Burns psychology service
The burns psychology team provides psychological support to current and historical Chelsea and Westminster Hospital patients of all ages. This may include families (especially parents of burn-injured children) and the social networks who have been, or will be, supporting patients to manage having experienced a burn and the challenges this may bring. We also provide support, training and consultation to other burns and non-burns professionals. Our team is led by Dr Lisa Williams (Clinical Psychologist), who set up the service in 2006 with support from the adult burns charity Dan’s Fund for Burns. Since then, the team has grown to include part-time paediatric burns lead Dr Aayesha Mulla, part-time burns psychologists Dr Maddy Jago, Dr Harriet Rankin and full-time assistant psychologist Louis Cursan. From time to time we also have Clinical Psychology Doctoral trainees with us from the North Thames courses.
Inpatients
The National Standards for the Provision of Adult and Paediatric Burn Care’ (2023) outline that all patients who are admitted to a burns service for 24 hours or more are offered a psychosocial screen. We also know that details of the actual burn injury, including the size, cause or location are not helpful predictors of coping. We will attempt to speak to all inpatients as soon as possible and cover a number of important topics which we know will better help us identify who might need support at this early stage:
- Social support
- Coping strategies
- Developmental history (children)
- Trauma symptoms (adults and young people/adolescents) and behavioural changes (children)
- Historical and current non-burns difficulties
- Appearance concerns
If the person, themselves, cannot answer our questions for whatever reason we will identify the next best person to provide that information. We also have access to interpreting services which we prefer to use rather than relatives or friends. If we identify problems, we will try to help, provide information about where to get help and make referrals to other professionals, charities or organisations. In addition, we offer to check back in with everyone three months later by asking similar questions via a choice of email, phone or by post.
Outpatients
The service supports patients after they have been discharged, and those who were never admitted but were treated in our outpatient services or have had their care transferred to Chelsea and Westminster after initial treatment elsewhere. Some of the difficulties we commonly see include:
- In adults: Pain, fear and uncertainty, anxiety, depression, loss and grief, adjustment to the new situation, appearance issues and acute stress through to PTSD, social anxiety, avoidance, sleeping difficulties, relationship difficulties, poor social support, and reduced quality of life and functioning.
- In children: Behavioural changes (eg reverting to younger behaviour, anger outbursts, challenging boundaries, increased worries about or avoidance of danger or pain), upsets to routine, separation anxiety, disruption of school life (learning, bullying, nightmares and avoidance) and appearance-related concerns.
- In parents: We often see more distress in parents than in their burn-injured child. Many parents express feelings of guilt about the injury having happened, feeling judged, anxious, helpless and blame from themselves or others, as well as worries about the future. The main issue that preoccupies many of our parents is whether their child is going to have a scar and what this will mean for their child’s future.
Burn injuries myth busters
Myth: The size of the burn matters—the bigger, the more distressing it feels
There is no direct relationship between the size of the burn and distress. Some of the most upset people we see have very small burns and, yet, other people with large burns do not seem that bothered. To know, we have to ask.
Myth: Site matters, especially on the face is the worst, or if it is visible (eg hands)
There is no direct relationship between where the burn is and distress. Some of the most upset people we see have burns that are hidden and nobody else is likely to see and, yet, other people with visible burns do not seem that bothered. Once again, to know, we have to ask.
Myth: As the injury heals the person looks better and therefore should feel better
It does not always follow that people feel better as their injuries heal. In fact, some people become more distressed when they do not feel an expected psychological boost from physical healing.
Myth: People want you to tell them if they are looking better
When there is a mismatch between how a person feels and how they look to others, this can cause distress and unhelpful expectations from others, such as ‘but you should feel better’.
Getting support
The good news is that most adults and children who experience a burn injury will recover psychologically without the need for professional support. Indeed, not everyone will want or need professional support for managing burns, and we invite you to visit our burns support page for information, support groups, events, useful websites and other resources.
To access the burns psychology service, you must currently be a registered patient of the Chelsea and Westminster Hospital burns service. We also accept self-referrals and referrals from other members of the burns team. If you are not a registered patient, you would need to be referred to the service by your GP and will need to see one of the burns doctors first.
Contact information
Chelsea and Westminster Hospital
Mon–Fri, 8am–4pm
E: chelwest.burnspsychology@nhs.net
T: 020 3315 2504
The Chelsea and Westminster Burns Psychology Service has good links with our fellow teams within the London and the South East Burns Network (LSEBN), and we meet regularly to discuss issues and share ideas about best practice in burns psychology. Lisa Williams is the current LSEBN lead for psychosocial care and chairs these meetings. A psychosocial work plan is agreed with the network every year and an annual report of psychosocial activity data is produced.
We are also active members of the British Burn Association Psychosocial Special Interest Group and provide advice and consultation to organisations including: