Sarah Markham: Integrating physical and mental healthcare to improve patient outcomes

As human beings we are intimately aware of the dynamic interactions between our physical and mental selves. In the context of having an illness, we may also become aware of the relationships which can exist between our mental and physical conditions. The mind and body are inextricably connected and so it is no surprise that mental and physical health conditions, when they co-occur, may be dependent in some manner. In fact, 30% of people with long-term physical health conditions, such as diabetes, also have a mental health condition and nearly half of all people with diagnosed mental illness also have at least one long-term physical condition.

Traditionally doctors and other healthcare specialists have practised in siloes determined by their medical specialty, with little co-interaction or co-working with other specialties. Nowhere has this divide been more pronounced than between mental and physical health provision. From my own experience of mental health services, I can recount many instances of overhearing psychiatrists complaining of the difficulty in accessing physical healthcare services for their inpatients.

Fragmented healthcare leads to inefficient service provision and poorer outcomes and experiences for patients. As a user of both mental and physical healthcare services and a member of various patient networks, I can testify to the stress and distress this can cause for people trying to get their needs met in a seemingly ever more complex healthcare system. A lack of alignment between practitioners and/or services can lead to patients receiving inconsistent or even conflicting treatment and advice.  

In recognition of the need to better manage and treat co-morbid mental and physical health conditions the Mind & Body Programme was established by King’s Health Partners Academic Health Science Centre (AHSC) in collaboration with their partners King’s College London, Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts in 2016. This new initiative is committed to integrating mental and physical healthcare, training, and research to improve health outcomes for patients, service users, and carers.

The Mind & Body Programme has sensibly chosen to take a long-term approach to improving healthcare, aiming to have an impact on health outcomes over a 5-20 year period, such as reducing the 15-20 year mortality gap for people with severe mental illness, and improving the mental health of people with long-term conditions. The programme aims to achieve this through its three main workstreams: improving screening for mental and physical health needs; developing care pathways and aligning existing services to meet this demand; and supporting its workforces to care for patients and themselves through learning and development. In this way the programme is targeting cultural change in the associated organisations to promote whole systems change around mind and body care.

The Mind & Body PPI Programme engages with service users, patients, and carers through the Expert Advisory Group (EAG) and wider local engagement events. The aim of the EAG is to help guide and develop the Mind & Body Programme vision, implementation strategy, and projects, to ensure these areas are designed with patient experience and outcomes at the centre. EAG members are involved in the co-design and co-facilitation of wider engagement events such as the Southwark and Lambeth Strategic Partnership People’s Assembly, and other engagement meetings for all stakeholders, both public and professional. Members of the EAG also attend Mind & Body Programme Board meetings to create an effective feedback loop, so information can be shared between groups and the patient and service user perspective is always present in discussions regarding the programme.

A unique feature of the Mind & Body PPI Programme is the scale of its ambition in terms of utilising the experiential learning of people with both mental and physical health conditions to help inform and effect large scale change. The needs of the population concerned are complex and diverse and hence the aim of the EAG is to capture and harness the expertise current local people have gained in negotiating services in the context of managing their health conditions.

The EAG has already been consulted on the development of a public open online course on depression and anxiety and the relationship with physical illness. The EAG has also assisted with the development of an online cognitive behavioural therapy tool called Compass, which has led to the decision to make several alterations to the tool such as a code to ensure therapist case-loads are evenly balanced, an interactive revision guide for each module, and directive pop-ups at first log-in to support users to navigate the site.

Key areas of focus for the EAG and wider engagement events in the future will include refining and improving the mind and body screening process and new service development projects in primary care and social care settings. Furthermore, education and training of staff is to be co-produced in consultation with patients, service users, carers, and families using the EAG as a focus for this process.

As members of the EAG we are all looking forward to utilising current and future opportunities to ensure the Mind & Body Programme continues to be informed by our vibrant and purposeful patient, service user and carer voices.

Sarah Markham is an academic mathematician and patient representative currently pursuing a second PhD in theoretical computer science. She is a member of the BMJ Patient Advisory Panel. Twitter: @DrSMarkham

Competing interests: None declared.