A key statutory role in mental health care previously restricted to psychiatrists has been opened to other professions. The first four psychologists in England and Wales have been granted 'approved clinician' status and will now take responsibility for the overall care of patients who are detained for assessment and treatment under the Mental Health Act.

The Policy Director of the British Psychological Society's Division of Clinical Psychology, John Hanna, believes that 'this result is, without much understatement, a milestone in the history of British mental health services'. It has been hailed as 'a significant breakthrough for the application of psychological models in mental health care that holds important implications for mental health service policy' by Peter Kinderman, Professor of Clinical Psychology at the University of Liverpool.

The introduction of non-medical approved clinicans under the Mental Health Act is the first statutory manifestation of the Department of Health's New Ways of Working (NWW) programme. John Taylor, President of the British Association for Behavioural and Cognitive Therapies, told The Psychologist: 'NWW explicitly aims to achieve cultural change through service transformation and freeing the most experienced and highly trained practitioners to work with the most complex clients. Psychologists should be prepared to offer clinical leadership'. Kinderman called this 'a radical challenge for those who view mental health care as a natural branch of medicine'.

Hanna is mindful of the 'exceedingly small psychology resource available to service users on general acute inpatient wards - where only 13 per cent of wards have a psychologist - and under the primary care of crisis/home treatment services - where the figure is only 8 per cent'. He urges that 'having now attained parity in statutory responsibility with psychiatrists, we must continue to press for parity in the delivery of evidence-based psychological therapy'. Taylor urged 'more psychologists from a range of service settings to step forward and help meet the needs of these vulnerable clients and develop more psychologically-minded services'.

The Society's Mental Health Act Working Party, chaired by Bruce Gillmer, will continue to provide facilities for psychologists seeking support as they prepare for these roles. 'We will work with other professions, universities and the NHS in the design and initiation of courses preparing eligible professionals to undertake these roles,' Gillmer said, 'and undertake quality assurance to ensure that our profession is enabled to undertake clinical leadership with confidence.' js

I Nigel Atter, Policy Adviser for the Society's Professional Practice Board, can be contacted for further information: nigel.atter@bps.org.uk. The Guidance for Registered Psychologists in Making Application to the BPS Approved Clinician Peer Review Panel (January, 2010) can be downloaded from the Society website.

-- Jon Sutton

New guidelines on meeting the psychological needs of people who are homeless were published in July by the National Mental Health Development Unit and the Department for Communities and Local Government. 'People who are homeless or insecurely housed are among those most in need of psychologically informed help,' the guidance states, 'but are also among those least able to access mainstream clinical psychology services.'

The 144-page document provides best-practice tips, summaries of recent relevant research, case studies of services and individuals, and key definitions of psychological disorders associated with homelessness, plus weblinks to further information.

A recurring theme in the guidance is that personality disorder, a diagnosis given to many people who are homeless, is treatable. However, it's argued that a more useful term is complex trauma: 'a reaction to an ongoing and sustained traumatic experience'.

The guidance recommends establishing 'psychologically informed environments (PIEs)' - hostel or daycare centres that are designed to make residents feel emotionally safe. A PIE is an 'approach not a place', the guidance explains. PIEs can 'be developed within existing commissioned services, wherever appropriate training and development enables staff to respond effectively to people with psychological needs and longstanding emotional problems.'

Another key point concerns the idea that 'reflective practice', including regular supervision with a psychologist, is essential for any staff working closely with people who experience complex trauma. 'This is just as applicable when working psychologically in an informal way as when working formally as a psychologist or psychotherapist,' the guidance says.

A principal contributor to the guidance was the Chartered Clinical Psychologist Dr Nick Maguire (quoted extensively in our April feature on homelessness). 'This is the first official government policy document to say explicitly that we need to be dealing with the psychological issues [in homelessness] in a coherent way,' Maguire said.

The document came about after a meeting involving Maguire, who's based at the University of Southampton, and Helen Keats, special adviser for the Department of Communities and Local Government, in 2009, to discuss the complex trauma that underpins many of the behaviours that can lead to homelessness.

What about the change of government in May? 'Grant Shapps, Minister of State for Local Government and Housing, seems to be very interested in homelessness,' Maguire said. 'And Grant has taken the guide on and formally announced its publication.'

