Abstract
S1 LET'S WALK TOGETHER TO OUR FUTURE, NOT RUN AMOK: REFORMING THE COLLEGE'S GOVERNANCE
1 Chair RANZCP Governance and Risk Committee, Sydney Local Health Network, Sydney, Australia
2 College President, Private practice, Adelaide, Australia
3 President-elect, Waitemata District Health Board, Auckland, New Zealand
4 Royal Australian and New Zealand College of Psychiatrists
5 RANZCP Hon-Secretary, Private practice
6 Hon-Treasurer, Modbury Public Hospital, Adelaide, Australia
The panel will open up the symposium to general discussion and take questions.
S2 SCHIZOPHRENIA AS A DISORDER OF ‘NEURAL INTEGRATION’: LINKING BRAIN SYNCHRONY, COGNITION, EMOTION AND CLINICAL PROFILE
1 Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute, University of Sydney, Sydney, Australia
2 Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia
3 University of Adelaide, SA, Australia
4 University of Medicine and Dentistry of New Jersey, New Jersey, USA
5 The Children's Hospital at Westmead, NSW, Australia
6Ramsay Health Care (SA) Mental Health Services
7Northern Mental Health, Adelaide Health Service
Schizophrenia can be understood as a disorder in how the brain synchronises its information – as a disorder of neural integration where the “close relations” in brain networks are disrupted. Utilising measures of neural integration, we have been able to describe changes in young people with schizophrenia and early onset psychosis that differentiate them from major depression. This program is investigating if disruptions to brain synchrony are present from the first onset of schizophrenia, how they relate to cognition and emotional information processing, and their contribution to symptoms. Answers to these questions will help us understand the psychophysiology of this disorder. Our symposium will follow this structure:
Introduce the ‘neural integration’ and brain synchrony model of schizophrenia.
Study 1. Results showing that there are specific disruptions in brain synchrony present from recent onset in schizophrenia, compared to depression. These disruptions impact emotion processing.
Study 2. Results showing that poor neural integration in this first onset sample is reflected in a generalised profile of cognitive impairments. These impairments predict functional outcomes in the real world, like social functioning and quality of life.
Study 3. Results showing that disruptions to brain synchrony relate to symptoms, from the first onset of schizophrenia.
This program of studies shows that there is an association between the clinical experience of schizophrenia and brain synchrony across multiple levels of analysis. The symposium will conclude with the final speaker leading an open discussion.
S3 JOINT SYMPOSIUM JSPN AND RANZCP – DISASTER RESPONSE
The Asia Pacific region has recently experienced several devastating natural disasters with large scale loss of life, destruction of property and infrastructure and community disruption. These disasters create significant new mental health problems for affected communities and require a coordinated and sequential mental health response that is well integrated with other areas of disaster response and community recovery. The area of disaster response has evolved considerably over the last 20 years with the evolution of concepts such as psychological first aid and trauma-specific mental health service models. This workshop will explore these developments from a Japanese and a local perspective.
This workshop will involve presentations from members of the Royal Australian and New Zealand College of Psychiatrists and the Japanese Society for Psychiatry and Neurology. This is the first such collaboration and represents the welcome first stage of a developing relationship between our two organisations.
S4 LET'S START (NGARIPIRLIGA'AJIRRI) – A TARGETED THERAPEUTIC PARENT-CHILD INTERVENTION ADAPTED AND DELIVERED IN REMOTE COMMUNITIES IN THE NT – THE ARGUMENT FOR A REFLECTIVE RATHER THAN PRIMARILY DIDACTIC APPROACH
1 Menzies School of Health Research
2 Western Sydney AHS
The relevance and accessibility of any therapeutic intervention, as well as patterns of interaction between parents and children varies greatly across cultural contexts. In understanding parent-child relationships, this needs to be taken into account along with individual and developmental factors, reactions to current family or community stress and family dysfunction.
Recent adaptation of the program has incorporated a focus on strategies and activities to promote parental reflection and we will argue for a reflective rather than a primarily didactic approach to parent-child intervention in cross-cultural settings, particularly in work with indigenous parents and families.
An overview of the practical and theoretical challenges encountered in developing, delivering and evaluating a therapeutic parent-child program in a remote context.
An introduction to a reflective therapeutic approach and why this has informed recent adaptation of the Let's Start program.
An overview of the program, using video and stories to discuss and demonstrate the experience of delivering and participating in Let's Start.
Questions about evaluation of individual and group functioning in different cultural settings.
S5 THE SPECIALIST TRAINING PROGRAM IN PSYCHIATRY
1 School of Psychology and Psychiatry, Monash University, Melbourne, Australia
2 Melbourne Health and Harvester Private Consulting Suites, Melbourne, Australia
3 Gold Coast Mental Health Service, Gold Coast, Australia
4 Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Provide an overview of the STP (in Psychiatry) and the experiences of health services participating in the program
Discussion around the need for expanded settings training
Progress of the STP and future sustainability
The STP, its predecessor programs and the RANZCP's role
The barriers and enablers for establishing an STP post within a psychotherapy practice
Overview of establishing an STP post in a private practice setting
Perspective of a large metropolitan health service with multiple STP posts
Demonstration of an interactive cost-recovery model to assist STP participants
Cost of STP in Psychiatry training positions in 2009
Presentation of recent results from the RANZCP's comprehensive evaluation of the STP in Psychiatry
Presentation 1 will be approximately five mins in length. Following presentations will each be 10–12 minutes. Discussion and questions (time allowed 25 minutes) may be interspersed between presentations.
S6 AN ENGAGEMENT WITH YOUR EDITORS
The College journals – the Australian and New Zealand Journal of Psychiatry and Australasian Psychiatry – provide a wonderful opportunity for authors to “make a mark” and for readers to become familiar with cutting edge developments in psychiatric research, service developments and much, much more. In this interactive session, the editors, Professor Gin Malhi and Professor Garry Walter, discuss various journal aspirations and processes, with a view to educating and enthusing would-be authors, article reviewers and readers.
S7 NEUROSTIMULATION SYMPOSIUM
1 Ramsay Health Care (SA) Mental Health Services, SA, Australia
2 Discipline of Psychiatry, University of Adelaide, SA, Australia
3 Northern Mental Health, Adelaide Health Service, SA, Australia
A comparison of Acute Transcranial Magnetic Stimulation given in a course of five treatments per week over four weeks versus three treatments per week over six weeks, Cherrie Galletly, Cassandra Burton.
A descriptive study of Maintenance Transcranial Magnetic Stimulation, Patrick Clarke, Shane Gill.
An outcome study of Transcranial Magnetic Stimulation in the acute management of depression, bipolar versus unipolar depression, Shane Gill.
A case presentation of Transcranial Magnetic Stimulation for the treatment of intractable auditory hallucinations, David Kelly.
A naturalistic study of Ultrabrief Electroconvulsive Therapy versus Standard Unilateral or Bilateral Electroconvulsive Therapy, Brian McKenny, Tom Paterson, Shane Gill, Cassandra Burton.
A proposal for the establishment of an Electroconvulsive Therapy and other neurostimulation Special Interest Group within the RANZCP, Patrick Clarke.
