mental health

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Bringing together physical and mental health 1 2 3 4 5 6 7 adaptation and can be accompanied by significant functional impairment, economic disenfranchisement and social isolation. In this report we argue that from a patient perspective, a meaningful definition of integrated care must also include provision of integrated psychological support to help people adapt and manage their health effectively. Failure to do so can be associated with poor outcomes and faster disease progression (de Ridder et al 2008). It is also important to consider the psychological aspects of health as opposed to illness. The case for integrated approaches applies to prevention and health promotion as much as to treatment and care; in the following sections we argue for much greater inclusion of a mental health and wellbeing perspective within public health programmes targeting risk factors for heart disease, lung disease, stroke, cancer and other preventable conditions. Similarly, integration of mental and physical health is particularly important in relation to the perinatal period. Although not an illness, this is a time when mental and physical health are very closely connected, and during which psychological needs are not always well addressed. Medically unexplained symptoms A large number of people experience physical symptoms for which no clear biological cause can be identified. These symptoms are often chronic in nature (for example, persistent pain, tiredness or gastric symptoms); they can cause people significant distress, and often have an important psychological component. The terminology used to describe these symptoms is a subject of debate. However, the most widely used term is ‘medically unexplained symptoms’. Symptoms of this kind illustrate that in practice, it is often not possible or helpful to draw a distinction between ‘mental’ and ‘physical’ health. For these difficult-to-define problems, applying a clear diagnostic label (mental or physical) can be inappropriate, and a biopsychosocial approach towards management is particularly important. The concept of medically unexplained symptoms can also include people who have a physical condition but experience symptoms at a level that is disproportionate to the severity of that condition. Medically unexplained symptoms are more common than is often recognised, and people experiencing them are typically referred for multiple investigations and assessments, at considerable expense to the system and with little or no benefit for the patient. The NHS in England is estimated to spend at least £3 billion each year Introduction9
Bringing together physical and mental health 1 2 3 4 5 6 7 attempting to diagnose and treat medically unexplained symptoms (Bermingham et al 2010). Much of this expenditure currently delivers limited value to patients; at worst, it can be counterproductive or even harmful. What does this report add? The challenges described above are all part of the rationale for integration of mental and physical health. These are well-recognised challenges that have been subject to extensive research. Our intention in this report is to add to the evidence base by providing: •• an analysis of what integrated care for mental and physical health would look like from a patient or service user perspective (Section 2) •• an overview of 10 areas where integrated care is most needed, highlighting the existing evidence available in relation to each (Section 3) •• examples of innovative service models currently being developed and deployed in England (Section 4) •• an analysis of the barriers to change and suggestions as to how these can be overcome (Section 5). The report draws on a review of published research evidence, qualitative interviews and focus groups with service users and carers, and case studies of 10 services in England. We conclude by arguing that overcoming the longstanding barriers to integration of mental and physical health should be a central component of efforts to develop new models of care that bring together resources from across local health systems. Introduction10
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Bringing together mental and physic
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