The community psychiatrist of the future

Current Opinion in Psychiatry

Volumn 19, Issue 4, 2006, Pages 380-388

  Rosen, Alan ^a,b,c  

^a ROYAL NORTH SHORE HOSPITAL   (Australia)

^b UNIVERSITY OF SYDNEY   (Australia)

^c UNIVERSITY OF WOLLONGONG   (Australia)

Author keywords

Bio psycho social; Community psychiatrist; Leadership; Multidisciplinary team; Psychiatric training

Indexed keywords

BURNOUT; CLINICAL COMPETENCE; CROSS FERTILIZATION; CULTURAL FACTOR; HEALTH CARE DELIVERY; HEALTH CARE MANAGEMENT; HEALTH CARE PERSONNEL; HEALTH CARE QUALITY; HEALTH PROGRAM; HUMAN; LEADERSHIP; MEDICAL EDUCATION; MEDICAL EXPERT; MENTAL HEALTH CARE; PATIENT CARE; PSYCHIATRIST; PSYCHOLOGICAL THEORY; REVIEW; SOCIAL CAPITAL; SOCIAL JUSTICE; SOCIAL PSYCHIATRY; SOCIOECONOMICS; TEAMWORK;

ATTITUDE TO HEALTH; COMMUNITY MENTAL HEALTH SERVICES; HUMANS; MENTAL DISORDERS; PATIENT CARE TEAM; PATIENT EDUCATION; PSYCHIATRY;

EID: 33748270658     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.yco.0000228758.18109.22     Document Type: Review

References (67)

