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    Embedding cultural safety in Australia’s main health care standards

    Martin Laverty, Dennis R McDermott and Tom Calma
    Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00328
    Published online: 3 July 2017

    Accreditation with nationally consistent standards for culturally safe clinical care will improve Indigenous health outcomes

    In Australia, the existing health safety and quality standards are insufficient to ensure culturally safe care for Indigenous patients in order to achieve optimum care outcomes. Where “business as usual” health care is perceived as demeaning or disempowering — that is, deemed racist or culturally unsafe — it may significantly reduce treatment adherence or result in complete disengagement,, even when this may be life-threatening. Peak Indigenous health bodies argue that boosting the likelihood of culturally safe clinical care may substantially contribute to Indigenous health improvement. It follows that a more specific embedding of cultural safety within mandatory standards for safe, quality-assured clinical care may strengthen the currently inadequate Closing the Gap mechanisms related to health care delivery.

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      Recognising the communication gap in Indigenous health care

      Robert Amery
      Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00042
      Published online: 3 July 2017

      Improving shared understandings between health professionals and remote Indigenous people

      The communication gap between health professionals and Indigenous Australians has a significant impact on health outcomes.,,, Limited health literacy is not confined to Indigenous people, but it is greatly magnified for speakers of Indigenous languages in comparison, for example, to non-English speaking migrants from countries where a scientific approach to medicine is practised and where these health concepts are already codified. The communication gap is most pronounced in remote areas where cultural and linguistic differences are greatest. The close interdependence of language and culture amplifies the gap, such that communication difficulties in these communities run deeper than language barriers alone.

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      • University of Adelaide, Adelaide, SA


      Acknowledgements: 

      I thank Jane Thompson for providing practical examples relating to medical education, Mary-Anne Gale and David Scrimgeour for their comments on an early draft of this article, Steven Guthridge from the Department of Health in Darwin for his assistance, and the reviewers for their valuable comments.

      Competing interests:

      No relevant disclosures.

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      • 2. Cass A, Lowell A, Christie M, et al. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Med J Aust 2002; 176: 466-470. <MJA full text>
      • 3. Mitchell AG, Lowell A, Ralph AP. Report on the Patient Educator service at Royal Darwin Hospital, 2001-2009: insights into inter-cultural communication in healthcare. Darwin: Aboriginal Resource and Development Services, 2016. https://www.researchgate.net/publication/304121921_Report_on_the_Patient_Educator_service_at_Royal_Darwin_Hospital_2001-2009_insights_into_inter-cultural_communication_in_healthcare (accessed Mar 2017).
      • 4. Amery H. They don’t give us the full story: attitudes to hospitalisation amongst Yolŋu people of north-east Arnhem Land, a comparative study. Darwin: Aboriginal Resource and Development Services, 1999. https://www.ards.com.au/resources/downloadable/they-dont-give-us-the-full-story-attitudes-to-hospitalisation-amongst-yolŋu-people-of-north-east-arnhem-land-a-comparative-study (accessed Mar 2017).
      • 5. Phillips C. Improving health outcomes for linguistically diverse patients. Med J Aust 2016; 204: 209-210. <MJA full text>
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      • 9. Trudgen R. Why warriors lie down and die. Towards an understanding of why the Aboriginal people of Arnhem Land face the greatest crisis in health and education since European contact. Darwin: Aboriginal Resource and Development Services, 2000.
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        Caring for country and the health of Aboriginal and Torres Strait Islander Australians

        Rosalie Schultz and Sheree Cairney
        Med J Aust 2017; 207 (1): . || doi: 10.5694/mja16.00687
        Published online: 3 July 2017

        Investment in caring for country may help close the gaps in education, employment and health

        Health services for Aboriginal and Torres Strait Islander people are expensive. The National Aboriginal Community Controlled Health Organisation reported that government Aboriginal and Torres Strait Islander health and hospital service expenditure per person in 2010–11 was $8190 nationally, and as high as $16 110 in the Northern Territory, compared with $4054 per non-Indigenous person. Increasing expenditure on health services for Aboriginal and Torres Strait Islander people is not closing the gap in health outcomes at the rate to which governments have committed.

