Topics

Investment in caring for country may help close the gaps in education, employment and health

Health services for Aboriginal and Torres Strait Islander people are expensive. The National Aboriginal Community Controlled Health Organisation reported that government Aboriginal and Torres Strait Islander health and hospital service expenditure per person in 2010–11 was $8190 nationally, and as high as $16 110 in the Northern Territory, compared with $4054 per non-Indigenous person.1 Increasing expenditure on health services for Aboriginal and Torres Strait Islander people is not closing the gap in health outcomes at the rate to which governments have committed.2

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1 Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT
2 Cooperative Research Centre for Remote Economic Participation, Alice Springs, NT

Correspondence: rosalie.schultz@flinders.edu.au

Acknowledgements:

This research is supported by the Cooperative Research Centre for Remote Economic Participation, hosted by Ninti One. We acknowledge the support and involvement of our key organisational stakeholders: Centre for Remote Health (Flinders University and Charles Darwin University), Department of Prime Minister and Cabinet, Northern Star Resources, Yalu Marŋgithinyaraw Indigenous Corporation, Marthakal Homelands Resource Centre, Central Desert Native Title Services, Poche Centre for Indigenous Health, Miwatj Health Aboriginal Corporation, Australian Bureau of Statistics, Muntjiltjarra Wurrgumu Group, Kalano Community Association, Wurli–Wurlinjang Health Service, StrongBala Men’s Health Program, Flinders NT (Katherine), Katherine Stolen Generation Group, Banatjarl Strongbala Wumin Grup, Wiluna Martu Rangers, and Ngangganawili Aboriginal Health Service Community.

Competing interests:

No relevant disclosures.

1. Alford K. Economic value of Aboriginal community controlled health services. Canberra: National Aboriginal Community Controlled Health Organisation, 2014. http://apo.org.au/node/39333? (accessed May 2017).
2. Australian Government Department of Prime Minister and Cabinet. Closing the Gap: Prime Minister’s report 2017. Canberra: Department of Prime Minister and Cabinet, 2017. http://closingthegap.dpmc.gov.au (accessed May 2017).
3. Houston S. We need transformative change in Aboriginal health. Med J Aust 2016; 205: 17-18. <MJA full text>
4. Australian Government Department of Health. National Aboriginal and Torres Strait Islander Health Plan 2013-2023 Canberra: Commonwealth of Australia, 2013. http://www.health.gov.au/natsihp (accessed Aug 2016).
5. Kingsley J, Townsend M, Henderson-Wilson C, et al. Developing an exploratory framework linking Australian Aboriginal peoples’ connection to country and concepts of wellbeing. Int J Environ Res Public Health 2013; 10: 678-698.
6. Nguyen O, Cairney S. Literature review of the interplay between education, employment, health and wellbeing for Aboriginal and Torres Strait Islander people in remote areas: working towards an Aboriginal and Torres Strait Islander wellbeing framework. (CRC-REP Working Paper CW013). Alice Springs: Ninti One, 2013. http://www.crc-rep.com.au/resource/CW013_InterplayLiteratureReview_TowardsWellbeingFramework.pdf (accessed Aug 2016).
7. Hill R, Pert P, Davies J, et al. Indigenous land management in Australia: extent, scope, diversity, barriers and success factors. Cairns: CSIRO: Ecosystem Sciences, 2013. http://www.agriculture.gov.au/SiteCollectionDocuments/natural-resources/landcare/submissions/ilm-report.pdf (accessed Aug 2016).
8. Whitehead PJ, Purdon P, Russell-Smith J, et al. The management of climate change through prescribed savanna burning: emerging contributions of Indigenous people in northern Australia. Public Admin Dev 2008; 28: 374-385.
9. Davies J, Campbell D, Campbell M, et al. Attention to four key principles can promote health outcomes from desert Aboriginal land management. Rangeland J 2011; 33: 417-431.
10. Burgess C, Johnston F, Berry H, et al. Healthy country, healthy people: the relationship between Indigenous health status and “caring for country”. Med J Aust 2009; 109: 567-572. <MJA full text>
11. Gorman J, Vemuri S. Social implications of bridging the gap through ‘caring for country’ in remote Indigenous communities of the Northern Territory, Australia. Rangeland J 2012; 34: 63-73.
12. Campbell D, Burgess C, Garnett S, et al. Potential primary health care savings for chronic disease care associated with Australian Aboriginal involvement in land management. Health Policy 2011; 99: 83-89.
13. Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Canberra: AIHW, 2015. http://www.aihw.gov.au/indigenous-observatory/reports/health-and-welfare-2015 (accessed Aug 2016).
14. Australian Government Department of Prime Minister and Cabinet. Indigenous Rangers — Working on Country. https://www.dpmc.gov.au/indigenous-affairs/environment/indigenous-rangers-working-country (accessed Aug 2016).
15. Australian Government Department of Prime Minister and Cabinet. Project funding — Indigenous land and sea management. Indigenous Advancement Strategy funding. https://www.dpmc.gov.au/indigenous-affairs/environment/project-funding-indigenous-land-and-sea-management (accessed May 2017).
16. Social Ventures Australia. Social return on investment — consolidated report on Indigenous protected areas. Sydney: Social Ventures Australia Consulting, 2016. https://www.dpmc.gov.au/resource-centre/indigenous-affairs/social-return-investment-%E2%80%93-consolidated-report-indigenous-protected-areas (accessed May 2017).
17. World Health Organization. Declaration of Alma-Ata. International conference on primary health care, Alma-Ata, USSR, 6–12 September 1978. http://www.who.int/publications/almaata_declaration_en.pdf (accessed May 2017).

