Sustaining evidence-based practice for young people who self-harm: a 4-year follow-up.

OBJECTIVE: In 1998 and 1999, two NSW Area Health Services conducted the Youth At Risk of Deliberate Self Harm (YARDS) project. The YARDS project was designed to implement evidence-based service enhancements for the clinical management of young people with Deliberate Self Harm. This paper examines the extent to which service enhancements implemented during YARDS were maintained 4 years after the conclusion of the project and compares service quality with another NSW Area Health Service that did not participate in the YARDS project. METHOD: Staff from mental health services and emergency departments completed the Service Activity Scale, a measure developed for the YARDS project to assess the quality of health service response to individuals who present following a suicide attempt. RESULTS: RESULTS indicated that the service improvements made during the YARDS project were maintained 4years after the project ended. Furthermore, a significant difference was found between scores for services that participated in YARDS and services that did not participate in YARDS. CONCLUSIONS: These results suggest that projects such as YARDS which support evidence based service nhancements may be useful in improving the management of young people with deliberate self-harm, and that these improvements may be long-lasting.

Factors associated with treatment compliance in young people following an emergency department presentation for deliberate self-harm.

This study investigated factors associated with patient non-compliance with follow-up treatment after a presentation to an Emergency Department (ED) for deliberate self-harm (DSH). 56 patients under 24 years and 20 parents participated in this study. Subjects were interviewed by telephone after they had attended or missed a follow-up appointment following a presentation to an ED for DSH. Convenience of the appointment time and the patients' beliefs about whether counseling would help them were found to differentiate attending and non-attending patients. The attitudes of parents also had a major influence on decisions to attend or not attend an appointment. These results support the use of a therapeutic intervention in the ED, targeting both patients and their parents' attitudes toward counseling.

Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.

Consumer participation in mental health services: who wants it and why?

Contemporary health policy dictates that health services have a demonstrable consumer focus and actively progress the issue of consumer participation in services. Given that costs of such initiatives are not insignificant, there is a responsibility to ensure that the resources are being directed to appropriate means, and are achieving worthwhile results. In examining the impact and effectiveness of consumer participation initiatives in their own Service, the authors undertook a qualitative study exploring the extent and quality of consumer participation following a three-year period of support and funding. Using trained consumers as interviewers, current consumers were asked about their perceptions and personal experience of "participation". Findings identified low familiarity and involvement with the concept of consumer participation overall. Barriers to involvement included lack of motivation or invitation, stigma, and a lack of information. A need to integrate consumer participation activities into the wider system was also noted. The authors conclude that simply devoting energy and resources to consumer initiatives, and thereby achieving a politically correct approach, may not be a worthwhile exercise. Such initiatives need to be based on evidence, available resources and identifiable and achievable outcomes, with a balance struck between endorsing the value of consumer participation and establishing realistic goals for what can be offered and managed.

Are psychiatrists equipped for management roles in mental health services?

OBJECTIVES: To promote the discussion of leadership and management skills development among psychiatrists in Australia and New Zealand. METHOD: A key informant survey of fellows of the Royal Australian and New Zealand College of Psychiatrists was conducted via a semi-structured interview. This canvassed views about leadership and management issues including levels of confidence and needs for additional skills. RESULTS: There was widespread support for psychiatrists to be in management roles in mental health services; however, on entering management positions, psychiatrists often felt inadequately trained and prepared for their new role. Furthermore, many who had made the transition to management perceived a lack of support from their clinical colleagues. Clinicians appeared to believe that management was not difficult to learn and could be done by any experienced clinician. The provision of short courses and mentoring programmes is the preferred option for most psychiatrists seeking to acquire leadership and management skills. CONCLUSIONS: For psychiatrists to maximize their potential as leaders in Australian and New Zealand mental health services, greater attention to promoting the acquisition of relevant skills throughout training and in the post-fellowship years is required. Psychiatrists need to be supported and encouraged to pursue further education, training and research in this area. Failure to address this issue risks psychiatrists continuing to feel disadvantaged in management roles and hence reluctant to undertake the challenge.