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19 Cards in this Set

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Primary Care

- 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

National Institute for Health and Clinical Excellence

- NICE
- Manage mental health in primary care services

Newman & Rozensky (2005)

- 40-60% GP consultations psychological in nature

Foster (2005)

- 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

What Can Clinical Psychology Provide?

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

Competencies Required

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

Current Issues in Primary Care

- 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?

Models of Intervention

- 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

Clark (1999)

geer

Gillespie et al. (2003)

eg

Transdiagnostic

- 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

Hansen et al. (2002)

- Average number of sessions attended is around five

Lambert et al. (2001)

- Greatest treatment gains in first session

Stepped Care

- 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)

Older Adults Key Issues

- 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

Dementia Person-Centred Care

- 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

Craig & Mindell (2007)

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

Chew-Graham (2004)

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

Dewey & Saz (2001)

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