Mental Health Matters

What is Liaison Psychiatry?

Published on 06/02/2021 by Andrew MarshallLeave a comment

Introduction

Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry that specialises in the interface between general medicine/paediatrics and psychiatry, usually taking place in a hospital or medical setting.

The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Consultation-liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, health psychology and neuropsychiatry.

Brief History

The history of liaison psychiatry is partly a history of psychiatry and medicine. Galen was highly influential for over 1500 years in medicine particularly advocating the use of experimentation to advance knowledge. The polymath physician Avicenna produced many insights into medicine but only became influential in Western medicine when William Harvey’s elucidation of the circulatory system forced a re-evaluation of Galen’s work. The French philosopher René Descartes began the dualistic debate on the division between mind and body. Johann Christian August Heinroth is credited with the origination of the term psychosomatic illness. At the beginning of the 19th century Johann Christian Reil created the term psychiatry whilst the polymath Benjamin Rush wrote Diseases of the Mind. The philosopher Spinoza’s concept of conatus, Mesmer’s development of hypnosis together with Charcot’s refinement of this technique influenced Sigmund Freud whose development of psychoanalytic theory was to have a profound impact on the development of liaison psychiatry. Under the guidance of Alan Gregg, psychoanalysis impacted on hospital medicine through figures such as Franz Alexander, Stanley Cobb and Felix Deutsch.

Edward Billings first coined the term “liaison psychiatry.” The publishing of two texts A Handbook of Elementary Psychobiology and Psychiatry, by Billings, and Psychosomatic Medicine, by Edward Weiss and O. Spurgeon English, outlined the theoretical foundations for the developing field. George L. Engel is considered to have been one of the most important figures in the development of liaison psychiatry and coined the term “Biopsychosocial Model” which overcame divisions created by Cartesian Dualism and was to have wider repercussions on psychiatric practice.

United Kingdom

The Faculty of Liaison Psychiatry was established within the Royal College of Psychiatrists in 1997. The European Association for Consultation Liaison Psychiatry and Psychosomatics also produced a set of guidelines for training in Liaison Psychiatry.

A survey for NHS England in 2015 found 133 out of 179 A&E departments could not deliver the minimum core standard for 24/7 liaison psychiatry. 11 hospitals had no liaison psychiatry service, and only 35 delivered at or above the minimum standards. Collectively there was a shortage of 1,270 trained nurses and 230 trained consultants.

United States

The American Psychiatric Association formally recognised C-L psychiatry as a subspecialty in 2004, with its own sub-specialty board exam. The profession debated about the best term for this specialty, finally settling on “Psychosomatic Medicine”.

Scope

Liaison psychiatry usually provides a service to patients in a general medical hospital, either inpatients, outpatients or attenders at the Emergency Department. Referrals are made when the treating medical team has questions about a patient’s mental health, or how that patient’s mental health is affecting their care and treatment. Typical issues include:

Patients with medical conditions that cause/exacerbate psychiatric or behavioural problems, such as delirium.
Supporting the management of patients with mental disorders who have been admitted for the treatment of medical problems.
Assisting with assessment of the capacity of a patient to consent to treatment.
Patients who may report physical symptoms as a result of a mental disorder, or patients with medically unexplained physical symptoms.
Patients who may not have a psychiatric disorder but are experiencing distress related to their medical problems.
Patients who have attempted suicide or self-harm.
Assisting with the diagnosis, treatment and functional assessment of people with dementia, including advice on discharge planning or the need for long-term care.

The psychiatric team “liaises” with many other services, including the treating medical team, other mental health services, social services, and community services. There is increasing interest on extending liaison psychiatry to primary care, for the management of long-term medical conditions such as diabetes mellitus.

