Holistic approach supporting mental wellbeing of people in enforced quarantine in South Australia during the COVID-19 pandemic.

OBJECTIVES: To report the experience of quarantine for international arrivals to South Australia requiring quarantine in a medi-hotel setting during the COVID-19 pandemic and to describe the range of evidence-based support services to mitigate the mental health impacts of quarantine. METHODS: A range of services targeted at physical and mental wellbeing were provided. Data from 533 adult respondents out of 721 passengers were included. The Kessler 10 was used to measure psychological distress at two time points. RESULTS: About 7.1% of respondents reported psychological distress at time one, reduced to 2.4% at time two. There was no significant difference in psychological distress by gender at either time point. The mean K10 score at time one was 13.6 (standard deviation=5.2) and the mean score at time two was 11.5 (standard deviation=3.1), with a significant reduction in mean scores (p<0.001) between the two time points. CONCLUSIONS: The level of psychological stress in repatriated Australians was low at arrival and improved further at the time of release from quarantine. Implications for public health: A collaborative multi-sector approach to provide support services for individuals in quarantine can mitigate risks to mental wellbeing.

Legal criteria for involuntary mental health admission: clinician performance in recording grounds for decision.

OBJECTIVES: Mental health laws set criteria that limit the use of involuntary admission to specific circumstances, and clinicians are expected to justify the lawfulness of such detention by referral to these criteria. The South Australian Mental Health Act 1993 required grounds to be documented on the detention form, specifically with respect to the presence of a mental illness, risk to self or others, and a need for immediate treatment. This investigation sought to determine whether the grounds provided for detention met legislative requirements. DESIGN AND SETTING: 2491 consecutive forms authorising the initial detention of involuntary patients in South Australia between July 2008 and June 2009 were rated to determine whether criteria stipulated by legislation were addressed. RESULTS: Only 985 forms (40%) addressed all the legal requirements for detention. 1471 forms (59%) did not comment on a requirement for immediate treatment, 540 (22%) did not state the presence of mental illness, and 359 (14%) did not discuss risk to self or others. Given the particularly poor performance of clinicians in addressing the need for immediate treatment, the data was reanalysed with respect to the presence of mental illness and risk only; 1697 forms (68%) addressed both these criteria. CONCLUSIONS: This low compliance rate with legal requirements is concerning. It may reflect clinical decision making, the attention given to the form by the physician filling it, or a combination of both. Stating the grounds for involuntary admission should provide protection for the rights of patients, and the requirement to do so reflects the gravity that the loss of liberty entails for the patient. Our findings are relevant to jurisdictions that are currently reviewing mental health legislation and the need to document the grounds for involuntary treatment, including South Australia.

Tackling the global mental health challenge: a psychosomatic medicine/consultation-liaison psychiatry perspective.

BACKGROUND: Consultation-liaison (C-L) psychiatry, informed by principles of psychosomatic medicine, is well-positioned to address the global impact of mental disorders through primary care C-L models. OBJECTIVE/METHOD: The authors review the international burden of mental disorders, highlighting medical comorbidity, undertreatment, and the rationale for enhancing primary-care management. RESULTS: C-L psychiatry fosters the skills required for global mental health work. The authors describe successful C-L models developed in a low-income country (Ethiopia) and an under-resourced region of a high-income country (Australia). CONCLUSION: C-L psychiatrists have the potential to marshal their unique skill-set to reduce the global burden of mental disorders.