In the developing CNS, GABA A responses switch from early excitation to late mature inhibition. The developmental factors that induce the polarity switch remain to be unraveled. Here, we bring the first experimental evidence in vivo in the retina that chronic activation of GABA A receptors is necessary for the switch to occur and for the chloride extrusion mechanism (through the K ϩ /ClϪ cotransporter KCC2) to develop. Using a turtle model and calcium imaging, we investigated how chronic blockade of GABA A receptors with bicuculline during the period of the GABAergic polarity switch (from 1 week before hatching until 4 weeks after hatching) influences developmental changes in the patterns of spontaneously generated electrical activity in the retinal ganglion cell (RGC) layer. During that period, spontaneous activity normally switches from propagating waves to stationary patches of coactive cells, until correlated activity completely disappears. These changes in activity patterns coincide with the switch of GABA A responses from excitation to inhibition. When GABA A receptors are chronically blocked, GABA A responses remain excitatory and spontaneous waves keep propagating across the RGC layer. Concomitantly, the developmental upregulation of KCC2 is inhibited on dendritic processes in the inner plexiform layer, suggesting that the intracellular concentration of chloride remains higher, as in younger cells. This study presents the first demonstration in vivo that GABA autoregulates its developmental polarity switch, emphasizing the importance of GABAergic activity in controlling activity patterns in the maturing retina.

Regional integrated service planning has been identified as a key priority for improving the mental health system in Australia. The National Mental Health Service Planning Framework (NMHSPF) is an integrated planning tool that estimates the resources required to deliver the optimal mix of mental health services to a population. In 2016, Queensland Health commissioned a trial application of the NMHSPF for joint mental health planning between a Primary Health Network (PHN) and the corresponding state Hospital and Health Services (HHSs) in a regional area. The aim of this work was to collaborate with stakeholders from each organisation to collect available data on the delivery and resources of existing mental health services in the region and compare these to NMHSPF estimates to identify potential priority areas for planning. This paper provides mental health planners with an exemplar model for using the NMHSPF to support integrated planning at the regional level and describes the barriers, facilitators and key outcomes of this work.

The Health Ministers of all Australian States, Territories and the Commonwealth endorsed a National Mental Health Policy in April 1992. This Policy is intended to set a clear direction for the future development of mental health services within Australia. The Policy recognises the high prevalence of mental health problems and mental disorders in the Australian community and the impact of these on consumers, carers, families and society as a whole. It also clearly accepts the need to address the problems confronting the promotion of mental health and the provision of mental health services.

Objective: Severe, persistent and complex mental illness (SPCMI) affects a small proportion of young people but is associated with severe disability and a large burden on families and health services. This article identifies and describes service models for adolescents and young adults with SPCMI. Methods: A systematic search was conducted for services for young people aged 12–25 years with SPCMI. The review sought service models providing extended care and/or multidisciplinary services to meet the complex and long-term needs of this population. Results: A total of 43 sources were identified. Evidence of effectiveness was found for both community- and bed-based services. Specific components suggested as important in service delivery included care provided by multidisciplinary teams, consumer and family involvement in care planning, intensive case management and service integration through the continuum of care. Conclusion: Clinical frameworks for this population must incorporate effective community care integrated with inpatient treatment of short duration. Frameworks require consumer and family-centred care with flexibility to support progression through developmental stages and tasks while addressing issues related to risk management, fluctuation in illness severity and stages of recovery. A continuum of care is necessary to meet the needs that arise from SPCMI in adolescents and young adults.