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Mental health

Indigenous health Letters 19 August 2019 Free

Screening for perinatal depression and predictors of underscreening: findings of the Born in Queensland study

To the Editor: We agree with San Martin Porter and colleagues1 about the importance of mental health screening during pregnancy and acknowledge the role of the Edinburgh Postnatal Depression Scale (EPDS) in screening in Australia and internationally. In the article, the authors stressed that the EPDS has been validated. However, the high heterogeneity demonstrated during these validation studies suggests that it is not equally valid across all populations and settings.2 The authors also suggested that low uptake of screening with Aboriginal women is related to less frequent attendance to antenatal checks. This interpretation fails to consider broader cultural safety issues surrounding antenatal care, and more specifically, the language and cultural appropriateness of the EPDS.3 This tool has not been validated with Aboriginal and Torres Strait Islander women. Many Aboriginal women find the EPDS language complex and confusing, and providers find using it with Aboriginal women challenging.3 Screening processes need to be acceptable to patients and staff, and seen to be easy to use and helpful, or they are unlikely to be well implemented. The need to consider the language and cultural appropriateness of the tool used was acknowledged in the latest Clinical practice guidelines: pregnancy care.4 The Kimberley Mum's Mood Scale (KMMS) is a locally designed approach to screening Aboriginal women.3 Part 1 is an adaption of the EPDS. Part 2 is a “yarn” between health professionals and women about contextual or psychosocial factors that are important to the women. Health professionals work with women to identify how they are coping (strengths focus) without minimising risk factors. Validation of the KMMS demonstrated clinical efficacy and high levels of user acceptability.5 Women identified that “just yarning” was a positive start to understanding and managing their perinatal mental health. An approach such as the KMMS, which values listening (health professional) and talking (woman), is a positive, contemporary and logical next step from the EPDS. We suggest that all women, Aboriginal and non‐Aboriginal, would benefit from this approach. Traditional screening practices are not enough, but the next generation of screening tools provides new opportunities for women and their health professionals.

Julia V Marley · Emma Carlin · Catherine Engelke

General medicine Guideline summary 15 July 2019 Free

Diagnosing and managing work‐related mental health conditions in general practice: new Australian clinical practice guidelines

New Australian clinical practice guideline recommendations to assist GPs with the diagnosis and management of work-related mental health conditions

Danielle Mazza · Samantha P Chakraborty · Bianca Brijnath · Heather Nowak · Cate Howell · Trevor Brott · Michelle Atchison · David Gras · Justin Kenardy · Richard Buchanan · Seyram Tawia

Mja2 50240
Ageing Letters 6 May 2019 Free

Nursing home “no returns” policy, when residents are discharged to the emergency department at 4 am: what does the law say?

To the Editor: We note with interest the letter from Peisah and colleagues.1 A group of oft‐forgotten patients also affected by “no returns” policies is older people with mental illness. We have recent experience of a 72‐year‐old man with diagnoses of schizoaffective disorder and Alzheimer dementia who was admitted to an aged mental health inpatient unit with a relapse of his schizoaffective disorder. He was admitted from a nursing home where he had resided for 4 years, during which time his illness had been stable except for an admission some 12 months earlier. On admission, after minor changes to his pharmacological management, supportive psychotherapy and allied health input, his condition returned to baseline. When the medical team liaised with his nursing home to arrange his return, they were informed that he could not return because they did not have the facilities required for him. When the patient was informed of this, there was subsequent deterioration in his mental state. After his brother with enduring power of attorney threatened legal action, he was accepted back at the home. The community mental health team who are continuing his care in the community have indicated that he remains stable following discharge. There is a high proportion of nursing home residents with a mental illness other than dementia.2 United States and Canadian data suggest that older adults with mental illness experience stigma from nursing homes (mostly due to fear of aggression and other behaviour) and poor quality care.3 Such patients tend to be placed in the first instance in nursing homes with deficiencies in care and with a paucity of resources and specialised expertise to provide care for this group;4 this probably explains the recourse to the “no returns” policy experienced by our patient. Such situations cause harm to the patient and contribute to bed block in hospitals.5 The issues involving this particularly vulnerable population will hopefully be uncovered in the Royal Commission into Aged Care Quality and Safety. We encourage improved mental health literacy in Australian nursing homes.