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        • 1 Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT
        • 2 Cooperative Research Centre for Remote Economic Participation, Alice Springs, NT


        Acknowledgements: 

        This research is supported by the Cooperative Research Centre for Remote Economic Participation, hosted by Ninti One. We acknowledge the support and involvement of our key organisational stakeholders: Centre for Remote Health (Flinders University and Charles Darwin University), Department of Prime Minister and Cabinet, Northern Star Resources, Yalu Marŋgithinyaraw Indigenous Corporation, Marthakal Homelands Resource Centre, Central Desert Native Title Services, Poche Centre for Indigenous Health, Miwatj Health Aboriginal Corporation, Australian Bureau of Statistics, Muntjiltjarra Wurrgumu Group, Kalano Community Association, Wurli–Wurlinjang Health Service, StrongBala Men’s Health Program, Flinders NT (Katherine), Katherine Stolen Generation Group, Banatjarl Strongbala Wumin Grup, Wiluna Martu Rangers, and Ngangganawili Aboriginal Health Service Community.

        Competing interests:

        No relevant disclosures.

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          Improving Indigenous health through education

          Michael B Hart, Michael J Moore and Martin Laverty
          Med J Aust 2017; 207 (1): . || doi: 10.5694/mja17.00319
          Published online: 3 July 2017

          Better education may close the life expectancy gap by up to 12 years

          In an inquiry into Indigenous health in 1979, the House Standing Committee on Aboriginal Affairs noted: “When innumerable reports on the poor state of Aboriginal health are released there are expressions of shock or surprise and outraged cries for immediate action. However, the reports appear to have no real impact and the appalling state of Aboriginal health is soon forgotten until another report is released”.

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          • 1 Social Determinants of Health Alliance, Canberra, ACT
          • 2 Puntukurnu Aboriginal Medical Service, Newman, WA
          • 3 Public Health Association of Australia, Canberra, ACT
          • 4 Royal Flying Doctor Service of Australia, Canberra, ACT


          Correspondence: bret@hart-solutions.com.au
          Acknowledgements: 

          We thank the contributions, advice and cultural oversight provided by Dennis McDermott and Tom Calma.

          Competing interests:

          M Bret Hart is the current chair of the Social Determinants of Health Alliance (SDOHA). Michael Moore and Martin Laverty were the previous chairs of SDOHA.

          • 1. House of Representatives Standing Committee on Aboriginal Affairs. Aboriginal health. Canberra: Commonwealth of Australia; 1979. http://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=reports/1979/1979_pp60report.htm (accessed Apr 2017).
          • 2. Webb-Pullman M, Vorrath S, Nethercote J. The 25 reports on Aboriginal Australia that line government bookshelves. Melbourne: Crikey; 25 May 2006. https://www.crikey.com.au/2006/05/25/the-25-reports-on-aboriginal-australia-that-line-government-bookshelves (accessed Apr 2017).
          • 3. Wilkinson R, Marmot M. Social determinants of health: the solid facts; 2nd ed. Copenhagen: World Health Organization; 2003. http://www.euro.who.int/en/publications/abstracts/social-determinants-of-health.-the-solid-facts (accessed Apr 2017).
          • 4. Marmot M, Friel S, Bell R, et al. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet 2008; 372: 1661-1669.
          • 5. Commission on the Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008. http://www.who.int/social_determinants/thecommission/finalreport/en (accessed Apr 2017).
          • 6. Cohen AK, Syme SL. Education: a missed opportunity for public health intervention. Am J Public Health 2013; 103: 997-1001.
          • 7. Johnston V, Lea T, Carapetis J. Joining the dots: the links between education and health and implications for Indigenous children. J Paediatr Child Health 2009; 45: 692-697.
          • 8. Baker DP, Leon J, Smith Greenaway EG, et al. The education effect on population health: a reassessment. Popul Dev Rev 2011; 37: 307-332.
          • 9. Korda RJ, Soga K, Joshy G, et al. Socioeconomic variation in incidence of primary and secondary major cardiovascular disease events: an Australian population-based prospective cohort study. Int J Equity Health 2016; 15: 189.
          • 10. Brinkman S, Gregory T, Harris J, et al. Associations between the early development instrument at age 5, and reading and numeracy skills at ages 8, 10 and 12: a prospective linked data study. Child Indic Res 2013; 6: 695-708.
          • 11. Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey: first results, Australia, 2012-13 (Cat. No. 4727.0.55.001)Canberra: Commonwealth of Australia; 2013. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.001main+features802012-13 (accessed Apr 2017).
          • 12. Department of the Prime Minister and Cabinet. Closing the Gap Prime Minister’s report 2017. Canberra: Commonwealth of Australia; 2017. http://closingthegap.pmc.gov.au/sites/default/files/ctg-report-2017.pdf (accessed Apr 2017).
          • 13. Silburn S, McKenzie J, Guthridge S, et al. Unpacking educational inequality in the Northern Territory. Australian Council for Educational Research Conferences; 2014. http://research.acer.edu.au/cgi/viewcontent.cgi?article=1234&context=research_conference (accessed May 2017).
          • 14. Wilks J, Wilson K. A profile of Aboriginal and Torres Strait Islander higher education student population. Aust Univ Rev 2015; 57: 17-30.
          • 15. Fiske ST, Kaplan RM, Spittel ML, Zeno TL. Educational attainment and life expectancy. Policy Insights. Behav Brain Sci 2014; 1: 189-194.
          • 16. Georges N, Guthridge SL, Li SQ, et al. Progress in closing the gap in life expectancy at birth for Aboriginal people in the Northern Territory, 1967–2012. Med J Aust 2017; 207: 25-30.
          • 17. Marmot M. Social determinants and the health of Indigenous Australians. Med J Aust 2011; 194: 512-513. <MJA full text>
          • 18. Spittel ML, Riley WT, Kaplan RM. Educational attainment and life expectancy: a perspective from the NIH Office of Behavioral and Social Sciences Research. Soc Sci Med 2014; 127: 203-205.
          • 19. Stringhini S, Carmeli C, Jokela M, et al. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1.7 million men and women. Lancet 2017; 389: 1229-1237.
          • 20. World Health Organization. 2013–2020 Global action plan for the prevention and control of non-communicable diseases. Geneva: WHO; 2013. http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf (accessed May 2017).
          • 21. Thomson S, De Bortoli L, Underwood C. PISA 2015: reporting Australia’s results. Melbourne: Australian Council for Educational Research; 2017. http://research.acer.edu.au/ozpisa/22 (accessed Apr 2017).
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            The 2016 Royal Australian and New Zealand College of Psychiatrists guidelines for the management of schizophrenia and related disorders

