Society, July 2006

A decade of outcomes

TO mark 10 years of the Society's Centre for Outcomes Research and Effectiveness (CORE), we thought it appropriate to consider its work so far.Working within the sub-department of clinical health psychology at UCL, CORE's broad aims are to promote clinical effectiveness, encourage the use of high quality outcome measures, and to evaluate health services and interventions. Through its links with the Society's Professional Practice Board, CORE provides support to applied psychologists working in or with a research interest in health and social care.

In 2001, the National Institute for Health and Clinical Excellence (NICE) formed the National Collaborating Centre for Mental Health (NCCMH), which was a partnership between CORE and the Royal College of Psychiatrists Research and Training Unit, to develop evidence-based clinical practice guidelines. The first guideline emerged the following year, on the treatment and management of schizophrenia. The World Health Organization and World Psychiatric Association, in a comparison of 24 schizophrenia guidelines worldwide, found a 'remarkable superiority of the NICE guidelines with respect to methodological quality'.

At any one time several guidelines are under development, with each one taking one to two years to produce. The guidelines are updated every two to four years, with schizophrenia currently under review. Other published guidelines include eating disorders, self-harm, depression, post-traumatic stress disorder, depression in children, and obsessive-compulsive disorder. Guidelines are currently in development on antenatal and postnatal mental health, ADHD, bipolar disorder, dementia, drug misuse, and personality disorder.

Professionals can register as stakeholders through the Society or other organisations, in order to comment on draft guidelines.

NICE guidelines are now an important element of the Department of Health's Standards for Better Health, on which the Healthcare Commission bases its assessment of trusts in terms of performance ratings. The Commission looks at how well trusts are taking clinical guidelines into account, and from 2006/7, how far patients are being treated according to clinical guidelines.

CORE also works to support implementation of NICE guidelines. It works alongside the NICE implementation programme in helping to produce implementation advice and tools (such as slide sets focusing on the key messages, audit criteria, and cost impact analyses and templates). Independently CORE, through its part in the NCCMH, produces its own materials to support implementation, organises conferences and establishes links with training and education. It is also involved in supporting the use of guidelines in practice locally, through managing a NICE implementation pilot in London.

The NICE guidelines are just one part of CORE's main areas of research and development. Researchers also work on the development and implementation of routine outcome monitoring in health services and advise professionals on the appropriate use of outcome measures. Part of this work is to encourage service user- and carer-focused monitoring methods.

Important work is also being undertaken to further understanding of the psychological processes involved in the implementation of evidence-based practice in healthcare services. Researchers are developing a psychological framework to study and support the implementation of evidence-based practice with a view to expanding the use of psychological theory in implementation research.

Finally, CORE contributes to the evaluation of health service interventions occurring as a result of national and local policy initiatives, and to the increasing involvement of service users and carers in that process. Current research includes a trial on early intervention services for psychosis and, with UCL's Department of Primary Care and Population Sciences, on enhanced care for depression.    
Steve Pilling, Clare Taylor and Kathryn Price
See www.psychol.ucl.ac.uk/CORE/index.html.

Fellowship citation
Professor Mark Griffiths
IN these days of the multi-million pound lottery rollovers we need to consider the true cost of gambling. Professor Mark Griffiths is having a major impact on how we view this activity. He already holds the John Rosencrance Prize for his 'outstanding scholarly contribution to the field of gambling research' as well as the award of 'International Excellence' from the Responsible Gambling Council of Canada and the Joseph Lister Prestige Award from the British Association for the Advancement of Science for his role as an 'outstanding science communicator'. The Fellowship Committee is pleased to add a further honour to Mark Griffiths' collection by making him a Society Fellow.

Dr Griffith's academic career started in Bradford, then via Exeter and Plymouth to Nottingham Trent where he rapidly rose from lecturer to professor with visiting professorships also held at McGill and Western Sydney on the way.

He is a prolific writer with over 150 peer-reviewed publications from his early work in fruit-machine gambling to more recently focusing on video-gaming and online gambling. His focus on problem gambling as an addiction has led to an understanding of the psychological processes underpinning the downside of playing the machines. The 'near miss' and the physiological arousal it engenders appear to be sought-after prizes by the pathological gambler, at whatever cost.

Mark Griffiths also authored a popular series of 'Tips on…' for the British Medical Journal advising readers on how to beat stress, how to lead a team, how to support your colleagues and how to listen. His eclectic approach to publishing has included material for Bizarre magazine, the Daily Star, the Sun and the Guardian. In his spare time he has appeared on over 1300 radio and television programmes from Crime Squad to Kilroy.

As one of the leading UK psychologists on gambling and probably the most cited throughout the world, Professor Griffith's has influenced policy makers on issues of gambling and alerted us to the perils of the slogan 'It could be you' when in all probability 'It won't be you'!

