Psychological consultancy in mental health services: A systematic review of service, staff, and patient outcomes.

OBJECTIVES: Psychological consultation in mental health is an organizational intervention aiming to enable mental health care to be delivered in a more efficient manner. This review sought to: (1) clarify what theoretical models underpin consultancy, (2) define how consultancy is implemented, (3) assess the methodological rigour of the evidence base, and (4) define the outcomes achieved for services, staff, and patients. The review was focal to direct and indirect forms of consultation. METHOD: PRISMA guidelines were followed. Three databases were searched identifying N = 17 studies, and these were quality assessed using the QualSyst quality ratings checklist. Studies were grouped by model of consultation and outcome. A thematic analysis then clustered the patient, staff, and service outcomes into either discrepant or confirmatory evidence. RESULTS: The most frequently adopted theoretical models underpinning psychological consultation are cognitive-behavioural and cognitive-analytic. Method of consultancy implementation is typically via case formulation meetings. Study quality varied from limited to strong. The main confirmatory and positive outcomes for staff are an increase in understanding and also more positive feelings towards patients, and for the service, there is a reduced need for other interventions. CONCLUSIONS: Psychological consultation appears a useful and worthwhile aspect of leadership by psychological therapists. Training in delivering consultancy needs to be well integrated into the core curricula of clinical training programmes. The evidence base is still in its infancy, and further well-controlled research is required.

Delivering cognitive analytic consultancy to community mental health teams: Initial practice-based evidence from a multi-site evaluation.

OBJECTIVES: This study sought to employ the hourglass model to frame the methodological evolution of outcome studies concerning 5-session cognitive analytic consultancy (CAC). DESIGN: Pre-post mixed methods evaluation (study one) and mixed methods case series (study two). METHODS: In study one, three sites generated acceptability and pre-post effectiveness outcomes from N = 58 care dyads, supplemented with qualitative interviewing. The client outcome measures included the Clinical Outcomes in Routine Evaluation Outcome Measure, Personality Structure Questionnaire, Work and Social Adjustment Questionnaire, Service Engagement Scale, and the Working Alliance Inventory. Study two was a mixed methods case series (N = 5) using an A/B phase design with a 6-week follow-up. Client outcome measures were the Personality Structure Questionnaire, Clinical Outcomes in Routine Evaluation Outcome Measure, and the Working Alliance Inventory, and the staff outcome measures were the Working Alliance Inventory, Maslach Burnout Inventory, and the Perceived Competence Scale. RESULTS: In study one, the cross-site dropout rate from CAC was 28.40% (the completion rate varied from 58 to 100%) and full CAC attendance rates ranged from 61 to 100%. Significant reductions in client distress were observed at two sites. Qualitative themes highlighted increased awareness and understanding across care dyads. In study two, there was zero dropout and full attendance. Clients were significantly less fragmented, and staff felt significantly more competent and less exhausted. Potential mechanisms of change were the effective process skills of the consultant and that emotionally difficult CAC processes were helpful. CONCLUSIONS: Cognitive analytic consultancy appears a promising approach to staff consultation, and testing in a clinical trial is now indicated. PRACTITIONER POINTS: CAC is a suitable method of consultation for care dyads struggling to work effectively together in CMHTs. Staff feel more competent and clients feel less fragmented following CAC, and the benefits of CAC appear to be maintained over follow-up time. CAC processes can be difficult for care coordinator and client, but this is not an impediment to change.

Adversarial growth in patients with multiple sclerosis and their partners: relationships with illness perceptions, disability and distress.

The purpose of this study was to investigate whether patients with multiple sclerosis (MS) and their partners show adversarial growth and to examine which psychological and disability variables contribute to this in patients and their partners. The study also investigated the relationship between growth and distress. Seventy-two patients with MS and their partners provided demographic information and completed measures of posttraumatic growth, illness perceptions, depression, cognitive function and disability. Both patients and partners showed adversarial growth, with patients reporting significantly higher growth than partners. The only significant predictor for patient growth was partner growth, and vice versa. Dissimilarity in illness representations between patients and their partners on the consequences of MS dimension, patient mood and patient growth accounted for significant variance in partner growth. The findings support the idea of a 'communal search for meaning' where patients and their partners experience the trauma of having a chronic illness and subsequently find positive aspects together.

How perception impacts on drawings.

In 3 experiments the authors investigate how errors in perception produce errors in drawings. In Experiment 1, when Shepard stimuli were shown as a pair of tables, participants made severe errors in trying to adjust 1 part of the stimulus to match the other. When the table legs were removed, revealing a pair of parallelograms with minimal perspective cues, the illusion was weaker. The authors predicted that participants would err when drawing the table but not the parallelogram stimuli. The results of Experiment 2 support the prediction and establish a direct link between degree of perceptual distortion of the table stimuli and the severity of error in drawing. When drawing only the right-hand part of the figure, participants also erred to a greater degree in drawing the table than the parallelogram (Experiment 3). Collectively, the results suggest that perceptual distortion is linked with errors in drawing the table stimuli.

Widening the sphere of influence: using a tool to extend extrapersonal visual space in a patient with severe neglect.

We report evidence that visual representations of space close to the body can be extended when a patient uses a tool to explore the environment. HB had severe neglect of left and far spatial regions which was determined more by how locations were visually perceived than by how they were represented tactilely or through proprioception. His ability to detect visual targets in left and far space was improved, however, when he held a tool. He also had limited tactile/proprioceptive knowledge about the location of his hand. These data suggest that by holding a tool, HB's more intact representation of near, visual space could be extended to include stimuli presented at a distance from his body. This extension of space improved his detection of visual stimuli. We discuss the implications of the results for the nature of our internal representation of space.