April 15, 2024 • 20 mins
“…the skin is not just the skin. Underneath the skin, there is a person, who is really suffering.” Professor Anthony Bewley.
In 2020, the 'Mental Health and Skin Disease' report produced by the All-Party Parliamentary Group on Skin highlighted that 98% of individuals with skin disease reported an impact on their wellbeing, despite this, only 18% received effective professional help.
The report stated that skin disease can adversely impact on all aspects of someone's life, from schooling, self-esteem, career choices, to social, sexual, and leisure activities.
We are honoured to be joined by Professor Anthony Bewley on our latest podcast to discuss this report, in which we’ll be covering:
- How we, as healthcare professionals, can, within 4 minutes, get our patients to talk to us about whether their condition affects their mental health
- The reasons why Professor Bewley believes that only 18% of individuals seek professional help for their mental health
- How psychodermatology has improved in the UK
- What the Cumulative Life Course Impairment is and its importance in dermatology
In today’s modern world where body image expectations can be both significantly and adversely affected by unrealistic social media expectations and where mental health is less of a taboo topic, this episode is definitely one that needs to be heard.
Thank you to our kind sponsor AproDerm, who provide a comprehensive range of quality emollients designed for the management of dry skin conditions, including eczema, psoriasis and ichthyosis.
To simplify the process of finding the most suitable emollient for each patient, they have developed a remarkable solution: the AproDerm Emollient Starter Pack. This pack conveniently combines all four of their emollients in a single prescription, enabling patients to identify their ideal emollient more efficiently, aiding both compliance and adherence.
Find out more: https://aproderm.com/aproderm-emollient-starter-pack/
LI: https://www.linkedin.com/company/fontus-health-ltd/
Got some feedback for us? Please rate and review Rash Decisions to help us keep creating educational podcasts for you.
Is there a dermatology topic you’d like us to explore? Email us at info@aproderm.com, and we’ll do our best to cover it.
The views expressed in this podcast are of Dr George Moncrieff and Dr Roger Henderson. Fontus Health has not influenced, participated, or been involved in the programme, materials, or delivery of educational content.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Roger Henderson (00:08):
Hello and welcome to this Rash Decisions podcast,
where we look at skin-related issues,conditions and treatments in an
interesting and informative way.
I'm Dr Roger Henderson.
I'm a GP with a long-standing interestin this particular area of health.
Dr George Moncrieff (00:24):
And I'm Dr George Moncrieff.
I was also a GP, although I've now retiredfrom my practice and I'm a former Chair
of the Dermatology Council for England.
Dr Roger Henderson (00:33):
Now in this podcast, we'll be looking at the
importance that skin diseases canhave on someone's mental well-being.
And this is the first of threepodcasts on this topic, because
it is such a huge area to cover.
And in the next ones, we'll be lookingat the scale of the problems, what this
means for healthcare professionals,the importance of recognising
(00:54):
these issues and how we should goabout helping our patients and what
patients should ask of us as doctors.
We'll also look at some mentalhealth conditions that present with
the skin-related problem, and we'llbe discussing these with our very
special guest, Professor Tony Bewley.
(01:21):
Now, George, we both know just how muchsomeone's mental and physical health
is intrinsically linked and being bothvisible and such a large organ, skin
disease can have a massive impact onsomeone's quality of life, particularly
when areas such as the face, the hairor the genitals of someone is involved.
Dr George Moncrieff (01:41):
Certainly.
When those areas are affected, theobjective severity of a skin disease
can be grossly underestimated.
And the effect that can have onhow people feel, the psychological
distress it can cause for thatpatient can be absolutely devastating.
(02:03):
And doctors often measure thesewith fairly crude measures like the
PASI score, which stands for thePsoriasis Area and Severity Index,
or the EASI score for eczema, whichis Eczema Area and Severity Index.
But these are pretty crude when it comesto the impact that a condition can have
(02:26):
on someone, how someone feels about it.
Particularly when it affects theface or the hands or the genitals,
as you mentioned, these areas arehigh impact areas, and so minor
disease, which is clearly visible,can really be underestimated.
I can't, overestimate how importantthat is for us to be aware of.
(02:48):
Many a time I've seen a patientwho, doctors have dismissed their
disease as minor or trivial, andthey're almost apologetic about
asking for help with managing it.