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Perspectives

Improving Indigenous health through education

Michael B Hart, Michael J Moore and Martin Laverty

Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00319
Published online: 3 July 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Indigenous health

Global health

Social determinants of health

Better education may close the life expectancy gap by up to 12 years

In an inquiry into Indigenous health in 1979, the House Standing Committee on Aboriginal Affairs noted: “When innumerable reports on the poor state of Aboriginal health are released there are expressions of shock or surprise and outraged cries for immediate action. However, the reports appear to have no real impact and the appalling state of Aboriginal health is soon forgotten until another report is released”.1

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1 Social Determinants of Health Alliance, Canberra, ACT
2 Puntukurnu Aboriginal Medical Service, Newman, WA
3 Public Health Association of Australia, Canberra, ACT
4 Royal Flying Doctor Service of Australia, Canberra, ACT

Correspondence: bret@hart-solutions.com.au

Acknowledgements:

We thank the contributions, advice and cultural oversight provided by Dennis McDermott and Tom Calma.

Competing interests:

M Bret Hart is the current chair of the Social Determinants of Health Alliance (SDOHA). Michael Moore and Martin Laverty were the previous chairs of SDOHA.

1. House of Representatives Standing Committee on Aboriginal Affairs. Aboriginal health. Canberra: Commonwealth of Australia; 1979. http://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=reports/1979/1979_pp60report.htm (accessed Apr 2017).
2. Webb-Pullman M, Vorrath S, Nethercote J. The 25 reports on Aboriginal Australia that line government bookshelves. Melbourne: Crikey; 25 May 2006. https://www.crikey.com.au/2006/05/25/the-25-reports-on-aboriginal-australia-that-line-government-bookshelves (accessed Apr 2017).
3. Wilkinson R, Marmot M. Social determinants of health: the solid facts; 2nd ed. Copenhagen: World Health Organization; 2003. http://www.euro.who.int/en/publications/abstracts/social-determinants-of-health.-the-solid-facts (accessed Apr 2017).
4. Marmot M, Friel S, Bell R, et al. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008; 372: 1661-1669.
5. Commission on the Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008. http://www.who.int/social_determinants/thecommission/finalreport/en (accessed Apr 2017).
6. Cohen AK, Syme SL. Education: a missed opportunity for public health intervention. Am J Public Health 2013; 103: 997-1001.
7. Johnston V, Lea T, Carapetis J. Joining the dots: the links between education and health and implications for Indigenous children. J Paediatr Child Health 2009; 45: 692-697.
8. Baker DP, Leon J, Smith Greenaway EG, et al. The education effect on population health: a reassessment. Popul Dev Rev 2011; 37: 307-332.
9. Korda RJ, Soga K, Joshy G, et al. Socioeconomic variation in incidence of primary and secondary major cardiovascular disease events: an Australian population-based prospective cohort study. Int J Equity Health 2016; 15: 189.
10. Brinkman S, Gregory T, Harris J, et al. Associations between the early development instrument at age 5, and reading and numeracy skills at ages 8, 10 and 12: a prospective linked data study. Child Indic Res 2013; 6: 695-708.
11. Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 2012-13 (Cat. No. 4727.0.55.001)Canberra: Commonwealth of Australia; 2013. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.001main+features802012-13 (accessed Apr 2017).
12. Department of the Prime Minister and Cabinet. Closing the Gap Prime Minister’s report 2017. Canberra: Commonwealth of Australia; 2017. http://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2017.pdf (accessed Apr 2017).
13. Silburn S, McKenzie J, Guthridge S, et al. Unpacking educational inequality in the Northern Territory. Australian Council for Educational Research Conferences; 2014. http://research.acer.edu.au/cgi/viewcontent.cgi?article=1234&context=research_conference (accessed May 2017).