            David J Castle, Cherrie A Galletly, Frances Dark, Verity Humberstone, Vera A Morgan, E&oacute;in Killackey, Jayashri Kulkarni, Patrick McGorry, Olav Nielssen, Nga T Tran and Assen Jablensky
            Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.01159
            Published online: 19 June 2017

            Abstract

            • Introduction: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) clinical practice guidelines for the management of schizophrenia and related disorders provide evidence-based recommendations for optimising treatment and prognosis. This update to the 2005 RANZCP guidelines has a greater emphasis on psychosocial treatments, physical health comorbidities and vocational rehabilitation.

            • Main recommendations: The guidelines advise a clinical staging approach and deliver specific recommendations for:•comprehensive treatment using second generation antipsychotic agents continuously for 2–5 years;•early treatment of comorbid substance use;•community treatment after initial contact, during crises and after discharge from hospital;•physical health monitoring and management of comorbidities, particularly metabolic health;•interventions to optimise recovery of social function and return to study or work; and•management of schizophrenia in specific populations and circumstances.

            • Changes in management as a result of the guidelines: The guidelines provide benchmarks against which the performance of services and clinical teams can be assessed. Measuring treatment response and clinical outcome is essential. General practitioners have an important role, particularly in monitoring and reducing the high cardiovascular risk in this population. Clinical services focusing on early detection, treatment and recovery need continuous funding to be proactive in implementing the guidelines and closing the gap between what is possible and what actually occurs.


            • 1 St Vincent's Hospital, Melbourne, VIC
            • 2 University of Melbourne, Melbourne, VIC
            • 3 University of Adelaide, Adelaide, SA
            • 4 Northern Mental Health, Adelaide, SA
            • 5 Metro South Health, Brisbane, QLD
            • 6 University of Queensland, Brisbane, QLD
            • 7 Northland District Health Board, Whangarei, New Zealand
            • 8 University of Auckland, Auckland, New Zealand
            • 9 University of Western Australia, Perth, WA
            • 10 Orygen Youth Health, Melbourne, VIC
            • 11 Alfred Health, Melbourne, VIC
            • 12 Monash University, Melbourne, VIC
            • 13 National Centre of Excellence in Youth Mental Health, Melbourne, VIC
            • 14 headspace National Youth Mental Health Foundation, Melbourne, VIC
            • 15 Macquarie University, Sydney, NSW
            • 16 Medical Research Foundation, Royal Perth Hospital, Perth, WA
            • 17 Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Perth, WA


            Correspondence: david.castle@svha.org.au
            Acknowledgements: 

            We thank Susie Hincks, Lived Experience Advisor for her contribution to the guidelines.

            Competing interests:

            No relevant disclosures.