S8 METABOLIC COMPLICATIONS IN FIRST EPISODE PSYCHOSIS: DEFINING THE ISSUES, NEURAL SUBSTRATES & DEVELOPING AN EFFECTIVE EARLY INTERVENTION FRAMEWORK
1 Early Psychosis Program, Prince of Wales Mental Health Program, Sydney, Australia
2 School of Psychiatry, University of New South Wales, Sydney, Australia
3 Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
4 Australian Centre for Metabolic Health, St Vincent's Clinic, Sydney, Australia
5 Faculty of Medicine, University of New South Wales, Sydney, Australia
Metabolic complications, including weight gain, obesity and metabolic syndrome in FEP are known to be significant problems that can occur early in the course of psychotropic treatment and lead to increased morbidity and reduced life expectancy. This symposium will address the problems from a variety of perspectives. Dr Samaras will present an endocrine perspective of this issue and discuss the pathophysiology of obesity and its endocrine and cardiac complications. A/Prof. Ward will outline the evidence for neural plasticity linked to physical health parameters and how this may impact on psychopathology in FEP. Mr Watkins will describe the development of a centre of excellence for the assessment, prevention and early intervention of cardiometabolic complications in FEP. Dr Curtis will present a paper outlining a cardiometabolic algorithm specifically designed for FEP youth on psychotropic medications, using a prevention and early intervention framework. The application of the algorithm in a community-based FEP program in Sydney, Australia will be described.
AN ENDOCRINE VIEW OF THE METABOLIC CHANGES ASSOCIATED WITH ANTI-PSYCHOTIC TREATMENT IN FIRST EPISODE PSYCHOSIS: CHAMPIONING THE CARDIOMETABOLIC NEEDS OF OUR PATIENTS
1 Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
2 Australian Centre for Metabolic Health, St Vincent's Clinic, Sydney, Australia
Use of atypical antipsychotic medications in first episode psychosis is associated with metabolic complications including substantive weight gain, hyperlipidemia, and insulin resistance. This accelerated obesity is associated increased risk for type 2 diabetes and heart disease. As many patients are young and obesity is challenging to reverse, it is plausible that development of metabolic complications in youth will promote premature cardiovascular disease and diabetes, which are major health concerns in people with psychosis who are already at higher risk of cardiac mortality and type 2 diabetes.
Prevention of weight gain at initiation of atypical antipsychotic medication and, monitoring and intervention of cardiometabolic complications as they arise, would positively contribute to the total health care of people experiencing their first episode of psychosis. Preventing the accrual of physical illness, to those who are least able to deal with the burden of added diseases, would appear to be an essential part of the care of FEP patients.
The pathophysiology of obesity and its endocrine and cardiac complications will be discussed. The experience in our metabolic clinic in assisting patients suffering from obesity and psychosis will be outlined, defining our treatment paradigm and clinical pathways. A transportable and resource-efficient framework for prevention of weight gain and cardiometabolic complications will be discussed.
WORKING OUT SCHIZOPHRENIA: HOW AEROBIC EXERCISE MAY COUNTERACT STRUCTURAL BRAIN CHANGES, PSYCHOPATHOLOGY AND COGNITIVE DEFICITS IN FIRST EPISODE PSYCHOSIS
1 School of Psychiatry, University of New South Wales, Sydney, Australia
There is growing evidence that structural brain change can be detected in healthy volunteers following short-term changes in physical and/or cognitive activity. A recent study (Pajonk et al., Archives of General Psychiatry, 2010) found significant increases in hippocampal volumes, improved memory performance and reduced psychopathology ratings in chronic schizophrenia patients who performed twelve weeks of aerobic exercise, compared to a control group who engaged in a non-aerobic activity for a similar period of time. In collaboration with the Exercise Physiology program, School of Medical Sciences, UNSW, a similar study is currently being undertaken in a first episode cohort recruited from the Bondi Junction EPP program. Preliminary results will be discussed, along with implications for service delivery, and the potential mechanisms that may underlie such exercise-induced structural brain changes.
THE PRACTICALITIES OF PREVENTING AND TREATING METABOLIC SYNDROME. A TREATMENT PROGRAM FOR YOUNG PEOPLE EXPERIENCING EARLY PSYCHOSIS
1 Early Psychosis Program, Prince of Wales Mental Health Program, Sydney, Australia
2 School of Psychiatry, University of New South Wales, Sydney, Australia
It is now well established that there is a significantly increased risk of metabolic syndrome in consumers with psychotic illness. Metabolic syndrome (increased waist circumference and altered TGL, HDL, LDL, BP and/or fasting glucose) results in increased morbidity and reduced life expectancy (1). Lifestyle and pharmacological interventions for obesity and metabolic abnormalities in this population are effective (2, 3). This paper details the process by which an early psychosis treatment team came to recognise the importance of the metabolic syndrome in young consumers, and the practical applications of interventions they developed to address this major cause of morbidity in young mental health consumers.
Tackling physical health concerns has not traditionally been the core business of mental health clinicians. The establishment in 2006 of a metabolic clinic to screen young mental health consumers identified serious metabolic abnormalities in this population (4). In response to this a range of interventions have been developed and implemented by clinicians in the early psychosis treatment team.
All clients are provided with metabolic screening and monitoring, as well as individualised lifestyle (exercise and nutrition-based) interventions with a dietitian and exercise physiology students. Group interventions are also offered through the Recovery and Discovery in Community and Lifestyle (RaDiCaL) program which has a dedicated physical health and education stream.
1. J. P. McEvoy et al. Schizophrenia Research 80:19 (2005)
2. M. Alvarez-Jimenez et al. J Clin Psychiatry 67:1253 (2006)
3. Wu et al. American J Psychiatry 165:352 (2008)
4. J. Curtis et al. Early Intervention in Psychiatry (2011, in press)
POSITIVE CARDIOMETABOLIC HEALTH: AN EARLY INTERVENTION FRAMEWORK FOR PATIENTS ON PSYCHOTROPIC MEDICATIONS
1 Early Psychosis Program, Prince of Wales Mental Health Program, Sydney, Australia
2 School of Psychiatry, University of New South Wales, Sydney, Australia
3 Faculty of Medicine, University of New South Wales, Sydney, Australia
4 Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
There is increasing recognition of the impact of weight gain on the development of metabolic abnormalities in young people receiving atypical antipsychotropic drugs for first episode psychosis. Over a third of young patients being treated for their first episode of psychosis (FEP) either had metabolic syndrome or showed metabolic abnormalities (Curtis et al., 2011 in press). There is a need to identify appropriate interventions to promote positive cardiometabolic health outcomes in this population. This paper outlines an algorithm specifically designed for FEP youth, using a prevention and early intervention framework. A key concept is the need for effective intervention as soon as patients meet “at-risk” criteria (e.g. significant weight, waist or BMI increase, hypertension and dyslipidaemia). The algorithm initially focuses on non-pharmacological interventions (e.g. structured nutritional counselling, smoking cessation and lifestyle modification). If targets have not been reached after three months, specific pharmacological strategies are outlined (e.g. switching, metformin, statins). The algorithm stresses the importance of collaboration with family physicians and appropriate specialist services (e.g. dietitian, exercise physiologist, endocrinologist). An essential element in being able to initiate intervention is screening for cardiometabolic risk factors on a regular basis for all FEP patients receiving psychotropic medication. The application of the algorithm in a community-based FEP program in Sydney, Australia will be described.
