Beccaria², R Ostini¹, G Nicholson¹

¹Faculty of Medicine, University of Queensland, Brisbane, Australia

²Faculty of Psychology and Counselling, University of Southern Queensland, Toowoomba, Australia

Background: Although mental illness among Indigenous Australians is generally accepted to be a major health problem, there is little evidence to show whether a clinical diagnostic tool is culturally appropriate for this population.

Objectives: To determine the cultural appropriateness of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (SCID-I) in the diagnosis of mental illness among Indigenous Australians.

Methods: SCID-I, a semi-structured clinical interview that uses the clinical judgement of the psychologist as well as the information collected by the SCID-I tool itself, was administered by culturally trained psychologists to 544 Indigenous adults living in Southern Queensland and Northern New South Wales.

Findings: The feedback questionnaire was completed by 498 (91.5%) participants. Administrating psychologists provided qualitative feedback for 502 (92.3%) interviews. Most (95.6%) participants were totally comfortable or mostly comfortable during the interview: 96.2% felt that they psychologist understood their responses during the interview; and 83% said that there were no culturally inappropriate questions. For psychologists, 72.5% of interviews did not encounter any cultural challenges to reach a clinical diagnosis; and 40.4% developed an excellent rapport with the participant. Sections of the interview where cultural aspects did need to be considered included those of psychosis (n = 99, 19.7%), anxiety (n = 4, 0.8%) and trauma sections (n = 4, 0.8%).

Conclusions: Cultural nuances need to be considered when SCID-I is used for Indigenous Australians. When administered by a culturally trained psychologist, SCID-I is considered culturally appropriate in this group.

Antipsychotic Prescribing in Aboriginal and Torres Strait Islander Populations: Formulation of Preliminary Guidelines for Clinical Practice

M Das, R Kini, G Garg, D Chapman, R Weerasundera, A Patton, U Khalid, R Parker

Top End Mental Health Service, Darwin, Australia

Background: While there is lack of comprehensive data, the incidence of psychosis in Aboriginal and Torres Strait Islander peoples is higher than the rest of the Australian population. There are data to suggest higher comorbidities (cognitive impairment and substance misuse). There is a need for guidelines regarding prescribing of antipsychotic medication in this population.

Objectives: To develop prescribing guidelines for antipsychotics in Aboriginal and Torres Strait Islander peoples.

Methods: These preliminary guidelines have been developed by psychiatrists from the Top End with years of experience of treating Aboriginal and Torres Strait Islander peoples. The Agree II protocol for practice guideline development was followed. This involved defining scope of the process, stakeholder involvement, literature reviews, peer focus groups to refine recommendations and examine applicability. A detailed literature search did not reveal any guidelines for antipsychotic prescribing. Secondary searches were completed to examine areas relevant to prescribing (e.g. physical health, comorbidities and compliance).

Findings: Some key findings are discussed here. Given the high prevalence of cardiovascular and metabolic risk in Aboriginal and Torres Strait Islander peoples, consideration should be given to detailed initial screening, choice of ‘metabolic sparing’ antipsychotics, caution with doses/polypharmacy, more intensive monitoring for side-effects/physical status, consideration of polydipsia and hyponatraemia and renal impairment. A collaborative approach should be considered in prescribing incorporating principles of cultural safety and the involvement of Aboriginal mental health workers. Prescribing of depot should be considered (due to compliance, remoteness, medication storage issues). Prescribing clozapine and prescribing in children has unique considerations.

Conclusions: Special considerations for antipsychotic prescribing in Aboriginal and Torres Strait Islander peoples and implications of these preliminary guidelines for clinical practice are discussed.

Islamic Beliefs and Psychiatric Disorders: Psychopathology and Perceptions of Mental Illness in Muslim Migrants

A Munib^1,2

¹Armadale Health Service, Perth, Australia

²The University of Western Australia, Perth, Australia

Background: Presentations of mental Illness among Muslim migrants and refugees are uniquely complex, based on Islamic beliefs, pre-morbid cultural perceptions and pre-migration experiences of trauma and resettlement. Particularly important is the spiritual significance of Jinn, described as metaphysical beings in Islamic scripture. Such beliefs and illness perceptions are often incorporated in the clinical symptomatology of Muslim migrants and refugees with mental illnesses. Consequently, they are difficult to diagnose and differentiate in the context of psychopathology, and therefore challenging for mental health practitioners to accurately assess, evaluate and effectively treat.

Objectives: To clarify the relationship between Islamic beliefs and mental illness presentations impacting Muslim migrants/refugees. The author also offers recommendations for culturally compliant assessment strategies and collaborative interventions.

Methods: The author provides case vignettes and narrative examples of de-identified Muslim migrants/refugees with mental illness, who have attended for psychiatric treatment at a public hospital (Armadale Health Service, Perth, Western Australia).

Findings: This presentation particularly focuses on the complex phenomena of Jinn and clarifies the interplay with mental illness experiences. The author provides a conceptual analysis and background understanding of the intricate relationship among Islamic belief systems, religiosity, spirituality, psychopathology and effective interventions.

Conclusions: The author provides suggestions for cultural and religious awareness and recommendations for collaborative interventions in accordance with transcultural assessment and diagnosis of mental illnesses affecting Muslim migrants and refugees in an evolving and transitioning global society.

Clozapine: When to Start, How to Augment and Guidelines for Management

B O’Donaghue^1,2, D Siskind^3,4, N Warren^3,4, S Clark⁵

¹Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia

²Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia

³Metro South Addiction and Mental Health Service, Brisbane, Australia

⁴School of Medicine, The University of Queensland, Brisbane, Australia

⁵Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia

Background: Clozapine is the most effective antipsychotic for treatment-refractory schizophrenia (TRS) and Parkinson’s psychosis; however, it remains under-prescribed with extended periods of time before clozapine trials.

Objectives: To examine the proportion of people with first episode psychosis eligible to start clozapine and to give guidance on how to augment clozapine-refractory schizophrenia. We will explore the evidence for clozapine in Parkinson’s psychosis and look at system-wide guidelines for clozapine use.

Methods: Treatment delay data are from Orygen. Augmentation strategies for clozapine-refractory schizophrenia and use of clozapine in Parkinson’s psychosis are from two separate systematic reviews and meta-analyses. The guidelines for clozapine are from South Australia.

Findings: Of the 9.4% of people seen at Orygen deemed eligible for clozapine, 59% were commenced on clozapine, with a median delay of 42 weeks. Aripiprazole, fluoxetine and electroconvulsive therapy have some evidence to support their use as augmentation agents. Clozapine, at low doses, is superior to placebo and other atypical antipsychotics for Parkinson’s psychosis. The guidelines demonstrate that early intervention to prevent serious adverse events is essential and can be facilitated by a systems approach to care.

Conclusions: Clozapine is effective for TRS and Parkinson’s psychosis; however, greater access is required. This can be facilitated through earlier prescribing, better evidence for safe usage and state-wide processes to support prescribers and consumers.

What do Non-Psychiatrists Need to know about Psychiatry?

S Rotstein^1,2,3

¹Monash Alfred Psychiatry Research Centre (MAPrc), Melbourne, Australia

²Monash University, Melbourne, Australia

³Alfred Health, Melbourne, Australia

Background: All doctors will encounter psychiatric conditions in their clinical practice. For many, teaching in medical school is the only dedicated psychiatry teaching they will receive. It is therefore the universities’ responsibility to ensure that the psychiatry curricula prepare graduates for future clinical practice.

Objectives: To find out what areas of psychiatry teaching are clinically relevant to junior doctors and general practitioners (GPs).

Methods: Surveys were distributed to junior doctors employed by Alfred Health and GPs associated with Monash University. Questions related to respondents’ medical school teaching in addition to their current clinical practice. Psychiatry registrars were also asked to comment on what elements of psychiatry teaching would be most useful for their non-psychiatry trained colleagues.

Findings: GPs with a wide range of experience responded to the ‘GP survey’. In general, respondents ‘neither agreed nor disagreed’ that the psychiatry teaching they received in medical school prepared them well for future practice as a GP. Comments highlighted medical schools focus on inpatient psychiatry and limited teaching regarding high-prevalence psychiatric disorders.

Respondents to the ‘junior doctor survey’ included interns, basic physician trainees, surgical trainees and psychiatry registrars. Respondents generally agreed that their psychiatry teaching in medical school prepared them well for their future clinical practice. However, numerous areas for improvement were highlighted, including a need for more teaching regarding aggression management, cognitive disorders and high-prevalence conditions.

Conclusions: Universities should utilize these data to reconsider the psychiatry curricula in medical degrees.

