Assignment Rubric ( CRITICAL REVIEW ) 1822

1- Criterion; Description of characteristics and impacts of the problem.

Mark; 20%;

Exceptionally well described and insightful overview of the problem, aetiology impacts, trajectories informed by the best available evidence

2- Criterion; Critical analysis of the literature relating to therapies, treatments for programmes to address the issue in primary care.

Mark; 50%

Draws from the best available evidence to provide an exceptionally comprehensive and critical discussion of effective approaches to address the presenting problem, facilitate recovery, and holistically address the needs of the young person.

3- Criterion; Critically discuss the need for early intervention and recovery focused services in primary care.

Mark 20%

Exceptional, comprehensive and well-articulated case made for early intervention and recovery focused service with a clarity of vision about what such services would look like for a person in this scenario.

4- Critirion; Writing Spelling & Grammar Referencing

Mark 10%

Exceptionally clear, crisp and coherent style. Exceptionally well organised. Completely free of grammar and spelling errors. All citations follow required style.



Mapping the ideal response to emerging mental health problems in primary care

Assignment type;

Critical review

Word limit/length;

2000 words

APA 7th edition, citation and reference must be accurate.

****Minimum of 20 reference – Relevant references*


It is well established that the 12-25-year-old age bracket is commonly where mental health conditions emerge. Timely assistance to young people at the right time can reduce the impact, severity and progression of mental health conditions and improve social and occupational outcomes. For this assessment task, you will specifically explore the ideal response to emerging mental health problems in primary care and community settings with reference to the stepped care model.

Your final two assessments will build from each other to explore an individual from a vulnerable population’s journey through Australia’s primary health system acknowledging the role of non- government organizations and the available interventions within the primary health setting.

Learning outcomes

This assessment task is aligned with the following learning outcomes:

1. Identify and critique the policy and funding context of mental health service provision in primary mental health care and non-government organisation sectors.

2. Integrate paradigms of service delivery ranging from the recovery to medical models and how these models translate to the non-government and primary health service delivery to consumers.

3. deconstruct stepped care, its barriers and opportunities and its impact on consumers and their families

Assignment details

Choose one of the three scenarios listed in Appendix A of this document which represent common mental health problems encountered within primary care. Provide a brief overview of the problem / issue (and probable diagnosis).
1. Describe what is known about the etiology, and likely trajectory if the problem untreated or undertreated.
2. With reference to the best available evidence what psychotherapeutic approach, treatments, or evaluated therapeutic programmes reflect the best or ideal approach to facilitate recovery in primary care with this problem or constellation of problems.
3. Critically discuss the need for early intervention and recovery focused services in primary care.

Appendix A: Scenarios for assessment task 2 and 3

Select one scenario from the options below to complete both assessment task two and three

SCENARIO 1: Theme: Grief / Depression


Sam is 14 and lives at home with his father and two older siblings. When he was 12 his mother died suddenly from cancer. Sam had a very close relationship with his mum. His father works long hours to provide for the family and Sam does not see him often. He has two older siblings, his brother aged 16 and his sister aged 17, who run the household. Within the household, there is limited discussion surrounding emotions and they do not discuss their mother. Sam’s father expects that everyone pulls their weight around the house and is happy.
Sam is currently in year 9 at school. Previously Sam was a very conscientious student who received high grades, however, since the passing of his mother his grades have deteriorated. Sam has few friends and does not engage in any extracurricular activities like he once did. His school teachers have noticed he has become increasingly oppositional and argumentative toward his peers and teachers. Moreover, Sam has begun “wagging” school.

Past medical/ psychiatric history:

Developmentally, Sam met all of his milestones to date without issue. Aside from his mother’s passing from cancer, there are no known medical issues within the family. Sam does not have a history of any medical conditions/ infectious diseases. There is no known family history of any mental illness and Sam has not previously engaged with mental health services before.

Current presentation:

Sam reports that, even though everyone thinks he is happy, sometimes he goes home, shuts the door to his bedroom and cries on his bed for hours. He does not really know why he gets so sad, but often he feels very, very lonely.


