Patterns of Service Provision in Older People's Mental Health Care in Australia.

Australia has a population of around 4 million people aged 65 years and over, many of whom are at risk of developing cognitive decline, mental illness, and/or psychological problems associated with physical illnesses. The aim of this study was to describe the pattern of specialised mental healthcare provision (availability, placement capacity, balance of care and diversity) for this age group in urban and rural health districts in Australia. The Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) tool was used in nine urban and two rural health districts of the thirty-one Primary Health Networks across Australia. For the most part service provision was limited to hospital and outpatient care across all study areas. The latter was mainly restricted to health-related outpatient care, and there was a relative lack of social outpatient care. While both acute and non-acute hospital care were available in urban areas, in rural areas hospital care was limited to acute care. Limited access to comprehensive mental health care, and the uniformity in provision across areas in spite of differences in demographic, socioeconomic and health characteristics raises issues of equity in regard to psychogeriatric care in this country. Comparing patterns of mental health service provision across the age span using the same classification method allows for a better understanding of care provision and gap analysis for evidence-informed policy.

What makes a hospital-based psychiatry training program successful? The experience of St Vincent's Hospital, Sydney.

OBJECTIVES: The purpose of this paper is to describe those features that have contributed to the popularity and success of the psychiatry training program at St Vincent's Hospital, Sydney, and to discuss the factors that potentially weaken the program and how these might be addressed. CONCLUSIONS: The strengths of the psychiatry training program at St Vincent's Hospital are the high rate of recruitment of junior medical officers to psychiatry training, the provision of quality in-house teaching, the in-house provision of psychotherapy supervision and exam preparation, the positive influence of the chief psychiatry registrar, having enough trainees to alleviate the tension between training and service delivery, and the availability of a variety of 'extra', high-quality, professional development opportunities.

Lessons learned in developing community mental health care in Australasia and the South Pacific.

This paper summarizes the findings for the Australasia and Pacific Region of the WPA Task Force on Steps, Obstacles and Mistakes to Avoid in the Implementation of Community Mental Health Care. We present an overview of mental health services in the region; discuss policies, plans and programmes; chart progress towards achieving community-oriented services, and detail the lessons learned.

On representation of solids: a note.

Current theories of representation of 3-D objects assume that they are geometrical facsimiles of represented objects and, therefore, imply that various aspects of the representations are as concordant as are those of the objects themselves. Empirical data presented here question this as they show that subjects' choices of distinct views of objects are not mutually concordant. This being so, it seems unlikely that a facsimile representation of a solid yields a full description of the process of representation.

Mental Health Commissions: making the critical difference to the development and reform of mental health services.

PURPOSE OF REVIEW: Several Mental Health Commissions (MHCs) have emerged in developed countries over recent years, often in connection with mental health reform strategies. It is timely to consider the types of MHC which exist in different countries, their characteristics which may contribute to making them more effective, and any possible limitations and concerns raised about them. RECENT FINDINGS: The emerging literature on MHCs indicates, particularly with the wider types of MHCs, that they may contribute to the substantial enhancement of mental health resources and sustainability of services; mental health reform is much more likely to be implemented properly with an independent monitor such as a MHC which has official influence at the highest levels of government; and they can encourage, champion and monitor the transformation of services into more evidence-based, community-centred, recovery-oriented, consumer, family and human rights-focused mental health services. SUMMARY: The advent of MHCs may enhance the resourcing, quality and consistency of distribution of effective clinical practices and crucial support services, and foster more relevant practice-based research. MHC variants can work in different countries and the model can be adapted to state jurisdictions, single state nations and federated systems of government, without duplicating bureaucracies. Achievements and possible limitations are considered.

WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care.

This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates.

Multiple-object tracking: enhanced visuospatial representations as a result of experience.

