Long-term conditions and mental health: The cost of co-morbidities

Thank goodness this is at last being recognised by the top professionals! Depression isk of course, very prevalent amongst those with lTCs but GPs are often apparently ignorant of this fact. More education of GPs and hospital ward staff is needed, plus the back-up facilities, such as counselling. It is important that professionals are able to spot the signs at an early stage - people often do not admit to being depressed.

I have yet to read the full report, but I sincerely hope that reference is made to the benefits of robust self-management courses. The probability is high (no doubt there are statistics) that those with LTCs will have more than one, and that one of these will depression. The overwhelming feedback from self-management courses is how much better participants feel about their capacity to manage their condition, not be consumed by it, and lead lives to their full potential - in other words, overcoming depression. Fingers crossed that Self-management courses will become embedded into the care pathway for everyone with LTCs; an integral part of map of medicine and a valued element of achieving full shared decision-making at individual patient/clinician level.

Yes - people with mental ill-health are often bad at self-management; of both their mental and physical conditions. So they need new tools and support.

(One idea: use moodscope.com or similar, including carer or family as a automatic recipient of daily 'mood' scores, thus triggering potential intervention.)

Lets start with the simple things, like asking the people about anxiety and mood state in OPD in the same way that we examine urine or take blood pressure. See 1000 Lives in Wales for more details of this strategy

I work with older adults just moving from nursing home liaison to intermediate support team. With colleagues we work for early discharge and to prevent admission. Time again the need for integrated care is demonstrated. How many decades does it take to deliver this? I champion a conceptual framework - Hodges' model - that facilitates person-centered, integrated care.

The model is introduced through a website and blog -

hodges-model.blogspot.com/

Originally created in the UK by Brian E Hodges (Ret.) at Manchester Metropolitan University - Hodges' Health Career - Care Domains - Model [h2cm]

p-jones.demon.co.uk/

- can help map health, social care and OTHER issues, problems and solutions. The model takes a situated and multi-contextual view across four knowledge domains:

* Interpersonal;
* Sociological;
* Empirical;
* Political.

Our links pages cover each care (knowledge) domain e.g. SOCIOLOGY:

p-jones.demon.co.uk/links3.htm

SCIENCES:

p-jones.demon.co.uk/linksTwo.htm

Best regards,

Peter Jones
RMN, RGN, CPN(Cert), PGCE, PG(Dip) COPE, BA (Hons.).
Community Mental Health Nurse for Older Adults,
Independent Scholar and Informatics Specialist
Lancashire, UK
h2cm: help 2C more - help 2 listen - help 2 care
twitter.com/h2cm

We are working with the Self Management manuals/handbooks but using Bread making sessions as the medium to exploring the topics raised in the manuals. It works very well, we made 6 different breads and had great fun..

The particular mental health needs of young adults (18-30)with serious chronic illness are often neglected, especially in some branches of medicine, and particularly for so-called 'first generation survivors'. These young adults need extra support in entering employment and other areas of normal adult social life.
Helen Lewis
Social researcher in renal medicine

I wondered why there is no mention of Parkinson's disease? People with this long term condition often suffer from depression and anxiety...

A welcomed report into the relationship between several named LTCs and common mental disorder, although no mention made of the well recognised psychological burden of end stage renal disease on health. The provision of psychologists in acute renal settings (and dialysis units) to offer integrated treatments throughout the illness trajectory has been useful in improving mental health, medical treatment adherence and QoL.

An aspect of Long term conditions is lesser mobility or options to socialise. Isolation from friends and community activities means that wider support structures that help with mental well being are often not there for people of differing ages.

This aspect also affects family carers whose physical or mental condition is severe.

Can we put resources into this venture. I know Carers have a right to "Life of my own" but is there realistic investment in supporting Carers, I doubt it. Integration and making systems joined up with single assessment and support plan can work a long way towards taking some of the frustrations for those suffering long term conditions and their family carers.

I have gained a consolidated response from our organisation, which the following comments refer to:
•The NICE Collaborative care model paper 2009, recommends a structured care management plan in supporting people with long term conditions, whilst this a valid method, it is clear that in the current economic climate that there is no likelihood of achieving this within current mental health staffing levels.
•Whilst the document is based on long term people with MH far too little emphasis on Wellbeing and early intervention models in the recommendations to decision makers at national level, the Sandwell model illustrates that early intervention model is likely to prevent many falling into the long term MH category whilst experiencing other non related MH conditions described in the paper.
•It was found to be interesting that the link between improved support for emotional, behavioural mental health aspects of physical illness - this has been researched for years by Health and Clinical Psychologists and is not new. It was assumed that the link being made here is that if barriers to integration are removed between mental health services and primary care of physical illness then cost savings can be made. This document is aimed at Clinical Commissioning Groups. E.g. the work on smoking cessation, which mcch is looking to promote in services and behavioural aspect links to mcch challenging behaviour strategy
•P.15 – mcch would all welcome a closer working relationship between mental health specialists and primary care. It is one of the issues that initially caused concerns when GP Commissioning was first debated. The examples are well thought out on pages 15, 16 and 17.
•A summary of this document would be good for our staff within the services to refer to.

I have several roles - as a Counsellor, a Quality specialist with a Hospice and as a volunteer providing support for Offenders. In every case there is a desperate need to 'join up' care plans and service provision, but very little structure to provide this. New models of encouraging joint working are largely ignored because they are new and so are not welcome additions to the funding list, event though they save money overall. 'Silo budgets' are a key problem - each agency points at others to provide resources for multi-disciplinary work, and is too busy to talk with others. There is extensive provision of private counselling services that can support NHS work, but absolutely no will to communicate by NHS professionals with the private providers, to the detriment of overall care. This is a clear example of the problems arising from competition. The private psychological service providers are partly to blame as we do not apply evidence-based practice sufficiently. The evidence is clear however - addressing mental health needs saves money for the community in improving health overall, improving employability, reducing crime, improving child care/family relations, reducing strain on carers, etc etc. There really is a need to co-ordinate this at Cabinet level as well as locally. Am I frustrated? darned right I am!

What about CERLETTI ( i.e. SHOCK THERAPY ) in UK? In Italy the SINi s going to give very high emphasis in remebering the inventor.What is your opinion on this matter?

I conducted a survey of over 800 primary healthcare clinicians in the UK looking at depression following heart attack. The results clearly demonstrated those who had received training in the diagnosis and management of depression were far more proficient and confident in recognising and treating this. This vital element of long term health condition care needs to be fully integrated at all levels. Really pleased to see the publication of this report and hope it leads to improvements in the support and management of individuals, not conditions!

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I recently suffered a heat attack now the wait for my second operation is closing in and i'm at an all time low,my doctor has told me it could be depression/anxiety,caused through post treatment trauma.It gave me a lift,but surely there are better way's to deal with it other than taking tablet's