Steve Kisely

• MD PhD DMedRes
• Professor at The University of Queensland

Objective The impact of COVID-19 on Australia’s National Bowel Cancer Screening Program remains unclear, especially for individuals with severe mental illness. These individuals have historically participated in the National Bowel Cancer Screening Program at significantly lower rates than the general population. This study aimed to understand the i...

Recent changes in US government priorities have serious negative implications for science that will compromise the integrity of mental health research, which focuses on vulnerable populations. Therefore, as editors of mental science journals and custodians of the academic record, we confirm with conviction our collective commitment to communicating...

Obesity is a major health problem among people with severe mental illness, linked to increased risk of chronic diseases and reduced life expectancy. This is attributable to a combination of factors, including lifestyle, social circumstances, medication side-effects and the illness itself. Second-generation antipsychotics are particularly associated...

Internationally, capacity building for mental health implementation and translation research has lagged. A review of literature found initiatives since 2008 indicating limited dedicated attention to growing capabilities of early-to-mid-career mental health researchers, and little reporting of tailored career pathways and skills growth. Significant...

Background The use of compulsory community treatment (CCT) in Australia is some of the highest worldwide despite limited evidence of effectiveness. Even within Australia, use varies widely across jurisdictions despite general similarities in legislation and health services. However, there is much less information on whether variation occurs within...

Background and Aims Child maltreatment (CM) is associated with several negative mental health outcomes in later life, including alcohol and substance use (AU and SU). Internalising (e.g. anxiety and depression) and externalising (e.g. delinquency and anti‐social behaviour) behaviours have also been associated with CM, and with AU and SU. This study...

AimsThere has been concern about violent acts and other criminal behaviour by people with a possible history of mental health problems. We therefore assessed the effects of community treatment orders (CTOs) on self-, third-party-, and agency-reported criminal behaviour when compared to voluntary treatment. MethodsA systematic search of PubMed/Medli...

Objective The Australian climate has warmed by 1.51°C since preindustrial times, and the Commonwealth Scientific and Industrial Research Organisation (CSIRO) predicts further warming with an increased risk of extreme heat events. This article discusses how the most recent Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) position...

Objective The Australian Institute of Health and Welfare publishes statistical indicator reports on the specialised mental health workforce. These include data for 2022–2023 on psychiatrists, mental health nurses, mental health occupational therapists, psychologists and mental health social workers. We provide a brief commentary on these reports, r...

AimsStudies show that people with severe mental illness (SMI) have a greater risk of dying from colorectal cancer (CRC). These studies mostly predate the introduction of national bowel cancer screening programmes (NBCSPs) and it is unknown if these have reduced disparity in CRC-related mortality for people with SMI. Methods We compared mortality ra...

Background Most evidence on associations between child maltreatment and subsequent common mental disorders (CMDs) comes from retrospective studies. Such findings may be affected by recall bias. Prospective studies of reports to statutory agencies are less common and may be subject to attrition bias. Aim To examine the associations of child maltrea...

Aims Most information about the association between childhood maltreatment (CM) and subsequent psychiatric morbidity is based on retrospective self-reports. Findings from longitudinal studies using prospective reports to statutory agencies may be subject to attrition. We therefore compared the prevalence to age 30 of inpatient psychiatric diagnoses...

Objective To compare rates of participation in the National Bowel Cancer Screening Program (NBCSP) and follow‐up for people with severe mental illness with those for people without severe mental illness or not prescribed antidepressants. Study design Retrospective cohort study; analysis of de‐identified linked NBCSP, Pharmaceutical Benefits Scheme...

The Royal Commission into Defence and Veteran Suicide recently published research analysis of the risk of suicide based on data from the Australian Defence Force (ADF). We aim to provide a brief summary of the salient findings, as well as a commentary from a clinical perspective for the psychiatric profession providing care for ADF serving members...

Background: Anxiety is widely prevalent, exhibiting higher rates among individuals with chronic health conditions, notably cardiovascular diseases such as atrial fibrillation (AF). Studies have shown interventions targeting anxiety can improve AF outcomes, while AF management can reduce anxiety levels. This study explores the association between AF...

