New NCEPOD report focuses on joined up mental and physical health

New report authored by King’s Health Partners experts highlights importance of joining up physical and mental healthcare in hospitals. NCEPOD report

A new national report authored by King’s Health Partners experts has found that the failure by general hospitals to integrate physical and mental healthcare services is leading to poor care for patients with a physical illness who also have a mental health condition. ‘Treat as One: Bridging the gap between mental and physical healthcare in general hospitals’ is the latest report from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

The study is the result of an in-depth review into 552 cases (all patients had a physical illness and a mental health condition) where the confidential enquiry looked into the impact a patient’s mental health condition had on the care they received in hospital. Most of the 552 patients had been admitted through hospital emergency departments (ED).

The NCEPOD report comes at a time when health professionals are expressing concerns that patients with a severe mental illness develop medical conditions a decade earlier in their lives than other people, and die 15 to 20 years younger as a consequence.  Also, a significant number of patients in general hospitals with physical health conditions often have more common mental health conditions such as depression and anxiety.

The King’s Health Partners Mind and Body Programme is beginning to address this issue by screening patients in our acute trusts for common mental health problems and by providing training to all staff in how to identify and support patients with dual mental and physical health needs.

Calling on all general hospitals to integrate physical and mental healthcare services as a matter of urgency, report co-author Dr Vivek Srivastava, NCEPOD Clinical Co-ordinator and Consultant in Acute Medicine at Guy’s and St Thomas’ NHS Foundation Trust, says that general hospital  staff often don’t have the knowledge or confidence to care for people with mental health conditions appropriately:

Good care was only provided to 46% of patients in this study, showing patients who had a mental health condition suffered the double-whammy of both poor physical and mental healthcare.
The systems don’t exist to train hospital staff appropriately in the care of patients who also happen to have a mental health condition, so immediately there is an issue with having the confidence to care for this group of patients. Once someone is admitted to hospital it is likely to expose any underlying issue such as a mental health problem, and staff need to have the confidence to deal with this, and have access to and know how to refer to mental health services.

Dr Srivastava went on to say that as a direct result of poor physical healthcare, patients with a mental health condition stay longer in hospital:

They are often discharged into the community inappropriately and then bounce back in and out of hospital if the underlying health condition is not treated properly.

One example of poor physical care he highlighted is the failure to provide stop smoking services routinely to people with mental health conditions: “We found high levels of smoking among the patients we reviewed - over a third of them (39.7%) were documented as a smoker compared to 19% of adults in the general population. However, only a minority received effective smoking cessation support. Primary and secondary care services must provide stop smoking services.”

Co-author Dr Sean Cross, NCEPOD Clinical Co-ordinator in Liaison Psychiatry, Consultant Liaison Psychiatrist at King’s College Hospital NHS Foundation Trust and Clinical Director of the King’s Health Partners Mind and Body Programme also expressed serious concern that the health of some patients is so adversely affected:

Our report reveals a massive divide between the physical healthcare and mental healthcare people receive in general hospitals. One in four of us will suffer a mental health condition at some point in our lifetime. General hospitals need to take mental healthcare seriously and understand how to provide holistic care for mind and body.

Dr Cross also added that mental healthcare often involves use of mental health legislation.

This was not done well in 15/65 patients in the study who were detained under the legislation, either on admission to the general hospital or during their hospital stay.

To find out more about how we are joining up mental and physical health at King’s Health Partners, including training opportunities for our staff, visit our website

NHS England response to NCEPOD Treat as One report 

Responding to the publication of the above report on mental health care in general hospitals, Professor Tim Kendall, National Clinical Director for Mental Health, describes how the NHS is working hard to deliver priorities set out in the Five Year Forward View for Mental Health for changing the way in which mental and physical health have traditionally been viewed and treated.

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