Friday, August 31, 2012

Help at the End of the Line? What does analysis of rural and remote calls to SANE Helpline tell us about mental health needs in the country?

The SANE Helpline is a national 1800 and online service providing information, advice, and referral to people concerned about mental illness.

Every year, the Helpline takes thousands of calls from people in rural and remote Australia who are worried about their own mental health, or that of a family member or friend.

The call might be about a daughter exhibiting signs of what might be a psychosis. It might be about a boyfriend who is depressed and suicidal. All calls are logged on our database, and while these records are anonymous, they include demographic data so that calls from rural and remote areas of the country can be aggregated and compared with national trends.

This data forms a rich resource of information about mental health needs in rural and remote Australia.
  • Are callers from country areas more or less likely than those in urban areas to express suicidal thoughts?
  • Are distance to services and transport issues which are raised?
  • Is stigma more of a problem or can smaller communities be more supportive?
  • Is ehealth a practical option to provide psychological support in areas where clinicians are thin on the ground, or is it seen as a second-best service? What support do rural carers most often request, and is this different to the needs of families in cities?
Analysis of the SANE Helpline database enables us to answer these questions and others, providing a finely-tuned, valuable image of mental health needs in rural and remote Australia based on the the actual experience of thousands of callers.

Dr Paul Morgan, Deputy CEO of SANE Australia will present at the:
4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

Web:       Email:

Wednesday, August 29, 2012

The complex phenomenon of disordered gambling: emerging approaches to diagnosis and treatment in rural communities

Associate Professor Peter Harvey provides an overview of the phenomenological and methodological aspects of a treatment programme available for people who have serious gambling problems. A CBT based graded exposure therapy treatment programme is currently being provided for people with gambling problems through the Statewide Gambling Therapy Service (SGTS) in South Australia.

Approaches to treatment are being tailored to suit consumers from a range of communities including CALD, Aboriginal and Rural communities. Discussion focuses on current trends in identifying, assessing and treating people with gambling problems and highlights some of the difficulties experienced in providing gambling treatment programmes in rural communities.

Further, the proposition that a population health approach to remediating disordered gambling could address the emerging problems associated with the gaming industry is outlined, as the crucial question about who should fund help services and support programmes for people with gambling problems becomes increasingly topical in our communities today.

In conclusion, as problem gambling or disordered gambling is now seen as a form of mental illness, this classification raises the possibility of disordered gambling being treated and managed using self-management strategies similar to those used in the management of chronic and complex illness. Initial results of a pilot study into the application of peer led self-management education programmes are presented as an example of a relapse prevention strategy for clients following participation in the formal SGTS treatment programme.

Associate Professor Peter Harvey, Flinders Centre for Gambling Research & Manager of the Statewide Gambling Therapy Service, Flinders University will present at the:

4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

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Monday, August 27, 2012

The effects of natural disasters on rural communities: strategies for survival

Alexandra GartmannThe 2009 Victorian bushfires are arguably the greatest natural disaster Australia has faced. In early 2009, even while the emergency relief effort in response to the Victorian bushfires was in full-swing, the Foundation for Rural and Regional Renewal (FRRR) championed the creation of a collaborative grants program known as Repair-Restore-Renew. That program addressed many of the medium-term recovery needs however it also revealed that ongoing support is required to address volunteer fatigue. Three years on, the volunteers rebuilding bushfire affected communities are suffering a range of psychosocial and psychiatric issues due to the trauma they have experienced. Volunteers are over worked and performing tasks that do not match their skill base.

They are involved in the recovery mission due to necessity not through the normal motives that inspire individuals to volunteer in their community and the positive outcomes that volunteering usually instills in individuals are absent. All rural communities have a small pool of individuals from which to recruit volunteers. Without leadership and continuing support, the community’s experience of volunteering is likely to be disconcerting and unsustainable. Consequently, FRRR has developed the STEPS program - Skills, Training, Engagement and Practical Support.

