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Integrating physical and mental healthcare in a paediatric setting

A holistic approach to care will be at the heart of Cambridge Children’s ethos. To do this, it’s important that staff are dual trained in mental and physical health conditions, so they have the skills and knowledge to support and look after every single child and young person who enters the hospital – a whole child approach. This is why the first ChARMS seminar of the academic year was bang on message!

Images of four different children

ChARMS is the University of Cambridge research team for Child and Adolescent Resilience and Mental Health. Two members, Tamsin Ford, Professor of Child and Adolescent Psychiatry at the University of Cambridge and Laura Panagi, Research Associate at the University’s Department of Psychiatry, joined the research team at Great Ormond Street Hospital to look at the benefits of integrated physical and mental healthcare in paediatric settings.

“This is such an important project," said Professor Tamsin Ford. "We are delighted to be collaborating with GOSH to generate evidence of how to better integrate mental and physical health care so that we can ensure that the care in Cambridge Children’s Hospital is truly world leading.”

The study focused on children and young people who develop mental health problems as a result of a neurological condition. Over 75% of these patients are more likely to develop mental health difficulties, but often go undiagnosed and so don’t receive adequate care.

The MICE trial (Mental health Interventions for Children with Epilepsy) found that patients with epilepsy were spending a lot of clinic time, with their nurses or paediatricians, talking about mental health problems, such as anxiety, even though they weren’t trained in evidence-based interventions.

Dr Sophie Bennett, UCL academic clinical psychologist at GOSH, said: “These services aren’t integrated, with people who have expertise in mental health completely separated - different buildings, sometimes different trusts - from those who have expertise in epilepsy and physical health conditions.”

National data shows less than 13% of health wards or trusts can facilitate Mental health provision from within epilepsy clinics. “Only a tiny proportion could facilitate integrated care and the vast majority could not,” said Dr Bennett. This leads to a lack of understanding that a child or young person might actually recover with a small amount of evidence-based treatment.

A decision was made to train people within epilepsy services to deliver Cognitive Behavioural Therapy (CBT). Staff were offered five-day training courses, plus monthly supervision, so they could support children and young people. This led to a significant improvement in patients’ mental health and quality of life. It showed that it was feasible for healthcare professionals with limited experience to offer effective psychological therapy - a model which could be used for other chronic illnesses.

Dr Bennett concluded her presentation by highlighting Cambridge Children’s vision of integrated care and how important it is for improving outcomes. “We couldn’t agree more. We are excited that this work is being taken forward.”