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Looi JCL, Reutens S, Loi S, Bastiampillai T. Free expression and open discourse in Australasian Psychiatry. Australas Psychiatry 2024:10398562241248937. [PMID: 38652456 DOI: 10.1177/10398562241248937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, The Australian National University School of Medicine and Psychology, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Sharon Reutens
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Samantha Loi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- University of Melbourne, Parkville, VIC, Australia
- Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
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Hayter CM, Allison S, Bastiampillai T, Kisely S, Looi JCL. The changing psychiatry workforce in Australia: Still lacking in rural and remote regions. Aust J Rural Health 2024; 32:332-342. [PMID: 38419201 DOI: 10.1111/ajr.13092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. OBJECTIVE To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. DESIGN We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. FINDINGS Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. DISCUSSION Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. CONCLUSION There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.
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Affiliation(s)
- Catherine Mary Hayter
- Mental Health, Justice Health, Alcohol and Drug Services, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Discipline of Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Jeffrey C L Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, The Australian National University School of Medicine and Psychology, Canberra, Australian Capital Territory, Australia
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Looi JC, Amos A, Loi S, Bastiampillai T, Reutens S, Woon L, Maguire PA, Kisely S, Miller E, Benipal A, Wilkes F. Australasian psychiatry - for the art and science of psychiatry. Australas Psychiatry 2024; 32:113-117. [PMID: 38342996 DOI: 10.1177/10398562241232749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Andrew Amos
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Samantha Loi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia; Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Sharon Reutens
- Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Luke Woon
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Edward Miller
- Division of Psychological Medicine, Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand
| | | | - Fiona Wilkes
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
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Tan JQE, Dawson JL, Bastiampillai T. Can lithium be used in the setting of clozapine commencement in patients with COVID-19 associated neutropenia: A case report. Clin Case Rep 2024; 12:e8758. [PMID: 38617070 PMCID: PMC11014804 DOI: 10.1002/ccr3.8758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/06/2024] [Accepted: 03/16/2024] [Indexed: 04/16/2024] Open
Abstract
COVID-19 infection may increase the likelihood of neutropenia in patients already on clozapine. In clozapine treated patients experiencing COVID-19 associated neutropenia, adjunct therapy with lithium can be considered.
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Affiliation(s)
- Jin Quan Eugene Tan
- SA Pharmacy, Flinders Medical CentreSouthern Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Jessica L. Dawson
- SA Pharmacy, Flinders Medical CentreSouthern Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityParkvilleVictoriaAustralia
| | - Tarun Bastiampillai
- Discipline of Psychiatry, College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
- Department of PsychiatryMonash UniversityClaytonVictoriaAustralia
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Woon LSC, Allison S, Bastiampillai T, Kisely S, Maguire P, Pring W, Reay R, Looi JC. Comparison of the out-of-pocket costs of Medicare-funded telepsychiatry and face-to-face consultations: A descriptive study. Australas Psychiatry 2024:10398562241237128. [PMID: 38438122 DOI: 10.1177/10398562241237128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric services to understand the differential out-of-pocket cost burden for patients across these modalities. METHODS out-of-pocket cost information was obtained from the Medical Costs Finder website, which extracted data from Services Australia's Medicare claims data in 2021-2022. Cost information for corresponding face-to-face, video, and telephone MBS items for outpatient psychiatric services was compared, including (1) Median specialist fees; (2) Median out-of-pocket payments; (3) Medicare reimbursement amounts; and (4) Proportions of patients subject to out-of-pocket fees. RESULTS Medicare reimbursements are identical for all comparable face-to-face and telepsychiatry items. Specialist fees for comparable items varied across face-to-face to telehealth options, with resulting differences in out-of-pocket costs. For video items, higher proportions of patients were not bulk-billed, with greater out-of-pocket costs than face-to-face items. However, the opposite was true for telephone items compared with face-to-face items. CONCLUSIONS Initial cost analyses of MBS telepsychiatry items indicate that telephone consultations incur the lowest out-of-pocket costs, followed by face-to-face and video consultations.
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Affiliation(s)
- Luke S-C Woon
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia; and
- Department of Psychiatry, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- School of Medicine, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia; and
- Departments of Psychiatry, Community Health and Epidemiology, Dalhouise University, Halifax, NS, Canada
| | - Paul Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - William Pring
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
- Centre for Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia; and
- Egmont Terrace Specialist Rooms, Private Psychiatrist, Melbourne, VIC, Australia
| | - Rebecca Reay
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, Canberra Hospital, The Australian National University Medical, Canberra, ACT, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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Castle D, Copolov D, Singh B, Bastiampillai T. Seven decades of antipsychotic drugs: Why is the life of Australians with schizophrenia still so suboptimal? Aust N Z J Psychiatry 2024; 58:201-206. [PMID: 38130026 DOI: 10.1177/00048674231209840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The advent of dopamine (D2) receptor-blocking medications over 70 years ago, ushered in a new era of biological treatment for schizophrenia. However, we argue that little subsequent progress has been made in translating this into fulfilled and fulfilling lives for people with schizophrenia. This Viewpoint asks why this is the case, and suggests ways forward for capitalising on extant and emerging new treatments for psychotic disorders, to the betterment of the lives of people living with schizophrenia.
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Affiliation(s)
- David Castle
- Department of Psychiatry, University of Tasmania, Hobart, TAS, Australia
| | - David Copolov
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Bruce Singh
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Richmond, VIC, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Nair PC, Shajan B, Bastiampillai T. Newly identified structures of trace-amine associated receptor-1 (TAAR1) will aid discovery of next generation neuropsychiatric drugs. Mol Psychiatry 2024:10.1038/s41380-024-02466-z. [PMID: 38326558 DOI: 10.1038/s41380-024-02466-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Pramod C Nair
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
- Flinders Health and Medical Research Institute (FHMRI) College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Britto Shajan
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, Monash University, Clayton Campus, Melbourne, VIC, Australia
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Della DF, Smith D, L JC, Allison S, Bastiampillai T. Seasonal Surge for Mental Health Demand in Emergency Departments. Prim Care Companion CNS Disord 2024; 26:23m03629. [PMID: 38334375 DOI: 10.4088/pcc.23m03629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
Objective: To analyze emergency department (ED) mental health presentations over a 7-year period to estimate the timing and magnitude of the seasonal effect across Australia. Methods: We analyzed data collected by the Australian Institute of Health and Welfare (AIHW) from 2014-2015 to 2020-2021, which included all public hospital ED presentations in Australia that received a mental health diagnosis per the Australian Modification of ICD-10. The data were divided into 4 sequential quarters (Q1 = July-September, Q2 = October-December, Q3 = January-March, Q4 = April-June) and analyzed by sex and age (youth: 18-24 years, adult: 25-64 years, and older adult: > 65 years). Regression analysis was used to assess seasonal variation. Results: On average, mental health ED presentations were 9% higher in October-December than April-June, which had the lowest rates of mental health ED presentations for males and females. The peak continued into January-March, most prominently for females. Seasonality was evident in the 18-24 and 25-64 age groups. There were increased ED psychiatry presentations in October-December of 14.4% (males) and 9% (females) in the group aged 18-24, as well as increases of 10.3% (males) and 10.1% (females) in those aged 25-64. In January-March, there was an increase in presentations for females of 7% (aged 18-24) and 10.3% (aged 25-64). For adults aged > 65, there were increased presentations in July-September compared to April-June of 4.9% (males) and 3.9% (females). Conclusions: We found strong, statistically significant peaks in mental health ED presentations in spring and summer. Mental health services need to plan for significantly higher ED mental health demand during these seasons. Further research is required to estimate the size of the mental health seasonal effect in acute hospital settings. Prim Care Companion CNS Disord 2024;26(1):23m03629. Author affiliations are listed at the end of this article.
