Australian and New Zealand Journal of Psychiatry最新文献

Objective: To describe characteristics, service use and clinical changes among people who received treatment through Australia's Better Access programme.

Methods: We re-analysed data from the usual care arms of two randomised controlled trials of tailored care approaches for depression and anxiety in primary care (Target-D, 2016-2019; Link-me, 2017-2019). Participants completed measures of depression and anxiety symptoms, quality of life and days out of role due to psychological distress over 12 months. They reported the use of mental health services from different providers/settings; from this, we classified a subset as likely Better Access treatment users.

Results: Of 394 Target-D and 547 Link-me participants, one-third were classified as having used Better Access treatment sessions over 12 months. They used five to seven Better Access sessions on average; half to two-thirds paid out-of-pocket costs (median $78-$89 per session). The number of Better Access sessions and other mental health services they used increased with severity of mental health problems. At baseline, Better Access treatment users reported more severe symptoms and more days out of role than those who used other or no mental health services, and poorer quality of life than those who used no services. Approximately half (43-55%) of Better Access treatment users showed improvements in mental health over 12 months. Among those with severe problems, improvements in depression and anxiety symptoms were associated with using 5+ Better Access sessions.

Conclusions: Better Access treatment is used by people with different levels of mental health need. Many experience improvements in their mental health and functioning.

Objective: Australia's Better Access initiative enables Australians with mental disorders to receive sessions of evidence-based psychological treatment following referral from an eligible provider (usually a general practitioner), subsidised through Medicare. As part of a commissioned evaluation, we examined patterns of Better Access treatment.

Methods: We sourced aggregated Medicare Benefits Schedule data from Services Australia on Better Access services delivered from 1 January 2018 to 30 June 2022. From this, we developed profiles of Better Access treatment over time and according to key consumer characteristics.

Results: In 2021, over 1.3 million Australians received at least one treatment session subsidised through Better Access (up by 0.9% per year since 2018). People living in medium/high socioeconomic status areas within major cities, females and young adults were more likely to receive Better Access treatment compared to other groups. Consumers made an out-of-pocket payment for two-thirds (64.8%) of treatment sessions in 2021 (vs 52.7% in 2018). The median out-of-pocket payment per session was constant between 2018 and 2021 ($74) but increased to $90 in the first half of 2022. In 2021, 29.9% of fees charged for all treatment sessions nationally came from consumer out-of-pocket payments (vs 24.5% in 2018). Fewer people accessed treatment following referral in 2021 than in 2018 (58.8% vs 66.9%), and those who did waited longer until their first session (median 22 days in 2021 vs 18 days in 2018).

Conclusion: Better Access enables many Australians to receive psychological treatment. Efforts are required to address gaps in access and increased wait time and consumer costs.

Objective: Australia's Better Access initiative enables people with mental disorders to be referred for treatment and management through a range of providers. The costs to consumers are offset by Medicare rebates. We examined eligible providers' and referrers' views and experiences with Better Access.

Method: An anonymous online survey was completed by 2386 participants: 572 clinical psychologists, 1140 psychologists, 398 social workers, 104 occupational therapists, 45 general practitioners and 126 psychiatrists. The survey included questions about processes, outcomes, barriers and facilitators associated with Better Access.

Results: Most survey participants (54-99% depending on professional group) had provided Better Access services in 2021. The majority believed Better Access enables them to deliver care that is appropriate, tailored to consumers' needs and achieves good outcomes. However, there were concerns that consumers who require more intensive or linked-up care might not receive adequate care through Better Access. Many providers, particularly allied health professionals, did not have the capacity to take on new consumers, leading to long waiting lists and delayed treatment. High out-of-pocket costs (a flow-on effect of inadequate rebates) were seen as discouraging engagement by consumers on low incomes. Good communication between referrers and providers was seen as a key facilitator of Better Access care, but complicated referral and review processes were identified as impeding communication and disrupting continuity of care for consumers.

Conclusion: Providers and referrers agreed that Better Access achieves good outcomes for consumers. Strategies to address workforce capacity and affordability for consumers, and to streamline referral and review processes are needed.

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.

Objective: This study examined the effectiveness of the Better Access initiative using outcome data from real-world practice settings.

Methods: We used anonymised data from four datasets to assess outcomes for consumers over 86,121 episodes of care. The datasets contained routinely captured episode-level data from the practices of psychologists and other eligible Better Access providers. Across the datasets, outcomes were assessed on 11 different measures (mostly consumer-rated measures of depression and anxiety symptoms, psychological distress, functioning and wellbeing). We conducted purpose-designed analyses with three of the datasets (83,346 episodes), examining score changes on given measures between the first and last assessment occasion within an episode. We used preexisting outputs for the fourth dataset (2775 episodes), again considering change from the beginning to the end of the episode.

Results: In the purpose-designed analyses, consumers' mental health improved in around 50-60% of episodes. However, consumers showed no change or experienced deterioration in their mental health in 20-30% and 10-20% of episodes, respectively. Those with more severe baseline scores had a greater probability of showing improvement. The preexisting outputs also identified significant improvements, particularly in episodes where treatment was complete.

Conclusion: Better Access is achieving reductions in symptoms and improvements in functioning and wellbeing for the majority of consumers. A minority of consumers do not have these sorts of positive outcomes, however, and further work is required to understand why. Routine measurement of outcomes - particularly consumer-rated outcomes - would enable ongoing monitoring of the extent to which Better Access is achieving its goals.

