mental health

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Bringing together physical and mental health

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Integrating mental and physical health in NHS England vanguard sites

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As part of the Fylde Coast MCP, there are plans to establish an ‘extensive care service’ in

Blackpool to provide intensive multidisciplinary case management for people with complex

mental health needs, substance abuse and/or social problems. This will be targeted at

people who tend not to be well served by secondary care mental health services (for

example, people with complex, chronic problems rather than acute illness), and who often

have poor physical health alongside mental health problems.

In West Cheshire MCP, there is an emphasis on supporting wellbeing in a broad sense,

with wellbeing co-ordinators from the voluntary sector being included in local integrated

care teams. The intention is that this person-centred approach will bring the relationship

between mental and physical health to the forefront of multidisciplinary case discussions.

Liaison psychiatry/psychological medicine services

Liaison psychiatry (or psychological medicine) services have existed in some acute

hospitals for several decades and have received renewed policy attention recently

in England, partly as a result of evidence indicating that liaison services can deliver

a substantial and rapid financial return on investment (Parsonage et al 2012).

This renewed attention has included a recent commitment to invest £247 million

over five years to expand the availability of liaison mental health in emergency

departments (Department of Health 2016). Despite this policy interest, the provision

of liaison services currently remains highly variable across the country (Joint

Commissioning Panel for Mental Health 2013b).

Recent attention has focused on the rapid assessment interface and discharge (RAID)

model. The components of this vary between hospitals, but as the name suggests,

the emphasis is typically on rapid assessment and facilitation of discharge from A&E

departments and inpatient wards. In A&E settings, the focus tends to be largely on

self-harm and substance misuse, whereas for inpatients, the issues dealt with most

commonly are mental health problems associated with older age, such as dementia

and delirium. An economic evaluation of the RAID model in Birmingham reported

that by facilitating early discharge and reducing rates of readmission (particularly

among older people), the value of reduced bed use within the acute hospital exceeded

the costs of the service by a factor of more than 4 to 1 (Parsonage and Fossey 2011).

Integrated service models: current developments and trends 53

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