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Affiliation(s)
- David F Della
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Corresponding Author: David Della, BParamedicSc, MD, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042
| | - David Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jeffrey C L
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis, Canberra, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis, Canberra, ACT, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis, Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Wellington Road, Clayton, VIC, Australia
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Looi JCL, Allison S, Bastiampillai T, Maguire PA, Kisely S, Looi RCH. Mitigating the consequences of electronic health record data breaches for patients and healthcare workers. AUST HEALTH REV 2024; 48:4-7. [PMID: 38109886 DOI: 10.1071/ah23258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
Electronic health records (EHRs) have been widely adopted in Australian public sector healthcare and will remain an ongoing, essential data system. However, recent substantial data breaches from hacked business data systems in Australian enterprises, as well as international healthcare providers, mean that EHR data breaches are increasingly likely in Australia. Risks include medical identity theft and extortion attempts based on threats to release sensitive patient information. Hacking is now a foreseeable additional risk of medical treatment. Risk mitigation for the consequences of data breaches needs to be considered, as well as support for patients (and families) and healthcare workers. This includes identity theft protection services, cybersecurity insurance, and psychological support.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, The Australian National University, Canberra Hospital, Building 4, Level 2, PO Box 11, Garran, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, School of Medicine and Psychology, The Australian National University, Canberra Hospital, Building 4, Level 2, PO Box 11, Garran, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Looi JCL, Allison S, Bastiampillai T, Kisely S, Pring W. Medicare Benefits Schedule (MBS) Review Advisory Committee post-implementation review of MBS telehealth items: abolition of initial telehealth consultations for non-general practitioner specialists. AUST HEALTH REV 2024; 48:34-36. [PMID: 38245912 DOI: 10.1071/ah23237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024]
Abstract
In 2022, the Australian Federal Minister for Health and Aged Care commissioned the Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) to conduct a post-implementation review of MBS telehealth services, including settings of video and telephone consultations. The MRAC has made a series of administrative recommendations for telehealth practice that appear at cross-purposes to the evidence-base on medical consultations and that would limit patient access to medical specialist assessment in Australia. These recommendations particularly underestimate the role of telehealth in rural and remote Australia and did not take into account high patient satisfaction with telehealth assessment and treatment during the ongoing coronavirus disease 2019 (COVID-19) pandemic. They also appear to contradict the Medical Board of Australia's guidance on telehealth. On this basis, the recommendations for telehealth principles and abolition of reimbursement for telehealth for all initial non-general practitioner medical specialist consultations should be withdrawn.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Garran, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - William Pring
- Delmont Private Hospital, Glen Iris, Vic., Australia; and Department of Psychiatry, Monash University, Clayton, Vic., Australia
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Smith D, Cammell P, Battersby M, Bartsch D, Stevenson J, Bastiampillai T. Recurrent Mental Health Presentations to Public Hospital Services: A Focus on Borderline Personality Disorder. Prim Care Companion CNS Disord 2024; 26:23m03559. [PMID: 38228069 DOI: 10.4088/pcc.23m03559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Objective: To investigate associations between patients with borderline personality disorder (BPD)-related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation. Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019. Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder (P < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days (P = .036). Conclusions: Findings suggest the need for (a) more accurate recording of BPD and related presentations, (b) more in-depth investigations of BPD care pathways, and (c) identifications of subpopulations who may benefit from a specific inpatient length of stay. Prim Care Companion CNS Disord 2024;26(1):23m03559. Author affiliations are listed at the end of this article.
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Affiliation(s)
- David Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Corresponding Author: David Smith, BSc, MNurs, MAppStat, PhD, Senior Researcher, Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, GPO Box 2100, ADELAIDE SA 5001, Australia
| | - Paul Cammell
- Royal Melbourne Hospital Head of Psychotherapy Training, St Vincent's Health, Melbourne, Victoria, Australia
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Mental Health Division, Adelaide, South Australia, Australia
| | - Dianna Bartsch
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy Stevenson
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Mental Health Division, Adelaide, South Australia, Australia
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Bastiampillai T, Wu A, Giam A, Tibrewal P. Letter to the Editor: Letter to the Editor regarding 'Early impacts of the "National Suicide Prevention Trial" on trends in suicide and hospital admissions for self-harm in Australia'. Aust N Z J Psychiatry 2024; 58:94-96. [PMID: 37786397 DOI: 10.1177/00048674231201081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Aaron Wu
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Giam
- Cramond Clinic, The Queen Elizabeth Hospital, Woodville South, SA, Australia
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Prashant Tibrewal
- Cramond Clinic, The Queen Elizabeth Hospital, Woodville South, SA, Australia
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia
- Central Adelaide Local Health Network, Adelaide, SA, Australia
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Looi JCL, Kisely S, Allison S, Bastiampillai T, Maguire PA. The unfulfilled promises of electronic health records. AUST HEALTH REV 2023; 47:744-746. [PMID: 37866822 DOI: 10.1071/ah23192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
We provide a brief update on the current evidence on electronic health records' benefits, risks, and potential harms through a rapid narrative review. Many of the promised benefits of electronic health records have not yet been realised. Electronic health records are often not user-friendly. To enhance their potential, electronic health record platforms should be continuously evaluated and enhanced by carefully considering feedback from all stakeholders.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Building 4, Level 2, PO Box 11, Canberra, ACT 2605, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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Looi JC, Allison S, Bastiampillai T, Pring W. Private health insurance, methodology and interpretation of 'Variation in outpatient consultation fees of psychiatrists in Australia by state and territory'. Australas Psychiatry 2023; 31:854-855. [PMID: 37795940 PMCID: PMC10725618 DOI: 10.1177/10398562231205121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
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Allison S, Bastiampillai T, Kisely S, Looi JCL. Deterioration of mild anxiety and depression with Better Access treatment: implications for scaling up psychotherapy worldwide. AUST HEALTH REV 2023; 47:741-743. [PMID: 37844607 DOI: 10.1071/ah23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
The Australian Medicare Better Access initiative in mental health reached one in every 10 Australians in 2021 (more than 2.6 million people) with interventions targeted at mild-to-moderate anxiety and depression, provided by general practitioners, allied health professionals, and/or psychiatrists, at a cost of AUD1.2 billion. However, the overall mental health of the Australian population has not improved since the introduction of Better Access. The benefits of population-scale mental health interventions (medications and psychotherapies) might have been overestimated for milder conditions, and the iatrogenic potential underestimated. A recent evaluation of Better Access found that mild anxiety and depressive symptoms were threefold more likely to worsen (32%) rather than improve (10%). Better Access might be targeted more cost-effectively towards severe and complex conditions, for which treatment appears to have superior risk-benefit ratios. These findings have implications for similar initiatives worldwide, such as those proposed by the World Health Organization.
