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.

Introduction: Effective management of mental health crises is a growing global concern, significantly impacting emergency services. In New Zealand the New Zealand Police have begun reducing their involvement in mental health emergencies. This shift positions paramedics as primary responders in pre-hospital mental health crisis management. This current study conducts a comparative analysis of mental health legislation in New Zealand, Australian jurisdictions and the United Kingdom to assess how laws empower paramedics in mental health crises.

Methods: A structured framework was employed to evaluate 12 key domains relevant to pre-hospital mental health interventions. These domains include criteria for involuntary detention, emergency detention and transportation powers, integration of services and legal protections for paramedics.

Results: The analysis reveals that New Zealand's Mental Health Bill (as introduced in 2024) emphasises reducing coercion and promoting culturally appropriate care but lacks provisions granting paramedics the authority to manage crises in isolation. In contrast, jurisdictions like the Northern Territory, Western Australia and Queensland empower paramedics with greater legal authority and more integrated roles in mental health emergencies.

Discussion: The absence of health-based legal tools and insufficient integration with mental health services in New Zealand may limit paramedics' effectiveness in crisis management, potentially increasing reliance on police and delaying interventions. Recommendations include expanding paramedic authority in line with other jurisdictions and improving integration with mental health services. By adopting models from leading Australian jurisdictions, New Zealand paramedics will be better placed to manage mental health responses and support a reduction in police involvement.

Background: Lesbian, gay, bisexual, transgender, queer or questioning, asexual or aromantic and more (LGBTQA+) populations face disparities in health outcomes, which are particularly pronounced in relation to mental health. While psychotic disorders are associated with added barriers to treatment, they are rarely included in conversations around improving healthcare for LGBTQA+ individuals. The present study compared the healthcare experiences reported by LGBTQA+ individuals with psychotic disorders, common mental disorders (anxiety and depressive disorders) and physical health conditions.

Methods: A large online cross-sectional survey of LGBTQA+ adults in Australia was completed by 6835 individuals: 84 diagnosed with psychotic disorders, 521 diagnosed only with common mental disorders and 318 diagnosed only with common physical health conditions. Logistic regression analyses were used to investigate the association between diagnostic groups and health service access, service satisfaction and perceived respect for identity, and the importance of service LGBTQA+ inclusivity.

Results: Compared to those with psychotic disorders and common mental disorders, participants with physical health conditions were more likely to access mainstream clinics that are not explicitly LGBTQA+ inclusive and demonstrated a trend towards lower importance of service LGBTQA+ inclusivity. Participants with psychosis reported lower levels of respect for gender identity in LGBTQA+ inclusive services than those with common mental disorders.

Discussion: Differences in healthcare experiences between LGBTQA+ participants with physical health conditions, common mental disorders and psychotic disorders are present but not marked. Findings highlight a need for improved LGBTQA+ competencies in mainstream services and resource allocation to community-led services. Further research is needed to explore the factors contributing to worsened healthcare experiences for individuals with psychosis.

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: People with different psychiatric diagnoses use certain suicide methods more frequently. These findings could have implications for reducing suicide. Therefore, the aim of this study was to assess associations between three severe mental illnesses (SMIs) and suicide methods, while adjusting for other confounding factors that could influence choice of suicide methods.

Methods: We used information on all individuals dying by suicide in Queensland, Australia, from 1989 to 2021. Methods were compared to hanging, strangulation and suffocation for people with three different SMIs with adjusted risk ratios in multinomial logistic regression models.

Results: People with psychotic disorders were over three times more likely to jump from a high place, jump or lie before a moving object, or use a sharp object. They were also more than twice as likely to use explosive material or smoke, fire and flames; or drowning and submersion and 60% more likely to use crashing of a motor vehicle. Poisoning by drugs was around 50% higher in those with psychotic disorders or depression. No other methods were substantially elevated relative to hanging, strangulation and suffocation (HSS). People with bipolar and depression had a lower risk ratios (RR) for several suicide methods.

Conclusion: People with psychotic disorders were the most likely to use diverse methods and would benefit the most from means restriction interventions. Trialling interventions to ensure that people with psychotic disorders can avoid situations where they could use these methods may reduce suicides in this group. Further analysis of what drugs people with depression and bipolar might use is needed.