Complexity Factors and Implications for Service Development in Enhanced Primary Care Youth Mental Health Settings

S Adams^1,2,3, J Cook⁴, A McRoberts¹, E Burgat¹

¹headspace, Melbourne, Australia

²Orygen, The National Centre for Excellence in Youth Mental Health, Melbourne, Australia

³The University of Melbourne, Melbourne, Australia

⁴North Western Mental Health, Melbourne, Australia

Background: Youth mental health in the enhanced primary care context is an emerging opportunity to provide specialized services as early intervention. There remains heated academic debate regarding the usefulness of this service model. Despite this, attendance numbers at headspace centres continue to increase. Our four centres see 4500 young people per year with more than 25,000 occasions of service.

Objectives: To undertake a qualitative file audit to examine clinical pathways, resources and complexity factors associated with differing service utilization and to demonstrate the clinical needs of this cohort.

Methods: A qualitative audit was undertaken at two sites, selecting the first 2–4 young people referred per month to obtain 100 for the year 2015–2016 using a purposefully designed proforma. Data on diagnoses, demographic, complexity factors, staging and service utilization including direct contacts, telephone calls and numbers of multidisciplinary team members involved were obtained.

Findings: The data demonstrate that self-referral is key to attendance, alongside the degree of psychosocial adversity and the number of complexity factors present. There are high rates of social disadvantage, abuse and neglect, culturally and linguistically diverse (CALD), lesbian, gay, bisexual, transgender, intersex, queer/questioning and allied (LGBTIQA) and other complexity factors. Greater complexity factors are associated with higher contacts, longer episodes of care and greater numbers of multidisciplinary staff input. Staging data correlate with the number of adverse life challenges.

Conclusions: This study provides evidence for the value in utilizing diagnostic, staging and complexity factors in predicting service utilization and resourcing needs in service delivery, innovation and development to future-proof such services.

Impact of Dementia Care Home Learning Community in Dementia Care Homes in Torbay, Devon, Uk

A Rana¹, D Somerfield², R Sheaff³

¹Mackay Hospital and Health Service, Mackay, Australia

²Devon Partnership NHS Trust, Exeter, UK

³Plymouth University, Plymouth, UK

Background: South Devon, UK, has 196 care homes with a population of 296,000 and 1 in 8 homes were rated poor by the Care Quality Commission in 2010. The 2009 SouthWest Dementia Partnership study identified the quality of leadership, clarity of role for staff, the quality of person-centred care, care planning, environment and meaningful activity as the key differences between poor and excellent homes. Consultative and collaborative interventions have been shown to improve the quality of life for residents (Alzheimer’s Society, 2008).

Objectives: The Dementia Care Home Learning Community (DCHLC) project aims to

Methods: The DCHLC carried out the following interventions in 13 intervention sites (compared with 12 control sites that received regular visits):

Findings: Independent evaluation by Plymouth University reported

Conclusions: The DCHLC project won the BMJ Dementia Team of the Year 2015 award to improve quality and safety of people with dementia in care homes by improving the skills and self-confidence of staff and the satisfaction of carers.

Reference

Alzheimer’s Society (2008).

Use of Valproate and Carbamazepine in Women of Childbearing Age with Bipolar Affective Disorder: Routine Practice in a Large Australian Public Mental Health Service District

C Perera¹, S Patterson², D Debattista¹, U Wijayatunga³, G Bruxner¹, P Wimalaguna⁴

¹Redcliffe–Caboolture Mental Health Service, Metro-North Mental Health Service, Brisbane, Australia

²Metro North Mental Health Service, Brisbane, Australia

³University of Queensland, Brisbane, Australia

⁴Queensland Health, Brisbane, Australia

Background: Due to teratogenicity, valproic acid and carbamazepine are contraindicated in pregnancy and should be avoided whenever possible in women of childbearing age.

Objectives: To ascertain the extent to which valproic acid and carbamazepine are prescribed in childbearing-age women with the diagnosis of bipolar affective disorder (BPAD).

Methods: We performed an audit of pharmacotherapy of all patients of a large mental health service with a diagnosis of BPAD or mania on a census date. As part of the audit, cross-sectional data were collected relating to 383 patients. This provided a snapshot of pharmacotherapy and patient demographics including gender and age.

Findings: The sample included 218 women, 98 of whom were aged 17–45 years: 79 women were prescribed either carbamazepine or sodium valproate. Nearly one-quarter (n = 23) were potentially child bearing. Comparisons of women younger than 45 years with older women and men 17–45 years demonstrated that women of childbearing age were less likely than older female counterparts to be prescribed either medicine but were no less likely than men of a similar age to be prescribed either medicine.

Conclusions: Prescription of medicine known to cause foetal harm to one in ten women with diagnosis of BPAD is cause for concern. It may be that doctors prescribing carbamazepine or sodium valproate provided patients with advice regarding contraception and potential harms, but many pregnancies are unplanned. Findings indicate a need for research to understand prescribing practices and potentially provision of further education regarding use of hazardous medications in women of childbearing age.

Psychiatric Presentations of Autoimmune Encephalitis

N Warren^1,2, A Swayne^2,3, S Blum^2,3

¹Metro South Addiction and Mental Health Service, Brisbane, Australia

²University of Queensland, Brisbane, Australia

³Princess Alexandra Hospital, Brisbane, Australia

Background: Autoimmune encephalitides are rare disorders that may present with psychiatric symptoms. Typical presentations include behavioural disturbance, anxiety and mood changes, memory deficits and psychosis. These symptoms may precede other neurologic manifestations of the disease (e.g. seizures) and differentiation of these cases from primary psychiatric disorders can be challenging.

Objectives:

Methods: Systematic literature review of known psychiatric characteristics of autoimmune encephalitis.

Retrospective case review of all antibody-positive cases of autoimmune encephalitis identified in Queensland. Summary demographic and clinical data for identified cases will be presented.

Findings: Psychiatric presentations appear to be most common in NMDA (N-methyl-d-aspartate) receptor encephalitis. Key psychiatric features of this diagnosis include rapid onset, atypical psychotic phenomena, memory impairment, confusion and mild neurological abnormalities. Neuroimaging and neurophysiological (electroencephalographic (EEG)) findings are unreliable indicators of organic pathology in this cohort.

Conclusions: The psychiatric features of autoimmune encephalitis can be clinically differentiated from primary psychiatric disorders in some cases. There are high-risk features that may identify cases that require further investigation. These findings will be of benefit to clinicians who assess and treat acutely psychotic patients.

Closing the Gap for People with Mental Illness

V Moudgil^1,2

¹Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia

²University of Queensland, Brisbane, Australia

Background: People with serious mental illness die younger by 15–20 years in comparison to the general population, with cardiovascular disease (CVD) making it the single biggest cause of premature and preventable death (more than suicide). These people have two to three times increased risk of developing metabolic complications and three to four times more risk of becoming nicotine dependent.

Our existing mental health services have primarily focused on delivering treatment interventions, which have potentially contributed to decline in physical health for our consumers. We have a responsibility to our consumers in addressing their overall health by considering new innovative ways of providing integrated services to this disadvantaged population.

Objectives: To focus on process and impact of service-level interventions in collaboration with primary care, various non-health sectors and dental services in an attempt to improve the physical health of our consumers with serious mental illnesses. Integrating physical health interventions with overall mental healthcare is inseparable in the current era.

Evaluating Effects of a Healthy Lifestyle Intervention Implemented at a Residential Mental Health Rehabilitation Unit

N Korman^1,2, C Dodd^1,2, S Suetani^1,2, S Rosenbaum⁴, S Shah¹, F Dark^1,2, K Kendall³, D Siskind^1,2

¹Addiction and Mental Health Services, Metro South Health Services, Brisbane, Australia

²School of Medicine, University of Queensland, Brisbane, Australia

³Queensland University of Technology, Brisbane, Australia

⁴School of Psychiatry, UNSW Sydney, Sydney, Australia

Background: People with severe mental illness (SMI) are sedentary, have high cardiometabolic risks and significantly reduced life expectancy compared to the general population.

Objectives: To evaluate feasibility and acceptability of the implementation of a novel collaboration between a mental health residential rehabilitation service with exercise physiology (EP) and dietetic students to deliver a 12-week healthy lifestyle intervention.

Methods: We conducted a single-arm prospective pilot study for patients with SMI at two sites: the Coorparoo and Logan Continuing Care Units. Participants were asked to engage in three sessions per week of an exercise program supervised by senior EP students and attend six group nutrition classes delivered by dietetics students. The primary outcome was feasibility and acceptability. Secondary outcomes included functional exercise capacity, metabolic data and a range of other mental and physical health outcomes.

Results: Of the potentially eligible participants, 50% enrolled. There was broad level acceptance: 20 participants (74%) completed the program. Participants attended an average of 64.5% of PA sessions and 75% of the nutrition classes. Of those who completed the program, there were promising improvements in functional exercise capacity, negative symptoms of schizophrenia and volume of exercise. Metabolic outcomes were unchanged.

Conclusions: Our findings suggest healthy lifestyle programs delivered by EP and dietetics students using a novel, low-cost, naturalistic real-world design appear acceptable and feasible for people with SMI in a residential rehabilitation setting. Individual dietary intervention sessions over a longer period may be required to produce significant change in metabolic outcomes in people with SMI.

Chronic Physical Illness in Childhood and Adolescence and the Association with Mental Illness: An Australian Population-Based Study

A White¹, J Scott^1,2, H Thomas^2,3

¹Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia

²Centre for Clinical Research, The University of Queensland, Brisbane, Australia

³Queensland Centre for Mental Health Research, Brisbane, Australia

Background: Although there is substantial research on physical and mental health comorbidities in adults, there is a paucity of studies in child and adolescent populations.

Objectives: To examine the associations between a range of chronic physical illnesses with mental disorders, in a randomly selected, nationally representative sample of Australian children and adolescents.

Methods: The sample was drawn from the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing, known as Young Minds Matter. In total, 6310 parents (55%) from the households deemed eligible provided information about their child aged 4–17 years to a trained interviewer. Parents were asked a series of questions about their child’s physical health, as well as modules from the Diagnostic Interview Schedule for Children IV to assess mental disorder diagnoses. Adolescents aged 11–17 years also completed the youth-report module for major depressive disorder.

Findings: Physical illness in the previous 12 months was common, with high prevalence rates for asthma (14.5%), digestive problems (18.9%) and frequent headaches (6.7%). A range of physical disorders in children and adolescents were associated with increased risk of depressive, anxiety and externalizing disorders for both children (4–10 years) and adolescents (11–17 years).

Conclusions: This is one of the few large, population-based surveys to inform the increased burden of mental disorders in children and adolescents with physical disorders. This study highlights the need for clinicians working with children and adolescents with chronic physical illness to screen for mental disorders and to provide effective interventions for those with physical and mental health comorbidities.

Community Implementation of Lifestyle Modification Interventions for People Recovering from Mental Illness

J Chapman^1,2,3, G Whybird², N Avery⁴, S Tillston², D Cross²

¹Metro South Addiction and Mental Health Services, Brisbane, Australia

²Queensland Police-Citizens Youth Welfare Association, Brisbane, Australia

³QIMR Berghofer Medical Research Institute, Brisbane, Australia

⁴Metro North Mental Health Services, Brisbane, Australia

Background: The poor physical and psychosocial well-being of adults with mental illness is well documented. Exercise is widely recognized as being beneficial for physical and mental health.

Objectives: To assess the feasibility of implementing exercise interventions for consumers of government and non-government mental health organizations (NGOs) across a broad geographical region in North Brisbane.

Methods: A pragmatic, multicomponent exercise intervention was implemented at five Queensland Police–Citizens Youth Welfare Association (QPCYWA) sites. The program was a collaboration between QPCYWA, Metro North Mental Health Services (QLD Health), NGOs Community QLD, The Richmond Fellowship, Neami National, Open Minds and headspace. Participants completed an 8-week exercise program, which involved aerobic exercise twice per week, nutrition classes and a social engagement component facilitated by a peer worker. Assessments included mental health questionnaires, metabolic health outcomes (blood pressure, waist, triglycerides, fasting glucose, cholesterol) and a 6-min walk test.

Results: Over 12 months, 100 referrals were received: 58 participants began the program, 38 (66%) of whom completed. Of those who completed, median attendance to the supervised exercise sessions was 75% (interquartile range = 50–88%). Participants significantly improved on mental health outcomes of depression, psychological distress, self-worth, hope and mental health-related quality of life (p < 0.04). The 6-min walk distance improved; metabolic outcomes remained similar.

Conclusions: A pragmatic and holistic healthy lifestyle program can be effectively implemented across a broad geographical region with high participant attendance and improvements in mental health outcomes and functional capacity. Longer supervised intervention duration may be necessary to achieve positive changes in metabolic outcomes.

Treading Carefully Around Inquiries after Homicide

L Ng

The University of Auckland, Auckland, New Zealand

Background: Undertaking research into a sensitive topic can impact participants and researchers in a significant way. Researching a topic such as homicide has the potential to evoke emotional responses in participants’ recall of intensely personal experiences. Obtaining informed consent, preserving confidential details and providing psychological follow-up are essential considerations in the conduct of such research.

Objective: To describe the process of obtaining ethical approval to undertake research on a sensitive topic of inquiries into the provision of mental health services after a homicide.

Method: The researcher’s lens as a forensic psychiatrist is used to reflect on consultations with stakeholders and these influences on the study’s methodological and ethical framework.

Findings: Mining is used as a metaphor to illustrate the non-linear nature of the exploratory phase of research. This is detailed in six phases: grounding, prospecting, excavation, extraction, smelting and refinement.

Conclusions: Negotiating the process of research into a sensitive topic requires building relationships with stakeholders and partners. They are instrumental in shaping the research process and focusing a researcher’s lens on finer details of executing the research. The combined inputs strengthen and refine the research design.

Serious Incident Review Protocol – A Critic of its Process Prompted by the Dissonance between Intention and Outcome: If Sirp is a Staged Play, it is a Play that Benefits only the Performers but not the Four Audiences (The Psychiatrist, The Team, The Family, The Public)

A Djurkov

Te Rawhiti CMHC, Counties Manukau Health, Auckland, New Zealand

Background: Suicides are normal occurrences in a psychiatrist’s practice. They bring significant and underappreciated consequences to the psychiatrist. They bring soul searching and critical analysis of your own clinical practice.

Typically, the views of management, affected families and public are aligned – if there is a suicide, there is an error in the care of that person. Typically, management starts searching for that error with stated intention that the findings help learning not blaming, sincerely believing that the search is scientific and fair, and that its result, of finding the error or the errors, reflects the occurred reality, meaning ‘the truth’.

Objectives: To find why dissonance between the subjective experience and the stated intention of serious incident review protocols (SIRPs) occurred and how to align intention and outcome.

Methods: Subjective analysis of two cases of serious incident reviews with reference to objective evidence (literature and peer review).

Findings: The outcome for the targeted beneficiaries of serious incident reviews differs from the stated intention. There are multiple factors for that, starting from metaphysical, involving the inherited uncertainty of psychiatric practice and ending with the procedure.

The process is dubiously scientific and the findings are affected by limitations and biases that are not considered, let alone acknowledged.

These reviews’ findings entrench the distorted general view about psychiatric practice and are missed opportunities for public education.

Conclusions: Psychiatrists, not the structures above them, should take leadership of serious incident reviews. We all will benefit from a change in the current practice of serious incident reviews.

Why People Who are Homeless Present to a Hospital Emergency Department and How They and Their Care Differs

S Stafrace^1,2, S Lee^1,2, P Thomas¹, H Newnham^1,2, J Freidin¹, C Smith¹, J Lowthian², F Borghmans¹, R Gorcentas¹, D De Silva¹

¹Alfred Health, Melbourne, Australia

²Monash University, Melbourne, Australia

Objectives: To measure the prevalence of homelessness in patients attending one hospital’s emergency department (ED), factors that differ by homelessness status, and qualitatively explore why homeless patients attend, their health and social needs and current community service use.

Design, setting and participants: Prospective sampling of housing status for patients attending ED during a 7-day period. Identified homeless patients completed a study questionnaire. A retrospective audit of coded accommodation status, demographic and clinical variables for all presentations during the same period supplemented prospective data collection.

Main outcome measures: Proportion of patients identified as homeless and re-presenting within 28 days and responded to a developed Community Service and Emergency Department Use questionnaire.

Results: Of 504 prospectively screened ED patients, 7.9% were homeless. Homeless patients were more likely to be male, arrive with emergency ambulance or the police, have a psychosocial diagnosis, have presented to ED at least three times in the previous 12 months and were four times more likely to re-represent within 28 days. Twenty-nine homeless patients were surveyed and attended for physical and mental health and social reasons. Almost one-third of participants stated that viewing ED staff as a regular source of support and a lack of suitable housing, an available general practitioner, or money to pay for medication had contributed to ED attendance.

Conclusions: Strengthened pathways to integrated health and psychosocial support for homeless patients presenting to ED and more accessible, flexible and multifocal community-based services are needed to reduce ED visits and address the health and social needs of this population.

Telepsychiatry in The Australian Defence Force: A Success Story

D Wallace^1,2, S Hodges¹

¹Australian Defence Force Centre for Mental Health, Canberra, Australia

²UNSW Sydney, Australia

Background: The Australian Defence Force (ADF) operates across Australia and on overseas deployments in many parts of the world. Access to mental health services for serving members can sometimes be challenging.

Objectives: To report the successful operation and expansion of a telepsychiatry service in the Australian Defence Force (ADF), located at the ADF Centre for Mental Health since 2011.

