Understanding barriers to mental health service utilization for adolescents in rural Australia
- Authors: Aisbett, Damon , Boyd, Candice , Francis, Kristy , Newnham, Krystal , Newnham, Karyn
- Date: 2007
- Type: Text , Journal article
- Relation: Rural and Remote Health Vol. 7, no. (2007), p. 1-10
- Full Text:
- Reviewed:
- Description: INTRODUCTION: There is a general paucity of research in the area of rural adolescent mental health in Australia, and in particular a lack of data regarding the experiences of rural adolescents who seek help for mental health problems. This study used a qualitative approach to data collection and analysis in order to assist understanding of the barriers to mental health service utilization for young people in rural communities. METHOD: A series of interviews were conducted with each of the study's participants, who ranged in age from 15 to 17 years. All participants were clients of the Child and Adolescent Mental Health Services in the rural cities of Horsham and Ararat, Victoria, Australia. RESULTS: Participants described how the lack of reliable transport to and from the mental health service affected the utilization of the service by rural young people. They also expressed concern regarding a lack of qualified professionals in their region who specialize in child and adolescent mental health. Participants reported frustration at long waiting lists and the lack of an after-hours service. One participant shared her experiences of deliberate self-harm to in order to gain access. Results also revealed that rural gossip networks and social visibility within rural communities compounded the experience of stigma and social exclusion for these young people. Furthermore, participants explained how these experiences negatively impacted on their utilization of the mental health service and their progress towards recovery. CONCLUSIONS: There are several barriers to mental health service utilization for rural adolescents which affect both their decision to access help as well as their ability to engage effectively with mental health services over time. Clinicians who work with rural adolescents need to be mindful of the influence of rural culture on mental health service utilization by young people. The co-location of mental health services and general health services is suggested as one way to reduce the fear associated with 'being seen' entering a stand-alone mental health service. It is suggested that treatment programs for adolescents in rural areas address the different types of stigma that these young people are likely to encounter. Furthermore, community and school-based interventions aimed at reducing the social stigma of young people with mental illness in rural areas is recommended.
- Description: C1
- Description: 2003005804
The old and mentally ill in Australia : Doubly stigmatised
- Authors: Thomas, Kelly , Shute, Rosalyn
- Date: 2006
- Type: Text , Journal article
- Relation: Australian Psychologist Vol. 41, no. 3 (2006), p. 186-192
- Full Text:
- Reviewed:
- Description: This review proposes that the stigma attached to being old and having a mental illness has a disproportionate impact on those who are categorised as both. A brief historical account is given of what it means to have a mental illness and, separately, what it means to be old. Next, the stigmatising attitudes and their implications for the two separate groups will be reviewed, with discussion of the Australian media's portrayal of mental illness and old age. It is further argued that the implications of double stigma may be multiplicative, having even more of an impact on elderly mentally ill people than a separate consideration of these categories might suggest. Finally, some suggestions are made for beginning to address the double stigma attached to being both old and having a mental illness in Australia. © The Australian Psychological Society Ltd.
- Description: C1
- Description: 2003002024
Mental health of older adults : the development and testing of a model
- Authors: Turner, Jayne
- Date: 2006
- Type: Text , Thesis , PhD
- Full Text:
- Description: The high rates of depression and suicide among older adults have given rise to research which aims to identify factors that protect older people from mental illness. Recently, Bailey and McLaren (2005) developed and tested a model which investigated the relationships between engagement in various leisure activities performed alone or with others, sense of belonging, depression, and suicidal ideation. The present study examined an extended version of the mental health model, incorporating the additional variables of perceived freedom in leisure and physical health status. A sample of Australian males and females (N = 379) aged 65 years and over (M age = 77.23, SD = 7.48) completed the Perceived Freedom in Leisure Questionnaire, the Yale Physical Activity Survey,the Duke Health Profile, the Sense of Belonging Instrument, the Centre for Epidemiological Studies-Depressive Scale, and the Suicide Subscale of the General Health Questionnaire. Results indicated that the model was invariant for gender, and accounted for 56% of the variance in suicidal ideation. The model indicated that physical health had direct relationships with each variable in the model. Perceived freedom in leisure predicted engagement in physical activity, sense of belonging-antecedent, and depression, whereas sense of belonging psychological state predicted depression and suicidal ideation. Results suggest that interventions aimed at improving older adults’ perceptions of freedom and personal choice with regard to their leisure experiences, maintaining optimal health, and increasing opportunities to foster feelings of belonging and relatedness with others, should protect against the development of mental ill health.
