Psychological Medicine Intervention Service

The Department of Child and Adolescent Mental Health has a Psychological Medicine Intervention Service, coordinated by the Psychological Medicine Team that offers brief, focused, evidence-based treatments to children with mental health difficulties.

Service overview

  • The service is available to children attending services at GOSH who have significant mental health needs that require further assessment and treatment. External referrals will also be considered
  • The focus is on integrating mental and physical health care
  • We deliver evidence-based treatment packages for mental health conditions occurring in conjunction with physical illness
  • Packages of care will be individualised to meet the specific needs of the child and their family

We work in conjunction with the Paediatric Psychology service to the hospital, and have joined up care pathways. Referrals from the general hospital should be discussed with the Paediatric Psychologist attached to the service. A full list of Paediatric Psychologists is found on the meet the team page.

Scope of Paediatric Psychology

Paediatric Psychology will generally assess and manage:

  • Adjustment to diagnosis and facilitating treatment for the child and family
  • Anxiety or distress related to symptoms/condition (below threshold for mental health diagnosis)
  • Pain management
  • Procedural anxiety
  • Medically unexplained symptoms 

Referral criteria

  1. The young person has or needs further assessment for a significant emotional or behavioural difficulty e.g. anxiety, depression or challenging behaviour  in the context of complex health/neurodevelopmental difficulties or medically unexplained symptoms.
  2. The case would be suitable for us to treat here in conjunction with their local Child and Adolescent Mental Health service. 

The Psychological Medicine Intervention Service will deliver: 

  • Mental health diagnostic assessments and evidence-based treatments for specific mental health conditions occurring in children who have complex presentations, either because of comorbid physical illness or multiple other comorbidities.
  • Scientifically validated treatment protocols for childhood mental health conditions, including: Depression, Anxiety Disorders, Obsessive Compulsive Disorder, Attention Deficit Hyperactivity Disorder and Disruptive behaviour disorders.
  • Services for children where medical tests have not fully explained the severity or impact of symptoms, and help to detect and treat psychological difficulties. We aim to develop a joined up care pathway with the Paediatric Psychology service to provide intervention packages for children presenting with medically unexplained symptoms incorporating a stepped care approach. 

We emphasise: 

  • Measurement of treatment outcome and evaluation of patient and family satisfaction
  • Multi-Disciplinary Team working including psychologists, child and adolescent psychiatrists, systemic psychotherapists and a paediatrician
  • Stepped-care (offering the most effective and least intrusive treatment based on the severity of the problem)
  • Low intensity treatment e.g. guided self-help
  • Medium intensity treatment e.g. weekly cognitive behaviour therapy for 12 weeks
  • High intensity treatment e.g. daily treatment for several days or preparation for in-patient treatment
  • Close liaison/co-working with community mental health teams (CAMHS)
  • Flexible psychological treatment delivery e.g. telemedicine using telephone, telecommunication 

The department's experience 

Case example 1:

  • Kevin is a 16 year old boy who began experiencing non-epileptic attacks (NEA) one year prior to assessment. These non-epileptic attacks are episodes which look like epileptic seizures, although they are not caused by electrical activity in the brain. They can involve collapsing and periods where the young person appears unresponsive, often cause a lot of distress, and may lead to unnecessary and unhelpful medical treatment.
  • At the time of referral, Kevin’s school attendance had dropped to below 50%, he was having 3-5 non-epileptic attacks per week and he had stopped socialising with friends and family.
  • Kevin was referred to our service by a consultant paediatric neurologist, after being given the diagnosis of Non Epileptic Attack Disorder.
  • We offered Kevin a mental health assessment and found that he also experienced social anxiety disorder and depression. We discussed with his local CAMHS whether they might treat these problems, but they felt ill-equipped to deal with the frequent non-epileptic attacks and were unsure how to support his school who were so worried they unnecessarily and regularly called an ambulance when he had a NEA. Kevin felt that social anxiety was the problem he would most like help with, as his non-epileptic attacks occurred mainly in group social situations, such as school and he felt that social anxiety may be a trigger for his non-epileptic attacks. He also reported difficulties in reading and writing which led to him feeling unable to keep up with his peers.
  • Following our assessment, Kevin was offered a 12 week course of cognitive behaviour therapy for social anxiety, with carefully designed exercises to practice at home. We also consulted with Kevin’s school and shared strategies that they could use to reduce the frequency of Kevin’s non-epileptic attacks. In addition, Kevin was offered an assessment of his learning (cognitive abilities) to explore his difficulties with reading and writing. Based on the assessment we found that Kevin had dyslexia, which was likely to have contributed to stress and under-performance at school. This enabled us to produce a learning assessment report, which made recommendations regarding the type of support Kevin needed within school and to help Kevin understand his own learning strengths and weaknesses.
  • At the end of treatment, we evaluated the outcome of treatment and found that Kevin’s symptoms had significantly reduced on a measure of social anxiety and depression. The results showed that Kevin no longer met the criteria for either an anxiety or depressive disorder and was functioning similarly to the majority of adolescents his age. While Kevin still found certain social situations a little difficult at the end of therapy, such as parties, he reported that he no longer avoided socialising with friends. Positively, Kevin had joined a drama club and began a new part time job. Kevin’s school attendance had also improved and he had not experienced any non-epileptic attacks in the past four months.

