Acute Inpatient Services are transforming and Psychological Practitioners are in a fantastic position to be the supportive agents of change

Question: What can Psychological Practitioners bring to acute inpatient settings?

Answer: A great deal. There are so many opportunities to impact culture, improve care received, support the workforce and create psychologically healthy systems. Acute inpatient settings are going through significant transformation for the better and the opportunities for Psychological Practitioners to work within these environments, have a meaningful impact and a fulfilling job role are profound.

With the recent release of two important documents, one a collaboration between The BPS and the Association for Clinical Psychologists (ACPUK) (1) and the other from NHS-England (2), comes appetite and direction for change within the Acute Adult Mental Health Care Pathway. This change is welcomed as we adapt and adjust to the ever-changing landscape of providing NHS services, with inpatient mental health settings having experienced rises in demand and acuity.

Inpatient services offer an opportunity for Psychological Practitioners to use all their skills and competencies. There are multiple layers and opportunities where assessment, formulation and intervention will benefit both client and system. It’s fantastic that so many health and social care professionals are recognising and talking about the importance of providing trauma informed care (TIC) and Psychological Practitioners will be integral to delivering this approach. Inpatient services are places where the impact of trauma permeates all aspects of care delivered and received. From trauma experienced and adaptive behaviour- both at a team and individual level, to the health of the workforce and the difference between proactive and reactive processes.

Both the BPS/ACPUK and NHS-E guidelines outline the contribution needed from Psychologists to ensure compassionate, high-quality care and continuous improvement.  Services are required to grow and develop the workforce in line with national workforce profiles, to enable acute settings to offer a full range of multi-disciplinary interventions and treatments (1,3,4). There is significance importance applied to multi-disciplinary inpatient teams and there is good reason for this. Analysis by NHS Benchmarking has indicated a strong relationship between the number of therapeutic staff and length of stay on wards, with lower length of stays being linked to higher numbers of allied health professionals, per inpatient bed (1).

When someone is in acute and intense distress and their need is high, it is vital that the care they receive should meet this need; inpatient stays need to be therapeutic. There should be timely access to evidence-based assessments and treatments which are recommended by NICE (e.g., 5, 6, 7, 8, 9, 10). Care should be personalised, with choices about intervention being available (1) and Psychological intervention should be part of ‘routine’ treatment within inpatient wards and not reserved for the very few (11, 12).

Care should be delivered in a therapeutic environment that is trauma-informed (1) to reduce the risk of re-traumatisation. Psychological Practitioners are key to support this approach in teams to make meaningful improvements towards TIC, across service processes, treatment and staff wellbeing. The CCQI Standards state staff members should have access to reflective practice groups at least every 6 weeks (12). Reflective, psychologically led team supervision and post-incident support helps promote the resilience and retention of staff; ameliorating the emotional impact of working in challenging environments (1). To deliver on TIC and achieve the recommended standards of care (1, 2), there is a need to support psychological healthy systems and a compassionate, trauma-informed culture (2).

  @miranda_budd

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References

(1) The British Psychological Society and Association of Clinical Psychologists (2021). Briefing paper: Psychological services within the Acute Adult Mental Health Care Pathway. Guidelines for service providers, policy makers and decision makers.

(2) NHS-England (2023). Acute inpatient mental health care for adults and older adults.

(3) NHS LTP (2019) & NHS Mental Health Implementation Plan.

(4) Royal College of Psychiatry (2019a) Home Treatment accreditation standards

(5) NICE (2014). Psychosis and schizophrenia in adults: prevention and management. National Institute for Health and Care Excellence.

(6) NICE (2018). Bipolar Disorder: assessment and management. CG185. National Institute for Health and Care Excellence

(7) NICE (2018a). Post-traumatic Stress Disorder. NG116. National Institute for Health and Care Excellence.

(8) NICE (2009). CG78 Borderline personality disorder: recognition and management. National Institute for Health and Care Excellence.

(9) NICE (2013). Self-harm Quality standard 34. National Institute for Health and Care Excellence.

(10) NICE (2021). Depression in adults: treatment and management (update) In development. National Institute for Health and Care Excellence.

(11) Mental Health Act (1983) Code of Practice (Department of Health, 2015)

(12) Royal College of Psychiatrists (2019). Standards for Acute Inpatient Services for Working Age Adults: 7th Edition. Royal College of Psychiatry.