Australasian Psychiatry

Forensic mental health services (FMHS) have higher rates, duration and frequency of restrictive practices (seclusion, physical restraint and mechanical restraint). Data generated by services can be used to set targets (benchmarks) with like services to reduce or eliminate restrictive practices. The aim of this study was to develop restrictive practice benchmarks for Australian and New Zealand FMHS.

A participatory action research methodology was used by conducting a Delphi study. FMHS experts provided de-identified service-specific restrictive practice data, which was used to stimulate reflection towards the development of restrictive practice benchmarks.

Consensus decision-making was reached on benchmarks for the rate, duration and frequency of seclusion and physical restraint. Mechanical restraint was found to be a rare event, requiring event specific review in each service.

Benchmarking with FMHS may assist in working to reduce restrictive practices and encourage the scrutiny of service practice. Establishment of a FMHS network might assist to embed the proposed benchmarks.

To investigate trends in admissions to the state forensic hospital (Western Australia (WA)) from court on hospital orders from 2007 to 2016.

A retrospective survey was undertaken. Demographic, clinical and legal data were obtained from hospital records. Hospital orders referred on less serious charges or without a primary diagnosis of major mental illness were identified as ‘non-forensic’.

There were 890 hospital orders representing 40% of total admissions. Eighty-one per cent were male and 50% had a diagnosis of schizophrenia; 22% were Indigenous; 421 (47%) were admitted on less serious (non-Schedule 1) charges; 199 (22%) did not have a primary diagnosis of a major mental illness recorded on the discharge summary; 82 (9%) had neither major mental illness nor serious charges. Overall, 539 hospital orders (60%) were identified as non-forensic; 243 (45%) of these were made with no input from the Court Liaison Service (CLS).

Hospital orders make up a significant proportion of admissions to the forensic unit in WA. Many do not require secure forensic care. Developing alternative diversion pathways is essential.

In May 2018, a small paperback book was published, which briefly described 10 cases of persons charged with murder whom an Australian psychiatrist had assessed for the court. This article considers the ethical issues raised by identifying both the persons charged with murder and their victims in newspaper articles and interviews to promote a book.

When persons who have committed homicide are named in a ‘true crime’ book, their recovery trajectory may be prejudiced and the families of their victims may be re-traumatised. Such publications may also contribute to the stigmatisation of persons with mental illness who commit serious offences. Respect for the dignity of the person is fundamental to the ethical practice of forensic report-writing. There can never be any implied agreement or consent that a psychiatrist who writes a report for the court can also use the material in a book written for profit. The Royal Australian and New Zealand College of Psychiatrists Code of Ethics includes several principles relevant to psychiatrists who write medico-legal reports. Psychiatrists should carefully consider the ethical issues raised in publishing outside of textbooks and professional journals and engaging with the lay media.

Our college name The Royal Australian and New Zealand College of Psychiatrists (RANZCP) and Crest (Coat of Arms) are echoes of our colonial past, which create a barrier to an inclusive 21st-century Australasian psychiatry. Two hundred and fifty years after European settlement, this article reviews the colonial legacy, the evolution of the college and the process by which the prefix ‘Royal’ came to be attached. This is now an anachronism that symbolically undermines our mission to create a fully inclusive psychiatry for all Australians and New Zealanders, from indigenous people across the spectrum of cultures drawn from recent migrations within our complex multicultural society.

As psychiatrists, it is time to modernise and reinvent the college name and Crest. We will be a healthier and more inclusive community of practice without the ‘Royal’ prefix, and with a new symbol for our college that embodies our values and vision.

To investigate the war crimes committed by psychiatrists during the German Nazi regime in the twentieth century and better understand the moral arguments used to justify them.

This article provides a historical review of the crimes committed by psychiatrists in Nazi Germany and ethical analysis from the perspectives of consequentialism and deontology.

Nazi psychiatrists oversaw the death of more than 200,000 people with mental illnesses and inflicted harm on many more. Consequentialist reasoning may have been used to justify these atrocities. Deontological reasoning proved impervious to exploitation by the Nazi regime, but without codification it was too easily abandoned and thus failed to protect patients.

A duty-based code of ethics that enshrines universal respect for the humanity, dignity and autonomy of all persons, and condemns the misuse of professional knowledge and skills, may be a safeguard against the future political abuse of psychiatry.

