Assumptions and values of community health psychology

There is a need to widen the practice of health psychologists to include the theories and methods of community psychology and an awareness of contemporary issues in community health. The aim of such a community health psychology would be both to deepen our understanding of the aetiology of health and illness in society and to develop strategies that will contribute to a reduction in human suffering and an improvement in quality of life. The aim of this article is to review the background and assumptions of community health psychology and to consider some values that would underlie such an approach.     

A community psychology framework for participating in mental health policy making

Psychologists are becoming more and more sensitized to the influence of mental health policy on the delivery of psychological services and, simultaneously, to the role they can or ought to play in the mental health policy-making process. Traditional and potential roles for psychologists in this process are identified and classified by means of a community psychology framework. The centrality of values in these roles is identified, and conceptual tools are presented for understanding the relationship between psychologists and policy makers. Implications for research, training, and practice are drawn.     

Public health psychology: a conceptual and practical framework

Increasingly, the development of public health infrastructures requires psychology to reevaluate its contribution to public health at local, national and global levels. Already familiar to some psychologists, particularly those in community psychology and health promotion, the expansion of public health has implications for psychology in terms of knowledge/practice and working differently in multidisciplinary settings. In this article, I provide a critical overview of the implications of the historical and international development of health psychology and the changing nature of public health to strengthen the establishment of public health psychology. A conceptual and practical framework is proposed in which public health psychology theory, methods and practice are considered as well as its relevance to the health social sciences more generally.     

Psychotherapy in Australia: clinical psychology and its approach to depression

In Australia, clinical psychology training is dominated by cognitive and behavioral treatments (CBTs), although there is exposure to other theoretical orientations. Since 2001, over 20% of general medical practitioners (GPs) have received training in CBT, and psychiatry training increasingly incorporates CBT elements. Psychotherapy by medical practitioners is financially supported by universal health care funding with supplementation by patients and their private health insurance. Federally funded health benefits for up to 12 psychology consultations per year are provided on referral from GPs and psychiatrists, and initial takeup has been very strong. Mrs. A would be a typical patient for such a referral. However, she would not fulfill criteria for priority access from state-funded mental health services. Mrs. A would probably consult a GP and receive antidepressants, although she may also access a range of other community support programs. Access to and acceptance of psychotherapy would be greater in urban areas, and if she were of Anglo-Saxon and non-indigenous origin.     

The genesis,implementation and impact of the Better Access mental health initiative introducing Medicare‐funded psychology services

The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare‐funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has also had a substantial impact on the profile of the psychology profession. After a full year of implementation, analysis of the impact of the availability of funded psychology services identified a number of issues and challenges. However, it is evident that the inclusion of these services under Medicare has been a most important advance for the psychology profession and the mental health of the Australian community.     

Clinical psychology in Spain

A general view of the field of clinical psychology in present-day Spain is offered here. The field has experienced an enormous development over the past two decades. Many journals and specialized societies have been established, and a large number of professionals now are working in the field, most of them in private practice, but some in medical centers belonging to the Spanish national health service. This great expansion seems due mainly to the creation of a degree in psychology(1968) and the continuous flow of students demanding training in clinical subjects. A theoretical orientation toward a cognitive-behavioral approach seems to dominate, closely followed by those choosing a dynamic orientation. A large group of professionals dealing with health problems are reinforcing their idiosyncratic profile among the clinical psychology. A new study program to become a specialist in our field recently has been implemented and is just entering its initial stages (Internship in Psychology-PIR); it represents a significant improvement in the curriculum of the clinical psychology. All of these facts seem to prove the great vitality of this field in present-day Spain.     

The development of a district community psychology service

A survey was carried out to assess the difficulties encountered by general practitioners within a health district in the management of patients with emotional problems, and their attitudes to the involvement of clinical psychologists in primary health care.

Based on the response to this survey a district community psychology service has been established. This is an adjunct to hospital-based services and attempts to overcome some of the shortcomings of traditional psychotherapeutic services.

