leeds and york partnership

Leeds and York PartnershipNHS Foundation Trust

The Yorkshire Centre for Psychological Medicine

The Yorkshire Centre for Psychological Medicine

02 The Yorkshire Centre for Psychological Medicine

Content

Introduction

Purpose

Treatment Approaches

Environment

Quality and Effectiveness

Finance and Value

Who to refer to YCPM

Patient Vignettes

Patient Testimonial

How to refer to YCPM

How to find us

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Patient feedback‘I would never have got going without you. I have appreciated the kindness and cheerfulness of you all, even when I was at my most miserable, you always had something positive to remind me of.’

The Yorkshire Centre for Psychological Medicine (YCPM)

delivers biopsychosocial care for people with complex

medically unexplained symptoms and physical/psychological

comorbidities.

The YCPM is an eight bed specialist in-patient unit which was

originally established on Ward 40 of Leeds General Infirmary

in 1980.

This is a unique service which has a history over many years

of delivering services within Leeds and West Yorkshire, but

which is now able to offer access to patients from across the

north of England and beyond.

The YCPM is part of the wider Liaison Psychiatry service in

Leeds. This is the sub-speciality concerned with clinical service,

teaching and research in the general hospital setting. It aims

to provide healthcare professionals in general hospitals,

primary care and secondary care with defined access to a

specialist multidisciplinary team, for the care of patients

presenting with psychological as well as physical problems.

The YCPM aims to help people with complex difficulties

make significant improvements with regard to their health

and quality of life. Clinical outcomes, even in a range of

very chronic and complex cases, are often very good, and

patient feedback positive. This is possible due to the nature

of the YCPM Unit and its function within the general hospital

setting, but also due to the depth of experience and breadth

of expertise within the team. Further details of this can be

found in later sections of this brochure, along with information

regarding value for money, illustrated by real case examples.

More details regarding the range of treatment approaches

available, the environment, and quality and effectiveness,

are also provided in this brochure, but requests for further

information can be directed to:

Clinical Team Manager

Yorkshire Centre for Psychological Medicine

Brotherton Wing

Leeds General Infirmary

Great George Street

Leeds LS1 3EX

Telephone: 0113 39 27140

Research activity within the service is facilitated by close

links with the Institute of Health Sciences at the University

of Leeds.

The YCPM is part of Leeds and York Partnership NHS

Foundation Trust. Everything we do accords with NHS

values and our stated Trust purpose of improving health and

improving lives.

04 The Yorkshire Centre for Psychological Medicine 05The Yorkshire Centre for

Psychological Medicine

Introduction

Patient feedback“All I can say is a very big thank you to all of you. Everyone has been so supportive and I leave here looking forward”.

The YCPM team specialises in helping people with the following types of problems:

n Chronic and/or complex and/or severe medically

unexplained symptoms and somatisation

(psychologically-based physical symptoms and

syndromes).

n Severe physical and psychological/psychiatric

comorbidity:

A) in people who are already general hospital

in-patients but who have psychological needs at a

level that cannot be effectively met on a general

medical or surgical unit.

Or

B) in people in other services or the community who

could benefit from focussed multidisciplinary

treatment provided in an in-patient setting.

n Patients with severe CFS/ME.

(We provide the in-patient component of the Leeds and

West Yorkshire CFS/ME Service).

The YCPM is staffed by a multidisciplinary team, with the following elements:

n Liaison psychiatryn Nursing n Occupational therapyn Physiotherapyn Social Work

n Dieteticsn Pharmacyn Administration

The unit benefits from staff with dual (general/physical in

addition to mental health) training, and others trained in

cognitive behavioural and psychodynamic psychotherapeutic

approaches.

The Unit also has direct access to the following personnel:

n Cognitive behavioural therapistsn Psychosexual therapistsn Outpatient chronic fatigue/ME teamn Hospital mental health team

The unit provides a biopsychosocial approach to assessing and

treating the full range of patients’ problems. The expertise of

the team has been developed over many years and the YCPM

exists within the broader liaison psychiatry service provided

by Leeds and York Partnership NHS Foundation Trust. This is

the most comprehensive liaison psychiatry service in the UK.