Objective The Vastaamo psychotherapy data breach in Finland is perhaps the largest cybersecurity incident in mental healthcare to date, resulting in significant patient harm. There are specific lessons for mental healthcare providers from an analysis of the incident. Method Case study of this specific electronic health record data breach, based on...

Background Although clozapine is the most effective antipsychotic for people with treatment-resistant schizophrenia (TRS), only 40% of people with TRS respond, and there is limited evidence for augmentation agents. Cannabidiol (CBD) reduces positive symptoms in individuals with schizophrenia, but no trials have specifically examined its efficacy in...

Introduction People with severe mental illness (SMI) have a higher risk of suicide compared with the general population. However, variations in suicide methods between people with different SMIs have not been examined. The aim of this pre‐registered (PROSPERO CRD42022351748) systematic review was to pool the odds of people with SMI who die by suici...

Medium secure mental health units (MSUs) provide a specialised secure environment to assist people recovering from mental illness where less restrictive care has been unsuccessful or been unable to provide safety for the person or the community. Internationally, it has been found that these units can be associated with prolonged admissions, posing...

Objectives Psychosocially unsafe workplaces are related to burnout, especially amongst trainees and psychiatrists. Burgeoning research on psychosocial workplace safety indicates the importance of organisational governance to reduce adverse professional, and consequently patient, outcomes in healthcare by balancing job demands and resources. We prov...

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines on mood disorders recommend psychotherapy as foundational care for patients with acute depression with minimal discussion of any potential adverse effects. Randomised controlled trial evidence on psychotherapy adverse effects is limited. This is problematic b...

Objective Recent guidelines suggest that the overall quantity and duration of antidepressant prescriptions should be reduced. In this paper, we comment on the evidence both for and against this view. Methods We critically review the arguments proposed by proponents of antidepressant deprescribing in the context of the evidence-base for the treatme...

Objective In this perspective, we investigate how the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) position statement on psychotherapy takes the potential for adverse effects into account. Conclusions Psychotherapy has two critical outcomes – efficacy and adverse effects. Evidence-based psychotherapy is significantly more ef...

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of smoking cessation interventions on tobacco smoking in adults receiving inpatient psychiatry treatment. To assess whether the effects of smoking cessation interventions differ according to psychiatric diagnosis or type of intervention or c...

Objective Specialised mental healthcare delivery is highly labour intensive, and the COVID-19 pandemic has exacerbated workforce shortfalls. We explore the information on the mental healthcare labour supply in Australia from a health policy viewpoint. Our purpose is to stimulate discussion, further research and development of interventions. Conclu...

We discuss the ramifications of the Commonwealth of Australia Budget allocations for mental healthcare for 2024–2025. There is funding for population-based mental health initiatives for milder anxiety and depression but no direct funding of services for the most severe and disabling forms of mental illness, other than pre-existing state/territory d...

Objective The Medicare Benefit Schedule (MBS) telehealth items were expanded in March 2020 during the COVID-19 pandemic. We measured the use of MBS telepsychiatry items compared to consultant physician telehealth items within the context of these item changes, to understand differences in telepsychiatry and physician telehealth utilisation. Method...

Community treatment orders (CTOs) have been introduced in many jurisdictions with evidence of increasing use over time as well as a disproportionate use in marginalised populations. Rates of CTOs also vary widely, both internationally and within the same country, for reasons that are poorly understood. This is despite evidence for effectiveness bei...

Objective The RANZCP conducted an anonymous survey of 7200 members (trainees and psychiatrists) in December 2023, receiving 1269 responses, representing the views of roughly 1 in 6 members, and of the respondents, three quarters reported experiencing burnout in the last 3 years. We provide a commentary, citing evidence from relevant previous resear...

Child maltreatment (CM) is associated with negative health outcomes in adulthood, including deliberate self-harm (DSH), suicidal behaviours, and victimisation. It is unknown if associations extend to emergency department (ED) presentations for non-DSH related injuries. Birth cohort study data was linked to administrative health data, including ED p...

Objective: Emergency departments the world over have seen substantial increases in the number of individuals presenting for mental health reasons. However, we have a limited understanding of their experiences of care. The aim of this review was to systematically examine and synthesise literature relating to the experiences of individuals presentin...

