mental health

Bringing together physical and mental health
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health problems during the perinatal period highlighted missed opportunities to
identify problems at an early stage and offer proactive support.
It is a reactive service, not a proactive service.
Focus group participant
People with conditions such as bipolar disorder or psychosis made similar
observations about the lengths they had to go to in order to get help with their
physical health. The difficulties people often described, such as the effect of
psychotropic medications on weight gain, are well-established and entirely
predictable – and therefore potentially avoidable. By explaining and monitoring
these side effects, professionals can help service users know what to expect, and can
support self-management behaviours that could mitigate some of the worst effects.
Encouragingly, participants also identified good practice that can be built on. For
example, as part of rehabilitation programmes for long-term conditions, some had
received psychological support as a routine part of their care package, and said that
this had been very valuable in helping them adapt to living with their condition and
prepare for what was to come. However, not all individuals had received this kind
of support. There appeared to be some variation in the support available according
to the type of condition; some participants observed that proactive psychological
support appeared to be more embedded in cancer care than other long-term
conditions such as cardiac rehabilitation. This observation was not solely related to
the presence or absence of psychological therapy within rehabilitation programmes,
but also extended to the general culture and levels of psychological-mindedness
within different specialisms. This raises the important question of how good practice
in one area can be transferred to others.
Peer support and self-management
The role of patients in quality improvement was identified as being a critical
issue, in two senses. First, participants argued that they would be able to manage
their physical and mental health more effectively if provided with the necessary
information, self-confidence and support. Some highlighted specific improvements
they felt would enable them to do so – for example, shared electronic records
that patients can access, combining information from mental and physical health
consultations. There is a careful balance to be struck here though; some participants
Getting the basics right: integrated care from a service user perspective 17