'I'm hoping the document will be picked up by NHS commissioners of homelessness services who will then know the kind of approach that's effective,' Maguire said. 'Because it's a web document, I'm also hoping that it will be organic in the sense of being added to. If it's a document that people want to get their good practice publicised in, then a sense of competition could be established, driving up standards. In other words, you can be published in this document if you evaluate your project properly. Hopefully this will drive up the quality of evaluation in social care settings'

--Christian Jarret

Edited: 08/10/2010 at 10:27 AM by jonsut

Psychology at the University of York and beyond is set to benefit from a £4.36 million joint Wellcome Trust and Wolfson Foundation grant to fund research into an innovative form of imaging.

Spin Amplification By Reversible Exchange (SABRE) is a form of hyperpolarisation, developed at the University of York, that allows the signal used in fMRI (functional magnetic resonance imaging - a technique for observing brain activity used by many psychologists) to be dramatically enhanced, thus increasing the sensitivity of the scan.

The grant will contribute towards the new 'Centre for Hyperpolarisation in MRI', which is to be built next to the York Neuroimaging Centre. Psychology professor Gary Green, director of the York Neuroimaging Centre, explained the relevance of the news to psychology: 'SABRE...offers the opportunity to make carbon based molecules much more visible in MRI. The high spatial and chemical resolution of MRI could then be used to map the distribution and the metabolic fate of key neurotransmitters, drugs that act on the brain, or biomarkers related to specific brain disorders.

'This technique will be combined with fMRI to investigate the links between neurochemistry and behaviour. This major investment will make it possible to take the new SABRE technology away from the chemistry bench and make it a practical tool in the study of the brain in both health and disease.'

--Christian Jarret

The Health Secretary Andrew Lansley announced in July that half the so-called 'arms length bodies' run by his department were to be culled as part of the coalition government's drive to cut bureaucracy and save money. Among the planned changes is that the General Social Care Council will be abolished, with the regulation of social workers passing instead to the Health Professions Council - the body that currently regulates psychologists. Also in the line of fire is the Health Protection Agency. The National Institute for Health and Clinical Excellence and the Care Quality Commission are among the quangos being retained.

The American Psychological Association (APA) has taken the unusual step of writing to a State licensing board that's considering a complaint against a specific psychologist. This isn't just any old complaint. Dr James Mitchell stands accused of designing torture techniques for the CIA.

'The APA took the unusual step of communicating with the Texas Board because of the serious nature of the allegations against Dr Mitchell,' Rhea Farberman, APA's executive director of public and member communications, told The Psychologist. Mitchell isn't an APA member and so he's beyond the jurisdiction of the organisation. 'The purpose of the APA letter', Farberman explained, 'was to inform the Texas Board of how the APA ethics code would apply if Dr Mitchell is found to have committed the allegations outlined in the complaint.'

The action against Mitchell is one of several complaints registered in recent weeks against psychologists alleged to have been involved in interrogation practices during the Bush era (find related Psychologist news items in April, November 2008, June, November 2009 issues). Associated Press report that the San Francisco Centre for Justice and Accountability has filed a complaint against Dr John Leso, and the International Human Rights Clinic has done the same with regard to army psychologist Colonel Larry James. Leso is accused of designing abusive interrogation techniques, whilst James is accused of observing such practices and failing to intervene.

Stephen Soldz, President of Psychologists for Social Responsibility, said: 'In the absence of action by the major institutions in our country, activists have undertaken grassroots accountability efforts, including ethics complaints against psychologists implicated in abuses and calls for an investigation of illegal and unethical CIA research on detainees. These efforts are essential.

'We have long called for an independent investigation, both of psychologists' potential complicity in torture, but also of the actions of the APA itself,' Soldz told us. 'That investigation is now needed more than ever, before we can turn the corner.'
In a related development, the Massachusetts-based group Physicians for Human Rights published a report in June calling on the Obama administration to investigate claims that prisoners in the Bush era were used as subjects by psychologists and others researching interrogation techniques.

--Christian Jarret

When attempting to change people's behaviour - for example, encouraging them to eat more healthily or recycle more - a common tactic is to present scientific findings that justify the behaviour change. A problem with this approach, according to new research by Geoffrey Munro at Towson University in America, is that when people are faced with scientific research that clashes with their personal view, they invoke a range of strategies to discount the findings.

Perhaps the most common of these is to challenge the methodological soundness of the research. However, with newspaper reports and other brief summaries of science findings, that's often not possible because of lack of detail. In this case, Munro says people will often judge that the topic at hand is not amenable to scientific inquiry. What's more, he's found that, having come to this conclusion about that specific topic, the sceptic will then generalise their belief about scientific impotence to other topics as well. Munro says that by embracing the general idea that some topics are beyond the reach of science, such people are able to maintain belief in their own intellectual credibility, rather than feeling that they've selectively dismissed unpalatable findings.

