Major Trauma Psychology by

We work with...

plhtrmtcpsychology — 2023-07-20 13:17:41 UTC

• Must be a Major Trauma Patient
• Distress must be in relation to their Major Trauma not pre-existing mental health difficulties. For example distress in relation to flashbacks, memory loss and adjustment to injuries.
• We will automatically screen major trauma patients with the following injury mechanisms: vehicle incident, crush, blow, blast, shooting, stabbing and drowning.
• Major trauma patients who were injured through a fall must be referred for a screening.

We don't work with...

plhtrmtcpsychology — 2023-07-20 13:18:03 UTC

• We don't work with patients unless they are considered Major Trauma Patients. Major Trauma is a medical term, therefore we won't see anyone who has been through a traumatic event unless their injuries are classed as Major Trauma.
• We do not work with patients who carry risk for example suicide attempts, psychiatric liaison work with these patients and ask for our input where needed.
• We do not work with patients while they are on the ICU, once they have been stepped down from the ICU and are discharged from ICU rehab/psychology we will screen patients
• We do not work with patients who are not orientated, have severe cognitive difficulties. However if their cognition improves we can see them.

Dr Heidi Muir

plhtrmtcpsychology — 2023-07-20 13:20:15 UTC

Role: A Specialist Clinical Health Psychologist
Availability: Works in Major Trauma from Monday - Thursday. Heidi is based in her outpatients clinic in Tavistock on a Monday. On Tuesdays and Thursdays Heidi is based in Major Trauma from 8:00am-1pm, in the afternoons she works in her other health clinics.
Work: Heidi created and runs the Major Trauma Psychology Service. She provides the outpatient telephone clinics for patients, runs the outpatient therapy clinic, provides inpatient screenings in more complex cases and inpatient follow ups where necessary. She also provides supervision for the assistant psychologist and any trainee psychologists in post.
Contact: heidi.muir@nhs.net

Liz Hart

plhtrmtcpsychology — 2023-07-20 13:20:30 UTC

Role: Assistant Psychologist
Availability: Works in Major Trauma on Tuesdays and Thursdays.
Work: Provides automatic inpatient screenings for major trauma patients. Screenings can include some basic psychoeducation on why flashbacks happen and normalising memory loss in Trauma. From the initial screening Liz can refer patients to Heidi's outpatient telephone clinics and provide signposting for patients in their rehabilitation prescription (our notes that patients receive upon discharge).
Contact: e.hart7@nhs.net

As a band 4 assistant psychologist Liz is not HCPC registered and therefore cannot work with risk, disclosures of suicidal ideation are managed by a discussion with Heidi or a referral to psychiatric liaison.

Automatic Inpatient Screenings

plhtrmtcpsychology — 2023-07-20 13:42:28 UTC

We provide automatic inpatient screening for all major trauma patients who meet our referral criteria, except for those injured by fall who will need to be referred for a screening. We aim to screen patients within 5 days of admission.

Screening involves completing two questionnaires with patients. First the Clinical Outcomes in Routine Evaluation (CORE-10) which is a general measure of psychological distress. Secondly, the Post Traumatic Adjustment Scale (PAS) which is a predictive screening instrument for posttraumatic stress disorder and depression. These are not diagnostic measures.

After inpatient screening patients who have elevated scores may have further inpatient work, be referred for an outpatient telephone clinic with the Specialist Clinical Psychologist or be signposted to more relevant services.

Outpatient Telephone Clinic

plhtrmtcpsychology — 2023-07-20 13:42:36 UTC

Patients who scored above clinical threshold during inpatient screening may be offered a telephone follow up approximately 1 month after screening, in line with the NICE guidelines for PTSD. Patients will have another screening over the phone, using the CORE 10 and PCL (a 20 item checklist of PTSD symptoms based on the diagnostic criteria). The Specialist Clinical Health Psychologist will explore the difficulties the patient is experiencing and will make recommendations i.e. signposting, referrals to other services and self help resources. Some patients may be accepted for therapy in our Outpatient Therapy Clinic in Tavistock, however there are limited slots available.

Outpatient Therapy Clinic

plhtrmtcpsychology — 2023-07-20 13:43:35 UTC

The Specialist Clinical Health Psychologist offers a face to face outpatient therapy clinic in Tavistock on a Monday. This is only for complex cases as we don't have many outpatient therapy clinic slots available. Patients who need psychological support but don't qualify for the clinic may be referred to appropriate services.

Trainee Clinical Psychologist

plhtrmtcpsychology — 2023-07-20 13:46:42 UTC

We don't currently have a trainee. In the past trainees have supported with inpatient screening and run outpatient clinics for therapeutic support with less complex clients.

Referral Routes

plhtrmtcpsychology — 2023-07-20 14:01:05 UTC

• Inpatient screen: Major Trauma patients with the following injury mechanisms: vehicle incident, crush, blow, blast, shooting, stabbing and drowning will be automatically screened by the Assistant Psychologist. If screening scores are elevated patients can be offered inpatient support through psychoeducation or more complex work where required. Patients with elevated scores may be referred for an outpatient telephone clinic.

• Rehab Co-ordinators: The major trauma rehab team identify patients they have concerns about in relation to psychological distress, this is likely to be from the falls category as we do not automatically screen patients injured through falls. They can be referred via email or verbal discussion. Patients who are referred will usually have an inpatient screening to assess their needs and what support is appropriate.

• Telephone Clinic: Major Trauma patients often have telephone clinics with the rehab co-ordinators post discharge, during these they will be asked about their psychological distress, any concerns and if they would like a referral to psychology.

• Self Referral: Patients can contact the service for up to six months post discharge and book a telephone clinic with the Specialist Clinical Health Psychologist.

Psychoeducation

plhtrmtcpsychology — 2023-07-20 14:32:09 UTC

During inpatient screenings we can offer some basic psychoeducation on why patients experience memory loss and flashbacks after a Major Trauma injury. Psychoeducation can normalise patients experiences and reduce distress around concerns about why they are experiencing symptoms.

What we don't offer...

plhtrmtcpsychology — 2023-07-28 10:27:33 UTC

We don't offer inpatient therapy on the wards, as flashbacks, nightmares and memory loss are normal reactions to trauma in the first month. However, if these symptoms continue after a month a trauma focused intervention may be appropriate, in line with the NICE guidelines. Therapy can be offered at our outpatient clinic or through IAPT services.

Our inpatient service is only open when Dr Heidi Muir is available. If Heidi is on annual leave we only offer psychological screenings and psychoeducation.

plhtrmtcpsychology — 2023-08-17 14:53:28 UTC

Scan to access relevant mental health and practical signposting for Major Trauma patients

ICU

chppad — 2023-10-10 13:27:47 UTC

We communicate with the ICU team when shared patients are stepped down from the ICU and moved to the wards. This is to find out if patients are having ongoing support from the rehabilitation team/psychology team and any concerns around delirium or hallucinations.

ICU also join our meetings with psychiatric liaison if there is a need to discuss shared patients.

Psychiatric Liaison

chppad — 2023-10-10 13:32:11 UTC

We meet with the psychiatric liaison team every 2 weeks to discuss shared cases.

chppad — 2023-10-19 14:34:24 UTC

Referrals and queries

chppad — 2023-11-09 15:00:21 UTC

You can email plh-tr.mtcpsychology@nhs.net for Major Trauma referrals