14. Wilks J, Wilson K. A profile of Aboriginal and Torres Strait Islander higher education student population. Aust Univ Rev 2015; 57: 17-30.
15. Fiske ST, Kaplan RM, Spittel ML, Zeno TL. Educational attainment and life expectancy. Policy Insights. Behav Brain Sci 2014; 1: 189-194.
16. Georges N, Guthridge SL, Li SQ, et al. Progress in closing the gap in life expectancy at birth for Aboriginal people in the Northern Territory, 1967–2012. Med J Aust 2017; 207: 25-30.
17. Marmot M. Social determinants and the health of Indigenous Australians. Med J Aust 2011; 194: 512-513. <MJA full text>
18. Spittel ML, Riley WT, Kaplan RM. Educational attainment and life expectancy: a perspective from the NIH Office of Behavioral and Social Sciences Research. Soc Sci Med 2014; 127: 203-205.
19. Stringhini S, Carmeli C, Jokela M, et al. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women. Lancet 2017; 389: 1229-1237.
20. World Health Organization. 2013–2020 Global action plan for the prevention and control of non-communicable diseases. Geneva: WHO; 2013. http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf (accessed May 2017).
21. Thomson S, De Bortoli L, Underwood C. PISA 2015: reporting Australia’s results. Melbourne: Australian Council for Educational Research; 2017. http://research.acer.edu.au/ozpisa/22 (accessed Apr 2017).

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Guideline summary

The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders

David J Castle, Cherrie A Galletly, Frances Dark, Verity Humberstone, Vera A Morgan, Eóin Killackey, Jayashri Kulkarni, Patrick McGorry, Olav Nielssen, Nga T Tran and Assen Jablensky

Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.01159
Published online: 19 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Mental disorders

Abstract

Introduction: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management of schizophrenia and related disorders provide evidence-based recommendations for optimising treatment and prognosis. This update to the 2005 RANZCP guidelines has a greater emphasis on psychosocial treatments, physical health comorbidities and vocational rehabilitation.
Main recommendations: The guidelines advise a clinical staging approach and deliver specific recommendations for:•comprehensive treatment using second generation antipsychotic agents continuously for 2–5 years;•early treatment of comorbid substance use;•community treatment after initial contact, during crises and after discharge from hospital;•physical health monitoring and management of comorbidities, particularly metabolic health;•interventions to optimise recovery of social function and return to study or work; and•management of schizophrenia in specific populations and circumstances.
Changes in management as a result of the guidelines: The guidelines provide benchmarks against which the performance of services and clinical teams can be assessed. Measuring treatment response and clinical outcome is essential. General practitioners have an important role, particularly in monitoring and reducing the high cardiovascular risk in this population. Clinical services focusing on early detection, treatment and recovery need continuous funding to be proactive in implementing the guidelines and closing the gap between what is possible and what actually occurs.

1 St Vincent's Hospital, Melbourne, VIC
2 University of Melbourne, Melbourne, VIC
3 University of Adelaide, Adelaide, SA
4 Northern Mental Health, Adelaide, SA
5 Metro South Health, Brisbane, QLD
6 University of Queensland, Brisbane, QLD
7 Northland District Health Board, Whangarei, New Zealand
8 University of Auckland, Auckland, New Zealand
9 University of Western Australia, Perth, WA
10 Orygen Youth Health, Melbourne, VIC
11 Alfred Health, Melbourne, VIC
12 Monash University, Melbourne, VIC
13 National Centre of Excellence in Youth Mental Health, Melbourne, VIC
14 headspace National Youth Mental Health Foundation, Melbourne, VIC
15 Macquarie University, Sydney, NSW
16 Medical Research Foundation, Royal Perth Hospital, Perth, WA
17 Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Perth, WA

Correspondence: david.castle@svha.org.au

Acknowledgements:

We thank Susie Hincks, Lived Experience Advisor for her contribution to the guidelines.