Munro presented 84 student participants with brief summaries of five studies that either consistently supported or undermined the idea that homosexuality is associated with mental illness. Students who read research summaries that clashed with their own personal view were more likely to say afterwards that the topic was unsuitable for scientific inquiry. Moreover, these participants were also more likely to say that other topics, including the effectiveness of smacking children as a disciplinary technique, and the effect of violent TV, were also beyond the reach of scientific inquiry.

A second study with 93 more students was similar to the first, but this time, after reading the scientific summaries about homosexuality, the students were asked what sources of information they'd use to make a decision about the death penalty. This time, the students who'd read earlier about scientific findings on homosexuality that clashed with their own beliefs were less likely to say they'd use science to help them decide about the death penalty - 24 per cent of them did compared with 54 per cent of students who'd read science findings that matched their beliefs.

Writing in the Journal of Applied Social Psychology Munro said that as well as focusing efforts on improving the public understanding of science, 'some attention should also be given to understanding how misconceptions about science are the result of belief-resistant processes and developing techniques that might short-circuit these processes.'

--Christian Jarret

Human fetuses of 24 weeks and younger are unable to feel pain because their brains lack the necessary connections between the periphery and the cortex. That's according to a report into fetal awareness published in June by the Royal College of Obstetricians and Gynaecologists.

Commissioned by the Department of Health, the new report represents a complete rewrite of the same document published in 1997. The psychologist Dr Stuart Derbyshire of the University of Birmingham was among the working party members who collated the necessary evidence for the update. A companion report Termination of Pregnancy for Fetal Abnormality was published concurrently.

Although nervous system development beyond 24 weeks allows for noxious stimuli to trigger cortical responses, the fetal awareness report also concludes that such activity is unlikely to be accompanied by the subjective experience of pain because increasing evidence suggests 'the fetus never enters a state of wakefulness in utero and is bathed in a chemical environment that induces a sleep-like unconsciousness, suppressing higher cortical activation.' On this basis the report cautions against extrapolating from the experience of premature newborns to form conclusions about unborn fetuses of the same age.

The Psychologist asked Chartered Psychologist Professor Peter Hepper of the University of Belfast - an expert in fetal psychology - for his verdict on the new report. He told us the document was 'reasonably balanced', 'detailed' and 'comprehensive' and that the conclusion regarding on pain prior to 24 weeks was 'probably' correct. '"Probably" being important,' Hepper clarified, 'as we do not have the ability to directly address the question.'

Regarding the conclusion about lack of wakefulness after 24 weeks, Hepper said the evidence was less convincing, not least because much of it comes from research with sheep. 'The sheep is precocial and its intrauterine development is required to prepare it for "independent motor life" immediately after birth,' Hepper explained. [In contrast] 'the human newborn is altricial and has a long period of dependent development. How these differences are reflected in prenatal development are unknown.'

Hepper also pointed out that post 24-weeks, the fetus exhibits different levels of responsiveness: 'suggestive of the fact that it is not in one specific state but in several different states - however whether one of these is wakefulness is not known.'
Looking to the future, Hepper said that our reliance on indirect measures to determine whether the fetus feels pain means the question will 'undoubtedly be with us for a long time yet.'

Fetal Awareness, Review of Research and Recommendations for Practice is available click here for link.

--Christian Jarret

British Psychological Society Fellow Professor Chris Code has received the Robin Tavistock Award from the Tavistock Trust for Aphasia. Professor Code currently holds various academic and voluntary positions, including a Professorial Research Fellow in the School of Psychology at the University of Exeter, and he has dedicated a huge part of his life to furthering the understanding of the issues that surround aphasia. He told The Psychologist he was 'gobsmacked'.

Edinburgh University psychologist Dr Ben Schögler and his colleague physicist Dr David Skulina have invented a musical instrument called 'the Skoog' that can be played by children who are severely disabled.

Children and teachers helped inform the design of the Skoog - a colourful, robust, rubber cube with five touch-sensitive sides that translate tactile input, via computer, into distinctive sounds. 'Even the slightest touch or twist of the cube can give a slightly different timbre or tone quality, allowing for limitless expressive opportunity,' Schögler tells us. 'The sounds, for example, can be made to represent a flautist pursing their lips or blowing harder. The surface sensitivity is completely adjustable to cope with the individual needs or progressing levels of attainment of players and in this sense can be used in a highly intuitive way.'