S9 ABORIGINAL AND TORRES STRAIT ISLANDER MENTAL HEALTH COMMITTEE PANEL DISCUSSION
BEYOND SORRY – IMPROVING MENTAL HEALTH IN INDIGENOUS COMMUNITIES
1 Winnunga Nimmityjah Aboriginal Health Service
2 Aboriginal Health Worker, Galiwinku/Elcho Island
3 Hunter New England Health; Australian Indigenous Doctors’ Association
4 Child and Youth Mental Health Service, Thursday Island
5 Victorian Aboriginal Health Service
All are welcome to attend this panel discussion, organised by the Aboriginal and Torres Strait Islander Mental Health Committee. The open forum format will encourage audience participation and feedback.
It has been over a decade since the publication by the Human Rights and Equal Opportunity Commission of “Bringing them Home”, an investigation into the Australian governmental policy of forced removal of Aboriginal and Torres Strait Islander children from their families.
The consequences of this policy, along with other discriminatory and culturally destructive policies and practices, continue to impact on the health and social wellbeing of the Aboriginal and Torres Strait Islander peoples of Australia and their communities.
Despite recent developments such as the “apology” from Prime Minister Rudd, the “Closing the Gap” campaign and other positive steps, as well as the strengths and initiatives of indigenous communities, the current rates of social and emotional wellbeing and physical health problems continue to perpetuate negative outcomes.
Broad policy initiatives need to be followed by action. It is important for psychiatrists as a group to contribute to this and continue to practise and support reconciliation.
This panel will bring together a range of experts in indigenous mental health, including indigenous representatives, to confront the issue of practical ways to improving mental health in indigenous communities.
Key points for discussion include:
Examining the roles of psychiatrists and other partners in supporting reconciliation
Constitutional acknowledgment of indigenous people
Breaking down barriers to the healthcare system
S10 A MODEL OF CARE FOR INTEGRATED METABOLIC AND PSYCHIATRIC HEALTH CARE: CONCORD CENTRE FOR CARDIOMETABOLIC HEALTH IN PSYCHOSIS (ccCHIP)
1 Concord Centre for Mental Health, Concord, Australia
2 University of Sydney, Sydney, Australia
3 Concord Hospital Department of Endocrinology and Metabolism, Concord, Australia
S11 THE BEST IN PSYCHIATRIC RESEARCH
1 University of Adelaide
2 Exeter University, UK
3 Institute of Psychiatry, London, UK
4 School of Psychiatry, University of New South Wales, Australia
5 Neuropsychiatric Institute, The Prince of Wales Hospital, Australia
Symposium organised by RANZCP Committee for Research.
THE RESEARCHER AND THE CONSULTING ROOM: HOW RESEARCH SHAPES PSYCHOTHERAPY PRACTICE AND VICE VERSA
Psychoanalysts have at best an uneasy relationship to research—as a process and its findings. My talk will explore some of the conceptual underpinnings of the notion of psychoanalytic research, and to suggest ways in which scientific evidence, wittingly or unwittingly, could, should, and sometimes does, influence clinical practice.
CANNABIS AND PSYCHOSIS: FROM MELLOW TO MADNESS
People diagnosed as having schizophrenia-like psychoses are more likely to use illicit drugs than the populations from which they are drawn. Two types of drugs have been particularly implicated, the amphetamines and cannabis, the former particularly in Asia and the latter everywhere else. Cannabis is the most widely abused illicit drug in the world, and has been causing concern because of a) the general increase in consumption over the last 25 years, b) increased potency of street preparations available in many countries, and c) decreasing age of first use. Among those with an established psychosis, continued consumption of cannabis results in a worse outcome. In addition, over the past eight years, a series of cohort studies have produced evidence that regular use of cannabis increases the risk of psychosis in a dose-related manner. Furthermore, experimental studies have shown that THC, the active ingredient of cannabis, can induce a transient psychotic state. Several factors have been suggested as increasing vulnerability to cannabis-induced psychosis: i) genetic susceptibility, ii) having a psychosis-prone personality, iii) frequent use of skunk and other high potency types and iv) starting use in early adolescence.
THE GENETICS OF AGE-RELATED WHITE MATTER LESIONS
White matter lesions (WMLs), commonly seen as hyperintensities on T2-weighted MRI scans of healthy elderly individuals, are considered to be due to small vessel disease in the brain, and are often associated with subtle cognitive and functional impairments. While a number of vascular risk factors for WMLs have been identified, genetic factors are also important. Twin and family studies have reported that WMLs have high heritability. Mutations in several genes have been described for WMLs, such as Fabry disease, CADASIL and homocysteinuria. However, most of the focus has been on single nucleotide polymorphisms (SNPs) as genetic risk markers for WMLs, either directly or through their interactions with other genes or medical risk factors. We have examined a number of candidate genes including those involved in cholesterol regulation and atherosclerosis, hypertension, neuronal repair, homocysteine levels, DNA repair, and oxidative stress pathways. Additionally, two genome-wide association studies (GWAS) have been reported, and we have recently completed a GWAS on the Sydney Memory and Ageing Study which included 550 elderly individuals with MRI scans and measures of WMLs. Some interesting findings have emerged from these studies which need independent replication. The identification of individuals genetically at risk of developing white matter lesions will have important implications for understanding their aetiology and developing preventative strategies.
S12 INNOVATIVE PROGRAMS FOR SIMGS: ASSESSING AND ENHANCING CLINICAL COMMUNICATION AND INTERVIEWING SKILLS
1 University of Melbourne, Melbourne, Australia
2 NorthWestern Mental Health, Melbourne, Australia
3 Flinders Medical Centre, Adelaide, South Australia
The proposed outline for the 90-minute symposium is a 45-minute presentation from each of the two programs and their authors, as described below.
SIMG CULTURAL AND COMMUNICATION ENHANCEMENT PROGRAM
Flinders Medical Centre, Adelaide, South Australia
The program was funded by the Commonwealth Government as part of the “SIMG Upskilling Project”, and supported by the RANZCP.
IMPROVING PSYCHIATRIC CLINICAL INTERVIEWING SKILLS OF IMGS: A PIONEERING PROJECT
1 NorthWestern Mental Health
2 University of Melbourne, Melbourne, Australia
S13 THE BEYONDBLUE/NHMRC CLINICAL PRACTICE GUIDELINES: DEPRESSION IN ADOLESCENTS AND YOUNG ADULTS – PROCESS CONSIDERATIONS, KEY FINDINGS AND IMPLICATIONS FOR POLICY AND PRACTICE
Beyondblue, Melbourne, Australia
Depression, anxiety and related disorders affect approximately one in five adolescent girls and one in nine adolescent boys, and can seriously affect quality of life for these young people and their families. There are many factors which influence the risk of depression and rate of recovery following depression. In order to address these factors and provide comprehensive and appropriate care for adolescents and young adults it is vital that prevention, diagnosis and treatment strategies are underpinned by high quality research evidence.
