Jennifer Snyder, Ph.D.

Transcription

1 Jennifer Snyder, Ph.D. Central Regional Hospital University of North Carolina at Chapel Hill Presented at the annual convention of the American Psychological Association, August, 2010, San Diego, CA

2 No role exists for psychology in treatment of people with severe mental illness in state hospitals Primarily medical model Psychologists who work in state hospitals are ineffective and disengaged

3 There are a number of articles that discuss the potential roles psychologists may play in state hospitals and other public mental health facilities (Roe, Yanos, & Lysaker, 2006; Jansen, Menditto, and Pickett-Schenk, in press) But there is very little information about what psychologists in state hospitals actually do Similarly, there now exists a significant body of literature describing evidence-based practice in serious mental illness But is it being applied? By psychologists?

4 Sent link to electronic survey to 203 directors of state psychiatric facilities in the United States Asked them to forward to director of psychology 87 (42%) responded Answered a variety of questions about the types of activities psychologists in their institution engage in And also amount of time spent in various activities

5 Average number of psychologists employed Ph.D. level: M.A. level: 3.90 Number with prior training in serious mental illness About 25% indicated all About 25% indicated none Remaining half in between

6 East Midwest South West

7 By unit Centrally Both

8 Percentage of respondents endorsing

9 This appears positive, as most of these have good empirical support with people with severe mental illnesses One question, however, is whether models of treatment necessarily translates into actual treatment For this, we looked at several indicators of psychologists activity

10 Asked respondents to rank order 9 tasks by amount of time spent per week Direct care tasks (assessment, individual and group therapy) Non-direct care tasks (training, administration, paperwork, research)

11 Direct care services were ranked above indirect care services in all units Order of direct care services in line with mission of unit, i.e., assessment higher on admission and forensic units, treatment higher on longer-term units Training, both of students and staff, tended to be ranked low Research was consistently ranked last or nextto-last For most services, there was a very wide range of rankings

12 Percentage endorsing "yes"

13 Individual therapy Group therapy Behavior management Treatment planning At least 20 hours none

14 admit lead treatment teams make diagnoses order restraint discharge

15 Comments suggested that respondents felt that psychologists role on treatment teams was primarily clerical Also took away from direct care When asked to identify measures that could be taken to improve psychologists ability to carry out their duties, the most frequent responses were actions that would increase psychologists privileges and authority to direct treatment Med staff, admit/discharge, prescribe incentives, direct treatment teams, order seclusion/restraint

16 Psychologists in state hospitals are engaged in a broad array of direct-care services Not necessarily ones with empirical support But they tend to NOT be engaged in activities for which they are uniquely qualified (and, in some cases, credentialed) Training/supervision and research Leading treatment teams

17 Follow up with institutions Ask more specific questions about group and individual treatment Ask individual psychologists about their activities Foster communication and engagement among state hospital psychologists Find ways to disseminate and support evidence-based practice As well as practice-based evidence