FRRR’s CEO, Alexandra Gartmann, will share the lessons learnt from this recovery journey, which are incredibly relevant given the increasing prevalence of natural disasters across Australia. We will also share some of the findings and lessons from similar international events, as well as some other regional social research following 10 years of drought in rural Victoria. Finally, it will explore the critical role that the philanthropic sector can play in medium to long term natural disaster recovery.

Alexandra Gartmann, CEO of the Foundation for Rural and Regional Renewal will present at the:

4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

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Wednesday, August 22, 2012

Bridging the rural-urban divide for improved mental health

The devaluing of rural Australia as an important contributor to Australia’s social and economic fabric, and the declining profitability of core industries in rural Australia, including an absence of understanding and support for these industries by metropolitan communities and governments, have been identified among the many complex factors attributed to the causation of the high rate of suicide in rural Australia. (SPA Position Statement - Responding to suicide in rural Australia 2008).

Farmers will tell you they want a dynamic, innovative, exciting, profitable and sustainable agrifood sector that attracts the best and brightest of the next generation, but farmers in Australia today are less than 1% of the population and the future of the farming sector in Australia is uncertain. Australia has developed sophisticated supply chains to supply our cities with fresh, affordable, ethically produced food and fibre but farmers have become victims of their own success - we have a food ‘value’ chain with farmers down one end and consumers at the other.

Farmers are feeling demoralised and physically pushed to the limit by the supermarket prices wars, animal welfare campaigns, a booming mining sector competing for land use, lack of a national food security plan and out-of-touch government policy. Our farmers are questioning why they bother to farm in this hostile environment.

Ms Fairleigh's workshop will explore current research on farmers, mental health and suicide; programs addressing the rural-urban divide; how improved understanding impacts positively on farmer mental health; and how to create a community which is informed about, and engaged with, agriculture and rural Australia.

Alison Fairleigh, Rural Development Officer, Mental Illness Fellowship of North Queensland will present a workshop at the:

4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

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Tuesday, August 21, 2012

Supporting mental health post-disaster: Disseminating a 'Skills for Psychological Recovery' training program to practitioners across Queensland

Following the 2011 natural disasters in Queensland, the Queensland Government funded delivery of the SPR training and support program to hundreds of health, mental health and welfare providers across the state. This paper reports on the delivery and evaluation of this program.

For many, their difficulties will be limited to mild or sub-threshold mental health problems that may not require specialist interventions. The Skills for Psychological Recovery (SPR: Berkowitz et al, 2009) program was specifically developed to enable health practitioners and counsellors to teach coping skills to community members affected by such problems.

SPR focuses on evidence-based interventions including a brief needs assessment, problem-solving, promoting positive activities, helpful thinking, rebuilding social supports and managing distressing reactions. The Australian Centre for Posttraumatic Mental Health (ACPMH) has developed an SPR training and support program using a capacity-building dissemination model.

The aims of the program are to train and accredit competent trainers, improve the competence of practitioners to teach simple coping skills, and promote uptake of teaching these skills by practitioners. Key program activities include selection, training and accreditation of SPR trainers from both adult and child/adolescent services; quality assurance and support visits by ACPMH to practitioner workshops; teleconferences for trainers facilitated by APCMH; and completion of online modules by both trainers and practitioners.

Alexandra Howard, Clinical Specialist, Australian Centre for Posttraumatic Mental Health will speak at the 4th Australian Rural and Remote Mental Health Conference in Adelaide on November 19th to 21st,  2012.


The Conference Program is available here.

Monday, August 20, 2012

The prevalence of cognitive impairment in rural substance treatment participants: The implications for treatment approaches

Cognitive impairment (CI) includes acquired or traumatic brain injury, intellectual disability or Fetal Alcohol Spectrum Disorder (FASD). Cognitive impairment is a hidden disability which, for example, affects encounters with people in their surroundings, and can lead to difficulties in relations and contacts with society.

