Availability of Psychological and Psychiatric Care

Introduction

With psychological distress being increasingly common in those who are terminally ill, there is an increasing need to ensure the availability of psychological and psychiatric care in the UK hospices. Without the appropriate care, these conditions can have very adverse impacts on both the victims and their families. This write up presents a report of a study conducted to evaluate the level of the availability of psychological and psychiatric care services in the UK hospices. It follows a research that had been carried out on the same topic and that had necessitated the need to compare the research findings with what is in the current literature. This research had hypothesized that the patients in the UK’s hospices are not receiving the required psychological and psychiatric care as per the recommendation of the NICE.

During the research, 20 hospices were to be interviewed using a well-designed questionnaire, after what an analysis was to be done and the outcome obtained. However, the study was able to successfully obtain the response from 15 hospices out of which only 5 hospices (33%) had access to a clinical psychiatry while only 7 percent had access to clinical psychologist. It was sad to realize that 47 percent of the hospices were not having access to any of these services. Even worse was the fact that only 3 of the hospices interviewed had clear guidelines on how they make their services available in the local areas.

In conclusion, the study has shown that there was a high possibility that the poor delivery of these care services had majorly resulted from the fact that the country is facing the challenge of lack of enough specialists in these fields. This factor has continued to have a negative impact on the availability and quality of these services in the entire United Kingdom.

Literature Review

Research has established that both psychological and emotional supports are basic to providing a complete end-of-life care. Price et al (2006) note that this is not just for people suffering from cancer but even for those suffering from a number of other illnesses, such as dementia, heart failure, and the chronic obstructive pulmonary disease. They observe that recent studies have shown that such diseases are equally becoming common not only in the U.K but also in the other parts of the world.

Murray, Chinn, and Sheikh (2006) observe that there are several challenges to the ease with which the services of the psychologists and psychiatrics are accessed by both the patients and the staff who are directly involved in the hospices in the UK. They note that there has been a big gap between the services provided and various recommendations made by the National Institute of Clinical Excellence, which has formulated a clear guideline for the kind of supportive and palliative care to be given to adults suffering from cancer. Moreover, Murray, Chinn and Sheikh (2006) report that approximately 45% of hospices confessed having no access to both psychological and psychiatric services. With the seemingly growing number of people falling victim to mental health problems in the UK, it is clear that this challenge needs to be treated with a matter of urgency.

The fact is that most of the hospice patients suffer from cancer, of which a good proportion, almost one in every 10 patients, normally experience distress, which makes them psychologically unstable. Price et al (2006) observe that such individuals will, therefore, automatically require the services of either the psychiatrics or psychologists. These findings are also in line with a survey conducted in the country in the year of 1999 which found out that the ease with which the citizens accessed the services of the psychologists and psychiatrics greatly varied and, in some cases, was even very problematic. Murray, Chinn, and Sheikh (2006) noted that in such scenarios, it was the social workers, chaplains, and counselors who were consistently involved in offering these services. Another problem was that even in cases where the services of the psychologists and psychiatrics were available, patients were not being referred to them.

Price et al (2006) note that NICE recently provided a four-level model to provide guidelines for all assessments and interventions done by the psychologists. It included the level one care which helps medical practitioners to act responsibly while having any form of contact with the patient. Its level four is normally concerned with coming up with ways to assess and manage the patients by those specializing in mental health.

According to Murray, Chinn, and Sheikh (2006), hospices will still continue to be basic to the improvement of the kind of palliative care given to cancer patients. They, however, note that even if such services are greatly improved, some cancer patients will still die outside these facilities. They identified a number of factors that may be responsible for this. Such factors include: culture, stigma, and the long distances which some patients have to travel in order to access the services. Price et al (2006) added that the lack of capacity and training of staff have also seen a number of people who do not suffer from cancer being frequently admitted to hospices. Others have also been admitted to these facilities based on certain historical and funding reasons.

From these observations, Murray, Chinn, and Sheikh (2006) argue that any attempt to increase the ease with which people can access the needed psychological support in the hospice sector must be done concurrently with the increase in other related sectors. According to them, the failure to do this will only work to increase the already witnessed inequalities in the end-of-life care. They have thus recommended that the services of the psychologists and psychiatrics should be provided at the regional levels to give people equal chances to access their services.

Murray, Chinn, and Sheikh (2006) further recommend that the model that is used in Australia, in which counselors and psychologists group themselves into community palliative care teams and make visits to patients in their homes after they have attended their first nursing assessment, should be borrowed. However, the note that it may not be possible for the government to begin offering such services because of the massive financial investment that it requires. Thus, they recommended the support of such interventions as the provision of palliative care right in the communities by the generalist. According to them, this will help to eliminate the presently witnessed biasness in the provisions of such services as the psychological and spiritual support to those who are ill within different communities.

Price et al (2006) noted that a proposal on the Assisted Dying Bill had been introduced to help close the gap that is being witnessed in the provision of these services. Equally, the select committee of the House of Lords had emphasized the significance of depression and a number of psychiatric disorders which are believed to have their treatments. They note that the committee particularly took notice of the difficulty that exists in the psychological assessment of the patients with mental-related complications. They, thus, suggested that all those who apply for a voluntary euthanasia should be taken through a psychiatric assessment to help determine their capacity and to avoid judgments that may not take into account the impact of the disorder. This further calls for the proper training of the physicians involved in the provision of the palliative care.

In identifying some of the challenges faced by the patients in these facilities, the Royal Society of Medicine (2006) noted that the lack of sufficient funding for these facilities have had an adverse impact on their ability to provide quality services. This is especially true for those patients who are at the very advanced stages of cancer and whose care must be compromised in such a situation.

Discussion

The findings of this study also reflect data that was reported by the Royal Society of Medicine. The society which had conducted a research in both the UK-based and the Ireland-based hospices had indicated that only around 30 percent of these facilities had professional psychiatrists while those with clinic psychologists were around 40 percent. The society had further noted the importance of the mental well-being of any patient to his/her overall health and emphasized the need for the implementation of the NICE guidelines.

This is necessary since even though there is an increase in the ease with which people can access the services of the complementary therapists, chaplains, and social workers, it has remained difficult to access the services of those with specific trainings in managing psychological and psychiatric related problems in the hospices. The number of these care providers is far much below the standard recommended by the guidelines that was provided by the NICE. It is also revealed that even in the cases where these professionals are available, their services have not been formalized. The variation in the provision of these services by professionals is a clear indication that the provisions in the model four have not been successfully implemented.

Even as the country is facing such challenges, it is increasingly being accepted that depression is one of such problems that are not easy to manage by the physicians specializing in the provision of the palliative care in the UK. This problem is further complicated by the fact that it has not been easy to access the services of the few existing psychiatry services. This has been because such services are not to the expected quality and are as well poorly coordinated. Irrespective of the attempts being made to revive the liaison of psychiatry services in the country, such services have been interfered with by various unfavorable recommendations reached at the existing royal colleges.

Recommendations

Because of their correlations, there should be emergency psychiatric services in every palliative care services centre. The staff involved in the provision of the psychological support should also be involved in a constant training and supervision in order to ensure the quality of the services provided. Additionally, the services of the psychologists and psychiatrics should be provided at the regional levels so as to give people an equal chance in accessing their services.

Conclusion

In conclusion, the study has made it clear that the ease with which patients have been able to access mental health professionals in the UK’s hospices is still very limited and incapable of meeting the requirements of the NICE guidelines. Thus, there is a need for implementing all of the above recommendations.