In 2008 beyondblue was charged with the task of updating the revoked NHMRC Clinical Practice Guidelines: Depression in Young People (1997), to assist health professionals to accurately identify and effectively treat depression amongst adolescents and young adults. The development of the updated guidelines involved adherence to NHMRC guideline development methodology, and through this process has highlighted a number of recommendations for health professionals as well as areas where the evidence is not sufficient.
Attendees at the symposium will learn about the key processes which were undertaken by an expert panel of academic, clinical and consumer representatives to ensure that the updated guidelines were of high scientific and ethical quality; the key findings from the comprehensive literature search, and final guideline recommendations will be reported and discussed, including a discussion about how these evidence-based recommendations can be incorporated into practice and policy; and areas for further research will be highlighted.
S14 DIFFICULTIES OF THE OTP/IMG WORKING THROUGH THE COMPLEX BUREAUCRATIC SYSTEM
1 South Eastern Illawara Health Service, Univeristy of Wollongong and IHMRI
OTP Committee Chair; Consultant Psychiatrist SESIAHS.
To highlight the complex bureaucratic system that an Overseas Trained Psychiatrist/IMG has to go through during their pathway to Fellowship.
To suggest ways to remove impediments and promote pathways for OTD's to achieve full Australian qualifications.
S15 IF YOU BUILD IT, THEY WILL COME… INNOVATIONS IN PRIVATE PRACTICE
1 St John of God Health Services, Sydney, Australia; RANZCP Chair, Private Practitioners Network
2 Australian Association of Practice Managers, Sydney, Australia
3 Australian College of Mental Health Nurses, Canberra, Australia
4 Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
In Australia, approximately 72% of psychiatrists engage in private practice at an average of 28 hours per week. In New Zealand, these figures are slightly lower, with 39% of psychiatrists working an average of 14 hours per week in private practice. Given these figures, the Private Practitioners Network would like to promote innovation in private practice.
Provide an overview of important considerations when planning, evaluating or improving your private practice
Discuss funding models and financial considerations when maximising your staffing, practice income and patient care
Explore new innovations in each area to exemplify how psychiatrists can drive high quality patient care
S16 FORENSIC SYMPOSIUM
NSW Justice Health
ESTABLISHING A FORENSIC MENTAL HEALTH INPATIENT NETWORK – CHALLENGES AND OPPORTUNITIES
Justice Health, NSW, Australia
MODELS FOR THERAPEUTIC DECISION-MAKING ACROSS THE FORENSIC MENTAL HEALTH SYSTEM – SECURITY AND PATIENT FACTORS
Justice Health, NSW, Australia
REHABILITATION WITHIN A HIGH SECURE PSYCHIATRIC FACILITY
Justice Health, NSW, Australia
THE ALIENATED CLOSE RELATIONS: WORKING WITH FAMILIES OF FORENSIC PATIENTS
Justice Health, NSW, Australia
S17 COMMUNITY INVOLVEMENT IN MENTAL HEALTH RESEARCH
1 Honorary Fellow, University of Otago, Wellington, New Zealand
2 WHO PIMHnet Facilitator, Adjunct Professor AUT, Visiting Professor University of Sydney
3 Clinical Lead, Manaaki House, ADHB, Auckland, New Zealand
4 Clinical Director, Raukura Hauora O Tainui, Auckland, New Zealand
It has been very difficult to get active participation in psychiatric research by service users and their family members. However psychiatry is currently reinventing itself world-wide. Advances in treatment, greater awareness of human rights, and growth of consumer movements mean that the relationship between profession and community is undergoing major changes. This symposium explores these changes. Contributors are: (i) One whose early life was scarred by psychotic illness, and since then has been involved in research on brain mechanisms for, and public education about, mental illness (RM); (ii) A facilitator for the WHO Pacific Island Mental Health net, with expertise in mental health policy evaluation and research (FH); (iii) A psychiatrist, working as clinical lead in a community mental health centre and as the clinical director in a primary healthcare organisation (IS). Topics covered include: (i) Implications of seeing those involved in research as participants (experts in their own lived experiences, complementing the expertise of researchers) rather than as subjects (distancing researchers from persons they study); (ii) Ways to involve participants in true partnership, which may mean acknowledging past shortcomings or abuses in mental health services, and a requirement that research be as transparent as possible; (iii) Consumer involvement in setting the agenda for some research. A recent workshop held in Palmerston North, New Zealand, will be described where researchers, consumers and family members came together to discuss these issues. In the future, such open forums with diverse contributors may encourage active, willing and well-informed research participation by family members and consumers.
S18 PUBLIC SECTOR PSYCHIATRISTS NETWORK – SYMPOSIUM
“WHERE BEAST MEETS STRESSED – FEAR AND MISUNDERSTANDING AT THE FORENSIC/GENERAL PSYCHIATRY BORDERLANDS…EXPLORING WAYS TO STRENGTHEN PARTNERSHIPS”
Justice Health, NSW, Australia
A sophisticated legal framework has developed, subtly different across every jurisdiction, to manage patients who have encountered the criminal justice system, have an identified significant mental illness requiring ongoing treatment and are now transitioning back into mainstream mental health services. Significant challenges exist for psychiatrists in managing this complex interface amongst the forensic and general mental health services; the law including the courts, prison system and specialist Mental Health Tribunals; and a complex, high risk patient population, their families and in some cases their victims.
This panel will bring together a range of experts in the mental health and legal arenas to consider the myriad issues confronting public sector psychiatrists working in this challenging, constantly evolving and closely scrutinised area of practice. A hypothetical case will be utilised to initiate discussion and debate, followed by an open forum for audience participation – ‘Q and A’ style.
S19 TOWARD FAIRER MENTAL HEALTH LEGISLATION: LEGAL AND ETHICAL ISSUES IN COERCIVE DETENTION
1 Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
2 Prince of Wales Hospital, Sydney, Australia
3 Discipline of Psychiatry, University of Sydney, Sydney, Australia
The three presentations in this symposium each cover a major issue in the law and practice of coercive treatment of people suffering mental illnesses. Each presentation is brief, to allow ample time for audience participation. Lawyer, Sascha Callaghan, presents some recent developments in the review of involuntarily detained psychiatric patients in New South Wales and Victoria. Ms Callaghan argues that the practices and standards that apply to review of detention for these patients in all Australian jurisdictions compare badly to review of detention in other contexts – including the rules that normally apply in criminal arrests. She suggests that these standards reflect entrenched discrimination against people living with mental illness in social and legal systems.
Christopher Ryan will discuss the issue of capacity in the coercive treatment of people with mental illness. No Australian Mental Health Act currently uses the absence of capacity as threshold consideration in coercive detention and treatment. Dr Ryan draws comparisons with legislation allowing coercive treatment for other medical conditions, concluding that the law should change to place capacity at the centre of the decision to coercively treat mentally ill people. He comments on moves in Victoria aimed at doing just that.
Matthew Large will discuss risk assessment in clinical practice and its role in allowing coercive treatment for patients deemed to be at risk of harm to themselves or others. Dr Large argues that risk assessment is a flawed and failed paradigm for harm reduction, and cannot justify the loss of autonomy and freedom experienced by those receiving compulsory treatment.
