Aims and methodThe Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017–2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire.ResultsAnalysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances.Clinical implicationsAn integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services.Declaration of interestNone.
This article explores the impact of the first year of lockdown on the UK nations. It highlights the impact of the social determinants of health before exploring other areas where the virus affected large numbers of the population. Discussion of economic and psycho-social phenomena indicates that there are no obvious conclusions and that it may be many years before we understand the true consequences of lockdown. Particular attention is given to the experience of the Jewish community.
ObjectiveTo improve affect regulation, increase physical and social functioning, and reduce health care utilisation in patients with functional motor, sensory, and physical disorders, and/or chronic health anxiety.MethodFollowing a biopsychosocial assessment at The Persistent Physical Symptoms Clinic, patients were invited* to enrol in a 12 week group therapy programme (the Programme). Designed on principles of CBT and ACT (Acceptance and Commitment Therapy), the Programme combined psycho-education, behavioural experiments, cognitive reframing and Mindfulness. Pre-group and weekly validated measures (EQ-5DL, WEMS, SEPS) were collected, together with data about health care utilisation in the previous year. Patients with Health Anxiety additionally completed the Health Anxiety inventory (HAI).Individuals’ health beliefs and behaviours were recorded, along with historical and recent stressors (childhood/adult trauma, family physical and mental health status, financial worries). Alexithymia – a trait implicated in the impaired development of emotional neural structures, (Kano & Fukudo, 2013; Shibata et al, 2014) – was assessed using the TAS-20. Discussion of individual conditions (including NEAD, Conversion, Movement, Gastro-intestinal, Pain, and Respiratory disorders) was discouraged during the sessions, both to avoid iatrogenic perpetuation through fostering a ‘competitive’ ethos and to keep participants recovery-focused. Expanding psychological flexibility was encouraged in order to enhance acceptance and facilitate change. Learning to identify and name emotions related to their experience of illness helped patients establish links between affect and behaviour (e.g. anger with self, health professionals, and family, lack of exercise, isolation). Role play developed assertiveness skills, whilst experiential exercises – guided-relaxation and compassionate mindfulness – aimed to reduce somatosensory amplification ((Derakshan, Eysenck & Myers, 2007; Edwards & Bhatia, 2012). Patients drew on their own values to design goal-based behavioural experiments for inter-session practice. Dysfunctional cognitive styles implicated in both low mood and the exacerbation of functional conditions – dichotomous thinking, catastrophizing and over-generalising (Lumley, Neely, & Burger, 2007) were challenged, using humour as appropriate. Resilience skills were inter-woven with relapse-prevention techniques. An individual review was offered half-way through the Programme. *Non- English speakers and/or patients currently experiencing psychotic symptoms were excluded.ResultsParticipants who completed the group recorded decreases in health utilisation, isolation and anxiety, and an improvement in perceived control over their symptoms, quality of life, and inter-personal skills.ConclusionPreliminary results include reduced hyper-vigilance and symptomatology. Narcissistic traits are barriers to progress. OT physiotherapist input would enhance the Programme.
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