Anxiety and depression are around 3 times more common among people attending hospital than among the general population. This anxiety and depression that co-exists with other medical and surgical problems is important as it is not only associated with people experiencing greater misery, fatigue and fearfulness, but it is also associated with worse medical outcomes. For example, someone may experience more episodes of illness, which could result in greater use of emergency care services, longer stays in hosptial and worsen their quality of life.
Current medical/surgical care within the Royal Devon and Exeter Hospital and many other NHS providers focuses on the delivery of excellent physical healthcare. However, they are not well equipped to provide high quality psychological care to people attending hospital. Despite the availability of national guidance (NICE) and effective treatments for anxiety and depression, lack of staff training, increasing patient numbers and difficulty accessing psychological care pathways mean that anxiety and depression often go untreated among patients attending the hospital.
Aims and objectives
The aim of this project is to provide excellent psychological care to patients attending the Royal Devon and Exeter (RD&E) hospital by development of an Intergrated Psychological Medicine service, which will run alongside routine medical and surgical care.
This project will have 5 broad objectives that are reflected in separate work themes:
- To develop within the RD&E a culture of compassion towards patients and staff
- To comprehensively review the current availability of psychological care within the RD&E
- To develop mechanisms for identifying patients with mental health needs though the introduction of appropriate screening and to develop appropriate care pathways to ensure delivery of excellent psychological care
- To provide excellent psychological support and care for staff in the hospital by developing mechanisms for identifying staff with mental health needs and to develop appropriate care pathways for staff with mental healthcare needs
- To ensure that all developments are informed by research and all future service are amenable to research and evaluation.
- Induction for all staff joining the hospital team now includes a specific emphasis on how compassion towards patients and staff is a core value of the organisation (RD&E).
- Key services have been identified with the aim of introducing screening for psychological problems as part of routine care. These services include: Diabetes and Obesity service; Gastroenterology inpatients and outpatients services; Rheumatology outpatients (development of a joint medical / psychiatry clinical for young adults with medically unexplained symptoms); oncology services, starting with Head and Neck surgical team. Training sessions have been hosted to provide staff with the skills with use psychological screening tools, to assess any associated risk and to ensure delivery of appropriate care.
- Care pathways are being developed using the stepped care model advocated by NICE which involve liaison with and in-reach (where feasible) by local depression and anxiety services.
- As part of a NIHR funded multicentre project (NIHR HS&DR HOME trial), we are evaluating the clinical and cost-effectiveness of a pro-active liaison psychiatry (PLP) service compared to care as usual. As part of the PLP service being evaluated, inpatients > 65 years are seen by a senior psychiatrist within 2 days of admission to identify psychosocial problems that could delay discharge and then to introduce appropriate interventions to overcome potential barriers to discharge.
- Regular staff and patient surveys are being changed to include questions on the extent to which patients and staff perceive the RD&E and its staff to be a compassionate. Systems are under development to ensure our ability to monitor prevalence rates of psychological morbidity and flow through psychological care pathways
The anticipated impact of this project will be better provision for psychological support and care for patients and staff within the RD&E, that will result in reduced physical and psychological morbidity, greater engagement in self-care, improved quality of life, shorter hospital stays and reduced healthcare and work absence
In the short term, the next steps are to complete the training and introduction of routine screening for psychological problems in the key services identified and to establish and evaluate feasibility and acceptability of care pathways to patients and staff. In the medium term next steps will include extension of the training, screening and care pathways to other services.
How can we best address prolonged acute hospital stays in older inpatients with medical-psychiatric multimorbidity?: A pragmatic multicentre randomised controlled trial to compare the effectiveness and cost-effectiveness of Proactive Liaison Psychiatry with usual care.
- Adrian Harris