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Treating physical and mental health separately costs £11bn

Treating physical and mental health separately costs £11bn

Seperating mental and physical health is costing the NHS £11 billion a year, in terms of poor symptom management, missed diagnoses, and poor access, a leading thinktank has revealed
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Seperating mental and physical health is costing the NHS £11 billion a year, in terms of poor symptom management, missed diagnoses, and poor access, a leading thinktank has revealed.

The King’s Fund argues that by integrating physical and mental healthcare the NHS can improve health outcomes and save money.

The £11 billion a year is the collective cost of:

·      High rates of mental health issues among those with long-term conditions such as cancer, diabetes or heart disease.

·      Limited support for the psychological aspects of physical health, for example during and after pregnancy.

·      Poor management of ‘medically unexplained symptoms’ such as persistent pain or tiredness.

Chris Naylor, senior fellow at The King’s Fund said: “Traditionally physical and mental health have operated as distinct, separate systems in terms of both treatment and funding. That is no longer affordable financially or acceptable clinically.

“The government has set the goal of parity of esteem, meaning that mental health care should be “as good as”physical health care. We argue that there is an even greater prize at stake – that mental health care should be delivered “as part of” an integrated approach to health,” he added.

The ten priorities outlined in the report:

1.     Incorporating mental health into public health programmes.

2.     Promoting health among people with severe mental illnesses.

3.     Improving management of medically unexplained symptoms in primary care.

4.     Strengthening primary care for the physical health needs of people with severe mental illnesses.

5.     Supporting the mental health of people with long-term conditions.

6.     Supporting the mental health and wellbeing of carers.

7.     Supporting mental health in acute hospitals.

8.     Addressing physical health in mental health inpatient facilities.

9.     Providing integrated support for perinatal mental health.

10.   Supporting the mental health needs of people in residential homes.

All health professionals have a role here, the report argued, and skill gaps would have to be addressed, for example practice nurses do not receive training in how to perform physical health checks for people with severe mental health illnesses.

To improve, practices would systematically and proactively identify relevant individuals on their lists using disease registers and patient records, and provide specific clinics for people with mental illnesses to review the services and treatments currently being received.

Here, GPs could also undertake appropriate monitoring (eg blood tests or electrocardiograms (ECGs)), provide health promotion information, and signpost people to appropriate services. All community mental health teams would have access to a physical health liaison service, providing easy access to advice and treatment from GPs and others, including for people not registered with a GP, the report stated.

GPs should also receive training to help patients with medically unexplained symptoms, as this accounts for 15-30% of all primary care consultations as GPs report that these can be the most challenging appointments.

The report also calls for further integration – between primary and secondary care – for example, arguing for a board-level champion for physical health in mental health trusts and vice versa.

Other necessary improvements outlined in the report:

·      Staff working in care homes would have sufficient training to be able to detect and manage dementia, delirium, depression and other conditions, with support and supervision from specialists as required.

·      Admission to a mental health inpatient facility would be seen as an opportunity to improve the person’s mental and physical health, and all people admitted would receive a full physical examination on admission or within 24 hours.

·      Wherever possible, perinatal mental health problems would be identified early, during pregnancy. Specialist health visitors would be given advanced training in perinatal mental health to enable them to deliver brief psychological interventions.

See the full report here.

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