Topics
Mental health
Reorienting Allied Health Into Community-Based Care for People Experiencing Trauma and Social Disadvantage
Trauma and social disadvantage are strongly associated with higher rates of chronic disease, partly driven by modifiable risk factors such as physical inactivity and poor diet. Despite strong evidence supporting exercise and dietary interventions for both physical and mental health, access to allied health professionals—particularly exercise physiologists, physiotherapists and dietitians—remains profoundly inequitable. Current prevention efforts predominantly reach individuals with stable living conditions and sufficient resources, ultimately privileging the privileged and entrenching health disparities. To close these gaps, these workforces must be reoriented: embedded within trusted community settings and delivered earlier in the care pathway, in ways that are trauma-informed and responsive to social context.
Simon Rosenbaum, Grace McKeon, Gulsah Kurt, Oscar Lederman, Kemi Wright, Sabuj Kanti Mistry, Jackie E. Curtis, Philip B. Ward, Zachary Steel, Hamish Fibbins, Rachel Morell, Melissa C. Eaton, Andrew Watkins, Ben Harris-Roxas, Brendan Goodger, Eleanor Beck, Megan Teychenne, Joseph Firth, Davy Vancampfort, David Burns, Russell Roberts, Tristan Favaloro, Danielle Weber, Rosanna Barbero, Vasili Maroulis, Melissa Holmes, Stefan Mackenzie, Chiara Mastrogiovanni, Afsana Anwar, Uzma Choudhry, Catherine Sherrington, Jane Currie, Thomas Gadsden, Scott Teasdale
Stigmatising Attitudes Towards People With Depression, Bipolar Disorder, Borderline Personality, ADHD and Early and Long-Term/Untreated Schizophrenia: Representative Survey of Australian Adults
Objectives To examine the prevalence in Australia of stigmatising attitudes towards people with six different mental health conditions: depression, early and long-term/untreated forms of schizophrenia, bipolar disorder, borderline personality disorder and attention-deficit/hyperactivity disorder (ADHD). Design Cross-sectional population-based survey using the probability-based online panel Life in Australia. Participants responded to one of six vignettes describing a person with a mental health condition. Setting Australia, 11–25 November 2024. Participants Representative sample of 6032 adult residents of Australia. Main Outcome Measures Proportions of participants who agreed or strongly agreed with 13 stigmatising attitudes and proportions who were definitely or probably unwilling to interact in five different social situations with the person in the vignette. Results Stigmatising attitudes were generally lowest for depression and highest for long-term schizophrenia and borderline personality disorder. Beliefs about unpredictability had the highest endorsement: 61.9% (95% confidence interval [CI], 58.2%–65.5%) for long-term schizophrenia; 56.3% (95% CI, 52.5%–59.9%) for borderline personality disorder; 52.8% (95% CI, 49.0%–56.6%) for early schizophrenia; 50.7% (95% CI, 47.0%–54.4%) for bipolar disorder; 29.2% (95% CI, 25.9%–32.7%) for ADHD and 23.3% (95% CI, 20.2%–26.7%) for depression. Forcing treatment was endorsed by 25.9% (95% CI, 22.6%–29.5%) for early schizophrenia and 24.1% (95% CI, 21.0%–27.6%) for long-term schizophrenia. For all conditions, at least 20% of participants did not agree that the person in the vignette was a person of worth, with agreement ranging from 78.5% (95% CI, 75.1%–81.6%) for early schizophrenia to 67.4% (95% CI, 63.8%–70.9%) for long-term schizophrenia. There were high levels of unwillingness for the person in the vignette to marry into the family: ranging from 29.7% (95% CI, 26.4%–33.2%) for ADHD to 64.4% (95% CI, 60.7%–67.9%) for long-term schizophrenia. Conclusions Stigma related to mental health conditions remains prevalent in Australia and contributes to social and economic exclusion among those affected. Sustained action is needed across multiple sectors to address stigma, particularly towards conditions such as schizophrenia and borderline personality disorder, which are poorly understood within the community.
