The New England Framework, based on 50 years combined clinical practice, has been recently consolidated as an adaptation of the United Kingdom's 'Improving Access to Psychological Therapies' to include physical conditions. Founded on a collaborative approach in helping, health workers assist individuals to select and use self-administered cognitive and behaviourally based (CB) interventions specific to health problems. Heart disease and depression are the leading causes of disability worldwide. Obesity, diabetes, renal disease, respiratory conditions, chronic pain and addictions constitute another large percentage of suffering. Cognitive behavioural therapy (CBT) is the most effective non-pharmacological evidence-based treatment for most of all mental disorders and a wide range of physical health conditions. While CBT was originally developed as a self management tool to help reduce the negative impact that particular thinking and behaving patterns have on health, it evolved into a specific domain practice of professionals. Because of this, access to CBT has been impeded because of lack of available help, cost of treatment and time required - issues compounded for rural populations. With the rapid expansion of freely available online, virtual and print-based CBT, the value of self-directed minimal-assisted first-line treatments has been established.

Alula Tarif's daughter, Leila, had called the community mental health clinic to request an evaluation for her mother. She said that she and her older brother live with her mother and that - though her brother does not think that there is anything wrong with their mother - she has become very worried about her mother's increasing complaints of fatigue, lack of energy, and loss of interest in life. She had bought her mother some multi-purpose vitamins, but when she did not seem to improve, she had taken her mother to the primary care physician, who recommended that she be evaluated at the community mental health clinic. When Leila called for an appointment, she said that it was very important that her mother be seen by a woman doctor. An appointment was arranged with a female psychiatric nurse practitioner. Alula Tarif enters the examining room hesitantly, holding the arm of her daughter, Leila. She is dressed in a black long skirt and long-sleeved loosely fitting tunic top and is wearing a headscarf that covers her hair and forehead. She appears much older than her stated age of 43 years. Her face is lined and there are dark circles under her eyes. She does not make eye contact and appears very anxious. She responds to the nurse's greeting with a nod. Leila explains that her mother speaks Kurdish, and although she understands a little English, she does not speak much English. The nurse asks Mrs. Tarif if she would like to have her arrange for an outside interpreter. When Leila translates the question, Mrs. Tarif becomes very agitated and prepares to leave unless Leila can stay and interpret for her.

Saudi Arabia has prioritised health care, resulting in an excellent health care system for the country. Improvements, however, have been hindered by a serious shortage of qualified nurses. This can be attributed to the poor image of nursing held in Saudi Arabia and across the Middle East because of cultural and religious believes. In this context Saudi Arabia has looked overseas for qualified nurses. However the employment of overseas qualified nurses in Saudi Arabia has given rise to challenges for both to the health care system and the nurses themselves. This study aimed to explore the problems and challenges experienced by a group of Overseas Qualified Nurses (OQNs) who had worked in the King Fahad Medical City for a period of more than two years. The study employed a qualitative, phenomenological design to assist in understanding the experiences of twenty-three (23) OQNs nurses who provide nursing care to Saudi patients. Thematic analyses were used as the data analysis technique.

In this study, an aspect of psychodrama, a little-known, action-oriented form of group psychotherapy, will be examined. Psychodrama was founded by the psychiatrist Dr Jacob Moreno in the 1920s, and was regarded as a major alternative to Freudian psychoanalysis in the United States of America during the 1930s and 1940s. Today, although practised worldwide, psychodrama has been overshadowed by less action-oriented and more talking-oriented, non-psychoanalytic psychotherapies, and therefore lacks visibility. Further, due to a lack of outcome research published in scholarly journals, it is not being included among evidencedbased psychotherapies.

Reviews of outcome studies published between 1970 and 2016 have shown that psychodrama researchers regard the single psychodrama enactment as the basic therapeutic unit, while other group psychotherapies regard the whole multi-session group process as such. Although some psychodrama researchers acknowledge the possible influence of group process on psychodrama outcomes, none have studied this influence. The reviewers saw this as a gap in the research. They also noted that no researcher has mentioned client psychosocial themes that arise during single enactments or during multi-session psychodrama groups.

This study examined the development of client psychosocial themes in a multisession psychodrama group, and used Young’s early maladaptive schema (EMS) framework to assess these themes. A collective case study approach was used with both within-case and across-case data being analysed. As no other universally accepted theme theoretical framework exists, schemas—which comprise cognitive, affective and somatic elements—were used to assess psychosocial themes. Young’s EMS framework was chosen because it offered an accepted, standardised system of naming and defining schemas, and his EMS questionnaires have been shown to be valid and reliable.

Ethics approval was obtained to video-record a multi-session psychodrama group that ran for nine three-hour sessions over three consecutive days. There were nine participants. The psychodramatist and group leader was a registered psychotherapist accredited with the Australian and Aotearoa New Zealand Psychodrama Association (AANZPA). The researcher was not present in the group.

