New evidence has linked physical activity with improved colon health, underscoring the vital role of exercise in cancer prevention and care.

The landmark international trial – the Challenge study – showed that structured exercise programmes can dramatically improve survival rates for colon cancer survivors.

The study was unveiled at the meeting of the American Society of Clinical Oncology. Each June, cancer specialists from around the world convene in Chicago for the conference where new research is announced that pushes the boundaries of cancer treatment and this year’s conference featured a wealth of exciting discoveries.

Conducted across six countries and published in the New England Journal of Medicine, the Challenge study tracked 889 patients for several years following chemotherapy. Participants were randomly assigned to one of two groups: one received standard post-treatment care, while the other took part in a three-year coaching programme that included personalised exercise plans and regular check-ins with fitness professionals.

The results were striking. Those in the exercise group experienced 28% fewer cancer recurrences and 37% fewer deaths.

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In the programme, people slowly built up how much they exercised, with most choosing to go on brisk 45-minute walks four times a week. Ninety per cent of the people who exercised stayed cancer free for five years, compared with just 74% of those who didn’t.

This study provides the first strong evidence that exercise not only correlates with better outcomes but directly improves survival rates in cancer patients. While earlier observational studies found a link between being active and better cancer outcomes, this first randomised controlled trial helps show causation, meaning that exercise can directly benefit the survival of cancer patients.

We don’t know yet if the same goes for other cancers like breast, prostate or lung, but it’s a big step forward.

The programme’s success hinged on consistent support. Participants met with fitness coaches every two weeks at first, then monthly, which helped them stick to their routines even after treatment ended.

While minor injuries such as muscle strains were slightly more common among those who exercised (19% compared to 12% in the control group), researchers emphasised that these issues were manageable and far outweighed by the significant survival benefits.

Potential downsides to exercise?

In contrast to the encouraging findings on structured exercise, a separate study presented in Chicago has raised questions about the potential downsides of extreme endurance training.

Researchers tracking marathon runners found a higher rate of polyps (small growths in the colon that can sometimes develop into cancer) compared with the general population. This unexpected finding has sparked a fresh debate about the effect of high-intensity exercise on long-term colon health.

However, context is needed. The study did not find higher cancer rates among runners, and most of the detected polyps were low risk.

Several possible explanations have been offered: endurance athletes may simply undergo more frequent screenings, leading to increased detection, or intense exercise might temporarily raise inflammation markers. Crucially, the overall risk of cancer remains lower in active people than in those who are more sedentary, reinforcing the well-established protective benefits of regular exercise.

This apparent contradiction highlights the medical community’s evolving understanding of the “dose” of physical activity. While moderate exercise is consistently linked to significant health benefits, emerging data from endurance athletes suggests that extreme, high-intensity training may place different kinds of stress on the body’s systems.

Researchers also suggest that factors such as dehydration during long-distance runs, changes in gut function, or the use of certain nutritional supplements common among endurance athletes could play a role in polyp development. These findings don’t diminish the well-documented benefits of physical activity, but instead point to the importance of personalised, balanced health strategies.

For cancer survivors, the structured exercise study provides a message of practical hope. Participants aimed for the equivalent of about three hours of brisk walking per week, gradually increasing their activity levels over time.

The programme’s social support was key, with fitness coaches helping participants tailor their routines to match their abilities and recovery needs.

Exercise is believed to affect key biological processes – including insulin sensitivity, inflammation and immune function – that play important roles in cancer development and progression. Ongoing research is analysing participants’ blood samples to better understand these mechanisms and eventually create personalised exercise “prescriptions” based on an individual’s genetic profile.

While the findings from marathon runners are less conclusive, they still offer practical takeaways. The research suggests that although vigorous exercise is generally beneficial, high-intensity athletes may face a higher risk of developing polyps and should therefore consider regular colonoscopies as a precaution.

For the general public, these findings reinforce that combining moderate exercise with timely screenings offers the best protection against colon cancer, a disease that remains the fourth most common worldwide and is alarmingly increasing among young people.

For both patients and athletes, these findings highlight a central truth: movement matters, but the right approach is crucial. Colon cancer survivors now have proven tools to reduce recurrence through structured exercise, while endurance enthusiasts gain motivation to pair their training with preventative care.

As science continues unravelling the intricate dance between activity and biology, one message remains clear: whether recovering from illness or chasing personal bests, informed exercise combined with medical guidance is the most reliable path to long-term health.

Justin Stebbing, Professor of Biomedical Sciences, Anglia Ruskin University

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Three and a half years ago, then-sex discrimination commissioner Kate Jenkins’ Set the Standard report was handed to federal parliament, commissioned after Brittany Higgins’ allegations of sexual assault in Parliament House, which had shocked the public and politicians alike. Since then, work has been underway to implement its 28 recommendations.

The report found unacceptable levels of sexual harassment, bullying and misconduct in parliamentary workplaces, and laid out a radical plan to create a standards regime. The plan would provide tools to deal with such conduct, and try to prevent it by changing the culture of parliament.

In 2025, parliament’s implementation of the Jenkins review is due to be evaluated by an external independent reviewer. Have the recommendations been implemented? What are the prospects for continued reform of conduct in the parliamentary workplace? Will the election of an historic number of women into parliament create pressure for further reform?

Action after the review

On February 8 2022, the first sitting day of federal parliament after the Jenkins review had been handed down, both houses of parliament made an historic statement of acknowledgement and apology to the victims of misconduct in its workplace. It stated:

We say sorry. […] This place and its members are committed to bringing about lasting and meaningful change to both culture and practice within our workplaces. We today declare our personal and collective commitment to make the changes required.

Parliamentarians committed to implement all 28 recommendations of the Jenkins review. A cross-party body was created to lead the implementation process.

Known as the Parliamentary Leadership Taskforce, it had members from both houses of parliament, ministers and legislators, Labor, the Coalition, the Greens and one independent parliamentarian. It worked hard for three years to design and put in place the rules and mechanisms laid out in the Jenkins review, before disbanding in September 2024.

The magnitude of the changes parliament had to make should not be understated. Among many ground-breaking reforms, it involved developing codes of conduct and a body to enforce them by investigating complaints about breaches of the code.

In February 2023, both houses of parliament agreed on codes of conduct. In October 2024, an Independent Parliamentary Standards Commission was established to receive complaints, investigate and make findings about misconduct. There are seven commissioners, appointed from outside parliament, who are lawyers, former public servants, tribunal members and ex-ombudsmen. For the first time, there will be external independent review of parliamentarians’ conduct.

An independent human resources body for the parliamentary workplace was also created, known as the Parliamentary Workplace Support Service. These are huge achievements and represent historic reforms.

In line with Jenkins’ recommendations, the taskforce committed to an external independent review of parliament’s implementation of the Jenkins report.

But has it been effective?

It is hard to evaluate new rules, systems and bodies that are in their infancy, but one part of the new standards architecture does not represent best practice. After the Independent Parliamentary Standards Commission has completed an investigation of a parliamentarian’s conduct, made findings and recommended sanctions, it will hand its report to the privileges committee in each house.

The privileges committees are made up of parliamentarians, almost exclusively members of the major parties. It is up to these committees to decide on any action to be taken. We won’t know if they depart from the commission’s recommendations, as standards commission reports are not public.

In the United Kingdom House of Commons, which represents best practice in this area, independent investigation reports are handed to a parliamentary committee called the Committee on Standards. Half the members of that committee are MPs, but half are “lay members” – that is, appointed members of the community, including lawyers and HR professionals.

The House of Commons established its standards regime in 2018, and has reviewed and improved it over time. Lay members were placed on the committee because it was evident MPs found it difficult to judge the conduct of their peers and struggled to hold them accountable.

Unfortunately Australia’s new standards system leaves decisions in the hands of parliamentarians, without the corrective and robustness that members of the public would provide. Will the federal parliament continue to reform and reshape its arrangements if they prove not to be robust enough?

Ongoing leadership is needed if parliament is to continue to address conduct issues, drive culture change and refine and develop its new standards regime. Some believe the culture of parliament has improved since the Jenkins review. Others disagree.

There are still recommendations of the review that have not been addressed. These include developing a ten-year strategy to increase diversity in the workplace, establishing a health and wellbeing service in parliament, and introducing an alcohol policy. Now that the Parliamentary Leadership Taskforce has disbanded, who will continue to advance the reform process?

In October 2024, parliament decided to create a Parliamentary Joint Committee on Parliamentary Standards. Its functions include reviewing the operation of the new codes and the Independent Parliamentary Standards Commission.

