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L2 Neuro/Clinical S2 > clinical practice > Flashcards

clinical practice Flashcards

1
Q

why are mental health services needed?

A
  • reduction of suffering
    –> lessening distress
    –> improved quality of life, meaning and purposeful activity
    –> limit risks to the individual and other people
  • social benefits
    –> foster a more diverse, inclusive and fairer society
    –> lower risk to self and others
  • economic costs and benefits
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2
Q

mental health sats and facts

A
  • 1 in 6 experience common mental health difficulties (i.e. broadly depression or anxiety)
  • 1 in 5 experience suicidal thoughts over their lifetime
  • number of people with mental health problems is increasing
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3
Q

economic benefits of providing care

A
  • output effects
    –> employment
  • savings to the NHS
    –> reduced costs per person, including physical and mental health services
    –> reduced referrals to secondary sector, fewer inpatient admissions, fewer GP consultations and less medication
    –> estimated £300 over two year period
  • savings to the exchequer
    –> increased employment (reduction in benefits and increased tax receipts)
    –> savings in NHS costs
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4
Q

economic costs of mental health

A
  • mental health problems cost around £105 billion per year in England
    –> providing services, lost work, reduced quality of life
    –> costing over £2000 per person per year in England
  • only about 1/3 of people with a mental health disorder get help for it
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5
Q

key questions regarding economic cost

A
  • should we put more resources into services to provide help for more people?
  • does paying more to treat people actually have to cost more?
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6
Q

economic costs of mental health in England

A

health care costs for:
- all problems = around £100 billion per year
- people with mental health problems = £13 billion
–> anxiety and depression = £3.75 billion
–> children and adolescents with mental health problems = £0.75 billion (750 million)
- medically unexplained symptoms = £3 billion

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7
Q

proportion of funding to mental health

A
  • of all health research funding, only 5% goes to mental health
    –> large chunk goes to Dementia research
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8
Q

cost-benefit trade off: an example

A
  • initiative was set up based on the cost-benefit trade off
    –> Improving Access to Psychological Therapies (IAPT)
  • mean resource cost for course of treatment = £750
  • financial planners and commissioners of services want to know - do the benefits outweigh the cost?
  • if they don’t, what other interventions or resources that might be offered?
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9
Q

cost analysis for IAPT

A
  • what are the benefits of treatment?
  • across all patients (whether they recover or not)
    –> treating someone reduces their mean benefit costs by one month = £750
    –> employment level goes up by 18%
    –> absence from work goes down by 31 days/year
    –> economic output per person rises by £1100/month
    –> where present, costs of comorbid physical conditions go down by several thousand pounds
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10
Q

cost-benefit trade off: early intervention in psychosis

A
  • around 1% of the population will develop psychosis require longer term care
  • Early Intervention in Psychosis (EIP) services seek to reduce the amount of time between the onset ofsymptoms and when people receive help
  • aims to reduce the impact of symptoms on:
    –> their ability work, foster relationships
    –> engagement in education
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11
Q

non-EIP vs EIP patients

A
  • compared to patients receiving non-EIP services, patients receiving EIP services were:
    –> 116% more likely to gain employment
    –> 52% more likely to become accommodated in a mainstream house
    –> 17% more likely to have an improvement in the emotional well-being domain of the HONOS questionnaire
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12
Q

cost analysis for EIP

A
  • the key cost differences associated with EIP were:
    –> lower mental health inpatient costs (£4,075)
    –> lower acute hospital outpatient costs (£59)
    –> lower accident and emergency costs (£31)
    –> higher mental health community costs (£648)
  • overall using significantly less (costly) health services had a saving associated with EIP of £4,031
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13
Q

overview of mental heath services

A
  • mental health services provide life saving care
  • people benefit from reduced distress / increases quality of life
  • research also shows how mental health services reduce costs that would otherwise happen (e.g. increased unemployment, acute care, housing, police involvement)
  • this approach can be controversial and has been criticised
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14
Q

basic outline of the NHS

A
  • across lifespan
  • acute to longer term care
  • for physical and mental health
  • provides information and evidence of practices
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15
Q

general practice

A
  • around 90% of NHS patient interaction is with primary care services:
    –> GPs
    –> dentists
    –> community pharmacy services
  • around 30% of people who make an appointment with a GP do so for help with psychological distress
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16
Q

