Psychology in Healthcare

Psychology in HealthcarePsychology in Healthcaremeeting the needs of themeeting the needs of the

Scottish populationScottish population

Prof. Ray MillerChartered Clinical Psychologist and Chartered Health Psychologist

Professional Advisor for Psychology, NHS Lothian (Retired)Past President, The British Psychological Society (2006-07)

15 March 201215 March 2012 Psychology in HealthcarePsychology in Healthcare

Prof. Ray MillerProf. Ray Miller 22

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DefinitionsDefinitions

PsychologyPsychology

The scientific study of mental and behavioural The scientific study of mental and behavioural processesprocesses

Applied Psychology in HealthcareApplied Psychology in Healthcare

The application of a knowledge of normal and The application of a knowledge of normal and abnormal mental and behavioural processes to abnormal mental and behavioural processes to issues of physical and mental health and well-being issues of physical and mental health and well-being and health care deliveryand health care delivery



Healthcare ObjectivesHealthcare Objectives

Promote good healthPromote good health

Prevent ill healthPrevent ill health

Identify, assess and treat psychologically based Identify, assess and treat psychologically based dysfunction dysfunction

Promote recovery and rehabilitationPromote recovery and rehabilitation

Promote and facilitate good psychological practicePromote and facilitate good psychological practice

Promote and facilitate quality health care deliveryPromote and facilitate quality health care delivery

Develop and research innovation in healthcareDevelop and research innovation in healthcare



ContextContext

Health IssuesHealth Issues Health PolicyHealth Policy Healthy (and unhealthy) behaviourHealthy (and unhealthy) behaviour Public HealthPublic Health Mental HealthMental Health Physical HealthPhysical Health Research and DevelopmentResearch and Development



Recent Scottish PoliciesRecent Scottish Policies (2007 & 2012)(2007 & 2012)



Current PoliciesCurrent Policies



Health Survey 2010Health Survey 2010Main HeadingsMain Headings

GENERAL HEALTHGENERAL HEALTH (Self-assessed general health, Long-term conditions, (Self-assessed general health, Long-term conditions, Mental Health and wellbeing) Mental Health and wellbeing)

DENTAL HEALTHDENTAL HEALTH ALCOHOLALCOHOL SMOKINGSMOKING DIETDIET PHYSICAL ACTIVITYPHYSICAL ACTIVITY ADULT AND CHILD OBESITYADULT AND CHILD OBESITY RESPIRATORY HEALTHRESPIRATORY HEALTH CARDIOVASCULAR DISEASE, HYPERTENSION AND DIABETESCARDIOVASCULAR DISEASE, HYPERTENSION AND DIABETES MULTIPLE RISKSMULTIPLE RISKS

Risk clusteringRisk clustering• • The most common combination of risks was being overweight and not meeting the physical The most common combination of risks was being overweight and not meeting the physical

activity and fruit and vegetable recommendations (15% of adults in Scotland had these three activity and fruit and vegetable recommendations (15% of adults in Scotland had these three risks). A further 10% had these three risks and also drank outwith the recommended limits.risks). A further 10% had these three risks and also drank outwith the recommended limits.

• • 44% of adults in Scotland drank outwith the recommended limits and had at least one of the 44% of adults in Scotland drank outwith the recommended limits and had at least one of the other risks. other risks.



Projected % change in age structure of Projected % change in age structure of Scotland's population, 2004-2031Scotland's population, 2004-2031

Source: REGISTRAR GENERAL FOR SCOTLAND - Projected Population of Scotland (2004-based)



Psychological MorbidityPsychological Morbidity



Common Mental DisorderCommon Mental Disorder(England 2007)(England 2007)



Common Mental DisorderCommon Mental Disorder(England 2007)(England 2007)



Cost of Mental Ill HealthCost of Mental Ill Health



Published Date: Published Date: 25 February 201125 February 2011

Stressed and depressed - mental health Stressed and depressed - mental health problems cost £10bn a year problems cost £10bn a year

By Gareth RoseBy Gareth Rose

SCOTLAND'S poor mental health is now costing the country SCOTLAND'S poor mental health is now costing the country more than £10 billion a year, a charity has revealed.more than £10 billion a year, a charity has revealed.

Problems such as stress, depression and various disorders Problems such as stress, depression and various disorders are keeping people out of work, putting pressure on the NHS, are keeping people out of work, putting pressure on the NHS, and also hitting police, housing and other services.and also hitting police, housing and other services.

The Scottish Association for Mental Health (SAMH) has launched a The Scottish Association for Mental Health (SAMH) has launched a pre-election manifesto urging parties to take a broader approach to the pre-election manifesto urging parties to take a broader approach to the problem.problem.

The charity, which helps 3,000 Scots every week, is also nearing The charity, which helps 3,000 Scots every week, is also nearing completion of a study looking at the cost of mental health to the completion of a study looking at the cost of mental health to the country.country.

The final figures will be published in a few months, but is expected to The final figures will be published in a few months, but is expected to be a sharp increase on the £8.6bn estimated cost of five years ago.be a sharp increase on the £8.6bn estimated cost of five years ago.



