Effective chronic care means recognising the importance of mental health

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The interaction between physical and mental health has been attracting increasing attention across the political spectrum. Last year, the government recognised the importance of the issue with its mental health strategy 'No health without mental health'. And more recently, Andy Burnham chose integration of mental and physical health care as the subject of his first major speech since returning to the health portfolio.

The role of poor mental health in exacerbating physical health problems is a subject that deserves every bit of the attention it gets. People with long-term conditions are two to three times more likely to experience mental health problems than the general population. In absolute terms, at least 4 million of the 15 million people in England with a long-term physical health condition also have a mental health problem.

The interdependency of mental and physical health has significant implications for individual patients. Mental health problems can complicate people's physical health conditions greatly, resulting in them spending more time in hospital, experiencing poorer clinical outcomes and lower quality of life, and requiring more intensive support from services.

There are also wider implications for how we care for the growing number of people with long-term conditions. Internationally, the prevailing approach to this is to attempt to reduce demands on formal care by supporting patients to manage their own condition effectively. But attempting this without recognising the effect of co-existing mental health problems is a recipe for failure. Left untreated, mental health problems can significantly reduce the motivation and energy needed for self-management, and lead to poorer adherence to treatment plans among people with diabetes, cardiovascular disease and other long-term conditions. This goes a long way towards explaining why this group experience poorer physical health outcomes, as well as greater service costs.

The evidence in our new paper on long-term conditions and co-morbidities suggests that at least £1 in every £8 spent on long-term conditions is linked to poor mental health and wellbeing. And it shows that there are a number of ways we could support the mental health needs of people with long-term conditions more effectively, including: closer working between primary care and mental health professionals; integrating psychological interventions into chronic disease management frameworks; and investing in enhanced forms of psychiatric liaison services in acute hospitals.

Can we afford to develop such approaches? With evidence suggesting that some innovative forms of integrated mental health care can deliver a sizeable return on investment by reducing physical health care costs, not doing so would be a waste of resources. But realising the potential benefits in practice will require policy changes, including redesign of payment mechanisms.

The professional, institutional and cultural separation of mental and physical health creates substantial costs for both patients and the health system. As policy-makers and professionals increasingly focus on how integrated care can become a reality in the UK, integration of mental and physical health care must become a key part of the debate.

Read our paper: Long-term conditions and mental health: the cost of co-morbidities


Chris Manning

UPstream Healthcare Ltd
Comment date
29 January 2013
I agree with the above and I'm delighted that the Kings Fund is pushing this agenda as many of us seek to help people to Dump Descartes. "Mind is one of the things the brain does" (not all that it does and not just the brain) and our mental functions have to be generated in full or in part by that wondrous physical organ in a wondrous physical body. This is not scientific reductionism, but expansionism.

Unless and until policy makers, health and social care managers, medical training establishments, commissioners, the public et al are helped to abandon non evidence-based and time-expired physical-mental dualism - the mind, mental health-wellbeing and mental illness will continue to wander around in the woop-woop of stigmatising attitudes, discriminatory behaviuours and defunct practices.

This is our next Enlightenment and it will also result in the Arts/Humanities being re-united with the Sciences - all of which latter reveal how our brains "wire up and fire up" in relation to the creative arts, relationships, attachment and compassion.

Carole Hirst

Comment date
12 July 2012
Mental health problems, including depression, can be a 'long term condition'. Some people experience depression without full remission for many years and it can begin in childhood (e.g. early onset dysthymia). I don't think it is helpful to think of long term conditions purely in physical terms with mental health problems as secondary issues.

David Young

Comment date
10 February 2012
Mental health issues not only exacerbate physical conditions, they CAUSE them. The immune system is damaged by the cortisol released by anxiety.

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