Methods: We conducted a retrospective review of telepsychiatry service records and an analysis of telepsychiatry patient satisfaction scores from the Second Opinion Clinic, a tertiary level service for ADF personnel.

Findings: Defence Health services in Darwin were the largest users of the service, followed by Townsville. A few personnel on overseas deployment were also seen. Telepsychiatry patient satisfaction scores were similar to those in patients seen face to face and showed a high level of satisfaction with the service.

Conclusions: Our findings add to the growing literature around the efficacy of telepsychiatry when compared to traditional face-to-face assessment. Given the wide geographical distribution of the ADF, including remote, rural and international areas, the acceptance and effectiveness of telepsychiatry greatly enhances the level of care available to ADF personnel.

The Cultural Psychiatry of Sexual Abuse of Children – The Case of Cambodia

M Eisenbruch

Monash University, Melbourne, Australia

Background: Child abuse remains a global scourge and, despite the body of research on its cross-cultural aspects, a gap between the understanding of the cultural context of child abuse and the potential to channel this understanding into prevention remains. This paper focuses on present-day neoliberal Cambodia, where more than half of all children experience physical violence and one-quarter suffer emotional abuse.

Objectives: To examine how Cambodians view the causes and effects of child sexual abuse (CSA) of girls and to analyse its underlying cultural forces.

Methods: We performed an ethnographic study of 164 informants involved in some form of violence, such as intimate partner violence, of which 55 involved child abuse and related forms of family violence. Victims’ ages ranged from 2 to 16 years.

Findings: Most people see the sexual abuse of children as stemming from eight ‘cultural attractors’: blighted endowment (being destined for misfortune) caused by deeds in a previous life; early character; astrological vulnerability to abuse, pre-ordained entanglement between the child and her abuser (they are fated to meet); cravings and anger; ‘entering the road to ruin’ through pornography; loss of judgment; and a moral blindness that portrays the abuser as blameless.

Conclusions: This article identifies a cultural epigenesis of child sexual abuse and provides a blueprint for developing a culturally responsive plan to prevent child abuse. By providing a culturally coherent language, this template can enable mental health professionals to provide better services to child abuse victims and their families.

A Systematic Review of Barriers to Help-Seeking in Violent Transgender Relationships

R Bancroft¹, S Vella², N Pai^2,3

¹Australian Catholic University, Sydney, Australia

²University of Wollongong, Wollongong, Australia

³Illawarra Shoalhaven Local Health District, Warrawong, Australia

Background: Intimate partner violence (IPV) is a prevalent issue in heteronormative relationships having received deserved attention in recent times. However, IPV remains largely ignored within the transgender community, although the issue is as prevalent, if not greater, in transgender relationships. More often than not, professionals working in the field of IPV are not well equipped to effectively deal with the issue and are lacking in specific knowledge and resources for transgender people.

Objectives: To systematically review previous empirical research investigating IPV in transgender relationships and the associated barriers to help-seeking. Further this review aims to delineate key recommendations for research, policy development and clinical practice.

Methods: A systematic search of PsycINFO, SocINDEX, MEDLINE and Web of Science was conducted to identify previous studies on the transgender experience of IPV. Four studies met the inclusion criteria and were reviewed.

Findings: The results indicated that transgender people who experienced IPV faced the following barriers to help-seeking: gender identity victimization, heteronormative biases, a lack of awareness of specific needs, heteronormative-focused resources, poor treatment from law enforcement and a lack of support from the transgender community.

Conclusions: Re-thinking the normative gender binary when it comes to IPV will shift the victimization of transgender people accessing services when they have experienced IPV. This includes training into trans-specific issues, review and overhaul of heteronormative policies and beliefs and taking a collaborative approach. Recommendations are made for the development of specific resources, training for service providers and future research.

Infants Co-Admitted to Auckland’s Newly Developed Mother–Baby Unit

T Wright^1,2, S Stevens¹, T Wouldes¹

¹Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

²Child and Family Unit, Starship Hospital, Auckland District Health Board, Auckland, New Zealand

Background: In 2014, New Zealand’s second Mother Baby Unit (MBU) opened in Auckland. In accordance with New Zealand health policy (New Zealand Ministry of Health, 2012), infant social and emotional development was prioritized by infants being conferred patient status by co-admission.

Objective: To describe the history, health and developmental status of a cohort of infants admitted from May 2014 to December 2015.

Methods: Prospective study of 45 infants. Pre- and postnatal clinical outcomes and social–emotional and developmental characteristics were measured with the following: infant mental health (IMH), the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC-03R) (Zero to Three, 2005); social, cognitive and motor development, Ages & Stages-3 (ASQ-3) (Squires et al., 2009); and mother–infant relationships, Parent–Infant Relationship Global Assessment Scale (PIRGAS) (Zero to Three, 2005).

Findings: Infants had high rates of in utero exposure to psychoactive medication (55.6%), were born small (20% <2500 g) and had high rates of medical problems (31% admitted to hospital in their first month). Over 50% had IMH diagnoses and developmental concerns identified during admission.

Conclusions: Co-admission, rather than the traditional model of ‘boarding’, confers advantages to the clinical care of infants; however, it has been criticized as stigmatizing. Results of this study suggest that these infants face extreme early disadvantage; therefore, co-admission provides the opportunity to identify these and intervene. Further research and services orientated to infants born to mothers admitted to MBUs is warranted.

References

New Zealand Ministry of Health (2012) Healthy Beginnings: Developing Perinatal and Infant Mental Health Services in New Zealand. Wellington, New Zealand.

Squires J, Twombly E, Bricker D, Potter L (2009) ASQ-3 Users Guide. Baltimore, MD: Paul H Brookes Publishing.

Zero to Three (2005) Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised edition (DC:0-3R). Washington, DC: Zero to Three Press.

The Association Between Adolescent Psychopathology and Subsequent Physical Activity in Young Adulthood: A 21-Year Birth Cohort Study

S Suetani^1,2,3, A Mamun⁴, G Williams⁵, J Najman^5,6, J McGrath^1,2,7, J Scott^1,8,9

¹Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia

²Queensland Brain Institute, The University of Queensland, Brisbane, Australia

³Metro South Addiction and Mental Health Services, Brisbane, Australia

⁴Institute for Social Science Research, The University of Queensland, Brisbane, Australia

⁵School of Population Health, The University of Queensland, Brisbane, Australia

⁶School of Social Science, The University of Queensland, Brisbane, Australia

⁷National Centre for Register-based Research, Aarhus University, Aarhus C, Denmark

⁸University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia

⁹Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia

Background: The beneficial effects of physical activity (PA) for both physical and mental well-being are well established. Given that adolescence presents a critical developmental period during which lifelong patterns of PA become established, the exploration of the longitudinal impact of adolescent psychopathology on adult PA status is of interest.

Objectives: To explore the longitudinal association between adolescent psychopathology at age 14 years and subsequent PA engagement at age 21 years.

Methods: We analysed prospective data from 3663 young adults who participated in the Mater-University of Queensland Study of Pregnancy. Psychopathology was measured using the Youth Self-Report (YSR) at age 14 years. Participants’ engagement in three types of PA (vigorous exercise, moderate exercise and walking) at age 21 years was dichotomized into either none or any. For our main analysis, we examined the association between the YSR score and subsequent PA engagement using logistic regression. We also conducted sensitivity analyses of longitudinal associations between the YSR internalizing and externalizing symptoms score at age 14 years and PA engagement at age 21 years.

Findings: We found no longitudinal association between the total YSR score at age 14 years and PA engagement at age 21 years. In addition, there was no longitudinal association between the YSR internalizing or externalizing symptoms and PA engagement.

Conclusions: Our findings suggest that there is no longitudinal association between adolescent psychopathology and PA in young adulthood.

A Systematic Review and Critical Appraisal of The Association Between Prescribed Stimulants for ADHD and the Risk of Psychosis

JG Scott^1,2,3, JP Kesby^1,4, S Thio⁵, HE Erskine^1,5,6

¹Centre for Clinical Research, The University of Queensland, Brisbane, Australia

²Queensland Centre for Mental Health Research, Wacol, Australia

³Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia

⁴Queensland Brain Institute, The University of Queensland, Brisbane, Australia

⁵School of Public Health, The University of Queensland, Brisbane, Australia

⁶Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA

Background: Pharmacotherapy is commonly used for the management of attention-deficit hyperactivity disorder (ADHD). Some studies suggest that stimulants prescribed to patients with ADHD may increase the risk of future psychotic disorders.

Objectives: To systematically review the available literature examining association between pharmacotherapy for ADHD and risk of psychosis outcomes.

Methods: A systematic review was conducted for studies reporting psychosis outcomes (symptoms or disorders) in cohorts of individuals diagnosed with and prescribed stimulants for ADHD during childhood and adolescence.

