Publications: Science Omega Review UK Issue 2

Stroke’s hidden shockwaves: those affected need greater support

Physiotherapy outdoors
As the leading cause of adult disability in the UK, costing the government £3.172bn in healthcare costs each year, more needs to be done to find out how to prevent strokes and reduce the impact on people’s lives.
Joe Korner
The emotional impact of a stroke can be as devastating as the physical effects, and those affected need greater support, explains the Stroke Association’s Joe Korner...

One person has a stroke every five minutes in the UK. Yet the impact and cause of this devastating condition is relatively unknown to the general public. Thanks to the wide-reaching ‘FAST’ advertising and ‘Make stroke a medical emergency’ campaigns, more people are now surviving a stroke as emergency and acute stroke care has improved. However, this presents us with the challenge of ensuring that survivors and their families are getting the support they need for the best possible recovery after they leave hospital and in the long term.

A stroke happens suddenly and the survivor and their family often struggle to find information and support. The Stroke Association campaigns to raise awareness of stroke prevention and the impact of strokes. Last year we launched our first ever Action on Stroke month in May 2012, which featured survivors’ own stories showing that there is life after a stroke. This year we have been focusing on raising awareness of aphasia (a condition that affects communication) and in our second Action on Stroke month we’re talking about the emotional impact of strokes.

Physical effects of a stroke and rehabilitation

A stroke is a brain attack, which happens when the blood supply to the brain is cut off, caused by a clot or bleed. Every year more than 150,000 people in the UK have a stroke, which can leave the survivor with mobility problems, memory loss, aphasia and depression.

Rehabilitation is essential for stroke survivors, whether it is physiotherapy, speech and language therapy or occupational therapy. For every stroke survivor the recovery rate can be different; some will recover significantly in hospital; for others, their recovery can take years.

Access to rehabilitation services is improving, but our research last year found that stroke survivors are still facing many barriers in making their best possible recovery.

38 per cent of stroke survivors had not received an assessment of their health and social care needs. Over half of people whose stroke occurred in the last three years received only one assessment and two-thirds who received an assessment had been left without a care plan, which should outline the services and treatments that would be put in place to help their recovery.

Emotional impact

While all the effects of a stroke can be devastating, the physical impact of a stroke is more obvious to health and social care professionals. The emotional shockwave of a stroke is often hidden.

Our most recent survey of over 2,700 stroke survivors and carers suggests that their emotional and psychological needs often go unrecognised or unmet. Many reported feeling ‘abandoned on leaving hospital’.

Strokes triggered emotional problems for most survivors (96 per cent), with nearly 60 per cent feeling depressed and even more (70 per cent) experiencing anxiety. Family members, who often become the main carer, feel tired, anxious and sleep-deprived, with over half (57 per cent) reporting feelings of depression.

When in place, post-discharge care concentrates on physical rehabilitation, ignoring the critical role of psychological and emotional support in aiding recovery and preventing burnout amongst carers.

Psychological assessment

The National Stroke Strategy in England and the Royal College of Physicians (RCP) have both recognised the importance of a psychological pathway of rehabilitation. Survivors should have a psychological assessment within a month of the stroke, followed by regular reviews. The outcomes of that assessment should shape access to a wide range of mental health services – running from peer support or local counselling services through to psychiatric care.

Work by NHS Improvement’s Stroke Improvement Programme (in England) shows that an investment in psychological care can lead to net savings for the NHS and social care across the UK of £10m over two years, while improving services to survivors and carers.1

However, over half of stroke units in England, Wales and Northern Ireland still have no access to psychology services at all.2 In Scotland only one-third of stroke units have access to clinical psychology services.3

Call to professionals

It is essential for professionals to recognise when survivors might require interventions and support from specialist mental health professionals, trained to respond effectively to the complex and unique neuropsychological and psychological changes often associated with strokes. One carer told us that it was really hard to get the professionals to listen to her concerns about the changes in her husband’s emotional state; she explained to us that the professionals had no knowledge of what her husband was like before the stroke and she had to speak to lots of people before they listened to her and organised counselling support.

Stroke research

Rehabilitation and support is an ongoing issue that we are campaigning hard to improve, but the Stroke Association also carries out research into the prevention, cause and treatment of strokes. Over the last 20 years we’ve spent more than £40m supporting vital stroke research; however, it is still desperately underfunded. For every cancer patient living in the UK, £295 is spent each year on medical research, compared with just £22 a year for every stroke patient.4 As the leading cause of adult disability in the UK, costing the government £3.172bn in healthcare costs each year, more needs to be done to find out how to prevent strokes and reduce the impact on people’s lives.

The Stroke Association is currently funding some promising new therapies, such as the mechanical retrieval of blood clots and the use of magnetic brain stimulation to boost recovery. However, like rehabilitation support for the emotional impact of strokes, research into the mental consequences of a stroke has lagged behind research into the physical impairments. Clearly, more needs to be done to recognise the mental and emotional challenges faced by stroke survivors.

More than one million stroke survivors are alive in Britain today, partly due to improvements in acute care. We must now ensure they have the physical and psychological rehabilitation support they need to have a good quality of life after a stroke.


NHS Improvement (2012) Psychological care after stroke: Economic Modelling of a clinical psychology led team approach
2 Sentinel Stroke National Audit Programme (SSNAP) (2012) Acute organisational audit report
The Scottish Government (2009) Better Heart Disease and Stroke Care Action Plan
4 Luengo-Fernandez R, Leal J and Gray A (2012) UK research expenditure on dementia, heart disease, stroke and cancer: are levels of spending related to disease burden? European Journal of Neurology 19: 149-154


Joe Korner
Director of Communications
Stroke Association

www.stroke.org.uk



[This article was originally published on 10th June 2013 as part of Science Omega Review UK 02]


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Next: FAST action is crucial
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