Australian and New Zealand Journal of Psychiatry最新文献

Aims: To examine self-perceived need for mental health care in the Australian adult population between 2007 and 2021.

Methods: The Perceived Need for Care Questionnaire in the 2007 and 2021 National Study of Mental Health and Wellbeing captures types of help needed in five mental health care categories: medication, information, counselling, social interventions and skills training. Needs are rated as unmet, partially met, or fully met. Twelve-month affective, anxiety and substance use disorders are assessed using WHO's Composite International Diagnostic Interview.

Results: Demand for mental health care (composite of need categories) among adult Australians increased from 14% (2007) to 20% (2021). It also increased in those with common disorders (43.3-58.9%) and without (6.5-9.9%). Highest 2021 demand was in those with affective (76%), followed by anxiety (61%) and substance use (43%) disorders. Rates of demands being fully met remained stable (45% in 2007; 48% in 2021), with rates among those with substance use (24% in 2021), affective or anxiety (38%) disorders, and those without a common disorder (63%). In 2021, needed supports were counselling (16%), information (11%), medication (10%), skills training (6%) and social interventions (5%). Fully met needs were highest for medication (81%), then counselling (57%), information (54%), skills training (41%) and social interventions (15%).

Conclusions: Despite service expansion, less than half of people with demand had fully met needs. Attention is needed on the causes, population-level prevention as well as treatment strategies to address this burgeoning mental health crisis.

Australia's reclassification of psilocybin as a Schedule 8 substance for treatment-resistant depression represents a significant shift in psychiatric policy. While this regulatory change positions Australia as a global leader in psychedelic medicine, its implementation has revealed substantial challenges. This article critically examines the regulatory, ethical and operational complexities surrounding the provision of psilocybin-assisted therapy in clinical practice. Key issues include limited prescriber access, absence of Australian Register of Therapeutic Goods-listed products, lack of standardised training pathways and significant cost barriers. Ethical considerations such as informed consent, cultural safety and therapeutic fidelity are also discussed, particularly in the context of trauma-informed care. This article proposes a series of structural recommendations to support safe and equitable deployment, including national training accreditation and fidelity monitoring tools. In addition, to maximise the efficacy of psilocybin-assisted therapy, we recommend that research explores the potential of neurobiologically informed stratification models to assist with treatment recommendations. These recommendations aim to enhance clinical integrity through evidence-based patient selection, improved safety, and to ensure that emerging psychedelic treatments are integrated responsibly within Australia's mental health system. By addressing these foundational gaps, Australia can move beyond regulatory novelty ensuring the therapeutic potential of these products is realised in a manner which is scientifically sound and upholds the integrity of psychiatric practice.

Background: There is a paucity of quality appraisal tools specific to determine cultural validity. Cultural validity measures the appropriateness and applicability of a construct for a specific cultural group. It is often discussed in reference to determining if a construct developed in one cultural group is applicable, meaningful and equivalent in another cultural group. First Nations people conceptualise mental ill-health in vastly different ways than the biomedical models most used. Thus, research that does not consider cultural validity can have harmful effects. A specific tool to assess cultural validity in First Nations communities is required to address this significant gap in the literature.

Method: The First Nations Cultural Validity Assessment Tool was developed to assess cultural validity in a meaningful way for First Nations people in Australia. The tool was designed by First Nations researchers with guidance from cultural and lived experience experts and pilot-tested by clinicians and researchers.

Results: The First Nations Cultural Validity Assessment Tool includes 10 criteria within three overarching factors (Psychometric properties, Cultural Psychometric properties and Cultural competency of staff/ethics). The First Nations Cultural Validity Assessment Tool is scored from 0 to 15, with higher scores indicating greater cultural validity. Pilot testing demonstrated excellent inter-rater reliability between scorers.

