Forming the bridge between psychological and physical care

People with long term medical conditions are at a greatly increased risk of having a mental health problem – two to three times more likely than the general population. Two ... Read more

People with long term medical conditions are at a greatly increased risk of having a mental health problem – two to three times more likely than the general population. Two separate initiatives that the Trust is involved in are aiming to shine a light on the best way forward to treat people with both physical and mental health conditions.

The incidence of panic disorder is ten times higher amongst people with chronic obstructive pulmonary disease. This has a very negative effect on their quality of life. Healthy Minds, the Buckinghamshire-based IAPT (Improving Access to Psychological Therapies) service, is currently working with other health colleagues to deliver clinics that teach self-help techniques to tackle breathlessness. This has been shown to improve mood, reduce A&E attendance and prevent acute admissions.

Patients with cardiac disease are also much more likely to develop depression and anxiety than the general population. Talking Space, the Oxfordshire IAPT service, is currently collaborating with the cardiac service provided by Oxford University Hospitals NHS Trust to provide psycho-educational sessions as part of their normal cardiac rehabilitation programme. This project has seen some excellent joint working with the cardiac nursing team with some very promising results (see case study below).

Both of these initiatives, which started in April 2012, have come about after the Department of Health IAPT programme called for proposals for pathfinder sites to develop new integrated physical and psychological care for people with long term conditions last December. Although both of these initiatives are small, there has been considerable interest from patients, service users and those within the NHS.

People with long term medical conditions are far more likely to use mental health services and overall account for 70% of all health and social care expenditure.  Integrating physical and psychological care could potentially provide much better outcomes for patients, as well as significant savings for the NHS – although it would require a sea change in the way care is provided.

Case study

Malcolm is 42, married with two children. He described himself as a busy, full speed person and worked very long hours in his job. He had no family history of cardiac problems. Malcolm had a heart attack last year and has been on various medications since. He started individual Cognitive Behavioural Therapy sessions as a result of being part of the Heart2Heart pathfinder service – the CBT is provided in the same place as his cardiac appointments and is a normal part of the integrated community care he receives. At assessment, Malcolm had severe depression and severe anxiety. He was having frequent panic attacks and was very anxious about any physical sensation, being concerned that he might be having another heart attack.  He had stopped doing the activities he had enjoyed before the heart attack and was not going out much. He had begun to drink, up to 12 units each day.

After three sessions of CBT, Malcolm had the therapy goals of reducing his alcohol consumption and managing his anxiety better. As a result he has started doing more activities, has days of abstinence from alcohol and his depression and anxiety scores have begun to reduce.

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Published: 31 July 2012