Theme: Self-Harm


Melanie is a 15-year-old girl who lives at home with her mother. She has no siblings and her parents separated when she was 8. Her father lives close by but he is a heavy drinker and is not very supportive; she does not have a close relationship with him.
Recently Melanie’s schoolwork has deteriorated and over the past six months she has started missing school. Melanie has started drinking alcohol and using cannabis every weekend,
Melanie has been in a relationship with her girlfriend Joanna for the past two weeks. A weekend ago she had a physical altercation with girl whom she accused of flirting with Joanna,and allegedly punched her so hard she fractured her ribs.

Past medical / psychiatric history:

Melanie has a history of asthma but has not experienced an episode for 5 years. She currently does not have any medical concerns. There is a paternal history of substance abuse but no other history of mental illness within the family. A former boyfriend of Melanie’s mother was ‘sexually inappropriate’ with Melanie when she was around 12-13 years. He is however, in prison for other offences and Melanie’s mother reports that the family have moved on and it is no longer discussed,

Current presentation:

When at home Melanie withdraws into her room, she states that she loves her mother but “she is an alcoholic who loves pedophiles” so shouldn’t be telling her how to live her life.. Melanie has felt low in mood for about the last six months and has been thinking about suicide a lot but has made no definite plans yet. On two occasions, in the last fortnight, Melanie has made cuts to her legs and abdomen with a razor, she found this quite satisfying as it helped to relieve the ‘pain’ she was feeling.


Theme: Psychosis


Daniel is a 20-year-old Kamilaroi male who is in his second year at university. Daniel currently is employed part time at a local restaurant and lives in share accommodation. Both of Daniel’s parents are school teachers, but are very active in the Indigenous community. Daniel has very strong connections with his family and community but has found university a struggle as he is away from them.
Daniel is struggling to submit his assessments and has been feeling very negative about people and life in general. He is having trouble sleeping and is becoming increasingly withdrawn. More recently, he has failed 2 of his subjects and is facing failing 2 more as he has not been able to submit his assessments.

Past medical/ psychiatric history:

Daniel grew up on country and was born in the local hospital. He experienced middle ear infections when he was a young child, however this was treated appropriately and he did not sustain permanent hearing deficits. There is a family history of diabetes on his maternal side but no other medical concerns of note. Daniel’s cousin died by suicide at the age of 24 following a “psychotic episode”.

Current presentation:

A few weeks ago, he began having some strange experiences. For example, he began seeing people out of the corner of his eye who were looking straight at him, but who were not there when he looked again. He was also sure there was someone yelling at him and calling his name loudly in his ear. It seemed like every radio announcer was talking directly to him on the radio and telling him what to think or what to do. His housemates have become increasingly concerned as Daniel has been heard yelling at “nothing” and has been holding “bizarre” conversations with them.

Australian & New Zealand Journal of Psychiatry, 52(11)

Australian & New Zealand Journal of Psychiatry
2018, Vol. 52(11) 1057 –1062
DOI: 10.1177/0004867418804066

© The Royal Australian and
New Zealand College of Psychiatrists 2018
Article reuse guidelines:


It is concerning that, despite large increases in the provision
of treatment to people with mental health problems in high-
income countries over recent decades, there has been no
detectable decline in the prevalence. This finding has been
reported for Australia, Canada, England, the Netherlands,
New Zealand and the United States (Jorm et al., 2017;
Mulder et al., 2017; Ormel et al., 2004). However, one of
the problems in evaluating the population impact of
increases in treatment, such as the steady rise in use of anti-
depressants, is that they typically occur gradually over
many years. It is possible that any effects of increases in
treatment on reducing prevalence are counteracted by other
social changes occurring at the same which are having the
opposite effect. Such counteracting social changes could
include increasing exposure to risk factors or greater
acceptability of reporting symptoms of mental health prob-
lems (Jorm et al., 2017). A stronger test of the impact of
increasing treatment on population mental health would be
provided if there were a large increase in treatment over a

short period of time, approximating an interrupted time
series. Such a situation has occurred in Australia with the
introduction of the Better Access scheme in November

The Better Access scheme was designed to greatly
expand the availability of psychological treatment under
Medicare (Australia’s national universal health insurance
scheme). Originally, Medicare only covered services by
medical practitioners, including private psychiatrists.
Access to psychological treatment was not widely availa-
ble, being provided by the public health services funded by

Australia’s ‘Better Access’ scheme:
Has it had an impact on population
mental health?

