Providing psychological support for patients after critical illness.

The majority of patients have little or no memory of their stay in ICU or remember only pain, suctioning or lack of sleep. Dreams and nightmares while in the intensive care unit (ICU) and after discharge home have also been reported. The few studies investigating the longer-term psychological problems of critical illness point to a picture of social isolation with patients avoiding company and showing less affection to their partners. Our own experience, running a special outpatient clinic and following up patients by post, showed a picture of depression, anxiety, irritability and social isolation. This led to the setting up of an ICU staff-led support group for patients recovering from critical illness. This article outlines the possible problems and pitfalls of setting up and running a support group for patients recovering from critical illness. The type of patients suitable to attend such a group is examined. Two case histories give an illustration of the type of problems ICU patients experience during their recovery and how an informal support group can help. In addition to possible benefits to the patients, support groups can also give ICU staff a chance to understand the process of recovery from critical illness and to examine the effects on patients of their own practice. However, they must also have enough insight to know when a patient needs professional help; for example, a patient displaying symptoms of post-traumatic stress disorder should be referred, with their agreement, to a clinical psychologist.