A high prevalence of substance use problems has been identified in cognitively impaired people and alcohol use is a frequent contributing factor to acquired brain injury. Some of the behaviours described as common features of CI such as poor self-monitoring and self-regulation and dependence/lack of initiative are seen to be causes and consequences of addiction thereby prescribing a moral rationale to behaviour that may have a physical cause.

To increase staff awareness of the prevalence of CI, screening of all consenting clients with the Addenbrooks Cognitive Examination – Revised (ACE-R) for a 3 month period was conducted. Analysis of the ACE-R total scores included qualitative variables (indigenous status and gender) and quantitative variables (age and effective years of education). Logistic regression was used to analyse the effect of all variables at once. The analysis of fifty completed ACE-R screens found that 40% of participants were likely to have a cognitive impairment (scored <88 88="88" age="age" and="and" below="below" br="br" clients="clients" effect="effect" gender="gender" had="had" indigenous="indigenous" likely="likely" more="more" no="no" on="on" p="0.0241)" results.="results." score="score" that="that" the="the" to="to" were="were">
These results have significant implications for the way drug and alcohol treatment interventions are provided, particularly in residential settings. The agency identified two strategies to improve accessibility for clients with cognitive impairment, a quality improvement plan with a training component and a resource review. 

These strategies will be discussed by
Dr Julaine Allan
at the:

4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

Web:          Email:

Thursday, August 16, 2012

Help seeking for Suicide in an Aboriginal Community: The Njernda CRUNCH study

Youth suicide among Aboriginal communities
Youth suicide among
Aboriginal communities
Youth suicide among Aboriginal communities is much higher than in the mainstream population. Both federal and state governments have highlighted the need to address this public health problem.

Njernda Aboriginal Corporation in Echuca is in the process of developing an early intervention response to suicide among Aboriginal youth.

As part of a larger youth suicide prevention program, this study explores help-seeking preferences of Aboriginal people in the event of a threat of or an attempted suicide in Echuca.

A cross-sectional pilot study wherein a survey of individual community members including Aboriginal youth, adults and Elders as well as service providers from both mainstream and the Aboriginal health service was conducted in Echuca using the Njernda CRUNCH questionnaire.

This is a pictorial questionnaire developed by Njernda to explore the current help seeking preferences of individuals in the event of a threat of or an attempted suicide. It asks participants to indicate how they would respond when confronted with an individual in seven different suicide related scenarios. Mr Stuart Hearn and Dr Anton Isaacs will describe help seeking preferences of people from Echuca when faced with a threat of or an attempted suicide and will provide crucial information in developing early intervention strategies for suicide prevention in rural Aboriginal communities.

Mr. Stuart Hearn, Community Support worker at the Mental Health Unit of Njernda Aboriginal Corporation and Dr. Anton Isaacs Lecturer,  Monash University Department of Rural and Indigenous health at Gippsland in Victoria will present at the:

4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

Web:         Email:

Wednesday, August 15, 2012

Alcohol and drugs can lead to regrets (PRESS RELEASE Helen Morton: AUGUST 5, 2012)

Helen Morton
Minister for Mental Health; Disability Services

Sun 05 August, 2012
Portfolio: Mental Health
  •         New cinema and radio ads designed for young Aboriginal people
  •         Campaign focus on impact on the mind, body, law and support
New cinema and radio advertisements form part of an innovative campaign to prevent and reduce harm caused by alcohol and other drug (AOD) use among young Aboriginal people.

Mental Health Minister Helen Morton said the advertisements would feature as part of the ‘Strong Spirit Strong Mind’ Metro Project, which aimed to strengthen the range of AOD prevention and service responses for Aboriginal young people, their families and communities in the Perth metropolitan area.

“This campaign has been designed with help from Aboriginal young people keen to get the message out that alcohol and drugs can lead to doing things they may regret, and to encourage those who need help to seek support,” Mrs Morton said.

