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National Updates 5 March 2010

Hospital debate turns into tax battle
Publication: aap Australian General News (Fri 5 Mar 2010 2:33:42 AM)
The battle lines are drawn over the future of our hospitals .. with the government saying Canberra has to shoulder a bigger burden of the cost .. and the opposition saying this'll lead to higher taxes. And .. state premiers are totally unenthusiastic about Canberra's plan to requisition tens of billions of dollars from their GST allocations. But prime minister KEVIN RUDD says the hospitals overhaul is unavoidable .. and really means the states will gain 15 billion dollars. Meanwhile .. Health Minister NICOLA ROXON's admission the reforms may be followed by higher taxes .. has had opposition treasury spokesman JOE HOCKEY proclaim the Rudd government has a secret agenda to increase taxes.

Doubts cast on hospital overhaul
Author: By MARK METHERELL and KATHARINE MURPHY With NICK MILLER
Publication: The Age, Page 1 (Fri 5 Mar 2010)
Rudd plan ‘too complex’ A SENIOR health bureaucrat has cast doubt on the ability of Kevin Rudd to deliver his hospitals plan, saying it would be "extraordinarily difficult" to implement key proposals. The warning came as federal Health Minister Nicola Roxon said she could not rule out future tax increases to fund the sweeping health funding overhaul, which is still facing resistance from several states, including Victoria.
As Ms Roxon and the Prime Minister stepped out to promote their plan, Stephen Duckett, a former federal Health Department head, said the government might have under-estimated the difficulty of rolling out two key elements: national price-setting for hospital services and local hospital networks. Dr Duckett, a member of the National Health and Hospitals Reform Commission, welcomed the Rudd plan as a good response to the proposals of the commission, which spent 16 months canvassing ideas from across the country. But he warned of problems ahead, and said the roof insulation fiasco had shown the federal government was "not strong on implementation" of services on the ground.
He specifically questioned the plan for a national "case-mix" system to set standardised prices for hospital services. "It will be extraordinarily difficult to implement the case-mix system on a national scale," said Dr Duckett, who was responsible for introduction of the system in Victoria in the early 1990s.

Differences among the states in the cost of procedures and even in superannuation would generate significant barriers to calculating a standardised pricing formula. The challenge of adjusting funding to the states to allow for differences in costs for Aboriginal and rural services would also be complex. "The Commonwealth has not demonstrated it has the skill to do it". Dr Duckett, who now heads Alberta Health Services in Canada, also expressed doubts about the proposal to appoint local clinicians and community leaders to the boards of new "local hospital networks". He said it appeared Mr Rudd might have underestimated the tendency for local boards to pursue local interests at the expense of the overall capacity to fund projects. The provision of 150 to 180 local hospital networks would create a big demand for executive expertise not readily available in many centres.
Mr Rudd's promise to provide 60 per cent of hospital funding also risked generating a rise in unnecessary hospital procedures. The fixed cost of running a public hospital accounted for about 50 per cent, with the other half generated by surgery and treatment costs for individuals. "That will be an incentive to increase activity," he said. The government cites findings by the Health Reform Commission that the new approach to pricing of hospital services would produce savings of $300 million to $1.5 billion a year.
Dr Christine Bennett, who chaired the commission, gave a more positive response to the Rudd plan than Dr Duckett, saying she and fellow commissioners were pleased with how closely the government's plan mirrored their recommendations. "There are some differences - some of it is half a step forward and some is half a step sideways - but it is definitely all there," she said. The move to Canberra paying 60 per cent of every public patient admission took her by surprise - the commission had recommended starting at 40 per cent and gradually increasing over time. But Dr Bennett called for doctors, nurses and other health workers to support the plan, which she said was a "good first step" towards a better health system. Ms Roxon, when asked who would take ultimate responsibility if a local hospital network went wrong, said: "The Commonwealth will be accountable for funding the system properly, local hospital networks will be responsible for managing its day-to-day performance." She also would not rule out higher taxes to pay for the plan. "It certainly means there may be (tax increases), we have to be able to fund the delivery of services into the future," she said.
Mr Rudd yesterday began his sell on the plan in his home state of Queensland, where he called on premiers to back the reforms. "Our approach is to try and get right-thinking state and territory governments behind this because I think the public of Australia are fed up, sick and tired with the blame game, all the criticism, all the complaints, everyone looking for someone else to blame," Mr Rudd said. "I believe the overwhelming mood of the nation is to get on with the business of reform." But some premiers remain to be convinced. Victoria's John Brumby said the Commonwealth should look at a 50/50 funding model, which would deliver an additional $1 billion for the state. WA's Colin Barnett warned that stripping state health departments of their management role and installing local boards in their place "could end up an absolute fiasco". The NSW Government said it needed to examine the details before lending its support.

Boards and pricing pose challenges to hospital reforms
Author: Mark Metherell HEALTH CORRESPONDENT
Publication: Sydney Morning Herald, Page 7 (Fri 5 Mar 2010)
RADICAL SURGERY
THE government appears to have underestimated the difficulties it faces in rolling out its hospital reforms, a top health bureaucrat, Stephen Duckett, says. Dr Duckett, a member of the National Health and Hospitals Reform Commission, welcomed the response to the commission's report. But he was cautious about national price-setting for hospital services and local hospital network boards. As the insulation fiasco had shown, the federal government was "not strong on implementation" of services, said Dr Duckett, a former secretary of the federal Health Department. The proposal for a "casemix" system to set prices that state and federal governments would pay hospitals would be complicated. "It will be extraordinarily difficult to implement the casemix system on a national scale," said Dr Duckett, who was responsible for introducing the system in Victoria in the 1990s.
Differences among the states in the cost of procedures and even in superannuation would generate barriers to calculating standardised pricing. Adjusting funding to the states to allow for differences in costs for Aboriginal and rural services would be complex. "The Commonwealth has not demonstrated it has the skill to do it". Dr Duckett, who now heads Alberta Health Services in Canada, expressed doubt about the proposal to appoint local clinicians and community leaders to the boards of new "local hospital networks".

He said it appeared the Prime Minister may have underestimated the tendency for boards to pursue local interests at the expense of overall capacity to fund projects. Establishing 150 to 180 hospital networks would create demand for executive expertise not readily available in many centres. Mr Rudd's promise to provide 60 per cent of hospital funding could result in more unnecessary hospital procedures. The fixed cost of running a public hospital accounted for about 50 per cent of its expenditure. The other half was generated by surgery and treatment costs for individual patients. "That will be an incentive to increase activity. It relaxes rationing of hospital services, which might reduce waiting times but may increase marginally necessary procedures." A government source said the government would not cap local hospital network spending. The government cites findings by its health reform commission that the new approach to pricing would bring savings of $300 million to $1.5 billion a year. The Health Minister, Nicola Roxon, when asked who would take responsibility if a hospital network went wrong, said: "The Commonwealth will be accountable for funding the system properly, local hospital networks will be responsible for managing its day-to-day performance. "

Tax rises will fund health changes But reforms in trouble
Author: Phillip Coorey CHIEF POLITICAL CORRESPONDENT
Publication: Sydney Morning Herald, Page 1 (Fri 5 Mar 2010)
THE federal government has flagged tax increases to fund the growing gap between revenue and health costs as part of Kevin Rudd's plan to reform the public health system.
The admission came yesterday as the legislation necessary to implement the Prime Minister's reforms appeared in trouble before it was even introduced. The independent Senator Steve Fielding told the Herald he would oppose it. If the Coalition did the same, as it has been suggesting, the legislation would fail. The Prime Minister and his senior ministers mounted a publicity blitz to sell the health reform plan which would see the Commonwealth become the majority funder of public hospitals and the sole funder of GPs and outpatients services. Mr Rudd's key message was that any premier or senator who opposed the push was effectively telling the Australian people their current health system was good enough. "The people of Australia are tired of the current system. They want improvement. No one believes the current system is meeting the demands at present," he said. "If you out there are happy with the current state of your hospitals and you don't think they should be improved, well, I think, you'd be in the minority." The federal Health Minister, Nicola Roxon, agreed tax increases may be necessary to meet what would be "a significant extra burden on Commonwealth expenditure" over the latter half of this decade. "Of course, we will need to make announcements to indicate how that will be funded into that forward period," she said. Asked if there may be tax increases, she said: "Well, it certainly means that there may be. We have to be able to fund the delivery of services into the future." Mr Rudd said any new tax or increased tax to pay for health would be offset by reductions in other taxes.
"This government will continue to adhere to its commitment that we will not increase taxes as a proportion of gross domestic product, consistent with our pre-election commitment," he said. The shadow treasurer, Joe Hockey, said the government was softening the ground for tax changes to be announced when the Henry tax review was released. As well as the Senate, the states have to be convinced to adopt the takeover plan because it will be funded, in part, by the states agreeing to surrender 30 per cent of their GST revenue. The revenue will be given directly by the Commonwealth to a new local hospital network which would run hospitals at a local level under strict national performance requirements designed to improve care and reduce waiting times.
The states must give an answer at an April 11 Council of Australian Governments meeting or face a referendum. South Australia and Queensland have agreed to the proposal and NSW is favourable. The Western Australian Liberal Premier, Colin Barnett, and Victoria's John Brumby, remain hostile.
To encourage the states, the Commonwealth will reduce their share of health funding from 60 per cent to 40 per cent and free them from having to pay for the ever-growing gap between health costs and revenue. In the five years from 2014-15, that blowout between costs and revenue is estimated to reach $15.6 billion. Mr Rudd said if the states did not sign up, they, not the Commonwealth would have to find this money. The cost to NSW alone would be $4.9 billion, including $1.6 billion in 2019-20. He repeated his referendum threat but constitutional experts predicted it would fail without bipartisan support. Professor George Williams, from the University of NSW, said the twin hurdles of the states and the Senate showed it was too difficult in Australia to achieve reform.
"It should not be as difficult as this to bring about reform," he said. "The barriers are too high. "The problem is not a lack of policy but a federal system blocking the way."

Is your hospital on PM's hit-list?
Author: Simon Benson Chief Political Reporter
Publication: The Daily Telegraph, Page 7 (Fri 5 Mar 2010)
THIS is the list of 117 NSW hospitals senior health clinicians claim will struggle to survive under Kevin Rudd's health reforms. They include services in remote areas of NSW, regional centres, as well as inner-city hospitals in Balmain, Rozelle and Auburn.
All are currently block-funded and considered financially unviable under the Federal Government's plans for a pay-for-service model. They don't perform enough medical procedures to fund their own existence. As a war of words erupted yesterday between Mr Rudd and the states over the funding of small community hospitals, NSW Health Minister Carmel Tebbutt, who supported the plan in principle, suggested an agreement on funding must be reached before the Keneally Government would sign on. Mr Rudd's radical health reform includes a proposal for Canberra to take over 60 per cent of the cost of funding public hospitals by taking a third of the states' GST revenue and reallocating it under an activity-based model. It currently funds between 35 per cent and 40 per cent. ``The NSW Government does not support the closure of rural and regional hospitals, which provide essential healthcare services and are heavily relied on by local communities,'' Ms Tebbutt said.
``Any moves by the Commonwealth to fund hospitals based on their activity must take into account these circumstances.'' Mr Rudd, who has threatened to take the issue to a referendum if the states do not agree, was adamant there was nothing in his reform package that would force any hospital closures. ``We're going to have opposition from health bureaucrats, state health bureaucrats, state politicians across the country,'' he said.
``My appeal out there to right-minded, right-thinking premiers, state health ministers, state politicians and state health bureaucrats and others, is let's get on with the business of fixing this system.'' Federal Health Minister Nicola Roxon would also not rule out tax increases to pay for the reforms, while Deputy Prime Minister Julia Gillard said there was nothing in the reforms about closing hospitals. NSW Health officials, including some of the country's leading surgeons, claimed more than 100 NSW hospitals were at risk of becoming financially unviable under what is known as a casemix -- or activity-based -- funding.
Professor Bob Farnsworth, chair of the Sydney Illawarra Area Health Service's health advisory council, said Mr Rudd's reforms were ``appalling'' and ``potentially a disaster'' for NSW. ``It is taking healthcare in NSW back 20 years,'' he said.
Under threat
* District hospitals:
Ballina, Batemans Bay, Bulli, Casino and District Memorial, Cessnock, Cooma, Cowra, Deniliquin, Forbes, Gunnedah, Inverell, Kempsey, Kurri Kurri, Lithgow Health Service, Macksville, Maclean, Milton and Ulladulla, Moree, Moruya, Mudgee, Murwillumbah, Muswellbrook, Narrabri, Parkes, Queanbeyan, Singleton, Bellinger River, Byron Bay, Glen Innes, Gloucester Soldiers' Memorial, Narrandera, Pambula, Quirindi, Scott Memorial (Scone), Springwood, Temora, Cootamundra, Tumut, Wauchope, Yass
* Community acute surgery:
Young
* Community acute non-surgery:
Bonalbo, Bulahdelah, Campbell Hospital (Coraki), Cobar, Condobolin, Coonabarabran, Finley, Gulgong, Holbrook, Mullumbimby War Memorial, Murrumburrah-Harden, Nelson Bay and District Polyclinic, Portland, Prince Albert Memorial (Tenterfield), Walgett, Wee Waa, Wellington (Bindawalla), Wyalong
* Community non-acute:
Balranald, Barham and Koondrook Soldiers' Memorial, Batlow, Berrigan War Memorial, Bingara, Bombala, Boorowa, Canowindra Soldiers' Memorial, Coonamble, Crookwell, Cudal War Memorial, Dunedoo War Memorial, Dungog, Eugowra Memorial, Gundagai, Guyra, Hay, Hillston, Lockhart, Long Jetty, Manilla, Merriwa, Molong, Narromine, Nyngan, Peak Hill, Tingha, Tocumwal, Tottenham, Tullamore, Walcha, Warialda, Wentworth, Werris Creek, Wilson Memorial, Murrurundi, Woy Woy
* Psychiatric hospitals:
Bloomfield, Coral Tree Family Centre, Cumberland, James Fletcher, Kenmore, Macquarie, Morisset, Rozelle, Thomas Walker
* Nursing homes:
Bourke, Braidwood, Jerilderie
* Multi-purpose hospitals:
Balmain, Braeside, Coledale, David Berry, Greenwich Home of Peace
* Sub-acute:
Mercy Care Centre Albury, Mercy Care Centre Young, Port Kembla, Sacred Heart Hospice, St Joseph's (Auburn)

Access to care set by region: inquiry --- RUDD'S HEALTH TAKEOVER
Author: DAVID UREN
Publication: The Australian, Page 4 (Fri 5 Mar 2010)
THE Rudd government's proposed hospital reform risks ``balkanising'' health services, with people's access to care determined by where they live, according to the government's own inquiry into hospitals. The reform plan unveiled by Kevin Rudd on Wednesday repudiated the findings of the National Health and Hospitals Reform Commission, set up by the government two months after its election to work out how to implement its promise to tackle inefficiencies in health services caused by bickering between the commonwealth and the states. The commission, headed by the chief medical officer of private health fund BUPA, Christine Bennett, considered the idea of Local Hospital Networks in its interim report, but concluded in its final report, delivered last June, that they would add bureaucracy and risk. ``Regional health authorities would be an additional layer, adding to cost and bureaucracy, all requiring governance and management infrastructure,'' it said. ``There would be considerable risk in moving quickly to make the commonwealth government the single funder of health services, given (its) lack of experience and capacity in planning and purchasing across the care continuum.
``Experience in other countries has shown that it is difficult to set fair budgets that reflect the health needs of the population, which leads to dissatisfaction and contested decisions.
``There are dangers of `balkanising' health services, with people's access to care determined by the region they live in.'' The report recommended an overhaul of Medicare, to be known as Medicare Select, which would fund individual healthcare regardless of whether it was in the public or private sector.
Federal Health Minister Nicola Roxon said yesterday that the government's decision to go with Local Hospital Networks reflected the feedback it received during consultation after the NHHRC report. ``One of the clearest messages we got from the 103 consultations we did was that local clinicians wanted to have more say in the running of their hospitals and Local Hospital Networks do precisely that,'' she said. Melbourne Institute health specialist Tony Scott said the NHHRC's conclusions were wrong. He said England had achieved reductions in both health costs and waiting times using Local Health Networks.

There are two problems with this government: Kevin and Rudd
Publication: The Australian, Page 15 (Fri 5 Mar 2010)
Alan Jones interviews his preferred prime minister
Julia Gillard goes on 2GB to talk health reform yesterday:
ALAN Jones: We've got the wrong person running the country. I will say to my listeners this is a woman who has nothing to do with health care and she is the Minister for Education and Industrial Relations, and she'd most probably run rings around anyone in government arguing the case today. The Prime Minister telling us all the government's shortcomings, all their failures, all their mistakes, all their bungles. Surely in everything that we've seen, the government has only two problems, Julia; one is Kevin and the other is Rudd. What is the message that Mr Rudd is sending? Vote for me even though I'm a failure, vote for me even though I fibbed about all the things I said I'd do before the election, vote for me because governing is hard, it's really much harder than I said it was and I'm sorry about health care but we found it just too complex, and then two days later he says trust me, here's the big health reform package and I'm on top of the detail. It's stretching the credibility for people to believe all that.
Gillard: Well Alan, I suspect I'm not going to dissuade you, but you know what, I think Kevin Rudd is saying to the nation: I get it, I get it that from time to time I and my government haven't met all of your expectations.
Meanwhile, the real health minister, Nicola Roxon, struggles with host Neil Mitchell on 3AW yesterday:
THERE'LL be new maximum waiting times for surgery . . . what will they be?
Roxon: We made clear that we've got more announcements to come. And the Prime Minister has flagged that having national access times will be part of that.
Mitchell: He won't say what they are.
Roxon: Not today, no.
Mitchell: When will he say?
Roxon: Well, soon.
Mitchell: We're playing politics with it, minister, aren't we? We've got people sitting out there waiting to get into hospital and you won't tell them because of some political game plan.
Roxon: This isn't a political game plan.
Mitchell: So why not tell us now?
Roxon: That's not something that I am publicly announcing today.
Mitchell: Do you know what the targets will be?
Roxon: We've done a lot of work internally about this . . .
Mitchell: But this is cruel. You know what the new maximum waiting times will be but you won't tell us because you want to put it out on the drip feed.
Roxon: No . . .
Mitchell: Do you know what they are?
Roxon: I know a lot of things about the health system . . .
Mitchell: Oh minister, minister, minister! This is cruel to people!

