SHROPSHIRE COUNTY PRIMARY CARE TRUST
Department of Psychological Therapies

Annual Report 2002/2003

Craig Newnes Director of Psychological Therapies 1.06.03

The Department of Psychological Therapies provides counselling, supervision, research, training and consultancy throughout Shropshire and Telford and Wrekin. It is part of the Adult Mental Health and Learning Disabilities Directorate of Shropshire County PCT.

The department consists of 70 staff trained and supervised in a variety of psychological therapies and six administrative staff. Staff are multi-disciplinary including mental health nurses, counsellors, nurse-counsellors, clinical psychologists, a consultant psychiatrist, occupational, art and couple therapists. There are:
Fifteen part-time counsellors based in GP surgeries and a senior counsellor.
Eighteen part and full time counsellors, OTs, mental health nurses, and art therapists based at Dawley and Chaddeslode House, Shrewsbury.
Three cognitive behavioural therapists.
Eleven part and full time clinical psychologists based in nine CMHTs, two consultant clinical psychologists, one based in Wroxeter Ward and the Director, based at Chaddeslode House and two part-time clinical psychologists working in psychosocial rehabilitation.
A part-time staff counsellor.
A specialist Eating Distress Therapy Service managed by a consultant clinical psychologist with two mental health specialists, two sessions from a cognitive analytic therapist and two assistant psychologists.
A Mental Health Liaison Service managed by a consultant clinical psychologist with a part-time clinical psychologist and two clinical nurse specialists offering liaison services to Princess Royal, Royal Shrewsbury and RJ&AH hospitals.
Two part-time specialist psychotherapists.

Service user involvement
The department was the first in the Trust to regularly employ service users on interview panels and remains one of very few national centres for psychological therapies to do so (see Research and Effectiveness section below).
The department has supported and researched Shelton Patients' Council since its inception (see publications).
Service users are routinely involved in research activity as consultants and had a key role in the planning and guidance for the Medication Information Project at Shelton .
Service user consultants are employed on the steering group for the Eating Distress Therapy Service.
Craig Newnes and Dr Guy Holmes have worked with service users in training local and Regional staff in advocacy and service user involvement in research.
Craig Newnes has consulted on service user involvement with the National Committee of the Division of Clinical Psychology and clinical psychology departments in Stafford, Chester and Birmingham.
The OCD support group arose as a result of consultation with clients who had received treatment for OCD by the CBT service.

Clinical activity and audit
Chaddeslode House: 754 referrals to the centre led to 10003 attendances for individual and group work. An increasing number of G.P. practices have adopted self referral for their clients. Clients who self refer are much more likely to attend therapy appointments.

CMHT clinical psychologists: 3568 individual consultations.

Dawley Centre: 1,007 referrals led to 12,000 individual, couple and group therapy consultations.

Mental Health Liaison Team: 663 patients presenting at the acute hospitals with deliberate self harm participated in a psychosocial assessment. In excess of 95% patients were seen on the day of referral. 49 patients were referred on to the short term intervention programme.

Cognitive Behavioural Therapy Service: 151 referrals led to 800 consultations (the service was closed for the first six months of the year). In addition, a further average of 8 referrals per month (100 per annum) are received, but at team meeting are referred back as unsuitable; or referred on for less intensive clinic-based CBT interventions accessible through the Psychological Therapies Department. A substantial increase in new CBT books and self-help materials has been provided through the Department this year to enhance clinical work and training in CBT. There are four groups: Depression (10 weeks), ongoing with 6 clients; Hearing voices (8 weeks), ongoing with 4 clients; OCD support group (open, twice monthly), average attendance 8; Chronic Fatigue (10 weeks) 6 clients waiting.

Eating Distress Therapy Service: This service has worked intensively to help people with eating distress remain close to home rather than being referred out of county. There is a case load of 40 people. 1456 consultations have been given.

Counselling in Primary Care: The counsellors working in general practice offered 4127 consultations in 15 surgeries. Their outcome measure (see R and E) is also now used by Chaddeslode, Dawley and the clinical psychologists in CMHTs. We have provided two counsellors to work with the CMHT in Oswestry each offering a session per week. This contract was temporary and ran for 12 weeks. 74 face to face contacts were made.

Counselling and support service for GPs: There are currently 6 clinical psychologists available to provide counselling at bases in Shrewsbury, Telford, Bridgnorth and Ludlow. Over the past 12 months 92 hours of counselling have been provided to 8 GPs. There have been 6 new referrals.