            • 1. Castle DJ, Buckley P. Schizophrenia, 2nd ed. Oxford: Oxford University Press, 2015.
            • 2. Morgan VA, McGrath JJ, Jablensky A, et al. Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychol Med 2014; 44: 2163-2176.
            • 3. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness 2010: report on the Second Australian national survey. Canberra: Commonwealth of Australia; 2011. http://www.health.gov.au/internet/main/publishing.nsf/content/717137a2f9b9fcc2ca257bf0001c118f/$file/psych10.pdf (accessed May 2017).
            • 4. Galletly C, Castle D, Dark F, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust NZ J Psychiatry 2016; 50: 410-472.
            • 5. McGorry P, Killackey E, Lambert T, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust NZ J Psychiatry 2005; 39: 1-30.
            • 6. Galletly CA, Foley DL, Waterreus A, et al. Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 753-761.
            • 7. National Health and Medical Research Council. NHMRC additional levels of evidence and grades for recommendations for developers of guidelines. 2009. Canberra: NHMRC; 2009. https://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/developers/nhmrc_levels_grades_evidence_120423.pdf (accessed Nov 2016).
            • 8. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust NZ J Psychiatry 2012; 46: 735-752.
            • 9. Stafford MR, Jackson H, Mayo-Wilson E, et al. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346: f185.
            • 10. Lubman DI, King JA, Castle DJ. Treating comorbid substance use disorders in schizophrenia. Int Rev Psychiatry 2010; 22: 191-201.
            • 11. Cooper J, Mancuso SG, Borland R, et al. Tobacco smoking among people living with a psychotic illness: the second Australian Survey of Psychosis. Aust NZ J Psychiatry 2012; 46: 851-863.
            • 12. Liu D, Myles H, Foley DL, et al. Risk factors for obstructive sleep apnea are prevalent in people with psychosis and correlate with impaired social functioning and poor physical health. Front Psychiatry 2016; 7.
            • 13. Moore S, Shiers D, Daly B, et al. Promoting physical health for people with schizophrenia by reducing disparities in medical and dental care. Acta Psychiatr Scand 2015; 132: 109-121.
            • 14. Buckley PF, Miller BJ, Lehrer DS, Castle DJ. Psychiatric comorbidities and schizophrenia. Schizophr Bull 2009; 35: 383-402.
            • 15. Shah S, Mackinnon A, Galletly C, et al. Prevalence and impact of childhood abuse in people with a psychotic illness. Data from the second Australian national survey of psychosis. Schizophr Res 2014; 159: 20-26.
            • 16. Morgan VA, Morgan F, Galletly C, et al. Sociodemographic, clinical and childhood correlates of adult violent victimisation in a large, national survey sample of people with psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 269-279
            • 17. Morgan VA, Castle DJ, Jablensky AV. Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Aust NZ J Psychiatry 2008; 42: 74-82.
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              Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial

              Marc M Cohen, De Villiers Smit, Nick Andrianopoulos, Michael Ben-Meir, David McD Taylor, Shefton J Parker, Chalie C Xue and Peter A Cameron
              Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.00771
              Published online: 19 June 2017

              Abstract

              Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain.

              Design: A pragmatic, multicentre, randomised, assessor-blinded, equivalence and non-inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department.

              Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10-point verbal numerical rating scale (VNRS) of at least 4.

              Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units.

              Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non-inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention-to-treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between-group differences.

              Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed.

              Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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              • 1 RMIT University, Melbourne, VIC
              • 2 The Alfred Hospital, Melbourne, VIC
              • 3 Monash Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, VIC
              • 4 Cabrini Hospital, Melbourne, VIC
              • 5 Austin Health, Melbourne, VIC
              • 6 Monash University, Melbourne, VIC


              Correspondence: marc.cohen@rmit.edu.au
              Acknowledgements: 

              The trial was supported by a grant from the National Health and Medical Research Council (#555427).

              Competing interests:

              No relevant disclosures.

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                Broken promises and missing steps in mental health reform

                Patrick D McGorry and Matthew P Hamilton
                Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00329
                Published online: 19 June 2017

                We are still seriously failing to resource and integrate mental health into the mainstream of the health care system

                A young colleague recently shared his family’s experience of the Australian health system. His older brother has schizophrenia, an illness that is typically serious, persistent and reduces life expectancy by a minimum of 15–20 years., He was untreated and seriously ill for 2 years before he gained access — as a result of a life-threatening crisis — to a mental health system that could no longer avoid a response. Expert early intervention services (an Australian innovation), which improve health, social and economic outcomes,, were then and now simply not available in his community and remain embryonic nationally. The inexcusable treatment delay cost him his chance of recovery, and he has languished for years with severe symptoms and disability. His care now consists of brief general practitioner visits, non-evidence-based support from a non-government organisation, and stress-laden hospital admissions that achieve nothing more than risk management. He has no meaningful access to specialist expertise or the multidisciplinary team-based approach that is essential to remission and recovery. In 2016, his sister was diagnosed with cancer. The contrast was a revelation to the family. The cancer diagnosis galvanised the same local health system, which this time delivered truly exemplary care. Rapid investigation, effective treatment and widespread support followed, leading to full remission. Not only was the medical care high quality, intensive and sustained, but the young woman was even provided with expert mental health care, of much higher quality than that offered to her brother, for as long as it was needed, with no rationing of sessions or barriers to specialist care.


