Promoting psychological interventions in psychosis: the NSW Tertiary Referral Service for Psychosis

ABSTRACT Experience of psychotic illness has an enduring impact on a person’s life, relationships and function. International guidelines recognise the importance of psychological interventions alongside pharmacological strategies in improving outcomes for people living with psychosis, including cognitive remediation therapy (CRT) and CBT for psychosis (CBTp). The Tertiary Referral Service for Psychosis (TRSP) is a publicly funded mental health service, consisting of a multidisciplinary team that utilises a biopsychosocial framework to inform holistic evidence-based recommendations tailored to an individual’s goals, including access to psychological therapies. In this commentary, we introduce the TRSP, and describe its origins and development. We detail the complementary roles and specific expertise of the clinicians involved within the TRSP multidisciplinary team. We highlight a key aspiration of the service: to routinely promote the use of evidence-based psychological interventions in addition to pharmacological treatment. We summarise the evidence base for these psychological therapies both in improving function and in reducing distressing symptoms in psychosis. Finally, we describe the challenges faced by the TRSP to date in aspiring to promote routine access to psychological interventions in psychosis. Key Points What is already known about this topic: (1) Psychotic illness is often chronic. Distressing experiences such as auditory hallucinations can persist despite antipsychotic treatment. (2) Many people living with psychosis experience cognitive and functional impairment, which often goes unaddressed. (3) Evidence-based psychological interventions exist which improve function and reduce distressing symptoms and cognitive impairment, but access to skilled clinicians is limited in Australia. What this topic adds: (1) Summarises the evidence base for psychological interventions such as cognitive remediation therapy and cognitive behavioural therapy for psychosis. (2) Introduces the NSW Tertiary Referral Service for Psychosis as an example of a multidisciplinary team providing holistic recovery-based care utilising psychological interventions alongside pharmacological treatment. (3) Discusses the challenges faced in promoting the need for greater access to psychological interventions as part of a holistic recovery-based approach to care.