The Fellowship Committee recognises his outstanding contribution to the advancement and dissemination of psychological knowledge by this award from his fellow psychologists.

What you think of us
EARLIER this year, The Psychologist worked with a research company to find out what our members want from their membership publication, and how The Psychologist measures up. Structured telephone interviews were carried out with 205 members.

The results were generally positive: 88.8 per cent either 'agreed' or 'strongly agreed' that The Psychologist is an interesting, useful publication. Some questions addressed the importance of the magazine/journal hybrid nature of The Psychologist, and there are some implications for style and content that stem from results such as three quarters expecting to keep their copy indefinitely, and 80 per cent keeping it as a resource to refer back to. Two thirds felt it was either very or extremely important that the articles are peer-reviewed. Of those who said The Psychologist is 'not very relevant' or 'not at all relevant' to their work (23 per cent), 83 per cent said they still enjoyed and valued it. Those who are not finding The Psychologist particularly interesting or useful do not seem so convinced of the importance of having an introduction to a wide range of areas in psychology.

Should The Psychologist be a mouthpiece for the Society or for the discipline? Results suggested there is little appetite for more Society-related information: subsystem notices and (particularly) the President's column received low ratings for interest and usefulness.

Around 90 per cent of respondents thought both the articles and The Psychologist overall are about the right length. 75 per cent either agree or strongly agree that 'The Psychologist has good cover design'. There was little support for devoting more space to illustration.

Results for the website were quite disappointing. Although 82 per cent of respondents accessed www.bps.org.uk, 59 per cent of the sample said they never accessed the Psychologist part of it. We are looking to provide more 'added value' on The Psychologist site – more news, extra articles, more interactivity – but for now visit www.thepsychologist.org.uk to see what is already up there.

The topline results are available from the editor on [email protected]. He would also be happy to hear views from anyone who didn't get a chance to take part in the survey. The next phase of development is a full redesign for January 2009: your views on our function, emphasis, organisation, content and design will be crucial in ensuring it is a success.

NEWS OF MEMBERS
Dr G.E. Berrios has been appointed Professor of the Epistemology of Psychiatry at the University of Cambridge.
Professor Graham Davies will be retiring from the University of Leicester at the end of July 2006.
Two Society members, Professor Emeritus Simon Folkard and Professor Emeritus Graham Harding, have been elected to Honorary Fellowship of the Royal College of Physicians.
Dr Jane Ireland has been appointed professor at the University of Central Lancashire.
Dr Sarb Johal is currently working for the Ministry of Health in New Zealand on the Pandemic Influenza Psychosocial Recovery Plan, part of the National Health Emergency Plan.
Dr Pam Maras the Society's President Elect will become Professor of Social and Educational Psychology from 1 September.

Ethics Column No.6 Risk assessment
The assessment of risk is an area of some psychologists' work which provides important safeguards of the public, but is also likely to be the subject of intense scrutiny if decisions made on the basis of the risk assessment are later proved to be wrong. At the time of writing this column, the Chief Inspector of Probation's report into the management of Anthony Rice had just been released. Rice committed murder while released from prison on licence following an earlier offence. While the report covers a specific area of work, there are some comments about risk assessment that are of wider relevance.

The Chief Inspector of Probation accepts that it is not possible to eliminate risk altogether but says that the public are entitled to expect that all reasonable action will be taken to keep risk to a minimum.

The report emphasises the importance of taking an investigative approach to risk assessment. In the case of Anthony Rice, information about some previous convictions was missing from his prison file. The report reminds those who carry out risk assessment of the need to check that they have all the available evidence and ask questions about any gaps in that evidence.

The Chief Inspector of Probation also considers the possibility that someone involved in the treatment of a person might weigh the available evidence differently from somebody independent. His report recommends that an independent assessor should be used at key decision making points in the process of assessing offenders. The report says "Someone not involved in delivering treatment is sometimes better able to see the recent progress made in a clearer perspective and in proper proportion to the size of the overall problem presented by the case as a whole". The Investigatory Committee has also taken the view in the past that it may not be ethical for someone treating a client to, for example, provide expert evidence to a court about that person.

The report highlights the difficulty of ensuring that public protection is not undermined by consideration for the person being assessed – in this case in relation to human rights legislation. The Society's Code of Ethics and Conduct also recognises that psychologists may have a number of different clients or stakeholders in their work, and that the clients' interests are likely to include the protection of the public. The Code requires psychologists to weigh different clients' interests and the potential harm caused by alternative courses of action or inaction.

These reports are always written with the understanding that hindsight gives a perspective not available to those who made the original decisions. However it is useful to be reminded of the importance of an independent and investigative approach, and of the need to take careful account of all of those who are likely to be affected by decisions about risk.