Patients may have difficulties attending outpatient

appointments or may have failed to make improvements

with this level of care. An in-patient stay at YCPM allows for

comprehensive assessment followed by carefully planned

and implemented treatment approaches. As a result, other

services from across Yorkshire and beyond refer cases to the

unit.



Purpose

Patient feedback“My care has been excellent and it has given me hope for much more of a normal life”.

Patients referred to the YCPM will be contacted to discuss the aims of the admission and to answer any questions regarding treatment approaches, length of stay, housekeeping arrangements, etc. A key individual will keep contact with the patient about the proposed admission date. The first meeting may be an assessment in hospital or at home, or a visit to the unit. This usefully facilitates meeting key individuals from the team and an appreciation of the location of the unit in the general hospital.

On admission, and in the first week, the various members of the MDT will meet the patient and carry out specific assessments. These are then shared with the patient at the weekly MDT meeting. The care planning process is designed to encompass physical, psychological and social health needs. Care plans are designed by the team in collaboration with the patient.

Physical (for example)Physical monitoring - liaison with and input from medical/surgical teams within the general hospital. Any required physical treatments to improve health.

Programmes to improve physical functioning - Occupational Therapist and Physiotherapist interventions.

Graded activity programmes - particularly in relation to fatigue. Pharmacological treatments.

Psychological (for example)‘Living with pain’, ‘Living with anxiety’ and ‘Living with illness’ are all packages of care available to each patient delivered on an individual basis. Patients may also then be referred on to the particular groups focussing on this work.

Programmes to deal with particular fears and anxieties (graded exposure)

Individual sessions with key members of the multidisciplinary team - focus on particular areas of the psychological care plan - working with ambivalence / motivation / symptom management and symptom reattribution, etc.

Cognitive behavioural and psychodynamic psychotherapy approaches.

Family members and carers are offered support and can be included in discussions around clinical care, with agreement and consent from the patient concerned.

Social (for example)Specific social needs are assessed in relation to the patient’s home and community situation. The unit is essentially a social space and patients are encouraged to talk to and engage with each other in the experience of being in hospital. To this end there are various groups and activities which enable the social environment to work therapeutically.

GroupsThe unit provides a group treatment programme with psychotherapeutic, educational, and activity based groups

Risk management Formal risk assessments are carried out regularly with all patients. Risk management plans are reviewed at all MDT meetings and inform planned interventions, including observation procedures and individual and group therapies.



Treatment Approaches

Patient feedback“Thank you for seeing me as a ‘whole’ person and not as a list of problems to be separated off as either mental or physical. This is something that I have really appreciated, as it is so rare to happen in other health settings.”

The unit is in the centre of Leeds with excellent rail, road and

public transport links and parking facilities. This facilitates

admission and visiting but also means the unit is ideally

placed to help patients re-engage in normal activities in the

wider community as and when appropriate.

The eight bedrooms all have:

n An electric profiling bedn Vanity suiten Wardroben Bedside tablen Window blindn Armchairn Privacy/observation windown Extra wide 2 way opening doors n Assistance call facilities

In addition the Unit provides

n One assisted bathroomn One independent bathroomn One level access shower room (each with assistance call facility)n Laundry Roomn Patient telephone

The YCPM is based at Leeds General Infirmary. Although this

is a general hospital setting, the environment is specifically

designed to provide a therapeutic environment for patients

with mixed physical and psychological/psychiatric difficulties.

The unit provides a comfortable environment with communal

areas where patients have the opportunity to socialise with

peers but also have their own individual bedrooms. Patients

have the use of two lounges which provide televisions, DVDs,

music and other group and therapeutic activities.

The conservatory and balcony areas enable patients to spend

time with their fellow patients and with their visitors in a

relaxing environment.



Environment

Patient feedback“...deeply grateful for your knowledge and expertise that has put me on the long road to recovery from CFS. Also for the manner in which it has been done…..without exception the staff have been kind, encouraging and supportive…’

The YCPM delivers its therapies and treatment packages

within the standards and levels of quality assurance set

by Leeds Partnerships NHS Foundation Trust. Quality and

effectiveness are addressed in an organised way within

the Clinical Governance structure of the organisation, and

the Specialist Services Directorate, within which the Liaison

Psychiatry Service and YCPM are managed.