“The advertisements are the first of their kind for young Aboriginal people in Perth, and it’s great to see a focus on alcohol and cannabis, which are the primary drugs of concern.”

Consultation with Aboriginal youth groups and agencies identified that the campaign should focus on the effects of alcohol and other drugs on the mind and body, the law and where to get support.

The campaign is expected to run initially for four weeks, in metropolitan cinemas and radio.

Funding for the ‘Strong Spirit Strong Mind’ Metro Project was made available through the Council of Australian Governments Closing the Gap National Partnership Agreement, and includes culturally secure prevention and early intervention initiatives, along with the establishment of an outreach treatment team.

Fact File
  • In 2011, 77% of treatment episodes for Aboriginal young people indicated alcohol or cannabis as primary drug of concern
  • Surveys show Aboriginal people less likely to drink alcohol than non-Aboriginal people, but those who do, more likely to do so at harmful levels
  • More information: or

Minister’s office - 6552 6900

Tuesday, August 14, 2012

National Health Priority number 9!

By Yasmin Noone

Federal and state health ministers have finally succumbed to the demands of the sector and the needs of the thousands of Australians, having officially agreed to make dementia a National Health Priority Area (NHPA).

The nation's health ministers, who gathered for a meeting of the Australian Health Minister’s Advisory Committee in Sydney on Friday, have designated dementia as the ninth National Health Priority Area, along side eight other priority areas like asthma, mental health, cardiovascular health and obesity.

The motion was put forward by federal Minister for Health, Tanya Plibersek and Minister for Mental Health and Ageing, Mark Butler, who jointly argued the case to make dementia the ninth NHPA, saying the condition is predicted to become the leading cause of disability in less than four years.

“Today 280,000 Australians live with dementia and by 2050 that figure will have risen to more than one million,” said Mr Butler on Friday.

“This presents major challenges for health and aged care services.”

Mr Butler added that spending on dementia beyond 2060 is set to outstrip that of any health condition, with expenditure due to top $80 billion by 2062-63.

To read the full story, click here

A Dialectical Behaviour Therapy (DBT) Program a Rural Community Mental Health setting

In Australia the recent development of draft guidelines for the treatment of Borderline Personality Disorder (BPD) will set a standard for the provision of services for people with this disorder.

It is therefore timely to review programs that are in place and consider how these programs fit with the proposed new national guidelines for the provision of comprehensive services informed by the recovery framework.

Dialectical Behaviour Therapy (DBT) is an evidence based treatment for BPD. Clients with this disorder have complex, multi-axial problems, are difficult to engage in treatment and intense transference and counter-transference issues can lead to clinician burnout.These problems are compounded when clinicians are working in isolated rural and remote areas.

Elizabeth Gifford will describe the challenges and opportunities encountered in providing DBT treatment as part of community mental health services in a rural area. The DBT program has evolved over the past ten years to provide treatment for adults diagnosed with BPD as well as a DBT informed program for youth aged 14-24 years with emerging disorders of the self.

Clinical outcome data from both the adult and youth cohorts from the past three years of the program will be presented which shows reductions in service utilisation and improvements in quality of life. These outcomes indicate that DBT is a promising treatment that can be offered utilising the resources of a rural community mental health service.

Elizabeth Gifford, Clinical Nurse Consultant in Community Mental Health, Co-ordinator Dialectical Behaviour Therapy Program in Western NSW LHD will be presenting at the:

4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

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Tuesday, August 7, 2012

Vietnam and Iraq: lessons to be learned about mental health and war

By David Dunt, University of Melbourne
Physical injury and death in war is expected. But we also now know the stories of large numbers of veterans suffering major psychological trauma.
These involve Post Traumatic Stress Disorder (PTSD), anxiety, depression, alcohol and drug problems and sometimes suicide. Former soldiers, whether they fought in Vietnam or Iraq, are dealing with some common but distinct experiences.
All wars are horrible but each is different in its own way. Those who were in Vietnam, for example, often fought at close range with a resourceful enemy who could not be easily distinguished from civilians. Massacres occurred.
Those who fought in Iraq and Afghanistan were affected by the ever-present dangers of Improvised Explosive Devices (IEDs) and suicide bombers while on patrol during their period on deployment.
The failure to properly treat Vietnam veterans, should remind us of our obligation to help returning soldiers to get the support they need.