Conclusion: This is the first tool to assess the cultural validity of measurement tools from the perspective of First Nations frameworks. The First Nations Cultural Validity Assessment Tool prioritises First Nations research values using a methodological approach that is acceptable within both non-Indigenous and Indigenous research practices.

Objectives: Data from a longitudinal national cohort study was used to test associations between young caregiving and self-harming and suicidal behaviours.

Methods: We used data from Waves 6-8 (2014-2018) of the Longitudinal Study of Australian Children to assess the effect of 'core' caregiving activities (e.g. personal care, assistance moving around) on suicidal and self-harming behaviours. Care activities at 16-17 years were classified as core caregiving, non-core caregiving and no caregiving. Five self-harming and suicidal measures, collected at age 18/19 years, were used to form two outcomes: thoughts (of self-harm or suicide, or plan to suicide) and behaviours (self-harm, suicide attempt), operationalised as binary variables. Analyses were carried out using augmented inverse probability treatment weighting, adjusting for potential confounders, on complete case data.

Results: Core caregiving was associated with higher levels of suicidal and self-harming behaviours compared no caregiving, with an average treatment effect (ATE) of 0.07 (95% confidence interval [CI] = 0.02, 0.12), equating to a risk ratio of 1.86 (95% CI = [1.21, 2.45]). The ATE of core caregiving on thoughts of suicide or self-harm (compared to non-caregiving) was 0.05 (95% CI = [-0.00, 0.11]), equating to a risk ratio of 1.26 (95% CI = [0.97, 1.56]). There was no evidence of an association between non-core care and any outcomes tested. Sensitivity analyses confirmed main findings.

Discussion: Core caregiving is associated with elevated risks of self-harm among young carers, underlining the crucial need to better identify and support young carers to mitigate these adverse outcomes.

One of the key concerns of recent national mental health policy has been to lift the rate of population access to mental health services.

Ketamine has emerged as a rapid-acting intervention for treatment-resistant psychiatric disorders, generating both enthusiasm and unease. While evidence demonstrates robust antidepressant, anxiolytic and anti-suicidal effects, ketamine also carries risks, including dissociation, dependence and uncertain long-term safety. Its reputation as a recreational drug further complicates clinical adoption, fostering stigma and regulatory caution. In this article, we consider ketamine's psychiatric use through the lens of medical ethics, structured around the principles of autonomy, beneficence, non-maleficence and justice. We argue that while ketamine should be embraced as a legitimate psychiatric therapy, its application must be grounded in rigorous ethical practice, supported by regulation and research, and shielded from both undue dismissal and premature over-promotion.

Objective: To estimate the proportions and correlates of Australian young people who consulted with health professionals or used services via digital technologies for their mental health in 2020-2022.

Methods: Data from 16- to 24-year-olds (N = 1620) in the 2020-2022 Australian National Survey of Mental Health and Wellbeing were analysed to estimate proportions, population counts and unadjusted odds ratios of past-year health professional consultations and use of services via digital technology for mental health within geographic regions. Logistic regression models explored socio-economic, psychosocial and clinically meaningful correlates of past-year consultation in the full sample, metro subgroup and regional, rural and remote subgroup.

Results: In total, 24.2% of Australian young people consulted with a health professional for their mental health in the past year. Of those with a probable 12-month Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) mental health condition, 46.3% consulted a health professional. This proportion differed by sex (male: 34.2%, female: 55.6%) and symptom severity (mild: 20.0%, moderate: 47.8%, severe: 66.0%) but did not vary by geographic region. One-in-ten (9.9%) young people used other services via digital technologies for their mental health in the past year, doubling among those with a probable 12-month mental health condition (18.8%), and increasing with severity (mild or moderate: 14.2%, severe: 33.6%). Different factors were associated with service use in different regions.

Conclusion: Experiences of young people accessing mental health care in Australia differ by geographic region of residence, neighbourhood disadvantage, sex and disorder class. Australia's mental health care system must facilitate diverse pathways to care that are responsive to young people's needs and preferences.