     

Health psychology, embodiment and the question of vulnerability

The topic of the body is now firmly on the agenda for psychology, as it has been for sociology for some time. What contribution will health psychology make to this debate? This article argues that the biomedical view of the physical body is inappropriate for a psychology addressing the key concerns of suffering and healing. Instead, health psychology needs to theorize what it means to be embodied in the context of illness and of health care. To do this requires investigation of the practical relationships between staff and patients as well as of experiences of sufferers. By reflecting critically upon the relationship between clinical practice and the conceptualization of the body, a health psychology embracing the idea of embodiment becomes possible.     

Systems theory perspective and community psychology

This article explores some implications of recent epistemological revisions in community psychology, beginning with the developments of the community perspective and proceeding through its subsequent transformations. The changes produced from the shift from cybernetic models to dialogical models generated a serious review of our understanding of community change processes. The major unanticipated questions resulting from these changes have generated many uncertainties in the field that are likely to alter our conceptions, our scientific methods, and our ability to impact community processes. These uncertainties create possibilities for new metaphors that may open up new ways to think about the design and implementation of community-based intervention. Some consequences of recent epistemological changes in the multidisciplinary field referred to as “community psychology” are explored in this article. In general, this field incorporates the perspectives of many social sciences that share an interest in the interconnections between “subjectiveness” and “social.” In its development, community psychology has spread beyond disciplinary boundaries, thus promoting the exploration of new conceptual metaphors, methods, and techniques. These explorations have yielded epistemological and theoretical changes as well as alterations in how one thinks about practice. In the systems theory perspective, the movement from “first order cybernetic” models to a “dialogical” position has significantly changed how one plans actions, how one thinks about the role of professionals in the context of community work, and how one defines genuine cooperation. The goal of the article is to examine the consequences of this ongoing process, which has yielded uncertainty and a range of unanticipated possibilities. Some steps which have already been taken will be explored and new steps which might be taken will be recommended. Naturally, some unanswered questions will, hopefully, engage readers in the examination of these issues. © 1998 John Wiley & Sons, Inc.     

Does providing more accessible primary care psychology services lower the clinical threshold for referrals?

BACKGROUND: The growing number of specialist services being provided within primary care has lead to the argument that this will reduce the clinical threshold for referrals to these clinics. AIM: The possibility that increasing the accessibility of primary care psychology services will reduce the threshold for referral was examined by comparing levels of psychological disturbance among patients seen by practice-based clinical psychologists with those attending outpatient clinics. METHOD: Psychological symptoms, distress, disruption in daily life and satisfaction with life were assessed using a questionnaire-based methodology. A consecutive series of 177 patients, assessed in a local general practice or an outpatient department across a wide range of urban locations, was studied over a fixed period. RESULTS: The study revealed equivalent levels of psychopathology within both specialist and primary care clinics. Of the overall sample, 79% were likely to merit a formal psychiatric diagnosis, relating primarily to mood disorder. Levels of subjective distress and life satisfaction were also equivalent at both service locations. CONCLUSION: The lack of evidence for a reduction in clinical threshold for referral within the primary care sample suggests that general practitioners' referral rates are similar regardless of whether practice-based clinical psychology services are available. This has implications for primary-care-led commissioning of mental health services.     

The Present and Future of Clinical Psychology in Private Practice

This article discusses clinical psychologists' current concerns, challenges, and opportunities in private practice. The future of clinicians in independent practice is presented within two paradigms, namely, psychology as a health profession, and psychology as life enhancement. Finally, the author argues that psychotechnology, corporate clinical psychology, and psychology as life enrichment will evolve within the future of clinical psychological independent practice.     

Relationship between practice counselling and referral to outpatient psychiatry and clinical psychology.

