‘When the Manchester Arena attack happened we developed our plans on the way to work'
Dr Alistair Teager is a Consultant Clinical Neuropsychologist at Salford Royal Hospital, working in one of the UK’s largest neuropsychology departments. We talked over the phone, and I could hear colleagues, in what sounded like a busy office, chipping in with agreement and clarification as Alistair described their work. During our discussion he raised an event that obviously affected the department hugely and raises an important issue for many psychologists.
Most people will remember the Manchester Arena bombing on 22 May 2017 when 23 people were killed and 139 injured at an Ariana Grande concert. ‘The neuropsychology department were involved from first thing on the Tuesday, offering advice and information on trauma and providing ‘psychological first aid’. We had to improvise and move quickly. Our response had to be ad hoc, but the British Psychological Society’s Crisis, Disaster and Trauma Section had some really useful guidance on early interventions for trauma.’
Most commercial organisations prepare major incident and emergency plans. Do you? ‘Yes, most hospitals have them, but the role of psychologists in those plans is rarely integrated. So, when the Manchester Arena attack happened we developed our plans on the way to work. What we did was not rocket science but, in the moment, it can be hard to think. Having a plan is vital and having the flexibility to deliver it even more so. We’re in the process of writing up what we did, so hopefully others can inform their approach should something like this happen again.’
Initially, I’d wanted to be clear about one basic distinction – could Alistair help me discriminate between neuroscience and neuropsychology?
‘A neuroscience centre might offer a range of clinical services specialising in work relating to the brain: neurophysiology, neurosurgery and neuropsychology are examples. Clinical neuropsychology involves understanding how difficulties or damage in certain areas of the brain influence someone’s cognition, behaviours, and emotions, and how this might be affecting individuals and those around them. Clinical neuropsychologists will have completed clinical psychology training, followed by additional training via the Qualification in Clinical Neuropsychology – the QiCN.’
What sorts of areas does the Salford department work in? ‘A huge range. We do tertiary outpatient work and feed into multidisciplinary inpatient and community neurorehabilitation teams, as well as surgical teams and diagnostic services. For example, we might see someone for a pre-surgical cognitive assessment, and during the surgery itself in the case of awake craniotomies – a technique in which a surgeon removes a brain tumour while the patient is awake – and then provide post-surgical assessments and psychological therapy.’
Alistair says he does a lot of work in inpatient services, helping service users to return to a meaningful life after acquired brain injury. ‘Here, we also develop an understanding of a patient’s needs given their neuropsychological presentation; provide input around complex formulations; support staff and patients who present with behaviour that challenges; undertake mental capacity assessments; and support with cognitive rehabilitation. Specialist neuropsychological assessments do form a part of our toolkit, but we also provide therapy, often drawing on cognitive-behavioural, ACT, and schema approaches. We offer several specialist services for traumatic brain injury, brain tumours and epilepsy. We also run a service for people who suffer from non-epileptic attack disorder, an often-misunderstood condition which causes debilitating attacks but doesn’t involve a change in the electrical activity in the brain like epilepsy does.’
In addition to all of this, Alistair and his team provide training for staff across the hospital and have a number of research interests. ‘At the moment – for obvious reasons – I’m particularly interested in looking at psychological responses to major incidents and the role of clinical psychologists in major trauma centres, but we also have people working on studies around epilepsy surgery, care mapping and neuro-oncology.’
How did the department get so big? ‘Our previous Head of Service, Elisabeth Berry, is the main reason. She is a nurse who retrained as a neuropsychologist in the 1990s. Initially it was just her, now there are nearly 30. I think that Elisabeth knew that we needed to embed ourselves into other neuroscience teams to show our worth, both in terms of bringing pure neuropsychology skills to the table, but also the core clinical psychology skills we gained during training.’
What issues are going to be important for the department in the future? ‘At the moment, we’re doing more and more work with clinical psychology courses to develop “neuro” teaching, and we also hope to support the Division of Neuropsychology in increasing opportunities for people to do the QiCN. As hinted earlier, I’m also keen for the BPS to try and inform and influence government organisations at a strategic level to integrate psychological preparedness into major incident plans to dovetail with emergency medical care.’
What sort of person will be able to master what seems like a full and growing agenda – what qualities will future neuropsychologists have? ‘You obviously need an interest in the brain and how it functions. Feeling comfortable with numbers to interpret test results is a component of the job, but it’s not the be-all and end-all of what we do, despite how we’re sometimes portrayed. I’d say that care and compassion are central. A lot of people have experience of dementia, stroke, multiple sclerosis or traumatic brain injury, through lived experience, or via family and friends. This often motivates people to work in the area and can inform what they want to achieve and how they want to go about it.’
Alistair also says that to be a good clinical neuropsychologist you need to be a good clinical psychologist first. ‘You don’t need to specialise too soon; I really benefited from having a broad range of experience pre-qualification.’
Alistair’s own career and training was influenced by a family with a tradition of working in nursing, and then a gap-year job at SureStart ‘which really opened my eyes to the difficulties children and families face in underprivileged, disadvantaged communities’. He certainly didn’t start out as a neuropsychology specialist.
‘I did my psychology degree at Liverpool, and really enjoyed the stuff on forensic and investigative psychology, crowd behaviour and cognition, but I wasn’t sure what I wanted to do with my degree at that point. I thought about going into teaching, into sport psychology, into advertising and into clinical psychology, but I couldn’t make my mind up. After a fair bit of thinking and looking, I found out about the Master’s in Performance Psychology at Edinburgh, and so moved to Scotland for a year. I had a sporting background and it was a great course, which helped me think about topics like attention, peak performance and resilience.’ [The course is featured in an interview with Alan MacPherson in the June 2018 issue of The Psychologist.] The course had people from a variety of interests and backgrounds on it – sport, dance, music, military and business, but it also got me thinking about clinical psychology more as I talked about it with a friend of mine up there, and it felt more and more like the route I wanted to take. I subsequently moved back home to Derbyshire and eventually managed to get an assistant psychologist post in a child psychology team in Stoke, before doing some service evaluation work with a homelessness team in Derby, and then moving on to a neuropsychology service in Oxford. It was there that I felt I was best matched, at the intersection of psychology and medicine. This got my foot in the door, so to speak, and I went on to do my clinical psychology training in Manchester, which led me to a specialist placement at Salford Royal, and that’s where I’ve worked ever since.’
Alistair has been a consultant for the last couple of years and stresses that his experience has reinforced the idea that ‘You need to learn as well as advise. Your job is to understand by listening to other professionals as well as your service users, their families and friends. Trainees on placement and new people joining the department has really helped with this, and everyone has something to contribute. It’s great to hear what people do elsewhere, or what’s being taught on the DClin.’
Alistair closes with one piece of invaluable advice about working in the NHS. ‘It might seem less than glamorous, but we’ve been looking at how we work as well as what we do. We’ve found having yearly workstreams has helped us to push our service forward. We’ve overtly aligned these streams with Trust goals – for instance, those around paperlite working, engaging in research, or thinking creatively about waiting list initiatives or the psychological wellbeing of staff. This seems to have made us more visible in the hospital and has highlighted the efforts we’re making to be both productive and efficient so that we can provide the best possible care for our service users. That can only be good.’
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