5. Improving the management of patients with both mental and physical health needs

What is it?

Developing a more integrated response to people with both mental and physical health problems, in particular supporting people with common mental health problems (such as, depression or anxiety) alongside a physical long-term condition.

Why is it important?

  • At least half of all people with long-term conditions suffer from multiple co-existing conditions. Mental health problems are one of the most common forms of co-morbidity, particularly among people from the most deprived population groups (Barnett et al 2012).
  • Mental health problems interact with physical health and can trigger or severely exacerbate other conditions. For example, depression has been associated with a four-fold increase in the risk of heart disease (Osborn et al 2007) and a three-and-a-half-fold increase in mortality rates after heart attack (Lesperance et al 2002).
  • Between 12 and 18 per cent of all NHS expenditure on long-term conditions is estimated to be linked to mental health problems (Naylor et al 2012). Across a range of conditions, each patient with co-morbid depression costs health services between 30 and 140 per cent more than equivalent patients without depression (Welch et al 2009; Melek and Norris 2008).
  • Unidentified mental health problems often underlie 'medically unexplained symptoms', which cost the NHS around £3 billion each year and cause significant distress to patients (Bermingham et al 2010).

What is the impact

  • Improving the way we respond to co-morbid physical and mental health problems would have a high impact in terms of patient experience and clinical outcomes, since both of these are substantially poorer relative to those for people with a single condition (Naylor et al 2012).
  • There could also be a significant impact on costs. Integrated models of disease management have been found to deliver savings four times greater than the investment required (Howard et al 2010), as have enhanced models of liaison psychiatry in acute hospitals (Parsonage et al 2012).

How to do it

Some of the changes required would be relatively simple for commissioners to implement, while others would be more complex as they involve redesigning the interface between multiple providers. Specific priorities include:

  • improving identification of mental health needs among people with long-term conditions
  • strengthening data systems to support more systematic coding and recording of mental health needs
  • commissioning services that improve the interface between primary care, mental health and other professionals, for example, based on collaborative care models recommended by National Institute for Health and Clinical Excellence (2009).
  • strengthening disease management and rehabilitation programmes by including psychological or mental health input
  • using CQUIN payments and other targeted quality incentives to encourage providers to develop innovative forms of liaison psychiatry within acute hospitals, care homes and elsewhere
  • expanding Improving Access to Psychological Therapy services to support people with co-morbid long-term conditions, in line with government ambitions
  • improving mental health skills in general practice using training programmes developed specifically for primary care professionals.

Useful resources

For further information