Under which circumstances does a patient get referred to a psychologist (as opposed to a PWP, CBT counsellor, etc.)?

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sorvio
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Under which circumstances does a patient get referred to a psychologist (as opposed to a PWP, CBT counsellor, etc.)?

Post by sorvio » Sun Oct 18, 2020 2:27 pm

It seems very hard in this country to get access to mental health support. I myself have had issues in the past getting access and had to turn to charities like Mind. Under what circumstances does one get through to a clinical psychologist? Do you have to be incredibly severely distressed? Even then it seems hard, judging from stories like all the ones posted in this recent reddit thread where people report having tried to kill themselves but still being refused help. What sort of clients do clinical psychologists usually see? I'm guessing you never see patients who are only mildly depressed or anxious.

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Spatch
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Re: Under which circumstances does a patient get referred to a psychologist (as opposed to a PWP, CBT counsellor, etc.)?

Post by Spatch » Sun Oct 18, 2020 11:51 pm

sorvio wrote:
Sun Oct 18, 2020 2:27 pm
It seems very hard in this country to get access to mental health support. I myself have had issues in the past getting access and had to turn to charities like Mind. Under what circumstances does one get through to a clinical psychologist? Do you have to be incredibly severely distressed? Even then it seems hard, judging from stories like all the ones posted in this recent reddit thread where people report having tried to kill themselves but still being refused help. What sort of clients do clinical psychologists usually see? I'm guessing you never see patients who are only mildly depressed or anxious.
Some of this will depend on your locality and how particular services have been configured. The skill mix and workforce for teams where psychologists are located will vary depending on whether it is CAMHS, Adult Mental Health, LD etc.

In my prior experiences working within secondary care, I (as a Band 7/8a Clinical Psychologist) would tend to work with the more complex and chronic clients. The stepped care model would have people working with PWPs, Care coordinators, CPNs and other staff before being referred upwards to me. Referrals to psychology would be accepted on the basis of what had been tried before, the client's insight, acclimatisation to therapy and readiness to change. The advantages of working in that setting was that I was often allowed to work for lengthy periods of time and was trained to deliver more in depth therapies such as CBT for PTSD (6 months+), CBT-E for Eating disorders (40 weeks+) or schema focussed therapy.

I would rarely work with someone in acute distress, as most of that stabilisation work would be done by other team members. However, when I was attached to the inpatient ward, I would do some of this work (as the time scales for working are different) but this wouldn't be under the banner of 'in depth therapy', more of a 'formulation based ward based intervention/ safety planning'.

Previously, I would never work with mild to moderate anxiety and depression once I qualified, as IAPT exists. However, more recently I have started moonlighting for BUPA/AXA a couple of evenings a week outside my NHS job, and have started doing some of this work as well as some other stuff that wouldn't normally get passed on my way (e.g. moderate OCD, grief). If you have a workplace that offers insurance, it's another way to see a Clinical Psychologist that people are increasingly taking advantage of.
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