mental health

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Bringing together physical and mental health

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a foundation of basic common competencies in mental and physical health

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an openness to explore what a person’s wider needs might be beyond the

boundaries of their own specialism

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an understanding of other forms of support that are available and how to make

a referral to relevant services.

There are a number of barriers that could discourage clinicians from conceiving

of their professional responsibilities in the way described here. The service users

involved in our research were often conscious that time can be a very significant

constraint – for example, limiting a clinician’s scope to explore the physical and

mental aspects of a person’s health (professionals involved in other components

of our research made this point too). It is particularly difficult to envisage how

this can be done within a typical 10-minute consultation in general practice,

raising the question of whether alternative approaches are needed in primary care.

While these constraints need to be recognised, it should also be acknowledged

that time is not the only issue; sometimes the barriers are as much about skills

and confidence, habitual ways of understanding role boundaries, or stigmatising

attitudes towards mental health problems. These are all factors that are amenable

to change.

Communication and consultation skills

The importance of good communication and consultation skills stood out as a

major priority for service users and carers. Their accounts highlighted that there are

particular aspects of communication that are important in relation to integration

of mental and physical health. The way information and reassurance is given, the

kind of questions that are asked, and the quality of listening a professional is able

to offer all have the effect of either narrowing or broadening the scope of a clinical

encounter. For example, a participant with diabetes described how the first question

in check-ups was generally ‘how are your HbA1c levels looking?’ rather than

‘how are you coping?’ – the latter being more likely to open up a discussion about

psychosocial wellbeing.

The language used by professionals can shape what kind of problems a person

feels it is acceptable or legitimate to experience and discuss. A striking number of

participants described how language around ‘being a fighter’ and remaining stoic

Getting the basics right: integrated care from a service user perspective 14

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