Results: Of the 39 articles assessed for eligibility, 12 met the inclusion criteria. Psychotic symptoms are an uncommon adverse event arising from pharmacotherapy and occur with an incidence ranging from one in every 68 to one in every 500 children with ADHD treated for 1 year with pharmacotherapy. Psychotic symptoms occur with both stimulant and non-stimulant medications and are more common in those with familial risk of mental illness. There was no evidence that pharmacological treatment for children and young adolescents with ADHD increased the risk of psychosis beyond the known higher incidence in patients with neurodevelopmental disorders. Young adults initiated on stimulants had an increased risk of hospitalization for psychosis, although this was rare.

Conclusions: Children treated for ADHD should be screened for psychotic symptoms prior to and after initiation of pharmacotherapy. Clinical vigilance is required in those with familial risk of mental illness and young adult patients with worsening cognitive difficulties. There is no evidence that pharmacotherapy for ADHD increases the risk of future psychotic disorders in younger patients prescribed pharmacotherapy for ADHD.

The Human Endocannabinoid System and Medicinal Cannabis

B Jansen^1,2

¹Burleigh Heads Cannabis, Australia

²General Practitioner, Bundall Medical Centre, Queensland, Australia

Background: When a healthy mother breastfeeds her child, she expresses a cannabinoid called 2-arachidonoylglycerol (2-AG). Why is this? Because our bodies’ own cannabinoids regulate our physical and mental health, bone growth, healing, digestion, pain modulation and more.

Cannabinoids are essential messengers of health regulation. If we don’t make enough of them, we get sick. So, we should understand and support our endocannabinoid system (ECS).

The use of medicinal cannabis is on the rise worldwide. Evidence for use for a variety of symptoms and conditions is mounting. The US Governments Department of Health has a patent for cannabinoids as neuroprotectants and specifically mentions non-psychoactive cannabidiol (CBD) as an excellent therapeutic agent. Around 10% of the population will use cannabis each year, with half stating it is for medicinal use. Both these populations deserve the understanding of their clinicians and harm minimization at very least.

Objectives: To educate doctors and health professionals on the ECS and medicinal cannabis use.

Methods: Oral presentation.

Findings: Well received at all previous conferences and teachings. A distinct lack of knowledge by doctors of the ECS and medicinal cannabis.

Bandelow Revisited: A Conventional Analysis of a Meta-Analysis of Anxiety Disorder Treatments

A Basu, G Andrews

UNSW Sydney, Sydney, Australia

Background: There are many meta-analyses of anxiety, but a lack of analyses comparing medication, face-to-face cognitive behavioural therapy (CBT) and internet-delivered CBT (iCBT). The 2015 Bandelow et al. meta-analysis is the exception, analysing 567 arms from 234 studies. While most meta-analyses in this field compare an intervention group with a control group and produce between-group effect sizes, the Bandelow data were presented in terms of pre–post (or within-group) effect sizes.

Objectives: To re-analyse the data conventionally from Bandelow et al. (who provided justification for their method selection) to enable comparisons with other literature in the field.

Methods: Analysing papers comparing current treatments of relevance (selective serotonin reuptake inhibitors (SSRI), serotonin–norepinephrine reuptake inhibitors (SNRI), CBT, iCBT, waitlist control, pill placebo), we had 152 trial arms from 123 papers. They were analysed conventionally using comprehensive meta-analysis. The effect size (Hedge’s g) was calculated. Subgroup analyses were done to examine the effect of the Hamilton Anxiety Rating scale (HAM-A) outcome measure, sample sizes >100 and the effect of length of follow-up.

Findings: CBT had an effect size of g = 1.008 compared to waitlist, 0.466 over pill placebo and 0.506 over psychological placebo. The superiority of SSRIs and SNRIs over pill placebo was 0.547 and 0.404, respectively. There was no significant difference attributable to use of outcome measure, sample size or length of follow-up.

Conclusions: When analysed conventionally, there was no significant difference between medication and CBT; pill placebo is associated with a high improvement. This has implications for optimal management of people with anxiety disorders and raises questions about why pill placebos are so effective.

Reproductive and Sexual Health in Women with Mental Disabilities

V Moudgil^1,2

¹Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia

²University of Queensland, Brisbane, Australia

Background: Women with serious mental disabilities may have impaired capacity around decision-making on reproductive and sexual health. In addition, this group is vulnerable to exploitation if decisions around sexual and reproductive health are not deliberated carefully.

Objectives: To highlight ethical, legal and social tensions that are reflected in our decision-making for people with serious mental disabilities lacking capacities around mental and physical health issues.

Methods: By using a case study of an Indigenous woman, under the Mental Health Act, suffering from treatment-resistant schizoaffective disorder, this presentation will discuss reproductive and sexual health issues in people with mental disabilities. Literatures review and legislative framework from the Mental Health Act, Guardianship Act and United Nations Conventions will be highlighted. The importance of therapeutic alliance will be emphasized.

Barriers and Facilitators Affecting Engagement with an Australian Perinatal Mental Health Service

A Ayres^1,2, R Chen^1,2, T Mackle¹, A Kothari^1,2, G Bruxner^1,2

¹Metro North Mental Health Service, Brisbane, Australia

²University of Queensland, Brisbane, Australia

Background: Perinatal depression is an undertreated pregnancy complication. This is due in part to low rates of engagement by women with perinatal mental health services (PNMHS). International studies have examined the factors influencing women’s engagement with PNMHS, but there is limited research within the Australian context.

Objectives: To identify pragmatic and modifiable factors that act as barriers and facilitators to women accessing PNMHS.

Methods: A cross-sectional survey was used to collect data from pregnant women attending their first medical appointment in an outer metropolitan hospital. Women were asked to rate the extent to which certain factors influenced their engagement with PNMHS. A tree algorithm was used to separate respondents into three groups: women who were not offered a referral to the PNMHS, women who were offered a referral to PNMHS but did not engage and women who engaged with the PNMHS.

Findings: A total of 218 women participated over 5 months of sampling. A response rate of 69.8% was achieved. The most commonly selected barriers to engagement with the PNMHS were time restraints, lack of childcare support and encouragement by family and medical staff. These themes were consistent across all three groups. Of note was that 38.1% of women did not believe they were knowledgeable about mental illness, and 14.7% reported they were not asked about their mental health during this pregnancy.

Conclusions: Understanding pragmatic and modifiable factors influencing women’s engagement with PNMHS and improving education may increase rates of engagement and guide service delivery improvements.

Antipsychotic Prescribing in the Longitudinal Study of Australian Children

A Kaim^1,2, J Jureidini^1,2, M Raven^1,3

¹University of Adelaide, Adelaide, Australia

²Women’s and Children’s Health Network, Adelaide, Australia

³Flinders University, Adelaide, Australia

Background: Increasing numbers of Australian children and adolescents are prescribed antipsychotics. Disadvantaged children are more likely to be prescribed antipsychotics (Matone et al., 2015). However, there has been little investigation of this in Australia and very little investigation anywhere using individual-level data.

Objectives: To investigate antipsychotic prescribing to Australian children and adolescents; mental health, physical health, and educational outcomes of those who are prescribed antipsychotics; and relationships between risk factors and antipsychotic prescribing.

Methods: Data from the Longitudinal Study of Australian Children (LSAC) were used to investigate predictive factors for antipsychotic prescribing. Linked Medicare Benefits Scheme and Pharmaceutical Benefits Scheme databases were used to determine antipsychotic prescribing and health service use. Descriptive statistics were used to characterize children who were prescribed antipsychotics, and their health and educational outcomes. Logistic regression was used to analyse relationships between risk factors and service use, and antipsychotic prescribing.

Findings: There were proportionately more children prescribed antipsychotics in lower-income families, with unemployed primary caregivers, and in single-parent households. Children prescribed antipsychotics also had higher parent-reported Strengths and Difficulties scores, were more likely to have repeated a grade at school and had lower school achievement.

Perinatal vulnerability, intrafamilial environment and outcomes that compound risk were significant predictors of psychological service use. These factors also significantly predicted antipsychotic prescribing, albeit to a lesser extent. These findings were consistent across most age groups.

Conclusions: The findings strengthen the evidence that children from disadvantaged families are more likely to be prescribed antipsychotics, use more psychological services and have worse health and educational outcomes.

Reference

Matone M, Zlotnik S, Dorothy Miller JD, Kreider A (2015) Psychotropic Medication Use by Pennsylvania Children in Foster Care and Enrolled in Medicaid Philadelphia: An Analysis of Children Ages 3–18 Years. PolicyLab at The Children’s Hospital of Philadelphia.

The Woes of Women – in Addition, Let’s Add Adhd!

SE Romans^1,2

¹University of Otago, Wellington, New Zealand

²Private Psychiatric Consultant, Wellington, New Zealand

Background: A literature review shows significant comorbidity of attention-deficit hyperactivity disorder (ADHD) in adult women with a range of psychiatric disorders.