But for the patient, itis not minor or trivial.
It is the main thingthey think about 24/7.
And of course, in today's modernworld, body image expectations can be
(03:13):
significantly and adversely affected byunrealistic social media expectations.
And this is especially a problemfor young people, for whom how they
look, how they come across, even onsocial media, really, really matters.
So, this can lead to stigmatisation,discrimination, and even rejection.
(03:38):
And sadly, sometimes a very naturalresponse to that is for the individual
to conceal their disfigurement, concealthe changes that they are worried about,
and avoid further social interaction,which can result in worsening isolation,
spiralling, low self-esteem, andgenerally worsening mental health issues.
Dr Roger Henderson (04:03):
Professor Anthony Bewley, now we're extremely lucky
to have him on our podcast today.
Tony's a consultant dermatologistat Barts Health and has developed an
interest in how the skin interactswith the brain and the mind.
He's got a specialist clinic witha multidisciplinary team, at least
every week, at the Royal LondonHospital, and that was awarded the BMJ
(04:26):
Dermatology Team of the Year in 2017.
No small feat.
He's the co-author of PracticalPsychodermatology, Secretary
of the European Society forDermatology and Psychiatry, and
Co-chair of Psychodermatology UK.
And if all that wasn't enough,he's a lovely chap to boot.
(04:47):
Welcome, Tony.
Professor Anthony Bewley: Thanks very much, Roger. (04:47):
undefined
Great to be here.
Dr George Moncrieff (04:51):
Well, it's a real pleasure to have you with us today, and
thank you so much for joining us Tony.
In 2020, the All-Party ParliamentaryGroup for Skin produced a report, the
Mental Health and Skin Disease report,which I think you chaired, Tony.
Professor Anthony Bewley: That's right, yes. (05:07):
undefined
Dr George Moncrieff (05:09):
And this report stated that skin disease can adversely
impact on all aspects of someone'slife, schooling, self-esteem,
career choices, as well as social,sexual, and leisure activities.
And it went on to say that commonissues related to skin disease
(05:29):
include isolation, embarrassment,shame, depression and anxiety.
Thinking about all ofthat, if that isn't enough.
What do you feel are the mainpoints from this report that
you would like to highlight?
Professor Anthony Bewley: Yeah, thanks George. (05:46):
undefined
I mean, it's absolutely correctthat the skin is not just the skin.
Underneath the skin, there is aperson, who is really suffering.
And that's what the All-PartyParliamentary Group on Skin report in 2020
said, it said that a massive 98%, so theoverwhelming majority of people, who live
(06:11):
with a skin disease really suffer withall of those things that you alluded to.
Frank psychosocial comorbidities likeanxiety and depression, or anxiety or
depression, remembering that anxiety anddepression is more common than one or
other by itself, anxiety or depression.
(06:32):
But you know, the vast majority ofpeople who live with skin disease
really understand that it affectstheir sense of wellbeing, their
confidence and their personal image.
And the stigmas, and it's notjust one stigma, it's not just
about the physical appearance,it's about all sorts of things.
(06:53):
For example, it can beabout ethnic identity.
If you have a condition that meansyour skin goes lighter or darker
or changes in some way, then itcan be about ethnic identity.
And it can also be about theimpact it has from other people.
So, for example, one of my colleagueshad a baby with a strawberry
(07:15):
birthmark on the baby's face.
And if she walked out with this childin the park, quite often somebody
would come across and say, "What abeautiful baby, but what on earth
is that on that child's face?"
So, the public come up with allsorts of unsolicited comments,
many of which are not that helpful.
(07:36):
So, the All-Party ParliamentaryGroup on Skin report wanted to
highlight that it is a massive 98% ofpatients who live with skin disease
who have to deal with all of this.
And what's kind of even more soberingreally is that 82% of those individuals
(07:57):
are not signposted or facilitatedby healthcare professionals.
And it's not just GPs or nurses,it's also dermatologists as well.
So, we really need to get betterat trying to signpost people and
move them towards having helpfuladvice and better facilitation about
(08:21):
management of their skin disease.
Dr George Moncrieff (08:24):
Doing my sums, that means that only 18% had sought
any effective professional help.
