To investigate levels of knowledge and attitudes towards advance healthcare directives among inpatient psychiatry service users in Ireland.

A survey was completed among adult inpatient psychiatry service users (n = 47) in Tallaght University Hospital, Dublin.

Just over one in ten (11%) inpatient psychiatry service users had heard of advance healthcare directives. None had created an advance healthcare directive, but over a quarter (25.5%) had written down or verbally told someone what they would like to happen when they became unwell. When asked ‘if you were supported by your healthcare provider to make an advance healthcare directive, would you like to make one?’, over two thirds responded either ‘definitely yes’ (34%) or ‘probably yes’ (34%). On multi-variable testing, future willingness to make an advance healthcare directive was significantly associated with younger age but not with ethnicity, gender, education, employment status, or prior knowledge of advance healthcare directives. All respondents would involve someone else in making an advance healthcare directive. There was high confidence that healthcare practitioners would respect an advance healthcare directive (87%).

There are high levels of interest in advance healthcare directives, but low levels of knowledge and use among inpatient psychiatry service users in Ireland. Our findings indicate a need for educational initiatives and resources to increase awareness. Such efforts could usefully focus especially on appropriate use of advance healthcare directives in psychiatric care and seek to bridge the gaps between evidence of benefit, legislative reform, and their use in mental healthcare.

The Transitional Support Unit (TSU) is a unique 10-bed state-wide service and currently operates as one of two community-based long-term mental health services in Victoria. TSU is geared towards adults with complex mental health disorders in addition to a co-occuring intellectual disability or acquired brain injury--also referred to as a dual disability (DD). The aim of this project is to identify the benefits of this service to participants in order to improve the current structure and also to encourage development and expansion of similar services in Australia or globally.

The project was performed at the TSU. Participants included all previous and current residents of the TSU program (N = 24). Data were collected from three different evidence-based measures; the Health of the Nation Outcome Scales (HoNoS), Lifestar, and the Life Skills Profile (LSP). Each participant had these scales performed on admission, at time of discharge, and at 91 day intervals throughout their stay at TSU. The change in the measures were used to determine what clinical benefit, if any, resulted from undergoing engagement with the TSU program. Inclusion criteria was broad and encompassed any adult who had a DD and was admitted into TSU. Exclusion criteria was defined as any TSU resident with no completed discharge scales for comparison.

On review, it was found that on average, there was an overall decrease in HoNoS scores from admission to discharge of 4 points. For the LSP, there was an average decrease of 10 points in TSU participants and the Lifestar was found to have an average increase of 20 points. Within Lifestar specifically, participants were found to have an average improvement between 1.64 and 2.94 in each individual category assessed. No TSU participants were observed to suffer from any decline or step back in categories related to how they spent their time, feeling good about themselves, or the people they knew.

TSU does appear to have notable benefit for adults with DD, particularly in improving overall mood, social interaction, and development of a routine as well as activities throughout the day. The least improvement was found in categories such as physical health and communication. The data were limited by participants who have not yet been discharged from TSU, therefore any discharge scales were unavailable for comparison.

The aim of this study was to ascertain the correlations between patients’ views of their recovery and clinicians’ views of patients recovery, symptoms and risk, in a cohort of patients in the National Forensic Service Dundrum (NFMHS).

A cross sectional study was performed of all inpatients in the NFMHS Dundrum. The self-rated Dundrum tool was offered to all 96 in-patients and completed by 64. Clinican rated measures of violence risk (HCR-20), programme completion (Dundrum-3), recovery (Dundrum-4), symptoms (PANSS) and functioning (GAF MIRECC) were rated. ANOVA and concordance ratings were calculated using SPSS

A total of 64 patients agreed to participate, of whom 10 were female. The self-rated Dundrum-3 correlated with the staff rated Dundrum-3 (0.471, p < 0.001). The self-rated Dundrum-4 correlated with the staff rated Dundrum-4 (0.373, p = 0.003). The self-rated Dundrum-3 correlated with the HCR-20 total (0.0352, p = 0.005), HCR-C (0.3677, p = 0.004), and HCR-R (0.301, p = 0.018). The self-rated Dundrum-3 correlated significantly with GAF occupational (-0.273, p = 0.48), symptomatic (-0.299, p = 0.03). The self-rated Dundrum-4 correlated only with the GAF symptomatic (-0.333, p = 0.05). The self-rated Dundrum-3 correlated with PANSS positive (0.457, p = 0.001), PANSS negative (0.514, p < 0.001), PANSS general (0.395, p = 0.004) and PANSS total (0.352, p = 0.005). The self-rated Dundrum-4 correlated with PANSS positive (0.356, p = 0.01) and PANSS negative (0.413, p = 0.002).

There was good correlation between patient and clinician ratings of programme completion and recovery. Patient self-ratings of programme completion and recovery correlated with staff ratings of functioning and symptoms. The directions of agreement were correct