Anthony F Jorm


Background: Australia introduced the Better Access scheme in late 2006, which resulted in a large increase in the pro-
vision of mental health services by general practitioners (GPs), clinical psychologists, other psychologists and allied health
professionals. It is unknown whether this increase in services has had an effect on the mental health of the population.

Methods: The following data were examined: per capita use of mental health services provided by GPs, clinical psychol-
ogists, other psychologists, allied health professionals and psychiatrists from 2006 to 2015 according to the Australian
Government Department of Human Services; prevalence of psychological distress in adults (as measured by the K10)
from National Health Surveys in 2001, 2004–2005, 2007–2008, 2011–2012 and

The Long Wait:
An Analysis of Mental Health
Presentations to Australian
Emergency Departments
October 2018

Australasian College for Emergency Medicine
Department of Policy, Research and Advocacy

2018–1 Access Block Point
Prevalence Survey Summary

June 2018

The Long Wait: An Analysis of Mental Health

Presentations to Australian Emergency Departments

1. Background

The Australasian College for Emergency Medicine (ACEM, the College) is the not-for-profit organisation in Australia
and New Zealand responsible for training emergency physicians and advancing professional standards in
emergency medicine. Fellows of ACEM (FACEMs) – our members – are specialist emergency physicians working in
emergency departments (EDs) across Australia and New Zealand, and internationally.

As the peak binational professional organisation for emergency medicine, the College has a vital interest in
ensuring that the highest standards of medical care are maintained for all patients seeking help from EDs across
Australia and New Zealand, including patients with mental health presentations.

Following on from the release of ACEM’s report Waiting Times in the Emergency Department for Patients with
Acute Mental and Behavioural Conditions, this report is an analysis of key mental health presentation data
from the 2016/17 Australian Institute of Health and Welfare’s (AIHW) National Non-Admitted Patient Emergency
Department Care (NNAPEDC) Database.

Emergency departments often act as the ‘front door’ to the health system, playing a unique role in the provision
of safe, high quality acute medical care to everyone in the community. Each year, more than a quarter of a million
Australians present to EDs seeking help for acute mental and behavioural conditions. Yet for many of these
patients, the evidence suggests that EDs are not adequately fulfilling their role as a timely and accessible entry
point to the mental health system.

It is likely that the poor experiences many people have when they present to EDs with a mental health
crisis reflect the ways in which the wider health system treats mental health. When hospitals cannot find an
appropriate care pathway for people suffering severe episodes of mental illness, patients end up stuck in the ED
until a bed can be found. In some cases, patients refuse to stay any longer and leave the ED at their own risk.

In recent years, ACEM members have consistently reported to the College that this group of ED patients
disproportionately experiences unacceptably long lengths of stay while they wait for admission to specialist
inpatient care. In other words, inadequate prioritisation of and resourcing for mental health hospital admissions,
together with a lack of other options for care, show up in extended stays for mental health patients in EDs.

In many communities, EDs are the only option for people undergoing acute mental health crises. However, it is
difficult to imagine an environment


Access to primary health care services for
Indigenous peoples: A framework synthesis
Carol Davy1* , Stephen Harfield1, Alexa McArthur2, Zachary Munn2 and Alex Brown1


Background: Indigenous peoples often find it difficult to access appropriate mainstream primary health care
services. Securing access to primary health care services requires more than just services that are situated within
easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of
additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis
aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore
how, if at all, these were addressed by Indigenous health care services.

Methods: To be included in this framework synthesis papers must have presented findings focused on access to
(factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary
health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings
were coded to and then thematically analysed using Levesque and colleague’s accessibility framework.

Results: Issues relating to the cultural and social determinants of health such as unemployment and low levels of
education influenced whether Indigenous patients, their families and communities were able to access health care.
Indigenous health care services addressed these issues in a number of ways including the provision of transport to
and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if
not the direct involvement of, community members in identifying and then addressing health care needs.

Conclusions: Indigenous health care services appear to be best placed to overcome both the social and cultural
determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis
also suggest that Levesque and colleague’s accessibility framework should be broadened to include factors related
to the health care system such as funding.