To examine laws in three Australian jurisdictions that prohibit therapy to change or suppress a person’s sexual orientation or gender identity.

The laws in Victoria and the ACT provide inadequate protection for clinically appropriate psychiatric practice and may deprive patients of mental health care.

To describe the collaboration between Youth Justice New South Wales (YJNSW) and Justice Health and Forensic Mental Health Network (JHFMHN) during the early COVID-19 Response (CR) across the six Youth Justice centres in NSW, and the reduced incidence of self-harm noted over this period.

Narrative article with analysis of self-harm incident data during the initial CR period of March to May 2020, compared to the same period in 2019.

During the initial CR period (March to May 2020), there was a highly significant, four-fold reduction in self-harming incidents recorded by both YJNSW and JHFMHN compared with the equivalent time period in 2019 (p < .00001).

The greater than four-fold reduction in self-harm by young people during the early CR may relate to the ‘interagency response’, with an increase in positive interactions between staff, and between staff and young people. The reduction in self-harm and improvements in mental health will be further explored through standardised interviews with the young people and staff.

This paper highlights the significant mental health vulnerabilities of people who have sought asylum in Australia and their additional adversities as a result of the Covid-19 pandemic.

Australia’s policies in relation to asylum seekers result in multiple human rights violations and add significantly to mental health vulnerabilities. Despite a majority being identified as refugees, people spend years in personal and administrative limbo and are denied resettlement in Australia. Social isolation and other restrictions associated with Covid-19 and recent reductions in welfare and housing support compound their difficulties. The clinical challenges in working with people impacted by these circumstances and the role of psychiatrists and the RANZCP in advocacy are identified.

Australian school teachers have been affected by the Covid-19 pandemic. Teachers have had to face relentless and challenging working conditions, take on new roles and responsibilities, and embrace new ways of working. We searched reports and the available research literature on teacher mental health between September 2020 and October 2020. In our perspective piece, we summarise this literature and draw attention to the struggles of Australian school teachers and how Covid-19 has impacted their mental health.

To date, there has been a lack of research focusing on teacher mental health both internationally and in Australia. That which is available indicates that teacher mental health is likely to have deteriorated substantially during the pandemic. We position teachers as the forgotten frontline of Covid-19 and make recommendations to facilitate improvements into the future.

The Australian Federal government introduced new COVID-19-Psychiatrist-Medicare-Benefits-Schedule (MBS) telehealth-items to assist with providing private specialist care. We investigate private psychiatrists’ uptake of telehealth, and face-to-face consultations for April–September 2020 for the state of Victoria, which experienced two consecutive waves of COVID-19. We compare these to the same 6 months in 2019.

MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April–September 2020 and compared to face-to-face consultations in the same period of 2019 Victoria-wide, and for all of Australia.

Total Victorian psychiatry consultations (telehealth and face-to-face) rose by 19% in April–September 2020 compared to 2019, with telehealth comprising 73% of this total. Victoria’s increase in total psychiatry consultations was 5% higher than the all-Australian increase. Face-to-face consultations in April–September 2020 were only 46% of the comparative 2019 consultations. Consultations of less than 15 min duration (87% telephone and 13% video) tripled in April–September 2020, compared to the same period last year. Video consultations comprised 41% of total telehealth provision: these were used mainly for new patient assessments and longer consultations.

During the pandemic, Victorian private psychiatrists used COVID-19-MBS-telehealth-items to substantially increase the number of total patient care consultations for 2020 compared to 2019.

To describe the rationale for, and benefits of, trainees and psychiatrists to be involved in medico-political volunteering.

Volunteering for professional organisations and other bodies may be considered as an important advocacy role for psychiatrists. Such volunteering is meaningful through shared goals and achievements, as well as developing a sense of mastery and significance as part of a larger quest. Volunteering is also a professional developmental process that both enhances individual skills/career development as well as organisational efficacy.

This article aims to describe ‘The Mind-Body Well-being Initiative’, a residential mental health treatment model based on the Lifestyle Medicine paradigm, which comprises a mind and body well-being programme. In people with severe mental illness (SMI), particularly for those experiencing psychotic illness, the physical health and mortality gap is significant with greater presence of chronic disease and a 15–20-year life expectancy gap.