The Liaison Psychiatry Service, including YCPM, has its

own multidisciplinary Clinical Governance Council. This is

accountable to the Specialist Services Directorate Clinical

Governance Group chaired by the Associate Medical Director

and reporting to the Trust Clinical Governance Committee.

Clinical Governance within this structure is organised under the following headings:

n Risk Managementn Clinical Guidelinesn Auditn Research and Developmentn Patient and Carer Experience and Viewsn Access to Servicesn Informationn CPD/Staff Development n Public Health Issuesn Service Development

The YCPM is committed to collecting and acting upon patient and carer feedback

about their experiences of the Unit. This is achieved through several means:

• The Forum (discussion meeting involving patients

and staff) which takes place once a week. This provides

the opportunity for patients and staff to identify any

problems with the ward environment and identify

solutions.

• Individual patient feedback sessions with key staff

• Every patient is asked to complete a feedback

questionnaire at the point of discharge. Importantly, this

all takes place in the setting of a philosophy which

invites and encourages discussion and feedback

throughout the admission.

Clinical outcome measurement is achieved in three main ways:

• Routine use of CORE—OM outcome measurement tool

at the point of admission and again at discharge.

• Use of condition specific and therapeutic modality

specific measures as required in each case.

• Clinical Global Impression Scoring at the point of

discharge.

Information / figures regarding outcomes and effectiveness

are available in the YCPM Annual Reports, which are being

produced from 2009/10 onwards.

The YCPM service is registered with and has been inspected

by the Care Quality Commission (in 2011) and declared to be

compliant with all essential standards of quality and safety.



Quality & Effectiveness

Patient feedback“Thank you so much for all your hard work, patience and determination over the past few months and for all your advice in helping me kick start my recovery”

For details regarding cost per bed day referrers / commissioners

should contact the Clinical Team Manager (see contact details

on page 25).

It should be noted that the cost per bed day is inclusive

of all treatment interventions. This includes all necessary

investigations, all medication, all psychotherapeutic work,

all physical treatment interventions, and all catering needs

(including NG tube feeding, etc). The only additional cost that

may, on rare occasions, be applied would be with regard to

increased levels of observation if requiring additional staff.

The YCPM service represents good value for money. Many

patients referred will previously have required a great deal of

input over a prolonged period of time, including both multiple

physical investigations and long periods of treatment. It may

be helpful to consider the potential impact of an admission

to the YCPM upon immediate and medium / long-term costs.

Two cases are described below by way of examples which

may help to illustrate some issues regarding finance and value

for money.

1. A young man was referred to the Unit from North East

England who had been suffering with medically unexplained

weakness and pain in his lower limbs and head since a

routine ear operation. The severity of his symptoms and

the perceived need for continuing investigation and input

by a range of medical and surgical specialties meant that

he was an in-patient in a general medical ward for a five

month period post-operatively. All attempts to discharge him

home failed, as he returned to the hospital through the A&E

Department with severe pain within hours or days of transfer

home. All attempts locally, including by the liaison psychiatry

in-reach team, had proved to be unsuccessful in attempting

to improve his condition. The basic cost of the bed days of

the medical ward over the five month period concerned were

approx. £61,000 (this does not include any cost attached

to the multiple contacts required with neurology, ENT, pain

management and liaison psychiatry teams). Transfer to

a national pain management centre was considered but

assessment by the team from that centre led to the conclusion

that this gentleman would need a very flexible / bespoke

package of care to address his physical and psychosocial issues

together, which could not be provided using a standardised

pain management approach. Transfer to the YCPM followed,

leading to a multidisciplinary biopsychosocial assessment

and care plan. Treatment involved physical and occupational

rehabilitation alongside psychological work in relation to

underlying issues and relationship dynamics which were the

basis of his physical symptoms. This took place over a period of

six weeks, at the end of which full recovery had been achieved

and the patient was able to walk prolonged distances and to

function normally. The inclusive costs associated with this six

week admission were £19,698. This case clearly illustrates

the immediate financial benefit of the admission, without

which the medical admission would have continued. Perhaps

just as importantly the resolution of all symptomatology has

profound implications for avoiding the very significant costs

which are attached to cases such as this in the longer term.