Increasing numbers of healthcare data breaches highlight the need for structured organisational responses to protect patients, trainees and psychiatrists against identity theft and blackmail. Evidence-based guidance that is informed by the COVID-19 pandemic response includes: timely and reliable information tailored to users’ safety, encouragement...

Introduction: Clozapine is the gold standard treatment for treatment-resistant schizophrenia, however adverse events remain a clinical challenge. Areas covered: This review presents a narrative synthesis of systematic reviews and meta-analyses that have reported the onset, incidence, prevalence, and management of clozapine's adverse events. We c...

There has been recent discussion in Australia and New Zealand concerning the utility of Clinical Practice Guidelines (CPGs) and the role of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in their development. The College Board therefore established a Steering Group (SG) to oversee an exploration of options and produce recomm...

Aims Community treatment orders have been introduced in many jurisdictions with increasing use over time. We conducted a rapid umbrella review to synthesise the quantitative and qualitative evidence from systematic reviews and/or meta-analyses of their potential harms and benefits. Methods A systematic search of Medline, PubMed, Embase and PsycINF...

Background and aims Evidence on the associations between child maltreatment (CM), alcohol use disorders (AUDs) and other substance use disorders (SUDs) comes largely from retrospective studies. These rely on self-reported data, which may be impacted by recall bias. Using prospective CM reports to statutory agencies, we measured associations between...

To determine whether smoking prevalence in first‐episode psychosis (FEP) is different than in people with established psychosis in long‐term treatment. A systematic review of cross‐sectional, case–control and cohort studies identified from searches of PubMed, Embase, CINAHL and PsycINFO up to 12 August 2023. 20 studies out of 2773 screened titles w...

Aims To compare prospective reports of child maltreatment (CM) with emergency department (ED) presentations for deliberate self-harm (DSH) and suicidal ideation in individuals aged between 25 and 39 years old. Methods Linked records between the Mater-University of Queensland Study of Pregnancy birth cohort and Queensland administrative health data...

Objective Telepsychiatry items in the Australian Medicare Benefits Schedule (MBS) were expanded following the COVID-19 pandemic. However, their out-of-pocket costs have not been examined. We describe and compare patient out-of-pocket payments for face-to-face and telepsychiatry (videoconferencing and telephone) MBS items for outpatient psychiatric...

Introduction There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. Objective To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. Design We descriptively analysed population‐level d...

Background Research exploring the relationship between prenatal infection and child behavioural outcomes would benefit from further studies utilising full‐population samples with the scale to investigate specific infections and to employ robust designs. We tested the association among several common infections requiring inpatient admission during a...

Objective To update psychiatrists and trainees on the realised risks of electronic health record data breaches. Methods This is a selective narrative review and commentary regarding electronic health record data breaches. Results Recent events such as the Medibank and Australian Clinical Labs data breaches demonstrate the realised risks for elect...

In 2022, the Australian Federal Minister for Health and Aged Care commissioned the Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) to conduct a post-implementation review of MBS telehealth services, including settings of video and telephone consultations. The MRAC has made a series of administrative recommendations for telehealth...

Background Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices. Aims We determined r...

Electronic health records (EHRs) have been widely adopted in Australian public sector healthcare and will remain an ongoing, essential data system. However, recent substantial data breaches from hacked business data systems in Australian enterprises, as well as international healthcare providers, mean that EHR data breaches are increasingly likely...

Mental illness is firmly established as a risk factor for criminal legal system contact, particularly for women and Indigenous people. While patterns of criminal legal contact vary by gender and Indigenous status, we do not know how mental health contacts factor into these patterns. The aim of this research is to examine whether mental health chara...

We provide a brief update on the current evidence on electronic health records’ benefits, risks, and potential harms through a rapid narrative review. Many of the promised benefits of electronic health records have not yet been realised. Electronic health records are often not user-friendly. To enhance their potential, electronic health record plat...

The Australian Medicare Better Access initiative in mental health reached one in every 10 Australians in 2021 (more than 2.6 million people) with interventions targeted at mild-to-moderate anxiety and depression, provided by general practitioners, allied health professionals, and/or psychiatrists, at a cost of AUD1.2 billion. However, the overall m...

Background Severe mental illness (SMI) is associated with significant morbidity. Frailty combines biological ageing, comorbidity and psychosocial factors and can predict adverse health outcomes. Emerging evidence indicates that frailty is higher in individuals with SMI than in the general population, although studies have been limited by sample siz...