S20 HEARTS AND MINDS: PSYCHOSOCIAL FACTORS AND CHRONIC DISEASE IN CENTRAL AUSTRALIA
Margaret Ross Chair in Indigenous Health, Baker IDI, Central Australia
The life expectancy (LE) gap experienced by Aboriginal and Torres Strait Islander peoples in one of Australia's most enduring health divides. Whilst there are many likely reasons, cardiovascular diseases (CVD) stand as the primary contributor. The reasons for this disparity remain incompletely understood. Current research has focused on the likely contribution of traditional risk factor burdens in Aboriginal people, yet less attention has focused on the potential contribution of disadvantage and its interplay with psychosocial factors.
Research on the psychosocial determinants of health, particularly in relation to CVD, has a long pedigree. Among them, socioeconomic position [SEP] and depression are the most robust, and most widely researched. They have not been adequately explored in the context of Aboriginal Australians.
This presentation reports on the exploration of psychosocial factors and chronic disease and its risk factors in Aboriginal communities in Central Australia, with a view to identifying the possible ways in which social disadvantage may lead to illness. This required a detailed and multi-disciplinary plan of research, covering the epidemiology of mental illness and chronic diseases, biomedical science, ethnographic field work and qualitative methodologies.
Stage I required the development of measurement tools for exploring depression, stress, resilience, mastery and socioeconomic indicators that were valid and robust for use with Aboriginal communities within Central Australia. These tools were then used in community dwelling samples of Aboriginal people in Central Australia to explore the interaction of SEP, stress and depression and their potential contribution to chronic disease risk.
INPATIENT CARE IN BROOME: ‘ROOMING-IN’-INNOVATION, FAILURE, AND BACK AGAIN
Kimberley Mental Health and Drug Service, Broome, Australia, University of Western Australia, Perth, Australia
A TWO-WAY APPROACH IS THE ONLY WAY FORWARD FOR RECOVERY
Team Coordinator, Tiwi Islands, Program Manager, Kalano Flexible Aged Care, Sanderson, NT, Australia
A psychosocial rehabilitation approach, such as Personal Helpers and Mentors (PHaM), has been making significant improvements to people's wellbeing for some time. In remote areas of the Top End of the Northern Territory, a two-way approach using traditional and cultural ways combined with specialist psychosocial recovery, is starting to show results.
The Australian Red Cross is currently working with two remote communities in the Top End, to deliver a PHaM program which is integrated, comprehensive and appropriate, and which addresses participants and community needs. In these communities the program promotes spiritual, cultural, mental and physical healing. PHaM builds strong relationships, increased community participation and community strength and resilience.
It is not beneficial to assist individuals without assisting the family and wider community. The family makes the collective decisions, plans and actions for loved ones. A community development approach is vital for the long term success and sustainability of PHaM.
This two-way approach combining psychosocial rehabilitation with traditional and cultural healing is showing improved participant outcomes. Anecdotally there is evidence that people with mental health worries are staying well longer, engaging with employment or meaningful activities and reconnecting with families and community.
AN INTEGRATED RESPONSE TO THE PIKE RIVER MINE INCIDENT
NOVEMBER 2010 AND ONWARDS
West Coast District Health Board, Greymouth, New Zealand
REPORT FOR THE FIRST YEAR OF THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF PSYCHIATRISTS NSW BRANCH RURAL PSYCHIATRY PROJECT
1 Greater Western Area Health Service, Orange, Australia
2 The Royal Australian and New Zealand College of Psychiatrists, Sydney, Australia
Peer support and continuing professional development.
Establishment of a mentoring program for clinical leaders
Maintaining a rural psychiatry recruitment service
Re-development of the NSW Rural Psychiatry Project website to better support the needs of the rural psychiatry workforce.
FOETAL ALCOHOL SPECTRUM DISORDERS: WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH SERVICES?
Menzies School of Health Research, Charles Darwin University
Foetal Alcohol Spectrum Disorder (FASD) describes the range of effects that may occur in an individual whose mother drank alcohol during pregnancy, which include foetal alcohol syndrome (FAS), alcohol-related birth defects (ARBD) and alcohol-related neurodevelopmental disorder (ARND). Information on the FASD in Australia is limited.
Data from the Western Australian Birth Defects Registry showed a birth prevalence of FAS of 0.18/1,000 live births between 1980–1997, Aboriginal children being 100 times more likely than non-Aboriginal children to be diagnosed with FAS. In Australia, a prospective national surveillance study of FAS from 2001–2004 reported a birth prevalence of FAS of 0.06/1,000 live births (n = 92 cases). These rates are much lower than those reported in countries such as the USA, France and Sweden. A survey of paediatricians in Western Australia found that only 19% correctly identified the diagnostic features of FAS, which may explain the low rates. The national surveillance reported that the median age of diagnosis was 3.26 years, 40% were living with biological parents, 51% had a sibling with FAS and 65% were indigenous. The study found that one or more behavioural problems were reported in 49% of children and 28.3% were found to have emotional problems. These findings have implications for general and mental health services.
S22 DUAL DISABILITY (INTELLECTUAL DISABILITY AND MENTAL ILLNESS) IN YOUNG PEOPLE IN SOUTH AUSTRALIA: A NEW APPROACH TO OLD CHALLENGES
1 GAP Service, Centre for Disability Health, Disability SA, South Australia
2 GAP Service, Centre for Disability Health, Disability SA, South Australia
S23 WILL WE EVER HAVE ENOUGH PSYCHIATRIC REGISTRARS?
1 Chair, RANZCP Network of Public Sector Psychiatrists, Executive Director, Metro North Mental Health, Royal Brisbane and Women's Hospital and University of Queensland, Australia
S24 MODEST BUT PRACTICAL WAYS: IMPROVING INDIGENOUS CHILD AND FAMILY MENTAL HEALTH
1 Mental Health and Drug and Alcohol Office, MH-Kids; Chair, RANCZP Faculty of Child and Adolescent Psychiatry Indigenous Child and Family Mental Health Project
The Indigenous Child and Family Mental Health Project was established after identifying the mental health of Aboriginal, Torres Strait Islander and Maori children and families as an area of concern, with a clear need for collaboration.
To share the Indigenous Child and Family Mental Health Project
To examine the roles of psychiatrists and other partners in “big picture issues”
To encourage collaboration in “modest but practical” ways to improve access to appropriate mental health services
Indigenous children and families have disproportionate exposure to risk factors for poor emotional and social wellbeing and mental health outcomes, and difficulties with health service access. It's not OK.
Do no harm. Don't waste money.
“Big picture” interventions are beyond the control of the mental health sector.
Psychiatrists have an urgent mandate to work with partners to improve mental health services for indigenous children and families.
1“insisting only on fundamental and revolutionary social change is dooming us to programs that will take years and generations to take effect… If we really want to change the world, we may have to begin in more modest but practical ways.2”
References
1Hunter E. ‘Best intentions’ lives on: untoward health outcomes of some contemporary initiatives in Indigenous affairs. Australian and New Zealand Journal of Psychiatry 2002; 36: 575–584.
