‘There is no health without mental health’

In an earlier brief interview about a job advertisement in the Psychologist, Karen Howell mentioned the growth of parity between mental and physical health in the organisation she works for, Elysium Healthcare. This is reflected in her role as a Clinical Director for Psychology Projects. How is this development expressing itself and how has her experience in forensic psychology led to her present role?

'Over the years a lot of national policy talk referenced parity between mental and physical health, but we've been pretty well hog-tied by funding and other issues. But there's a lot more going on in the mental health agenda than before. You can sum it up in the phrase "there is no health without mental health". If you look at emerging roles like clinical psychology associates, and initiatives such as Improving Access to Psychological Therapies (IAPT), you can see the trend. Mental health won't go away, particularly since younger people have more expectations about the area.'

The organisation she works for, Elysium Healthcare, offers a wide range of services. 'We have over 60 psychologists in the organisation and my job involves developing psychological career paths, raising psychology's profile and ensuring best practice: in effect, bringing the psychological family together and promoting its value to clients.'

Plugging gaps in skill sets

How has this translated into your day-by-day work? 'In the last six months, we've set up a psychological academy and delivered it face-to-face. A sizeable chunk of my work has been developing core skills among postgraduates to help them integrate what they've learnt into their day-by-day work. We've created a partnership with Birmingham University and we've been recruiting trainee clinical and forensic psychologists as well as clinical associate psychologists, so this developing infrastructure will support them as well as our existing psychologists. My work also involves conference and masterclass planning.'

Karen is very interested in campaigns to promote mentoring, and so 'a large part of my work is working as a line manager supporting and mentoring people'. Karen's MBA, of which more later, has helped her develop business cases for these initiatives which support their adoption.

Of course, there are still many things to do and a number of issues that need to be addressed. 'We don't get as many applicants for Assistant Psychologist posts as we used to. This partly reflects the fact that there are other roles – those associated with IAPT, for instance – that graduates might choose. We need to work more on transition skills as individuals move from graduate to assistant to trainee roles. But there are other possible reasons for this reduction in the number of applicants. There may be some factors influencing decisions within the cohort. And, more specifically, the acuity, diversity and complexity of our client groups are all increasing. Plugging gaps in skill sets when faced with this increased acuity is a real challenge as is ensuring that we keep the workforce healthy, given the demands this increased acuity makes on them as individuals. Coming straight out of university and getting involved in case work is an eye-opener. At the same time, we need to ensure that psychologists stay humble and relatable. We still have a long way to go in developing multi-disciplinary teams, particularly in ensuring psychological mindedness and trauma-informed decision-making. This sometimes means challenging the medical model. There is still so much weight of certainty about medical solutions, and this can sometimes be to the detriment of more holistic approaches to patient care.'

Karen talks more generally about the roles of clinical directors within Elysium. 'Most of our clinical directors have medical backgrounds but the area is opening up for psychologists; we have a wide range of leadership skills. We work corporately to reduce restrictive practices, improve patient safety, and reduce problematic incidents, for instance.

'I was fascinated by the juxtaposition'

How did Karen move to this role? 'I come from Yorkshire and I was the first person in my family who went to university or college. I wanted to be a journalist and my interests were in the arts: film, media, literature. But I didn't take to the arts teaching at the university: too much post-modernism for me, if I remember rightly! I'd done a GCSE in psychology and loved it then, so I transferred from English to psychology. A couple of modules in criminal psychology during my final year left me awe struck.'

After working in NHS research Karen found out Whitemoor – a high secure prison in the Fenlands – was advertising roles. One special secure unit contained IRA terrorists. My day trip there left me really intrigued. I was sitting in on an assessment when someone came in with a pot of tea. He was polite, seemingly very kind. Then someone told me the horrendous things this person had done to get into prison. I was fascinated by understanding this juxtaposition. I applied for a trainee role there and started a Masters in applied criminal psychology.'

C Wing was obviously a challenging work environment. One summer there was a riot and prisoners had escaped the previous year. But Karen remembers the experience with huge affection. 'The camaraderie and teamwork really appealed to me. The governor, Brodie Clark, was a phenomenal leader and enabled the team to cope. Support and supervision were fantastic and I learnt a huge amount, becoming a specialist in working with sexually-motivated murderers and other violent people.'

Karen points out that her engagement with the area was influenced by her earlier experiences.

'I was interested in the media and my upbringing was overshadowed by the activities of Peter Sutcliffe, the Yorkshire Ripper, one of whose murders was carried out near where I lived. I studied the Sutcliffe case at undergraduate level.'

'Of course, forensic psychologists were very involved in risk assessment, but I always felt that I could work therapeutically with these people. What surprised me was how traumatised many of them were and how much remorse they felt for their own actions. Understanding that point, you could see them as a whole person.' Do you ever struggle with what a person has done? 'I found it difficult to work with people who had offended against children when I was pregnant – something I've had to work through. Different people find different behaviours beyond their limits, but colleagues can always step in with a client who you find difficult.'

Karen worked at other prisons, one of which was setting up privately. This allowed her to develop leadership skills, work with different client groups and train in areas such as hostage negotiation. But she found the private prison difficult. 'Coming from a high secure prison with high levels of staff and great teamwork, it felt quite vulnerable to be walking onto a unit with only two, typically inexperienced staff.

I set up and established a department, but then felt that my career had a glass ceiling. I moved to St Andrews Hospital Northampton where I was a principal forensic psychologist in a clinical setting. It had a large, well-managed psychology department so we were able to develop great therapeutic relationships.'

'It's time to think through a whole workforce planning mechanism'

After a career break, Karen got a role as a Lead Psychologist at the Priory-run Chadwick Lodge. 'The team consisted of two psychologists a trainee and an assistant looking after 90 patients. We built a much larger department over ten years, introducing more career development and recruiting trainees. I was on the senior management team and felt I needed to develop my skills as a leader, so that was where I took my MBA through the apprenticeship route, which I think is the future for matching professions to workforce needs. I started that a few months before COVID-19 hit and finished it in 2022. It introduced me to transferable ideas and practices from other sectors in areas such as project management, strategic planning, HR, and diversity. This really helped me in organisational development work; the role I'm in now was born out of work I learnt on the course, not least workforce planning.'

Karen is presently a committee member of the Division of Forensic Psychology and the career development framework task and finish group with the BPS.

So, given these varied interests, what does the future hold? 'I want to be in a position to develop different training routes for the profession. We have a lot to give the world. We have so many skills. But the problem is how to train a greater volume of people. We need more clinical psychologists but no employer outside the NHS has a foothold in clinical training, despite independent providers looking after NHS patients. It's time to think through a whole workforce planning mechanism. One issue is where Stage 2 is going to go. Another is self-funding of people who are not going the clinical route. So, I'd like to help develop a way of providing enough psychologists with high-level skills to meet the growing needs in society.'