Megan Rattray

Objective: To systematically evaluate the extent and quality of patient and public involvement (PPI) reporting in prehabilitation programmes and research. Data Sources: Keyword searches were conducted in MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane Central Register of Controlled Trials from 1 January 1994 to 22 October 2025. Review methods: Using an a priori protocol registered with PROSPERO, a systematic review was conducted in accordance with PRISMA guidelines. A narrative synthesis approach was used to interpret findings across heterogeneous studies. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A patient representative contributed to the study design and co-authored the review. Results: From 14,078 records, 16 studies reporting PPI were included from the UK, Australia, Canada, USA and Spain. Most studies involved patients at multiple stages, using varied approaches including experience-based co-design. Reporting quality was suboptimal; only three studies met all items of the GRiPP2-SF checklist criteria, and none used a formal PPI reporting checklist tool. Conclusion: Few prehabilitation programmes are designed with patient and public involvement; highlighting the need for collaborative approaches to improve acceptability and adherence. Although evidence of PPI is limited, several studies demonstrated sustained and meaningful involvement. Reporting remains inconsistent, underscoring the need for clearer reporting to strengthen the evidence base and support wider adoption. The findings highlight substantial opportunities for collaboration in future programmes, and further research should examine how PPI influences adherence, patient experience and the overall effectiveness of prehabilitation interventions.

Objective: To co‐design, deliver and evaluate a suicide prevention workshop aimed at improving the knowledge, skills and confidence of general practice and community staff in rural South Australia. Setting: A 2.5‐h in‐person workshop was delivered across three rural communities on the Eyre Peninsula, Australia. Participants: Sixty‐seven individuals attended the workshop. Of these, 61 completed a pre‐ and post‐workshop survey (91% response rate). Participants who completed the survey included practice staff ( n = 27), mental health or psychosocial support workers ( n = 18), community volunteers ( n = 6), suicide prevention network representative ( n = 4) and other ( n = 6). Method: The design of the workshop was guided by Participatory Action Research principles and underpinned by the Double Diamond model. The workshop was co‐designed by a multidisciplinary advisory group, including two individuals with lived experience. The objectives of the workshop were to help attendees to: (1) recognise verbal and non‐verbal warning signs of suicidal ideation, (2) respond effectively to provide immediate support and (3) connect individuals with appropriate referral services. A mixed‐methods pre–post survey assessed changes in participants' confidence, knowledge and skills aligned with these objectives, along with their perceptions of the workshop. Pre‐ and post‐workshop responses were compared using the Wilcoxon Signed‐Rank Test, with statistical significance set at p < 0.001. Open‐ended survey responses were analysed using a combination of deductive and inductive content analysis. Results: Statistically significant improvements were observed across all evaluation items from pre‐ to post‐workshop, with the greatest gains in recognising subtle behavioural or emotional changes (1.25 points mean difference) and feeling skilled in knowing what services to recommend (1.28 points mean difference). Participants also reported high satisfaction (4.6 ± 0.73) and found the content highly relevant to their roles (4.5 ± 0.78). Content on referral pathways, local services and strategies for responding to suicidal ideation was identified as the most impactful. Including deeper coverage of culturally safe approaches for First Nations people, greater discussion around the differences among genders in the experiences of suicidality and more detailed exploration of specific mental health conditions and self‐care strategies for staff were suggested as enhancements. Conclusion: The co‐designed workshop effectively enhanced suicide prevention capabilities among frontline and community staff. Its success highlights the value of locally tailored, collaborative training that integrates lived experience and responds to community‐specific needs. This model offers a scalable framework for workforce development in suicide prevention.

Primary care (general practice) clinics play a significant role in ongoing mental health care and assessment, treatment, and referral of people experiencing distress. Peer support workers (PSWs) are part of the growing Lived Experience workforce in many mental healthcare settings and evidence for their value is growing rapidly. Yet, this workforce is largely absent from primary care. Qualitative interviews with 10 consumers, six family carers, eight PSWs, and 14 general practice doctors, nurses and administrative staff occurred prior to a real-world trial and explored their perceptions of the potential benefits of introducing a PSW intervention for people who seek help for their mental health within primary care in Australia. Interview data were analysed thematically using Braun and Clark’s six-step guide, following an inductive approach. Four themes were identified: (1) offering companionship, validation, and hope; (2) sharing learnings and providing practical support; (3) aiding in communication and offering consistency to help address service system gaps and health service navigation; and (4) redistributing power and advocacy. There was strong agreement across interviewees about potential positive impacts that PSWs could have in enhancing mental health care in primary care. These benefits require testing within primary care, given known challenges with awareness and understanding of the PSW role by other health professional disciplines in mental health settings, and differences related to how peer support and primary care practice are delivered. Overall, these perspectives and the existing evidence suggest that peer support may lead to more responsive, safe, effective, and person-centred primary mental health care.

Addressing workforce issues such as recruitment, retention, and skill development is essential for ensuring that community psychosocial and mental health programs can meet growing demand and provide high-quality care. This paper examines current efforts to tackle these challenges and explores additional measures required. This qualitative study, framed within a naturalistic paradigm, employed semi-structured interviews with mental health support staff across Australia. Interviews, lasting approximately 37 min (range, 23–55 min), were audio recorded and transcribed verbatim. Data were analysed using a combination of inductive and deductive thematic analysis, whereby participants’ verbatim codes were initially mapped across the three workforce issues: recruitment, retention, and skill development. Solutions for each issue were then analysed inductively, with subthemes emerging from common concepts. Themes and subthemes were discussed among the authors until consensus was reached. Sixteen staff members were interviewed, most of whom were female (n = 9, 56%) and held management roles (n = 10, 62%), while the rest were in client-facing positions (n = 6, 38%). To improve staff recruitment, subthemes included revising recruitment processes and standards, dispelling misconceptions and promoting the field and leveraging existing networks and resources. Staff retention subthemes included offering competitive salary packages and incentives, fostering a positive work culture with engaged leadership and encouraging supportive and effective practices. Lastly, upskilling staff subthemes included engaging in regular or mandatory training and supervision, encouraging resource sharing and networking and supporting and granting opportunities to upskill. The findings offer insights and recommendations for policymakers, administrators, and practitioners to strengthen the community mental health workforce.