2Syme SL. Individual vs. community interventions in public health practice: some thoughts about a new approach. Health Promotion Matters 1997; 2: 2–9.
S25 SOCIAL MEDIA AND PSYCHIATRY: PITFALLS AND PROMISE
1 Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
2 Redbank House, Sydney West Area Health Service, Westmead, Australia
3 Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, Australia
4 Department of Psychiatry, Westmead Hospital, Westmead, Australia
The use of online social networking tools such as Facebook, MySpace, LinkedIn, Twitter and youTube has exploded over the past half-decade. Just as the internet has become an integral part of daily life, so social networking now encompasses social, educational and professional domains. However, it brings with it substantial and often poorly understood risks to privacy, confidentiality and professionalism, and it may blur the boundaries of the relationship between psychiatrist and patient. At present many clinicians are unsure how to navigate this new terrain and avoid using what is potentially a highly useful tool, or dip into the use of the new media exposing themselves to considerable professional risk. Internationally the challenges that social media present to health professionals are only just being confronted and few guidelines exist.
In this interactive symposium we will present a series of vignettes that aim to highlight the risks and possibilities of social media. This builds upon a process started at the Centre for Values, Ethics and the Law in Medicine at the University of Sydney where these vignettes were presented to health, legal and consumer representatives. The symposium will help develop practical ethical guidelines that can be used by psychiatrists to guide them through difficult and novel professional and ethical situations.
S26 CHALLENGING BEHAVIOUR IN PEOPLE WITH INTELLECTUAL DISABILITY: ESSENTIALS FOR THE PSYCHIATRIST
1 Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
2 Queensland Centre for Intellectual and Developmental Disability, University of Queensland, Brisbane, Australia
3 Centre of Excellence for Behaviour Support, University of Queensland, Brisbane, Australia
4 Mental Health Outreach and Assessment Team, Disability Queensland, Wacol, Queensland
5 Emeritus Professor in Developmental Psychiatry, Northumbria University, Coach Lane, Newcastle Upon Tyne, UK
The association between challenging behavior and mental or physical disorders
Assessment of challenging behaviour
An illustration of the psychiatrist's role in challenging behaviour
A template for research strategy and development in challenging behaviour
The pharmacotherapy of challenging behaviour
MANAGEMENT OF CHALLENGING BEHAVIOUR: FOCUS ON PHARMACOTHERAPY. “CHEMICAL RESTRAINT” – FACT OR FICTION?
1 Queensland Health Mental Health Assessment and Outreach Team (Intellectual Disability), Community Services Queensland, Aveyron Road, Wacol, Australia
to determine whether those individuals referred to MHAOT as cases of “chemical restraint” had been correctly classified
to determine whether, for those individuals correctly so-classified, the assessment had resulted in some change to the restrictive management regime
INTELLECTUAL DISABILITY AND CHALLENGING BEHAVIOUR – ORGANISING THE RESEARCH AGENDA
Centre of Excellence for Behaviour Support, University of Queensland
THE INTELLECTUAL DISABILITY RESEARCH TEMPLATE
1 University of Queensland, Ipswich, Australia
IS CHALLENGING BEHAVIOUR IN PEOPLE WITH INTELLECTUAL DISABILITY CORE BUSINESS FOR PSYCHIATRISTS?
Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
THE ASSESSMENT OF CHALLENGING BEHAVIOUR IN PEOPLE WITH INTELLECTUAL DISABILITY: A PRACTICAL GUIDE
Queensland Centre for Intellectual and Developmental Disability, University of Queensland, Brisbane, Australia
S27 CONSUMER TEAM: FAMILY OF CHOICE AND CREATIVITY: PEERS WORKING ALONGSIDE FORENSIC MENTAL HEALTH CONSUMERS
1Te Korowai Whariki, Capital and Coast District Health Board, Wellington, New Zealand
Part of the presentation will involve using powerpoint and part will be done using visual stimuli.
Using strengths-based models increases, amongst other things, participation and involvement of forensic consumers in their daily living. This means that their tino rangatiratanga – self-determination – gives them the courage to ask questions and consider treatment options available to them.
Previous blocks experienced in treatment participation are able to be identified and addressed to enhance therapeutic relationships.
Peer workers offer a positive tool that can be successfully used to enable and enhance the recovery and healing of forensic inpatient consumers.
The consumer team can assist in the development of family of choice where biological family relationships are fractured, often beyond repair.
Continuing this family of choice keeps hope alive for the recovery of forensic consumers.
Creativity also helps draw consumers and their stories out into the open, increasing self-esteem, moving forensic consumers into a place where healing can occur.
S28 MANA AND WHAKAPAPA PROTECTION: AN INDIGENOUS MODEL THAT DESCRIBES THE SIGNIFICANCE OF TIME, PLACE AND PERSON IN THE HEALING PROCESS
1Moe Milne: Te Moemoea, Matewaia, North Island New Zealand
Phyllis Tangitu, Community Member Te Kaunihera, RANZCP, New Zealand
This presentation will explore the significance of the Maori context in delivering health services in particular the importance of understanding “wairua, tapu, noa”. What happens when a law has been breached or transgression made, how do we know what to do from a Maori world view? Relationships are important, including the relationships a person has with his family/whanau, social network, community. Phyllis and Moe will share their experience in working with individuals and their families in a Maori context and how they support the individual develop a road toward recovery.
They also will describe the importance of establishing sound relationships with the patient and client at the centre, ensuring respect and recognition of Maori/indigenous models of practice, access to elders/Kaumatua as required, and Maori models of practice throughout the therapeutic journey.
S29 THE COMPETENCY-BASED FELLOWSHIP PROGRAM: CHANGES TO RANZCP TRAINING PROGRAM 2012/13
1 Royal Australian and New Zealand College of Psychiatrists Competency-Based Fellowship Program
Following on from the CBFP information sessions with training directors and health services representatives in Australia and New Zealand, this session is offered to the broader Fellowship, including training directors, supervisors and other members involved in training.
The purpose behind modifying the RANZCP Psychiatry Training/Assessment Program in Australia and New Zealand
Outline and principles of the Competency-Based Fellowship Program (CBFP)
Comparisons between the current and new training/assessment programs
The curriculum structure of the CBFP
Impacts of the CBFP to supervision
The introduction of workplace-based assessments to the RANZCP Training Program – rationale and advantages/disadvantages
The introduction of Entrustable Professional Activities to the RANZCP Training Program – rationale and advantages/disadvantages
Current CBFP project activities/timelines
S30 DEALING WITH DIFFICULTY: A THEORETICAL AND PRACTICAL GUIDE TO WORKING WITH COMPLEX CASES AS PART OF DYNAMIC PSYCHIATRIC PRACTICE
Complex cases form an increasing proportion of psychotherapists’ workload, and are often hard to accommodate within a short-term, target-oriented therapeutic culture. Using psychoanalytic, attachment (including mentalising) and systemic perspectives I shall suggest ways of classifying and thinking about these difficult cases and our counter-transferential responses to them. At a practical level I shall look at the nature of the psychotherapeutic contract when working with complexity, and how to strike a balance between support and pushing for change. The workshop will fall into two halves: lecture/discussion, followed by ‘live supervision’ with depth-discussion of participants’ cases.
