mental health



Bringing together physical and mental health

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A new frontier for integrated care

Integrated care has traditionally focused on bridging the gaps between health and

social care, or between primary and secondary care. Bringing together mental and

physical health is an important third dimension of integration that needs to take its

place alongside the other two.

This new dimension also comes with a change in emphasis in terms of the

beneficiaries of integrated care. Integrated care programmes have often targeted

patients at greatest risk of acute hospital admission, identified through the use of

risk stratification tools, with a particular focus on frail older people. While they

remain an important target group, other population groups are known to experience

poor health outcomes, and these also stand to benefit significantly from integrated

care. This includes people with co-morbid mental and physical health problems, and

people with chronic medically unexplained symptoms, who experience many of the

features of frailty but from a younger age.

This line of argument has parallels with the work of Alderwick and colleagues (2015),

which makes the case for building closer connections between integrated care and

public health. If, as the authors suggest, those leading integrated care initiatives are

to move from an emphasis on the care of patients to the health of populations, this

will involve adopting a health inequalities perspective, and broadening the focus to

consider the role of social determinants of health. Integration of mental and physical

health must be central to this, for two reasons. First, the premature mortality of

people with mental illnesses is one of the starkest health inequalities in the UK

today. Second, the relationship between mental and physical ill health is intimately

connected with social deprivation, as shown by the work of Barnett and colleagues

(2012), and represents an important mechanism through which inequalities are

perpetuated. In short, taking a population health perspective on integrated care puts

integration of mental and physical health centre stage.


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