CPT in an Australian Public Community Mental Health Setting: Does it work and does it affect service utilisation?

Casey and her colleagues (2022) conducted a study evaluating the effectiveness of Cognitive Processing Therapy (CPT), delivered in a tertiary mental health service in Victoria, Australia. This article summarises their research findings.

We know that clients with PTSD or Complex PTSD frequently present to community mental health settings. Unfortunately, it has been estimated that in Australia, only half of those with PTSD seek therapy and of those, not all receive evidence-based interventions (Mihalopoulos et al., 2015). Organisational and clinician factors can reduce the likelihood of clients receiving effective treatment for PTSD.

CPT is an evidence-based psychological therapy with substantial empirical support although most of this is derived from non-Australian contexts. There is a lack of research on the effectiveness of CPT in Australia in non-specialist mental health settings and to date, no Australian studies have reported on changes to mental health service utilisation pre- and post- CPT.

Casey et al (2022) set out to examine the efficacy of CPT in an open design trial as part of usual care in a tertiary mental health outpatient service. Clinicians received training and supervision in CPT and formed a network of CPT clinicians who worked across the Monash Health mental health program. These clinicians received CPT referrals for PTSD clients as part of their general clinical caseload. The study specifically examined patient outcomes (PTSD and depressive symptoms) and use of mental health services (pre-CPT and following CPT). Any exacerbation in clients’ symptoms and adverse events were also documented.

A total of 223 clients were referred to the CPT program between March 2016 and July 2020. Of those assessed, the majority commenced CPT within the service (N = 158). Clients were given information about CPT and invited to receive CPT which involved 12-16 sessions of individual therapy that adhered to the CPT manual. Clients attended an average of 10.68 CPT sessions (SD = 5.87), once or twice weekly depending on client and clinicians’ availability, with number of sessions ranging from 1 to 26 sessions.

Casey and her colleagues’ (2022) results replicate international findings that CPT is a safe, effective therapy for PTSD in community mental health settings. No serious adverse events were reported for this cohort of clients throughout CPT therapy. There were statistically significant improvements on all outcome measures with typically meaningful effect sizes. Although qualified by the use of an open trial design, these findings indicated that clients significantly reduced their use of mental health services following CPT relative to pre-CPT usage. The research shows that CPT can be effectively delivered in routine mental health settings with appropriate organisational support and clinician training.

In March 2021, The Royal Commission into the Victorian Mental Health System delivered 65 recommendations in their Final Report. Over the past two years, health services have been preoccupied with responding to the COVID pandemic, but the

Victorian government is working on delivering its promise to implement all 65 recommendations. It is expected that funding for public mental health services will significantly increase over the coming years. The Commission’s recommendations are very comprehensive and include a chapter solely dedicated to the impact of trauma, with a call for our mental health and wellbeing system to better meet the needs of clients whose mental health has been affected by trauma. Casey and her colleagues have demonstrated a way in which to integrate evidence-based PTSD treatments into the standard model of mental health care.

References


Casey, M., Yates, K., Tulchinsky, M., Zheng, A., Perera, D., Miller, C., & Nixon R.D.V. (2022). Posttraumatic stress disorder and service utilisation outcomes following delivery of Cognitive Processing Therapy in a community mental health setting. Clinical Psychologist. DOI: 10.1080/13284207.2022.2128642

State of Victoria, Royal Commission into Victoria’s Mental Health System, Final Report, Volume 1: A new approach to mental health and wellbeing in Victoria, Parl Paper No. 202, Session 2018–21 (document 2 of 6).

Mihalopoulos, C. et al. (2015). Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective? The Australian & New Zealand Journal of Psychiatry, 49(4), 360-376. https://doi.org/10.1177/0004867414553948