GPs can refer patients to…

A
  • child and adolescent mental health services (CAMHS)
    –> NHS services that assesses and treat young people with emotional, behavioural or mental health difficulties to age 18
    –> most CAMHS services work with the whole family to support a young person’s health
  • Improving Access to Psychological Therapies (IAPT)
    –> IAPT services provide evidence based treatments for people with anxiety and depression, predominantly stepped care relying on CBT principles
    –> IAPT also accept direct referrals
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17
Q

GPs refer patients to… (continued)

A
  • Early intervention in Psychosis (EIP)
    –> integrated service for people 14 – 65 presenting with a first episode of psychosis
    –> multi disiplinary team structure (doctors, nurses, social workers etc)
  • Community Mental Health Team (CMHT) & Assessment and Brief Treatment (ABT)
    –> many areas have services that provide an initial assessment for signposting to other services
  • Older Adult Mental Health Team (OAMHT)
    –> work families and adults 65+ who are in mental health crisis
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18
Q

types of longer term care

A
  • Community Recovery Teams (CRTs)
    –> supporting people 18 – 65 with long term needs
  • High support / Integrated care teams
    –> provide support to people over 18 who have a long term condition (mental or physical health) who live at home or in nursing care
  • rehabilitation services
    –> for people who’ve undergone a recent change in functioning
    –> e.g. as a result of acquired brain injury or illness
  • Community Learning Difficulties Services (CLDS)
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19
Q

specialist services

A
  • Eating Disorder Services (EDS)
  • Early Intervention in Psychosis Services (EIP)
  • Personality Disorder Services
  • Therapeutic Communities / Crisis Houses
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20
Q

acute care for physical and mental health

A
  • Accident and Emergency (A&E)
    –> treat patients with acute health problems
    –> loss of consciousness
    –> acute confused state
    –> fits that are not stopping
    –> persistent severe chest pain
    –> breathing difficulties
    –> severe bleeding that cannot be stopped
    –> severe allergic reactions
    –> severe burns or scalds
  • Mental Health Liaison (MHL)
    –> work in acute general hospital settings and assess people for referral to mental health teams
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21
Q

services for mental health crisis:

A
  • Inpatient mental health care provided in all areas of the country. - This is provided where:
    –> there’s need to be admitted for a short period for further assessment
    –> there’s a risk to safety if they don’t stay in hospital, for example, if the person is severelyself-harmingor at risk of acting onsuicidal thoughts
    –> there is a risk they could harm someone else
    –> there isn’t a safe way to treat them at home
    –> need more intensive support than can be given to them elsewhere
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22
Q

Home Treatment Teams (HTT)

A
  • inpatient services are supplemented by Home Treatment Teams (HTT)
    –> for adults aged 16-65 whose mental health crisis is so severe that they would otherwise have been admitted to a hospital
  • these are sometimes called Crisis Resolution and Home Treatment (CRHT) teams
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23
Q

4 tiers to child and adolescent services

A
  • tier 1
    –> generalist workers (GP, school nurse etc..)
    –> low level psychotherapeutic interventions
    –> e.g. recommending self-hep
  • tier 2
    –> general workers (GP, school nurse etc…)
    –> low-level specific interventions
    –> e.g. counsellors, bereavement workers
  • tier 3
    –> mental health team workers
    –> high level psychotherapeutic interventions
    –> e.g. CBT for relatively moderate to severe cases
  • tier 4
    – highly intensive or specialist services
    –> psychological therapy is highly specialised
    –> or is only part of a wider package of care
    –> e.g., in-patient units
    –> e.g. specialist eating disorders services
24
Q

