The CARS has strong psychometric properties and is now available for clinical and research work in India.

ObjectiveImproving dementia care is a policy priority nationally and internationally; there is a ‘diagnosis gap’ with less than half of the cases of dementia ever diagnosed. The English Health Department's Quality and Outcomes Framework (QOF) encourages primary care recognition and recording of dementia. The codes for dementia are complex with the possibility of underidentification through miscoding. We developed guidance on coding of dementia; we report the impact of applying this to ‘clean up’ dementia coding and records at a practice level.DesignThe guidance had five elements: (1) identify Read Codes for dementia; (2) access QOF dementia register; (3) generate lists of patients who may have dementia; (4) compare search with QOF data and (5) review cases. In each practice, one general practitioner conducted the exercise. The number of dementia QOF registers before and after the exercise was recorded with the hours taken to complete the exercise.SettingLondon primary care.Participants23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants.OutcomesThe number on dementia QOF registers; time taken.ResultsThe number of people with dementia on QOF registers increased from 1007 to 1139 (χ2=8.17, p=0.004), raising identification rates by 8.8%. It took 4.7 h per practice, on an average.ConclusionsThese data demonstrate the potential of a simple primary care coding exercise, requiring no specific training, to increase the dementia identification rate. An improvement of 8.8% between 2011 and 2012 is equivalent to that of the fourth most improved primary care trust in the UK. In absolute terms, if this effects were mirrored across the UK primary care, the number of cases with dementia identified would rise by over 70 000 from 364 329 to 434 488 raising the recognition rate from 46% to 54.8%. Implementing this exercise appears to be a simple and effective way to improve recognition rates in primary care.

BackgroundPaediatricians can be empowered to address the Priority Mental Health Disorders at primary care level. To evaluate the effectiveness of a collaborative workshop in enhancing the adolescent psychiatry knowledge among paediatricians.MethodsA 3-day, 27-hours workshop was held for paediatricians from different regions of India under the auspices of the National Adolescent Paediatric Task Force of the Indian Academy of Paediatrics. A 5-item pretest-posttest questionnaire was developed and administered at the beginning and end of the workshop to evaluate the participants' knowledge acquisition in adolescent psychiatry. Bivariate and multivariate analyses were performed on an intention-to-participate basis.ResultsForty-eight paediatricians completed the questionnaire. There was significant enhancement of the knowledge in understanding the phenomenology, identifying the psychopathology, diagnosing common mental disorder and selecting the psychotropic medication in the bivariate analysis. When the possible confounders of level of training in paediatrics and number of years spent as paediatrician were controlled, in addition to the above areas of adolescent psychiatry, the diagnostic ability involving multiple psychological concepts also gained significance. However, both in the bivariate and multivariate analyses, the ability to refer to appropriate psychotherapy remained unchanged after the workshop.ConclusionsThis workshop was effective in enhancing the adolescent psychiatry knowledge of paediatricians. Such workshops could strengthen paediatricians in addressing the priority mental health disorders at the primary-care level in countries with low-human resource for health as advocated by the World Health Organization. However, it remains to be seen if this acquisition of adolescent psychiatry knowledge results in enhancing their adolescent psychiatry practice.

ObjectiveWorld Health Organization has identified Priority Mental Health Disorders (PMHD) of adolescence. To effectively address these disorders at the primary care level paediatricians have to be trained in the low-income countries, which often have paucity of mental health resources. We studied: (1) the need of psychiatric training required among paediatricians; (2) if the content and process of the model workshop suits them to identify and treat these disorders.MethodsForty-eight paediatricians completed evaluation questionnaire at the end of a 3-day workshop on adolescent psychiatry. They participated in a focused group discussion addressing the areas in psychiatry that needs to be strengthened in these workshops, the changes in the content and process of the workshop to bolster their learning. Qualitative and descriptive analyses were appropriately used.ResultsTraining in adolescent psychiatry was considered necessary among the paediatricians at zonal level frequently to develop their private practice, treat psychiatric disorders confidently, make correct referrals, and learn about counselling. Prioritizing training from under and postgraduate training, integrate psychiatry training with conference, conducting special workshops or Continuing Medical Education were suggested as ways of inculcating adolescent psychiatry proficiency. Mental status examination, psychopathology and management of the PMHD were considered by the respondents as important content that need to be addressed in the program but aspects of behavioural problems and developmental disabilities were also identified as areas of focus to gain knowledge and skill. Appropriate group size, flexibility in management decisions to fit the diverse clinical practice- settings was appreciated. Lack of skills in giving clinical reasoning in relation to PMHD, time management and feedback to individuals were identified as required components in the collaborative effort of this manner. Providing delegates with basic information on adolescent psychiatry prior to the workshop was suggested to make the workshop more valuable.ConclusionsThere is a need to expand training for paediatricians from various backgrounds in adolescent psychiatry to strengthen their clinical skills to address the PMHD at the primary-care level. The evaluation suggests that the design and collaborative approach evident in this programme have merit as a model for training paediatricians in adolescent psychiatry in countries with low human resource for health.

Objective: Using a case study, we aim to report on the compatibility of funding and policy settings under Australia's National Disability Insurance Scheme (NDIS) with the delivery of evidence based, recovery-oriented psychosocial services. Type of program or service: We reflect on the impact of the NDIS on a psychosocial rehabilitation service run by Woden Community Service (WCS), one of the major service providers in the Australian Capital Territory, and specifically its Transition to Recovery (TRec) program. Methods: We examine NDIS funding and policy settings and consider the recovery-oriented practices underpinning psychosocial programs like TRec. The construct of the program, its staffing and related issues are considered. The article draws on a formal evaluation of TRec conducted in 2015. Results: The NDIS is having a seismic impact on Australia's psychosocial sector. Despite its positive evaluation, the future of the TRec program is problematic. Practically, service exit points have disappeared, reducing the program's capacity to properly transition clients between services and effectively increasing the likelihood of relapse. More generally, current NDIS policies are threatening the fidelity of WCS's approach to recovery practice. Lessons learnt: This case study highlights tension between a new public insurance scheme primarily aimed at better managing consistent conditions and circumstances, and the recovery philosophy which has emerged in relation to episodic mental illness. This has implications for psychosocial services nationwide. The psychosocial rehabilitation sector has always been a peripheral element of Australia's mental health service mix. The advent of the NDIS offers hope that this may change. However, WCS's experience suggests that the NDIS must reconsider how best to foster recovery-oriented practice in mental health. This should be part of a more fundamental reconceptualisation of the role of psychosocial rehabilitation services in contemporary mental