Australasian Psychiatry

Objective: To demonstrate the practical utility of a new generation of hand-held computers in the practice of consultation-liaison psychiatry.

Method: In their work over the last 3 years as consultation-liaison psychiatrists in two large general hospitals in Sydney, the authors have developed a series of clinical databases carried on small computers. Illustrative examples demonstrate the utility of this dynamic learning tool.

Results: An affordable pocket computer provides a new means of accumulating, organizing and readily accessing the reams of information required by the consultation-liaison psychiatrist in day to day clinical work.

Conclusions: The information explosion in psychiatry, and in psychiatric pharmacology in particular, has placed enormous demands upon the practicing psychiatrist. Retaining and gaining access to this information is even more onerous for the consultation-liaison psychiatrist, who must maintain a familiarity with general medical illness and its treatment and investigation. The use of hand-held computers to assist is relevant to continuing medical education and embedding evidence-based medicine in clinical practice.

Objective: To describe the potential benefits and pitfalls in relation to the use of email with patients, with a view to fostering discussion about the impact of the technology on our discipline.

Conclusions: Email is useful for supplementing information provided in face-to-face sessions and for monitoring progress. ‘Cyberclinics’ present many possibilities to augment traditional patient management. Problems include not all patients having access to the technology and issues relating to confidentiality. The therapeutic relationship is inevitably altered through its use.

Objective: To describe the duties of editors and the ways in which authors can make an editor's life easier.

Conclusions: An editor's tasks include knowing his or her reader, making a journal attractive and ensuring articles are accurate and up to date. Authors can assist by having the reader in mind, writing in plain English and keeping articles short. Peer review is an important aspect of medical publishing but has limitations.

Objectives: To summarise changes in education and medical education which have influenced the development of a new model for postgraduate and continuing education in psychiatry, and to describe that model.

Conclusions: The NSW Institute of Psychiatry Postgraduate Course in Psychiatry has incorporated developments in problem-based learning in medical education, the modern principles of adult learning, the principles and practices of distance education, and selected advances in computerbased learning. The course is unique in postgraduate and continuing medical education, and is at the forefront of learning in psychiatry.

Objective: This paper challenges the adversarial judicial model of the Mental Health Review Tribunal. Following a brief history of the adversarial legal system, it questions the impact of imposing a legal environment on the mentally ill and on the traditional doctor/patient relationship. It also examines issues of poor communication and excessive bureaucracy.

Conclusions: The current legal process is inhumane, outdated, and inefficient. There is room for lateral thinking into developing a more appropriate and contemporary model to address issues of civil liberties and medical treatment for the mentally ill. One possible model could be made up of a non-judicial and independent team with appropriately trained staff, recruited from more ‘caring’ professions, with well-defined, but discretionary legal powers.

Editor's note: The continuum of training in psychiatry commences at university. Sydney University's new postgraduate medical program has adopted a different model to train students in aspects of psychological medicine. During their placement, students are being asked to think critically about, and if necessary challenge, current orthodoxies. The following essay, by a final year medical student, was written during a placement at Rozelle Hospital. The essay examines the impact of legal intervention on mental health. The author is currently an Intern at Nepean Hospital in Sydney. He has worked previously as a commercial and naval lawyer.

Objective: To review aspects of the history of psychiatry in Western Australia since Federation.

Method: Summary of a meeting of the WA Branch RANZCP with contributions from selected senior psychiatrists and one surgeon.

Conclusion: As the population of Western Australia has moved from about 150,000 to nearly 2,000,000 in the twentieth century, psychiatry has reflected world trends and sometimes has led them.

Objectives: To examine (1) perceived roles and functions of psychiatry medical staff in two multidisciplinary teams at two state-funded health services, a community mental health clinic at a general public psychiatry service and an alcohol and drug service, and (2) factors influencing these roles and functions.

Method: Data were obtained from focus groups, key informant interviews, participant observation and document review.