The Skoog allows children with special needs to make their own music and Schögler says they often progress within one session. As their confidence grows, the device's sensitivity can be adjusted downwards.

The Skoog is rooted in the principles of ecological psychology, designed in such a way that it can be used intuitively with little or no instruction. Whereas the design of traditional instruments is dictated in part by the demands of their particular sound production, the use of a computer as the Skoog's sound source means that its physical appearance and design is focused on usability.

Does Dr Schögler, who now works full-time for spin-out company Skoog Music, have any advice for other psychologists planning to translate their own research ideas into real-life products? 'Get the technology into the hands of the user as soon as possible and do as much development in the field as you can,' he says. 'We were lucky to be supported by four local authorities in Scotland: East Ayrshire, North Ayrshire, North Lanarkshire and Fife, and we worked with teachers and pupils from day one to make sure we were developing something that would be of real value to the schools as opposed to just being clever technology.'

'It's going well,' Schögler says. 'We created the Skoog in response to the needs of children and educators and so far it's been well received.'

--Christian Jarret

As psychological scientists, we, perhaps more than most, recognise that superstitions are irrational. However, that doesn't mean they can't be beneficial. In a series of studies involving dozens of students, Lysann Damisch and colleagues at the University of Cologne have demonstrated the following: playing with a ball described as lucky improves participants' putting accuracy; telling participants that you're pressing thumbs for them (the German equivalent to crossing fingers) improves their resolution of a balls into holes dexterity task; and the presence of their own personal lucky charm boosts participants' performance on memory and anagram tasks.

Further analysis revealed these benefits came about because activating good-luck superstitions increased participants' self-efficacy - that is, their belief in their own ability. In turn this increased participants' persistence, thus fuelling superior performance.
'The present findings suggest that engaging in superstitious thoughts and behaviours may be one way to reach one's top level of performance,' the researchers wrote in Psychological Science. In reference to well-known elite athletes with strong superstitions, including Michael Jordan's habit of wearing lucky underwear, they added: 'The observation that a superstitious thought or behaviour leads to subsequent performance improvement may help explain the prevalence and maintenance of superstitious thoughts and practices across different eras and cultures.'

In other sports psychology news, The Independent reported that golfer Louis Oosthuizen, winner of this year's Open, had worked with Karl Morris - a self-defined 'mind coach'. Morris, who isn't chartered or registered with the HPC, said: 'One of the tips I gave [Oosthuizen] was to put a red spot on his glove and to focus on it during his swing'

--Christian Jarret

The 17th European Congress of Psychotherapy took place on July 1st-4th, 2010 in Bucharest, Romania. The host was the Romanian Federation of Psychotherapy (FRP) which, this year, celebrates its first decade of existence. The FRP brought together delegates from a great variety of psychotherapeutic approaches, starting with the classical Freudian psychoanalytic psychotherapy or the well-established cognitive-behavioral therapies to the newly emerged integrative psychotherapy, body therapy or even second order cybernetics of psychotherapy. Moreover, this diversity, which was a unique feature in the European Association for Psychotherapy (EAP) annual events, was complemented by a multidisciplinary presence of psychologists, psychiatrists and psychotherapists. Two books were launched in the Romanian language during the congress. One was Person-Centered Counseling in Action by Dave Mearns and Brian Thorne. The second was The Performance of Practice: Enhancing the Repertoire of Therapy with Children and Families by Jim Wilson.

The theme of the congress was "Crisis: Change and Challenge". The event was opened by Giovanni Boria, founding member and first President of the Italian Association of Morenian Psychodramatists who encouraged the participants to reflect on the topic of the congress and formulate their thoughts within multicultural groups. Some emerging ideas were that networking can help overcome crisis while chaos can prompt to perhaps frightening change that can nevertheless be innovative and productive. In the following days, Peter Schulthess, President of the European Association of Gestalttherapy, talked about the utility of psychotherapy in the three stages of crisis: preparation phase, critical phase and post-crisis phase. While Courtenay Young, NHS psychotherapist, discussed the spiritual emergency of a client as crisis, Augustin Cambrosie, President of the Romanian Association of Psychoanalytic Psychotherapy mentioned the crisis in the psychotherapist's office which can have the psychotherapist himself as a protagonist. Apart from the representatives of the cognitive-behavioural therapies who advocated for evidence-based practice and a clearly defined role of the psychotherapist, most participants agreed that psychotherapy is focused on a fluid relationship between the therapist and the client, in which they are both involved with their personal values and vulnerability and through which they both acquire change. Dave Mearns, Emeritus Professor at Strathclyde University, Scotland explained that the authenticity of the therapist as a human being contributes to the construction of relational depth with difficult clients.

