Approximately one in four people in the UK experience a mental health problem of some kind each year, and one in six report experiencing a common mental health problem (like anxiety or depression) in any given week in England.
For children and young people, the latest evidence suggests that rates of mental illness may be growing at a faster rate than amongst adults, and for those aged 17-19, rates increased from one in 10 to one in four between 2017 and 2022.
In a recent survey by mental health charity, Mind, one in three UK adults said they never make space in their day or the time to speak about their mental health – that’s the equivalent of almost 20 million adults. And according to Mind, the nation’s mental health is predicted to get worse due to the cost of living crisis, on top of the lasting impact of the pandemic.
With so many people suffering with their mental health at any given time - many of them young and vulnerable - aesthetic practitioners have a clear duty of care, as healthcare professionals, to support both their own and their patients’ mental health throughout the patient journey - from marketing, advertising, social media and ethical offers, to the consultation, the treatment process and beyond - heath and aesthetics are inextricably linked.
We spoke with Kimberley Cairns BSc (Hons) MSc GMBPsS, a specialist integrative psychologist and JCCP board member, with a special interest in body image and trauma. Kimberley provided her top tips for supporting patients’ mental health and wellbeing throughout the patient journey.
“Practitioners can support their patients’ mental health throughout the patient journey in so many ways, and this really is all-encompassing,” says Kimberley. She adds, “From the first contact your clinic has with the patient is the time to start supporting a patient’s mental health. This includes portraying responsible marketing and advertising, ethical offers, and a body positive narrative on social media; all of which is then transmitted authentically, through a sensitive non-assuming tone when speaking to patients during their consultation and throughout the treatment process.”
The Advertising Standards Authority (ASA) and Committees of Advertising Practice (CAP) have pulled together clear guidance and core principles for advertising cosmetic procedures, with an emphasis on handling issues relating to body image sensitively – advertisers must make sure that their ads do not imply that one body type or specific trait is preferable over another as this may exploit those with body insecurities. Any advertising should also highlight the need for a consultation before booking a procedure, and ads must be scheduled and targeted appropriately in order to minimise the risk of children seeing an ad which has the potential to have a negative impact on their body image. ASA’s website contains lots of useful information on the advertising rules for cosmetic surgery and procedures, including examples of previous ASA rulings in this area, all of which should support practitioners looking to understand the relationship between mental health and aesthetics, and advertising.
Kimberley advises that when advertising or posting on social media, practitioners should be asking themselves whether it is, “legal, truthful and honest? Have I exaggerated claims? Am I steering somebody into thinking they are suitable for treatment when we need to explore their motivations?”
The Joint Council for Cosmetic Practitioners stated in its response to the All-Party Parliamentary Groups, “For those who seek cosmetic treatments, emotional and psychological needs may also be identifiable at the time of initial consultation. As such, all practitioners should be aware of the need to consider potential consumer vulnerability and prioritise making treatment decisions that reflect the interests of consumer wellbeing and mental health. These considerations should occur jointly with practitioners and consumers, to inform the appropriate treatment, signposting for alternatives and/or ongoing assessment of treatment outcomes and aftercare.”
When it comes to the patient consultation stage of the patient journey, using a validated psychological assessment tool can help equip both aesthetic practitioners and the patient, providing a wider understanding of their needs. However, there are considerations to bear in mind, “Psychological tools should not be seen as a ‘pass or fail’ to access treatment, but as a beneficial tool to look beyond the primary concern or presenting symptoms,” says Kimberley.
Body dysmorphic disorder (BDD) is a condition which most aesthetic practitioners are likely to have come across in patients, and can affect both men and women and people of any age, but is most common in teenagers and young adults. BDD is a mental health condition where a person spends a lot of time worrying about flaws in their appearance; flaws which are often unnoticeable to others. One study found up to 70%of people with BDD had sought cosmetic procedures, and half had received such interventions. However, BDD is not the only mental health condition that patients may present with.
Kimberley says:
“Statistics tell us that it is more likely that you will see anxiety and depression in your patients. Comorbidities that present alongside BDD such as obsessive-compulsive disorder, social phobias and substance misuse must also not be ignored as their prevalence will be debilitating and can pose substantial risk to those individuals with a diagnosis.”