Scottish ReviewScottish ReviewMarch 2011March 2011



Psychology WorkforcePsychology Workforce



Psychology WorkforcePsychology Workforce



Psychologists per 100,000 Psychologists per 100,000 population population (Scotland 2011)(Scotland 2011)



No Health without No Health without Psychological HealthPsychological Health Children and EducationChildren and Education

– Health Promoting SchoolsHealth Promoting Schools– Childhood obesityChildhood obesity– Immunisation uptakeImmunisation uptake– Parenting skills/ abuse and neglectParenting skills/ abuse and neglect

Workplace Workplace – Scotland’s Health at WorkScotland’s Health at Work– Workplace stressWorkplace stress– Work/Life balance and retirementWork/Life balance and retirement– AbsenteeismAbsenteeism



No Health without No Health without Psychological HealthPsychological Health LifestyleLifestyle

– SmokingSmoking– AlcoholAlcohol– ExerciseExercise– DietDiet

Mental Health and Wellbeing Mental Health and Wellbeing – Mental Health & (In)Capacity ActsMental Health & (In)Capacity Acts– Choose LifeChoose Life– Doing Well by People with DepressionDoing Well by People with Depression– Stigma (See Me)Stigma (See Me)– Mental Health Delivery PlanMental Health Delivery Plan



No Health without No Health without Psychological HealthPsychological Health Physical HealthPhysical Health

– Cardiac rehabilitationCardiac rehabilitation– DiabetesDiabetes– Sexual healthSexual health– Chronic Illness and RehabilitationChronic Illness and Rehabilitation

Social wellbeing Social wellbeing – Social inclusion/ Fair for AllSocial inclusion/ Fair for All– Public HealthPublic Health– Confidence and wellbeingConfidence and wellbeing– Anger and violenceAnger and violence



Service modelService model Consultancy and adviceConsultancy and advice

Training and developmentTraining and development

Support and supervisionSupport and supervision

Direct and indirect interventionDirect and indirect intervention

Research, monitoring and evaluationResearch, monitoring and evaluation

Skill mix service deliverySkill mix service delivery

Responsive to national and local needs and prioritiesResponsive to national and local needs and priorities

Delivered within team approach to holistic healthcareDelivered within team approach to holistic healthcare



BenefitsBenefits

Health promotion/ prevention and lifestyle change Health promotion/ prevention and lifestyle change

Early and proactive intervention Early and proactive intervention

Individual formulation and care planIndividual formulation and care plan

Realistic treatment alternativesRealistic treatment alternatives

Increased adherence and satisfactionIncreased adherence and satisfaction

Recovery focusRecovery focus

Comprehensive healthcareComprehensive healthcare



Training and Training and CompetenceCompetence

4 year honours degree + experience + 3 year doctoral level4 year honours degree + experience + 3 year doctoral level 7 to 10 years in total7 to 10 years in total Skill + Knowledge + Practice + Review = CompetenceSkill + Knowledge + Practice + Review = Competence Basic interpersonal skillsBasic interpersonal skills Assessment and FormulationAssessment and Formulation Theoretical frameworks for interventionTheoretical frameworks for intervention Supervised therapeutic practiceSupervised therapeutic practice Continuing professional developmentContinuing professional development Personal development (reflective practitioner)Personal development (reflective practitioner)



Basic skillsBasic skills

Establishing & Maintaining CommunicationEstablishing & Maintaining Communication creating the environmentcreating the environment active listeningactive listening

verbal & non verbal cuesverbal & non verbal cues genuinenessgenuinenessempathyempathy respectrespectconfidentialityconfidentiality trusttrustagreementagreement sharingsharingpartnershippartnership exploringexploringsetting boundariessetting boundaries networkingnetworkingendingending

Within an ethical and professional code of practiceWithin an ethical and professional code of practice



AssessmentAssessment

Intellectual:Intellectual: IQ, Mental AbilityIQ, Mental Ability Cognitive:Cognitive: Memory, Perception,Memory, Perception,

Thinking, ProcessingThinking, Processing Personality:Personality: Sociability, Stability, TraitsSociability, Stability, Traits Emotional State:Emotional State: Anxiety, Depression, Anxiety, Depression,

AttributionsAttributions Functional:Functional: Behaviour, Skills, Behaviour, Skills,

Aptitudes, Aptitudes, Strengths and WeaknessesStrengths and Weaknesses



Intervention (Therapy)Intervention (Therapy)Presenting problemsPresenting problems

Emotional problems: anxiety, depression, angerEmotional problems: anxiety, depression, anger

Organic impairment and traumaOrganic impairment and trauma

Behavioural problems: obsessions, phobias, habitsBehavioural problems: obsessions, phobias, habits

Relationship problems: social and sexual dysfunctionRelationship problems: social and sexual dysfunction

Addiction, dependency and self controlAddiction, dependency and self control

Coping with illness / injury and rehabilitationCoping with illness / injury and rehabilitation

Coping with living: stress, bereavement, disasterCoping with living: stress, bereavement, disaster



