Abstract
OS01 INCREASING CONSUMER AND CARER PARTICIPATION – RHETORIC TO REALITY?
Jenny Burger, Ingrid Ozols
The lived perspective of mental illness is a powerful measure of what works and what doesn't with respect to health services and treatments.
Genuine participation of consumers and carers requires their involvement in every aspect of development, planning, design, implementation, delivery and evaluation of mental health services. This includes work at: the strategic (national policy) level, organisational level (structural support), operational level (services) and individual level (personal).
Ideally participation is a philosophy of genuine collaboration, a natural process. It is complex and can be diverse and can enable empowerment for one's own destiny and ultimately recovery. Collaboration and partnership between consumers, carers and clinicians means that the lived experience is valued and respected, and is used to enrich and complement the expertise of clinicians, researchers and service providers.
Though consumers and carers share many similar viewpoints, they also offer important differences that require specific attention – e.g. confidentiality. Consequently, it is important to ensure that both groups have an opportunity to participate.
Increasing consumer and carer participation is a key policy in Australia's National Mental Health Plan, but much debate continues to rage on its implementation.
This open community workshop, which has been sponsored and supported by the Australian Government Department of Health and Ageing will endeavour to explore further what consumer and carer participation is, why it is important, what is acceptable, and how it can be increased.
A “hypothetical” will be presented involving psychiatrists, consumers, carers and lawyers, followed by discussion of the key underlying principles of participation and an exploration of some best practice examples.
OS02 ELDER ABUSE: AUSTRALIA'S RESPONSE
Victor Harcourt, Daniel O'Connor
This symposium will address the issue of elder abuse from clinical, legal and community perspectives. Abuse takes many forms – emotional, financial, physical and sexual – and arises in both family and residential settings. It is now clear that abuse is much commoner than previously suspected and Australian aged care services, legal advisers, health providers and Government bodies must work together to protect vulnerable older people, educate carers, encourage disclosure and investigate complaints.
AGED CARE REFORMS – RIGHTS v RESPONSIBILITIES
Victor Harcourt
The Commonwealth Government's aged care reforms have as their purpose to protect the elderly against abuse. The compulsory reporting provisions took away from aged care residents their autonomy and choice in dealing with allegations of an assault. The provisions have also added a significant degree of complexity as approved providers struggle with suspicions, the rights of the elderly to engage in sexual relations and infringements on the liberties of those with a mental or cognitive impairment.
I will examine the impact of the reforms on how approved providers and residents deal with these issues. I will consider the role of the police, the Department of Health and Ageing and the Aged Care Standards and Accreditation Agency in managing reportable assaults. I will also focus on the duty of care of approved providers and the problems which may arise in a psycho-geriatric setting.
ELDER ABUSE IN AGED RESIDENTIAL FACILITIES: CAUSES AND CONSEQUENCES
Daniel O'Connor
The majority of the residents of nursing homes in Australia and other countries have significant cognitive impairment. As a result, many exhibit behavioural symptoms such as pacing, resistiveness, aggression, calling out and nocturnal disturbance. Some are also anxious, depressed and experience delusions. These behavioural and psychological symptoms of dementia are stressful to care staff, many of whom are inadequately trained to cope with this burden. One consequence is that staff members will sometimes respond to challenging symptoms in a dysfunctional manner and some examples of resident abuse will be described. Because the residents concerned are often forgetful and confused, they may not report such incidents and, even if they do, their complaint may not be believed. If incidents are unwitnessed, as they often are, authorities cannot always take action, even if they wish to do so. The consequences of abusive behaviour for the residents concerned, other residents who observe abuse, staff members and families will be outlined. I will also describe the characteristics of residential facilities and management practices that increase the risk of abuse occurring. There will be a presentation following this one concerning the work of the newly-formed Australian Age Care Complaints Investigation Scheme.
