Multiaxial classification in child and adolescent mental health - a reaffirmation of benefit and practical applications.

OBJECTIVE: Classification systems and their practical implications have become increasingly important in child and adolescent psychiatry. This paper presents the evolution and practical applications of a multiaxial classification system for children and adolescents presenting to mental health services. Included are some worked examples demonstrating both the complexity of many presentations and how broadening the use of the multiaxial system can help in identifying appropriate interventions. CONCLUSIONS: Classification systems in child and adolescent psychiatry have largely remained uniaxial in nature. A multiaxial system encapsulates the broader biopsychosocial aspects of the presenting child or adolescent, and orders complex data in a concise manner. This approach can be used to concisely communicate with other treating clinicians, and assist with case reviews, formulation and teaching.

Functional outcomes in rural Australia of two continuing care teams: a regional town-city comparison of the 16-item Life Skills Profile.

OBJECTIVE: The primary aim was to examine differences in functional health outcomes in consumers entering a regional mental health service compared with a city service. METHOD: A retrospective analysis of consumer outcomes and characteristics was undertaken. Consumer demographics and diagnoses were compared between the two services. Functional outcomes were measured using the 16-item Life Skills Profile (LSP-16). The data analysis plan utilised descriptive statistics. For between-clinic comparisons, relevant inferential statistics was used. RESULTS: Patients attending the regional health service were five times more likely to be in the high impairment category on the LSP-16, independent of demographic factors and diagnosis. Other independent contributions to high impairment were being male, Indigenous and a diagnosis of schizophrenia. Of the four LSP-16 subscales, regional consumers scored relatively higher on withdrawal, compliance and anti-social but not self-care subscales. CONCLUSIONS: There was a greater level of functional impairment in consumers attending the regional service. The independent contributions did not explain the higher impairment; therefore, other factors such as socioeconomic disadvantage may explain the difference. Regional clinicians may need to consider recovery-orientated interventions that address a greater burden of functional impairments in regional services.

Mental health service provision in rural Australia: a regional town-city comparison of two continuing care teams.

OBJECTIVE: The primary aims were to compare the characteristics and health outcomes of consumers entering a regional mental health service compared with a city service. METHOD: A retrospective audit was undertaken of consumers aged 18 and over from a regional town and city mental health service. Consumer demographics, diagnoses and outcomes were compared between the two services. The data analysis plan utilised descriptive statistics. For between-clinic comparisons, relevant inferential statistics was used. RESULTS: Regional service patients had a significantly greater proportion of substance use disorder diagnoses. Outcome rating scales were higher (worse) for regional consumers. There was significantly less overall service utilisation for regional service consumers including shorter duration of episodes of care, less hospitalisations and less people treated under the Mental Health Act. CONCLUSIONS: There were a broader range of patient presentations in the regional town. Regional practitioners may specifically need more training and skills in treating substance use disorders.