Professor Anthony Bewley (08:32):
That's right.
So, a really small minority accessed somekind of assistance for their psychosocial
wellbeing, their mental health.
Dr George Moncrieff (08:42):
And do you think that's due to a perceived lack of
interest from the healthcare professionalor just a lack of awareness and
training of healthcare professionals?
Professor Anthony Bewley (08:51):
So, I think there are several problems here.
The first problem is that healthcareprofessionals on the whole
believe that they are not trainedsufficiently to be able to manage
the psychosocial comorbidities.
They also fear that if theyopen up that box, that the
consultation will last forever.
And in primary care, you don't get longto be able to address these issues.
(09:17):
Similarly, in secondary or tertiarycare, you don't get long, but
actually, it's a misperception.
On average, you can find out allyou need to know from a patient,
usually within four minutes.
Patients are much more articulate, anderudite than we give them credit for.
And then the second mistake that we ashealthcare professionals make, is that
(09:41):
we believe that we don't have the skillsto be able to assess or signpost people
towards better mental health services.
And we do, we do havethose, those capabilities.
And then the third thing is that, webelieve, and this is correct, that
there might not be the facilities orresources around to be able to really
(10:03):
slot patients in, into the correct way.
And there are still, I mean, youknow, just being able to listen to
a patient is massively important.
Patients feel engaged and at least theyfeel heard, and that for me, you know,
from our research, is half the battle.
So, just being heard is really important.
(10:24):
But of course, if we can signpost themand direct them towards better mental
health services, so much the better.
And there is, of course, IAPT,you'll, remember IAPT, Improved
Access to Psychological Therapies,which is a national programme.
And patients can self-refer to IAPTin some parts of the UK, or else
we can signpost them towards IAPT.
Dr George Moncrieff (10:46):
I think you've hit the nail on the head there with
that, in that, I do think that evenwithin 30 seconds, I normally have
a feeling for what is going on andwhat the patient's problems might be.
And I think sitting back andbeing sensitive, it should,
ring home quite firmly.
But I suspect, as you say, manydoctors are terrified of opening
(11:08):
that can of worms and feeling thensuddenly out of their depth and the
consultation running out of control.
And it's very reassuring to hear thatwe probably do have the skills, and we
haven't necessarily got to address itall here and now, that we can signpost
them, we can seek help, we can evensay, highlight it and say, look, this is
(11:28):
important, I haven't got the resource tomanage it today here in this consultation,
but I do want you to come back forus to explore this in more detail.
And I think that can be very empoweringfor both the patient and the doctor, and
go huge ways to sorting out and relievingthat relationship that they have.
(11:48):
It could be terribly important.
It's particularly important, Ithink, in children, isn't it?
And this was highlighted by the report.
And I mention children because I thinkhere, the, something I spoke about
when I was talking about psoriasis, theCumulative Life Course Impairment, that
something that is relatively minor earlyin your life can affect your self-esteem,
(12:11):
your confidence, your relationships.
And can have a devastating impacton where you get to in life with
marriage, having a family, a career.
And the report highlighted the importanceof looking for this in children.
Professor Anthony Bewley: Well, that's right. (12:26):
undefined
So, we talk about the cumulativelife course impairment in
terms of disease modification.
If we think about rheumatology, therheumatologists have been talking
about disease modification for years.
In other words, joint preservation.
If you have a destructive jointdisease, then if you can reduce the
(12:46):
destruction of the joint disease,then you have disease modification.
In dermatology, most of the conditionsthat we have, do not scar, at least
visibly on the skin, do not scar.
Though, of course, I wouldargue that the psychosocial
scarring is quite significant.
And that's the point, really, aboutthe cumulative life course impairment.
(13:06):
We're talking about trying tonegate or obviate the buildup
of, anxiety and or depression,confidence issues, self-esteem.
And then separately, quality oflife issues, which I think is what
you're alluding to there, George.
It's about how you achieve yourpotential, how you excel to the best
(13:29):
you can do at school or at college, orin your apprenticeship or in your job,
but also how you connect with otherpeople, and that can be family members,
it can be partners, it can be friends.
So, the Cumulative Life CourseImpairment is a really important concept.