S31 PUTTING THE MAP ON THE CLINICAL PSYCHIATRIST'S DIAGNOSTIC MAP
1 Black Dog Institute, New South Wales, Sydney, Australia and University of New South Wales, Sydney, Australia
The presenter will overview the development of the Mood Assessment Program (MAP), developed to provide clinicians with a report that is comprehensive and of diagnostic relevance for patients with a suggested primary mood disorder.
Initially, data needed to be entered at MAP Centres in Sydney and in rural NSW but, since mid-2010, data are now entered over the web by patients, and the report goes to the referring clinician within the next 48 hours.
The presentation will detail components of the MAP and its key diagnostic decisions (e.g. bipolar or unipolar, melancholic or non-melancholic depression) as well as its other components and detail the level of accuracy about the diagnostic algorithms.
The presentation will also cover a range of ‘tools’ and website components provided by the Black Dog Institute for assisting practitioners and their patients in managing mood disorders.
S32 PRACTICE VISIT SESSION: TRAIN TO BECOME AN ACCREDITED VISITOR
1 The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
The Committee for Continuing Medical Education (CCME) is currently reviewing practice visit resources with the view to update and promote this option for peer review activity to all Fellows.
The practice visit is a structured peer review activity where a trained visitor reviews the host practice against the RANZCP “Guidelines for Outpatient Psychiatric Practice”. The visit is designed to allow the host and the visitor to reflect on their practice and review the way in which they work.
Practice visits are conducted in two stages. Firstly, the visitor conducts a structured interview with the host, who reviews the practice against the relevant guidelines as mentioned above. At the end of the interview, a discussion on where the practice might benefit from some improvement or fine tuning occurs. The host and visitor develop a plan for making any agreed changes. The second stage of the visit takes place between six and twelve months after the first visit. This visit provides an opportunity to review the effectiveness of the planned changes. The second stage of the visit may be conducted in person or electronically.
This session is designed to train participants to become accredited practice visitors to ensure a high standard of practice visits is maintained.
It is envisaged that the promotion of a practice visit session at Congress will achieve:
increased awareness of this option for mandatory peer review in CPD
increased knowledge of what practice visits entail
increased awareness of acceptable standards of practice
increased number of practice visits undertaken
larger selection bi-nationally of accredited practice visitors by which training sessions can continue at a branch level
It is of note that funding has recently been secured via the RHCE for development of this resource and this project will also benefit from this proposed Congress session
S33 COGNITIVE AND SOCIAL COGNITIVE REMEDIATION THERAPY: TREATMENT FOR A NEGLECTED ASPECT OF SEVERE MENTAL ILLNESS
1 Discipline of Psychiatry, University of Sydney, Sydney, Australia
2 Princess Alexandra Hospital and District Mental Health Services, Brisbane, Australia
3 Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia
4 Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
Cognitive and social-cognitive deficits are now known to be hallmarks of severe mental illnesses such as schizophrenia, bipolar disorder and autism. These deficits are present early in the developmental course of the disorders, probably worsen at the time of their presentation, are prominent causes of dysfunction and correlate strongly with overall patient outcomes; yet they are rarely targeted for treatment. Current mainstream approaches to treatment using second-generation antipsychotic medication make little impact upon neurocognitive and social-cognitive deficits. However, a number of remediation or training approaches to these deficits are significantly more successful.
This symposium will present:
An introduction to Cognitive Remediation Therapy (CRT) and a meta-analysis of studies in schizophrenia
A review of the introduction and provision of CRT in a mental health service in Brisbane
A comparison of the effectiveness of computer-assisted CRT in recent onset as against chronic schizophrenia
An introduction to social cognition in schizophrenia
A description of the development of a novel treatment for social cognition: mental state reasoning training
A review of the link between outcome and neurocognitive and social-cognitive deficits particularly regarding employment.
The symposium will finish with a discussion examining practical aspects of the provision of CRT and social-cognitive therapeutic approaches.
COGNITIVE REMEDIATION IN SCHIZOPHRENIA: A META-ANALYSIS
1 Discipline of Psychiatry, University of Sydney, Sydney, Australia
2 Centre for Graduate Studies, Research and Commercialisation, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
COGNITIVE REMEDIATION: DISSEMINATION AND IMPLEMENTATION WITHIN MENTAL HEALTH SERVICES
1 Mobile Intensive Treatment Team, Princess Alexandra Hospital and District Mental Health Services, Brisbane, Australia
2 Logan Mobile Intensive Treatment Team, Logan and District Mental Health Services University Drive, Meadow Brook, Brisbane, Australia
3 Metro North Mental Health Services, Lutwyche Rd, Windsor, Brisbane, Australia
SOCIAL-SKILLS TRAINING OR SOCIAL-COGNITIVE REMEDIATION? INSIGHTS FROM AN EXPERIMENTAL STUDY OF SOCIAL KNOWLEDGE AND SOCIAL COGNITION IN SCHIZOPHRENIA
1 Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia
2 School of Psychiatry, University of New South Wales, Sydney, Australia
3 Schizophrenia Research Unit, Sydney South West Area Health Service, Australia
4 Schizophrenia Research Institute, Sydney, Australia
THE DESIGN AND DEVELOPMENT OF A NOVEL MENTAL STATE REASONING TRAINING (MSRT) PROGRAM FOR SCHIZOPHRENIA
1 Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia
2 Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
BOLSTERING WORK: POTENTIAL BENEFITS OF COGNITIVE INTERVENTIONS TO EMPLOYMENT INTERVENTIONS FOR PEOPLE WITH EARLY PSYCHOSIS
1 Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
Failure to make gains in functioning is recognised as a major problem associated with psychotic illness. In particular, functioning in the vocational realm is particularly affected with up to 95% of people with schizophrenia unemployed although employment is the most frequently cited goal of people with schizophrenia. It is also economically important, with over half of all costs associated with schizophrenia caused by unemployment.
Recent studies have shown that an employment intervention called Individual Placement and Support is effective at helping people with psychotic illness return to work. In populations with schizophrenia approximately two-thirds of people can be assisted to make a vocational recovery. In early psychosis two RCTs have shown that up to 85% of people can make such a recovery. The key area now is to prolong the length of employment.
Two candidate interventions to assist in this task are cognitive remediation and social-cognitive remediation. This presentation will review the literature about cognitive remediation and social-cognitive remediation in relation to employment interventions for people with psychotic illness. It will develop a rationale for combining employment interventions with these two approaches and discuss where in the course of illness such interventions may be best targeted.
S34 INTELLECTUAL DISABILITY MENTAL HEALTH: ATTITUDES, CONFIDENCE AND LEARNING NEEDS OF MENTAL HEALTH STAFF
1 Department of Developmental Disability Neuropsychiatry, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
2 Brain and Ageing Research Program, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
S35 PROVIDING EXPERT EVIDENCE IN MEDICO-LEGAL SETTINGS
1 Forensic Psychiatrist in Private Practice, Adelaide, South Australia
Exploration about the significant differences between clinical and forensic settings
Preparing psychiatric reports
Giving oral evidence before courts and tribunals
Ethical considerations, including potential difficulties as a treating psychiatrist in a medico-legal setting
S36 THE COMPETENCY-BASED FELLOWSHIP PROGRAM: CHANGES TO RANZCP TRAINING PROGRAM 2012/13
1 The Royal Australian and New Zealand College of Psychiatrists Competency-Based Fellowship Program
Following on from the CBFP information sessions with training directors and health services representatives in Australia and New Zealand, this session is offered to the broader Fellowship, including training directors, supervisors and other members involved in training.
