The NICE Guidance1 outlines the following four-level model of professional psychological assessment and intervention, which should be developed and implemented in each Cancer Network (see Figure 1).
Figure 1 : Recommended model of professional psychological assessment
All health and social care professionals
Recognition of psychological needs
Effective information giving,
Compassionate communication and general psychological support
Health and social care professionals with additional expertise
Screening for psychological distress
Psychological techniques such as problem solving
Trained and accredited professionals
Assessed for psychological distress and diagnosis of some psychopathology
Counselling and specific psychological intervention such as anxiety management and solution-focused therapy, delivered according to an explicit theoretical framework
Mental health specialists
Diagnosis of psychopathology
Specialist psychological and psychiatric intervention such as psychotherapy, including cognitive behavioural therapy CBT
It recommends that psychological support at Levels 1 and 2 should, in the first instance, be provided by health and social care professionals directly responsible for the care of people with cancer (and any life threatening illness irrespective of diagnosis).More severe psychological distress (Levels 3 and 4) should be managed by a variety of psychological specialists, including counsellors, mental health nurses, clinical and health psychologists, psychotherapists and liaison psychiatrists.
Whilst some attempts have been made to develop psychological support at all levels locally, the picture that emerges is that effective psychological support heavily relies on the multi-disciplinary supportive and palliative care teams and Chaplains across the care settings.