- Description: Doctor of Psychology (Clinical)
Generalist telephone counselling and referral call data as a social indicator : a lifeline to social support?
- Authors: Watson, Robert
- Date: 2006
- Type: Text , Thesis , PhD
- Full Text:
- Description: The aim of this Australian Research Council Linkage doctoral project with industry partners UnitingCare-Lifeline Ballarat and Lifeline Australia was to investigate whether calls to Lifeline – a generalist telephone counselling and referral service – could be used as valid and reliable social indicators of health. The Lifeline Australia service receives approximately 1,000 calls a day and key details of each call are recorded on its Client Services Management Information System (CSMIS). A number of research questions directed this study: (1) What are the characteristics or attributes of callers to Lifeline?; (2) How do the patterns of calls to Lifeline vary spatially?; and (3) What is the statistical relationship between calls to Lifeline and other measures of community health? This thesis presents a detailed descriptive summary and analysis of Lifeline’s national CSMIS call data (N = 90,128 cases) from 01-04-2003 to 29-06-2003. It explores this and other sources of call data, such as the Telstra Exchange data, for their potential to be used as social indicators. The project created a model of generalist telephone counselling and referral use (MGTCRU). The MGTCRU was used as a theoretical base to a call rate indicator, named the Lifeline Indicator of Social Need (LISN), which reflects the community’s capacity to provide social support to its most socially isolated residents. The LISN was found to have useful attributes and a potential for use as a social indicator of community strength. The call rate indicator showed a statistically significant relationship with the Accessibility/Remoteness Index of Australia, measures of socio-economic disadvantage, and suicide rates. However, the CSMIS database was found to have certain limitations. The thesis presents recommendations for this situation to be addressed. While acknowledging that there are limitations to telephone counselling call data it is clear that these call data can be used to create cost effective, rapid, reliable, and potentially valid social indicators. This thesis has made a number of significant empirical and theoretical contributions to knowledge on telephone counselling and referral. The descriptive summary of the CSMIS data provided in this thesis might be used in innovative ways by social researchers. The LISN could be used on its own or included in other social indices. The MGTCRU provides a theoretical framework for understanding telephone counselling and referral services use and may assist these services to organise their operations and meet the needs of their callers. This project may have particular application to a current upgrade of Lifeline Australia’s telephony and call data systems.
- Description: Doctor of Philosophy
Mentors and mountainboarding : The development and delivery of an innovative program for rural adolescents at risk of mental health problems
- Authors: Boyd, Candice , Kemp, Evan , Filiades, Toula , Aisbett, Damon , Markus, Martin
- Date: 2009
- Type: Text , Journal article
- Relation: Children Australia Vol. 34, no. 2 (2009), p. 4-10
- Full Text: false
Personality disorders in clinical practice : Axis 1 comorbidity, management/treatment, psychologist boundary issues and self-care
- Authors: Grech, Paul
- Date: 2003
- Type: Text , Thesis , PhD
- Full Text:
- Description: Three thematically linked placement project reports and an exegesis addressing professional/ethical issues in the practice of clinical psychology submitted in partial fulfilment of the requirements for the degree of Doctor of Psychology (Clinical).