Amy J. Morgan, Anna M. Ross, Gayle McNaught, Rachel Green, Nicola J. Reavley
Psychosocial Hazards for Healthcare Workers: Supporting the Second Victim Also Helps the Primary Victims
The psychosocial hazards of healthcare are well-recognized and are now subject to new legislation in Australia. Missing from this discussion has been the recognition of the second victim phenomenon—the distress experienced by healthcare workers involved in an adverse event, medical error or unexpected patient outcome—which appears to meet criteria for a psychosocial hazard. Organizations should ensure support for second victims by building a restorative and just culture, including ensuring all staff are educated on the second victim phenomenon and can support their colleagues, implementing a staff peer-support programme and ensuring that specialist mental health supports, such as an employee assistance programme, are geared towards supporting the second victim.
Sarah Michael
Supporting Population Mental Health in the Wake of Mass Tragedies
The Bondi Beach terrorist attack has caused widespread community distress resulting in complex psychosocial challenges that require urgent attention to protect population mental health. Acute reactions including shock, fear and anger are normative, while the psychological responses unfolding over time may vary from adaptive to dysfunctional. A range of mental health and psychosocial services have been mobilised to address acute needs; however, to ensure a sustained and coherent framework of care, interventions should be guided by a set of principles that accurately respond to the unique nature of the event. We provide an overview of the Adaptation and Development After Persecution and Trauma (ADAPT) model as an overarching framework that can guide psychosocial interventions and promote adaptive coping, recovery and resilience.
Susan J. Rees, Derrick M. Silove
In the Wake of the National Suicide Prevention Strategy 2025–2035: Suicide Prevention in Type 1 Diabetes
Rigel Paciente, Keely Bebbington, Alix Woolard, Helen Milroy
The risk of death after hospitalisation following intentional self‐poisoning: a retrospective observational study (PAVLOVA‐2)
Aftercare for people who have poisoned themselves should include both mental health assessments and reviews of physical health conditions
Firouzeh Noghrehchi · Nicholas A Buckley · Rose Cairns
Access to mental health services continues to be under duress
Access to mental health services continues to be a significant problem for most Australians.1 This problem has been exacerbated in regional and rural areas.1 Most recently though, psychiatrists in the public hospital system in New South Wales threatened to walk off the job en masse due to a myriad reasons, the most prominent being the substantial pay gap for clinicians in NSW compared with other states.1 In this issue of the MJA, Huber and colleagues2 tried to identify modifiable causes of stress in clinicians and administrators working in NSW psychiatric emergency care centres. The study design was qualitative and 35 participants across 12 sites were interviewed. Systemic challenges at three levels were identified in staff interactions with patients and carers, the broader health system and the hospital. The study found that relational work (the core of clinician–service user interactions) is both meaningful and difficult. Psychiatric Emergency Care Centres (PECC) are the nexus of suicide risk management, with conflicting system expectations of staff to ensure safe care while making risky discharge decisions, which causes anxiety and high turnover. Moreover, there is tension between the model of care and the frequent reality of PECCs being used to manage patient flow, which leads to clinicians feeling professionally undervalued by the hospital. Two protective themes enabling staff to meet these challenges were developed. First, well defined treatment protocols enhanced clinical satisfaction, continuity of care for patients, and supported wellbeing. Second, working in a collaborative team environment with a flattened hierarchy fostered autonomy and robust teamwork. On the other end of the spectrum is access to community‐based paediatricians and psychiatrists, especially for attention deficit hyperactivity disorder (ADHD) and developmental assessments. Rates of ADHD diagnosis have increased substantially in the past ten years and the reasons for this are complex and multifactorial.3 In this issue of the MJA, Bradlow and colleagues4 examine adult ADHD in Australia and how its current commercial model for diagnosis and treatment may be encouraging misdiagnosis. The rise in ADHD diagnoses and the most appropriate management approaches are debated. This rise is particularly pronounced among adults, the authors write, and could be in part attributed to growing public awareness, amplified by social media platforms