SLAM provides a comprehensive array of services for FND across South East London within ‘King’s Health Partners’ (KHP), the umbrella term for the 3 Trusts affiliated with King’s College London University – one of only 8 ‘Academic Health Sciences Centres’ in the UK. SLAM is a Mental Health Trust but the other 2 are Acute (physical health) Trusts – King’s College Hospital (in Denmark Hill, next to the Maudsley Hospital) and Guys & St Thomas’ Hospitals Foundation Trust (in London Bridge and Waterloo) respectively.
SLAM provides psychiatry services for the 2 Acute Trusts in the form or neuropsychiatry services which are housed within departments of ‘Psychological Medicine’ in King’s College Hospital, St Thomas’ Hospital and Guy’s Hospital. These services provide emergency care to the A&E departments and the wards ‘24/7’ but also review patients less urgently on the wards and in outpatient services in close collaboration with our neurology colleagues.
Our Neuropsychiatry Services assess and treat all types of FND and offer a wide range of different treatment options are provided.
The Lishman unit is a 15-bedded inpatient ward which is currently located at the Bethlem Royal Hospital in South East London. This is the sister hospital to the Maudsley Hospital in south London and the unit is part of South London and Maudsley NHS Trust (SLAM).
We are a specialist neuropsychiatry inpatient unit and admit two types of patient:
- People with severe FND
- People with brain damage or organic neurological disease causing mental health problems (most commonly these are patients who have suffered significant head injuries).
What these two groups have in common is that they often have a mixture of physical and mental health issues and on the ward we pursue a combined ‘mind and body’ treatment and rehabilitation approach.
When patients with FND are referred to the unit, we see them first as an outpatient to discuss possible admission. We review the case, discuss the diagnosis, and talk about what might help. If the patient wants to proceed with admission, and we as a team feel we can help them, we will then place them on a waiting list for admission. Unfortunately this can sometimes mean a wait of many months – there simply aren’t enough services for FND, so we are often very over-subscribed.
On the ward, we use a combination of physical (e.g. physiotherapy) and psychological interventions. Exactly how these fit together in an individual case will vary from patient to patient. Physiotherapy and occupational therapy input is tailored to each patient: typical areas of focus are mobility, pain reduction, and fine motor control. In terms of psychological treatment: it is part of our way of working that we consider psychological factors as potentially important in FND. Many of our patients have background histories involving abuse or trauma and we see these as often being relevant to the development of FND symptoms. For specific problems such as dissociative (non-epileptic) seizures, our psychologists teach patients grounding and relaxation techniques to help them gain control over the attacks. Our clinical psychologists also help talk people through FND and educate them about their condition.
Patients with FND have often seen many other professionals, received conflicting opinions and advice, and ended up on a lot of prescribed medication by the time they are referred to our service. We aim to carry out a full medication review for each patient to ensure they are not on medications that are causing more problems than they are helping with.
We are one of very few specialist inpatient units in the UK who admit patients with severe FND causing complex nursing or medical needs such as requiring hoisting for mobilisation and where there is no cap on length of admission – as long as justifiable clinically. We cannot always help everyone, but we do have a track record of helping people who have not made improvements with other less intensive or comprehensive treatment packages elsewhere.
Specialist CBT (Cognitive Behavioural Therapy) for all types of FND:
4 full time CBT Therapists providing outpatient (1 session per week) CBT at the Maudsley Hospital – Ken McKeown, Clare Grey, Lorenza Tedesco, 1 vacancy. 1 part time therapist Renata Pires provides a similar service at St Thomas’ Hospital.
Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS) is available for selected patients with motor FND (especially severe weakness) at King’s College Hospital via Tim Nicholson, including as part of the TONICS randomised controlled trial.
Limited outpatient specialist neurophysiotherapy is available at King’s College Hospital for FND presenting with weakness or movement disorders and we hope to expand this service shortly.