- Description: Doctor of Psychology (Clinical)
Seeking help for mental illness : A qualitative study among greekaustralians and Anglo-Australians
- Authors: Alexi, Nektarios , Moore, Kathleen
- Date: 2016
- Type: Text , Journal article
- Relation: Hellenic Journal of Psychology Vol. 13, no. 1 (2016), p. 1-12
- Full Text:
- Reviewed:
- Description: Des ite the high revalence of mental illness, research indicates that many eo le who ex erience mental illness do not access hel and therefore go unnecessarily without treatment. It was the aim in this study to investigate reasons why eo le do not seek hel for mental illness and to determine if there were any cultural differences between Anglo- Australians and the large Greek-Australian o ulation. Nine Greek-Australians (six males) (age M = 29.84 years, SD = 8.75) and eight Anglo-Australians (one male) (age M = 34.93 years, SD =14.10) artici ated in interviews focused on their attitudes towards, and willingness to seek hel for, mental illness. Results revealed artici ants had a oor understanding of mental illness er se, and in terms of hel seeking suggested similar factors to those re orted in the literature. Partici ants indicated embarrassment is associated with mental illness des ite ongoing media cam aigns and awareness-raising concerning mental illness.While both grou s acknowledged that rofessional hel may be useful they stressed the im ortance of a trusting and confidential relationshi with the thera ist. Anglo-Australians sam led were somewhat more willing to utilise rofessional help , while the Greek-Australian artici ants were more likely, in the first instance, to seek-out informal su ort such as from a riest.
The role of primary care mental health nurse practitioners in Australia
- Authors: McKinnon, Brett , Cross, Wendy
- Date: 2021
- Type: Text , Technical report
- Full Text:
- Description: The Tristar Medical Group use Mental Health Nurse Practitioners (MHNPs) to both provide and co-ordinate care. Completion rates of entire 90-day cycles of care and review of GPMHCPs sits at approximately 70%, which is significantly better than the National average of 42% since the introduction of the MBS 2712 billing item. This item itself is integral in demonstrating effectiveness in reviewing planned care. The role of the MHNP has been vital to achieving excellent patient care outcomes in this domain. MHNPs value add into Primary Care and General Practice by: • Advanced assessment and diagnosis of Mental Health Issues • Monitoring physical health, • Ordering and analysing tests • Prescribing medications, • Providing psychoeducation for medication adherence • Psychotherapy / Psychological Interventions • Monitoring and reporting all aspects of care to the Treating Team Participants in this evaluation believe that Mental Health Nurse Practitioners (MHNP) provide the maximum value for clinical care across the entire biopsychosocial Model. Clients receiving treatment and support by MHNPs experienced improved outcomes through increased continuity of care- including through home visits, follow up and care co-ordination, access to support and greater compliance with their treatment plans. Care provided by MHNPs demonstrated evidence of an overall reduction in hospital admission rates and lengths of stay in hospital where admission occurred; increased levels of employment; improved family and community connections; and positive impacts on GP workloads. Evidence of effectiveness of the MHNP model of service delivery whereby MHNs were actively providing clinical interventions and co-ordinating care for patients is well supported by the results of this evaluation. If the business model and funding changed, more MHNPs could be recruited, especially given the scarcity of other mental health clinical discipline in rural communities. Current funding for MHNPs has been restricted to those who receive PHN subsidy under the stepped care model. This limits the opportunity to provide the full range of care that MHNPs are capable of delivering compared to other clinical disciplines. Submissions to government to facilitate greater access to MBS items for their services is recommended.
Continuing professional development for accredited mental health social workers : an evaluative study
- Authors: Martin, Jennifer , Paul, Lauren , Robertson, Melissa
- Date: 2018
- Type: Text , Journal article
- Relation: Advances in social work and welfare education Vol. 20, no. 2 (2018), p. 129-143
- Full Text:
- Reviewed:
- Description: This article considers how the Australian Association of Social Workers (AASW) has responded to the recommendations made by accredited mental health social workers in the first national study on continuing professional development needs in 2010. The aim of the study was to ascertain the responsiveness of the AASW to the recommendations made so that members knew if their concerns had been listened to. A five-year timeframe was considered timely for such a review. An evaluative approach was used in August 2015 sourcing data from both public and private domains from 2010 to 2015 to identify, and not appraise or critique, how the AASW had responded to the recommendations in the 2010 review. This is in acknowledgment that there may be other reasons influencing changes made and that these may not be a direct response to the 2010 survey recommendations. The study found that all recommendations made in the 2010 review were responded to by the AASW. [Author abstract]
Mood disorders
- Authors: Wilhelm, Kay , Alvarenga, Marlies
- Date: 2020
- Type: Text , Book chapter
- Relation: Mental health and collaborative community practice : An Australian perspective Chapter 4 p. 628-661
- Full Text: false
- Reviewed:
- Description: Mental Health in Australia is the go-to reference on mental health for students, academics and practitioners. With a new four part structure, the book thoroughly covers the current context of mental health, clinical practice principles, and the assessment and management of mental health disorders. Taking a cross-disciplinary approach, Mental Health in Australia reflects a wide range of opinions and perspectives in the field of mental health care. This approach also allows the text to be used throughout a degree and into professional practice. Authoritative and up-to-date, Mental Health in Australia is the most comprehensive Australian book on mental health on the market.