Objectives: To highlight the current thinking about ADHD in women and describe my current approach to its clinical assessment.

Methods: A precis of my understanding of the key publications in the field, a summary of discussions from our monthly peer review discussions on adult ADHD and a focused review of my own clinical practice.

Findings: The scanty literature suggests clear links between adult ADHD in women and borderline personality disorder (Philipsen et al., 2008), anxiety disorders (van Ameringen et al., 2011), panic disorder and eating disorders (Cumyn et al., 2009) and obesity (both genders, Cortese et al., 2016).

This suggests a requirement of a clear procedure for assessing ADHD in women who present for psychiatric evaluation.

Our peer review group highlighted the under-recognition of ADHD diagnosis in women

I use a two-interview strategy for the evaluation for adults with ADHD. The first interview is a traditional assessment for psychiatric disorders. The second interview uses the DIVA, an online 18-item structured interview for ADHD, and allows time to explain the complexity of simulant prescription in New Zealand.

Conclusions: Pragmatically, my clinical approach is working well. While care is needed to protect against stimulant diversion, the under-recognition of ADHD in women requires attention.

Equally Well: Together We are Making a Difference

H Lockett¹, A Bates², DB Menkes³, M Thorn⁴, J van Leeuwen⁵, M Blake⁶

¹The Wise Group, Hamilton, New Zealand

²Wellbeing Wellington, Wellington, New Zealand

³Royal Australian and New Zealand College of Psychiatrists, Wellington, New Zealand

⁴Royal New Zealand College of General Practitioners, Wellington, New Zealand

⁵Te Pou o te Whakaaro Nui, Auckland, New Zealand,

⁶Platform Trust, Wellington, New Zealand

Background: Many interrelated factors contribute to the premature mortality of people who use mental health services. These include the cardiometabolic effects of psychotropic medication, elevated rates of smoking and obesity, the separation of mental health from other health services and clinician issues such as diagnostic overshadowing. To address this complex health disparity, action is needed at multiple levels across the health system.

Objectives: To create and support a national collaboration of people and organizations to take a systematic approach to addressing the causes of physical health disparities in those who use mental health services.

Methods: We used the principles of collective action and service user involvement to develop a collaborative diverse enough to effect change at multiple levels. A summit was held in 2014, which launched an evidence review, consensus position paper and priorities for action. Te Pou o te Whakaaro Nui provide backbone support, which communicates the shared vision for change, coordinates actions between partners and engages new stakeholders.

Findings: New Zealand has a large and growing Equally Well collaborative, with more than 100 organizations committed to action in their spheres of influence. For example, the Royal New Zealand College of General Practitioners (GPs) has an Equally Well action plan including evidence briefings to GPs, special symposia at conferences and is developing resources on prescribing for well-being. In 2016, Equally Well won The MHS Award for primary care and the World Congress’ Integrated Care Award.

Conclusions: Collective action to address this long-standing and unacceptable disparity is both necessary and, as we have shown, feasible.

Oh Sh**t – An Approach to Dealing with the Burden of Clozapine on Community Mental Health Teams

L Rose

Carramar Community Mental Health Team, Adelaide, Australia

Background: Ever increasing numbers of patients taking clozapine are causing the Community Mental Health System to struggle to cope with the workload and the protocol requirements.

Objectives: To develop a general practitioner (GP) shared care model to reduce the burden of managing increasing numbers of patients on clozapine, who can rarely be discharged from the public mental health system.

Methods: Patients with the potential for management in a shared care setting were identified using an algorithm that will be presented. Clozapine coordinators were initially reluctant to accept a shared care model for their patients and dealing with this was integral to a successful outcome. GPs, practice nurses and practice managers in identified clinics and regions were approached and provided with education and information.

Findings: My team was able to considerably increase the proportion of clozapine patients managed within shared care arrangements. Clozapine coordinators had more time to provide care to complex patients, and gradually the naysayers from adjoining regions began to adopt the model.

Conclusions: This model takes time to implement and requires an interested psychiatrist to drive it and provide support for GPs and clozapine coordinators. Once implemented, this model gathers momentum, making it easier to set up arrangements for future patients.

A key outcome has been an improvement in the identification and treatment of comorbidities in patients on clozapine managed in shared care, and this has encouraged the team to see shared care as a valuable strategy.

Longitudinal Association Between Physical Activity Engagement During Adolescence and Mental Health Outcomes in Young Adults: A 21-Year Birth Cohort Study

S Suetani^1,2,3, A Mamun⁴, G Williams⁵, J Najman^5,6, J McGrath^1,2,7, J Scott^1,8,9

¹Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia

²Queensland Brain Institute, The University of Queensland, Brisbane, Australia

³Metro South Addiction and Mental Health Services, Brisbane, Australia

⁴Institute for Social Science Research, The University of Queensland, Brisbane, Australia

⁵School of Population Health, The University of Queensland, Brisbane, Australia

⁶School of Social Science, The University of Queensland, Brisbane, Australia

⁷National Centre for Register-based Research, Aarhus University, Aarhus, Denmark

⁸University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia

⁹Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Australia

Background: Previous studies provide mixed evidence that physical activity engagement (PAE) in adolescence is associated with later mental health outcomes.

Objectives: To examine the association between PAE at age 14 years and mental health outcomes at age 21 years using a large birth cohort study.

Methods: Prospective data from the Mater-University of Queensland Study of Pregnancy, consisting of 3493 young adults, were analysed. PAE at age 14 years was estimated using self-report, and participants were categorized into frequent, infrequent or no PAE groups. Mental health outcomes at age 21 years consisted of common mental disorders, psychosis-related outcomes and emotional and behavioural problems. The association between PAE in adolescence and later mental health outcomes in young adulthood was examined using logistic regression, adjusted for age, sex, body mass index and adolescent psychopathology.

Findings: No PAE at age 14 years was associated with the increased likelihood of a lifetime diagnosis of any affective disorder, elevated delusional ideation and endorsement of visual perceptual disturbance at age 21 years. Conversely, infrequent PAE at age 14 years was associated with the decreased likelihood of subsequent lifetime diagnosis of any substance use disorder.

Conclusions: Our findings suggest that lack of PAE in adolescence influences some, but not all, later mental health outcomes. Interventions to increase PAE in adolescence may represent an opportunity to prevent future mental health problems.

Selective Serotonin Reuptake Inhibitors in Ischaemic Heart Disease: Benefits, Risks and Interactions

C Andrade

National Institute of Mental Health and Neurosciences, Bangalore, India

Background: Depression is frequent in the elderly. Cardiovascular conditions, including hypertension, stroke and ischaemic heart disease (IHD), are also frequent in the elderly. Research from the past two decades and earlier has shown that depression and IHD each increase the risk of, and worsen, the course and outcome of the other. This makes it important to detect and treat both conditions effectively and completely.

Objectives: To provide psychiatrists with an understanding of psychopharmacological issues that need to be considered when prescribing antidepressants to patients with cardiovascular diseases, especially hypertension and IHD.

Methods: This presentation is based on a review of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and their safety and efficacy in patients with IHD, and also on a review of antidepressant drug interactions with medications that patients may receive for hypertension and IHD.

Findings: The presentation will address the following subjects:

Conclusions: Clinicians who prescribe medications for patients with IHD need to be aware of pharmacodynamic and pharmacokinetic issues that influence the safety and efficacy of antidepressants in patients with IHD. Take-home messages will be summarized and a list of key discussion papers, including those that are open access, online, will be provided.

Indigenous Drug Policy Reform

G Taurua

New Zealand Drug Foundation, Wellington, New Zealand

Background: Indigenous people experience disadvantage across all socioeconomic indicators, with legal and illicit drug use, supply and manufacture having further serious implications. Drug use is often disproportionately concentrated in Indigenous communities and that this pattern, combined with law enforcement, explains the racial disparity in drug arrests and poor health outcomes for these populations. The evidence is growing that drug arrest rates result from racial bias or racist intent and that this is reinforced by international treaties, conventions and declarations. The gap in health status between Indigenous and non-Indigenous remains unacceptably wide and is identified as a human rights concern by the United Nations (United Nations Committee on the Rights of the Child).

Working together to address addiction and treat mental health is a complex social, cultural and health issue. The role of psychiatry is critical. Drug harm in New Zealand comes from both the substances, the drug law itself, and the disproportionate over-criminalization of Indigenous peoples as a result. We need to move to a health-based drug law that respects human rights, including the right of Indigenous people to equal access to health services. This is what is happening around the world and is based on the extensive evidence that a criminal justice approach is outdated, inequitable and ineffective. A health-based drug law would reduce the barriers people face when seeking help for drug-related issues, making it easier to access education, harm reduction, primary healthcare and treatment.

