Treatment decision making for young people diagnosed with major depressive disorders: The case for shared decision making

Shared decision making (SDM) is a model of medical or treatment decision making that involves collaboration between a clinician and client. One way of implementing SDM is with the use of decision aids (DA), which have demonstrated effectiveness for non-psychiatric conditions and emerging evidence for adults diagnosed with mental disorders.

A theoretical basis for SDM for young people has been made, yet work in this area is in its infancy.

The aim is to develop an online, evidence-based, preference sensitive DA to support young people facing a choice about treatment for moderate to severe depression.

The DA was based on systematic reviews and semi-structured qualitative interviews that were conducted with clients (n=10), caregivers (n=5) and clinicians (n=22) about their experiences and beliefs about treatment decision making for young people diagnosed with major depressive disorders.

Further consultations were held with medical, consumer and caregiver experts and pilot testing completed the development process.

Data from interviews demonstrated that client preference for involvement in treatment decision making for depression is not static and may vary with different clients and at different times for the same client. Caregiver involvement was seen as optional.

All participants voiced a preference for interactive, evidence-based information to support decision making. Based on this and consultations with expert groups, a DA was developed and pilot tested. Clients and clinicians found the DA to be acceptable and useful, and their feedback was used to refine the DA.

Treatment decision making in this area is a complex process that can be supported with the use of an evidence-based, preference-sensitive DA. The development of this DA contributes to the emerging field of youth SDM and can now be further tested for effectiveness. Approaches such as this DA hold the potential to improve client satisfaction, adherence and clinical outcomes.

Ms Magenta Simmons,  Research Fellow Headspace Centre of Excellence in Youth Mental Health 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: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Elyn Saks: A tale of mental illness -- from the inside

Rural Mental Health consultation in WA

Australian Greens spokesperson for Mental Health, Senator Penny Wright, travelled to Western Australia in early June to begin the first leg of an Australian-wide tour to hear about the unique issues affecting mental health care services for Australians living in rural, regional and remote areas.

Senator Wright said while the Federal Government had injected a significant amount of funding into mental health over the past two years, people living in rural and remote areas were still encountering problems accessing quality mental health services compared to their urban counterparts.

"People living outside our capital cities are facing distinct challenges when it comes to mental health care," Senator Wright said.

"The shortage of specialist mental health professionals is a key problem for many communities and general practices often have long waiting lists and limited referral options. Concerns about privacy and the stigma still attached to mental health issues mean many people in small communities are reluctant to seek help.

"Suicides in rural Australia are reportedly as high as one a week and, with the impacts from climate change predicted to worsen, these numbers are likely to rise in the future. Suicide has a profound impact on small communities and it is vital that we consider the most effective ways to reverse this devastating trend.

During the tour, Senator Penny Wright will listen closely to the people and organisations who come face-to-face with these issues every day.  "I am keen to hear from them about the gaps in services and the things that work well."

"We need to identify gaps in service delivery so we can determine what is needed to build healthier, more resilient communities, where people with equal need have access to equal services."

Depression as a Physiological Disease – Implications for Prevention and Intervention

Dr Chris Stapelberg

While major depressive disorder (MDD) was regarded as a purely psychological disorder in the past, increasing evidence points to physiological mechanisms which contribute to this disorder, but also arise from it.

The same physiological mechanisms also underlie antecedents to depressive disorders, such as stress. Mechanisms such as hypothalamic pituitary adrenal (HPA) axis dysfunction and autonomic dysfunction are implicated not only in MDD, but also in the development of other disease processes which co-occur with depressive illness, such as metabolic syndrome, atherosclerotic changes, inflammatory changes and platelet activation. These changes are in turn implicated in other medical conditions closely linked to MDD, including diabetes, coronary heart disease and stroke.

A greater understanding of these disease mechanisms and their interaction will allow opportunities for disease prevention and early intervention. Viewing MDD as a physiological disease in addition to its adverse psychological impact raises several important issues: These include the recognition of stress and depressed mood as risk factors for developing metabolic changes and cardiovascular disease, and thus the importance of comprehensive medical screening in MDD patients.

