ORCID Profile
0000-0002-7357-625X
Current Organisation
Flinders University Caring Futures Institute
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Publisher: Informa UK Limited
Date: 02-05-2017
DOI: 10.1080/13607863.2017.1320702
Abstract: Integrated care has been identified as means of managing the demands on the healthcare budget while improving access to and quality of services. It is particularly pertinent to rural health services, which face limited access to specialist and support services. This paper explores the capacity of three rural communities in South Australia to deliver integrated mental health support for older people. Thirty-one interviews were conducted with local health and social service providers from mental health, community health, general practice, residential aged care, private practice, NGOs and local government as part of a larger action research project on service integration. Participants highlighted differences in service delivery between the communities related to size of the community and access to services. Three structural barriers to delivery of integrated care were identified. These are as follows: fragmentation of governmental responsibility, the current funding climate, and centralisation and standardisation of service delivery. We conclude that despite a focus upon integrated care in mental health policy, many features of current service delivery undermine the flexibility and informal relationships that typically underpin integration in rural communities.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Publisher: SAGE Publications
Date: 27-07-2023
DOI: 10.1177/00207640231189424
Abstract: Employment is an important social determinant of health and is associated with positive health outcomes. However, in iduals who have been diagnosed with borderline personality disorder (BPD) are significantly underrepresented in the workforce. Whilst there is an array of evidence based therapeutic interventions, there remains a gap in knowledge regarding the most effective ways to enhance employment outcomes for people with a diagnosis of BPD. To explore employment interventions for people with BPD, map the available evidence and identify key concepts and knowledge gaps. A scoping review was conducted to identify and map the relevant literature. Findings were summarised using a narrative approach. Consultation was provided by a reference group including peer support workers with lived experience of BPD and mental health clinicians. Seven articles met the inclusion criteria, including non-randomised and case study/series designs and a randomised controlled trial protocol, with participant numbers generally low. All programmes combined a psychotherapeutic component with work related goals however, there were notable differences in relation to the conceptual/theoretical approach of the psychotherapeutic component and delivery of the work-related components. Barriers and enablers to programme participation and success are explored. This review provides important insights into the characteristics of vocational rehabilitation interventions for people diagnosed with BPD. The findings will inform the co-production of approaches to support people with BPD to engage in employment.
Publisher: Wiley
Date: 07-05-2021
DOI: 10.1111/INM.12877
Abstract: Community treatment orders (CTOs) require in iduals with a mental illness to accept treatment from mental health services. CTO legislation in South Australia states that treatment and care should be recovery‐focused, although justification for use is predominantly risk‐based, and care often coercive. Although CTOs are contested, in iduals, families, and clinicians frequently engage in care planning within this context. This paper examines how the concepts of risk and risk management impact care planning from the perspectives of in iduals on CTOs, their families, and clinicians. Ethnographic methods of observation and interview provided a detailed account of the perspectives of each group over an 18‐month period from two community mental health teams in South Australia. Findings show that care planning occurred within a culture of practice dominated by risk. Risk, however, was understood differently by each participant group, with the dominant narrative informed by biogenetic understandings of mental illness. This dominance impacted on the positioning of participant groups in care planning, focus of care contacts, and care options available. To improve care experiences and outcomes for in iduals on CTOs, narrow conceptualizations of risk and recovery need to broaden to include an understanding of personal and social adversities in iduals face. A broader understanding should reposition participants in the care planning context and rebalance care discussions, from a focus on clinical recovery to recovering citizenship.
Publisher: Wiley
Date: 07-01-2022
DOI: 10.1111/INM.12971
Abstract: Implementing psychosocial approaches into mental health inpatient settings continues to be challenging. This is despite mental health policies prioritizing trauma‐informed and recovery‐orientated care approaches. This study reports on an interdisciplinary project that implemented and examined the uptake of weighted modalities in a psychiatric inpatient rehabilitation setting. While over‐reliance on pro re nata (PRN) medication in these settings has been reported, weighted modalities are a sensory approach that can be self‐initiated by consumers as an alternative to use of PRN to manage distress and agitation. A mixed‐methods realist approach was used to determine what works, for whom, and in what circumstances weighted modalities were offered by clinicians and used by consumers. Additionally, we were interested in determining whether there was an associated change in PRN use during the trial. Data included in‐depth interviews with consumers ( n = 12) and clinicians ( n = 11), and extraction of PRN medication use preceding, throughout, and following implementation. Statistical analysis revealed a significant increase in PRN rates in the first 3 months of implementation (mean difference from baseline = 29.5, P = 0.047) but a significant decrease in the second three‐month period following implementation (mean difference from baseline = −30.7, P = 0.036). Qualitative findings highlighted the key components of successful implementation as being environmental restructuring (availability/accessibility and visibility of weighted modalities) and social influences. Strategies to enhance these components are discussed.
