Psychology in Healthcare

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Psychology in Healthcare

• meeting the needs of the
• Scottish population

Prof. Ray Miller Chartered Clinical Psychologist
and Chartered Health Psychologist Professional
Advisor for Psychology, NHS Lothian
(Retired) Past President, The British
Psychological Society (2006-07)
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• www.raymiller.net/download

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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
• Develop and research innovation in healthcare

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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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Recent Scottish Policies (2007 2012)
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Current Policies
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Health Survey 2010Main Headings

• GENERAL HEALTH (Self-assessed general health,
  Long-term conditions, Mental Health and
  wellbeing)
• DENTAL HEALTH
• ALCOHOL
• SMOKING
• DIET
• PHYSICAL ACTIVITY
• ADULT AND CHILD OBESITY
• RESPIRATORY HEALTH
• CARDIOVASCULAR DISEASE, HYPERTENSION AND DIABETES
• MULTIPLE RISKS
• Risk clustering
• 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 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
  other risks.

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Projected change in age structure of Scotland's
population, 2004-2031
Source REGISTRAR GENERAL FOR SCOTLAND -
Projected Population of Scotland (2004-based)
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Psychological Morbidity
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Common Mental Disorder(England 2007)
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Common Mental Disorder(England 2007)
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Cost of Mental Ill Health
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Published Date 25 February 2011

• Stressed and depressed - mental health problems
  cost 10bn a year
• By Gareth Rose
• SCOTLAND'S poor mental health is now costing the
  country more than 10 billion a year, a charity
  has revealed.
• Problems such as stress, depression and various
  disorders are keeping people out of work, putting
  pressure on the NHS, and also hitting police,
  housing and other services.The Scottish
  Association for Mental Health (SAMH) has launched
  a pre-election manifesto urging parties to take a
  broader approach to the problem.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 country.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.

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Scottish ReviewMarch 2011
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Psychology Workforce
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Psychology Workforce
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Psychologists per 100,000 population (Scotland
2011)
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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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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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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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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
• Assessment and Formulation
• Theoretical frameworks for intervention
• Supervised therapeutic practice
• Continuing professional development
• Personal development (reflective practitioner)

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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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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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Intervention (Therapy)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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Intervention (Therapy)Theoretical frameworks

• Some major dimensions
• Psychodynamic Freud, Adler, Jung
• Counselling Client Centred Rodgers / Skills
  Model Egan
• Cognitive Ellis, Kelly
• Behavioural and CognitiveBehavioural (CBT)
  Wolpe, Beck
• Cognitive Analytic Therapy (CAT) Ryle
• Systemic Minuchin
• Positive Psychology Seligman
• ACT, IPT, DBT, REBT, EMDR, Personal Construct,
  Solution focussed, Problem Solving, Mindfulness,
  etc.
• Eclectic/ Integrative

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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(John Teasedale)

• 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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Post QualificationRegistration

• Protected 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 psychologistRegistered
  psychologistClinical psychologistCounselling
  psychologistEducational psychologistForensic
  psychologistHealth psychologistOccupational
  psychologistSport and exercise psychologist

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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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NHS Pay Scales
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Professional Body(www.bps.org.uk)
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BPS Membership
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Scottish Branch
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Divisions

• 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

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DCP
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BPS Research Digest

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Also Student Members Group www.bps.org.uk/smg/
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Your Professional Body(www.bps.org.uk)
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• www.raymiller.net/download