Many acute hospitals have in‐house psychological support services. It is hoped that the prevalence of psychological services in physical health settings will increase as there is better recognition of the bidirectional relationship between physical and psychological health, and as the ‘parity of esteem’ principle (Health and Social Care Act [126]) is embedded in NHS services.

There are a range of psychological professionals, such as counsellors, psychologists, psychotherapists (including art, music and psychosexual therapists) and psychiatrists. All of them aim to support people in understanding and improving their psychological, or mental, health. Depending on the type of training they received, professionals will emphasize different aspects of the biopsychosocial model:

There are a range of therapy approaches, including:

It can be difficult for nurses, patients and their families to ascertain the differences between types of psychological training and therapy; the links at the end of this chapter may be useful.

Psychological therapists based in acute settings perform a number of functions. In addition to providing direct psychological interventions, psychologists, counsellors and psychotherapists have a consultative role. Thus, they can support teams to think about the psychological impact of contextual issues that may influence a patient or family member's thoughts, emotions, behaviour and choices; this can be particularly helpful when psychological therapy is not appropriate or when a patient does not consent to it. Furthermore, psychological therapists often provide training and supervision to the healthcare workforce as a way of disseminating psychological knowledge and skills. For example, within cancer services, guidelines state that one core member of each multidisciplinary team should be trained to provide Level 2 psychological support with ongoing monthly supervision to supplement this training (NICE [201]).

Similarly to physical health services, NHS mental health services are structured in a stepped‐care model (NICE [206]). In primary care, some GP practices have an in‐house psychological therapist; however, most do not. Instead, primary care mental health services are embedded within the Improving Access to Psychological Therapies (IAPT) program, which started in 2008 to help people with anxiety and depression. IAPT has expanded to support people with common physical long‐term conditions, including diabetes, respiratory disease, cardiac disease and medically unexplained symptoms. Most IAPT services accept GP and/or self‐referrals, and tend to provide a telephone assessment to better understand the person's psychological concerns and needs. Services may include group or individual work via the telephone, online or in person. Waiting times vary from area to area.

As psychological difficulties increase in severity, people will be referred to secondary care services or to specialist tertiary services. Referrals are usually made by a GP and waiting times vary; however, there can be long waits.

It is important to note that as the NHS has reorganized itself over time, some psychological services have come to be provided by third‐sector organizations, such as MIND or Relate, and by private companies. If someone is accessing a service via an NHS pathway, it will be free at the point of access regardless of the provider. When young people are affected psychologically, it may be useful to identify counselling services at school, college or university.