Why those who are immunocompromised need psychological support now more than ever

A professor of health psychology and behavioural medicine at Cardiff University who specialises in inflammatory skin and joint conditions, and health anxiety, offers a view on how to support those for whom the pandemic is definitely not over, and may never be.

Christine Bundy

As many across the UK return to a maskless pre-pandemic way of life, there remain people who will never be safe from the worst effects of COVID-19.

Vaccination is not suitable for those who are unable to raise a sufficient antibody response.

This vulnerable group includes those suffering from psoriatic arthritis (PsA), a chronically progressive inflammatory arthritis that occurs in up to 30% of people with psoriasis and affects around 150,000 people in the UK. Most of the patients in this category receive expensive immunosuppressant therapy that carries significant risk of susceptibility to opportunistic infection and their physical health has to be monitored regularly.

Now those people are being asked to live in a world where we are being told to ‘live with the virus’.

The ‘no masks’ policy means that these people are more frightened than ever to leave home. From their perspective, the policy is absolutely disastrous. It’s the equivalent of a permanent state of lockdown, but without the social support package to help manage its effects.

I work as a consultant psychologist for an integrated clinic with rheumatology and dermatology colleagues I established in 2019 that supports patients’ well-being and provides help to self-manage their complex condition more effectively.

Dermatology and rheumatology colleagues refer patients to us for up to seven sessions to work on a range of topics including mood or sleep management, weight management, reducing alcohol, smoking cessation, increasing physical activity or improving adherence to medication.

Since the pandemic I’ve seen a large increase in the number of requests for support. But I cannot keep up with the volume.

A survey launched by our team in March 2020 showed us that those with existing health conditions used more avoidant coping mechanisms, such as over eating or alcohol use, probably as a way of self-managing low mood and anxiety, compared with healthy participants during the early period of restrictions, many participants cited the additional burden on self-management caused by COVID-19.

Yet during this time, my patients personally also reported to me a sense of satisfaction that their needs were visible by the specialist service we run and they really appreciate the integrated service and its availability when they need it, and not after a wait list of half a year or more.

During early lockdown, this vulnerable group received high levels of community support with daily essentials being delivered by family, friends, volunteers or care organisations.

Now this group remains at home, but without the support networks that came to represent the very best of our society’s pandemic behaviour, in the form of voluntary and statutory networks that rapidly collaborated to protect the most vulnerable.

As Integrated Care Systems (ICSs) are rolled out across England, it’s time to consider including specialist psychological support for people with complex medical conditions, both to minimise the impact of their continued isolation, and alleviate subsequent strain on healthcare services.

The health psychology (HP) workforce currently serving people with long-term medical conditions is highly educated, mostly to doctoral level, but small and insufficient to provide cover for all long-term conditions.

Substantial investment in training places is required for HPs who support people with existing health conditions.

In particular, we need to invest in training places for practitioner health psychologists (PHPs) as we have for clinical psychologists. NHS trusts in England and Health Boards in the devolved nations need to recognise the skills and knowledge PHPs bring and open up the career opportunities for them that are available to other specialist psychologists.

In addition, we need better joined up services for patients, this includes excellent communication between services, seamless referral routes between mental health specialists, be they liaison psychiatrists, clinical psychologists, health psychologists or mental health nurses. We should not expect patients to have to return to the overstretched GP services to request a referral to specialist services that can take many months. Lastly, our colleagues in mental health services could also recognise the skills and knowledge that PHPs have and welcome them into roles that often are protected for traditional service providers.

I have no doubt we all want better wraparound services for patients to support themselves better when living with challenging health conditions. The need is more pressing than ever.

Christine Bundy has been an advisor to the Welsh Government Technical Advisory Group on International Intelligence since the beginning of the pandemic.