Video game addiction, engagement and symptoms of stress, depression and anxiety: The mediating role of coping
- Authors: Loton, Daniel , Borkoles, Erika , Lubman, Dan , Polman, Remco
- Date: 2016
- Type: Text , Journal article
- Relation: International journal of mental health and addiction Vol. 14, no. 4 (2016), p. 565-578
- Full Text: false
- Reviewed:
- Description: A number of studies have reported a co-occurrence between video game addiction and poorer mental health, but few have contextualised this relationship by identifying mediating variables. Further, there remains uncertainty in how to differentiate high engagement from what may be termed addiction in the context of video gaming. This study examined the mediating role of coping between one measure of video game addiction and engagement, and mental health. An international sample of 552 adult participants (M age 24.9 years, 52.3 % Australian) completed an online survey including the Computer Addiction-Engagement Scale (CAES), Depression, Anxiety Stress Scale (DASS-21) and Approach/Avoidance Coping Questionnaire (BACQ). Multiple mediation analysis showed that coping explained a significant portion of the relationship between video game addiction and symptoms of depression, anxiety and stress. However, even after accounting for coping, a direct relationship remained. Video game engagement, on the other hand, indicated full mediation with no direct connection to declined mental health, except in the case of anxiety. Less use of approach coping strategies and particularly more use of resignation and withdrawal coping strategies were related to poorer mental health. Gaming for distraction was unrelated to mental health. This study identified maladaptive coping as a partial explanation of the relationship between video game addiction and poorer mental health. Also, the findings provide validity for making a distinction between video gaming engagement and addiction. Highly engaged gamers with maladaptive coping styles may be more vulnerable to developing video game addiction.
MAM : a metaphor-based approach for mental illness detection
- Authors: Zhang, Dongyu , Shi, Nan , Peng, Ciyuan , Aziz, Abdul , Zhao, Wenhong , Xia, Feng
- Date: 2021
- Type: Text , Conference paper
- Relation: 21st International Conference on Computational Science, ICCS 2021 Vol. 12744 LNCS, p. 570-583
- Full Text:
- Reviewed:
- Description: Among the most disabling disorders, mental illness is one that affects millions of people across the world. Although a great deal of research has been done to prevent mental disorders, detecting mental illness in potential patients remains a considerable challenge. This paper proposes a novel metaphor-based approach (MAM) to determine whether a social media user has a mental disorder or not by classifying social media texts. We observe that the social media texts posted by people with mental illness often contain many implicit emotions that metaphors can express. Therefore, we extract these texts’ metaphor features as the primary indicator for the text classification task. Our approach firstly proposes a CNN-RNN (Convolution Neural Network - Recurrent Neural Network) framework to enable the representations of long texts. The metaphor features are then applied to the attention mechanism for achieving the metaphorical emotions-based mental illness detection. Subsequently, compared with other works, our approach achieves creative results in the detection of mental illnesses. The recall scores of MAM on depression, anorexia, and suicide detection are the highest, with 0.50, 0.70, and 0.65, respectively. Furthermore, MAM has the best F1 scores on depression and anorexia detection tasks, with 0.51 and 0.71. © 2021, Springer Nature Switzerland AG.
Sustaining work participation across the life course
- Authors: Pransky, Glenn , Fassier, Jean-Baptise , Besen, Elyssa , Blanck, Peter , Ekberg, Kerstin , Feuerstein, Michael , Munir, Fehmidah , Boot, C.R.L.
