Childhood Trauma and Neural Development. Indicators for interventions with special reference to rural and remote environments

Advances in Neurobiology and Neuropsychotherapy in understanding the development of the young brain have demonstrated the need for early intervention to address childhood trauma and subsequent detrimental neural development.

The prevailing paradigms of psychopharmacological and cognitive based interventions as first line interventions for treatment of childhood trauma are confronted with a growing body of neurodevelopmental and neurobiological research that points toward the fundamental development of the right hemisphere during the last trimester pre natally and the first two years post natally.

Violation of basic needs (attachment, orientation and control, self-esteem enhancement and self-esteem protection and pleasure maximization and distress avoidance are explored in terms of neural development and developmental dysfunctions.

Since neurologist Paul MacLean postulated the Triune Brain Theory, research into neural development indicated the key functions of gene expression, synaptogenesis, neural plasticity, neural pruning and enriched environments and the detrimental effects of childhood trauma.

One of the most fundamental aspects of effective interventions (enriched environments) is the facilitation of secure attachment. Violation of secure attachment (especially in the very early stages of neural development) leads to the formation of protective (avoidance) neural loops - implicit memory systems which express especially in the limbic structures, right prefrontal cortex, anterior cingulate and orbito frontal areas.

The implications of these neural facilitations for therapeutic interventions are discussed. Specific reference is made to early intervention and challenges in rural and remote areas to provide effective service delivery. Specific strategies for early intervention are proposed.

Dr Julie Rowse, Ballarat Health Services - will speak at The 4th Australian Rural and Remote Mental Health Conference,in Adelaide on November 19th to 21st 2012

PUTTING PEOPLE FIRST: MENTAL HEALTH NEEDS AND INITIATIVES IN AUSTRALIAN RURAL AND REMOTE COMMUNITIES.

A Dialectical Behaviour Therapy (DBT)Program in 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.

This paper 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.

Ms Rebecca Graham, Country Health SA LHN will speak at The 4th Australian Rural and Remote Mental Health Conference, in Adelaide on November 19th to 21st 2012

PUTTING PEOPLE FIRST: MENTAL HEALTH NEEDS AND INITIATIVES IN AUSTRALIAN RURAL AND REMOTE COMMUNITIES.

The Psychs on Bikes rural suicide prevention project: a preview of the documentary

In April 2012 a couple of dozen psychiatrists, psychologists and mental health nurses left Cottesloe Beach in Perth riding motorcycles.  Nine days later "Psychs on Bikes" arrived at Bondi Beach in Sydney. 

The ride raised money for the Australasian Centre for Rural and Remote Mental Health and the riders developed an interest in trying to address the high suicide rate in rural areas (see www.psychsonbikes.com).

Renee Marie Petropoulos accompanied the ride and filmed its progress.  The conference presentation is a preview of her documentary, some of which can be viewed at  https://vimeo.com/44092061 (password is psych101).

Dr Joseph Dunn, Psychs on Bikes, will speak at the 4th Australian Rural and Remote Mental Health Conference in Adelaide on November 19th to 21st 2012.

Visit the Conference website here

Childhood Trauma and Neural Development. Indicators for interventions with special reference to rural and remote environments

Dr Pieter Rossouw, University of Queensland will present at the 4th Australian Rural and Remote Mental Health Symposium to be held on the 19 - 21 November 2012, Adelaide, South Australia.

Advances in Neurobiology and Neuropsychotherapy in understanding the development of the young brain have demonstrated the need for early intervention to address childhood trauma and subsequent detrimental neural development.

The prevailing paradigms of psychopharmacological and cognitive based interventions as first line interventions for treatment of childhood trauma are confronted with a growing body of neurodevelopmental and neurobiological research that points toward the fundamental development of the right hemisphere during the last trimester pre natally and the first two years post-natally.