Intervention (Therapy)Intervention (Therapy)Theoretical frameworksTheoretical frameworks

Some major dimensions:Some major dimensions:

PsychodynamicPsychodynamic [Freud, Adler, Jung][Freud, Adler, Jung]

Counselling:Counselling: Client Centred Client Centred [Rodgers][Rodgers] / Skills Model / Skills Model [Egan][Egan]

CognitiveCognitive [Ellis, Kelly][Ellis, Kelly]

Behavioural and CognitiveBehavioural and Cognitive––BehaviouralBehavioural (CBT) (CBT) [Wolpe, Beck][Wolpe, Beck]

Cognitive Analytic TherapyCognitive Analytic Therapy (CAT) (CAT) [Ryle][Ryle]

SystemicSystemic [Minuchin][Minuchin]

Positive PsychologyPositive Psychology [Seligman][Seligman] ACT, IPT, DBT, REBT, EMDR, Personal Construct, Solution ACT, IPT, DBT, REBT, EMDR, Personal Construct, Solution

focussed, Problem Solving, Mindfulness,focussed, Problem Solving, Mindfulness, etc. etc. Eclectic/ IntegrativeEclectic/ Integrative



Therapy in practiceTherapy in practice

Enable clients to:Enable clients to:

Access and use relevant informationAccess and use relevant information

Identify aims and goalsIdentify aims and goals

Decide on options for actionDecide on options for action

Acquire appropriate skillsAcquire appropriate skills

Implement a course of actionImplement a course of action

Review outcomesReview outcomes



Successful therapySuccessful therapy(John Teasedale)(John Teasedale)

A model (formulation) of the problem understood and A model (formulation) of the problem understood and accepted by the clientaccepted by the client

A model for the therapy understood and accepted by A model for the therapy understood and accepted by the clientthe client

Actual change in cognitions and behaviourActual change in cognitions and behaviour

Reinforcement in the “real world”Reinforcement in the “real world”

Change equation: reason + benefits > inertia + costsChange equation: reason + benefits > inertia + costs



Post QualificationPost QualificationRegistrationRegistration

Protected titlesProtected titles

The titles below are protected by law. Anyone using one of these titles must be registered with the Health Professions Council, or they may be subject to prosecution and a fine of up to £5,000.

Practitioner psychologistPractitioner psychologistRegistered psychologistRegistered psychologistClinical psychologistClinical psychologistCounselling psychologistCounselling psychologistEducational psychologistEducational psychologistForensic psychologistForensic psychologistHealth psychologistHealth psychologistOccupational psychologistOccupational psychologistSport and exercise psychologistSport and exercise psychologist



Personal and ProfessionalPersonal and Professional DevelopmentDevelopment

SupervisionSupervision - external review of practice- external review of practice

Establishing networksEstablishing networks - support, onward referral- support, onward referral

UpdatingUpdating - refreshing the old- refreshing the old

Professional advancesProfessional advances - acquiring the new- acquiring the new

Evidence basedEvidence based - efficacy and effectiveness- efficacy and effectiveness

ResearchResearch - breaking new ground- breaking new ground

Personal awarenessPersonal awareness - reflective practice- reflective practice

Personal therapyPersonal therapy - physician heal thyself- physician heal thyself



NHS Pay ScalesNHS Pay Scales



Professional BodyProfessional Body(www.bps.org.uk)(www.bps.org.uk)



BPS MembershipBPS Membership

6,95211,843

24,604

43,764

48,950

05,000

10,00015,00020,00025,00030,00035,00040,00045,00050,000

1975 1985 1995 2005 2010

BPS Growth in Members



Scottish BranchScottish Branch

1,131

1,688

3,1203,475

0

500

1,000

1,500

2,000

2,500

3,000

3,500

1975 1989 1995 2005 2010

Growth in Scottish Branch Members



DivisionsDivisions

DCP (Clinical)

DECP (Education &

Child)

SDEP (Scottish

Education)

DOP (Occupational)

DFP (Forensic)

DoN (Neuropsychology)

DHP (Health)

DCoP (Counselling)

DARTP (Academic, Research

& Teaching)

DSEP (Sport & Exercise)

Special Groups Psychology & Social

Care Coaching Psychology



DCPDCP

6291574

2988

5884

9554

0

2000

4000

6000

8000

10000

1975 1985 1995 2005 2010

Growth in Clinical Division



BPS Research DigestBPS Research Digest FreeFree E-mailed fortnightlyE-mailed fortnightly Key information on the Key information on the

latest, interesting latest, interesting researchresearch

Join in online Join in online discussionsdiscussions

Follow on Facebook andFollow on Facebook andTwitterTwitter

Sign up at:Sign up at: www.researchdigest.org.ukwww.researchdigest.org.uk

Also Student Members Group:

www.bps.org.uk/smg/



Your Professional BodyYour Professional Body(www.bps.org.uk)(www.bps.org.uk)



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Psychology in Healthcare

Documents

cost of mental health

mental health samh

retirementabsenteeismno

scientific study of

population scotland

psychological healthchildren

psychological healthli

common combination of