Neurology and Mental Health
Parkinson's Disease/Mental Health (PDMH) clinic based in
the Queen Elizabeth Hospital in Woolwich and working across
Greenwich
Ethos
In Parkinson's the physical symptoms are sometimes combined with
mental health difficulties such as cognitive impairment, depression
and anxiety.
Likewise conditions such as Lewy Body Dementia can present with
the physical difficulties of parkinsonism with psychological
symptoms of fluctuating cognition and hallucinations.
Action
The Parkinson's Disease/ Mental Health (PDMH) clinic was the
original idea of Lee Sri Ghandi, the Parkinson’s nurse at the Queen
Elizabeth Hospital in Woolwich.
The clinic was set up as a joint initiative between her,
Marjorie Dolan, Community Mental Health Nurse (CMHN) and Dr Adrian
Treloar, Consultant and Senior Lecture in Old age Psychiatry who
work for Oxleas NHS Foundation Trust at the Memorial Hospital.
The first clinic was held in July 2003. The clinic is held
approximately every 6 weeks for patients over 65 with Parkinson's
and mental health problems. It provides the opportunity for the
patient and their carer to discuss their diagnosis.
Patients' Parkinson's and mental health symptoms are optimally
managed with relevant medication management and, most importantly,
they receive ongoing support and education.
The conditions being treated are likely to deteriorate but the
aim of the care provided is for the patient to recover to their
optimum level, which is, of course, dependent on the particular
stage of the condition.
Once the patient is accepted into the service they also fall
under the care of the Community Mental Health for older people.
This is a multidisciplinary team and can offer to assess for and
arrange any social care needed in the way of care packages at home,
referrals to day centres and carers breaks.
They can also be assessed by an occupational therapist for any
necessary aids and adaptations in their home. Home visits are a
regular feature of the CMHN and the Parkinson's nurse will also
visit at home if necessary.
Both patients and carers are able to phone either the CMHN or
the Parkinson's nurse with any difficulties they may be
experiencing and this point of contact has been highlighted as a
key feature in the service.
They are also involved in any decisions made regarding their
care and receive a copy of any letters sent to their GP giving
details of progress and decisions made.
Before the service was set up patients with a dual diagnosis of
Parkinson's/parkinsonism and related mental health difficulties
were usually seen by separate teams for their difficulties
associated with their Parkinson's and their mental health.
This led to either the Community Mental Health team or the
Parkinson's nurse and neurology service trying to deal with both
issues separately.
The collaborative approach now provided by this service is both
supportive to the health care professionals involved and increases
their knowledge on the respective conditions and, most importantly,
provides a better quality of care to the patient and their
carer.
It has been made clear to us by some of our carers of relatives
with Parkinson's that, in many districts, people often lose contact
with specialist services toward the end of the illness.
Late on in Parkinson's and dementia, physical frailty and severe
confusion often combine to provide a very complex set of needs for
support and treatment. Sadly these complex needs often lead to
people leaving home and being cared for in nursing homes.
In conjunction with our work in the joint PDMH clinic Dr Treloar
has been working on a "Hope for Home" initiative in which we hope
to support any of our patients and their carers to remain in their
own home if they wish to do so.
We have now successfully supported people at home and are
researching into the factors which enable families to keep their
loved ones at home.
We know that such care is not right for everyone, but also know
that it is feasible and can have good outcomes.
Achievements
This innovative practice has now developed into a service
offering holistic and seamless care across Greenwich.
We think that we are in a position where we should be letting
others know what we have learnt and how this collaborative way of
working with joint PDMH clinics and "Hope for Home" style care can
benefit both patients and carers.
Research
We presented research findings about PDMH at the 33rd European
Association Geriatrics Psychiatry Symposium, held in Switzerland in
2005.
There were good outcomes, including high user satisfaction
achieved after being managed by a multidisciplinary team with
psychiatric input.
The type of care given to Parkinson's patients has significantly
improved due to better understanding of the condition and
availability of newer treatments.
Most patients and carers were happy to attend a joint
clinic.
Finally, our research confirmed that the joint clinic approach
does manage patients with complex health needs and significant
psychiatric co-morbidity.
- email
-
Share