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Communication Skills in Mental Health Care: An Introduction PDF

191 Pages·2022·3.035 MB·English
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Communication Skills in Mental Health Care AN INTRODUCTION Edited by XAVIER COLL Consultant Child and Adolescent Psychiatrist Mary Chapman House, Norfolk and Suff olk NHS Foundation Trust Honorary Senior Lecturer School of Medicine, University of East Anglia, Norwich ALEXIA PAPAGEORGIOU Senior Lecturer in Clinical Communication University of Nicosia’s St George’s (University of London) Medical Programme ANN STANLEY Consultant Forensic Psychiatrist Norvic Clinic, Norfolk and Suff olk NHS Foundation Trust Recognised Teacher University of East Anglia, Norwich and ANDREW TARBUCK Consultant in Old Age Psychiatry Julian Hospital, Norfolk and Suff olk NHS Foundation Trust Honorary Senior Lecturer School of Medicine, University of East Anglia, Norwich Foreword by JONATHAN SILVERMAN Associate Clinical Dean and Director of Communication Studies School of Clinical Medicine University of Cambridge CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2012 by Xavier Coll, Alexia Papageorgiou, Ann Stanley and Andrew Tarbuck CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Printed on acid-free paper Version Date: 20170123 International Standard Book Number-13: 978-1-84619-516-7 (Paperback) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publish- ers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com DOI: 10.4324/9781846198304 Contents Foreword vii Preface ix About this book x About the editors xi List of contributors xiii Acknowledgements xv List of fi gures and tables xvi 1 Introduction 1 Alexia Papageorgiou Why are teaching and learning communication skills in mental health important? 1 Communication skills training for mental health professionals 2 The way forward 5 References 6 2 Taking a good psychiatric history 7 Jonathan Wilson Learning outcomes 7 The purpose of the psychiatric history 7 The psychiatric history compared with a medical history 8 Gathering a psychiatric history 10 Eliciting a psychiatric history 11 The Mental State Examination 16 The domains of the Mental State Examination 17 References 20 3 Mental health assessment of anxiety and depression 21 Nick Viale and Rebecca Horne Learning outcomes 21 Introduction 21 Depression 21 Anxiety disorders 23 The overlap between symptoms of depression and anxiety 23 Skills for you to apply 25 Top tips 32 Further reading 32 iv CONTENTS 4 Assessing risk to self: suicide and self-harm 33 Ann Stanley Learning outcomes 33 Introduction 33 Assessment of self-harm 39 Further reading 43 5 Information gathering in psychosis 44 Jaap Hamelijnk, Andrew Tarbuck and Somayya Kajee Learning outcomes 44 Introduction 44 Skills for you to apply 46 How to do it 48 References 56 6 Information giving and shared decision making in psychosis 57 Katherine Hill, Jonathan Wilson and Ann Stanley Learning outcomes 57 Introduction 57 Skills for you to apply 58 How to do it 58 7 Working with families and young people 69 Xavier Coll and Sarah Maxwell Learning outcomes 69 Introduction 69 Skills for you to apply 70 How to do it 74 References 82 Further reading 82 8 Assessment of mental capacity 83 Andrew Tarbuck and Roger Wesby Learning outcomes 83 Introduction 83 Skills for you to apply 86 How to do it 87 References 95 Further reading 95 9 Dealing with emotions 96 Roger Wesby, Xavier Coll and Andrew Tarbuck Learning outcomes 96 Introduction 96 Dealing with emotions: general principles 96 Skills for you to apply 98 Dealing with extremes of emotion 105 Dealing with our own emotions 107 CONTENTS v References 108 Further reading 108 10 Breaking bad news in mental health 109 Xavier Coll and Sarah Maxwell Learning outcomes 109 Introduction 109 Skills for you to apply 111 How to do it 115 References 121 Further reading 121 11 Mental health consultations in primary care: managing the ‘heartsink patient’ 122 Jane Calne and Lisa Jackson Learning outcomes 122 Introduction 122 Why is it important to understand communication skills for dealing with the ‘heartsink patient’? 123 Who is the heartsink patient? 123 So why does the clinician’s heart sink when these patients’ names appear on the list for the day’s consultations? 123 Special considerations for this topic 124 Skills for you to apply 125 Key tasks 126 References 131 Further reading 131 Appendix 1: Calgary–Cambridge guides 132 Appendix 2: The psychiatric history 137 Appendix 3: Adolescent psychosocial history: the HEEAADSSS + ICE protocol 144 Appendix 4: Family tree (pedigree diagram for Kevin’s family history) 145 Appendix 5: How to pass communication skills OSCEs in mental health 146 Appendix 6: Example of OSCE mark sheets in mental health 153 Appendix 7: OSCEs model answers 156 Index 172 To our families, friends, colleagues, students and patients. Foreword Health care professionals working with patients with mental health issues face some of the most complex communication challenges in medicine. Consider for a moment the common problems that patients present with to both psychiatric services and primary care. Health professionals will be consulting with patients at risk of self-harm and suicide, who have disordered thought processes, who may be delusional or paranoid, with problems of capacity in old age or of con- fi dentiality with young people. Th ey will be routinely working with signifi cant emotions or with patients with medically unexplained symptoms and will be dealing with distressed family members as well as the patient themselves. Th ey will be working with patients with complex alcohol- and drug-related problems. Th ese