Psychology in Healthcare

1. Psychology in Healthcare What Psychology has meant for me… Prof. Ray Miller Clinical and Health Psychologist Retired Professional Advisor for Psychology, NHS Lothian Past President, The British Psychological Society

2. The making of a Psychologist Psychology in Healthcare Prof. Ray Miller

3. Why Psychology? • “The greatest discovery of my generation is that human beings can alter their lives by altering their attitudes of mind.” William James (1842-1910) • “I am not what happened to me, I am what I choose to become.” Carl Jung (1875-1961) • “Man is not a rational animal, he is a rationalizing animal.” Robert A Heinlein (1907-1988) Psychology in Healthcare Prof. Ray Miller

4. 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, well-being and health care delivery Psychology in Healthcare Prof. Ray Miller

5. Our Health and Well Being Today • “The nature of health threats have changed dramatically; infectious disease now only accounts for 2% of deaths. Most people now die in old age and of non-communicable diseases such as circulatory (accounting for 34% of deaths), cancers (27%), and respiratory diseases (14%). Vast improvements in public health have meant that the biggest threats to our lives now are diseases that usually occur later in life. The onset of diseases that occur earlier in life are at least partly linked to the way we live our lives.” (DoH - 2010 report) Psychology in Healthcare Prof. Ray Miller

6. Europe • Mental illness is one of the top public health challenges in Europe as measured by prevalence, burden of disease and disability. • Across Europe, neuropsychiatric disorders are the second largest contributor to the burden of disease accounting for 19% of the total. • Mental disorders are by far the most significant of the chronic conditions affecting the population of Europe, accounting for just under 40% of all years lived with disability. • The prevalence of mental disorders does not appear to be changing significantly over time, though more people are accessing treatment and support… (Mental Health Strategy for Scotland: 2012-2015) Psychology in Healthcare Prof. Ray Miller

7. Causes of Dysfunction • Bio Medical Illness v Psychological Function Model Bio Psycho Social • Viruses • Bacteria • Lesions • Genetics • Senesence • BioChemistry • Neurology • Behaviour • Emotions • Beliefs • Attitudes • Coping • Stress • Pain • Class • Education • Employment • Ethnicity • Culture • Sex/Gender • Age Biopsychosocial Model Psychology in Healthcare Prof. Ray Miller

8. Psychology 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 Psychology in Healthcare Prof. Ray Miller

9. Context • Health Issues • Health and Social Policy • Healthy (and Unhealthy) Behaviours • Public Health and Health Promotion • Physical Health, Fitness and Well Being • Mental Health, Fitness and Well Being • Service Planning and Delivery • Research and Development Psychology in Healthcare Prof. Ray Miller

10. Scottish Policies(2007 & 2012) Psychology in Healthcare Prof. Ray Miller

11. Scottish Health Surveys (http://www.scotland.gov.uk/Topics/Statistics/Browse/Health/scottish-health-survey/Publications) (http://www.scotpho.org.uk/publications/reports-and-papers/887-scotlands-mental-health-adults-2012) Psychology in Healthcare Prof. Ray Miller

12. WEMWBS(http://www.healthscotland.com/documents/1467.aspx) Psychology in Healthcare Prof. Ray Miller

13. Health Survey 2011 The first stage interview includes questions every year about: • general health and long-term conditions • mental health and wellbeing • cardiovascular disease, hypertension and diabetes • eating habits, including fruit and vegetable consumption • smoking and drinking • physical activity • dental health • demographic and other background details. Risk clustering • The most common combination of risks is 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. Psychology in Healthcare Prof. Ray Miller

14. Scotland's Ageing Population http://www.scottish.parliament.uk/S4_FinanceCommittee/Reports/fiR-13-02w.pdf Psychology in Healthcare Prof. Ray Miller

15. Common Mental Disorder(England 2007) Psychology in Healthcare Prof. Ray Miller

16. Common Mental Disorder(England 2007) Psychology in Healthcare Prof. Ray Miller

17. Cost of Mental Ill Health Psychology in Healthcare Prof. Ray Miller

18. Demand for Psychology • England: “Improving Access to Psychological Therapies” • Scotland: “The Matrix” Psychology in Healthcare Prof. Ray Miller

19. Psychologist Numbers(http://www.isdscotland.org/Health-Topics/Workforce/Psychology/) Psychology in Healthcare Prof. Ray Miller

20. Psychologists per 100,000 population (Scotland 2012) Psychology in Healthcare Prof. Ray Miller

21. What do they do? Psychology in Healthcare Prof. Ray Miller

22. Who do they do it with? Psychology in Healthcare Prof. Ray Miller

23. No Health without Psychological Health • Children and Education • Health Promoting Schools • Childhood obesity • Immunisation uptake • Parenting skills/ abuse and neglect • Workplace • Scotland’s Health at Work • Workplace stress • Work/Life balance and retirement • Absenteeism Psychology in Healthcare Prof. Ray Miller

24. 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 Recovery Psychology in Healthcare Prof. Ray Miller

