A National Evaluation of the Counselling in Primary Care Service (CIPC)

Abstract

Until this study, there were no national data for the effectiveness of counselling or psychotherapy provided in the primary care context in the Republic of Ireland. The government policy document Vision for Change states that 35% of all primary healthcare service users attend their GP with a mental health element to their overall presentation (The Stationery Office, 2006). The HSE?s nationally available Counselling in Primary Care (CIPC) service was fully implemented in July 2013 in order to address excessive waiting times for access to psychology services for people experiencing mild to moderate mental difficulties. Clinical evaluations are crucial for providing evidence for the effectiveness of counselling in primary care settings. The aim of this study was to provide the international research community, mental health policy makers and other stakeholders with effectiveness benchmarks regarding the behaviour of variables shown by previous research to be influential in outcomes of counselling and psychotherapy. This study involved a very large sample of CIPC clients (N = 2,781) attending therapy at locations spread across the Republic of Ireland. In order to improve counselling services for users it is beneficial to know the relationships between particular therapeutic characteristics in a real-world setting and outcomes for service users, e.g. severity of initial distress, gender differences etc. Further, while the efficacy of psychological treatments is established in randomised clinical trials it is vital that funding bodies can comprehend how investment in efficacy is converted into effectiveness in routine conditions. Evaluations have been conducted in the United Kingdom Australia and the United States and contribute greatly to understanding the role of primary care counselling and psychological interventions. As well as assessing the overall effectiveness of the CIPC service using pre/post analyses and calculating effect sizes, the study also examined the effect of the duration of therapy on client outcomes using logistic regression to determine the likelihood of clients achieving reliable and clinically significant improvement (RCSI).The role of the initial severity of clients problems was also examined (as determined by counsellor/therapists? evaluation as well as an objective measure as determined by CORE OM scores) in terms of its effect on outcomes. Regarding the longer term effect of counselling, additional data were provided by 240 study participants six months after therapy ended which as analysed by way of multi-level modelling. The model indicated a significant effect of time on CORE OM scores, which were also predicted by the initial severity of clients? problems and the overall duration of therapy at statistically significant level. There were no differences in outcomes for clients receiving a single therapy approach and those receiving more than one approach and no one of the approaches performed better than others in terms of statistical significance. The study also examined outcomes from the Health Related Quality of Life questionnaire (HRQOL). This measure is used extensively in the United States by the Centre for Disease Control (CDC) as both an outcome measure and population health tracker. Its brevity (four items) and framing of three of the four items as a number of days in the previous 30 when respondents physical and mental health was not good, and the days their activity was limited has been widely accepted as a reliable and valid measure of HRQOL. This study found a good level of congruence between the HRQOL and the CORE OM. Participants in the study showed significant levels of improvement across all items with significant reductions in the number of unhealthy days reported between pre and post therapy and improvement in their perception of their general health.