A survey of stroke survivors published today found that 60% felt depressed as a direct result of their stroke, yet after-care often focuses on physical rehabilitation. Clinical psychologist Dr Catherine Ford says it is vital that social workers and other professionals respond to the emotional impact of stroke.
Imagine one night you experience a medical emergency, a life or death event. You survive, but there are differences to your movements, senses, thinking and communication. You have just become one of the 1.2m stroke survivors living in the UK today. With all those changes to contend with, would it be surprising if you became depressed, anxious, or found it hard to adjust?
A survey released today of 2,700 stroke survivors and carers by the Stroke Association shows that stroke triggered emotional problems for almost all survivors with nearly 60% feeling depressed and even more (67%) experiencing anxiety. Carers too are severely affected with many suffering from sleep deprivation and anxiety and more than half (57%) reporting feelings of depression. The report reveals that the emotional and psychological needs of stroke survivors and their families often go unrecognised or unmet, with many feeling abandoned on leaving hospital.
Much of the information provided to survivors and carers about practical and emotional support is given in hospital, when those affected are least able to absorb and consider it. In some places, post-discharge care concentrates on physical rehabilitation, ignoring the critical role of psychological and emotional support in aiding recovery and preventing burnout among carers.
Last year when my colleague Alys Mikolajczyk, a neuro-specialist speech and language therapist and psychodynamic counsellor, and I talked to stroke professionals at the UK Stroke Forum, half said they worked in services that lacked access to stroke psychology or counselling.
Assessing psychological needs – and responding to them – can improve the effectiveness of rehabilitation services and reduce future demand for services. The National Stroke Strategy and the Royal College of Physicians (RCP) recognise the importance of a psychological pathway of rehabilitation. The Stroke Improvement Programme recommends meeting psychological needs with a stepped care approach that provides appropriate psychological support according to the level of need.
All professionals working with stroke survivors, including social workers, care managers and professional carers or support workers, should be equipped to provide basic psychological support. They should be able to signpost people to local services, provide timely information and ensure it has been understood and is recorded somewhere easily accessible. They should also know when and how to refer stroke survivors to clinical psychologists or psychiatrists to get specialist support.
In Cambridgeshire, where I work as a community clinical psychologist supporting stroke survivors, carers and staff, we have sought to improve psychological support after stroke through innovative, partnership working. In 2011 the Stroke Association, the Oliver Zangwill Centre for Neuropsychological Rehabilitation, part of the Cambridgeshire Community Services NHS Trust, Anglia Stroke and Heart Network and Cambridgeshire County Council, came together to learn how to provide a stepped care psychological pathway of rehabilitation.
This funded both my post two days a week and a full-time Stroke Association information, support and advice co-ordinator, and at the end of the initial project, funding was secured to continue our work. We have helped a number of stroke survivors and carers adjust to the consequences of stroke and navigate related difficulties such as loss of income, unfair dismissal and homelessness.
Providing survivors and carers with information, support and advice prepares them for the rehabilitation and emotional challenges ahead. Services exist that can do much to mitigate the feelings of abandonment the Stroke Association survey uncovered. Stroke clubs can provide peer-to-peer support and the national Stroke Helpline can signpost stroke survivors, carers and professionals to local resources.
We all have a role to play in recognising the psychological needs of stroke survivors and their carers and ensuring they receive the support they need. Working together with other agencies we can ensure that they go on to make their best possible recovery and support them in adjusting to a life after stroke.
Dr Catherine Ford is a clinical psychologist, at the Oliver Zangwill Centre for Neuropsychological Rehabilitation, Cambridgeshire Community Services NHS Trust.
Pictured is Inger, a stroke survivor interviewed for the Stroke Association report, who said: “I wish people would realise that stroke is not an illness that can be treated and then you are well again, but a major life event that usually has lifelong effects.