Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists
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Australas Psychiatry · Oct 2010
Shared decision-making: benefits, barriers and current opportunities for application.
Patient preference and involvement are two important aspects for many psychiatric treatment decisions. Shared decision-making (SDM) has been proposed as the optimal model to include patient preferences and involve patients in such decisions. Decision-making tools called decision aids (DA) are the most common application of SDM. DAs have been demonstrated to increase patients' knowledge, reduce decisional conflict, and reduce the proportion of patients who are passive in the decision-making process or remain undecided. Unfortunately, there are few DAs available for treatment decisions for psychiatric disorders and implementing SDM can be a challenge for mental health professionals. There are also issues unique to psychiatry related to the development and implementation of DAs that need consideration. Despite this, mental health professionals can and do still employ SDM techniques. This article offers an overview of the skills required to implement a SDM model and the resources currently available. ⋯ The core features of SDM are advocated for in clinical guidelines, but more resources are needed to ensure these recommendations are implemented in practice. In particular, the benefits of freely available DAs developed according to international standards need to be assessed for suitability and effectiveness.
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Suicide is a global health priority. It is important to analyse the effects of investment in mental health services on suicide rates. This paper presents and discusses recent changes in suicide rates and diagnostic mix among clients of the mental health service in Auckland during a time of service growth. ⋯ As access to services expands the proportion of suicides that occur in known clients will paradoxically increase. Service expansion may have contributed to the falling population suicide rate in Auckland.
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The aim of this paper is to examine whether advertising in the College journals and at RANZCP Congress, in particular from pharmaceutical companies, gives rise to a conflict of interests, and to discuss how this should be managed. ⋯ While advertising will often represent a conflict of interests, banning advertising from the College journals or Congress is unlikely to the best way to manage this. Conflicts of interest may be better managed by development of clear policies on advertisements, broadening the advertising base (i.e. beyond pharmaceutical companies), checking the accuracy of advertisements, and, in the case of Congress, ceasing sponsored symposia.