Bringing psychological support to a physical environment

Having previously worked in mental health hospitals, I was excited to join the world of physical health and be based in a large, major trauma centre hospital. Mental health liaison services bridge the gap between physical and mental health. Our service operates 24/7, providing mental health assessment and treatment for patients of all ages presenting through the emergency department, inpatient medical wards, and community hospitals.

My previous work with patients in crisis on acute wards, and in secure rehabilitation hospitals, taught me a lot about resilience, team working and core therapeutic skills. Although this role is very different from my earlier experiences, the skills I've learnt have really helped me to adapt to this fast-paced environment.

The vast array of presentations and diverse physical health complications means no one day is the same for me. I've now become used to seeing open wounds, tracheostomies and what looks like scaffolding providing support to patient's limbs! Having a 'go-with-the-flow' approach to each working day is essential, which suits me as I find too much structure and routine can easily become stale. I'm slowly becoming familiar with a whole dictionary of medical abbreviations and working closely with a whole raft of different roles that make up our multi-disciplinary team.

A trail-blazing role

Assistant psychologists are somewhat uncommon in liaison services, and I am the first to have ever worked in my team. There was a substantial break in provision of a qualified psychologist until recently, so we are both shaping the way psychology operates within our service. My colleagues now understand what I can bring compared to the qualified psychologist, and they consider this in their referrals. I tend to see less complex and lower risk patients when working independently, and carry out more straightforward brief interventions such as anxiety and mood management, coping skills and psychoeducation. The psychologist and I will often work jointly with more complex and risky cases, which is a valuable learning experience for me. The mental health practitioners and psychiatrists in the team are all highly skilled, it has been a huge learning process to attend patient assessments or meetings with them and learn through watching them work. 

I have frequently been involved in discussions where others have valued my insight which feels great. In previous roles, I haven't always felt as heard or my opinion wasn't asked for but I think because my liaison colleagues haven't worked with an AP in this service before, they are more eager to hear my perspective. Alternatively, maybe my combined experience is beginning to show and I'm more confident to offer an opinion compared to when I started my journey in Psychology. Whatever the reason, I most definitely felt fully immersed and appreciated as a team member shortly after starting in this role.

A broad spectrum of patients

I work with a wide range of patients of all ages and presentations, some with psychiatric histories and mental health diagnoses prior to their physical injuries or illness, some of whom are very well known to local services. Other patients referred to our team may not consider themselves to have mental health difficulties, and this will be the first time they have encountered someone in our role. This gives our team a golden opportunity to model positive working relationships, and, specifically for me, a chance to shine a light on what it is like for individuals to be supported psychologically, something which can initially feel daunting to some. 

Discharges can happen very quickly once somebody is medically fit, and for these reasons, I try to make the most of every interaction with a patient. Even if I only see somebody once, I strive to make this a positive experience for them, so if or when they require mental health support in the future they may be more open to and confident in seeking help from services.

I am sometimes met with resistance or uncertainty, patients wonder if I want to see them because they are 'going mad' or 'losing the plot'. I most often hear these type of comments from older adults. I dedicate time to reassure them, explaining the process and normalising concerns. Some of the most influential work we have done so far has been with those patients who it took considerable time to build a rapport with. I enjoy seeing progression from one word answers and patients appearing wary about us, to free flowing conversation and an appreciation for the chance to chat. Moving from 'not today', or less polite expletives, to welcoming smiles along with a request to pull up a chair. One patient, who initially was very resistant to engaging, said to me, 'I'm glad you kept coming back'. I remind myself of this when work is difficult and getting to this point with patients feels impossible. I'm grateful to work in a service we can give patients many opportunities to engage with us. This flexibility suits individuals with complex needs who, for various reasons, take time to trust others.

With our service being open to people of all ages, from children to older adults, I quickly learned that working with children also means working with their parents/caregivers. At the moment, this still feels like a daunting task, but I am looking forward to becoming more skilled in working with the younger population and navigating the complexities of having family members involved in discussions too.

Sometimes, we see patients who are in need of long term therapy. There is definitely a pull of wanting to do more, particularly when I engage with patients over a number of weeks and build positive working relationships with them. My role involves liaison with other services who can provide support post-discharge, or signposting should patients wish to self-refer to talking therapies for example. I hope that the work put into rapport-building and laying foundations for community intervention helps our patients feel more open to receiving continuing support.   

Educating physical health professionals

My role involves supporting patients through life changing injuries, helping them to navigate their fears over adapting to a future they hadn't ever imagined. We frequently see patients who find themselves survivors of attempts to end their life or serious road traffic accidents, or work with those understandably anxious over upcoming operations or a life-limiting diagnosis. 

The lack of understanding from some physical health professionals has at times been frustrating. For example, one colleague did not seem able to grasp a patient's experience of depression, and described them as 'lazy'. I sometimes forget that what seems obvious to those of us working in mental health is unfamiliar to others not specifically trained, and hearing things like this can feel disheartening. 

My role encompasses providing education and advice to ward staff, for example on how to communicate effectively, or offering insight by normalising mental health difficulties in the context of tough situations. I advocate for patients and have supported staff to develop increased compassion to help to make patients' stays in hospital a little easier.

A more pro-active approach to self-care 

I'm trying to keep in check the result of my increased awareness into the world of physical health injuries, bodily malfunctions, operations gone wrong, and hospital born infections. I'm learning there is a lot to be worried about! I wonder how long it will take before I become desensitised to this world, like a lot of my more experienced colleagues. I recently had a conversation with another AP, who said that working in a similar setting had the opposite effect on her. She told me how she witnessed the resilience of our bodies and felt reassured by this. 

Because of my work, I know I must take a more pro-active approach to self-care. Looking after my own wellbeing has never been as crucial as it is now. I prioritise a consistent sleep routine and make sure I am eating healthily (meal prep for the working week is very important to me)! More and more, I have been declining invites to things that don't bring me joy, which allows me to spend more time with the people I care about or enjoy some quiet downtime.

Working in this environment provides a regular reminder that life is short and unpredictable. It's a cliché to say we shouldn't take things for granted, but in my role, I'm reminded of this daily and it's becoming embedded in the way I live my life. Liaison is a fascinating area to work in as an AP. I'm frequently inspired by the robustness of those with the right toolkit, and dedicated to helping those who need extra support. It would be great to see more liaison services across the country employing an AP as we have so much to offer services as a whole and most importantly, our patients.