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Affiliation(s)
- Stephen Allison
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, SA 5042, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Department of Psychiatry, Monash University, Wellington Road, Clayton, Vic., Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jeffrey C L Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
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16
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Looi JCL, Allison S, Bastiampillai T, Kisely S. What have been the clinical outcomes of the Project Synergy/InnoWell digital health platform? AUST HEALTH REV 2023; 47:747-749. [PMID: 37814472 DOI: 10.1071/ah23159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
Project Synergy is a digital mental health tool for assessment, referral and follow-up of people with mental health problems. The Australian federal government Department of Health entered an AUD33 million formal funding arrangement with InnoWell, a proprietary company vehicle (primarily the consultancy firm PwC and University of Sydney) to continue development of Project Synergy. This followed an initial federal National Health and Medical Research Council grant of AUD5.5 million over the previous 3 years. However, based on the assessment of peer-reviewed research data, the Project Synergy/InnoWell platform does not seem to have demonstrated clinical outcomes of healthcare value to date.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Wellington Rd, Clayton, Vic., Australia
| | - Steve Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Magarey AW, Weng J, Looi JCL, Allison S, Bastiampillai T. Systematic Review of Psychiatric Observation Units and Their Impact on Emergency Department Boarding. Prim Care Companion CNS Disord 2023; 25:22r03468. [PMID: 37976230 DOI: 10.4088/pcc.22r03468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Objective: To investigate the effectiveness of acute short-stay hospital admissions in psychiatric observation units for improving the flow of patients with mental health presentations through the emergency department (ED). Data Sources: CINAHL, MEDLINE, OVID, PsycINFO, PubMed, Web of Science, and Google Scholar were systematically searched for English-language studies from 1990 onward. Descriptors used to describe psychiatric observation units were identified, and in databases with MESH term availability, the terms "mental disorder" and "emergency services, psychiatric" were also utilized to further enhance the search. Study Selection: A total of 6,571 studies were screened. The PICOS framework was used to determine the inclusion and exclusion criteria, and the process of study selection followed PRISMA guidelines. Articles were included if the unit studied had a length of stay (LOS) < 72 hours and if patients suffered from a mental health condition and were treated as hospital inpatients. Data Extraction: Reviewers performed data extraction and quality assessment of the included studies following the review protocol. Results: A total of 14 psychiatric observation unit studies were included in the review: 5 in North America and 9 in Australia. Most of these units were in large urban general hospitals. There appears to be some improvement in ED LOS for patients with mainly crisis mental health presentations. Seven of the 14 studies specifically discussed ED LOS, and 6 of these studies showed mild to moderate improvement in ED LOS, ranging from 17 minutes to > 11 hours. Conclusions: Psychiatric observation units were mainly located in North American and Australian settings. These units may reduce ED LOS based on limited, poor-quality evidence. Further research is required to determine whether psychiatric observation units have ongoing effects on ED LOS and alleviate access block. Prim Care Companion CNS Disord 2023;25(6):22r03468. Author affiliations are listed at the end of this article.
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Affiliation(s)
- Alastair W Magarey
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Corresponding Author: Alastair W. Magarey, MD, MMus, College of Medicine and Public Health, Flinders University, Flinders Drive Bedford Park, South Australia 5042
| | - Jianfeng Weng
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Wellington Road, Clayton, VIC, Australia
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Fauska C, Bastiampillai T, Adams RJ, Wittert G, Eckert DJ, Loffler KA. Effects of the antipsychotic quetiapine on sleep and breathing: a review of clinical findings and potential mechanisms. J Sleep Res 2023:e14051. [PMID: 37833613 DOI: 10.1111/jsr.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
Quetiapine is an antipsychotic medication indicated for schizophrenia and bipolar disorder. However, quetiapine also has hypnotic properties and as such is increasingly being prescribed at low doses 'off-label' in people with insomnia symptoms. Pharmacologically, in addition to its dopaminergic properties, quetiapine also modulates multiple other transmitter systems involved in sleep/wake modulation and potentially breathing. However, very little is known about the impact of quetiapine on obstructive sleep apnoea (OSA), OSA endotypes including chemosensitivity, and control of breathing. Given that many people with insomnia also have undiagnosed OSA, it is important to understand the effects of quetiapine on OSA and its mechanisms. Accordingly, this concise review covers the existing knowledge on the effects of quetiapine on sleep and breathing. Further, we highlight the pharmacodynamics of quetiapine and its potential to alter key OSA endotypes to provide potential mechanistic insight. Finally, an agenda for future research priorities is proposed to fill the current key knowledge gaps.
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Affiliation(s)
- Cricket Fauska
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tarun Bastiampillai
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Flinders Medical Centre, Adelaide, South Australia, Australia
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Respiratory, Sleep and Ventilation Service, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Gary Wittert
- University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Danny J Eckert
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kelly A Loffler
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Han J, Allison S, Looi JCL, Chan SKW, Bastiampillai T. A systematic review of the role of clozapine for severe borderline personality disorder. Psychopharmacology (Berl) 2023; 240:2015-2031. [PMID: 37572113 PMCID: PMC10506937 DOI: 10.1007/s00213-023-06431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
RATIONALE Clozapine is a unique medication with a potential role in the treatment of severe borderline personality disorder (BPD). OBJECTIVES The review examines the effectiveness of clozapine as a medication for management for severe BPD with high risk of suicide, violence or imprisonment, and aims to help guide clinical practice in managing severe BPD. METHODS A database search of the terms "Clozapine" AND "BPD"; "Antipsychotics" AND "BPD"; "Clozapine" AND "Borderline Personality Disorder"; and "Antipsychotics" AND "Borderline Personality Disorder" were performed in CINAHL, Cochrane Library, Embase, Medline, PsychINFO, PubMed, and Web of Science. Full-text articles of clinical clozapine use for BPD were included for review. RESULTS A total of 24 articles consisting of 1 randomised control trial, 10 non-controlled trials, and 13 case reports were identified. Most of the studies reported benefits from clozapine when used for severe BPD. Many of the studies focused on clozapine use in BPD patients at high risk of suicide. Results from these non-controlled and case reports support the use of clozapine in patients with severe BPD at high risk of suicide. CONCLUSION There may be a role for clozapine in treating severe treatment refractory BPD, especially for those patients at high risk of suicide and frequent hospitalisations.
