Psychology Psychology ServicesServices

Denise Beck – Psychology Denise Beck – Psychology managermanager

Jan Helbert – Consultant Jan Helbert – Consultant Clinical PsychologistClinical Psychologist

AgendaAgenda

Brief overview of health psychology Brief overview of health psychology services in Bradford & Airedaleservices in Bradford & Airedale

Neuropsychology provision and gaps Neuropsychology provision and gaps in servicein service

Non-cancer palliative care provision Non-cancer palliative care provision – Jan Helbert – Jan Helbert

Health Psychology Services Health Psychology Services – Bradford– Bradford

Cover a range of health Cover a range of health conditions, and work conditions, and work across organisations across organisations including:including:

Heart Disease and Heart Disease and DiabetesDiabetes

Renal DiseaseRenal Disease COPDCOPD PainPain ICUICU Child Development Child Development

CentreCentre

PlasticsPlastics OncologyOncology Sexual Health, Sexual Health,

Psychosexual Therapy.Psychosexual Therapy. NeuropsychologyNeuropsychology Palliative Care (Cancer Palliative Care (Cancer

and non cancer)and non cancer) Staff counsellingStaff counselling

15.4 WTE 15.4 WTE PsychologistsPsychologists

Airedale & Craven Health Airedale & Craven Health Psychology ServicesPsychology Services

General Health Psychology Service General Health Psychology Service (1 WTE)(1 WTE)

Neuropsychology service (1WTE)Neuropsychology service (1WTE)

No palliative care psychology service No palliative care psychology service (cancer or non-cancer)(cancer or non-cancer)

Airedale referralsAiredale referrals

Over the last year:Over the last year: 4 refs for people with terminal 4 refs for people with terminal

neurological conditions eg MS, MNDneurological conditions eg MS, MND 3 refs for people with Parkinsons 3 refs for people with Parkinsons

Disease (1 palliative)Disease (1 palliative) 1 person with tetraplegia, referred 1 person with tetraplegia, referred

from ICUfrom ICU Support and consultancy to the Support and consultancy to the

palliative care teampalliative care team

Challenges within Challenges within neuropsychology Bradfordneuropsychology Bradford

Limited service provision – 1WTE neuro-Limited service provision – 1WTE neuro-psychologist –psychologist –

Community Head Injury Team (0.5) Community Head Injury Team (0.5) Neuro-rehab outreach service Neuro-rehab outreach service Neuro-rehab in-patientNeuro-rehab in-patient Out-patient referrals (consultants, GP’s & Out-patient referrals (consultants, GP’s &

Psychologists)Psychologists)

A detailed neuro-psychological A detailed neuro-psychological assessment (6 -10 hours) assessment (6 -10 hours)

Neuropsychology ServiceNeuropsychology Service

Assessment and interventions where Assessment and interventions where cognitive impairment is identified as an cognitive impairment is identified as an obstacle to rehabilitation in the obstacle to rehabilitation in the community.community.

No service for longer term psychological No service for longer term psychological adjustment issues or mental health adjustment issues or mental health difficulties arising from a particular difficulties arising from a particular neurological diagnosis. neurological diagnosis.

Broader service remit for CHIRTBroader service remit for CHIRT

Who can be referred?Who can be referred?

People with acquired (non-traumatic People with acquired (non-traumatic brain injury)brain injury)

People with a neurodegenerative People with a neurodegenerative condition (MS, PD, MND) – where work condition (MS, PD, MND) – where work is neuropsychological functioning rather is neuropsychological functioning rather than emotional/adjustment to illness than emotional/adjustment to illness issues.issues.

People with a traumatic brain injury People with a traumatic brain injury (seen within the Community Head Injury (seen within the Community Head Injury Team). Team).

Reasons for referralReasons for referral Assessment – return to work / education; Assessment – return to work / education;

capacity issues, financial affairs / driving; capacity issues, financial affairs / driving; managing challenging behaviour (related to managing challenging behaviour (related to cognitive impairment)cognitive impairment)

Feedback - info / education on impairment, Feedback - info / education on impairment, consequences & prognosis.consequences & prognosis.

