Sunday 23 October 2011

'Those with most serious problems would be left without the best help'


PSYCHIATRIST Dr David Smith has more than 30 years of experience and believes the NHS Commissioners proposals to decommission Psychodynamic Psychotherapy Services in Derbyshire could leave patients without the most effective form of therapy. He said psychodynamic psychotherapy was of "major benefit" to patients.

Read the whole article from the Derby Evening Telegraph here.

Dr Smith has written a response to the plans to decommission Derbyshires highly specialist, front line NHS Mental Health Psychodynamic Psychotherapy Services. You can read "The Case for Long-Term Psychodynamic Psychotherapy: A response to the Derbyshire County Primary Care Trust" here


ANALYSIS AND CRITIQUE OF THE CONSULTATION DOCUMENT  ‘Psychological Therapies Specification’ Draft Version 0.9

 Read the whole document here

This paper offers an analysis and critique of proposals contained in the Consultation Document 'Psychological Therapies Specification Version 0.9 (Draft)' produced by Derbyshire PCT Commissioners in July 2011.

It is presented by UNITE on behalf of Clinicians who work as Specialist Psychodynamic Psychotherapists within the Derbyshire Healthcare NHS Foundation Trust.

We address concerns about the processes by which these proposals were arrived at and presented for consultation, and their content.

We address our concerns to all stakeholders: the Commissioners, Derbyshire Healthcare NHS Foundation Trust, G.P.s, service users and their representatives, and the Overview and Scrutiny Commissions for Derby City and County Councils who have authority for holding Commissioners accountable for their decisions.

We describe who we are, provide an initial executive summary of our response and then speak in more depth to these issues.

The Specialist Psychodynamic Psychotherapy Service.
For over thirty years, we have provided a tertiary service within Derbyshire Healthcare NHS Foundation Trust treating adults with severe and complex psychological disorders. These are vulnerable adults, often presenting with lifelong histories of mental ill-health and multiple use of local services. Staff have a core professional training in mental health, and a post-qualification specialist training in psychodynamic psychotherapy of four or more years. Some staff have Doctorate or PhD qualifications in addition to their clinical qualifications.


Treatment within the service takes the form of individual, group or couple therapy, with an average attendance time of 18 months to 2 years. The service aims not just to ameliorate symptoms, but to produce lasting change and a number of outcome measures are used to demonstrate this. The Psychodynamic Psychotherapy Service is provided from the Department base in Derby City, and from locality Recovery Team bases in the South of the County. 

Summary of Response.
     
     The draft Service Specification fails to provide a context within which to understand what is being proposed. It does not make clear which clinical services are included and what the implications are for service users. 

The opportunity has been missed for a review of the whole range of psychological therapies within Adult Mental Health services in Derbyshire, and the Specialist Psychodynamic Psychotherapy service appears to have been singled out to bear the brunt of the need for savings in the general mental health budget.

Commissioners did not consult with clinicians to ensure they understood the needs and vulnerability of service users currently engaged in Psychodynamic Psychotherapy, and the adverse effect the proposals would have on them.

The draft Service Specification was developed without necessary dialogue with all relevant stakeholders, and this has serious consequences for the clinical viability of the proposals.

Through these proposals, the choice of therapy for service users will be restricted to cognitive and behavioural approaches. Commissioners do not appear to have appreciated the important part that service user choice is known to play in the success or failure of a therapy.

The proposal to de-commission the Psychodynamic Psychotherapy Service is based on a flawed analysis of the evidence base as, contrary to the assertion of Commissioners, there is clear and objective evidence in support of psychodynamic psychotherapy for the treatment of severe and complex disorders. Furthermore, Department of Health guidance repeatedly asserts that clinically indicated psychodynamic psychotherapies of appropriate length should be provided as part of Specialist Mental Health Service provision. Either there has been an exclusion of step 5 service users from this proposal or a relegation of their clinical needs to step 4 levels of treatment. The struggle to appreciate the severity and complexity of difficulties, and the intensity of highly skilled treatment required is evident throughout the draft Service Specification document.
      
      At a time when there is increased funding available through the Improving Access to Psychological Therapies (IAPT) programme for those with mild to moderate difficulties, an appreciation of the needs of those in greatest difficulty has become lost and they appear to have become a lesser priority.

The failure to recognise the costs of these proposals to service users, their families and wider society, as well as the provision of mental healthcare in Derbyshire is a major omission.


Read the whole document here