such as TikTok, where ADHD‐related content is reported to have had over 36 billion views. The authors note that “most adults with ADHD are diagnosed by private psychiatrists”. The dearth of public services for ADHD raises serious concerns regarding equity of access and the potential that normal behavioural variability is “medicalised”. Their view is that there is a risk that complex psychosocial issues may be misattributed to ADHD. This latter concern is grounded in psychiatry’s history of oversimplified biological explanations to complex psychosocial causes. Pharmacotherapy for the condition is not without harm, they write, although the rise in stimulant prescriptions has not led to an increase in stimulant‐related deaths, there has been a rise in hospital presentations for stimulant‐related poisonings. It is important to consider how the current ongoing issues around the cost of living will affect access to essential health care services without causing a significant burnout within health professionals and researchers. This issue of the MJA also includes clinical practice guidelines for hepatocellular carcinoma surveillance for people at high risk in Australia.5 With metabolic syndrome and prevalence of fatty liver on the rise, these guidelines provide up‐to‐date information regarding the surveillance of high risk populations. The recommendations were developed by a working group of experts in liver cancer control and included evidence reviews, synthesis and adaptation of existing guidelines for the Australian context, and predictive modelling. The updated guidelines formalise recommendations for people with cirrhosis, identify other patient groups who are recommended for surveillance, and highlight gaps in evidence where the benefit of surveillance is unclear.
Aajuli Shukla
Identifying modifiable causes of stress in clinicians and administrators working in New South Wales psychiatric emergency care centres, 2023–24: a qualitative study
Conflicting demands in crisis care units can be alleviated by a flat team hierarchy and clear treatment protocols
Jacqueline P Huber · Alyssa Milton · Matthew Brewer · Kat Fry · Sean Evans · Jason Coulthard · Nicholas Glozier
An autoethnographic critique of a past report of inpatient psychiatric treatment for gender diverse children
Contrary to ongoing representations of efficacy, “therapy” that aimed to change or suppress a gender diverse child served to delay self-acceptance for two decades and caused long term harm
Jayne McFadyen · Timothy W Jones · Rowena Koek · Fintan Harte · Brendan Jansen · Megan Galbally · Warren Kealy‐Bateman · Catherine Wall · Quinnehtukqut McLamore · Anja Ravine
Sex‐ and gender‐responsive management of anxiety disorders: future pathways for research, education, policy and practice
Better integration of sex and gender considerations in health and medical research, in Australian clinical practice guidelines, and in health and medical education curricula, is needed to improve the quality of care for all people with anxiety disorders
Bronwyn M Graham
The contribution of evidence‐based practice and the practice‐based evidence approaches to contemporary Australian psychology: implications for culturally safe practice
Adopting a broader and more inclusive approach to evidence represents an important step toward addressing the persistent inequities experienced by many Aboriginal and Torres Strait Islander peoples and diverse communities
Paul Gray (Wiradjuri) · Dawn Darlaston‐Jones · Pat Dudgeon AM (Bardi) · Kate Derry · Joanna Alexi · William Smith (Wiradjuri and Wemba Wemba) · Tanja Hirvonen (Jaru and Bunuba) · David Badcock · Shraddha Kashyap · Belle Selkirk (Noongar)
Country revealing the way: evaluating Elder‐governed cultural therapy for Aboriginal and Torres Strait Islander young people with mental health conditions
Cultural therapy may be an effective intervention for Aboriginal and Torres Strait Islander young people with mental health conditions and should be offered alongside but separate from Western mental health management
Alasdair Vance · Janet McGaw · Jo Winther · Naomi Tootell · Herb Patten · Sandra Eades
A precautionary approach to social media: protecting young minds in an evolving digital world
We present a multilayered approach focused on systems-level change, including policy action, social media platform accountability and school-based initiatives, individual-level strategies and the critical need for a research agenda co-designed with young people
Ivana Stankov · Yonatal Tefera · Melissa Bradley · Alison Pickering · Emma Willoughby · Carmel Williams
Participation in the National Bowel Cancer Screening Program by people with severe mental illness, Australia, 2006–2019: a national data linkage study
Oyedeji Ayonrinde · Sara Mohamed · Jenna Nensi
When may an adult woman with cognitive impairment still have capacity to consent to an abortion?
