Delivery of psychological therapies and interventions: national specification

Socialising referrers to what psychological interventions are - what–it is, good timing/readiness to maximise probability of effective referrals. Preparatory work done before referring to psychological therapies (eg. Psychoeducation, some safety and stabilisation, basic self-care including sleep, grounding. Referring elsewhere for support with social issues such as financial, housing, social work or support). Also trauma informed formulation by the professional network early in a service-user’s journey may support active models of change vs a medical or more passive model.

Principles underpinning the document are good. Helpful to have standards and for people to know what they can expect with a degree of consistency. However, they are general and not specific enough or practical enough to direct change. The specifications do not go into how these outcomes will occur in practice, and could lead to unrealistic expectations.
Timing specifications are unrealistic expectations, not practical – would be more useful if service specific. Useful to be working towards similar broad aims but not clear how this will be translated into practice for example through staff training, outreach, translation. Mismatch between expectations and what services have the staff to offer.

Tone of document a bit passive. We thought it seemed as if we are acting on clients rather than it being a collaborative process requiring their active engagement.
Document could be shorter and more practical.
Formulation is mentioned throughout but there is no reference to it being based on psychological theory. A link to the glossary when the word is first used would be helpful.
It would be helpful to have a rationale for 12/18wk target. Many services are a long way from achieving this.
Sense that the simplified language version loses a lot of the detail.

Providing feedback from the clients would be very beneficial however the involvement/feedback from others could potentially be detrimental (e.g. for those in coercive relationships). Would need to ensure that the feedback is supportive of the person’s treatment.

Prioritisation could be problematic in relation to people believing that in order to receive support they would need to have “severe difficulties”. Also in terms of early intervention it is best that people are supported early on in the problem cycle/younger age.

Measures are designed to monitor specific things – a one size fits all approach is unlikely to be helpful eg a basic symptoms measure won’t pick up on change in someone with severe EUPD where containment a big part of the goal.

Outcomes would be dependent upon staff recruitment, training and retention of staff.
1.2 how are they providing feedback
1.4 ‘timely way’ – need to create realistic expectations
1.8 re: “There will be a commitment to reduce inequalities and improve access to psychological care for all.” Agree with the sentiment but how is this going to be done in practice. Could this be detailed somewhere in the document.
1.9 Outcome measures need to be attuned to client so client doesn’t feel they are failing at therapy

A judgement needs to be made with the client regarding whether family/carer involvement is helpful. “If I express a wish to seek psychological care from a professional…”, a wish for psychological therapy is not an automatic entry to a discussion with a mental health professional about accessing therapy. Many times, the discussion of needs will remain with other professionals. At times it is unhelpful to offer therapy for example trauma therapy if person not in a safe environment. Some people unable to utilise psychological therapy, instead wanting a supportive relationship that doesn’t require any change.

The details given within this outcome are very lengthy and could be potentially overwhelming for people.

It is really helpful for people to have shared aims but you would need to have staff available that can meet these aims so that expectations are not getting raised unduly.

2.2 ‘live the life I choose’ – improving quality of life would be better end to sentence as life I choose could include behaviours that are damaging to their mental health including drug use, DSH, avoidance.

Aspirations of the outcome are laudable but delivery depends upon the right staffing and infrastructure. 12 weeks is much quicker than most of our services in GGC due to demand outstripping capacity.
Re choice of location often choice between remote or local clinic. Home visits are sometimes a service user’s choice but often not an appropriate setting for psychological therapy. Limited options for staff to offer. At times client may have a preference for remote via AA/tel but clinician feels they need to see the client in person to assess fully or as part of treatment.

Lacks mention of psychological therapies not mentioned in Matrix (eg arts psychotherapies).
Simplistic to suggest anxiety is simple and severe trauma is complex – treatment of anxiety may require many sessions and some survivors of severe trauma may benefit from brief therapy.
Issue of non-attendance difficult balance between assessing risk and individuals’ responsibility not to waste scarce NHS resources and attend or cancel if at all possible.

Simple and consistent referral systems are difficult to achieve as there are so many variables. A laudable aim but some clarity re mechanisms would be more helpful.

I think most people would agree it is important to involve families/carers where either the patient wishes this or where it is clinically indicated and the patient consents. However in many cases in an adult mental health setting it isn’t appropriate to have family members/carers sitting in on every appointment – maybe for 10mins at start or end. Also need to carefully assess whether relationship is supportive and not abusive, coercive or critical.

This needs to be funded appropriately with consideration to sliding scale pay offers and the impact on the most senior/leading grades of psychology workforce over the long run and make these posts attractive to staff if want to retain and recruit staff in long run.

While assessment tools can be helpful, difficult to identify one which would be appropriate across wide range of settings. Need to ensure administration wouldn’t be counter-productive and sufficiently sensitive to pick up on areas of change.

Needs to be meaningful – why is it 18 weeks? This may be appropriate for some services but not all. Indicators need to be realistic and appropriate measures/support understanding needs to be put in place to support services who are unable to meet the standards. Important that services aren’t forced to provide sub-therapeutic input to meet waiting targets, when not actually providing treatments in line with evidence base/Matrix.

We believe some of these issues are wider than NHS and the Scottish govt needs to look at wider societal issues including public health, social care and education to address inequalities.
The MH strategy mentions self-management and responsibility and this needs to be addressed on a wider scale. A recent example being A&E attendance and the public being asked not to attend unless necessary. It is difficult to deliver this message in a nuanced way however as we don’t want to deter people from accessing mental health services if they need them.