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Affiliation(s)
- Joshua Han
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Stephen Allison
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Consortrium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), ACT, Canberra, Australia
| | - Jeffrey C L Looi
- Consortrium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), ACT, Canberra, Australia
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
| | - Sherry Kit Wa Chan
- Department of Psychiatry, the School of Clinical Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Psychiatry, Monash University, Wellington Road, Clayton, Victoria, Australia
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20
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Nair PC, Bastiampillai T. Letters to the Editor: Letter to the Editor regarding 'A challenge to the dopamine orthodoxy in schizophrenia'. Aust N Z J Psychiatry 2023; 57:1394-1395. [PMID: 37465954 DOI: 10.1177/00048674231187998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Pramod C Nair
- Discipline of Clinical Pharmacology, Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Discipline of Psychiatry, Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Psychiatry, Monash University, Clayton, VIC, Australia
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Ma CF, Luo H, Leung SF, Wong GHY, Lam RPK, Bastiampillai T, Chen EYH, Chan SKW. Impact of community mental health services on the adult psychiatric admission through the emergency unit: a 20-year population-based study. Lancet Reg Health West Pac 2023; 39:100814. [PMID: 37927999 PMCID: PMC10625018 DOI: 10.1016/j.lanwpc.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 11/07/2023]
Abstract
Background There is a lack of real-life population-based study examining the effect of community mental health services on psychiatric emergency admission. In Hong Kong, Integrated Community Center for Mental Wellness (ICCMW) and telecare service were introduced in 2009 and 2012, respectively. We examined the real-life impact of these services on psychiatric emergency admissions over 20 years. Methods Number of psychiatric emergency admissions between 2001 and 2020 was retrieved from the Hong Kong Clinical Data Analysis & Reporting System. We used an interrupted time series analysis to examine monthly psychiatric admission trend before and after service implementation, considering socioeconomic and environmental covariates. Findings A total of 108,492 psychiatric emergency admissions (47.8% males; 64.9% aged 18-44 years) were identified from the study period, of which 56,858, 12,506, 12,295, 11,791, and 15,051 were that for schizophrenia-spectrum disorders, bipolar affective disorders, unipolar mood disorders, neuroses, and substance use disorders. ICCMW introduction has an immediate effect on psychiatric emergency admission (adjusted estimate per 100,000: -10.576; 95% CI, -16.635 to -4.518, p < 0.001), particularly among adults aged 18-44 years (-8.543; 95% CI, -13.209 to -3.877, p < 0.001), females (-5.843; 95% CI, -9.647 to -2.039, p = 0.003), and with neuroses (-3.373; 95% CI, -5.187 to -1.560, p < 0.001), without a significant long-term effect. Unemployment, seasonality, and infectious disease outbreak were significant covariates. Interpretation ICCMW reduced psychiatric emergency admission, but no further reduction following full implementation. Community mental health services should be dynamically tailored for different populations and socioeconomic variations over time. Funding None.
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Affiliation(s)
- Chak Fai Ma
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Rex Pui Kin Lam
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tarun Bastiampillai
- Department of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Looi JC, Allison S, Bastiampillai T. RANZCP elections: What becomes of the disengaged? Australas Psychiatry 2023; 31:707-708. [PMID: 37488915 PMCID: PMC10566200 DOI: 10.1177/10398562231191700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
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Nguyen T, Ullah S, Looi JCL, Allison S, Mulder R, Bastiampillai T. Indigenous suicide rates in the United States, Australia and New Zealand between 2006 and 2019. Aust N Z J Psychiatry 2023; 57:1324-1330. [PMID: 37092737 PMCID: PMC10517587 DOI: 10.1177/00048674231167327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Indigenous suicide prevention is an important focus for national health policies. Indigenous suicide rates in formerly colonial English-speaking countries such as the United States, Australia and New Zealand are considerably higher than the general population, particularly in young males. Given the similarities in their sociocultural history, a time series analysis was conducted to assess recent sex and age trends of suicide in the Indigenous and general populations in the United States, Australia and New Zealand. METHODS Using the number of deaths by intentional self-harm and estimated resident population, suicide incidence rates were calculated for the years 2006-2019 and stratified by Indigenous status, year, time period, sex and age group (above 15 years). Incidence rates were plotted. Using the Poisson regression model, calculated suicide incidence rate ratios were used to make comparisons for sex and age. RESULTS Across all countries studied, Indigenous suicide rates have increased over time, with Indigenous males having higher suicide rates than Indigenous females. However, the increase in Indigenous female suicides was greater than that for Indigenous males in Australia and New Zealand. Indigenous males aged 15-44 years have the highest suicide rates across all countries. CONCLUSION Indigenous suicide rates have remained consistently high in the United States, Australia and New Zealand, with Indigenous males aged 15-44 years showing the highest rate. However, suicide rates for Indigenous females in Australia and New Zealand are increasing more rapidly than males. Given this, it is critical that further research is dedicated to understanding and addressing the issues driving this problem, particularly in youth.
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Affiliation(s)
- Teresa Nguyen
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jeffrey CL Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University, Canberra Hospital, Canberra, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Roger Mulder
- Department of Psychological Medicine (Christchurch), University of Otago, Dunedin, New Zealand
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
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Harford P, Agaciak M, Looi JCL, Smith D, Allison S, Chan SKW, Bastiampillai T. Urbanisation and Declining Suicide Rates in China Between 2005 and 2017. East Asian Arch Psychiatry 2023; 33:79-88. [PMID: 37771214 DOI: 10.12809/eaap2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Worldwide suicide rates have declined since 2000s, with China being the primary contributor. This study aimed to investigate whether urbanisation is associated with decreasing suicide rates in China. METHODS Suicide rates and economic indicators of 31 provinces, municipalities, and autonomous regions of China between 2005 and 2017 were analysed. Poisson random intercept models were used to determine associations between suicide rates, urbanicity, sexes, and gross regional product (GRP). RESULTS Between 2005 and 2017, suicide rates in 31 provinces, municipalities, and autonomous regions of China continued to decrease. Urbanicity and GRP were associated with decreased suicide rates among Chinese males and females. An increase in urbanicity by 1% was associated with a 2.2% decrease in suicide rates (p < 0.001). The most urbanised and populous cities (Beijing, Shanghai, Tianjin) had the lowest suicide rates. Urbanicity was associated with a greater decline in suicide rates among females, compared with males. Association between increased urbanicity and reduced suicide rates was independent of GRP. CONCLUSION Urbanisation was associated with declining suicide rates in China; this association was stronger among females than males.
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Affiliation(s)
- P Harford
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - M Agaciak
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - J C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - D Smith
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - S Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - S K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - T Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia
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Looi JCL, Allison S, Bastiampillai T, Kisely SR, Robson SJ. Supply and demand - a health economic perspective on the Australian hospital and elective surgery crisis. AUST HEALTH REV 2023:AH23048. [PMID: 37339737 DOI: 10.1071/ah23048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
The COVID-19 pandemic has contributed to longstanding structural shortfalls in the supply of healthcare services in high-income countries, including Australia. These impacts are reflected in Australian public hospital key performance indicators for acute care, elective surgery and hospital exit block. The challenges occur in the context of increased demand following the suspension of a range of healthcare services during the pandemic. The main supply challenge is suitable numbers of skilled healthcare workers. Rebalancing of supply and demand in healthcare is challenging, but needs to be achieved.