Case example 2:

  • Naomi is a 15 year old girl with a history of Anorexia Nervosa. She had a number of mental health inpatient hospital admissions. She had been seen by the Eating Disorder Team service (GOSH), to facilitate reducing rigidity around eating which had a significant impact on her day-to-day life.
  • The Eating Disorders Team referred Naomi to the Psychological Medicine Intervention Service for an assessment of panic disorder, due to concerns that on-going panic attacks were impacting on her ability to respond to treatment for her eating disorder and in day-to-day functioning.
  • We offered Naomi a mental health assessment and found that she met the clinical threshold for panic disorder and separation anxiety. Naomi felt that she would like help with the panic attacks as this was having the most impact on her experience of school and leading her to be socially isolated.
  • Naomi commenced an evidence based talking therapy, cognitive behaviour therapy (CBT). This treatment enables people to manage their problems through helping them to change the way that they think and the things that they do. This is a 12 week course of weekly therapy sessions, with carefully designed practice at home, the impact of which is regularly monitored using standard measures. 
  • To promote ‘One Team’ working, our therapist also joined fortnightly family sessions with the Eating Disorder Team. The joint-working between both teams ensured co-ordinated care. It also allowed for clinicians and family to consider how some of the strategies identified in the panic disorder treatment helped Naomi progress in reducing her anxiety around trying new foods and eating in social situations – that is working out a hierarchy of fears and gradually getting braver about trying to ‘face the fear’ and eat a new or less familiar food.
  • The paediatrician within PMIS also monitored Naomi’s growth and weight throughout treatment and she made steady gains.
  • Naomi identified clear goals in treatment both in relation to reducing her remaining rigidities around food but also to feel more confident about going to places she had previously avoided due to her panic attacks.
  • Naomi engaged well in treatment and standardised measures demonstrated excellent progress both in terms of reduced frequency of panic attacks and more independence in her eating.

Key team members

Assessments and treatments are delivered by:

  • ·Dr Eve McAllister, Clinical Psychologist
  • Dr Maria-Hadji-Michael, Clinical Psychologist

Other clinicians in the department may also undertake treatment according to the clinical needs of the child and family. 

The service is coordinated by the Psychological Medicine Team. It is led, supervised and evaluated by senior clinicians and academics including:

  • Dr Isobel Heyman, Consultant Child and Adolescent Psychiatrist
  • Dr Margaret DeJong, Consultant Child and Adolescent Psychiatrist
  • Dr Rachel Bryant-Waugh, Consultant Clinical Psychologist
  • Dr Tara Murphy, Consultant Neuropsychologist
  • Professor Roz Shafran, Professor of Translational Psychology and Honorary Consultant Clinical Psychologist

In general, medical responsibility for GOSH referrals will remain with the referring consultant, however all referrals will be discussed within a multidisciplinary team meeting. In some cases it may be considered appropriate for medical responsibility to be held by a consultant psychiatrist within the referring team, after discussion with the referrer.

Referral process and referral criteria 

Read the referral criteria.

Referring clinicians should fill out this short referral form (134.5 KB) and then email it to psych.med@gosh.nhs.uk before a child can receive psychological treatment or cognitive assessment. All referrals must be open to their local CAMHS service, or in some cases where this may not possible, their local paediatrician. Referring clinicians should check that a child’s local CAMHS service would prefer us to treat them here rather than locally.

What we do when we receive a referral:

All referrals we receive are discussed within the Psychological Medicine Team meeting. This to ensure they meet our referral criteria. Referring clinicians are welcome to join the Psychological Medicine Team meeting briefly to discuss any cases they wish to refer.

If the case meets our referral criteria, then we invite the family for a shorter treatment focused assessment (i.e. which anxiety disorder is present; which Axis I mental health diagnosis are we prioritizing for treatment, if there is more than one). Where appropriate we welcome referring clinicians to join this appointment in order to provide a smooth transition between teams. Our further assessment may also include administering psychometric measures, liaison with school and involving other members of the team when appropriate.

Subsequent to this assessment, we will write to the referring team with a starting treatment letter to inform the referrer about the work we plan to carry out.

Referrals can also be made in writing to:

The Psychological Medicine Intervention Service
Department of Child and Adolescent Mental Health
Great Ormond Street Hospital for Children NHS Foundation Trust
Great Ormond Street
London
WC1N 3JH 

Please contact the team’s administrator for further information on 02074059200, or e-mail psych.med@gosh.nhs.uk

Research

We have an active programme of research. Children and families attending our service may be invited to participate in one of these.

Current projects include:

  • Guided self-help for child mental health problems in the context of physical illness
  • Detection of mental health problems in children attending neurology clinics at GOSH