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Treating psychological problems that arise from physical illness and injury

CNWL offers a range of clinical health psychology services that focus on psychological problems arising from physical illness and injury or pre-existing psychological problems that are made more complicated by the management of physical health problems.

Dr Denise Ratcliffe, CNWL Consultant Clinical Psychologist and Head of Clinical Health Psychology, is based at Chelsea & Westminster Hospital for more than 14 years. There are 15 psychologists in the team and they provide specialist services including:

HIV/Sexual Health Psychology
Bariatric Surgery Psychology
Burns Psychology
Oncology Psychology
Weight Management Service
Pain Management Services

Dr Ratcliffe tells us more about why the team was established and how it’s changed over the years:

“Since I moved to the psychology department 14 years ago it’s grown considerably, we now offer more services than ever before to meet the ever changing needs of patients.”

The service was initially set up in the midst of the HIV epidemic in the 1980’s, when those recently diagnosed with HIV needed help to come to terms with a negative diagnosis and what it meant for them not only physically but psychologically. A specialist HIV/Sexual Health Psychology and Psychiatry Service was established to help those patients suffering from anxiety and depression and the reality of what was then a chronic condition. Chelsea & Westminster Hospital is the largest specialist HIV/Sexual Health Service in Europe and we provide psychology services to all their clinics.

A recent addition to the service is the Weight Management Service. The clinic was set up four years ago following a rise in obesity levels. The team support people with severe obesity to lose weight and improve their health and includes a team of dieticians, a physiotherapist, a clinical psychologist and a physician, all with specialist skills in managing obesity.

The team work closely with the Bariatric Psychology Service which provides specialist weight loss surgery. This is Dr Ratcliffe’s area of expertise, she says:

“People need to meet certain criteria to be eligible for bariatric surgery - they usually have a BMI of >35 and have a weight-related condition such as Type 2 diabetes. Bariatric surgery is by no means a quick fix. It requires considerable commitment, motivation and a good understanding of one’s eating behaviour. We work closely with patients for at least a year to offer a programme of integrated care before surgery is even considered.

“We help patients with emotional and binge eating and low mood. We often find that patients have suffered from abuse in their childhood that they have kept a secret for many years. Working with patients to build self-esteem and develop emotional support and coping strategies is crucially important before we even consider surgery.

“Surgery is one of the most effective means of losing weight but only if we work with the patient to change the pattern of behaviour so they do not slip into past habits of comfort eating.”

The hospital has developed a reputation as a major UK centre for bariatric surgery over the past 10 years.

Another area that has grown over the years is the Burns Psychology Service. They are based in the regional burns service at Chelsea and Westminster Hospital and see patients across the entire lifespan who have suffered burn injuries requiring specialist outpatient, inpatient and ICU treatment. They are embedded within a large team of multi-disciplinary professionals including surgeons, nurses, occupational and physical therapists. The burns psychology service will be celebrating its tenth anniversary in February 2016 and has grown from 1 to 3.4 staff.

Lead psychologist, Lisa Williams, describes the service:

"One of our team will attend the daily 8am handover meeting in order to establish who is due to have theatre that day, whether any new patients have been admitted and whether there are any issues that require our urgent attention that day.

We have a mixture of outpatient appointments for psychological therapy for common post-burn presentations like post-traumatic stress and appearance concerns plus we see every single inpatient that spends at least one night on the unit. We developed a series of age-appropriate screening questionnaires that assess the top risk factors for our population and give us the best chance for early intervention. With parents of young children - scalds to the chin, chest and neck area are one of the most common presentations we see – our aim is to contain their guilt and distress quickly so that they continue to provide good emotional support to their child.

For our adult population many of them are already struggling with physical, social and mental health issues prior to their burn injury and these are often critical factors in how they acquire their injury, e.g. through undiagnosed or poorly managed health problems including epilepsy, diabetes and substance misuse. Thankfully serious injuries from house fires are relatively rare as most of us now have smoke and heat alarms.

One of the big myths we work with all the time is that the size and location of burn injury relate to the level of psychological distress. This is not only untrue, but also unhelpful to those who have smaller and less visible burns. The research literature demonstrates that this is not the case and it is our experience and that of our patients too. We regularly participate in burns teaching programs to healthcare professionals and this is one of the most important messages we try to get across.

Thankfully most people will not develop appearance distress after a burn but we still have plenty of people to support who do. Something we see every day in this job is that human beings are incredibly resilient even under the toughest of circumstances and most of us will recover and move on, perhaps only needing a little help from psychology."