As part of our new report, Mental health and new care models, we explored what, in principle, successful integration of mental health within new models of care would look like. We held an engagement workshop with frontline staff, service users, carers, providers, commissioners and relevant national stakeholders and have identified nine key principles.
Local system leaders can use these principles to help ensure that integration of mental health is a core part of the development of new care models, and to capitalise on the opportunities this presents.
1. The commissioning, design and implementation of new models of care should be consistent with the requirement to deliver parity of esteem.
The requirement to deliver parity of esteem, defined as ‘valuing mental health equally with physical health’, has been laid out in legislation and numerous policy documents over recent years. It is characterised by: equal access to the most effective and safest care and treatment; equal efforts to improve the quality of care; the allocation of time, effort and resources on a basis commensurate with need; equal status within health care education and practice; equally high aspirations for service users; and equal status in the measurement of health outcomes (Royal College of Psychiatrists 2013). These principles must be reflected throughout the development of new models of care.
2. Mental health should be considered from the initial design stages of new models of care.
The fundamental changes needed are likely to be harder to achieve if mental health is added onto pre-existing plans that have not considered it from their inception. To achieve meaningful integration of mental health in new care models, it must be a key consideration throughout the entire development process, including during the early design phases.
3. New care models should address and measure outcomes that are important to patients and service users, identified through a process of co-design.
It is important that new models of care address outcomes that are important to service users and carers, in addition to outcomes designed to bolster the financial sustainability of the system. Co-designing the care model with people using services and the wider local population is an essential part of this. Meaningful public engagement is necessary to identify the outcomes that are most important to the population being served, and the design of new care models should then follow from these priorities. Once the care model is implemented, progress against these outcomes should be measured systematically and include patient-reported measures.
4. New care models should take a whole-person approach spanning an individual’s physical, mental and social needs.
New models of care should focus on delivering whole-person care that supports mental health alongside other aspects of health, rather than being addressed in isolation. This requires attention to the full range of an individual’s needs, including their psychological and social needs – regardless of whether their primary health need is mental or physical in nature. As part of this, there needs to be a clear understanding among those involved in developing new models of care that mental health is about more than mental illness; good mental health is a key determinant of other outcomes and should be considered as a routine part of care.
5. New models of care should extend beyond NHS services to include all organisations that may impact on people’s health and wellbeing.
Relationships and networks should be built with a variety of partners, not only those delivering NHS-funded services. Key partners include social care, housing and voluntary sector organisations as well as employers and the education system, all of which can play an indispensable role in relation to mental health. Through bringing together parts of the wider system, new models of care can capitalise on the full range of assets in an area.
6. Invest in building relationships and networks between mental and physical health care professionals.
New care models should be designed in a way that helps to break down the barriers between organisations and individuals. This will require an explicit focus on strengthening relationships at all levels, including between senior leaders from different organisations as well as between frontline staff from different professions and provider organisations.
7. New models of care should enhance the provision of upstream, preventive interventions to improve mental health and wellbeing.
Strengthening prevention should be a key focus for new care models, including primary, secondary and tertiary prevention. For example, integrated care teams established as part of new care models should aim to address the range of factors (including social and environmental factors) that shape the mental and physical health and wellbeing of the people they are serving.
8. Every clinical interaction should be seen as an opportunity to promote mental and physical wellbeing.
All interactions between health care professionals and members of the public represent valuable opportunities to help people improve their mental and physical wellbeing. Staff should be equipped with the necessary knowledge, information and skills to initiate conversations with people about their mental wellbeing, to encourage positive behaviour change, and to signpost to local support resources.
9. All frontline staff should receive appropriate training in mental health, regardless of the setting in which they work.
Training should equip staff to recognise and manage common mental health problems at different stages in the life course, and to understand the psychological components of physical illness. Where appropriate, education and training should be conducted on an inter-professional basis, bringing together staff working in physical and mental health care settings to share their knowledge and expertise.
Find out more
These nine principles provide an overview of the approach to mental health integration that key stakeholder groups would like to see implemented through new models of care. In our full report, we explore the approaches being taken to mental health integration in a number of vanguard sites, providing insights into how some of these principles may be applied in practice.
- Read the rest of the Mental health and new care models report
- Read Chris Naylor's blog: Get mental health right and we can get the whole system right