Competing interests:

No relevant disclosures.

1. Castle DJ, Buckley P. Schizophrenia, 2nd ed. Oxford: Oxford University Press, 2015.
2. Morgan VA, McGrath JJ, Jablensky A, et al. Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychol Med 2014; 44: 2163-2176.
3. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness 2010: report on the Second Australian national survey. Canberra: Commonwealth of Australia; 2011. http://www.health.gov.au/internet/main/publishing.nsf/content/717137a2f9b9fcc2ca257bf0001c118f/$file/psych10.pdf (accessed May 2017).
4. Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust NZ J Psychiatry 2016; 50: 410-472.
5. McGorry P, Killackey E, Lambert T, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust NZ J Psychiatry 2005; 39: 1-30.
6. Galletly CA, Foley DL, Waterreus A, et al. Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 753-761.
7. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. 2009. Canberra: NHMRC; 2009. https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf (accessed Nov 2016).
8. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 735-752.
9. Stafford MR, Jackson H, Mayo-Wilson E, et al. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346: f185.
10. Lubman DI, King JA, Castle DJ. Treating comorbid substance use disorders in schizophrenia. Int Rev Psychiatry 2010; 22: 191-201.
11. Cooper J, Mancuso SG, Borland R, et al. Tobacco smoking among people living with a psychotic illness: the second Australian Survey of Psychosis. Aust NZ J Psychiatry 2012; 46: 851-863.
12. Liu D, Myles H, Foley DL, et al. Risk factors for obstructive sleep apnea are prevalent in people with psychosis and correlate with impaired social functioning and poor physical health. Front Psychiatry 2016; 7.
13. Moore S, Shiers D, Daly B, et al. Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatr Scand 2015; 132: 109-121.
14. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull 2009; 35: 383-402.
15. Shah S, Mackinnon A, Galletly C, et al. Prevalence and impact of childhood abuse in people with a psychotic illness. Data from the second Australian national survey of psychosis. Schizophr Res 2014; 159: 20-26.
16. Morgan VA, Morgan F, Galletly C, et al. Sociodemographic, clinical and childhood correlates of adult violent victimisation in a large, national survey sample of people with psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 269-279
17. Morgan VA, Castle DJ, Jablensky AV. Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Aust NZ J Psychiatry 2008; 42: 74-82.

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Research

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial

Marc M Cohen, De Villiers Smit, Nick Andrianopoulos, Michael Ben-Meir, David McD Taylor, Shefton J Parker, Chalie C Xue and Peter A Cameron

Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.00771
Published online: 19 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Complementary therapies

Anesthesia, analgesia and pain

Emergency medicine

Abstract

Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain.

Design: A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department.

Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10-point verbal numerical rating scale (VNRS) of at least 4.

Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.

Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non-inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention-to-treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between-group differences.

Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed.

Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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1 RMIT University, Melbourne, VIC
2 The Alfred Hospital, Melbourne, VIC
3 Monash Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, VIC
4 Cabrini Hospital, Melbourne, VIC
5 Austin Health, Melbourne, VIC
6 Monash University, Melbourne, VIC

Correspondence: marc.cohen@rmit.edu.au

Acknowledgements:

The trial was supported by a grant from the National Health and Medical Research Council (#555427).

Competing interests:

No relevant disclosures.

