The Medical journal of Australia
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Mental health laws set criteria that limit the use of involuntary admission to specific circumstances, and clinicians are expected to justify the lawfulness of such detention by referral to these criteria. The South Australian Mental Health Act 1993 required grounds to be documented on the detention form, specifically with respect to the presence of a mental illness, risk to self or others, and a need for immediate treatment. This investigation sought to determine whether the grounds provided for detention met legislative requirements. ⋯ This low compliance rate with legal requirements is concerning. It may reflect clinical decision making, the attention given to the form by the physician filling it, or a combination of both. Stating the grounds for involuntary admission should provide protection for the rights of patients, and the requirement to do so reflects the gravity that the loss of liberty entails for the patient. Our findings are relevant to jurisdictions that are currently reviewing mental health legislation and the need to document the grounds for involuntary treatment, including South Australia.
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To examine the use of cardiac troponin (cTn) testing for acute coronary syndrome (ACS) diagnosis in primary care. ⋯ GP-initiated cTn testing involves patients at high risk of ACS. ACS and associated adverse outcomes can occur in patients undergoing testing, even when the cTn test result is negative. Potential gaps exist in physicians' understanding of the limitations of cTn testing, and cTn test results have minimal influence on their management of patients. GPs may benefit from guidance about ordering cTn testing.
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Greatly enhanced accountability can drive mental health reform. As extant approaches are ineffective, we propose a new approach. Australia spends around $7.6 billion on mental health services annually, but is anybody getting better? Effective accountability for mental health can reduce variation in care and increase effective service provision. ⋯ There are important social priorities in mental health that must be assessed. We provide a brief overview of the existing system and propose a new, modest but achievable set of indicators by which to monitor the progress of national mental health reform. These indicators should form part of a new, system-wide process of continuous quality improvement in mental health care and suicide prevention.