Malcolm P Forbes · Angelo Ferraro

Letter to the Editor1
Environmental health Perspective 29 November 2018 Free

The MJA–Lancet Countdown on health and climate change: Australian policy inaction threatens lives

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health. This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health. Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning. Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia’s engagement with and progress on this vitally important issue.

Ying Zhang · Paul J Beggs · Hilary Bambrick · Helen L Berry · Martina K Linnenluecke · Stefan Trueck · Robyn Alders · Peng Bi · Sinead M Boylan · Donna Green · Yuming Guo · Ivan C Hanigan · Elizabeth G Hanna · Arunima Malik · Geoffrey G Morgan · Mark Stevenson · Shilu Tong · Nick Watts · Anthony G Capon

18 00789
Environmental health Research 26 November 2018 Free

Pregabalin misuse‐related ambulance attendances in Victoria, 2012–2017: characteristics of patients and attendances

The known: Pregabalin misuse is increasing worldwide, and is associated with acute psychiatric and medical harms, but patterns of pregabalin misuse in Australia have not been reported. The new: The rate of pregabalin‐related ambulance attendances has increased tenfold since 2012, associated with an increase in the national prescription rate. Patients frequently misused pregabalin with other sedatives, particularly benzodiazepines, and almost 40% of misuse‐related events requiring paramedic attendance were suicide attempts. The implications: Caution is required when prescribing pregabalin for patients using other sedatives. Misuse might be reduced by restricting dispensing of the drug.

Rose Crossin · Debbie Scott · Shalini Arunogiri · Karen Smith · Paul M Dietze · Dan I Lubman

Mja2 12036
Mental health Letters 1 October 2018 Free

Nursing home “no returns” policy, when residents are discharged to the emergency department at 4 am: what does the law say?

To the Editor: Behavioural and psychological symptoms of dementia can manifest as aggression directed towards staff or other residents,1 often culminating in recourse to the local emergency department as a “permanent solution”. What does the law say? Under Division 2, User Rights Principles 2014 (section 96-1, Aged Care Act 1997), the only circumstances in which a provider may ask a care recipient to leave a residential care service are if (i) the service is closing; or (ii) the service no longer provides suitable accommodation and care (as assessed by an aged care assessment team or at least two medical or other health practitioners chosen by the recipient who are competent to assess their care needs) and the provider has not agreed to provide the care that the recipient presently needs; or (iii) the recipient no longer needs the care provided, as assessed by an aged care assessment team; or (iv) the recipient has not paid any agreed fees for a reason within their control; or (v) or the recipient has intentionally caused serious damage to the service or serious injury to staff or another care recipient; or (vi) the recipient is away continuously for 7 days or more from the service for reasons not permitted by the Aged Care Act or an emergency. The approved provider must neither imply nor take action to make the care recipient leave, unless suitable alternative accommodation is available that is affordable and meets the care recipient’s needs. Written notice must be given of the decision and reasons for it. A person cannot be asked precipitously to leave a nursing home or, in practical terms, hospital staff or family cannot be told that a bed is no longer available without adhering to the guidelines above. Intention regarding injury and behavioural and psychological symptoms of dementia is complex and cannot be used as grounds for discharge without proper assessment. An alternative is to use the Dementia Behaviour Management Advisory Service and Severe Behaviour Response Teams (24-hour helpline: 1800 699 799), which provide clinical support for carers of people with behavioural and psychological symptoms of dementia. Aged care consumers need to be aware of their rights around security of tenure, and facilities should be resourced sufficiently to fulfil their commitments under the Aged Care Act to care for residents with behavioural and psychological symptoms of dementia.

Carmelle Peisah · Tiffany Jessop · Henry Brodaty

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