PSY2003 S2 W8 Clinical Practice Flashcards
(72 cards)
Why are Mental Health services needed?
Reducing of suffering: Lessening distress, Improved quality of life, meaning and purposeful activity & Limit risks to the individual and other people.
Social Benefits: Foster a more diverse, inclusive and fairer society & Low risk to self and others
Economic costs and benefits (Chisholm et al., 2016, Lancet)
What are the economic benefits of providing care?
Output effect (Layard et al, 2007): Employment, Savings to the NHS, Reduced costs per person, including physical and mental health services, Reduced referrals to secondary sector, fewer inpatient admissions, fewer GP consultations and less medication & Estimated £300 over two year period
Saving to the Exchequer: Increased employment (reduction in benefits and increased ax receipts) & Saving in NHS costs
What are the economic costs of Mental health services?
Mental health problems cost c.£105 billion per year in England: Service provision, lost work, reduced quality of life.
Costing over £2000 per person per year in England. But only about one person in three with mental health disorder gets help for it.
What are the costs of health research funding?
Of all health research funding, only 5% goes to mental health: a large chunk to dementia research
What are the mental health care costs in the uk?
Layard & Clark (2014) Healthcare costs for:
all problems = c.£100 billion/year
people with mental health problems = £13 billion
people with anxiety and depression = £3.75 billion
children and adolescents with mental health problems = £0.75 billion
Plus medically unexplained symptoms = £3 billion
What does the healthcare costs look like?
Most:
Physical Health
Mental Health - other
Anxiety/depression
Unexplained medical problems
Child/adolescent mental health
Least
What is an example of the cost-benefit trade off?
Improving Access to Psychological Therapies (IAPT) initiative was set up on this basis.
Layard & Clark (2014):
The mean resource cost for a course of treatment = £750.
Financial planners and commissioners of services want to know – do the benefits outweigh the costs?
If they don’t, what other interventions or resources that might be offered?
What is the cost analysis for IAPT?
What are the benefits of treatment?
Across all patients (whether they recover or not).
Treating someone reduces their mean benefit costs by one month = £750
-Employment level goes up by 18%
-Absence from work goes down by 31 days/year
-Economic output per person rises by £1100/month
-Where present, costs of comorbid physical conditions go down by several thousand pounds
So what is the argument for NOT treating patients with common mental health problems? Might more psychological therapy cost nothing?
What is an EIP example for cost-benefit trade off?
(Tsiachristas, et al. 2016)
1% of the population will develop psychosis require longer term care (NICE, 2014).
EIP services seek to reduce the amount of time between the onset of symptoms and when people receive help that aims to reduce the impact of symptoms on their ability work, foster relationships and/or engage in education.
Compared to patients receiving non-EIP services, patients receiving EIP services were:
116% more likely to gain employment
52% more likely to become accommodated in a mainstream house
17% more likely to have an improvement in the emotional well-being domain of the HONOS questionnaire
What is EIP ?
Early intervention in Psychosis (Tsiachristas, et al. 2016)
What is the Cost analysis for EIP?
The key cost differences associated with EIP were:
Lower mental health inpatient costs (£4,075, 95% CI, £1,164 to £6,986)
Lower acute hospital outpatient costs (£59, 95% CI, £9 to £109)
Lower accident and emergency costs (£31, 95% CI, £12 to £51)
Higher mental health community costs (£648, 95% CI, £122 to £1,175).
Overall: Using significantly less (costly) health services with a mean annual NHS cost saving associated with EIP of £4,031 (95% CI, £1,281 to £6,780)
Getting people with disability back into work is controversial - especially now, it’s the idea that it makes disabled people feel at fault for not having a job
What does mental health services provide?
life saving care
People benefit from what?
reduced distress / increases quality of life
What does research also shows?
shows they reduce other costs that would otherwise happen (e.g. increased unemployment, acute care, housing, police involvement) - controversial
What is the care that is offered by the NHS?
Basic outline of NHS care offered: Across lifespan, Acute to longer term care, For physical and mental health & That provides information and evidence of practices
How much care do GPs provide?
Around 90% of NHS patient interaction is with primary care services: General Practitioners (GP), dental practice or community pharmacy services.
Around 30% of people who make an appointment with a GP do so for help with psychological distress.
Are mental health services cost effective?
Mental health services can be shown to be cost effective – they reduce other costs and so become at least cost neutral.
Is there a range of mental health services ?
There are a range of mental health services for people of all ages and with a variety of presenting problems
Mental health professionals have different ways of working and expertise. Services should ideally bring these strengths together.
Psychological therapists have established training pathways and regulation of qualified practitioners
What is the researching voluntary sector support?
Our research has found people who self-harm value voluntary and community sector support because: We are now developing ways for clinical psychologists to better support volunteers.
How do we address the gaps?
One way is clinical psychologists are now working in public mental health teams.
E.G: whole system approach in suicide prevention: Train and support local authored staff, Guide policy on messaging: Schools, emergency services and beyond, Assist in the development of a regional suicide prevention strategy & Support voluntary and community sector organisations
What is Missing?
Factor outside of individuals: social and community networks, Enviornmental factors: work environment, school environment, air pollution
The availability of resource reduce the needs (financial privilege)
What underpins our clinical practice?
Grounded in research/Evidence => Clinical Practice <= ethical and practice guideline
How do clinical psychologists help?
Use expert knowledge in consolation, therapeutics and evaluation. Talking therapy, working with relative, developing specialist services supporting care poviders.
What kind of settings clincial psychologist work in?
Clinical psychologists work in a range of health and social care settings, such as Hospitals, Health centres, CMHTs, Primary Care, Social Services, Forensic, individually and within teams.
