Case study: Psychological Support Service for patients with IBD, Brighton and Sussex University Hospitals NHS Trust

Case study: Psychological Support Service for patients with IBD, Brighton and Sussex University Hospitals NHS Trust

Crohn’s & Colitis UK’s 2017 Quality of Life survey found that 47% of respondents said that their IBD had impacted their mental health.1 This finding echoes research that found more than 1 in 4 people with IBD will experience depression in their lifetime.2

However, despite increasing awareness of the link between Crohn’s and Colitis and levels of emotional well-being, 45% of people surveyed said they were ‘dissatisfied’ or ‘somewhat dissatisfied’ with the emotional support they receive for their Crohn’s and Colitis.3 The IBD Audit, which ceased in 2014, found that only 53% of services could refer people with IBD for psychological support.4

Statement 3.4

After diagnosis, all patients should have full assessment of their disease, nutritional status, bone health and mental health, with baseline infection screen, in order to develop a personalised care plan.

Statement 5.4

Patients with IBD being considered for surgery should be provided with information in a format and language they can easily understand to support decision-making and informed consent and offered psychological support.

Statement 5.6

Patients and parents/carers should be provided with information about post-operative care before discharge, including wound and stoma care, and offered psychological support.

Statement 6.8

On admission, patients with IBD should have an assessment of nutritional status, mental health and pain management using validated tools and be referred to services and support as appropriate.

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

This support has led to much greater enjoyment and engagement with my life. It feels like every aspect of my Crohn’s Disease is being catered for, not just the physical. The therapy was focused, comprehensive and effective.

Patient

It has revolutionised the way that we can support and help our patients, because before we had this service, all the psychological impact of IBD went completely unaddressed. We didn’t even dare to ask about these things, having no idea what to say to people in distress and not coping, and certainly not being able to offer useful intervention.

Clinician

1Crohn’s & Colitis UK’s Charity Survey 2017. Q8

2Walker JR, et al (2008) The Manitoba IBD cohort study: a population‑based study of the prevalence of lifetime and 12‑month anxiety and mood disorders. Am J Gastroenterol. 2008;103(8):1989–97.

3Crohn’s & Colitis UK’s Charity Survey 2016. 14b

4UK Inflammatory Bowel Disease Audit (2014), Royal College of Physicians. P12

5This briefing is based on: