The psychological problems associated with physical health conditions, and vice versa, are costing the NHS more than £11 billion a year and care is less effective than it could be. But integrating mental and physical healthcare services could save the NHS money and improve outcomes, a new report has found.
The report, Bringing together physical and mental health: a new frontier for integrated care, by The King’s Fund, said the £11 billion a year is the collective cost of:
• High rates of mental health issues among those with long-term conditions such as cancer, diabetes or heart disease
• Limited support for the psychological aspects of physical health, for example during and after pregnancy
• Poor management of ‘medically unexplained symptoms’ such as persistent pain or tiredness.
In addition, the separation between physical and mental health has a high human cost: the life expectancy for people with severe mental illness, such as bipolar disorder or schizophrenia, is 15 to 20 years below that of the general population, largely as a result of physical health conditions.
The King’s Fund report identifies 10 areas where it believes there is particular scope for improvement across the system from enhancing mental health input in acute hospitals and assessing physical health problems in mental health inpatient facilities, to increased support for GPs in managing people with complex conditions.
It draws on examples of how improvement can be made through integrated approaches such as bridging the gaps between secondary and primary care and by embedding physical and mental health in routine care processes – which will also reduce the stigma around ‘mental health’. It also suggests how to enable change through practical steps like having a board-level champion for physical health in mental health trusts and vice versa.
King’s Fund research with service users and carers shows how all health and care professionals have a part to play in integrating physical and mental health by adopting a 'whole person' approach. A key way to achieve this is by helping the existing workforce to develop their skill-set by supporting learning between different groups of professionals and through a common foundation training in physical and mental health to support the workforce of the future.
Chris Naylor, senior fellow at The King’s Fund, said: “Traditionally physical and mental health have operated as distinct, separate systems in terms of both treatment and funding. That is no longer affordable financially or acceptable clinically. The government has set the goal of parity of esteem, meaning that mental health care should be ‘as good as’ physical health care. We argue that there is an even greater prize at stake – that mental health care should be delivered ‘as part of’ an integrated approach to health.
“When we spoke to patients they told us that they wanted to see health care professionals who recognised all of their care needs. What’s more, at £11 billion a year, the disconnect between treating physical and mental health is costing the NHS greatly and isn’t meeting patient needs.”
Stephen Dalton, chief executive of the Mental Health Network, agreed that health outcomes can be greatly improved by bringing mental and physical care closer together.
“We need to see the mental and physical health care of individuals as two sides of the same coin and which require equal attention, equal funding and coordination at the point of delivery,” he said.
“There is now a significant body of evidence that signposts the need for government to invest in mental health services after years of neglect.”
Dalton added that greater integration is “essential” and called on government and national bodies look at it in more detail.
Derek Caren, chief executive of Recovery Focus, agreed: “Today’s report from the King’s Fund highlights the raw deal people with mental health issues are getting from our NHS when it comes to ‘integrated care.’
“We believe passionately in further integration of mental and physical health care as we believe that this integrated approach will help to lower the drastically high mortality rates for people with mental health issues today.
“In the current economic climate of public health budgets being slashed and mental health trust budgets being squeezed even further, this £11 billion waste is incomprehensible and we call on the government and NHS England to accelerate plans to address this situation before it worsens.”