Clinical psychologist Dr Paul D'Alton would like to see mental health added as a sixth vital sign in hospitals and health centres across Ireland. Currently, the five vital signs are pulse, blood pressure, weight, temperature and respiratory rate but D'Alton believes that patients will recover faster if their mental health is addressed as part of their overall illness.
“People’s psychological health has a huge impact on how compliant they are with their in-patient and out-patient treatment. Also, it impacts on the length of time they stay in hospital. Younger patients come into acute care setting expecting that their emotional health will be acknowledged,” says Dr D’Alton who heads the psychology department at St Vincent’s University Hospital, Dublin.
While communications between doctors and patients have arguably improved in the last 20 years or so, D’Alton says that patients’ behaviour can often be misunderstood in busy clinics. “Some patients’ [negative] response to treatment might be rooted in their early experience and if the medical staff understands this, they can respond more compassionately to the patient,” he says. “Distress is normal when faced with a serious illness but those who are upset, afraid and lonely for more than two to three weeks need more help,” he says.
St Vincent’s University Hospital, Dublin has one of the largest teams of clinical psychologists working in an acute hospital in Ireland. Psychologists work with patients with chronic pain, cancer, dementia, cardiac and neurological conditions. With other health professionals, they run free courses in chronic disease self management, mindfulness-based cognitive therapy and coping with cancer-related fatigue. They also train other healthcare professionals how to best ask patients personal questions related to their illness while helping the healthcare professionals themselves cope when patients die on their watch.
“We’ve done a lot of work to help staff cope psychologically when working with terminally ill patients. Death can be seen as a failure in an acute hospital and staff feel like they let someone down but death is the most natural thing. It’s important to know that sometimes, as a staff member, you won’t know what to say to a terminally ill patient or that you might become fearful of the death of one of your loved ones.”
Cancer patients
Clinical psychologist Louise O’Driscoll works with cancer patients at St Vincent’s University Hospital. “All cancer patients need emotional support from their peers and their medical team and I would like to see mental health discussed when cancer is diagnosed,” says O’Driscoll. Some people will go to a cancer support centre or a counsellor but the psychologists at St Vincent’s University Hospital see patients who have a pre-existing mental health difficulty (depression, anxiety, psychosis or schizophrenia), patients whose cancer diagnosis pushes them into a clinical level of distress (eg they can’t make appointments due to their fear of cancer) and patients with a terminal diagnosis.
“Some people diagnosed with cancer can feel very vulnerable with heightened levels of anxiety that makes it difficult to engage with healthcare. I ask these patients about their life before cancer to understand if there were times when they didn’t get the help they needed,” says O’Driscoll. She adds that people living on the margins of society need help navigating an acute hospital setting.
Dr Rosemary Walsh is a senior clinical psychologist working in pain management at St Vincent's University Hospital. The hospital has one of the longest running chronic pain self-management courses in Ireland which Dr Walsh helped set up. "Chronic pain is a sensory and an emotional experience. Often, people with chronic pain look normal and have normal scans yet they suffer from daily chronic pain," she says.
Dr Walsh says that people with chronic pain need a psychological based rehabilitation approach. “It’s not just about the loss of [your previous] life when you have chronic pain but also people with chronic pain need behavioural therapy to [combat] the avoidance of movement that comes with chronic pain.” She says that patients who do the chronic pain self-management course benefit hugely from the peer-led healing. “It’s like they find their tribe and learn so much from each other. It’s huge for their self-confidence,” she says.
Dr Elizabeth O’Brien is a senior clinical psychologist who works in the cardiology department at St Vincent’s University Hospital. She says that psychological input is significant in cardiac rehabilitation programmes. Many people who suffer from cardiac conditions – arrhythmias, coronary heart disease or heart failure – can also suffer from shock and increased levels of stress and anxiety following their heart event. “Some people are also vulnerable to depression so I run one-to-one psychological therapy sessions and the eight week mindfulness based stress reduction course,” she explains.
Dr O’Brien suggests that having psychologists on the multidisciplinary team in an acute hospital means that people’s psychological health won’t get forgotten. “When people need extra psychological support, other health professionals know that they can refer patients to us.”
