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Chris Naylor: Effective chronic care means recognising the importance of mental health

9 Feb, 12 | by BMJ Group

The interaction between physical and mental health has been attracting increasing attention across the political spectrum. Last year, the government recognised the importance of the issue with its mental health strategy “No health without mental health.” And more recently, Andy Burnham chose integration of mental and physical health care as the subject of his first major speech since returning to the health portfolio.

The role of poor mental health in exacerbating physical health problems is a subject that deserves every bit of the attention it gets. People with long-term conditions are two to three times more likely to experience mental health problems than the general population. In absolute terms, at least 4 million of the 15 million people in England with a long-term physical health condition also have a mental health problem.

The interdependency of mental and physical health has significant implications for individual patients. Mental health problems can complicate people’s physical health conditions greatly, resulting in them spending more time in hospital, experiencing poorer clinical outcomes and lower quality of life, and requiring more intensive support from services.

There are also wider implications for how we care for the growing number of people with long-term conditions. Internationally, the prevailing approach to this is to attempt to reduce demands on formal care by supporting patients to manage their own condition effectively. But attempting this without recognising the effect of co-existing mental health problems is a recipe for failure.
Left untreated, mental health problems can significantly reduce the motivation and energy needed for self-management, and lead to poorer adherence to treatment plans among people with diabetes, cardiovascular disease and other long-term conditions. This goes a long way towards explaining why this group experience poorer physical health outcomes, as well as greater service costs.

The evidence in our new paper suggests that at least £1 in every £8 spent on long-term conditions is linked to poor mental health and wellbeing. And it shows that there are a number of ways we could support the mental health needs of people with long-term conditions more effectively, including: closer working between primary care and mental health professionals; integrating psychological interventions into chronic disease management frameworks; and investing in enhanced forms of psychiatric liaison services in acute hospitals.

Can we afford to develop such approaches? With evidence suggesting that some innovative forms of integrated mental health care can deliver a sizeable return on investment by reducing physical health care costs, not doing so would be a waste of resources. But realising the potential benefits in practice will require policy changes, including redesign of payment mechanisms.

The professional, institutional and cultural separation of mental and physical health creates substantial costs for both patients and the health system. As policy-makers and professionals increasingly focus on how integrated care can become a reality in the UK, integration of mental and physical health care must become a key part of the debate.

Read our paper: Long-term conditions and mental health: the cost of co-morbidities.

Find out more about our work on mental health and long-term conditions.

Chris Naylor leads the King’s Fund’s research on mental health, and also works on other policy issues including clinical commissioning, health system reform, and the development of integrated care.

This blog also appears on the King’s Fund website at http://www.kingsfund.org.uk/blog/

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  • Zekria Ibrahimi

    The problem with the anti- psychotic drug treatment of schizophrenia is that daily tablets and depot injections actually cause long- term physical difficulties, from the metabolic syndrome- diabetes and chronic weight gain- to movement disorders, above all the incurable tardive dyskinesia. I am obese because of anti- psychotics as a patient under the mental health services. It is disingenuous not to emphasize the terrible long- term side effects of drugs such as clozapine and olanzapine. Anti- psychotics can feel like an ocean of numbness and physical deterioration in which the patient drowns.

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