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Black Dog Institute: Mental health training for health professionals

With rising rates of mental health issues in Australia, it is essential for all health professionals, regardless of their work setting, to have a strong platform of knowledge to provide comprehensive care for their patients.

Mental health training for health professionals and a thorough understanding of help pathways can improve prognosis, treatment responsiveness, and quality of life and prevent death by suicide.


Arranging evidence-based mental health training for your workforce can improve patient outcomes and health professional confidence in managing the complexities of comorbid mental and physical health conditions.


A snapshot of mental health in Australia

The latest statistics from the Australian Bureau of Statistics1 indicate that over two in five Australians aged 16 to 85 years had experienced a mental health disorder at some time in their life and that in the last twelve months, one in five had experienced a mental health disorder.


One in six Australians experience anxiety and one in 13 experience an affective disorder (including depression). Approximately 3.3 per cent of Australians meet the criteria for a substance use disorder and depression, and anxiety and substance use disorders often co-occur.1 These rates are even higher for those living with chronic physical health conditions.


Mental health is broader than a dichotomous distinction between well and unwell. A person does not need to meet the criteria for a mental health disorder to be negatively affected by their mental health.


It is more helpful to consider mental health and wellbeing as existing along a continuum (see Figure 1) from well to unwell. Every person varies their position along this continuum over time and it is normal for people to experience periods where they struggle with their mental health. This is evidenced by rates of psychological distress in the community.


15.4 per cent of Australians aged between 16 and 65 reported experiencing high to very high rates of psychological distress in the last 12 months.1 Provision of support, when someone is struggling with their mental health, can prevent the onset of a mental health episode and reduce the negative consequences of an episode.


Mental health issues are caused by a complex interaction of factors including genetics, family history, personality factors, lifestyle, difficult life experiences, physical health, and environment. Everyone is different and will have a unique combination of factors that contribute to developing mental health issues.


Mental illness is a major risk factor for death by suicide. In 2022, there were 3,249 suicide deaths in Australia, with an age-standardised rate of 12.5 deaths per 100,000 population.

It was the 15th leading cause of death for Australians, and the leading cause of premature mortality (in terms of years of life lost). Men represent over three-quarters of all suicide deaths in Australia, with a rate of 18.8 per 100,000, compared to 5.9 per 100,000 for women.(2)


Mental and behavioural disorders were present in almost 63 per cent of deaths of people by suicide.1 Mood disorders (including depression) were the most common risk factor for both males (34.9 per cent) and females (43.3 per cent) for all age groups except for those 85 years and older.2 Accurate diagnosis and better management of mental health conditions reduce suicide risks.


All health professionals have a role to play in suicide prevention as many patients present to primary care settings rather than to mental health services. Training all health professionals in recognising and responding to distress and assessing for suicidality improves patient outcomes and practitioner confidence and competence.


The link between mental health and physical health

Mental health and physical health are fundamentally connected. A significant proportion of individuals experiencing mental illness will also experience poor physical health, and poor physical health can in turn be associated with poor mental health.


Mental illnesses are associated with a risk of obesity, diabetes and cardiovascular diseases that is 1.4 to 2.0 times higher than in the general population. (3)


One-third of people with cancer meet diagnostic criteria for at least one mental health disorder, including major depressive disorder, anxiety disorders, adjustment disorders, sleep disorders and delirium.4 The prevalence is higher in people with advanced cancer. Comorbid mental disorders reduce quality of life, interfere with treatment adherence and, in the case of depression, may affect the rate of cancer progression. (5)


Depressed mood and cardiovascular diseases frequently occur together with an estimated 20 to 45 per cent of individuals with heart disease and depression. Those who have had a heart attack are three times more likely to be depressed compared to the general population.6


People diagnosed with severe physical health conditions, such as chronic obstructive pulmonary disease, degenerative neurological diseases, slow-survival cancers and chronic ischemic heart disease, are at increased risk of dying by suicide. (7)


People living with chronic unremitting pain and functional decline associated with illness can experience heightened feelings of burdensomeness, loss of autonomy, and hopelessness, which are risk factors for death by suicide. (8,9)


Co-morbidity increases the burden on individuals, their families, and communities. Comorbidity is the norm, not the exception. It complicates health professionals’ ability to recognise, provide assistance and organise appropriate health services for their patients.


Mental health training: equipping your team with essential skills

Mental health training was once considered a specialist field, however, now it has become an essential skill for all healthcare professionals. Given the high rates of mental health issues in the community and the overlap between mental and physical health conditions, upskilling health professionals in recognising and responding is recommended.