This committee should play a leadership role on conduct and culture issues, but its membership is tightly restricted. The government dominates positions and all members must also be members of the privileges committees. Presiding officers are not permitted to sit on the committee, despite their important leadership roles and responsibilities in parliament. Crossbenchers and independent parliamentarians are largely locked out of the committee (only two positions are reserved for them), despite the fact they have often been the leading voices calling for culture change.

With the influx of many more women and new faces into the parliament after the election, there is an opportunity to press for continued reform and for membership of the joint committee to include diverse voices from across the parliament.

Maria Maley, Senior Lecturer in Politics, School of Politics and International Relations, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Toowong Private Hospital in Brisbane is the latest hospital to succumb to financial pressures and will close its doors next week. The industry association attributes the psychiatric hospital’s closure to insufficient payments from and delayed funding negotiations with private insurers.

Meanwhile, the future of Australia’s second-largest hospital provider, Healthscope, remains uncertain, after its parent company went into receivership last week.

Healthscope’s 37 private hospitals are being kept afloat with a A$100 million loan and will continue to operate for now. But the hospitals will be sold to repay lenders, so their future depends on who buys and what the new owners decide to do.

Across the board, private hospitals are struggling with soaring costs for staff and supplies, while private health insurance isn’t paying enough to cover these expenses.

These underlying issues will not disappear magically. More private hospitals will face similar financial troubles and some will be forced to close. But we’re unlikely to see the collapse of the entire private sector.

A mix of public and private

Australia operates a unique public-private health-care mix, with around 700 public and 647 private hospitals.

Public hospitals are largely government-owned and provide free care, funded by taxes. Private hospitals are owned and managed by private organisations, some of which are non-profit.

The private health-care sector plays a large role in Australia, providing 41% of all hospitalisations, however 74% are same-day stays.

Private hospitals are often smaller than public hospitals, without emergency departments, focusing on simpler, same-day care, and are more likely in cities. Some 83% of private hospitals are in metropolitan, 9% in regional centres and 8% in rural towns.

In contrast, 27% of public hospitals are in the major cities, 57% in regional areas and 16% in remote areas.

The role of private health insurance

Most people who access private hospitals have private health insurance or are covered by another system such as Veterans Affairs – otherwise private hospital care is too expensive and few can afford it.

In 2022-23, the total A$21.5 billion was spent on private hospitals. Private health insurance covered about 45% ($9.7 billion), which comes from members’ premiums. Patients contributed 11% ($2.4 billion) in out-of-pocket costs.

The government contributed a substantial 37% ($8 billion) mainly through Medicare. This is separate from the additional $8 billion the government provides annually as rebates to individuals for buying private health insurance.

A key issue is this rebate money doesn’t directly flow to private hospitals, leaving them vulnerable in negotiations with insurers, as we saw with Toowong Private Hospital.

Evidence suggests these rebates might not be the most effective government investment. Experts, including me, have argued for direct funding into hospitals instead.

So, as more private hospitals face troubles, what does this mean?

Less choice and access for patients

Patients will experience less choice and potentially harder access for specific types of care.

In larger metropolitan areas with numerous private and public hospitals (including private wings in public hospitals), patients might switch to other private facilities or seek care as private patients in public hospitals.

However, in smaller or rural areas with limited or no other private hospitals, choice diminishes significantly. In this case, you will need to reconsider whether you need to buy private health insurance.

Currently, people earning over $97,000 (or families over $194,000 face an additional Medicare Levy Surcharge if they don’t hold private health insurance.

This policy is not fair to those who have no access to private hospitals and should be changed.

While there might be slightly longer waits in the short-term for elective surgeries due to shifting patient loads, our analysis suggests this won’t be a major long-term problem. The primary constraint for wait times is often personnel, not facilities.

If private hospitals close, doctors and nurses could potentially shift to public hospitals, helping to alleviate staffing shortages and reduce overall wait times.

Impacts for the public system

The impact on public emergency departments will be minimal, as most private hospitals lack them.

Many private hospital admissions are same-day and for simpler procedures. So public hospitals and remaining private hospitals (that are not operating at full bed capacity) should be able to absorb this extra demand in the long run, if they can attract more staff previously employed (or even facilities) in the closing private hospitals.

These hospitals will also receive additional revenue for these additional procedures.

Consequently, the effect on public hospital wait times for most conditions should not be substantial.