Effectiveness of Liaison Psychiatry

Consultation-liaison psychiatry helps improve patients’ coping mechanisms, treatment adherence, school/work re-integration and quality of life. An evaluation of the Rapid Assessment, Interface and Discharge (RAID) model of liaison psychiatry – employed at City Hospital, Birmingham – estimated that the service saved between 43 and 64 beds per day through reduced lengths of stay and prevention of readmission. In 2011 the Centre for Mental Health published an economic evaluation of the service, estimating savings of around £3.5 million. This was followed in 2012 by the publication of a report recommending that every NHS hospital should have a liaison psychiatry service as standard.

On This Day … 02 June

Published on 06/02/202105/30/2021 by Andrew MarshallLeave a comment

People (Deaths)

1875 – Józef Kremer, Polish psychologist, historian, and philosopher (b. 1806).
1987 – Anthony de Mello, Indian-American priest and psychotherapist (b. 1931).

Jozef Kramer

Józef Kremer (22 February 1806 to 02 June 1875), was a Polish historian of art, a philosopher, an aesthetician and a psychologist.

He studied at Kraków, Berlin, Heidelberg and Paris.

He was a professor of philosophy and rector of the Jagiellonian University in Kraków: 1847, assistant professor; 1850, full professor; 1865, Dean of the Faculty of Philosophy; in academic year 1870-1871, rector.

He was a member of the Polish Academy of Learning from the day of its founding (1872). Professor of art history and aesthetics of Academy of Fine Arts in Kraków.

Kremer was the first proponent of Hegelianism in Poland. In 1843 he published the first volume of Listy z Krakowa (Letters from Kraków), a dissertation in aesthetics in the Hegelian spirit (vols. 1-3, Vilnius 1855-1856), which brought him recognition and renown. Also his Wykład systematyczny filozofii [A systematic course of philosophy] (vol. 1, Kraków 1849; vol. 2, Vilinius 1852), apart from the work of Karol Libelt, the first systematic textbook of philosophy in 19th-century Poland, was well received.

Kremer’s popularity and fame was, however, ensured primarily by his Podróż do Włoch (Journey to Italy; vols. 1-5, Vilnius 1859-64), which soon found place among the classics of Polish literature, and its excerpts were included in textbooks and anthologies of the day. Thanks to the efforts of Henryk Struve, in 1877-1880 a twelve-volume edition of Kremer’s collected works was published in Warsaw. No other Polish philosopher contemporary of Kremer’s could boast such a publication.

Kremer’s most important achievement in psychology was the systematic division of psychic phenomena into the conscious and the unconscious, and the treatment of anthropology as a science which probes the mutual relations between these two. By considering the act as the best source of information about a person, Kremer anticipated Wilhelm Dilthey’s position.

Anthony de Mello

Anthony de Mello, also known as Tony de Mello (04 September 1931 to 02 June 1987), was an Indian Jesuit priest and psychotherapist. A spiritual teacher, writer, and public speaker, de Mello wrote several books on spirituality and hosted numerous spiritual retreats and conferences. He continues to be known for his storytelling which drew from the various mystical traditions of both East and West and for introducing many people in the West to mindfulness-based practices he sometimes called “awareness prayer.”

In 1972, he founded the Institute of Pastoral Counselling, later renamed the Sadhana Institute of Pastoral Counselling, in Poona, India.

On This Day … 01 June

Published on 06/01/202105/30/2021 by Andrew MarshallLeave a comment

People (Deaths)

1952 – John Dewey, American psychologist and philosopher (b. 1859).

John Dewey

John Dewey (20 October 1859 to 01 June 1952) was an American philosopher, psychologist, and educational reformer whose ideas have been influential in education and social reform. He was one of the most prominent American scholars in the first half of the twentieth century.

The overriding theme of Dewey’s works was his profound belief in democracy, be it in politics, education, or communication and journalism. As Dewey himself stated in 1888, while still at the University of Michigan, “Democracy and the one, ultimate, ethical ideal of humanity are to my mind synonymous.” Dewey considered two fundamental elements – schools and civil society – to be major topics needing attention and reconstruction to encourage experimental intelligence and plurality. He asserted that complete democracy was to be obtained not just by extending voting rights but also by ensuring that there exists a fully formed public opinion, accomplished by communication among citizens, experts and politicians, with the latter being accountable for the policies they adopt.