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Yee B, Looi JCL, Agaciak M, Allison S, Chan SKW, Bastiampillai T. Non-Psychosis Symptoms of Clozapine Withdrawal: a Systematic Review. East Asian Arch Psychiatry 2023; 33:44-64. [PMID: 37400227 DOI: 10.12809/eaap2261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Clozapine is a potent antipsychotic medication with a complex receptor profile. It is reserved for treatment-resistant schizophrenia. We systematically reviewed studies of non-psychosis symptoms of clozapine withdrawal. METHODS CINAHL, Medline, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews were searched using the keywords 'clozapine,' and 'withdrawal,' or 'supersensitivity,' 'cessation,' 'rebound,' or 'discontinuation'. Studies related to non-psychosis symptoms after clozapine withdrawal were included. RESULTS Five original studies and 63 case reports / series were included in analysis. In 195 patients included in the five original studies, approximately 20% experienced non-psychosis symptoms following discontinuation of clozapine. In 89 patients in four of the studies, 27 experienced cholinergic rebound, 13 exhibited extrapyramidal symptoms (including tardive dyskinesia), and three had catatonia. In 63 case reports / series included, 72 patients with non-psychosis symptoms were reported, which were catatonia (n=30), dystonia or dyskinesia (n=17), cholinergic rebound (n=11), serotonin syndrome (n=4), mania (n=3), insomnia (n=3), neuroleptic malignant syndrome (NMS) [n=3, one of them had both catatonia and NMS], and de novo obsessive compulsive symptoms (n=2). Restarting clozapine appeared to be the most effective treatment. CONCLUSIONS Non-psychosis symptoms following clozapine withdrawal have important clinical implications. Clinicians should be aware of the possible presentations of symptoms to ensure early recognition and management. Further research is warranted to better characterise the prevalence, risk factors, prognosis, and optimal drug dosing for each withdrawal symptom.
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Affiliation(s)
- B Yee
- Department of Medicine, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - J C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - M Agaciak
- Department of Medicine, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - S Allison
- Department of Medicine, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - S K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - T Bastiampillai
- Department of Medicine, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Psychiatry, Monash University, Melbourne, Victoria, Australia
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Della DF, Allison S, Bidargaddi N, Wa SK, Bastiampillai T. An Umbrella Systematic Review of Seasonality in Mood Disorders and Suicide Risk: The Impact on Demand for Primary Behavioral Health Care and Acute Psychiatric Services. Prim Care Companion CNS Disord 2023; 25. [PMID: 37230063 DOI: 10.4088/pcc.22r03395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Objective: To review the current literature focusing on the most recent systematic reviews relating to mood, suicide, and psychiatric service utilization. Study Selection and Data Extraction: A systematic literature search of PubMed, CINAHL, and PsycINFO databases using the search terms "Systematic review" AND "season*" AND mood OR depression OR bipolar OR psychosis OR suicid* OR psychiatr* initially yielded 209 results. After screening by title and abstract for relevance, 6 records remained, while a further 3 were identified after screening of reference lists. A qualitative synthesis of these results was then performed due to data heterogeneity between studies. Results: We found evidence of winter peaks for depressive symptoms and suggestions of summer peaks for suicidal activity, emergency department (ED) self-harm presentations, and manic-related hospital admissions. Suicide is 11%-23% more frequent in spring and summer. ED suicide attempts are also 1.2-1.7 times higher in spring and summer compared to winter. Admissions for mania are 7.4%-16% higher in spring and summer, while there are 1.5 times more admissions for bipolar depression in winter months. Conclusions: There is a summer peak for many aspects of mental health activity, particularly in terms of acute hospital utilization and suicidality. This is contrary to the winter-related peak of depressive symptoms. Further research is needed to affirm these findings.
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Affiliation(s)
- David F Della
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Corresponding author: David F. Della, BParamedicSc, Flinders Medical Centre, Flinders Dr, Bedford Park South Australia 5042
| | - Stephen Allison
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Niranjan Bidargaddi
- Discipline of Digital Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sherry Kit Wa
- Department of Psychiatry, The School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR
| | - Tarun Bastiampillai
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Psychiatry, Monash University, Melbourne, Australia
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Soo A, Bastiampillai T, Dhillon R. Quetiapine-Induced Acute-Onset Catatonia. Prim Care Companion CNS Disord 2023; 25. [PMID: 37227393 DOI: 10.4088/pcc.22cr03368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- Alwin Soo
- Flinders Medical Centre, Bedford Park, South Australia
- Corresponding author: Alwin Soo, MD, Flinders Medical Centre, Bedford Park, South Australia 5042
| | - Tarun Bastiampillai
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Department of Psychiatry, Monash University, Melbourne, Australia
| | - Rohan Dhillon
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Tibrewal P, Nair PC, Gregory KJ, Langmead CJ, Chan SKW, Bastiampillai T. Does clozapine treat antipsychotic-induced behavioural supersensitivity through glutamate modulation within the striatum? Mol Psychiatry 2023; 28:1839-1842. [PMID: 36932159 PMCID: PMC10575773 DOI: 10.1038/s41380-023-02026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Prashant Tibrewal
- Cramond Clinic, The Queen Elizabeth Hospital, Woodville South, SA, 5011, Australia
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Pramod C Nair
- Discipline of Clinical Pharmacology, Flinders Health and Medical Research Institute (FHMRI) College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide, Adelaide, SA, Australia
| | - Karen J Gregory
- Drug Discovery Biology and ARC Centre for Cryo-electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia
| | - Christopher J Langmead
- Drug Discovery Biology and ARC Centre for Cryo-electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC, 3052, Australia
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Tarun Bastiampillai
- Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
- Department of Psychiatry, Monash University, Wellington Road, Clayton, 3800, Australia.
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Allison S, Looi JC, Kisely S, Bastiampillai T. Could negative outcomes of psychotherapies be contributing to the lack of an overall population effect from the Australian Better Access initiative? Australas Psychiatry 2023:10398562231172417. [PMID: 37097000 DOI: 10.1177/10398562231172417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
OBJECTIVE We examine deterioration in psychotherapies, as reported in the recent evaluation of the Australian Medicare Better Access initiative. CONCLUSION A focus on patients who experience poor clinical outcomes helps programs minimise harm and improve quality of care. The Better Access evaluation found the mental health of 20-40% of patients deteriorated. This may partly explain why population distress and suicide rates were not reduced by the introduction of the Better Access initiative. Deterioration was more likely for milder conditions, and less likely for severe conditions, which also improved the most. Using severity as a criterion for priority setting and resource allocation may minimise patient risk and maximise benefits. Patients with severe conditions may require considerably more sessions than the current average for Better Access psychotherapies.
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Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra, ACT, Australia; and
- Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT, Australia
| | - Steve Kisely
- School of Medicine, University of Queensland, Woolloongabba, QLD, Australia
| | - Tarun Bastiampillai
- Psychiatry, Flinders University, Adelaide, SA, Australia; and
- Psychiatry, Monash University, Clayton, VIC, Australia
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Kisely SR, Bastiampillai T, Allison S, Looi JC. More smoke and mirrors: Fifteen further reasons to doubt the effectiveness of headspace. Australas Psychiatry 2023:10398562231167683. [PMID: 37022312 DOI: 10.1177/10398562231167683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Commentary on the debate concerning the effectiveness of headspace, including the most recent independent evaluation of its services. CONCLUSIONS The available evaluations indicate that headspace does not deliver therapy of adequate duration that results in clinically significant improvement. Most evaluations have used either short-term process measures or uncontrolled satisfaction surveys, and where there have been data on outcomes using standardised instruments, findings have been disappointing. Costs are poorly quantified and probably underestimated. Even so, headspace as a primary care intervention costs twice as much as a mental health consultation by a general practitioner and, depending on the assumptions, may not be cost effective.
