Discussion/Conclusion

DISCUSSION

The literature identifies a number of clear points. There are a variety of psychotherapy approaches that successfully support people experiencing mental illness. Regardless of the particular therapy used in treatment, efficacy is strongly influenced by the quality of the therapeutic relationship between clinician and client. It has been established that a sound therapeutic relationship is a predictor of improved client treatment outcomes, and that client perceptions of the therapeutic relationship are reliable informants of success treatment.

The delivery of public mental health services has been subject to sweeping structural change underpinned by EBP, and delivered within recovery framed, community based models of care. Mental health is a part of the overall health sphere, and individuals are central within the treatment and support of the health spectrum. This change, mirrored within government policy and health services governance structures, presents a significant cultural challenge to both health services, and the individual mental health clinician. The pending Victorian Mental Health Act (2014) will frame the provision of mental health services reflective of the fundamental reforms to the perception of treatment, and the delivery of care.

What are the implications for mental health services and mental health clinicians in such an environment of change?

RECOMMENDATIONS

Model of care and service delivery

  • What is the health service’s model of care?
  • Is the model of care reflective of the recovery model and indicative of the application of the MHA (2014)?
  • Do clinicians receive training in delivering the model as part of induction into the service?
  • Is the structure and cultural standards of the service reflective of a recovery focus toward service delivery?

These are relevant questions to be answered within a health service intent on setting strong cultural standards and supporting clinicians in achieving those standards.

 Psychotherapy

  • Clinical staff to be supported in a) identifying their practice, and b) developing their practice.
  • Intranet based information kits containing introduction to psychotherapy approaches, further links to relevant learning opportunities. All information to reflect best practice in a recovery framed delivery of care.
  • Developed information can be provided to clinical staff as part of induction into the service. The process of learning and application to practice can be built into professional development processes.
  • Benchmarks of practice can be adopted and evidence of application built into supervision and the professional development process.

 Therapeutic relationship

  • Provide clinical staff with intranet based information kits containing evidence – based literature identifying the therapeutic relationship as vital to psychotherapy approaches.
  • Provide training and information identifying aspects of building and structuring therapeutic relationships that reflect best practice and a recovery focus.
  • Make a clear and public link between the elements of accepted standards of practice, model of care and the collaborative elements gained through a structured therapeutic approach to client care.

CONCLUSION

This literature review has focused on the fundamental aspects of current psychotherapeutic approaches identified within the treatment of mental illness, and the clearly identified connection with a sound therapeutic relationship as vital to successful client outcomes, regardless of the psychotherapeutic approach used. The current climate of structural change to the delivery of mental health services within a recovery framework, provides significant challenges to the culture and professional development demands on mental health services, and this should be a clear focus in the support of clinical staff. Recommendations are focused toward improving clinical knowledge and building the capacity of clinical staff to practice within a recovery framework. Information technology provides the ability to access and share information easily while the professional development process allows health services to build expectation into staff clinical and practice development.

The practice of the mental health workforce can no longer rely on intuition, or following the well – trodden path forged by others. One must be able to articulate ones psychotherapeutic approach to care that reflects the elements of the recovery model, based on EBP. The mental health service must act responsibly in establishing a framework that promotes structural and cultural change for the same reasons. There is a collective responsibility to deliver a standard of care that people living with mental illness deserve. Can we improve it? ….

YES WE CAN!