Objectives: To explore emerging issues associated with methamphetamine and synthetic substances and decriminalization including the impact on Māori.

Methods: This presentation will examine a new approach to drug policy in New Zealand and how we are engaging the public in this complex social and health policy issue.

Conclusions: How New Zealand is joining a new consensus on health-based drug laws and the role psychiatry can have in supporting change.

Reference

United Nations Committee on the Rights of the Child Concluding Observations – Australia, Unedited version, UN Doc: CRC/C/15/Add.268; United Nations Committee on the Elimination of Racial Discrimination, Concluding observations of the Committee on Australia, UN Doc:CERD/C/AUS/CO/14, para 17.

Rates and Predictors of Relapse Following Discontinuation of Antipsychotic Medication after a First Episode of Psychosis

B O’Donoghue^1,2,3, M Bowtell^1,2, S Eaton^1,2, K Thien^1,2, M Bardell-Williams^1,2, L Downey^1,2, A Ratheesh^1,2,3, E Killackey^1,2, P McGorry^1,2

¹Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia

²Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia

³Orygen Youth Health, Melbourne, Australia

Background: There is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis. Robust predictors of relapse after discontinuation are yet to be identified.

Objectives: To determine the proportion of young people who discontinue their antipsychotic medication after a first episode of psychosis, the proportion who experience relapse and predictors of relapse.

Methods: A retrospective study of all individuals presenting to the Early Psychosis Prevention and Intervention Centre between 1 January 2011 and 31 December 2013 was conducted. A Cox regression analysis was conducted to identify predictors of relapse.

Findings: A total of 544 young people with a first-episode psychosis (FEP) were included. A trial of discontinuation, which may have been initiated by either client or clinician, was undertaken by 61% of the cohort. The median duration of antipsychotic medication prior to the first trial of discontinuation was 174.50 days. Among those trialling discontinuation, 149 (45.8%) experienced relapse in a median follow-up time post discontinuation of 372 days. On multivariate analysis, predictors of relapse were a diagnosis of cannabis abuse disorder (hazard ratio (HR): 1.40) and longer duration of antipsychotic medication (HR: 1.05

Conclusions: Antipsychotic discontinuation frequently occurs earlier than guidelines recommend. Individuals with a diagnosis of cannabis abuse are more likely to experience relapse and addressing this substance abuse prior to discontinuation could possibly reduce relapse rates.

Flexible Assertive Community Treatment (FACT): How Does it Compare with Assertive Community Treatment and Other Care Management Models for People with Severe Persistent Mental Illness

A McGeorge¹, R van Veldhuizen,²

¹UNSW Sydney, Sydney, Australia

²Certification Centre for Assertive Community Treatment (ACT) and Flexible ACT, Groningen, Holland

Background: Assertive Community Treatment (ACT) is an evidence-based approach to care management that has been widely adopted throughout the world. It has limitations, however, for low-density populations and its provision of crisis-intervention services. FACT is a Dutch version of ACT, which has shown to be adaptable to context and has been well received by consumers and clinicians alike.

Objectives:

Methods: The development, implementation and evaluation of ACT and FACT teams are described in the context of evolving international models of recovery-oriented, rehabilitation psychiatric services.

Findings: FACT teams are now servicing consumers in Holland, Europe and Australia. FACT works adaptively with consumers and community services providing two different levels of care intensity (crisis and rehabilitation) by one team. Structured attention is given to developing partnerships with Community and Public Mental Health Services.

Consumers, families and clinicians report high satisfaction with FACT. While randomized controlled trials are yet to be conducted, early research reports patients experiencing better quality of life, improved continuity of care, less inpatient admissions and fewer outpatient contact.

Conclusions: Models of care management, including ACT, are loosely applied in Australasia resulting in questionable benefits for consumers. FACT offers a rigorous and innovative model of care that can be effectively implemented in settings where the classic ACT model may not be so readily applicable.

Treatment Effectiveness of Methamphetamine Abusers – 3-Year Experience in Kowloon East Substance Abuse Clinic in Hong Kong

J Leung¹, A Man¹, P Wai², S Wong³, P Kong⁴

¹Department of Psychiatry, Kowloon East Cluster, Hospital Authority, HKSAR

²Department of Occupational Therapy, United Christian Hospital, Hospital Authority, HKSAR

³Medical Social Services Unit, Social Welfare Department, HKSAR

⁴Department of Clinical Psychology, Kowloon East Cluster, Hospital Authority, HKSAR

Background: The Kowloon East Substance Abuse Clinic started its operation in October 2008 to provide psychiatric treatment to psychotropic substance abusers and opiate narcotics abusers with psychiatric complications and psychiatric comorbidity on an outpatient basis, serving around 1 million people in the Kwun Tong and Tseung Kwan O districts.

We emphasize the multidisciplinary approach in case management. Disciplines involved include psychiatrist, nurse, clinical psychologist, occupational therapist and medical social worker.

Objective: To update the illness profile and treatment effectiveness of methamphetamine abusers from 2015 to 2017. Previously, we reported on the spectrum of psychotic illness and treatment patterns of methamphetamine abusers in our clinic from 2009 to 2014 as well as different treatment strategies to address clients’ needs and improve the treatment concordance (Leung et al., 2016).

Method: New patients (305) from 2015 to 2017 were recruited for analysis. Data on age, gender, primary drug of abuse (DOA) and principal psychiatric diagnosis were collected. Scores of Christo Inventory for Substance-misuse Services (CISS) (Christo et al., 2000) were collected at the time of intake and 6-month post-treatment to measure the treatment effectiveness.

Results: The mean age was 34.6 years (range 17–55 years): 80 patients were identified with methamphetamine as the primary DOA. A current psychiatric diagnosis of psychotic disorder was formulated in 73% of methamphetamine abusers (59 of 80 cases), of which 41% were diagnosed with substance-induced psychotic disorder and 32% as dual diagnosis.

The average CISS total score and score in item 7 (drug/alcohol usage) among the methamphetamine abusers are 7.7 (range 4–11) and 1.56 (range 0–2), respectively. The average reduction of total score in 6-month post-treatment (last observation carrying forward) is 1.84 (range 0.75–4) and that in item 7 (alcohol or drug usage) is 0.455 (range 0.13–1).

Conclusions: We found a static trend in the rate of methamphetamine identified as primary DOA in our clinic in the last 3 years. Instead, we observed that the prevalence of cocaine use is on the rise and it may warrant further study on any change in pattern of illicit drugs in our locality.

The reduction of CISS scores was not significant and many of the clients were still presenting with various residual problems and active illicit drug usage at 6-month post-treatment. It may reflect that a longer treatment period with better adherence would be required to address the complex clinical need in this group of patients.

References

Christo G, Spurrell S and Alcorn R (2000) Validation of the Christo Inventory for substance-misuse services (CISS): a simple outcome evaluation tool. Drug and Alcohol Dependence 59: 189–197.

Leung JCW, Lo S, Sin A, Kong P, Man A, Lam WC (2016) Psychosis in methamphetamine abusers – 3-year experience in Kowloon East Substance Abuse Clinic. RANZCP 2016 Congress Rapid Fire Presentation.

Psychotropic Medication, Friend or FOE?

A Bates¹, DB Menkes^2,3, B Arroll²

¹Wellbeing Wellington, Wellington, New Zealand

²University of Auckland, Auckland, New Zealand

³Royal Australian and New Zealand College of Psychiatrists, Wellington, New Zealand

Background: Collaborative therapeutic relationships provide people who use mental health services the greatest opportunity for beneficial outcomes. The connections between psychiatry, general practice and people who use services are becoming stronger and the information-sharing and partnership approach has much to offer each of these parties. Getting the best outcomes from prescribed psychotropic medication, in particular, can benefit from this collaborative approach.

Objectives: To strengthen the collaboration between mental health services, primary care and services users around prescribing psychotropic medications. There are many opportunities to improve consultations between psychiatrists, general practitioners and service users. Communication styles and information provision are important factors to continuously reflect and improve upon.

Methods: Combining academic and experiential knowledge, the presenters will address how culture and gender have an impact on these conversations, what fully informed consent requires, the benefits of open communication between the three parties and the need to balance research data and conclusions with the goal of supporting a person to live their best life.

Findings: There has been a marked rise in psychotropic prescriptions for mental health conditions in recent years resulting in the need to give greater attention to prescribing conversations in both mental health and primary care services. The practice of prescribing for well-being can support recovery for people using mental health services and improve both mental and physical health outcomes.

Conclusions: It is both possible and useful to navigate the complexities of prescribing psychotropic drugs, incorporating both primary care and secondary services.

