Working in the Liaison Psychiatry Service

Hilary Lewis, Cognitive Behavioural Psychotherapist

The Liaison Psychiatry Service offers assessment and treatment to people who have a mixture of physical and psychological difficulties. This includes helping people who have medically unexplained symptoms (MUS). This means that people experience symptoms such as pain, fatigue, weakness or digestive problems, but no evidence of any disease is found when they have medical tests or investigations. The service recently featured as a best practice example in national guidance for commissioners of services for those with MUS*. Here, Hilary Lewis, a Cognitive Behavioural Psychotherapist in the service, describes some of her work in the team…

Today I am meeting with Lucy, a young woman with significant problems walking. Unlike many other service users in the Trust, she came to see us with mainly physical problems. She has weakness in both legs, and needs crutches to walk. This began last year, during a period of stress in her life. Her neurologist could not find anything on her CT scan or other investigations to explain this weakness. This can be extremely frustrating for our clients, as their physical symptoms are real and can be very disabling, and they can struggle to find services to help them.

I first met with Lucy three months ago, and we have been meeting once a week in my outpatient clinic. Our first appointments were to build a relationship, and to try to understand the various factors contributing to her problems. I also reassured her that we knew her symptoms were real and not “all in her head”. We are now working together to help her manage her symptoms, and be more active, whilst also looking at how she manages stress in her life.

Lucy really values the input of our specialist team:

“Before I was referred to Liaison Psychiatry, I felt extremely bad about myself and that nobody truly cared about my problems. I saw lots of different teams but felt I was just part of a procedure, and people only saw me for six sessions. But since seeing Hilary and the team, I feel like someone genuinely cares about my health, and wants to see me get better. We work together to find different techniques to improve my lifestyle – such as substitutes for self-harm, relaxation and ways to improve my sleep. I have regained confidence and can now walk without crutches or a wheelchair!”

I can’t take the credit for the improvement in Lucy’s walking, although it’s great to see her today walking into her session without her crutches! It’s really important that I work as part of a team, as people often have a complex mix of problems. Our multidisciplinary team also includes liaison psychiatrists, nurses, occupational therapists and a physiotherapist. Our physio, James, has also been seeing Lucy regularly to rebuild her muscle strength and retrain her balance. This has helped improve her confidence in walking, and she’s made great progress so far. We’re all really hopeful that she will make a full recovery over time.

It’s rewarding to work with this group of people, although challenging at times. As a team, we need to understand how a person’s physical health interacts with their mental health, and vice versa. We also need to liaise with the staff in the general hospital regularly to ensure our care is collaborative. The team are really pleased to see this hard work and expertise recognised in national guidance. We are now working on collecting a range of information and outcomes to demonstrate the difference the service makes in the lives of people like Lucy.

*The guidance has been issued by the Joint Commissioning Panel for Mental Health, which is co-chaired by the Royal College of General Practitioners and the Royal College of Psychiatrists. Its intention is to encourage the commissioning of comprehensive services for those with medically unexplained symptoms. Read the guidance from the Joint Commissioning Panel for Mental Health here.