Zoe Rutherford

Objective: This study aimed to describe rural data from the Australian National Study of Mental Health and Wellbeing survey (2020–2022) to assess strengths-based questions, differences by rurality, and factors associated with excellent social connectedness. Methods: Survey questions were mapped to the Rural Strengths Socioecological Framework. Descriptive and logistic analyses assessed rural adults’ use of strengths by remoteness and presence of affective/anxiety disorders in the past 12 months. Logistic regression explored factors associated with social connectedness. Results: Survey questions reflected some strengths within the Framework including self-management techniques, family and friend support, social connectedness, and health care personnel. However, questions were primarily framed using a deficit perspective and many strengths from the Framework (i.e. nature, rural norms, culture, and lay personnel) were absent. Most strengths did not differ significantly between levels of rurality, though making healthy diet choices (as a self-management technique) was significantly lower in remote areas. Adults without affective/anxiety disorders more often reported good social support and self-efficacy. Conversely, those with affective/anxiety disorders were more likely to self-manage and access consultations for mental health. Excellent social connectedness was associated with better mental health. Conclusion: The survey questions reflected limited strengths. Future surveys should include a broader range of strengths-based questions spanning the extent of the Rural Strengths Socioecological Framework. Healthy diet choices as a self-management tool in remote areas may need to be prioritised. Findings also suggest the need for targeted approaches to protect, improve, or leverage social connectedness for those with more severe illness in rural areas.

Objective: This study aimed to identify characteristics that define population need groups with similar mental health service needs within prisons and describe the mix of services required to meet those needs. Methods: Mixed methods were used, including three iterative, semi-structured focus groups, followed by an online survey, seeking information on the characteristics that define service needs, how these can identify groups of people who require mental health care in prisons and the services required by each group. Participation was sought from prison health services, prison mental health services, non-government service partners and people with a lived experience. Focus group transcripts and free text survey responses were thematically analysed. Descriptive statistics were generated for online survey responses to Likert Scales to determine the levels of agreement with survey content. Results: The characteristics and service needs of four distinct population groups who require mental health care in prisons were defined: indicated prevention, mild, moderate, severe and complex. These groups were delineated using characteristics including presence of a diagnosed mental illness, level of functional impairment, presence of added complexity and service response required. The required service mix varied across need groups, however service types common across all groups included assessments, psychological therapies, peer support, lifestyle interventions and carer support. Conclusions: The identified need groups and service descriptions will contribute to the evidence required for needs-based planning of mental health care in Australian prisons. This information can be used for planning a responsive, equitable, and needs-based mental health service system within custodial environments.

Background: Master protocols leverage a common trial infrastructure for launching multiple sub-studies. Translational research aims to progress scientific discoveries toward public health impact, which depends on establishing an intervention’s efficacy, effectiveness in real-world conditions, and successful strategies for implementation. While master protocols have been designed to improve the efficiency of clinical trials as sub-studies addressing a particular disease, their application with effectiveness-implementation hybrid studies is yet to be explored. The aim of this study was to develop recommendations for adapting mater protocol methods for effectiveness-implementation research. Methods: A method of consultation with translational research networks was undertaken between January and December 2024. Consideration was given to the requirements for service providers to engage in translational research, and how master protocols could support effectiveness-implementation hybrid sub-studies. The underlying rationale for potential adaptations is provided with reference to implementation frameworks, discussion of advantages and disadvantages, and summary recommendations. Results: Recommendations are proposed on establishing common trial infrastructure, aims and hypotheses, data collection, control groups, adaptive elements, and eligibility criteria. By leveraging cross-sectoral partnerships, co-producing research and dissemination, and incorporating adaptive elements, master protocols may offer a promising approach for accelerating progress along the translational research pipeline. Conclusions: The adaptation of master protocols for hybrid sub-studies could enable evidence-based interventions to be more effectively implemented in routine care settings. The feasibility of master protocols for effectiveness-implementation research is yet to be tested, and further development in this area is needed to trial the proposed methodology.

