mental health

Bringing together physical and mental health
1 2 3 4
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£13 billion of NHS spending in England is linked to co-morbid mental health
problems among people with long-term conditions (Naylor et al 2012).
Co-morbid mental health problems also have wider economic costs as a result
of lower employment rates and productivity (Hutter et al 2010).
What would a more integrated approach look like?
People with long-term physical health conditions would receive support for the
psychological aspects of their condition as a standard part of their care. This would
include: routinely providing psychological education and support as part of cardiac
and pulmonary rehabilitation and other self-management programmes; making full
use of peer support groups (locally or online); and embedding clinical psychologists
within multidisciplinary teams to allow skills transfer in both directions. Active
case-finding would be used to identify people at greatest risk, in line with guidelines
from the National Institute for Health and Care Excellence (NICE 2010). Integrated
approaches involving close working between primary care and other professionals –
for example, based on the collaborative care model (see Section 4) – would be
available for people with co-morbid depression or anxiety (Coventry et al 2015;
Rosenberg et al 2014; Sharpe et al 2014). The most complex patients with multiple
conditions would not be referred to generic psychology services, but would be
supported by professionals skilled in working at the interface between physical and
mental health.
Further guidance
••
Investing in emotional and psychological wellbeing for patients with longterm
conditions. A guide to service design and productivity improvement for
commissioners, clinicians and managers in primary care, secondary care and
mental health (NHS Confederation 2012)
••
London’s care pathway for diabetes: commissioning recommendations for
psychological support (London Strategic Clinical Networks 2014b)
Case study examples
••
3 Dimensions of care for Diabetes (Appendix A)
••
LIFT Psychology in Swindon (Appendix F)
The case for change: 10 areas where integration is needed most 31