Preparation for Improved Psychological CareSue ChambersSenior Lecturer, Staffordshire University

‘Psychological care after stroke: Improving stroke services for people with cognitive and mood disorders’ (2011)

‘...psychological support ...as critical to recovery from stroke as physical rehabilitation.’ (p.6)

Holistic needs assessment at key points in the care pathway

Provision of psychological care as multifaceted

Why?

Depression Most common psychological presentation

Approx 25-50%

Anxiety Between 30-49% up to 12 years post stroke

Phobias, generalised anxiety, panic

Why?

Medical definition: “A clinical syndrome of rapid onset of focal or

global cerebral deficit lasting more than 24 hours or leading to death, with no apparent cause other than a vascular one”.

Psychological definition: “A stroke is a sudden and often traumatic major

life event that usually occurs with minimal warning and, for many, results in life-changing consequences”

Definitions of Stroke:

National Stroke Strategy (2007)

Royal College of Physicians (RCP) National Clinical Guidelines (2008)

Accelerated Stroke Programme (2010)

Psychological care after Stroke (2011)

Policy Drivers

Untreated psychological mood disorders are associated with higher rates of :

Mortality Suicide Long term disability & institutionalisation Hospital readmission Higher utilisation of outpatient services

Ignoring the Issue……….

It is essentially about treating the whole person.

It is not something that stands alone and is separate from physical care.

It should be organised, and practical.

It should be seen as everybody’s business!

Psychological Care in a Physical Health Care Setting?

Within both these modules a full afternoon is dedicated to psychological care following stroke.

Recognition of the psychological impact of stroke is included within the Competency Framework document

Stroke School / Stroke Rehab

Stepped care aims to offer patients psychological care in a hierarchical approach offering simpler intervention first and then progressing on to more complex interventions if required

Embedding the Stepped Care Approach

Identifying Barriers

• Patient’s belief that nothing can be done• Not wanting to burden busy staff• Staff lacking in confidence about:

- what to ask- How they can psychologically support patients- What to do with the information

‘Can of Worms’

Two Day Workshops

Workshop Outcomes List common triggers and contextual cues that indicate

the possible impact of stroke on the individual and their family.

Differentiate between Level 1 (Awareness), Level 2 (Interventions), and Level 3 (Psychological therapy).

Demonstrate an awareness of appropriate mood screens or scales which could be used in order to assist in the assessment of the patient’s psychological state.

Demonstrate an awareness of Person Centred Care and Relationship Centred Care in relation to Stroke.

Demonstrate the ability to utilise person centred care through effective communication and the ability to reflect upon personal clinical practice.

Preparation and Education

Identification of the Stepped Care Model

Overview of bio/psycho/social model with case examples, formulation of questions and exploration of questioning styles.

The identification of mood screens their uses, advantages and disadvantages

Skill identification and practice

What do we look at?

• Teaching; Group work; Questioning; Clarification: Facilitation; Games; Skill identification and practice through role play.

Achieved through……………..

Level One Two day

workshop Series of one day

workshops

Level Two Series of one day

workshops

Looking at: Active listening, giving time, talking Non clinical goal setting Explanation (normalising) Information, answering questions Giving back control (patient centred

goals) Watchful waiting

Looking at: Identification of past coping strategies Mood Screens Psycho education Problem solving Motivational techniques Signposting

Education and Preparation so far:

Overall workshops were found to be ‘excellent and relevant’

Very Appropriate Enjoyable and relevant Higher level workshop as a follow up Desire for the workshop to be more stroke

specific

Evaluation of events to date:

We can all provide a degree of psychological care in stroke

Take time to listen, will be revisiting team working

Listen and spend more time with patients and carers

To take more responsibility for psychological care

Evaluation report undertaken by The Heart and Stroke Network

Impact of Training:

“Mental health is everyone’s business …. Good mental health and resilience are fundamental to our physical health, our relationships, our education, our training, our work and to achieving our potential.”

Remember:

Stroke is an extraordinary life event

No health without mental health

Psychological care should be embedded into and seen as an integral part of care delivery

Education in relation to the identification and provision of relevant interventions should be seen as an essential aspect of staff training.

In Summary

Thank you