Project Synergy is a digital mental health tool for assessment, referral and follow-up of people with mental health problems. The Australian federal government Department of Health entered an AUD33 million formal funding arrangement with InnoWell, a proprietary company vehicle (primarily the consultancy firm PwC and University of Sydney) to continu...

Background People with schizophrenia die almost 20 years earlier than the general population, most commonly from avertable cardiometabolic disease. Existing pharmacological weight-loss agents including metformin have limited efficacy. Recently available glucagon-like peptide (GLP-1) receptor agonists such as semaglutide have shown promise for weigh...

Purpose of Review People with mental illness are vulnerable to periodontal diseases. Explanations include the direct effects of the psychiatric illness, side effects of psychotropic medication, lifestyle (e.g., alcohol, tobacco, and other substance use), shared risk factors, and difficulties with activities of daily living and access to dental care...

Objective: Contemporary medical education lacks a strong focus on health economics which guides major decisions in private and public health services. We briefly outline the rationale, guiding principles, main analytic methods, and a suggested framework for health economics education in psychiatry. Conclusions: Health economics aims to improve t...

Objective: We provide an update of the current challenges facing public and private psychiatric care sector in Australia, contextualised by international and national information on factors affecting health system performance. Conclusions: There are practical and sustainable repairs that may bridge the gaps between primary care, private psychiat...

Background Psychiatric illness is a well-established risk factor for criminal justice system involvement, but less is known about the relationships between specific psychiatric illnesses and reoffending. Research typically examines reoffending as a single discrete event. We examined the relationship between different psychiatric disorders and types...

This article highlights some of the concerns concerning the recent decision by Australia’s medicines regulatory authority to allow limited clinical use of MDMA and psilocybin. In the view of this author, the decision goes beyond the available scientific literature. Of particular concern, is the fact that the authority made the decision in the absen...

To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre-registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta-analyses of randomized controlled trial...

Objective: We examine deterioration in psychotherapies, as reported in the recent evaluation of the Australian Medicare Better Access initiative. Conclusion: A focus on patients who experience poor clinical outcomes helps programs minimise harm and improve quality of care. The Better Access evaluation found the mental health of 20-40% of patient...

Background: Community treatment order (CTO) use in Australia and New Zealand ranges from less than 40 per 100 000 population in Western Australia and Canterbury to over 100 per 100 000 in Victoria, South Australia and Waitemata. Recent publications on CTO use now permit a meta-regression to investigate whether differences in CTO use by jurisdictio...

Objective This study evaluated maintenance of improved delivery of smoking cessation assistance in adult acute psychiatry inpatient units 3 years post statewide implementation of a system change intervention through analysis of a statewide administrative health dataset. Method Rates of documenting smoking status and providing a brief smoking cessa...

Background: Although clozapine is the most efficacious medication for treatment-refractory schizophrenia, not all patients will have an adequate response. Optimising clozapine dose using therapeutic drug monitoring could therefore maximise response. Aims: Using individual patient data, we undertook a receiver operating characteristic (ROC) curve...

Background: Poor oral health is increasingly recognised as an important comorbidity in people with psychiatric illness. One risk factor is psychotropic-induced dry mouth. Aims: To perform a systematic review of the severity of dry mouth due to psychotropic drugs in adults (CRD42021239725). Study quality was assessed using the Cochrane risk of bi...

Objective: The incidence and mortality rates of breast cancer in individuals with pre-existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following di...

Background: Child maltreatment is a major public health issue worldwide. Retrospective studies show a strong association between self-reported child maltreatment and poor mental and physical health problems. Prospective studies that use reports to statutory agencies are less common, and comparisons of self- and agency-reported abuse in the same co...

Autism is a lifelong condition for which intervention must occur as early as possible to improve social functioning. Thus, there is great interest in improving our ability to diagnose autism as early as possible. We take a novel approach to this challenge by combining machine learning with maternal and infant health administrative data to construct...

Background: Mental health services are encouraged to use language consistent with principles of recovery-oriented practice. This study presents a novel approach for identifying whether clinical documentation contains recovery-oriented rehabilitation language, and evaluates an intervention to improve the language used within a community-based rehab...