What kind of public health and prevention work is currently undertaken by UK clinical psychologists?
It is too early to know what toll Covid-19 has taken on the nation’s mental health, but there is concern that services could buckle under the impact of a world turned upside down.
05 November 2020
Pre-Covid, many clinical psychologists murmured about the need for community and population-level work, but found themselves stymied by the individualistic models that continue to dominate mental health services.
Covid-19 has changed the conversation, and there is growing momentum behind the idea that a population-wide mental health crisis needs population-based interventions.
Where are the opportunities for preventative work?
The Division of Clinical Psychology's Public Health and Prevention Subcommittee was established to promote awareness, innovation and practice in preventative work within the clinical psychology community.
Recently the committee undertook a survey exercise to understand "who is doing what, with whom" in relation to public health and prevention.
Most clinical psychologists who responded to the survey (70%) were employed in the NHS with a handful working in local authorities, academic posts, and jointly funded initiatives.
A number of those in predominantly clinical roles said that they were able to collaborate with public health/health promotion professionals, teachers, youth workers, and other community-based professionals.
Opportunities to use public health and prevention approaches appeared more common in child and adolescent services.
This is likely linked to the growing understanding of the social determinants of mental health in children and young people's services, the NHS Long Term Plan's (2019) commitment to action on prevention and improvements in children and young people's service, and the 'Transforming young people's mental health services' green paper's proposal to embed mental health support within schools.
Much of the prevention work undertaken by respondents in their roles involved psychoeducation and consultation for young people and families, which were designed to be easy to access and community based.
Opportunities outside mental health services
We spend a third of our time at work, with an abundance of research demonstrating good work is good for mental health, providing essential purpose, structure and community.
Only one respondent to our survey reported involvement in workplace interventions, representing an under-utilised opportunity for population-level work.
Clinical psychologists are beginning to address the dearth of prevention work amongst adults, including working with Health Education England to research mental health prevention and promotion in primary care and community settings.
We are acutely aware of the relationship between how we move, how we eat, and how our physical health impacts our mental health.
Twenty percent of respondents worked in health psychology services, supporting interventions such as those for lower back pain.
Clinical psychologists have the potential to support many populations who may be vulnerable to mental-ill health due to health conditions and social inequalities.
For example, one respondent working with people with learning disabilities partnered with stakeholders to create accessible events providing greater social opportunities for peer support.
Facilitating partnerships, overcoming barriers
Organisational partnerships and stakeholder relationships were seen by respondents as a key enabler for those undertaking preventative work, while committed resourcing was the most common barrier.
Respondents wanted the opportunity to do more preventative work, for example, one clinical psychologist reported developing a local public health and prevention network, and the survey suggested that much public health and prevention work is driven by individuals and their community networks, rather than being supported and planned for strategically.
Some clinical psychologists had preventative work funded through a local authority or Public Health England, while others reported ringfencing small proportions of their working time to such activities, however most did not formally have it resourced within their roles.
Population-based interventions need to be repositioned from a bolt on to individual work to a core component that clinical psychologists can develop within services.
Next steps
Based on the survey, the Public Health and Prevention Subcommittee are prioritising the following activities:
- Establishing mechanisms for a network of clinical psychologists interested in public health and prevention
- Publishing a paper on clinical psychologists' role in public health and prevention providing examples how clinical psychologists can integrate preventative work into their practice and sharing knowledge on the business case for undertaking this work. We will be hosting a virtual workshop in the new year to support this.