Prevalence of psychiatric disorders in New Zealand prisons: a national study

OBJECTIVE: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder. METHOD: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview - Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited. RESULTS: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive- compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population. CONCLUSIONS: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.     

The role of the psychiatrist: job satisfaction of medical directors and staff psychiatrists

In a previous survey of Columbia University Public Psychiatry Fellowship alumni, medical directors reported experiencing higher job satisfaction compared to staff psychiatrists. To further this inquiry, the authors conducted an expanded survey among the membership of the American Association of Community Psychiatrists (AACP). We mailed a questionnaire to all AACP members. Respondents categorized their positions as staff psychiatrist, program medical director or agency medical director, and rated their overall job satisfaction. The form also included a number of demographic and job characteristic items. Of 479 questionnaires mailed, a total of 286 individuals returned questionnaires (61%—12 forms were undeliverable). As in our previous survey, medical directors experience significantly higher job satisfaction compared to staff psychiatrists. Program and agency medical directors do not differ significantly. In addition, job satisfaction is strongly and negatively correlated with age for staff psychiatrists but not for medical directors. This survey strengthens the previously reported advantage medical directors have over staff psychiatrists regarding job satisfaction. The finding that job satisfaction decreases with increasing age of staff psychiatrists but not medical directors is particularly interesting, suggesting that staff psychiatrist positions may come to be regarded as dead-end over time. Psychiatrists are advised to seek promotions to program medical director positions early in their careers, since these positions are far more available, and provide equal job satisfaction, compared to agency medical director positions.     

Burnout in psychiatrists: an etiological model

OBJECTIVE: This article reviews burnout in psychiatrists. A model of burnout is presented which considers three factors: those which may predispose, precipitate, and perpetuate burnout. Lastly, recommendations are made for future research. METHODS: We conducted a selective literature review to expand on two recent systematic reviews to examine the etiology, prevalence, and consequences of burnout in psychiatrists. We distinguish the effects of burnout, depression, and work-related stress. RESULTS: An etiological model for the development of burnout in psychiatrists is described here in terms of an interaction between the predisposing, precipitating, and perpetuating factors. CONCLUSIONS: Research is needed on the long-term effects of work-place stress on psychiatrists, to identify possible protective factors, and to utilize this information to inform the design of interventions that protect or mitigate the effects of work-place stress on psychiatrists.     

Towards ICD 10: the attitudes of Australian and New Zealand psychiatrists

About 15% of practising psychiatrists in Australia and New Zealand responded to a brief postal questionnaire. This sample appears reasonably representative of the various groups within the profession and of the geographical distribution of the clinicians. Ninety-one per cent of the respondents thought it was important to have a reliable classification; 83% thought that ICD 10 should incorporate specific diagnostic criteria; and 78% were of the view that ICD 10 should have a multiaxial system. Overall, DSM-III is used twice as often as ICD 9, and only 12% of psychiatrists do not use DSM-III at all. A very small minority (6%) use some other classification system. The results of this survey are discussed against the background of the intended introduction of ICD 10 in about 1990. Preliminary preparations for it are already in progress.     

Mentally abnormal homicide in New Zealand as defined by legal and clinical criteria: a national study

BACKGROUND: Homicides by people with mental illness have been studied using either clinical or legal categorization of the homicide as abnormal. No previous study has employed both definitions in the same population. METHOD: A retrospective study of all homicides in New Zealand between 1988 and 2000 considered mentally abnormal homicide using a legal definition (when the courts deemed a contribution of mental illness was present) and a clinical definition (defined as the presence of a discharge diagnosis from inpatient mental health treatment) of 'mentally abnormal'. Rates, characteristics and time trends were investigated. RESULTS: Of the 844 cases, 7.1% met legal criteria for being mentally abnormal, while 7.7% had ever received a diagnosis for a psychotic illness, and a further 14.5% had been admitted to a psychiatric hospital for any other reason. The majority (60%) of perpetrators with a psychotic diagnosis received a mental health disposition from the court. Of these, 60% were first diagnosed with their psychotic illness prior to the homicide, while 28% were first diagnosed at the time of the offence and a further 12% after imprisonment. Of all those who received a psychotic diagnosis, 89% had post-conviction admissions or a mental health disposition. CONCLUSION: Legal and clinical definitions of mentally abnormal homicide detect similar rates of mentally abnormal homicide, but illustrate somewhat different dimensions of the relationship between mental illness and homicide.     