Publisher: Springer Science and Business Media LLC
Date: 10-01-2022
DOI: 10.1186/S12888-022-04459-0
Abstract: There is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes. An in-depth policy and document analysis was conducted using Carol Bacchi’s ‘What is the problem represented to be?’ approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves. Two dominant representations of the ‘problem’ were identified: 1) the ‘problem’ of mental health service quality and accountability, relating to the need for mental health outcome measures and 2) the ‘problem’ of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the ‘problem’ of mental health outcomes in these ways locates the problem within in idual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision. This critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.
Publisher: Elsevier BV
Date: 05-2008
Publisher: Informa UK Limited
Date: 25-08-2015
DOI: 10.1080/13607863.2015.1078283
Abstract: Mental health care for older people is primarily delivered in the community and is largely dependent on informal carers. Mental health policy encourages partnerships between carers and service providers to facilitate service access, coordination and positive experience of care. However, carers often lack information and support from services, with the potential for carer burden, and negative impacts on their own health and capacity to fulfil caring tasks. This paper explores rural carers' experiences of accessing care from a range of services for older people with mental health problems. The Pathways Interview Schedule was used to facilitate 9 in-depth care journey interviews with 11 carers of older people with a mental health problem. Interviews explored their journeys to and through mental health, aged care, primary care and social care services. Framework analysis was used to explore carers' experiences and perceptions of care with a focus on access enablers and barriers. Carers had a significant role in navigating services and operationalising care for their relative. Enablers to accessing care included carer knowledge and workers actively involving carers in planning. Barriers included carer mental health literacy, consumer and carer readiness for services, and worker misinterpretation of confidentiality and privacy laws. Carers should be considered key partners in mental health care planning that crosses service sectors. For this to occur, changes are required at the worker level, including increased communication between mental health workers and carers, and the service level, involving training for staff in interpreting confidentiality and privacy policy.
Publisher: Wiley
Date: 09-09-2019
DOI: 10.1111/INM.12654
Abstract: One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast-acting medication, called chemical restraint. Such management often needs to be delivered in crisis situations to patients who are at risk of harm to themselves or others. This paper summarizes the available evidence on the effectiveness and safety of chemical restraint from 21 randomized controlled trials (RCTs) involving 3788 patients. The RCTs were of moderate to high quality and were conducted in pre-hospital, hospital emergency department, or ward settings. Drugs used in chemical restraint included olanzapine, haloperidol, droperidol, risperidol, flunitrazepam, midazolam, promethazine, ziprasidone, sodium valproate, or lorazepam. There was limited comparability between studies in drug choice, combination, dose, method of administration (oral, intramuscular, or intravenous drip), or timing of repeat administrations. There were 31 outcome measures, which were inconsistently reported. They included subjective measures of behaviours, direct measures of treatment effect (time to calm time to sleep), indirect measures of agitation (staff or patient injuries, duration of agitative or aggressive episodes, subsequent violent episodes), and adverse events. The most common were time to calm and adverse events. There was little clarity about the superiority of any chemical method of managing behaviours of concern exhibited by patients in Emergency Departments or acute mental health settings. Not only is more targeted research essential, but best practice recommendations for such situations requires integrating expert input into the current evidence base.
Publisher: Informa UK Limited
Date: 03-06-0024
DOI: 10.1080/11038128.2020.1714719
Abstract: In iduals with severe mental illness (SMI) are under-represented in the workforce. The In idual Placement and Support (IPS) programme is an evidence-based intervention that co-locates an Employment Specialist in a community mental health team to support in iduals with a SMI with their goal of finding work. Previous research predominantly explored IPS programme outcomes rather than stakeholder experiences. To explore programme stakeholder perspectives and experiences during the early stages of IPS programme implementation. Qualitative descriptive methodology explored consumers ( Three main themes emerged: enacting core care philosophies, IPS programme process and catalyst for supportive environments and relationships. The combination of IPS programme relationships, enactment of core care philosophies, and programme process promoted development of supportive environments and relationships for consumers participating in the programme. Findings suggest IPS processes promoted the enactment of person-centred and recovery-oriented care approaches and positively influenced care planning practices and service culture. IPS directly tackles the compounding disadvantage resulting from unemployment for people with a SMI. At a service level, IPS can foster positive changes to care practices and service culture.
Publisher: Springer Science and Business Media LLC
Date: 10-11-2016
Publisher: Wiley
Date: 12-08-2021
DOI: 10.1111/HEX.13329
Abstract: In many jurisdictions worldwide, in iduals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery‐focussed. Key components in the care planning process include engagement and decision‐making about a person's support needs and care options, with trust being an essential component of care planning relationships. This study examines how these components were enacted during service care contacts for in iduals on community treatment orders. The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with in iduals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day‐to‐day care interactions. Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of ‘knowing’, with consumers assumed to have less knowledge than clinicians. Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision‐making. This study included in iduals with lived experience of mental illness, their carers and clinicians as participants and researchers.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2012
Location: No location found
No related grants have been discovered for Suzanne Dawson.