mental health

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Bringing together physical and mental health 1 2 3 4 5 6 7 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
Bringing together physical and mental health 1 2 3 4 5 6 7 qualified their support for the idea of self-management with the observation that it is important that patient empowerment is not equated with the message that it is ‘all up to you’. Second, peer support groups, online networks and other means through which patients can offer support to people in a similar situation to themselves were consistently emphasised as an indispensable way of bridging the gap between mental and physical health. Participants described how various forms of peer-led support were valuable in helping them deal with the psychological aspects of physical illness, or cope with mental health problems during the perinatal period. It was suggested that where this does not already happen, patients should be signposted to relevant forms of peer support as a routine part of clinical practice. Recovery colleges were mentioned as one recent innovation within the mental health sector through which peer-led support can be delivered. The most useful person in your journey is someone who is two to three years ahead of you in your treatment. Focus group participant Support for family and carers The final theme that emerged from our focus groups and interviews was the importance of emotional and practical support for family members and carers. Some of the participants who had lived with conditions such as cancer reflected that the emotional toll on their partners had, in some ways, been greater than the impact on their own mental health. My wife suffered mentally more than I did, and that was completely overlooked. Focus group participant As we argue in the following section, routinely supporting the mental wellbeing of carers is an important component of integrated approaches towards mental and physical health. Several participants also suggested that people providing significant levels of care to a person with a physical or mental health problem should be considered an integral part of the care team, and that by working closely with professionals they could help support co-ordination of care for physical and mental health. Getting the basics right: integrated care from a service user perspective 18
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