Abstract
This month brings readers some good news, mixed with a little bad news. A clear piece of good news is that the Australian public have moved closer to mental health professionals in beliefs about treatments for mental disorders (Morgan et al., 2014). Surveys carried out in the 1990s showed many large gaps between public and professional beliefs, with many members of the public holding negative views of some standard psychiatric treatments. However, the public–professional gap has now reduced considerably, indicating a greater public understanding of treatment options. Data from the same surveys show that mental health professionals are lower on personal stigma than the Australian public, being less likely to see people with mental disorders as weak or dangerous, although they are similar to the public in their willingness to have contact with people with mental disorders in their personal lives (Reavley et al., 2014). However, one area of concern is that GPs reported more stigmatizing attitudes than psychiatrists and clinical psychologists, indicating the need for further action within this professional group.
Some potential good news comes from a meta-analysis by Large and colleagues (2014) of studies on the outcome of people with psychosis. The authors report that current substance users with psychosis may have more severe positive symptoms than patients who have never used substances. While Large and colleagues are cautious in discussing the implications of their findings, a commentary by Sara (2014) takes a decidedly optimistic interpretation, proposing that ceasing drug use is a way that people affected by psychosis can improve their outcome. He calls on mental health services to find ‘better ways of engaging and more effective interventions for people with comorbid substance use and psychosis’.
In the mainly ‘bad news’ category, we have a report from Fleming and colleagues (2014) in New Zealand of data from large surveys of high school students carried out in 2007 and 2012. Over this 5-year period, there was a small decline in mental health, with a greater proportion of students reporting low mood, depressive symptoms, self-harm, emotional symptoms, hyperactivity, and peer problems in 2012. On the positive side, there was an improvement in conduct problems and no change in suicidal thoughts or attempts. These findings underscore the importance of routine monitoring of population mental health to allow better targeting of action. It could be argued that clinical services are unlikely in themselves to overcome such population trends and that greater attention to prevention is needed (Jacka et al., 2013).
This month’s issue of the ANZJP also flags some issues to watch. A big one for Australian readers is the National Disability Insurance Scheme, which is currently in its early stages of roll-out. Williams and Smith (2014) summarize the problems in implementing this scheme for people with a psychiatric disability, review the experience from trials of similar schemes in the UK and propose some lessons for Australia.
Another issue to keep a close eye on is the development of the International Classification of Diseases, 11th Revision (ICD-11) – now in its last stages. The development of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was mired in controversy and has failed to satisfy many stakeholders. Can ICD-11 avoid the same fate? Pim Cuijpers (2014), acting as matchmaker, discusses the tension between dimensional and categorical approaches and proposes a marriage of the two as a solution.
Finally, we have a Key Review on dissociative identity disorder (Dorahy et al., 2014). This is a concept that has been surrounded in controversy ever since its inception, but the authors argue persuasively for its validity and provide a sanguine assessment of its treatability. Again, this is a space to watch.