The mental health of Australians: can informative data be found?

A grounded theory study of the role that nurses play in increasing clients' willingness to access community mental health services

Clients and caregivers frequently encounter difficulties in accessing mental health services. Early intervention to care and treatment is essential to recovery as delays can adversely affect the severity and the duration of the illness. This paper reports the factors that encouraged and deterred young adults with schizophrenia and their caregivers when trying to seek early access to community mental health services, and examines how community mental health nurses made themselves accessible to these individuals in order to increase their access to services. The findings showed that several factors simultaneously encouraged and inhibited individuals initiating contact at community mental health centres, and these had serious implications for care and treatment, and recovery. There were two client access pathways to care: a direct access pathway where an individual recognized signs of being unwell and sought help early; and an indirect access pathway where others, such as caregivers, general practitioners, police, and inpatient facilities initiated contact on an individual's behalf. Nurses used three strategies to enhance client and caregiver access to services: 'promoting favourable experiences to enhance approachability', 'using technology to promote access' and 'being available'. The findings have significance for nursing practice because they reinforce the importance of having good relationships with clients and caregivers, and the need to take account of the needs of caregivers. They highlight the benefits and drawbacks of using telecommunications to enhance accessibility, and why it is necessary to analyse nurses' workloads and time management skills.

Models of mental health nurse-general practitioner liaison: promoting continuity of care

AIM AND RATIONALE: Community mental health nurses and general practitioners share a pivotal role in the provision of mental health care in the community. The focus of this study was to identify models of general practitioner collaboration used by these nurses, and analyse the implications of these models for promoting continuity of care. The study was derived from a larger study of how community mental health nurses promote wellness with clients who are experiencing an early episode of psychotic illness.

METHODS

This qualitative study used interviews and observation to collect data. The study took place in 1999 in regional and rural New South Wales, Australia and involved community mental health nurses.

FINDINGS

The findings show that two models of nurse and general practitioner (GP) collaboration emerged from the data: Shared Care and Specialist Liaison. In the Shared Care model, nurses maintain close contact with GPs throughout the episode of acute care. In the Specialist Liaison model, the community mental health team assumes overall responsibility for care and treatment throughout the acute episode of illness. Contact with GPs throughout the episode of care by the community mental health team is, at best, intermittent.

CONCLUSION

The findings suggest that the Shared Care model is more consistent with supporting personal and organizational continuity of care, whereas the Specialist Liaison model is limited to encouraging personal continuity of care but further study is needed.

Uncovering hope with clients who have psychotic illness

This article presents findings about how community mental health nurses enable young adult clients who have schizophrenia uncover hope for the future. Grounded theory methodology and simultaneous data collection and analysis took place using interviews and observations. The study was undertaken in the community in regional and rural New South Wales, Australia, and the participants were clients, significant others, and community mental health nurses. The study findings show that nurses used two main strategies to uncover hope: enhancing motivation and developing pathways to wellness. These activities have to be seen within the context of good nurse-client relationships, advancing client self-determination, education, and planning for the future. The process of uncovering hope can be compromised for various reasons. The findings highlight the importance of hope for clients with schizophrenia and the way in which nurses can enable the process.

Best practice in psychogeriatric care

This paper presents a best practice model for psychogeriatric care. Best practice is becoming one of the most common expressions used in the area of health care, and is often referred to in government reports and documents. The definition of 'best practice', however, is still evolving. What then, is best practice? And how can the principles of best practice be applied and integrated into the clinical speciality of psychogeriatrics? The article emphasizes the importance of evidence-based interventions and the need to focus on the pragmatic aspects of providing best practice in the clinical area of psychogeriatrics; that is, what works best in practice? The position taken by the authors of this paper is that the conceptualization of a best practice model in psychogeriatrics is necessary in order to describe and explain the different components involved in the service provided. This conceptualization also communicates and articulates the role of the major stakeholders, and the key players in the achievement of best practice. A psychogeriatric service may become more coherent, more goal-orientated and more efficient if a model is utilized. This paper outlines a proposed model of best practice in psychogeriatrics, and discusses the potential implications for achieving desirable clinical outcomes.

New methods in psychiatric epidemiology

Research on the epidemiology of mental disorders has now reached the stage where it is possible for comparisons to be cautiously made between population samples. This is made possible for the following reasons: recognition that the populations at risk, including their age composition and exclusions, must be clearly specified; the use of the standardized diagnostic criteria in international use (ICD-10 and DSM-IV); and standardized clinical assessments, such as the Schedule for Clinical Assessment in Neuropsychiatry, the Diagnostic Interview Schedule (DIS) or Composite International Diagnostic Interview (CIDI), including the automated CIDI-A, and for the elderly, the Geriatric Mental State Examination and the Canberra Interview for the Elderly. Some recommendations are made for future epidemiological studies, including these advances in methodology. Emphasis is given to the value of using continuous measures of symptoms, in addition to categorical diagnoses. In research on etiology, investigators should make every effort to test innovative hypotheses, particularly where these involve both biological and psychosocial variables.

Predicting intentions to seek help from professional mental health services

OBJECTIVE

This study investigates the factors related to the intention to seek professional help for psychological problems utilising Ajzen and Fishbein's theory of reasoned action. Many of the variables identified in previous studies can be subsumed within this theory, which emphasises the importance of the subjective point of view of the individual.

METHOD

One hundred and forty-two patients waiting for consultations at a community based general practice completed a questionnaire designed to assess the components of this theory as they relate to seeking help from mental health professionals.

RESULTS

The results of this study supported the prediction of the intention to seek help from a mental health professional from the variables 'attitude toward the behaviour' and 'subjective norm'. However, personal attitudes toward seeking help were found to be more important than the approval or disapproval of significant others in predicting help-seeking intentions.

CONCLUSIONS

Overall, the findings indicate that a significant factor influencing people's decisions to utilise professional mental health services in Australia may be the belief that mental health professionals are not actually able to provide a great deal of help or support for people's difficulties.

The present state of psychiatric epidemiology

The seven uses of epidemiology identified by Morris all have direct relevance for mental disorders. But psychiatric epidemiology has a number of distinguishing features: it has to depend on a nosology that may lack validity; it depends largely on subjective symptoms for its data; the morbidity it deals with is really a continuum, and not a dichotomy of cases and unaffected persons; the measurement of morbidity using scales or standardised interviews is open to considerable error; and the unbiased assessment of environmental exposures proves to be technically challenging. Some of these features have been the basis of interesting research developments. The main milestones in the progress of psychiatric epidemiology are reviewed, together with some of the current issues of general interest, including activities in Australasia.