Exploring Mental Health Presentations in Remote Aboriginal Community Controlled Health Services in the Kimberley Region of Western Australia Using an Audit and File Reviews
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Study Design
3. Results
3.1. Audit
3.2. File Review
3.2.1. Clinical Coding
3.2.2. Complex Health Profile
Documented Characteristics for File Review Patients | Patient Category Based on Number of Coded Mental Health-Related Interactions a | |||
---|---|---|---|---|
A (1 Coded) n = 10 | B (2–9) n = 10 | C (≥10) n = 10 | Total n = 30 | |
Patient characteristics and external stakeholder involvement in 2020 | ||||
Alcohol or other drug use documented | ||||
No | 3 | 4 | 2 | 9 |
Yes | 7 | 6 | 8 | 21 |
Psychosocial factors b | ||||
Family violence c | 5 | 4 | 1 | 10 |
Other violence | 1 | 1 | 0 | 2 |
Other family and/or partner conflict | 1 | 5 | 3 | 9 |
Assault of family member | 2 | 3 | 3 | 8 |
Imprisonment | 0 | 1 | 1 | 2 |
Greif and loss | 2 | 2 | 1 | 5 |
Food insecurity | 2 | 0 | 0 | 2 |
Under guardianship order | 0 | 0 | 4 | 4 |
Overcrowding/insufficient housing | 2 | 2 | 5 | 9 |
Complex primary health | 6 | 5 | 1 | 12 |
None | 0 | 1 | 3 | 4 |
External stakeholders involved in relation to mental health care b | ||||
Tertiary health provider | 3 | 6 | 2 | 11 |
Specialist mental health service | 6 | 6 | 9 | 21 |
Allied health (counselling/psychological services) | 3 | 1 | 0 | 4 |
Alcohol and Other Drug services | 0 | 0 | 1 | 1 |
Police | 4 | 1 | 0 | 5 |
Other | 1 | 0 | 1 | 2 |
None | 1 | 3 | 0 | 4 |
Characteristics of clinical response in 2020 | ||||
Documentation of mental health screening | ||||
No | 7 | 8 | 10 | 25 |
Yes | 3 | 2 | 0 | 5 |
Documentation of transfer to hospital due to mental health status | ||||
No | 7 | 4 | 8 | 19 |
Yes d | 3 | 6 | 2 | 11 |
Documentation of medication related to mental health | ||||
No | 8 | 4 | 0 | 12 |
Yes | 2 | 6 | 10 | 18 |
Documentation of diagnosis | ||||
No | 9 | 4 | 0 | 13 |
Yes | 1 | 6 | 10 | 17 |
Schizophrenia e | 0 | 3 | 9 | 12 |
Schizophreniform disorder | 0 | 1 | 0 | 1 |
Organic psychosis | 0 | 0 | 1 | 1 |
Post-traumatic stress disorder | 1 | 0 | 0 | 1 |
Depression and/or anxiety | 0 | 2 | 0 | 2 |
Documentation of follow up clinic care relating to distress/mental health | ||||
No | 6 | 4 | 0 | 10 |
Yes | 4 | 6 | 10 | 20 |
3.2.3. The Psychosocial Context of Mental Health Presentations
‘Intentional MVA [motor vehicle accident], pt [patient] stated he wanted to end his life after conflict and argument with family. Pt states he was in a wrong skin relationship and has been forced to end the relationship. Pt [patient] heavily intoxicated. Minor lacerations’.(After-hours presentation, entered by Remote Area Nurse (RAN). Male patient, aged 18-24)
‘BIB [brought in by] police. Found by family with rope threatening suicide. Very upset by his actions, caused serious injury to adult son–son flown to Perth for treatment 1 day ago. Pt intoxicated. No money in the house, no food, has abdominal pain’.(After-hours presentation, entered by RAN. Male patient 45–54)
‘Assault by brother. Noted pt [patient] called police. Pt stated they had been drinking’.(Clinic-hours presentation, entered by RAN)
‘Pt phoned threatening suicide. AHW [Aboriginal Health Worker] attends house with me. Pt did not answer the door. Police called. Pt bought to the clinic. Stated she has no fridge, might lose house, anxious. Pain from previous assault. Denied suicide/self-harming thoughts’.(After-hours clinic presentation, entered by Clinic Manager)
‘Interaction prior to coded interaction (total 5 interactions): (1) intention to self-harm [not coded], police involved; (2) DV [domestic violence] assault; (3) DV assault; (4) disclosure of sexual assault; (5) DV assault, assistance to leave community’.(After-hours and clinic-hours presentations, entered by various clinic staff, including AHW, RAN, and GP)
‘Separated from a violent partner, he has been at house threatening her, grandmother away; isolated; distressed, attempted to hang herself; found by community member standing on a crate with a noose around her neck’.(After-hours presentation, entered by GP)