1. Grant PS. Analgesia delivery in the ED. Am J Emerg Med 2006; 24: 806-809.
2. Stalnikowicz R, Mahamid R, Kaspi S, Brezis M. Undertreatment of acute pain in the emergency department: a challenge. Int J Qual Health Care 2005; 17: 173-176.
3. Taylor DM, Fatovich DM, Finucci DP, et al. Best-practice pain management in the emergency department: a cluster-randomised, controlled, intervention trial. Emerg Med Australas 2015; 27: 549-557.
4. Shergis JL, Parker S, Coyle ME, et al. Key considerations for conducting Chinese medicine clinical trials in hospitals. Chin Med 2013; 8: 3.
5. Cohen M, Pirotta M, Da Costa C. The integration of complementary therapies in Australian general practice: results of a National Survey. J Altern Complement Med 2005; 11: 995-1004.
6. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012; 172: 1444-1453.
7. Madsen MV, Gotzsche PC, Hrobjartsson A. Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups. BMJ 2009; 338: a3115.
8. Hopton A, MacPherson H. Acupuncture for chronic pain: is acupuncture more than an effective placebo? A systematic review of pooled data from meta-analyses. Pain Pract 2010; 10: 94-102.
9. Ernst E, Lee MS, Choi TY. Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain 2011; 152: 755-764.
10. eTG complete [website]. Melbourne: Therapeutic Guidelines, 2014. https://tgldcdp.tg.org.au/etgcomplete (accessed Dec 2016).
11. Macintyre PE, Schug SA, Scott DA, et al; APM:SE Working Group of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute pain management: scientific evidence. 3rd edition. Melbourne: ANZCA and FPM, 2010. https://sydney.edu.au/medicine/pmri/pdf/Acute-pain-management-scientific-evidence-third-edition.pdf (accessed Dec 2016).
12. Zhang AP, Parker SJ, Smit de V, et al. Acupuncture and standard emergency department care for pain and/or nausea and its impact on emergency care delivery: a feasibility study. Acupuncture Med 2014; 32: 250-256.
13. Fleckenstein J, Schottdorf J, Kreimeier U, Irnich D. Acupuncture in emergency medicine: results of a case series. Anaesthetist 2011; 60: 854-862.
14. Reinstein AS, Erickson LO, Griffin KH, et al. Acceptability, adaptation, and clinical outcomes of acupuncture provided in the emergency department: a retrospective pilot study. Pain Med 2016; 18:169-178.
15. Goertz C, Niemtzow R, Burns SM, et al. Auricular acupuncture in the treatment of acute pain syndromes: a pilot study. Mil Med 2006; 171: 1010-1014.
16. Wong A, Leong CP, Su TY, et al. Clinical trial of acupuncture for patients with spinal cord injuries. Am J Phys Med Rehabil 2003; 1: 21-27.
17. Grillo CM, Wada RS, da Luz Rosário de Sousa M. Acupuncture in the management of acute dental pain. J Acupunct Meridian Stud 2014; 7: 65-70.
18. Cohen M, Parker S, Taylor D, et al. Acupuncture as analgesia for low back pain, ankle sprain and migraine in emergency departments: study protocol for a randomized controlled trial. Trials 2011; 12: 241.
19. Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med 2003; 10: 390-392.
20. Holdgate AK, Kelly, AM. Management of acute migraine (Emergency care evidence in practice series). Melbourne: National Institute of Clinical Studies, 2006. https://www.nhmrc.gov.au/_files_nhmrc/file/nics/programs/Management%20of%20acute%20migraine%20%5BPDF%20190KB%5D.pdf? (accessed Dec 2016).
21. Australian Acute Musculoskeletal Pain Guidelines Group. Evidence-based management of acute musculoskeletal pain: a guide for clinicians. Brisbane: Australian Academic Press, 2003. https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp94_evidence_based_management_acute_musculoskeletal_pain_131223.pdf (accessed Dec 2016).
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25. Vase L, Baram S, Takakura N, et al. Specifying the nonspecific components of acupuncture analgesia. Pain 2013; 154: 1659-1667.

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Editorials

Broken promises and missing steps in mental health reform

Patrick D McGorry and Matthew P Hamilton

Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00329
Published online: 19 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Mental disorders

We are still seriously failing to resource and integrate mental health into the mainstream of the health care system

A young colleague recently shared his family’s experience of the Australian health system. His older brother has schizophrenia, an illness that is typically serious, persistent and reduces life expectancy by a minimum of 15–20 years.1,2 He was untreated and seriously ill for 2 years before he gained access — as a result of a life-threatening crisis — to a mental health system that could no longer avoid a response. Expert early intervention services (an Australian innovation), which improve health, social and economic outcomes,3,4 were then and now simply not available in his community and remain embryonic nationally. The inexcusable treatment delay cost him his chance of recovery,4 and he has languished for years with severe symptoms and disability. His care now consists of brief general practitioner visits, non-evidence-based support from a non-government organisation, and stress-laden hospital admissions that achieve nothing more than risk management. He has no meaningful access to specialist expertise or the multidisciplinary team-based approach that is essential to remission and recovery. In 2016, his sister was diagnosed with cancer. The contrast was a revelation to the family. The cancer diagnosis galvanised the same local health system, which this time delivered truly exemplary care. Rapid investigation, effective treatment and widespread support followed, leading to full remission. Not only was the medical care high quality, intensive and sustained, but the young woman was even provided with expert mental health care, of much higher quality than that offered to her brother, for as long as it was needed, with no rationing of sessions or barriers to specialist care.

