The following is a case study of a patient at the National Inpatient Centre for Psychological Medicine in Leeds, UK. – It is taken from the BACME Working Group on Severe CFS/ME Shared Clinical Practuce Document (version 1 – Jan 2017)
Appendix C Inpatient services
National Inpatient Centre for Psychological Medicine (NICPM)
previously known as the Yorkshire Centre for Psychological Medicine (YCPM), Leeds
http://www.leedspft.nhs.uk/our_services/Specialist-LD-Care/YPCM
http://www.leedspft.nhs.uk/our_services/Specialist-LD-Care/NICPM
This service takes referrals from all across the UK, ie from multiple commissioners and
on a cost per case basis, and provides expert multidisciplinary biopsychosocial assessment and treatment in an inpatient ward in a general hospital setting.
Case example from NICPM
This case example is intended to give referrers and potential patients an idea of what is
provided by this service and how things tend to go for people who are admitted. We
would want to stress that all care plans are tailored to each individual, that progress is of
course also individual to each person, and that a key feature of the approach on the ward
is a recognition that what needs to be addressed to make progress, and what helps, may
be different from one person to another.
We hope that the case example illustrates several things; that we take care to understand
the person at the beginning of the admission, that the pace of rehabilitation is set
collaboratively and adjusted according to individual needs, and also that a
multidimensional rehabilitation approach can make a huge difference.
Sarah (name changed for this case example) was admitted to the NICPM following several years of illness with severe CFS/ME and in the context of significant deterioration in her level of functioning. She suffered extreme sensitivity to light, sounds and, in particular,perfumes/scents. She was virtually bed bound, otherwise entirely wheelchair bound, andrequired an intense level of support from her husband and local services, upon whom shewas almost entirely dependent. She had become very anxious in relation to her physical health difficulties. Her GP was also very concerned about her presentation and, despite their best efforts, local CFS/ME services had been unable to arrest this decline.
Multidisciplinary approach
Sarah settled into the ward environment and engaged in a period of assessment
undertaken by the occupational therapy, physiotherapy, medical and nursing staff. After
being on the ward for a week, Sarah appeared to understand the concept of grading and
pacing very well and describe her mood as “more hopeful”. Her admission blood tests
were all within the normal ranges and an admission ECG was also normal. As always, a
detailed, individualised and biopsychosocial approach to both assessment and commencing treatment was taken by the multidisciplinary team.
Collaborative plan of care involving the patient and the whole team
In the initial few weeks the focus was on arriving at a collaborative set of care plans,
across Sarah’s range of needs. She was engaging fully in her (paced and graded) daily plan and had also been noted to be “very positive regarding staff input.” She continued to be supported by her husband on visits and reported a reduced frequency of her energy levels dipping. Over time she started to sit out in a chair from her bed. She was also able to tolerate normal light levels without sunglasses and was walking independently to the ward toilet. She had also noted some reduction in her anxiety levels, and also begun to receive input from the hospital chaplain. She had chosen to set a goal of being able to mobilise to the hospital chapel during her admission.
Multidimensional rehabilitation
As the care plans progressed over several weeks, Sarah was feeding herself at all meal times, had taken 2 baths and began to socialise with other patients. She spoke openly of her concern for her husband, the impact her illness and recovery had on him, and how she would like to support him. Staff suggested that he attend MDT and Sarah was keen for this to happen. She continued to feel that she was benefitting from medication in terms of reduced anxiety levels and had noted no side effects. After several weeks of inpatient stay, Sarah was virtually independent in terms of her personal hygiene care and had been preparing meals and eating in the dining room with other patients on a regular basis. She also requested a haircut and had met all of her goals as per her graded care plan. The NICPM team discussed with Sarah the various aspects of care delivered (medication, occupational and physiotherapeutic work, psychological work to address anxiety, etc) and how each was contributing in an important way to her rehabilitation. It was also discussed that some of the physical sensations that she found disturbing may be related to the physical de-conditioning of her body and she was able to recognise that this could be a contributory factor given the progress she was now making.
Sarah continued to engage well in 1:1 sessions with nursing staff, and although she continued to experience vibration sensations she did not allow this to prevent her from completing her goals. She was able to attend the nursing station if she needed assistance from staff instead of using her room buzzer. She had revised her activity plan several times and, with ongoing support, continued to display excellent motivation to progress with her rehabilitation.
A couple of months into admission, she identified three further areas she wished to tackle before leaving the NICPM; increasing her mobility further, managing a flight of stairs safely, and improving her activities of daily living such as cooking and cleaning. Her key and overall aim was to increase her level of independence. She also had a formal CBT assessment with the CBT therapist. Anxiety was identified as a significant factor making her rehabilitation process more difficult. She described “worrying about the anxiety, and a loss of control.” She was able to accept that there was an interaction between her physical symptoms and the intense anxiety symptoms which she experienced, and was willing to explore this further as part of her ongoing rehabilitation work. She made excellent progress in all of these areas over the three remaining weeks on the unit.
Transferring progress made to home / the real world
A plan was made for Sarah to go on a period of home leave which went very well. On her return to the ward she spoke about sitting in her lounge for the first time in 20 months and feeding her chickens, all of which she described as “bliss“, and she had been able to spend time with a friend for the first time in two years. Sarah has also found that she was able to maintain her activity plan, and further discussion around her discharge took place.
Continuing progress and recovery
By the end of the admission at the NICPM Sarah was able to attend a local branch of Tesco’s independently from the ward and was able to reach the hospital chapel (on the other side of the building) unaided. She was fully self-caring regarding hygiene, etc, and in many ways now independent, including being able, to her delight, to wear scented body products. She was in very good spirits upon leaving the unit. Sarah made excellent use of the treatment and support offered at the NICPM, and her improved physical functioning was very clear. She was able to socialise, to make meals, and carry out coordinated tasks independently. She had also made significant progress
with regard to her anxiety management, and was no longer overwhelmed by anxiety about her difficulties and the impact of it. She left the unit keen to continue with CBT work, alongside her ongoing occupational and physical rehabilitation, and now able to benefit from attending her local CFS/ME service to build upon the progress she had made at the NICPM.
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