New tax fear on shake-up Health revolution will come at a price
Author: Ben Packham and Stephen McMahon
Publication: Herald Sun, Page 10 (Fri 5 Mar 2010)
NEW taxes could be on the cards to pay for Kevin Rudd's overhaul of financing of the nation's hospitals. And Victorians could end up footing the bill to fix the basket-case health systems in NSW and Queensland. Premier John Brumby has indicated there will be a showdown at next month's Council of Australian Governments meeting, when the states will be asked to sign the deal. Mr Brumby rejected the Prime Minister's 60 per cent hospital funding offer, saying the split should be 50:50, up from the Commonwealth's current share of about 40 per cent. ``The single fundamental test for us is what is in the interest of patients in Victoria,'' he said. ``That is the only test that matters.'' The Federal Government wants to claw back 33 per cent of GST payments to the states to help pay for the plan. But Health Minister Nicola Roxon said new taxes would have to be considered to put more money into the system. ``It certainly means there may be (new taxes),'' she said. ``We have to be able to (pay for) the delivery of services into the future.'' Shadow treasurer Joe Hockey responded: ``What is clear is that this government has a secret agenda on tax. ``It means higher taxes and more taxes to pay for Kevin Rudd's reckless spending program.'' But the Prime Minister said the overall tax burden would not rise.
``This Government will continue to adhere to its commitment that we will not increase taxes as a proportion of gross domestic product,'' he said. The PM said on Wednesday that no state would be worse off in the short term, and all would be better off in the medium term. But if Victorian taxpayers paid more into federal coffers, there are no guarantees the money would not be spent on ailing hospitals in other states.
The Federal Government is also yet to confirm whether Victoria will get back its full share of the 30 per cent of GST siphoned from the states under the deal.

Mr Rudd said it was time for the states to put aside petty bickering and focus on delivering better health care. ``There's going to be a lot of argument in the weeks ahead. I accept that. But this is an argument we will not shrink from,'' the Prime Minister said.
Former prime minister Malcolm Fraser said the role of the states was diminishing as Canberra looked to seize control on several fronts, not just health.
``There is a Canberra attitude which often thinks it's more important than the rest of Australia put together,'' he said. ``One of the best safeguards of a real democracy is the true division of power.''

DR RUDD'S HEALTH PLAN: WHAT IT MEANS FOR US
PROS:

• The Federal Government will fund 60 per cent of hospital costs, boosting the state's overall pool of health funds after four years
• The Federal Government will fund 60 per cent of hospital capital costs. These are currently met by the states
• The Federal Government will fund 100 per cent of out-of-hospital care, picking up the tab for some areas of care provided by the state
• Victoria's hospitals, which are considered the nation's most efficient, will receive the same amount per procedure as those in other states, but should be able to perform operations cheaper

CONS:

• Victoria will surrender control of its hospital system to federal and local masters. Management of the system could get worse
• Victoria will lose 33 per cent of its GST revenue with no guarantee it will get the money back in full via federal payments to local hospital networks
• Victorian taxpayers could end up subsidising ailing hospitals in other states while reforms are put in place
• There is no new money for the state's health system for four years

Meanwhile, mental health stays on the waiting list…

March 3, 2010 – 5:55 pm, by Croakey (online) Sebastian Rosenberg, Director, ConNetica Consulting, and Senior Lecturer, Brain and Mind Research Institute at the Sydney Medical School, writes: “The Federal Government’s willingness to address the issue of health care is laudable as is their recognition that fundamental reform is required. However, the report launched today by Prime Minister Rudd raises several issues for me:

1. There is no model of care described. What is it exactly we want to see for our patients in the 21st century? What does the evidence indicate is best practice and how do we go about arranging our services against this evidence? In fact, the report really aims to shore up a hospital system well-suited to a 19th century model of hospital-centric care. This is not reform.
2. This paper is all about inputs (GST revenue etc) and outputs (activity funded). It is about increasing the efficiency of the process of allocating costs and operating hospitals. There is almost nothing about outcomes. There is considerable commitment to standards, but the focus here is on waiting times etc. The paper concentrates on managing hospital system expenditure going forward and this is important. But the lack of discussion about outcomes (return to work, return to school etc) is disappointing.
3. Does the paper deliver any more funding to the health system or just change who is paying? This is not clear.
4. The process of monitoring and reporting is not yet clear but there is no commitment to ensuring this process is independent. It could still be governments reporting on themselves. What guarantee does the community have of independence and transparency? The Safety and Quality Commission was established by governments, without statutory independence. Every state and territory is a member of the Commission, as is the Department of Health and Ageing through Jane Halton.
5. Casemix costing is a black art. There are real limitations around casemix technology as the basis for setting prices for services, even for inpatients where the technology is most robust. For outpatients it is worse. Where price adjustments need to be made to reflect casemix or geography, how will this be done? Will each new local network lobby their case to the independent umpire, as the states do now to the Grants Commission? Or will lobbying be done by the states on behalf of all the networks in their jurisdiction? How will the umpire understand the nuances of each network and set a fair price accordingly?
6. The days of the general hospital are over. Casemix funding has been demonstrated to encourage service specialisation and this will in turn have an impact on patient access. The paper indicates that the states are set to retain control of patient transportation assistance schemes – this needs very careful monitoring as people’s access to care locally changes. Efficient pricing cannot be allowed to create disincentives for service providers to treat complex cases.
7. According to the table on page 65, workforce planning is undertaken by the states, not by the networks or the Commonwealth. Is this appropriate?
8. The lines of communication between a new hospital network and primary care providers is unclear. What will drive these two arms of health care to work together more effectively? This will require more than both being paid by the same funder. Who will set the service standards and monitor the performance of the primary care system?
9. There is nothing about mental health in this report. The list of ‘key’ NHHRC recommendations on page 24 of the paper does not mention any of the 12 mental health recommendations made by the Reform Commission. Mental health is only mentioned three times in the whole document, and then only to indicate that it may or may not be in scope for transfer from the states to the Commonwealth (page 41).
10. In other places, Italy, NZ, elsewhere, acute beds have become minor parts of a mental health system geared more towards care at home or in the community. As stated earlier, this report aims to shore up a hospital system that people with mental illness (and other chronic illnesses) should not be required to use. There is still a need to shift the focus of care and funding towards early intervention/prevention of illness.

Tax rise on cards to fund federal hospital takeover
Publication: The Canberra Times, Page 4 (Fri 5 Mar 2010)
''It's very easy to go out there and carp and complain and criticise. I believe the system's at a tipping point and we need to reform it for the future, fund it properly for the future.''The plan had exceeded the expectations of Dr Haikerwal, who served on the Government-appointed National Health and Hospital Reform Commission.
''We thought it would be a toe in the water,'' Dr Haikerwal said.''Obviously there's consternation around it because the politics hasn't been sorted out but the big message is that to make reform happen you've got to make quite a big set of changes, not just one change.'' He was also disappointed that the state of hospitals still dominated the debate about health reform.
''You can't improve what seems to be the big sore, which is the hospitals, without actually improving and supporting other parts of the agenda as in aged care, primary care, rehabilitation services, mental health [and e-health],'' he said.''The main things are that hospitals are still seen as being the big area of need and I certainly understand that. But the majority of services to people for their health care actually take place outside of hospital.
The support of the non-hospital sector is something that really needs to be much clearer other than saying, 'We're going to take it over'.''[That] doesn't bring very much comfort bearing in mind that Medicare, that provides a lot of the funding for the primary care sector, is so underfunded and actually does not reflect the true cost of the services that are being required.''

HEALTH REVOLUTION
Author: By JULIA MEDEW HEALTH REPORTER
Publication: The Age, Page 7 (Fri 5 Mar 2010)
Fears for primary healthcare
PRIMARY healthcare providers are mostly optimistic about a federal takeover of funding, but some fear they will be swallowed up by bigger, GP-centric models of care.
Victorian Healthcare Association chief executive Trevor Carr said the Rudd government's proposal to wholly fund primary healthcare and push for more integrated services could disadvantage well-established providers, including Victoria's 132 community health centres. Mr Carr said he was worried an overhaul would overlook social health services, such as housing and employment assistance, which are currently delivered by community health centres alongside medical, dental and other allied healthcare for the state's most needy.

"There's a whole range of different mainstream primary care providers such as occupational therapists, physios, dietitians, dentists, GPs and pharmacists. They seem to be the main things Rudd is talking about, but our concern is that the social health and welfare services that are part of primary care as well don't seem to be captured at this stage," he said. Peter Ruzyla, chief executive of EACH social and community health in Ringwood, said although he hoped the changes would lead to more funding for community health centres, he feared they could be undermined or dragged into other models of care such as GP super-clinics. "I'm worried about the perception that a medically focused GP model will solve the problem," he said. Mr Ruzyla hoped Canberra's proposal to increase its funding share for hospitals might prompt the Victorian Government to move more services out of hospitals and boost community health centres.
"[This process] could create a very strong network of services for the community at large," he said.
Professor Mark Harris, executive director of the Centre for Primary Healthcare and Equity at the University of NSW, said many primary healthcare providers were anxious about Canberra's desire to create more integrated services such as GP super-clinics, because different professions feared being dominated by others.
He hoped the proposals would not create "forced marriages" or large "super health centres" that would become less patient-minded. "Despite people finding a one-stop shop appealing, health isn't like going to a supermarket."
The Australian Practice Nurses Association, the peak association for nurses in primary healthcare, welcomed the idea of exclusive federal funding as a chance to reduce duplication and confusion. Professor Patrick McGorry, a psychiatrist and advocate for mental health reform, said he hoped Canberra's proposal would push mental health services closer to services such as GP clinics and lead to more funding.

HEALTH FAQS FOR THE CONFUSED
Author: HENRY ERGAS
Publication: The Australian, Page 14 (Fri 5 Mar 2010)
The government needs to explain how its medical reforms are going to work
HERE are some frequently asked questions about the government's proposed hospital plan.

• Will it solve the healthcare funding problem?

Difficult to see why it would.
True, the states may not have the tax base to easily fund rising health costs. But if you believe the recently released Intergenerational Report, neither does the commonwealth. There is no magic pudding in the basement of Treasury that will allow the commonwealth to painlessly finance what the states cannot.