The introduction of the National Disability Insurance Scheme (NDIS) in 2013 and the resulting changes in mainstream funding for psychosocial supports have led to disparities in funding between the two existing systems. Currently, people supported under the NDIS receive significantly more funding compared to those supported through federal and state programs. The NDIS review has highlighted this inequity, prompting a commitment to increase state and federal funding for foundational psychosocial supports. However, the specifics of this funding remain unclear. This article synthesises and critically evaluates the recent NDIS review recommendations relating to psychosocial disability and makes recommendations on how both systems could be enhanced to ensure equitable and accessible psychosocial support provision in Australia.

The ‘Service Navigation Measure’ (SNM) initiative was introduced in 2020 as part of Commonwealth Psychosocial supports delivered through the Primary Health Networks (PHNs) in Australia. The aim of this study was to explore the experiences of clients who received this initiative. An exploratory sequential mixed method study was undertaken in the Australian primary care setting. Quantitative data, which involved closed-ended questions, were collected via a survey. Qualitative data were then collected through open-ended questions in the survey and during one-on-one, semi-structured interviews. This data was collected from clients (consumers, families, carers, and health practitioners) who accessed the service one or more times for mental health support. Interviews were audio recorded and transcribed verbatim. Methodological triangulation was employed to enhance the validity and credibility of the findings. This involved thematically analysing the qualitative data to identify emergent themes and sub-themes, and aligning the quantitative data, which were summarised using frequency (%), to these findings where appropriate. A total of 349 clients (159 consumers, 43 family members, 70 carers or support workers, 72 health practitioners, 7 unknown) completed the survey and 8 of these participated in a follow-up interview (7 consumers and 1 health practitioner). Three overarching themes emerged from the data: (i) Receiving helpful and timely support, (ii) Appreciating empathetic and understanding support, and (iii) Valuing and enhancing follow-up support. Clients expressed overwhelmingly positive experiences, attributing their satisfaction to timely, helpful, and empathetic support, as well as the vital role of follow-up care. This appreciation extended not only to individuals facing mental health challenges but also to the carers and healthcare practitioners seeking information for those under their care. By incorporating these insights into service navigation practices, healthcare systems may enhance their ability to address the mental health needs of their communities, potentially contributing to improved experiences and outcomes for individuals facing mental health challenges.

The Commonwealth Psychosocial Support Program, funded by the Australian Government, offers psychosocial support to individuals with severe mental illness. Currently, little research has addressed the challenges confronting its workforce. This study aimed to assess whether recruitment, retention, and staff skills pose significant issues for the Commonwealth Psychosocial Support Program and to identify contributing factors. This study used a mixed-methods explanatory sequential design. 159 mental health support staff across Australia participated in an online survey. From this sample, 16 participated in a semi-structured interview. Survey data was analysed using descriptive statistics and chi-squared tests, while qualitative data was examined through deductive content analysis. 84%, 77% and 56% of staff agreed that recruitment, retention and the skill of staff are significant issues affecting the delivery of the Commonwealth Psychosocial Support Program, respectively. While no significant differences were found in staff characteristics for recruitment and retention concerns, geographical location showed notable disparities in perceptions of staff skill (χ²(4, N = 153) = 11.318, p = 0.023). Specifically, a higher proportion of rural or remote (68%) and regional (63%) staff identified staff skill as an issue compared to metropolitan counterparts (39%). Key factors contributing to poor recruitment included short-term contracts (77%), while burnout (74%) and job insecurity (72%) were indicated for poor retention. Inadequate skill was attributed to infrequent professional development (53%), insufficient on-the-job training (53%), limited mentoring and supervision (50%), and unclear role expectations (50%). Addressing these multifaceted issues is imperative for enhancing the effectiveness of community-based mental health services and ensuring sustained support for individuals with severe mental illness across diverse geographical locations.

General practice is pivotal in delivering mental health care within communities, yet the attitudes and professional factors influencing this provision remain underexplored. This study seeks to understand the perspective of general practice staff around the professional factors that influence the provision of primary mental health care. A qualitative study was conducted with semi-structured interviews of 14 general practice staff involved in mental health care. Participants included receptionists (n = 3), nurses (n = 4), practice managers (n = 3), and general practitioners (n = 4), recruited via purposive sampling. The Theoretical Domains Framework (TDF) guided the interviews, and thematic analysis was used to identify themes and subthemes. Three themes were identified. The first, ‘Role identity, skills, and leadership in mental health care,’ included subthemes of distinct role recognition with overlap, essential relational and practical skills, and leadership valued among experienced GPs. The second theme, ‘Confidence and involvement in mental health care,’ covered variability in confidence levels, differing perceptions of involvement, and attitudes towards further involvement. The third theme, ‘Drivers for and outcomes of delivering mental health care,’ revealed intrinsic motivations and acknowledged both benefits and serious consequences. This study explored general practice staff beliefs about role identity, skills, leadership, confidence, involvement, motivations, and perceptions of benefits in mental health care provision. The findings offer valuable insights into the complexities of mental health care in general practice, with significant implications for practice management and healthcare policy development.