1. Cox J. Psychiatric training and professional conduct. Curr Opin Psychiatry 1996; 9:372-376.
2. Woodbridge K, Fulford KWM. Whose Values? A workbook for values-based practice in mental healthcare. The Sainsbury Centre for Mental Health. No. 4373019, Extract; 2004. pp. 1-20.
3. Buckley EG. Apprentices or spinning tops? Rotational training programmes in postgraduate medical education. Med Educ 1995; 29:391-392.
4. Rosen A, Callaly T. Interdisciplinary teamwork and leadership: issues for psychiatrists. Australas Psychiatry 2005; 13:234-240. Sets out to answer questions from the viewpoint of a sceptical psychiatrist challenging interdisciplinary teamwork.
5. Rosen A. Destigmatizing day-to-day practices: what developed countries can learn from developing countries. World Psychiatry 2006; 5:21-24. An argument for combining evidence-based interventions with strategies related to traditional healing practices, for individuals, families and communities.
6. Turbott J. Religion, spirituality and psychiatry: steps towards rapprochement. Australas Psychiatry 2004; 12:145-147.
7. Subotsky F, Williams R, Kendall T. Teams, team working and the role of the psychiatrist. Report of the scoping group on roles and values. London: Royal College of Psychiatrists [chapter 10] (in press).
8. Brimblecombe NR. The changing relationship between mental health nurses and psychiatrists in the United Kingdom. J Adv Nurs 2005; 49:344-353. Concludes that though psychiatrists in the UK remain highly influential, their loss of exclusive control over prescribing, and hospital admission, among other factors will continue to change their relationship with mental health nurses.
9. Rosen A. New roles for old: the role of the psychiatrist in the interdisciplinary team. Australas Psychiatry 2001; 9:133-137.
10. Diamond R, Susser E, Stein LI. Essential and nonessential roles for psychiatrists in community mental health centres. Hosp Community Psychiatry 1992; 42:187-189.
11. Miller V. I took the road less travelled by, and that has made all the difference: pathways towards mental health service integration. Key note paper. Proceedings of the THEMHS Conference, Auckland. Sydney: The Mental Health Services Conference of Australia and New Zealand; 1995.
12. Rosen A, Diamond R, Miller V, Stein L. Becoming real: from model programs to implemented services. In: Hollingsworth EJ, editor. The successful diffusion of innovative program approaches. San Francisco: Jossey Bass New Directions in Psychiatry series; 1997.
13. National Steering Group. Guidance on new ways of working for psychiatrists in a multidisciplinary and multiagency context. London: Royal College of Psychiatrists and National Institute of Mental Health in England, National Health Service, Department of Health England and Wales; 2004.
14. Detre T, McDonald MC. Managed care and the future of psychiatry. Arch Gen Psychiatry 1997; 54:201-204.
15. Callaly T, Minas H. Reflections on clinician leadership and management. Australas Psychiatry 2005; 13:27-32. Clarifies the extent and limitations of leadership roles and the effectiveness of transformational models of leadership.
16. Onyett S. Teamworking mental health. London: Palgrave Macmillan; 2003.
17. Department of Health and Social Services (The Nodder Report). Organisational and management problems of mental illness hospitals: report of a working group. London: DHSS; 1980.
18. Royal Australian and New Zealand College of Psychiatrists, Psychiatrists as Team members. Position statement no. 47. Melbourne: RANZCP; 2002.
19. NSW Department of Health. Information bulletin no. 92/96. Sydney: New South Wales Government; 1992.
20. Ilchef R. Diamonds in the coalface: new research in consultation-liaison psychiatry. Curr Opin Psychiatry 2006; 19:175-179. A comprehensive review integrating the multiple facets of consultation-liaison psychiatry, including the interface with emergency departments.
21. Blashki G, Selzer R, Judd F, et al. Primary care psychiatry: taking consultation-liaison psychiatry to the community. Australas Psychiatry 2005; 13:302-306. Adopting the consultation-liaison paradigm for working with GPs as a consistent component of community mental health services.
22. Meadows G. Overcoming barriers to reintegration of patients with schizophrenia: developing a best practice model for discharge from specialist care. Med J Aust 2003; 178 (Suppl):53-56.
23. Horner D, Asher K. General practitioners and mental health staff sharing patient care: a working model. Australas Psychiatry 2005; 13:176-180. A well organized low-cost implementation of the Graham Meadows (q.v.) model of transfer from specialist care to GP care, with continual monitoring and crisis intervention by the mental health service.
24. Eagar K, Pirkis JE, Owen A, et al. Lessons from the National Mental Health Integration Program. Aust Health Rev 2005; 29:189-200. A diverse set of pilot projects integrating public and private consultant psychiatrists into urban semirural and remote public practice. This includes the systematic redevelopment of the community consultant psychiatrist's role to provide regular direct consultation with GPs, flying doctors, nongovernment organizations, communal and indigenous service providers.
