What are the unique skills?

Pam James on psychiatrists and psychologists.

I write to stimulate debate at a time when resources are precious and the number of distressed people seeking mental health care through their GP is ever increasing. Practitioner psychologists have, over recent years, been in situations and departments within the NHS where their skills and competences have been ‘portioned off’ and replaced by CBT and IAPT therapists.

Psychologists’ competence in formulating is informed by theory, taking into account the person in their situation. Psychologists working in the NHS and other settings have developed complex work portfolios. Their perspective is generally an awareness of the use of diagnosis, whilst preferring to assess their clients using formulations.

Has anyone stopped to reflect on the role and function of the psychiatrist? This is a profession that can prescribe complex medication which is often essential in situations where human distress has become out of reasonable control. With the growth of early intervention teams, the use and need for ongoing psychopharmacology has reduced. The psychiatrist can of course diagnose, and yet so can the psychologist, so this is no longer their unique skill.

The concern then is that much available resource is in the employment of psychiatrists, which may be more prudently spent on more psychologists, CBT therapists, counsellors and other IAPT professionals. These people can work in tandem with fewer psychiatrists according to the required professional competences of the demands of the situation. In this way, resources may be appropriately spread, rather than perpetuating a regime that may itself be becoming questionable in its use.

This argument also concerns and involves the way in which diagnosis and its subsequent prescribing is becoming an over-used response to psychological distress. Furthermore, medical responses from GPs will follow NICE guidelines which usually include both talking therapy and medication. The former often results in people waiting for therapy as there are insufficient psychologists or other mental health professionals available. A redeployment of resource away from psychiatrists and towards other mental health professionals as described above would help people with mental health issues of whatever severity to reach psychological help that addresses the uniqueness of each person and their situation.

Pam James
Professor of Counselling Psychology in Independent Practice
[email protected]

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