Research has demonstrated that individuals who routinely engage in complex visuospatial tasks (e.g., radar operators) show an enhanced ability to track multiple randomly moving targets. This study examined tracking expertise using members of a University Officer Training Corps (OTCs) who regularly engage in tasks requiring good dynamic spatial cognition. As expected, the results show that OTCs have enhanced tracking ability relative to other undergraduates. More importantly, they support the idea that, while one set of executive processes are involved in the moment-by-moment updating of the visuospatial representations necessary for dynamic, multiple-object tracking, other processes are activated when whole object sets disappear simultaneously, to create a long-term memory trace of the objects' locations at the moment of their disappearance. Expertise only arose in the former processes, but was lost after a short decay period, such as occurred with a delayed response.

Psychiatrically impaired medical practitioners: an overview with special reference to impaired psychiatrists.

OBJECTIVE: This paper will define and describe impairment in medical practitioners due to mental illness, with special reference to the specialty of psychiatry, and then review the prevalence and identification of impaired practitioners. METHODS: The quantitative and qualitative evidence regarding the incidence and impact of medical practitioner impairment due to mental illness (and, to some extent, substance use), with special reference to impaired psychiatrists, is reviewed. RESULTS: Medical practitioner impairment due to mental illness has a severe impact on their lives and their families due to both the effects of the disorder and the experience of communal, professional and self stigma. CONCLUSIONS: The consequences of impairment among medical practitioners and specialist psychiatrists as well as the under-reporting of impaired practitioners is a significant problem.

Psychiatrically impaired medical practitioners: better care to reduce harm and life impact, with special reference to impaired psychiatrists.

OBJECTIVE: The aims are to briefly review treatment outcomes for impaired practitioners, and to explore how preventive and early intervention, and the accessing of and retention within treatment systems for impaired medical practitioners, and particularly psychiatrists, could be improved to maximize the doctors' chances of full recovery and to minimize danger to self and others. METHODS: The literature on the treatment and care of medical practitioner impairment due to mental illness, and substance use, with special reference to impaired psychiatrists is briefly reviewed. The implications of deficiencies of usual clinical management of doctors impaired by mental illness and opportunities for improvement in services for them are explored, including the impact of the experience of being an impaired medical practitioner under psychiatric treatment. The roles of medical boards and advisory services are examined. RESULTS: Medical practitioner impairment due to mental illness has a severe impact on doctors' lives and the lives of their families due to both the effects of the disorder and the experience of communal, professional and self stigma and discrimination. Deficiencies in usual practice in the treatment and rehabilitation of such individuals are identified, and alternatives explored. CONCLUSIONS: Prevention, early detection, intervention, and treatment programs that are more continuous more sensitive to the needs of impaired practitioners, that are more continuous, better structured, and rehabilitation and recovery focused, may be more likely to produce a positive outcome.

Enumeration: shape information and expertise.

This study examined the interaction between grouping information and expertise in a simple enumeration task. In two experiments, participants made rapid judgements about the number of items present in a visual display. Within each display, items were grouped into a canonical representation (e.g., triangle, square, and pentagon) or were arranged linearly. In both experiments, grouping information facilitated enumeration performance, replicating previous findings in the literature. In Experiment 2, the facilitative effect of grouping information was found to be greater for Air Traffic Controllers (ATCs) than for matched novices, though they were no better than novices on linear arrays. This may be because linear, like canonical arrays, hold unique numerosity information, but only when they contain the minimum number of points necessary to define a line (i.e., 2). So ATCs' performance on linear arrays containing more than two items does not benefit from a facilitative effect of grouping information. That their experience of being ATCs, in terms of years served, was shown to account for the expertise effect suggests that such visuospatial expertise is acquired through frequent exposure to spatial arrays.

Perception and the art of depiction of cylindrical objects.

Many works of art, notably those in the Byzantine tradition, contain depictions of upright cylindrical objects such that the outline of their top surfaces is incompatible with that of their bottom surfaces. We endeavour to elucidate whether this is a consequence of a painterly usage or a perceptual effect and conclude, on the basis of empirical evidence, that the latter cause is more likely.

