What is PsyCheck?

Introduction

Psycheck

A significant part of the challenge for AOD treatment services is that people with comorbid depression or anxiety and alcohol or other drug use problems will frequently be managed within AOD treatment settings, without specialist mental health intervention. PsyCheck was designed as an evidence-based treatment program to use in this context.

The screening tool has been scientifically validated, the intervention manual contains best practice techniques and there is a focus on the scientist-practitioner approach, including ‘hypothesis testing’ as part of the case formulation and an emphasis on reflective practice.

The PsyCheck Program was designed to draw these elements into a single package that can be easily incorporated into routine AOD practice. It is presented as a manualised but flexible package, so that AOD clinicians with a broad range of experience and backgrounds are able to use it. It outlines the steps of the screening and intervention in detail for clinicians who are new to mental health intervention but is presented so that more experienced clinicians can use techniques and strategies as appropriate in their routine practice.

Background

Concurrent mental health and alcohol and other drug (AOD) problems continue to pose a complex clinical and management issue for treatment services, despite increasing recognition of the high rates of these co-occurring or ‘comorbid’ conditions. Research indicates that people with concurrent mental health and alcohol and other drug problems are more likely to suffer lower levels of psychosocial functioning than individuals who do not have these co-occurring issues. These may include homelessness, family disruption, poorer social supports, and financial and legal issues. They are also at higher risk of harm to themselves and others.

A significant part of the challenge for AOD treatment services, in Australia and elsewhere, is the current focus of mental health resources towards the low prevalence disorders (such as schizophrenia) with little available for treating people who are not considered to have a "mental illness". As a result, people with comorbid depression or anxiety and alcohol or other drug use problems will frequently be managed within AOD treatment settings, without specialist mental health intervention.

Mirroring this situation, much of the research and the materials developed to treat and manage comorbid AOD use and mental health problems have focused on the low prevalence disorders and have been conducted within mental health services. Research and treatment materials targeting anxiety and depression among AOD treatment clients represent a significant deficit in the resources available for the management of comorbid conditions.

By far the greater proportion of mental health problems among AOD clients fall under the categories of mood and anxiety disorders, with relatively few presentations of the more ‘serious’ disorders. Affective disorders are most prevalent among clients of AOD services, occurring in more than 50 per cent of cases, in contrast to rates of comorbid schizophrenia of around 3–7 per cent.

Yet these more prevalent and potentially treatable forms of comorbidity remain relatively overlooked in the allocation of resources. This is despite the significant negative impact of affective disorders on the outcomes for people with AOD use problems.

A fundamental step in addressing this problem is to increase the skill and training of professionals in the AOD treatment services in the recognition and treatment of co-occurring affective symptoms among their AOD clients. In particular, Hall and Farrell (1997) recommend that staff in AOD service settings should focus particularly on anxiety and depressive conditions, and the detection and treatment of associated symptoms. The development of standardised screening and manualised treatment packages, targeting comorbid anxiety and depression, is recommended for use in the AOD setting (Proudfoot et al., 2003). As there is a wide range of mental health experience among alcohol and other drug clinicians, these packages need to be easy to implement for new AOD workers, but comprehensive enough for experienced clinicians. Prior to the development of PsyCheck there were few appropriate resources currently available, and very little research existed to suggest how best to implement these strategies within the existing AOD treatment system.


Evidence for comorbidity screening

Epidemiology of comorbidity

Comorbidity is a serious treatment issue for AOD clinicians. Up to one-third of clients with mental health conditions have an alcohol or other drug use problem (Regier et al., 1998; Teesson et al., 2001) and may be referred to AOD services. On the other hand, up to 80 per cent of clients in AOD treatment also have a co-occurring mental health problem (Burns & Teesson, 2002; Callaly et al., 2001; Darke & Ross, 1997; Degenhardt et al., 2001). Even greater numbers may have ‘subclinical’ symptoms of mental health problems, which may also result in significant distress and impact on relapse and recovery rates (Kay-Lambkin et al., 2004).

What is clear is that people with co-occurring problems have a poorer prognosis than those with a single problem. Co-occurring problems are more likely to become chronic and disabling, and result in greater use of health services (Teesson et al., 2000). Effective management of comorbidity is, therefore, critical to the cost-effectiveness of services as well as for the wellbeing of clients (Kavanagh et al., 2004).

Risk of self-harm among AOD clients

People with co-occurring problems are more likely to be at risk of harm to themselves and others (Wallace, Cutler & Haines, 1988). Alcohol and other drug use can impair judgement and increase the likelihood that people will act impulsively. Clinicians must always be aware of the potential for clients to harm themselves or others. Although self-harm and suicidality are quite distinct clinical phenomena, with different causes and intentions, for the purpose of this discussion they will be considered together in terms of the risk to the client’s safety. There is a strong link between alcohol and other drug use and suicidality, particularly when mental health problems are added to the picture (McCloud et al., 2004). Assessment and management of suicidal ideation and self-harm are included in the PsyCheck Screening Tool and discussed further in the PsyCheck Screening Tool User’s Guide.

Models of comorbidity and implications for treatment

Comorbidity has implications for prevention, treatment and relapse prevention of both mental health and alcohol and other drug problems. Several hypotheses exist as to why comorbidity might occur. The primary consideration is whether mental health conditions cause AOD symptoms, or vice versa, in those with combined problems. A number of models have been proposed (Crome et al., 2000; Hall & Farrell, 1997; Kushner & Mueser, 1993).

 

The PsyCheck program

PsyCheck was designed as an evidence-based treatment program. The screening tool has been scientifically validated, the intervention manual contains best practice techniques and there is a focus on the scientist-practitioner approach, including ‘hypothesis testing’ as part of the case formulation and an emphasis on reflective practice.

The PsyCheck program was designed to draw these elements into a single package that can be easily incorporated into routine AOD practice. CBT is a therapy based on principles used in both AOD and mental health intervention and is thus suitable for an integrated approach to comorbidity treatment.

The PsyCheck intervention utilises four core cognitive techniques:

  • Educating the client about the cognitive model and the common unhelpful thinking patterns.
  • Educating the client about how to identify their unhelpful patterns of thinking.
  • Modifying these negative or distorted thoughts by a process called cognitive restructuring.
  • Developing strategies to prevent relapse and maintain healthier patterns of thinking.

The package outlines the steps of the screening and intervention in detail for clinicians who are new to mental health intervention but is presented so that more experienced clinicians can use techniques and strategies as appropriate in their routine practice.

Thank you for your interest in PsyCheck. If you would like further information about this article or an information in regard to PsyCheck please contact Kieran Connolly on 03 8413 8702 or kieran.connolly@turningpoint.org.au

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