Actions targeting the integration of peer workforces in mental health organisations: a mixed-methods systematic review.

BACKGROUND: Lived experience workforces are one of the fastest growing emerging disciplines in Australian mental health service settings. Individuals with lived and living experience of mental distress employed in mental health services, often referred to as peer or lived experience workers, are widely considered essential for mental health recovery and reform. Despite vast growth of this workforce, concerns remain over the widespread integration of peer workforces to align with recommended movement of healthcare services toward greater recovery-orientated and person-centered practices. Previous research has identified barriers for peer work integration including a lack of clear role definition, inadequate training, and poor supportive organisational culture. Stigma, discrimination and a lack of acceptance by colleagues are also common themes. This systematic review seeks to identify organisational actions to support integration of peer workforces for improved mental health service delivery. METHOD: A systematic search was conducted through online databases (n = 8) between January 1980 to November 2023. Additional data were sourced from conference proceedings, hand searching grey literature and scanning reference lists. Qualitative data was extracted and synthesised utilising narrative synthesis to identify key themes and findings reported adhere to PRISMA guidelines. The review protocol was registered with Prospero (CRD: 42,021,257,013). RESULTS: Four key actions were identified: education and training, organisational readiness, Structural adjustments, resourcing and support and, demonstrated commitment to peer integration and recovery practice. CONCLUSIONS: The study identifies actions for mental health service organisations and system leaders to adopt in support of integrating peer and lived experience workforces in service delivery.

'Everything would have gone a lot better if someone had listened to me': A nationwide study of emergency department contact by people with a psychosocial disability and a National Disability Insurance Scheme plan.

Australians with a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan may at times require emergency care due to the fluctuating nature of their physical and mental health conditions or when their supports have become insufficient. This nationwide study investigated the experiences of people presenting to an emergency department (ED) who have a PSD and an NDIS plan. The objective was to understand current care and communication practices and to provide recommendations for service integration. Twenty-four interviews were conducted with people who had a PSD and an NDIS plan. Participants were asked semi-structured questions about their experiences when engaging with NDIS processes and when engaging with the ED as an NDIS recipient and how communication practices could be improved between the two services. A qualitative, descriptive thematic analysis approach was used. A lived experience advisory group participated in the research and provided commentary. The findings of this study indicate that the NDIS, as a personalised budget scheme, presents challenges for people with complex PSD and physical needs. ED clinicians appear to be unclear about what the NDIS provides and communication between the two systems is fragmented and inconsistent. The themes identified from the analysed transcripts are: (a) People with PSD experience distress when dealing with the NDIS; (b) There's a blame game between the ED and the NDIS; and (c) Inadequate service integration between the ED and NDIS. Recommendations to assist with service integration include building service capacity, providing overlapping care and bridging the diverse biomedical, psychosocial and disability care services.

I have not come here because I have nothing better to do: The lived experience of presenting to the emergency department for people with a psychosocial disability and an NDIS plan-A qualitative study.

Almost 60 000 people have a psychosocial disability (PSD) and a National Disability Insurance Scheme (NDIS) plan. As PSD can be a fluctuating condition, people with a PSD and an NDIS plan, at times, may require crisis care and present to the emergency department (ED). This national study explored the experiences of people with a PSD and an NDIS plan when presenting to the ED. To understand the unique lived experience of people with a PSD and an NDIS plan, semi-structured interviews were conducted with 24 people between March and November 2022 and were analysed thematically. A lived experience advisory group was engaged as part of the research team. Participants were asked about their experiences in the ED including barriers to therapeutic care and what worked well. Participants reported emotional distress caused by receiving a biomedical rather than a person-centred mental health response. A previous mental health history overshadowed diagnostic decisions and most participants interviewed stated they would not choose to return to the ED. Half of the participants spoke of one presentation only where needs were met. Four main themes emerged from the data: (a) Diagnostic overshadowing; (b) Judgement and stigma; (c) Waiting without hope; and (d) If things went well. This study provides evidence of the unique lived experience of people with a PSD and an NDIS plan when presenting to the ED. The results highlight the need for clinicians in the ED to understand the complexity and nuances of supporting people with a PSD. Recommendations for a person-centred care approach are provided. Alternative support options for this group of people need to be explored.

The impact of trauma-informed suicide prevention approaches: A systematic review of evidence across the lifespan.