Violation of basic needs (attachment, orientation and control, self-esteem enhancement and self-esteem protection and pleasure maximization and distress avoidance are explored in terms of neural development and developmental dysfunctions.

Since neurologist Paul MacLean postulated the Triune Brain Theory, research into neural development indicated the key functions of gene expression, synaptogenesis, neural plasticity, neural pruning and enriched environments and the detrimental effects of childhood trauma. One of the most fundamental aspects of effective interventions (enriched environments) is the facilitation of secure attachment. Violation of secure attachment (especially in the very early stages of neural development) leads to the formation of protective (avoidance) neural loops - implicit memory systems which express especially in the limbic structures, right prefrontal cortex, anterior cingulate and orbito frontal areas.

The implications of these neural facilitations for therapeutic interventions are discussed. Specific reference is made to early intervention and challenges in rural and remote areas to provide effective service delivery. Specific strategies for early intervention are proposed.

Web:  http://anzmh.asn.au/rrmh  | Email: ruralhealth@anzmh.asn.au

Preparing for environmental adversity in rural Australia: Aligning the Rural Adversity Mental Health Program (RAMHP) with state and national policy

The Drought Mental Health Assistance Package (DMHAP) in NSW was implemented (in 2007) as a response to the observed effects of the ongoing drought on the mental health and wellbeing of rural communities. By early 2010 it was decided to broaden the scope of DMHAP and rename the program to better reflect the range of elements contributing to rural adversity.

The Rural Adversity Mental Health Program (RAMHP) has moved beyond considering drought alone as an environmental stressor, and the aim has broadened to reflect a more comprehensive approach to capacity building. The aim of RAMHP reflects current and emerging policy thinking across a number of commonwealth and state areas of responsibility. For example, the National Strategy for Disaster Resilience (NSDR) calls for the underlying principles of emergency management in Australia to be built on the concept of “prevention, preparedness, response and recovery”.

The NSDR also advocates for action-based resilience planning at local and statewide levels, to strengthen local capacity and capability. A focus on individual and community resilience to prevent and recover from mental illness is also a recurring theme in both state and national mental health policy, with an emphasis on building community capacity as an integral part of strategic health and mental health frameworks.

To assist in future planning, implementation and evaluation of RAMHP, a program logic representation was developed based on clearly articulated theoretical constructs and relevant frameworks for action. The theoretical framework allows RAMHP to contribute to the knowledge base of disaster resilience and community capacity building for better mental health, with reference to both state and national policy. Four broad goals of activity that emerge from the theoretical frame will form the “narrative” for the program as it establishes itself as a long-term contributor to community resilience in rural NSW. The relevance of the program goals in the context of state and national policy will be discussed.

Prof Prasuna Reddy, Centre for Rural and Remote Mental Health
Co- Author: A/Prof Virginia Lewis, Australian Institute for Primary Care and Ageing
Prof Reddy 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:  http://anzmh.asn.au/rrmh  | Email: ruralhealth@anzmh.asn.au

Predictors of suicide in rural and remote areas: A psychological autopsy study in Queensland

The aims of the study are to: assess suicide predictors in rural and urban regions by comparing suicides to sudden-death controls; and, compare the differences between rural and urban suicides.

The Psychological Autopsy method was utilised to investigate suicides over the age of 35 in QLD by interviewing next-of-kin in 2006-2008. A case-control study design was applied using sudden-deaths as controls. The study involved 50 suicides and 26 sudden-death controls from rural and 150 suicides and 108 sudden-deaths from urban regions.

No significant differences were found between the urban and rural suicides and their controls by gender, age, ethnicity or language. In both areas, suicides were more frequently separated, living alone and unemployed, compared to the sudden-deaths.

There were no significant differences in marital status, living arrangements, education, and employment status between two suicide groups. Previous suicide attempt(s) and having any psychiatric disorder were significant suicide predictors in both urban and rural regions. Compared to the urban suicides, there was a significantly higher prevalence of psychiatric diagnoses in rural suicides.

