mental health

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Bringing together physical and mental health

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fragmentation between support for physical and mental health – a finding that

is perhaps unsurprising given the institutional separation of mental and physical

health care in England. A common observation was that the only person performing

any form of co-ordination role was the patient themselves.

You are your own advocate – you have to be able to navigate all the

different services.

Focus group participant

Many of those we interviewed believed that having someone to help with coordination

– someone with a good overview of both mental and physical health

needs – would be a significant step towards integrated care. Some described

receiving help with this from their GP, but experiences were mixed; others felt

that GPs are not always best positioned to play this role, particularly in terms of

their accessibility. Participants emphasised the need for care to be co-ordinated by

someone who is easy to contact when difficulties arise. Some of the participants

with experience of cancer had been allocated a specialist nurse key worker – a

named individual who was readily accessible, and who helped co-ordinate different

appointments and aspects of treatment. This kind of support was valued immensely

by those who received it.

Participants suggested that a key feature of a well-co-ordinated system of care would

be ‘only telling your story once’, illustrating that care co-ordination needs to be

underpinned by common assessment processes and appropriate sharing of patient

information across providers.

Proactive care

An integrated approach towards mental and physical health would involve

professionals anticipating how and when physical health conditions might have an

impact on mental health (or vice versa), and suggesting appropriate pre-emptive

action. Many of the participants in our research described the system as being

reactive rather than proactive. For example, although individual experiences varied,

many of those who had experienced physical health conditions reported that they

had only received support for their mental health after they had been very persistent

in asking for it, or when their mental health deteriorated to a sufficiently poor level

that it could no longer be ignored. Similarly, women who had experienced mental

Getting the basics right: integrated care from a service user perspective 16

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