• What about the third of GST taken from the states? Won't that allow the commonwealth to fund rising hospital costs?

Yes, but only by making it impossible for the states to pay their share. The accounting on this is tricky, not least because the government has released about as much information on the financials as Communications Minister Stephen Conroy has on the costs and benefits of his broadband network. But here are some sums.
The 2009-10 Intergenerational Report projects that GST revenue will average about 3.5 per cent of gross domestic product during the next 40 years. One-third of GST revenue would therefore be 1.15 per cent of GDP. The report also projects that commonwealth spending on hospitals amounts to 1 per cent of GDP in 2009-10, increasing to 1.1 per cent of GDP in 2019-20.
In other words, the GST revenue the government intends to take back from the states is roughly equal to the entire amount the commonwealth was already projected to spend on hospitals. Since the commonwealth's share of spending is only set to rise as a result of the plan by about 0.20 per cent of GDP, this looks like a huge windfall for the commonwealth, while stripping the states of more than $140 billion (in present value) during the next 10 years.
Claims that the plan is a way of strengthening the states' finances seem bizarre. But even if that were the objective, the way to address it would be to fix the states' tax base, rather than slashing their funding.

• Will it stop cost shifting?

Again, difficult to see how. True, the transfer to the commonwealth of full funding responsibility for hospital outpatient services will remove one area where cost shifting can be a significant problem. It is also true the states will bear a somewhat lower share of the hospital bill and hence will have less incentive to shift costs.
But, at 40 per cent of public hospital outlays, the states' share will be high enough for cost-shifting games to remain attractive, not least for the commonwealth. Moreover, with aged and mental care excluded from the plan, the problems of co-ordinating hospital and non-hospital services will remain acute.

• Will it stop the blame game?

Hardly. The proposed governance arrangements are clear as mud. Boards will run local hospital networks to performance targets set by the commonwealth. How these boards are appointed, controlled and (if they fail to perform) dismissed is not yet known. What is known is that the bulk of the funding for the boards will come from case-mix payments (see below) set by an independent regulator. But states remain responsible for 40 per cent of the funding, will have key planning functions and will continue to own the public hospitals and employ their staff.
Overall, the spaghetti-like chart for the scheme could have been devised by Barry Jones: little wonder it hasn't been released. The bottom line: everyone will still have someone else to blame.

• But won't hospitals become more efficient?

Here the government's hopes seem pinned on case-mix funding. The idea is straightforward: hospitals get paid a set amount for each procedure, depending on the estimated cost of undertaking that procedure efficiently.
This is indeed a good idea, but it is no cure for baldness. One problem among others. If case-mix funding is applied strictly, it creates strong incentives to control costs, but at the expense of quality, and exposes hospitals to great financial risk. But if it is not applied strictly, then the incentives for efficiency may evaporate.
Patients are not widgets, capable of being treated at a standard cost. Treatment costs vary greatly, so a payment pegged to average cost makes dealing with the tough cases unattractive. The temptation, therefore, is to shift those cases elsewhere in the system or, if forced to take them, to control costs by skimping on quality. Regulators can use instruments to prevent that skimping, but there are many limits on how effective that can be.
At the same time, hospitals will keep a lid on costs only if bad things happen when costs exceed revenues. In the US, loss-making hospitals get taken over or even shut down. But hospitals may incur a loss simply because they are unlucky and draw a large number of high-cost cases.

When this occurs, good hospitals can contract, while hospitals that skim off the low-cost patients prosper.
So some income smoothing mechanism is needed, along with a means of compensating those hospitals that take on the riskiest, costliest patients. In many countries, this involves low-cost hospitals financing high-cost hospitals.
But European experience shows this undermines the incentive to be efficient. The result is cost blow-outs, invariably followed by a reversion to micro-management from the centre, compromising cost efficiency and local responsiveness. The harm would be acute under the government's scheme, as the micro-management would be from Canberra.
The government has said nothing about how any of these predictable difficulties will be addressed. Without specifics, claims of increased efficiency are little more than assertions.

• So why are they doing it?

Cynics say this plan was made to be rejected. Perhaps, for it is difficult to believe the states could, within a month, sign on to it. Not merely would it strip them of substantial revenues but so far, the proposal has fewer verifiable details than your average Nigerian email scam. That is a pity, for there is certainly plenty to fix.
And who knows, there may be credible arguments for Rudd's plan. If there are, it's time for him to explain them.

National Updates 2 March 2010

Snooping staff hurt e-health plan - Breaches have validated privacy fears for the Healthcare Identifiers Bill

Author: KAREN DEARNE

Publication: The Australian, Page 29 (Tue 2 Mar 2010)

REVELATIONS that Medicare Australia has investigated 1058 employees for potential unauthorised access to client records in the past three years may rock a Senate inquiry into the controversial Healthcare Identifiers Bill.

The bill has been dogged by concerns over patient privacy raised by consumer health, privacy and technology advocates.

Australian IT uncovered evidence that 948 staff out of a total 5887 employees were being tracked via an Unauthorised Access database as at June 30, 2009 for apparently snooping among client files without a valid reason.

But a Medicare spokesman has disputed the one-in-six figure provided to the federal Privacy Commissioner in a statutory report, saying that by December 2009, 1058 cases had been investigated since surveillance started in November 2006. ``Of these, 54 per cent were found to be unauthorised access, although about 30 per cent of these cases involved staff accessing their own record,'' the spokesman said.

``About 43 per cent were found to be legitimate access, and investigations are still in progress in relation to the other 3 per cent.''

It is understood the internal surveillance system was introduced as part of a Medicare crackdown on privacy breaches.

Health Minister Nicola Roxon has been relying on Medicare's reputation as a secure handler of Australians' personal information as it prepares to launch a nationwide Healthcare Identifier service from July 1 -- provided enabling legislation is passed in time.

While the barebones bill has been touted as a foundation for the future expansion of e-health activities, the broader designs, plans and funding for individual e-health records and other programs are yet to be released.

Last week, the Healthcare Identifiers Bill was referred to the Senate Community Affairs committee for an inquiry and report on ``the significant changes'' proposed by Ms Roxon by March 15.

Under the planned regime, Medicare will issue every Australian with a unique, 16-digit identity number, while more than 600,000 healthcare providers -- including pharmacists, psychologists and podiatrists -- will be given similarly unique identifiers to access patient numbers.

While the Medicare-operated service will not store clinical information along with the patient's number, name, address and date of birth, the HI number will be used to populate records held by a range of care providers, so that eventually all related files can be brought together at the point of care. But the unexpected news of snooping by Medicare staff has set off alarm bells.

``These figures suggest hundreds or thousands of patient records may have been accessed without authorisation over the past few years,'' says Australian Privacy Foundation health spokeswoman Juanita Fernando.

``Healthcare authorities have always claimed Medicare staff respect people's privacy yet the federal government is currently considering a bill that extends `birth to grave' access to the private information of all Australians to an additional 600,000 individuals.''

Dr Fernando said it was perplexing that health authorities had not provided details of alleged data breaches at a time when ``HI bills that further reduce our privacy rights are before parliament''.

AusHealthIT blogger David More said the disclosures confirmed the need for pilots and testing in a live environment ``at a scale less than the entire country'', so the system could be assessed for security and reliability.

Hospital reforms to honour '07 promise Rudd grabs health reins

Author: Sue Dunlevy and Phillip Hudson

Publication: Herald Sun, Page 3 (Tue 2 Mar 2010)

PRIME Minister Kevin Rudd will move to seize control of hospital funding from the states in a provocative reform of the nation's health system to be announced this week.

The states no longer will be given federal money to run their public hospitals and could have their share of the GST clawed back if they refuse.

Mr Rudd proposes to directly fund regional health authorities, who will be in charge of running public hospitals in their regions.

The states will have one month to sign up to the plan crafted by Mr Rudd and Health Minister Nicola Roxon. If they refuse there will be a showdown after Easter between Canberra and the states.

The Government has also decided to hold back key parts of its health package, with voter-friendly aspects dealing with preventative and primary care being kept for the May Budget and the election campaign.

The states currently manage about 60 per cent of hospital funding and will be forced to hand that to a new central national health funding authority so it can be distributed direct to hospitals.

States that refuse to do this will be penalised by having their GST revenue withdrawn. Canberra would then redirect that GST money to the hospitals in their state.

Victoria is due to get $10.5 billion from the GST next year. The state spends about $7 billion on ``acute health services'', the bulk of which is hospitals.

The plan to set up a single national funding system allows Mr Rudd to effectively honour his 2007 election promise to take over hospitals. He will control hospital funding but the actual management of the hospitals will be carried out locally by regional authorities.

Mr Rudd has poured billions of extra dollars into the hospital system since he came to office in 2007 but, despite that, waiting lists for elective surgery and emergency care have steadily increased.

The Government will use the Intergenerational Report to convince the states to agree. It shows rising health costs will exceed 100 per cent of state tax revenue by 2050 due to the ageing of the population and the growing cost of medical technology.

Health spending by the states is rising at 11 per cent a year compared with their revenue growth of 4 per cent.

Mr Rudd believes the single funding system will remove the waste, inefficiency and blame-shifting that costs millions of dollars and which could otherwise be spent on patients.

Doctors working in hospitals have been arguing for a single national funding system, and are expected to warmly welcome the plan.

Opposition Leader Tony Abbott said Mr Rudd was trying to shift attention away from the roof insulation fiasco.

``Hospital reform is too important to become a smokescreen for failure,'' Mr Abbott said.

