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This paper aims to evaluate the effectiveness of a stepped-care primary care psychology service through triangulating clinical outcome data, service user satisfaction ratings and feedback from referrers.

A mixed method approach including a repeated measures design (pre- and post-clinical data on standardised psychometrics) for clinical outcomes and an online and postal survey with quantitative and qualitative elements offered to all service users and referrers to the service.

In total, 125 service users completed a full intervention with the service with 56% treatment completers demonstrating a reliable reduction in the symptoms of low mood and 49.6% in anxiety. Of those within the clinical range for depression at assessment, 66.67% achieved clinical recovery following an intervention. Of those within the clinical range for an anxiety disorder at assessment, 62.03% achieved clinical recovery following an intervention. Service users reported high levels of satisfaction with the service specifying particular interpersonal qualities of the therapists and the individualisation of service provision as crucial positive factors. Referrers similarly reported high levels of overall satisfaction with the service, specifying that the speed of response to referral and length of intervention was of greatest importance to them.

Stepped-care psychological interventions reduce psychological distress in treatment completers with mild to moderate symptoms of anxiety and low mood. The overall interpersonal experience may be of greater importance to service users in their evaluation of a service than clinical outcomes. In their relationship to a Psychology service, referrers value speed of response and ongoing feedback. Building a robust, highly valued service may require the triangulation of evidence from all key stakeholders.

This paper provides a pragmatic template of how a rigorous evaluation of a primary care psychology service requires evidence from multiple stakeholders.

The purpose of this paper is to summarise the development of a recovery-oriented and socially inclusive acute care clinical psychology service in one of the NHS Trusts based in East Anglia. It demonstrates the service's compliance with relevant national policies and guidelines, and addresses some of the criticisms directed at acute mental health care in recent years. Both achievements and difficulties are reflected on.

The paper employs an organisational development case example related to applicable clinical practice model, based on national guidelines and policies, in order to demonstrate that it is possible to develop and implement a recovery-oriented clinical psychology practice in acute inpatient mental health care. This is based on the authors, experiences as a public sector clinical psychologists specialising in complex, severe, and enduring mental health needs.

Clinical psychologists may effectively contribute to the development of psychosocially informed and recovery-based multidisciplinary attitudes towards emotional difficulties of individuals admitted to psychiatric wards.

Future service development project of similar nature ought to implement standardised measures (e.g. ward atmosphere scales) to increase validity of findings.

Despite limited, and continuously decreasing, resources in the NHS it appears possible to develop and establish a successful and objectively replicable provision of recovery-based psychological services across an entire acute care mental health pathway.

Recovery-enhancing clinical psychology interventions should not be limited to those receiving care from community-based services only. Building psychologically informed understanding of mental health needs should be employed on inpatient wards too, in order to counterbalance the dominating biomedical models of mental illness.

Dissemination of examples of effective psychosocial practice in acute mental health settings appears largely underrepresented.

Nursing teams supporting people with intellectual disabilities in inpatient settings are known to be vulnerable to burnout, compassion fatigue and vicarious trauma. Aspects such as resourcing, support, training and the fundamental challenges of supporting this patient group are known risk factors for these difficulties. The aim of this paper is to synthesise the literature on these issues and provide suggestions for operationalising solutions.

Literature on the experiences of nursing teams supporting people with intellectual disabilities in inpatient settings was considered, alongside the established offer of clinical psychologists working into these services.

There are common themes of staff’s emotional health and the impact this can have on patient care and the steps that managers and organisations can take to support their teams to remain emotionally healthy, compassionate and effective practitioners. Clinical psychology can play a role in offering this support only where services and teams are aware of the contribution they can make.

Clinical psychology has been undersold and under-represented in inpatient settings for people with intellectual disabilities, and this practice paper outlines the important contributions that they can make to the psychological well-being of all within the system, not just patients.

The purpose of this paper is to explore mental health service users’ experiences of involvement in a clinical psychology course.

Five participants were recruited from a service user and carer group aligned to a university professional clinical psychology course. Data were collected using semi-structured interviews and data were analysed using an interpretative phenomenological analysis (IPA).

Four superordinate themes, group processes, advocating, transforming and power, were drawn from the data, with ten subthemes emerging capturing experiences on the personal, professional and group levels.

The study is not generalisable and has a small number of participants. However, many of the themes have resonance with existing literature.

Service user initiatives need to consider the personal and contextual issues that service users may have experienced prior to their involvement. The needs of service user initiatives may change over time. Such initiatives must evolve in conjunction with the personal and political journeys of participants.

Few studies have explored the experiences of mental health service users in clinical psychology training using a robust methodology. The current study suggests that eliciting these experiences highlights factors that facilitate involvement as well as the barriers.

