Are Young People Hospitalised with Psychosis Interested in Psychological Therapy?

Abstract

The reasons why some patients with psychosis are not interested in receiving psychological therapy may relate to past negative experiences with psychologists, negative perceptions of psychologists as a group and low perceived efficacy of therapy. These barriers may be addressed through interactions with psychotic patients during an admission to a hospital that disconfirms these perceptions and provides a positive alternative experience with a psychologist. Patients who are hospitalized with psychosis may be interested in receiving psychological therapy; however, the reason for this likely will not be to address psychotic symptoms. Rather, the therapist should be willing to work with the patient on a range of other presenting problems. If a patient has a lack of insight into their psychotic symptoms, this does not always negate them from perceiving other psychological problems for which they may desire support in addressing. Thus, therapists should be encouraged to approach all psychotic patients on a ward, even when there is an apparent lack of awareness of their psychotic symptoms. The themes related to patients' perspectives were generated from psychologists' summaries of interviews with patients and not directly from verbatim transcripts. Although this meant that the reasons given for participants being interested or not interested in therapy were interpreted by the psychologist, efforts were made to relate the exact reasons provided by the participants. Eighteen (29%) of the potential participants were not interviewed, usually as a result of their being discharged or transferred prior to arrangement of an interview. This meant we were unable to capture the views of these patients. Discharge prior to being seen by a psychologist is a barrier to engaging a patient in therapy and preventing them falling through the gaps of service provision.

Psychological interventions on a specialist Early Intervention Inpatient Unit: An opportunity to engage?

“…Two thirds of service users attended some form of psychological intervention. This is higher than the 41% of participants who expressed an interest in therapy in a previous study (Mitchison et al, 2013). Our finding indicates that an acute setting could offer the opportunity to engage people who are both actively interested and those who are ambivalent.…”

“…This might circumnavigate some of the identified barriers in the community such as low referral rates () and challenge an individual's perceptions of a psychologist and their perceived efficacy of therapy. (Mitchison et al, )…”

“…A recent study explored interest in psychological therapy within an inpatient setting. In their qualitative study with young people, Mitchison et al () found that 41% of participants were interested in engaging in therapy, whereas 36% and 23% were rated as not interested or ambivalent. Engagement with psychology in psychosis community teams has been more explored, there is evidence of significant disparities between ethnic groups in this context (Schizophrenia Commission, ).…”

The Phenomenology and Generation of Positive Mental Imagery in Early Psychosis

“…For service users with early psychosis, these images may reflect hopes and ambitions for the future, an aspired identity or role. This links with recent research suggesting that for some individuals with psychosis, their interest in engaging in psychological therapy was to help build skills (e.g., communication or social skills) and to receive assistance with practical problems rather than focusing on psychotic symptoms per se (Mitchison, Jakes, Kelly, & Rhodes, ). In this manner, positive imagery may be a valuable technique for identifying client goals and practicing skills.…”

Clinical profiles of people with persecutory vs grandiose delusions who engage in psychological therapy during an acute inpatient admission

“…The primary treatment is anti-psychotic medication and although psychological therapy is not readily available, patients often report wanting greater access to this within inpatient settings (The Schizophrenia Commission 2012; Csipke et al 2014;Wood & Alsawy 2016). However, not all patients who are offered the opportunity to engage in a psychological therapy for psychosis during an acute admission will accept the offer (Mitchison et al 2015;Reynolds et al 2017). A better understanding of the profile of people who do agree to engage with a psychological therapy during an inpatient admission is therefore helpful to improve targeting of inpatient psychological therapies and adapting them appropriately to meet the needs of patients.…”