Primary Care – Psychiatric Liaison Service

A Ang

Flourish Australia, Sydney, Australia

Background: WentWest Primary Health Network (PHN) has commissioned this project in partnership with Flourish Australia. The PHNs role is to commission solutions for better health outcomes to the Western Sydney community. Flourish Australia is a well-established non-government organization focusing on recovery-oriented mental health supports. This collaborative work was inspired by the primary mental health integration in East Tamaki, Auckland, led by Dr David Codyre.

Objectives: To improve mental health outcomes for people accessing general proactitioner (GP) services in the Western Sydney Local Health District (WSLHD) by building the capacity of GPs to provide mental health services. The nature of the clinical work includes joint consultation with the GPs and capacity-building activities.

Methods: Co-location of a psychiatrist within GP practices across the WSLHD providing consultation through joint clinical assessments, case conferencing and referral supported by a support coordinator and peer worker.

Findings: The findings will be based on qualitative feedback from the people accessing the service, the GPs and the psychiatrist looking for factors such as the level of satisfaction with service delivery and the GP’s level of confidence in their delivery of mental health treatment using this collaborative work.

Conclusions: In is intended that this project will improve the effectiveness of GPs to manage mental health conditions in the primary care setting and reduce the overall burden of mental healthcare in the longer term. This may set the path for further development of mental health treatments to the community.

Encouraging Shared Decision-Making when Treating Patients for Major Depression: Use of a GP Clinical Audit

M Hopwood

Department of Psychiatry, University of Melbourne, Melbourne, Australia

Background: Shared decision-making (SDM) leads to improved treatment outcomes and recovery for patients with mental illness (The Mental Health Act, 2014). Decisions about assessment, treatment and recovery should involve patients, and views and preferences should be respected (The Mental Health Act, 2014).

Objectives: To develop a clinical audit, encouraging clinicians to involve patients in the decision-making process when selecting antidepressant medication (ADM).

Methods: Patients with a new episode of depression (first episode or recurrence), not currently on ADM, were identified by clinicians for inclusion. A questionnaire exploring patient treatment preferences was completed and ADM was discussed based on responses.

Findings: More than 1700 GPs and 6900 patients participated. Patients felt it was ‘important’ (49%) or ‘very important’ (49%) that their GP discussed treatment preferences. Most GPs were positive to the SDM model with 93% responding that they like to get patients involved in making treatment decisions.

Of the patients audited, 53% had concerns about starting ADM, with fear of becoming dependent the main specific concern (51%). Longer term, patients wanted to avoid weight gain (60%), followed by reduced emotional range (18%) and sleep disturbance (16%). GPs associated weight gain most commonly with mirtazapine (86%), followed by selective serotonin reuptake inhibitors (66%), tricyclic antidepressants (62%) and serotonin–norepinephrine reuptake inhibitors (53%).

In the post-audit follow-up, 80% of GPs reported change in behaviour by tailoring ADM to ensure efficacy and minimize side effect concerns, as understood through implementing the SDM model.

Conclusions: The audit highlighted both patients and GPs value the SDM model. Post audit, most GPs changed behaviour by implementing SDM and tailoring treatment.

Funding

Clinical audit supported by Servier Laboratories.

Reference

The Mental Health Act (2014). Available at: https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/mental-health-act-2014-handbook

Bridging the Gap: Finding a Home in Primary Care

L Matthews^1,2

¹Waitemata District Health Board, Auckland, New Zealand

²headspace, Sydney, Australia

Background: To present the process and findings of a 2-year pilot that established mental health (MH) services in a primary care setting in West Auckland 2014–2016. The New Zealand Health and Mental Strategies emphasize integration of care, earlier intervention and better outcomes for patients. This paper describes one District Health Board initiative to shift towards this goal.

Objectives:

Methods: A one day a week psychiatrist clinic using a consultation–liaison model of care that expanded to include child and adolescent clinic and worked alongside alcohol and drug non-government organization clinician. A referrals database allowed formal evaluation.

Findings: The referrals database outcomes 2014–2016 will be reviewed. Barriers to implementation will be discussed along with the learning and the opportunities that can inform future services development.

Conclusions: Seeing people in a primary care setting improved attendance and was experienced as less stigmatizing. It facilitated collaboration between specialist, general practitioner and primary care staff allowing rich learning opportunities and, for patients, earlier intervention.

Patterns of Antidepressant Medication use in Australia

GS Malhi^1,2, M Acar³, P Juneja⁴, S Siva⁵, BT Baune⁶

¹Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia;

²CADE Clinic, The University of Sydney, Sydney, Australia.

³Real World Evidence, Janssen-Cilag Pty Ltd, Sydney, Australia

⁴Prospection Pty Ltd, Eveleigh, NSW, Australia

⁵Medical and Scientific Affairs, Janssen-Cilag Pty Ltd

⁶Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia

Background: There is a paucity of literature and research data describing the utility of antidepressants for the clinical management of depression in Australia. The prescribing habits of clinicians and how closely they match treatment guideline recommendations are also unknown. The Department of Human Services Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS) data enable large-scale investigation of prescribing habits.

Objective: To describe antidepressant prescribing patterns in Australia.

Methods: A retrospective cohort analysis was conducted using the PBS and the MBS 10% sample data including patients who commenced antidepressant therapy between July 2013 and March 2017. A descriptive analysis was undertaken to understand antidepressant use, duration of therapy, time to augmentation, dose increase, combination therapy and switching along with the administration of electroconvulsive therapy. Results were stratified by region, gender, age and prescriber specialty.

Findings: A total of 151,366 patients were identified as ‘treatment naïve’ (no prior antidepressant or antipsychotic therapy). As first-line therapy 52% of patients were prescribed a selective serotonin reuptake inhibitor (SSRI), 24% a tricyclic antidepressant (TCA) and 14% a serotonin and noradrenaline reuptake inhibitor (SNRI), with a median duration of therapy of 3 months. A total of 26,174 patients receiving second-line therapy had an 8-month median duration of therapy; 46% were prescribed an SSRI, 35% an SNRI, 22% a noradrenergic and specific serotonergic agent and 19% a TCA.

Conclusions: An understanding of the real-world use of antidepressants, patterns of prescription and treatment strategies has the potential to inform clinical practice, optimize management and improve clinical outcomes.

Safety of Lurasidone in Adolescents with Schizophrenia: Interim Analysis of a 24-Month, Open-Label Extension Study

M Tocco¹, C Correll^2,3, R Goldman¹, J Cucchiaro¹, L Deng¹, A Loebel¹

¹Sunovion Pharmaceuticals, Fort Lee and Marlborough, USA

²Department of Psychiatry and Molecular Medicine, Hofstra North Shore–LIJ School of Medicine, Hempstead, USA

³Zucker Hillside Hospital, Recognition and Prevention Program, Glen Oaks, USA

Background: Few data are available from prospective studies that demonstrate the long-term safety of second-generation antipsychotics in adolescents with schizophrenia. Lurasidone has demonstrated efficacy in the treatment of schizophrenia in both adults and adolescents.

Objectives: To obtain data on the long-term safety of lurasidone in adolescents with schizophrenia in an open-label (OL) trial.

Methods: Patients 13–17 years with schizophrenia were enrolled in a 2-year, OL study of lurasidone (20–80 mg/day) after completing a 6-week, double-blind (DB), placebo-controlled fixed-dose (40 mg/day, 80 mg/day) study of lurasidone. We present the safety results of an interim analysis of 12-month data.

Findings: A total of 271 patients entered the extension study and were treated with a mean lurasidone dose of 61.2 mg/day; 48.7% had completed 52 weeks at the time of the interim analysis, and 9.6% had discontinued due an adverse event by that time. The only adverse events leading to study discontinuation in more than one patient were schizophrenia (8/271), suicidal ideation (4/271) and psychotic disorder (2/271). Median changes from DB baseline at 12 months (observed cases) for metabolic parameters were total and low-density lipoprotein cholesterol (−3.0 and 0.0 mg/dL), triglycerides (5.0 mg/dL), haemoglobin A1c (0.0 %) and prolactin (males, +0.15 ng/mL; females, +0.5 ng/mL). Mean change in weight at 12 months was +3.8 kg (vs. an expected weight gain of +3.3 kg).

Conclusions: Long-term treatment with lurasidone was generally well-tolerated and was associated with few effects on body weight, lipids, glucose and prolactin in adolescents with schizophrenia.

Funding

Sponsored by Servier and Sunovion Pharmaceuticals Inc.

ClinicalTrials.gov identifier: NCT01914393

Efficacy and Safety of Agomelatine (25–50 Mg/Day) Versus Escitalopram (10–20 Mg/Day) in Severe Generalized Anxiety Disorder

D Stein¹, J-P Khoo², M Van Ameringen³, C Hӧschl⁴, A Ahokas⁵, M Bauer⁶, I Bitter⁷, M Jarema⁸, SN Mosolov⁹, L Vavrusova¹⁰, F Picarel-Blanchot¹¹, V Olivier¹¹, C de Bodinat¹¹