Melbourne School of Population and Global Health - Theses
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ItemA Cultural Adaptation of the World Health Organization’s Mental Health Gap Intervention Guide for use in Community Healthcare Centres, in Shenzhen, China( 2022-11)Over the last decade, China has instigated substantive national health system reform and established a new primary healthcare sector. Shenzhen, China’s flagship of innovation, rapidly developed a network of Community Healthcare Centres (CHC), doubled its medical workforce and now aspires to provide high quality person-centred care. Newly appointed doctors, however, have received limited mental health training and are insufficiently equipped to identify and manage depression. Against a backdrop of high depression prevalence and limited mental health literacy, most depression cases continue to go undetected and untreated. The World Health Organization’s (WHO) Mental Health Gap Intervention Guide (mhGAP- IG.v2), is a decision-support tool for non-specialists, to support assessment, management and follow-up of priority mental, neurological and substance use disorders, including depressive disorder. mhGAP-IG.v2 offers CHCs an evidence-based training resource, however, it requires adaptation to take account of China’s unique healthcare system and cultural context for mental health services. This PhD study is the first in China to involve primary healthcare in the adaptation of the depression component of mhGAP-IG.v2 for the community healthcare context. Designed as a mixed-methods study, it applies the Theoretical Domains Framework (TDF), innovative mental health workshops and the Delphi approach to: 1) explore the current barriers and enablers to depression care in the CHC setting; 2) to compare the mhGAP-IG.v2 against the current clinical practice; and 3) to elicit consensus among primary care doctors to inform the adaption of mhGAP-IG.v2. This research presents the proposed adaptation of mhGAP-IG.v2 for each step of assessment, management, and follow-up of depression. Proposed adaptations include: modifications of the format and content of symptom listings to reflect the cultural nuances; country-specific healthcare priorities and a life course approach for primary care; restructuring of the management section to better reflect CHC role as a key coordinator of intersectoral care; and full replacement of the follow-up section with action-oriented templates for a mental health treatment plan and follow-up review summary to support patient-centred care. Supplementary charts provide additional guidance for person-centred enquiry, the use of assessment instruments and managing patient information. Family members are incorporated as a vital resource to care. Increased attention to suicidal risk is emphasised throughout. The final form of the adapted depression component of mhGAP-IG.v2 will require further development and input from multiple stakeholders at local and national level.
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ItemNo Preview AvailableIdentification of key messages for a national suicide prevention media campaign( 2020)The suicide rate in Australia has increased over recent years, indicating a need for novel suicide prevention interventions. A large proportion of people at risk of suicide do not seek professional help, but rather express their suicidal thoughts to close friends and family members. However, expressions of suicidal thoughts to family and friends can be indirect and ambiguous, and consequently can be missed or misunderstand, leading to dismissive response and missed opportunities for suicide prevention. A suicide prevention media campaign aimed at family members and friends may be one useful population-level suicide prevention strategy to encourage greater recognition of suicide risk and appropriate helping actions in response to suicidal communications. Current evidence for what messages would be acceptable and appropriate for inclusion in such as campaign, however, is limited. The research described in this thesis was undertaken to develop suicide prevention messages to include in an Australian suicide prevention campaign aimed at family and friends of adults at risk of suicide. To understand what messages would be most important to include, five studies were undertaken and are described in this thesis. Study 1 was an expert consensus study involving suicide prevention professionals and people with lived experience of suicide risk. This study established which suicide prevention actions these experts believe are the most important to encourage in a suicide prevention campaign aimed at family and friends. Study 2 was an online survey study involving people with lived experience of suicide risk that aimed to assess the most and least helpful actions taken by others in response to their suicidal communications. Studies 3 to 5 used data from a nationally representative telephone survey conducted with Australian adults. Study 3 examined Australian adults’ confidence and intentions to help a person close to them at risk of suicide. Study 4 examined helping actions given and received in response to suicidal communications. Study 5 assessed the relationships between beliefs in suicide ‘myths’ and helping intentions and actions. Overall, the findings from these studies show that Australian adults are confident and willing to assist a person close to them at risk of suicide. They intend to undertake, and indeed do undertake, a number of appropriate helping actions toward people close to them who are at risk of suicide. These appropriate actions include listening and talking to the person at risk and encouraging them to seek professional help. However, Australian adults also largely fail to ask important risk assessment questions, and commonly undertake actions that do not conform to best practice in suicide prevention. Such non-recommended actions include telling the person at risk ‘what they have going for them’ and telling them that their suicide would hurt their family and friends. A substantial minority of Australian adults also believe in suicide myths, including those related to encouraging suicidal thoughts by talking about suicide. The combined results of these studies have been utilised to make recommendations regarding the most useful messages to include in an Australian suicide prevention campaign aimed at family members and friends at people at risk of suicide.
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Item‘I’m proud of how far I’ve come. I’m just ready to work.’ Exploring the relationships between the life circumstances of people with psychosocial disability and their engagement with the Australian Disability Employment Services program( 2020)Participation in decent work is recognised as central to supporting individuals, with and without disabilities, to attain socio-economic opportunities, and, health and well-being. Through their ratification of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), Australia has committed to supporting people with disabilities realise their right to work. Yet, Australians with disabilities continue to experience significantly poorer employment outcomes when compared to Australians without disabilities. Among those with disabilities, people with psychosocial disability experience some of the lowest levels of employment. Challenging life circumstances, intertwined with vocational and non-vocational barriers to employment, are recognised as both causes and consequences of poorer employment outcomes. The Australian Disability Employment Services (DES) program, is the federal government’s specialised welfare program for people whose disability is assessed as their main barrier to employment. Over recent decades, continual reform has seen the DES program transition from a publicly-funded and delivered program to a quasi-market of government contracted for-profit and non-profit businesses who support and monitor the efforts of people with disabilities in receipt of income support (and a small number of voluntary participants) to actively promote their employability and participation in work. Under the current reforms, implemented in July 2018, DES participants have been given more choice and control to determine which provider they use and to change providers if they are not satisfied. It is assumed that these reforms will incentivise DES providers to be more responsive to participants’ needs, ultimately leading to improved employment outcomes. Drawing on survey data from 369 respondents with disabilities engaged with government funded employment services, and, qualitative interviews conducted at two time points with 30 DES participants with psychosocial disability (total 56 interviews), this thesis explored the perspectives of these participants on how their life circumstances influence and/or are influenced by their engagement with the DES program, in the context of the current reforms. The findings suggest that despite considerable investment and reform, the DES program struggles to address the significant and complex barriers to employment experienced by DES participants with psychosocial disability. Addressing these barriers requires broader social policy investment. Until this is achieved, the effectiveness of the DES program will continue to be undermined.