Burnout and stress amongst old age psychiatrists

OBJECTIVE: to investigate the relationship between work patterns, burnout and stress in consultant old age psychiatrists. METHODS: we sent a postal survey to all old age psychiatrists on the Faculty of Old Age Psychiatry, Royal College of Psychiatrists, list. Participants completed a workload questionnaire, the Stress Checklist and the Maslach Burnout Inventory during a specified week. RESULTS: burnout scores were unaffected by gender and team working, but old age psychiatrists scoring within the high burnout range were younger, scored highly on stress, spent less time on research, study and audit, and more time travelling. The whole group scored highly on emotional exhaustion. CONCLUSIONS: job plans should encourage research/study and audit, and cut down travelling. The finding related to age is not fully understood, but suggests consideration of support groups for new consultants and review of whether current training programmes adequately prepare people for work as a consultant.     

New Zealand psychiatrists views on global features of ICD-10 and DSM-IV

OBJECTIVE: The present accepted classificatory systems (ICD-10 and DSM-IV) represent the culmination of 100 years of post-Kraepelinian evolution. The present paper reports on a study to ascertain the views of New Zealand psychiatrists on their requirements of a classificatory system, and their opinions on those currently in use. METHOD: An anonymous postal survey of 542 psychiatrists and trainees was undertaken in New Zealand. RESULTS: A total of 235 questionnaires were returned, completed. New Zealand psychiatrists primarily use DSM-IV and do so because that is what they were taught on. They make relatively limited use of the multiaxiality. The purposes of classificatory systems that they value most highly are reliable interclinician communication, and to inform patient management planning. The two purposes they valued least were usefulness for a national statistical base, or to indicate prognosis. CONCLUSIONS: New Zealand psychiatrists' views are consistent with some of the stated objectives of ICD-10 and DSM-IV, but there is significant diversity in the former and over-ambition in the latter, with much to be resolved.     

A survey of the distribution of psychiatrists in Australia and New Zealand in 1987

A survey is described of the number and distribution of all psychiatrists and trainee psychiatrists in Australia and in New Zealand in 1987, with estimates of available psychiatrists over the next decade. Australia as a whole is not short of psychiatrists or of trainee psychiatrists, but has a marked maldistribution between States and between city and rural areas which needs to be seriously addressed. In 1987 the ratio of psychiatrists to population in Australia was 1:11 290 and in New Zealand 1:21 440. It is estimated that by 1997 the corresponding ratios will be 1:9 130 and 1:12 440. There were 549 trainee psychiatrists in Australia and 103 in New Zealand. Relativity of human resources needs are emphasised. Those Australian States with the highest ratio of psychiatrists to population also have the highest ratio of trainees to population, a fact which has obvious implications.     

Burnout among CMHC psychiatrists and the struggle to survive

Comments gathered in a national survey of community mental health center (CMHC) psychiatrists indicate that many suffer from burnout. Of the 96 respondents who provided comments, 46 expressed dissatisfaction with their work in CMHCs, 14 expressed satisfaction, and seven had mixed feelings. Factors contributing to the respondents' dissatisfaction included a lack of administrative support and validation, low pay, responsibility without authority, and pressure to sign documents related to patients unknown to them. Factors contributing to their satisfaction were having a variety of tasks, being valued for having uniquely comprehensive experience, being supported in the clinical oversight role, being in charge of CMHC operations, and working in a CMHC affiliated with an academic center or the medical community. The authors believe that CMHCs must redress the issues contributing to burnout among CMHC psychiatrists if they are to retain psychiatrists and provide quality patient care.     

DSM-III in the training of British psychiatrists: a national survey.

All 223 psychiatric clinical tutors in the UK were surveyed on their use of DSM-III in their postgraduate training programmes. Results indicate that DSM-III is widely used in clinical training to some extent in the majority of schemes (73%) and in the schemes where it is used it is rated as moderately useful by nearly everyone (93%). DSM-III is generally perceived to have positive effects on learning basic elements of psychopathology and in offering a common language for diagnostic discussion. Interestingly only 16% of users felt that DSM-III was so complicated that it impeded rather than facilitated the teaching of diagnosis. Few schemes provide specific teaching courses and case conferences provide the major forum for teaching DSM-III.     

Burnout among neurology residents during the COVID-19 pandemic: a national cross-sectional study

Neurological Sciences - Neurology residents are particularly vulnerable to burnout because of the novel logistical and clinical challenges brought about by the coronavirus disease 2019 (COVID-19)...     

How mental health clinicians view community treatment orders: a national New Zealand survey

OBJECTIVE: To determine New Zealand mental health clinicians' views about community treatment orders, indications for their use, their benefits, problems and impact on patients and therapeutic relationships. METHOD: A national survey of New Zealand psychiatrists and a regional survey of non-psychiatric community mental health professionals for comparison. RESULTS: The great majority of NZ psychiatrists prefer to work with community treatment orders as an option. They consider they are used properly in most cases, can enhance patients' priority for care, provide a structure for treatment, support continuing contact and produce a period of stability for patients during which other therapeutic changes can occur. They consider these orders can harm therapeutic relationships, especially in the short term, but when used appropriately their overall benefits outweigh their coercive impact. The other mental health professionals surveyed have similar views. A minority of clinicians do not support their use. CONCLUSIONS: The precise impact of community treatment orders on patients' quality of life remains an open question. Until that matter is more clearly resolved, New Zealand law should continue to authorise compulsory outpatient care, provided it is carefully targeted and adequate community services are available.     