And what we're beginning tounderstand as dermatology healthcare
(13:51):
professionals is that if we canreally reduce that cumulative life
course impairment then that for ourpatients is disease modification.
Dr George Moncrieff (14:01):
It's a nice way of putting it, I have to say, yes.
Dr Roger Henderson (14:04):
Now, Tony, you, George and I are old enough to know
that it doesn't matter who you votefor, the government still gets in.
And there have been two previousreports on this particular topic by
the APPGS, I think 2003, 2013, thatagain, quite correctly highlighted
the magnitude of this problem.
And yet, unfortunately, relatively fewof those recommendations, just from those
(14:28):
first two reports, have been implementedby policymakers or commissioners
in the government or the NHS.
Are you confident that this reallyquite damning 2020 report might make
things any better this time around?
Professor Anthony Bewley (14:45):
Yeah, it's a slow battle, Roger.
I have to say, since 2003 and2013, things have improved, albeit
inadequately and slowly and so on,but things are improving and that's
the great news that the momentum forpsychodermatology and the voice of
psychodermatology is getting better.
(15:07):
In Europe, I'm part of a task force atthe EADV, European Academy of Dermatology
and Venereology, it's much worse, in fact.
So, there are various statesacross Europe that do not have
any psychodermatology whatsoever.
And even in the places where there issome psychodermatology, it's alright,
(15:27):
and again is beginning to gain momentum.
So actually, the UK probably doespretty well, and I think there
are various reasons for that.
I mean, I say pretty well comparativelybecause we've still got a long way to go.
But, you know, all the same, we doreasonably well, compared to the
rest of the globe actually, and Ithink one of the reasons for that
(15:49):
is the model, the NHS, the model ofsocialised medicine that we have in
the UK, does allow a greater capacityfor multidisciplinary team working.
And the kind of relative, not absence,but the relative smaller role of the
business aspect of medicine, means thatpsychodermatology can flourish at least a
(16:13):
little bit better than in other countries.
But you're absolutely right, comparedto 2003 and 2013, things have improved
but are still very inadequate.
So, for example, we now have about 11or 12 psychodermatology units across the
UK, Um, whereas in 2003, there were six,and I think in 2013, there were nine.
(16:34):
So, we are improving and some ofthat is training, as well as will.
And as I've alluded to, psychodermatologyis very much a multidisciplinary
speciality, involving very muchprimary care colleagues and nurses
and psychologists and so on.
So things are improving, but westill have an awfully long way to go.
Dr George Moncrieff (16:55):
I think you're probably being a bit modest there, Tony.
I think it's great that we can holdour heads up a little higher than
Europe and the rest of the world.
But, you have been a crusader forthis as long as I've known you.
I've known you probably 20, 25 years,and, you have been banging on about the
need for more training, more resources,more awareness, more sensitivity.
(17:18):
I think our society hasmoved on as well, actually.
I think the Royal family helps that,but I think there's been definitely
an attitude change in our society thatit is much more acceptable to talk
about mental health issues than itwas perhaps just 5, 10 years ago.
But, throughout, you, individually,have been spearheading this and really
(17:40):
fighting this corner with such passion.
Professor Anthony Bewley (17:43):
That's very kind George, even though,
of course, we are both only about26 years old now, of course.
But it is very much a team.
So, you know, I mean, you know, myteam is great and I could not do, what
I hope to do, without my psychiatrycolleagues and my psychologist colleagues.
And of course, my dermatologycolleagues and primary care
(18:04):
colleagues for that matter.
Dr George Moncrieff: Tony, thank you so much. (18:05):
undefined
I have learnt so much from you, asI always do, when I'm at your knees.
It's been absolutely brilliant.
And I'm sure Roger will endorse that.
Dr Roger Henderson (18:14):
Absolutely.
It's been wonderful, Tony.
It's been an absolute delight, andthank you so much for your time with us.
Professor Anthony Bewley (18:20):
Thanks, guys.
Always a pleasure.
Dr Roger Henderson (18:22):
Now, in addition, in the upcoming podcasts, we'll be looking
at the scale of the problem, lookingat conditions where the skin can be the
presentation of a mental health condition.
We'll also consider how us, as the medicalprofession, should respond to some of
the shocking facts and figures linkedto mental health issues in our patients
with skin disease, and also how we shouldgo about helping those who are affected.
