The physical health of Indigenous people with a mental illness in the Kimberley: is ongoing monitoring effective?

OBJECTIVE: The aim of this paper is to evaluate the effectiveness of ongoing physical health monitoring for Indigenous Australians with mental health issues in the Kimberley region of Western Australia. METHOD: This longitudinal, within-groups investigation assessed physical health parameters such as blood pressure and blood glucose levels at baseline and at 18 months for the same cohort. No standardised intervention was in place, but action was taken if results were found to be abnormal. RESULTS: Most measures of physical health remained stable, with mean lipid and fasting glucose levels remaining abnormal over the entire assessment period. Systolic blood pressure showed a significant improvement. CONCLUSIONS: More needs to be done to improve the physical health of Indigenous mental health patients - culturally appropriate and secure interventions incorporating holistic models of care are needed.

Advancing social and emotional well-being in Aboriginal and Torres Strait Islander Australians: Clinicians' reflections.

OBJECTIVE: An expert reference group met on four occasions to consider ways forward in terms of Indigenous mental health. This paper summarises the discussion and recommendations. CONCLUSION: While the negative effects of colonisation and trans-generational trauma continue, we propose renewed emphasis on improving access, cultural orientation and trauma-informed care, and a focus on the needs of young Indigenous Australians.

Suicidal ideation and non-fatal deliberate self-harm presentations in the Kimberley from an enhanced police-mental health service notification database.

OBJECTIVES: To determine the rate of presentations for suicidal ideation and deliberate self-harm in the Kimberley region of Western Australia, characterized in terms of age, gender, rates of repetition and engagement with community mental health services. METHODS: An observational study of health service presentations over 12 months. SETTING: 10 sites across the region with police services were included, capturing the overwhelming majority of self-harm presentations in the region. PARTICIPANTS: all Indigenous presentations were analyzed. Of the 433 individuals who presented, 361 were Indigenous. MAIN OUTCOME MEASURES: suicidal phenomena, including suicidal ideation and any type of deliberate self-harm regardless of intent. RESULTS: Analysis suggests a broadly similar age and sex stratification of self-harm in this population compared with international reports. The rates, however, are 5-20 times higher than those reported in non-Indigenous populations in Australia and abroad, depending on whether the comparison rate is calculated from population surveys or hospital presentations. CONCLUSIONS: Prevalence of suicidal phenomena is very high and is likely to be much higher than estimated by this hospital based study. Such high prevalence suggests that a population level intervention is required in addition to interventions involving clinical services.

Rising Indigenous suicide rates in Kimberley and implications for suicide prevention.

OBJECTIVES: This audit examined the demographics of Indigenous Australians dying by suicide in the Kimberley region of Western Australia during the period 2005-2014. METHODS: This is a de-identified retrospective audit of reported suicide deaths provided to Kimberley Mental Health and Drug Service during the period 2005-2014. Variables such as age, sex, method of suicide, previous engagement with mental health services, locality and ethnicity were assessed. RESULTS: Indigenous suicide rates in the Kimberley region have dramatically increased in the last decade. There is also an overall trend upwards in Indigenous youth suicide and Indigenous female suicides. CONCLUSIONS: These findings highlight the need for culturally informed, and youth focussed, suicide prevention interventions within the Kimberley region.

Kimberley Indigenous mental health: An examination of metabolic syndrome risk factors.

OBJECTIVE: There is an increased risk of physical health comorbidities in people with a mental illness. This paper examines the metabolic syndrome parameters for the general population, indigenous Australians and people with a mental illness, and compares them to a sample of predominantly indigenous adults with mental health problems. DESIGN: A longitudinal (24 month) audit of patient medical records was conducted between February 2011 and March 2013. SETTING: The Kimberley Mental Health and Drug Service in Broome, Western Australia. PARTICIPANTS: Largely indigenous adults with a mental illness. Sample numbers increased from 56 at baseline (80% indigenous) to 136 at 18 months (70% indigenous). MAIN OUTCOME MEASURES: Waist circumference, blood pressure, fasting lipids, and fasting blood glucose. RESULTS: Preliminary assessment of the data indicates a high percentage of abnormalities at baseline and at the 18 month period on all four parameters, yet not all patients were assessed on a regular basis. CONCLUSIONS: Abnormalities in metabolic profiles consistent with the non-Indigenous mental health population were found. There are considerable challenges to implementing regular monitoring of physical and metabolic profiles of indigenous people in rural and remote communities.

Videoconferencing and forensic mental health in Australia.

Videoconferencing is in common use in Australian forensic mental health services. It provides opportunities to link remote prisons, courts, and psychiatric clinics with distant specialist services, and enables a range of activities including assessment, treatment and feedback, expert testimony, education, and inter-service planning. These functions are acceptable to patients and clinicians, and in Australia videoconferencing minimizes disruption to small services and their patients, who might otherwise face lengthy journeys. In particular, marginalized patient groups, including indigenous people and prisoners, may receive better services. The evidence base supports use of videoconferencing despite a number of practical, legal, and clinical issues that may reduce its effectiveness compared with face-to-face assessments. Videoconferencing technologies are critical to effective forensic mental health services in Australia.

Co-morbid post-traumatic stress disorder in a substance misusing clinical population.

BACKGROUND: USA studies have reported high rates of co-morbid post-traumatic stress disorder (PTSD) and substance (drugs and alcohol) dependence/misuse. Avoidance of trauma reminders and associated distress may be achieved by the use of drugs and alcohol, alternatively a substance abusing lifestyle might predispose such individuals to experience traumatic events. This may have implications for treatment and management of patients with co-morbid substance misuse and PTSD. There have been no British studies looking at the extent of traumatic life events and post-traumatic stress disorder amongst substance misusers, although high rates of reported sexual and physical abuse have been reported in two recent UK studies with drug- and alcohol-dependent patients in clinical settings. AIMS: (i) To investigate the prevalence of co-morbid PTSD in a UK substance use disorder (SUD) inpatient clinical population; (ii) to identify the characteristics, severity and types of trauma experienced; (iii) to compare SUD patients with and without co-morbid PTSD on substance use and history, psychological/psychiatric and social variables METHOD: This is a cross-sectional study involving interviews with patients and case note review. SUD inpatients were interviewed about traumatic experiences, PTSD, and addiction. RESULTS: Ninety-four percentage reported experiencing one or more PTSD criterion A traumatic experiences. 38.5% met criteria for current PTSD and 51.9% for lifetime PTSD. Significant differences between the PTSD and non-PTSD groups were found in PTSD and trauma-related variables, notably social variables and distress associated with traumatic experiences, but few differences were found in addiction severity (medical and psychiatric composite scores of the ASI) and psychiatric symptomatology. CONCLUSIONS: This study highlights not only the importance of assessment of trauma and PTSD amongst substance misusers but, conversely the need for the assessment of substance abuse among victims of PTSD. Co-morbid psychopathology is common, so trauma histories and PTSD symptoms may become embedded in other co-morbid psychopathology.