Implementing the NICE guideline for schizophrenia recommendations for psychological therapies: a qualitative analysis of the attitudes of CMHT staff

• Published in: Clinical psychology and psychotherapy 2011-01, Vol.18 (1), p.48-59
• Main Authors: Prytys, M., Garety, P. A., Jolley, S., Onwumere, J., Craig, T.
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Attitudes; CBT; Clinical psychology; Cognitive Therapy - methods; Community Mental Health Services - methods; Data processing; Family Therapy - methods; Female; Guideline; Health Plan Implementation - methods; Humans; Implementation; Intervention; Interviews as Topic; London; Male; Mental disorders; Mental health; Practice Guidelines as Topic; Pressure; Psychosis; Psychotherapy; Psychotherapy - methods; Qualitative research; Sampling; Schizophrenia; Schizophrenia - therapy; State Medicine
• ISSN: 1063-3995; 1099-0879
• DOI: 10.1002/cpp.691

Objectives. Despite national guidelines recommending cognitive–behavioural therapy (CBT) and family intervention (FI) in the treatment of schizophrenia, levels of implementation in routine care remain low. The present study investigates attitudinal factors amongst community mental health team (CMHT) staff affecting guideline implementation. Design. CMHTs were audited to measure the capacity and delivery of CBT and FI, and semi‐structured interviews were conducted with staff from the teams. Methods. Four CMHTs were audited, and five care coordinators from each team were interviewed. A purposive approach to sampling was used to represent the range of professional training of care coordinating staff. Data were analysed using thematic content analysis. Results. Positive views towards guidelines were evident, although tempered by specific implementation issues. Employing simple psychological interventions and approaches as part of the care coordinating role also emerged as highly valued by staff. Severe workload, time pressure and the need for specialist staff were crucial barriers to implementation. Pessimistic views of recovery for clients with psychosis were also apparent and may affect implementation. Conclusions. Staff attitudes and knowledge are an important area of research when examining guideline implementation and require further study. Key themes that have emerged could inform future training agendas and should be considered when developing guideline implementation strategies for the updated 2009 guidelines. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: • There continues to be limited access to psychological therapies for those with a diagnosis of schizophrenia—barriers relate to staff attitudes and knowledge as well as training, resources and organization of services. • A rolling programme of training is required to ensure all clinical staff have a broad understanding of recommended psychological therapies and are competent to discuss these interventions with patients and carers. • Services require access to staff with both the appropriate competencies and dedicated time to deliver CBT for psychosis and FI and ongoing supervision of this work. • Services should regularly and objectively audit eligibility for interventions and offers, uptake and outcome of therapy.