The group leader, who was recruited through an email sent from the AANZPA research committee to its members, recruited participants from among his clients and psychodramatist trainees. All participants consented to being video-recorded for research purposes. The contents of each video-recorded session were catalogued in detail. Researcher-developed schema rating sheets based on Young’s EMS were used to assess and record each client’s schemas arising in psychodrama enactments. Two raters completed the assessment separately and achieved significant inter-rater agreement.

A qualitative descriptive approach was used to analyse the within-case and across-case data. Due to the paucity of multiple enactments for most participants, it was not possible to examine within-case schema development. However, it was possible to examine across-case data for the nine sessions as a whole.

The data was also examined as possible support for Moreno’s assertion that there is a deficit of spontaneity among people in the civilised world. He saw spontaneity as a pre-requisite to finding new solutions to old, dysfunctional, psychosocial problems and adequate solutions to new ones, in a creative way. The occurrence of the emotional inhibition schema in 92% of enactments supported his assertion.

The data was also examined to assess whether the psychodramatic techniques of doubling, mirroring and role-reversal effectively reduced emotional inhibition and increased spontaneity. Most enactments demonstrated this through a reduction of dysfunctional interpersonal behaviours and increase in new functional ones. Transcripts of three enactments are provided to support this. This change did not occur as strongly as a result of member-to-member group interaction outside the enactments. The next most frequently occurring schemas came from the disconnection and rejection domain, which had implications for the participants’ ability to establish and maintain intimate relationships.

This study is significant for future research into the connection between the therapeutic effects of psychodrama and group process, and moves psychodrama closer to becoming accepted as evidence-based. It will also add to the knowledge and skill base of psychodrama practitioners.

The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. 'Methods': Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. 'Results': Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. 'Conclusions': The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable and sustainable link between students, health care professionals, community based organisations, the university, and the community. The community benefits from the clinic by learning to self-manage health and wellbeing issues. The benefits for students are that they gain practical experience in an interdisciplinary setting and through exposure to a community with unique and severe needs.

In this chapter, I describe why Benner's insights on human experience are important for understanding psychiatric phenomena. Her stance critiques narrow decontextualized views of what constitutes illness and honors the experiences of individuals and communities who confront and live through challenges. In psychiatry such experiences that become problematic are most often reduced to a list of symptoms, disorders, and technical terms and can obscure personal and collective coping possibilities. In this chapter, diagnoses of Post-Traumatic Stress Disorder (PTSD), Seasonal Affective Disorder (SAD), and schizophrenia are used to illustrate the dangers of classification systems generally - and why the interpretive approach developed by Benner and colleagues paves the way to restoring human connections that can preserve dignity and worth that is necessary for health and healing. The research excerpts spotlighted in this chapter point to the iatrogenic nature and trend of the diagnostic culture of psychiatry. Undoubtedly, diagnoses can bring meaning to experiences and join individuals in suffering. However, they can also serve to disconnect individuals and communities when the meanings are based on the deficit view of the person or persons. This view undermines personal and collective strength and cultural resilience and coping practices.

In this paper we describe the development of the New England 4G Framework of Guided Self-health including rural health and workforce issues, models of care, and the United Kingdom's (UK) 'Improving Access to Psychological Therapies' (IAPT) initiative from which the Framework was derived. With a long history in the UK of CBT delivery by workforces such as mental health nurses, we have adapted the IAPT model to fit rural environments of Australia and included physical as well as mental health conditions as part of a low intensity approach to helping. Health workers in the New England Framework assist individuals to select and use self-administered cognitive and behaviorally-based (CB) interventions specific to health problems. The worker in the New England Framework goes beyond dispensing health information or brokering services and guides the person to identify a specific problem and make change. The framework includes information gathering information, generating a CB plan, giving self-health materials and guiding with follow-up.

James is a 27-year-old Caucasian male who presented at interview with expansive mood. Affect was friendly, engaging, and initially appropriate to words. He appeared well groomed, tall, and very muscular, wearing clean, expensive name-brand athletic wear, jeans, and sneakers. He was tanned, with large dark eyes and long eyelashes, highlighted by a single, blackish-blue, teardrop-shaped tattoo under one eye. (Interviewer aware that literature shows that some gang members have one tattooed teardrop under their eye as a symbol for each person's life they have taken.) James reported that last month he had been court ordered to go to counseling but skipped a few appointments, as he believed he knew more about life than the counselor. In a matter-of-fact way, he stated that because he missed counseling and had a fight with the mother of his 4-year-old son, he was arrested. He then presented as very remorseful, with intrusive eye contact, and stated, "The judge told me I had to resume counseling, so I'm ready to work on improving myself." He then leaned forward in his chair and stated, "I was in a gang for awhile but I gave up that life for the sake of my son."