Frequently asked questions

How suitable is the PsyCheck package for staff with little or no mental health experience?

The package is designed primarily for staff with little or no mental health experience. The screening tool can be self completed by the client and there is no necessity for expertise in mental health assessment to use it. The brief intervention that is linked to the PsyCheck screening tool is based around relapse prevention and should be familiar to most drug and alcohol workers. We encourage all clinicians to be seeking or accessing supervision to assist with their ongoing learning and practice of screening for mental health symptoms and providing suitable interventions amongst clients.

Can we use just the screening tool on its own or do we need to use the whole mental health intervention?

The screening tool can be used on its own. In the development of the PsyCheck tool, AOD workers identified the need for a 'what next' after screening. Many reported a reluctance to screen for fear of opening a Pandora’s Box with no specific tools to then provide any intervention. The benefit of the brief intervention is that is linked to the screening tool and provides an option for intervention based on the severity of the mental health problems identified.

How is PsyCheck of value to staff with extensive mental health experience?

The package was designed so that it was also useful to staff with extensive experience in mental health. Experienced practitioners may prefer not to follow the step by step guide but use the sessions as a framework for structuring their comorbidity intervention. Experienced practitioners also find that the worksheets and other tools are useful to their practice.

I have as much difficulty dealing with my clients' complex behaviours as I do with their anxiety and depression. Is there anything to help me?

There is a new PsyCheck package under development that is designed to help AOD practitioners better respond to complex behaviours and situations, such as those sometimes associated with personality disorders. This package will follow a similar format to the original PsyCheck guidelines with a screening tool and options for intervention.

When should I seek a more detailed assessment of mental state, if at all?

At cut-off of 5, you definitely need to do further assessment. Under that then it's up to you to monitor your client and then offer external assessment if required.

Question 5 in the General Screen section refers to recent suicidal ideation. What is the definition of "recent"?

That's a good question. A DSM 1V diagnosis means that the client has usually had symptoms in the last 12 months, so anything around that timeframe would be a useful guide. You would also need to take into consideration if someone has had symptoms prior to 12 months for substantial periods, but maybe not someone who had symptoms 12 months ago and never before or after.

If a client answers NO at Question 5 on Section 1, should I conduct a risk assessment? What about for other forms of self harm apart from having thoughts about ending their life?

You can still ask those questions if you want. If the client answers yes, you definitely need to complete Section 2 of the risk assessment. This should be routine practice in AOD anyway.

There is inadequate space on the form for collecting the required detail.

Your feedback is really helpful. The formatting of the PsyCheck Screening Tool is under review.

Is there an AOD standard for case formulations and expected capacity to provide a level of intervention, i.e. case formulation and CBT?

No, but there is a very simple explanation of case formulation provided in the package. It is designed for any AOD worker in a counselling role and is "Cert IV friendly".

Why is the package only focused on anxiety and depression?

Although psychotic disorders can be more disruptive in a treatment setting, they are relatively uncommon and the vast majority of clients with comorbid mental health disorders in an AOD setting will be experiencing anxiety or depression symptoms. These symptoms often go undetected because they are less visible. There are also fewer affordable options for referral for anxiety and depression management so these problems often need to be managed within AOD services. This package offers a simple way for AOD clinicians to respond to subclinical, mild and moderate anxiety and depression, so that AOD treatment will be more effective.

What is the relationship with PTSD and picking this up in a PsyCheck screening?

The PsyCheck screening will screen for general anxiety, depression and somatic problems and then if anything positive comes up, clinicians need to work out how to do a proper assessment (as in the package). The system is purposely symptom based rather than diagnosis based so that non-mental health professionals can still do something without having to be trained as mental health clinicians and make diagnoses. You will need to determine the disabling symptoms of your client and address those regardless of  whether they make up a syndrome called PTSD or not.

Can I just ask my client some of the questions on the SRQ?

The SRQ has been designed and validated as a whole scale. It is unclear whether single questions on the scale can predict mental health problems.

Do I need to use the whole PsyCheck screen?

The main part of the PsyCheck screening tool is the SRQ. This is the part of the screening tool that will be most helpful in assisting you to work out what level of mental health intervention is required. You can use this scale on its own or in conjunction with the suicide risk assessment framework and other information. However if you have standard procedures for suicide risk assessment and collecting this other information already, these sections may be substituted.

Do I need training to undertake the PsyCheck intervention?

People with some training or experience of CBT may be able to use the guideline materials without further training. Most practitioners and services that do not have substantial background or experience in CBT or mental health intervention usually find training helpful. Most practitioners find training more helpful when others in their service have also been trained. Turning Point offers training for the whole service.

Is the current package suitable for working with Indigenous and CALD communities?

The current package has not been designed for nor tested with Indigenous and CALD communities, but is definitely an area for development in the future. However, some trainers have slightly modified the material for Indigenous and CALD workers and they report positive results.

