1. Preventative Work & Promotion
of Psychological Wellbeing
in Clinical Psychology
Shona Brown
Fleur-Michelle Coiffait
Gráinne O’Brien
Louise Roach
Trainee Clinical Psychologists
University of Edinburgh
Monday, 14 May 2012

2. Preventative Approach
• “…interventions that anticipate a disorder,
or promote optimal health prior to the
onset of a disorder (Goldston, 1977).
• Physical health – immunizations, obesity
Monday, 14 May 2012

3. Why useful in mental health?
• 450 million people alive today suffer
mental health disorders (WHO, 2001)
• Personal impact
• Economic implications (Layard Report,
2005)
– Focuses on individual level
Monday, 14 May 2012

4. Focus of interventions
• Why don’t individuals seek help?
– Stigma
– Failure to identify symptoms
– Unaware of local resources
Targeted by prevention of mental health
problems and promotion of mental
health wellbeing.
Monday, 14 May 2012

5. Types of Prevention
Programmes
• Universal
• Selective
• Indicated
Monday, 14 May 2012

6. Prevention Programmes
• Depression in adults – prevention of
development of moderate depressive
episodes and reduction in symptoms of
anxiety and depression
(Seligman et al., 1999; Munoz et al.,
1995)
Monday, 14 May 2012

7. Prevention Programmes
• Depression in children – reduction in
depressive episodes and symptoms of
depression
(Clarke et al., 1995; Jaycox et al., 1994)
• Substance misuse, anxiety, suicide...
Monday, 14 May 2012

8. Recommendations for
Prevention Programmes
• In order to be most effective, a screening
process should be used. Focus on
participants especially at risk
• CBT is a popular model on which to base a
programme
• Group programmes are common, but
individual approaches are also possible
Monday, 14 May 2012

9. Prevention Programmes?
Early Bird
The NAS EarlyBird Programme is autism-
specific and has three content 'threads'. It
helps parents to:
• understand their child's autism
• structure interactions in which
communication can develop
• pre-empt problem behaviours and handle
those that occur.
Monday, 14 May 2012

10. Prevention Programmes?
Mellow Parenting / Mellow Babies
• Aims to support parents with relationship
problems with their infants and young
children
• Combines personal support for parents
with video and direct work with parents
and children addressing parenting
problems
Monday, 14 May 2012

11. Prevention Programmes?
The Solihull Approach
• Integrated model of working
• Resource packs and training for care
professionals
• Focuses on containment, reciprocity, and
behaviour management
• Research suggests 66% reduction of
parental anxiety
Monday, 14 May 2012

12. ‘Mental capital’
over the course of life
Beddington et al. (2008)
Monday, 14 May 2012

13. Early Intervention in Childhood
• Maximising protective factors: proactive
approach to mental health and wellbeing
• Minimising effect of threats to mental
wellbeing: early intervention
Monday, 14 May 2012

14. Pyramid Clubs
• Screening of children at risk: Strengths
and Difficulties Questionnaire
(SDQ; Goodman, 1989)
• Multi-agency meeting to select 10 children
• 10 week activity club hosted by schools
• Trained volunteers provided by National
Pyramid Trust (charity) run the clubs
Monday, 14 May 2012

15. Pyramid Clubs
• SDQ completed as follow-up measure
• Rich data set (pre- and post- activity club)
but little published research
• Children with and without difficulties
appear to benefit from attending.
• Significantly larger effect size for children
with identified difficulties (Ohl et al., 2008)
Monday, 14 May 2012

16. Nurture Groups
• For primary school children with social,
emotional or behavioural difficulties (as
measured using Boxall Profiles)
• Small ‘nurturing’ class with increased staff
ratio
• Taught social skills and practical skills as
well as curriculum based work
• Routines, explanations in context
Monday, 14 May 2012

17. Examples with Adults
• Role for CPs in training, consultancy and
research at multiple levels. Some
examples:
- media e.g. BBC’s “Headroom”
- specific programmes e.g. Positive Mental
Attitudes Workplace Intervention in
Glasgow
Monday, 14 May 2012

18. Media
• May 2008 BBC launched 2 year
“Headroom” campaign
• Includes on air programming, outdoor
events and interactive website
• Aim “to actively encourage people to
assess their mental wellbeing and take
simple, practical steps to manage or
improve it”
Monday, 14 May 2012

19. Media
• Peter Kinderman (Professor of Clinical
Psychology at the University of Liverpool)
developed “Mind Spa” component of
website
• Participants complete online assessments
of their mental wellbeing and receive offer
of personal life coach to explore results
and develop plan with goals for the future
Monday, 14 May 2012

20. Media
• Benefits = BBC so reaching large
audience, multifaceted “intervention”,
increasing knowledge?, reducing stigma?
(need for well conducted research)
• But.. Many similar websites (e.g. Chris
Williams’ LLTTF, Mood Gym). Waste of
resources? Risk that users (and possibly
referrers) will feel overwhelmed with
choice?
Monday, 14 May 2012

21. Positive Mental Attitudes (PMA) –
Workplace Programme
• Visit workplaces throughout Glasgow to
provide mental health awareness sessions
to staff.
• Assist organisations to develop mental
health and wellbeing policies
• Claim benefits to organisation (e.g.
reduced staff absence and staff turnover).
• Broader aim of increasing knowledge and
reducing stigma
Monday, 14 May 2012

22. Positive Mental Attitudes (PMA) –
Workplace Programme
Aim for participants to leave with increased
understanding of:
• Mental health, mental health problems
and their causes
• How to maintain their own mental health
and that of those around them
• Mental health and wellbeing resources
Monday, 14 May 2012

23. Positive Mental Attitudes (PMA) –
Workplace Programme
• PMA run other projects (Later Life, School
based, Asylum Seekers and contribute to
Scottish Mental Health and Arts Festival)
• Funding and management input from NHS
• Input from CPs based in primary care
mental health team – consultancy role
with regards content of programmes and
research supervision
Monday, 14 May 2012

24. Why are psychologists best placed?
• Knowledge base
- expertise in area
- Increase own knowledge
• Interdisciplinary working
• Scientist Practitioner
– Research, audit and evaluation
Monday, 14 May 2012

25. Barriers to preventative mental health
practice
• Who to target?
• Is it possible within current resources of
clinical psychology?
• Where responsibility lie?
– ‘Bystander effect’ (Ball, 2008)
Monday, 14 May 2012

26. Future Directions
• Shift in paradigm needed – become more
prevention focused
• Further research needed
– Need to ascertain validity and effectiveness of
interventions.
• CPs well placed to contribute to this
research agenda
Monday, 14 May 2012

27. Any questions?
Monday, 14 May 2012