The Women’s Health Psychological Service (WHPS) is an essential dimension of ethical, holistic and quality care for women and their families. Through direct patient care, and work with colleagues in multi-disciplinary teams, we uphold the trust values of kindness, safety, teamwork and improving.
Our objectives are to:
- Increase patient capacity to cope with health conditions and treatment demands
- Help patients (re) engage with key life goals
- Facilitate informed consent where treatment choice is psychologically complex
- Apply psychological principles to advance quality multi-disciplinary care delivered by the division for women and their families.
- Improve the quality and quantity of psychological research in women’s health
The WHPS consists of ten psychological practitioners (specialist counsellors, psychotherapists and psychologists), led by a Consultant Clinical Psychologist. Trainee clinical and counselling psychologists on doctorate programmes, assistant psychologists and interns are also part of the team. Input is provided into a number of specialty areas within the Women’s Health Division, as outlined below. Each sub-specialty of WHPS has a slightly different way of working, including face-face, online and telephone appointments. The referral processes may also differ, which is explained in each section.
A number of genetic conditions can affect how the reproductive and sex organs are formed. The conditions used to called ‘intersex’. In medicine, they have recently become known as ‘differences’, ‘divergences’ or ‘disorders’ of sex development (DSD). Some psychologists prefer ‘diverse’ sex development (dsd). Most affected people do not identify with any of these labels.
We know that women with dsd diagnoses can live very well. We also know that at some time point, psychological input can be helpful for working towards important life goals such as a cultivating a positive self-identity, reducing stigma, accessing relationships and enjoying sex. The psychologist interfaces closely with the physician/surgeon and client, perhaps especially when complex or invasive interventions are being considered for psychological reasons (e.g. to be happier) rather than to treat an illness.
The psychologist consults alongside doctors and nurses in multi-disciplinary clinics and also meets separately with clients and families. Anyone attending the specialist team at UCH can request to meet with the psychologist.
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The Gynaecological Oncology Psychology Service is comprised of two part- time clinical psychologists and clinical psychology doctoral trainee on placements. The team provides specialist assessment and interventions for distress associated with cancer diagnosis, treatment and post treatment difficulties, including psychosexual problems. This is generally provided in 1:1 format but group interventions may also be available. Input can also be provided to those making decisions relating to genetic cancer risks and elective oophorectomy. The psychologists work closely with the multi-disciplinary team and provide teaching and clinical discussion groups for staff. The consultant psychologist also facilitates advanced communication skills training for clinicians working in cancer and palliative care. Referrals to this service are usually made by the consultant or specialist nurse.
The Mesh Psychological Well-Being Service is delivered by a psychologist and specialist counsellor, who offer up to 5 psychological consultations to women attending the LCMC. The team aim to allow women the space to explain what has happened to them and specialise in helping with the emotional and psychological struggles that come alongside mesh related complications. This can include trauma reactions, sexual and relationship difficulties alongside other health issues such as reduced mobility and pain. One aspect of this service is to provide a supportive space to allow patients to carefully consider the benefits and potential limitations of further surgery, with someone other than their treatment provider. This process can often help clarify any additional information or support that patients might need in order to make an informed decision about their treatment. The Psychological Well-Being team work closely alongside the other multi-disciplinary team members to ensure holistic care to all of the patients attending the LCMC. All patients receiving their care under the LCMC will be offered an initial meeting with the Psychological Well-Being Service and further appointments can be organised from there. Alternatively, any of the LCMC team can make a referral to the Mesh Psychological Well-Being Service.
The PAG Psychology Service is delivered by two part time psychologists, who aim to provide a safe space and support to help people live a meaningful life alongside their diagnosis. There are various points during an individual’s life that it might be helpful to speak with a psychologist. For example, when a person first receives their diagnosis and/or when working towards important life goals such as: cultivating a positive self-identity, reducing stigma, accessing relationships, enjoying sex and for some, when thinking about starting or expanding their family. This may involve one or several meetings and can include a family member or partner. The psychologist interfaces closely with the doctors, nurses and patient, especially when complex or invasive interventions are being considered for psychological reasons (e.g., to be happier) rather than to treat an illness as the outcomes can be more variable. It is therefore even more important that people have the space to think through their options and the pros and cons of treatment. Anyone receiving their care under the UCLH PAG service can request an appointment with the psychologist.
Adults
The Zahra Clinic runs weekly to provide a service for adults affected by FGM. It consists of a gynaecologist, an obstetrician, a midwife and a specialist counsellor. The team is assisted by our dedicated clinical fellows, trainees and interns who have helped to forge and maintain close links with community groups. The counsellor’s role is to develop brief psychological interventions for women and couples adversely affected by FGM and to triage to local psychological and mental health services as appropriate. Referrals to the counsellor are via the team doctors or midwife.
