Psychology in Healthcare

1. 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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3. 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 Psychology in Healthcare Prof. Ray Miller

4. 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

5. Context • Health Issues • Health Policy • Healthy (and unhealthy) behaviour • Public Health • Mental Health • Physical Health • Research and Development Psychology in Healthcare Prof. Ray Miller

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

7. Current Policies Psychology in Healthcare Prof. Ray Miller

8. 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. Psychology in Healthcare Prof. Ray Miller

9. Projected % change in age structure of Scotland's population, 2004-2031 Source: REGISTRAR GENERAL FOR SCOTLAND - Projected Population of Scotland (2004-based) Psychology in Healthcare Prof. Ray Miller

10. Psychological Morbidity Psychology in Healthcare Prof. Ray Miller

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

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

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

14. 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. Psychology in Healthcare Prof. Ray Miller

15. Scottish ReviewMarch 2011 Psychology in Healthcare Prof. Ray Miller

16. Psychology Workforce Psychology in Healthcare Prof. Ray Miller

17. Psychology Workforce Psychology in Healthcare Prof. Ray Miller

18. Psychologists per 100,000 population (Scotland 2011) Psychology in Healthcare Prof. Ray Miller

19. 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

20. 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 Psychology in Healthcare Prof. Ray Miller

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. Intervention (Therapy)Theoretical frameworks Some major dimensions: • 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

29. 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

30. 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

31. 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

32. 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

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

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

35. BPS Membership Psychology in Healthcare Prof. Ray Miller

36. Scottish Branch Psychology in Healthcare Prof. Ray Miller

37. 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 Psychology in Healthcare Prof. Ray Miller

38. DCP Psychology in Healthcare Prof. Ray Miller

39. BPS Research Digest • Free • E-mailed fortnightly • Key information on the latest, interesting research • Join in online discussions • Follow on Facebook and Twitter Sign up at:www.researchdigest.org.uk Also Student Members Group: www.bps.org.uk/smg/ Psychology in Healthcare Prof. Ray Miller

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

41. Download www.raymiller.net/download Psychology in Healthcare Prof. Ray Miller