It has long been recognised that patients with long-term physical ill health will often have associated mental health problems. Today the King’s Fund published a report into the cost of such co-morbidities, which concluded that between 12-18% of all NHS expenditure on long-term conditions is linked to poor mental health.
Health outcomes for such patients are often worse, largely because such patients find it harder to manage their conditions and often take up unhealthy behaviours such as smoking.
The stark compartmentalisation within health and between health and social care has proven challenging for patients to navigate. This can be seen both in the way we artificially separate out health and social care and also in the institutional and professional separation of primary and secondary care.
The role of CCGs
This is an important report for clinical commissioning groups (CCGs) as they are well placed to make a difference to an issue that affects large numbers of their patients; indeed the King’s Fund highlighted this as one of the top 10 priorities for CCGs in their report last year.
The solutions are multi-faceted and incorporate preventive strategies such as wellbeing in the workplace, supporting individuals with debt advice and befriending interventions aimed at older people.
However before we can discuss solutions it is important to recognise that the majority of cases of depression among people with physical illnesses go undetected and untreated.
Under the government’s reform programme CCGs will have a duty to promote integrated services and herein lies one of the main strategies for success.
Some areas such as Torbay have recognised the benefits and formed an integrated health and social care organisation, yet integration at the organisational level is not essential.
Simply integrating mental health support with primary care and chronic disease management programmes can yield very positive results. The incorporation of psychological or mental health support within disease management or rehabilitation programmes are cost effective, with the costs of these interventions more than outweighed by the savings arising from improved physical health and decreased service use.
Patients with long-term physical ill health often have mental health problems
Linking mental health and primary care
There is also a strong argument for much closer working between mental health and primary care. Such enhanced models of primary care provision, with closer input from mental health specialists, enable the patient’s needs to be fully addressed rather than compartmentalised into physical or mental health issues.
It is common practice to commission mental health services separately from services for physical health conditions, and the needs of co-morbid patients are often not considered in either commissioning process. CCGs are clinically-led organisations interested in care pathway transformation. As they consider care pathways for their patients with long-term conditions they will need to consider how the emotional, behavioural and mental health aspects of physical illness can be supported as an integral part of that pathway.
This clearly requires close collaboration between primary care, mental health services and local authorities. The commissioning process must carefully consider the interface between the current organisations and professionals and develop pathways spanning these artificial divides.
The rewards are great; significant improvements in health outcomes and reduced costs. CCGs should prioritise such integration as part of their strategies to improve the quality and productivity of care.
- Dr Paul Zollinger-Read is medical adviser and clinical lead on primary care at The King’s Fund