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Separating mental and physical health care ‘no longer affordable’ – King’s Fund

Treating mental and physical health problems separately costs the NHS £11bn a year and is “no longer affordable”, the King’s Fund has warned.

In a new report, the think tank says integrating physical and mental health is necessary because of the high rate of mental illness amongst people with long-term health conditions, poor management of medically unexplained symptoms and reduced life expectancy among people with severe forms of mental illness.

It also states that there is limited support for wider psychological aspects of physical health and illness. This lack of co-ordination is associated with problems such as increased service costs, health outcome inequalities and ineffective care, costing NHS England more than £11bn annually, the King’s Fund stated.

Chris Naylor, senior fellow at the King’s Fund, said: “Traditionally physical and mental health have operated as distinct, separate systems in terms of both treatment and funding. That is no longer affordable financially or acceptable clinically.

“The government has set the goal of parity of esteem, meaning that mental health care should be “as good as” physical health care. We argue that there is an even greater prize at stake – that mental health care should be delivered “as part of” an integrated approach to health.”

Financial and human costs

Last month the government promised to invest an extra £1bn in mental health care by the end of the decade, after a new report warned that mental health services are inadequate and unequal.

Stephen Dalton, chief executive of the Mental Health Network, said: “We need to see the mental and physical health care of individuals as two sides of the same coin and which require equal attention, equal funding and coordination at the point of delivery.

“There is now a significant body of evidence that signposts the need for government to invest in mental health services after years of neglect.”

The report warns that 12-18% of NHS expenditure on long-term health conditions is linked to mental health problems such as depression and anxiety, affecting 4.5m people.

Life expectancy for people with bipolar disorder or schizophrenia is 15 to 20 years below the general population, largely as a result of raised rates of cardiovascular disease and other physical health conditions.

Professor Sir Michael Marmot recently told the Health Select Committee that the UK is “not making progress” on health inequality.

Dr Phil Moore, chair of the NHS Clinical Commissioners Mental Health Commissioners Network and vice chair of NHS Kingston CCG, said: “Achieving an integrated mental and physical health approach was one of the key priorities set out by the recently published Mental Health Taskforce report ‘The Five Year Forward View’.

“The King’s Fund report today provides further evidence on how costly in both economic and human terms it would be not to do our utmost to achieve this.”

Recommendations for integrating care

The King’s Fund recommended 10 areas for change:

• Incorporating mental health into public health programmes.
• Promoting health among people with severe mental illnesses.
• Improving management of medically unexplained symptoms in primary care.
• Strengthening primary care for the physical health needs of people with severe mental illnesses.
• Supporting the mental health of people with long-term conditions.
• Supporting the mental health and wellbeing of carers.
• Supporting mental health in acute hospitals.
• Addressing physical health in mental health inpatient facilities.
• Providing integrated support for perinatal mental health.
• Supporting the mental health needs of people in residential homes.

The latest National Maternity Review also recommends introducing better perinatal and postnatal mental health care.

Saffron Cordery, director of policy and strategy at NHS Providers, and a member of NHE’s editorial board, said: “This report provides an excellent, thorough, and intelligent intervention into the conversation on integrating physical and mental health.  It achieves this by focusing on both analysis and solutions.

“Of particular importance are the benefits to patients and service users that the King’s Fund report highlights, and the financial savings that can be made by integrating physical and mental health. This is a part of the integration agenda that is often overlooked. However, it is fundamental if we are to continue to improve quality and drive through the efficiencies required in these straitened times.”

A Department of Health spokesperson said that the department was "absolutely committed" to integrated mental and physical healthcare, and that the £1bn extra investment would include helping people with mental illness access services and receive health checks.

(Image c. Dominic Lipinski from PA Wire)