Mental health training for health professionals focuses on early identification of signs that someone may be struggling, skills in how to support a patient and their family, increasing awareness of referral pathways for adjunct care, and identifying and responding to suicidality.


Choosing the right training given the diversity of roles and settings that health professionals work in can be daunting. Here’s a checklist of some features to look for when considering training options for your team:


  • Informed by theory and the latest research evidence

  • Incorporates the voice of lived experience and best-practice clinical expertise

  • Rigorously evaluated to ensure learning outcomes are met

  • Interactive, engaging with the opportunity to practice skills

  • Real-life scenarios as a foundation for learning

  • Tailored to the profession, role and work setting

  • Facilitated by expert clinicians

  • Offers a range of modalities to fit in with participants' learning preferences and time, e.g. face to face workshops, interactive online workshops, self-directed online modules, and blended options with a mix of online and face-to-face

  • Fulfills accreditation requirements of professional regulatory bodies.


Black Dog Institute has been running training programs for health professionals since 2003 and in the last 12 months, ran 327 programs for 10,851 health professionals.

Black Dog Institute’s training is designed to improve skills to diagnose and treat common mental health issues, educate health professionals on how to contribute to suicide prevention, and teach evidence-based approaches to treatment planning and prioritise developing practical skills. The training aims to provide skills and resources to be used the very next day with your next patient.


The institute’s experience working with Primary Health Networks, GP registrar Training Providers, the Department of Human Services, and the Pharmacy Guild of NSW has emphasised the importance of tailoring programs to meet the specific needs of the organisation rather than a one-size-fits-all approach. Rigorous evaluation ensures learning outcomes are met and the skills are relevant to participants’ practice.

Evaluations from 2020 to 2022 of the six-hour Dealing with Depression workshop for GPs and GP registrars indicated that 95.6 per cent of participants rated the course as relevant to their practice.


Evaluation from the 7.5 hours of multidisciplinary Advanced Training in Suicide Prevention indicated that after the training, 97.2 per cent rated themselves as having the skills to support a suicidal person.


Given the complexity of mental and physical health comorbidities for health professionals, accessing evidence-based training is a priority.


Black Dog Institute can partner with your organisation to identify training solutions to suit the needs of your team or group of health professionals. Training can be delivered in-house face-to-face or online.


By Dr Kris Kafer, Clinical Psychologist, Facilitator and Senior Psychology Content Developer, Black Dog Institute


References

1. National Study of Mental Health and Wellbeing. Australian Bureau of Statistics. July 22, 2022. Accessed August 24, 2023. https://www.abs.gov.au/statistics/ health/mental-health/national-study-mental-health-and-wellbeing/latest-release

2. Causes of Death, Australia. Australian Bureau of Statistics. September 27, 2023. Accessed September 27, 2023. https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2022

3. Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, et al. The Lancet Psychiatry Commission: A blueprint for protecting physical health in people with mental illness. Lancet Psychiatry. 2019;6(8), 675-712. https://doi. org/10.1016/S2215-0366(19)30132-4

4. Grassi L, Caruso R, Hammelef K, Nanni MG, Riba M. Efficacy and safety of pharmacotherapy in cancer-related psychiatric disorders across the trajectory of cancer care: A review. Int Rev Psychiatry. 2014;26(1), 44-62. https://doi. org/10.3109/09540261.2013.842542

5. Ciaramella A, Spiegel D. Psychiatric disorders among cancer patients. Handb Clin Neurol. 2012;106, 557–72.

6. Raič M. Depression and Heart Diseases: Leading Health Problems. Psychiatria Danubina. 2017;29 Suppl 4(Supp 4), 770–777

7. Nafilyan V, Morgan J, Mais D. Risk of suicide after diagnosis of severe physical health conditions: Retrospective cohort study of 47 million people. The Lancet Regional Health – Europe. 2023;25(100562). https:// doi.org/10.1016/j.lanepe.2022.100562

8. Khazem LR, Jahn DR, Cukrowicz CR, Anestis MD. Physical disability and the interpersonal theory of suicide. Death Studies. 2015;39(10), 641-646. https://doi.org/ttps://doi.or g/10.1080/07481187.2015.1047061

9. Onyeka IN, Maguire A, Ross E, O’Reilly D. Does physical ill-health increase the risk of suicide? A census-based follow-up study of over 1 million people. Epidemiology and Psychiatric Sciences. 2020;29(e140), 1-10. https://doi. org/10.1017/S2045796020000529




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