Staff Counselling Service and Sixth Form College: 56 staff self-referrals were received leading to 336 consultations. At the Sixth Form College the counsellor gave 36 appointments. The college counsellor also offers groups on topical subjects such as coping with exam stress and assertiveness.

Total therapy consultations (face-to-face contacts) provided by the department in 2002/2003: 36829 (an increase of 25% from 01/02)

Research and effectiveness
The department continues a remarkable record of research and research publication in a service independent of any academic institution. In the last year we have researched:
the effectiveness of counselling in general practice
developing short term interventions in self-harm
support for families and friends of people experiencing eating distress
outcome measures in eating distress and short term intervention for self harm
user satisfaction on Wroxeter ward
In Mental Health Liaison psychosocial assessments are recorded on a custom designed data base for the purposes of audit evaluation and research. A recent audit has examined the involvement of patients in secondary mental health
CBT for people identified with panic in emergency medical care settings.
counselling needs of culturally diverse people in Telford and Wrekin
information about medication on the acute wards at Shelton Hospital
DNAs for medical consultations
Dr. Carolyn McQueen, clinical psychologist, is a member of both the Scientific Affairs Board and the Professional Affairs Board of the British Psychological Society.
Craig Newnes is Chair Elect of the Psychotherapy Section of the British Psychological Society

Craig Newnes and Dr. Guy Holmes are commissioning editors for a book series published by PCCS books. This is Madness and This is Madness Too are on the MIND bestseller list. In the last year two new titles have appeared: The Gene Illusion by Jay Joseph and Beyond Help by Susan Hansen, Alec McHoul and Mark Rapley

Helen Jones and Craig Newnes are editors for Clinical Psychology, Craig Newnes is editor of the Journal of Critical Psychology, Counselling and Psychotherapy and Dr Guy Holmes and Dr Carolyn McQueen are on the editorial board.

The following papers have been published:
Baker, E. (2003) Service user views on a low secure ward. Clinical Psychology, 25, 11-13
Baker, E., Newnes, C., and Myatt, H. (2003) Drug companies and clinical psychology. Clinical Psychology, 24, 31-35
Cox, R and Kelly, P (2002) From anti psychiatry to critical psychology. The Journal of Critical Psychology, Counselling and Psychotherapy, 2(3) 171-174
Goodwin, I. (2003) The relevance of attachment theory to the philosophy, organisation and practice of adult mental health care. Clinical Psychology Review, 23, 35-56
Holmes, G. (2002) What is called thinking? The Journal of Critical Psychology, Counselling and Psychotherapy, 2(3), 33-39
Holmes, G. (2003) An audit: do the people I see get better? Clinical Psychology, 24, 47-50
Maclachlan, A. and Newnes, C. (2002) The information. Clinical Psychology, 16, 12-15
McQueen, C., and Henwood, K. (2002) Young men in crisis: attending to the language of teenage boys' distress. Social Science and Medicine, 55, 1493-1509
Moloney, P., Everill, J., Kelly, P., Bahia, I., and Cox, R. (2003) An appreciation of David Smail. Clinical Psychology 24, 7-10
Myatt, H. (2003) Clinical psychology and helping people: a developmental perspective. Clinical Psychology, 25, 21-23
Myatt, H. (2003) Getting better and getting out. Openmind, 121, 8
Newnes, C. (2002) The rhetoric of evidence-based practice. Ethical Human Sciences and Services, 4, 2, 121-128
Perrin, A. and Newnes, C. (2002) Professional identity and the complexity of therapeutic relationships. Clinical Psychology, 15, 18-22
Ross, K. (2003) The psychology of being sectioned. Clinical Psychology, 23, 9-13

The following papers are in press:
Baker, E., Newnes, C., and Myatt, H. (2003) Big pharma and clinical psychology. Ethical Human Sciences and Services
Cox, R., Brenner, V and Thayne, S. Reflections from a Hearing Voices Group. Clinical Psychology
Cox, R., and Orford J. A qualitative study of the meaning of exercise for people who could be labeled as 'addicted' to exercise - can 'addiction' be applied to high frequency exercising? Addiction Research and Theory
Cox, R., and Orford, J. Exercise addiction: A comparison between exercisers, drinkers and gamblers with implications for theories of exercise addiction. Addiction Research and Theory
Cox, R., Thayne, S., and Brenner, V. Reflecting on the work of a hearing voices group. Openmind
Dunn, C. Do service users want to be involved in planning services? Clinical Psychology
Goodwin, I., Holmes, G., Cochrane, R. and Mason, O. (2003) The ability of adult mental health services to meet clients' attachment needs: the development and implementation of the Service Attachment Questionnaire. British Journal of Medical Psychology
Holmes, G., and Hudson, M. Coming off medication. Openmind
Lucas, R. Consent to treatment in psychosocial rehabilitation. Clinical Psychology
Newnes, C. Individuality is an illusion created by skin. The Journal of Humanistic Psychology
Newnes, C. The evidence game. Openmind ·

The website is managed by Helen Jones and receives 400 visits per month.

