ABSTRACT
BACKGROUND: Behavioural Activation (BA) is an evidence-based psychological treatment for depression based on behavioural theory. However, in common with other talking therapies, there is limited evidence about occupational factors related to treatment. This is an important gap in the research given the emphasis placed on employment considerations in recent service initiatives. AIM: A service evaluation to investigate the clinical and fitness to work outcomes of a group BA programme for serving military personnel. METHOD: 46 patients experiencing moderate to severe depression attended a 12-session Military Behavioural Activation and Rehabilitation Course (MBARC). The primary outcomes were the Patient Health Questionnaire-9 (PHQ-9), a self-report measure of depression and the patient's medical employability category. RESULTS: Clinical and statistically significant changes were found on the PHQ-9 between pre-course and 3-month follow-up. Pretreatment 3 patients (6.5%) were psychologically fit to deploy on full operational duties in their primary role; this increased to 25 (56.8%) and 29 (65.9%) at 3 and 6-months respectively. CONCLUSION: Preliminary findings suggest that MBARC is a clinically and occupationally effective treatment for depression in military personnel. Further research is required to identify if BA delivered in a group setting would be effective in non-military settings and whether treatment benefits are maintained in the longer term.
Subject(s)
Behavior Therapy/methods , Depressive Disorder/rehabilitation , Military Personnel/psychology , Psychotherapy, Group/methods , Rehabilitation, Vocational/methods , Work Capacity Evaluation , Adult , Community Mental Health Centers , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Disability Evaluation , England , Follow-Up Studies , Humans , Occupational Health Services , Outcome Assessment, Health Care , Psychometrics , Surveys and QuestionnairesABSTRACT
OBJECTIVES: Recent service developments in the NHS on the provision of talking therapies such as the Improving Access to Psychological Therapies (IAPT) initiative have made the compliance with clinical supervision (CS) inherent among its service guidelines. This paper presents the findings of an audit, measuring compliance with CS among clinicians providing psychological therapies within a military Department of Community Mental Health. METHOD: Adherence to the recommended monthly supervision and the presence of an indate CS contract were audited on two separate occasions over 2 years by analysing the departmental electronic CS database. RESULTS: Compliance rates were found to be lower than the Defence guidelines, which are already modest in their expectations compared with IAPT CS standards. DISCUSSION: Potential reasons are hypothesised including high levels of staff rotation, other military commitments, clinicians not keeping up-to-date records and the pressures of meeting performance indicators on other clinical issues. Proposals for improving the uptake of CS are suggested along with areas for further research.
Subject(s)
Military Personnel , State Medicine , Humans , Mental HealthABSTRACT
These are my personal views and reflections from a hugely rewarding experience. They are not opinions or recommendations of the MOD or any other institution I am associated with. I realise that there may be various logistical reasons why my recommendations cannot be carried out; however I do hope that some will be able to be put into place. If nothing else I gained a massive amount from my travelling fellowship and it has already had a positive impact on my own clinical work. I hope to continue to pass on what I have learnt from the fellowship for many years to come. A special thank you goes to the Winston Churchill Memorial Trust for providing me with this fantastic opportunity and everyone who helped me before and during my visit.
