A mental health nurse-led multidisciplinary team has set up a project to meet the emotional and mental health needs of patients who have multiple sclerosis
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Sally Askey-Jones, BN, RN,is mental health nurse specialist in multiple sclerosis, Institute of Psychiatry, King’s College London.
Richard Gray, PhD, RN,is professor of mental health, University of East Anglia;Pauline Shaw, BSc, RN,is multiple sclerosis nurse specialist, Southwark PCT;Trudie Chalder, PhD, MSc, SRN, RN,is professor of cognitive behaviour psychotherapy;Anthony David, FRCP, FRCPsych, MSc, MD,is professor of neuropsychiatry;Kevin Gournay, CBE, PhD, FRCPsych, CPsychol, RN,is professor emeritus, all at the Institute of Psychiatry, King’s College London;
Eli Silber, MD,is neurologist, King’s College Hospital, London.
This project provides a unique service that aims to enhance the mental and emotional well-being of people who have multiple sclerosis (MS).
In collaboration with King’s College Hospital MS service, South London and Maudsley NHS Foundation Trust, the Institute of Psychiatry and the MS Society, this service provides assessment and treatment using medication, cognitive behavioural therapy (CBT) and psychosocial interventions.
Patients also receive education that helps to empower them to take control over their lives.
Research suggests that mental health issues are undertreated in people with MS because of overlapping physical symptoms and that there is a high incidence of mental health problems, which is exacerbated by the uncertainty of the condition.
However, the evidence also suggests that mental health problems in MS are treatable, with patients responding well to antidepressants/other neuroleptics and/or CBT and psychosocial interventions.
In light of this, we felt it was necessary to provide a service to meet this need, and evaluate it after three years to ascertain whether patients do benefit from mental health nurses’ input.
As research in this area is limited, part of my work is to develop a research agenda, with a view to raising the profile of the issue within mental health and MS services.
People with MS can experience a variety of mental health problems, with up to 50% of them experiencing depression during their lifetime.
There are also high rates of anxiety and other mental health problems such as psychosis, mania, pathological laughter and crying.
Many people with MS have not received adequate care for mental health problems because of overlapping physical symptoms and difficulties in accessing services.
Our project aims to reduce psychological distress by offering patients assessment, treatment and follow-up. We also educate MS nurses so they feel more empowered to manage mental health issues.
The project began in March 2006 and was completed at the end of 2008. It has received over 120 referrals, indicating the service is desperately needed in the area.
All patients complete initial assessment scales when they start treatment and rating scales at six months.
This means we can quantify whether the service is having an impact and what patients respond well to. This will hopefully provide opportunities to make important changes and enable us to be more responsive to patient needs.
Benefits for patients
Patients are provided with an initial assessment within 4–8 weeks of the referral. If a patient is in crisis, I assess them within one week of referral. This is quicker than assessment by local community mental health teams and, because the service is more specific to MS, patients feel I have an understanding of their experiences.
Care is tailored to individual patients’ needs. A range of services is offered including: home visits for mental health assessment and treatment for people who are unable to attend clinic; an outpatient clinic co-managed with a neuropsychiatrist; and a CBT clinic.
Regular teaching sessions are provided to MS nurse specialists in the south east of England.
These nurse specialists have been asked to complete questionnaires at the beginning and end of the module to evaluate whether the teaching has changed their attitudes to mental health issues and whether they feel more confident in working with people with mental health difficulties.
I have developed guidelines on depression and anxiety for south-east London, and nurses in this area are using these to change their practice.
This has been done in conjunction with their mental health training, and has led to increased confidence and positive attitudes to mental health issues. The training will also be promoted nationally with the MS Society and this will lead to further dissemination of practice.
We plan to publish the results of the evaluation this year. We hope that publication of its benefits will lead to the project being established on a more permanent basis.
Further studies could establish whether this model could be used in other parts of the UK.
Find out more
If you would like to have additional information on this project, contactSally.Jones@iop.kcl.ac.uk