Post date: 
Tuesday, 1 August 2017
Adrian Iuga ECLO

A new project could help identify depression within people with significant sight loss during their first appointment with an Eye Clinic Liaison Officer (ECLO). NB Online spoke to Adrian Iuga, the ECLO at King’s College Hospital, to find out more about the project.

"We know that mental health conditions are more prevalent in people with sight loss, particularly depression. Last year’s Depression in Visual Impairment Trial (DEPVIT) study, carried out by the University of Cardiff, found that nearly half of those with sight loss experience significant depressive symptoms. 


Although there is excellent provision for mental health treatment both in the NHS and through counselling services provided by the third sector from charities including RNIB, the Macular Society and Thomas Pocklington Trust, there is no consistent screening for mental health conditions among people with sight loss. There is definitely an under-referral of people with sight loss to mental health services. 

In order to curb this issue, we set out to come up with a pilot project that provided a robust method of early identification and clear referral pathways to mental health services for patients with sight loss. 
The objectives of the pilot were two-fold. Firstly, we wanted to be able to identify early signs of depression in people with significant sight loss and to provide them with a better joined-up service. Secondly, to be able to record good data that could be used for future research purposes. 
The pilot
To do this, the eye clinic at Kings College Hospital joined with the hospital’s IMPARTS (Integrating Mental and Physical Healthcare in Research, Training and Clinical Services) team, an initiative funded by  Kings Health Partners. The aim of the eye clinic working with the IMPARTS team was to bridge the gap between mental health care and physical health care to make them work together. Jointly, we came up with a screening pack which included four questionnaires that ask patients about their feelings of depression and anxiety, as well as general quality of life and smoking habits.    
The pool of patients we have been working with are any patient over the age of 18 with significant sight loss, regardless of how recent their diagnosis was. Together, we complete the questionnaires, I record their responses on an iPad and the results are saved to the patient’s electronic record. If they scored highly, there would be an alert prompting me to go into further detail about how they’re feeling and to immediately discuss any potential referral to any mental health services.  

The clear referral pathways identified mean we can act as soon as we have the results. These pathways included the NHS service, Improving Access to Psychological Therapies, and counselling services run by RNIB and the Macular Society. 

In addition, there’s an A and E referral pathway for those who are actively suicidal (we do a risk assessment while they’re in the clinic). There’s also a smoking cessation pathway which is particularly relevant for patients who have macular degeneration. And obviously, we have results of overall quality of life questions that we monitor as we go with the patient. 
The pilot started in April this year and will run until the end of August so we haven’t yet been able to follow up with patients. However, in the longer-term, the protocol would be to contact the patient after six months to see how they’re doing. We’re also looking to get feedback from counselling services too. 
What are the benefits of the screening?

As an ECLO, part of my job is to look at the emotional aspects of sight loss on patients. If I decided a patient would benefit from further emotional support, I’d refer them onto a counselling service. However, this hasn’t been a consistent or structured process. Previous to the pilot, I’d write to the counselling service and say, ‘I feel this patient would benefit because…’ Now, I can send the counselling service concrete evidence of a patient’s signs of depression. These are the same measures that are widely used in the NHS. 

Although completing the questionnaire does take a bit more time, it is worth doing. Formalising the process has given me more confidence when I make the referral. As results are on the patient’s electronic record, clinicians can speak to the patient about how they are dealing with their sight loss in future appointments. 
The results
So far we’ve screened over 30 patients of which a third have at least some symptoms of depression and 18 per cent have had major depression. All of these people have been referred on using the established pathways. No patients as of yet have been referred to A and E.  

We believe this provides an excellent tool for robust screening in order to pick up any mental health disorders early on. We can direct people to the help they need. For us, as we’ve tapped into existing support services, we have incurred absolutely no extra cost apart from some additional involvement with some members of staff. 

What’s next?
In the future, as well as using the data captured for audit and research purposes, we also want to extend the screening to all of our outpatient appointments, not just to those who have significant sight loss. 
We are working on developing a freely available group-specific mental health self-help guide, in particular for patients with depression. We hope to make this as accessible as possible for everyone with sight loss.
Who else could use the screening process? 
A few hospitals within the Trust and some sight loss charities have shown interest in setting up the screening process in their own clinics. It seems that for a long time, a lot of people working with patients with sight loss have wanted to do something like this but it’s just not happened.

ECLOs are in a very good position to help set this up and facilitate the running of the screening process. But in other departments, screening could be facilitated by others, perhaps an ophthalmic nurse or even receptionists. What we’ve developed at Kings College Hospital can be adapted for pen and paper if teams don’t have access to iPads and the IT infrastructure required.

I’d be happy to help other eye clinics set up their own screening and can offer training and guidance based on our experience at Kings College Hospital."

To find out more, get in touch with Adrian at [email protected]

Doctor Tom Margrain, lead researcher of the DEPVIT study, said: "I am glad that our DEPVIT work is beginning to gain some traction [with the Kings College Hospital pilot]. I think there is an increasing recognition that we can't go on ignoring the significant mental health issues that exist in the sector."

Further information
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