May 3, 2011

Future of Clinical Psychology in the NHS

Nature (21 April 2011 edition) recently ran a series of special articles on the future of the PhD., all of which asked serious questions about the value of the doctorate in a job market that no longer appears to properly compensate the hard work of students with rewarding careers of their choice. Mark Taylor's editorial was quite frank: "Reform the PhD. system or close it down", suggesting updated and relevant curricula as well as cross-disciplinary communications as ways to move forward, and to discontinue 'redundant' programmes and use their resources for more productive lines.

Noah Gray, a senior editor at Nature, elaborated:
"..At some point we have to expand our view beyond academia and ask which jobs really need a PhD. and which don't. Academia asks a lot from its graduate students and isn't prepared or capable of providing a return on the investment of blood, sweat and tears made by the students. It only seems logical to contract somewhat, for the good of the students who are not aware of this difficult reality, rather than continue to exploit masses of under-compensated labor who may ultimately invest far more energy and time into a endeavor that will not place them in an adequate career."

In general it sounds a lot worse than it is; assuming that the ideas discussed in this series come to fruition, it becomes mainly an attempt at streamlining rather than wholesale cutting down.

It got me pondering the situation in the UK. Two years ago, the Feb 2009 issue of Clinical Psychology Forum (forum magazine of the Division of Clinical Psychology of the British Psychological Society) published an interesting article/study regarding the future of clinical psychology placements within the NHS. While it is well known that clinical psychology is a highly competitive area and that more applications are turned down than accepted, there seems to be newer causes for worry other than excellence in academia or training. Harriet Francis-Ehnholm and Tanya Petersen (hereafter "the authors") introduce the topic by describing their attempt to undertake a survey of ClinPsy. trainees and their opinions about clinical psychology during a conference held at the University of Hertfordshire. In the 1990s a shortfall in NHS clinical psychologists was remedied by increasing the number of training places, 583 places were available in 2007 which was a huge improvement from 321 places in 1997. (The situation has improved since; Leeds Clearing House report 617 places were available in 2010, although it is humbling to note that 11,319 applications were made.) However in the face of funding cuts the reduction in the number of clinical psychology posts results in fewer clinical placements for those already in training, leading trainees to wonder about the availability of jobs after completing the course.

To get an idea of the trainees' views, the authors carried out a survey questionnaire that covered three main topics:

  • What were trainees' thoughts about the future of the profession?
  • Had working in an 'uncertain' climate affected trainees' views of clinical psychology?
  • How does the next generation of psychologists intend to make the future more certain?
The surveys were distributed to the sample of 40 trainees, though only 24 returned a response! The results were more or less what one would expect: before the commencement of training job and security expectations were varied, which significantly narrowed after embarking on training and which resulted in envisaging a more constrained career path along with less security and choice. The interesting thing is that despite experiencing negative effects of funding cuts such as low morale and the threat of job cuts/service closures, all of them indicated that they still wanted to continue training to be clinical psychologists. Although it came to light that trainees felt they might benefit from advice on alternatives to working in the NHS and also on how to market the profession effectively to the public, they remained generally optimistic about the future of clinical psychology.

The authors concluded that while University of Hertfordshire trainees were fortunate not to experience the effects of any cuts in training places, they nevertheless experienced the effects of NHS funding crises on their clinical placements and of working in a climate of uncertainty. Now that things have moved on from 2009, that climate is sure to have worsened with service cuts, poor results and the resultant low morale that has emerged in clinical services across the board. A recent blog at The Psychologist by Christian Jarrett reports a disconcerting outlook for psychology as a whole in the UK as a result of the Conservative-Liberal Democrat coalition government's spending review; a 50% slashing of PGCE Psychology places, research councils announcing a redirection of neuroscience-allocated funds in line with their research priorities, and a possible restructure of client services.

It all begs the question as to what clinical psychology trainees might think now in this bleaker situation. If the authors' snapshot article is anything to go by, the anxiety and stress felt by current trainees is likely to be amplified even more in this uncertain situation of global economic worries. However, a surprising suggestion of the authors is for the NHS to modify their programmes and training accordingly, even to the extent of suggestion that trainees be provided with teaching in private practice and how to set about this type of work, in spite of the fact that this may cause a conflict of interest (you know, getting trained by the NHS to work in the NHS and then uh,... not doing that).

Considering all of this, what can prospective clinical psychologists look forward to? More uncertainty? Faint light on the horizon? Is it time to call for an open discussion?


  1. Pretty good post. Great job. I think this is a very insightful post, very informative .

  2. The future of clinical psychology hinges on our ability to integrate science and practice.Clinical psychology, like other branches of psychology, has seen many changes over the past 50 years.
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  3. Psychology has extended from the time of Sigmund Freud. There a lot of branches of psychology and one of the most basic is the clinical psychology. And this blog has given a wide range of information regarding it which enhanced what I used to know before. Although there have been been many slight changes and additional knowledge contributed by many outstanding psychologists nowadays, Sigmund Freud's notion about it is the most referred when looking for its main idea and definition. Clinical Psychology is wonderful to understand.