Table Of ContentCommunication 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
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Boca Raton, FL 33487-2742
© 2012 by Xavier Coll, Alexia Papageorgiou, Ann Stanley and Andrew Tarbuck
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Version Date: 20170123
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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