However, some complex, long-stay, or specific mental health cases (such as those from Toowong) may be hard to absorb without additional supply of specialists and funding.

What about health budgets?

In areas where patients are absorbed into existing public hospital capacity or other private facilities, the direct impact on the health budget would be minimal.

With more patients, the remaining private hospitals may gain more power to negotiate better funding contracts with insurance companies and achieve better supplier costs through economies of scale.

In areas where private hospitals (or public hospitals offering private care) cease to be viable, and people drop their private health insurance cover to use public hospitals, the government would pay more directly into public hospitals. However, this increased cost would be partially offset by reduced expenditure on private health insurance rebates.

Patients would also save money on premiums and out-of-pocket costs in private hospitals, though they would lose the choice of private care.

Ultimately, where a private model isn’t financially sustainable, the government or taxpayers often end up bearing the cost anyway.

Investing more directly in public hospitals in these areas, rather than relying on inefficient rebates, could be a more effective solution.

Correction: an earlier version of this article said access to private hospitals requires private health insurance.

Yuting Zhang, Professor of Health Economics, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The federal government has launched a “rapid review” to look at what works to prevent bullying in schools.

Led by mental health experts, the review will underpin a new national standard to respond to bullying. This follows the death of a young Sydney school student last year.

It also comes as the Queensland government rolls out a A$33 million anti-bullying plan in the state’s schools.

As schools, parents and governments look at what more can be done to prevent bullying, we have to ask why children bully other kids.

If we understand the motives, we can help these children change their behaviour – and achieve their goals or have their needs met in other ways.

What lies behind bullying?

Research tells us children broadly bully for social reasons. For example, a 2022 study showed children can bully to gain social status among peers – to be seen as powerful, tough or cool. Or they can bully to maintain status as part of an in-group. Perhaps another child is seen as a “threat” to that status.

Children can also bully for revenge for perceived insults. Or for entertainment – making a joke at another student’s expense.

Research shows motivations can also differ depending on the type of bullying. For example, face-to-face bullying seems to involve more children who bully for social dominance, while those who cyberbully do it more for entertainment and “fun”.

In a 2014 study, Marilyn Campbell and colleagues asked different groups about their perceptions of why young people engaged in cyber-bullying. Parents said children did it out of revenge for being bullied themselves, teachers said students did it for fun, and students thought others cyber-bullied because of peer pressure.

This highlights how complex understanding children’s motives can be.

Children may not bully for long

We should be careful about thinking of all students who bully as long-term “bullies”.

Most children who bully try the behaviour and stop when it does not get them what they want, just as many children who are victimised are not bullied for long.

Though of course, even being bullied for a short time can still be damaging and traumatic for the student on the receiving end.

This could suggest there is a developmental phase in bullying as most bullying occurs between children in Year 6 through to Year 10.

However, there are those students who persistently bully others and these are the students whose behaviour remains a problem despite interventions and prevention approaches.

Who is more likely to bully?

There are certain personality types who are more likely to persistently bully others. These include:

• students with defensive personalities. This means they think very highly of themselves and actively seek attention but can’t take criticism

• students with narcissistic personalities, who are likely to become aggressive when their egos are threatened

• students who are emotionally unstable.

But research is mixed on the question of self-esteem. Some researchers say children who bully have high self-esteem, yet others have found they have low self-esteem.

There are many reasons why a child might develop the personality traits that would lead them to bully.

Physical abuse in childhood can play a role. There is an association between a child being exposed to domestic violence at home and then bullying their peers.

Parenting can also be a factor. For example, being overvalued but not well disciplined by parents can lead to higher traits of narcissism and a greater likelihood a child will bully.

What can we do?

Children who persistently bully may require targeted and nuanced approaches. Current approaches emphasise restoring positive relationships, rather than punishments or sanctions.

One approach is individual motivational interviewing. Here a school counsellor shows young people they can achieve their goals by other means. This encourages perpetrators to see there are more benefits in not bullying than in bullying. For example, “I want to be popular. But if I bully, I also make other kids scared of me and not want to hang around me.”

More broadly, schools can also teach explicit programs on social and emotional learning.

These programs focus on emotional intelligence and emotional literacy, enabling students to recognise and manage their emotions, understand the perspectives of others and have positive relationships with peers.

Schools which respect the diversity of students, are also better placed to address bullying. If all students have opportunities to participate in learning, it will develop their sense of belonging to their school community. This not only decreases rates of bullying but supports students who have been victimised.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14 or Kids Helpline on 1800 55 1800.