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Affiliation(s)
- Stephen R Kisely
- School of Medicine, 1974The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Poilicy Research and Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Consortium of Australian-Academic Psychiatrists for Independent Poilicy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Consortium of Australian-Academic Psychiatrists for Independent Poilicy Research and Analysis (CAPIPRA), Canberra, ACT, Australia; Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra Hospital, Canberra, ACT, Australia
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Rogers B, Legaspi JP, Bastiampillai T. Hospital congestion: a market solution to address delayed transfers of care from hospital beds. Med J Aust 2023; 218:298-300. [PMID: 36966447 DOI: 10.5694/mja2.51876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 03/27/2023]
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Phu PJJ, Looi JCL, Nair PC, Allison S, Chan SKW, Bastiampillai T. Psychosis Related to Baclofen Withdrawal or Overdose: A Systematic Review. East Asian Arch Psychiatry 2023; 33:3-14. [PMID: 36991550 DOI: 10.12809/eaap2237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To systematically review case reports of psychosis related to withdrawal or overdose of baclofen, which is a gamma-aminobutyric acid (GABA) B agonist. METHODS PubMed, MEDLINE, CINAHL, and PsychINFO were searched to identify articles related to psychosis secondary to withdrawal or overdose of baclofen using the terms 'baclofen' and ' psychosis'. Comparisons were made between cases in terms of concomitant antipsychotic use, diagnosis of delirium, and evidence of association. Quality of case reports was assessed using the CARE Case Report Guidelines checklist. RESULTS In total, 34 patients from 28 case reports were reviewed. Twenty-three patients experienced psychosis upon baclofen withdrawal; among them, 18 had resolution of psychosis upon reinitiation of baclofen, whereas antipsychotic monotherapy was less successful (only four of eight patients responded). An additional baclofen withdrawal period led to recurrence of psychotic symptoms in four of seven patients. Eleven patients had psychosis on induction or after overdose of baclofen; among them, four patients had resolution of psychosis upon cessation of baclofen. The mean quality of the case reports was 6.4 of 13. CONCLUSION Considering its GABAergic agonism, along with evidence of psychosis on induction or withdrawal, baclofen may have some antipsychotic and pro-psychotic properties.
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Affiliation(s)
- P J J Phu
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - J C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University Medical School, Canberra Hospital, Canberra, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
| | - P C Nair
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Discipline of Clinical Pharmacology, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - S Allison
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
| | - S K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - T Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
- Department of Psychiatry, Monash University, Australia
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Allison S, Bastiampillai T, Looi JC, Kisely SR, Lakra V. The new World Mental Health Report: Believing impossible things. Australas Psychiatry 2023; 31:182-185. [PMID: 36814361 PMCID: PMC10088332 DOI: 10.1177/10398562231154806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE We examine whether the recent World Health Organization (WHO) report on global mental health uses severity of illness as a criterion in priority setting for resource allocation. CONCLUSIONS The WHO does not prioritise severity in the recent landmark World Mental Health Report. It recommends instead the insuperable task of scaling-up interventions for broadly defined mental health conditions, including milder distress, amongst over a billion people, with the majority living in low- and middle-income countries. Schizophrenia, the most severe and disabling of all psychiatric illnesses, is relatively neglected in the WHO report, and the disability associated with bipolar disorder is underestimated. This is inconsistent with the ethical principle of vertical equity, where the most severe illnesses should receive the greatest priority. The global mental health movement must refocus on deinstitutionalisation, and ensure adequate community and general hospital treatment for severe illnesses, especially the 24 million people with schizophrenia.
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Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; Department of Psychiatry, Monash University, Wellington Road, Clayton, VIC, Australia
| | - Jeffrey Cl Looi
- The Australian National University School of Medicine and Psychology, Academic Unit of Psychiatry and Addiction Medicine, Canberra, ACT, Australia; Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen R Kisely
- School of Medicine, 1974University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhouise University, Halifax, NS, Canada; Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Vinay Lakra
- Mental Health, 6451Northern Health, Melbourne, VIC, Australia
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Looi JC, Kisely SR, Bastiampillai T, Allison S. Commentary: Is Australian headspace socioculturally westernised, educated, industrialised, rich and democratic in conceptualisation and accessibility? Australas Psychiatry 2023:10398562231153007. [PMID: 36752178 DOI: 10.1177/10398562231153007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The Australian headspace model has been proposed as an internationally significant exemplar for reducing the mental health 'treatment gap' amongst young people around the world. We provide a commentary that discusses the conceptualisation and delivery of headspace services within Australia, a predominantly Westernised, Educated, Industrialised, Rich and Democratic (WEIRD) society, as well as examining accessibility and suitability for culturally and linguistically diverse (CALD) communities. CONCLUSION headspace was conceptualised, designed, implemented and evaluated according in a WEIRD sociocultural context, and is therefore most applicable to that setting. Australia also has CALD communities, who have not seemed to access headspace in the reported patient and staff demographics. On this basis, there may be questions about the potential generalisability of headspace models outside WEIRD societies.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, Canberra, ACT, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, Princess Alexandra Hospital, 1974The University of Queensland, Brisbane, QLD, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
| | - Stephen Allison
- 1065Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Frost H, Giam A, Tibrewal P, Bastiampillai T. What is the optimal weekly schedule for ECT in major depression? Australas Psychiatry 2023; 31:109. [PMID: 36494084 DOI: 10.1177/10398562221143922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Brazel M, Allison S, Bastiampillai T, Kisely S, Loi SM, Looi JC. Australian older persons mental health inpatient and ambulatory services in 2015-2020 - A descriptive analysis and commentary. Australas Psychiatry 2023; 31:43-46. [PMID: 36337025 DOI: 10.1177/10398562221135492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To provide a commentary on Australian state/territory older persons mental health service (OPMHS) expenditure, inpatient and outpatient services and key performance indicators (KPIs). METHOD Descriptive analysis of data from the Australian Institute of Health and Welfare (AIHW), the Australian Bureau of Statistics and the World Health Organisation. RESULTS Between 2015-16 and 2019-20, annual expenditure on OPMHS in Australia increased by an average of only 2.3%, compared to 2.9% for all population groups, despite an increase in the number of over 65 year olds. Per capita recurrent expenditure on OPMHS decreased by an average of 1% annually. Australia's total mental health beds increased, whereas OPMHS beds decreased, mainly due to a reduction in non-acute beds. Outcomes for OPMHS admissions were similar to other age groups, except for a longer length of stay and reduced readmission rate. Older Australians accessed ambulatory mental health care at a lower rate and had a lower rate of improvement after a completed episode. CONCLUSIONS OPMHS expenditure has not increased at commensurate levels compared to other populations. The mental health of people aged over 65 appears to be a neglected policy priority in Australia. The Royal Commission into Aged Care Quality and Safety may herald service and expenditure changes.
