Mental health in rural and regional emergency departments: An issue of equity of access

For many Australians seeking assistance with mental health problems, the Emergency Department (ED) is the primary point of contact, and it is therefore imperative that emergency services are adequately equipped to assess and manage a wide range mental health related presentations.

This paper discusses the findings of a recent study investigating the mental health triage program of a large regional health network, involving consultation with 7 regional/rural emergency departments, the specialist mental health services, and consumers and carers who accessed the service.

The study found that regional and rural emergency services experience extreme difficulty coping with mental health related presentations. The lack of after-hours specialist mental health expertise, grossly inadequate patient transportation systems, and lack of material resources impact significantly on timely and appropriate treatment for people with mental illness.

EDs reported feeling under pressure to manage a wide variety of high risk presentations without adequate training, support, and safety measures in place. Consumers and carers described excessive wait times and barriers to accessing services, resulting in crisis situations escalating into psychiatric emergencies that may have been avoided with timely intervention.

The lack of adequate mental health resourcing to regional and rural EDs is a well-documented and long-standing problem that amounts to inequitable access to quality healthcare for an already marginalised and stigmatised group of healthcare consumers, and highly challenging work environments for rural and regional emergency healthcare providers.

A/Prof Natisha Sands

Campus Leader, Nursing and Midwifery, Deakin Geelong, Deakin University

 3rd Australian Rural & Remote Mental Health Symposium
"Impacts & Outcomes" - Mercure, Ballarat 14th – 16th November 2011

Implementing a Multifaceted Transcultural Mental Health Capacity Building Project in Rural NSW

The Transcultural Rural and Remote Outreach Project (TRROP) is the first of its kind in rural NSW.

The Project is a partnership between the Transcultural Mental Health Centre, the Centre for Rural and Remote Mental Health and selected rural sites.

The Project was funded to develop demonstration models of service delivery and collaborative frameworks that enhance the cultural responsiveness of rural mental health services for the growing number of culturally and linguistically diverse (CALD) communities living in rural NSW.

The presentation will initially present an overview of the TRROP; its effective governance structure, the rural and remote areas covered in NSW and its key performance areas. A detailed description of the capacity building initiatives undertaken over the life of the Project to date will be offered. These initiatives have targeted health, mental health, government and non-government service providers.

The presentation will illustrate the principles underpinning TRROP’s capacity building strategies, including: designing training in response to the needs of the participants, developing partnerships with a range of service providers and consumers in the planning and delivery of the training, trialing theatre-based approaches to training and the use of new technologies. The presentation will focus on the training of clinical staff on cultural competencies and the assessment and treatment of CALD individuals experiencing mental health issues.

Finally, drawing from the experience of the TRROP, valuable recommendations for working with rural mental health service providers in the area of capacity building will be presented.

Ms Maria Cassaniti

Centre Manager, Transcultural Mental Health Centre

The Charter of Peer Support

The “Charter of Peer Support” The Victorian Mutual (Peer) Support Self Help Network has just published the “Charter of Peer Support”.

This document has been developed by men and women and their family members who have lived through a range of mental health issues. They have come from six specialist Peer Support organisations. The core value underpinning the Charter is: “Peer Support is intrinsic to mental health and total wellbeing”

The Charter reflects the importance that the writers place on Peer Support, and the value that this service provides in the continuum of care of consumers and carers experiencing mental health issues at any time in their life. The Charter highlights the cost effectiveness of Peer Support and provides understanding of its power in both prevention and recovery.

John will review the Charter and highlight its implications for Organisations, for Mental Health Service Providers, and for Federal and State Governments. 

John Pernu Branch Manager GROW (Vic), GROW (Tas), “GROW-Better Together”

 3rd Australian Rural & Remote Mental Health Symposium
"Impacts & Outcomes" - Mercure, Ballarat 14th – 16th November 2011

Mental Health Peer Workforce Competency Development Project: Development of the Australian Peer Worker Qualification

The Community Services and Health Industry Skills Council (CS&HISC), in consultation with industry, is developing a competency framework specifically for the Mental Health peer workforce (consumers and carers).

The units of competency will describe work functions in Mental Health peer work roles and, when grouped together, units of competency make up a qualification. The national qualification that will be produced will be an appropriate, tailored and nationally-recognised competency framework or qualification. National qualifications set industry standards, ensuring that work roles are acknowledged Australia-wide.

