Clinical Health Psychology services news and reviews

CHPS staff present at Havering End of Life conference

NELFT joined with BHRUT and St. Francis Hospice to organise a Havering End of Life Conference, enabling all health and social care professionals to come together and discuss palliative care in the local community.

This event provided an opportunity to work in partnership and ensure that people with life-limiting illnesses, and for families and friends, receive the care that they need and in their place of choice. 

The conference focused on the following six 'Ambitions'; 

•             Each person is seen as an individual

•             Each person gets fair access to care

•             Maximising comfort and wellbeing

•             Care is co-ordinated

•             All staff are prepared to care

•             Each community is prepared to help 

Marc Kingsley, consultant clinical psychologist, Suraj Mehan, assistant psychologist and Tarek Seeraullee. carers lead, Havering presented at the Havering End of Life conference on the important and often underreported area of suicide risk within palliative and end of Life patient groups and Palliative Carers Support. You can access their presentations and hear their views below

Marc Palliative Care End Of Life Conference [pptx] 213KB

End of Life Conference Presentation - Carer Awareness and Support [ppt] 308KB

Read CHPS staff present at Havering End of Life conference…

Karen Rogers gains Distinction in the Mental Health Law and Practice Certificate course from Northumbria University

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Congratulations to Karen Rogers, our CHPS admin co-ordination on her wonderful achievement. She has gained a Distinction in the Mental Health Law and Practice Certificate course from Northumbria University following 6 months of intense study undertaken for her role in the Mental Health Act Office which she does alongside her CHPS admin work. Well done and we are thrilled for and proud of you! 

Read Karen Rogers gains Distinction in the Mental Health Law and Practice Certificate course from Northumbria University…

NELFT staff members recognised as inspirational women leaders as part of NHS70 celebrations

We are delighted to announce that Lindsay Royan, consultant clinical psychologist with our B&D psychological services, was recognised, alongside 3 of her colleagues, as inspirational women leaders across the NHS in London. As part of the NHS70 celebrations the NHS London Leadership Academy requested nominations for staff from London NHS organisations. Over 150 nominations were received and 70 women leaders were chosen following judging panels.

Lindsay was recognised for her goodwill, experience, insight and compassion. Lindsay was also awarded the NELFT Lifetime Achievement Award earlier this year as part of the Trust’s NHS70 celebrations.

NHS70 women leaders - Lindsay Royan

All NHS70 Women Leaders received a certificate and pin badge at the ceremony in London on 4 July. Later in the year they will be offered access to a leadership development session and the opportunity to apply for a leadership development course.

Read NELFT staff members recognised as inspirational women leaders as part of NHS70 celebrations…

Psychological distress in Endometriosis, Margreet Hendriks

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A recent headline in a national newspaper stated ‘Endometriosis; not just a heavy period’.  This article was timely as the combination of the difficulty in diagnosing endometriosis and the general lack of understanding about what it is and how it affects women can have a significant impact on the quality of life and the emotional and psychological well-being of the women diagnosed with the condition.

Experts compare endometriosis to a benign cancer; an unusual cell mutation that can cause the endometrium tissue to form most commonly around the bladder, bowel or appendix but there have been isolated cases of this tissue being confined to the brain or lungs. Removal of this tissue is often offered but can lead to scarring which can result in more pain and so the number of times this can be done is limited. It is a life-long condition with no cure but women tend to find that it affects them less after the menopause.

10% of women suffer with this condition worldwide which makes it as common as asthma and diabetes and the impact of it is regarded the same as breast or ovarian cancer.

I work as a highly specialist counselling psychologist in the maternity & gynaecology psychology clinical health service for NELFT and Barking, Havering & Redbridge University Trust (BHRUT) and frequently receive referrals requesting psychological intervention for women with endometriosis. Research in this area is limited however, the existing research I read consistently established that there is an association between psychiatric disturbances and endometriosis which determines that women presenting with endometriosis are at risk for psychosocial disturbances and/or psychiatric distress.  The research generally agreed that the main clinical symptoms of endometriosis; pain, fatigue and infertility are strongly influenced by psycho-social factors and have a significant impact on personal and professional quality of life.  Moradi et al (2014) who interviewed 35 Australian women concluded that ‘those living with chronic pelvic pain caused by endometriosis suffer emotionally, psychologically and socially and report feeling upset, angry, depressed, uncertain, weak, powerless, helpless, hopeless, defeated, disappointed, frustrated, exhausted and a burden to others.’ Furthermore, the authors reported that the average delay time to diagnosis is currently 8.1 years.  

