How psychological therapies are benefiting stroke patients

There are many long term physical side effects when a person has a stroke, and the road to recovery can sometimes take its toll on their mental health too.

Since the summer of 2023, patients under the care of our community stroke rehabilitation service have been able to get additional support from a specialist psychological wellbeing practitioner (SPWP), all thanks to a trial project funded by NHS England.

Dawn Murray, a psychological wellbeing practitioner in our Talking Therapies service, was appointed into this role, initially for a 12-month secondment while the impact and benefit for patients was evaluated. The secondment has now been extended until March 2025.

It’s another example of physical and mental healthcare professionals working more closely together within our integrated trust, and of how psychological work particularly can support physical recovery.

Dr Adam Bevins, our consultant clinical neuropsychologist, explains why this new role is making a huge impact in the recovery of patients.

“We know that patients who’ve had a stroke are at an increased risk of psychological disorders,” he says.

“During a person’s rehabilitation from stroke, there’s traditionally quite a lot of emphasis put on their physical recovery, mobility, continence and pain management, but not so much on their mental health.

“Part of the reason we applied for funding for this new post is because we know that if we address both the physical and psychological changes in a patient at the same time, then they’re much more likely to have a better recovery.”

Dawn began her role within the stroke service in June 2023 and says that many colleagues who’ve traditionally never had much contact with mental health professionals, have been really welcoming and have taken on board many of her ideas.

She says: “We began offering psychological therapies last summer, and to be fair it took colleagues in the service quite a while to get to know me and what I’m able to offer, especially as stroke and neuro care is made up of such a diverse range of colleagues.

“It gives colleagues those extra options for their patient, and they’re able to give me a call if they’re not sure about anything mental health related too.

“One of the things that we’ve had to be quite thoughtful about is how we adapt the cognitive behavioural therapy technique to meet the needs of someone with a stroke, as it may be that they have problems with their vision, fatigue, or problems with memory or motor function, which means they can’t write.

“As part of the model, patients tend to get around five or six sessions, but sometimes fewer sessions can still be successful.

“For our patients, being able to access emotional support in this way means they don’t have the stigma that can sometimes be attached to it, which can only be a good thing.

“It could be that I’ve done some work with a patient where I’ve identified that there’s something that our health psychologist can do, so the patient is able to attend the group he runs.

“I’ve also set up emotional health checks within our Living Well After Stroke service, so we help patients up to six months after their stroke happened. This fits in with the regular six month review for everyone who’s had a stroke.”

The main focus of the new service includes individual treatment sessions led by Dawn using low-intensity, cognitive behavioural therapy, which teaches people how to break the vicious cycle of depression or anxiety. It’s common for people to find themselves in this after having a stroke.

A third part of the service is the offer of a group-based intervention, which again involves teaching people skills based on cognitive behavioural therapy to help manage their mental health.

“We’re collecting data on the measures that Dawn uses with patients, both during her assessment of the patient and after an intervention is complete, and we’re going to look at this in more detail,” continues Adam.

“We’ve seen a mixture of results so far, as for some patients it hasn’t been the right intervention, but for others it has worked really well.

“We have a really great skill mix within the psychology team, as we have a clinical neuropsychologist (myself) and we also have a health psychologist, a specialist psychological wellbeing practitioner (Dawn’s role), and we’ve recently appointed a clinical associate in psychology, which allows us to respond to a whole range of patient needs.

“Colleagues have said they feel reassured that if they identify an issue at a patient’s six month review, they can ask Dawn to take a look and she can explore the problems in greater depth with the patient.

“The stroke six month review, conducted by our Living Well After Stroke team, covers things like blood pressure, medication compliance and the patient’s general mood, and our stroke colleagues know that they can get a timely intervention from Dawn if they identify any difficulties with their mental health. They’re also able to make a referral for an emotional health check .”

A low-intensity, cognitive behavioural therapy session often involves getting people to keep diary records, something that Dawn says is particularly helpful.

“I have a regular clinical supervision with Adam, where I can explore any of the challenges of doing this kind of work with stroke patients, and often, I need to make adjustments to the way the treatment is delivered. I also have my regular case management supervision with our Talking Therapies service.

“Within my role I read through extra background information that I wouldn’t necessarily do within the standard talking therapies service. There tends to be more complexity with this patient group, which requires more knowledge of who else is involved in their care.

“This means I can really add to my knowledge about what is going on in the wider context of somebody’s life as well, which helps to inform the treatment I’m able to offer, so that’s really helpful.

“I’ve been able to do some really creative things, for example when I was treating a patient, I was then able to contact an occupational therapist and get a fatigue management plan put in place, to help aid their recovery and overall treatment plan.

“We’re now looking to further review the service, and we’re certainly keen to explore how we can continue with this role for our group of patients.”

Marc McDonagh, our head of psychological professions, adds: “It’s inspiring to see how our neuropsychology team has really embraced the wider field of psychological therapy and how it creates a more holistic approach to recovery. I hope it encourages other services to talk to us about similar integrated approaches.”