He said when the Government mismanaged the $2.5 billion insulation program ``you've got to question the ability of that government to deliver complex reform and the most complex reform of all is reform of the public hospital system''.

Now Prozac pets get the black dog

Publication: The Daily Telegraph, Page 7 (Tue 2 Mar 2010)

THEY say it's a dog's life but it's far from a happy existence for a growing number of man's best friends.

Top animal behaviourists said as many as one in seven Aussie dogs suffered mental illness, with many needing human drugs such as anti-depressant Prozac just to get through the day.

It's society's addiction to the 9-5 grind that's being blamed for a generation of animals with depression and anxiety disorders, dubbed the Prozac pets.

The problem is so widespread an international pharmaceuticals company has launched a drug, using the same ingredients as Prozac, specifically for dogs.

Known as Reconcile, it went on sale last week in the UK and is poised to be launched here, costing up to $60 a month .

Top animal behaviourist Kersti Seksel said that as humans were more prepared to talk about mental problems, they were also more open to identifying similar conditions in pets.

``It's now much more acceptable to say: `Well, yes, my pet might have a problem as well','' Dr Seksel said.

Newcastle vet Mark Simpson said dogs were social animals that often reacted badly when left alone without stimulation.

As a result, some suffered from severe separation anxiety, with symptoms such as incessant barking and behaviour so destructive they tore holes in walls and ripped out their own claws.

``Our lifestyles today don't always fit their lifestyles,'' Dr Simpson said.

``Back in the days when we worked on the farm and were there all the time, dogs were with us all day but that is not usually the case anymore.''

Cats and even rabbits suffering from anxiety can also benefit from human anti-depressants, Dr Seksel said.

Medication alone will often not cure an animal's psychological problems but coupled with training a success rate of up to 85 per cent is claimed.

About 75 per cent of dogs seen at Dr Seksel's Sydney Animal Behaviour Service practice at Seaforth will be prescribed human Prozac.

One is Zeke the beagle, diagnosed with separation anxiety after losing his best mate Jess the border collie in 2008.

``He didn't want to go for walks anymore, he wasn't sleeping properly and he lost all confidence where other dogs were concerned,'' his owner Jenny Edwards said.

Now after months of Prozac and behavioural therapy, Zeke is back on track.

Wintergirls in from cold

Author: Laurie Halse Anderson

Publication: Herald Sun, Page 57 (Tue 2 Mar 2010)

A new book by US author Laurie Halse Anderson offers teachers the chance to explore body-image issues

You wrote Wintergirls because readers of your previous books have written and talked to you about their struggles with eating disorders and feeling lost. What advantages are there to telling this story through fiction rather than an awareness campaign, essay or article?

Non-fiction avenues, such as awareness campaigns and articles, can effectively transmit information. A good novel does a better job by conveying emotion and growth. There is a place for both kinds of writing, certainly, but if I want to feel the truth rather than to know it intellectually, I'll reach for a novel.

Where does the term ``wintergirls'' come from and what does it mean?

I made it up. The words anorexia and bulimia come with preconceived notions that I wanted to avoid. People struggling with eating disorders occupy a liminal place between life and death. The myth of Persephone got me thinking in terms of an emotional winter. Then the word appeared. My publishers seem to prefer I use only one-word titles; that was a piece of it, too.

It's a confronting topic, like your novel Speak about a teenage rape victim. What age group are your books pitched at?

Anyone who is 13 or older. I've been stunned at the number of readers in their 20s and 30s who have started reading my stuff in the past few years. They are welcome, of course, but it's the teens I write for; readers stuck in years that are filled with strong convictions and emotions, confusion and a limitless sense of possibility.

You don't shy away from any of the details of the two girls' behaviour. Were you concerned the book might encourage vulnerable teenagers to continue with their self-destructive behaviour?

Ignoring self-destructive behaviour (and the turmoil that underlies it) doesn't solve anything. It usually makes things worse. Wintergirls does not glorify eating disorders. It shows the stark reality, but more than that, it gives readers a chance to understand the pain that creates a wintergirl (or a winterboy). For someone struggling with an eating disorder a book like mine can give them the courage to get help.

A simplistic explanation for anorexia nervosa is that the sufferer exerts extreme control over their body because they feel they have no control over their life and other people. What have you learnt about the condition?

Anorexia is complicated and heart-wrenching. In the US, it has the highest mortality rate of any mental illness. The experts I consulted told me much is not understood about the condition, but it seems to have a clear genetic tie. Just because you have the genetic predisposition does not mean you are fated to develop anorexia; many environmental influences play a part. American culture's absurd fascination with emaciation has a role. More important is the focus on the superficial. Children who believe they are judged on their appearance instead of their spirits will always be vulnerable.

In your acknowledgment at the end of the book you write, ``It takes a village to raise a book''. What do you mean?

This was an emotional book for me to write. Though I was never anorexic, I've spent far too many years worrying about ridiculous things like the size of my thighs or my weight. Writing Wintergirls helped me look at those unhealthy notions (and the self-loathing they represented) and throw them out once and for all. But there were plenty of times when I needed to turn to my husband and friends for a good chat and a dose of common sense. Beyond that, I've been incredibly lucky and appreciate all the people at my publishers who let me spend my days making things up and scribbling.

You won the ALAN (Assembly on Literature for Adolescents) award in 2008 for your contribution to adolescent literature. What do you ultimately hope to achieve through your writing?

I want to tell good stories that will help my readers feel less alone.

Wintergirls, by Laurie Halse Anderson, Text Publishing, rrp $19.95. Teachers' Guide at wintergirls.net/

Pot users at risk

Publication: Herald Sun, Page 17 (Tue 2 Mar 2010)

THE longer people use marijuana, the more likely they are to experience hallucinations or delusions or to suffer psychosis, according to a study by Australian scientists.

The study found that people who first used marijuana when they were aged 15 or younger were twice as likely to develop a ``non-affective psychosis'' -- which can include schizophrenia -- than those who had never used the drug.

``Individuals who had experienced hallucinations early in life were more likely to have used cannabis longer and to use it more frequently,'' it said.

Of the 3800 people surveyed, 17 per cent reported using cannabis for three or fewer years, 16 per cent for four to five years and 14 per cent for six or more years.

Take a stand - Say no to bullying

Publication: Courier Mail, Page 42 (Tue 2 Mar 2010)

BULLYING and victimising behaviour represent a significant problem for schools around the world.

Safe and caring school environments for students and happy workplaces that promote personal and professional growth should be our common mission.

Start this week by becoming involved in The Courier-Mail and Brisbane's 97.3FM Say No to Bullying campaign. Read our week-long series looking at bullying in schools - the causes, the solutions and what parents should do, and show your support for the campaign by wearing orange this Friday.

Share your thoughts and experiences about bullying online at www.facebook. com/saynotobullying

Some facts:

* 1 in 4 kids are bullied

* 1 in 5 kids admit to doing some kind of bullying

* Bullying is viewed as a contributor to youth violence, homicide and suicide

* People who were bullied as children are more likely to suffer from depression and low self-esteem

* Bullies are more likely to engage in criminal activities later in life

What we need to teach:

* Behaviours that communicate care, consideration and respect of self and others

* How one's behavior may evoke responses in others

* Strategies for resisting negative peer pressure

* Methods used to recognise and avoid threatening situations

* Non-violent strategies to resolve conflicts

* Ways to seek assistance if worried, abused or threatened

ThinkUKnow: www.thinkuknow.org.au

Cybersmart: www.cybersmart.gov.au

Net Alert: www.netalert.gov.au

These and other resources are available on Headst@rt blog via www.couriermail.com.au

Archived March 2, 2010

Possible warning signs a student is being bullied

* Comes home with torn, damaged or missing pieces of clothing, books or other belongings

* Has unexplained cuts, bruises, scratches or other injuries

* Has few, if any, friends with whom he or she spends time.

* Seems afraid of going to school, walking to and from school or catching the bus

* Has lost interest in schoolwork or suddenly begins to do poorly in school

* Appears sad, moody, teary or depressed when he or she comes home

* Complains frequently of headaches, stomach aches or other physical ailments

* Has trouble sleeping or has frequent bad dreams

* Experiences a loss of appetite

* Appears anxious and suffers from low self-esteem

MATT FINISH

Author: Kate Watson

Publication: Courier Mail, Page 31 (Tue 2 Mar 2010)

Thanks to Jamie Oliver's Fifteen, a troubled Aussie became a head chef

WHEN you're given an opportunity, you need to grab it with both hands, says Matthew ``Outback Matty'' McKenzie, head chef at Brisbane's Old Government House.

The genteel surrounds of the historic sandstone building nestled in the grounds of the Queensland University of Technology are lightyears away from what 23-year-old Matty describes as his dark life before Fifteen. That's Fifteen, the Melbourne restaurant where Tobie Puttock trains disadvantaged youngsters to be professional chefs, as featured in the reality TV show Jamie's Kitchen Australia. That's Jamie as in Jamie Oliver, father of the Fifteen concept. It was Puttock who gave Matty the nickname to differentiate him from another Matt at Fifteen.

While not exactly the Outback, Matty did grow up in country Victoria.

A family breakdown led to the disintegration of his family, and a life on the streets. A descent into drugs and depression followed.

``One day I was standing on a bridge, looking at the rocks below, imagining throwing myself off,'' he says.

Instead of stepping off, he stepped up. ``I decided to forge a life worth living for,'' he says.

Matty was working on a dairy farm when the opportunity at Fifteen came up in 2006. ``I thought it was going to be easy, but it was extremely difficult at times.

``There was a lot of competition between the students. We all tried to deny it but you could clearly see the tension built up between one another,'' he says.

