David Crompton

Objective: The study assessed the impact on clinicians' ‘perception of skills’ in postdisaster evidence‐informed care (EIC) following participation in an online training programme implemented following the Queensland floods and cyclones of 2010–11, clinician confidence to provide EIC, the frequency clinicians used EIC and barriers to providing postdisaster specialist mental health care.Design: Clinician perception of pre and posttraining skills, confidence in providing therapies such as trauma‐focused cognitive behaviour therapy (TF‐CBT), frequency of therapies provided and clinician perception of barriers to the programme were assessed quantitatively and qualitatively.Participants and Setting: Clinical staff (n = 60) employed by the 2010–11 postdisaster mental health programme participated in an online survey conducted over the last 12 weeks of 2012. After the programme concluded an independent audit of the clinical record of mental health clients treated by clinicians employed in the specialist mental health programme was undertaken.Main Outcome Measure(s): Perception of clinical skills in various EIC modalities was completed pre and posttraining. Confidence to provide a treatment was rated on a five‐point scale. The clinical record audit identified the treatments provided to clients. Barriers to programme delivery were rated on a five‐point scale, with qualitative feedback highlighting programme concerns.Results: Posttraining clinicians perceived skills in TF‐CBT (p < 0.0001), cognitive behaviour therapy (CBT) (p < 0.001) and exposure therapy (p < 0.001) had improved. Following training, clinicians described themselves as moderately to extremely confident in implementing TF‐CBT (87%), exposure therapy (80%) and skills for psychological recovery (SPR) (88%). Clinical records analysis indicates that 25% of cases received no TF‐CBT, while 43% received one to five sessions. Barriers to care included a lack of cross‐service relationships. Recommendations focused on training and early commencement of intervention programmes.Conclusion: The study echoes the findings of the 2020 Australian Bushfire Royal Commission recommendations that highlighted a need for clinician training in postdisaster EIC and the availability of clinicians with specialised postdisaster mental health skills.

Objectives: A retrospective naturalistic evaluation was undertaken to identify if pre- and post-disaster factors may predict the likelihood of those considered “at risk” of post-traumatic stress disorder (PTSD) entering a post-disaster clinical treatment program. Methods: The intake data of 881 people referred to the program following the Queensland (Australia) natural disasters of 2010-11 was evaluated. Those referred scored >2 on the Primary Care PTSD scale. Assessment included the disaster exposure experience, demographic and clinical information, and measures of coping and resilience. Descriptive analyses and a Classification Tree Analysis (CTA) were undertaken to ascertain which factors may predict treatment participation. Results: The treatment group (TG) in comparison to the non-treatment group (NTG) were more likely to perceive their life was threatened (85.1% vs 8.1%), less able to cope (67% vs 25.8%) and less resilient (4.2% vs 87.5%). The CTA using all the assessment variables found the Connor-Davidson (2-item scale) (P < 0.001), degree of property damage (P < 0.001), financial losses (P < 0.001), perception their life was threatened (P < 0.001) and insurance claims (P < 0.003) distinguished the TG from the NTG. Conclusions: The study identified factors that distinguished the TG from the NTG and predicted the likelihood of participation in a post-disaster mental health treatment.

The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of care following suicide-related emergency presentations. This study aimed to evaluate the pilot program’s effect on suicidal ideation and hope, and to explore the acceptability and participants’ experiences. A mixed-methods design was employed with pre- and post-evaluation questionnaires, including the GHQ-28-SS (general health questionnaire suicide scale), AHS (adult hope scale), and K10 (Kessler psychological distress scale). Participant engagement rates and semi-structured interviews were used to explore program acceptability. In total, 142 people were engaged with the PAUSE pilot between 24 August 2017 and 11 January 2020. There were no significant gender differences in engagement. The suicidal ideation scores decreased, and the hope scores increased after participation in PAUSE. A thematic analysis revealed that participants identified that the key program mechanisms were holistic and responsive support, ongoing social connectedness, and having peer workers who understood their experiences and treated them like people rather than clients. The small number of participants and lack of a control group limited the result generalizability. The findings suggest that PAUSE was an effective and acceptable model for supporting people following suicide-related hospitalisations in this pilot sample.

