mental health

Bringing together physical and mental health
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Introduction
The NHS five year forward view makes the case for what has been called ‘triple
integration’ (Stevens 2015) – integration of health and social care, primary and
specialist care, and physical and mental health care. The importance of the third of
these components has been further emphasised in the report of the independent
Mental Health Taskforce to the NHS in England, which called for the development
of integrated care spanning people’s physical, mental and social needs (Mental Health
Taskforce 2016). The purpose of our report is to explore in greater detail what this
should involve.
Physical and mental health are closely interconnected and affect each other through
a number of pathways (see Fig 1) (Prince et al 2007). Throughout this report we take
a biopsychosocial perspective, in which health is understood as being a product of
biological, psychological and social processes. This is the conceptual framework
that many health professionals are trained to work within, but often the principle is
not borne out in practice. A number of factors have made it difficult to respond to
physical and mental health needs in an integrated way, including institutional and
cultural barriers, separate payment systems for physical and mental health care, and
the trend for increasing sub-specialisation in professional education. As a result,
people using services commonly find that their physical and mental health needs are
addressed in a disconnected way.
A strong consensus has emerged calling for more integrated approaches in the
health and care system. However, this report argues that to date, efforts to develop
integrated care in England and elsewhere have too often paid insufficient attention
to integration of mental and physical health. There needs to be a stronger focus on
this aspect of integration, which should address four related but distinct challenges:
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rising levels of multi-morbidity
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inequalities in life expectancy
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psychological aspects of physical health
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medically unexplained symptoms.
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