mental health

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Bringing together physical and mental health

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A key test for any attempt to develop integrated approaches towards mental and

physical health is the extent to which it succeeds in bringing about the vision for

integrated care articulated by service users in Section 2 of this report. It could

be argued that there is a disconnect between this vision and the service-level

innovations described in Section 4. In the former, the emphasis is significantly on

the human and relational aspects of care rather than on structural solutions. Efforts

to integrate physical and mental health care will need to include change at this more

fundamental level to ensure that all health and care professionals are equipped to

take a ‘whole person’ or biopsychosocial approach in their work.

While structural change may not be necessary to ‘get the basics right’, substantial

workforce development certainly is needed. Integrated service models that

bring physical and mental health professionals together in new ways could be an

important mechanism for achieving this workforce development. The creation of

new opportunities for inter-professional learning and skills transfer could encourage

those involved to reframe their professional responsibilities – with physical health

professionals feeling more confident and more skilled to consider the mental health

and wellbeing of the people using their services, and vice versa. What is needed is a

way of scaling up the local successes already seen so that mental and physical health

are brought into closer relation across the country. One way this might be done is

through the changes set in motion by the Forward View.

Achieving the Forward View

The new models of care introduced by the Forward View create a potentially

important opportunity for the wider introduction of integrated approaches towards

physical and mental health. Some of the most promising vehicles for implementing

these integrated approaches will be those that deconstruct traditional boundaries

in the system. For example, significant progress could be made on several of the

10 priorities described in Section 3 if work on these is pursued within multispecialty

community providers (MCPs) and primary and acute care systems (PACS).

Similarly, vanguard sites focusing on enhanced health in care homes could support

improvements in mental health care in residential homes, and the urgent and

emergency care vanguard sites could strengthen the management of mental health

in acute hospital emergency departments (as indeed some are aiming to do).

Discussion68

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