Mental and physical health – two parts of the same?
Mental health problems are the largest single source of disability in the UK, accounting for 23% of the total burden of disease.(1) Mental health related social and informal care costs to England amount to £22.5bn per year, while the cost of mental health problems to the UK economy is £70-100bn per year (4.5% of GDP).(2,3) The economic case for investing in mental health services is clear, but what does this mean for patients with mainly physical conditions?
Patients with long term physical health conditions are two to three times more likely to experience mental health problems than the general population. Nearly half of all people with diagnosed mental illness also have at least one, and often more, long-term physical conditions. Over £11bn per year is spent treating patients with psychological and physical conditions separately, and care is less effective than it could be.(4)
Traditionally the treatment of mind and body has been separated, but does treating the mind also benefit the body?
Integrating mental and physical health – better outcomes, fewer hospital stays, less costs
Studies show that integrating mental health support into physical treatment pathways for adults can be effective and economical across disease areas. For example, cognitive behavioural therapy has been shown to reduce hospital admissions for patients with angina, while including a psychological component to a breathlessness clinic for COPD has led to fewer bed days and A&E presentations.(5)
Furthermore, the benefits of a holistic approach to a patient’s mental and physical health needs are realised beyond a hospital’s income statement. Mental ill-health costs the UK £94bn every year, nearly half of which (£42bn) are indirect costs related to lower employment and productivity.(6)
For children and young people, effective interventions could increase educational attainment and long-term productivity through successful participation in the workforce. For adults, effective interventions could reduce income loss and the demand on social support through a reduction in long-term sickness. For example, universal screening for postnatal depression followed by psychological interventions for women at high risk of PND are shown to be effective and have a net benefit of £300 million for England, with impacts beyond one year for mothers as well as on longer term health and education benefits for children.(7)
How can organisations take an integrated approach to physical and mental healthcare?
An evidence-based approach should be taken to identify the priority areas to focus on, and the evidence base is growing all the time. Now is the time to challenge clinical service leaders to implement the most effective changes, giving them the tools to bridge the physical-mental divide with their mental health peers.
To embed real change, new multi-disciplinary working relationships and a clear structure to design and implement future pathways is needed between these traditionally separate disciplines. We recommend using five principles to design and implement future care pathways.
Five principles for future pathway design
- Codify and prioritise service user cohorts
- Define the key patient cohorts and their mind and body needs.
- Prioritise effort on the areas which will have the biggest impact on outcomes and activity, whilst being cost effective.
- Map pathways and challenges
- Bring a multi-disciplinary team together to map the current patient pathways and challenges to meeting psychological and physical patient needs along the patient journey.
- Identify the biggest opportunities for more integrated working.
- Apply transformation lenses
- Consider new therapies, technologies, and workforce models that could deliver care effectively (e.g. the cross-skilling of clinical staff with mental health competencies).
- Embed smart use of data and digital working from the beginning: How is accurate and insightful data built into the future model, helping to standardise working between organisations, measure impact, and test future changes?
- Set out the future state design
- Bring together staff from physical and mental health teams to design the future pathway, contributing and owning the future vision.
- Quantify the impact of new models of care on volume, activity, workforce and infrastructure. Recognise the benefits to the wider system may extend beyond the organisation.
- Implement future pathways
- Ensure a smooth transition by good planning, and collate robust data and outcomes to quantify the impact.
2020 Delivery has proven expertise in leading clinical model strategies and supporting organisations and systems in building sustainability. Please get in touch if you’d like to know more about how our strategy practice can support public services.
- The King’s Fund and the Centre for Mental Health. Long-term conditions and mental health – The cost of co-morbidities. 2012; Available from: http://www.kingsfund.org.uk/publications/long-term-conditions-and-mental-health
- The King’s Fund. Paying the Price: The cost of mental health care in England to 2026. 2008; Available from: http://www.kingsfund.org.uk/sites/files/kf/Paying-the-Price-the-cost-of-mental-health-care-England-2026-McCrone-Dhanasiri-Patel-Knapp-Lawton-Smith-Kings-Fund-May-2008_0.pdf
- Chief Medical Officer. Annual report of the Chief Medical Officer 2013 – Public Mental Health Priorities: Investing in the Evidence. 2013; Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data
- The King’s Fund. Bringing together physical and mental health: A new frontier for integrated care. 2016;(March). Available from: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Bringing-together-Kings-Fund-March-2016_1.pdf
- Carlson LE, Bultz BD. Benefits of psychosocial oncology care: Improved quality of life and medical cost offset. Health Qual Life Outcomes. 2003;1:1–9.
- OECD. Health at a Glance: Europe 2018 State of Health in the EU Cycle. 2018.
- European Union. Making the Long-Term Economic Case for Investing in Mental Health To Contribute To Sustainability. 2011;1–29. Available from: http://eprints.lse.ac.uk/41901/