Normal Lamb: The importance of joining up physical and mental health services

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Norman Lamb

Speaking at our conference on joining up physical and mental health care on 8 March 2016, Norman Lamb discusses why it's so important to integrate physical and mental health care services.

Normal Lamb: The importance of joining up physical and mental health services

Transcript

My two passions in healthcare are integrated care and the pursuit of equality for people who suffer from mental ill health. And on both of those causes I think we have a very, very long way still to go.  It is I think a remarkable achievement of our system that we manage spectacularly to neglect the physical health needs of people who have severe and enduring mental ill health, but we also spectacularly manage to neglect the mental health needs of people with physical health problems.  The most tragic of all consequences of failure is suicide.  At present there is a failure to join up support for people, to treat the person as a whole person.  The mother who has just had a baby who is suffering from post natal depression, or from psychosis after giving birth.  The need absolutely to ensure that in every part of our country they get access, in a joined up way, to specialist perinatal mental health services, the absolute need to ensure that mental health is properly integrated within primary care.  The training of doctors needs to be addressed.

Isn’t it remarkable in a system that when we have about 33% of an average GP’s workload, related in some way to mental health, that we don’t ensure that every GP in our country is properly trained in mental health? We need to address these things.  Look at Intermountain Health in Utah in the United States, where they have gone through a programme of completely integrating, bringing in mental health into primary care, so that people get access in the primary care setting to support at a much earlier stage, to stop the remote referral at a later stage when the condition has already become entrenched.  They have found that they are using resources better and making a difference to people’s lives.

Now I wanted to saying a little bit more about the work that we are doing in the West Midlands, because it seeks to extend this principle of joining up services a bit more effectively. And we are looking at key areas where we believe there is a failure of public service to provide proper support for people.  So we start for example with employment.  Now we know there is loads of evidence that something called individual placement and support works, if you invest in it, this is the intensive support for people with severe and enduring mental ill health, to help them back into work, and to continue that support once they are in work, and if they fall out of work to help them back in again.  We know the evidence shows internationally, on randomised controlled trials, that if you make the investment you get a return on your investment.  But out of a total of about 250,000 people in our country who could benefit, about 4,000 people actually do benefit.

And it is one of the problems of Government, that so often one area of Government is expected to make the investment, but another area of Government gets the gain. So health makes the investment, the Department for Work and Pensions achieves the gain.  So how do we square that circle?  So we are working with an organisation called Social Finance, and what we are exploring is whether we can raise the social investment from individuals, from charitable organisations and others, to rollout IPS across the whole of the West Midlands.  This would be internationally significant if we can do it.  And if we can do it on that basis, then we seek to persuade the Government to make the return on investment to the investors if we do what we know will work and we get people back into work.

The next area where we completely fail far too often is the link between mental ill health and housing. We all know that secure housing is critical to your wellbeing.  But how many parts of the country really join up housing providers with mental health providers in an effective way?  Housing first is a very interesting emerging model that has been used in Finland, in Canada, in parts of the United States where again just like IPS you give people intensive support to get them straight into secure housing and provide them with continued intensive support, and it might just work.

And then finally the criminal justice system where probably lies the biggest scandal of all. The fact that there are so many people in our country who are in prison essentially because of their mental ill health or their learning disability.  So we introduced in Government a liaison and diversion service, being rolled out now across the country, now covers 50% of the country.  The aim is provided the business case stacks up to treasury, to get the whole of the country covered by 2017, so that when someone turns up in the criminal justice system they get referred to diagnosis and to treatment, to give them the chance of a better life, to address their mental health problems, which may be the underlying cause of their offending behaviour.  And when people come out of prison, they are too often just completely neglected, allowed to return to their offending behaviour, without their mental health issues being properly addressed.  So we are looking at that in the West Midlands as well.

I take the view that the Government needs to spend more money on the NHS and the care system. I have argued the case for a cross party commission to achieve a long term settlement.  But let me just say this, that we cannot just complain about the Government.  All of us who work in the NHS, in the care system, all individually have a moral obligation to make the system work more effectively for people.  And if we don’t do that, we fail some of the most vulnerable people in our society.

Thank you very much indeed.

Comments

#545944 George Coxon
Various inc specialist MH advisor & MHNA National Chair
Various inc Cogora (Nursing in Practice)

Really pleased that yet further high profile comments being made on this critical issue. There remains a huge body of evidence & acknowledgement of the life expectancy gap regarding a person with a MH diagnosis - especially one of an enduring so called serious mental illness I've written articles over many years and presented at big conferences on the subject including in several countries such as in Copenhagen & Istanbul. I'm not claiming particular expertise. How could I. The wisdom amongst us all is making little difference to the reality of those affected and struggling. Question is are we able to properly construct a multi pronged approach that can engage better people in terms of primary and secondary prevention, well devised self care & self management support, decent early access, willingly accepted responsive interventions for people ? Creative 'can do' enthusiastic flexible & reliable help as well as cross system proactive help is so much needed. My presentation in Copenhagen to a large group of European psychiatrists advocated the introduction of a 'virtual ward' style of annual MOT type invitation based package to those we know to be vulnerable to neglect, disengagement and non adherence to treatment eg medication non concordance. I recommended identifying those with comorbidities eg diabetes, copd, cvd etc to have a 3 day planned breaking a health spa for massage, pampering as well as a physical screen and work up with meds reviews foot & teeth care along with help with other life style explorations ( note I'm not calling it advice!!).
Part of the new model of care re a genuine MH Vanguard really must address combining what people with long term mental health difficulties want as much as what they need
Well done Norman. Good luck in your (and our) quest.
I'm joining Luciana Berger - labour shadow minister for MH on the 20th April and will reflect your work & words in our roundtable debating

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