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

Part of Integrating physical and mental health

Posted:08 March 2016
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Publication details

ISBN: 978 1 909029 60 6
Pages: 120

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.

Related events

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Joining up physical and mental health care: Time to deliver for patients and service users

Comments

Dear Tracey,

Thank you for contacting us and I'm sorry to hear about your poor experience of care.

Unfortunately we're not best placed to advise on your situation and we would advise that you try contacting these organisations or individuals:

• Patients Association - https://www.patients-association.org.uk/
• Healthwatch - http://www.healthwatch.co.uk/
• Parliamentary and Health Service Ombudsman - https://www.ombudsman.org.uk/
• Local MP - https://www.theyworkforyou.com/

We're sorry that we're not able to help directly but we hope that these organisations are able to.

Kind regards,
Lizzie

I NEED TO ADD AFTER READING THESE COUNTLESS ARTICLES GUILDLINES ON APPROPRIATE CARE WHICH I HAVE BEEN A RESULT OF SEVERE NEGLECT.THERE IS SO MUCH TO LEARN FROM MY EXPERIENCES AND CHALLENGES TRYING TO OBTAIN MY RIGHTS TO BE WELL AND OBTAIN A DIAL DIAGNOSIS TREATMENT CLINIC.AFTER THREE SUFFERING YEARS I HAVE FINALLY BEEN GIVEN A DATE THIS MONTH BUT THIS DOES NOT ERASE THE SEVERITY OF MY NEGLECT MY BMI IS 18 .I HAVE EVIDENCE OF EVERYTHING I SAY FROM MY OFFICIAL DIAGNOSIS PAPERWORK THE IGNORANCE STIGMA HAS LED TO ME BARELY LIVING IT IS TIME FOR JUSTICE SUPPORT RECOGNITION AND REWARD.PLEASE CONTACT ME FOR ANYTHING THERE IS ALOT TO SAY.THANKYOU

Bringing together physical and mental health

Having integrated care provision of health and care services will allow and ensure that various needs of patients will be met and appropriately cared for.

Professionals working together will develop and focus more with support to help the individual. Rather than leaving them to deal with the issues themselves. It can be very worrying for parents or family members dealing with physical and mental health problems if the support is not received.

Sine the 1980's the UK has had an epidemic of Lyme Disease. Many of us dispite a positive test have been put in
Psychiatric hospitals. Trying to convince use our symptoms are psychosomatic. We need long term IV antibiotics. However due largely to the UK government following American protocol.
A condition which can impersonate over 300 conditions is being given the wrong treatment and diagnoses.
American insurance companies refused treatment beyond a few months while in the U.K. It was beyond 2 weeks. The DOH has been forced into of all things recognising CE approved tests. Which it should of done all a long.
NICE are publishing new guidelines in 2018.
Still we can't get treatment unless we pay privately.

NICE guidelines say we have 2 to 3000 while John Caudwell say we have 45,000 per year
The only help most of us can get is a psychiatrist.
I have septic legs and heart block.

At Evolve we are pioneering an innovative, preventative intervention, Project HERO (Health Engagement Real Outcomes).
Delivered by inspiring Evolve Health Mentors HERO simultaneously provides physical health, emotional wellbeing and school progress gains.

Independent studies give testimony to the positive outcomes the HERO programme delivers. Our challenge is support with national roll out.

..

integartion of care, mental and physical, NHS and non NHS will not 'appen unless it is backed up by the integartion of data supported by a data model designed at the national level

“There is a common tendency in medicine when faced with medically unexplained symptoms to assume that they are psychogenic in origin. This is a high-risk approach that can have disastrous consequences.”
This is a quote from Prof R Grahame, from a paper about EDS. He goes on to discuss that the symptoms of EDS/JHS were – and sometimes still are - considered to be a form of ‘illness behaviour’ He concludes by saying “To dismiss disparate symptoms as ‘illness behaviour’ is, in my view, wrong and does much disservice both to our patients and to our reputation as a profession.”

In the light of what happened to the late Dr Lisa Steen, I have to hope that the medical profession will take a long, hard look at how easy it is for patients to be inappropriately labelled as having ‘medically unexplained symptoms’ and take appropriate measure to prevent this from happening to anyone else. My area of interest is rare conditions and it is stunning to know that, according to the 2016 RDUK report, the main barriers to diagnosis are that patients are not being believed and/or are told that their symptoms are ‘psychological’. This is not OK.

Meanwhile, whilst I agree with Mrs Wenn that patients need to take action if their GPs label or diagnose them inaccurately, this can be very difficult. Doctors have been known to wriggle off the hook by saying that these diagnoses are ‘only an opinion’ and that all patients are entitled to a second opinion (see the NHS Choices information on ‘MUS/functional’ diagnoses). And far too often I hear reports back from patients who challenge these labels only to be told that they are resistant to mental health diagnoses because they are prejudiced against people with mental health conditions. This is also not OK.

Ultimately it doesn’t surprise me that people who are diagnosed as having ‘functional disorders’ cost our health service so much. It would be interesting to know how much of this cost is due to patients having to go to their GPs (often after consultations with neurologists) in an attempt to find out what ‘functional’ means. The only answer to this question that has ever made sense to me is that a ‘functional’ diagnosis ‘is a form of lazy psychological profiling.’ We deserve better.

Bringing together physical and mental health services presents itself with significant potential benefits for physical health services and mental health services - but also significant risks for mental health services within this relationship.

There is, and has been for sometime, benefits for patients with long term conditions (e.g. diabetes, cardiopulmonary disorders, chronic pain) in understanding and treating their mental health, with potential benefits to their wellbeing and the efficiency of services (e.g. reduced unplanned admissions). Similarly there are benefits to those with mental health problems who have long been known to have poorer physical health care and subsequent outcomes.

However, the relationship comes with significant risks, often specifically for mental health. Risks to mortality often are perceived to outweigh those of morbidity; it can be easier to justify cuts to mental health services in favour of those supporting physical health care on safety grounds at the costs of parity of esteem. From experience these risks are not insignificant and increased collaboration whilst providing significant benefits needs to be considered in the light of ensuring that mental health does not become neglected to support the physical healthcare of patients and the public.

the lack of mental health services and poor quality of them when they are available will not necessarily be improved by integration but it may make it easier for carers to be involved.
As the mother of a son who committed suicide I can only look on now and hope this will help,unfortunately my experience with regards to mental health provision and support in the community leaves me fearful.

Faculty for Clinical Health Psychology of the Division of Clinical Psychology have been lobbying for integrated physical and mental health care for years. At last there is a quality document which brings the arguements together and which can be used to make the case for wider MDT care vs. over-reliance on medical models and services.