Psychology in Edinburgh

1. Psychology in Edinburgh meeting the needs of health care clients Prof. Ray Miller Chartered Clinical Psychologist and Chartered Health Psychologist Professional Advisor for Psychology, NHS Lothian Past President, The British Psychological Society (2006-07)

2. Craighouse Asylum • Founded by Andrew Duncan in 1813 as the Edinburgh Lunatic Asylum • Originally for the wealthy who could pay • Opened to all in 1842 replacing the City’s ‘Bedlam’ in 1845 • Substantially rebuilt in 1894 as a magnificent neo-Gothic building Psychology in Edinburgh Prof. Ray Miller

3. New Craighouse Psychology in Edinburgh Prof. Ray Miller

4. Royal Edinburgh Hospital • Renamed in 1922 • 1948 National Health Service (NHS) founded • Moved to present site in 1965 • Managed by NHS Lothian Psychology in Edinburgh Prof. Ray Miller

5. Current Services • Adult psychiatric in-patient unit for Edinburgh, East Lothian and Midlothian • Adolescent mental health unit • Dementia and early dementia unit • Forensic unit • Learning disabilities • Older Adult continuing care • Emphasis now on community, not hospital, care • Plans currently being prepared for new hospital Psychology in Edinburgh Prof. Ray Miller

6. A Day in the Life Psychology in Edinburgh Prof. Ray Miller

7. The Role of Psychology 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 Edinburgh Prof. Ray Miller

8. 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 Psychology in Edinburgh Prof. Ray Miller

9. Recent Scottish Policies(Dec 2006 & Dec 2007) Psychology in Edinburgh Prof. Ray Miller

10. Prevalence in GP Practice Range (per 1000) • Dementia 1.2 to 1.6 • Psychoses 2.7 to 8.6 • Personality disorder 7.2 to 4.0 • Psychosocial problems 4.6 to 10.0 • Organic with psychological 13.1 to 16.6 • Psychosomatic 24.5 to 34.5 • Neuroses/ affective disorder 55.7 to 116.6 Psychology in Edinburgh Prof. Ray Miller

11. Psychological Distress • Prevalence of neurotic symptoms - by gender (people aged between 16 to 64 years) All figures are percentages • Diagnosis and rate Female Male All • (past week)199320001993200019932000 • Sleep problems 28 34 21 24 2529 • Fatigue 33 33 21 23 2728 • Irritability 25 24 19 20 2222 • Worry 23 23 17 18 2020 • Depression 11 12 8 11 1012 • Concentration and forgetfulness 10 11 6 9 810 • Depressive ideas 11 12 7 9 910 • Anxiety 11 10 8 9 109 • Somatic symptoms 10 9 5 6 87 • Worry about physical health 5 7 4 7 57 • Obsessions 12 4 7 5 96 • Phobias 7 6 3 4 55 • Compulsions 8 4 5 3 63 • Panic 3 2 2 2 32 • Source: ONS, 2000, Psychiatric morbidity among adults living in private households in Great Britain. Psychology in Edinburgh Prof. Ray Miller

12. Cost of Mental Ill Health Psychology in Edinburgh Prof. Ray Miller

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

14. 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 framework • Supervised therapeutic practice • Continuing professional development • Personal development (reflective practitioner) Psychology in Edinburgh Prof. Ray Miller

15. 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 Edinburgh Prof. Ray Miller

16. 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 Edinburgh Prof. Ray Miller

17. Theoretical frameworks some major models: • Counselling: Client - Centred (Rogerian/Humanistic)/ Skills Model (Egan) • Psychodynamic • Cognitive - Behavioural • Cognitive Analytic • Systemic • IPT, DBT, REBT, EMDR, Personal Construct, Solution focussed, etc. • Eclectic/ integrative Psychology in Edinburgh Prof. Ray Miller

18. 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 Edinburgh Prof. Ray Miller

19. Successful therapy • 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 Edinburgh Prof. Ray Miller

20. 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 Edinburgh Prof. Ray Miller

21. 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 Edinburgh 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 Edinburgh 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 Edinburgh 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 Delivery Plan Psychology in Edinburgh 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 Edinburgh Prof. Ray Miller

26. 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 Edinburgh Prof. Ray Miller

27. Professional Body(www.bps.org.uk) Psychology in Edinburgh Prof. Ray Miller

28. BPS Membership Psychology in Edinburgh Prof. Ray Miller

29. BPS Research Digest • Free • E-mailed fortnightly • Key information on the latest, interesting research • Join in online discussions Sign up at:www.researchdigest.org.uk Psychology in Edinburgh Prof. Ray Miller

30. Download • www.raymiller.net/download/ Psychology in Edinburgh Prof. Ray Miller