The important third dimension for integrated care

Chris Naylor on bringing together physical and mental health
Chris Naylor
Publication:  Insight, Summer 2016

Chris Naylor

There has been hard-won progress on integrated care in recent years. Many local areas have developed services that bring together health and social care, or that bridge the gaps between hospital and out-of hospital care. This is welcome, and is a journey that is far from over. However, there is another fault line that has received less attention, and which could undermine attempts to improve quality of care and control costs. This is the longstanding disconnection between care for physical and mental health.

The close relationship between physical and mental health has important implications for people and for health services. Consider the fact that people with long-term physical health conditions are two to three times more likely to experience mental health problems, and that the prognosis for their physical condition is often considerably poorer as a result. Overall, we estimate that the NHS spends at least 11 billion each year as a result of associated physical and mental health problems.

While physical and mental health are intimately connected, the same cannot always be said of the services provided to meet these needs. All too often support for the psychological aspects of physical illness is limited, and the lack of attention paid to the physical health of people with severe mental illnesses means that many peoples lives are cut short prematurely.

So what can be done to improve this situation? Our research has identified 10 areas where there are particular opportunities for better integration, ranging from public health through general practice to acute hospital care. In our report, Bringing together physical and mental health: a new frontier for integrated care, we also describe examples, from across England, of services that have developed a more integrated approach. While these examples are encouraging, the challenge lies in scaling up and embedding integrated working in routine practice. Vanguard sites and other areas developing new models of care provide an important opportunity to do so, and this aspect of integration needs to be a high priority.

There is also a wider cultural challenge. Bringing together physical and mental health is not only a question of innovative service design, it is also about getting the basics right. It is about how health and care professionals understand their role, how they communicate with people using services, and whether their training and the environments they work in enable them to work in a whole person way. These are big issues that won't be solved overnight, but that is not a reason for inaction.

The recent report of the independent Mental Health Taskforce to the NHS in England made developing integrated approaches towards physical and mental health one of three main priorities for the next five years. What is needed now is for leadership and ownership of this agenda to move beyond the mental health community and become part of wider strategic thinking for the system as a whole.

This article was originally published as one part of two in The King's Fund Insight magazine, summer 2016. The accompanying piece was by patient representative Angela Camber on her personal experience.