The referrals from the endometriosis team often reflect the psycho-social impact of endometriosis; referrers often also highlight the delays and difficulties in diagnosing this condition. These delays have often involved multiple abdominal investigations (laparoscopies/MRI’s amongst others) which may not be conclusive as period cycles and hormone treatments suppress symptoms adding to the already damaging impact of feeling disbelieved or dismissed.  To illustrate, here are a couple of examples (names have been changed and identifiable information removed):

Alison: Long standing lower abdominal pain, pelvic pain and painful sexual intercourse. This lady has suffered with pelvic pain since she was 16 years old and has been progressively getting worse in the last two years. Her symptoms have a significant impact in her daily life, social life and relationship. She was very tearful during her appointment and she tells me she feels isolated and her relationship is really affected by the symptoms and is unable to cope with the pain. She had multiple laparoscopies in the past (5x); first laparoscopy was when she was just 15 years old.She also had an appendectomy at the age of 14.

Patient suffers with increasing pelvic pain. MRI was discussed on MDT. MRI shows no evidence of endometriosis. Outcome discussed with her and she was offered to have Mirena coil however, she currently has Mirena in-situe which didn’t help with her symptoms’.

Charlotte: ‘Patient is very young with no children. Due to her pain she wants to have pelvic clearance. She is aware of the consequences of having a hysterectomy and due to her age and not having children it is unlikely to be offered to her at this time. Her condition also has significant impact on her life. She is unable to socialise with friends and has cancelled meetings with friends on many occasions because of her pain. She has been avoiding being in a relationship because sexual intercourse is very painful. The pain medication she is on (oromoph solution, tramadol, mefenamic acid) makes her feel drowsy resulting in having to take sick leave as when she takes the medication she is not able to get out of bed’.

When I first meet the clients at the initial psychological assessment appointment clients typically report finally ‘feeling validated and heard’ as their patient journey has often involved having been dismissed for ‘just having heavy period pains’ by health professionals. What also becomes immediately clear from the women’s narrative is that all domains in their lives are affected by endometriosis as emphasised by the research and usually this starts to happen from quite a young age (typically symptoms become apparent around 15-16 years of age). The impact on marital/sexual relationships, social life, and physical and psychological aspects are reported by all the women I see but differ in order of priority; younger sufferers report education attainment difficulties, older individuals speak of loss of income and reduced life opportunities.

During the therapy sessions the women express the varying ways endometriosis has impaired their quality of life. The severe chronic pelvic pain affects their level of social and romantic interaction with many avoiding entering into romantic relationships for fear of painful intercourse and subsequent rejection. Some sex-education is therefore helpful in reducing the stigma and humiliation women may feel in this area as it explores different ways of viewing and engaging in sexual activity.

Sub- or infertility is one of the main consequences of endometriosis and worrying about the future and grieving for a life they cannot live is often expressed as the worst symptom in psychologically.  In the workplace, endometriosis sufferers can find themselves in a difficult situation when employers do not recognise their condition as a disability under the Equality Act (2010) resulting in potentially unlawful dismissal due to frequent absences from work which is often caused by pain and fatigue. This additional stress and anxiety leads to an increase in pain symptoms and fatigue which can render these women feeling unjustly victimised giving rise to feelings of hopelessness and powerlessness. These work experiences are unfortunately quite common and frequently recalled during therapy.

 

As women have often lived with endometriosis for a long time without support, many women I see have tried to find ways of coping with the sometimes unpredictable and debilitating nature of endometriosis themselves.  Their stories reveal the complex blend of physical, psychological and emotional suffering which they describe as a ‘constant battle’ which can be driven by a belief system that ‘giving in’ to endometriosis is ‘being defeated’ which results typically in unhelpful behaviours such as the ‘boom-bust’ activity cycle; doing too much on good days and paying for this for days after. However, as the condition is chronic and enduring, it demands a level of ‘grit’ in order to achieve a reasonably normal life which can necessitate developing coping mechanisms that involve engaging in some of these unhelpful responses to the condition. Therefore, an integration of pain management, stress relief and psychological approaches would mitigate these responses and be therefore of most benefit to them.

Psychological education on pain which focuses on separating the emotional suffering from the direct physical experience and the influence of anxiety and stress on pain is usually discussed during the first sessions and this typically changes the way the woman relates to her pain which can reduce pain levels as psychological distress caused by her pain is reduced. An understanding of the ‘boom-bust cycle’ by paying attention to her body’s sensations may help her to promote pacing her activity level. Research has particularly highlighted the effectiveness of body-mind approaches and so mindfulness meditation is also introduced early in therapy to reduce stress and promote relaxation reducing pain levels to a more manageable level. Furthermore, mindfulness typically promotes an awareness of the connection between body and mind and it will, therefore, facilitate the growing awareness of bodily sensations and their changing nature especially the sensation of pain which many chronic pain sufferers perceive as continuous.