There were times, he says, he didn't think he could go on.

``Jamie Oliver believed in me, he told me `Matthew, you are better than the drugs, the alcohol and crime; dream, believe and achieve'.

``That inspired me to pass the Fifteen program.''

Today, he's working at Old Government House, birthplace of the lamington, working on a recipe book for students, a TV project, and various charities.

Forum for cyber-vandals

Author: CAITLIN FITZSIMMONS

Publication: The Australian, Page 4 (Tue 2 Mar 2010)

MEMBERS of a notorious website with links to the hacker community have discussed the defacement of the Facebook tribute sites for Australian schoolchildren Elliott Fletcher and Trinity Bates.

Facebook pages set up to honour the two Queensland children, who died in separate acts of violence, were defaced with obscene commentary and pornographic images.

The Australian can reveal that members of the 4chan.org website have posted amused comments and exchanged information about the cyber-vandalism.

The website hosts a number of online discussion forums, mostly covering innocent topics. But one of the forums, called /b/ random, has a reputation for attracting people who like to vandalise websites with pornography and offensive messages.

The incidents involving the tribute sites for Elliott and Trinity echo a 2006 episode in which members of the /b/ board defaced a MySpace page for a Minnesota teenager,Mitchell Henderson, who had committed suicide.

The Australian has uncovered evidence that /b/ random members used the forum to share the web addresses of the Facebook tribute sites and exchange comments such as ``LOL'', which stands for ``laugh out loud'', next to links to media reports about the vandalism.

Young people ponder election issues

Author: LUCIE HADLEY

Publication: The Mercury, Hobart, Page 28 (Tue 2 Mar 2010)

JOINING in the state's current election frenzy, the Tasmanian Youth Forum (TYF) held a young people's pre-election forum with the three main political parties at Parliament House last Wednesday.

Both students and the general public were there getting actively involved in deciding on their future political leaders, and to ask them the hard questions.

Covering issues directly relating to young people, each candidate was given the same question to answer. All questions had been submitted by people aged 12 to 35.

Some of the main issues covered were abuse, suicide, education, health and the common ``three Ds'' (drugs, drinking and driving).

One fact brought up at the forum was that tobacco use among young people in Tasmania is the highest in the country and a serious issue that needs to be addressed by the elected party.

The Tasmanian Greens raised the topic of lowering the voting age to 16, to give a voice to youth interested in being heard and having their say count.

It was suggested that this would most likely be voluntary until reaching 18 when it becomes compulsory.

The forum highlighted that today's youth can become tomorrow's leaders. It is apparent that young people want to be heard and the TYF is a starting point to activate your interest -- make your vote count. * Lucie Hadley is a Rosny College student

Media Release - Ostara launches a novel nationwide program to help people with a mental illness find and keep a job

1 March 2010

Ostara Australia opens 112 new offices today tasked with assisting people with mental health issues to choose, find and keep employment. Funded by the Federal Government‟s Disability Employment Service program, Ostara will assist over 5,000 job seekers who have experienced mental illness.

The three year contract worth $50 million, enables Ostara to provide a new level of employment support to people with mental health issues, previously unavailable in Australia. It will help them to integrate into the community more effectively and live more independent and fulfilling lives.

„For people that live with the effects of depression, anxiety, bi-polar disorder or schizophrenia, our support can make all the difference. With work comes an income and a pathway to improved self esteem, to friendships and freedom from the legacies of being a patient or being unemployed‟ said Ostara‟s CEO Nic Bolto.

The program uses an approach found to be highly effective for people with mental health concerns. „We adopt a “whole person” one to one service that integrates job assistance with support from the client‟s health providers‟, Mr Bolto said.

The Ostara program has a focus on rapid placement into training or employment. But it provides flexible long term support to help employees and employers find solutions when issues arise, such as an outbreak of symptoms or when personal issues create stress which threatens to jeopardise ongoing participation in work.

The company also provides training for employers or corporations who need to manage mental health issues or crises that arise within the workplace.

Ostara is the second largest disability employment service in the country, in terms of geographic spread. It is a national not-for-profit company, with headquarters in Melbourne. Together with the 19 member organisations in its partnership network, Ostara delivers service to highly disadvantaged jobseekers in remote, regional and metropolitan locations.

Job seekers or potential employees can contact their nearest Ostara office by calling 1300 656 294 or visiting www.ostara.org.au.

Media Contact : Alexandra de Blas 0414 509 404, This e-mail address is being protected from spambots. You need JavaScript enabled to view it

INTERNATIONAL NEWS 2 March 2010

UK: Rise in self-diagnosis of bipolar disorder: research

Publication: aap International News (Tue 2 Mar 2010 4:49:09 AM)

LONDON, March 1 AFP - Psychiatrists in Britain claim to have discovered a new phenomenon - people diagnosing themselves with bipolar disorder.

Celebrities talking publicly about suffering from the illness are linked to the rise in self-diagnosis, London-based psychiatrists Dr Diana Chan and Dr Lester Sireling said on Monday.

Bipolar disorder, which was previously known as manic depression, is a condition affecting an individual's mood where manic or depressive episodes can fluctuate between 'normal' periods.

Writing in the March issue of The Psychiatrist, Chan and Sireling claim celebrities talking openly about their personal experiences of bipolar disorder has led to increased awareness of the illness.

"The increasing popularity of bipolar disorder may be attributed to increased media coverage, coupled with the high social status associated with celebrities such as (British TV personality) Stephen Fry talking about their own personal experiences of mental illness," they said.

Other high-profile celebrities such as actor Mel Gibson and rock star Axl Rose have also spoken publicly about bipolar disorder.

Gibson said in a documentary in 2002 that his childhood alcohol abuse led to high and lows which resulted in him being diagnosed with the disorder.

About one in every 100 adults is said to suffer from bipolar disorder at some point in their lives although recent studies shows that figure could be as high as 11 in every 100.

"Public awareness of bipolar disorder has spread through the internet, radio and television shows such as MTV's 'True Life: I'm Bipolar' and BBC's 'The Secret Life of the Manic Depressive," the report said.

Referring to the BBC program, the psychiatrists said: "It appears to have portrayed mental illness from a fairly benign perspective, noticeably without the strong association of risk and violence that are often reported in the media."

However, Chan and Sireling say patients who 'want to be bipolar' may not always comprehend the consequences of being diagnosed with the disorder.

"Current evidence suggests that bipolar disorder may be underdiagnosed in the community, with a significant delay to diagnosis," they said.

"The challenge for the primary care psychiatrist is in either making or excluding the diagnosis of bipolar disorder and then sensitively dealing with the patient who wants to be bipolar."

New York Is Ordered to Move Mentally Ill (sic) Out of Group Homes

New York Times

By A. G. SULZBERGER

Published: March 1, 2010

New York State must immediately begin moving thousands of people with mental illness into their own apartments or small homes and out of large, institutional adult homes that keep them segregated from society, a federal judge ordered on Monday.

The decision by Judge Nicholas G. Garaufis of Federal District Court in Brooklyn followed his ruling in September that the conditions at more than two-dozen privately run adult homes in New York City violated the Americans With Disabilities Act by leaving the approximately 4,300 mentally-ill residents isolated from the outside world in warehouse-like conditions.

The remedial plan offered by Judge Garaufis, which drew from a proposal presented by advocates for the mentally ill that was backed by the Justice Department, calls on New York to develop at least 1,500 units of so-called supported housing a year for the next three years in New York City. That would give virtually all residents the opportunity to move out of adult homes.

Gloria Thomas, who lives in a shared room at the Queens Adult Care Center, reacted to the ruling with joy. “Thank you Jesus, this is what I‟ve been waiting for for the longest time,” said Ms. Thomas, 54. “I need to get out of here.”

In supported housing, a resident lives alone or in small groups and receives specialized services from counselors who visit as needed. Advocates for the mentally ill, who were delighted by the ruling, touted supported housing as more humane housing option that allowed residents to become self sufficient community members.

“This will give adult home residents the opportunity to live the way the rest of us do,” said Jennifer Mathis, deputy legal director of the Bazelon Center for Mental Health Law, which provided legal support for the lawsuit. “In the future people should not be steered to adult homes if they don‟t want it and they don‟t need it.”

The state is considering an appeal, according to the one sentence statement released by the office of Gov. David A. Paterson. During a five week trial last summer the state argued that advocates had overestimated the demand for supported housing and underestimated the cost, making a quick transition for the bulk of the adult home population unfeasible. It was unclear whether any changes resulting from the lawsuit, which was limited to New York City, would be applied to adult homes elsewhere in the state.

Jeffrey J. Edelman, president of the New York Coalition for Quality Assisted Living, which represents 14 of the 28 group homes in the case, called the order irresponsible and deeply disturbing and he urged the state to appeal. “The judge‟s decision, entirely following the advocates‟ agenda, could force thousands of the mentally ill from their stable lives in adult homes into independent living situations for which the majority are neither psychiatrically suited nor prepared,” he said in a statement.

If it stands the order would begin a process aimed at transforming a system that first took shape in the 1960s, when the government embraced adult homes as a way to care for people with mental illness following the rapid closure of large state-run hospitals. But as with the predecessor institutions the adult homes struggled with continued lax state regulation and poor private management.

The lawsuit was filed in 2003 by Disability Advocates, a nonprofit legal services group, following a series of articles in The New York Times that described a system in which residents were poorly monitored and barely cared for, with residents left to swelter in the summer and sometimes subjected to needless medical treatment and surgeries for Medicaid reimbursement.

