1 / 35

Psychology at St Vincent s Adult Mental Health Program

Across the service . Clinical psychologists totalling 7 EFT Hawthorn

niveditha
Download Presentation

Psychology at St Vincent s Adult Mental Health Program

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Psychology at St Vincent’s Adult Mental Health Program Speakers: Angelika Bastin-Popp Evrim March

    2. Across the service Clinical psychologists totalling 7 EFT Hawthorn & Clarendon Community Clinics (1 EFT each) Acute Inpatient Unit (1 EFT) Primary Mental Health Team (1.8 EFT) Footbridge CCU (1 EFT) IBD counselling (0.2 EFT) Neighbourhood Justice Centre (1 EFT) Neuropsychologists totalling 0.6 EFT Across all MH services (0.4 EFT) CL Psychiatry (0.2 EFT) Postgraduate degree students approximately 6 to 8 at a given time

    3. Clinical Activities PAIS: Psychological Assessment and Intervention Service (Hawthorn clinic) CALM: Intervention Program for Comorbid Anxiety in psychotic disorders Acute Inpatient Unit – programs Inflammatory Bowel Disease Counselling Clinic

    4. Research Activities Acceptance and Commitment Therapy – a randomised clinical trial for treating psychotic symptoms in the inpatient setting Screening for acquired brain injury – evaluation of the usefulness of screening at acute inpatient unit.

    6. PAIS and CALM Hawthorn Community Clinic Angelika Bastin-Popp

    7. PAIS at Hawthorn Clinic A psychological assessment and intervention service provided for clients case managed at HC Implemented in response to requests from clients, carers and case managers for greater access to psychological services. Needs analysis with clinicians in early 2008 identified a need for psychological services to improve clinical care and client outcomes, and to assist CMs in managing the complex needs of their clients. Was resourced by 5 psychologists (3 hrs per week) and 3 postgraduate students from Swinburne.

    8. PAIS at Hawthorn Psychological services offered: Mood management Anxiety management CBT for psychosis Grief/loss/trauma therapy OCD management Treatments for personality disorders Family work Communication and social skills training Enhancing self-esteem Psychological assessments (cognitive and personality assessments) Group interventions

    9. PAIS evaluation PAIS was evaluated over a period of 8 months (March-October 2008). The evaluation included process data and outcome data on a range of measures for both clients and case managers. Total of 46 referrals to PAIS (app. 15% of the total clinic client population) The outcomes, though based on small numbers, were encouraging and the feedback from CMs was overwhelmingly positive.

    10. PAIS Evaluation Since the completion of the evaluation four psychologists have left Hawthorn Clinic. There have been a further 14 referrals to PAIS in the past year which have been managed by the student on placement under supervision.

    11. CALM: A Psychological Group Intervention A psychological group intervention for treatment of anxiety as a comorbidity with psychotic disorders Collaboration btw Hawthorn Clinic & Swinburne University Arrangement based on the principle of “outsourcing” provision of psychological services in order to improve access to these services for our clients. The goal was to provide greater accessibility to psychological group interventions for clients, and to increase the opportunity for student placement. Therapeutic principles underpinning the group intervention were based on CBT and ACT model.

    12. CALM at Hawthorn Clinic Group over 8 sessions (90 min each) between Oct-Dec 2008 for clients case managed at the Clinic. Group facilitated by an experienced clinical psychologist from Swinburne and a post-graduate student. Student supervision shared by the Swinburne psychologist (clinical sup.), and Hawthorn senior psychologist (organisational sup.). 12 clients were referred, and 8 clients completed the group. Outcome evaluation is currently in progress. The group will be repeated in 2010 as part of a larger research study.

    13. Psychology at Inpatient Unit Dr Maria Ftanou Dr Ekaterina Kamysheva

    14. Group Program Part of an extensive ward group programme (all voluntary) Psychology-run groups: Admissions group For newly admitted patients Orientation to the ward & ward programme Explore feelings about admission Anxiety group For any patient experiencing anxiety CBT-based group: psychoeducation and strategies

    15. Education/ Training Postgraduate input in 2009 Six sessions with Swinburne postgraduate students Topics on mental state examination, mental health, ACT, psychosis, personality disorders, presented by various disciplines Medical Student Training Introduction to psychological treatments focusing on CBT provided every 6 weeks

    16. Inflammatory Bowel Disease Counselling Clinic Dr Maria Ftanou Dr Felicity Whitworth

    17. The IBD Counselling Clinic Only service of this kind in Australia In 2006, discussions between Gastroenterology and SVMH identified that patients struggling with the psychosocial challenges associated with Crohn’s Disease and Ulcerative Colitis would benefit from psychological support Staffed by CL psychologist and supervised student. A CL psychiatrist available as required.