Recommendations re level of care / supportRecommendations re level of care / support Assessment of mental capacityAssessment of mental capacity Support for rehab staff in work with Support for rehab staff in work with

cognitive & psychological barriers to rehab cognitive & psychological barriers to rehab Broader remit with CHIRT Broader remit with CHIRT

Gaps in service in Gaps in service in Bradford Bradford

Psychological support is offered by many Psychological support is offered by many different health and social care staffdifferent health and social care staff

But….. Insufficient neuropsychological But….. Insufficient neuropsychological provisionprovision

& Service users and staff have identified a & Service users and staff have identified a need for specialist support for complex need for specialist support for complex emotional / psychological / relationship emotional / psychological / relationship issues that can be triggered by or issues that can be triggered by or exacerbated by the impact of an injury or exacerbated by the impact of an injury or diagnosis.diagnosis.

Support / consultancy for staff working with Support / consultancy for staff working with psychological issues psychological issues

What What Psychological Care Psychological Care can be provided for can be provided for

patients with patients with advanced MS ?advanced MS ?Mrs Jan HelbertMrs Jan Helbert

Consultant Psychologist Consultant Psychologist Palliative Care and OncologyPalliative Care and Oncology

Bradford Teaching Hospitals Bradford Teaching Hospitals NHS Foundation TrustNHS Foundation Trust

Palliative CarePalliative Care

Palliative Care is:……………. the active Palliative Care is:……………. the active holistic care of patients with advanced, holistic care of patients with advanced, progressive illness. Management of pain progressive illness. Management of pain and other symptoms and provision of and other symptoms and provision of psychological, social and spiritual support is psychological, social and spiritual support is paramount.paramount.

The goal of palliative care is achievement of The goal of palliative care is achievement of the best quality of life for patients and their the best quality of life for patients and their families. Many aspects of palliative care are families. Many aspects of palliative care are also applicable earlier in the course of the also applicable earlier in the course of the illness in conjunction with other treatments.illness in conjunction with other treatments.(National Council for Hospice and Specialist (National Council for Hospice and Specialist Palliative Care Services 2002)Palliative Care Services 2002)

Psychosocial care in Psychosocial care in palliative care…palliative care…

The impact of advancing illness for both The impact of advancing illness for both patient and those close to thempatient and those close to them

BothBothLiving and coping with a life limiting Living and coping with a life limiting illnessillness

Support to face loss and death Support to face loss and death

Psychosocial care Psychosocial care encompasses..encompasses..

Psychological approaches to enable Psychological approaches to enable patients and those close to them to patients and those close to them to express thoughts, feelings and express thoughts, feelings and concerns relating to the illness.concerns relating to the illness.

Psychological interventions to Psychological interventions to improve psychological and emotional improve psychological and emotional well being of patients and their well being of patients and their families.families.

The psychological needs The psychological needs of those with advanced of those with advanced

illnessillness For patient centred careFor patient centred care Sensitive and timely communication and information Sensitive and timely communication and information

(breaking of bad news)(breaking of bad news) Conversations to help patient + other family members to Conversations to help patient + other family members to

share issues arising through their adjustment and share issues arising through their adjustment and readjustment to illnessreadjustment to illness

Support through transitions, dealing with challenges and Support through transitions, dealing with challenges and

losses - of independence, of certainty, of roles…losses - of independence, of certainty, of roles… Eliciting concerns, exploring fears and copingEliciting concerns, exploring fears and coping Talking with family, children- how, what and when?Talking with family, children- how, what and when? Help to manage symptomsHelp to manage symptoms Support with end of life decisions- to enable people to be Support with end of life decisions- to enable people to be

cared for in place of their choicecared for in place of their choice Support with grief and bereavement follow-up.Support with grief and bereavement follow-up.