Dewey was one of the primary figures associated with the philosophy of pragmatism and is considered one of the fathers of functional psychology. His paper “The Reflex Arc Concept in Psychology,” published in 1896, is regarded as the first major work in the (Chicago) functionalist school. A Review of General Psychology survey, published in 2002, ranked Dewey as the 93rd-most-cited psychologist of the 20th century.

Dewey was also a major educational reformer for the 20th century. A well-known public intellectual, he was a major voice of progressive education and liberalism. While a professor at the University of Chicago, he founded the University of Chicago Laboratory Schools, where he was able to apply and test his progressive ideas on pedagogical method. Although Dewey is known best for his publications about education, he also wrote about many other topics, including epistemology, metaphysics, aesthetics, art, logic, social theory, and ethics.

What is a Mental Health Nurse?

Published on 05/31/2021 by Andrew MarshallLeave a comment

Introduction

A Mental Health Nurse (MHN), sometimes referred to as a psychiatric nurse, is someone who specialises in the care of patients with mental health issues.

Background

In 2015, MHNs comprised approximately 12% of the total NHS Nursing workforce (Addicott et al., 2015). In order to qualify as a MHN in the UK, a Nursing & Midwifery Council (NMC) accredited nursing degree or diploma is required. Registration must be renewed every three years, for which 450 hours of registered practice and 35 hours of study must have been completed in the past three years. The total number of registered mental health nurses in the UK was 48,130 in 2010, however, since then there has been a slight decrease, as some nurses have transferred over to voluntary and independent providers. MHNs typically work within community or hospital settings, as part of Crisis Assessment and Treatment, inpatient environments and/or community mental health teams.

Roles of a Mental Health Nurse

MHNs act to bridge the gap between mental health services and general practice for patients suffering from acute to chronic mental illnesses. The role of an MHN has gradually transitioned over the years, to encompass a greater level of involvement in patient care e.g. nurses now have authority to prescribe medication. The main responsibilities of a MHN can be subdivided into six broad categories with a certain degree of overlap:

Case management:
- This consists of tailoring care to the specific needs of an individual.
- It involves providing interventions in the form of psychotherapy or familial support; arranging other services when required; establishing networks with community agencies; overseeing changes in medication; community integration and actively seeking out people who drop out of services.
Psychosocial interventions:
- A holistic approach to patient care is required, by which the MHN should build rapport with patients to encourage trust, while listening to and interpreting their needs and concerns.
- If a patient is having social/financial problems, the MHN may offer advice and interventions e.g. by arranging social events in the community, in order to develop patients’ socials skills and combat feelings of isolation.
- They may also work with patients’ families and carers, helping to educate them about the burden of mental illness.
Physical health:
- Long-term mental illness sufferers may have substantial cardiometabolic/ respiratory illnesses.
- Furthermore, this population is at considerable risk of contracting infections, such as HIV and AIDS.
- The MHN will prepare and maintain comprehensive patient records, whilst also producing care plans and risk assessments.
- They must also monitor weight, blood pressure and provide health education and interventions in areas such as diet, smoking and sexual behaviour.
Medication management:
1. MHN must ensure correct administration of medication, including injections, and monitoring the results of treatment.
Working with dual diagnosis patients, and promoting a ‘recovery’ based approach to care.
Behavioural therapy:
- Providing evidence-based individual therapy e.g. cognitive behavioural therapy for depression and anxiety.
- Empathising with distressed patients and applying ‘de-escalation’ techniques to help patients manage their emotions and behaviour better.
- Encourage patients to take part in therapeutic hobbies such as art or drama.

Reference

Addicott, R., Maguirre, D., Honeyman, M. & Jabbal, J. (2015) Workforce Planning in the NHS. Available from World Wide Web: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Workforce-planning-NHS-Kings-Fund-Apr-15.pdf. [Accessed: 30 May, 2021].

What is a Mental Health Counsellor?