(18:48):
And also, let's not forget, we should alsobe looking to raise the issues of mental
health and not be afraid to do so in ourpatients who do have skin conditions.
It should remind us toalways check this area.
Dr George Moncrieff (19:03):
Yes, that was a point that Tony went
out of his way to emphasise.
And I think that was a reallyuseful learning point for me.
We were honoured to be joined byProfessor Bewley for this episode.
Thank you so much for your expertise,wisdom, and your contribution.
So Roger and I do hope you'lljoin us for the next podcast.
(19:23):
We'd also like to thank our sponsor,AproDerm®, for all their help in putting
these Rash Decisions podcasts together.
We couldn't have done it without them.
Dr Roger Henderson (19:32):
And if you do like what you hear, and George and I really
hope you do, then do leave us a review,or rate us, and send us some feedback.
We'd love to hear from you.
So, until the next podcast,it's goodbye from George.
Dr George Moncrieff (19:46):
Goodbye.
Dr Roger Henderson (19:47):
And as always, it's goodbye from me.
Goodbye.
Hello and welcome to this Rash Decisions podcast,
where we look at skin-related issues,conditions and treatments in an
interesting and informative way.
I'm Dr Roger Henderson.
I'm a GP with a long-standing interestin this particular area of health.
Dr George Moncrieff (00:24):
And I'm Dr George Moncrieff.
I was also a GP, although I've now retiredfrom my practice and I'm a former Chair
of the Dermatology Council for England.
Dr Roger Henderson (00:33):
Now in this podcast, we'll be looking at the
importance that skin diseases canhave on someone's mental well-being.
And this is the first of threepodcasts on this topic, because
it is such a huge area to cover.
And in the next ones, we'll be lookingat the scale of the problems, what this
means for healthcare professionals,the importance of recognising
(00:54):
these issues and how we should goabout helping our patients and what
patients should ask of us as doctors.
We'll also look at some mentalhealth conditions that present with
the skin-related problem, and we'llbe discussing these with our very
special guest, Professor Tony Bewley.
(01:21):
Now, George, we both know just how muchsomeone's mental and physical health
is intrinsically linked and being bothvisible and such a large organ, skin
disease can have a massive impact onsomeone's quality of life, particularly
when areas such as the face, the hairor the genitals of someone is involved.
Dr George Moncrieff (01:41):
Certainly.
When those areas are affected, theobjective severity of a skin disease
can be grossly underestimated.
And the effect that can have onhow people feel, the psychological
distress it can cause for thatpatient can be absolutely devastating.
(02:03):
And doctors often measure thesewith fairly crude measures like the
PASI score, which stands for thePsoriasis Area and Severity Index,
or the EASI score for eczema, whichis Eczema Area and Severity Index.
But these are pretty crude when it comesto the impact that a condition can have
(02:26):
on someone, how someone feels about it.
Particularly when it affects theface or the hands or the genitals,
as you mentioned, these areas arehigh impact areas, and so minor
disease, which is clearly visible,can really be underestimated.
I can't, overestimate how importantthat is for us to be aware of.
(02:48):
Many a time I've seen a patientwho, doctors have dismissed their
disease as minor or trivial, andthey're almost apologetic about
asking for help with managing it.
But for the patient, itis not minor or trivial.
It is the main thingthey think about 24/7.
And of course, in today's modernworld, body image expectations can be
(03:13):
significantly and adversely affected byunrealistic social media expectations.
And this is especially a problemfor young people, for whom how they
look, how they come across, even onsocial media, really, really matters.
So, this can lead to stigmatisation,discrimination, and even rejection.
(03:38):
And sadly, sometimes a very naturalresponse to that is for the individual
to conceal their disfigurement, concealthe changes that they are worried about,
and avoid further social interaction,which can result in worsening isolation,
spiralling, low self-esteem, andgenerally worsening mental health issues.
Dr Roger Henderson (04:03):
Professor Anthony Bewley, now we're extremely lucky
to have him on our podcast today.
Tony's a consultant dermatologistat Barts Health and has developed an
interest in how the skin interactswith the brain and the mind.
He's got a specialist clinic witha multidisciplinary team, at least
every week, at the Royal LondonHospital, and that was awarded the BMJ
(04:26):
Dermatology Team of the Year in 2017.