The state argued that conditions had improved markedly at adult homes in recent years, but the judge ruled last year that their very setup discriminated against residents by keeping them separated from society and providing little encouragement to find work, make friends or learn skills like cooking, shopping or budgeting.

“This decision is really important for those of us who want to live in the community,” said Erica von Nardroff, 49, who has lived at Elm York Adult Home for the past three and a half years. “I need to move on with life and being isolated here is not the way to do it.”

The order by Judge Garaufis rejected the remedy proposed by the state, which continued to dispute many of the findings of his previous rulings and which sought to cap the number of new supportive housing units at 1,000, to be made available on a more restrictive basis over five years. “The court is disappointed and, frankly, incredulous that defendants sincerely believed this proposal would suffice,” the judge wrote Monday.

The state had argued that, particularly in current economic conditions, such a mandate would be too expensive. But the judge wrote last year that evidence showed that supported housing would cost less per resident than group homes do.

In Monday‟s order the judge said that only people with the most severe mental illness, including those deemed a danger to themselves or others, should be housed in adult homes. He also said that residents who were eligible for supportive housing may choose to stay in adult homes as long as they have been apprised of their options.

The judge ordered the appointment of a federal monitor to ensure the state followed his plan and said that both sides must suggest candidates by the end of the week.

“Defendants‟ demonstrated resistance to the remedy, as evidenced by their refusal to abide by the court‟s findings in crafting their patently inadequate proposal, further highlights the need for a Monitor in this case,” he wrote.

Marie Osmond's Son's Death Spotlights Teen Suicide

Family Therapist: Suicide 'Can Come Out of the Blue,' but Parents Should Look for Signs of Depression

By KELLY HAGAN and KATIE ESCHERICH

March 1, 2010—

The death of Marie Osmond's 18-year-old son, Michael Blosil, who took his life last Friday after struggling with depression for years, highlights teen suicide in the United States.

Suicide is the third-leading cause of death among older teenagers in America, according to the National Institutes of Mental Health, and boys are four times more at risk than girls.

Family therapist Terry Real, the author of "I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression," said any time something like this happens, "it just makes you shake your head. ... It's very hard to predict.

"We know from research that girls tend to turn things inward ... boys and men both tend to turn things outward," Real said. "So you look at not the depression per se, but the things the kid is doing to get away from it: Drugs and alcohol, acting out, along with feeling depressed."

Blosil, who was a first-year student at the Fashion Institute of Design and Merchandising, jumped to his death from his high-rise apartment building in downtown Los Angeles. On the site where he died, people created an impromptu floral tribute just a short walk from the school where he was said to be majoring in apparel manufacturing.

Online reports that Blosil sent a text message to a female friend before taking his life and left a suicide note in which he referred to a lifelong battle with depression remain unconfirmed.

Blosil was one of Marie Osmond's eight children, and one of five whom the star had adopted.

In a statement to ABC News, Osmond said, "My family and I are devastated and in deep shock by the tragic loss of our dear Michael and ask that everyone respect our privacy during this difficult time."

In 2007, the year his mother and father, Brian Blosil, were divorced, Michael Blosil entered rehab as his mother reluctantly confirmed on the talk show "Larry King Live."

"It's really hard," she told King. "My son is amazing. He's dealing with a lot. He's one of my kids. He's dealing with adoption issues, all kinds of things right now.

He is the most amazing kid," she said, tearing up. "It's been a painful year."

Signs of Teenage Depression

Parents should know the signs of depression to look for in their own children.

"I think with a teenager you're looking at any real radical changes of behavior," he said. "Changes in sleep, either more or less, in food, changes obviously in mood, loss of interest, difficulty concentrating. They feel depressed. They tell you they're depressed."

He said that while it can be difficult to differentiate between normal moodiness in teenagers and depression, but there are signs parents can look for.

"With the mood swing, the central word there is 'swing,'" he said. "So you want to look at severity, how bad is it, and you want to look at duration, how long is it. If a kid is depressed for more than two weeks you might want to think about an evaluation."

"Depression is one of psychiatry's great success stories," he said. "Ninety percent of people report relief, but fewer than three in five ever get it. If you have any doubts at all that your kid might be mad, sad or bad & get him or her in front of a mental health professional."

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Govt vows to act on mentally ill offenders

Author: By Noel Towell
Publisher: The Canberra Times
Publication: The Canberra Times, Page 1 (Fri 8 Jan 2010)

The ACT Government has promised action to take mentally ill people out of the territory's criminal justice system but has been accused by the territory Opposition of eight years of inaction on the issue.A day after a magistrate said  courts were being called upon to manage the treatment regimes of mentally ill offenders, Attorney- General Simon Corbell said justice and health officials were working on an overhaul of mental health laws and maintained that progress was being made on a long-awaited secure mental health unit for Canberra.

Magistrate Grant Lalor made his comments while sentencing a serial offender, known to police and the courts to suffer serious delusions, who was arrested on a minor offence and went on to attack a female prosecutor. The Attorney-General acknowledged yesterday there was an ongoing problem with the management of mentally ill offenders but said the Government was acting in ''a challenging and difficult and complex area''.

''This is an issue that is of concern to our magistracy and also to our judges in the Supreme Court from time to time about having to deal with mental illness in the criminal justice system ... and the Government acknowledges that this is a problem,'' Mr Corbell said. ''We're undertaking a complete review of the Mental Health Act in order to broaden the circumstances where people are able to be diverted away from the criminal justice system and into treatment and care or into the Civil Administrative Tribunal which deals with mental health orders.'

The minister said progress was being made on a secure mental health facility a project which had been on the drawing board for several years for people who had committed offences but were too ill for prison. But Mr Corbell acknowledged a location had not been found for the unit to be built. ''We're consulting with the community about where we should build a secure forensic mental health facility to house people in these circumstances,'' Mr Corbell said.

But the Liberals' justice spokeswoman Vicki Dunne said the Government should have taken action on this issue several years ago. ''These are matters that are commented on frequently by magistrates and on two or three occasions over the past four or five years, former chief magistrate Cahill had made adverse comments about the management of people with mental health problems who were inappropriately housed in detention centers,'' Ms Dunne said. ''This is an ongoing issue and we should have seen action a lot sooner that we are now.'

'Ms Dunne accused the Government of procrastination in building the secure unit in Canberra. ''We have serious problem in the ACT that we don't have a secure mental health facility and we haven't ever,'' she said. ''But this Government has been 'gunna do it' for as long as they've been in Government and that's the real problem.'

Bring Back the Institutions

Author: GARY JOHNS
Publisher: News Ltd
Publication: The Australian, Page 12 (Fri 8 Jan 2010)

THE wheel has been reinvented. Institutions for the mentally ill, orphans, alcoholics and so on were closed decades ago. Now, under the rubric of solving youth homelessness, they are making a comeback. Sure, a kinder, more enlightened version, but acknowledgement nevertheless that sometimes even in an immensely wealthy country the great desire to house people in the community was an ideal too far. One commentator posed it as a trade-off between conscience and convenience: institutions were a convenient place to leave society's unwanted. This is too harsh. There was much wrong with old institutions, but in poorer times they were better than the street.

There is now a reappraisal, not that many would be able to read it in the commonwealth's white paper on homelessness, The Road Home. It is shot through with bureaucratese and endless repetition. Kevin Rudd could have drafted it.

Institutions are back. For example, several ``foyer models'' are operating across Australia. The term itself is so apologetic. These models are large homes that provide young people with longer term accommodation and education, training and employment links. Sounds awfully like a latter-day orphanage.

Foyer homes were developed in France to provide for young people moving from rural areas to the city to find work. As they developed, the focus was widened to providing support on a range of issues faced by young people living away from home. The model has spread through Europe and has also been established in the US. The Australian Foyer foundation is worth watching.

The institutional path has been anathema to the welfare sector. It has argued long and hard that all services should be provided to the needy in their own homes. It then complains that ``people are generally expected to find their own way to the right services through a complex and disconnected service system. They often need to tell their stories over and over again.''

Here is the heart of the matter. If government wants to live people's lives, it will need to pay for an enormous array of helpers. This may only be possible in an institutional setting. The homeless report never informs the reader of policy trade-offs.

In 1987, Bob Hawke promised that by 1990 ``no Australian child will be living in poverty''. In 2008 Rudd promised that by 2020 ``homelessness would be halved and all rough sleepers will be offered accommodation''. Will he be any more successful than Hawke?

In the white paper there are some bright sparks and some dullards. The youth homes are a start. These will inevitably become the stalking horse to institutional settings for all types of people with needs, especially the mentally ill. Another is the possible introduction of compulsory rent payments from Centrelink for public housing tenants at risk of eviction.

One dullard is the idea to establish the Bea Miles Foundation ``to channel funding, in-kind support and sponsor innovation and research in combating homelessness''. This appears to be quite different from the B. Miles Women's Housing Scheme, which provides supported accommodation for women without dependent children who have a mental illness.

According to the Australian Women's Register, ``Bea Miles was notorious in Sydney for her disruptive conduct in public places and her criticism of political and social authorities. She had no fixed address, and claimed to have been falsely convicted by police 195 times, and fairly convicted a further 100 times. Her occupation was listed as `rebel'.'' Far from addressing the issues of mental illness, such a foundation embeds the ideology of the anarchist and destructive ideas about railing against authority, which in this context means police and social workers.

Other examples are the argument to clean up the residential tenancy database, which records bad tenants, and water down legislation that permits ``without-grounds termination''. Yet these are legitimate tools for reducing the risk of rent loss and damage to a rental property and managing properties for best return. It may rankle some that a tenant has a record or that a landlord wishes to use the property for other purposes, but if the government prevents a formal record of bad tenants an informal one will operate, and entrenching tenants will force up rents.