BACKGROUND: Although reduction in the use of secondary care mental health services is a suggested benefit of counselling in general practice, there has been little empirical investigation of this relationship. AIM: To investigate the relationship between the provision of counselling in general practice and the use of outpatient psychiatry and clinical psychology services across a geographical area. METHOD: Information on referrals to outpatient psychiatry and clinical psychology from all general practices in the London Borough of Islington over one year (October 1993 to September 1994) was collected from the routine information systems of the main hospital departments serving this area. Referral rates per 1000 practice population were compared for practices with and without a practice-based counsellor. RESULTS: Fifteen (35%) of the 43 practices had a counsellor based in the practice. The median referral rate to clinical psychology was higher in practices with a counsellor (4.1 per 1000) than in practices without a counsellor (0.8 per 1000). There was no relationship between the provision of practice counselling and median referral rates to outpatient psychiatry (1.8 per 1000 with a counsellor, 1.7 per 1000 without a counsellor). CONCLUSION: Provision of practice counselling in the study was associated with higher referral rates to clinical psychology and no difference in referral rates to outpatient psychiatry. This is in contrast to the hypothesis that counselling reduces the use of secondary care mental health services.     

Improving the continuity between undergraduate psychology and graduate community psychology: Analysis and case study

Discussions of graduate education in community psychology often have failed to note that undergraduate psychology programs exercise a crucial gatekeeping function by helping to shape students' attitudes about areas for subsequent study. Integrating concepts and methods of community psychology in undergraduate curricula is proposed as a change strategy to improve the viability of community psychology as a discipline. The Applied and Community Psychology Internship at Rutgers University is presented as a case example of a vehicle for providing this integration. Evidence is provided that students emerge from the internship primed for subsequent study and practice from a community perspective.     

Child health psychology: Emerging responsibilities of the pediatric health psychologist

Child health psychology is an emerging discipline. Emerging, according to Webster's Dictionary, means “to come forth into view; become visible” and “to evolve as something new, improved, etc. ” Both of these definitions aptly describe the current state of child health psychology, and will be used to frame this discussion.As the basis upon which to evaluate the articles which follow, we will describe: 1) the successes of medicine and the resultant context of contemporary medical care that have provided the opportunity and necessity for the development of child health psychology; 2) the knowledge base and responsibilities of the clinical psychologist which are necessary for practice in the health care setting; and 3) the complementary role of the psychological practitioner in the evaluation and management of children with chronic disease.     

Teaching evidence-based practice: implications for psychology

A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum.     

Health psychology for children: a step-child/stepping stone

This paper presents the position that health psychology for children is not given proper attention in mainstream health psychology, which is primarily adult in orientation. It is proposed that the neglect of child-related problems in the recent Proceedings of the National Conference on Training in Health Psychology exemplifies the general orientation of mainstream health psychology, which views children's health problems primarily in terms of their effect on adult health rather than as problems that need current and immediate attention. We propose that applying a developmental perspective to the health psychology field would be one way of highlighting the fact that children's problems are unique and that children need to be viewed as something other than potential consumers of adult health psychology services or as agents for the prevention of adult health problems.     

Health psychology in context

Over 25 years there has been a remarkable growth of theoretical and empirical studies in health psychology. Its theoretical underpinnings have been largely derivative, its focus primarily clinical, and its subject, the individual. Relatively little attention has been paid to the cultural, sociopolitical and economic conditions which set the context for individual health experience and behaviour. Theories which do not reflect the complex interaction of these variables are unlikely to provide a satisfactory account of individual health. Multidisciplinary efforts are needed at a community level to provide effective interventions which are relevant to the exposure groups being targeted. Health psychology needs measures which are valid and relevant to the general population regardless of culture, gender, social class or age. Putting health psychology into its cultural, sociopolitical and community context is a major priority for future development.     

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace.     

Current developments in community psychology in Canada

Extant historical sources on the evolution of community psychology in Canada provide different perspectives on the subdiscipline's origins but tend to neglect developments in Québec. The present account is based on oral history data and pertains chiefly to current issues in academic community psychology. Recent interviews of seven prominent Canadian-based community psychologists indicated that there has been a relative lack of cooperation and of knowledge sharing between francophone and anglophone community psychologists. Another theme was the dominating effect of U.S. community psychology on the Canadian subdiscipline. Interviews of 13 central figures in the U.S. subdiscipline confirmed this impression of unidirectional influence. The issues of cultural division and U.S. domination bear significantly on the identity of Canadian community psychology. However, trends in graduate training, community practice, and political support appear to bode well for the future.