making complaints / patient involvement

A
  • The Patient Advice and Liaison Service (PALS)
    –> offers confidential advice, support and information on health-related matters
    –> they provide a point of contact for patients, their families and their carers
  • healthwatch England
    –> the national consumer champion for people who use health and social care services
    –> Its purpose is to ensure that the voices of people who use services are listened and responded to
  • Integrated Care Boards (ICBs)
    –> commission most of the hospital and community NHS services in the local areas for which they are responsible
    –> many local ICBs have public engagement and involvement activities that you can participate in
25
Q

types of recovery orientated care

A
  • clinical recovery
  • personal recovery
26
Q

clinical recovery

A

an idea that has emerged from the expertise of mental health professionals, and involves getting rid of symptoms, restoring social functioning, and in other ways ‘getting back to normal’

27
Q

personal recovery

A
  • a deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles
  • it is a way of living a satisfying, hopeful, and contributing life even within the limitations caused by illness
  • recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness
28
Q

traditional approach to treatment

A
  • basic concepts:
    –> psychopathology
    –> diagnosis
    –> treatment
    –> staff and patients
  • working practices:
    –> description
    –> focus on disorder
    –> illness based
    –> goal = brining under control
29
Q

recovery approach

A
  • basic concepts:
    –> distressing experience
    –> personal meaning
    –> growth and discovery
    –> experts by training and by experiences
  • working practices
    –> understanding
    –> focus on person
    –> strengths based
    –> goal = self control
30
Q

‘recovery in the bin’ perspective

A
  • do not like the use of ‘recovery’ to control and discipline those trying to find a place in the world and trying to deal with the very real mental distress they encounter on a daily basis
  • want to place mental health within the context of social justice and the wider class struggle
31
Q

first mental health professionals approached

A
  • many people initially approach their General practitioner (GP) for help with their mental health
    –> a GP can offer help themselves or refer onto more specialist services
  • trained therapists and counsellors provide a range of different therapies through NHS services or privately
32
Q

secondary mental health professionals

A
  • people who are acutely distressed might go directly to hospital either by attending A&E or via the police
  • here they will receive help from multidisciplinary mental health teams including:
    –> psychiatrists
    –> clinical psychologists
    –> nurses
    –> social workers
    –> occupational therapists
  • mental health teams also work in community settings
33
Q

members of the multidisciplinary team:

A
  • psychiatrist
  • mental health nurse
  • social worker
  • occupational therapist
  • clinical psychologist
34
Q

role of a psychiatrist

A
  • qualified medial doctor
  • provide assessment, care management (including medication and physical treatment)
  • consultant psychiatrist can recommend detention for treatment under the Mental Health Act
35
Q

role of a mental health nurse

A
  • registerednursewith specialist training in the area ofmental health
  • they provide a wide range of support from helping with day-to-day life, facilitating medication, assessing risk and counselling
36
Q

role of a social worker

A

specialise in helping people with mental health problems to overcome practical difficulties and access services

37
Q

role of an occupational therapist

A
  • aims to help people overcome any practical difficulties as a result of mental health problems
  • this might involve the learning of specific skills or techniques, including creative activities and day-to-day living skills
  • promoting agency
38
Q

define a therapist

A
  • anyone who provides a therapy or talking treatment
  • may be a psychologist or psychiatrist, nurse, social worker if part of their role and involves providing therapy
  • some require additional training
39
Q

types of talking therapy practitioners

A
  • Counsellor:
    –> offers counselling (a talking treatment that aims to help people find ways of coping with problems that they are experiencing)
  • Psychotherapist:
    –> are trained using therapeutic model CBT, Psychoanalysis, Family, Gestalt and many others
    –> there are accredited training programmes for most approaches
  • Clinical and Counselling Psychologists
    –> their training includes carrying out the therapist role trained in similar approaches to psychotherapists and usually more than one
40
Q

what are protected titles?

A
  • Professions have designated titles that are protected by law and professionals
  • must be registered to use them
  • membership of a specific professional body & registered with them
  • examples:
    –> dietician
    –> art therapist
    –> hearing aid dispenser
41
Q

how does someone become a psychotherapist?

A
  • ‘psychotherapist’ and ‘counsellor’ are not protected titles
    –> in UK and many other countries
  • take an approved course that provides the necessary eligibility for registration with a professional body
    –> e.g. HCPC; BABCP; BPS; BACP
  • require a basis in understanding psychology
    –> e.g. cannot get onto a clinical psychology course if you do not have Graduate Basis for Registration with the BPS
42
Q

how do you stay a psychotherapist?

A
  • continue professional development:
    –> regular updates in training, teaching, reading, conference attendance
    –> in some cases, passing tests and/or maintaining portfolios
  • maintaining standards:
    –> not getting struck off for inappropriate or unprofessional behaviour
43
Q

types of professional roles

A
  • Assistant Psychologist
  • Associate Psychologist
  • Counselling Psychologist
  • Clinical Psychologist
44
Q

assistant psychologist

A
  • posts advertised through NHS jobs
  • usually work under the supervision of clinical psychologists
  • could be doing assessment work or brief interventions
  • often seen as a step to clinical psychology, but is NOT a requirement
45
Q

clinical associate psychologist

A
  • new role:
    -> undertake circumscribed psychological assessments and interventions for specific populations and/or using specific therapies under supervision of a clinical psychologist
  • training:
    –> Graduate psychologist on NHS Band 5, Band 6 once qualified
  • MSc apprenticeship
46
Q

counselling psychology

A
  • Graduate Basis for Chartered (GBC) membership with the British Psychological Society (BPS)
  • relevant work with people with emotional demands
  • basic counselling skills training
  • doctoral training on an accredited course or BPS Qualification in Counselling Psychology
  • HCPC registration
  • Self funding
47
Q

clinical psychologists

A
  • Clinical psychologists work with people with mental or physical health problems
  • aim to reduce psychological distress
    nd enhance and promote psychological well- being
  • use of research and psychological theory and data
  • they work with people throughout the life-span and with those with learning disabilities
48
Q

clinical psychology as a profession

A
  • work in range of health and social care settings
    –> e.g. hospitals, health centres, social services, individually or in teams
  • most work in the NHS but some can work in teaching and training and in private sector work
  • work can centre around:
    –> anxiety and depression
    –> serious and enduring mental illness
    –> adjustment to physical illness
    –> neurological disorders
    –> addictive behaviours
    –> childhood behaviour disorders
    –> personal and family relationships
49
Q

how do clinical psychologists help?

A
  • use expert knowledge in consultation, therapeutics and evaluation
  • talking therapies
  • working with relatives
  • developing specialist services
  • supporting care providers
50
Q

what underpins clinical practice?

A
  • psychological theory
  • grounded in research / evidence
  • clinical practice
  • ethical and practical guidelines
51
Q

what is missing?

A
  • Health outcomes 20% is access to care
  • 80% other factors
  • Uptake can be low even when easily available
  • Not always culturally acceptable underserved groups
52
Q

addressing the gaps in clinical practice

A
  • one way is Clinical Psychologists are now working in Public Mental Health teams
  • For example, our colleagues in Derbyshire take a whole system approach in suicide prevention
    –> Train and Support Local Authority Staff
    –> Guide Policy on Messaging
    –> Assist in the development of a regional suicide prevention strategy
    –> Support voluntary and Community Sector Organisations
53
Q

the voluntary sector support

A
  • research has found people who self harm value voluntary and community sector support because
  • we are now developing ways for clinical psychologists to better support volunteers
54
Q

routes into clinical psychology

A
  • A three year taught doctorate in clinical psychology
  • Currently trainees are employed and have their university fees paid for by the NHS
  • HCPC registration
55
Q

steps towards getting a place in clinical doctorate

A
  • relevant degree
  • relevant experience
  • or application via clearing house
56
Q

summary

A
  • mental health services can be shown to be cost effective
    –> they reduce other costs and so become at least cost neutral
  • there are a range of mental health services for people of all ages and with a variety of presenting problems
  • mental health professionals have different ways of working and expertise
    –> services should ideally bring these strengths together
  • psychological therapists have established training pathways and regulation of qualified practitioners

L2 Neuro/Clinical S2 (9 decks)

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