    18. The IBD Counselling Clinic: 2 main groups – Ulcerative Colitis (UC) or Crohn’s Disease (CD). UC affects the large intestine and causes formation of ulcers, open sores CD can affect any portion of the digestive tract, from mouth to anus. can occur at any age but diagnosed most frequently in 2nd and 3rd decades of life

    19. Symptoms of IBD Fatigue, tiredness Loss of appetite Sometimes fever Irregular bowel movements with mucus/ blood Diarrhoea Abdominal pain Nausea, sometimes vomiting Anemia Inflammation in other areas (joints, skin, eyes) Nutritional deficiencies and weight loss (esp. CD)

    21. IBD and Mental Health Comorbid IBD and mental health linked to a lower quality of life and more frequent CD or UC relapses (Mittermaier et al., 2004; Walker et al., 1996) Depression and anxiety are the most common Depression and anxiety can be both a consequence of the disease itself and the side effects of the medication.

    22. Presenting Concerns Distress regarding the illness Anxiety re uncertainty Lowered mood Social difficulties Relationship difficulties Body image Pain Worry/preparation about surgery Past traumatic histories

    23. IBD and Mental Health – The Challenge of Diagnosis Eg. Elizabeth surgery As the symptoms of IBD and anxiety/depression overlap, it can be difficult to differentiate between “normal” levels of distress as a result of a chronic illness, and clinical distress due to anxiety or depression - however, this distinction can be crucial for treatment and the client’s overall health and safety Eg. Elizabeth surgery As the symptoms of IBD and anxiety/depression overlap, it can be difficult to differentiate between “normal” levels of distress as a result of a chronic illness, and clinical distress due to anxiety or depression - however, this distinction can be crucial for treatment and the client’s overall health and safety

    24. IBD Counselling Clinic 2 sessions a week (0.2 EFT) – short or long-term therapy (2 to 26 sessions) including couple-therapy. Therapies targeting adjustment, preparing for surgery, body image, depression and anxiety, relationships, sexuality, quality of life. Plans for research on effectiveness of CBT – via Swinburne University

    25. Research on ACT – Inpatient Unit Dr Maria Ftanou Dr Ekaterina Kamysheva

    26. Research at Acute Inpatient Acceptance and Commitment Therapy (ACT) study – commencing in 2010 Aims to reduce rehospitalization rates to reduce believability of positive symptoms, and to increase commitment to value-based behavioural goals Offer 4 sessions of ACT to inpatients with current psychotic symptoms Randomised trial: Treatment As Usual (TAU, n = 30) and TAU + ACT (n =30)

    27. Research: Dual-Diagnosis in Psychiatric Setting Dr Evrim March Dr Mike Salzberg

    28. What is Dual-diagnosis? Coexisting diagnosis which can be separately diagnosed but are interrelated (comorbidity, co-existing disorders). Dual-diagnosis ? Mental illness and substance abuse Dual-diagnosis ? Mental illness and acquired brain injury – ABI Triple-diagnosis ? Mental illness, substance abuse, ABI

    29. Risk for dual-diagnosis Having a mental illness increases the risk of substance abuse as well as acquired brain injury. Alternatively, substance abuse and/or ABI increases the risk of mental illness. Having a dual-diagnosis increases likelihood of poorer psychosocial outcome.

    30. Screening for Substance Use ASSIST - Alcohol, Smoking and Substance Involvement Screening Test by World Health Organisation Currently, ASSIST is being administered on admission to all inpatients to screen for Alcohol and Substance Use.

    31. Screening for Acquired Brain Injury Screening for ABI – inefficient based on information collated at intake; neuropsychological referrals (not mentioning past ABI, brain scanning etc). Rates of traumatic brain injury is higher in psychiatric patients compared to non-psychiatric medical clinic patients (McGuire et al, 1998). A significant step for identification and recognition in the at-risk mental health patients, with implications for treatment and management of patients.

    32. Screening for ABI - research Aim: To evaluate the clinical usefulness of a brief ABI screening tool in detecting ABI rates. Retrospective Study: examining rates of reported ABI as baseline study – using a file audit of 100 retrospective patients. Prospective Study: use an ABI screening for 60 patients, independent of the routine admission procedure. Compare findings i.) admission rates for detected ABI; ii) retrospective study findings.

    33. Screening for ABI - research Future - room for screening in mental health settings. Need for recognising and screening for ABI in mental health services; Providing pathways to address ABI as comorbidity in mental illness Liaising with Vic specialist mental health services: diagnostic clarification (RMH Neuropsychiatry, Repatriation Neurobehaviour Clinic), and review, secondary consultation, and linkages (Royal Talbot Brain Disorders Program inc. CBDATS and ABI Behaviour Consultancy)

    34. Thoughts on Future of Psychology Difficulties in attracting and keeping psychologists in the public sector: Partly an effect of the recently introduced Medicare rebate – move to private practise (evidence from APS supporting this trend) Partly guided by limited capacity to undertake specialist roles within the community positions

    35. Current Focus For attracting and retaining psychologists within the service: 1. Increasing capacity for specialist roles 2. Providing opportunities for in-service professional development 3. Increasing academic links & research opp’s 4. Contributing to postgraduate psychology training across Victoria, supervising intern psychologists

More Related