Capacity to consent to abortion is decision-specific, so that even when a woman is found to lack capacity to make decisions in other areas of her life, she may still have capacity to consent to an abortion
Julia P Duffy · Sam Boyle · Casey M Haining
Prescription opioid supply‐restricting policies and hospital use by people prescribed opioid medications, Victoria, 2018–22: a controlled interrupted time series analysis
Opioid-related harm can be reduced without increasing long term non-opioid substance- or mental health-related harm
Suzanne Nielsen · Louisa Picco · Bosco Rowland · Nadine E Andrew · Taya A Collyer · Samanta Lalic · Rachelle Buchbinder · Christopher Pearce · J Simon Bell · Dan I Lubman · Ting Xia
Exploring the role of urine drug screening in opioid agonist therapy
Instructive guidelines for urine drug screening during opioid agonist therapy might minimise unnecessary tension in the therapeutic relationship between prescribers and patients
Grace FitzGerald · Sione Crawford · Adrian J Dunlop · Jon Cook · Dean Membrey · Paul MacCartney · Thileepan Naren
The potential benefits of a needle and syringe program in Australian prisons
Needle and syringe programs are evidence-based best practice interventions that reduce the harm associated with needle sharing
Alexander J Thompson · Michael H Levy
Strong medication overdose data, but we need to consider both toxicity and therapeutic need when prescribing
Physicians should know which medications should be prescribed in limited quantities and only after safer alternatives have been tried
Angela L Chiew · Geoffrey K Isbister
The relative toxicity of medicines detected after poisoning suicide deaths in Australia, 2013–19: a data linkage case series study
More toxic medicines should be supplied in limited quantities and their dispensing to individuals monitored
Jessy Lim · Nicholas A Buckley · Kate Chitty · Andrea L Schaffer · Jennifer Schumann · Zein Ali · Rose Cairns
Improving palliative care for people who use alcohol and other drugs
A discussion of the complexities that arise when people who use alcohol and other drugs require palliative care
Grace FitzGerald · Jon Cook · Peter Higgs · Charles Henderson · Sione Crawford · Thileepan Naren
Participation in the National Bowel Cancer Screening Program by people with severe mental illness, Australia, 2006–2019: a national data linkage study
Barriers to screening may contribute to higher colorectal cancer case fatality rates in people with severe mental illness
Steve Kisely · Rebecca Seth · Susan J Jordan · Bradley Kendall · Dan J Siskind · Grant Sara · Justin Chapman · Lisa Brophy · David M Lawrence
Disorders of gut–brain interaction, eating disorders and gastroparesis: a call for coordinated care and guidelines on nutrition support
Current knowledge and service limitations in treating the complex interplay between eating disorders, gut–brain disorders and motility disorders
Trina Kellar · Chamara Basnayake · Rebecca E Burgell · Michael Kamm · Hannah W Kim · Kate Lane · Kate Murphy · Nicholas J Talley
Guidelines for the design and implementation of youth participation initiatives to safeguard mental health and wellbeing
The youth participation guidelines aim to improve youth participation initiatives while safeguarding the mental health of participating young people
Kailin Guo · Danica Meas · Dominik Mautner · Fulin Yan · Imeelya Al‐Hadaya · Amarina Donohoe‐Bales · Lily Teesson · Stephanie R Partridge · Magenta B Simmons · Mariam Mandoh · Emma L Barrett · Maree R Teesson · Scarlett Smout · Marlee Bower