No small feat.
He's the co-author of PracticalPsychodermatology, Secretary
of the European Society forDermatology and Psychiatry, and
Co-chair of Psychodermatology UK.
And if all that wasn't enough,he's a lovely chap to boot.
(04:47):
Welcome, Tony.
Professor Anthony Bewley: Thanks very much, Roger. (04:47):
undefined
Great to be here.
Dr George Moncrieff (04:51):
Well, it's a real pleasure to have you with us today, and
thank you so much for joining us Tony.
In 2020, the All-Party ParliamentaryGroup for Skin produced a report, the
Mental Health and Skin Disease report,which I think you chaired, Tony.
Professor Anthony Bewley: That's right, yes. (05:07):
undefined
Dr George Moncrieff (05:09):
And this report stated that skin disease can adversely
impact on all aspects of someone'slife, schooling, self-esteem,
career choices, as well as social,sexual, and leisure activities.
And it went on to say that commonissues related to skin disease
(05:29):
include isolation, embarrassment,shame, depression and anxiety.
Thinking about all ofthat, if that isn't enough.
What do you feel are the mainpoints from this report that
you would like to highlight?
Professor Anthony Bewley: Yeah, thanks George. (05:46):
undefined
I mean, it's absolutely correctthat the skin is not just the skin.
Underneath the skin, there is aperson, who is really suffering.
And that's what the All-PartyParliamentary Group on Skin report in 2020
said, it said that a massive 98%, so theoverwhelming majority of people, who live
(06:11):
with a skin disease really suffer withall of those things that you alluded to.
Frank psychosocial comorbidities likeanxiety and depression, or anxiety or
depression, remembering that anxiety anddepression is more common than one or
other by itself, anxiety or depression.
(06:32):
But you know, the vast majority ofpeople who live with skin disease
really understand that it affectstheir sense of wellbeing, their
confidence and their personal image.
And the stigmas, and it's notjust one stigma, it's not just
about the physical appearance,it's about all sorts of things.
(06:53):
For example, it can beabout ethnic identity.
If you have a condition that meansyour skin goes lighter or darker
or changes in some way, then itcan be about ethnic identity.
And it can also be about theimpact it has from other people.
So, for example, one of my colleagueshad a baby with a strawberry
(07:15):
birthmark on the baby's face.
And if she walked out with this childin the park, quite often somebody
would come across and say, "What abeautiful baby, but what on earth
is that on that child's face?"
So, the public come up with allsorts of unsolicited comments,
many of which are not that helpful.
(07:36):
So, the All-Party ParliamentaryGroup on Skin report wanted to
highlight that it is a massive 98% ofpatients who live with skin disease
who have to deal with all of this.
And what's kind of even more soberingreally is that 82% of those individuals
(07:57):
are not signposted or facilitatedby healthcare professionals.
And it's not just GPs or nurses,it's also dermatologists as well.
So, we really need to get betterat trying to signpost people and
move them towards having helpfuladvice and better facilitation about
(08:21):
management of their skin disease.
Dr George Moncrieff (08:24):
Doing my sums, that means that only 18% had sought
any effective professional help.
Professor Anthony Bewley (08:32):
That's right.
So, a really small minority accessed somekind of assistance for their psychosocial
wellbeing, their mental health.
Dr George Moncrieff (08:42):
And do you think that's due to a perceived lack of
interest from the healthcare professionalor just a lack of awareness and
training of healthcare professionals?
Professor Anthony Bewley (08:51):
So, I think there are several problems here.
The first problem is that healthcareprofessionals on the whole
believe that they are not trainedsufficiently to be able to manage
the psychosocial comorbidities.
They also fear that if theyopen up that box, that the
consultation will last forever.
And in primary care, you don't get longto be able to address these issues.
(09:17):
Similarly, in secondary or tertiarycare, you don't get long, but
actually, it's a misperception.
On average, you can find out allyou need to know from a patient,
usually within four minutes.
Patients are much more articulate, anderudite than we give them credit for.
And then the second mistake that we ashealthcare professionals make, is that
(09:41):
we believe that we don't have the skillsto be able to assess or signpost people
towards better mental health services.
And we do, we do havethose, those capabilities.