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Occupational Rehabilitation Vol. 26, no. 4 (2016), p. 465-479
- Full Text: false
- Reviewed:
- Description: Introduction Many disability prevention strategies are focused on acute injuries and brief illness episodes, but there will be growing challenges for employers to manage circumstances of recurrent, chronic, or fluctuating symptoms in an aging workforce. The goal of this article is to summarize existing peer-review research in this area, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long sponsored collaboration that ultimately led to an invited 3-day conference, “Improving Research of Employer Practices to Prevent Disability”, held October 14–16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the scientific and industry literature, group discussion to identify key areas and challenges, drafting of initial documents, and feedback from peer researchers and a special panel of experts with employer experience. Results Cancer and mental illness were chosen as examples of chronic or recurring conditions that might challenge conventional workplace return-to-work practices. Workplace problems identified in the literature included fatigue, emotional exhaustion, poor supervisor and co-worker support, stigma, discrimination, and difficulties finding appropriate accommodations. Workplace intervention research is generally lacking, but there is preliminary support for improving workplace self-management strategies, collaborative problem-solving, and providing checklists and other tools for job accommodation, ideas echoed in the literature directed toward employers. Research might be improved by following workers from an earlier stage of developing workplace concerns. Conclusions Future research of work disability should focus on earlier identification of at-risk workers with chronic conditions, the use of more innovative and flexible accommodation strategies matched to specific functional losses, stronger integration of the workplace into on-going rehabilitation efforts, and a better understanding of stigma and other social factors at work.
Anti-stigma initiatives for mental health professionals—a systematic literature review
- Authors: Sreeram, Anju , Cross, Wendy , Townsin, Louise
- Date: 2022
- Type: Text , Journal article , Review
- Relation: Journal of Psychiatric and Mental Health Nursing Vol. 29, no. 4 (2022), p. 512-528
- Full Text:
- Reviewed:
- Description: What is known on the subject?: Negative attitudes towards mental illness lead to the formation of stigma. Stigma prevents the recovery of people diagnosed with mental illness. There is evidence of stigmatic attitudes towards mental ill health among mental health professionals. Anti-stigma initiatives, such as education and training, may be effective in enhancing or maintaining positive attitudes towards mental illness among mental health professionals. What this paper adds to existing knowledge?: Education and training that is designed and delivered around a specific mental health diagnosis or condition appears an appropriate strategy that could benefit mental health professionals to develop a deeper appreciation and understanding of mental ill health and its impacts on individuals. Consumer involvement in the education and training of mental health professionals regarding the stigma of mental illness is recommended; however, this is an under-explored area of investigation. There is a weak evidence base regarding the long-term sustainability of effects from anti-stigma education and training. This should be addressed via further research in future. What are the implications for practices?: Anti-stigma initiatives can support mental health professionals to develop stigma-free, recovery-oriented practices in their work. Further, such initiatives can improve the provision of evidence-based quality care for the consumers, facilitating their recovery. Abstract: Introduction Despite an increasing focus on stigma, evidence shows prejudicial attitudes towards mental illness among mental health professionals still exist. It is suggested that anti-stigma initiatives can aid in enhancing the attitudes of mental health professionals. However, research on initiatives targeting stigma of mental illness among mental health professionals is limited. Aim To identify and analyse scientific literature pertaining to the effectiveness of anti-stigma initiatives regarding mental ill health among mental health professionals. Method A systematic literature review was performed using the databases MEDLINE, CINAHL, PsycINFO, PubMed, Scopus, Google Search engine and Google Scholar. The papers were limited to English language, published in peer-reviewed journals with full-text articles available and published between the years 2008 and 2020 to understand the most recent trends in the attitudes of mental health professionals including nurses. The Population, Intervention, Comparison and Outcome (PICO) strategy was used to identify papers meeting the inclusion criteria. Results A total of 439 papers were identified. However, papers not meeting the inclusion criteria were excluded from selection. Three appraisers reviewed the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. Finally, eight unanimously accepted papers were included in the systematic review. Several effective anti-stigma initiatives were identified through the review, and these had positive impacts on mental health professionals’ attitudes towards mental illness, for at least a short period. It was identified that contact-based interventions are relevant and effective although the involvement of consumers and caregivers in the design and delivery of interventions was not explicitly addressed in detail in studies included in the review. Education strategies tailored for specific mental illness may be more appropriate, rather than approaches that refer to mental illness in general. Conclusions This review shows the evidence of pessimistic attitudes towards mental illness persists among mental health professionals. Anti-stigma initiatives identified in the selected papers were effective in changing these attitudes. Future research should be focused on the effectiveness of contact-based interventions and understanding the longer-term effects of the interventions among homogeneous groups. Full consideration of the varying level of clinical experience and expertise in mental health should guide the development and implementation of anti-stig a initiatives in this context. Implications for practice Anti-stigma interventions can have a positive impact on mental health professionals’ knowledge, attitudes and supportive caring for people diagnosed with mental illness. Such anti-stigma interventions may meaningfully support stakeholders to address the impact of negative attitudes on the physical and mental health status of people diagnosed with mental illness. With sustained leadership, effort and reinforcement, it is possible to create workplace cultures that prioritize stigma-free and recovery-oriented behaviours and practices within mental health services. © 2022 John Wiley & Sons Ltd.