Objectives: Clinicians rely on clinical practice guidelines to inform evidence-based management of conditions. However, the quality and availability of clinical practice guidelines for mental health conditions in children and adolescents vary. This systematic review aimed to assess the quality of existing clinical practice guidelines and identify gaps to inform future guideline development in child and adolescent mental health.

Methods: A systematic literature search was conducted to identify clinical practice guidelines for mental health conditions in children and adolescents published between April 2019 and April 2025. Using the Appraisal of Guidelines for Research and Evaluation II tool, identified clinical practice guidelines were assessed for rigour of development (n = 85) using a 70% cut-off. Gaps in the literature were identified by categorising guidelines based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.), ensuring comprehensive coverage while considering feasibility in guideline development.

Results: Nine of the 22 Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.) categories were represented among the 20 clinical practice guidelines extracted. Literature gaps were identified for bipolar and related disorders, trauma and stressor-related disorders, sleep-wake disorders and neurocognitive disorders. In addition, gaps persisted in 13 categories where high-quality guidance was not identified. While methodological quality varied (M = 5.6/7 ± 0.7), guidelines that met threshold were identified for depressive disorders, attention deficit/hyperactivity disorder, autism spectrum disorder, anxiety disorders, feeding and eating disorders, and suicidal behaviours and non-suicidal self-injury.

Conclusion: There is a high degree of variability in the quality of available clinical practice guidelines for child and adolescent mental health conditions, emphasising the need for more rigorous development and implementation standards. While some disorders have sufficient guidance, there are major gaps, necessitating the development of high-quality resources to enhance clinical impact.

Objective: Better Access is a major Australian Government mental health initiative that provides rebates to people experiencing mental health problems so they can access psychological services at reduced or no cost. Currently, GPs, psychiatrists, clinical psychologists, psychologists, social workers, and occupational therapists provide referrals and/or treatment services under Better Access. This study sought to consult a broad range of stakeholders and identify their collective view on future reform priorities for Better Access.

Methods: Consultations followed a three-phase process. In Phase 1, participants completed a brief online survey to identify priority topics. In Phase 2, participants took part in an online forum where they discussed and refined topic summary statements. In Phase 3, participants rated agreement with a revised set of statements and ranked topics in a second online survey.

Results: Ninety stakeholders participated. Collective views emphasised the need to enhance access through improving affordability for consumers and increasing workforce capacity, particularly in rural/remote areas. Participants also identified a need to review the scope and rules of the programme to better accommodate the increasing use of Better Access by people with more complex mental health needs. Views varied on the best mechanisms to address these issues.

Conclusions: Collective views emerged on key areas for reform for Better Access. While there were varying views on the best way to address these priority areas, stakeholders concurred that the programme's capacity needed to be expanded to meet the increasing levels of community demand for mental health care.

Objective: We sought consumers' views about Better Access, which funds sessions of care with eligible providers via the Medicare Benefits Schedule (MBS).

Methods: We surveyed a stratified random sample of consumers who saw a clinical psychologist, psychologist, social worker or occupational therapist (OT) via Better Access during 2021. The survey focussed on consumers' experiences with receiving treatment through Better Access, and the outcomes of this treatment. Survey data were linked to MBS claims data for consenting participants.

Results: In total, 2013 individuals completed the survey; linked MBS data were available for 1317 (65.4%). The majority (85.2%) were satisfied with their care, although they raised some issues, particularly around affordability. When asked to rate their mental health before and after treatment, 91.9% indicated it had significantly improved. Overall, 77.5% attributed this improvement to treatment by the mental health professional. For the full sample, baseline self-rated mental health was predictive of improvement, as was the number of sessions. For the sub-sample with linked data, these factors also predicted improvement, as did whether they paid a co-payment.

Conclusion: In general, consumers who use Better Access appear to appreciate the programme and benefit from the care it provides. However, affordability remains an issue.

Objective: Aggression is a persistent clinical challenge, particularly prevalent in individuals with psychotic disorders. This systematic review aimed to compile current non-restrictive clinical interventions for aggression management in this population and identify those supported by a high level of evidence.

Methods: A systematic literature search was conducted across Scopus/Elsevier/ClinicalKey/Embase, PubMed, Cochrane Library and CINAHL from 27 March to 10 May 2024. The review included randomized controlled trials (RCTs), non-randomized controlled trials and pre-post studies without a control group. From an initial pool of 575 records, 17 studies met the inclusion criteria for evidence assessment.

Results: The 17 included studies comprised 15 RCTs, 1 non-randomized controlled trial and 1 pre-post study. Eleven studies demonstrated that the tested interventions were effective for aggression management, with evidence levels rated as high to moderate. Interventions were categorized into six groups: risk assessment (n = 2), cognitive skills improvement interventions (n = 2), social skills improvement interventions (n = 1), environmental management (n = 1), staff training (n = 3) and multicomponent interventions (n = 8). The findings underscore the necessity of multicomponent, holistic approaches over single-dimensional strategies.

Conclusion: The review confirms the benefits of cognitive and social interventions and reinforces the effectiveness of staff de-escalation training. The positive results for sleep hygiene and therapeutic environment interventions support their integration into multidimensional aggression management protocols. Future research should employ larger RCTs to assess long-term sustainability, identify patient subgroups most likely to benefit from specific interventions and evaluate cost-effectiveness. This review is registered with PROSPERO (CRD42024579465).