Working with Individuals with LTCs

The role of the mental healthcare professional

Initially, many mental health professionals may feel nervous about working with a client with an LTC and often worry that because they aren’t a medical expert, that they could give their client the wrong advice or harm them in some way. At SilverCloud Health, we hope the platform will help mental health professionals feel empowered in their ability to support a client with a co-morbid LTC within their existing skill set. For any mental health professional working with someone with an LTC there are some dos and don’ts that can help guide you in your work and prevent treatment blocks. 

Key DOs for working with a client with an LTC:

• Do use your core competencies; empathy, active listening, case management
• Do manage client expectations; be clear with your client from the beginning why they have been referred and what your role is
• Do explain to your client that the aim of the programme is to improve their overall ability to cope but not to cure their LTC
• Do engage with other healthcare professionals involved in your clients care to achieve the best outcome for them
• Do acknowledge the difficulties in living with a long-term condition
• Do signpost your client to organisation, groups etc. that support their particular illness
• Do acknowledge the limitations of your role
• Do seek expert advice when you need it
• Do be honest with your client when you don’t know the answer
• Do acknowledge your client as expert on their own body, their condition and their lives
• Do talk to your supervisor if you feel out of your depth
• Do empower your client to take control of their life
• Do focus on the emotion not the condition

Key DON’Ts for working with a client with an LTC

• Don’t proceed with physical/behavioural interventions until you have medical clearance from their healthcare team
• Don’t pretend you are an expert on their condition
• Don’t be afraid to signpost them back to their GP for medical advice
• Don’t be afraid to acknowledge when you don’t have an answer
• Don’t give false hope that they will be cured
• Don’t fall into a medical model of interacting with your client– patients with LTCs are used to being told what to do and will often seek your direct advice. Being clear on your role in this instance is central and helping client to find their own solutions can be very empowering.
• Don’t use mental health jargon like disorder, depression, anxiety – this can frighten many people off, particularly if they are older. Reflect back the client’s own language and try to use words such as condition or low mood as an alternative.

Our suite of programmes for depression and anxiety in those with Diabetes, COPD and Chronic Pain are tailored to improve engagement and acceptability for those with long-term conditions. As a mental health professional, it is normal to feel nervous about working with a client with a co-morbid LTC. Nobody expects you to be a physical health expert. However, if you use your core competencies in mental healthcare, acknowledge the limits of your knowledge and work in close collaboration with your client’s care team, you have the opportunity to improve your client’s quality of life and enhance their ability to cope. To find out more about or request a demo of our co-morbid LTC programmes please contact us.  

References:

Beatty, L. & Koczwara, B. (2010). An effectiveness study of a CBT group program for women with breast cancer. Clinical Psychologist, 14(2), 45–53.  doi:10.1080/13284207.2010.500307

Cimpean, D. & Drake, R.E. (2011). Treating co-morbid medical conditions and anxiety/ depression. Epidemiology and Psychiatric Sciences, vol 20, no 2, pp 141–50.

Das-Munshi, J., Stewart, R., Ismail, K., Bebbington, P.E., Jenkins, R. & Prince, M.J. (2007). Diabetes, common mental disorders, and disability: Findings from the UK National Psychiatric Morbidity Survey. Psychosomatic Medicine, vol 69, no 6, pp 543–50.

Department of Health (2011). Ten Things You Need to Know about Long-term Conditions. Department of Health website. Available at: https://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Healthcare/Longtermconditions/tenthingsyouneedtoknow/index.htm

Hadert, A. (2013). Adapting Cognitive Behavioural Therapy Interventions for Anxiety or Depression to Meet the Needs of People with Long-Term Physical Health Conditions. Exeter: University of Exeter.

Hind, D., O'Cathain, A., Cooper, C. L. , Parry, G. D. , Isaac, C. L. , Rose, A., & Sharrack, B.  (2010). The acceptability of computerised cognitive behavioural therapy for the  treatment of depression in people with chronic physical disease: a qualitative study  of people with multiple sclerosis. Psychology & Health, 25(6), 699–712.  doi:10.1080/08870440902842739

Katon, W.J. (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry, vol 54, no 3,  pp 216–26.

Livermore, N., Sharpe, .L & McKenzie, D. (2010). Panic attacks and panic disorder in chronic obstructive pulmonary disease: A cognitive behavioral perspective. Respiratory Medicine, vol 104, no 9, pp 1246–53.

Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M. & Galea, A. (2012). Long term condition and mental health; the cost of co-morbidities. London: The Kings Fund and Centre for Mental Health.

NICE (2009). Depression in adults with chronic physical health problem: recognition and management. London: National Institute for Health and Care Excellence.

Thompson, R.D., Delaney, P., Flores, I. &  Szigethy, E. (2011). Cognitive-behavioral therapy for children with comorbid physical illness. Child and Adolescent Psychiatric Clinics of North America, vol 20, no 2, pp 329–48.

Vamos, E.P., Mucsi, I., Keszei, A., Kopp, M.S. & Novak, M. (2009). Comorbid depression is associated with increased healthcare utilization and lost productivity in persons with diabetes: a large nationally representative Hungarian population survey. Psychosomatic Medicine, vol 71, no 5, pp 501–7.

Whooley, M.D., de Jonge, P., Vittinghoff, E., Otte, C., Moos, R., Carney, R.M., Ali, S., Dowray, S., Na, B., Feldman, M.D., Schiller, N.B. & Browner, W.S. (2008). Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA, vol 300, no 20, pp 2379–88