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Affiliation(s)
- Matthew Brazel
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University School of Medicine and Psychology, 34381Canberra Hospital, Canberra, ACT, Australia; and Department of Psychiatry, 34381The Canberra Hospital, Garran, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - Stephen Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, 1974University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samantha M Loi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; University of Melbourne, Psychiatry, Grattan Street, Parkville VIC, Australia; and Melbourne Health, Neuropsychiatry NorthWestern Mental Health, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University School of Medicine and Psychology, 34381Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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Looi JC, Galambos G, Pring W, Allison S, Bastiampillai T, Kisely SR. Commentary on the private practice implications of the Deed of Settlement in the Honeysuckle Health - NIB Australian-Competition-Tribunal-hearing. Australas Psychiatry 2023; 31:61-64. [PMID: 36420569 DOI: 10.1177/10398562221140993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide a commentary on the implications of the Deed of Settlement in the Honeysuckle Health - nib Australian-Competition-Tribunal Hearing. This hearing has major implications in relation to the potential for a single dominant private-health-insurance buying-group to contract for medical-purchaser-provider-agreements that might limit the clinical autonomy of patients and psychiatrists. CONCLUSIONS The Australian Competition and Consumer Commission (ACCC) authorised the formation of a joint buying-group for private-health-insurers in 2021 to provide collective contracting and related services to private-health-insurers and other healthcare-payers. A consequent legal challenge resulted in a Deed of Settlement on 18 July 2022 that for 5 years preserves doctor-patient autonomy in clinical decision-making, the medical gaps scheme, the transparency of contractual arrangements, and if clinical data of those insured are collected by HH-nib, it must be with the full informed consent of patients. However, there remain options for private-health-insurers to apply for formation of new buying-groups, as well as to collect data and profile the general public and insured patients using online programs. Vigilance on private-health-insurer buying-groups, and the potential for US-style managed-care is warranted.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry & Addiction Medicine, 1065the Australian National University School of Medicine and Psychology, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, AU
| | - Gary Galambos
- Young Adult Mental Health Unit, 94768St Vincent's Private Hospital, Sydney, NSW, AU; and School of Psychiatry, Faculty of Medicine, UNSW, Sydney, NSW, AU
| | - William Pring
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, AU; and Delmont Private Hospital, Glen Iris, VIC, AU; and Department of Psychiatry, 22457Monash University, Clayton, VIC, AU
| | - Stephen Allison
- 104822Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, AU; and College of Medicine and Public Health, Flinders University, Adelaide, SA, AU
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, AU; and Department of Psychiatry, 22457Monash University, Clayton, VIC, AU; and College of Medicine and Public Health, Flinders University, Adelaide, SA, AU
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, AU; and School of Medicine, 1974the University of Queensland, Brisbane, QLD, AU; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, CA
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Allison S, Bastiampillai T, Looi JC, Kisely SR, Lakra V. American Psychiatric Association dynamic modelling of psychiatric bed shortages: Implications for frontline Australian trainees and public sector psychiatrists. Australas Psychiatry 2023; 31:107-108. [PMID: 36424176 DOI: 10.1177/10398562221140995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Looi JC, Bastiampillai T, Allison S, Maguire PA. Considering patient narrative-based and medico-scientific epistemologies in framing psychiatric care. Australas Psychiatry 2023; 31:58-60. [PMID: 36112795 DOI: 10.1177/10398562221126427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Personal narratives of lived experience with psychiatric illness and distress remain central in the epistemology of mental illness. We provide a commentary on this potential bridging of patient narrative-based epistemology, and medico-scientific epistemology used by psychiatrists used for diagnosis, formulation, prognosis and treatment. CONCLUSION Discussion and planning of psychiatric care can be framed by understanding the narrative-based epistemology of a patient's illness as highlighted by five key questions to explore the patient's illness explanatory models. We propose five key questions for the psychiatrist's complementary consideration of medico-scientific epistemology that frame conceptual models of aetiology, pathophysiology, diagnosis, formulation, prognosis and treatment, which are embedded in the predominant socio-cultural environment. These questions assist in bridging patient narrative and medico-scientific explanatory models to facilitate more effective collaborative care planning.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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Bastiampillai T, Lim S, Giam A, Tibrewal P. Letter to the Editor regarding 'Homicide associated with psychotic illness: What global temporal trends tell us about the association between mental illness and violence'. Aust N Z J Psychiatry 2023; 57:148-149. [PMID: 36120939 DOI: 10.1177/00048674221124508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Tarun Bastiampillai
- Department of medicine, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Seungryeol Lim
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Andrew Giam
- Cramond Clinic, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.,Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Prashant Tibrewal
- Cramond Clinic, The Queen Elizabeth Hospital, Woodville South, SA, Australia.,Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, Australia.,Central Adelaide Local Health Network, Adelaide, SA, Australia
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Looi JC, Kisely SR, Allison S, Bastiampillai T. Letter to the Editor regarding 'Defending and demonstrating the psychodynamic orientation in psychiatry'. Aust N Z J Psychiatry 2023; 57:146-147. [PMID: 36039919 DOI: 10.1177/00048674221121572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
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Affiliation(s)
- Kyle Ratcliff
- Department of Psychiatry, Flinders University, College of Medicine and Public Health, South Australia, Australia.,Corresponding author: Kyle Ratcliff, MD, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, Australia 5042
| | - Vineet Juneja
- Department of Psychiatry, Flinders University, College of Medicine and Public Health, South Australia, Australia
| | - Arun Gupta Mbbs
- Department of Psychiatry, Flinders University, College of Medicine and Public Health, South Australia, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, Flinders University, College of Medicine and Public Health, South Australia, Australia.,Department of Psychiatry, Monash University, Faculty of Medicine, Nursing and Health Sciences, Victoria, Australia
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Looi JC, Bastiampillai T, Pring W, Reay RE, Kisely SR, Allison S. Lessons from billed telepsychiatry in Australia during the COVID-19 pandemic: rapid adaptation to increase specialist psychiatric care. Public Health Res Pract 2022; 32:3242238. [PMID: 36509691 DOI: 10.17061/phrp3242238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To summarise and comment upon research regarding the service delivery impact of the introduction of COVID-19 pandemic Medicare Benefits Schedule (MBS) psychiatrist telehealth services in Australia in 2020-2021. Type of program or service: Privately-billed, MBS-reimbursed, face-to-face and telehealth consultations with a specialist psychiatrist during the first year of the COVID-19 pandemic. METHODS This paper draws on analyses of previously published papers. MBS-item-consultation data were extracted for video, telephone and face-to-face consultations with a psychiatrist for April-September 2020 in Victoria, and compared to face-to-face consultations in the same period of 2019 and for all of Australia. We also extracted MBS-item-consultation data for all of Australia from April 2020-April 2021, and compared this to face-to-face consultations for April 2018-April 2019. RESULTS Although face-to-face consultations with psychiatrists waned following nationwide lockdowns, the introduction of MBS billing items for video and telephone telehealth meant that overall consultations were 13% higher in April 2020-April 2021, compared to the pre-pandemic year prior. A lockdown restricted to Victoria was associated with a 19% increase in consultations from April-September 2020, compared to the corresponding period in 2019. LESSONS LEARNT Telehealth has been an integral component of Australia's relatively successful mental health response to COVID-19. The public availability of MBS data makes it possible to accurately assess change in psychiatric practice. The Australian Federal Government subsidises MBS telepsychiatry care by a patient rebate per consultation, illustrating that government-subsidised services can rapidly provide additional care. Rapid and substantial provision of telepsychiatry in Australia indicates that it may be a useful substitute or adjunct to face-to-face care during future pandemics and natural disasters.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, ACT; Private psychiatrist, Canberra, ACT, Australia; Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT;
