IBD can have a serious psychological impact, especially during a time of critical illness or when facing life-changing surgery. That’s why it’s so important to consider mental health and provide support to IBD patients if necessary.
Case study: New psychological service, Liverpool University Hospitals NHS Foundation Trust
Statement 3.2
Following diagnosis, all patients should have a full assessment of their disease activity, nutritional status, mental health, fatigue and extra intestinal manifestations. This should include growth status for children and teenagers and an infection screen for patients likely to require immunomodulators, targeted small molecules or biologics.
Statement 5.8
Patients and parents/carers should be provided with information about postoperative care before discharge, including wound care. Stoma care and psychological support should be available where needed.
Statement 6.5
On admission to hospital, nutritional status, mental health, pain and extra intestinal manifestations should be assessed using validated tools, where available. Pathways should be in place for onward referral as appropriate.
Who's doing it well?
The IBD service at the Royal Liverpool Hospital, part of the merged Liverpool University Hospitals NHS Foundation Trust (LUHFT), recognised the need for an integrated psychological service within their IBD team, in response to a number of patient incidents where struggles with psychological health and accessing support negatively impacted IBD care.
After merging as a trust, a clinical psychologist has been appointed in 2021 to LUHFT, covering not just the Royal Liverpool Hospital but also Aintree Hospital in the north of Liverpool.
The idea
Clinicians within the IBD team developed the business case for the new psychological service for patients with IBD in Liverpool. This new service is now embedded and integrated within the IBD team with new processes currently being finalised for referrals and the overall scope of the service. It is expected that any member of the IBD team can refer patients to the psychological service, including doctors, specialist nurses, dieticians and pharmacists, with patients being prioritised on the basis of need and urgency.
As well as offering an inpatient and outpatient service, empowerment and training of other IBD team members to think more about the psychological aspects of IBD care is a specific goal of this new service. In addition, signposting to support services in the community is a key aim of the service so patients receive the right support from all available services.
The business case for a psychologist is not specific to IBD care, however it is felt that key IBD patient groups may benefit from this service (although not exclusive to these groups):
- IBD patients in distress – particularly those undergoing surgery in the future or who have had negative psychological outcomes from surgery in the past.
- IBD patients undergoing transition from paediatric to adult IBD care.
- IBD patients who require nutritional support, such as those with short bowel syndrome and those on long term parenteral nutrition.
Results
Although this is a new service, several key performance indicators have been set to assess the success of the service into the future – in line with the IBD Standards1.
It is hoped that the new LUHFT psychological service will improve the psychological wellbeing of patients in Liverpool and meet a clear unmet need within the region, hopefully becoming a flagship centre in the UK, which other centres can benchmark against.
The aim of integrating psychology within the gastroenterology service is to enhance both clinicians’ and patients’ recognition of the psychological impact that having IBD can have, and how this can interplay with a person’s ability to manage the condition, adapt accordingly and maintain a good quality of life. There is increased awareness of mind-body links and emphasis towards a bio-psycho-social model where an understanding of physical, social and psychological factors are integrated to provide a more holistic and person-centred approach.
1. Lamb CA, Picton C, Arnott I, Avery P, Attwood D, Banerjee S, et al. The 2026 IBD UK Standards of healthcare service design and delivery for adults and children living with Crohn’s disease and ulcerative colitis. BMJ Open Gastroenterology.
Date created: May 2021