1 University of Melbourne, Melbourne, VIC
2 Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, VIC

Correspondence: pat.mcgorry@orygen.org.au

Competing interests:

Patrick McGorry is a Director of headspace.

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3. Tsiachristas A, Thomas T, Leal J, Lennox BR. Economic impact of early intervention in psychosis services: results from a longitudinal retrospective controlled study in England. BMJ Open 2016; 6: e012611.
4. Hegelstad WT, Larsen TK, Auestad B, et al. Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcome. Am J Psychiatry 2012; 169: 374-380.
5. Morgan VA, Waterreus A, Carr V, et al. Responding to challenges for people with psychotic illness: updated evidence from the Survey of High Impact Psychosis. Aust N Z J Psychiatry 2017; 51: 124-140.
6. Castle DJ, Galletly CA, Dark F, et al. The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders. Med J Aust 2017; 206: 501-505.
7. Nielssen O, McGorry PD, Castle D, Galletly C. The RANZCP guidelines for schizophrenia: why is our practice so far short of our recommendations, and what can we do about it? Aust N Z J Psychiatry In press.
8. National Mental Health Commission. Report of the national review of mental health programs and services. Sydney: NMHC; 2015. http://www.mentalhealthcommission.gov.au/our-reports/contributing-lives,-thriving-communities-review-of-mental-health-programmes-and-services.aspx (accessed May 2017).
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11. Australian Institute of Health and Welfare. Mental Health Services in Australia. Expenditure on mental health services: table EXP.4, recurrent expenditure per capita on state and territory specialised mental health services, constant prices, states and territories, 1992–93 to 2014–15. Canberra: AIHW; 2017. https://mhsa.aihw.gov.au/resources/expenditure (accessed May 2017).
12. Duckett S, Cuddihy M, Newnham H. Targeting zero: supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care. Report of the review of hospital safety and quality assurance in Victoria. Melbourne: Victorian Government; 2016.
13. Andrews D. Safety overhaul to put Victorian patients first [press release]. Melbourne: Government of Victoria, 14 October 2016. http://www.premier.vic.gov.au/safety-overhaul-to-put-victorian-patients-first (accessed May 2017).
14. McGorry PD. Back to the future: schizophrenia in retrospect and prospect. Aust N Z J Psychiatry 2017; 51: 431-433.
15. Torrey EF. American psychosis: how the federal government destroyed the mental illness treatment system. Oxford: Oxford University Press; 2013.
16. Harris MG, Hobbs MJ, Burgess PM, et al. Frequency and quality of mental health treatment for affective and anxiety disorders among Australian adults. Med J Aust 2015; 202: 185-189. <MJA full text>
17. Bloom DE, Cafiero ET, Jané-Llopis E, et al. The global economic burden of non-communicable diseases. Geneva: World Economic Forum; 2011. http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf (accessed May 2017).
18. Turnbull M. Address — 2016 Australian Mental Health Prize. Canberra: Australian Government; 2016. http://www.pm.gov.au/media/2016-12-07/address-2016-australian-mental-health-prize (accessed May 2017).

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Perspectives

Ultrasound as a treatment modality for neurological diseases

Gerhard Leinenga, Rebecca M Nisbet and Jürgen Götz

Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.01013
Published online: 19 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Nervous system diseases

Immune system diseases

Diagnostic techniques and procedures

Neurological disorders are a particular challenge for therapeutic intervention — ultrasound has emerged as a novel approach with a broad range of applications

With an ageing population, neurological disorders present an increasing challenge to our health care systems. Although antibodies are increasingly being explored for therapeutic intervention,1 the inefficiency of their uptake by the brain means that the estimated cost of a vaccine to treat neurodegenerative disorders such as Alzheimer disease (AD) will exceed US$25 000 per patient per year.2 Not only is this expected to challenge the health care systems of many countries, it also raises ethical issues associated with making these vaccines available to every patient.

Queensland Brain Institute, University of Queensland, Brisbane, QLD

Correspondence: j.goetz@uq.edu.au

Competing interests:

No relevant disclosures.