Keywords: Indigenous, Aboriginal, First Nation, Maori, Primary health care, Models of service delivery

Ensuring access to primary health care is widely ac-
cepted as key to improving health outcomes [1]. In the
case of Indigenous populations living with high rates of
chronic disease, access to these services is even more
crucial [2]. Even in developed countries such as
Australia, the number of Indigenous peoples dying from
cardiovascular disease is 1.5 times that of their non-
Indigenous counterparts [3]. Despite this, Indigenous
peoples are often prevented from accessing these types
of services due to a range of barriers including the high
cost of health care, experiences of discrimination and

racism and poor communication with health care pro-



Associate Professor Patricia Davidson RN BA MEd, PhD,
School ot Nursing, College of Health and Science. University of
Western Sydney and Nursing Research Unit, New South Wales,
Sydney West Area Health Service. New South Wales, Australia

Elizabeth Haicomb RN BN (Hons) PhD Candidate, Senior
Research Feliow School of Nursing, Coiiege of Heaith &
Science University of Western Sydney New South Wales and
Centre for Applied Nursing Research Sydney South West Area
Heaith Service, New South Waies, Australia

Hickman i RN BN MPH PhD Candidate. Associate Lecturer
School of Nursing. Coiiege of Health & Science University of
Western Sydney, New South Wales, Australia

Phillips JRNB App Sci (Nurs) Grad Dip Health Promotion PhD
Candidate, Project Officer Mid North Coast Division of General
Practice, Coffs Harbour. NSW. Associate Lecturer School of
Nursing. College of Health & Science. University of Western
Sydney New South Wales, Australia

Graham, B RN RM MMGm (Pub Heaith) Prof Doctoral
Candidate. Clinicai Redesign Coordinator Sydney South West
Sydney Area Heaith Service. New South Waies, Austraiia and
University of Technology Sydney New South Wales

Accepted tor publicalioti May 2005

Key words: models of care, systems, health care delivery, development, evaluation


Contemporary health care systems are constantly

challenged to revise traditional methods of health
care delivery. These challenges are multifaceted and
stem from: (I) novel pharmacological and non-
pharmacological treatments; (2) changes in consumer
demands and expectations; (3) fiscal and resource
constraints; (4) changes in societal demographics in
particular the ageing of society; (5) an increasing
burden of chronic disease; (6) documentation of limit-
ations in traditional health care delivery; (7) increased
emphasis on transparency, accountability, evidence-
based practice (EBP) and clinical governance struc-
tures; and (8) the increasing cultural diversity of the
community. These challenges provoke discussion uf
potential alternative models of care, with scant
reference to defining what constitutes a model of care.

This paper aims to define what is meant by the

term ^model of care’ and document the pragmatic

systems and processes necessary to develop, plan,
implement and evaluate novel models of care delivery.


Searches of electronic databases, the reference lists
of published materials, policy documents and the
Internet were conducted using key words including
‘model*’, ‘framework*’, ‘models, theoretical’ and
‘nursing models, theoretical’. The collated material
was then analysed and synthesised into this review.


This review determined that in addition to key
conceptual and theoretical perspectives, quality
improvement theory (eg. collaborative methodology),
project management methods and change manage-
ment theory inform both

582 © 2019 Indian Psychiatric Society – South Zonal Branch | Published by Wolters Kluwer – Medknow

Biopsychosocial Model in Contemporary Psychiatry:
Current Validity and Future Prospects

The biopsychosocial model (BPS) was proposed
by George L. Engel in 1977 as a needed medical
model to explain psychiatric disorders.[1] Since then,
this model had gained wide acceptability across
the globe. It systematically explained the complex
interplay of three major dimensions (biological,
psychological, and social) in the development of
psychiatric disorders. It explained that a person does
not suffer as isolated organs but rather as a whole.
This provided a holistic approach to psychiatric
illnesses. The emotional tone of a person, his/her
personality, the surrounding environment, and other
social parameters do influence the manifestation
of illness. The model established a holistic and
empathetic approach in psychiatric practice[2] Over
the past four decades, many changes happened in our
understanding of psychiatric disorders, and hence,
there is reluctance in accepting the biopsychosocial
model in reality.[3,4]