Improving the physical health of young people with early psychosis with lifestyle interventions : scoping review
- Authors: Hui, Ting , Garvey, Loretta , Olasoji, Michael
- Date: 2021
- Type: Text , Journal article , Review
- Relation: International Journal of Mental Health Nursing Vol. 30, no. 6 (2021), p. 1498-1524
- Full Text: false
- Reviewed:
- Description: People with mental illness experience a shorter life expectancy compared to the general population. Poor physical health trajectory emerges following the onset of psychosis and is further compounded by the initiation of antipsychotic treatment. Young people are particularly at risk as the onset of mental illness mostly occurs between the age of 12 and 25 years. This represents a crucial period for early intervention to prevent a physical ill health trajectory. Furthermore, those who are at ultra-high risk for psychosis should also be targeted for early intervention. Lifestyle interventions have been identified as the first-line physical health promotion practice for improving the physical health of people with severe mental illness. The aim of this study was to conduct a scoping review following the JBI methodological guidance on scoping reviews to explore the current literature on lifestyle intervention trialled for early psychosis, including first-episode psychosis and those who are at ultra-high risk for psychosis. This review also explores the extent of literature examining physical health literacy in this specific population. The literature search was conducted on Medline, Embase, PsycINFO and Scopus. Twenty-two studies were included for the purpose of this scoping review, 21 of which examined the effects of lifestyle interventions and one of which reported on physical health literacy. This scoping review indicates the need for co-designed lifestyle interventions with the involvement of service users, families and carers and a focus on promoting physical health literacy, social support, and an incorporation of a health behaviour change model focus on promoting autonomous motivation. The findings of this study can inform future development of a novel co-designed lifestyle intervention for the targeted population. © 2021 John Wiley & Sons Australia, Ltd
Mental health nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient psychiatric units : a non-participant observation study
- Authors: Sreeram, Anju , Cross, Wendy , Townsin, Louise
- Date: 2023
- Type: Text , Journal article
- Relation: International Journal of Mental Health Nursing Vol. 32, no. 4 (2023), p. 1112-1128
- Full Text:
- Reviewed:
- Description: National mental health policies accentuate the importance of having positive attitudes, skills, and knowledge among mental health professionals to facilitate recovery-oriented practices in all areas of mental health care. However, evidence suggests that mental health professionals' negative attitudes towards mental illness are still evident and that recovery-oriented practice in acute inpatient units may be poorly implemented. At the same time, there is also a paucity of research to understand Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice specifically. Therefore, this non-participant observation study aimed to explore Mental Health Nurses' attitudes towards mental illness and recovery-oriented practice in acute inpatient units by observing the interactions between the consumers and nurses. The Mental Illness Clinicians Attitudes Scale-v4 and The Recovery Attitudes Questionnaire inspired the development of a non-participant observation chart for this study and the observations were recorded on the chart. Six observations were conducted in three acute inpatient units. Observations focused on Mental Health Nurses' knowledge about mental illness, communication, dignity, respect, anxiety, fear, punishment, facilitation of real choices for consumers, physical care, cooperation with consumers' families and others and recovery orientation. Interpretive descriptive analysis was used to analyse the data. The results show that Mental Health Nurses generally have positive attitudes towards mental illness and recovery-oriented practice. Some deficits in the physical care of people with mental illness in the acute inpatient units were observed. Therefore, future research could address the adequate preparation of Mental Health Nurses to provide physical care to people with mental illnesses. © 2023 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.