Finance and Value

Patient feedback“Staff were polite, courteous and available at all times. Nothing was too much trouble”.

2. A married mother in her early 40s was referred from

the South of England with a history of four years medically

unexplained perineal pain. The presentation was extremely

severe, with regard to the impact upon the life of the patient

and her family. She was presenting on a daily basis at either

the GP’s surgery or the A&E Department asking for more

medication to help with her excruciating pain and demanding

a nerve block. Her local Acute Hospital Trust was taking legal

advice to be able to refuse to provide care, due to the amount

of time that was being taken up by the constant calls and

attendances. The GP was also finding it difficult to help, and

the patient was taking a wide range of analgesic medication

which was not helping. The working diagnosis by the local

teams, including liaison psychiatry, was Somatoform Pain

Disorder. She was admitted to the YCPM and within a few days,

in the context of a more intensive multidisciplinary assessment

approach than had previously been possible, it became clear

to the team that the diagnosis was actually one of an atypical

psychotic depression presenting with delusional beliefs

regarding her pain, the causes of it, and treatments for it. This

was a difficult case which involved the patient being detained

on Section 3 of the Mental Health Act for several months whilst

treated for the aforementioned condition. Antipsychotic and

antidepressant medication (the latter involving combination

therapy) were required alongside psychological interventions.

After a relatively prolonged admission of around six months

this patient had fully recovered and was, for the first time for

almost five years, entirely pain free. She was discharged home

to be followed up by the local psychiatry team and when an

enquiry was made by the YCPM team some ten months later

the news was that despite her previous level of distress and

inability to function within the family or to work outside of

the home she had remained pain free since discharge, was

enjoying life, and had returned to work full time.

It is very difficult to assess the cost of her care prior to admission,

although daily attendances at the GP practice, frequent and

numerous unnecessary physical investigations and assessment

and treatment through the local A&E Department obviously

carry a very high financial cost. Although the admission was

several months in duration the impact of this patient’s recovery

with regard to the avoidance of future healthcare costs, which

otherwise would certainly have been required, is very clear.



Finance and Value continued

Patient feedback“My care on the unit has been first class and if I have had a problem it has been dealt with straight away”.

The YCPM team specialises in helping people with the following types of problems:

n Chronic and/or complex and/or severe medically

unexplained symptoms and somatisation

(psychologically-based physical symptoms and

syndromes).

n Severe physical and psychological/psychiatric

comorbidity:

A) in people who are already general hospital in-

patients but who have psychological need at a level that

cannot be effectively met on a general medical or

surgical unit.

Or

B) in people in other services or the community who

could benefit from focussed MDT treatment provided in

an in-patient setting.

n Patients with severe CFS/ME.

(We provide the in-patient component of the Leeds and

West Yorkshire CFS/ME Service).

The nature of some of the patients we help is illustrated in

three brief vignettes on page 21.

Enquiries and referrals are taken from any health care

professional in either primary or secondary care settings.



Who to refer to YCPM

Patient feedback“I have been very happy with my care on the unit and have felt my needs were met”.

Previous patient brief vignettes

Patient A was a 22 year old man who had Insulin Dependent Diabetes since 4 years of age.

• He had ‘manipulated’ his glycaemic level from a very young age to escape bullying and difficult circumstances by ensuring frequent and prolonged admissions to hospital. • Very high sugar levels over years suppressed his growth hormone secretion so that he was of diminutive size and lacking secondary sexual characteristics.• Also led to secondary medical complications of diabetes; seriously impaired eyesight, chronic renal failure, neuropathy and poor peripheral circulation.• Depression and anxiety (mainly social phobia).

The underlying behaviour causing his major problems had not been addressed by the diabetes teams previously. He required admission to YCPM to:

• Effectively treat his psychological problems through medication, individually tailored psychotherapeutic work and involvement in the group treatment programme.

