Psychology%20in%20Healthcare

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Psychology in Healthcare

• meeting the needs of clients

Prof. Ray Miller Chartered Clinical Psychologist
and Chartered Health Psychologist Professional
Advisor for Psychology, NHS Lothian Past
President, The British Psychological Society
(2006-07)
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Definitions

• Psychology
• The scientific study of mental and behavioural
  processes
• Applied Psychology in Healthcare
• The application of a knowledge of normal and
  abnormal mental and behavioural processes to
  issues of physical and mental health and
  well-being and health care delivery

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Healthcare Objectives

• Promote good health
• Prevent ill health
• Identify, assess and treat psychologically based
  dysfunction
• Promote recovery and rehabilitation
• Promote and facilitate good psychological
  practice
• Promote and facilitate quality health care
  delivery

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Recent Scottish Policies (Dec 2006 Dec 2007)
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Projected change in age structure of Scotland's
population, 2004-2031
PERCENTAGE CHANGE
0-15 16-29 30-44 45-59
60-74 75
AGE (years)
Source GROS, http//www.gro-scotland.gov.uk/stati
stics/library/popproj/04population-projections/lis
t-of-figures.html 2004-based populations.
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Rates per 1000 in GP Practice

• Range
• Dementia 1.2 to 1.6
• Psychoses 2.7 to 8.6
• Personality disorder 7.2 to 4.0
• Psychosocial problems 4.6 to 10.0
• Organic with psychological 13.1 to 16.6
• Psychosomatic 24.5 to 34.5
• Neuroses/ affective disorder 55.7 to 116.6

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Psychological Distress

• Prevalence of neurotic symptoms - by gender
  (people aged between 16 to 64 years) All figures
  are percentages
• Diagnosis and rate Female Male All
• (past week) 1993 2000 1993 2000 1993 2000
  
• Sleep problems 28 34 21 24 25 29
• Fatigue 33 33 21 23 27 28
• Irritability 25 24 19 20 22 22
• Worry 23 23 17 18 20 20
• Depression 11 12 8 11 10 12
• Concentration and forgetfulness 10 11 6 9 8 10
• Depressive ideas 11 12 7 9 9 10
• Anxiety 11 10 8 9 10 9
• Somatic symptoms 10 9 5 6 8 7
• Worry about physical health 5 7 4 7 5 7
• Obsessions 12 4 7 5 9 6
• Phobias 7 6 3 4 5 5
• Compulsions 8 4 5 3 6 3
• Panic 3 2 2 2 3 2
• Source ONS, 2000, Psychiatric morbidity among
  adults living in private households in Great
  Britain.

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Cost of Mental Ill Health
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Cutting the Costs
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BPS Membership
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Divisions
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Divisions

• DECP
• SDEP
• DCP
• DOP
• DFP
• DCoP
• DTRP

• DHP
• DoN
• DSEP
• Special Groups
• Social Services
• Coaching

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DCP
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Training and Competence

• 4 year honours degree experience 3 year
  doctoral level
• 7 to 10 years in total
• Skill Knowledge Practice Review
  Competence
• Basic interpersonal skills
• Theoretical framework
• Supervised therapeutic practice
• Continuing professional development
• Personal development (reflective practitioner)

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Pay Scales
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Context

• Health Issues
• Health Policy
• Healthy (and unhealthy) behaviour
• Public Health
• Mental Health
• Physical Health
• Research and Development

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Basic skills

• Establishing Maintaining Communication
• creating the environment active listeningverbal
  non verbal cues genuinenessempathy respect
  confidentiality trustagreement sharingpar
  tnership exploringsetting boundaries network
  ingending
• Within an ethical and professional code of
  practice

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Theoretical frameworks

• some major models
• Counselling Client - Centred (Rogerian/Humanistic
  )/ Skills Model (Egan)
• Psychodynamic
• Cognitive - Behavioural
• Cognitive Analytic
• Systemic
• IPT, DBT, REBT, EMDR, Personal Construct,
  Solution focussed, etc.
• Eclectic/ integrative

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Assessment

• Intellectual IQ, Mental Ability
• Cognitive Memory, Perception, Thinking,
  Processing
• Personality Sociability, Stability, Traits
• Emotional State Anxiety, Depression,
  Attributions
• Functional Behaviour, Skills, Aptitudes,
  Strengths and Weaknesses

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Therapy in practice

• Enable clients to
• Access and use relevant information
• Identify aims and goals
• Decide on options for action
• Acquire appropriate skills
• Implement a course of action
• Review outcomes

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Successful therapy

• A model (formulation) of the problem understood
  and accepted by the client
• A model for the therapy understood and accepted
  by the client
• Actual change in cognitions and behaviour
• Reinforcement in the real world
• Change equation reason benefits gt inertia
  costs

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Presenting problems

• Emotional problems anxiety, depression, anger
• Organic impairment and trauma
• Behavioural problems obsessions, phobias, habits
• Relationship problems social and sexual
  dysfunction
• Addiction, dependency and self control
• Coping with illness / injury and rehabilitation
• Coping with living stress, bereavement, disaster

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Personal and Professional Development

• Supervision - external review of practice
• Establishing networks - support, onward referral
• Updating - refreshing the old
• Professional advances - acquiring the new
• Evidence based - efficacy and effectiveness
• Research - breaking new ground
• Personal awareness - reflective practice
• Personal therapy - physician heal thyself

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Service model

• Consultancy and advice
• Training and development
• Support and supervision
• Direct and indirect intervention
• Research, monitoring and evaluation
• Skill mix service delivery
• Responsive to national and local needs and
  priorities
• Delivered within team approach to holistic
  healthcare

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No Health without Psychological Health

• Children and Education
• Health Promoting Schools
• Childhood obesity
• Immunisation uptake
• Parenting skills/ abuse and neglect
• Workplace
• Scotlands Health at Work
• Workplace stress
• Work/Life balance and retirement
• Absenteeism

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No Health without Psychological Health

• Lifestyle
• Smoking
• Alcohol
• Exercise
• Diet
• Mental Health and Wellbeing
• Mental Health (In)Capacity Acts
• Choose Life
• Doing Well by People with Depression
• Stigma (See Me)
• Mental Health Delivery Plan

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No Health without Psychological Health

• Physical Health
• Cardiac rehabilitation
• Diabetes
• Sexual health
• Chronic Illness and Rehabilitation
• Social wellbeing
• Social inclusion/ Fair for All
• Public Health
• Confidence and wellbeing
• Anger and violence

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Benefits

• Health promotion/ prevention and lifestyle change
  
• Early and proactive intervention
• Individual formulation and care plan
• Realistic treatment alternatives
• Increased adherence and satisfaction
• Recovery focus
• Comprehensive healthcare

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Your Professional Body(www.bps.org.uk)
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BPS Research Digest

• Free
• E-mailed fortnightly
• Key information on the latest, interesting
  research
• Join in online discussions
• Sign up at www.researchdigest.org.uk

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Download

• Powerpoint presentation can be downloaded or
  viewed at
• www.raymiller.net/download