Mental health screening for patients with ‘Long-COVID’

Clinicians working in ‘Long-COVID’ clinics describe their experiences screening the mental health of patients and how they use patient reported outcomes in care pathways.

According to a Lancet study of 236,389 adults monitored for six months after being diagnosed with COVID-19, 24% had experienced a mood, anxiety or a psychotic disorder. Data shows that almost 400,000 people based in the UK have reported having ‘Long-COVID’ symptoms for at least a year. Clearly the long-term impact of the disease can take a toll on our patients’ mental health.

30% of people with long-term physical health conditions, such as diabetes, arthritis or heart problems, also have a mental health condition, yet traditionally, mental and physical health are treated separately. Mental and physical health conditions are often interrelated and when treated separately, lead to challenges for patients and those around them, resulting in poorer health outcomes as well as increased healthcare costs.

Our Integrating Mental & Physical healthcare: Research, Training & Services (IMPARTS) programme supports the identification of anxiety and depression, alongside other symptoms, in patients. This is achieved through a questionnaire that patients complete ahead of appointments at physical health clinics and seeks to bridge the gap between mental and physical healthcare. Since June 2020, IMPARTS screening has been available to patients remotely who are able to complete the questionnaire in the comfort of their own home. One year on, we interviewed clinicians working in ‘Long-COVID’ clinics about their experiences setting up IMPARTS and asked their advice for others considering establishing the programme.

Long-COVID clinics

[Some members of the Denmark Hill team (left to right): Dave Walder, Mike Waller, Renuka Vijikaran, and Emma Ballard Members of the Princess Royal University Hospital (PRUH) team (left to right): Lynette Linkson, Rebecca Russell, Ana Bastos and Debbie McKenzie]

Please describe your roles at King’s Health Partners.

Emma: I am an occupational therapist who works across neurology and respiratory at King’s College Hospital NHS Foundation Trust’s ‘Long-COVID’ clinics. As an occupational therapist my role is to understand how people function in their daily lives, promote independence and strategies to improve this through rehabilitation.

Mike: I am a respiratory physician with a particular interest is chronic respiratory infection. I am the clinical lead at the ‘Long-COVID’ clinic based at Denmark Hill, King’s College Hospital NHS Foundation Trust.

Lynette: I am a respiratory consultant with an interest in ‘Long-COVID’. I am the clinical lead for respiratory at Princess Royal University Hospital, King’s College Hospital NHS Foundation Trust.

Please describe your work at the ‘Long-COVID’ clinics.

Mike: When NHS England announced the ‘Long-COVID’ bid to assess patients who had ‘Long-COVID’ symptoms, working with colleagues across King’s Health Partners, I set up the ‘Long-COVID’ clinics based at Denmark Hill, King’s College Hospital NHS Foundation Trust.. I am currently one of the five respiratory consultants that looks after patients with lung disease in the COVID-19 population and I work alongside the neurology and neuropsychiatrists who care for those with symptoms such as fatigue and headaches.

Emma: In the ‘Long-COVID’ clinics, my main role is to explore how persistent COVID-19 symptoms are impacting a person’s daily life. For a lot of people that involves their personal care, domestic tasks, ability to look after children, their social relationships, and ability to go to work. A lot of my conversations with patients are around how they were prior to COVID-19 and how they are functioning now. Then I look at any services I can recommend to them in communities, for example, rehabilitation, support to return to work and fatigue management. Some people are also coming in with impairment in mental processes, so for these patients I would look to do further assessment with patients and strategies to help them with their cognitive deficits.

Lynette: At Princess Royal University Hospital we have aimed to apply to same ‘Long-COVID’ clinic model as the one at Denmark Hill, with both respiratory and neurological functions. Patients either complete their IMPARTS questionnaire before clinic, or if they have not, they can complete the questionnaire in a room on their own. Then the patient will see the physiotherapist, occupational therapist and finally, come and see me for their respiratory needs.

In your view, what are the benefits of using IMPARTS for patients?

Emma: The IMPARTS results give you an idea of what your patient may present like before your consultation with them. It is really useful before a patient consultation for me look through a patient’s IMPARTS results, to find out what their primary concerns are, along with their self-reported symptoms and the severity of their symptoms. When you screen for a patient’s PHQ9, which is the depression module, is a good prompt for an in-depth discussion around their mood and whether a follow-up risk assessment is required. If the patient scores particularly high, the result does provide a helpful opening conversation with patients. For me it helps with planning and preparing for the session I am about to have with a patient.

Mike: It is really nice to calculate a score for someone’s mental health and highlight what that means, especially in understanding what the risk to the patient may be. The symptom scoring is a nice way to collect the data - particularly as COVID-19 is a new disease and the impact of ‘Long-COVID’ largely unknown – and to try to understand the disease in a clear, accessible way. The suicidal and self-harm risk alerts for at-risk patients that present during completing the IMPARTS screening is also incredibly helpful for us caring for patients, to know where additional help is needed. 

Lynette: The IMPARTS results are a helpful tool to guide consultations and frame conversations. Anything that gets us information about a patient electronically, ahead of time, is incredibly helpful to inform how to structure our time with patients.

Tell us about your experience using IMPARTS in your clinic.

Emma: We had a few teething difficulties where patients were not aware of their hospital numbers to start and they had to complete IMPARTS while they were in clinic on printed out paper forms. More recently, this has been resolved now that the majority of patients complete IMPARTS before coming into clinic.

Mike: There is definitely a group of patients whose level of mood to a physician is very disproportionate to how a patient sees their mood. Knowing the mental health of our patients affected by their physical health conditions is incredibly helpful to better understand their needs.

Lynnette: Having moved here from Denmark Hill where IMPARTS was already in place, one of my ambitions was to bring IMPARTS to our clinics at Princess Royal University Hospital. It worked really well. I think for me it gives a very objective measure about a complex health topic. We know that patients are going to have a lot of different symptoms coming into a ‘Long-COVID’ clinic. Having IMPARTS is incredibly helpful to identify what the priorities for patients are. I find it incredibly helpful to have objective measures alongside the patient’s own story.

Have you any advice for those who may be interested in setting up IMPARTS in their clinic?

Lynette: If you are interested in setting up IMPARTS in your clinic, I would say you have just got to do it. Already I am thinking about how I am going to apply IMPARTS in other clinics with whom I work. The key thing is to make sure you set out knowing you are signing up to manage patients’ mental health concerns. From the outset you need to ensure you have the right safety nets in place for patients should concerns around mental health arise. Another important factor to consider is knowing the relevant mental health pathways to refer patients to, should they need it. Really understanding what is on offer to patients locally is incredibly important.

Mike: My advice to new clinics is make sure there are systems in place for patients to easily access their hospital numbers, such as through appointment letters. Setting up IMPARTS acquiring the hospital numbers for patients was our biggest stumbling block. Using iPads are incredibly helpful for patients who have not completed IMPARTS to complete them in clinic. 

What are your future plans for IMPARTS in your area of work?

Lynette: Knowing how invaluable IMPARTS has been in respiratory and following the success of IMPARTS in our ‘Long-COVID’ clinics, I have plans to roll it out to other respiratory clinics, such as asthma and chronic obstructive pulmonary disease (COPD).

Mike: Needing to follow-up with patients up to six months after their contact with us in ‘Long-COVID clinics’, we would likely require acquiring a little bit of quantitative feedback in a similar format to the IMPARTS questionnaire.

The mind and body are inseparable, and mental and physical health conditions are often connected. Integrating mental and physical healthcare services has the potential to vastly improve the care that patients receive. Read more about our Mind & Body programme.

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