Risk management
Effective clinical supervision and staff training are key to reducing risk. All members of the department access at least fortnightly clinical supervision and the majority additionally access group or specialist supervision. The department provides an invaluable service to the wider Trust in this regard. For example the clinical psychologists in the department offered a total of 667 hours of supervision to other staff while EDTS has offered 156 hours.
The Mental Health Liaison Team has developed a national pilot process of risk assessment for those presenting with self-harm. Our psychosocial assessment procedure which incorporates rigorous risk management has been used with over 1800 clients and data is available for analysis.
The Mental Health Liaison Service has responsibility for the Trust debriefing training and co-ordinates the debriefing activities on behalf of the wider Trust. This service contributes to the Trust Corporate Risk needs and co-ordinates the Trauma Response Team.
Operational plans in the event of a major incident have been finalised and are incorporated in the Major Incident Plan for the Trust.
The department trained 40 staff in Trauma Response and approximately half of these have received advanced training in Critical Incident Debriefing. Staff have volunteered from all parts of the Trust. This year we have received training from internationally recognised experts based in the UK and Israel.
One complaint was received in 2002/2003. Numerous thank you cards were received.
Due to high rates of referral a strategy for prioritising those at risk of suicide has been adopted throughout the department.
Similarly, we have established anger management groups at Chaddeslode and Dawley Centre.

Challenges
After 4 years we are still unable to offer a consistent and reliable liaison service, despite increasing pressures on emergency care in the general hospitals. There is no cover for staff absence and no service at weekends. The referral options after assessment have become even more limited because the client group with high psychological distress and high risk of further self harm is not a priority for secondary mental health services. Plans have been made during the year to deliver a 7 day service to the General Hospitals and funding will be made available to make improvements. However these will not be complemented by improved access to mental health services.
Whilst the data is available for evaluation, audit and research the resources are not available to carry out these essential components of MHL work.
Considerable MHL management time was lost this year through a move to a temporary building which finally occurred some 7 months behind schedule.
The core Trauma Response Team currently comprises 4 members of staff who all work part time and this role does not fall within their job descriptions.
Major Incident preparations are now being supplemented by Mass Casualty Plans which will make a greater call on community services but the team is not in a position to expand its remit.
£36K was taken from the total departmental budget at the start of the year as "efficiency" savings, ironic in a department that could hardly be more efficient. This loss of funding resulted in cuts to staff training and other forms of support essential to clinical governance.
The EDTS coped with two changes of base and a significant reduction in administrative support in a context where security is a key issue for clients with life threatening difficulties.
Finally, as part of the chain of moves aimed at delivering 24 hour nursed care in Telford, two clinicians remain without permanent bases at Chaddeslode House.

Education and staff development
The department offers regular staff appraisal to all members, documented annually through the EDR process.
There is a monthly training session on relevant clinical topics at Dawley Centre organised by Helen Jones, clinical psychologist.
Two members of the department completed Masters level qualifications in Counselling Supervision.
Two completed Diploma level courses in CBT.
Staff gained the following additional qualifications: CBT, ENB R01, ENB NO1, Certificate in Person-Centred Art Therapy and a Certificate in Family Therapy.
A clinical nurse specialist successfully completed the one year City and Guilds 730 course: Certificate in Teaching Adult Learners and he undertook part of his teaching experience on the City and Guilds 3056 Certificate in Community Mental Health Care.
One counsellor has just completed an advanced course of training in Psychodrama and now provides a Psychodrama Group.
A counsellor is completing a Masters Degree in Integrative Psychotherapy
The CBT manager is completing an MSc (CBT) at the University of Derby
A nurse counsellor is training in psychoanalytic psychotherapy

Three staff have been on part-time secondment to other parts of the service this year: Helen Jones to the Telford and Wrekin CSMT, Alex Nuthall (CBT manager) to the Staffordshire University School of Health and Dr Carolyn McQueen to the Medical Foundation for the Care of Victims of Torture.

