Do we need more clinical psychologists?

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Do we need more clinical psychologists?

Postby aojke22 » Wed Nov 08, 2017 11:56 pm

Hello,

Wasn't sure where to put this, so I hope this is okay.
I went to the IOPPN open evening yesterday and left with lots of thoughts and not many people to discuss them with so thought I'd post here :) The feeling I left with was that yes, there are lots of people with good experience, but unfortunately the places are few and they have so, so many applicants (like all courses, of course). The following comments are in no way a slight on the IOP (I found the evening super informative and interesting), rather general thoughts about the path to clinical psychology more broadly.
I left thinking that there are many people who would likely make good psychologists who just won't make it due to the numbers. They cited that they have 40 applicants per place and most of those meet the minimum criteria, with many exceeding this significantly. In the teams I've worked in, the psychologists are never able to see all the people who want psychology because they just don't have enough time. This says to me ...maybe we need more psychologists? I don't know if this is a naive view, but it feels like there are many people who could in theory train successfully, and there are many people who struggle to access psychology due to resources, but there are so few places. (Of course this doesn't cover the fact that psychologists don't just do therapy - but I suppose the difficulties people have in accessing psychology when they want it is something that feels particularly pertinent to me when I'm thinking about the training bottleneck). I admit I don't know how the commissioning process works etc, but I wonder if there's any push from already qualified psychologists anywhere to try and argue for an increase in funding for training places?
I suppose I'm wondering what others think about this numerical quandry - lots of keen people with good skills and experience, but relatively few training places, and lots of people who would like to consider psychological therapy? I also acknowledge that in the current context, I would hardly expect a whole bunch of training places to suddenly appear if someone asked for them - but it feels a bit strange that I'm not aware of anyone arguing for this explicitly and publically. I don't think I've seen anything on the forum about this specifically before, but I'm happy to be redirected if I'm duplicating something here :)

I'd be v interested to hear anyone's thoughts :D

A. x
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Re: Do we need more clinical psychologists?

Postby lingua_franca » Thu Nov 09, 2017 3:36 am

I think the big issue is austerity. Mental health services are woefully overstretched, but the NHS only has the money to fund so many staff and to commission so many training places, and in the current climate they often look for people who can provide a cheaper service than psychologists. In one inpatient service I worked in as a HCA, the psychologist was not replaced when she left - they got a CP from another ward to do a few sessions on ours (nowhere nearly the amount of input that the previous psychologist had provided) and a CBT-trained nurse therapist was expected to pick up the slack. From what I've heard this is not an uncommon situation. I don't know much about NHS politics, but I imagine it would be difficult to push for an increase in training places if this sort of thing continues.
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Re: Do we need more clinical psychologists?

Postby ell » Thu Nov 09, 2017 9:08 am

Training a CP is extremely expensive (and then they are an expensive resource once qualified), and in times of austerity etc, commissioned places have been cut over the last few years. So while your logic holds true, there are realities that courses face. Even so, courses do fight hard for more places, and Oxford is an example of how places were cut and they fought for some of them back, and succeeded. Qualified CPs do care about this stuff. It's just that the real world means that this hasn't materialised into dozens more training places.

I also think that we need more nurses, medics, and other professionals. I would be inclined to say that these professions also need an influx of cash for training.

Another question I often wonder about when this debate comes up is, does the NHS/public service sector/government owe the large number of psychology graduates their choice of career? I'll just leave that one there...
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Re: Do we need more clinical psychologists?

Postby Spatch » Thu Nov 09, 2017 1:45 pm

I think there are several issues combined with that question.

1) As mentioned above, we really need more of everyone (GPs, nurses, social workers etc) so in that regard yes -we need more clinical psychologists. Demand is increasing, problems are becoming more complex and there is an increased focus on mental health. Everyone wants more clinical staff, but no one wants to pay more taxes to fund them (or push for privatisation which is the other way to raise funding).

2) Do we need to train more clinical psychologists under the current model? I am not sure we can. Training isn't just dependent on throwing money at courses, it is also heavily dependent on available supervisors in an area to provide core and elective placements. Just because you may theoretically be able to fund thousands of CP trainees, it doesn't mean that there will be the supervisors to train them. In reality placements are like gold dust, and courses guard their patches quite rigorously because of this.

