King's Fund: all physical health problems have a psychological dimension
In a 122-page report on physical and mental health provision, the King’s Fund says professionals should take a ‘whole person’ perspective, and have the skills to do so.
The high rates of mental health issues among people with long-term physical health problems, along with the poor management of ‘medically unexplained symptoms’, cost the NHS more than £11 billion a year in England alone, says the report.
Integrating physical and mental health care could improve outcomes and save money.
‘The need to integrate support for mental and physical health is not limited to people meeting formal diagnostic criteria.
‘All physical health problems have a psychological dimension, particularly when they involve learning to live with a long-term condition.’
Physios and other professionals should anticipate how and when physical and mental health conditions might impact on each other, and suggest pre-emptive action.
Carley King, a CSP professional adviser, said: ‘It is important for individual physios to take a holistic view of patients. For example, depression is more common in people with long-term health conditions, and there are guidelines to help healthcare professionals.’
‘And of course it is important that physios know when to refer people for specialist advice.’
The report highlights examples where physiotherapy staff work in redesigned care pathways, which can improve outcomes and be cost-effective.
One of these, an integrated persistent pain pathway in Oldham, went live last June. Provided by Pennine MSK Partnership, Pennine Care NHS Trust and Pennine Acute Hospitals NHS Trust, it is commissioned by Oldham Clinical Commissioning Group.
Led by a team of clinicians, it offers an integrated pathway across all musculoskeletal conditions. Patients are assessed by a multidisciplinary team, including physios and clinical psychologists, who decide on the type of services each patient will receive.
The new care pathway represents a significant shift for the local healthcare system. Patients with long-term pain can now access a wider range of support for their psychological and social needs.
There is ‘high quality’ multidisciplinary working and good communication between physiotherapists and other professionals, the King’s Fund says.
Many patients being treated in high secure settings at Broadmoor Hospital in Berkshire and Ealing Hospital in west London have long-term conditions, such as diabetes and cardiovascular disease. The trust covering these hospitals created a multidisciplinary team of physiotherapists, GPs, nurses and dieticians based in health centres on site.
New patients receive full physical health checks and a care plan, which is reviewed every six months.
Results show ‘significantly’ better control of blood glucose levels compared with people with diabetes in the community. In addition, the incidence of chronic obstructive pulmonary disease has fallen compared with levels in the local populations outside the hospitals.
Lead author Chris Naylor, a 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.
‘When we spoke to patients they told us that they wanted to see healthcare professionals who recognised all of their care needs. What’s more, at £11 billion a year, the disconnect between treating physical and mental health is costing the NHS greatly and isn’t meeting patient needs.’