Trauma is associated with an increased likelihood of experiencing suicidality, indicating the need for and potential value of trauma-informed suicide prevention strategies. The aim of this study is to systematically review published literature regarding trauma-informed approaches for suicide prevention, and the impact on suicide outcomes. Systematic searches were conducted in eight databases (Medline, Embase, PsycInfo, Emcare, Nursing, and JBI in the Ovid platform; as well as ProQuest Psychology Database and The Cochrane Library) in March 2022, with no publication date limit. Four studies met the inclusion criteria: two randomized controlled trials and two quasi-experimental studies. Two studies reported reductions in ideation, intent, and behaviour among youth and a cultural minority group. Few studies directly reporting suicide outcomes were identified, all were quantitative, and heterogeneity prevents generalizability across population groups. Currently, there is limited evidence focusing specifically on trauma-informed suicide prevention across the lifespan. Additional research, incorporating lived experience voices, is needed to understand the potential of this approach, as well as how mental health nurses can incorporate these approaches into their practice.

Disentangling Rates, Risk, and Drivers of Suicide in the Construction Industry.

Background: Research suggests construction industry workers (CIWs) face increased suicide vulnerability. Aims: The current study synthesizes international evidence examining rates, risk, and drivers of CIW suicide. Method: Comprehensive searches of MEDLINE, PsycInfo, Embase, Emcare, Web of Science, Scopus, and gray literature were undertaken, identifying studies that discussed, theorized about, or demonstrated risks and/or rates and/or drivers of CIW suicide, without inclusion of other industries. Results: A number of included studies statistically analyzed suicide outcomes in a variety of CIW populations, with the majority reporting increased rate and/or risk, however significant heterogeneity limited comparisons. Twenty-five potential drivers were identified and classified as personal- or industry-related. Disentanglement highlighted the relevance of previously understood personal drivers, need for future focus on industry drivers, and potential interplay between drivers. Limitations: Exclusion of non-English articles as well as inability to extend analysis to fully understand rates and/or risk of CIW suicide and tenuous links between suggested drivers and suicide outcomes. Conclusion: Despite limitations, this paper aids understanding in relation to the suggestion that CIWs are at increased suicide vulnerability. Disentanglement of potential drivers demonstrates the importance of future research focused on industry drivers to assist in prevention strategies.

A model of lived experience leadership for transformative systems change: Activating Lived Experience Leadership (ALEL) project.

PURPOSE: This discursive paper presents a lived experience leadership model as developed as part of the Activating Lived Experience Leadership (ALEL) project project to increase the recognition and understanding of lived experience leadership in mental health and social sectors. The model of lived experience leadership was formulated through a collaboration between the South Australian Lived Experience Leadership & Advocacy Network and the Mental Health and Suicide Prevention Research and Education Group. DESIGN/METHODOLOGY/APPROACH: As one of the outcomes of the ALEL research project, this model incorporates findings from a two-year research project in South Australia using participatory action research methodology and cocreation methodology. Focus groups with lived experience leaders, interviews with sector leaders and a national survey of lived experience leaders provided the basis of qualitative data, which was interpreted via an iterative and shared analysis. This work identified intersecting lived experience values, actions, qualities and skills as characteristics of effective lived experience leadership and was visioned and led by lived experience leaders. FINDINGS: The resulting model frames lived experience leadership as a social movement for recognition, inclusion and justice and is composed of six leadership actions: centres lived experience; stands up and speaks out; champions justice; nurtures connected and collective spaces; mobilises strategically; and leads change. Leadership is also guided by the values of integrity, authenticity, mutuality and intersectionality, and the key positionings of staying peer and sharing power. ORIGINALITY/VALUE: This model is based on innovative primary research, which has been developed to encourage understanding across mental health and social sectors on the work of lived experience leaders in seeking change and the value that they offer for systems transformation. It also offers unique insights to guide reflective learning for the lived experience and consumer movement, workers, clinicians, policymakers and communities.

Communication pathways from the emergency department to community mental health services: A systematic review.

This systematic review synthesizes existing peer reviewed evidence reporting on evaluated strategies used for enhancing communication pathways for continuity of care between the emergency department and mental health community supports. Following the PRISMA guidelines and the PICO framework, this review was conducted between January and July 2021. Included articles needed to evaluate communication pathway interventions for continuity of care between the emergency department and mental health community services which support service users with mental health and/or suicidal crisis. The seven included studies identified three support coordination interventions, two motivational interviewing interventions, an electronic record enhanced strategy and results from a phone follow-up study. This review demonstrates that support coordination, motivational interviewing, education, or an enhanced electronic record strategy can improve continuity of care, and in some cases, reduce the need for people to re-present to ED when they are experiencing mental health concerns or suicidal crisis. Results of this review reveal that a multipronged approach of communication pathways for continuity of care would enable more effective connections with mental health community supports and enable better outcomes for people requiring services.

An Evaluation of Suicide Prevention Education for People Working With Refugees and Asylum Seekers.