The war weary

The experience of soldiers in wars in Afghanistan and Iraq contrasts to those involved in the Vietnam War. First, deaths and physical injuries for our forces in Vietnam were much higher than in Iraq and Afghanistan. Second, levels of PTSD and other mental illnesses associated with the Vietnam War were also very high.
A full 29% of all veterans who ever served in Vietnam have had PTSD that is accepted for compensation by the Department of Veterans Affairs (DVA). Over 8% had alcohol dependence or abuse, 5.5% had anxiety and 3.6% had depression that was accepted for compensation. Some of the veterans, of course, had all four conditions. But surprisingly, levels of suicide for veterans, when compared to the rest of the population do not appear elevated or if so, only to a small extent.
These high levels of mental health issues immediately pose the question: what was it about the Vietnam War that was so disturbing.
Films like Apocalypse Now and The Deer Hunter vividly represent the profound personal crisis of many of the soldiers involved. The nature of the combat meant the soldiers were killing in close range.
But another key issue was that after Vietnam, we became much more aware of the psychological impact of war than previously. This awareness has led to changes in attitude and a greater understanding of veterans' mental health.

Post-traumatic stress

The PTSD syndrome was “discovered” in the aftermath of the Vietnam War. PTSD is characterised by re-experiencing the original traumas through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal – such as difficulty falling or staying asleep, anger, and hypervigilance.
To be accepted as a disability, symptoms must last more than one month and cause significant impairment in functioning. PTSD, of course, is not new – think of “shell shock” and “combat fatigue” as other words to describe the condition from earlier twentieth century wars.
In Vietnam, these high levels of mental disorders are linked with a massive absence of services. They were also substantially affected by the public response to their service involvement.
Vietnam veterans came home to no fanfare, to indifference and sometimes open hostility. It wasn’t until the Vietnam Veterans “Welcome Home” March of 1987 that public sentiment started to change but by then it was too late. A half generation of young men were psychologically scarred not only in the medical sense described above, but also through a loss of direction in life and embitterment.

Here to help

It is too early to know if Iraq and Afghanistan veterans will experience the same level of mental disorders. Early indications are that this is unlikely in Australia. Mental health services for both serving members of the Australia Defence Force (ADF) and retired veterans are much improved. Attitudes to veterans by the public are also more sympathetic.
Nevertheless, present problems are real and concerning enough, remembering that PTSD can present some decades after exposure to the wartime trauma.
More worryingly, there has been an increase in suicide rates in United States soldiers in Iraq or Afghanistan. This has not been observed to date in Australian soldiers but could still occur.
As noted, services are much improved. These include the post-deployment psychological screening programs and the All-hours Support Line for ADF members.
For veterans there is for example, the Veterans and Veterans Families Counselling Service (VVCS).

Room for improvement

However, treatment services can be further improved. In 2008, I conducted two ministerial reviews – Mental Health care in the Australian Defence Forces (ADF) and a study of suicide in veterans for the Department of Veterans' Affairs (DVA).
It was clear that the ADF mental health workforce needed to be considerably expanded and better trained. It was also clear that the model of a multidisciplinary care team of psychologists, psychiatrists, mental health nurses and social workers, that is commonplace in civilian practice, did not exist in the ADF.
Psychologists were engaged in a wide variety of roles, more in human resources and training and less in clinical psychology relevant to mental health problems and illnesses. For DVA services, recommendations were for a review of services for the treatment of PTSD.
A wide variety of mental health promotion programs also exist in the ADF and operate through DVA. For ADF personnel, there are for example, the Suicide Prevention Program and the Alcohol Tobacco and Other Drugs Program. For veterans, there are for example, the At Ease Mental Health and the Right Mix alcohol websites.