Marilyn Campbell, Professor, School of Early Childhood & Inclusive Education, Queensland University of Technology and Shannon O'Brien, PhD Candidate, School of Education, Queensland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In an emergency, police are often the first called to the scene. But they are rarely equipped to deal with complex mental health crises.

Following recent parliamentary inquiries and royal commissions there has been a push – led by researchers, advocates and some senior police officials – for a shift to a health-led and paramedic-first response.

South Australia is one of a number of states trialling a program based on a “co-responder” model. This means trained specialists accompany police to some mental health call-outs in the community.

So, how do co-responder programs work? And are they effective? Here’s what the evidence says.

The current situation

Mental health legislation in all states and territories gives police the power to use “reasonable force” to transport people who “appear to have a mental illness” to hospital to prevent harm.

In most cases, this involves police taking people experiencing mental health crises to hospital emergency departments, without help from mental health clinicians or paramedics.

Overburdened emergency departments have long wait times for mental health and are often inadequate at responding to people experiencing distress.

Those who need mental health support may not need a hospital stay.

One study found only one in five (23%) of those taken to emergency by police – usually after expressing intention to self-harm – were admitted.

The strain on police resources is also significant. For example, in New South Wales, police now respond to triple zero calls about mental health crises in the community every nine minutes (in Victoria it’s every ten).

Criminalising mental health

The mere presence of police alone can escalate already heightened emotional situations.

Police frequently lack training in mental health, with combative police culture and the militarisation of police training presenting significant problems.

Police often acknowledge they are ill-equipped to intervene in a mental health crisis.

Yet, about one in ten people who access mental health services have previously interacted with police.

These encounters can be risky and even deadly.

People who experience mental health issues are over-represented in incidents of police use of force and fatal shootings.

Police involvement can also lead to the criminalisation of people with mental health issues and disability, as they are more likely to be issued with charges and fines or be arrested.

Yet the main reason police take people to hospital is for self-harm or suicidal distress, and most are not deemed to be of risk to others.

What do people with mental health issues want instead?

In our research, conducted in 2021–2022, we interviewed 20 people across Australia who’d had police intervene when they had a mental health crisis.

Those we spoke to often had multiple experiences of police call-outs over their lifetime.

They told us excessive use of force by police had traumatising and long-term effects. Many were subject to pepper spray, tasers, police dogs, batons, handcuffs and restraints, despite not being accused of committing criminal offences.

For example, Alex*, said:

I was having an anxiety attack, and they pepper sprayed me. I had bruises all over my hands from the handcuffs they put on really roughly, even though I wasn’t under arrest. Then they took me to hospital.

In our study, people with mental health issues said they would prefer an ambulance-led response wherever possible, without police attending at all.

They also wanted to be linked to therapeutic and community-based services, including mental health peer support, housing, disability support and family violence services.

What are co-responder programs?

Co-responder programs aim to de-escalate mental health incidents, reduce the number of emergency department presentations and link people experiencing mental health crises with services.

These programs, such as the one being trialled in South Australia, mean mental health clinicians (for example, social workers, counsellors or psychologists) attend some mental health incidents alongside police.

Peer-reviewed research shows these kinds of responses can be effective when compared to traditional police-led interventions.

An evaluation of a co-response program in Victoria found the mental health response was quicker and higher quality than when police attended alone.

The success of programs in the United States and Canada shows many mental health crises can safely managed without police involvement, for example by addressing issues such as homelessness and addiction with health workers, and reducing the number of arrests.

Limited by a lack of resources

While the evidence shows co-responder schemes are valued by people with lived experience, they are often limited by under-resourcing.

Co-responder programs are not universally available. Often, they do not operate after usual business hours or across regions.

There is also a lack of long-term evaluations of these programs. This means what we understand about their implementation, design and effectiveness over time can be mixed.

More broadly, the mental health sector is facing significant and ongoing labour shortages across Australia, posing another resourcing challenge.

How can responses to mental health crises be improved?

Last year, the final report from the Royal Commission into Victoria’s Mental Health System recommended paramedics should act as first responders in mental health crises wherever possible, instead of police, diverting triple zero calls to Ambulance Victoria.

However that reform has been delayed, with no indication of when it may be implemented.

A 2023 NSW parliamentary inquiry also remarked on the need to explore reducing police involvement.

