Back in July, talkhealth published an article which highlighted the need for psychological support which dermatology patients are severely lacking. The article was inspired by the team of experts from the Severe Eczema and Psoriasis Team at St. John’s Institute of Dermatology, St Guys’ and St Thomas’ NHS Foundation Trust. After reassessing their approach to dermatological patients, the team recognised the desperate need for more holistic care in all dermatology.
After the article was published, talkhealth contacted British Association of Dermatologists press team who published the findings to find out more about the psychological aspects of skin conditions. Dr Andrew Thompson, a Reader in Clinical Psychology at the University of Sheffield, and advisor to the All Party Parliamentary Group on Skin was recommended and was more than happy to be interviewed by us and share his thoughts on the need for psychological support for dermatology patients. During the conference call, Dr Thompson answered many of our questions, and provided a profound insight into the logistics of how support could or should be delivered as well as his thoughts on existing practices in dermatology practices:
How long is the process of being referred to a psychological specialist? (i.e. from diagnosis)
This is very variable and depends on the service. However, waits of several months for secondary care level support is not unusual.
In terms of the actual support offered, what form do you believe that support should take?
I think that psychological support or treatment should be available on a stepped care basis, this might involve advice and support simply being provided initially by treating clinicians, followed by access to self-help if required, and in some situations referral for psychological therapies such as cognitive behavioural therapy. There is also a place for support groups and group interventions. ‘We are currently undertaking research to develop self-help and the resources we have developed will be available on www.skinsupport.org.uk
Which is most effective in your opinion? (i.e. face to face meetings, support groups, etc).
This very much depends on the nature of the presenting issue. We conducted a systematic review a few years ago and this found that there have been relatively few studies that have evaluated the effectiveness of psychological therapy, so it’s difficult to be definitive as to what works. In my clinical experience individual cognitive behavioural therapy can be very effective with people with moderate to severe levels of distress. As I said we have been conducting research into self-help and group mindfulness and there is emerging research that people experiencing mild levels of distress might benefit from ‘these sorts of specific psychological treatments.
Do you envisage a time when psychological support is offered hand in hand with referrals to dermatologists?
This isn’t of course necessary in all cases, and I’ve argued in a number of articles that the most important thing is that psychological issues are assessed at the time of referral. Where psychological issues are identified (perhaps with the use of simply screening questionnaires) a referral for psychological support should be made alongside the referral to the dermatology services. The potential presence of significant psychological distress should also be screened again during the consultation within the dermatology service and there is a need to have clear pathways that dermatology staff can follow to access psychological services for people in their clinics.
Do you believe dermatology practices on the whole are making noticeable progress when it comes to offering psychological support?
I’m afraid that dermatology departments are under significant pressures at the moment and this is affecting services ability to make progress in the assessment and provision of psychological support. Having said that, there are some examples of emerging systems of providing psychological support within clinics that are to be commended. For example, recently one service in London used iPad’s to identify the possible presence of symptoms of anxiety and depression, whilst patients waited and to advice dermatologists as to the resources available for treatment (which included access to a Clinical Psychologist attached to the clinic). Certainly people using services in the hospital where I work in Rotherham can also gain a referral for psychological treatment.
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