Psychological Care

Psychological problems such as depression and anxiety are exceptionally common for people with heart failure (HF). The relationship between HF and psychopathology is bidirectional. Whilst worsening cardiac status is associated with increased prevalence of depression, psychological distress increases the risk for many adverse cardiac outcomes. Despite the known prevalence and the availability of evidence-based interventions, few people with HF have their psychological problems formally recognised and fewer still ever receive an appropriate intervention. National guidelines advocate the implementation of a collaborative, stepped care approach and recognise the potential utility of low-intensity, nonpharmacological interventions in helping improve access to evidence-based psychological therapy.
The Heart Failure Hub is keen to improve the identification and management of emotional distress and behavioural disturbance in people with HF and has received support from the Scottish Government via the Heart Disease Action Plan Implementation Fund for a national project to Improve Access to Psychological Therapy for HF (IAPT-HF). We are keen to help support HF services across Scotland to work towards achieving six quality statements: developing clinical pathways for psychological support; implementing systems to improve recognition and access to psychological care; and facilitating appropriate training of front-line staff.
For more information, please contact johnsharp@nhs.net

Resources

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Quality Statements

Introduction

Quality statements, a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care,were developed for psychological care in HF. These standards allow health care practitioners to make decisions about patient care based on the latest evidence and best practice. They provide criterion against which to inform and measure improvements in local health board areas and general parameters on which to base competencies for staff to work psychologically in HF. The aim of the IAPT-HF project is to work towards achieving these standards across Scotland.

Recognition of distress

People with heart failure should have their psychological well being monitored at every contact with their HF health care professional, assessing for the presence and symptoms of psychological distress

Psychological distress is common in people with heart failure. Assessment of psychological wellbeing which includes identification of psychological distress (e.g. anxiety or depression) can help the individual with heart failure understand and manage their condition and adjust to living with it. Appropriate use of validated assessment tools can help to ensure that the most appropriate treatment can be offered at the earliest opportunity.

GAD7

PHQ9

Forth valley case study

Psychological intervention

People with heart failure, recognised as experiencing psychological distress should be offered access to evidence-based psychological interventions appropriate to their needs and preferences

Evidence based psychological interventions can be effective treatments for psychological distress such as depression and anxiety; and behavioural difficulties such as non-adherence to medical treatment regimes. Psychological interventions can help patients with heart failure self-manage, cope with symptom burden and adjust to living with their condition. Healthcare professionals should offer the least intrusive, most effective intervention first, in line with a collaborative stepped care approach.

Treatment Monitoring

People with heart failure, receiving a psychological intervention, should have their response to
treatment monitored at each appointment using validated outcome measures and the delivery of
their treatment adjusted in response to such outcomes
Regular monitoring of response to psychological treatment ensures that the effectiveness of the
treatment can be assessed and allows for the adjustment of the treatment if necessary; given the
unpredictable and fluctuating nature of heart failure symptoms.

PHQ9

GAD7

PHQ4

Clinical Pathway

Heart failure services should have a clearly defined clinical pathway detailing the provision of psychological assessment and care for people with heart failure including systematic, routine monitoring of psychological well-being and ready access to psychological therapy as appropriate

Clinical pathways are multi-disciplinary plans of best clinical practice. They are designed to promote the implementation of guidelines and protocols. They support clinical effectiveness, risk management and clinical audit. They can improve patient outcomes. Each health board’s clinical pathway will look different depending upon resources and structure.

Clinical Pathway Diagram

Training for Healthcare professionals working within HF services

Healthcare professionals working within HF services should complete a NES-endorsed training programme to enhance their knowledge and skills of psychological care

Evidence-based psychological interventions can be effective treatments for psychological distress such as depression and anxiety and behavioural difficulties such as non-adherence to medical treatment regimens. Psychological interventions can help patients with heart failure self-manage, cope with symptom burden and adjust to living with their condition. Often as the first contact, healthcare professionals working within HF services have a unique opportunity to assess and manage psychological distress in HF patients. However this may not be a core component of their training, therefore they should have access to NES endorsed training programmes to enhance their skills of psychological care.

Training algorithm diagram

Emotion matters

Supervision for Healthcare professionals working within HF services

Healthcare professionals working within HF services delivering psychological interventions should have regular and routine access to consultation and/or supervision with a suitably qualified psychological therapist to optimise the competency and delivery of interventions

Given the expanding role of healthcare professionals working within HF services and the increasing requirement to assess for and manage psychological distress in HF patients, healthcare professionals working within HF services should have access to consultation with a suitably qualified psychological therapist. This will support the continued development and consolidation of psychological skills and thereby further improve the quality of psychological support provided by healthcare professionals working within HF services.

Patient Resources

Introduction

Please use the links below to read more about common psychological difficulties. If you would like more information or support, or feel you are struggling to cope at the moment please contact your GP.

Mood Juice: Scotland wide

Wellbeing Glasgow

Ed Space

Breathing space 

Heal the whole of me (HTWOM) Claks, Falkirk, Stirling

Professional Resources

Introduction

Please find below resources regarding screening, assessment, training and work undertaken by the IAPT-HF team which may be of interest.

Clinical Health Psychology Services across Scotland
A map of available Clinical Health Psychology services across each healthboard and their contact details.

Introducing Teach-Back into an Advanced Heart Failure Clinic– A Case Study
A project which aimed to evaluate the feasibility of introducing teach-back as a means of ensuring quality communication and patient education during a cardiologist led Advanced HF clinic.

PHQ9
A depression screening tool validated for use in the HF population.

GAD7
An anxiety screening tool validated for use in the HF population.

PHQ4
A brief screening tool for Anxiety and Depression validated for use in the HF population.

Training Algorithm
A tool which can be used to highlight the most appropriate level of psychological training for staff.

Emotion matters
A NHS Education for Scotland training package which aims to increase understanding and awareness of the psycho-social aspects of living with a long term condition and provide skills that will enable more holistic, collaborative and person centred care.

SWIFT
A structured assessment method for use when psychological distress is indicated by screening tools. For training in the use of this tool please contact your line manager.

A Local Information System for Scotland (ALISS)
A search and collaboration tool for Health and Wellbeing resources in Scotland.