challenges which might faze other medical practitioners will be the bread-and-butter of those working with patients with mental health issues. Communication will be all-important. Knowledge about psychiatric conditions is vital. But by itself without the communication process skills necessary to form a relationship, obtain appropriate complex and sensitive information, share deci- sion making with the patient where possible or communicate where the health professional must make decisions against the patient’s wishes, health care profes- sionals will struggle to get the best out of the interview and achieve a satisfactory working life, and patients will not be supported in dealing with their mental health issues. Health care outcomes will suff er and health care practitioners may also. Xavier Coll, Alexia Papageorgiou, Ann Stanley and Andrew Tarbuck have produced an important, highly readable and very well-organised account of how to organise mental health consultations. Th ey look fi rst at the general issues of the overall psychiatric history and then move onto the more complex specialist scenarios as outlined above. Th ey have taken an approach which importantly inte- grates the content of the interview (the information that we are trying to obtain or impart), the process of the interview (the ways we communicate with patients; how we go about discovering the history or providing information, the verbal and non-verbal skills we use, how we develop the relationship with the patient, the way we organise and structure the interview) and the perceptual (the clinical reasoning and problem-solving skills that underlie the direction we take the interview). Th e authors have chosen to use the Calgary–Cambridge model to provide a clear structure and skill set throughout the book. As one of the authors of the approach, vii viii FOREWORD I’m delighted to see our work so carefully mapped onto the daily life of health care professionals. Interestingly, when we wrote our approach, we said the following: ‘Th e skills collated in the guides provide the foundations for eff ective doc- tor –patient communication in a variety of diff erent medical contexts. Th ere are many highly challenging situations for doctors when they communicate with patients, such as in breaking bad news, bereavement, revealing hidden depression, gender and cultural issues, communicating with older patients, prevention and motivation. Th ese issues clearly deserve special attention in our teaching and we shall be exploring them further. However, we stress that the skills delineated in the guides are the core communication skills required in all these circumstances, providing a secure platform for tackling these spe- cifi c communication issues. Although the context of the interaction changes and the content of the communication varies, the process skills themselves remain the same: the challenge is to deepen our understanding of these core skills and the level of mastery with which we apply them.’ Th is book does just what we were recommending. It takes the core skills of the guide and shows how they apply in diff erent circumstances in complex consul- tations. Each issue is approached using the same structure and skill sets. Yet on each occasion, how to operationalise the skills is covered in detail so the reader can see how to selectively, skilfully and deliberately apply the skills in diff er- ent contexts. We had intended the skills to be used fl exibly and not slavishly depending on the context. Th is book demonstrates just how to use the skills intentionally in diff erent situations and considers whether indeed they may have to be carefully modifi ed such as in the reversal of the open to closed cone in patients with psychosis. What is particularly valuable is the amount of specifi c examples of phrasing included in the text to give readers a sense of how to accomplish these tasks from a communication process perspective. Th e message rings out that the clinicians writing each chapter have not only immense practical experience of the situ- ations that they are describing but also have thought very carefully about the communication skills necessary to accomplish their goals. I’m delighted to recommend this text and congratulate the editors and contributors on their contribution to the extremely important fi eld of commu- nicating in mental health care. Jonathan Silverman Associate Clinical Dean and Director of Communication Studies School of Clinical Medicine University of Cambridge January 2012 Preface Eff ective communication skills are the essence of good health-care practice. Health-care professionals with eff ective communication skills receive fewer complaints from patients and their relatives. Th ey also carry out more effi cient consultations, enjoy a more satisfactory working life and produce improved patient health outcomes. Th is book provides a clear and concise guide on how to run consultations using the Calgary–Cambridge model, as applied to a range of mental health conditions, ranging from taking a good psychiatric history to specialist scenarios, such as working with families and young people or breaking bad news in mental health, as well as chapters on anxiety, depression, psychosis, risk to self, mental capacity, dealing with emotions and mental health consul- tations in primary care. Th is book includes a DVD in which the authors have enacted the answers to the OSCE practice tasks that are formulated at the end of each chapter, to support the OSCEs model answers from Appendix 7. XC, AP, AS and AT January 2012 DVD materials can be found at www.routledge.com/9781846195167 ix

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