The exploitation-exploration (EE) trade-off describes how, when making a decision, an organism must often choose between a safe alternative with a known pay-off, and one or more riskier alternatives with uncertain pay-offs. Recently, the concept of the EE trade-off has been extended to the examination of how organisms distribute limited attentional resources between several stimuli. This work suggests that when the rules governing the environment are certain, participants learn to "exploit" by attending preferentially to cues that provide the most information about upcoming events. However, when the rules are uncertain, people "explore" by increasing their attention to all cues that may provide information to help in predicting upcoming events. In the current study, we examine how uncertainty affects the EE trade-off in attention using a contextual two-armed bandit task, where participants explore with both their attention and their choice behavior. We find evidence for an influence of uncertainty on the EE trade-off in both choice and attention. These findings provide support for the idea of an EE trade-off in attention, and that uncertainty is a primary motivator for exploration in both choice and attentional allocation.

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Objective: To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. Methods: We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. Results: People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. Conclusion: Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.

This is a conceptual replication of Stage 1 training of Experiment 2 of Beesley et al. (2015), and a companion report to Walker et al. (Submitted).

Adults with intellectual disability have high health care needs. Despite frequent contact with health services, they often receive inadequate health care. One method to improve health care delivery is reasonable adjustments, that is, the adaptation of health care delivery such that barriers to participation are removed for the person with disability. A starting point for the provision of reasonable adjustments is recognition of intellectual disability during the health care contact. To determine rates and predictors of the recognition of intellectual disability during hospital admissions, and its impact on admission metrics, we examined a population of adults with intellectual disability identified from disability services datasets from New South Wales, Australia between 2005 and 2014. Recognition of intellectual disability was determined by the recording of an International Classification of Diseases 10th revision (ICD-10) diagnostic code for intellectual disability during a given hospital admission. We examined how recognition of intellectual disability related to length of hospital episodes. We found an overall low rate of recognition of intellectual disability (23.79%) across all hospital episodes, with the proportion of hospital episodes recognising intellectual disability decreasing from 2005–2015. Admissions for adults with complex health profiles (e.g., those with many comorbidities, those with Autism Spectrum Disorder, and those admitted for urgent treatment) were more likely to recognise intellectual disability, but admissions for adults with complexity in other domains (i.e., for those in custody, or those with drug and alcohol disorders) were less likely to recognise intellectual disability. Recognition of intellectual disability was associated with longer episodes of care, possibly indicating the greater provision of reasonable adjustments. To improve the recognition of intellectual disability for adults during health service contacts, we advocate for the implementation of targeted initiatives (such as a nationwide disability flag to be included in health service records) to improve the provision of reasonable adjustments.

The exploration/exploitation trade-off (EE trade-off) describes how, when faced with several competing alternatives, decision-makers must often choose between a known good alternative (exploitation) and one or more unknown but potentially more rewarding alternatives (exploration). Prevailing theory on how humans perform the EE trade-off states that uncertainty is a major motivator for exploration: the more uncertain the environment, the more exploration that will occur. The current paper examines whether exploratory behaviour in both choice and attention may be impacted differently depending on whether uncertainty is onset suddenly (unexpected uncertainty), or more slowly (expected uncertainty). It is shown that when uncertainty was expected, participants tended to explore less with their choices, but not their attention, than when it was unexpected. Crucially, the impact of this "protection from uncertainty" on exploration only occurred when participants had an opportunity to learn the structure of the task prior to experiencing uncertainty. This suggests that the interaction between uncertainty and exploration is more nuanced than simply more uncertainty leading to more exploration, and that attention and choice behaviour may index separate aspects of the EE trade-off.

Peer mentoring programs are typically designed to support students transitioning into university. However, recent work has highlighted the importance of supporting transitions through and out of university. The Australian psychology honours year is a particularly stressful period that involves transitioning through university into the research environment and is soon followed by transitions into the workforce or postgraduate study. The School of Psychology at the University of New South Wales, Australia (UNSW) recently developed a graduate/honours peer mentoring program. Pairs of PhD students mentor small groups of honours students in monthly meetings, discussing various aspects of honours and career options. Most honours students sign up for mentoring and evaluation results show that mentees find the program helpful, most frequently acknowledging that their mentors helped them with general advice and understanding their career options. Peer mentoring can therefore support psychology student transitions through and out of university.