Clinical Psychology - Lecture 5

Front 1

Primary Care

Back 1

- Accessed directly by patients
- Does not require a referral
- Includes dentists, pharmacies, opticians
- Clinical psychology involved in GP practises
- GP's are independent professionals
- Range of attitudes regarding clinical psychology, from supportive to skeptical

Front 2

National Institute for Health and Clinical Excellence

Back 2

- NICE
- Manage mental health in primary care services

Front 3

Newman & Rozensky (2005)

Back 3

- 40-60% GP consultations psychological in nature

Front 4

Foster (2005)

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- 90% of common mental health problems treated entirely in primary care
- Yet 80% of NHS mental health funding foes to severe mental health (4% patients)
- 30% people with severe mental health problems managed entirely in primary care

Front 5

What Can Clinical Psychology Provide?

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- Individual, family & group interventions
- Supervision & consultation
- Training & education
- Service development & management
- Mental health promotion & community work

Front 6

Competencies Required

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- Psychological science
- Engagement
- Assessment
- Brief interventions
- Supervision skills

Front 7

Current Issues in Primary Care

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- Does the patient want therapy or something else?
- How to become core team member (working with other professionals)?
- Control over appointments (Carey & Mullan, 2007)
- Managing and evaluating variety of 'low intensity' interventions
- Improving Access to Psychological Therapies (IAPT)
- Which therapy to choose? Whether to diagnose?

Front 8

Models of Intervention

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- CBT, Psychodynamic & Humanistic all NICE recommended for depression in primary care
- CBT for specific anxiety disorders
- CBT informs low intensity interventions (e.g. computerised, group)
- 'Stepped care' system

Front 9

Clark (1999)

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geer

Front 10

Gillespie et al. (2003)

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eg

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Transdiagnostic

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- Therapy without specific diagnosis
- Many patients don't recover after disorder-based CBT
- No identifiable primary disorder
- Goals for therapy may not match a disorder
- Time and training not provided for diagnosis
- Flexible brief therapy, need to maximise active intervention
- 100's of different disorders, difficult to train therapist in all models

Front 12

Hansen et al. (2002)

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- Average number of sessions attended is around five

Front 13

Lambert et al. (2001)

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- Greatest treatment gains in first session

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Stepped Care

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- Increases efficiency of clinical services
- Level of clinical resources matched to level of need
- Severe, enduring, difficult-to-treat problems allocated high level of intervention
- Less severe, recent, easy-to-treat problems allocated lower level intervention
- Modest effect in meta-analysis (van Straten et al., 2015)

Front 15

Older Adults Key Issues

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- High prevelance
- Less than one in six report symptoms
- Risks and complications of physical illness
- Accessibility & social isolation
- Stigma & somatisation
- Ageism
- Bereavement
- Working with families and community groups
- Dementia

Front 16

Dementia Person-Centred Care

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- Tom Kitwood 1990's
- Core principle is humanistic
- Values needs, choices, values, preferences of individual at all stages of dementia
- Subtleties of communication are critical
- New development: Empowered conversations

Front 17

Craig & Mindell (2007)

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- High prevalence of mental health issues in older adults - 25%

Front 18

Chew-Graham (2004)

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- Less than one-in-six older adults report mental health symptoms

Front 19

Dewey & Saz (2001)

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- Diagnosis of depression in those over 65 increased subsequent mortality by 70%