Furthermore, the links between diseases like coronary heart disease (CHD) and MDD are reciprocal, putting people with pre-existing CHD at risk of developing depression, which in turn exacerbates CHD. Such reciprocal relationships have further implications for prevention and intervention, and in this context both existing and novel preventative strategies will be discussed.

Dr Chris Stapelberg, Consultant Psychiatrist, Griffith University and Queensland Health 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: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Rural patients will benefit from new infrastructure grants

Rural patients will benefit from new infrastructure grants to 50 projects across Australia, Health Minister Tanya Plibersek announced today.

Under Round 6 of the National Rural and Remote Health Infrastructure Program, $8.7 million is being directed to the projects.

“While rates of some chronic disease are high for patients living in rural and remote areas, they often find it harder to access the level of health care they require,” said Ms Plibersek.

“That is why the Gillard Government is committed to setting up new rural health services or the improvement of existing facilities.”

According to the National Strategic Framework for Rural and Remote Health, rural areas have higher rates of high blood pressure, diabetes, and obesity as well as poor dental, antenatal and post-natal health.

Ms Plibersek said by providing essential health infrastructure, either as capital works or as equipment, the program made it easier for patients to get care when and where they needed it.

Examples of some of the grants are:

• $500,000 for Tilligerry Medical Practice, Tanilba Bay, NSW, for relocation.
• $328,198 for Optometry at Cooroy, Cooroy, QLD, for optometry equipment.
• $453,550 for Njernda Aboriginal Corporation, Echuca, VIC, to renovate clinic.
• $274,276 for Robe Dental, Robe, SA, to refurbish practice.
• $395,000 for Hermitage Dental Kempsey, NSW, to expand services.
• $250,000 for Physikal Health Services, QLD, for mobile physiotherapy capacity.

The National Rural and Remote Health Infrastructure Program also funds strategic service planning for small rural private hospitals.

Funding is recommended by the independent National Assessment Panel.

For more information please contact the minister’s office on 02 6277 7220

Improving Employment Outcomes for People with a Mental Illness: Progress in the Hunter New England Region of NSW

Engagement in employment has been associated with significant financial, social and health benefits for people with a mental illness. However, as a population, people with mental illness experience high levels of unemployment and often have difficulty accessing services to support them.

Literature indicates that people with a psychotic illness have the worst employment outcomes of any disability group. Given the onset of mental illness often occurs in late adolescence, there is much to be done to prevent the disruption to employment and career trajectory that may occur with this illness experience.

Emma will discuss the progress of the implementation of evidence based employment services within the Hunter New England region mental health services in NSW. This region has been the leader in the state of NSW in the implementation of the Individual Placement and Support Model of supported employment.

Emma will describe the background to this model and its close alignment with the delivery of recovery based mental health services. Outcomes of the implementation of this model across nine different metropolitan and rural sites will be highlighted and compared to international benchmarks in this field.

Ms Emma Robson & Emma Smith, Occupational Therapists, Vocational Education Training and Employment Service, Hunter New England Mental Health 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: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au

Let’s Talk About Children: Dissemination of a family focused intervention

Improved outcome for children of parents with mental illness has been demonstrated through family focused interventions. Despite this, there are many barriers to family focused intervention in mental health service delivery.

Let’s Talk about Children was developed for use with families in which a parent has a mental illness. It focuses on improving communication surrounding mental illness, identifying children’s needs and linking the family with additional support or interventions. It has been used with parents with a range of diagnoses. It involves two to three sessions with parents. Let's Talk was developed in Finland by Prof Tytti Solantaus and was disseminated throughout the Adult Mental Health Service.

Through collaboration between the adult and child and youth mental health service, training in Let’s Talk has been offered. The feasibility of dissemination of an intervention such as this in the local context needed to be established.

Mary will focus on the response to offering training in the intervention to clinicians from a range of services. The results of a focus group discussion of barriers and enablers to a family focused intervention will be explored. Initial feedback with regard to the training offered and applicability to practice was positive.

There are particular issues related to the local context which need to be understood to assist in dissemination of a family focused intervention such as Let’s Talk.

Dr Mary Jessop, Child and Adolescent Psychiatrist, Children's Health Services, Royal Children's Hospital 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: http://anzmh.asn.au/conference Email: conference@anzmh.asn.au