25. Perkins DA, Roberts R, Sanders T, Rosen A. Far West Area Health Service Mental Health Integration Project: model for rural Australia? Aust J Rural Health (in press).
26. Thornicroft G, Tansella M. Components of a modern mental health service: a pragmatic balance of community and hospital care: overview of systematic evidence. Br J Psychiatry 2004; 185:283-290.
27. Rosen A. Integration is as essential as balance: a commentary on balancing community-based and hospital-based mental healthcare. World Psychiatry 2002; 1:91-93.
28. Johnson S, Nolan F, Pilling S, et al. Randomised controlled trial of acute mental healthcare by a crisis resolution team: the North Islington crisis study. BMJ 2005; 331:599-602. This article and Ref. [29] provide positive findings for discrete short-to-medium term psychiatric crisis services.
29. Johnson S, Nolan F, Hoult J, et al. Outcomes of crises before and after introduction of a crisis resolution team. Br J Psychiatry 2005; 187:68-75.
30. Falloon IRH, Montero I, Sunger M, et al. Implementation of evidence-based treatment for schizophrenic disorders: two-year outcome of an international field trial of optimal treatment. World Psychiatry 2004; 3:104-109.
31. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Aust N Z J Psychiatry 2005; 39:1-30. These guidelines were coordinated by Professor Pat McGorry with an expert group and therefore articulate the connection between the management of early psychosis and ongoing psychosis, including schizophrenia very well indeed.
32. McGorry P. 'Every me and every you': responding to the hidden challenge of mental illness in Australia. Australas Psychiatry 2005; 13:3-15. A futurology of the art of the possible in developing humane and adequate mental health service systems for a whole population.
33. Insel TR, Quiron OS. Psychiatry as a clinical neuroscience discipline. JAMA 2005; 294:2221-2224. A neuronally dense overview of the promising connections between psychiatry and the neurosciences.
34. Margison F. Integrating approaches to psychotherapy in psychosis. Aust N Z J Psychiatry 2005; 39:972-981. Overlooking and neglecting the use of psychotherapies in psychosis is easy when there is growing evidence for several modalities, including interpersonal and cognitive analytic therapy models. To these I would add cognitive behavioural and psychoeducational group family interventions.
35. Bell S, McLacklan AJ, Aslani P, et al. Community pharmacy services to optimize the use of medications for mental illness: a systematic review. Aust N Z Health Policy 2005; 2:1-11. This article is a systematic review of 22 controlled studies on the impact of pharmacists' direct participation in community-based mental health services, as a prelude to a multisite controlled study now in progress in Sydney.
36. Deveson A. Resilience. Sydney: Allen and Unwin; 2003.
37. Bloom SW. The relevance of medical sociology to psychiatry: a historical view. J Nerv Ment Dis 2005; 193:77-84. Describes the decline of sociological influence in psychiatry, being replaced by biomedical dominance of the field. Describes training programmes trying to redress the balance.
38. Whitley R, McKenzie K. Social capital and psychiatry: review of the literature. Harv Rev Psychiatry 2005; 13:71-84. A comprehensive review of a currently fashionable but contentious concept. (There appear to be almost as many definitions as writers on social capital!) It may be a promising heuristic for studies in community psychiatry, but there is no strong evidence supporting the hypothesis that social capital protects mental health.
39. Rosen A. What developed countries can learn from developing countries in challenging psychiatric stigma. Australas Psychiatry 2003; 11 (Suppl 1):S89-S95.
40. Kitchener BA, Jorm AF. Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry 2006; 40:6-8. Deceptively simple and powerful educational tool developing more self-aware lay resource people in each community.
41. Jorm AF, Barney LJ, Christensen H, et al. Research on mental health literacy: what we know and what we still need to know. Aust N Z J Psychiatry 2006; 40:3-5. A very useful review of the state of play in this promising field of societal intervention and research.
42. Sartorius N, Schulze H. Reducing the stigma of mental illness: a report from the global programme of the World Psychiatric Association. UK: Cambridge University Press; 2005; pp. 264. A comprehensive overview of different but related strategies in developing and developed countries for challenging stigma, particularly focused on the public image of schizophrenia.
43. Pilgrim D, Roger AE. Psychiatrists as social engineers: a study of an antistigma campaign. Social Sci Med 2005; 61:2546-2556. Examines the 'Changing Minds' campaign of the Royal College of Psychiatrists in Britain. Its more covert aim is reprofessionalization of psychiatry to be more responsive to public perceptions and requirements of psychiatrists.
44. Lauber C, Anthony M, Ajdacic-Gross V, Rossler W. What about psychiatrists' attitude to mentally ill people? Eur Psychiatry 2004; 19:423-427.