The interaction of delegates from diverse professional orientations created awareness of a lack of a gold-standard approach in psychotherapy, meaning that each has its strengths to be considered. Furthermore, the guest speakers mentioned, one by one, that today's world should lead to a reevaluation of the psychotherapeutic methods and an adaption to the new parameters of a society that is under increasing stress and demands. Sean Doherty, Secretary General of the European Association of Body Therapy, held a workshop about heart-inspired psychotherapy which presupposes listening the feedback of the body. Rodolfo de Bernard, President of the EAP, discussed the need for a new form of therapeutic communication that models the way in which today's children learn through images and media rather than through reading books. He proposed a therapy that uses collage and drawing, a method that could reduce the necessary therapeutic sessions to one third. Jim Wilson, Co-Director of Partners for Collaborative Solutions, ended the presentations at the conference by talking about a need of the psychotherapist to be a constant beginner that constantly critically evaluates own practice, respecting the initial guidelines while creating an own therapeutic style through spontaneity and a systematic modesty of acknowledging that other approaches may bring something useful as well. The congress ended with a common view of appreciating the diversity of psychotherapies and a thought of creating an integrative approach.

--Andra Raisa Petca
Institute of Health and Society, University of Worcester

From primary-school age and upwards children should be given age-appropriate education about sex, relationships and alcohol, beginning with advice on the value of friendships and having respect for others. Education of this kind helps children make healthier and safer decisions and improves their school performance. That's according to draft guidance published by the National Institute for Health and Clinical Excellence published in June, the final version of which is due in January 2011.

The draft guidance cites research which found 40 per cent of young people reported their sex and relationship education was poor or very poor. Among other details, the guidance recommends that parents be offered training in effective strategies for talking to their children about sex and relationships. The guidance also states that there's a need to reassure parents that education does not promote early sex. There's also an emphasis on the need for children with physical, learning or communication difficulties, to also receive good quality sex, relationships and alcohol education.

Simon Blake, Chief Executive of the young people's sexual health charity, Brook, is a Programme Development Group member for the new guidance. He said: 'It's a myth that sex and relationships education encourages children to be more promiscuous or have sex at an early age. In fact, evidence demonstrates this type of education helps children and young people resist pressures to get involved in activities that might damage their health. Importantly, it helps them develop the skills to only have the sex they choose when they are able to enjoy and take responsibility for their personal relationships and sexual health.'

--Christian Jarret

Click here for the The draft guidance

The Royal Society of Arts, Manufacturing and Commerce (the RSA) published the second report in their ongoing Social Brain Project in June. Entitled Steer: Mastering our Behaviour Through Instinct, Environment and Reason and written by outgoing project director Matt Grist, the report discusses the potential benefits of informing people about the psychology of decision making, so as to help them make better decisions. 'The very act of "thinking about thinking", in which people develop an understanding of how brains and behaviours work, has the potential to empower people as part of a new model of active, 21st century citizenship,' the report says.

At the heart of the new report is a qualitative study involving 24 people who were taught five principles of decision making over one or two workshops: 'Habit is king'; 'Go with your gut'; 'When it's difficult, just sit'; 'When you feel swayed, step back and say so'; and 'When you can't trust yourself, ask others for help'.

Phenomenological analysis of the participants' decision-making diaries, kept for two weeks, showed that they'd found the information about habit forming most useful - especially the idea that breaking old habits can be more effectively achieved by changing social and environmental circumstances, rather than simply relying on will power. '[W]hen people are informed about how their brains and behaviours work, they find this information interesting, useful in tackling immediate dilemmas and helpful for reflecting on the areas of their lives that they have found most problematic over time (e.g. quitting smoking),' the report says.

Responsibility for the Social Brain Project has now passed to the RSA's senior researcher Dr Jonathan Rowson. He told us the plan is to develop 'an account of the kinds of psychosocial skill required to adapt to what [developmental psychologist] Robert Kegan calls our "hidden curriculum", namely the implicit cognitive demands of adapting to 21st-century challenges like globalisation, environmental degradation and technological change. We intend to follow the pattern of Steer and track what happens when we share our account with interested parties...for instance police officers, teachers and social workers, depending on our theoretical emphasis.