3.2.4. Services and Stakeholders
3.2.5. Clinic-Based Response Summary
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient and Interaction Characteristics | n | (%) a | |
---|---|---|---|
Patients | 92 | ||
Sex | |||
Male | 47 | (51) | |
Female | 45 | (49) | |
Age (years) b | |||
18–24 | 27 | (29) | |
25–34 | 30 | (33) | |
35–44 | 19 | (21) | |
45–54 | 12 | (13) | |
55 and over | 4 | (4) | |
Clinic c | |||
Clinic 1 | 27 | (29) | |
Clinic 2 | 12 | (13) | |
Clinic 3 | 53 | (58) | |
Number of interactions | |||
1 | 41 | (45) | |
2–9 | 37 | (40) | |
≥10 | 14 | (15) | |
Clinically coded interactions d | 403 | ||
Clinic | |||
Clinic 1 | 192 | (48) | |
Clinic 2 | 28 | (7) | |
Clinic 3 | 183 | (45) | |
Category of interaction/presentation | |||
Did not attend appointment- mental health | 11 | (3) | |
Mental health review | 19 | (4) | |
Mental health medication | 8 | (2) | |
Mental health assessment | 3 | (1) | |
Mental health problem | 110 | (27) | |
Mental health disorder | 153 | (38) | |
Mental disability | 8 | (2) | |
Mental disease | 4 | (1) | |
Mental illness | 30 | (7) | |
Mental distress | 12 | (3) | |
Mental health crisis | 1 | (0) | |
Self-harm | 5 | (1) | |
Suicide attempt | 15 | (4) | |
Suicidal ideation | 13 | (3) | |
Suicide threat/fear | 8 | (2) | |
Suicide plan | 3 | (1) |
File Review Patient Characteristic | Patient Category Based on Number of Coded Mental Health-Related Interactions a | |||
---|---|---|---|---|
A (1 Coded) n = 10 | B (2–9) n = 10 | C (≥10) n = 10 | Total n = 30 | |
Sex | ||||
Male | 5 | 5 | 8 | 18 |
Female | 5 | 5 | 2 | 12 |
Age (years) | ||||
18–24 | 3 | 5 | 2 | 10 |
25–34 | 2 | 2 | 5 | 9 |
35–44 | 3 | 3 | 1 | 7 |
45–54 | 2 | 0 | 2 | 4 |
Clinic | ||||
Clinic 1 | 3 | 4 | 5 | 12 |
Clinic 2 | 3 | 2 | 0 | 5 |
Clinic 3 | 4 | 4 | 5 | 13 |
Mental Health-Related Interactions in 2020 Using Different Criteria | Patient Category Based on Number of Coded Mental Health-Related Interactions a | |||
---|---|---|---|---|
A (1 Coded) n = 10 | B (2–9) n = 10 | C (≥10) n = 10 | Total n = 30 | |
Median interactions using audit coding criteria (IQR) a | 1 (1–1) | 2.5 (2–4) | 17.5 (15–18) | 2.5 (1–15) |
Median interactions in file reviews (IQR) b | 5 (2–6) | 8.5 (3–19) | 69 (62–96) | 10.5 (5–62) |
Characteristics of First Coded Presentation 2020 | Patient Category Based on Number of Coded Mental Health-Related Interactions a | |||
---|---|---|---|---|
A (1 Coded) n = 10 | B (2–9) n = 10 | C (≥10) n = 10 | Total n = 30 | |
Timing | ||||
Clinic hours | 4 | 4 | 10 | 18 |
After hours | 6 | 6 | 0 | 12 |
Coding | ||||
Suicide (intentions, threatening, ideation) | 3 | 1 | 1 | 5 |
Suicide attempt | 1 | 3 | 0 | 4 |
Self-harm | 3 | 1 | 0 | 4 |
Mental health medication administered | 0 | 1 | 0 | 1 |
Mental health (problem, disorder, impairment) | 2 | 4 | 7 | 13 |
Mental distress | 1 | 0 | 1 | 2 |
Major mental health episode | 0 | 0 | 1 | 1 |
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Carlin, E.; Cox, Z.; Orazi, K.; Derry, K.L.; Dudgeon, P. Exploring Mental Health Presentations in Remote Aboriginal Community Controlled Health Services in the Kimberley Region of Western Australia Using an Audit and File Reviews. Int. J. Environ. Res. Public Health 2022, 19, 1743. https://doi.org/10.3390/ijerph19031743
Carlin E, Cox Z, Orazi K, Derry KL, Dudgeon P. Exploring Mental Health Presentations in Remote Aboriginal Community Controlled Health Services in the Kimberley Region of Western Australia Using an Audit and File Reviews. International Journal of Environmental Research and Public Health. 2022; 19(3):1743. https://doi.org/10.3390/ijerph19031743
Chicago/Turabian StyleCarlin, Emma, Zaccariah Cox, Kristen Orazi, Kate L. Derry, and Pat Dudgeon. 2022. "Exploring Mental Health Presentations in Remote Aboriginal Community Controlled Health Services in the Kimberley Region of Western Australia Using an Audit and File Reviews" International Journal of Environmental Research and Public Health 19, no. 3: 1743. https://doi.org/10.3390/ijerph19031743