9 1. Organising and Managing Psychological Services The 1996 Department of Health report on NHS Psychotherapy Services in England: Review of Strategic Policy (DoH, 1996) was the first document of its kind to be published in England. This was followed by the 2001 evidence based guideline Treatment Choice in Psychological Therapies and Counselling
The Department of Health (Department of Health, 2001) Treatment Choice in Psychological Therapies summarises those disorders found to benefit from talking therapies, and specifies which therapeutic approach is beneficial in which condition. Depression, anxiety, panic disorder, social anxiety, and phobias, post traumatic disorders, eating disorders, obsessive compulsive disorder, personality disorders, including repetitive self-harm were all found to benefit. Together, these two documents collated evidence for the effectiveness of psychological therapies and offered practical guidance about how to drive forward the evidence based practice agenda. In addition to this, The NHS Plan a) and the Priorities and Planning Framework (PPF) for 2003-6 set out a number of proposals for new teams and services to fast-forward the mental health National Service Framework NSF) and modernise services. Effective psychological therapies for common disorders were addressed specifically in the PPF (2002) target to develop new workers in primary care. The role of applied psychologists and the importance of psychological approaches were enshrined in the National Service Frameworks for Mental Health (DH, 1999), Children, Young People & Maternity Services DH, 2004), and Older Adults (DH,
2001). The role of psychological approaches in the care of people with physical health conditions and their families and carers is set out in the NSFs for Cancer (DH, 2000), Coronary Heart Disease (DH, 2000), Diabetes (DH, 2001), Renal Services (DH, 2004; 2005), and Long-term (neurological) Conditions (DH, 2005).
10 Building on the information contained in the above documents, Organising and Delivering Psychological Therapies was published on behalf of NIMHE (DH, b. The document provides a model of good practice in the management, training, access, choice, and supervision of psychological therapists. The main action points that came out of this document were to • Improve access to therapies to avoid long waiting times. This can be assisted by defining clear care pathways to psychotherapeutic help for different psychological conditions • Attend to the psychotherapeutic needs of different groups for example, older people, ethnic minorities • Involve users in choosing the most appropriate therapy for their condition and situation. This in turn would require psychological therapy services to provide more effective information about their services and how they can be accessed, to both users and potential referrers • Have systematic training in psychological therapies for mental health professionals supported by specialist supervision once they return to the workplace •
To offer clear leadership, both professionally and managerially, best achieved through the development of an organisation wide body i.e. a Psychological Therapies Management Committee
(PTMC). This was recommended to oversee the implementation of good practice in the delivery of psychological therapies and any Department of Health principles
11 The National Institute for Health and Clinical Excellence (NICE) has recommended that a range of psychological therapies be made available on the NHS. There is persuasive evidence of their effectiveness and cost-effectiveness in improving outcomes for people experiencing a range of common and severe mental health problems. NIMHE has highlighted care pathways as an important system for targeting appropriate interventions. Although care pathways are increasingly available, they do not specify levels of skills needed to provide specific psychological interventions. However, the Healthcare Commission standards highlight the need for monitoring of skills, training, and supervision, within an auditable framework.