GIRFT02: Identifying and addressing barriers to referral to a regional psychodermatology service

E. Mack ¹ and D. Alderdice²

¹Royal Victoria Hospital and ²Ulster Hospital Dundonald, Belfast, UK

The fundamental role of psychodermatology services in the management of patients with complex skin disorders was highlighted by an All-Party Parliamentary Group on Skin report. This publication emphasized the importance of the provision of mental health services to patients with skin conditions, including psychological interventions such as counselling, cognitive behavioural therapy and habit reversal. Our regional psychodermatology service provides multidisciplinary input from psychology, psychiatry and dermatology for patients with complex dermatological conditions. In October 2020, we conducted a survey to establish the current views of our dermatology team on the role of psychodermatology services, including physician knowledge of services available and perceived barriers to patient referral. The survey was distributed to all dermatology colleagues within the province, and 27 responses were received. Overall, the majority of our respondents were consultants (48%), with a lesser proportion of registrars (26%), specialty doctors (19%) and associate specialists (7%). Over the previous year, 100% of respondents had referred up to five patients to the service from their patient cohort. Firstly, we considered the role of physician knowledge of services available at the psychodermatology clinic; we found that 59% of respondents felt confident in describing the setup of the clinic to patients. In contrast, 55% of respondents had limited or no knowledge of services available at the clinic. We also considered potential limiting factors to referral; 56% of clinicians agreed that they had encountered patients who were resistant to referral to psychodermatology. Specific potential barriers were noted, such as patient reluctance to attend the clinic, the length of time taken during general dermatology clinic to discuss the referral process, lack of patient insight into their condition, patient perception of their skin condition being purely ‘physical’ and patients not wishing to be referred to a psychiatrist because of perceived stigma. In terms of discussion at the time of referral, 81% of clinicians usually explained to patients that they would be seen by psychology and/or psychiatry during their visit. However, 69% of clinicians stated that they had encountered concerns from patients about being referred to psychology or psychiatry, suggesting that clarity is needed in terms of explaining the potential benefits of multidisciplinary input and psychological intervention. Finally, we considered the treatment of conditions commonly encountered in psychodermatology clinics at a general dermatology clinic. Clinician confidence in prescribing antipsychotic drugs for psychodermatology conditions varied between 26% of clinicians feeling ‘somewhat confident’ and 74% who felt ‘not confident’. Following our survey feedback, we developed a patient information leaflet to optimize the referral process, which outlines the clinic setup, introduces team members and their roles, and describes the potential benefit of the available services.