Service impact: how patients use mental health and medical services before and after psychodynamic psychotherapy

Many patients referred for psychodynamic psychotherapy are also seen by other services. Due to the complex interplay between psychological distress, physical symptoms and care-seeking behaviour, engagement with a psychotherapy department has the potential either to increase or decrease use of other services. This service evaluation compared 268 patients' service use in the year preceding and following contact with an NHS psychodynamic psychotherapy department using t-tests. There were no significant changes from before therapy to afterwards for the sample as a whole. However, for sub-groups who made regular use of services at baseline, a full course of psychotherapy (16+ sessions) was associated with a statistically significant reduction in outpatient contacts, both for mental health (N = 32, mean 11.69 appointment per year pre-therapy vs 5.16 post-therapy, p = 0.01) and medical services (N = 23, from mean 9.65 to 3.00, p < 0.01). No compensatory changes were found in either A&E or inpatient contacts, suggesting this represents an overall reduction in service use. Due to the study design, it was not possible to establish causality; there may be other reasons for this observed reduction such as natural illness course. These findings tentatively support the existing literature that psychodynamic psychotherapy is associated with a reduction in use of wider services.