Published on 05/31/2021 by Andrew Marshall2 Comments

Introduction

A mental health counsellor (MHC), or counsellor, is a person who works with individuals and groups to promote optimum mental and emotional health.

Such persons may help individuals deal with issues associated with addiction and substance abuse; family, parenting, and marital problems; stress management; self-esteem; and ageing. The United States Bureau of Labour Statistics distinguishes “Mental Health Counsellors” from “Social Workers”, “Psychiatrists“, and “Psychologists“.

Duties

The legal definition of a counsellor, and hence the legal scope of practice, varies with jurisdiction. In some jurisdictions across the US, counsellors, marriage and family therapists, and psychologists have virtually identical definitions: evaluating and treating mental and behavioural disorders. In spite of such definitions, many mental health professionals reject the medical model (which assumes that clients are “disordered”) in favour of broader viewpoints, such as those that emerged from systems psychology.

Service Users

MHCs work with individuals, couples, families, and groups to address and treat emotional and mental disorders and to promote mental health. Most mental health counsellors in the US work in outpatient and residential care centres, individual and family services, and local governments. They are trained in a variety of therapeutic techniques used to address issues, including depression, anxiety, addiction and substance abuse, suicidal impulses, stress, problems with self-esteem, and grief. They also help with job and career concerns, educational decisions, issues related to mental and emotional health, and family, parenting, marital, or other relationship problems. Some career concerns include helping employees who have mental health conditions to manage their health condition whilst adhering to organisational demands to demonstrate performance and commitment to their work. MHCs also continue to play a growing role in the military mental health crisis, helping military personnel and their families deal with issues such as PTSD. MHCs often work closely with other mental health specialists, such as psychiatrists, psychologists, clinical social workers, psychiatric nurses, and school counsellors. Many mental health counsellors look to help their clients have a concise whole body treatment plan that addresses all the needs of the client. In the United States, MHCs diagnose as well as treat mental illness, though the scope of practice for mental health practitioners varies from state to state.

Regulation

United States

Licensing requirements can vary depending on which state a mental health counsellor practices in. Across the United States, mental health counselling licensure is required to independently practice, but can be practiced without a license if under close supervision of a licensed practitioner. Licensing titles for mental health counsellors vary from state to state: Licensed Mental Health Counsellor (LMHC), Licensed Professional Counsellor (LPC), Licensed Professional Clinical Counsellor (LPCC), and various forms of these titles may list differently per state statues. The title “Mental Health Counsellor” (or variation thereof) is often a protected title and thus it may be a violation of state law for persons to hold themselves as such without a proper credential.

A licensed mental health counsellor holds a minimum of a master’s degree in counselling or another closely related field in mental health care. After obtaining a master’s degree, mental health counsellors complete two to three years (depending on various state statutes) of clinical work under the supervision of a licensed or certified mental health professional. The qualifications for licensure are similar to those for marriage and family therapists and for clinical social workers. Becoming a counsellor and using it in daily life to help others to learn more about themselves is not a reason for someone to pursue a degree within this field. Ethics within this profession require the counsellor to remain professional to be able to adequately treat patients. Remaining detached as the witness to a client’s thought, feelings, and emotions can be a hard thing to do, but will ultimately reassure a patient that there are no judgement to what they will share. Guiding a patient to understand themselves and their choices is also another aspect of this profession.

What is a Bachelor of Psychology?

Published on 05/31/2021 by Andrew Marshall2 Comments

Introduction

The Bachelor of Psychology degree (BPsych, or PsyB; also Bachelor of Arts or Science in Psychology, BAPsy, BScPsy) is a degree awarded to students who have completed a specialised course of study in the field of psychology – i.e. as opposed to a broad major in the subject within a general BA or BSc degree.

Background

Variants include the Bachelor of Arts in Applied Psychology, Bachelor of Arts in Clinical Psychology, Bachelor of Arts in Forensic Psychology, Bachelor of Arts in Organisational Psychology. Courses typically last four years, but may be as long as six.

Refer to Master of Psychology and Doctor of Psychology.

What is a Master of Psychology?

