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Bringing together physical and mental health 1 2 3 4 5 6 7 What would a more integrated approach look like? Admission to a mental health inpatient facility would be seen as an opportunity to improve the person’s mental and physical health. All people admitted to a mental health inpatient facility would receive a full physical examination on admission or within 24 hours, with investigations carried out promptly and clearly documented. Mental health nurses would perform basic tests themselves, using standardised toolkits such as the Lester tool (Royal College of Psychiatrists 2014), and would consider this an important part of their role. Liaison physician roles would be widespread, advising mental health providers on patients’ physical health. Liaison roles would also exist for other professionals, such as clinical nurse specialists, practice nurses and health coaches. In secure or rehabilitation units with longer average length of stay, the more stable inpatient population would represent an opportunity to provide a comprehensive range of primary care services within the facility. Further guidance •• Whole-person care: from rhetoric to reality. Achieving parity between mental and physical health (Royal College of Psychiatrists 2013c) Case study examples •• Primary care for secure inpatient units in west London (Appendix H) •• Physical health liaison service in Highgate mental health unit (Appendix I) The case for change: 10 areas where integration is needed most 37
Bringing together physical and mental health 1 2 3 4 5 6 7 Priority 9: Providing integrated support for perinatal mental health The problem Mental health problems affect one in five women during the perinatal period (Davies 2015). Problems encountered include depression, anxiety disorders, postpartum psychosis and post-traumatic stress disorder. Despite the numbers of people affected, half of all acute trusts in the UK have no perinatal mental health services, and three-quarters of maternity services do not have access to a specialist mental health midwife (Bauer et al 2014; Hogg 2013). Midwives and health visitors receive variable and often limited training in identifying women who have, or are at risk of developing, perinatal mental health problems. Where perinatal mental health services are available, these are usually part of generic adult mental health services and are not always fully integrated with other maternity services (NHS Commissioning Board 2012). Access to services is particularly poor for minority ethnic groups – black Caribbean women are less likely to receive treatment for perinatal depression than their white British counterparts (Edge et al 2004). Impact on people There is considerable evidence that untreated mental health problems are associated with increased risk of obstetric complications and can adversely affect both the parent–child relationship and the child’s social and emotional development (Stein et al 2014; Howard et al 2003). There may be lasting effects on maternal self-esteem, as well as on partner and family relationships (Oates 2015; Meltzer-Brody and Stuebe 2014). Almost a quarter of maternal deaths occurring between six weeks and one year after pregnancy are due to psychiatric causes (MBRRACE-UK 2015). Women may delay seeking help due to stigmatisation and fears that their baby might be taken from them (Dolman et al 2013). Impact on the health system Perinatal depression, anxiety and psychosis carry a total long-term cost to society of about £8.1 billion for each one-year cohort of births in the UK, of which £1.2 billion falls on the NHS and social services (Bauer et al 2014). In comparison, estimates suggest it would cost around £280 million a year to bring perinatal mental health care pathways across the UK up to the standards recommended in national guidance (Bauer et al 2014). The case for change: 10 areas where integration is needed most 38
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Bringing together mental and physic
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mental health

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