Australian and New Zealand Journal of Psychiatry最新文献

This paper examines the legal meaning and clinical impact of the different harm to self and others criteria as they appear in the provisions permitting involuntary inpatient treatment in each of Australia's mental health acts. The wording of each criterion is reviewed along with relevant Court decisions, explanatory memoranda, second reading speeches and advice published by governments. Each jurisdiction's harm criterion is set out along with: the breadth of scope of the harms envisaged; how severe any harm must be to trigger the criterion; and how likely it must be that the envisaged harm will arise. The paper is designed so that readers from each jurisdiction may focus on advice relevant to their jurisdiction. In most clinical encounters where involuntary hospitalisation is proposed, the most salient harms for consideration are serious psychological harms and harms to relationships, alongside physical harm to self or others where relevant. The harm criterion sets the minimum level of harm that must be anticipated before clinicians have legal authority to provide involuntary treatment. Where a patient refuses treatment without decision-making capacity, anticipated harms must be 'serious', but only so serious as to justify overriding the patient's refusal, taking into account the harms involuntary treatment itself may cause. In such cases, whether a person can be detained and treated will hinge largely on each jurisdiction's least restrictive criterion.

Objective: This study presents estimates of the prevalence, severity and correlates of mental health conditions in Australian emerging adults within geographic regions.

Methods: We analysed data from 16- to 24-year-olds (N = 1620) of the 2020-2022 Australian National Study of Mental Health and Wellbeing, a national cross-sectional household survey. Estimated prevalence, population counts and unadjusted odds ratios of the 12-month Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) mental and substance use disorders (mental health conditions) are presented for Modified Monash Model categories (geographic region). Multivariable logistic regression models explored correlates of any mental health condition in the full sample, metro subgroup and regional, rural and remote subgroup.

Results: Over one-third of emerging adults met criteria for a mental health condition. Anxiety disorders were most prevalent (29.2%), then mood disorders (13.7%) and substance use disorders (7.8%). Prevalence was high across metro areas (36.1%); regional centres (35.4%); large rural towns (38.4%) and medium rural towns, small rural towns and remote communities (38.1%). Lifetime exposure to suicide or sexual assault was associated with mental health condition in all regions. In metro but not regional, rural and remote areas, female sex, neighbourhood disadvantage, household financial hardship, no engagement with education/employment, lifetime physical domestic or family violence, less social support and bodily pain were associated with mental health condition.

Conclusion: Mental health conditions are prevalent among Australian emerging adults in metro, regional, rural and remote regions. Equitable solutions bringing together the full continuum of care in mental health, suicide prevention, sexual violence and bodily pain are needed to reduce their significant impact.

The Early Psychosis Prevention and Intervention Centre model has significantly shaped early intervention strategies for psychotic disorders, setting a benchmark for effective care and influencing practices globally. The model's effectiveness has been demonstrated through various trials and systematic reviews, highlighting its benefits in symptomatic relief, functional improvement and reduced hospitalisation. This paper explores and proposes advancements to the current model of care for early psychosis, incorporating recent developments and emerging evidence in the field. We highlight several areas to further enhance the Early Psychosis Prevention and Intervention Centre model. This includes highlighting the importance of interventions to reduce duration of untreated psychosis, maximising pharmacological and cognitive interventions, incorporating digital technologies for real-time feedback and personalised care, and access to physical health interventions to prevent unwanted long-term physical outcomes. In addition, the growing role of trauma-informed care, and more recently, peer support, as well as approaches and interventions for culturally diverse and high-risk populations, underscores the need for more inclusive and tailored interventions. Future directions also need to concentrate especially on the long-term outcome, which are less favourable and equity of access to high-quality services. The development of national and international collaborative research platforms, including Australia's new clinical quality registry and clinical trials network, also represents a significant step forward in generating robust evidence and refining care models. We suggest that to further progress the early psychosis field a personalised, data-informed approach is needed and that we find ways to harness technological innovations and collaborative networks to enhance care and subsequent treatment outcomes.

Psychiatry currently faces the following four intersecting challenges: technological disruption through artificial intelligence (AI); the loss of exclusive prescribing authority; escalating systemic constraints within public psychiatry, and market-driven models in private practice. Together, these forces challenge the specialty's traditional identity, narrowing its scope towards containment rather than recovery and meaning-making, and risk diminishing the specialty's relevance if left unaddressed. To respond, we propose a structured approach based on three concentric domains of action, the circles of control, influence, and concern, to differentiate what psychiatry can act on directly, shape through collaboration, or advocate for systemically. Within the circle of control, the AIMS framework (Assessment, Intervention, Monitoring, Step-Up/Step-Down) offers a practical structure to refocus care on relational depth, ethical decision-making, and contextual continuity. The circle of influence is addressed through reform in training and interdisciplinary culture, equipping psychiatrists to lead reflectively and integrate technology wisely. Reclaiming psychiatry's biopsychosocial identity lies at the centre of this renewal, combining biological sophistication, psychological fluency, and social awareness to restore the discipline's integrative purpose. Rather than competing with AI, psychiatry must redefine its value through those capacities that cannot be automated: empathy, interpretation, and ethical discernment. The specialty's future will be secured not by speed or compliance, but by its ability to hold complexity, foster recovery, and sustain human connection in an increasingly algorithmic world.

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.