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

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More than 4 million people in England with a long-term physical health condition also have mental health problems, and many of them experience significantly poorer health outcomes and reduced quality of life as a result.

In terms of NHS spending, at least £1 in every £8 spent on long-term conditions is linked to poor mental health and wellbeing – between £8 billion and £13 billion in England each year.

Long-term conditions and mental health: The cost of co-morbidities, published jointly by The King's Fund and the Centre for Mental Health, suggests that care for a large number of people with long-term conditions could be improved by:

  • integrating mental health support with primary care and chronic disease management programmes

  • improving the provision of liaison psychiatry services in acute hospitals

  • providing health professionals of all kinds with basic mental health knowledge and skills

  • removing policy barriers to integration, for example, through redesign of payment mechanisms.

This paper suggests that developing more integrated support for people with mental and physical health problems could improve outcomes and play an important part in helping the NHS meet the quality, innovation, productivity and prevention challenge.

The authors conclude that the prevailing approach to supporting people with long-term conditions is at risk of failing unless we recognise the role of emotional and mental health problems in reducing people's ability and motivation to manage their physical health.

Comments

Gillian Seward

Position
Chairman,Older People's Working Group,
Organisation
Bristol LINk
Comment date
09 February 2012
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.

Liz Hankin

Comment date
09 February 2012
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.

John Campbell

Comment date
09 February 2012
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.)

Simon Neal

Position
Consultant Clinical Psychologist,
Organisation
NHS Wales
Comment date
09 February 2012
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

Peter Jones

Position
Intermediate Support Team,
Comment date
10 February 2012
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

Helen Lewis

Comment date
10 February 2012
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

Lucie

Comment date
10 February 2012
I wondered why there is no mention of Parkinson's disease? People with this long term condition often suffer from depression and anxiety...

Sarah Afuwape

Position
Clinical Health Psychologist in Nephrology,
Comment date
13 February 2012
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.

Varsha Dodhia

Comment date
14 February 2012
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.

jacky hammond

Position
Director of Operations,
Organisation
mcch
Comment date
22 February 2012
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.

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