Merry Gibbons, a Wellbeing Specialist for teenagers and young adults with cancer (TYA) at the Royal Surrey County Hospital in Guildford, explains how she provides a holistic cancer care service for young people with cancer.

Setting a good example - mindfulness 

The 8.02am Haslemere to Guildford train is the perfect opportunity to do 10 minutes mindfulness.  It readies my mind for the day, but I also suggest Andy Puddicombe's Headspace app to the TYAs, so I really should walk the walk not just talk the talk!

I then send my confirmation texts to the young people I’m seeing that day.  I offer them the option of a reminder and most take it up as sometimes they can forget, double book, don’t wake up in time or can simply change their mind.  

TYA designated hospital

I work at the Royal Surrey County Hospital in Guildford which is a Designated Hospital for teenagers and young adults with cancer.  We share care of TYAs age 16-18 years with University College Hospital (UCLH) and The Royal Marsden Hospital (RMH).  We offer a choice of place of care between us and RMH to those aged between 19-24 as per national policy.  The majority choose to stay locally mainly because of travelling times and local support.

So what is a TYA wellbeing specialist?

I am the TYA wellbeing specialist providing level 3 psychological support for 16-24 year olds.  I offer psychotherapy, counselling and also, amongst other things mindfulness, visualisation, reiki and relaxation techniques.  I’m part of the TYA Macmillan Outreach Survivorship Team (MOST) but also work with TYAs from diagnosis.

After treatment, young people can struggle to return to life away from the reassurance of regular TYA team/hospital contact.  This is often the time when difficult thoughts and feelings they’ve put to the back of their minds whilst they get on with treatment rise to the surface, inhibiting their ability to get on with their life or causing anxiety.

I arrive at 9am and set my room up, water, clock, tissues, bowl of mints (TYAs are not the only people who eat these I’ve noticed!), art materials, etc.  I aim for as non-hospital and relaxed an environment as possible.

Multi-disciplinary team

At 9.30am it’s our weekly MDT meeting.  It gels us as a team, keeps us aware of what’s going on for the young people and each other, and provides information about new referrals.

From 10.30am I’m seeing my TYA clients and it’s pretty much back-to-back till 3.30pm.  

Psychological support

Offering the option of counselling and wellbeing support provides an added level of psychological support that can help young people work through difficult thoughts, feelings and challenges.  

If supported early, we can avoid issues such as isolation, late effects, stress, anxiety and fear of dying manifesting into something more clinically serious, eg. depression, severe anxiety or in some cases post traumatic stress.

During my day I will see young people who are having regular counselling sessions.  However, I may also do a brief intervention for something more solution focused, eg. panic attacks, insomnia or the fear of a forthcoming scan.  I may visit TYA in-patients for a chat or pop down to the Fountain Centre (our cancer support centre) where I can use a therapy room to work with young people who want to try mindfulness, visualisation or run through some relaxation exercises.

Role-playing

A young person may want to have a difficult conversation with a friend, parent or consultant, so practices on me first with some role-playing.  

I have a strict confidentiality policy as TYAs often choose to disclose deeper thoughts and feelings during counselling.  I, therefore, don’t attend our monthly TYA socials.  This is because sharing something deeply personal and difficult in the safety of our therapeutic relationship then eating fajitas next to me in TGI Fridays could make them feel uncomfortable, embarrassed or inhibit their ability to open up to me in the future.

My day ends at 4.30pm after I have contacted any new referrals, written up next week's diary in the staff communications book, sent emails and made any referrals.  

If I had to pick three skills I find most important for this job they would be empathy, patience and a good sense of humour!

Holistic cancer care

My intention is to provide a more holistic cancer care service for TYAs.  I believe this means providing a robust support service for their non-clinical psychological needs.  

My aim is to enable TYAs to take back some control of their psychological wellbeing outside of the hospital.  Therefore I am always asking myself - am I supporting their autonomy?  Am I empowering them to manage their own psychological wellbeing?

One of the best moments for me is when a TYA says, ‘I don’t think I need to see you anymore Merry.  I feel I’m getting back in control now’.  This is a hallelujah moment for me, but they know it’s an open door and they can always come back if things change.

Author:  Merry Gibbons