'Our basic position is that if "knowledge is power", knowledge about how to change our behaviour might be particularly empowering,' Rowson said. 'So we are curious to see what happens when behavioural science is viewed as a public good.'

The RSA welcome the input of psychologists. You can get involved by being an early contributor to the RSA Social Brain Wiki and by giving feedback to relevant blog entries. 'We plan to host expert seminars on various aspects of our project,' Rowson said, 'so please get in touch if you would like to contribute your expertise.'

--Christian Jarret

Three psychologists were recognised in the latest round of Queen's Birthday Honours, published in June, and The Psychologist congratulates them all.

Dr Elizabeth Howells, Head of Primary Care and Health Psychology for Avon and Wiltshire Mental Health Partnership NHS Trust, was appointed OBE for services to mental health care in Wiltshire. Dr Howells told us: 'I am absolutely amazed I have been given this honour but realise that is actually an award for the service I happen to lead. I hope it will continue to raise the profile of the service.

'I am most proud of the fact that we have maintained a no-wait service in Swindon for 17 years. This started as a small service but has now grown to cover the whole of Wiltshire. This is due to using the LIFT (least intervention first time) within a stepped-care model. We were the first stepped-care service for mental health in the country and back in the nineties it was often a fight to get acceptance. We are probably still the only one with no wait and no exclusion criteria apart from active psychosis and active, imminent, serious suicide risk - these referrals are directed straight to secondary services.'

Howells says she and her colleagues, to whom she says she is indebted for the pleasure and praise her OBE will bring, continue to fight for more widespread use of the LIFT model, and for IAPTs to adopt a more primary/community type approach in line with New Horizons. 'For many services there is a danger of slipping back into a secondary care model delivered in primary care,' she says.

Howells and her team would also like to see more use of psychoeducational courses both to assist with current problems and prevent future distress, and to that end her service has already started a stepped-care approach to health-related problems. 'I would also like to add that most of the ideas came from Professor Jim Orford, the great proponent of community psychology.'

Dr Rachel Perkins was appointed OBE for services to mental health. Dr Perkins is Director of Quality Assurance and User Experience for South West London and St George's Mental Health NHS Trust. 'I am really flattered to have been awarded an OBE,' she said. 'However, I think it is important to make clear that I could not have done the things that I have in my career were it not for all the talented and committed people with whom I
have had the privilege to work over the years.

'For the last 30 years, both in my day job and outside, I have been committed to improving the lives and life chances of people with a mental health condition - especially those facing more serious challenges. Initially I was heavily involved in closing the old, remote asylums and establishing community services. Now we face the challenge of moving beyond "care in the community" to ensuring that people with mental health conditions have the same rights and opportunities that all citizens have a right to expect. In this context I have done a great deal of work looking at the development of recovery-focused practice and self-directed support.'

However, Perkins says it is her work establishing programmes to help people with mental health problems get back to work that she is most proud of. 'It seems to me that the right to contribute to the community in which we live - and be recognised and rewarded for that contribution - is one of the most important rights of all. What I treasure most is the memories of all the people - many of whom thought they would never work again - who have successfully gained employment and made a success of their careers with the support of the programmes I have initiated.'

Dr Emma Barrett of the Ministry of Defence was also appointed OBE.

----Christian Jarret

Psychological therapies will continue to be rolled out across the NHS in the coming year, the government has announced.

Visiting a psychological therapies service in Berkshire West, Health Secretary Andrew Lansley pledged £70 million funding and said: 'Our Coalition Programme set out our intention to ensure greater access to talking therapies. We want to offer long-term solutions to people with mental health problems and psychological therapies do that.' Lansley promised to broaden the geographical coverage of services and also the range of therapies available, saying that 'this will help us to deliver more choice and give people better access to the right psychological support'.

Care Services Minister Paul Burstow said: 'It is early days for the programme, but we know we need to do more to increase the number of trained therapists and reduce waiting times. It means that by 2011, we will have trained over 3600 therapists, with services up and running in every part of the country.'

John Hanna, Policy Unit Director for the British Psychological Society's Division of Clinical Psychology, said: 'The Society is delighted to receive the news that the new coalition government will continue to fund the Improving Access to Psychological Therapies programme for the coming year. We hope, during this parliamentary term, that this vital invest-to-save endeavour of delivering evidence-based psychological therapies to people with mild to moderate depression and anxiety can be extended to all who would benefit from similar improved access, in concordance with Mind's widely endorsed "We Need to Talk" campaign. Access to evidence-based psychological therapies remains extremely variable across conditions and regions, leaving many people in recurrent states of psychological distress, with their potential to contribute to society unfulfilled. Providing full access to NICE-recommended treatments in mental health will alleviate distress and, in the longer term, enhance national productivity.'