Best practice

Programs though need further development to achieve best practice including in suicide prevention. Both the ADF and DVA acted on the recommendations of the reviews and allocated $90 million to support their implementation. Upgrades and improvements to treatment services and mental health promotion programs are now in train but have not as yet been fully implemented.
Until they are fully implemented, members of the ADF and veterans will continue to face challenges to receive best services. Even when they are fully implemented, some problems are likely to continue.
For example, senior staff readily appreciate that military culture does not, by its nature deal well with mental health problems that can easily be stigmatised as weakness. New programs are likely to be only partially effective in changing these attitudes.
In defending and protecting Australian society, members of the ADF undertake activities that other Australians want but do not wish to do themselves. That these activities frequently have the consequences described above is a constant reminder that ADF members and veterans have every right to expect the best possible services and programs that can be provided.
Last week marked the 50th anniversary of Australian forces arriving in Vietnam. The Conversation will be looking at the war’s legacy throughout a number of articles over the next week.
Part 1: Forgetting the ‘American War’: Vietnam’s friendship with its former enemy
David Dunt received funding from the Ministries of Defence and Veterans Affairs in 2009 in 2008-9 in completing two Ministerial reviews for the Australian Government - A review of mental health services in the Australian Defence Forces through transition to discharge and An independent study of suicide in the Ex-Service Community.
The Conversation
This article was originally published at The Conversation. Read the original article.

Thursday, August 2, 2012

Dual Diagnosis of mental illness (MI) and acquired brain injury (ABI): Making positive changes towards rehabilitation and recovery.

Aims and Rationale
The aim of this exploratory study was twofold. It sought to describe some of the challenges faced by people with dual diagnosis of ABI and MI; and secondly, from these findings make recommendations on service practices and policies that would be required for an effective post discharge rehabilitation and recovery pathway.

This phenomenological study used in-depth interviews to obtain an insider perspective from eight individuals and/or their families, and case managers. Interviews were transcribed and the researchers used qualitative analysis to identify key themes that reflected the experiences of participants.

Participants faced a lack of appropriate supports available which reflected a deficiency of expertise in understanding the complex intersection of disability and mental illness. This created confused pathways towards recovery and improved quality of life. Participants were either categorized as having ABI or MI leading to inappropriate accommodation, social isolation, and lack of engagement in meaningful activities such as leisure activities and employment. Commonly, participants with ABI/MI fell “between the cracks”.

Implications for policy and practice

The rehabilitation and recovery of people with ABI/MI requires services that have knowledge and expertise in each condition and the implications of dual diagnosis. Improved integration of disability and mental health services will be an important strategy to achieve this.

Mrs Annalise O'Callaghan, Lecturer, School of Occupational Therapy and Social Work, Centre for Research into Disability and Society, Curtin University will present at the:

13th International Mental Health Conference, "Positive Change -- Investing in Mental Health"  6th to the 8th of August 2012, on the Gold Coast.

Web: Email:

Wednesday, August 1, 2012

Depression and Chronic Back Pain

By: William W. Deardorff, PhD, ABPP

Depression is by far the most common emotion associated with chronic back pain. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling "down for a few days".

The symptoms of a major depression occur daily for at least two weeks and include at least 5 of the following (DSM-IV, 1994):

A predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells
  •     Poor appetite or significant weight loss or increased appetite or weight gain
  •     Sleep problem of either too much (hypersomnia) or too little (hyposomnia) sleep
  •     Feeling agitated (restless) or sluggish (low energy or fatigue)
  •     Loss of interest or pleasure in usual activities
  •     Decreased sex drive
  •     Feeling of worthlessness and/or guilt
  •     Problems with concentration or memory
  •     Thoughts of death, suicide, or wishing to be dead
Read the full article here