Results: Clinical roles were well conceptualised in both services, with good concordance between medical and non-medical staff. Team and leadership roles, however, were not well conceptualised. Service-related factors influenced clinical and many other roles. Power and professional cultural differences between medical and non-medical staff influenced team and leadership roles.

Conclusions: Addressing lack of role clarity and teaching interpersonal and team leadership skills to psychiatry medical staff are likely to improve multidisciplinary team functioning for psychiatrists in these settings.

Objective: First, to describe the focus and scope of occupational therapy and some contributions of occupational therapy in mental health settings. Second, to identify opportunities for enhancing interdisciplinary teamwork so as to effectively address the full range of needs and issues experienced by people living with mental illness, from an occupational therapist's perspective.

Conclusions: The significance of occupation for health and wellbeing needs to be better understood within the mental health field, and wider community, if interdisciplinary teams are to more effectively address the occupational and other needs of those living with mental illness. To this end, improved opportunities for dialogue through shared education and professional development, informed dialogue about balancing generic, specialist and nonprofessional roles in service delivery, as well as inclusion of consumers and carers in these dialogues, are recommended.

Objective: The contributions of social work to the interdisciplinary team are described, along with opportunities for, and barriers to, effective teamwork.

Conclusions: Social work is concerned with the social context and consequences of mental illness on the individual, family and community. Social work serves to connect the treatment team to the broader issues of family welfare, housing, income security, and community and sense of belonging. This broader focus and the social justice framework for social work can create tension between social work and other disciplines. Both undergraduate and postgraduate education for social workers remain a challenge, given the complexity and demands of the mental health workplace.

Objective: To describe the nature of psychiatry work within a general medical hospital and to compare and contrast the nature of that work between emergency department and inpatient settings.

Method: The data from the Royal Melbourne Hospital (RMH) consultationliaison service database relating to referral, patient demographics, psychiatric diagnosis service use, management and discharge arrangements was recorded for all referrals to the RMH C-L service in 1999. The inpatient and emergency department arms of the service were compared.

Results: The referral rate for inpatients and the emergency department was 2.9% and 2.1% respectively. The reasons for referral and frequency of psychiatric diagnosis differed significantly between the two settings.

Conclusions: The provision of C-L services to inpatients and the emergency department needs to be tailored to the different patient populations.

Objective: The aim of this paper is to analyse the reasons for a major increase in expenditure on inpatient pharmaceutical costs over a two year period and to describe strategies developed to prevent further increases.

Conclusions: By educating our medical staff on the costs of the most commonly prescribed medications and favouring cost effective medications such as risperidone over olanzapine we have been able to contain our inpatient drug costs and achieve a 14% reduction this financial year.

Objective: The aims were (1) to establish whether Early Childhood Nurses (ECNs) can be trained in a modified Cognitive Behavioural Therapy (CBT) for Post-natal Depression (PND), and (2) to compare the outcome of women treated with this therapy with ‘ideal standard care’ using non-specific counselling by ECNs with no additional training.

Method: Five ECNs were trained in CBT and supervised weekly. Women were screened post-natally using the Edinburgh PND Scale (EPDS) and diagnostically assessed by a research registrar. Women with DSM-IV major or minor depression (n=37) were then randomized into either ‘ideal standard care’ (n=20) or CBT (n=17) for six weekly sessions. Two stages of follow-up were undertaken: research registrar interview immediately post-treatment and a postal follow-up at six months.

Results: The training package was evaluated both by ECN completed questionnaires and analysis of taped therapy sessions. These evaluations indicated that ECNs could deliver modified CBT. There was a very high rate of recovery at initial follow-up with 70-80% recovered (EPDS < 10) in both groups. Six month follow-up showed a trend towards CBT being more effective in the longer term.

Conclusions: ECNs can effectively provide a modified CBT intervention in the treatment of PND. For the majority of this sample with mild-moderate depression, perceived support from their ECN (forming an integral part of both the baseline assessment interview and control condition) appeared to be as effective as modified CBT.