And then the third thing is that, webelieve, and this is correct, that
there might not be the facilities orresources around to be able to really
(10:03):
slot patients in, into the correct way.
And there are still, I mean, youknow, just being able to listen to
a patient is massively important.
Patients feel engaged and at least theyfeel heard, and that for me, you know,
from our research, is half the battle.
So, just being heard is really important.
(10:24):
But of course, if we can signpost themand direct them towards better mental
health services, so much the better.
And there is, of course, IAPT,you'll, remember IAPT, Improved
Access to Psychological Therapies,which is a national programme.
And patients can self-refer to IAPTin some parts of the UK, or else
we can signpost them towards IAPT.
Dr George Moncrieff (10:46):
I think you've hit the nail on the head there with
that, in that, I do think that evenwithin 30 seconds, I normally have
a feeling for what is going on andwhat the patient's problems might be.
And I think sitting back andbeing sensitive, it should,
ring home quite firmly.
But I suspect, as you say, manydoctors are terrified of opening
(11:08):
that can of worms and feeling thensuddenly out of their depth and the
consultation running out of control.
And it's very reassuring to hear thatwe probably do have the skills, and we
haven't necessarily got to address itall here and now, that we can signpost
them, we can seek help, we can evensay, highlight it and say, look, this is
(11:28):
important, I haven't got the resource tomanage it today here in this consultation,
but I do want you to come back forus to explore this in more detail.
And I think that can be very empoweringfor both the patient and the doctor, and
go huge ways to sorting out and relievingthat relationship that they have.
(11:48):
It could be terribly important.
It's particularly important, Ithink, in children, isn't it?
And this was highlighted by the report.
And I mention children because I thinkhere, the, something I spoke about
when I was talking about psoriasis, theCumulative Life Course Impairment, that
something that is relatively minor earlyin your life can affect your self-esteem,
(12:11):
your confidence, your relationships.
And can have a devastating impacton where you get to in life with
marriage, having a family, a career.
And the report highlighted the importanceof looking for this in children.
Professor Anthony Bewley: Well, that's right. (12:26):
undefined
So, we talk about the cumulativelife course impairment in
terms of disease modification.
If we think about rheumatology, therheumatologists have been talking
about disease modification for years.
In other words, joint preservation.
If you have a destructive jointdisease, then if you can reduce the
(12:46):
destruction of the joint disease,then you have disease modification.
In dermatology, most of the conditionsthat we have, do not scar, at least
visibly on the skin, do not scar.
Though, of course, I wouldargue that the psychosocial
scarring is quite significant.
And that's the point, really, aboutthe cumulative life course impairment.
(13:06):
We're talking about trying tonegate or obviate the buildup
of, anxiety and or depression,confidence issues, self-esteem.
And then separately, quality oflife issues, which I think is what
you're alluding to there, George.
It's about how you achieve yourpotential, how you excel to the best
(13:29):
you can do at school or at college, orin your apprenticeship or in your job,
but also how you connect with otherpeople, and that can be family members,
it can be partners, it can be friends.
So, the Cumulative Life CourseImpairment is a really important concept.
And what we're beginning tounderstand as dermatology healthcare
(13:51):
professionals is that if we canreally reduce that cumulative life
course impairment then that for ourpatients is disease modification.
Dr George Moncrieff (14:01):
It's a nice way of putting it, I have to say, yes.
Dr Roger Henderson (14:04):
Now, Tony, you, George and I are old enough to know
that it doesn't matter who you votefor, the government still gets in.
And there have been two previousreports on this particular topic by
the APPGS, I think 2003, 2013, thatagain, quite correctly highlighted
the magnitude of this problem.
And yet, unfortunately, relatively fewof those recommendations, just from those
(14:28):
first two reports, have been implementedby policymakers or commissioners
in the government or the NHS.
Are you confident that this reallyquite damning 2020 report might make
things any better this time around?
Professor Anthony Bewley (14:45):
Yeah, it's a slow battle, Roger.
I have to say, since 2003 and2013, things have improved, albeit
inadequately and slowly and so on,but things are improving and that's
the great news that the momentum forpsychodermatology and the voice of
psychodermatology is getting better.
(15:07):
In Europe, I'm part of a task force atthe EADV, European Academy of Dermatology
and Venereology, it's much worse, in fact.
