Hope you are all well and good! In all honesty, I don’t enjoy being the bearer of bad news.. but my placement has unfortunately come to an end. I never imagined my time would come to an end so suddenly, but it seems if you keep yourself occupied long enough, you won’t even realise where time has disappeared to! It’s truly sad to see the placement coming to an end and especially saying the final farewells (the part I find the hardest!). The way I see it, it’s all part of the learning process and I’m really grateful for the opportunity that I have been given. I was always on the fence about choosing a career in clinical psychology, but I feel I have a much clearer idea now.
As this is my final blog post, I will give the most credible and honest (believe me when I say this) feedback about my time as an honorary at BSMHFT. I will give you a breakdown of the service, what I did on a day to day basis, the psychological interventions that you will encounter and important tips to remember if you are one of the lucky ones working in a CMHT setting as part of your placement year!
Community Mental Health Team (CMHT):
The core function of CMHTs are to provide assessments and interventions for people experiencing moderate to severe and enduring mental health problems. The diagnosis criteria includes psychosis, post-traumatic stress disorder, anxiety, depression, bi-polar disorder and OCD. People can only be referred to this secondary care service by their GP or a primary care service such as IAPTs (Improving Access to Psychological Therapies) or BHM (Birmingham Healthy Minds). To accomplish and complete shared objectives, a CMHT is made up of professionals from different disciplines including Clinical Psychologists, Psychiatrists, Support Workers, Occupational Therapists and Nurses.
➔ Shadowing assessments and other members of staff: I was given many opportunities to sit into assessments which measure a persons suitability for psychological therapy. During this, the clinician usually requested me to make notes from which I could make a formulation (see below). As you’ll be working in a multi-disciplinary team, you will be able to shadow other team professionals such as psychiatrists, occupation therapists and support workers.
➔ Writing formulations and case histories: Throughout the year, I was involved in planning service user care programmes. Following an assessment, I would use the 5P formulation (Predisposing, Precipitating, Presenting, Protective and Perpetuating factors) to organise the notes and present them to the clinician. Also I was given the task of completing detailed case histories which required reading through their past history and summarising the information into one easy to read document. Both helped in making a decision whether the client should be taken up for therapy.
➔ Facilitating group programmes: At my CMHT, I was fortunate enough to participate in a depression group programme. Here the service users were provided with therapy (Cognitive Behavioural Therapy and Mindfulness) in a group setting. My role as an honorary assistant was to write up progress notes, scoring measures and facilitating mindfulness exercises.
➔ Attending meetings: On a weekly basis, I attended multi-disciplinary team meetings which involved discussing about team caseloads. Here different professionals would offer their own insight into how best resolve managing a service user. Also on a monthly basis I attended business and depression group programme meetings.
➔ Conducting audits: As an Honorary Assistant, you will be required to complete an audit during your placement time. This will involve you collecting and analysing data from the database and trying to identify anomalies that shouldn’t otherwise be there. Once complete you will have to report back in the meeting.
➔ Maintaining databases: At the CMHT, the psychology team will have their own spreadsheet database which allows clinicians to track referrals to Psychology. As an Honorary Assistant, it will be your role to keep this spreadsheet up to date by entering referral dates, appointments attended and assessment forms received.
➔ Aston CPD programme: On a weekly basis you will be given training on topics relevant to your placement. These will be facilitated by clinical psychologists based on their speciality. Topics will cover basic formulations, psychosis, and research methods.
➔ CORE/Scoring measures: During assessments, service users are required to complete questionnaires. These are used to assess the severity of the individuals problems. You will come across measures such as Becks Depression Inventory, Depression Anxiety Stress Scale and Five Facet Mindfulness Questionnaire.
Psychological Interventions offered in a Community Mental Health Team (CMHT) setting:
Out of all psychological therapies provided, you will see that Cognitive Behavioural Therapy (CBT) will be administered quite frequently and is the first choice of therapy by Psychotherapists. There are interventions which focus on relapse prevention and early warning signs. Here therapists focus on making coping strategies which can help clients handle their symptoms and identify signs of relapse. This reduces the number of clients from becoming admitted to hospitals. A powerful and newly emerging therapy known as Mindfulness Based Cognitive therapy (MCBT) which aids in preventing relapse of depression, especially in individuals with major depressive disorder.
Therapy specially designed for treating patients with trauma related symptoms such as Eye Movement Desensitization and Reprocessing (EMDR) incorporates elements from many different treatment approaches. Individuals who may suffer from chronically suicidal thoughts and diagnosed with borderline personality disorder (BPD) can be offered Dialectical Behaviour Therapy (DBT). Behavioural Activation therapy is often used to encourage individuals to develop positive behaviour that they would usually avoid doing.
Things you need to remember:
➔ You will most likely feel overwhelmed when encountered with word terminologies and areas of psychology which you might not be familiar with. Don’t worry you will pick it up without realising but don’t be scared to ask others if you are unsure! They know you are a placement student and would be happy to answer all your questions.
➔ This placement year will be a steep learning curve, expect to make mistakes, but make sure to learn from them! Through my own experience I would highly recommend carrying a diary and making good use of it. Placement staff will begin to trust you when you can prove you can work by yourself and show self-initiative. As the placement progresses you will be given more and more to do!
➔ Before sitting in on an assessment to see a client, it is useful to read up on their background history. This will help you know what to expect!
➔ You will only gain shadowing experience if staff are aware of who you are! Try and get yourself known within the team by attending meetings and any other social events.
➔ You will have been assigned a placement tutor who will give you useful advice throughout the year and will be happy to talk to you about any thoughts, issues and most importantly your systematic review.
➔ You will have regular contact with other Aston placement students and will be attending weekly training sessions provided by the NHS. Make good use of this time to address any worries you may have with your peers.
➔ If you have any issues that you wish to raise don’t be afraid to speak up. Both the placement and Aston university want you to make the most of this year but also at the same time want you to enjoy it thoroughly.
Disclaimer: You will be expected to complete the minimum 150 days which will require you to work full-time unpaid 4 days a week. Remember don’t count the days, make the days count! Once you have finished for the day you have actually finished; you will not be required to take any work with you home. This leaves your evenings and weekends completely free!
It’s been a pleasure blogging my placement experience to you all! I wish you all the very best in life and hope I have been of help! Whenever in doubt remember:
“There is no elevator to success, you have to take the stairs!”