How equitable are psychological therapy services in South East London now? A comparison of referrals to a new psychological therapy service with participants in a psychiatric morbidity survey in the same London borough.

PURPOSE: Psychological therapy services are sometimes characterised as being small and inequitable, with an over-representation of white middle class women. The 'Improving Access to Psychological Therapies (IAPT)' initiative is a programme in England that attempts to make evidence-based therapies accessible to more people more equitably. The aim of this study is to assess whether an IAPT service is delivering an equitable service a London borough. Patients using services at the Southwark IAPT service (n = 4,781) were compared with a sub-group of participants in the South East London Community Health study (SELCOH) with diagnosable mental health problems and who were also resident in Southwark (n = 196). METHODS: We compared Southwark IAPT patients and SELCOH participants on equity criteria of age, gender, ethnicity, occupational status and benefits status. To investigate if referral pathways influenced equity, patients referred by their general practitioner (GP pathway) (n = 3,738) or who self-referred (self-referral pathway) (n = 482) were compared with SELCOH participants. RESULTS: Southwark IAPT patients significantly differed from SELCOH participants on all our equity criteria and similar differences were found with GP pathway patients. However, self-referrals did not differ from the SELCOH group on age, gender, ethnicity and benefit status. CONCLUSIONS: When compared to a community sample with diagnosable mental disorders, health disparities were found with the overall Southwark IAPT service and with GP pathway patients. Although unemployed people did access IAPT, fewer disparities were found with the self-referral pathway patients, suggesting that the IAPT self-referral pathway may be important in reducing inequitable access to services.

Delusional belief flexibility and informal caregiving relationships in psychosis: a potential cognitive route for the protective effect of social support.

Aims. For people with psychosis, contact with informal caregivers is an important source of social support, associated with recovery, and with better outcomes following individual cognitive therapy (CBTp). In this study, we tested whether increased flexibility in delusional thinking, an established predictor of positive outcome following CBTp, was a possible mechanism underlying this effect. Methods. 219 participants with delusions (mean age 38 years; 71% male; 75% White) were grouped according to the presence of a caregiver (37% with a caregiver) and caregiver level of expressed emotion (High/Low EE, 64% Low). Delusional belief flexibility was compared between groups, controlling for interpersonal functioning, severity of psychotic symptoms, and other hypothesised outcome predictors. Results. Participants with caregivers were nearly three times more likely than those without to show flexibility (OR = 2.7, 95% CI 1.5 to 5.0, p = 0.001), and five times more likely if the caregiving relationship was Low EE (OR = 5.0, 95% CI 2.0-13.0, p = 0.001). ORs remained consistent irrespective of controlling for interpersonal functioning and other predictors of outcome. Conclusions. This is the first evidence that having supportive caregiving relationships is associated with a specific cognitive attribute in people with psychosis, suggesting a potential cognitive mechanism by which outcomes following CBTp, and perhaps more generally, are improved by social support.

[Catamnestic results of 64 patients--5 years following inpatient psychosomatic treatment]. / Katamneseergebnisse von 64 Patienten--5 Jahre nach der stationären psychosomatischen Behandlung.

The present study is an attempt at evaluating with clinocosomatic, psychodiagnostic, and sociologic instruments the alterations achieved by (psychodynamically oriented) psychosomatic in-patient therapy. Out of a total of 64 patients who in 1975 had undergone treatment for an average period of two months 46 (i. e. 76.7 per cent) were available for re-examination after a five-year interval. In two thirds of the patients the various complaints and the general autonomic instability had receded. The psychical and social situation had improved for between two thirds and three fourths of all re-examined patients both in their own opinion and in that of other people. Correspondingly there was a significant reduction in consultations at the physician's as well as days of disability and days of hospitalization per year. Factors contributing to a favourable diagnosis were: low age of the patient, short duration of complaint, substantial stress induced by the disease, and long-term in-patient treatment.

[Psychosomatic differentiation in patients following myocardial infarct]. / Zur psychosomatischen Differenzierung von Patienten nach Herzinfarkt.

An experimental study, based upon clinical impressions and theoretical considerations toward a differentiation of patients having suffered cardiac infarction, was employed to investigate the question of differentiation with regard to specific psychosomatic therapy. In conformity with other investigations it was observed that the patients with cardiac infarction could be classified into three groups. The theoretical considerations combined with the results from the experiments were the basis for the recommendation of specific therapeutic measures for each of the three groups: athletic group therapy for the more impulsive patients, single and group therapy for patients with regressive tendencies, combined group therapy in autogenetic training for sociable patients.

[Psychosomatic differentiation between colitis ulcerosa and ileitis terminalis (Crohn disease)]. / Zur psychosomatischen Differenzierung zwischen Colitis ulcerosa und Ileitis terminalis (M. Crohn).

The discussion on the differentiation of colitis ulcerosa and ileitis terminalis (M. Crohn) respectively has not as yet been settled in regard to their psychosomatic aspects. This study attempts to examine differences in the psychic manifestation occasionally discussed in the literature and in the clinical environment with the aid of psychological tests and data won by means of semi-standardized interviews. The results support the hypothesis that there are differences in the psychic structures of the patients from the two samples. Patients suffering from colitis ulcerosa show a closer resemblance to one another than the M. Crohn patients. The general impression is that they area "more normal" and better adjusted. Among the M. Crohn patients a difference must be made between an older, depressive part of the sample, and a younger, more active group with pronounced dependency conflicts. The connections with psychodynamic interpretations are discussed.

[Understanding implicit behavior]. / Zum Begriff des impliziten Verhaltens.

The point of departure of the present paper is the comprobation that the visible behaviour of an individual conveys information about his internal state to others, yet the description of this information transfer is limited by an insufficient conceptual framework. The most important historical approaches to the field of expressive behaviour are discussed. The peculiarity of language in information transfer as an "explicit" system of rules is constrasted with all the other kinds of behaviour which also play "informative" and "communicative" roles. For these the concept of "implicit" system is proposed and discussed. It is further shown that a strict distinction between "implicit" and "explicit" is not possible for behavioural manifestations, but rather they constitute poles of a continuum in which all communicative modes could be incorporated. Dichotomies most commonly used in human and animal communication and interaction researach are compared with the presented implicit - explicit dichotomy. The advantages of the latter are seen in the semantic clarification it could provide, thus leading to a somewhat clearer approach to different forms of behaviour research.