NHS psychiatric staff may sometimes think that their patients exhibit ‘attention seeking’ behaviour, poor motivation, and aggression.
But these patients are mentally ill, and psychological factors influence their behaviour. Preliminary research in Manchester suggests that staff perceptions improve if the staff receive training in order to understand those psychological factors.
The research involved thirty mental health nurses and support workers with an average of nine years’ experience of working in mental health.
You or I might foolishly assume that professionals who have worked for that length of time in the field would have picked up a thing or two about what mental illness is all about, but the paper notes:
Frontline staff often have limited access to psychological expertise…
The patients (currently described as ‘service users’ by the NHS) had:
…severe and enduring mental health problems, [and] often had multiple care needs and a history of disengagement from mainstream services… All [the patients] had a diagnosis of schizophrenia recorded in their case notes…
The training (described in the report as an ‘intervention’, for unknown reasons):
…was carried out by a clinical psychologist and involved helping staff to understand psychological factors that might be involved in the development and maintenance of [patients’] problems.
It was not just theoretical. Instead each session focussed on on particular patient. CBT theory and some other related theories were used to:
…generate hypotheses about possible triggers of psychological distress for the [patient] and his preferred ways of coping, which were often related to the problem behaviours initially identified.
This kind of hypothesis-generation is common in CBT, and is known as ‘formulation’.
So what happened?
The staff completed questionnaires before and after the training, and there were statistically significant differences in the results.
For example, the average staff perception of “How much do you think your [patient] is to blame for his/her mental health problems?” went down from just over a quarter to just over an eighth.
The average staff perception of “How much effort do you think your [patient] is making to get well?” went up from just over half to just over two-thirds.
Amongst other changes in their perception of patients:
Staff also reported that they had a better understanding of [patients’] problems, rated their feelings towards [patients] as being less negative and reported greater confidence in working with [patients].
The researchers point out that they only measured the effect on staff themselves, not the effect (if any) on their relationships with patients:
[T]he effect of the intervention on staff and [patient] relationships was not assessed in this study… Previous studies that have tried to reduce staff criticism and hostility via improving staff knowledge of the symptoms of schizophrenia have had limited success…
A case example
As an example, the paper describes a patient, John:
[S]taff were experiencing difficulties in engaging him in a therapeutic relationship and in rehabilitation programmes… [I]t was hypothesized that John had had limited opportunities to develop positive relationships in his life and therefore had negative expectations of others.
After working on a formulation:
[T]he team agreed that it would be essential to allow John to get to know them at his own pace and avoid attempts to pressure him to do things.
Who knows…in years to come all NHS psychiatric staff might learn to understand mental illness in these elementary ways.
The research paper is here: Modifying staff perceptions of individuals with psychosis