Unusual experiences such as heightened perception, increased importance of ideas and feeling that previously unimportant events now have personal significance, are reported by people who experience a psychotic episode. ‘Aberrant salience’ theory (Kapur, 2003) attempts to explain how the neurobiological processes observed in psychosis, especially poor regulation of neurotransmitters, lead to experiences like these that are reported by consumers, however measurement of aberrant salience is not well developed. To address this need, we have altered an existing trait measure of salience (the Aberrant Salience Inventory; Cicero et al, 2010) to focus on measuring the current state of aberrant salience experienced by consumers during an acute phase of psychosis. This paper is the first report of our research program developing and evaluating the ASICS (Aberrant Salience Inventory – Clinical State). We report the performance of the ASICS in a large non-clinical population (n=414) and in acute in-patients with psychotic symptoms (n=41), examining the relationship of aberrant salience with symptom dimensions. The potential of this approach for measuring clinical recovery in psychosis and tracking the effect of changes in neurotransmitter dysregulation on consumer experiences will be discussed.

This presentation shares one woman’s lived experience of beginning Clozapine treatment in the community. Her story is told alongside that of her mental health team, who endeavoured to support her choice in the absence of policy and protocol to guide community implementation of Clozapine treatment.

Clozapine is often commenced while people are in hospital, but services vary widely on policy with only some having provision to commence treatment in the community. The service in question only initiates Clozapine while the person is in hospital due to potential risks. Other services have capacity for community commencement but it is often under utilised particularly with homeless and itinerant clients. As Clozapine is considered a best practice treatment option, homeless clients are further disadvantaged when services lack policy or impetus to access this choice.

Balancing risk can inadvertently create barriers to creative, recovery-based practise when supporting those who experience severe and persistent mental illness. This talk will speak to one such barrier – a lack of policy to begin Clozapine treatment whilst a person lived in the community – and how the mental health team responded to this barrier, keeping at the centre, the consumer’s choice to not be transferred to inpatient care.

In most parts of Victoria, outreach mental health teams can respond to people experiencing a mental health crisis, although often due to the level of risk associated with the crisis or when mental health teams are unavailable, police will respond. Without specialist mental health training, many police will then transport the person in crisis to hospital to access care instead of the person receiving timely and specialist care in the community. To strengthen the provision of a mobile, multidisciplinary response, Alfred Psychiatry, Victoria Police and Bayside Medicare Local jointly established the Alfred Police and Clinical Early Response (A-PACER). A-PACER delivered a daily (2-10pm) joint police and mental health clinician secondary response unit that primary police officers, Alfred Psychiatry clinicians and 000/dispatch could request to respond to situations involving people experiencing a mental health crisis. This presentation will explore how A-PACER has operated, how partner services contributed to the success of the collaborative response, and achieved outcomes. Introduction of A-PACER resulted in a reduction in statutory transportations by police to The Alfred Hospital, achieved in part through an improved capacity for A-PACER clinicians to divert people to primary care, addiction and welfare services to address the cause of the crisis.

Access to mental health services is essential to ensuring that consumers receive the right care at the right time. One way of achieving this has been the location of Mental Health Clinical Nurse Consultants (CNC’s) in the Emergency Department. However, consumers have concerns about the triage process, the long waits in emergency departments and the management of care. As part of a larger project, a bespoke database was created to capture information about the consumer’s experience of mental health care in the Wollongong Hospital Emergency Department (ED). To date, information on 1033 consumer’s has been collected, over 45% of consumers arrive by ambulance with less than 10% having contact with the 1800 mental health emergency telephone line prior to presentation. Over 65% were triaged to be seen within 30 minutes of arrival and almost 60% were returned home following assessment. While the length of stay in ED has been reported to average 5 hrs and 35 minutes, the current data indicates that the mental health CNC’s were involved with the consumer on average for two hours. The paper will outline those factors that impact on the consumer’s length of stay in the ED including their legal status, the number of concomitant consumers seeking access to mental health services and the need for psychiatric registrar involvement. The paper will conclude with suggests on how the consumers journey can be improved.