--Jon Sutton

Carrots and sticks were on the health menu in June as the National Institute
for Health and Clinical Excellence (NICE) rolled out guidelines recommending minimum pricing for alcohol, and held a Citizens Council meeting on the use of incentives to boost healthy behaviours.

The recommendation for the introduction of a minimum price per unit of alcohol formed part of new guidance on preventing harmful drinking. Another recommendation was for reducing the availability of alcohol, for example by considering the number of outlets selling alcohol in a given area at particular times.

BPS member Robert West is Professor of Health Psychology and Assistant Director of the Health Behaviour Research Centre at UCL. He told us that the main drivers of alcohol consumption and alcohol-related harm in society are price and availability. 'This has been shown time and time again,' he said. 'Educational campaigns by contrast have been shown to be largely ineffective. So society has a choice: keep cheap alcohol and continue to suffer the consequences of death and misery from accidents, violence, heart and liver disease and cancer that results from it or pay more for drinks and see a reduction in toll of death and misery that results.'

The NICE Citizens Council brings the views of the public to the decision making at NICE. At the latest meeting, 30 members of the public heard about the Give It Up For Baby scheme based in Dundee, which aims to reduce smoking in pregnant women with the incentive of grocery vouchers; the Pounds for Pounds financial incentive programme to encourage people in Kent to lose weight; and the successful food dudes intervention which uses rewards to encourage children to eat more fruit and vegetables. The Council were also told about a Cochrane Collaboration review published in 2008, which found no evidence that 17 incentive schemes had increased smoking cessation rates over the long term. A report on the Council's views on incentives will be published on the NICE website in due course.

Professor West told us it's clear that incentives can increase healthy behaviours but there are two issues which need to be considered in each case: (1) will the incentives have the desired effect and (2) will they also have unwanted side-effects?

'They may not have the desired effect if they are too small or what is being rewarded is not precisely the behaviour you want,' West said. 'For example research into incentives for smokers to stop have so far not found effects that outlast the period when the incentives operate. So vouchers to encourage and help pregnant smokers to stop during pregnancy looks to be a promising approach, but in other smokers there is little to commend it. Unwanted side-effects can involve people cheating to get the reward or becoming fixated on the reward and forgetting the other, more important, reasons for changing behaviour.'

For anyone considering developing an incentive scheme, another BPS member, Professor Theresa Marteau, Director of the Centre of Incentives in Health - a joint collaboration of King's College London, Queen Mary University of London, and the London School of Economics - published a British Medical Journal analysis last year with the following advice: 'Schemes targeting habitual behaviours such as smoking or physical inactivity may be more effective if they provide valued incentives for initial as well as sustained behaviour change, delivered intermittently and as part of effective behaviour change programmes. For schemes aimed at initiating relatively simple behaviours in low income populations such as clinic attendance... small incentives delivered immediately seem most effective.'

--Christian Jarret

I NICE guidance on preventing harmful drinking
BMJ analysis, 'Using financial incentives to achieve healthy behaviour'

Last year, 'right-to-die' campaigner Debbie Purdy, who has multiple sclerosis, helped prompt the publication of new guidelines on assisted suicide from the Director of Public Prosecutions. Purdy had been concerned that her husband would be sent to jail if he aided her reaching the Dignitas clinic in Switzerland. The clarified guidelines suggest that if his motives are compassionate he won't be charged. However, it still remains illegal for doctors in the UK to assist their patients to die. The 39th Maudsley debate held in April examined this issue with the house arguing that the existing law should be overturned to allow doctors to assist some people with suicide.

Proposing the motion was philosopher Baroness Mary Warnock. She argued that palliative care, while helpful and successful, is limited in many places such that many patients are left in considerable discomfort. The existing law, she said, is not respectful of people's freedom and decision making. A doctor may not believe it morally right to assist someone's death, but that judgement shouldn't be imposed on the patient.

Another Baroness, Ilora Finlay, a professor of palliative medicine, opposed the motion and said there were really two questions at hand: whether it should be legal for anyone to assist a person to die, and if so, whether doctors should be expected or allowed to do this.

