The NHS Strategic Review of Psychotherapy Services published by
the Department of Health NHS Executive (September 1996) identifies
three frameworks for the provision of psychotherapeutic treatments:
The Review states that
"well conducted psychological therapies are an important part of mainstream mental health care. They are one of two main approaches to the treatment of the mentally ill (the other being physical treatments such as medication and ECT)" (1.1)
The Psychotherapy Services provide type C interventions (formal psychotherapy) whilst offering training, supervision, support and consultancy to type A and B interventions, through supervision of mental health professionals who work in Community Mental Health Teams and other similar agencies e.g. Street-wise
The Psychotherapy Unit at St Thomas' also provides psychotherapy training and supervision to medical staff. Experience of psychotherapy is an obligatory part of the training of psychiatrists. Closure of St Thomas' Psychotherapy Unit would therefore severely affect the training of psychiatrists.
Patients often present with multiple pathology which may include dual diagnosis and such things as substance abuse, eating disorders severe somatic disturbances deliberate self-harm (self-mutilation and suicide attempts) and violence. The unit also sees a high number of patients who have a history of severe emotional and physical deprivation, including many survivors of violent and sexual abuse.
The Psychotherapy Services provide a range of interventions which include.
N.B. Individual psychoanalytic psychotherapy is only a small part of the service, it is offered to people who are deemed clinically inappropriate for the other interventions, requiring a longer term individual intervention.
Interventions (2), (3) and (4) are carried out 95% of the time by unpaid trainees seeking clinical placements within the service, under the supervision of senior, qualified psychotherapy staff. This renders the department one of the most cost effective in the country.
The Service is managed by a Head of Service located at St Thomas'. The Head of Service has a clinical as well as a service management role.
| Psychotherapy Unit (STH) | £113,000 |
| Shanti | £150,000 |
| Total | £263,000 |
At this time it costs approximately £470 to see one patient for a year in the Psychotherapy Unit (No. of patients seen in a year 240 £113,000). If this is broken down into clinical time/cost a group patient costs approx. £250 p.a. and a C.A.T. patient costs approximately £250 per annum. (No. patients senior staff clinical and supervision time). It costs approximately £650 per annum to see one patient for a year at Shanti (230 £150,000).
The loss of each clinical worker (full time equivalent) in terms of direct keyworker/therapist services would be as follows:
Psychotherapy Unit (STH) - 60 patients each week full time equivalent
Shanti - 40 patients each week full time equivalent
This figure increases if non-direct support or supervisory services are included.
The Psychotherapy Service is therefore ideally placed to actively implement many of the points identified within the strategic review of psychotherapy provision. It would lend itself especially to a 'hub and spoke' organisational model i.e. a specialist centre which provides distributed sessions into local CMHT's and to support staff, 'to help staff retain a reflective approach to their practice, to avoid 'burnout' and hence to enhance standards of care' (3.11.3)