Background: There are concerning rates of suicidality among asylum seekers and refugees in Australia, and tailored suicide prevention initiatives are needed. Aims: We aimed to evaluate the impact of a tailored suicide prevention education program for people working with asylum seekers and refugees. Method: Attendees of the education program completed self-report questionnaires at pretraining, posttraining, and 4-6 months follow-up. Results: Over 400 workers, volunteers, and students across Australia took part in the education program. A series of linear mixed-effects models revealed significant improvements in outcome measures from pretraining (n = 247) to posttraining (n = 231). Improvements were maintained at follow-up (n = 75). Limitations: Limitations of this research were the lack of a control group and a low follow-up response rate. Conclusion: Findings suggest that a 2 days tailored suicide prevention education program contributes to significant improvements in workers' attitudes toward suicide prevention, and their confidence and competence in assessing and responding to suicidal distress.

Staff Perspectives of Safety Planning as a Suicide Prevention Intervention for People of Refugee and Asylum-Seeker Background.

Background: Safety planning involves the co-development of a personalized list of coping strategies to prevent a suicide crisis. Aims: We explored the perspectives of workers regarding safety planning as a suicide prevention strategy for people of refugee background and those seeking asylum in Australia. Method: Participants attended suicide prevention training, specific to refugees and asylum seekers, at which safety planning was a key component. Semistructured, posttraining interviews (n = 12) were analyzed thematically. Results: Four key themes were identified: safety planning as a co-created, personalized activity for the client; therapeutic benefits of developing a safety plan; barriers to engaging in safety planning; strategies to enhance safety planning engagement. Limitations: First-hand refugee and asylum-seeker experiences were not included. Conclusion: As a relatively low-cost, flexible intervention, safety planning may be valuable and effective for these groups.

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review.

The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.HighlightsThe Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).

Correction: National Disability Insurance Scheme and Lived Experience of People Presenting to the Emergency Department: Protocol for a Mixed Methods Study.

[This corrects the article DOI: 10.2196/33268.].

National Disability Insurance Scheme and Lived Experience of People Presenting to the Emergency Department: Protocol for a Mixed Methods Study.

BACKGROUND: Currently, within Australia, 3.6% of all emergency department (ED) presentations are mental health-related. Information about the context of the person presenting to the ED (beyond immediate needs), including their psychosocial disability (PSD) National Disability Insurance Scheme (NDIS) plan, is reported as incomplete and fragmented. There are missed opportunities for early support and care continuity that could potentially inform ED practitioners to revise current practices. OBJECTIVE: The aims of this study are: (1) to obtain original data from the lived experience voice of those with the PSD NDIS plan and their experience when presenting to an ED, (2) to gather information from NDIS service providers to reveal communication pathways between the ED and NDIS services, and (3) to gain knowledge from ED clinicians around processes for improving continuity of care and consumer experience. METHODS: This inductive, mixed methods phenomenological study will involve data collection analyzed sequentially, with each stage informing future stages of the research. Interviews will focus on the lived experience voice exploring concerns that have led to an ED presentation, alongside an analysis of associated clinical and administrative documentation and communications. Focus groups with NDIS support workers and support coordinators will provide phenomenological data around the experience from their perspective. National quantitative surveys among those with a PSD NDIS plan and emergency services clinicians will provide insight into current practices within community care and ED presentations. The research project design includes a lived experience advisory group who are assisting with the design of the interview and focus group schedules and national surveys, as well as in shaping the interpretation of qualitative information. All transcripts will be subject to thematic analysis to understand individuals' meaning-making of these complex and particular phenomena. The research team includes a lived experience researcher and a lived experience carer (PhD candidate). RESULTS: This study is funded by MIND Australia as a PhD industry scholarship, which commenced in April 2020. A systematic review as a preresearch activity has been completed and is currently under review. The Human Research Ethics Committee of the University of South Australia has approved this project. An advisory group has been selected, and interview, focus group, and survey schedules are currently being codesigned. Recruitment will commence in November 2021. It is envisaged that data collection will be completed by June 2022. CONCLUSIONS: Understanding the lived experience of the precare, during care, and postcare stages of ED presentations from the perspective of those with a PSD NDIS plan will inform the research team around current practices and provide information about improvement for pathways of care for consumers and carers, while also informing health policy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/33268.

The impact of screen media portrayals of suicide on viewers: A rapid review of the evidence.

This rapid review aimed to review recent published literature and describe the current evidence regarding the impact, on viewers, of portrayals of suicide in screen/ moving-image fiction and non-fiction media, such as television/web series, films and documentaries. We searched various databases for research conducted within the past decade (2009-2019). A total of 16 articles were eligible for inclusion. The literature reported varying impacts of portrayals of suicide through moving-image media such as increased suicidal ideation and behaviour, as well as positive impacts such as increased help-seeking behaviour. While there is limited evidence which focuses specifically on the impact of moving-image media, the studies included in this review highlight concerning trends regarding the impact of media portraying deaths by suicide on subsequent suicidality. However, positive impacts on suicide awareness, literacy and help-seeking behaviour were also identified.

