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
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
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
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
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?
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
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
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?
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
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
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
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
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
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
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
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
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
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)
19
Q
specialist services
A
- Eating Disorder Services (EDS)
- Early Intervention in Psychosis Services (EIP)
- Personality Disorder Services
- Therapeutic Communities / Crisis Houses
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
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
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
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