| | - Tarun Bastiampillai
- Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT; ; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - William Pring
- Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT; Department of Psychiatry, Monash University, Melbourne, VIC, Australia; Centre for Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia; Private psychiatrist, Melbourne, VIC, Australia
| | - Rebecca E Reay
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra Hospital, ACT
| | - Stephen R Kisely
- Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT; School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhouise University, Halifax, Nova Scotia, Canada
| | - Stephen Allison
- Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis, Canberra, ACT; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Looi JC, Allison S, Bastiampillai T, Brazel M, Kisely SR, Maguire PA. Psychiatrist and trainee burnout: Commentary and recommendations on management. Australas Psychiatry 2022; 30:750-753. [PMID: 36112911 DOI: 10.1177/10398562221124798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To comment upon the evidence-base regarding psychiatrist and trainee burnout and provide recommendations on management. CONCLUSIONS Burnout has been conceptualised as a specific stress-related response, primarily related to work. There is a high prevalence of burnout amongst both trainees and psychiatrists internationally, with substantial consequences for personal and family wellbeing, organisational efficiency and patient care. We summarise the evidence on organisational and individual approaches to addressing burnout.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, 104822The Australian National University Medical School, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, 2541Monash University, Wellington Road, Clayton, VIC, Australia
| | - Matthew Brazel
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, 104822The Australian National University Medical School, Canberra, ACT, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, Princess Alexandra Hospital, 1974The University of Queensland, Woolloongabba, Brisbane, QLD, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, 104822The Australian National University Medical School, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
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Allison S, Bastiampillai T, Looi JC, Mulder R. Adolescent borderline personality disorder: Does early intervention 'bend the curve'? Australas Psychiatry 2022; 30:698-700. [PMID: 35514042 DOI: 10.1177/10398562221092311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (BPD) proposed a major change for youth mental health services. The Alliance recommended that early detection and specialised treatment for youth BPD becomes a major focus of their clinical activities. Since structured psychotherapies for BPD are complex and lengthy, this proposal has significant implications for youth policy, planning and resource allocation. Our commentary addresses whether BPD is diagnosable and treatable in youth, and whether early intervention results in longer-term benefits. CONCLUSION People diagnosed with BPD are highly heterogeneous and experience high levels of comorbidity. The low quality of the evidence for the treatment of BPD in adolescence limits our ability to develop evidence-based guidelines. Accordingly, there is no clear case for BPD early intervention as a major component of youth mental health services. The introduction of ICD-11 classification system may facilitate further empirical studies of personality disorders in adolescence and emerging adulthood.
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Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Jeffrey Cl Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, 104822The Australian National University Medical School, Canberra, ACT, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Webb B, Looi JC, Allison S, Bidargaddi N, Bastiampillai T. Point of view: Could social media use be contributing to rising rates of deliberate self-harm and suicide in Australian youth populations? Australas Psychiatry 2022; 30:694-697. [PMID: 35524370 DOI: 10.1177/10398562221100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A rapid clinical update on the potential interplay between social media use and rates of deliberate self-harm amongst young people in Australia. CONCLUSIONS Rising social media use has been associated with increasing cyberbullying and deliberate self-harm, especially in young women. On the other hand, social media use also provides beneficial support. Examination of problematic social media use in assessments of young people presenting with self-harm may be useful, along with discussion of responses to negative social media. In this point of view, we discuss these matters and the UK Royal College of Psychiatrists' recommendations for reducing the negative impact of social media.
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Affiliation(s)
- Beatrice Webb
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, Canberra Hospital, 104822The Australian National University Medical School, Canberra, ACT, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Niranjan Bidargaddi
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and
- Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
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Looi JC, Maguire PA, Bastiampillai T, Allison S. Penumbra of the pandemic workplace for psychiatrists and trainees in Australia. Australas Psychiatry 2022; 30:736-738. [PMID: 35748803 PMCID: PMC9234374 DOI: 10.1177/10398562221109742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A commentary on the workforce, infrastructure and health of psychiatrists and trainees providing psychiatric care during the COVID-19 pandemic in Australia. CONCLUSIONS The wide-ranging workplace, health system and societal changes necessitated by the SARS-CoV-2 virus have altered the practice and working lives of psychiatrists, trainees and other healthcare workers, as well as the general population. There have been workplace innovations, recalibrations and losses. There is a new baseline upon which to build better psychiatric services, as the pandemic's penumbra recedes.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Paul A Maguire
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Looi JCL, Allison S, Bastiampillai T, Kisely SR. Mental health services need action on organisational culture and justice. Australas Psychiatry 2022; 30:739-742. [PMID: 35762969 DOI: 10.1177/10398562221111945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A commentary on the usefulness of the concepts of organisational culture, organisational climate and justice on the quality and safety of mental health services and how conditions may be improved. CONCLUSIONS Organisational culture, organisational climate and justice impact upon the quality and safety of care, as well as well-being of staff, in mental health services. Psychiatrists and trainees, should consider, act and advocate for improved organisational culture, climate and justice. Improvement in these organisational domains can be achieved, through a coordinated framework that acts across all levels of administration, mid-level management and frontline clinical staff.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, 198094Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 198094Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, 1974The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Abstract
OBJECTIVES Australia is piloting a stand-alone early intervention programme for psychosis, based on the Early Psychosis Prevention and Intervention Centre (EPPIC) model that was developed within mainstream Victorian State Government psychiatric services. The Australian early intervention programme is located in primary care, and badged as 'headspace Early Psychosis Youth Services'. There are currently six metropolitan early intervention services with two further services planned for the 2023 Financial Year. We discuss key findings from an external evaluation of the first six services, released by the Australian Government Department of Health under a Freedom of Information request. CONCLUSIONS headspace Early Psychosis Youth Services received high ratings for patient satisfaction and engagement, which was associated with symptomatic improvement and functional recovery. However, governance was complicated, costs were relatively high, and caseload targets were not met. The cost for an additional year of good quality life was estimated at AUD 318,954, which exceeds the usual thresholds for defining a 'good buy'. Integrated models should be investigated, as they seem in principle to offer efficiencies and improved continuity of care.
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Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, 1065Flinders University, Adelaide, SA, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Anthony Jorm
- Centre for Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tarun Bastiampillai
- Department of Psychiatry, Monash University, Melbourne, VIC, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, ACT, Australia
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