Hemispatial asymmetries in judgment of stimulus size.

Recent research has demonstrated a leftward bias in judgments of size. In the present experiments, hemispatial size bias was measured through simultaneous presentation of a circle and an ellipse varying in horizontal or vertical extent. A consistent leftward bias of horizontal size judgments (but not vertical) was obtained; at the point of subjective equality, the width of the objects that were presented in left hemispace was smaller than the width of the objects that were presented in right hemispace. These data suggest that the horizontal extent of stimuli appear larger in left hemispace than in right hemispace. Results also indicated that symmetrical stimulus presentation, with respect to the vertical meridian, is required for the bias to emerge. Furthermore, increasing or decreasing stimulus eccentricity weakened the effect. Attenuation of this bias upon the manipulation of parameters indicates that this phenomenon is context specific and is affected by similar parameters that are known to influence the magnitude of error in pseudoneglect.

A lateralized bias in mental imagery: evidence for representational pseudoneglect.

One hundred right-handed healthy individuals were asked to imagine a familiar scene (the Piazza del Duomo, Milan) from two opposite viewpoints and report what they could see. For elements that should be visible from the participants' viewpoint, more elements were reported from the left side of the image than from the right, irrespective of view. These results establish that there is a lateralized bias in reporting the details in mental images--representational pseudoneglect. This bias is in the opposite direction and significantly smaller than the bias seen in individuals with representational neglect following right hemisphere damage. Representational pseudoneglect appears analogous to perceptual pseudoneglect and the two may share an underlying mechanism. The results are interpreted as indicating that pseudo-representational neglect arises as the result of a bias in the allocation of attention to the imagined scene.

Representing target motion: the role of the right hemisphere in the forward displacement bias.

Patients with left spatial neglect, patients with right hemisphere damage but no neglect, and a control group were asked to judge the final position of a series of moving targets. Both patient groups showed attentional deficits. All 3 groups demonstrated a forward displacement bias, overestimating the final target position along the object trajectory. However, in both patient groups the size of this forward displacement bias decreased as the distance the target traveled before vanishing increased. For horizontally moving targets, at the maximum distance only the control group showed significant forward displacement. For all 3 groups, the direction in which the target traveled had no influence, but the size of the forward displacement increased as target speed increased. Several attentional explanations of these results are considered, including the differential allocation of spatial attention between central and peripheral locations, differences between exogenous and endogenous attention, and deficits in sustained attention.

Explicit and implicit trust within safety culture.

Safety culture is an important topic for managers in high-hazard industries because a deficient safety culture has been linked to organizational accidents. Many researchers have argued that trust plays a central role in models of safety culture but trust has rarely been measured in safety culture/climate studies. This article used explicit (direct) and implicit (indirect) measures to assess trust at a UK gas plant. Explicit measures assessed trust by asking workers to consider and state their attitude to attitude objects. Implicit measures assessed trust in a more subtle way by using a priming task that relies on automatic attitude activation. The results show that workers expressed explicit trust for their workmates, supervisors, and senior managers, but only expressed implicit trust for their workmates. The article proposes a model that conceptualizes explicit trust as part of the surface levels of safety culture and implicit trust as part of the deeper levels of safety culture. An unintended finding was the positive relationship between implicit measures of trust and distrust, which suggests that trust and distrust are separate constructs. The article concludes by considering the implications for safety culture and trust and distrust in high-hazard industries.

Multiple-target tracking: A role for working memory?

In order to identify the cognitive processes associated with target tracking, a dual-task experiment was carried out in which participants undertook a dynamic multiple-object tracking task first alone and then again, concurrently with one of several secondary tasks, in order to investigate the cognitive processes involved. The research suggests that after designated targets within the visual field have attracted preattentive indexes that point to their locations in space, conscious processes, vulnerable to secondary visual and spatial task interference, form deliberate strategies beneficial to the tracking task, before tracking commences. Target tracking itself is realized by central executive processes, which are sensitive to any other cognitive demands. The findings are discussed in the context of integrating dynamic spatial cognition within a working memory framework.

