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  • Mental health in dementia patients costs £500 million a year
    2 June 2016

    In our blogs we have been exploring the importance of developing models of care which integrate physical and mental health. Joined-up care is essential for people with long-term conditions like dementia who have myriad needs.

  • Why good data must underpin mental health care
    2 June 2016

    Ambitious new models of care which integrate mental and physical healthcare are being spearheaded by the NHS Vanguards as part of the NHS Five Year Forward View. But how effective will service redesign be without in depth mental health data at its core?

  • NHS vanguards leading mental health integration
    2 June 2016

    The NHS Vanguards are rapidly gathering momentum to transform and integrate mental healthcare.

  • No health without mental health
    2 June 2016

    In his new role as NHS England’s National Clinical Director for Mental Health, Professor Tim Kendall has highlighted the unprecedented opportunity to ensure parity between mental health and physical health.

Thursday, 2 June 2016

No health without mental health

In his new role as NHS England’s National Clinical Director for Mental Health, Professor Tim Kendall has highlighted the unprecedented opportunity to ensure parity between mental health and physical health.

For one thing the boundary between physical and mental health is a blurred one, and one can have a profound effect on the other. About 30% of people living with a long-term physical condition also have a mental health problem, often as a result and which in turn creates a further detrimental effect on their physical condition. Estimates suggest that between 12 and 18% of NHS expenditure on the treatment and management of long-term conditions is linked to poor mental health and wellbeing.

And for people with a mental health condition their physical health suffers – many die too young as a result, for example the life span of people with schizophrenia is cut short by 12 to 15 years on average. Overall people with a mental condition are almost twice as likely to die from coronary heart disease as the general population and are four times more likely to die from respiratory disease

Gone are the days when mental health care could simply be an adjunct to the main event. Suicide is the leading cause of death in men aged 20–49 years; our healthcare systems cannot exclude good mental healthcare. This is our goal at NHiS and so it is a natural progression that we are extending the team’s expertise in long-term conditions to focus on mental health to support better mental health service provision nationwide.

To achieve these goals Tim Kendall explains in his blog for NHS England that we must all “find ways to reconfigure the NHS and to integrate mental and physical healthcare throughout primary and secondary care.... We have to boldly change the delivery of physical and mental healthcare to ensure everyone has timely access to appropriate mental healthcare where and when they need it. No small challenge!”.

He’s right, it’s no small challenge – particularly given the paucity of mental health data currently available which makes planning services appropriately really difficult. As part of NHS England’s Five Year Forward View the NHS Vanguards are rapidly gathering momentum to transform and integrate mental healthcare. But how far will they get creating new models of care that effectively intertwine physical and mental health without the data intelligence needed to truly understand the local population’s needs?

So far the impact of the poor existing data has in some cases been services which fail to adequately respond to patients’ needs at the scale needed. Looking forward, it provides a critical commissioning challenge, initially to benchmark local services and plan ahead for value and improved outcomes from integrated, multi-agency STP-based footprint budgets in England. We are involved in a number of data interpretation projects to begin this benchmarking process.

For us depression is a key area of focus because the condition is so widespread and creates such a massive burden: depression currently affects 1 in 10 people in the UK, and by 2030 it is predicted to be the world’s biggest health problem. We have developed a toolkit for anxiety and depression which has been developed to identify the burden of depression within a clinical commissioning group or local authority and help commissioners redirect resources where it is needed most.

Unsurprisingly many other health conditions which are currently poorly addressed put people at undue risk of depression, such as attention deficit hyperactivity disorder (ADHD) which is another area of our work. This not only severely impacts a child’s ability to learn when they are young, but shockingly 4 in every 5 adults with ADHD are not receiving any form of treatment which creates further challenges in later life.

While schizophrenia is less prevalent, it is a severe mental health condition with a huge toll on both individuals and their families. Developing services that can not only respond effectively to manage mental health crises in people with severe psychotic illness is essential, but so too is comprehensive care that supports and proactively manages a person’s condition to reduce the chances of a crisis in the first place.

We have developed a mental health performance dashboard which looks at patterns of access to acute hospital care by mental health patients, including the reasons why and how different care providers cross over. This type of information is a first step towards understanding how integration can streamline care for patients as well as significantly reduce costs for the provider consistent with the transformation agenda proposed in the Five Year Forward View.

Our mental health network events aim to help facilitate this type of change and improvement at a local level. The events which have been running for five years now bring together like minded people from primary and secondary care, and associated organisations involved in the commissioning and delivery of services. This provides a much needed platform for active discussion and exchange of ideas and local innovation to cope with the commissioning challenges encountered in mental health in a more integrated way.

Commissioning for mental health will be a challenge and will take input from everyone, but there is real impetus and optimism for change at the moment. Join us later this week as we dig down into some of the issues in more detail.

About the Author

Sarah Mehta has a varied background in health writing and developing materials for patient, professional and commissioner audiences, and now supports the NHiS team with their activities. Sarah initially worked as a medical writer for physician audiences and then moved to the voluntary sector with roles at the MS Society and Sense About Science focused on communicating evidence based medicine and research to the public in creative ways.

Having developed an interest in neurological conditions, Sarah joined Neurological Commissioning Support (NCS) and was responsible for marketing, communications and digital activities aimed at engaging NHS commissioners. Much of her work has involved meeting patients and professionals to better understand the challenges they experience in staying well / keeping their patients well.

More recently Sarah completed a certificate in science communication at Stellenbosch University in South Africa. During that time she guest blogged for a number of organisations including the World Health Organization and she also currently writes for the British Journal of Neuroscience Nursing.