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 disease 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 Disease Nurse
Specialist (PDNS) at the Queen Elizabeth Hospital in Woolwich. The
clinic set up three years ago 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 six 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 disease.
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 PDNS will also visit at home if necessary.
Both patients and carers are able to phone either the CMHN or
the PDNS 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 disease/Parkinsonism and related mental health
difficulties were usually seen by separate teams for their
difficulties associated with their PD and their mental health. This
led to either the Community Mental Health team or the PDNS 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
disease process 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.
Contact details
lee.srighandi@nhs.net
Marjorie.Dolan@oxleas.nhs.net
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