PsyCheck materials

Will there be changes to the format of the PsyCheck screening tool? More space to write in Section 1 & 2?

There are no plans for immediate formatting changes, but we're happy to take any feedback for future editions. Please email Sandra Roeg with the details.

Is it advisable to allow clients to complete the SRQ alone? I'm just wondering about giving it to clients in the waiting room.

This is OK, depending on the client. It is designed to be self completed

What if there is no improvement in the client after going through the 7P's, the formulation and worksheets?

>If you have done all you can, you should consider referral either internally if there is someone more experienced in the area or externally. Remember now that there are Medicare item numbers for psychologists, making referral much easier.

Cognitive behavioural therapy

Useful publications:

Aaron Beck - Cognitive therapy of substance abuse/Cognitive therapy for depression/Cognitive therapy for anxiety
Judith Beck - Cognitive therapy basics and beyond
Keith Hawton et al - Cognitive behaviour therapy for psychiatric problems (this one is quite an advanced text)
Sarah Edelman - Change your thinking (this is a excellent self help/basic book)
Mary Copeland - The depression workbook (self help)
Edmund Bourne - The anxiety and phobia workbook (self help)

Why is CBT so pervasive?

Many people use CBT because it is evidence based. The research that has been conducted and published has shown positive results. Importantly much of the research that has been published is controlled trials not just case studies or opinion pieces, so we can be more confident that any positive results aren't due to incidental factors. If a doctor said to you: 'I can prescribe you a medication that has been researched and we know that it is effective or I can prescribe another medication that we think might be effective, but we haven't done much research, so we aren't quite sure" which one would you ask for?

Other reasons why people use CBT (apart from that it works!):

  • it is easy to measure outcomes because it's a style of psychotherapy where the outcomes are very clear and measurable
  • it is focused and time-limited
  • it is easy to adapt to brief interventions and for people who are not expert in CBT to use in a modified or basic form
  • it can be easily adapted for a stepped care model

Can you direct me to info on dialectical behavioral therapy (DBT)?

Marsha M. Linehan: "Skills training manual for treating borderline personality disorder." Guilford Press (December 1993) Paperback - 180 pages Manual edition ISBN: 0898620341

Marsha M. Linehan: "Cognitive-behavioral treatment of borderline personality disorder." Guilford Press (May 1993) Hardcover - 558 pages ISBN: 0898621836 www.priory.com

PsyCheck says to give the client a copy of their CBT assessment and case formulation - what is the best way to do this?

Whatever is most natural for you and sensitive to the client's needs. Think about giving the client feedback on anything related to their treatment such as the results of an assessment or test.

I was reading that cognitive therapy comes from Socratic learning - is that right?

The interaction between client and clinician in CBT is based on a Socratic style of questioning. It's also called guided discovery. Socratic questioning is a style of interaction that develops the therapeutic relationship. The Socratic method is a method of questioning, the ultimate aim of which is for the person who is being questioned (the client in CBT) learns something about themselves or the world. It is originally a very powerful form of teaching that fosters critical thinking. It creates a shared point of view for the client and clinician, especially because the clinician doesn't have or need to have all the answers. It's a kind of teaching by asking rather than telling. The popular 'hypothetical' is based on the Socratic method.

How early or late are the early experiences that influence our core beliefs?

In theory early experiences occur mostly in childhood, but some beliefs may be developed as a result of events later in life, adolescents or adulthood. Some cognitive behavioural therapists believe that those core beliefs that were developed later in life maybe just triggered later in life but developed much earlier on. They are in a sense not in immediate consciousness and drive behaviour.

When did therapeutic alliance make a comeback in CBT?

It has always been an important part of CBT, but not considered the primary change agent in treatment. It has always been assumed that a good therapeutic alliance is necessary for good outcomes in CBT but the process of CBT is considered to develop that therapeutic alliance. For example the Socratic/guided discovery method of questioning helps build the relationship and trust between the clinician and client. Equally the collaborative nature and the emphasis on different skills that the clinician and client bring to the therapy situation, and the de-emphasis on the 'therapist as expert', help to build the therapeutic alliance.

I'm new at this type of work - Is it best to do the 7 P's - and develop the formulation with the client or with the clinical supervisor first?

Whatever you feel most comfortable with. We'd recommend that if you are uncertain about case formulations, consult with your supervisor or a colleague first and also practice in a role play explaining it to the client.

Behavioural assessment 7Ps - would you talk to the last 'P' Prognosis with your client?

You need to use your clinical judgement about how the client is likely to take the information. You should think about how to frame it sensitively if the prognosis is poor, and focus on the solutions to improve the client's quality of life

Comorbidity

Models of comorbidity - Which one do most subscribe to?

Any of these models might apply to any one person. Once someone has developed mental health and substance use conditions, there is usually a two way interaction between the two - relapse on one disorder will affect the other.

 

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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