So, there are various statesacross Europe that do not have
any psychodermatology whatsoever.
And even in the places where there issome psychodermatology, it's alright,
(15:27):
and again is beginning to gain momentum.
So actually, the UK probably doespretty well, and I think there
are various reasons for that.
I mean, I say pretty well comparativelybecause we've still got a long way to go.
But, you know, all the same, we doreasonably well, compared to the
rest of the globe actually, and Ithink one of the reasons for that
(15:49):
is the model, the NHS, the model ofsocialised medicine that we have in
the UK, does allow a greater capacityfor multidisciplinary team working.
And the kind of relative, not absence,but the relative smaller role of the
business aspect of medicine, means thatpsychodermatology can flourish at least a
(16:13):
little bit better than in other countries.
But you're absolutely right, comparedto 2003 and 2013, things have improved
but are still very inadequate.
So, for example, we now have about 11or 12 psychodermatology units across the
UK, Um, whereas in 2003, there were six,and I think in 2013, there were nine.
(16:34):
So, we are improving and some ofthat is training, as well as will.
And as I've alluded to, psychodermatologyis very much a multidisciplinary
speciality, involving very muchprimary care colleagues and nurses
and psychologists and so on.
So things are improving, but westill have an awfully long way to go.
Dr George Moncrieff (16:55):
I think you're probably being a bit modest there, Tony.
I think it's great that we can holdour heads up a little higher than
Europe and the rest of the world.
But, you have been a crusader forthis as long as I've known you.
I've known you probably 20, 25 years,and, you have been banging on about the
need for more training, more resources,more awareness, more sensitivity.
(17:18):
I think our society hasmoved on as well, actually.
I think the Royal family helps that,but I think there's been definitely
an attitude change in our society thatit is much more acceptable to talk
about mental health issues than itwas perhaps just 5, 10 years ago.
But, throughout, you, individually,have been spearheading this and really
(17:40):
fighting this corner with such passion.
Professor Anthony Bewley (17:43):
That's very kind George, even though,
of course, we are both only about26 years old now, of course.
But it is very much a team.
So, you know, I mean, you know, myteam is great and I could not do, what
I hope to do, without my psychiatrycolleagues and my psychologist colleagues.
And of course, my dermatologycolleagues and primary care
(18:04):
colleagues for that matter.
Dr George Moncrieff: Tony, thank you so much. (18:05):
undefined
I have learnt so much from you, asI always do, when I'm at your knees.
It's been absolutely brilliant.
And I'm sure Roger will endorse that.
Dr Roger Henderson (18:14):
Absolutely.
It's been wonderful, Tony.
It's been an absolute delight, andthank you so much for your time with us.
Professor Anthony Bewley (18:20):
Thanks, guys.
Always a pleasure.
Dr Roger Henderson (18:22):
Now, in addition, in the upcoming podcasts, we'll be looking
at the scale of the problem, lookingat conditions where the skin can be the
presentation of a mental health condition.
We'll also consider how us, as the medicalprofession, should respond to some of
the shocking facts and figures linkedto mental health issues in our patients
with skin disease, and also how we shouldgo about helping those who are affected.
(18:48):
And also, let's not forget, we should alsobe looking to raise the issues of mental
health and not be afraid to do so in ourpatients who do have skin conditions.
It should remind us toalways check this area.
Dr George Moncrieff (19:03):
Yes, that was a point that Tony went
out of his way to emphasise.
And I think that was a reallyuseful learning point for me.
We were honoured to be joined byProfessor Bewley for this episode.
Thank you so much for your expertise,wisdom, and your contribution.
So Roger and I do hope you'lljoin us for the next podcast.
(19:23):
We'd also like to thank our sponsor,AproDerm®, for all their help in putting
these Rash Decisions podcasts together.
We couldn't have done it without them.
Dr Roger Henderson (19:32):
And if you do like what you hear, and George and I really
hope you do, then do leave us a review,or rate us, and send us some feedback.
We'd love to hear from you.
So, until the next podcast,it's goodbye from George.
Dr George Moncrieff (19:46):
Goodbye.
Dr Roger Henderson (19:47):
And as always, it's goodbye from me.
Goodbye.
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