Mental health and new models of care
Lessons from the vanguards
While some of the vanguard sites developing new care models report promising early results from adopting a whole-person approach, the full opportunities to improve care through integrated approaches to mental health have not yet been realised.
This report draws on our recent research with vanguard sites in England, conducted in partnership with the Royal College of Psychiatrists. We found that where new models of care have been used to remove the barriers between mental health and other parts of the health system, local professionals saw this as being highly valuable in improving care for patients and service users. But there remains much to be done to fully embed mental health into integrated care teams, primary care, urgent and emergency care pathways, and in work on population health.
Key findings
- Knowledge and skills around psychology and mental health are important features of integrated care, whatever the client group.
- Emerging evidence from some vanguard sites suggests that integrated approaches to mental health can help to support improved performance across the wider health system.
- Despite this, the level of priority given to mental health in the development of new models of care has not always been sufficiently high.
- Some areas report that new models of care have made it easier for local professionals to obtain informal advice from mental health professionals without making a referral, creating a more seamless experience for patients.
- Working closely with voluntary sector organisations has allowed integrated care teams in some vanguard sites to better support the mental health and wellbeing of people with complex needs.
Policy implications
- Testing the mental health components of existing vanguard sites must be a central part of the evaluation strategy for the new care models.
- Other local areas rolling out multispecialty community providers, primary and acute care systems and related care models should go further than the vanguard sites in four key areas:
- complex needs: enabling local integrated care teams to draw on and incorporate mental health expertise to support people with complex care needs
- long-term care: equipping primary care teams to address the wide range of mental health needs in general practice (including among people presenting primarily with physical symptoms)
- urgent care: strengthening mental health support for people using A&E departments and other forms of emergency care
- whole-population health: placing greater emphasis on promoting positive mental wellbeing in the population, in particular among children and young people, and during and after pregnancy.
- All sustainability and transformation plans should set out ambitious but credible plans for improving mental health and integrating mental health into new models of care.
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Comments
Need to fully integrate health and social care if we are going to make long term gains
It is impossible to 'integrate' Health and Social Care if you have no idea who your Partners are to enable a 'seamless' system that allows allows those suffering from Mental Illness a 'quality' of life without any interruptions?
EXAMPLE: Living in Housing Association accommodation 'Supported Accommodation'?? subject to section 117 FREE aftercare??
Welfare Benefits:'Fit for Work' 45 questionnaire arrives to complete. (time scale) or ALL your Benefits will be withdrawn.
Welfare Benefits DLA/PIP another form: invited to interview by somebody with 'set questions' failure to 'turn up' NO AWARD.
MANY suffering from a 'severe mental illness' have become 'invisible to the system.
No Social Worker! despite Statutory Guidance 'Care Plan' at least once a year.
ACCOMMODATION; not able to keep the accommodation 'Habitable' .
RESULTS on the above.
HA takes 'severely Mentally Ill' to Court? why? No contact number with Social Services on this individuals file. FOUND GUILTY for NOT paying RENT, because their Welfare Benefits had 'STOPPED' because they were unable to complete a 45page Questionnaire. Housing Benefit 'STOPPED' paying their RENT.
COURTS AWARDED £450 in charges against them?? No money at ALL, now in the 'HANDS' of the 'LOAN SHARKS'. going to be 'EVICTED' to the Streets now a 'homeless' 'indivisible' 'severe mentally ill individual adding to the numbers of MENTALLY ILL on the STREETS.
It does NOT end there, after years of trying to get help for this person who also has a 'stoma' bag they were taken into Hospital (via Police) under Section 3, now out under Section 17 no 'Care Plan', mothers says unable to return to accommodation living with a friend.
This individual was discharged from Hospital (quickly) needed their BED. Possessions put into BIN BAGS, Taxi called destination 'unknown'??
The CQC have a responsibility to this SECTIONED patient in the COMMUNITY?
'Integration' is a word 'banded' about, unfortunately only those 'experts by experience' are able 2 HELP YOU OUT. I know i have been through every obstacle possible and learnt the hard way.
'Vanguards' who are they? not seen one, know idea where they are, obviously NOT in the right place at the right time.
Vangaurd, 5 years plan, STP and Devomanc are all good ideas but sadly has same old leaders saying same old things. Good ideas do not generate good outcomes until the ideas converted in to action and proof of the pudding is in eating.
Some Vaguards are doing well and some STPs are doing well but one swallow doesn't make summer! All NHS leaders must be good, kind, caring and compassionate and with courage!
Sadly courage is something missing in NHS because of culture of bullying, harassment, victimisation and club culture and old boys network. In such a culture patients, staff and NHS suffer! When NHS suffers the nation suffers! This is Brexit!
Please wake up and let us transform Health and social care and let us get leadership, accountability, integration, workforce planning, governance, staff and patient engagement right and let us make the whole of NHS and social care safest and the best and the most vibrant in the world!
Clinical Health Psychologists have been promoting and advocating for integrated care for many years but have always remained a cinderella service in favour of medical models of care (and in many acute Trusts, clinical health psychology services have been decommissioned in recent years). There is a wealth of evidence to show the wider systems benefits of holistic care where psychological interfaces with biological/medical; typical examples include psychology input with people with cardiac anxiety, dyspnoea management, diabetes - which positively impacts A&E outcomes, let alone benefits to patients and families.
An important consideration is our conceptualisation of 'mental health' - that there are widely differing care needs for someone with severe and enduring psychosis who is also physically ill and requiring self-management support vs. a person who is experiencing psychological distress and difficulty coping with a physical health challenge.
Clinical health psychology would typically work within an acute and/or primary care setting whereas clinical psychology per se sits more within mental health and associated services. There is a need for psychological services across this continuum of health and social care need, with liaison with OT, physio, social work etc colleagues.
Dorothy Frizelle
Vice Chair, Faculty for Clinical Health Psychology, British Psychological Society
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