Transcript Detecting the Unidentified Victims: Recognized Versus

Psychologists’ contributions to rehabilitation and recovery for serious mental illness:
A survey of training and doctoral education
Felice Reddy and William D. Spaulding
University of Nebraska-Lincoln
Introduction
The emergence of psychiatric rehabilitation (PR) and the recovery movement
have generated new and expanded roles for clinical psychologists in services for
people with serious mental illness (SMI).
PR is increasingly understood as a technology well suited to the values and
goals of recovery (Anthony, 1993). In contrast to a more traditional theoretical
orientation and service approach, which targets diagnostic assessment, symptom
reduction through pharmacological treatment, and case management, PR
includes training in case formulation, social and living skills, education in
wellness and illness management, assistance for families, and vocational training
and support. These are highly relevant to the values and goals of recovery, and
are heavily informed by psychological considerations and techniques. Similarly,
the recovery concept leads to new agendas for psychological research on the
nature of mental illness and the nature of recovery (Silverstein & Bellack, 2008).
Today, recovery and PR provide a new and important context in which to
evaluate the training and education of psychologists.
However, the proportion of psychologists in SMI services today is
substantially less than previous decades. Understanding the reasons why a
minority of clinical psychologists pursue work with SMI, and why the
percentage that does focus on this population is decreasing has significant
implications for advancing the progress of PR as well as improving the
incentives and perceptions of work in SMI treatment.
There are three objectives of the present study:
1) Assess the training and education resources relevant to SMI, PR, and recovery
that are currently available in clinical psychology doctorate programs.
2) Analyze the degree to which new psychologists are prepared and willing to
practice in rehabilitation- and recovery-oriented service systems for people with
SMI.
3) Generate hypotheses about what can and should be done to optimize
preparation of psychologists for SMI services in general, and in rehabilitationand recovery-oriented services in particular.
Methods
A survey designed to assess SMI-focused aspects of training programs was
sent to 164 directors of CUDCP clinical psychology doctoral training
programs.
This yielded 111 responses from directors or faculty members to whom the
task was delegated, a response rate of 68%.
Given that the majority of the accredited clinical programs graduate between
four and twenty students per year, with seven being the mode (CUDCP); there
were approximately 1132 students represented in the present study.
Results
Faculty that identify SMI as area of
primary interest
Response
% of respondents
“None”
39%
“One”
34%
“More than one”
70% of programs provide at least an exposure level (100 hours) of supervised practicum training in formal
psychological assessment of adults with SMI.
67% reported their students could get at least 100 hours of supervised experience in individual psychotherapy
with adults with SMI.
47% reported their students can get at least 100 hours supervised training in functional assessment, case
formulation, treatment planning and progress evaluation as a member of an interdisciplinary team serving adults
with SMI
18% offer students the opportunity to be involved in program management, system administration, program
evaluation, mental health policy or service planning for services for adults with SMI.
27%
Exposure to psychiatric rehabilitation services
51% of the responding programs graduate at least one student per year primarily interested in research, clinical
services and/or policy/administration for SMI.
Amount of experience
None
41% graduate at least one student per year who expects to practice as a clinician or administrator in the service
of people with SMI.
% of respondents
9%
Minimal exposure
47%
Substantial exposure
38%
Integrated experience
5%
If it is the case that the students indicated in each of these estimates are not overlapping in both categories then
this yields an estimated minimal production rate of about .9 new clinical psychology Ph.D.’s per program per
year.
Discussion
In summary, the past and present survey data provide qualified support for the hypothesis that unavailability of education, training and exposure in CUDCP clinical
psychology programs is a potential barrier to psychologists choosing SMI-related careers. On one hand, there are many programs where graduate students can get
exposure to core faculty with SMI interests, get relevant research experience, and get practicum exposure or experience in clinical settings that serve people with SMI.
On the other hand, relatively few programs have specialized coursework pertinent to SMI. Even fewer report having an ongoing research group or seminar that would
provide the key foundation for a major interest or career path. The particular areas of noticeable weakness in areas relevant to understanding the sociological aspects of
SMI are administrative and related leadership skills, and the consumer perspective. Improvement in these areas will be particularly important if PR and the recovery
movement continue to create new roles and opportunities for psychologists.
There are some changes that clinical psychology training programs could undertake to increase the competence of clinical psychologists in the various roles spurred
by PR and the recovery movement. These changes include:
1) More coursework on psychosocial treatment techniques having particular relevance to the needs of people with SMI.
2) More coursework in mental health program management, administration and policy, including particular attention to services for people with SMI.
3) More attention in conventional coursework to application of familiar methods, e.g. case formulation and treatment planning, to the particular context of SMI.
4) More coursework on and exposure to the consumer perspective, the concept of recovery and sociological aspects of mental health pertinent to SMI.
By failing to utilize the opportunity we have to adequately train psychologists to promote the concept of recovery for those with serious mental illness, we fail not
only our psychologist colleagues who developed and validated EBPs, we fail some of our most vulnerable members of society and their efforts to live full lives within
the community.
Visit the Severe Mental Illness Research Group website at the University of Nebraska-Lincoln: http://www.unl.edu/dsc