The Role and Contribution of the Consultant Psychiatrist in Psychotherapy in the NHS

This position statement has been prepared by the College's Psychotherapy Faculty in order to inform and advise the Department of Health about the specific role and contribution of medically qualified psychotherapists. The key points set out in the statement are summarised below.

The National Service Framework for Mental Health places psychological therapies at the heart of a modern health service. The National Plan is committed to workforce expansion and training.

Consultant psychiatrists in psychotherapy play a pivotal role in both training and delivery of psychological therapies. Their distinctive contribution includes:

1. • training junior psychiatrists, medical students and other health care professionals in communication skills, supportive psychotherapy and specific psychological techniques of proven effectiveness;

2. • the capacity to assess and treat complex and severe cases;

3. • the capacity to combine pharmacotherapy with psychotherapy;

4. • supervising and supporting psychotherapeutic work in primary care, community mental health teams (CMHTs) and acute in-patient units;

5. • acting as product champion for psychological therapies among doctors, psychiatrists and the mental health workforce as a whole;

6. • providing a specific service for people suffering from severe personality disorders and other complex diagnostic groups;

7. • taking responsible medical officer responsibility for complex cases, participating in ‘on-call’ rotas and other aspects of the work of the consultant psychiatrist.

They have a 6-year medical training: a 3-year general psychiatric training which includes a mandatory psychotherapy component, and a further 3-year specialist registrar training in psychotherapy. The latter programme equips them with a broad range of expert psychotherapy skills in at least three modalities, and enables them to assess and offer appropriate treatment to complex cases.

Psychological therapies are evidence-based treatments, best organised in a ‘tiered’ fashion, with simple time-limited treatments delivered in primary care, more difficult cases treated and held in CMHTs and complex cases referred for specialist therapies.

Consultant psychiatrists in psychotherapy work as part of a multi-disciplinary psychological therapies team alongside psychologists, nurses, counsellors, occupational therapists, social workers and ‘lay’ psychotherapists.

They are few in number and unevenly distributed. Users and carers consistently call for more ‘talking treatments’. ‘Postcode’ variation in provision of psychological therapies is the norm. A drive led by the Department of Health to create more consultant psychiatrists in psychotherapy posts will help overcome these gaps and inequalities in provision.

The full report is available from the College's Book Sales Office, tel: 020 7235 2351 ext. 146.