1. Wisniewski T, Goni F. Immunotherapeutic approaches for Alzheimer’s disease. Neuron 2015; 85: 1162-1176.
2. Golde TE. Open questions for Alzheimer’s disease immunotherapy. Alzheimers Res Ther 2014; 6: 3.
3. Sumbria RK, Hui EK, Lu JZ, et al. Disaggregation of amyloid plaque in brain of Alzheimer’s disease transgenic mice with daily subcutaneous administration of a tetravalent bispecific antibody that targets the transferrin receptor and the Abeta amyloid peptide. Mol Pharm 2013; 10: 3507-3513.
4. Nisbet RM, Polanco JC, Ittner LM, Götz J. Tau aggregation and its interplay with amyloid-beta. Acta Neuropathol 2014; 129: 207-220.
5. Pardridge WM. Drug transport across the blood-brain barrier. J Cereb Blood Flow Metab 2012; 32: 1959-1972.
6. Leinenga G, Langton C, Nisbet R, Götz J. Ultrasound treatment of neurological diseases - current and emerging applications. Nat Rev Neurol 2016; 12: 161-174.
7. Elias WJ, Lipsman N, Ondo WG, et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 2016; 375: 730-739.
8. Leinenga G, Götz J. Scanning ultrasound removes amyloid-beta and restores memory in an Alzheimer’s disease mouse model. Sci Transl Med 2015; 7: 278ra233.
9. Wrenn SP, Dicker SM, Small EF, et al. Bursting bubbles and bilayers. Theranostics 2012; 2: 1140-1159.
10. Coluccia D, Fandino J, Schwyzer L, et al. First noninvasive thermal ablation of a brain tumor with MR-guided focused ultrasound. J Ther Ultrasound 2014; 2: 17.
11. Carpentier A, Canney M, Vignot A, et al. Clinical trial of blood-brain barrier disruption by pulsed ultrasound. Sci Transl Med 2016; 8: 343re342.
12. Götz J, Ittner LM. Animal models of Alzheimer’s disease and frontotemporal dementia. Nat Rev Neurosci 2008; 9: 532-544.
13. Schneider LS, Mangialasche F, Andreasen N, et al. Clinical trials and late-stage drug development for Alzheimer’s disease: an appraisal from 1984 to 2014. J Intern Med 2014; 275: 251-283.
14. Nisbet RM, van der Jeugd A, Leinenga G, et al. Combined effects of scanning ultrasound and a tau-specific single chain antibody in a tau transgenic mouse model. Brain 2017; doi: 10.1093/brain/awx052 [Epub ahead of print].
15. Hatch RJ, Leinenga G, Götz J. Scanning ultrasound (SUS) causes no changes to neuronal excitability and prevents age-related reductions in hippocampal CA1 dendritic structure in wild-type mice. PLoS One 2016; 11: e0164278.
16. Jordao JF, Thevenot E, Markham-Coultes K, et al. Amyloid-beta plaque reduction, endogenous antibody delivery and glial activation by brain-targeted, transcranial focused ultrasound. Exp Neurol 2013; 248: 16-29.
17. Downs ME, Buch A, Sierra C, et al. Long-term safety of repeated blood-brain barrier opening via focused ultrasound with microbubbles in non-human primates performing a cognitive task. PLoS One 2015; 10: e0125911.
18. Liu HL, Hsu PH, Lin CY, et al. Focused ultrasound enhances central nervous system delivery of bevacizumab for malignant glioma treatment. Radiology 2016; 281: 99-108.
19. Deloitte Access Economics. Dementia across Australia: 2011-2050. Canberra: Deloitte Access Economics, 2011. https://www.fightdementia.org.au/sites/default/files/20111014_Nat_Access_DemAcrossAust.pdf (accessed Apr 2017).

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Perspectives

Psilocybin-assisted therapy for anxiety and depression: implications for euthanasia

Nigel Strauss

Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00081
Published online: 19 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Palliative care

Pharmaceutical preparations

Mental disorders

Contemporary research suggests potential benefits of psychedelic drugs in treatment-resistant depression and terminally ill patients

Despite their stigmatisation, psychedelic drugs are once again being clinically researched in Europe and North America. This long-awaited renaissance is showing very promising results and, unlike the pioneering research that occurred before these drugs were outlawed over 30 years ago, the current methodology is rigorous and of a very high standard.

Millswyn Clinic, Melbourne, VIC

Correspondence: drnigel@bigpond.net.au

Acknowledgements:

I thank Martin Williams for his assistance in the preparation and revision of this manuscript.

Competing interests:

No relevant disclosures.

