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. These conditions were previously referred to as “intersex,” but in medical practice they are now often described as “differences,” “divergences,” or “disorders” of sex development (DSD). Many people with these conditions 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 cultivating a positive self-identity, reducing stigma, accessing relationships, and enjoying sex. The psychology team works closely with the 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 psychology team also work alongside doctors and nurses in multi-disciplinary clinics and can also meet separately with clients and their families. Anyone attending the specialist team at UCH can request an appointment with the psychology team.
The Gynaecological Oncology Psychology Service is comprised of two part-time clinical psychologists and a clinical psychology doctoral trainee on placement.
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 surgery.
The psychologists work closely with the multi-disciplinary team and provide teaching and clinical discussion groups for staff. Referrals to this service are made by clinical members of the MDT; usually the consultant or specialist nurse.
The Mesh Psychological Wellbeing Service is led by a psychologist, who provides up to five consultations for women attending the London Complex Mesh Centre.
The service aims to give women a safe space to discuss their experiences and support them in managing the emotional and psychological challenges associated with mesh-related complications. This may include trauma responses, sexual and relationship difficulties, and other health issues such as pain or reduced mobility.
A key aspect of the service is to offer a supportive space where patients can carefully consider the potential benefits and limitations of further surgery, with guidance from someone other than their treatment provider. This process can help clarify any additional information or support a patient may need to make an informed decision about their care.
The psychologist works closely with the wider multidisciplinary team to ensure holistic support for all patients attending the LCMC. Every patient under the care of the LCMC is offered an initial meeting with the Psychological Wellbeing Service, with further appointments arranged as needed. In addition, any member of the LCMC team can make a referral to the Mesh Psychological Wellbeing Service.
The PAG Psychology Service is delivered by two part time psychologists and a trainee psychologist, 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 works closely with the doctors, nurse 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.
The paediatric and adolescent FGM/C service runs once a month on a Wednesday. The clinic consists of a paediatrician, a gynaecologist, a specialist nurse, and a psychological practitioner as part of the multidisciplinary team.
All children, young people and their families are offered the opportunity to meet with the psychological practitioner following their consultation with the medical team. The child or young person and their parents or carers can be seen separately or together, depending on their preferences and needs.
The psychological consultation offers a confidential and compassionate space for children, young people and their families to reflect on their experiences. It enables exploration of the psychological impact of FGM/C, the referral pathway, and the medical assessment, and can include brief, focused therapeutic support where appropriate within the remit of 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 miscarriage and 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 provided by a child and adolescent psychotherapist and a doctoral trainee in child and adolescent psychotherapy.
The psychotherapists work closely with the multi-disciplinary team. They facilitate a weekly parent support group, and they offer assessment and treatment for parents, parents and infants, and families. Parents can refer themselves or they can request a referral by the team.
They can be seen while their baby is on the unit and after their baby has been discharged. Referrals to community services can also be made, and if the baby is transferred to another hospital, parents can request an introduction to the psychological service there.
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 six 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.
The aim of this service is to provide short-term, focused therapeutic consultations to women (and parents) in the antenatal period, 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 six 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.