Safe Spaces offer a person-centred, non-clinical and welcoming place for adults experiencing a mental health crisis to seek support as an alternative to presenting to the Emergency Department (ED). The aim of the study was to evaluate the effectiveness of Queensland Health’s Crisis Support Spaces (CSS), which are a hospital-based Safe Space service that has been piloted in the state of Queensland in Australia. The research employed a mixed-methods design. Retrospective, de-identified program data was analysed from 2,235 consumers who accessed a CSS in Queensland during the period of 23/01/2021 to 31/10/2023. Outcome variables were computed using data from Queensland Health’s Consumer Integrated Mental Health and Addiction (CIMHA) and Emergency Data Collection (EDC) datasets. Within-groups t-tests were used to analyse pre- to post- intervention changes in psychological distress ratings, number of mental health related ED presentations and number of mental health related hospital admissions. In addition, 78 semi-structured interviews were undertaken with CSS consumers and carers, CSS staff and broader mental health system staff; these were analysed using applied thematic analysis. Consumers experienced a statistically significant, large sized reduction in psychological distress ratings at post-intervention (mean difference = -2.9; p <.001; d = 1.30). A statistically significant, large sized reduction was also observed in the number of mental health related hospital interventions at 6-months post-intervention for those consumers with a prior history of inpatient admissions (mean difference = -1.0; p <.001; d = 0.80). Furthermore, a statistically significant, small sized reduction was observed in mental health related emergency department (ED) presentations at 6-months post- intervention for those consumers with a prior history of ED presentations (mean difference = -0.8; p <.001; d = 0.37). Qualitative data provided insights into potential mechanisms through which the service may achieve its intended outcomes (e.g., providing a safe environment for consumers to de-escalate their psychological distress, teaching consumers skills to self-manage their mental health). The findings of this study provide mixed-methods evidence supportive of the effectiveness of CSS in helping consumers reduce their psychological distress and preventing mental health related ED presentations and hospital admissions.

Objective: This study aimed to determine if rural community strengths identified in the literature have been causally linked to improved mental health and whether these strengths have been harnessed in interventions.Methods: A secondary analysis of a systematic review of literature from Australia, Canada and the USA identified 28 studies that proposed a conceptual relationship to improved mental health. Studies were categorised, their distribution across a socioecological framework was assessed, and evidence of causality was evaluated.Results: Among 28 studies, 24 were analytical and focused mainly on community strengths, with four interventional studies that addressed both personnel and community strengths. None established a causal relationship, including those that harnessed strengths in interventions.Conclusions: Although rural strengths have been associated with improved mental health, evidence on causality, effectiveness and mechanisms for harnessing remains limited. Strengthening the evidence base is critical to justify incorporating rural strengths into mental health commissioning.

Purpose: To identify, critically appraise, and synthesise the published and grey literature on person-centred crisis support services as an alternative to support in emergency departments (EDs) for people experiencing mental health crises. This scoping review explores the characteristics and outcomes of these services. Methods: A systematic scoping review was undertaken to identify publications describing person-centred crisis support services and their outcomes. Search strings were applied to multiple databases, and publications were subjected to quality appraisal. The review process was informed by The Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Results: Thirteen publications were included in the narrative synthesis, and these considered eight separate crisis support services. The methodological quality of the publications included was limited. Key findings were positive visitors’ experiences, high rates of ED deflection, and overlaps between repeat visits, crises prevention, and hospital avoidance. Key recommendations included increasing opening hours and capacity and improving service awareness and accessibility. Conclusions: The available evidence suggests that person-centred crisis support services are perceived by stakeholders as safe and effective alternatives to EDs for people experiencing mental health crises, providing more timely and appropriate care while reducing ED mental health presentations. Due to the limited quality of the publications included, high-quality research is needed to better understand the model and confirm the findings reported in this review.

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This study aimed to define required forensic mental health service types in Australia. A staged Delphi process was used, including: (1) reference group consultation to establish a set of core forensic mental health service types; (2) Delphi survey to seek consensus on identified service types and definitions among forensic mental health stakeholders in Australia; and (3) amendment of service definitions in response to survey feedback. Nine forensic mental health service types were identified. Consensus (>80% agreement) was achieved among Delphi respondents that all services were core components of an ideal forensic mental health system. These included forensic bed-based (acute, sub-acute, non-acute, non-acute community), forensic community, outreach, prison and court liaison services. The high levels of agreement on service types are notable considering legislative differences impacting on design and operation of services across jurisdictions. The findings could contribute to the evidence base required for needs-based planning of forensic mental health services.