The mindset of needing to ‘battle on’ and engage in these unhelpful behavioural patterns do impact on a woman’s psychological health

Low mood, depression, excessive worrying and catastrophizing are often expressed and cognitive behavioural therapy can especially be helpful to manage mood and symptoms of anxiety by challenging particular thoughts and behaviours. Feelings of isolation and hopelessness often diminish after the client has started to implement these approaches as a level of control over their lives returns and a more positive outlook for the future is emerging.

Even though there are common themes in women’s experiences, there are many individual differences in how women cope with and adjust to the condition and I therefore tend to integrate different psychological approaches to accommodate these.

I have added some resources I have been made aware of below as having access to a wider network of support where women can share their experiences may further alleviate feelings of isolation and can normalise one’s experience.

Unfortunately misconceptions and lack of understanding is still driving much of the (lack of) care especially during the earlier stages of the patient’s journey leading to much unnecessary physical and psychological suffering.  A better understanding of how endometriosis affects all domains in a woman’s life can help decrease the negative impact of endometriosis by guiding service delivery and future research to meet more effectively the needs of women and teenagers with this condition.

References:

Moradi. M., Parker M., Sneddon A.., Lopez V. & Ellwood D.:  ‘Impact of endometriosis on women’s lives: a qualitative study’ (2014) BMC Women’s Health 2014 14:123

Resources for patients

Endometriosis: the experts’ guide to treat, manage and live well with your symptoms – Andrew Horne (2018)

Nancy’s nook – Facebook – personal journey of endometriosis sufferer

Endometriosis UK charity

Youtube.com documentary:  ‘Endo what?  (2016)

Read Psychological distress in Endometriosis, Margreet Hendriks…

The importance of sleep by Kim Lyons

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Sleep is crucial for physical and psychological wellbeing. Yet people frequently devote time, effort and money on faddy diets, exercise, therapy etc. than to sleep.

Often described as the ‘Health Trinity’: diet, exercise and sleep. Sleep is often thought of as the poor relation!

However, the physical and mental impairment caused by one poor night sleep dwarf those caused by a corresponding lack of food and exercise.

The World Health Organisation and the National Sleep Foundation both stipulate an average of eight hours of sleep a night for adults/

Nevertheless The Sleep Council’s Great British Bedtime Report, (March 2013) reported that the majority of Britons (70%) now sleep for seven hours or less per night, with more than a quarter (27%) experiencing poor quality sleep on a regular basis. And the number of Britons getting just five-six hours per night has risen dramatically in the past three years: more than a third of us get by on that amount of sleep, compared to 27% in 2010.

Did you know lack of sleep increases the risk of the following

  • Poor memory
  • Type 2 diabetes
  • Hypertension
  • Mood changes, including depression, anxiety, impulsive behaviour
  • Poor immune system
  • Over eating and weight gain
  • Accidents, one of the biggest cause of road traffic accidents
  • Poor concertation
  • Aging in general 

Despite the above evidence, it is increasingly neglected in twenty-first-century society, with shocking outcomes. We have to stop and re-evaluate our relationship with sleep.

Sleep is not a ‘luxury’, ‘waste of my precious time’ or ‘inconsequential’', it is necessity.

In reality we are living in a hectic, fast moving, frantic world, where regularly people are setting more than 1 alarm often multiple alarms to wake up so they can be up and ready to ‘go go go’. Time is now approaching where we need to set an alarm on our watches, mobiles and/or clocks in the evening to ‘slow, slow, slow’ and then ……sleep... zzzzzzz

For more information on sleep please see the following-

https://sleepcouncil.org.uk/

https://sleepfoundation.org/

https://www.nhs.uk/live-well/sleep-and-tiredness/how-to-get-to-sleep/

https://www.sleepio.com/2012report/

https://www.mind.org.uk/information-support/types-of-mental-health-problems/sleep-problems/#.Ww1m58uWy2w

The article is written by Kim Lyons. Highly Specialist Psychological Therapist/ CBT Therapist. Psycho-prosthetics and Psycho-oncology service.

Read The importance of sleep by Kim Lyons…

Breathworks and Mindfulness intervention article authored by NELFT clinical psychologists published in British Journal of Healthcare Management

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Huge congratulations to Suraj Mehan, honorary assistant psychologist and Julia Morris, consultant clinical psychologist on their article, 'A literature review of Breathworks and mindfulness intervention' was recently published in the British Journal of Healthcare Management.

You can read the full article here

Read Breathworks and Mindfulness intervention article authored by NELFT clinical psychologists published in British Journal of Healthcare Management…
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