'Every single minute and hour is scrutinised': neoliberalism and Australian private mental health care

Approaches for improving sexuality and sexual health care in mental health settings: A qualitative study exploring clinicians' own perspectives

There is an acknowledged professional practice gap regarding sexuality and sexual health related needs within mental health settings in Australia and internationally. Yet little is known about how clinicians can be best supported or enabled to improve sexuality-related practice, from their own perspective. This is important, given the sensitive and complex nature of sexuality and sexual health within the context of mental distress and service provision. This article reports a follow-up study, where mental health clinicians who participated in an initial study were invited to reflect on and discuss the (finalized) results and recommendations generated. The aim was to generate insights into the tools, strategies, and approaches participants felt would best equip and support clinicians to better incorporate sexuality and sexual health into their work. Six clinicians from three disciplines (mental health nursing, psychology, and psychiatry) participated in in-depth interviews to reflect on a plain language summary of the initial study. Three interconnected themes were generated via reflexive thematic analysis: (1) access to knowledge and information; (2) support from peers, senior colleagues, and workplaces; and (3) enacting a focus on sexuality-related care. These findings provide valuable insights into how clinicians may want to be supported in relation to (improving) their sexuality-related practice. The analysis also demonstrates the importance of a multifaceted approach to improving sexuality-related care in mental health and other health settings. This knowledge will contribute to directing future research and development of interventions, tools, strategies, or other approaches to this end.

Implementing Open Dialogue approaches: A scoping review

Open Dialogue approaches fall broadly into the area of systemic psychotherapeutic practices. They encourage active participation of families and social networks, and emphasize genuine collaboration within highly integrated systems of health-care service delivery. These approaches are currently being implemented in a growing number of services across the globe, and in this review, we summarize and discuss insights from papers concerned with the implementation of Open Dialogue. We used a scoping review method, which included systematic literature searches and summarizing data extraction as well as consultation with eight Open Dialogue implementation stakeholders who were invited to comment on preliminary review findings and a draft paper. We included 18 studies in the review and present their content under four thematic headings: 1. Training, 2. Family and network experiences, 3. Staff members' experiences, and 4. Structural and organizational barriers and resistance to implementation. In general, the studies did not include rich descriptions of the implementation contexts, which made it difficult to draw conclusions across studies about effective implementation practices. The discussion draws on Jamous and Peloille's (Professions and professionalisation, 1970, Cambridge University Press, 109-152) concepts of "indeterminacy" and "technicality," and we argue that the indeterminacy that dominates Open Dialogue is a challenge to implementation efforts that favor specific and standardized practices. We conclude by encouraging the development of implementation initiatives that theorize Open Dialogue practices with higher levels of technicality without corrupting the fundamental spirit of the approach.

An exploration of potential output measures to assess efficiency and productivity for labour and birth in Australia

Background

In maternity services, as in other areas of healthcare, increasing emphasis is placed on improving “efficiency” or “productivity”. The first step in any efficiency and productivity analysis is the selection of relevant input and output measures. Within healthcare quantifying what is produced (outputs) can be difficult.

The aim of this paper is to identify a potential output measure, that can be used in an assessment of the efficiency and productivity of labour and birth in-hospital care in Australia and to assess the extent to which it reflects the principles of woman-centred care.

Methods

This paper will survey available perinatal and maternal datasets in Australia to identify potential output measures; map identified output variables against the principles of woman-centred care outlined in Australia’s national maternity strategy; and based on this, create a preliminary composite outcome measure for use in assessing the efficiency and productivity of Australian maternity services.

Results

There are significant gaps in Australia’s maternity data collections with regard to measuring how well a maternity service is performing against the values of respect, choice and access; however safety is well measured. Our proposed composite measure identified that of the 63,215 births in Queensland in 2014, 67% met the criteria of quality outlined in our composite measure.

Conclusions

Adoption in Australia of the collection of woman-reported maternity outcomes would substantially strengthen Australia’s national maternity data collections and provide a more holistic view of pregnancy and childbirth in Australia beyond traditional measure of maternal and neonate morbidity and mortality. Such measures to capture respect, choice and access could complement existing safety measures to inform the assessment of productivity and efficiency in maternity care.

Engaging with Transformative Paradigms in Mental Health

When graduates of Australian social work courses embark on a career in mental health, the systems they enter are complex, fragmented and evolving. Emerging practitioners will commonly be confronted by the loneliness, social exclusion, poverty and prejudice experienced by people living with mental distress; however, social work practice may not be focused on these factors. Instead, in accordance with the dominant biomedical perspective, symptom and risk management may predominate. Frustration with the limitations evident in this approach has seen the United Nations call for the transformation of mental health service delivery. Recognising paradigmatic influences on mental health social work may lead to a more considered enactment of person centred, recovery and rights-based approaches. This paper compares and contrasts influences of neo-liberalism, critical theory, human rights and post-structuralism on mental health social work practice. In preparing social work practitioners to recognise the influence of, and work more creatively with, intersecting paradigms, social work educators strive to foster a transformative approach to mental health practice that straddles discourses.