Abstract
Across the UK, wide‐ranging efforts have been made to enhance citizen access to psychological therapy. Clinical psychologists are key providers of and gatekeepers for therapy. This article is concerned with how clinical psychologists foster access (or not) to psychological care. More specifically, it interrogates how psychologists manage, and make decisions around, patient referrals. Following a referral, psychologists must resolve an uncertain situation: should they accept a referral and continue with an assessment? Thereafter, they must decide whether a patient is suitable for their service – and for therapy more generally. Certainty is synthesised against a backdrop of sometimes powerful pressures to meet service targets. Taking cues from medical sociology and science and technology studies (STS), this article interrogates some of the uncertainties around access to psychological therapy, and how decisions made by clinical psychologists involve negotiations of patient, service and professional ontologies. To do so, it draws on interviews with 40 psychologists across England and Scotland. The paper spotlights a professional group that is often absent from or only dimly lit within sociological observation and analysis: clinical psychology. Through attending to the discourses of psychologists, I extend conversations about uncertainty through a distinctive case study.
Highlights
Across the UK, efforts have been made to enhance citizen access to psychological therapy
These changes have occurred as reports suggest that beyond Improving Access to Psychological Therapies (IAPT) and certain other services, funding changes for mental health care more broadly have resulted in cost-cutting measures, created workforce challenges and comprised the quality of patient care
The process of referral Before seeing a clinical psychologist, most people have to be referred by another health professional; for example a GP
Summary
Across the UK, efforts have been made to enhance citizen access to psychological therapy. A variety of initiatives have been deployed to increase the numbers of people who are able to obtain psychological care These changes have occurred as reports suggest that beyond IAPT and certain other services, funding changes for mental health care more broadly have resulted in cost-cutting measures, created workforce challenges and comprised the quality of patient care (as discussed in Gilburt 2015). This article is concerned with the practices of clinical psychologists in fostering access (or not) to psychological care. It interrogates how psychologists manage, and make decisions around, patient referrals. Psychologists – like other mental health professionals (McEvoy and Richards 2007) – have to juggle service demands and pressures, patient requests and concerns, and their personal ethical and epistemic frameworks for considering who should receive therapy and why
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