The importance of Cambridge Children’s Hospital’s vision of treating mental and physical healthcare together has been highlighted in a new study. The trial, which brought psychological treatment directly into epilepsy clinics, showed a reduction in mental health difficulties compared to standard care.
Children and young people with long-term physical health problems, including diabetes, asthma and epilepsy, often have increased rates of poor wellbeing, low mood and mental health needs. With up to 60% of those with epilepsy having associated mental health disorders and many having more than one mental health condition. These can have a huge impact on a child’s quality of life and overall health.
Cambridge Children’s Hospital mental health co-lead Dr Isobel Heyman, who co-authored the UCL-led study, has spent her career championing the importance of integrated care. She said over half of children with epilepsy have mental health challenges, which she described as a “huge unmet need.”
Dr Heyman, along with Cambridge Children’s Hospital mental health research lead Professor Tamsin Ford, joined a team of researchers and experts from other centres including Great Ormond Street Hospital (GOSH), King’s College London and University of California Los Angeles (UCLA). The work was funded by the National Institute for Health and Care Research (NIHR).
The trial was a culmination of a huge team effort over many years,” explained Isobel, “This has shown that we can effectively detect and treat mental health problems in children with epilepsy in their epilepsy clinics, so essentially a one-stop shop for physical and mental healthcare in one place.
Dr Isobel Heyman, Cambridge Children's Hospital mental health co-lead
Currently, mental health problems and epilepsy are treated separately, with patients typically being referred to child and adolescent mental health services (CAMHS) or hospital-based paediatric psychology services.
During the trial, mental health treatment was integrated into epilepsy services, meaning that it could be delivered by non-mental health specialists. Sessions took place over the phone or via video call so that families did not have to travel to the hospital and miss time from school or work. It was delivered to either the young person directly, or via their caregiver, based on their individual circumstances.
The new treatment, named the Mental Health Intervention for Children with Epilepsy (MICE), is based on the treatments that the National Institute for Health and Care Excellence (NICE) recommends for the treatment of common mental health difficulties, like cognitive behavioural therapy for anxiety and depression. However, it uses a modular approach, that enables multiple mental health conditions to be treated at once, instead of having different treatments for different mental health difficulties.
Mum-of-two Emma from Hertfordshire said her youngest daughter was diagnosed with epilepsy at the age of three, then autism and ADHD a few years later. She said her child would struggle with talking therapy, but she and her husband would have benefited from learning how to support her mental health challenges, which, over time, became very serious.
You want to have some strategies or tools to support your struggling child rather than ending up with a really struggling child and then scrabbling around in the background trying to find things that might help.
Emma, mum of child with epilepsy
Dr Heyman said the feedback from nursing staff who delivered the treatment was very positive, adding value to their work and in most instances not taking up additional time.
She said: “Learning specific skills in how to deliver mental health treatment, they felt for the first time that they knew how to treat an anxious child.
“Often it didn't take any longer than having a general supportive chat, but instead what they were doing in that time was delivering an intervention that really worked."
Dr Isobel Heyman talks about this revolutionary approach to care
Link: https://youtu.be/57iZP8X31e8
The new treatment, outlined here in The Lancet, was created together with young people, their families and the professionals who care for them, including doctors, nurses and psychologists.
Named the Mental Health Intervention for Children with Epilepsy (MICE), the treatments are based on the National Institute for Health and Care Excellence (NICE) recommendations for the treatment of common mental health difficulties, like cognitive behavioural therapy for anxiety and depression. However, it uses a modular approach, that enables multiple mental health conditions to be treated at once, instead of having different treatments for different mental health difficulties.
Researchers trialled the treatment with 334 children and young people aged three to 18. Of these, 166 received the new MICE treatment and 168 received the usual treatment for mental health problems in children with epilepsy.
The results showed that the children who had the MICE treatment had fewer mental difficulties than those who had the usual treatment, and the change is equivalent to a decrease of 40% in the likelihood of having a psychiatric disorder.
Lead author Dr Sophie Bennett, who carried out the research while working at UCL Great Ormond Street Institute of Child Health, said: “Integrating the care can help children with epilepsy and their families more effectively and efficiently. We were particularly pleased that benefits were sustained when treatment ended.”
Co-Chief Investigator, Professor Roz Shafran said: “These ground-breaking findings not only promise brighter futures for children with epilepsy but also pave the way for a revolutionary shift in mental healthcare practices."
This clearly demonstrates that children’s healthcare needs can be met in a holistic way to treat the ‘whole child’, in the same place at the same time.
Isobel Heyman