Understanding the provision of psychological interventions for psychosis in an Australian mental health service: a mixed methods study

Abstract

ABSTRACT Objective To describe the provision of evidence-based psychological therapies for the treatment of psychosis in a large Australian mental health service; and to explore the barriers and facilitators to providing these therapies. Method Mixed-methods study including: 1) a retrospective audit of 100 clients with schizophrenia spectrum disorder to estimate adherence to guideline recommended psychological therapies; and 2) a cross-sectional survey of community based mental health practitioners, based on the Theoretical Domains Framework, to understand the barriers and facilitators to delivering psychological therapies to clients with psychosis. Results Twenty-five percent (25/100) of the audited sample engaged with psychological services. Of those who did, two received the recommended dose of evidence-based therapy. Thirty-three percent (37/112) of mental health practitioners completed the survey. Barriers to the delivery of psychological therapies related to perceived lack of knowledge, skills, and confidence with the therapies, and beliefs about who will (and will not) benefit. Other barriers included lack of time, demanding caseloads, and a culture of risk and crisis management. Conclusions People with psychosis have poor access to evidence-based psychological therapies. The barriers to providing psychological therapies are multifactorial and should be systematically addressed to improve health and quality of life outcomes for people living with psychosis. Abbreviations: CBT: Cognitive behaviour therapy; CBTp: cognitive behaviour therapy for psychosis; CRT: cognitive remediation therapy; FIp: family intervention for psychosis; PORT: Patient Outcomes Research Team; RANZCP: Royal Australian and New Zealand College of Psychiatrists; NICE: UK National Institute of Clinical Excellence; TDF: The Theoretical Domains Framework; HoNos: Health of the Nation Scale; EBPIs: Evidence Based Psychological Interventions; ACT: Acceptance and Commitment Therapy.