OS03 WPA EDUCATION PROGRAM ON DEPRESSION: DEPRESSION 2007: ISSUES, PROBLEMS AND THE WAY FORWARD
N. Sartorius, A. Tasman, Sam Tyano, Marianne Kastrup, Michelle Riba, Oye Gureje
DEPRESSION IN CHILDREN AND ADOLESCENTS
Sam Tyano
Depression disorders are some of the most ancient disorders known in history of Psychiatry. Nevertheless, only 40 years ago Child Psychiatrists have started to study and describe the clinical course of child depression. Later on we started to understand and study the clinical manifestations of adolescent depression. Only recently, reports on depression in infants, have appeared.
In our lecture, we will describe the specificity of the clinical manifestations of pediatric depression, discuss its etiology and report on the pathways of depression from infancy to adulthood, as dependent on the interplay between risk and protective factors.
Finally, we will bring the last published guidelines for pharmacological and psychotherapeutic treatments in pediatric depression.
DEPRESSION IN THE ERA OF MIGRATION AND COLLISION OF CULTURES
Marianne Kastrup
Depression is the fourth most important contributor to the global burden of disease and comprised in year 2000 4.4% of the total Disability Adjusted Life Years (DALY) and 12% of YLD. The burden of depression is ranked number four in the global disease burden in women and number seven in men. The burden of depression depends upon region, having a relatively smaller burden in poorer regions. E.g. depression amounts to 1.2% of the total burden in Africa to 8.9% in high-income countries.
In recognition hereof, the number of studies focusing on cross-cultural aspects of depression has increased markedly during the last decade, and depressive disorders have been studied cross-culturally both with respect to their prevalence and phenomenology as well as classificatory shortcomings. It has been brought forward that the availability of international classifications, as the ICD-10 and DSM-IV, has facilitated such research.
In the WHO collaborative study on the assessment of depressive disorders a core depressive symptomatology was found across the participating centres, but with certain differences in the ranking of problems. Culture has been considered to have a pathoplastic effect on how the depressive behaviour manifests itself, and often it is indicated that in patients who are from non -industrialised nations the somatic symptoms dominate in relationship to psychological aspects. Furthermore, there is increasing focus on the impact of migration on depressive illness.
The presentation will provide an overview of the burden of depression in relation to culture, differences in symptomatology, the role of migration and other circumstantial factors having an impact on the appearance and outcome of the disorder.
DEPRESSION AND PHYSICAL ILLNESS
Michelle Riba
Depressive disorders are common in primary care settings and even more prevalent in patients with chronic medical illnesses. In patients with existing cardiovascular disease, depression predicts morbidity and death. There is strong evidence for poor post-myocardial infarction (MI) prognosis in patients with depression or depressive symptoms. Approximately 15-20% of acute MI patients have a major depressive disorder and, as multiple longitudinal studies have shown, depression post-MI often persists. Cardiac death risk in the six months after an acute MI is approximately four times greater in patients with depression compared with post-MI nondepressed patients.
In patients with cancer, the reported prevalence of major depression, up to 38% and depression spectrum syndromes, up to 58% varies significantly because of different criteria and rating scales used to define depression, different methodological approaches to the measurement of depression, and different patient populations studied. Nevertheless, quality of life and adherence to treatment are influenced in patients who have depression in the course of their cancer care.
The updated WPA Educational Programme module on Depression and Physical Illnesses addresses major chronic medical disorders in endocrinology; pain; neurology; oncology; cardiovascular diseases; rheumatology; HIV; obstetrics/gynaecology. This presentation will present an overview on the module and highlights of the relationship between depression and co-morbid medical disorders.
DEPRESSION IN DEVELOPING COUNTRIES
Oye Gureje
Depression has a strong social origin. Since social conditions defer in significant ways between developed and developing countries, it is plausible to speculate that the profile and correlates of depression will also be different in important ways between the two groups of countries. Early studies conducted in developing countries of Africa suggested that depression was not common among Africans or that the presentation of depression was sufficiently different from what obtained in Western countries as to make it difficult to detect. Later studies have substantially repudiated these claims. Nevertheless, questions remain about the status of depression in developing countries especially in view of the widespread use of ascertainment tools developed in Western Europe or North America.
Using data from several cross-cultural studies, this presentation will address the questions relating to the features and correlates of depression in developing countries. It will contrast findings from developing with those from developed countries with the aim of highlighting important similarities as well as differences between the nature and consequence of depression in both settings.