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Blog post: Psychological First Aid

10 Oct 2016

Dr Chris Hilton, the trust’s director of business and strategy and consultant in liaison psychiatry, has written a blog about psychological first aid to mark World Mental Health Day on 10 October:

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“The 10th of October is designated by the World Health Organisation to be World Mental Health Day and this year we’re being asked to think about psychological first aid – providing mental health support in emergencies.

“Designated days like this might seem like a gimmick, but they provide fantastic opportunities for organisations like West London Mental Health NHS Trust (WLMHT), our 3300 staff, partners and patients to pause and think about what we do and why we do it. They also allow us to shout and be heard about the things that still have to change before we can truly say that mental health has parity of esteem with physical health.

“At the end of last year I was asked to represent the Royal College of Psychiatrists in helping NHS England to shortlist applications from health partnerships across the country who were applying to become Vanguard sites for Urgent and Emergency Care.  These sites were asking to be given financial and operational support from NHS England to innovate care models, work in partnership, integrate services, and to improve the quality and safety of emergency provision across whole geographies.

“As you’d expect, all of the proposals included ways that they might reverse the downward trend in the performance of our emergency services – the NHS recorded its worst ever performance against the A&E four hour standard earlier this year. All were expected to think about how mental health pathways could be integrated and improved, along the lines agreed in the last government’s Crisis Care Concordat.

“Most of the sites proposed improved provision of Liaison Psychiatry Services. However, it is now mandated in the Five Year Forward View for Mental Health that by 2020/21 “all acute hospitals will have all-age mental health liaison teams in place.” Having a good Liaison team should now be standard, and to describe this as an innovation would be as incongruous as congratulating hospitals for planning to include a crash-team or a pharmacy. Therefore only those Vanguards proposing more ambitious improvements to mental health crisis care were put forward for shortlisting.

“North West London (already enjoying ‘Pioneer’ status from an earlier initiative) was not put forward to be a Vanguard site. This hasn’t stopped us from overhauling our urgent mental health pathways, creating earlier this year our Single Point of Access services and Crisis, Assessment and Treatment Teams in all of our boroughs, providing timely specialist care for patients at home.  This North West London initiative involving commissioners, WLMHT and CNWL, is shortlisted for a “Positive Practice in Mental Health Award” and we will find out on Thursday 13 October if we’ll take home an award.

“International studies suggest that 4% of patients attending Emergency Departments do so with a primary diagnosis of a mental health problem, a third of these with self-harm or suicidal thoughts. What these numbers fail to reflect is the crucial role of mental health professionals working alongside in emergency settings for patients who have both physical and mental health needs – where the mental health problem may not be the primary diagnosis, but a reaction or complicating process. elastoplast

“Anyone who has worked or visited hospitals knows that they are places full of anxiety and distress – and just because this might be understandable, doesn’t mean that it is something we can ignore. Psychological problems alongside physical health needs can make physical symptoms be perceived as worse, make it harder for people to receive care and increase unhelpful behaviours such as smoking or poor diet – together this can lead to poorer outcomes and more costly care.

“Ensuring we tackle these psychosocial factors is at the heart of the work we’re doing to integrate physical and mental healthcare and is one reason WLMHT is broadening the range of services we offer. We now provide integrated intermediate physical health care in Ealing, and soon in Hammersmith and Fulham; Thames Lodge and the new Broadmoor Hospital have fully-equipped physical healthcare facilities at their core; and we’re partnering with other organisations such as Hammersmith and Fulham GP Federation, Imperial College Healthcare NHS Trust, and Chelsea and Westminster NHS Foundation Trust, to improve all-round care for the patients we share.

“People with physical health problems deserve to have their psychological needs met, and people with mental health problems must have their physical health needs identified, assessed and treated.

“In WLMHT we’re helping our staff to gain new skills in physical healthcare and just as we all might have a first-aid box and not be afraid to apply a sticking-plaster when someone has a minor injury, we can work together to educate our friends and colleagues in other parts of the health service, from the ambulance crew, A&E receptionists, and MDT members in physical health settings to apply the principles of psychological first aid.”