Mental health conditions are not always visible, and patients can go to great lengths to disguise them, which can lead to practitioners feeling some pressure to identify issues. However, there are some red flags to look out for, including:
“‘Why now?’ is a key question that may give rise to red flags,” says Kimberley, adding, “Has there been a sudden, or significant life event? These do not always need to be negatively perceived and can include having a baby, starting a new job, attending a special wedding, or events such as marriage, bereavement, or divorce. Engaging in treatments during these heightened emotional times can result in regret and dissatisfaction if not appropriately supported.”
If patients are seeking short-term, immediate results, it is important to consider a cooling off period of at least 48 hours to provide breathing space and to safeguard the patient’s mental health. Kimberley says, “Getting your marketing and advertising right is so crucial, or you risk perpetuating a cycle of harmful aesthetics that gives temporary relief and a longer-term discomfort for the patient and your business.”
Conducting a thorough consultation into the patient’s medical history is key to any patient consultation and is a vital time to identify any red flags. “If a patient has a history of aesthetic procedures, be sure to ask about their satisfaction and why they are not returning to their original or previous practitioner – this will give invaluable clues to their mental health and appearance journey,” advises Kimberley.
Establishing a thorough understanding of ‘red flags’ through specialist training is essential to the link between mental health and aesthetics, according to Kimberley. She says, “It is important that you have a ‘red flag protocol’ and are equipped to use this in practice. For example, you need to be able to justify your treatment plan if a red flag is alerted, yet treatment is given.” She adds, “Do make sure you include justification in your clinical notes as to why you believe the treatment was necessary, as it will also support any issues arising with informed consent, complaint management, and potential insurance claims.”
If there are any warning signs in patient responses, consider whether having an aesthetic treatment now is in the patient’s best interests. It may be a question of deferring their treatment until they are in a more positive mindset, or it could mean refusing them. Treating a patient who is unsuitable for treatment could impact your reputation as a competent and ethical practitioner. Therefore, always have the patient’s best interests at the forefront of your mind; postpone their treatment or, if necessary, refuse to treat them.
When a patient is not ready for treatment, what is the best way to say no? Kimberley explains, “Ethical practice would encourage a practitioner to say ‘no’ without actually saying ‘no’, as this rigid phrase could be harmful, and patients may get offended. Alternative phrases may include ‘not right now’, ‘how about X instead of Y’, ‘have you considered X’, or ‘let us see you in X weeks instead’.
If concerned about a patient’s wellbeing, referring to a GP is a mark of best practice, however making a decision to act on mental health concerns can be difficult for even the most experienced practitioners, believes Kimberley. She says, “Risk dependent, a practitioner may choose to hold a safe space for the patient who is experiencing a decline in mental health, if this fits within their capacity of training, competency and if there is appropriate supervision.”
She adds, “Alternatively, referring to other expert wellness services such as EDEN wellness therapies of Harley Street London, who assign referrals to accredited psychological and counselling professionals within 48 hours, or the Integrated Practitioners of Aesthetic Wellness can provide specialist psycho-aesthetic interventions to support your patients and your practice.”
From integrating yoga and nutrition into your clinic, to offering psycho-dermatology and personal training, there is an eclectic mix of services practitioners can provide to support the mental health of their patients. Including patient wellness as part of your model of care can help patients benefit from a 360° service to enhance the patient’s health, mental wellbeing and lifestyle to optimise their overall wellness.
Ultimately, practitioners need to make sure they are educated in patient mental health and undertake training that covers a range of mental illnesses, mental health assessment, communication skills and motivations for treatment, as well as patient selection. Having the skills to assess mental illness, and offering mental health services, can help make sure you provide a safe experience for both the patient and practitioner and that your patients feel supported, heard and understood.
For related content read Kimberley's guest blogs, Mental health: safeguarding and fitness to practise, the importance of psychology in aesthetic licensing and ADHD in aesthetics, which offers guidance for practitioners treating patients with ADHD.
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