mental health



Bringing together physical and mental health

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biggest challenges are related to patients with a mixture of medically unexplained

symptoms and poor adjustment to a long-term physical health condition, leading

to disproportionate symptoms and medication use for the long-term condition.

The annual health care costs of medically unexplained symptoms in England were

estimated to be £3 billion in 2008/9, with total societal costs of around £18 billion

(Bermingham et al 2010).

What would a more integrated approach look like?

The needs of people with medically unexplained symptoms vary enormously, and

evidence suggests that biopsychosocial management delivered within a stepped care

framework can be an effective approach for some people (Chambers et al 2015). GPs

have an important role to play in this, identifying people affected, exploring relevant

psychosocial factors, and doing so in a way that acknowledges physical symptoms

as real (Peters et al 2009; Morriss et al 2007). Where symptoms are mild, sensitive

handling and watchful waiting by the GP may be sufficient. People with moderate

needs would receive appropriate psychological interventions and other support as

necessary. Those with the most complex needs would be considered for referral to a

dedicated service for medically unexplained symptoms with specialist mental health

input using a collaborative care approach including joint case management with

GPs. Where a referral for psychological intervention is made, GPs need to be able to

discuss this with patients in a way that avoids implying that their symptoms are ‘all

in the mind’ (Department of Health 2014c).

Further guidance


Medically unexplained symptoms: a whole systems approach (NHS Commissioning

Support for London 2009)


Guidance for commissioners of primary mental health care services (Joint

Commissioning Panel for Mental Health 2013d)


A commissioner’s guide to primary care mental health (London Strategic Clinical

Networks 2014a)

Case study examples


Integrated persistent pain pathway in Oldham (Appendix B)

• • City and Hackney Primary Care Psychotherapy Consultation Service

(Appendix C)

The case for change: 10 areas where integration is needed most 27

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