Preparation for Improved Psychological Care

1. Preparation for Improved Psychological Care Sue Chambers Senior Lecturer, Staffordshire University

2. Why? • ‘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

3. Why? • Depression • Most common psychological presentation • Approx 25-50% • Anxiety • Between 30-49% up to 12 years post stroke • Phobias, generalised anxiety, panic

4. Definitions of Stroke: • 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”

5. Policy Drivers • National Stroke Strategy (2007) • Royal College of Physicians (RCP) National Clinical Guidelines (2008) • Accelerated Stroke Programme (2010) • Psychological care after Stroke (2011)

6. Ignoring the Issue………. • Untreated psychological mood disorders are associated with higher rates of : • Mortality • Suicide • Long term disability & institutionalisation • Hospital readmission • Higher utilisation of outpatient services

7. Psychological Care in a Physical Health Care Setting? • 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!

8. Stroke School / Stroke Rehab • 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

9. Embedding the Stepped Care Approach • 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

10. Identifying Barriers

11. ‘Can of Worms’ 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

12. Preparation and Education 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.

13. What do we look at? • 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

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

15. Education and Preparation so far: • 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 • Level One • Two day workshop • Series of one day workshops • Level Two • Series of one day workshops

16. Evaluation of events to date: • 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

17. Impact of Training: • 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

18. Remember: • “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.”

19. In Summary 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.

20. Thank you