The counsellors in primary care have a bi-monthly training session. Topics have included: abusive and harmful counselling, bodywork and religion and spirituality. The clinical psychologists share a monthly training/reflective session with clinical psychologists from the wider Trust. Topics have included: community psychology and research. An assistant clinical psychologist from the Eating Distress Service Therapy gained a doctoral course place.

Training offered to others: The department has offered consultation to the wider Trust in terms of supervision, in-patient psychological therapies, the closure of Oak ward, Early Intervention in Psychosis and the philosophy of Wroxeter, Beech ward and the Elms. Additionally the clinical psychologists in CMHTs, the Eating Distress Service and Psychological Therapies Director have provided 1591 individual contacts of training to health workers from all backgrounds. Conferences and seminars for professionals and members of the public have been given on the themes of Holistic Health, Spirituality, Harmful Clinical Psychology, Medication and The Artist Practitioner. Six clinical psychology placements were offered to trainees. The EDTS has given open days and appeared on Radio Shropshire.

The CBT service manager runs a CBT course for qualified mental health staff at the School of Health. This has been well subscribed for two years. All members of the CBT Service team contribute to teaching and training sessions in CBT. The CBT service is currently resuming provision of a 3-month placement for mental health branch nursing students.

Dawley Centre and Chaddeslode continue to offer student nurse placements. Dr Tina Griffiths is running a 2 year Practitioner Training course in Cognitive Analytic Therapy in Shropshire for 6 trainees which ends in July 2003. Three of the trainees work within the Department of Psychological Therapies (an Occupational Therapist, an Art Therapist and a Nurse Specialist) and 3 trainees are external to the Department. In May 2002, Dr Isabel Goodwin was appointed on a part-time, fixed term contract. This post has focussed upon facilitating a review process on Beech Ward, including reappraisal of the current 'token economy' system, through an away day and ward working groups.

Primary Care Integration One of the CBT trained nurse counsellors provides one session CBT per week at Ellesmere Medical Practice; the other provided a two-month trial of the same at Stirchley Medical Practice. Prescott Surgery in Baschurch has recently requested a teaching session on CBT. Through a gradual retraining and redeployment of staff we have continued to offer additional GP counselling services to Hollinswood, Donnington, Lawley and Hodnet surgeries.

Additional funding has allowed expansion to Much Wenlock/Cressage, Mytton Oak, Riverside and Claremont Bank surgeries. The department provides supervision to Macmillan nurses and health visitors. The pilot scheme offering student counselling placements continues and is now functioning in three surgeries with three counsellors who have completed a Post Graduate Diploma in Supervision at Keele University

As noted above 19 GPs attend the department monthly in three support groups. The Support and Counselling Service for GPs has continued to offer individual counselling, peer consultation groups and support for training events from the Department of Psychological Therapies. A Consultant Psychiatrist has remained available for individual consultations. A one hour workshop looking at stress in GPs and further training needs was offered to 8 GPs via the Shropshire Stress Reduction Initiative. A further meeting on time-management was prepared and the resources given to a follow-up meeting of this group. A talk on "Coping with stress in the workplace" was delivered to 70 primary care staff, including GPs from across South Shropshire. The EDTS trained GPs in responding to eating distress.

Further Information
Chaddeslode House Tim Roberts (01743-361295)
Clinical Psychology (CMHT) Cailzie Dunn (01743 243300)
Cognitive Analytic Therapy Dr. Tina Griffiths (01743-343633)
Cognitive Behaviour Therapy Alex Nuthall (01743-361295)
Counselling in Primary Care Margaret Newton (01743-343633)
Counselling and Support to GPs Dr. Chris Pitts (01584-878167)
or Marilyn Owens (01746-768787)
Creative/Art Therapy Ivor Payne (01743-361295)
Dawley Centre, Fiona Huss (01952-506838)
Early Intervention in Psychosis Dr. Anne Maclachlan(01746-768787)
Eating Distress Dr. Vivien Lewis (01743-343623)
Mental Health Liaison Dr. Rosemary Corke (01743-341939)
Psychosocial Rehabilitation Rachel Lucas (01743-261000, ex 63269)
Research enquiries Dr. Guy Holmes (01743-254050)
Staff counselling Sue Davies (01743-356057)
Supervision enquiries Marilyn Owens (01746-768787)
Training and website Helen Jones (01952-222725)
Trauma Response Team Marilyn Owens (01746-768787)
or Rosemary Corke (01743-341939)
The rest Craig Newnes (01743-343633)