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.
In the 2023 IBD Service Self-Assessment survey, the majority of services agreed that they assessed nutritional status and pain management of patients upon admission to hospital (92% and 73% respectively), but only 14% agreed that mental health was assessed using validated tools on admission. This reveals a significant area for improvement when it comes to providing holistic assessment to inpatients.
Who’s doing it well?
The IBD service at Brighton and Sussex University Hospitals NHS Trust, together with the IBD patient panel, identified unmet emotional and well-being needs within its patient population. However, clinicians within the IBD team felt that they lacked the expertise to deal with these psychological difficulties, and that as a result these patients were not being treated effectively.
The idea
Clinicians within the IBD team came up with the idea for a Psychological Support Service for Patients with Inflammatory Bowel Disease (PSSPIBD). The PSSPIBD was embedded and integrated within the IBD team, running for 18 months. Referrals were made by the IBD team, including doctors, specialist nurses and pharmacists. Initial assessment was carried out by a psychiatrist who made a formulation, diagnosis and comprehensive treatment plan. This could include advice on psychotropic medications, signposting to support services in the community, referral to other mental health services in primary or secondary care, or referral on to the IBD psychologist, as well as liaising with the referrer and GP.
Patients seen by the psychologist received time-limited therapy, on average five sessions, but ranging from one to twelve, according to patient need. The psychiatrist also attended the weekly IBD multidisciplinary team meeting (MDT) to help clinicians identify patients that would benefit from referral to the PSSPIBD and provide support to clinicians in providing care for challenging patients with psychological difficulties who would not accept referral to the service.
Results
Between October 2015 to March 2017, 85 patients were assessed and treated by the PSSPIBD, staffed by a psychiatrist (0.1 whole time equivalent) and clinical health psychologist (0.3 whole time equivalent) with special interests in IBD. The most common reason for referral into the service was support adjusting to IBD and its symptoms, for example, pain, fatigue, incontinence, tolerating uncertainty (55%), followed by anxiety (30%) and depression (10%). 75% of patients seen were female.
Treatment through the PSSPIBD resulted in statistically significant improvements in all four domains of IBD symptoms (bowel symptoms, emotional health, systemic systems and social functioning) and a trend to improvement in quality of life.
Statistically significant improvements were also seen in depression scores and there was a strong trend to improvements in anxiety scores.
Patient satisfaction with the service was very high. Of those patients that completed the feedback survey, over 90% rated the service as excellent.
For every £1 spent on pilot project:
- Number of bed days reduced by more than 60%, thereby releasing bed days to improve patient flow.
- Inpatient admissions reduced by over 70%.
- IBD follow up appointments used reduced by 60%, reducing pressure on clinic and referral to treatment time.
- Number of scans reduced by 75%, reducing service pressure.
Further developments to the service could have included:
- Training to the IBD team to provide them with more skills in identifying and supporting patients with psychological difficulties.
- Group workshops for patients, including those with new diagnoses.
- Ward in-reach to engage patients early and support ward staff.5