45. Thornicroft G, Tansella M. The Mental Health Matrix: a manual to improve services. Cambridge: Cambridge University Press; 1999.
46. Rey JM, Walter G, Giuffrida M. Should the RANZCP comment about the political and social issues of the day? The opinions of Australian fellows and trainees. Australas Psychiatry 2003; 11:124-127.
47. Rey J, Walter G, Giuffrida M. Policy, structural change and quality of psychiatric services in Australia: the views of psychiatrists. Australas Psychiatry 2004; 12:118-122.
48. Priebe S, Fakhoury WK, Hoffmann K, Powell RA. Morale and job perception of community mental health professionals in Berlin and London. Soc Psychiatry Psychiatr Epidemiol 2005; 40:223-232. Important findings are differential professional burnout rates at variance from an earlier study by S. Onyett at The Sainsbury Trust (J Ment Health 1999; 8:243-251).
49. Coglan R, Lawrence D, Holman CDJ, Jablensky AV. Duty to care: physical illness in people with mental illness. Perth: The University of Western Australia; 2001. http://www.populationhealth.uwa.edu.au/welcome/research/chsr/ chsr/duty_to care.
50. Sokal J, Messias E, Dickerson FB, et al. Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. J Nerv Ment Dis 2004; 192:421-427.
51. Caton CLM, Drake RE, Hasin DS, et al. Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses. Arch Gen Psychiatry 2005; 62:137-145. Early substance-induced psychosis predictors included parental substance abuse and visual hallucinations, whereas primary psychotic disorders scored much higher in positive and negative symptoms.
52. Drake RE, McHugo GJ, Xie H, et al. Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders. Schizophr Bull 2006 [Epub ahead of print]. Long-term courses in such people are rarely studied. This article reports encouraging 10-year outcomes in 130 such clients in New Hampshire, where services for such comorbidity are relatively good. These outcomes were only weakly interrelated during the time period, suggesting that recovery, as defined by clients, is a multidimensional concept.
53. Sobhan T, Husain Z, Rahman A, et al. Residency training in public psychiatry: a review of literature. J Ky Med Assoc 2004; 102:307-314.
54. Rosen A, Teesson M. Does case management work? The evidence and the abuse of evidence-based medicine. Aust N Z J Psychiatry 2001; 35:731-746.
55. Drake RE, Becker DR, Goldman HH, Martinex RA. Best Practices: The Johnson and Johnson Dartmouth Community Mental Health program: disseminating evidence-based practice. Psychiatr Serv 2006; 57:302-304. Report on a collaborative six-state evidence-based supported employment initiative for persons with psychiatric disability.
56. Rosen A, Barfoot K, Newton L. Day care and occupation: structured rehabilitation and recovery programmes and work. In: Thornicroft G, Szmukler G, editors. Textbook of community psychiatry. Oxford: Oxford University Press; 2001.
57. Leff J, Trieman N. Long-stay patients discharged from psychiatric hospitals: social and clinical outcomes after five years in the community. Br J Psychiatry 2000; 176:217-223.
58. Hobbs C, Newton L, Tennant C, et al. Deinstitutionalization for long-term mental illness: a 6-year evaluation. Aust N Z J Psychiatry 2002; 36:60-66.
59. de Girolamo G, Picardi A, Santone G, et al. The severely mentally ill in residential facilities: a national survey in Italy. Psychol Med 2005; 35:421-431. A systematic survey of community residential facilities in largely community-based system of mental healthcare, demonstrating a 10-fold variation between regions of residential provision, which varies inversely with concentration of community-oriented services, possibly suggesting less need for residential placements where community psychiatric services are better developed.
60. Santone G, de Girolamo G, Falloon I, et al. The process of care in residential facilities: a national survey in Italy. Soc Psychiatry Psychiatr Epidemol 2005; 40:540-550. A cluster analysis of the differing characteristics of the range of residential facility alternatives to mental hospitals in Italy, suggesting an international empirical classification of standards of care and staffing levels.
61. Zygmunt A, Olfson M, Boyer CA, Mechanic D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry 2002; 159:1653-1664.
62. Nosé M, Barbui C, Gray R, Tansella M. Clinical interventions for treatment nonadherence in psychosis: meta-analysis. Br J Psychiatry 2003; 183:197-206.
63. Nosé M, Barbui C, Tansella M. How often do patients with psychosis fail to adhere to treatment programmes? A systematic review. Psychol Med 2003; 33:1149-1160.
64. Torrey WC, Green RL, Drake RE. Psychiatrists and psychiatric rehabilitation. J Psychiatr Pract 2005; 11:155-158. A comprehensive overview of characteristics and skills required from a recovery-orientated psychiatrist.
65. Cohen CI, Feiner JS, Huffine C, et al. The future of community psychiatry. Community Ment Health J 2003; 39:459-471.
66. Tansella M. The psychiatrist as archaeologist and architect. Adv Psychiatr Treat 2001; 7:81-82 [editorial].
67. Thornicroft G. Testing and retesting assertive community treatment, taking issue. Psychiatr Serv 2000; 51:703.