Model Mental Health Care
The way a doctor delivers the devastating news of a diagnosis of terminal cancer can have a profound impact on how a patient approaches the rest of their life. The doctor-patient relationship is pivotal in providing quality health care, and is a dynamic that Professor Brian Kelly has long considered, particularly when a patient is diagnosed with a terminal illness.
"I have always been very interested in oncology and the area of palliative care, which has enormous psychological and psychosocial components to it."
Kelly, the newly appointed Professor of Psychiatry in the School of Medicine and Public Health, has undertaken extensive research on the mental health needs of people with physical illnesses, especially cancer.
A compelling part of his research has been an investigation into the clinical aspects of terminal cancer patients’ wish to hasten death. Acclaimed by leading journal Psychosomatics as being among the best research published in recent years, his work explored doctor-patient interaction and relationships, and their association with terminal illness.
"One of the interesting findings from my study was that the doctors who indicated they had less training in the psychological aspects of medicine and counselling reported a significantly higher number of terminally ill patients wishing to hasten death," Kelly said. The study raised a number of questions about why this would be the case, including whether a doctor’s support for a patient’s wish to hasten death was a personal or medical response. The study also questioned the effect of a patient’s emotional distress on doctors, especially if the doctor felt unable to respond effectively.
"The study indicates models of supervision and support for clinical staff, improving recognition and treatment of psychiatric and psychological illness in cancer patients, and building communication skills in caring for distressed terminally ill patients and their families as critical areas for the direction of clinical research and care. Of equal importance is the need for equity of services for people with mental health problems.
"There is no doubt that the biggest barrier is trying to have mental health problems viewed as an illness that needs very effective treatments. It’s a matter of getting treatment to people, having the right care providers involved and the right models of care and service."
In his previous role as Director of the University’s Centre for Rural and Remote Mental Health, Kelly played an integral part in developing and implementing new models of mental health services for farmers and people in isolated rural areas. Major initiatives included the development of a state-wide policy for rural emergency mental health care.
Kelly said it had been extremely rewarding for an academic health facility to work with groups like the NSW Farmers Association, and a range of welfare, community and service organisations, to address mental health needs in rural areas.
For example, the Centre coordinated the NSW State-Wide Drought Mental Health Assistance Package, working with more than 20 farming and community organisations and thousands of individuals across 60 towns. In its first year it delivered 50 ‘Mental Health First Aid’ workshops and organised a significant number of meetings aimed to improve community understanding of mental health issues and encouraging distressed people to seek professional help.
Kelly said the success of the program resulted in it being extended in 2009 to cover climate change. "Part of the Centre’s new role was to research what impact climate change was having on rural communities and to lead effective programs that can assist communities in dealing with the consequences in the more immediate term."
Recently appointed co-director of the mental health group of the Australian Government’s National Climate Change Adaptation Research Facility, Kelly will use his broad experience to shape a national response to the psychological impact of climate change. He will also work closely with staff at the Hunter New England Area Health Service in a psychiatry consultation and liaison role at John Hunter Hospital – NSW’s largest hospital outside of Sydney.
While no longer in the Director’s chair, Kelly will maintain close links to the Centre for Rural and Remote Mental Health. In his new role, Kelly will not only direct the University’s psychiatry discipline and teach medical students, but continue to oversee and build on the research strengths of the Centre.
"A major focus will still be on aspects of rural mental health and retaining my research and other links there," Kelly said. "I hope to continue working in a clinical and research capacity with cancer patients or those receiving palliative care, particularly in rural areas, to ensure access to the most relevant and effective mental health services they need."
Professor Kelly works in the University’s Priority Research Centre for Brain and Mental Health Research, and in collaboration with the Hunter Medical Research Institute’s (HMRI) Brain and Mental Health Research Program.
Find out more about the University's Priority Research Centre for Brain and Mental Health Research and HMRI