mental health

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Bringing together physical and mental health

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Impact on the health system

Poor detection and treatment of physical ill health in primary care contributes

to people with severe mental illnesses being among the most frequent users

of unplanned care, with high associated costs. A recent analysis found that in

2013/14, people with mental health problems had three times more accident and

emergency (A&E) attendances and five times more unplanned inpatient admissions

than a matched control group drawn from the general population (Dorning et al

2015). Eighty per cent of these admissions were for physical rather than mental

health problems. While this cannot be attributed to shortcomings in primary care

exclusively, effective primary care will be critical in addressing these inequalities.

What would a more integrated approach look like?

Responsibility for monitoring and managing the physical health of people with

severe mental illnesses would be shared between primary care and specialist

mental health services, based on clear local agreements (Royal College of Psychiatrists

2009; Department of Health 2006). This would include comprehensive provision of

annual physical health checks, with practice nurses receiving appropriate training

to conduct such checks (Hardy et al 2014). General practices would systematically

and proactively identify relevant individuals on their lists using disease registers

and patient records. Practices would provide specific clinics for people with mental

illnesses to review the services and treatments currently being received, undertake

appropriate monitoring (eg, blood tests or electrocardiograms (ECGs)), provide

health promotion information, and signpost people to appropriate services. All

community mental health teams would have access to a physical health liaison

service, providing easy access to advice and treatment from GPs and others,

including for people not registered with a GP.

Further guidance

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Recognising the importance of physical health in mental health and intellectual

disability. Achieving parity of outcomes (British Medical Association 2014)

Case study examples

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Physical health check protocol in Bradford and Airedale (Appendix G)

The case for change: 10 areas where integration is needed most 29

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