Children
The paediatric and adolescent FGM service runs once a month with a child psychotherapist as a team member. All children and young people and their families can meet with the psychotherapist after the diagnostic medical examination. The child or young person and the parents can be seen separately or together. This consultation provides a supportive space where the psychological impact of FGM and/or the experience of referral and examination can be explored sensitively. Brief therapeutic input is provided if appropriate for the service.
The Reproductive Medicine Unit Counselling and Psychology Service is delivered by a specialist counsellor and psychologist. The service provides short-term psychological interventions and therapeutic consultations to women or couples with psychological difficulties related to their reproductive journey. A range of specialisms are covered which includes:
- Fertility treatment -In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), gamete donation and surrogacy, sign posting to adoption services
- Premature Ovarian Insufficiency (POI) and Menopause
- Fertility Preservation- Reproductive effects of cancer, chronic disease and trans people
- Reproductive Endocrinology -polycystic ovary syndrome PCOS, Disorders of Sexual Development DSD, and Turner syndrome.
- Urology/Male Infertility- Klinefelter Syndrome (KS), Microscopic Testicular Sperm Extraction (microTESE)
- Recurrent miscarriageand first trimester support after pregnancy loss
The service aims to offer an opportunity for people to discuss private thoughts and feelings in relation to diagnosis and treatment and through this process find new ways of coping. Referrals can be made by any member of the RMU team.
The Neonatal Psychotherapy Service is delivered by a senior psychotherapist who is available at the NNU most days of the week, which can include early and evenings appointments on request. The aim is to get to know all the parents informally and to provide tailored 1:1 or family-based emotional support as appropriate. Anyone wishing to see the psychotherapist can make contact directly using the contact details which are freely available and visible on the unit. Siblings can be seen at a parent’s request. Parents can also be seen following their baby’s discharge from NNU and referrals to community-based services can be facilitated. In addition to work with parents, the psychotherapist runs groups for junior doctors and nurses to support them in processing and managing the emotional aspects of the important work that they do. The current postholder is a member of the BLISS Psychological Advisory Group.
The perinatal loss service offers psychological input for to women, couples, and siblings, in the event of actual or expected perinatal loss after 14 weeks gestation, including stillbirth, termination and reduction of multiple pregnancies. Although the psychological input is limited to a maximum of 6 sessions, it nevertheless provides a useful space where confusing and conflicting feelings can be explored and processed. Clients can be seen in the ward, fetal medicine unit, and/or in outpatient clinic. They may self-refer or ask a maternity staff member to make a referral.
Coming to terms with losses take time, so that support may need to extend beyond our limited service. This would be discussed with the client and where appropriate, recommendations are offered to the GP for triaging to local services.
The Perinatal Psychological Service is delivered by a multi-professional team including specialist counsellors, psychologists, psychotherapists, and trainees. There are two parts to this service:
The Antenatal service: The aim of this service is to provide short-term, focused therapeutic consultations to women (and parents) with moderate psychological difficulties related to pregnancy and childbirth. An assessment is usually offered within three weeks of referral depending on gestation and patients may be offered between one and 6 appointments. Close liaison with maternity staff and GPs, Health Visitors, and where appropriate other care providers, is an essential part of the role to ensure that people have the support they need. Signposting to other services or onward referral to community-based services (e.g., IAPT or ICOPE) for antenatal/post-natal care is also part of what will be offered. There may be circumstances where women may need the input of a specialist perinatal mental health team (e.g., in the context of current diagnoses such as bipolar disorder, personality disorders, eating disorders, psychotic conditions, OCD, and recurrent self-harm) or where people require specialist advice around psychotropic medication during pregnancy and breastfeeding. The UCLH team can facilitate a referral to a specialist perinatal team should this be needed. Referrals to the UCLH PPS are through the maternity staff. In the event of a mental health emergency, patients should come to their local Accident and Emergency Department.
The perinatal loss service: This service offers psychological input (up to six sessions) for individuals and couples who have experienced a perinatal loss after 14 weeks gestation, including stillbirth, neonatal deaths and termination and in the context of multiple pregnancies. It is not usually advisable to begin formal “psychological work” immediately following perinatal loss and therefore patients will usually not be offered an initial meeting within the first six weeks after their loss. This service offers a useful space where confusing and conflicting feelings can be explored and processed. Clients can be seen on the ward, the Fetal Medicine Unit, an outpatient clinic or remotely. Referrals are accepted from maternity staff and clients can access the service up to a year following the initial loss by contacting the service directly.
