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). Download. - PowerPoint PPT PresentationTRANSCRIPT
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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)
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DownloadDownload
www.raymiller.net/downloadwww.raymiller.net/download
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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
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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
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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
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Recent Scottish PoliciesRecent Scottish Policies (2007 & 2012)(2007 & 2012)
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Current PoliciesCurrent Policies
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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.
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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)
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Psychological MorbidityPsychological Morbidity
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Common Mental DisorderCommon Mental Disorder(England 2007)(England 2007)
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Common Mental DisorderCommon Mental Disorder(England 2007)(England 2007)
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Cost of Mental Ill HealthCost of Mental Ill Health
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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.
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Scottish ReviewScottish ReviewMarch 2011March 2011
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Psychology WorkforcePsychology Workforce
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Psychology WorkforcePsychology Workforce
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Psychologists per 100,000 Psychologists per 100,000 population population (Scotland 2011)(Scotland 2011)
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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NHS Pay ScalesNHS Pay Scales
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Professional BodyProfessional Body(www.bps.org.uk)(www.bps.org.uk)
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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
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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
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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
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DCPDCP
6291574
2988
5884
9554
0
2000
4000
6000
8000
10000
1975 1985 1995 2005 2010
Growth in Clinical Division
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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/
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Your Professional BodyYour Professional Body(www.bps.org.uk)(www.bps.org.uk)
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