Mental Health Awareness Week 11th – 17th May 2015

Professor George Ikkos

Mental Health Awareness Week is marked on 11th – 17th May this year. Here, Professor George Ikkos, Consultant Psychiatrist at the RNOH, talks to us about the importance of looking after our patients' emotional as well as physical well-being, and our duty to combat stigma around mental health.

There are two consultant psychiatrists at the Trust working part-time – myself and Dr Sara McNally. We are supported by our invaluable secretary Melanie Smith.

Globally, musculoskeletal conditions and neuropsychiatric conditions are the two most common causes of disability. They are the reasons why people don’t go to work, or why they can’t perform as parents, or function properly at work or home. As both musculoskeletal and neuropsychiatric problems are common, they often occur together in the same patient and we help ensure good all-around care.

We work closely with staff throughout the hospital and we have excellent support from management here – Rob Hurd the Chief Executive has been very supportive and so have all the Medical Directors that we have worked with since 1998, from Mr Ian Bailey to Prof Tim Briggs to our current Medical Director, Mat Shaw.

We’re a support service for surgeons, pain consultants and rehabilitation physicians working in the hospital. We make sure that when patients have mental health needs they’re addressed for two reasons: first, because it makes for better outcomes all around, and secondly, because it improves the patient experience. Sometimes we may get referrals well before admission from surgeons for patients with known mental health problems and they want to have in place the right support when the patient arrives. Sometimes surgeons refer patients so that we can help prevent mental health problems altogether by planning carefully for support during admission.

We work with inpatients and outpatients with a range of needs. For example, people on the surgical wards who may become acutely confused after an operation because of the anaesthetics, patients who may be feeling anxious, depressed or suicidal because of fear or sad news about their illness or other reasons; or patients who are addicted to alcohol or drugs that  may cause behavioural disturbance. We work with spinal cord injury patients to ensure they are mentally at their best to take advantage of rehabilitation. We also see chronic pain patients who have various psychiatric issues such as stress, trauma, anxiety and depression, or sometimes personality disorders or somatoform disorders. We’re also here to make sure staff don’t get stressed because of the behaviour, mood or mental state of patients.

We work particularly closely with the rehabilitation and the chronic pain teams and the psychologists in these teams. In terms of care at the body-mind interface, I think this hospital has very high standards. We have been meeting with the chronic pain physicians and psychologists once a month to discuss cases to learn from each other and provide better care; we found this so useful that we recently decided to meet twice a month. Once a week we have a psycho-social ward round with rehabilitation physicians, therapists and nurses on the Spinal Cord Injuries Centre, so that everyone who comes in to have rehab is discussed in appropriate depth to make sure the team provides maximum emotional as well as physical care to our patients.

We have also developed SNAPS – the Stanmore Nursing Assessment of Psychological Status. It’s a one-page rating scale for nurses to monitor the mental state of their patients and to make sure that those who are distressed or frightened or angry, can voice their feelings and be cared for in a sympathetic way. Four or five times every year we put on special training events for SNAPS, including role-play and lectures – it’s really about communication skills and we get fantastic feedback from the nurses who take part. We also have a manual that goes with SNAPS for the nurses. After eight years of research, we’re just about to submit a paper for publication in the Scientific Journal and in that respect I think we are pioneers in the emotional care of patients by nurses.

There are times when a patient requests amputation because of a health problem and the surgeons ask us to help them assess whether that patient has the mental capacity to make the right decisions. It’s now standard procedure, as part of our pre-admission process at the RNOH, for older patients’ cognition to be checked through the ‘6 Item Cognitive Impairment Test’ (6CIT). And that’s very good because it means we can make sure that patients have the mental capacity to make decision and, if not, that their best interests are safeguarded.

Parliament has legislated that physical health and mental health are of equal importance and should have parity of esteem. If we don’t adequately address mental health issues it may lead to poor care. One of our key aims is to make sure people with mental health problems have an equal chance to be admitted and have the right orthopaedic treatment – and once they are here, to have an equally good experience as non-mental ill patients.

Unfortunately, mental illness is still stigmatised and that leads to people who need and can benefit from treatment not accessing it. People don’t want the label of depression or anxiety and yet that is what is taking them to the orthopaedic specialist or the pain specialist. Often this can lead to them not receiving the best treatment. So, it is really important that we combat stigma. We have prepared a special leaflet on Body and Mind: a Psychiatric Perspective to help clinicians understand the relation between the two and help combat stigma. 

The Royal College of Psychiatrists’ website also has brilliant health advice and a great range of mental health leaflets for patients and carers. It’s an essential resource for anyone who may have concerns either about their own or someone else’s mental health. 

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