The training of future mental health professionals offers one avenue of change to improve service user and carer involvement in mental health services. This study looked at experiences of trainees on the University of Surrey's Clinical Psychology Doctorate programme in involving service users and carers on training placements. Twenty trainees completed a self‐report semistructured questionnaire providing qualitative data that were analysed using thematic analysis. A number of benefits of service user and carer involvement in training were identified as well as practical considerations, including factors that might facilitate or limit such involvement on training placements. It is intended that the findings will prove useful to others involved with the training of mental health professionals.

It is widely acknowledged that there is a significant gap between the demand for psychological therapy services and the supply (Bower & Gilbody, 2005). It is also well‐known that the health needs of people with learning disabilities are typically greater than those of the rest of the population, and that they are more likely to experience mental health problems and psychological distress (Lindsey, 2002). Difficulties in accessing psychological therapy services and long waiting times have been commonplace in recent years (Richards et al, 2003). Current moves towards modernising the NHS have led to increased accountability and competition between health providers, and many providers of psychological services have tried to increase their accessibility, effectiveness and efficiency. Adaptations to referral pathways and service delivery models in psychological care services have made changes to how clients access services and the input they receive. Accessible services, employing collaborative and stepped care models, have been identified as effective in delivering services in ways which best meet the needs of individuals and maximise the efficient use of resources (Bower & Gilbody, 2005). In our local psychology service for adults with learning disabilities, we have attempted to develop service delivery strategies and modernise referral routes so that services can be delivered which better meet the needs of our client group by optimising accessibility, efficiency and effectiveness.

How can clinical psychologists promote social inclusion in their practice? Mark Hayward, Emily Brown, Rufus May and Emma Harding offer a variety of perspectives from professional and service user viewpoints.

This study aims to investigate whether factors previously shown to influence attendance rates for appointments in general practice and general mental health services also influence attendance rates in services for people with intellectual disabilities (ID).

Post hoc data from 452 psychology appointments, ID diagnostic and initial screening (triage) appointments were collected from the health-care files of a community adult ID psychology service. Demographic factors (age, sex) and clinical factors (waiting time, time between appointment invitation being sent and appointment being held, presence of prior telephone call or letter, type of appointment, weekday, month) were recorded along with the attendance outcome (attended/did not attend [DNA]). The impact of the COVID-19 pandemic was also explored by documenting whether the appointment predated March 2020.

No significant associations were found between any variable investigated and attendance outcome when analysing appointment data as a whole and when splitting the data between appointment type. Weekday was found to significantly be associated with attendance outcome for appointments held during COVID-19, in which more DNA appointments occurred on a Wednesday compared to the other days of the week. No other associations were found for appointments held during the COVID-19 pandemic or for appointments held prior to the COVID-19 pandemic. These results suggest that factors which influence attendance rates in general health-care settings do not necessarily generalise to ID services.

To the best of the authors’ knowledge, this study is the first to examine whether certain demographic and clinical factors influenced attendance rates in an adult intellectual disability service.

This paper aims to describe the challenges and rewards of service user and carer involvement in clinical psychology training as experienced in one training centre.

After outlining the major challenges of involvement in higher education and in clinical psychology training, the paper describes the work carried out by the authors. Members of the service user and carer advisory group Salomons Advisory Group of Experts by Experience (SAGE) recount their experiences of working with them in clinical psychology and Increasing Access to Psychological Therapies (IAPT) training. The challenges of inclusion and specific approaches that are used to work with these are explored.

Members of SAGE have experienced their contributions to the work in positive ways. However, inclusion in this context requires everyone involved to fully acknowledge the social and historical barriers in order to work together to overcome them.

Some of the approaches to meeting the challenges of inclusion in doctoral level clinical training may be applicable in other places.

In the authors' experience, true inclusion means openness to the authoritative voices of people not normally viewed as educators. A parallel question is the degree to which professionals feel safe to admit to service user experience or to draw upon other aspects of their personhood while working professionally. This may be crucial for successful partnership.

The authors are still on this journey of inclusion, and hope that by sharing some of their experiences of its complexities that they may help illuminate some elements of others' journeys.

The purpose of this paper, a qualitative study, is to explore service users’ experiences of attending clinical psychology within a public community adult mental health service.

Six individuals who had completed at least 16 sessions of psychotherapy participated in semi-structured interviews. Data were transcribed and analysed using interpretative phenomenological analysis.

The results showed the following overarching domains: the relationship and its impacts, structure and focus, and participant factors – timing/readiness. The importance of the use of language was also identified. Participants appeared to value a sense of humanity within the relationship. Interestingly, the personal impact of therapy as perceived by the participants was not focussed on symptom reduction, but on broader changes. The results are discussed in relation to the relevant literature.

Suggested principles for practice include maintaining attentiveness to relational factors, to client factors such as readiness for change and to the use of structure and flexibility. The use of recovery focussed and alliance measures are recommended.

For clinical psychologists providing psychotherapy within the public system, there are valuable lessons we can learn from asking the service users directly about their experiences, in terms of focussing on the human element of the relationship, and striking a balance between professionalism and humanity.