Outline and principles of the Competency-Based Fellowship Program (CBFP)
Comparisons between the current and new training/assessment programs
The curriculum structure of the CBFP
Impacts of the CBFP to supervision
The introduction of workplace-based assessments to the RANZCP Training Program – rationale and advantages/disadvantages
The introduction of Entrustable Professional Activities to the RANZCP training program – rationale and advantages/disadvantages
Current CBFP project activities timelines
S37 HOW TO AVOID BEING SUED AND WHAT TO DO IF YOU ARE
1 Forensic Psychiatrist in Private Practice, Adelaide, South Australia
S38 CLOSE RELATIONS ROLE REVERSAL IN THE DEVELOPING AND MANAGING OF CLOSENESS
1 Private Practice, Melbourne, Australia
How do we develop and manage close interpersonal relations so that we maximise the chance of creating positive productive relationships for our patients and ourselves.
Psychodrama, a psychotherapeutic group method was developed by a psychiatrist Dr J. L. Moreno to enhance our treatment of people through role-playing situations of interpersonal concern. To increase a person's awareness of what is happening in their role relationship with others in a psychodrama the psychodramatic technique of role-reversal is used. It has become a rule in directing a psychodrama session that a person needs to be able to reverse roles, to put themselves in the shoes of all the relevant people involved in the interpersonal situation being worked with to create adequate role responses.
Developing the ability to reverse roles with others is a normal part of healthy development and assists in managing close relations in all aspects of life.
S39 INTELLECTUAL DISABILITY PSYCHIATRY AND THE LEGAL SYSTEM; HOW CAN WE BEST WORK IN THE INTERESTS OF OUR PATIENTS ACROSS CLINICAL/LEGAL BOUNDARIES?
1 Clinical Director and Consultant Psychiatrist, The Victorian Dual Disability Service, St Vincent's Hospital, Melbourne, Australia
2 National Advisor in the Intellectual Disability (Compulsory Care and Rehabilitation) Act, Te Korowai Whariki, New Zealand
3 Queensland Health Mental Health Assessment and Outreach Team (Intellectual Disability), Community Services Queensland, Aveyron Road, Wacol, Australia
4 Regional Youth Forensic Service, Kari Centre, Auckland District Health Board, New Zealand
5 Community Child and Adolescent Mental Health Service, Kari Centre, Auckland District Health Board, New Zealand
This symposium focuses on recent forensic and legislative initiatives in the field of intellectual disability psychiatry.
The symposium will begin with a presentation on the background to and experience of working with the Intellectual Disability (Compulsory Care and Rehabilitation) Act in New Zealand. This Act gives courts the power to force people with an intellectual disability, who have been found unfit for trial or guilty of an imprisonable offence, to accept care and rehabilitation. Following this will be a presentation on the experience of working with people with intellectual disability who offend.
The symposium will then examine recent legislative initiatives for the non-forensic population of people with intellectual disability and mental health problems. These recent legislative initiatives have attempted to address “restrictive practices” for people with intellectual disability. They have defined the use of psychotropic medications for challenging behaviour as a restricted practice and have introduced a legal framework for assessment, review and consent for medication used in this way. The symposium will discuss the impact, and experience, of working with QCAT and the Guardian for Restricted Practices in QLD, and the Disability Act (2006) in Victoria.
The formal presentations will be followed by an open discussion of the issues raised, with the floor open for audience members to share their own opinions and experiences of working with people with intellectual disability who offend, and working with recent legislative initiatives.
HOW IS NEW ZEALAND'S INTELLECTUALLY DISABLED OFFENDER LEGISLATION WORKING IN PRACTICE
1 National Advisor in the Intellectual Disability (Compulsory Care and Rehabilitation) Act, Te Korowai Whariki, New Zealand
Introduced in 2003, the Criminal Procedure (Mentally Impaired Persons) Act (the Act) provided New Zealand courts with innovative processes for assessing and disposing of people with a legally mandated intellectual disability (ID) charged with imprisonable offences.
The Act introduced a new test for unfitness to stand trial and disposition to the ID sector was made available for eligible people convicted of imprisonable offences or found unfit to stand trial on such offences.
This paper reviews some of the clinical, ethical and legal issues the operation of this Act is throwing up in New Zealand. In reviewing these matters it attempts to inform jurisdictions considering similar legislation of some of the potentials and pitfalls of this framework.
Areas discussed will include:
The challenge provided by the statutory placement within disability services of disenfranchised and violent individuals whose mild intellectual disability is related to abuse-related developmental cognitive limitation.
The dilemma posed by disturbing adolescents whose reluctant statutory carers may see laying charges as a way of inducing the disability sector to care for them while they are still on a developmental trajectory.
The potential for long-term statutory detention of individuals following conviction for minor breaches of the law.
The implications of a possible lifting of the threshold of competence to stand trial.
The conflict between the court's desire to establish ID as an immutable legal fact and the clinical reality that IQ tests results are not always reliable.
YOUTH OFFENDERS WITH INTELLECTUAL DISABILITY: DEVELOPING SERVICES IN AUCKLAND
1 Community Child and Adolescent Mental Health Service
2 Regional Youth Forensic Service, Kari Centre, Auckland District Health Board, New Zealand
NEW LEGISLATION AND NEW SECURE SERVICE FOR QUEENSLAND – THE QUEENSLAND FORENSIC DISABILITY ACT (2011) AND THE NEW FORENSIC DISABILITY SERVICE
1 Queensland Health Mental Health Assessment and Outreach Team (Intellectual Disability), Community Services Queensland, Aveyron Road, Wacol, Australia
HOW TO DETAIN AND TREAT PEOPLE WITH INTELLECTUAL DISABILITY IN VICTORIA
Clinical Director and Consultant Psychiatrist, The Victorian Dual Disability Service, St Vincent's Hospital, Melbourne, Australia
S40 THE COMPETENCY-BASED FELLOWSHIP PROGRAM: HOW TO SUPPORT THE TRAINEE'S LEARNING BY USING FORMATIVE WORKPLACE-BASED ASSESSMENT
1 Royal Australian and New Zealand College of Psychiatrists Competency Based Fellowship Program
To have knowledge of workplace-based assessment protocols
To understand how workplace-based assessments are applied to everyday practice
To introduce the workplace-based assessment tools to the CBFP
To know how to give effective feedback
Workplace-based assessment measures what doctors actually do in practice; evaluating the development of competence in the clinical context. The range of workplace-based assessment tools support the supervisor to assess for learning and provide the trainee with accurate formative feedback that can be used to reflect on and improve performance. Convincing evidence supports the notion that systematic feedback through workplace-based assessment can change clinical performance. These tools will be particularly invaluable when supervising trainees experiencing difficulties.