Sarah Howe Specialist Dietitian Sarah is an experienced NHS Dietitian specialising in the fascinating area of Inherited Metabolic Disorders in adults. In her spare time she enjoys helping her work colleague and good friend, Louise Robertson run her blog 'Dietitian's Life'. She also loves fitness and spending time with her two girls. www. dietitianslife.com
DIETETICS AND MENTAL HEALTH: HOW MUCH DO YOU CONSIDER IT? I was sat in clinic recently, reviewing one of my metabolic patients. It was a straight forward consultation and we had built a good rapport. She started to tell me about past periods of bad stress and how these times had given her physical symptoms. She had not found a relaxation strategy that worked for her; but knew she would get past it in time. I found myself giving baseline advice: had she tried mindfulness or meditation Apps like Headspace? We talked about worry charts, a technique used in Cognitive Behavioural Therapy to help people document their worries and see how usually they amounted to nothing. She hadn’t considered either and it was good to provide some basic advice. The 10th of October sees World Mental Health Day. Mind tells us that each year, one in four of us in the UK will experience a mental health problem. Given that dietitians often see patients who are acutely unwell or living with a chronic disease, the propensity to see someone with a mental health issue is very high. The impact on a patient’s diet and lifestyle can be huge. As an Inherited Metabolic Disorders Dietitian (IMD), I look after a cohort of patients living with chronic conditions. We see many PKU patients with anxiety which can affect their ability to follow diet and, in our more severe cases, even attend clinic. However, we are extremely lucky to have Clinical Psychologist Anne-Marie Walker in the team, who is a rich source of advice when we are struggling. Anne-Marie has been working in the NHS for 22 years, with a special interest in physical health psychology. She is able to signpost and support the patient’s mental health journey through the NHS and in the community. I asked Anne-Marie to give some advice for when a patient is in emotional
distress in an outpatient clinic. This is what she advised: • It can be invaluable to listen attentively and fully at first to what is being said without too much interruption. Sometimes the most important thing you can do is simply be with your patients, take the time to listen, understand and follow their lead. Try to resist the urge to do something, fix or provide solutions. • Be curious with the patient, using occasional questions to facilitate their need to make you understand. • Use occasional calming comments to show empathy and have an empathic interest in making sure you understand, without making guesses about meaning. • Reflect back and summarise what you have heard and understood and check out you’ve got it right, trying to use phrases that validate and acknowledge the emotional distress. • Ask your patient what might help and how you can support them. The important thing is to leave the patient with a way of making sense of what’s been happening and how they have been feeling. You may also need to enquire about suicidal or self-harm thoughts and gain a brief history of the problem. You will need to follow your service guidelines to keep your patient safe, and refer onto the appropriate service/s for further help. Seek advice from your team clinical psychologist when you can. Their help in invaluable. www.NHDmag.com October 2018 - Issue 138
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