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Title: Psychological intervention for acute mental health inpatient care : a meta-analysis and feasibility study
Author: Paterson, Charlotte
ISNI:       0000 0004 7427 1700
Awarding Body: Edinburgh Napier University
Current Institution: Edinburgh Napier University
Date of Award: 2018
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Psychological intervention has been recommended to address some of the common problems reported in acute psychiatric inpatient services, such as having nontherapeutic environments, minimal provision of therapeutic interactions and activities and highreadmission rates. There is a small evidence base investigating the effectiveness of acute inpatient psychological therapy, however, this has never been reviewed or synthesised. Robust investigation of cross-diagnostic inpatient psychological intervention is alsoabsent, and whether this is feasible is unknown. Informed by the Medical Research Council (MRC) framework, this thesis examined and synthesised the current evidence base of controlled trials of psychological therapy for acute psychiatric inpatients for the first time. It also tested the feasibility of implementing and evaluating cross-diagnostic psychologically informed acute mental health care in comparison to treatment as usual. The latter was largely based on the Woodhaven Approach, which is theory-driven psychological model of care. The model offers psychological intervention for acute inpatients and targets mechanisms of psychological dysfunction identified by the Interacting Cognitive Subsystems model (ICS). This thesis, therefore, comprises two main studies: 1) a meta-analysis, and 2) a feasibility study. The meta-analysis focused on the effectiveness of brief inpatient psychological therapyon psychotic symptoms, risk of readmissions, and emotional distress (depression and anxiety). Results showed that in randomised and single-blind studies psychological intervention had little effect on psychotic symptoms. Other outcomes, however, showed more promising results. For example, although not significant, robust evidence suggests that brief psychological therapy may reduce emotional distress and risk of readmission for some acute inpatients. The feasibility study aimed to test the feasibility of implementing and evaluating a cross diagnostic psychological model of acute inpatient care, and gather preliminary clinical outcome data. Using a framework of methodological issues, the feasibility study showed that some aspects of the trial processes were run successfully, i.e. some clinical outcomes had good completion rates, some intervention components were successfully implemented and some outcomes produced effects which favoured the intervention group over the control group. However, other aspects of the trial processes were problematic and required amendment before progressing to a full trial. Key issues identified by the feasibility study include problematic eligibility criteria, poor implementation of some intervention components, poor engagement, poor completion of follow-up questionnaires and therefore poor trial retention. The feasibility study also highlighted methodological issues which have not yet been addressed, but are important in planning a future definitive trial, i.e. randomisation and assessor blinding. This thesis has provided the first study to test the feasibility of evaluating the effectiveness of this psychological model, in comparison to treatment as usual, and it was the first time the impact of this psychological model has been investigated in relation to re admissions. Overall, this thesis indicates that a cross-diagnostic approach to acute psychiatric inpatient psychological therapy is feasible, however further work is needed to fully implement the model into routine practice.
Supervisor: Karatzias, Thanos ; Hutton, Paul ; Harper, Sean ; Dougall, Nadine ; Dickson, Adele Sponsor: Edinburgh Napier University
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Psychological therapy ; mental health ; Woodhaven Approach ; 363 Other social problems & services ; HN Social history and conditions. Social problems. Social reform