Co-responder and ambluance-first models offer an improvement.

But our research suggests people with lived experience of mental health issues want more than ambulances replacing the police as crisis responders.

They need a mental health system that supports them and provides what they needed, when they need it: compassionate, timely and non-coercive responses.

*Name has been changed.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Panos Karanikolas, Research officer, Melbourne Social Equity Institute, The University of Melbourne; Chris Maylea, Professor of Law, La Trobe Law School, La Trobe University, and Hamilton Kennedy, PhD Candidate, La Trobe Law School, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

On ABC’s 4 Corners this week, psychiatrists and nurses have warned New South Wales’ mental health system is in crisis. They report some patients with severe mental distress are waiting two to three days in emergency departments for care.

The program highlighted chronic failures in NSW’s mental health system, but the shortfalls are being felt across the nation.

Just over 7% of the nation’s health budget is spent on mental health. But together with alcohol and drug issues, mental health accounts for around 15% of the nation’s burden of disease.

Problems in mental health go beyond under-funding: it’s also about how the resources we do have are spent.

So how did we get here? And what can we do to fix it?

It wasn’t supposed to be like this

Back in the 1980s, psychiatric deinstitutionalisation promised to replace treatment provided in the old psychiatric institutions with mental health services and care in the community. Too often, these institutions failed to promote recovery, and delivered improper care and even abuse.

Many of these institutions were indeed closed. But the shift in mental health care over the past 40 years has not been from asylums to the community, but rather to the mental health wards of Australia’s general public hospitals and the emergency departments (EDs) which operate in them.

Hospitals are expensive and often traumatic places to provide mental health care. We know this from frequent statutory inquiries and reports.

For presentations to EDs, all the indicators are heading in the wrong direction. More people are seeking care for their mental health in EDs, they are arriving sicker (according to their triage category) and they wait longer for care.

Hospitals account for more than 80% of total state and territory spending on mental health. In 2022–23, A$6.5 billion of the states and territories’ total spend of $8bn on mental health was directed towards hospital-based care. Just $1bn was provided outside hospitals.

Evidence indicates community-based care can reduce reliance on EDs for mental health care.

Yet community mental health services now often comprise little more than a phone call to check if a client is taking their medication. Of the 9.4 million community mental health service contacts in 2022–3, 4 million lasted less than 15 minutes.

Mental health clinical staff spend just 20% of their time with consumers.

What are the solutions?

The solutions are already at hand, but haven’t been pursued or scaled up. These include:

• multidisciplinary models such as assertive community treatments, which provide mixed specialist clinical and psychosocial support in the community, in people’s homes

• service models the Australian College of Emergency Medicine have proposed as alternatives to hospital ED care. These include safe havens, mental health nurse liaison services and dedicated homelessness teams. These services can provide the care required to divert patients away from hectic emergency departments, in calmer, more therapeutic spaces

• NSW programs such as the Housing and Accommodation Support Initiative provide community based, clinical and psychosocial support to people with severe mental health needs. This program reduced admissions due to mental health by 74% over two years

• Adelaide’s Urgent Mental Health Care Centre, which operates as an alternative to EDs and is open 24 hours a day, seven days a week. This clinic was designed in collaboration with the community, including people with a lived experience of a mental health crisis, and offers a welcoming, safe environment

• Step-Up Step-Down services, which can effectively meet the needs of some of “the missing middle”. These are people whose mental health needs are too complex for primary care but not assessed as a big enough risk to themselves or others to “qualify” for hospital admission.

Funding support for psychosocial services remains tiny. It accounts for about 6% of total spending on mental health care by states and territories.

As a result, almost half a million Australians with either severe or moderate mental health needs are currently unable to access necessary psychosocial care. This impacts their recovery.

It also leaves clinical services without a viable “psychosocial partner”. So people needing mental health care might be able to get a prescription, but are much less likely to receive assistance with unstable housing, employment support or help getting back to school.

Working together

There is already concern to address identified workforce shortages and psychiatrists’ pay disputes.

The next round of mental health planning must also discuss and clarify the complementary roles in mental health care, as people with more complex mental health needs typically benefit from multidisciplinary, team-based care. This includes psychiatrists, psychologists, allied health professionals, nurses, peer workers, social service providers, GPs, justice, school and housing services and others such as drug and alcohol services. Who is best placed to plan and coordinate this care?