Background: Following the 2010-2011 floods and cyclones that affected 78% of Queensland, Australia, a State-wide mental health response was established. The response plan included a 24-hour access line. This study examines the effectiveness of the mental health screening program conducted via the State-wide health call center (13HEALTH) in 2012.Methods: Callers to the 13HEALTH line were screened to assess the impact of the disaster. The 13HEALTH clinicians administered the Primary Care-Posttraumatic Stress Disorder Scale (PC-PTSD) screening measure. Those scoring more than two on the PC-PTSD Scale were provided information on the emotional impact of disasters and a referral to the post-disaster specialist mental health program (SMHP). For calls related to those under 18, a single-item question assessed behavioral or emotional changes since the natural disasters. Those with identified changes were offered a referral to a post-disaster SMHP.The study evaluates the relationship between disaster exposure and the likelihood of 13HEALTH callers experiencing physical health concerns and unacknowledged mental health symptoms. The program’s cost for the 12 months of 2012 was assessed using data from the financial contract.Results: In 2012, there were 205,064 calls to 13HEALTH: 19,708 identified as residing in a flood or cyclone-affected area, 7,315 adults indicated they were personally affected, and 907 scored more than two on the PC-PTSD Scale. Only 700 agreed to a referral to the SMHP. There were 290 children under 18 assessed as at risk; 207 accepted a referral to a SMHP.Regions that experienced a greater impact from the floods and cyclones were 1.3-2.3 times more likely to report being personally affected by the floods and cyclones. Similarly, these regions had more callers scoring more than two on the PC-PTSD Scale. The total cost of the 13HEALTH program for 2012 was $53,284 (AU) across all age groups.Conclusion: The 13HEALTH general health post-disaster screening program demonstrates opportunistic screening may assist identification of those with unmet mental health needs. The data indicate an increased likelihood of personal exposure in the more affected regions with an increased risk of unrecognized psychological symptoms as assessed by the PC-PTSD Scale. However, more than 20% declined referral to a SMHP.

Introduction: Following natural disasters, rural general practitioners (GPs) are expected to undertake several roles, including identifying those experiencing psychological distress and providing evidence-informed mental health care. This paper reports on a collaborative mental health program developed to support a rural GP practice (population <1,500) and a disaster response service.Methods: The program provided specialized disaster mental health care via the placement of a clinician in the GP facility. In collaboration with the GP practice, the program offered opportunistic screening using the Primary Care Posttraumatic Stress Disorder (PTSD) Scale (PC-PTSD) for probable PTSD as the primary measure and the Kessler 6 (K6) as a secondary measure. Those scoring higher than two on the PC-PTSD scale were referred to the mental health clinician (MHC) for further assessment and treatment.Results: Sixty screening assessments were completed. Fourteen patients (male = 3; female = 11) scored higher than two on the PC-PTSD. The referred group PC-PTSD mean score was 3.14 and K6 mean score of 19. Those not referred had a PC-PTSD mean score = 0.72 and K6 mean score = 7.30. The treatment and non-treatment groups differed significantly (PC-PTSD: P <.00001 and K6: P <.00001). A prior history of trauma exposure was notable in the intervention group. Eight reported a history of domestic violence, seven histories of sexual abuse, five childhood sexual abuse, and eight intimate partner violence (IPV).Conclusion: A post-disaster integrated GP and mental health program in a rural community can assist in identifying individuals experiencing post-disaster psychological distress using opportunistic psychological screening. The findings indicate that collaborative mental health programs may effectively support rural communities post-disaster.

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.

