Commissioning for Mental Health in Medically Unexplained Symptoms and Long Term Conditions

Commissioning for Mental Health in Medically Unexplained Symptoms and Long Term Conditions

Dr Theresa Eynon MRCPsych MRCGP

CLAHRC Clinical Translation Fellow & Lead GP Good Thinking Therapy Service

Five Areas CBT

Evidence based supported CBT models at Living Life to the Full www.llttf.com

US perspective

·  Improved integration between physical and mental health care is necessary to improve overall outcomes for patients and reduce overall cost for commissioners (Wheelan & Stanton, 2012)

·  up to 70 percent of primary care visits stem from psychosocial issues (Collins, Hewson, Munger, & Wade, 2010)

UK Public Health

·  ‘No health without mental health’ (Department of Health, 2011)

·  The first public health strategy to give equal weight to both mental and physical health.

·  This Government recognises that our mental health is central to our quality of life, central to our economic success and interdependent with our success in improving education, training and employment outcomes and tackling some of the persistent problems that scar our society, from homelessness, violence and abuse, to drug use and crime.

·  Mental health problems such as depression are also much more common in people with physical illness. Having both physical and mental health problems delays recovery from both

·  Children with a long-term physical illness are twice as likely to suffer from emotional or conduct disorder problems.

·  People with one long-term condition are two to three times more likely to develop depression than the rest of the population. People with three or more conditions are seven times more likely to have depression.

·  Adults with both physical and mental health problems are much less likely to be in employment

UK Economic Case

·  Co-morbid mental health problems raise total health care costs by at least 45 per cent for each person with a long-term condition and co-morbid mental health problem

·  This suggests that between 12 per cent and 18 per cent of all NHS expenditure on long-term conditions is linked to poor mental health and wellbeing – between £8 billion and £13 billion in England each year (Naylor, Parsonage, McDaid, Knapp, Fossey, & Galea, 2012)

·  Depression is associated with a 50% increase in the costs of long term medical care (Lyons, Nixon, & Coren, 2006)

Commissioning a Good Service in Long Term Conditions

·  They will be supported to self care, have more confidence and control over their condition and understand the impact it will have on their lives.

·  There will be a genuine shift towards addressing a person’s full range of needs, including psychological and emotional support, rather than simply focusing on a medical model.

(Department of Health, 2010)

Patient views

·  Integrated Care should be organised around the needs of individuals

·  Evaluated by its outcomes, especially those which service users themselves report (National Voices, 2011)

Hugh Griffiths Acting Clinical Director of Mental Health

Improving health outcomes for people with long term conditions

http://www.slideshare.net/kingsfund/hugh-griffiths-improving-health-outcomes-for-people-with-long-term-conditions

Bibliography

Collins, C., Hewson, D. L., Munger, R., & Wade, T. (2010). Evolving Models of Behavioral Integration in Primary Care. New York: Milbank Memorial Fund.

Department of Health. (2010). Improving the Health and Well-being of People with Long Term Conditions. Retrieved March 7, 2012, from www.dh.gov.uk: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_111187.pdf

Department of Health. (2011). No health without mental health: a cross-government mental health outcomes strategy for people of all ages.

Lyons, C., Nixon, D., & Coren, A. (2006). Long term conditions and depression: considerations for best practice in practice based commissioning. National Institute for Mental Health in England, Care Services Improvement Partnership. London: Department of Health.

National Voices. (2011, October). Principles for Integrated Care. Retrieved March 07, 2012, from www.nationalvoices.org.uk: http://www.nationalvoices.org.uk/sites/www.nationalvoices.org.uk/files/principles_for_integrated_care_final_20111021.pdf

Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M., & Galea, A. (2012). Long term conditions and mental health: the cost of co-morbities. London: King's Fund & Centre for Mental Health.

Wheelan, B., & Stanton, E. (2012). Can CCGs learn to integrate mental health services from a Californian healthcare model? Health Service Journal (12 January 2012).