Reducing our over-reliance on hospital-based mental health care and EDs needs agreement by all Australian governments to explicitly prioritise the principles of early intervention, community-based mental health care and hospital avoidance in mental health.

These steps, together with more personalised approaches to treatment and better accountability, will help us achieve systemic quality improvement in mental health care.

Sebastian Rosenberg, Associate Professor, Health Research Institute, University of Canberra, and Brain and Mind Centre, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

On Monday morning local time, a huge cloud of ash, hot gas and rock fragments began spewing from Italy’s Mount Etna.

An enormous plume was seen stretching several kilometres into the sky from the mountain on the island of Sicily, which is the largest active volcano in Europe.

While the blast created an impressive sight, the eruption resulted in no reported injuries or damage and barely even disrupted flights on or off the island. Mount Etna eruptions are commonly described as “Strombolian eruptions” – though as we will see, that may not apply to this event.

What happened at Etna?

The eruption began with an increase of pressure in the hot gases inside the volcano. This led to the partial collapse of part of one of the craters atop Etna.

The collapse allowed what is called a pyroclastic flow: a fast-moving cloud of ash, hot gas and fragments of rock bursting out from inside the volcano.

Next, lava began to flow in three different directions down the mountainside. These flows are now cooling down. On Monday evening, Italy’s National Institute of Geophysics and Volcanology announced the volcanic activity had ended.

Etna is one of the most active volcanoes in the world, so this eruption is reasonably normal.

What is a Strombolian eruption?

Volcanologists classify eruptions by how explosive they are. More explosive eruptions tend to be more dangerous, because they move faster and cover a larger area.

At the mildest end are Hawaiian eruptions. You have probably seen pictures of these: lava flowing sedately down the slope of the volcano. The lava damages whatever it runs into, but it’s a relatively local effect.

As eruptions grow more explosive, they send ash and rock fragments flying further afield.

At the more explosive end of the scale are Plinian eruptions. These include the famous eruption of Mount Vesuvius in 79AD, described by the Roman writer Pliny the Younger, which buried the Roman towns of Pompeii and Herculaneum under metres of ash.

In a Plinian eruption, hot gas, ash, and rock can explode high enough to reach the stratosphere – and when the eruption column collapses, the debris falls to Earth and can wreak terrifying destruction over a huge area.

What about Strombolian eruptions? These relatively mild eruptions are named after Stromboli, another Italian volcano which belches out a minor eruption every 10 to 20 minutes.

In a Strombolian eruption, chunks of rock and cinders may travel tens or hundreds of metres through the air, but rarely further. The pyroclastic flow from yesterday’s eruption at Etna was rather more explosive than this – so it wasn’t strictly Strombolian.

Can we forecast volcano eruptions?

Volcanic eruptions are a bit like weather. They are very hard to predict in detail, but we are a lot better than we used to be at forecasting them.

To understand what a volcano will do in the future, we first need to know what is happening inside it right now. We can’t look inside directly, but we do have indirect measurements.

For example, before an eruption magma travels from deep inside the Earth up to the surface. On the way, it pushes rocks apart and can generate earthquakes. If we record the vibrations of these quakes, we can track the magma’s journey from the depths.

Rising magma can also make the ground near a volcano bulge upwards very slightly, by a few millimetres or centimetres. We can monitor this bulging, for example with satellites, to gather clues about an upcoming eruption.

Some volcanoes release gas even when they are not strictly erupting. We can measure the chemicals in this gas – and if they change, it can tell us that new magma is on its way to the surface.

When we have this information about what’s happening inside the volcano, we also need to understand its “personality” to know what the information means for future eruptions.

Are volcanic eruptions more common than in the past?

As a volcanologist, I often hear from people that it seems there are more volcanic eruptions now than in the past. This is not the case.

What is happening, I tell them, is that we have better monitoring systems now, and a very active global media system. So we know about more eruptions – and even see photos of them.

Monitoring is extremely important. We are fortunate that many volcanoes in places such as Italy, the United States, Indonesia and New Zealand have excellent monitoring in place.

This monitoring allows local authorities to issue warnings when an eruption is imminent. For a visitor or tourist out to see the spectacular natural wonder of a volcano, listening to these warnings is all-important.

Teresa Ubide, ARC Future Fellow and Associate Professor in Igneous Petrology/Volcanology, The University of Queensland

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