David Kingdon, MD: Significant Advances in Psychosis

With mental health becoming a more frequent topic of discussion, the delivery of mental health care has come into the spotlight now more than ever. At the 2019 Annual Meeting of The American Psychiatric Association, clinicians and mental health professionals discussed novel treatments, advances in care, and the implications of new data on clinical practice.

David Kingdon, MD, FRCPsych, professor of mental health care delivery at the University of Southampton, chaired a discussion at APA 2019 on treating psychosis using cognitive behavioral therapy and sat down with MD Magazine® afterwards to discuss his thoughts on recent advances in psychosis.

MD Mag: What have been the most significant recent advances or discoveries in the area of psychosis?

Kingdon: Well, I'm biased about it but I think psychological treatment I've actually it is really revolutionizing care in places where it’s available because it really changes the attitude, the way people interact with people with psychosis, the way service users can develop these techniques quite often and work with others. In fact, we've learned a lot from Hearing Voices Network in the UK which showed us a lot of the ways in which people can communicate about voices very productively. So, I think those are some of the most important developments. I think the whole issue about how do we implement evidence-based practice — it's an absolutely key one now and we're looking at doing that much more systematically in the services in which I work so that we get really good outcome measurement in place. So, we use something called the Health and National Outcome Scale which quantifies a clinical assessment and dialogue, which is a patient rated outcome measure which asks people about their satisfaction with different levels of care and that's been shown alone to improve quality of life.

Then, you can add dialogue plus the solution-focused approach to it and these are some things that community care workers, psychiatrists, psychologists and others can all use, can use readily. It gives you a good idea about whether you're making progress because if the area they identify as a dissatisfaction is somewhere they want help with you, offer that help and they feel better for it. It's a pretty good outcome measure basically and then following on from that is really just rating against the different quality standards that are really so important in terms of care of people with psychosis.

So, again, the National Institute of Dual Excellence in the UK has set a series of quality standards about physical health, about family work, about employment and about CBT (cognitive behavioral therapy) for psychosis/ We're now reaching a point where our patients being assessed against those and you know much better now whether those standards are being met, or in progress, or not being met — and if they're not being met is it the resource isn’t there and available? This is giving us much better standing of how we can design services effectively. Design training so that trainings put in place that's appropriate, and at different levels as well to the same treatment. So, moving forward I think that's going to be a very, very important development in the next few years because it's great having the treatments got to have them available that you've got to have people actually using them and getting involved with them.