Implementing the NICE guideline for schizophrenia recommendations for psychological therapies: a qualitative analysis of the attitudes of CMHT staff

Prytys, Marta; Jolley, Suzanne; Onwumere, Juliana; Craig, Tom

doi:10.1002/cpp.691

Cited by 92 publications

(130 citation statements)

References 33 publications

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“…CBT is recommended over a course of 16 sessions and FI over a course of 10 sessions. However, despite these recommendations, research suggests that national rates of implementation of CBT and FI remain below the recommended level (Krupnik et al, 2005;Mairs & Bradshaw, 2005;Prytys et al, 2011). Preliminary research findings are supported by two national surveys: the Your Treatment, Your Choice survey (Rethink, 2008) and the ''No Voice, No Choice'' review (Commission for Healthcare Audit and Inspection, 2007) which also found low levels of CBT and FI implementation for individuals with schizophrenia and their carers.…”

Section: Introductionmentioning

confidence: 87%

An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia

Haddock¹,

Eisner²,

Boone³

et al. 2014

Journal of Mental Health

127

134

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Section: Introductionmentioning

confidence: 87%

An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia

Haddock¹,

Eisner²,

Boone³

et al. 2014

Journal of Mental Health

127

134

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“…13 Although psychological intervention approaches for psychosis such as cognitive-behavioural therapy (CBT) have been demonstrated to be effective and recent National Institute for Health and Care Excellence (NICE) guidelines for schizophrenia and BD have recommended that people be offered CBT, 14,15 there are a number of limitations to the delivery of CBT in routine services. 16 Such limitations are the widespread lack of trained therapists means that provision of this type of intervention is limited; the refusal rate for participating in trials of cognitive-behavioural therapy for psychosis (CBTP) is relatively high, suggesting that not all service users wish to engage in current modes of delivery of this therapy; there is some concern that the focus of CBT interventions for psychosis have been overly restrictive; and that such CBT does not necessarily target the priorities identified by service users.…”

Section: Introductionmentioning

confidence: 99%

“…Despite recommendations that CBT should be given to all individuals who experience psychosis, 83 the implementation of CBP within NHS services is poor 16 owing to a number of factors. First, the widespread lack of trained therapists means that provision of this type of intervention is limited.…”

Section: Introductionmentioning

confidence: 99%

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Morrison

Law

Barrowclough

et al. 2016

Programme Grants Appl Res

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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…However, despite the high cost of psychosis care, and evidence of the clinical and economic effectiveness of CBTp, access remains problematic (NICE, 2014;Schizophrenia Commission, 2012). In addition to the service factors, such as prioritisation of other service demands over psychological therapies, lack of trained staff and limited supervision, that have limited the routine implementation of psychosocial interventions (PSI) in community settings (Brugha et al, 2012;Brooker and Brabban, 2004), individual patient characteristics influencing engagement may also restrict access (Prytys, Garety, Jolley, Onwumere & Craig, 2011).…”

Section: Introductionmentioning

confidence: 99%

Psychological interventions for housebound people with psychosis: service user and therapist perspectives in South East London

Iredale

Fornells-Ambrojo

Jolley

2015

Journal of Mental Health

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Implementing the NICE guideline for schizophrenia recommendations for psychological therapies: a qualitative analysis of the attitudes of CMHT staff

Cited by 92 publications

References 33 publications

An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia

An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Psychological interventions for housebound people with psychosis: service user and therapist perspectives in South East London

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