Suicides had significantly higher neuroticism and lower agreeableness in both areas. Neuroticism was also higher in rural suicides compared to urban suicides. Aggression scores were significantly higher in suicides, compared to sudden-deaths; aggression score was significantly higher in rural than in urban suicides. No remarkable differences in physical health were found. While geographical location alone may not be a risk factor, life events and living conditions that are more likely to be found in rural environments may increase vulnerability to suicide.

In the present study, similarities in the predicting factors of suicide in rural and urban areas were found. However, some of the predictors were more prevalent in rural areas. For example, aggression, neuroticism and alcohol dependence were higher in rural suicides.

Dr Kairi Kolves, Australian Insitute for Suicide Research and Prevention, Griffith University
Co- Author: Prof Diego De Leo, Australian Insitute for Suicide Research and Prevention, Griffith University

Dr Kolves 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:  http://anzmh.asn.au/rrmh  | Email: ruralhealth@anzmh.asn.au

How do adults with substance dependence access treatment services? A qualitative descriptive study of help-seeking and behaviour change

Adults are less likely to access health services for substance use disorders, than any other psychiatric disorder, despite high prevalence, morbidity and mortality. Comorbid substance use and psychiatric disorders cause moderate to severe illness and disability, yet only half of people diagnosed perceive the need for and then access health care. Of the people that do access treatment, many drop out or are dissatisfied with the service.

This study explored client experiences of help-seeking and accessing drug treatment services. To understand how people engage in health intervention for substance misuse and comorbid mental health and welfare issues.

A qualitative descriptive research design was utilised. Eight participants were recruited from drug treatment programs at one community health setting that serviced a larger regional area in Victoria, Australia. In-depth interviews focussed on experiences of substance use, health issues, help-seeking and service utilisation were used to collect the data. Each interview was digitally-recorded and transcribed verbatim by the researcher.

Interview transcripts and other descriptive data sources including field notes, were thematically coded using principles of phenomenology. From this, four descriptive themes emerged; polydrug use, comorbid health conditions, help-seeking experiences, and health behaviour change. Findings and discussion provide a valuable insight on the client experience of problematic drug use and the influence of illness, attitudes and structural barriers on treatment access.

Help-seeking was facilitated by social support networks and regional inter-agency partnerships and service models. Future research and changes to health policy are strongly recommended to consider issues of polydrug use and comorbidity, primarily mental illness, employment and homelessness.

Ms Nerida Hyett, La Trobe Rural Health School
Co- Authors: Dr Virginia Dickson-Swift, La Trobe Rural Health School
Dr Carol McKinstry, La Trobe Rural Health School

Nerida 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:  http://anzmh.asn.au/rrmh  | Email: ruralhealth@anzmh.asn.au

Expanding help-seeking options for young people by delivering mental health services online – the eheadspace experience

Young people have the highest need for mental health care across the lifespan, yet the lowest level of service use. Improving access to appropriate mental health care and increasing engagement with services is a priority for mental health reform in Australia. Providing services and interventions via online and mobile technologies is increasingly a focus for improving access and engagement for young people.

It is argued that because of the almost universal uptake and integration of online and mobile communication within young people’s lives, this is one of the best ways to reach this age group. eheadspace has been developed to augment the headspace youth mental health initiative to increase access to mental health care through a national online and telephone support service for young people.

eheadspace was rolled-out nationally in October 2011 and comprises a clinically supervised, youth-friendly, online mental health information and support service that offers an accessible ‘soft entry’ point to the mental health system.

This paper will describe the development and roll-out of eheadspace and present data on the characteristics of young people accessing the service. The limitations and challenges of such an online intervention approach will be described, with discussions about the role of such approaches in the mental health care system.

Ms Carmen Garrett, headspace 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:  http://anzmh.asn.au/rrmh  | Email: ruralhealth@anzmh.asn.au