Symptoms common in Symptoms common in later stages of MSlater stages of MS

Spastic muscle Spastic muscle weakness, loss of weakness, loss of mobility and muscular mobility and muscular controlcontrol

PainPain Sleep disturbanceSleep disturbance Bladder dysfunction Bladder dysfunction

and urinary and urinary incontinenceincontinence

Sexual dysfunction- Sexual dysfunction- erectile failure, erectile failure, anorgasmyanorgasmy

Severe fatigueSevere fatigue Depression ( increased Depression ( increased

incidence with MS incidence with MS compared to other compared to other chronic neurological chronic neurological conditions)conditions)

Cognitive Cognitive dysfunction( for over dysfunction( for over 40%) impairment in 40%) impairment in recent memory, recent memory, sustained attention, sustained attention, conceptual reasoning, conceptual reasoning, verbal fluency and visuo verbal fluency and visuo spatial perceptionspatial perception

Specialist Psychology Specialist Psychology service to palliative care in service to palliative care in

BradfordBradford 1.5 WTE clinical psychologist posts1.5 WTE clinical psychologist posts

Both posts are embedded within the multi disciplinary Both posts are embedded within the multi disciplinary Community Palliative Care Team.Community Palliative Care Team.

The team accept referrals for adult patients who are The team accept referrals for adult patients who are registered with a Bradford GP who have advanced and registered with a Bradford GP who have advanced and progressive disease for whom the prognosis is limited progressive disease for whom the prognosis is limited (although it can be several years) and the focus of care is (although it can be several years) and the focus of care is quality of life.( Operational Policy 2005)quality of life.( Operational Policy 2005)

One or more of the following needs are unable to be met by One or more of the following needs are unable to be met by the Primary Health Care Team: Symptom control, the Primary Health Care Team: Symptom control, psychological support ,social support. Team also offer psychological support ,social support. Team also offer assessment for hospice care and staff support for dealing assessment for hospice care and staff support for dealing with difficult situations or death.with difficult situations or death.

Levels of specialist Levels of specialist psychological psychological interventionintervention Working directly with patients and familiesWorking directly with patients and families

Working with staff to help understand how Working with staff to help understand how neurological conditions may affect behaviour and neurological conditions may affect behaviour and personality and offer guidelines for working with personality and offer guidelines for working with patientspatients

Extending psychological care through others – Extending psychological care through others – teaching/training, consultation etcteaching/training, consultation etc

Contributing at organizational level to use Contributing at organizational level to use knowledge to help improve patients care and knowledge to help improve patients care and experienceexperience

Criterion for Specialist Criterion for Specialist Psychology Assessment Psychology Assessment

and interventionsand interventions

For those who have For those who have complex complex and/orand/or moderate-severemoderate-severe levellevel of emotional, of emotional, psychological, relationship issues arising psychological, relationship issues arising in response to advanced illness. in response to advanced illness. Where there is Where there is significant significant psychological distress psychological distress that does not that does not resolve; that interferes with general life resolve; that interferes with general life activities or treatment activities or treatment

Referrals to PsychologyReferrals to Psychology Adjustment Adjustment

difficulties- coping difficulties- coping with diagnosis, with diagnosis, prognosis, treatments, prognosis, treatments, illness progression.illness progression.

Depression/griefDepression/grief AnxietyAnxiety Anger/frustrationAnger/frustration Existential and end of Existential and end of

life issueslife issues Coping with Coping with

proceduresprocedures

Communication/Communication/relationship with relationship with family/stafffamily/staff

Psychosexual Psychosexual problemsproblems

Managing symptomsManaging symptoms Neuropsychological Neuropsychological

issues – issues – confusion,memory confusion,memory problems,disorientatproblems,disorientation, attentional diffsion, attentional diffs

IssuesIssues

New area of workNew area of work

Over last 2 years only 4 referrals to Over last 2 years only 4 referrals to psychologists with neurological psychologists with neurological componentcomponent

An important area for development. An important area for development.

IssuesIssues Steep learning curve about illnesses, Steep learning curve about illnesses,

specific psychological issues and specific psychological issues and approaches to best help patients and their approaches to best help patients and their familiesfamilies

Limited resourcesLimited resources How can specialist psychology knowledge How can specialist psychology knowledge

and skills best be used?and skills best be used? ?Working directly with patients + families?Working directly with patients + families ?Helping other staff to develop their skills?Helping other staff to develop their skills ?Contributing at organisational level to help ?Contributing at organisational level to help

improve patients care and experienceimprove patients care and experience