The units of competency forming a qualification and skill sets will also provide an avenue for progress by improving training and support mechanisms for the fast-growing peer workforce. They provide a long-awaited opportunity for peer workers to formally gain, enhance and/or up skill their knowledge in the area of peer support work. Furthermore, the formal qualification will validate the consumer and carer lived experience, and help service providers realise that peer workers complement the crucial role of mental health professionals.

In addition to providing opportunities for training and development of the Mental Health peer workforce, it also provides employers with an assurance that a consumer or carer worker will operate within acceptable and agreed parameters. For employees, the qualification provides a defined career path.

Learn more about this exciting initiative and how you can use the Mental Health peer workforce competency framework to increase your skills or those of your staff while gaining a nationally-recognised qualification.

Ms Vanessa Dayeh

Project Coordinator, Community Services & Health Industry Skills Council
3rd Australian Rural & Remote Mental Health Symposium
"Impacts & Outcomes" - Mercure, Ballarat 14th – 16th November 2011

The Black Dog Institute’s online MAP - Using the Internet to help GPs Diagnose and Treat Mood Disorders

The Black Dog Institute’s online Mood Assessment Program (MAP) is a diagnostic tool available free of charge to GPs and Psychologists throughout Australia. It is an invaluable aid in the management of mood disorders.

The online MAP provides a reliable second opinion in the diagnosis in mood disorders that is especially helpful to practitioners who are working in rural and remote locations, or where specialist psychiatric support is difficult to obtain. It is based on the Black Dog Institute’s subtyping model of depression, providing very useful information about appropriate treatment choices for individual patients.

It not only provides guidance about depression subtype, thus helping with the “to prescribe or not prescribe” dilemma, but also gives a clear indication of the likelihood of bipolar disorder, the presence of anxiety disorders and the nature and scale of the patient’s personality vulnerability. All this information is useful both in treating the current episode and preventing the next.

The MAP can be completed by the patient in their own home without supervision. It is accessed via a secure website using an access code provided by the referrer and reports are sent directly and promptly to the referring practitioner. It has been designed to be used in conjunction with clinical assessment and has been well validated over a number of years at the Black Dog Institute’s tertiary referral Depression Clinic and in community based studies in metropolitan and rural NSW.

The Institute is keen to encourage all practitioners across Australia to make use of the online MAP in the belief that more accurate diagnosis of mood disorders will have a positive influence on patient outcomes, as well as make practitioner’s lives easier.

Dr Jan Orman

GP Services Consultant, Black Dog Institute

3rd Australian Rural & Remote Mental Health Symposium
"Impacts & Outcomes" - Mercure, Ballarat 14th – 16th November 2011

12th International Mental Health Conference - special conference issue of Psychiatry Update

Unsupportive family associated with bipolar Unsupportive family environments are one of several factors that might be predictive of bipolar disorder, suggests the results of an Australian study... more Bipolar losing its boundaries Bipolarity is at risk of becoming a nonsense label, argues Professor Gin Malhi... more Dimensional thinking needed across axis I and II disorders Aspects of eating, mood, and personality disorders appear to exist along a single dimension, argues a leading eating disorders expert... more

Community mental health services and Non-Government Organisations

With the advent of community mental health services now being provided by Non-Government Organisations, it is becoming evident that we are catching many people with personality disorders. I work for a PHaMS program and previously was with a HASI program in NSW, and we receive many referrals from our local Mental Health Services.

I would estimate at least a third of these have PD’s, and what generally happens when we accept these referrals is the local MHS then discharges them from their case management and we are left to try and work with them.

This concerns me on several levels:

• MHS view that PDs problems are behavioural not mental illness, therefore they do not meet the criteria for services;  
• MHS inability to deal with this diagnosis so they just refer them onto Welfare organisations; 
• Lack of support from MHS to NGOs to deal with the very difficult spectrum of PDs (ie extreme borderline personality disorders); 
• Lack of training in the NGO sector to work with people with PDs, yet we have so many on our books;
• Lack of knowledge by workers in the Welfare sector on how to identify PD traits and therefore being twisted in knots by the demands of this cohort;
• No groups to send people to; 

Welfare workers having to cope with the stress that inevitably follows the breakdown in the relationship with the person with PD when we challenge their behaviours.

This is something we do successfully with others but has disastrous outcomes with people with PDs.

CINDI REES | Community Support Worker

PHaMS Hasting/Macleay
New Horizons Enterprises Limited
PO Box 5420 Port Macquarie NSW 2444