25. 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 Psychology in Healthcare Prof. Ray Miller

26. 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 Psychology in Healthcare Prof. Ray Miller

27. 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 Psychology in Healthcare Prof. Ray Miller

28. 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) Psychology in Healthcare Prof. Ray Miller

29. Basic skills Establishing & Maintaining Communication • creating the environment active listeningverbal & non verbal cues genuinenessempathy respectconfidentiality trustagreement sharingpartnership exploringsetting boundaries networkingending • Within an ethical and professional code of practice Psychology in Healthcare Prof. Ray Miller

30. 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 Psychology in Healthcare Prof. Ray Miller

31. 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 Psychology in Healthcare Prof. Ray Miller

32. Intervention (Therapy)Theoretical frameworks • Psychodynamic[Freud, Adler, Jung] • Counselling: Client Centred [Rodgers] / Skills Model [Egan] • Cognitive[Ellis, Kelly] • Behavioural and Cognitive–Behavioural (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 Psychology in Healthcare Prof. Ray Miller

33. 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 Psychology in Healthcare Prof. Ray Miller

34. 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 > inertia + costs Psychology in Healthcare Prof. Ray Miller

35. 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 Psychology in Healthcare Prof. Ray Miller

36. 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 Psychology in Healthcare Prof. Ray Miller

37. NHS Pay Scales Psychology in Healthcare Prof. Ray Miller

38. Professional Body(www.bps.org.uk) Psychology in Healthcare Prof. Ray Miller

39. What the BPS does The British Psychological Society promotes excellence and ethical practice in the science, education and practical applications of psychology. Psychology in Healthcare Prof. Ray Miller

40. Key missions • be the learned society and professional body for the discipline • make psychology accessible to all • promote and advance the discipline • be the authoritative and public voice of psychology • determine and ensure the highest standards in all we do Psychology in Healthcare Prof. Ray Miller

41. Achieved through • Supporting members’ careers and professional development • Providing information to the public • Increasing the awareness and influence of psychology in society • Raising standards of education, training and practice Psychology in Healthcare Prof. Ray Miller

42. Undergraduate approved courses Establishes, develops and maintains the standards of Psychology degrees in Higher Education through accreditation of courses: • Course Content • Facilities (Labs/ Libraries) • Teaching standards • Staff/ Student ratio Required for progress to professional psychology and registration Psychology in Healthcare Prof. Ray Miller

43. Developing the profession • Organising conferences and events • Recognising excellence in the science and practice of psychology • Setting standards in psychological testing • Preserving and recognising the history of psychology • Publishing Psychology in Healthcare Prof. Ray Miller

44. Publishing • 11 academic journals • Monthly publication of The Psychologist (free to members) • BPS Blackwell book publishing partnership (Discounts) • Research and Occupational Digests • Specialist and regional newsletters • Consultation papers, advice and guidance Psychology in Healthcare Prof. Ray Miller

45. Subscriber For anyone who is interested in psychology but has no applicable qualifications or students who are not studying an approved undergraduate psychology course. • e-Subscriber £10 • Subscriber £24 http://www.bps.org.uk/what-we-do/benefits-belonging/membership/membership Psychology in Healthcare Prof. Ray Miller

46. For students As a Student Member you get: • membership of Student Member Group (SMG) • The Psychologist magazine free every month • PsychTalk, a newsletter written by students • exclusive discounts (books, journals, conferences, events) • transfer to graduate membership free of charge • recognition of belonging to the professional body, with the chance to join member networks (make contacts/ friends) • access to a range of high street discounts and offers Psychology in Healthcare Prof. Ray Miller

47. What is Psych-Talk? www.bps.org.uk/smg/ • Psych-Talk is the magazine for the Student Members of the British Psychological Society. Psych-Talk is written by students for students and contains loads of articles and information about studying psychology, careers in psychology and keeping you up to date with the Student Committee activities. • Contributing to Psych-TalkBeing published in Psych-Talk looks pretty impressive on your CV. Psychology in Healthcare Prof. Ray Miller

48. Cost of student membership • See the video – what other students think: • http://www.bps.org.uk/videos/members-explain-benefits-belonging • Find out more and download application: • http://www.bps.org.uk/what-we-do/membership/student-member/student-member Psychology in Healthcare Prof. Ray Miller

49. And it doesn’t end there… • PsyPAG is a national organisation for all psychology postgraduates based at UK Institutions. Funded by the Research Board of the British Psychological Society, PsyPAG is run on a voluntary basis by postgraduates for postgraduates. • Graduate member (MBPsS) • Becoming a Graduate Member of the Society is the starting point to your career as a psychologist. • Also a great way to keep up with all psychology can contribute to your career even if you are not employed as a psychologist. Psychology in Healthcare Prof. Ray Miller

50. Free online Digests(fascinating updates and news from the latest publications) http://bps-research-digest.blogspot.co.uk/ Emailed to you fortnightly http://bps-occupational-digest.blogspot.co.uk/ Emailed to you monthly Psychology in Healthcare Prof. Ray Miller