Psychological Therapies Services (PTS)

Who to refer:

It is crucial to assess readiness for psychological therapy and West Lothian therapists have developed a video to help: https://vimeo.com/810921466/568214aa08

Please consider:

Are the presenting difficulties and/or distress related to and seen as psychological (internal) difficulties?   Yes/No

Does the individual have clear goals for treatment? Specify where possible.   Yes/No

Can the individual commit to regular sessions and see their role in therapy as active (often with tasks to complete between sessions)?   Yes/No

• Individuals experiencing mental health difficulties including, but not limited to:
  • depression
  • anxiety disorders
  • trauma reactions
  • complicated grief
  • difficulties with regulating emotions
• Individuals with co-morbid presentations of the above
• Individuals with the above presentations in the context of neurodevelopmental presentation (ASD/ ADHD) where mental health disorders are the primary concern.
• Mental Health Disorders are having a moderate to severe impact on day-to-day functioning.
• Individual demonstrates a degree of curiosity and reflection regarding their difficulties.
• Individual is able and motivated to attend regular, active therapy sessions.
• Able to identify a clear focus of treatment.
• Motivated to explore and engage in a process of change.
• Able to develop a positive working relationship with the therapist and service.
• Able to tolerate a degree of exposure to difficult emotional states.
• Able to sustain a level of stability in functioning to be held by an independent clinician.

Referral Prioritisation and Risk Management.

Lothian Psychological Therapy Services are not crisis services and do not provide urgent assessment or treatment appointments.

Prioritisation: the service offers priority appointments based on the following: Individual is pregnant and mental health difficulties are likely to impact on pending parenthood. For those with severe and chronic mental health problems who need MDT input, referrals should be made to the Community Mental Health Teams.The Community Perinatal Mental Health Team should be considered for those who have babies/children aged up to 12 months, as well as those with a history of mental health disorders who are pregnant.  Veterans with mental health disorders associated with their military service. Referral to Veterans 1st Point should be considered. This service also accepts self-referral.

Immediate Risk: Individuals who present with other immediate risk factors will be directed to appropriate alternative services for priority assessment. Such risk factors include: Immediate high level of risk to self or others.Risk of loss of home.Risk of hospital admission. Alternative services for priority assessment include: Primary care psychiatry/ nursing/ open access services.Community mental health teamMental health crisis services.Intensive Home Treatment Team.

Ongoing Risk: Individuals who present with ongoing long-term risk factors will follow the routine route for assessment.

Once accepted into the Lothian PTS for treatment, risk may be managed jointly between the Lothian PTS and relevant other disciplines via an agreed crisis plan. Individuals will continue to be directed to crisis services for urgent support. If an individual requires a case management approach and cannot be held safely by an independent clinician for psychological treatment, the treatment planning will be reviewed for other services with MDT input.

Who not to refer:

• Individuals whose primary needs are social or practical – consider establishing initial stability before considering psychological intervention.
• Individual is already undertaking psychological therapy or counselling in NHS, third sector or privately and wishing to continue this.
• Individual has significant cognitive impairment which may prevent them from engaging in therapy. This may be due to a learning impairment, neurological condition or ongoing drug or alcohol reliance.
• Individual is unable to commit to regular attendance at therapy sessions and a focus on change out with sessions.
• Individual is presenting with a degree of social instability which will likely impact engagement in a change process at the present time.
• Individual is presenting with a high degree of risk to themselves or others (see below) or social needs that requires a team coordinated / case management approach.

How to refer:

Referral is via SCI Gateway to the relevant local sector mental health team.

Any referral will be triaged by the multidisciplinary team and taken forward by the sector Psychologist if suitable. The outcome of all referrals will be communicated to the referrer.

Key referral information

To make an informed decision regarding suitability for the service, it would be helpful if a referrer could  include key questions:

Are the presenting difficulties and/or distress related to and seen as psychological (internal) difficulties?   Yes/No

Does the individual have clear goals for treatment? Specify where possible.   Yes/No

Can the individual commit to regular sessions and see their role in therapy as active (often with tasks to complete between sessions)?   Yes/No

Additional helpful information includes:

• Social context
• Significant life events.
• Previous/ current mental health input.
• Individual expectations of psychological therapy.
• To support this decision, it is helpful to complete the following with the individual and return with the referral:
  • Readiness for Psychotherapy Scale
  • Core-10