Transcript Slide 1

The Development of Clinical
Psychology Past and Future
Perspectives:
Monte Shapiro’s Legacy
Professor Tony Lavender
Friday 2 December 2011
BIRTH OF THE WELFARE STATE
No satisfactory scheme for social security can be devised [without
the] following assumptions.
A) A national health service for prevention and comprehensive
treatment available to all members of the community.
B) Universal children’s allowances for all children up to 14 or if in
full-time education up to 16.
c) Full use of powers of the state to maintain employment and to
reduce unemployment to seasonal, cyclical and interval
unemployment, that is to say to unemployment suitable for
treatment by cash allowances.
BIRTH OF THE NHS
(Tackle Disease)
“This is the biggest single experiment in social service that
the world has ever seen or undertaken”
(Aneurin Bevan, 7 October 1948)
“It was the first health system in any Western society to offer
free medical care to the entire population. It was,
furthermore, the first comprehensive system to be based not
on the insurance principle, with entitlement following
contributions, but on the national provision of services
available to everyone. It thus offered free and universal
entitlement to State-provided medical care. At the time of its
creation, it was a unique example of the collectivist provision
of health care in a market society.” (Klein 1986)
BIRTH OF CLINICAL PSYCHOLOGY:
UK/US CONTRAST
APA (1948)
“The need for clinical psychologists with a
combination of applied and theoretical knowledge in
three major areas: diagnosis, therapy and
research.”
Eysenck (1949)
“Clinical Psychology demands competence in
diagnosis and/or research”
Clinical Psychology should not involve a training in
therapy “therapy is something essentially alien”
Personal Therapy
APA, which advocated that:
“some kind of intense self-evaluation and that whenever possible that
should be psychoanalysis”
Eysenck was at his most strident in his response:
“It is proposed that the young and relatively defenceless student be
imbued with the ‘premature crystallizations of spurious orthodoxy’ which
constitute Freudianism through the ‘transferences and countertransferences’ developing during this training. Here, indeed, we have a
fine soil on which to plant the seed of objective, methodologically sound,
impartial, and scientifically acceptable research”
BIRTH OF CLINICAL PSYCHOLOGY
APA (1948)
“Unmet social needs for more and better mental hygiene
services, including research. The task before clinical
psychologists lies in adopting such policies in their training
institutions that are best calculated to provide services that
can demonstrate social usefulness.”
Eysenck (1949)
“Psychology can not go where social need requires. A
science must follow more germane arguments than the
possibly erroneous conception of social need.”
CLINICAL PSYCHOLOGY & NHS – 1950-1960
• First NHS Whitley Council Circular 1952 recognises
profession and publishes pay scales
• Three courses developed 1952-1957 (Maudsley, London;
Tavistock, London; Crichton Royal, Edinburgh)
• Whitley Council Circular 1957 recognises three courses and
allows entry ‘to pay scales’ for their students
• Queen’s University, Belfast, Course established 1959
• Whitley Council in 1960 uplifts clinical psychology pay scales
to align with other Scientific Officers in NHS
CLINICAL PSYCHOLOGY & NHS – 1960-1979
• Embraces therapy
• Increases range of client groups
• 1965 – BPS secures Royal Charter – Privy Council
• 1966 Division of Clinical Psychology formed
• 1967 The NHS Zuckerman Committee Report
• 1960-1976 Training programmes grow by approximately one
a year
TRETHOWAN REPORT 1976
Started in 1973: Report in 1976
Conclusions & Recommendations:
• Contribution potentially great but this was limited by
numbers in service and training
• Clinical Psychologists should have full professional status –
full responsibility for their work, also acknowledged
continuing ‘medical responsibility’ of doctors
• Stressed the importance of multi-disciplinary team work
• All employed by the NHS required to have a Post Graduate
Degree or BPS Diploma (end of independent route)
TRETHOWAN REPORT 1976
Started in 1973: Report in 1976
Conclusions & Recommendations:
•
Psychology services organised into the tiers of the first (1974)
NHS reorganisation
– Regional Health Authorities manage training
– Area HAs departments created with a base led by top grade
– Principal psychologists head all specialties (mental illness,
mental and physical ‘handicap’, neurology, geriatrics,
community, general practice)
• Clinical psychologists should have the opportunity to undertake
research
• Clinical psychologists should be supported by psychology
technicians
• Department of Health should carry a full ‘manpower’ review
PRECIPITANTS & CONTEXT OF MAS REVIEW
• Increasing demand for clinical psychologists in the
service
