Talking leadership: Chris Naylor on integrating physical and mental health care

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To achieve the vision described in the NHS five year forward view, the NHS needs to adopt more integrated approaches to physical and mental health. The Fund’s Integrating physical and mental health care learning network aims to accelerate that process, helping senior clinicians and managers to work together to overcome common challenges and learn from best practice. We talked to Chris Naylor, Senior Fellow, about the network and how it helps to translate a policy ambition to new models of care.

Who comes to the network and how does it work?

The great thing about the network is the diverse mixture of professionals and perspectives represented. Each community in the network brings a team of four or five people to meetings. It’s up to them exactly who they bring, but we encourage them to have a cross-section of their local system – for example, one mental health professional, a GP, a commissioner, and someone from local government – and also to include a local service user. The communities meet at The King’s Fund four times over the course of six months. Each meeting focuses on a slightly different issue, for example mental health in primary care, and includes workshops with invited experts, facilitated group work and problem-solving.

What are the main challenges network members have in integrating physical and mental health care?

Integrating mental health into the wider health and care system is something that’s firmly on the policy agenda, but putting it into practice has often proved harder to achieve. One reason is that it requires changes to traditional ways of working and to relationships that can sometimes be tricky to negotiate. For example, re-thinking how we respond to mental health needs in primary care can require both GPs and mental health professionals to work in new ways and to adapt well-established practices and processes. We’ve heard experienced NHS managers describe this as being one of the toughest change management tasks of their career. We also have to recognise that people are seeking to make these changes at a time when resources are under huge pressure –in terms of both funding and workforce shortages in some areas. Faced with this kind of challenges, I think it is all the more important for network members to share learning and insights with colleagues from around the country.

How has the network helped them to deal with these challenges?

People have told me they’ve got a number of things out of being part of the network. As you might expect, part of the value is in connecting with other people tackling similar challenges in other parts of the country. But, interestingly, participants have also said that taking part has helped to strengthen relationships within their own local system – in normal working life people often don’t have the opportunity to spend so much time with colleagues from across their system, developing a shared understanding of what they want to achieve for local people and how they will put that vision into practice. Participants also really value the speakers we bring in on specific topics and the presentations from inspiring local leaders, which always provide a great stimulus for discussion and thinking. Most importantly, we try to leave enough space for reflection, for sharing and for constructive challenge between peers.

What areas are people in the network focusing on to develop new models of care that integrate physical and mental health?

Primary care is one of the areas people are focusing on most commonly. Within that, a broad range of approaches are being taken. In some areas, the priority is to expand psychological therapy services to ensure these are embedded in GP practices. Other areas are expanding liaison mental health services (currently based largely in hospital settings) into the community. And others are developing step-up/step-down services that provide an intermediate level of care between primary care and specialist mental health services.

Another major focus is clarifying the role of mental health professionals in community-based integrated care teams. These ‘neighbourhood’ or ‘locality’ teams are being developed across most areas of England to provide joined-up care for people with the highest levels of care needs, and ensuring these teams have access to the right forms of mental health expertise is crucial to their success. Often in the network we see how wider national policy agendas around new models of care and accountable care are being played out in practice – and that really helps us to make sure the policy and research work we do at The King’s Fund is connected with realities on the ground.

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