                • 1 University of Melbourne, Melbourne, VIC
                • 2 Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, VIC


                Correspondence: pat.mcgorry@orygen.org.au
                Competing interests:

                Patrick McGorry is a Director of headspace.

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                  Ultrasound as a treatment modality for neurological diseases

                  Gerhard Leinenga, Rebecca M Nisbet and Jürgen Götz
                  Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.01013
                  Published online: 19 June 2017

                  Neurological disorders are a particular challenge for therapeutic intervention — ultrasound has emerged as a novel approach with a broad range of applications

                  With an ageing population, neurological disorders present an increasing challenge to our health care systems. Although antibodies are increasingly being explored for therapeutic intervention, the inefficiency of their uptake by the brain means that the estimated cost of a vaccine to treat neurodegenerative disorders such as Alzheimer disease (AD) will exceed US$25 000 per patient per year. Not only is this expected to challenge the health care systems of many countries, it also raises ethical issues associated with making these vaccines available to every patient.


                  • Queensland Brain Institute, University of Queensland, Brisbane, QLD


                  Correspondence: j.goetz@uq.edu.au
                  Competing interests:

                  No relevant disclosures.

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                    Psilocybin-assisted therapy for anxiety and depression: implications for euthanasia

                    Nigel Strauss
                    Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00081
                    Published online: 19 June 2017

                    Contemporary research suggests potential benefits of psychedelic drugs in treatment-resistant depression and terminally ill patients

                    Despite their stigmatisation, psychedelic drugs are once again being clinically researched in Europe and North America. This long-awaited renaissance is showing very promising results and, unlike the pioneering research that occurred before these drugs were outlawed over 30 years ago, the current methodology is rigorous and of a very high standard.


                    • Millswyn Clinic, Melbourne, VIC


                    Correspondence: drnigel@bigpond.net.au
                    Acknowledgements: 

                    I thank Martin Williams for his assistance in the preparation and revision of this manuscript.

                    Competing interests:

                    No relevant disclosures.

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                    • 12. Emanuel E. Euthanasia and physician-assisted suicide: focus on the data. Med J Aust 2017; 206: 339-340. <MJA full text>
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                      The disparity between changes in the prevalence of mental illness and disability support rates in Australia

                      Harvey A Whiteford
                      Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00274
                      Published online: 19 June 2017

                      Clarifying the type of support needed by people with a psychiatric disability must be a priority

                      One major focus of Australia’s national mental health strategy has been to increase access to treatment for those with common mental disorders, particularly anxiety and depressive disorders. Despite indications that treatment rates have increased in Australia, there is little evidence that the population prevalence of these disorders has declined, a phenomenon also reported in other high income countries where increased treatment has been made available.


                      • 1 University of Queensland, Brisbane, QLD
                      • 2 Queensland Centre for Mental Health Research, Brisbane, QLD
                      • 3 Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA


                      Correspondence: h.whiteford@sph.uq.edu.au
                      Competing interests:

                      No relevant disclosures.

                      • 1. Whiteford HA, Buckingham WJ, Harris MG, et al. Estimating treatment rates for mental disorders in Australia. Aust Health Rev 2014; 38: 80-85.
                      • 2. Jorm AF, Patten SB, Brugha TS, et al. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16: 90-99.
                      • 3. Harvey SB, Deady M, Wang M-J, et al. Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014. Med J Aust 2017; 206: 490-493.
                      • 4. Slade T, Johnson A, Oakley-Browne MA, et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust N Z J Psychiatry 2009; 43: 594-605.
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                      • 6. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust N Z J Psychiatry 2012; 46: 735-752.
                      • 7. Parliament of Australia. The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition. Joint Standing Committee on the NDIS — Mental Health Terms of Reference [webpage]. http://www.aph.gov.au/Parliamentary_Business/Committees/Joint/National_Disability_Insurance_Scheme/MentalHealth (accessed Mar 2017).
                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
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