Published on 05/31/202105/31/2021 by Andrew Marshall2 Comments

Introduction

The Master of Psychology (abbreviated Psy.M. or M.Psych.) is a master’s degree in the field of Psychology.

France

In France, the PsyM is a professional and/or a research master’s degree and is offered through a number of different universities. The PsyM is considered as a specialisation in one of the different fields of psychology (neuropsychology, psychopathology, occupational psychology, …).

A professional PsyM is required to access the title of psychologist.

All students entering a professional PsyM programme are required to have a recognised bachelor’s degree in a related field. The PsyM is a two years long diploma, conferring at its term a 5-years university diploma.

Refer to Bachelor of Psychology and Doctor of Psychology.

On This Day … 31 May

Published on 05/31/202105/23/2021 by Andrew MarshallLeave a comment

People (Deaths)

1996 – Timothy Leary, American psychologist and author (b. 1920).
2011 – Hans Keilson, German-Dutch psychoanalyst and author (b. 1909).

Timothy Leary

Timothy Francis Leary (22 October 1920 to 31 May 1996) was an American psychologist and writer known for his strong advocacy of psychedelic drugs. Evaluations of Leary are polarized, ranging from bold oracle to publicity hound. He was “a hero of American consciousness”, according to Allen Ginsberg, and Tom Robbins called him a “brave neuronaut”.

As a clinical psychologist at Harvard University, Leary worked on the Harvard Psilocybin Project from 1960 to 1962 (LSD and psilocybin were still legal in the United States at the time), resulting in the Concord Prison Experiment and the Marsh Chapel Experiment. The scientific legitimacy and ethics of his research were questioned by other Harvard faculty because he took psychedelics along with research subjects and pressured students to join in. However, the claims that Leary pressured unwilling students are refuted by at least one of Leary’s students, Robert Thurman. Leary and his colleague, Richard Alpert (who later became known as Ram Dass), were fired from Harvard University in May 1963. Most people first heard of psychedelics after the Harvard scandal.

Leary believed that LSD showed potential for therapeutic use in psychiatry. He used LSD himself and developed a philosophy of mind expansion and personal truth through LSD. After leaving Harvard, he continued to publicly promote the use of psychedelic drugs and became a well-known figure of the counterculture of the 1960s. He popularized catchphrases that promoted his philosophy, such as “turn on, tune in, drop out”, “set and setting”, and “think for yourself and question authority”. He also wrote and spoke frequently about transhumanist concepts of space migration, intelligence increase, and life extension (SMI²LE). Leary developed the eight-circuit model of consciousness in his book Exo-Psychology (1977) and gave lectures, occasionally billing himself as a “performing philosopher”.

During the 1960s and 1970s, he was arrested often enough to see the inside of 36 prisons worldwide. President Richard Nixon once described Leary as “the most dangerous man in America”.

Hans Keilson

Hans Alex Keilson (12 December 1909 to 31 May 2011) was a German-Dutch novelist, poet, psychoanalyst and child psychologist. He was best known for his novels set during the Second World War, during which he was an active member of the Dutch resistance.

Keilson, having worked with traumatised orphans, mainly wrote about traumas induced by the war. His first novel was published in 1934, but most of his works were published after the war. In 2010, The New York Times ‘s Francine Prose described Keilson as “one of the world’s greatest writers”, notably honouring Keilson’s achievements in the year in which he turned 101 years old.

On This Day … 30 May

Published on 05/30/202105/23/2021 by Andrew MarshallLeave a comment

People (Births)

1879 – Konstantin Ramul, Estonian psychologist and academic (d. 1975).

Konstantin Ramul

Konstantin Ramul (30 May 1879 to 11 February 1975) was an Estonian professor of psychology and long-time chair of psychology at the University of Tartu. He is best known for his work on the history of experimental psychology.

Ramul believed that history is dependent upon psychology, though the philosopher of science Ernest Nagel criticised him for “not stat[ing] clearly the type of psychological investigation which is relevant to the historian’s task”.