Bringing together physical and mental health: A new frontier for integrated care

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Part of Integrating physical and mental health

Until now, most efforts to promote integrated care have focused on bridging the gaps between health and social care or between primary and secondary care. But the NHS five year forward view has highlighted a third dimension – bringing together physical and mental health.

This report makes a compelling case for this ‘new frontier’ for integration. It gives service users’ perspectives on what integrated care would look like and highlights 10 areas that offer some of the biggest opportunities for improving quality and controlling costs.

Key findings

Efforts to develop integrated care should focus more on the integration of physical and mental health, addressing in particular four major challenges:

  • high rates of mental health conditions among people with long-term physical health problems
  • poor management of ‘medically unexplained symptoms’, which lack an identifiable organic cause
  • reduced life expectancy among people with the most severe forms of mental illness, largely attributable to poor physical health
  • limited support for the wider psychological aspects of physical health and illness.

Failure to address these issues increases the cost of providing services – the first two alone cost the NHS in England more than £11 billion a year – and affects outcomes for patients. There is much that can be achieved within existing structures to bring together mental and physical care at the clinical level. But this needs to be supported by wider changes such as development and evaluation of new service models, changes to professional education and increased use of new payment systems and contracting models.

Policy implications

  • NHS England should support and encourage vanguard sites and other areas to develop integrated approaches towards physical and mental health as part of efforts to build new models of care.
  • All health and care professionals have a part to play in taking a ‘whole person’ approach towards physical and mental health. Integrated service models can support this by creating opportunities for skills transfer between professionals.
  • Royal colleges and other bodies should continue working together to redesign curriculums so that all health professionals have a common foundation in mental as well as physical health.
  • Local authorities should assess how mental health and wellbeing interacts with other public health priorities and include this in joint strategic needs assessments.
  • Commissioners should take advantage of new payment systems and contracting approaches to overcome some of the current barriers to integration.
  • Mental health trusts should consider having a board-level champion for physical health, and vice versa in acute trusts.

Comments

GeraldDavies

Position
Retired Aviator,
Organisation
Humanist
Comment date
10 March 2016
It has taken the NHS some 70 years to realise that the brain controls everything including mental health, addiction etc. Finally recognising that one cannot separate Health and Care they have come to a belated and logical conclusion that the program in one's brain controls all the functions of the body, including mental health.

Pearl Baker

Position
CARER Independent Mental Health Advocate and Advisor,
Organisation
Independent
Comment date
10 March 2016
I totally agree with the comments of Dr David Marjot, and probably in a similar position, however although the Report is good, and describes it as the 'third way' it is important to remember CARERS are often supporting and Caring outside of the system due to inadequate resources allocated to those responsible for implementing a service that could prevent all the difficulties we find ourselves in today.

I would suggest there should be a 'fourth' way! if Carers were respected for what they do, and the knowledge they have acquired while providing often the ONLY SUPPORT and CARE to their relatives, we could eliminate STRESS, and ANXIETY that all Carers experience, while at the same time improve the lives of those we CARE for.

The 'forth' way? Multidisciplinary assessment of both the Carer and the Patient 'INTERESTING' identify their Health and Social Care Needs.

Ask any CARER why they are stressed and anxious, and suffer from anxiety. It is because we can never contact anyone in emergency, often providing Health and Social Care without any support, NOT acknowledged for what they do, no respite. and finally we ALL worry about what will happen to these vulnerable son's daughter's and friends when we die.

The above is probably me, but having experienced this 'feeling' for thirty years, we find other ways of 'coping'.

Carers are NOT given sufficient help or support for what they do. It is has become a 'battle' of the 'Titans' A war that lasted 10 years, which we don't have.

Dr David Marjot

Position
Retired Consultant Psychiatrist,
Organisation
Self
Comment date
09 March 2016
I started work in a large 'unreformed' mental hospital in 1958. We worked hard at bringing about the discharge of patients and establishment of community care. We were greatly helped by full employment, social security and 'council housing'. It became clear that community care was not cheap and required a large investment in staff and other facilities. There were a number of patients who could be better cared for in a residential facility. The net result was of inadequate clinical facilities including 'beds' attached to general hospitals and poor community facilities. Indeed the general hospital units were the old Observation Wards attached to the workhouse reinvented. As they did not discharge patients rapidly or transfer them to the Asylum after 28 days the general hospital units became psychiatric slums. Much if not most of the resources freed by the closure of the asylums went into general NHS expenditure.What I call the cynical rape of the assets of psychiatry or CRAP for short. As psychiatric services are now so inadequate it means that much/most expenditure is wasted. I am and distressed that we have come to this. Sadly as retired a long time ago not in a very good position to help. Having immediate family suffering or having suffered from 'psychiatric' conditions I have personal experience as well although as being better off and knowledgeable we have managed to get by. Any problems were not of the quality of the services but quantity.

Kim Lyons

Position
Psychological therapist/RMN,
Organisation
NELFT
Comment date
09 March 2016
Fantastic report. Something that North East London Trust have been constantly improving on. We even have intergrated electronic mental health/clinical health notes, much safer for clients

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