Improving mental health for young people in out-of-home care: Providing participatory evidence-based mental health care across services
Victoria’s Prevention and Recovery Care (PARC) services are sub-acute residential services that aim to minimise time in hospital for people with severe mental disorder. This NHMRC Partnershp Project aims to explore the appropriateness, effectiveness and efficiency of Victoria’s adult PARC services. Findings from the project will provide important information for service improvement and help shape future directions for PARC-type services in Australia. The investigation is being conducted by a team of independent researchers from the University of Melbourne, Monash University, La Trobe University and Deakin University alongside partners from all the current Mental Health Community Support Services (MHCSS): Break Thru, Ermha, Life Without Barriers, Cohealth, Wellways (formerly MIF), Mind Australia and Neami National. The project is a series of seven inter-related mixed methods studies which will use several different data sources. A detailed typology and comprehensive mapping of adult PARC services has been carried out. Mental health service data collected by the Victorian Government Department of Health and Human Services is being used to fully understand PARC service delivery in the context of mental health service provision in Victoria. The final study places a strong emphasis on cosumer perspectives by following a large number of consumers over a one-year period starting from their admission to a PARC service. A series of individual interviews, surveys and focus groups will also be conducted with a smaller group of consumers and carers. Recruitment of consumers from each PARC service for individual interviews was completed in October 2017. Between February and May 2018, a second group of consumers were recruited to participate in an individual interview, survey or focus group. FIndings are currently being written up for publication.
Building Family Skills Together (BFST) Mind
Building Family Skills Together (BFST) Mind provides an in-home evidence-based service to families who live in Northern Melbourne that have an adult family member who has a serious mental illness, such as schizophrenia, bipolar affective disorder and major depression. The service provides Behavioural Family Therapy, offering assistance to families by sharing information about the illness, finding easier ways to talk to each other and ways to manage difficulties when they arise. The aim is to improve family relationships, reduce stress, support recovery and deal with day-to-day challenges. The evaluation of BFST Mind showed that half the consumers receiving the service were born overseas along with one third of the carers, suggesting the program was successful in reaching hidden culturally and linguistically diverse (CALD) families. The evaluation, which compared assessments conducted before and after receipt of the service, showed improved mental health and quality of life and family functioning amongst consumers and decreased burden for their families, confirming the effectiveness of this family psycho-education approach. The evaluation also detected a higher percentage of consumers who reported satisfaction with their lives following the program, while the percentage of carers reporting a need for more assistance decreased
Survey of High Impact Psychosis (SHIP)
The second Australian national survey of psychosis (also known as the Survey of High Impact Psychosis (SHIP)) was a prevalence study of psychotic mental illness across Australia conducted in 2010, plus an in-depth analysis of factors influencing the daily lives of people living with psychosis, with a focus on those amenable to change. It was a follow up of the “Low Prevalence Study” in 1998. The NWAMHS national survey dataset has comprehensive data on consumer characteristics and service usage, including evidence-based psychosocial interventions (their availability from both consumer and case manager perspectives along with case manager views on barriers to their availability and whether similar interventions are being delivered). These NWAMHS data have been benchmarked against the other national survey sites and provided a gap analysis that informed the local community services re-design and its accompanying evaluation. Analysis of data from the second national survey of psychosis is continuing: over fifty articles (published or in press/submission) have already been generated by PRC staff and their collaborators.
A Survey of Caregivers of People with Psychosis in the Australian Survey of High Impact Psychosis (SHIP): The relationship between caregiver experience and consumer characteristics
This recently submitted PhD research project aimed to explore and better understand the grief, health and well-being, quality of life, social connectedness and caregiving consequences of carers of people with psychosis within a prevalence framework. This research took place in the context of the Australian National Survey of High Impact Psychosis (SHIP) in Victoria, with results which are likely to be representative of carers of people with psychosis. Ninety eight carers participated in this study; these carers experienced moderate grief and poorer social connectedness and higher psychological distress than people in the general population, according to population norms. CALD carers have even poorer mental health and quality of life than Australian-born carers. There were few changes for carers over the course of 1 year other than a worsened perception of their quality of life related to their physical health, suggesting a pressing need to assess and improve carers’ physical health. The carers’ perceptions of higher functioning of their relatives with psychosis at baseline led to better social connection, less grief and higher satisfaction in psychological health for carers at follow-up, suggesting increased efforts to improve consumer functioning through rehabilitation and recovery-informed approaches could impact positively on carer health and wellbeing.
Assessing mortality and morbidity in people with psychotic disorders
An empirical framework for assessing mortality and morbidity in people with psychotic disorders: A 7-year prospective and 10-year retrospective follow-up of 2075 participants in the Survey of High Impact Psychosis (SHIP) using linked registers.
It is well established that physical morbidity and premature mortality are elevated in schizophrenia. The CIs/AIs who collaborated on the 2010 National Survey of High Impact Psychosis (SHIP), have cross-sectional data revealing rates of physical morbidity among SHIP participants well above population rates and exposing a very high cost burden. However there is a critical need for longitudinal data.
This NHMRC project grant funding study builds on a unique opportunity to use an innovative dual-methods strategy. 17 years (2000-2017) of mortality and physical morbidity outcome data from state and national administrative registers will be extracted. We will add these register data to previously-collected survey data for a large, nationally representative and comprehensively characterised sample of 2075 people aged 18-64 years with psychotic disorders who took part in SHIP.
The aims are to:
- Estimate rates of 7-year mortality and morbidity in people with a psychotic illness with separate estimates for:
- mortality due to natural versus unnatural causes
- potentially avoidable morbidity in order to establish much needed Australian benchmarks for assessing the impact of changes in public health policies.
- Examine the impact of sets of risk factors on 7-year mortality and morbidity in order to move beyond estimation of rates to understanding the aetiology of adverse physical health outcomes in psychotic disorders and informing clinical practice.
- Develop and validate predictive risk equations for cardiovascular disease (CVD) for use with people with psychotic disorders in order to address a clinical need for CVD predictive risk equations appropriate for use in this subpopulation.
- Calculate the economic burden of severe and acute physical morbidity in addition to mental health impacts in order to meet a service planning need for scarce and accurate data on costs of physical morbidity in psychotic disorders.