Oppel-Kundt illusion in three-dimensional space.

A three-dimensional form of the Oppel-Kundt illusion was examined. Subjects viewed arrays consisting of two parallel rows of lights. For one group the rows consisted of equal numbers of lights (2, 3, or 4), while for a second group the row nearest the subject always had the greater number of lights. Subjects viewed these arrays from two vantage points, one directly in front of the array and the other displaced laterally. For each array subjects adjusted the extent of the far array until they felt the two rows were the same length. Both the nature of the array and the viewpoint had a significant influence on the perceived length of the far row. The size of the near row was overestimated significantly more when the array was viewed from the central position and also when the number of lights in the near row exceeded that of the far row. These results confirm that a lateral viewing position decreases the perspective effect and indicate that the Oppel-Kundt illusion can occur with three-dimensional stimuli.

Social norms and self-presentation: children's implicit and explicit intergroup attitudes.

Two studies examined whether social norms and children's concern for self-presentation affect their intergroup attitudes. Study 1 examined racial intergroup attitudes and normative beliefs among children aged 6 to 16 years (n=155). Accountability (i.e., public self-focus) was experimentally manipulated, and intergroup attitudes were assessed using explicit and implicit measures. Study 2 (n = 134) replicated Study 1, focusing on national intergroup attitudes. Both studies showed that children below 10 years old were externally motivated to inhibit their in-group bias under high public self-focus. Older children were internally motivated to suppress their bias as they showed implicit but not explicit bias. Study 1, in contrast to Study 2, showed that children with low norm internalization suppressed their out-group prejudice under high public self-focus.

General Practice care of enduring mental health problems: an evaluation of the Wellington Mental Health Liaison Service.

AIMS: To describe the development and evaluation of a primary care service for a population of mental health consumers who had previously been predominantly cared for by a specialist service. METHODS: Consumers were interviewed at regular intervals after entry to the programme. The Health of the Nation Outcomes Scale (HoNOS) and the Life Skills Profile (LSP) outcomes measures were used with consumers at intervals of 0,3,6,12 and 18 months after entry to the programme. A cost comparison was made between services provided to consumers in the year before entry to the programme, and after entry. RESULTS: Consumers reported no deterioration in their clinical condition while under the care of general practitioners, and they were largely satisfied with general practitioner care. Consumers' LSP scores were stable after entry to the programme. General practitioners were initially ambivalent about the programme, but were more supportive after 12 months had elapsed. The education provided to general practitioners, nurses, and receptionists was strongly welcomed. CONCLUSIONS: With carefully designed training and support, general practice can provide high-quality community-based mental healthcare for consumers with enduring mental health disorders, and it can support the introduction of integrated mental health care initiatives.

Understanding pretrial publicity: predecisional distortion of evidence by mock jurors.

Prejudicial pretrial publicity (PTP) constitutes a serious source of juror bias. The current study examined differences in predecisional distortion for mock jurors exposed to negative PTP (N-PTP) versus nonexposed control participants. According to work by K. A. Carlson and J. E. Russo (2001), predecisional distortion occurs when jurors bias new evidence in favor of their current leading party (prosecution or defense) rather than evaluating this information for its actual probative properties. Jury-eligible university students (N=116) acted as jurors in a mock trial. Elevated rates of guilty verdicts were observed in the N-PTP condition. Predecisional distortion scores were significantly higher in the N-PTP condition and reflected a proprosecution bias. The effect of prejudicial PTP on verdict outcomes was mediated by predecisional distortion in the evaluation of testimony. Results are discussed in relation to motivated decision making and confirmation biases.