3) To provide therapy? There are other workforces that can provide therapy more cheaply such as IAPT, but also entire workforces that are trained but not being utilised. Counselling is a good example, where there are thousands of motivated and accreddited counsellors coming off training courses who really struggle to find work, have to work for free, or never apply their skills. Wouldn't it be better to use that workforce before training other, more expensive clinicians?

It is a really complicated problem, and the boom years of the late 90s to the late 2000s where CP numbers shot up had some impact, but weren't really a magic bullet. It could be argued that increased capacity led to further demand and expectation.
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Re: Do we need more clinical psychologists?

Postby workingmama » Thu Nov 09, 2017 3:04 pm

Assuming that it were to be decided that there needs to be more clinical psychologists, the first link in that chain of recruitment would be to secure the funding for another qualified post/additional hours to existing services. Otherwise, you simply have a post-training 'bottleneck', than a pre training one. In monetary terms, any strategy that involves paying £200,000 per trainee (a figure that I have admittedly pulled out of thin air, but not entirely...) to then have a bunch of unemployed highly skilled psychologists, is not going to work. In my service we are decidedly working to increase funded CP hours. We have an apoplication for funding in consideration which is for another full time band 7, and another day at 8a for research. Once we had those hours, the next step is to recruit. Whilse there are posts unfilled at any time, I have no doubt that our service would fill those hours with good applicants, without having to train more CPs to do so. This doesn't mean that I don't think that we are not in need of greater access to psychology, but I think a focus on increasing the supply rather than the funded demand is a bit topsy turvy.
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Re: Do we need more clinical psychologists?

Postby miriam » Fri Nov 10, 2017 9:42 am

The first thing to say is that psychologists have always pressed the need for more clinical psychologists, and for increases in the numbers of training places - that has been the case for as long as I've been in the profession. We know that we have great skills to offer and that there is huge unmet need. But there are many intertwined supply and demand relationships - the funding for training, the available qualified posts, the banding we are given for our work and the roles we take on. We know that bandings are being squashed and posts are being cut, particularly at higher bands, and also that other professions are also in short supply and can be as good or better at therapy for lower cost.

Importantly, the level of competition means almost all CPs pass the course and are really good at their jobs. We don't have an obligation to provide employment for aspiring graduates, but we do have an obligation to safeguard our professional standards and the nhs investment in our training. We don't want to fund training for people who will drop out, or fail the course, or go off into the private sector as they qualify because there are no qualified jobs available in the nhs. So courses should be picky.

And finally, not all courses are as competitive as Oxford and London, so if you are more flexible geographically you can halve the level of competition.
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Re: Do we need more clinical psychologists?

Postby Rubedo » Thu Nov 30, 2017 1:43 pm

miriam wrote:Importantly, the level of competition means almost all CPs pass the course and are really good at their jobs. We don't have an obligation to provide employment for aspiring graduates, but we do have an obligation to safeguard our professional standards and the nhs investment in our training. We don't want to fund training for people who will drop out, or fail the course, or go off into the private sector as they qualify because there are no qualified jobs available in the nhs. So courses should be picky.


Would you say they're currently picky in the right way? i.e. effectively selecting the most promising trainees?
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Re: Do we need more clinical psychologists?

Postby maven » Tue Dec 05, 2017 4:05 am

Rubedo wrote:Would you say they're currently picky in the right way? i.e. effectively selecting the most promising trainees?
I would, yes. There is a very high success rate for training, and most CPs are very good at their jobs and stay in the profession. I think in my career to date I've met 3 CPs I don't think should have got onto training or passed the course, and another three who dropped out during training, and probably another three who were good CPs who have fallen below my thresholds due to various things that have happened after qualifying. Out of probably a thousand CPs that I have come across, that's not a bad ratio!
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Re: Do we need more clinical psychologists?

Postby aojke22 » Sun Dec 10, 2017 10:04 pm

Hello all and thank you for such thoughtful and detailed responses. I want to pop a quick placeholder reply here to say that I will respond to all of you who've been kind enough to comment at some point - I've not been too well and so haven't really had the spoons to sit down and engage with this in any meaningful way, but would hate to come across as someone who isn't contributing to a discussion they started up :) A.
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