– Accelerated by move to community care
– Reflected in growing vacancy rates
• The plateau in numbers of training places – funding
course capacity, government cynicisms with professions,
fears of trainee loss
MAS REPORT 1989: LEVELS AND MODEL
Identified a skills framework with three levels of activity:
• Level 1 Establishing and maintaining supportive relationships
• Level 2 Protocol driven circumscribed psychological interventions
(simple BM and manualised therapy)
• Level 3 Use of multiple theory and evidential analysis to tackle complex
problems – individually tailored solutions (characteristic of CPs)
Shared care model
• Equal status with medical practitioners
• Oversee psychological component of care of all professionals
• Support doctors in assessment, diagnosis and treatment
• Offer alternative psychological interventions
MAS REPORT 1989: WORKFORCE
Recommend increase in psychologists including
training place from 173 to 300 by 2000 (actually hit
450)
Recommended enlarging clinical psychology
workforce from just under 2500 to 4000 by 2000
(actually hit 4052 fte)
Should move to statutory registration (BPS granted
power to set up voluntary register in 1987)
CLINICAL PSYCHOLOGY TRAINING PLACES
1980-2011
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
Number
of
Training
Places
0
100
200
300
400
500
600
Clinical Psychology: FTE in the NHS (1995-2010)
FTE
7500
6901
7000
6706
6500
6056
5788
6000
5518
5562
5463
2004
2005
2006
5331
5500
4846
5000
4399
4500
3763
4000
4052
3660
FTE
3376
3500
3000
2859
3108
2500
2000
1500
1000
500
0
1995
1996
1997
1998
1999
2000
2001
2002 2003
Year
2007
2008
2009
2010
NEW WAYS OF WORKING FOR
APPLIED PSYCHOLOGISTS (2007)
Organising, Managing and & Leading Psychological Services – Tim Cate
Career Pathways – Tina Ball
Teamworking – Steve Onyett
New Roles – Tony Lavender and John Taylor
Improving Access to Psychological Therapies – Graham Turpin & Roslyn
Hope
Training Models – Jan Burns & Mike Wang
New Ways of Working
NEW WAYS OF WORKING FOR
APPLIED PSYCHOLOGISTS (2007)
PURPOSE OF THE APPLIED PSYCHOLOGIES
“to improve the psychological well being of the
population through working with individuals, teams,
organisations and communities.”
New Ways of Working
NEW WAYS OF WORKING:
OUTPUTS & RECOMMENDATIONS
• Developed leadership competencies based on NHS leadership Qualities
Framework (training to Band 9)
• NHS Trusts should have a named lead for psychological services,
ideally at Board level
• Psychologists should be active in the design, operation and evaluation
of teams – help crate effective teams
• Psychologists should develop the role and improve the effectiveness of
services through process consultancy at a systems level, peer
consultation and supervision
• Psychologists should become involved in service redesign and in IAPT
take up active roles in the commissioning and quality monitoring of
training as well as leading and delivering those services
New Ways of Working
NEW WAYS OF WORKING:
OUTPUTS & RECOMMENDATIONS
• Develop a broader base of prequalification training at three
levels, Trainee Psychology Assistant, Psychology Assistant
and Senior Psychology Assistant
• The established three-year doctoral training model is robust
and has a proven track record: alternatives should not be a
substitute for doctoral training
• Existing applied psychology training courses should explore
shared, common modules with other applied psychology
training courses within their host institution
New Ways of Working
CHALLENGES & WAY FORWARD
Economic downturn – ‘cold wind of debt’ – standing still we feel like
cuts
•
Lead, think and work strategically
– Keep purpose and vision clear
– Maintain and enhance work with key partners, Department of Health,
Centre for Workforce Intelligence, Health Professions Council, NHS
Confederation, Commissioners
– Develop and invest in current and future leadership
•
Value your work – its scientific base and demonstrate its utility to service
users, service providers and commissioners, policy makers and research
community
•
Maintain psychological stance in medicalised contexts
– Psychological (theory & research) formulation is key
– Applying psychological theory and research (science) is the key to
dealing with complexity – breadth of theories
CHALLENGES & WAY FORWARD
• Embrace new roles
– Mental Health Act (responsible clinicians)
– Participate, lead in, Improving Access to
Psychological Therapies
– Re-visit Assistants roles in delivering
psychological interventions
• Think globally – foster development
internationally (including in terms of recruitment)
MB SHAPIRO SMILE
• Psychological science is still at the core
• Numbers in training and the workforce
• Doctorate – high quality training is the norm
• Psychological formulation - key to embrace complexity
• Influencing Government and policy
• Much achieved but still much to do on our journey
Thank you for listening
and
the award