Until now, most efforts to promote integrated care have focused on bridging the gaps between health and social care or between primary and secondary care. But the NHS five year forward view has highlighted a third dimension – bringing together physical and mental health.
This report makes a compelling case for this ‘new frontier’ for integration. It gives service users’ perspectives on what integrated care would look like and highlights 10 areas that offer some of the biggest opportunities for improving quality and controlling costs.
Efforts to develop integrated care should focus more on the integration of physical and mental health, addressing in particular four major challenges:
high rates of mental health conditions among people with long-term physical health problems
poor management of ‘medically unexplained symptoms’, which lack an identifiable organic cause
reduced life expectancy among people with the most severe forms of mental illness, largely attributable to poor physical health
limited support for the wider psychological aspects of physical health and illness.
Failure to address these issues increases the cost of providing services – the first two alone cost the NHS in England more than £11 billion a year – and affects outcomes for patients. There is much that can be achieved within existing structures to bring together mental and physical care at the clinical level. But this needs to be supported by wider changes such as development and evaluation of new service models, changes to professional education and increased use of new payment systems and contracting models.
NHS England should support and encourage vanguard sites and other areas to develop integrated approaches towards physical and mental health as part of efforts to build new models of care.
All health and care professionals have a part to play in taking a ‘whole person’ approach towards physical and mental health. Integrated service models can support this by creating opportunities for skills transfer between professionals.
Royal colleges and other bodies should continue working together to redesign curriculums so that all health professionals have a common foundation in mental as well as physical health.
Local authorities should assess how mental health and wellbeing interacts with other public health priorities and include this in joint strategic needs assessments.
Commissioners should take advantage of new payment systems and contracting approaches to overcome some of the current barriers to integration.
Mental health trusts should consider having a board-level champion for physical health, and vice versa in acute trusts.