The white paper conflates too many people with different problems. Apparently, every night about 100,000 people are homeless. But the vast majority are living in temporary or makeshift accommodation, with family or friends, in specialist services or in substandard boarding houses. In fact, there were about 16,000 people sleeping rough.

Conflating the numbers conflates the issues, for the reasons for homelessness are so different as to not be amenable to similar solutions. An example is the argument in the paper that an increase in the supply of affordable housing is crucial to permanently reduce homelessness. Most of the homelessness occurs for reasons other than price and availability.

Rough sleepers and people who are chronically homeless are more likely to have mental health issues, substance abuse problems and disabilities. The evidence suggests that the longer people with mental health problems are supported by specialist homelessness services, the more likely they are to move into public, community or rental housing rather than return to rough sleeping. The key is how these services are best delivered, on the street or in an institution.

The paper advocates ``assertive outreach services'' and ``wrap-around'' or ``whole-of-person support'' for these groups. Evidence shows that the longer a client is supported, the better the outcome. But how? Personal helpers and mentors provide intensive community support for people who have difficulties in everyday functioning. They help people with mental illness build social networks, gain employment, learn how to better manage their illness and live independently. This program seems laudable, but clearly too many such people are sleeping rough. There must be a place where they can stay and where services can be readily supplied.

There will also be more chasing down people, quaintly known as outreach, but at the end of the day some people will have to be housed in institutions. Unless Rudd recognises this and, ignoring the welfare sector, acts on it, he will never halve homelessness.

Autistic pupils unfairly treated

Author: BRUCE MCDOUGALL
Publisher: News Ltd
Publication: The Daily Telegraph, Page 11 (Fri 8 Jan 2010)

GROWING numbers of students suspended for violence, aggressive behaviour or repeated disobedience have a serious mental disability such as autism.

Families with severely disabled children said they had become the victims of an under-funded school system incapable of adequately providing for special needs.

More than 69,000 students receive long or short suspensions in public primary and secondary schools each year but parents believe a large proportion have a disability and should be helped instead of disciplined.

Principals report increasing numbers of children entering school exhibiting mental illnesses and the number of students with autism has exploded by more than 65 per cent in the past three years.

A NSW Parliamentary inquiry is under way into the education of students with a disability or special needs but mother of two autistic boys Jane Salmon said yesterday it was too little too late and called on state and federal governments to boost special education funding substantially.

A survey of 800 primary and high school principals has found programs for students with special needs are severely over-stretched and under-resourced, with the worst spots including southwest Sydney and the Central Coast.

Ms Salmon, of Lindfield on Sydney's North Shore, said: ``It is time to stick the wheelchairs in the streets . . . many kids have unidentified problems and need help.

``No one is saying it is easy to manage these kids but they are entitled to an education and they have potential. Often the kid is not being naughty -- it's just that their head is in a bad place.''

Ms Salmon's six-year-old son Bill, in an autism support class at Warrawee Public School, and nine-year-old Lindsay, in a mainstream class at Lindfield East Public School, have made progress because of inspirational teachers.

``We have found the system has potential to be exceptional without the red tape and bureaucrats,'' Ms Salmon said. ``Special needs parents are very stressed -- when they enrol their child in public education at kindergarten they find a mainstream system that is not adapted to the needs of their child and which is fairly inflexible.

``A further $600 million per annum would make a huge difference to outcomes and also reduce the longer term burden on taxpayers and community services.''

A spokeswoman for NSW Education Minister Verity Firth said the Government aimed to provide a specialist teacher in every school and was consulting with the Teachers' Federation, parents and principals.

``Over 80 per cent of school students with disabilities in NSW are enrolled in public schools and the Government is investing a record $1.1 billion this year on special education,'' the spokeswoman said. ``We also provide more than 1400 specialist teachers to support students with learning difficulties including autism.''

In 2009 the public school system had 204 autism classes in regular and special schools.

Autism: The facts

* Affects more than 1 in 100 children (20 years ago it was 1 in 10,000)

* The number of public school students identified with autism has soared by more than 65 per cent in three years

* Four out of five affected are boys

* 87 per cent divorce rate for parents of kids with autism

* Autistic children are particularly vulnerable to bullying

* Most kids with autism are able to learn the skills required to fulfil their potential

* People have autism for life

Naked truth, according to our Jen

Author: Marcus Casey
Publisher: News Ltd
Publication: Herald Sun, Page 3 (Fri 8 Jan 2010)

AN embarrassed Jennifer Hawkins yesterday emerged to repair the damage caused by her racy nude photo shoot.

Critics slammed the former Miss Universe for shamelessly using the opportunity to show off her body -- and sell magazines.

But the supermodel interrupted her holiday to exclusively tell the Herald Sun she only did it to raise money for an eating disorder charity.

``I didn't do this for PR -- I did it to raise awareness for the Butterfly Foundation which helps men and women with eating disorders,'' she said.

``But you wouldn't know that because it has hardly been mentioned -- and I had no idea that what was a good intention to promote healthy eating and lifestyle could snowball out of control as it has.''

Hawkins appears naked on the cover of this week's Marie Claire magazine, which draws attention to blemishes including a ``slightly dimpled thigh'' in an apparent effort to make readers feel comfortable with their bodies.

But Hawkins yesterday said she was unaware the images also would be used to present her as a woman with ``flaws''.

``I don't see myself as a poster girl for body image,'' she said.

Hawkins would not comment on Marie Claire's use of the photos, but it is believed some in her camp feel the magazine exploited the naked shoot.

``Again, I didn't do this for PR or to attract attention -- just to help a cause,'' she told the Herald Sun.

Eating disorder experts have praised Hawkins for her support, but said Australia's magazines should do more to promote healthy body image.

The photo shoot also put a strain on Hawkins' relationship with Myer, which did not know about the nude photos until the magazine hit the streets.

``My relationship with Myer is as strong as it ever has been, but in hindsight maybe I should have told them -- but I thought it was just like any other cover shoot,'' Hawkins said.

Myer boss Bernie Brookes said he would meet with Hawkins' manager to ensure he was informed beforehand about any potentially controversial photo shoots.


INTERNATIONAL

Mobile phone use may reverse Alzheimer's

ABC News Online


The electromagnetic waves emitted by mobile phones could protect against and even reverse Alzheimer's disease, according to a US study.

Researchers at the University of South Florida exposed 96 mice, most of whom had been genetically altered to develop the Alzheimer's disease as they aged, to electromagnetic waves generated by mobile phones.

The mice were zapped with 918-megaherz of frequency twice a day for an hour each time over nine months - the equivalent of several decades in humans.

In older mice with Alzheimer's, long-term exposure to the electromagnetic fields caused the erasure of deposits of beta-amyloid - a protein fragment that accumulates in the brain of Alzheimer's sufferers to form the disease's signature plaques.

Memory impairment in the older mice disappeared, too, the study showed.

It also found that young adult mice with no apparent signs of memory impairment were protected against Alzheimer's disease after several months of exposure to the mobile phone waves.

The memory levels of normal mice with no genetic predisposition for Alzheimer's disease were also boosted after exposure to the electromagnetic waves.

The study was the first to look at the long-term effects of mobile phone exposure in mice or humans, and its findings took the researchers by surprise.

"I started this work with a hypothesis that the electromagnetic fields would be deleterious to Alzheimer's mice," lead author Professor Gary Arendash said.

"When we got our initial results showing a beneficial effect, I thought, 'give it a few more months and it will get bad for them'.

"It never got bad. We just kept getting these beneficial effects in both the Alzheimer's and normal mice."

Based on the findings, the researchers are hopeful electromagnetic field exposure could be an effective, non-invasive and drug-free way to prevent and treat Alzheimer's in humans.

MED: Genetic clue to cocaine addiction: study

Publisher: AAP NewsWire
Publication: aap International News (Fri 8 Jan 2010 8:44:06 AM)

WASHINGTON, Jan 7 AFP - US scientists have found a mechanism in the brain that helps explain why cocaine is so addictive and could pave the way towards a potential cure, a study shows.

Researchers revealed on Thursday how the highly addictive drug brings on changes in the brain through a process that influences the expression of genes without changing the brain's gene sequence.

These changes in the brain's pleasure circuits, which are also the first to be influenced by chronic cocaine exposure, appear to promote cravings for cocaine, said the study published in Science.

"This fundamental discovery advances our understanding of how cocaine addiction works," said Nora Volkow, director of the National Institute of Drug Abuse.

"Although more research will be required, these findings have identified a key new player in the molecular cascade triggered by repeated cocaine exposure, and thus a potential novel target for the development of addiction medications."

The research was carried out on mice. One group was given repeated doses of cocaine, the second was given a saline solution with a final dose of the drug to study what differences there were between repeated cocaine exposure and a one-time dose.

Those mice repeatedly given cocaine displayed dramatic alterations in their gene expression as well as a strong preference for the drug.

The study confirmed cocaine appears to block an enzyme that plays a critical role in the so-called "epigenetic" control of gene expression.

The study authors also showed that by reversing the repression of the enzyme, known as G9a, they could inhibit cravings for cocaine.

"The more complete picture that we have today of the genetic and epigenetic processes triggered by chronic cocaine give us a better understanding of the broader principles governing biochemical regulation in the brain," said Eric Nestler, director of the Brain Institute at Mount Sinai School of Medicine.

That could "help us identify not only additional pathways involved but potentially new therapeutic approaches", he added.

High Mortality Risk for Bulimia Nervosa and Unspecified Eating Disorders 1/12/09

From American Journal of Psychiatry, December 2009