On the first point, Finlay said it is not possible to legalise assisted dying and at the same time ensure public safety. 'What about people being discreetly manipulated?' she asked. 'Or what about people acting voluntarily out of a desire to spare others the burden?' Moreover, Finlay argued that were assisted dying ever legalised, it should be kept separate from the healthcare system. Medicine is about saving people's lives, she said, and for doctors to assist in dying would pull them in opposing directions.

Next up, seconding the motion, was philosopher and medic Professor Ray Tallis. He confessed that he used to be sympathetic to those who are opposing the motion but that he'd looked at the empirical evidence and changed his mind.

For example, he said that increasing the availability of palliative care doesn't alleviate all suffering. Tallis pointed to the State of Oregon where assisted dying has been legalised. Oregon has some of the best palliative care in the country, Tallis noted, yet 90 per cent of those who sought assisted dying did so in that context. Neither does legalised assisted dying deter investment in palliative care, Tallis argued. In the Netherlands, assisted dying has gone hand in hand with increased investment in palliative care.

What about patient - doctor trust? Far from breaking down this trust, Tallis said that a survey of nine European countries found that patient - doctor trust was highest in the Netherlands. The current UK legal framework means that many people are currently assisted in dying via a 'clinical, ethical and legal fudge', for example through continuous sedation, starvation and dehydration. Tallis argued that a change in the current 'unspeakably cruel' law would engender in patients a sense of control, even if they chose not to use it.

Last to speak, seconding the opposition to the motion, was Professor Rachel Jenkins, who quoted mental health survey data showing that only a minuscule proportion of people with suicidal ideation are free of mental illness. Once their underlying mental illness has been treated, Jenkins argued, 98 to 99 per cent of suicidal people no longer want to die. This translates to the palliative context, Jenkins said: if the right care is provided and fears are addressed, requests for assisted death reduce.

Jenkins also highlighted the fact that depression and other mental disorders impair people's judgement, even in mild and moderate cases. Combined with the fact that physicians are notoriously poor at detecting depression, especially in patients with physical illness, Jenkins said there was a significant risk of impaired capacity in patients seeking assistance to die. 'Palliative care knowledge is now excellent,' Jenkins said, 'we should be devoting our energy and skills towards this, not assisted suicide.'

Before the debate, 47 people voted for the motion, 32 against with five abstaining. Afterwards, equal numbers (43) opposed and supported the motion with three people abstaining.

--Christian Jarret

I The Institute of Psychiatry welcomes suggestions for future debates

Short-form journal articles have more scientific impact per page than their longer cousins, according to an analysis by Nick Haslam at the University of Melbourne (published in Perspectives on Psychological Science ).

Critics of established publishing practices in psychology, such as Denise Park at the University of Texas at Dallas and Shelley Taylor at the University of California, have argued that the house style of many journals is too long-winded and inaccessible, with drawn-out review procedures. They've called for journals to publish more snappy, short-form articles (for example, see 'How can we improve psychological science'; May issue of The Psychologist). In light of this, Haslam compared the citation impact of short articles published in Psychological Science, Cognition and the Journal of Experimental Social Psychology between 2002 and 2007 with the longer articles in those same journals.

Whilst for each journal the average longer article accrued more citations than the average shorter article, the shorter articles achieved more citations per page - that is, they delivered more scientific bang for your buck.

'Although short articles tend to have less citation impact than their heavyweight cousins, they punch above their weight class - they are more efficient in converting journal pages into citation impact,' Haslam wrote. He added that this means a 'journal composed entirely of short articles would be expected to have greater...influence than one with the same page count that contained only long articles.'

--Christian Jarret

Edited: 15/06/2010 at 11:07 AM by jonsut

The Education and Employers Taskforce charity is planning a national campaign to persuade leaders from all sectors to visit state schools and colleges in order to help shape the motivation, skills and employability of young people. Taking part is completely free and only requires two hours of your time in the week of 18 - 22 October to visit a school/college in your locality.

I Click here for further information and to register.

The mental health charity Depression Alliance has launched a new guide, Daring to Implement: Case Studies to Inspire Commissioning of Services for Depression and Anxiety. The guide details eight examples of excellence in services for depression from across the country, and identifies challenges and recommendations for NHS commissioners and healthcare professionals. Describing the key ingredients for a successful service Emer O'Neill, Chief Executive of Depression Alliance, said: 'Common to all the exceptional services identified by Depression Alliance for the report, was the acceptance that people with the depression need treatment and services to meet their needs and the offering of real choice in what and how people receive treatments.'