Goulburn Valley Area MHS Psychology Services Program

1
Goulburn Valley Area MHS Psychology Services
Program

• Development of Psychology Services in a Rural
  Mental Health Setting Challenges, Concerns
  Compliments.
• Presented by John Miksad (GVAMHS Senior
  Psychologist)

2
Introduction

• What is the Psychology Clinic?
• Why Psychology? How to demonstrate the importance
  of Psychology in MHS.
• Issues of retention of Allied Health staff in MHS
  Psychologists in particular.
• Rural setting challenges.

3
Challenges

• How do we embed psychology into the wider
  organisation?
• Staffing, recruitment, retention creating a
  sustainable model.
• Paperwork and procedures.
• Time allocation of Senior Psychologist role.

4
Concerns

• Staffing Nursing positions will be lost to
  Psychology!
• Clinical governance ensuring that decisions are
  discussed openly.
• Recommendations could be made to clients without
  proper clinical discussion.

5
Compliments

• Growth in demand for Psychology.
• Psychologists involved in clinical
  decision-making with psychiatrists.
• Psychology raised regularly for referral in
  clinical meetings.
• Academic presentations very well attended.
• Statistics - Case managers and Psychiatrists are
  voting with their feet.

6
Statistics

• 2008
  2009 (to October)
• Total referrals 38 33
• Psychotherapy 29 24
• Assessment 9 8
• Waiting List 0 1
• Completed Case 33 20
• Current Clients 0 10
• Dropped Out 5 2

7
Brief Case Example Joanne

• 40yo married female part-time working
  professional
• Referred by GP in context of depressed mood, and
  visual, tactile auditory hallucinations.
• Intrusive sexual images of a pornographic nature
  neutralising prayer to reduce distress (4-5
  times per day)
• Difficulties with intimacy in relationship with
  partner
• Auditory hallucinations, themes of guilt.
• Followed from a period of stress in relationship,
  death of aunt, resulting in 3 Inpatient
  admissions
• Family history of anxiety and depression.
• Medications Risperadone, Sertraline, Lorazepam,
  Benzotropine.

8
Brief Case Example (cont.)

• Diagnosis Major Depressive Disorder with severe
  psychotic features Obsessive Compulsive
  Disorder.
• Psychology Clinic assessment and intervention
  revealed core beliefs about sexual intimacy and
  sexual functioning, precipitated by rejection
  following intense sexual relationship.
• Difficulties arose in context of relationship
  problems, perpetuated by guilt, differing
  expectations from husband, and ongoing sexual
  advances.
• Intervention exploration and disputation of
  core beliefs about sexual intimacy, guilt, and
  self-deprecation. Psycho-education regarding
  anxiety, depression, relaxation strategies, and
  problem-solving to manage stress and anxiety.

9
Conclusions

• Psychology is generally well-accepted as a
  significant component of Mental Health
  intervention.
• In a rural setting, it is critical that
  Psychology Services are well-structured, embedded
  in the organisation, and delivered consistently
  to ensure broader acceptance within the wider MH
  service.
• Staffing of Psychology Services needs to consider
  the importance of an identified Discipline
  Senior, Provisional Psychologists, and Student
  placements to maintain a sustainable model of
  service delivery.