1. Mithoefer MC, Wagner MT, Mithoefer AT, et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol 2013; 27: 28-39.
2. Carhart-Harris RL, Bolstridge M, Rucker J, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 3: 619-627.
3. Ross S, Bossin A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol 2016; 30: 1165-1180.
4. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized double-blind trial. J Psychopharmacol 2016; 30: 1181-1197.
5. Widera E, Block S. Managing grief and depression at the end of life. Am Fam Physician 2012; 86: 259-264.
6. Hasler F, Grimberg U, Benz MA, et al. Acute psychological and physiological effects of psilocybin in healthy humans: a double-blind, placebo-controlled dose-effect study. Psychopharmacology (Berl) 2004; 172: 145-156.
7. Hofmann A. LSD: my problem child. Oxford: Oxford University Press; 2013.
8. Pahnke WM. Drugs and mysticism: an analysis of the relationship between psychedelic drugs and the mystical consciousness. Cambridge, MA: Harvard University Press; 1963.
9. Miller WR. The phenomenon of quantum change. J Clin Psychol 2004; 60: 453-460.
10. Royal Australian and New Zealand College of Psychiatrists. The economic cost of serious mental illness and comorbidities in Australia and New Zealand. Melbourne: RANZCP, 2016. https://www.ranzcp.org/Files/Publications/RANZCP-Serious-Mental-Illness.aspx (accessed Apr 2017).
11. Thienpont L, Verhofstadt M, Van Loon T, et al. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open 2015; 5: e007454.
12. Emanuel E. Euthanasia and physician-assisted suicide: focus on the data. Med J Aust 2017; 206: 339-340. <MJA full text>

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Editorials

The disparity between changes in the prevalence of mental illness and disability support rates in Australia

Harvey A Whiteford

Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00274
Published online: 19 June 2017

ARTICLE
AUTHORS
REFERENCES

Topics

Mental disorders

Statistics, epidemiology and research design

Clarifying the type of support needed by people with a psychiatric disability must be a priority

One major focus of Australia’s national mental health strategy has been to increase access to treatment for those with common mental disorders, particularly anxiety and depressive disorders. Despite indications that treatment rates have increased in Australia,1 there is little evidence that the population prevalence of these disorders has declined, a phenomenon also reported in other high income countries where increased treatment has been made available.2

1 University of Queensland, Brisbane, QLD
2 Queensland Centre for Mental Health Research, Brisbane, QLD
3 Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA

Correspondence: h.whiteford@sph.uq.edu.au

Competing interests:

No relevant disclosures.

1. Whiteford HA, Buckingham WJ, Harris MG, et al. Estimating treatment rates for mental disorders in Australia. Aust Health Rev 2014; 38: 80-85.
2. Jorm AF, Patten SB, Brugha TS, et al. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16: 90-99.
3. Harvey SB, Deady M, Wang M-J, et al. Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014. Med J Aust 2017; 206: 490-493.
4. Slade T, Johnson A, Oakley-Browne MA, et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust N Z J Psychiatry 2009; 43: 594-605.
5. Baxter AJ, Scott K, Ferrari AJ, et al. Challenging the myth of an “epidemic” of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010. Depress Anxiety 2014; 31: 506-516.
6. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust N Z J Psychiatry 2012; 46: 735-752.
7. Parliament of Australia. The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition. Joint Standing Committee on the NDIS — Mental Health Terms of Reference [webpage]. http://www.aph.gov.au/Parliamentary_Business/Committees/Joint/National_Disability_Insurance_Scheme/MentalHealth (accessed Mar 2017).

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Caring for country and the health of Aboriginal and Torres Strait Islander Australians

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Improving Indigenous health through education

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The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders

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Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial

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Broken promises and missing steps in mental health reform

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Ultrasound as a treatment modality for neurological diseases

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Psilocybin-assisted therapy for anxiety and depression: implications for euthanasia

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The disparity between changes in the prevalence of mental illness and disability support rates in Australia

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Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014

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The sugar content of soft drinks in Australia, Europe and the United States

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Improving Indigenous health through education

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The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders

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Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial

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Broken promises and missing steps in mental health reform

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Ultrasound as a treatment modality for neurological diseases

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Psilocybin-assisted therapy for anxiety and depression: implications for euthanasia

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The disparity between changes in the prevalence of mental illness and disability support rates in Australia

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Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014

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The sugar content of soft drinks in Australia, Europe and the United States

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Pagination