Objective: To review the Hospital Outreach Post-suicidal Engagement (HOPE) service in the first six months of the pilot program in a metropolitan Melbourne setting, including a description of: (a) socio-demographic, health and psychosocial stressors of people referred; (b) method of presentation; (c) interventions provided and (d) outcomes measured. Method: A retrospective case file analysis reviewed the first six months of HOPE service operation. Results: Forty people received HOPE service during the study period, 60% female, mean age 35 years (range 17–58). The majority had previously engaged in self-harm (72.5%) or attempted suicide (67.5%). Stressors included social isolation, relationship breakdown, unemployment, financial stress, medical problems, history of mental illness, exposure to family violence and adverse childhood events. Statistically significant improvements occurred in the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) following intervention. There were no deaths by suicide during the study period. Conclusion: People referred to HOPE had significant health and psychosocial stressors. Engagement significantly improved subjective well-being and connection with supports. Findings highlighted the need for an integrated clinical and psychosocial model to promote hope and connection in life post suicide attempt. It remains unclear which interventions improved well-being and if this contributes to suicide prevention.

Bipolar disorder is a common and severe condition, and has a clinical outcome that is frequently sub-optimal. Only a small number of therapeutic options are currently available for the disorder. A growing range of novel therapeutic options for the treatment of bipolar disorder are under investigation. These include the anticonvulsants, atypical antipsychotics and options such as the omega-3 fatty acids and transcranial magnetic stimulation. Of the anticonvulsants, lamotrigine is currently the agent for which the greatest amount of controlled clinical data is accumulating, particularly in the depressed and rapid cycling phases of the illness. Olanzapine is currently the atypical antipsychotic with the largest body of evidence in mania, although data is emerging on other atypical antipsychotics including risperidone and ziprasidone. Data regarding the atypical agents in other phases of the illness are awaited. The options available for this difficult to treat condition is increasing with the new range of agents.

Purpose To improve outcomes for people with co-occurring mental health and substance use disorders, the Eastern Health Mental Health Service implemented an integrated treatment model known as the dual diagnosis clinician shared care model. This study aims to provide evidence for a relatively unexplored model in clinical mental health services within the state of Victoria, Australia. Design/methodology/approach Dual diagnosis clinicians were placed into community mental health clinics in a shared-care, modified case management role, to provide primary and secondary consultations to select consumers and/or their carers, as well as to provide capacity-building training to the mental health staff facing real world clinical challenges in dual diagnosis service delivery. Findings Since the commencement of this service, more than 800 consumers of the adult mental health service have been supported to concurrently address their harmful substance use, while receiving recovery-focused community mental health care. Preliminary findings include previously unknown figures on the prevalence for co-occurring substance use at the point of referral and a demonstrated preference by consumers for treatment of both disorders at the same time by the same service (in-house treatment). Originality/value The establishment of a dedicated, integrated dual diagnosis team has significantly increased the capacity of a community-based clinical mental health service to engage with and treat consumers with dual diagnosis disorders. This model is beginning to produce evidence challenging traditional siloed approaches to mental health and alcohol and drug treatment.

Electroconvulsive therapy (ECT) is a controversial treatment modality that is only rarely performed on children and adolescents. There is a marked paucity of published data relating to the indications, use, clinical outcome and complications of ECT in this age group. The ethical and moral issues surrounding the use and in particular the research of ECT in this group of patients makes controlled data very difficult to come by. The following case report and review of the literature will address some of these issues.

The management of mania is an important and common clinical challenge. A wide array of psychopharmacological alternatives is available, diverse in their mechanism of action. They include lithium, the antipsychotics, anticonvulsants and others. With the exception of lithium, all these agents have been borrowed from other indications. The wide variety of therapeutic options does not help to clarify the primary pathophysiological mechanisms operative in bipolar disorder. While the development of novel therapeutic agents increases the available armamentarium, there is little clarity as to the place of the novel agents in treatment regimens. A further issue in the treatment of mania is the significant divergence of opinion as to choice of first-line antimanic therapy. This paper attempts to review the evidence of efficacy of the various antimanic agents, with a focus on the novel anticonvulsant and neuroleptic drugs, and to discuss the data available on these novel therapeutic options. ( Int J Psych Clin Pract 2000; 4: 171 - 193).