Va r i o u s b i o l o g i c a l b r e a k t h r o u g h s s u c h a s
e x p o n e n t i a l p r o g r e s s i n n e u r o i m a g i n g ,
neurophysiology, neurochemistry, neuro-immunology,
n e u ro e n d o c r i n o l o g y, a n d g e n o m i c s a n d t h e
advancements in psychopharmacology have changed
the very face of psychiatry in the last few decades.
Newer neurobiological discoveries along with advances
in science and technologies have paved the way for
a more evidence-based, objectively verifiable and
biologically grounded medical discipline of psychiatry.[5]
This progress has started giving hope of improving
the understanding of mental processes during health
and disease as well as the etio-pathological basis
of psychiatric illnesses. This biological framework
promises new and improved management strategies.
In this enthusiasm for the latest growth, psychosocial
aspects of psychiatric illnesses are being relegated to
the backside and are considered outdated. It has been
seen that there is a deficient theoretical background
regarding the content of the biopsychosocial model and
also it’s functioning. There is also a lack of consensus
on how these separate factors interact and result in
the expression of the disease. Thus, this model is being

questioned, and the biomedical model is promoted as
a marker of progressive thinking.

Unprecedented developments in biological psychiatry
have amassed a wealth of knowledge and demystified
some of the aspects of brain and mind. It has
started influencing the understanding of causation,
diagnostic, and assessment strategies as well as
management to certain extents. While working with
this new framework, it is easy to get disillusioned with
speculative and theoretical psychosocial sc

RESEARCH Open Access

Enhanced primary mental healthcare for
Indigenous Australians: service
implementation strategies and perspectives
of providers
Lennart Reifels1* , Angela Nicholas1, Justine Fletcher1, Bridget Bassilios1, Kylie King1, Shaun Ewen2 and Jane Pirkis1


Background: Improving access to culturally appropriate mental healthcare has been recognised as a key strategy
to address the often greater burden of mental health issues experienced by Indigenous populations. We present
data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for
Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological
Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers.

Methods: We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and
mental health professionals) that were analysed thematically and descriptively.

Results: Agency-level implementation strategies to enhance service access and cultural appropriateness included: the
conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development;
establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision;
stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level
strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery
(involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback
processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy).

Conclusions: This study offers insights into key factors underpinning the successful national service implementation
approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare
for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the
integration, adaptation and broader utility of these services within local Indigenous community and healthcare service
contexts. Despite the explicit provider focus, this study was limited by a lack of Indigenous stakeholder perspectives. Key
study findings are of direct relevance to inform the future implementation and delivery of culturally appropriate primary
mental healthcare programs for Indigenous populations in Australia and internationally.

Keywords: Indigenous health services, Aboriginal mental health, Mental health services, Health equity, Primary healthcare

* Correspondence:
1Centre for Mental Health, Melbourne School of Population and Global
Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC 3010,

Full Terms & Conditions of access and use can be found at

Asia Pacific Journal of Social Work and Development

ISSN: 0218-5385 (Print) 2165-0993 (Online) Journal homepage:

Lean on me: the potential for peer support in a
non-government Australian mental health service

Kate Davies, Mel Gray & Luke Butcher

To cite this article: Kate Davies, Mel Gray & Luke Butcher (2014) Lean on me: the potential for
peer support in a non-government Australian mental health service, Asia Pacific Journal of Social
Work and Development, 24:1-2, 109-121, DOI: 10.1080/02185385.2014.885213

To link to this article:

Published online: 09 Apr 2014.

Submit your article to this journal

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Citing articles: 6 View citing articles

Lean on me: the potential for peer support in a non-government
Australian mental health service

Kate Davies
*, Mel Gray

and Luke Butcher


School of Humanities and Social Science, University of Newcastle, Callaghan, Australia;


Australia, Sydney, Australia

(Received 13 September 2013; final version received 30 December 2013)

This paper examines the challenges and opportunities for integrating peer support in
mental health. After reviewing the contemporary literature, it considers how the
findings of a recent qualitative case study, which examined the perspectives of mental
health service users (n ¼ 11) on service-user participation and evidence-based
practice, might inform the introduction of a peer support program into a mental health
service provided by a large Australian non-government organisation. While there is
little empirical evidence demonstrating the effectiveness of peer support, the study
revealed that service users valued the expertise of their peers and offered guidance for
translating evidence into service models.

Keywords: peer support; mental health; service u

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