Our AIM Self-Capacity model of care attempts to address the physical and mental health care needs for the promotion of our patients’ recovery.

This opinion paper aims to provide an overview of the current evidence base supporting the use of music therapy in mental health care. It also aims to offer critique on the issue of access to music therapy in Australia.

There is a strong evidence base for music therapy to provide symptomatic relief and improve quality of life for people living with mental illness. However, music therapy is underfunded and framed as a supplementary service within mental health services in Australia, which limits its access to consumers. Funding music therapy as an evidence-based treatment option would fill an existing service gap and provide equitable access to a cost-effective and often consumer preferred treatment option for mental health consumers.

To provide reflection on career opportunities, benefits and challenges, with regard to commencing private practice psychiatry in Australia.

There are varied opportunities for a career in private practice psychiatry. Private practice has benefits and challenges, distinct from public sector psychiatry; with moderately greater professional autonomy, facilitating the provision of expert mental healthcare for the community.

Clinical psychologists are practitioners with expertise in mental health, who apply advanced psychological theory and knowledge to their practice in order to assess and treat complex psychological disorders. Given their robust specialised mental health training, clinical psychology is an integral component of the Australian mental health workforce, but is under-utilised. Recent reviews have identified significant problems with Australia’s mental health system, including unequal access to clinical psychology services and fragmentation of service delivery, including convoluted pathways to care.

Clinical psychology is well placed to contribute meaningfully to public mental health services (PMHS). We describe what clinical psychologists currently contribute to team-based care in PMHS, how we could further contribute and the barriers to making more extensive contributions. We identify significant historical and organisational factors that have limited the contribution made by clinical psychologists and provide suggestions for cultural change to PMHS.

SPARX is a computerized cognitive behavioral therapy self-help program for adolescent depression that is freely available in New Zealand. At registration, users identify themselves as either male, female, intersex, or transgender. We aimed to describe the mental health of adolescent intersex users.

A secondary analysis of SPARX usage data over 5 years.

Of the 8922 adolescents users, 0.6% (n = 50) identified as intersex. Based on Patient Health Questionnaire 9 – modified for Adolescents (PHQ-A) results, 78.3% of intersex users had high levels of depression and/or self-harm and suicidal ideation. The mean PHQ-A scores for intersex users were significantly higher than for males and females (p < .001). As only three intersex users completed SPARX Level 4 or more (of the seven-level program), we were unable to meaningfully investigate any reductions in their depressive symptoms over time.

There is a dearth of empirical data on the mental health of intersex adolescents. These results suggest that intersex adolescents seeking help from an online resource have high mental health needs compared with other young people, possibly because they defer seeking help.

To explore the themes related to self and illness representations in a public online community.

This project utilised an inductive process of data analysis with a phenomenological approach. Two hundred images from the social media image-sharing platform Instagram were described, coded and organised into themes.

Five themes were identified: the fragmented and obscured self; trepidation and disappointment about the threatening and persecutory world; an existence built of illness and symptoms; finding comfort in the natural and built environment; and sharing hope and positive experiences of growth.

#bpd encompassed a variety of content types, with a wide spectrum of emotional tones expressed through photographs, written communication and artwork.

Demand for places in postgraduate psychiatry training programmes has increased over recent years. All systems have capacity limits, and concerns have been raised regarding the sustainability of the current intake. This paper presents a modelling exercise to exploring the presence and strategies to resolve bottleneck in the Queensland training programme.

Mathematical modelling based on the RANZCP training regulations and the characteristics of the accredited training programme.

A training bottleneck was identified which has been impacted by increased training intake, demand for Advanced Training certificates, and location factors.

This investigation raises important questions regarding the future management of postgraduate training in psychiatry in Queensland that may be applicable more widely across Australia and New Zealand. In particular, it highlights the large impact that can result from even small incremental increases in trainees across varying levels of the postgraduate programme and the importance of limiting trainee intake in a manner proportional to the availability of mandatory terms.

To describe and provide experiential reflections on a model of continuing professional development in psychiatry for development and maintenance of specialised skills.

For clinical psychiatrists working in smaller population centres, clinical observer visits with peers may be a useful method to develop, improve and calibrate knowledge and skills. Such potential benefits may be even more marked for specialised fields of psychiatry, such as neuropsychiatry.