Workplace spirituality and job satisfaction

Abstract

In order to obtain an improved understanding of behaviour at work, employees should be studied from physical, psychological, and spiritual dimensions. Although the physical and psychological dimensions of individuals at work have been studied extensively, the spiritual dimension has been neglected for many years. The objective of the current research was to determine the relationship between workplace spirituality and a positive attitude related to work, that is, job satisfaction. A cross-sectional study was conducted with a sample of 600 white-collar workers, chosen from two organizations in different industries in South Africa. The research results indicate that there is a positive relationship between workplace spirituality and job satisfaction. These findings deepen the understanding of personal spirituality, organizational spirituality, and job satisfaction. They bring new insights into the significant role which spirituality plays in the context of the workplace. To survive in the 21st century, organizations need to be spiritually based. This, in turn, will lead to workers being satisfied with their entire work experience.     

Work environment and job satisfaction

BACKGROUND: The working environment in mental health wards has been shown to have profound effects on the health and work stability of mental health workers. Despite an apparent need for regular measurement of work environment, development of short and reliable instruments for such measurements has been largely neglected. The aim of the present study was to evaluate the psychometric properties of the Working Environment Scale-10 (WES-10). METHODS: During the period 1990 through 2000, a total of 640 staff members on 42 wards for psychotic patients completed the WES-10. To establish the number of subscales, a factor analysis was carried out. The internal consistency of the subscales was calculated as Cronbach's alpha. We also collected data concerning satisfaction with the ward, its patients and staff, and for how long the respondents had worked and expected to continue to work at the ward. RESULTS: We identified four subscales named: Self Realization, Workload, Conflict and Nervousness. The psychometric properties of the subscales proved to be acceptable. All the subscales were significantly correlated with at least one satisfaction item, and/or the time the staff expected to continue at the ward. Most notably, the Self Realization subscale was strongly correlated to general satisfaction with the ward, and to the time the staff expected to work on the ward in the future, while Conflict was strongly negatively correlated with liking for staff. CONCLUSION: The WES-10 appears to measure four clinically meaningful subscales. It seems well suited for use in further research and for evaluation of clinical milieus.     

Late‐life homicide‐suicide: a national case series in New Zealand

Homicide‐suicide is a rare event, but it has a significant impact on the family and community of the perpetrator and victim(s). The phenomenon of late‐life homicide‐suicide has not been previously studied in New Zealand, and there is only limited data in the international literature. The aim of this study is to systematically review coroners' records of late‐life homicide‐suicides in New Zealand. After ethics approval was granted, the Coronial Services of New Zealand was approached to provide records of all closed cases with a suicide verdict (age 65+) over a five‐year period (July 2007–December 2012). Of the 225 suicides, 4 cases of homicide‐suicide were identified (an estimated incidence of 0.12 per 100 000 per persons year). All four perpetrators were men; three had been farmers. Their ages ranged from 65 to 82. One case occurred in the context of an underlying psychiatric illness (psychotic depression in bipolar disorder). Firearms were used in three cases. Two cases were categorized as spousal/consortial subtype, one case as filicide‐suicide, and one case as siblicide‐suicide. The prospect of major social upheaval in the form of losing their homes was present in all four cases. The findings of this case series were consistent with the limited existing literature on homicide‐suicide. Age‐related biopsychosocial issues were highlighted in this case series of late‐life homicide‐suicide. Additionally, evaluating firearm licences in high‐risk groups may represent a prevention strategy.     

Prison mental health in-reach teams in Aotearoa New Zealand: A national survey

The STAIR in-reach model of care for prisoners with serious mental illness focuses on screening, triage, assessment, interventions and reintegration by using the principles of assertive community treatment. An evidence base exists for the efficacy for its use in Aotearoa New Zealand. However, little is known about its adoption throughout the country. This national survey of managers of in-reach teams to all prisons (N = 19) aimed to determine the pattern of in-reach service delivery. It compared STAIR in-reach teams with other teams regarding service structure, staffing, interventions, reintegration strategies and training needs. This study signals gains made by adopting the STAIR model (multi-disciplinary team service delivery, ‘through the wire’ support and use of technologies to assist discharge planning) and potential areas of improvement (further use of psychosocial interventions and training needs). To assist national adoption of STAIR, a review is required to consider the cultural responsivity, gender-responsivity and recovery-orientated characteristics of the model.Key words: assessment, in-reach, intervention, prison, reintegration, screening, triage