The psychological management of medically unexplained symptoms: a needs-led approach to improving quality and outcomes

Birmingham and Solihull Mental Health NHS Foundation Trust

  • Run by Birmingham and Solihull Mental Health NHS Foundation Trust, as part of a comprehensive whole-system partnership.
  • Patients were selected from Birmingham City Hospital.
  • Aimed to improve quality of care for patients with medically unexplained symptoms (MUS).
  • Embedded specialist MUS expertise in the acute hospital setting and created a new care pathway based on patient need.

Although medically unexplained symptoms (MUS) are commonly seen across all health care settings, expertise for assessing and treating them within acute hospital settings is rare and care is often fragmented.

This innovative project from Birmingham and Solihull Mental Health NHS Foundation Trust aimed to improve the quality and coordination of care for patients with MUS. It involved embedding specialist MUS expertise in an acute hospital setting, Birmingham City Hospital, and then working with physical and mental health specialists to create a new care pathway, based on patient need.

Clinicians were trained to identify patients with complex needs, for example those who frequently attended hospital or were seen in multiple specialties. They then worked with colleagues from acute specialties, psychiatry, psychology and psychotherapy to help deliver evidence-based interventions within existing clinical environments.

This pilot of a small scale whole system redesign successfully demonstrated a reduction in the psychological distress and physical symptoms experienced by patients. The new service was well received by clinicians and patients, as evidenced by the number of referrals (which increased as awareness and confidence in the service built) and the high levels of patient attendance for assessment and therapy.

Challenges to its implementation included working with different IT systems and clinicians from other trusts, and the considerable time and effort needed to set up the service and establish information-sharing protocols and methodology.

Despite these challenges, the project has established a MUS team with a sense of purpose and shared identity, and provided an accessible, acceptable, valued and potentially cost-effective clinical pathway for coordinated care across the traditional specialty divides.

This Innovating for Improvement project ran from the beginning of May 2015 until the end of July 2016.

Contact information

For more information about this project, please contact Dr Amanda Gatherer.

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Innovating for Improvement

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