Failure to address mental health problems in people with long-term conditions costs NHS billions

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People with long-term conditions, such as diabetes or heart disease, are two to three times more likely to experience mental health problems than the general population. However, a systemic failure to identify these problems and provide effective support is resulting in poorer outcomes for patients and could be costing the NHS billions, says a report published today by The King’s Fund and Centre for Mental Health.

Too often a mental health condition goes undetected where there is a co-existing long-term physical health condition. Where a mental health problem is identified alongside a physical health illness, the two have traditionally been treated separately with services designed around conditions rather than patients. A growing volume of research evidence suggests that more integrated approaches, with closer working between professionals responsible for patients’ mental and physical health, can improve outcomes while also reducing costs.

Researchers found that by exacerbating physical illnesses, co-existing mental health problems substantially increase the costs related to care for long-term conditions. Overall, £1 in every £8 spent on long-term conditions is linked to poor mental health, equating to £8-13 billion of NHS spending each year. For example, co-existing mental health problems can lead to:

  • increased hospitalisation rates – patients with chronic lung disease spend twice as long in hospital if they also have a mental health problem

  • increased outpatient service use – diabetes sufferers with mental health problems access twice the amount of outpatient services as those with diabetes alone

  • less effective self-management – poor mental health means that people with heart disease or other long-term conditions are less likely to look after their physical health, take medication as intended and attend medical appointments.

Not only do associated mental health conditions carry a significant financial cost for the NHS, the report shows they also contribute to poorer clinical outcomes for patients and lower quality of life. For example, studies have shown:

  • depression increases mortality rates after a heart attack by 3.5 times

  • children with diabetes are more likely to suffer retinal damage if they also have depression

  • co-existing mental health problems can have a greater effect on quality of life than the severity of the physical illness.

There are also wider financial implications for individuals, families and the economy. People with both a long-term condition and a mental health problem are less likely to have a job than those with a physical illness alone; take twice as many sickness days; and are more likely to rely on informal care, which in turn leads to family members taking time off work.

In Long-term conditions and mental health: the cost of co-morbidities, researchers review the available evidence on the interaction between mental health and long-term conditions and offer examples of innovative practice from the UK and abroad to combat the problems associated with the co-existing conditions. They conclude that a more integrated approach will help the NHS to make savings, improve patient outcomes, and meet its targets on productivity improvement.

Chris Naylor, the report’s lead author and Fellow at The King’s Fund said:

‘The prevailing approach towards improving care for people with long-term conditions is at risk of failing unless we look at patients’ needs as a whole, including their mental health needs. To achieve this, mental health provision cannot simply be tacked on to physical care but needs to be an integral part of it.’

Sean Duggan, Chief Executive, Centre for Mental Health said:

‘Failing to support the mental health of people with long-term physical conditions is costing the NHS billions of pounds at a time it can ill afford to spend money unwisely. Untreated or poorly managed mental ill-health among this group is cutting lives short, reducing quality of life and increasing health inequalities. Responding better, by contrast, will save lives, increase fairness and cut costs.’

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

Notes to editors

1. For further information, or to request an interview, please contact: Cara Phillips, Senior Press and Public Affairs Officer, at The King’s Fund on 020 7307 2632 or email

Main Press Office number: 020 7307 2585 / Out of hours assistance: 07584 146035

Andy Bell, Centre for Mental Health, on 07810 5023638 or email

2. Long-term conditions and mental health: the cost of co-morbidities by Chris Naylor, Michael Parsonage, David McDaid, Martin Knapp, Matt Fossey and Amy Galea. This report is a joint publication by The King’s Fund and Centre for Mental Health and has contributors from the London School of Economics. The report is available free to download from The King's Fund's website or can be purchased for £5.

3. A substantial proportion of the £8-£13 billion spend could be saved by investing in improved models of integrated mental health care. Research shows that by reducing costs for physical care, interventions, such as enhanced psychiatric liaison, can deliver savings which significantly outweigh the costs of providing them.

4. The benefits of a more integrated approach should not be underestimated. They can be far reaching for patients, the NHS and the economy. One five-year study of patients with diabetes and co-morbid depression in the United States saw a 14 per cent reduction in total costs. At Hillingdon Hospital including a psychological component in a breathlessness clinic led to savings of £837 per person. In terms of outcomes, multiple studies show that integrating the management of mental health and long-term conditions has positive results. For example, in one study, tailored cognitive behavioural therapy packages reduced anxiety in chronic obstructive pulmonary disease, improved self-management and reduced exacerbations and unnecessary admissions.

5.    Policy context.

  • The government’s mental health outcomes strategy, No health without mental health (Department of Health 2011), places considerable emphasis on the connections between mental and physical health, and gives new responsibilities to Improving Access to Psychological Therapy (IAPT) services for supporting the psychological needs of people with physical long-term conditions or medically unexplained physical symptoms.

  • Under the government’s reform programme clinical commissioners have a duty to promote integrated services, as do other bodies such as Monitor and the NHS Commissioning Board. A number of clinical commissioning groups are known to have identified mental health as an early priority for service improvement.

  • As a result of the Transforming Community Services programme, many mental health trusts have taken on new responsibilities for providing community services for people with physical health problems which will cost about £2 billion. This creates opportunities for developing more integrated ways of working.

  • The formation of Academic Health Sciences Centres, spanning mental health and acute trusts, creates an infrastructure for integrative research.

  • The Quality, Innovation, Productivity and Prevention (QIPP) challenge creates an imperative to develop innovative ways of providing health services which deliver better outcomes and more value to patients within constrained resources.