Integrating physical and mental health
- As covered in chapter two of the mental health needs assessment, there is a close bidirectional relationship between physical and mental health. People with long-term physical health conditions are between 2 to 3 times more likely to experience mental health problems than the general population (Naylor et al., 2012).
- The reasons behind the increased rates of poor physical health amongst people with enduring mental health conditions are complex, and include healthcare factors, patient factors and wider system factors side effects of antipsychotic medication, and health behaviours (Lawrence & Kisely, 2010).
- People with co-morbid physical and mental health conditions are more likely to experience poor outcomes, including greater rates of hospitalisation and less effective self-management (Public Health England, 2019).
- Physical and mental health problems should be supported in an integrated way across all aspects of the health system, from public health and prevention initiatives to the care provided by GPs, hospitals and social care (Public Health England, 2019). There are cost-effective interventions which protect the mental health of people with long term conditions (Public Health England, 2019).
Many services within Cambridgeshire and Peterborough provide integrated physical and mental health care. This includes some services which have a specific focus on improving the physical health of people experiencing mental illness (such as free and low cost fitness activities run by Cambridge City Council) and the mental health trainers within Healthy You. Other approaches include integrating physical and mental health, such as liaison psychiatry or a local pilot where general practitioners had placements within CPFT.
Talking Therapies for people with long-term physical health conditions
- People with co-occurring mental and physical health conditions are more likely to have poorer physical health outcomes (Naylor et al., 2016).
- The NHS Long Term Plan set out plans to expand Talking Therapies, stating that all ICSs should commission specific support for people with long term conditions (LTC). This builds on the core Talking Therapies model by including integrated care with physical healthcare services (Clarke et al., 2018).
- Early evaluations of this support identified positive benefits for both service users and healthcare systems: service users reported that they benefited from receiving specialist support, and physical health services reported varying levels of savings (Clarke et al., 2018).
NHS Cambridgeshire and Peterborough Talking Therapies provides a specific pathway of support for people with long-term physical health conditions, including coronary heart disease, chronic pain and diabetes (Cambridgeshire and Peterborough NHS Foundation Trust, 2023a). An initial evaluation of this service found for people who used the long-term condition pathway there was a (NHS England, 2023f):
- 73% reduction in GP appointments for diabetes, cardiovascular health and respiratory health.
- 61% reduction in Accident and Emergency attendances.
- 75% reduction in hospital admissions.
Predicting physical health risk in young people with psychosis
- Young people with psychosis are at a high risk of developing cardiometabolic disorders such as cardiovascular disease and type 2 diabetes.
- Recent NIHR funding led to the development of the Psychosis Metabolic Risk Calculator (PsyMetRiC), the first age-appropriate cardiometabolic risk prediction algorithm tailored specifically for young people with psychosis (Perry et al., 2021).
- This tool has been validated in multiple settings across the UK and is going through classification with the Medicines and Healthcare products Regulatory Authority (MHRA) so it can be used in clinical settings (Perry et al., 2021). Approval of PsyMetRiC will transform CPFT opportunities for further funding of the PsyMetRiC project by demonstrating feasibility and a path toward clinical integration and implementation.
This section of the mental health needs assessment focuses on policies and services which aim to address physical health inequalities faced by people with mental illnesses, particularly those with severe mental illnesses.
References
Full list of references is included at the end of this chapter.