News and Media, September 2010

First psychologist 'approved clinicians

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 clinicians 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.' 

I    Nigel Atter, Policy Adviser for the Society's Professional Practice Board, can be contacted for further information: [email protected]. 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.

 

New guidelines for homelessness 

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: http://ht.ly/2faTc). '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'

I    Meeting the Psychological and Emotional Needs of People Who Are Homeless is available at: tinyurl.com/3xf4sss

 

Massive imaging grant for York

 

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.'

 

Psychologist faces torture inquiry 

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 complaint report is here: tinyurl.com/3xwewst).

'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 (the report is at: tinyurl.com/3y4e42e). 

Cull of the quangos
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.

Denying science findings 

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 (tinyurl.com/2av7sxs) 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.' 

In utero pain 

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 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.'

I    Fetal Awareness, Review of Research and Recommendations for Practice is available at http://bit.ly/cP82Mh

 

Aphasia Award
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'.

 

Skoog music

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 (see www.skoogmusic.com), 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.' 

 

How lucky charms work

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 (tinyurl.com/27mb6k6). 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' (see http://ht.ly/2dNtE).