Purpose To synthesize the literature in relation to findings of system errors through reviews of suicide deaths in the public mental health system. Data sources A systematic narrative meta-synthesis using the PRISMA methodology was conducted. Study selection All English language articles published between 2000 and 2017 that reported on system errors identified through reviews of suicide deaths were included. Articles that reported on patient factors, contact with General Practitioners or individual cases were excluded. Data extraction Results were extracted and summarized. An overarching coding framework was developed inductively. This coding framework was reapplied to the full data set. Results of data synthesis Fourteen peer reviewed publications were identified. Nine focussed on suicide deaths that occurred in hospital or psychiatric inpatient units. Five studies focussed on suicide deaths while being treated in the community. Vulnerabilities were identified throughout the patient’s journey (i.e. point of entry, transitioning between teams, and point of exit with the service) and centred on information gathering (i.e. inadequate and incomplete risk assessments or lack of family involvement) and information flow (i.e. transitions between different teams). Beyond enhancing policy, guidelines, documentation and regular training for frontline staff there were very limited suggestions as to how systems can make it easier for staff to support their patients. Conclusions There are currently limited studies that have investigated learnings and recommendations. Identifying critical vulnerabilities in systems and to be proactive about these could be one way to develop a highly reliable mental health care system.

Background: While there have been increased calls for mental health consumers to be involved in mental health services research, there is limited research exploring the research interests of this group. Aims: To compare the interests in different research topics of a peer workforce (people who are employed to use their lived experience of mental illness and recovery to support others) with those of Allied Health Professionals in a Hospital and Health Service. Method: A survey asking participants to rate their interest in researching various topics was distributed to the peer and allied health workforce. Differences between the two groups were tested with the Kruskal–Wallis test for independent samples. Results: The peer workforce consistently rated their interest in all questions as greater than the Allied Health Workforce with five of the seven questions showing statistically significant differences. The median ratings of interest for four of the seven topics were high for both the peer and allied health. These were primarily items on how to help. The peer workforce also expressed a greater interest in being involved in the research. Conclusions: Our study emphasises the importance of creating opportunities for including the peer workforce in all aspects of the research process.

Preventing suicide is a global priority, and staff training is a core prevention strategy. However, frontline pressures make translating training into better care and better outcomes difficult. The aim of the paper was to highlight challenges in suicide risk assessment and management and introduce training frameworks to assist with mindful practice so professionals can strike a balance between risk and recovery. We combined the scientific literature with contemporary practice from two successful initiatives from Cambridgeshire, UK: 333 – a recovery‐oriented model of inpatient/community crisis care and PROMISE – a programme to reduce coercion in care by enhancing patient experience. The resulting PROTECT (PROactive deTECTion) frameworks operationalize ongoing practice of relational safety in these programmes. PROTECT is a combination of novel concepts and adaptations of well‐established therapeutic approaches. It has four training frameworks: AWARE for reflection on clinical decisions; DESPAIR for assessment; ASPIRE for management; and NOTES for documentation. PROTECT aims to improve self‐awareness of mental shortcuts and risk‐taking thresholds and increase rigour through time‐efficient cross‐checks. The training frameworks should support a relational approach to self‐harm/suicide risk detection, mitigation, and documentation, making care safer and person‐centred. The goal is to enthuse practitioners with recovery‐oriented practice that draws on the strengths of the person in distress and their natural circle of support. It will provide the confidence to engage in participatory approaches to seek out unique individualized solutions to the overwhelming psychological pain of suicidal distress. Future collaborative research with people with lived and carer experience is needed for fine‐tuning.

The insights of people who have experienced mental health issues are at the core of recovery frameworks. The inclusion of peer support workers in clinical care teams is crucial to a recovery-supportive focus. Peer support workers facilitate egalitarian spaces for non-peer staff and consumers to frankly discuss the lived experience of mental illness. This study was part of a larger evaluation study which aimed to explore the implementation of a newly formed community-based mental health team in South-East Queensland, Australia. The paper reports the role of peer support workers and answers two research questions: “How is peer support work constructed in an interprofessional clinical care team?” and (2) “How do interprofessional mental health clinical care teams respond to the inclusion of peer support workers as team members?” Three themes were identified: peer support worker’ ability to navigate a legitimate place within care teams, their value to the team once they established legitimacy and their ability to traverse the care landscape. Ultimately, successful integration in interprofessional teams was dependent upon the ability of clinical staff to focus on unique strengths that peer support workers bring, in addition to lived experience with mental illness as a carer or consumer.