The mental health status of asylum seekers in middle- to high-income countries: a synthesis of current global evidence.

INTRODUCTION: The last 5 years have witnessed a significant increase in the number of people fleeing their countries of origin and seeking refuge in host countries. By the end of 2018, there were 3.5 million asylum seekers awaiting outcomes on their applications, the majority of whom were hosted by middle- to high-income countries. This review aimed to identify and synthesize current knowledge regarding the mental health status of asylum seekers in middle- to high-income countries. SOURCES OF DATA: A search was conducted across various databases for research literature published within the last 5 years (2014-2019). The final review and synthesis included 25 articles. AREAS OF AGREEMENT: Findings highlighted significant differences in the mental health status of asylum seekers compared to those with refugee status and permanent residence. AREAS OF CONTROVERSY: Guidelines from the World Health Organization and the United Nations High Commissioner for Refugees emphasize the need to understand and address mental health issues. Instead, there have been policy changes in many host countries regarding asylum applications, and the associated effects of these changes have been shown to negatively impact mental health. GROWING POINTS: The synthesized findings from the present review provide information regarding the current mental health status of asylum seekers hosted by middle- to high-income countries. Areas of intervention and resource allocation were also identified. AREAS TIMELY FOR DEVELOPING RESEARCH: Future research should consider the impact of large-scale, low-cost interventions to support the mental health of those seeking asylum.

Development of an evidence-based Evaluation Toolkit for suicide prevention networks in regional Australia.

PROBLEM: Suicide is a global public health concern, particularly for those living in rural, regional and remote areas. Despite numerous prevention initiatives, suicide continues to impact individuals, families and communities. Suicide prevention networks are an innovative, community-based approach to addressing suicide within local government areas. Anecdotally, suicide prevention networks make an important contribution to suicide prevention, yet frameworks for evaluating their impact do not exist. The purpose of this project was to develop an Evaluation Toolkit to be used by suicide prevention networks throughout South Australia to monitor their impact. DESIGN: Participatory action research was used to work with one suicide prevention network in regional South Australia to co-design and produce the Evaluation Toolkit. SETTING: One regional South Australian town, with an established suicide prevention network. KEY MEASURES FOR IMPROVEMENT: The development of an Evaluation Toolkit, to allow all South Australian suicide prevention networks to measure their impact in a consistent manner. STRATEGIES FOR CHANGE: The Evaluation Toolkit has been made freely available in electronic form and as a hard copy booklet for use by all South Australian suicide prevention networks. EFFECTS OF CHANGE: The purpose of this project was to develop the Evaluation Toolkit. Formal assessment of its usability and effectiveness is yet to be undertaken, but preliminary anecdotal evidence indicates aspects of the Evaluation Toolkit are useful, especially the questionnaire templates that can be adapted and used to evaluate various community events. LESSONS LEARNT: Participatory action research is a useful method for working with community-based suicide prevention groups.

Metaplastic breast cancer.

Metaplastic breast carcinoma is uncommon and constitutes less than 5% of all breast cancers. The cancerous epithelium becomes non-glandular through metaplastic differentiation. There are various subtypes and the extent to which this process occurs varies. A case of a 52-year-old female patient is reported and the published literature is reviewed.

A seasonal variation in breast cancer.

AIM: To demonstrate a seasonal variation in the detection of breast cancer in women diagnosed at St Marks Breast Centre, Auckland. METHODS: Data on women diagnosed with breast cancer at St Marks Breast Centre from January 1992 till December 2001 were obtained from the computerised database. RESULTS: A total of 1760 women were diagnosed with breast cancer; 1584 were referred by their general practitioner and 176 self referred. The peak incidence of seasonal diagnosis was in spring (September, October, November) with 521 cases. The lowest incidence was in summer (December, January, February) with 375 cases. These findings were consistent annually from 1992 to 2001. CONCLUSIONS: There is a seasonal variation in the incidence of breast cancer similar to that noted in other studies. Our findings suggest that temporal factors and possible behavioural patterns may have a role in this seasonal variation.

Aggressive fibromatosis of the breast: a case report and literature review.

Aggressive fibromatosis is a rare, locally aggressive disease. It constitutes 0.3% of all solid tumors, but the tumor is rarely seen in the breast, particularly without pectoral muscle and fascial involvement. The etiology is unknown, but an association with Gardner's syndrome has been described. Clinical and imaging findings simulate breast carcinoma. A case in a 53-year-old female patient is reported.