Exploring the barriers to the implementation of cognitive behavioural therapy for psychosis (CBTp)
| Pages | 30-43 |
| DOI | https://doi.org/10.1108/MHRJ-06-2018-0017 |
| Published date | 03 May 2019 |
| Date | 03 May 2019 |
| Author | Fiona Switzer,Sean Harper,David Peck |
| Subject Matter | Health & social care,Mental health |
Exploring the barriers to the
implementation of cognitive behavioural
therapy for psychosis (CBTp)
Fiona Switzer, Sean Harper and David Peck
Abstract
Purpose –The purpose of this paper is to identify barriers for people with psychotic spectrum disorders
accessing CBTp in NHS Lothian. Despite national guidelines recommending CBT for the treatment of
schizophrenia (National Institute for Health and Care Excellence Guidelines 2014) and (Scottish Intercollegiate
Guidelines Network Guidelines 2013), levels of access to CBTp remain low. The overall goal of the study is to
uncover emergent themes regarding barriers to access to CBT for patients with psychosis. In addition, the
influence of psychosocial skills intervention (PSI) training for psychosis (Brooker and Brabban, 2006) will be
explored and if completion of this training effects referral behaviours and attitudes to CBTp.
Design/methodology/approach –This study is a quantitative service evaluation project which uses a
questionnaire design to explore the factors that influence a clinician’s decision to refer a patient for CBTp.
Three qualitative questions are included for thematic analysis to allow the respondents to elaborate on their
views on potential barriers. All appropriate Community Mental Health Team (CMHT) staff in adult mental
health in NHS Lothian were invited to participate in the study.
Findings –CMHT staff in NHS Lothian hold favourable views of CBTp and would support an increase in
access for patients with psychosis. Key barriers to access for CBTp identified in this study comprise of, little
or no access to CBTp, lack of integration of services and unclear referral pathways. Further themes emerging
from the study also included, improving multi-disciplinary communication and increasing CMHT staff
knowledge and confidence in CBTp. PSI training was shown to have a significant effect on referral rates.
Further research would be warranted to explore the influence of PSI training on CMHT staff confidence and
knowledge in CBTp.
Originality/value –This is the first paper of its kind to investigate the potential barriers to access to CBTp in
Scotland. The paper has highlighted some key barriers and potential strategies to overcome the barriers
identified will be discussed.
Keywords Access, Psychosis, Cognitive behavioural therapy, CBTp, Psychosocial intervention training
Paper type Research paper
Introduction
This study is a quantitative service evaluation project exploring factors that influence a clinician’s
decision to refer a patient for CBTp with three qualitative questions included for thematic
analysis. Richardson and Oldershaw (2011) carried out a similar study in a London Community
Mental Health Team (CMHT) for adults with mental health issues. The questionnaire they
developed explored factors that might influence the implementation of the NICE (2014) guideline
regarding access to psychological therapies for patients with schizophrenia. Permission was
given from the authors to adapt this questionnaire in NHS Lothian to compare population and
emergent themes. The questionnaire was refined with regard to the latest literature on access to
psychological therapies for people with a diagnosis of schizophrenia or psychosis. It was then
piloted to a group of mental health team staff, in NHS Lothian, to identify any ambiguous or
misleading questions and participants were asked to help identify any local issues the
questionnaire should explore. The questionnaire was then distributed to all members of the
Received 12 June 2018
Revised 10 December 2018
Accepted 12 December 2018
Fiona Switzer is based at
Psychological Therapies
Department, NHS Lothian,
Haddington, UK and Queen
Margaret University Edinburgh,
Musselburgh, UK.
Sean Harper is based at the
South of Scotland CBT Course,
NHS Lothian, Haddington, UK
and Queen Margaret University
Edinburgh, Musselburgh, UK.
David Peck is Professor at the
Faculty of Medicine and Health
Sciences, University of East
Anglia, Norwich, UK.
PAG E 30
j
MENTALHEALTH REVIEW JOURNAL
j
VOL. 24 NO. 1 2019, pp. 30-43, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-06-2018-0017
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