British nurses in behavioural psychotherapy: a 25-year follow-up

Background The National Service Framework for Mental Health has emphasized the need to prioritize the provision of cognitive behaviour therapy as the central evidence-based non-pharmacological intervention for mental health p roblems. For 25 years one programme (English National Board Course No. 650 - Diploma in Behavioural Cognitive Therapy, formerly called Nursing in Beha vioural Psychotherapy) has trained nurses in such methods. This is the only programme in nursing which qualifies graduates to be fully certified as a cognitive behaviour therapist by the British Association of Behavioural Psy chotherapy and by the United Kingdom Council for Psychotherapy. The practic e of these nurse therapists (most commonly known as nurse behaviour therapi sts, NBTs) is the most rigorously evaluated in mental health nursing, with several randomized controlled trials to testify to clinical and economic ef ficacy. Aim The aim of this study is to continue the systematic follow-up o f all NBT graduates previously undertaken in two earlier surveys published in 1986 and 1994. These previous surveys examined clinical practice, organi zational context and career and professional development issues. This up-to -date picture of NBTs will provide useful baselines for the implementation of the National Service Framework, and may be used by the Department of Hea lth, education providers and services. Method A postal survey (using the sa me template for categories of information as the two earlier surveys) was u sed and questionnaires were sent to 237 of the 274 trained NBTs whose name appears on the Central NBT Register, maintained at the Institute of Psychia try/Maudsley Training Centre. Results One hundred and five of 230 eligible respondents (45.6%) returned questionnaires and additional data were obtain ed from 27 NBTs who provided information to the Register in the year before the survey. Thus, some data were available for 57% of the sample. As in ea rlier surveys, it was found that the majority of therapists remain in clini cal practice, undertake substantial further education and training and are involved in research and teaching as part of their overall role. The two ce ntral developments are an increasing move towards working in primary care a nd an increased emphasis on cognitive interventions. NBTs complete a substa ntial number of treatments per year and increasingly treat clients with dif ficulties not encountered during their basic training. NBTs now receive muc h more supervision than in previous surveys and continue to use valid and r eliable measures of change in practice. However, the number of NBTs remains small and the impact on potential populations who would benefit from effec tive psychological interventions is minimal. This paper discusses the impli cations for service delivery.