RCP: Psychological therapies in psychiatry and primary care, new report provides guidance for practitioners, employers and commissioners

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Monday, 16, Jun 2008 12:00

Psychological Therapies in Psychiatry and Primary Care is the title of a new report from the Royal College of Psychiatrists in partnership with the Royal College of General Practitioners.

Its aim is to improve provision of psychological therapies to people suffering from mental and physical disorders in both primary and secondary care settings. The report provides information and guidance about psychological therapies that should be useful to psychiatrists, GPs, employers and commissioners of services.

The National Institute of Health and Clinical Excellence (NICE) has recognised the contribution that psychotherapeutic treatments can make to the care of people with a wide range of debilitating mental and physical illnesses, as well as the importance of initiatives such as Improving Access to Psychological therapies (DoH, 2007).

Psychological therapies encompass a broad range of interventions, including talking therapies, which follow different theoretical models (e.g. cognitive behavioural, psychodynamic and systemic models), as well as different forms of delivery (e.g. individual, group and family treatments).

Not only can psychological therapies reduce symptoms, just as medication can, but they can also produce other outcomes - from helping a person to cope with an adverse change in circumstances, to enabling people to make lasting changes in their personality, and improve their ability to develop and sustain relationships.

Problems with the delivery of these therapies include treatment factors, such as the perceived lack of efficacy of psychological therapies, inadequate information for staff and prospective patients, and cost in relation to the resources available.

Other problems concern workforce factors, such as lack of suitably trained staff, multiplicity of qualifications and accreditation bodies complicating recruitment and planning, and the absence of statutory regulation; and organisational factors, like failure to provide appropriate facilities, and belief in quick fixes rather than sustained recovery.

The conclusions and principal recommendations of the report can be summarised as:

· Meeting the need for dedicated psychological therapies

· Equitable provision of services, not only for improved access to therapies for anxiety and depression, but also to effective treatments for the elderly, people with severe and enduring mental illnesses, those with learning disabilities, and black and ethnic minority communities

· Development of 'stepped care' provision between the NHS and the voluntary sector, involving clinical leaders from primary care and mental health services in co-ordinating provision across both sectors

· Delivery standards to ensure patients' safety, as well as a high quality of care

· Commissioning: Improving Access to Psychological Therapies should be complemented by additional commissioning initiatives, and take into account the views of service users

· Organisational support, promoting the development of 'psychological mindedness' and therapeutic skills among all staff

· Workforce: providing opportunities for all front-line clinicians in primary and secondary care to develop personal skills in psychological therapies through training and support

· Research: greater support for research into frequently used and promising therapies is needed, as well as future research to optimise skills and compare different models of service delivery

· Future service and practice guidelines: a concerted attempt should be made to derive a single plan, with the aim of simplifying documentation for the future provision of psychotherapies

· General practice: GPs should have planned training to provide them with knowledge and experience of mental disorders, and skills to deliver therapeutic support and interventions

· Psychiatry: training in psychotherapeutic understanding and skills should be available throughout the postgraduate training of all psychiatrists; and consultant psychiatrists in all specialties should monitor the availability of psychological therapies on behalf of their patients

· Consultant psychiatrists in psychotherapy have a pivotal role in ensuring that new training expectations are met; in undertaking assessments and delivering complex treatments; and supporting staff teams and therapists through supervision and consultation. Mental health providers and commissioners should ensure that there are sufficient consultant psychotherapists to meet these needs.

CR 151 Psychological Therapies in Psychiatry and Primary Care costs £10 and is available from the College Book Sales Office on: +44 (0)20 7235 2351 ext 146, at the Royal College of Psychiatrists, 17 Belgrave Square, London, SW1X 8PG, UK.

For further information please contact Deborah Hart or Thomas Kennedy in the Communications and Policy Department.

Telephone: 020 7235 2351 Extensions. 127 or 154

E-mail: dhart@rcpsych.ac.uk or tkennedy@rcpsych.ac.uk.

Thomas Kennedy

Communication Manager

Communications and Policy Department

The Royal College of Psychiatrists

T: +44 (0)20 7235 2351 Extension: 154

F: +44 (0)20 7235 1935

E: tkennedy@rcpsych.ac.uk

W: http://www.rcpsych.ac.uk