The prevalence of pain in older persons is a significant issue in Australia, in one study of chronic pain, prevalence peaked at 27.0% of males between 65–69, while for females prevalence peaked at 31.0% between 80–84 years. An audit of the assessment of pain and its management on admission to acute hospital care found that approximately 60% of 140 consumers were asked about the presence or absence of pain with only 10% of these consumers having the severity of that pain documented. The impact of pain and its management can have considerable impact on the mental health of consumers with depression a common comorbid condition. Pain can also affect the way that symptoms of mental illness may be expressed however little is known about the assessment and management of pain for consumers of specialist older persons mental health services. The current paper aims to fill this gap but describing the assessment and management of pain by a specialist mental health service. An initial audit of 20 consumers found that while 65% of consumers were receiving on average 2800mgs of paracetamol a day, only 30% of consumers had any documentation of pain, and while 66% had the location of that pain documented only 33% had the severity of pain documented. This paper will outline work aimed at improving the assessment and management of pain, including a comprehensive clinical audit, a staff survey and forum on pain assessment and management in specialist older person’s mental health services.

Social inclusion can have protective benefits, ameliorating the negative effects of stress, and contributing to recovery from mental illness. It is for this reason that improving social inclusion is a priority under the 4th national mental health plan. In order to know if there is an improvement in social inclusion you need to be able to measure it. This paper outlines the development of the Living in the Community Questionnaire a new measure of social inclusion. The questionnaire was developed through an iterative process including reference to a technical advisory group, the results of a national consultation process and a small proof of concept trial. The questionnaire enables the measurement of social participation, education, employment, stability of housing and the person’s ability to have a say in the community. The questionnaire as been tested with consumers of specialist mental health services (n = 222) and the general population (n =2002) the results of this testing will be presented along with work on scoring the measure and the development of a short form. The questionnaire has been well received and several services are interested in undertaking trials. The Living in the Community Questionnaire will meet the need for service providers, policy developers and service planners to understand social inclusion and recovery for those having contact with mental health services.

Mental health services exist to improve outcomes for the people who use them. Counting the activities that the service undertakes does not give an accurate picture of this most fundamental result of service delivery. Further, clinical outcomes and the broader recovery based outcomes are both important indicators of a person’s wellbeing. Aftercare has implemented a suite of measures designed to yield a good a picture a person’s wellbeing. The philosophy for their introduction was that they be seen as a part of the recovery process rather than just more forms that ‘management’ wants filled out. Additionally, while it is common in mental health services to hear people say “it is the relationship that’s important when working with someone”, that relationship is never measured objectively. The tools Aftercare has implemented include: The CANSAS (needs), APQ6 (community engagement), RAS-DS (recovery and clinical outcomes), and the Working Alliance Inventory. Early analysis suggests that people have different ‘trajectories’ while being supported by Aftercare, that the working alliance is important to improvement in a person’s wellbeing, and that it can be used as a tool to improve the alliance.