• Monitor and treat his range of physical problems with regular input from renal, endocrine and ophthalmology teams which would not be possible at the level required on a different Mental Health Unit.

Patient B was a 32-year old woman who was moving from service to service requesting frequent physical investigations for her range of medically unexplained symptoms. These included: fatigue, somatoform pain and reduced mobility. She was moved from one GP to another and was presenting to general hospital services through multiple attendances at A&E. She was transferred from a neurology ward to the YCPM, where she received a package of care tailored to her needs including:

• Consistent education about her condition (1:1 and groups).• Graded activity and pacing using detailed activity scheduling. • Intensive psychological therapy including cognitive behavioural therapy with symptom reattribution, and addressing complex family problems systemically.

Patient C was a 60 year old woman on a surgical ward post-mastectomy.

• Presenting with severe depression and paranoid ideation. • Refusing to eat and drink.• Frightened, frail and generally physically unwell leading to transfer to the YCPM.

A structured plan was developed to support her in beginning to eat and drink. This was alongside the administration of antipsychotic medication under the Mental Health Act. Regular surgical review, and investigations including head CT and bone scans, were carried out. Raised serum calcium was dealt with promptly with input from the endocrinologists which contributed to the good outcome. Support was also provided to her husband and family members.



Patient Vignettes

Patient feedback“The team has saved my life for the second time, and I am determind to stay well and enjoy the rest of my life.”

‘I had been ill for 6 1/2 years when I arrived at (YCPM) and

was bed bound, unable to tolerate any light or noise, unable

to talk or listen to more than a few words from others or have

them in the room. I was also unable to feed myself, my hair

hadn’t been washed or brushed for 18 months and I couldn’t

even be physically washed by others or have my pyjamas

changed. Despite completing a music degree in the past I

was now unable to carry out any mental tasks. I hadn’t been

left alone in the house for over 2 years due to my emotional

state of complete fear, anxiety, frustration and anger.

Overall I was in a state of utter desperation and just wanted to get better.... but didn’t know how to…….

My Life Now – Since being discharged from the service I

have got back in touch with friends and family and completed

training in occupational therapy. I am now happily married

and working as an Occupational Therapist four days a week

covering two jobs, one in palliative care and one in CFS/

ME. I continue to use the strategies taught by the service

and cannot recommend their professionalism and approach

highly enough.

The whole process was a joint effort between me, the team,

and family/friends. Although it was difficult, I am so glad that

I persevered to get my life back. I will be eternally grateful to

the YCPM and its commitment to helping people.’



Patient Testimonial

Family feedback“We will always be eternally grateful to the team for giving us our daughter back; without them the outcome could have been so different. Be prepared to trust them, and never give up.”

EnquiriesAll enquiries should be directed to the Clinical Team

Manager, or any member of the senior YCPM team.

Please contact the team on 0113 39 27140. Informal visits to

the unit can be arranged by prior notice.

ReferralsReferrals are accepted by letter and should be

addressed to:



Brotherton Wing


Great George Street

Leeds LS1 3EX

Telephone: 0113 39 27140

Pre-admission AssessmentsPatients and their families/carers are encouraged to visit

the unit prior to admission to discuss and plan their

care and treatment. This will be coordinated by a member of

the multidisciplinary team in discussion with the patient.



How to refer to YCPM

Patient feedback“I can’t thank you all enough and will never forget each and every one of you for your care dedication and a job well done”.

Contact Details



Brotherton Wing


Great George Street

Leeds. LS1 3EX

Telephone: 0113 39 27140

Website: www.leedsandyorkpft.nhs.uk

(click “Our services” and then “Yorkshire Centre for Psychological Medicine”)

To find the YCPM enter Leeds General Infirmary at the Calverley Street entrance, which is directly opposite Millennium Square.

YCPM is situated on the ground floor immediately to your left.

Map: For a useful map go to ‘Google Maps’ and search for our postocde (LS1 3EX)

All flower photographs in this brochure have been provided by the YCPM Horticulture Group



How to find us

Patient feedback“I found the unit warm and welcoming and staff made me feel comfortable at a stressful time”.

leeds and york partnership

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