Mind and body care – the highest value proposition of all?
Kate Lillywhite, Programme Director for King’s Health Partners Mind & Body, blogs about why joining up mental and physical healthcare is a much needed part of achieving a value driven healthcare system.
The purpose of our Mind & Body Programme is to better integrate physical and mental healthcare. We know that our mental and physical health are inseparable, and that mental and physical health conditions are often connected - in fact, when these health problems are combined, people are less able to manage their conditions and their health outcomes can become worse. Our aim is to champion and drive the integration of mental and physical healthcare so we can provide whole person care and improve patient outcomes.
In the King’s Health Partners Value Based Healthcare Strategy Professor John Moxham argues that joining up mental and physical healthcare ‘is the greatest value proposition of all’. Here’s why.
Watch the third video in our Value Based Healthcare series. Professor John Moxham explains how our Mind & Body Programme is helping us deliver value based healthcare.
The argument for Mind & Body
Evidence shows that nearly half of people with mental illness also have at least one long-term physical condition, and that around a third of those with physical long term conditions will also suffer from depression or anxiety. The presence of one or more concurrent conditions, often results in worse outcomes for the patient and increased contact with the healthcare system. However, because of the way our healthcare systems are set up, patients are treated in separate settings for physical and mental illnesses, resulting in the fragmented provision of care.
Last year Southwark Clinical Commissioning Group published a local ethnographic engagement report showing the prevalence of co-morbid physical and mental ill-health in the borough, and the importance of developing coordinated whole person care for people with long-term conditions.
The report included a number of case studies, including those of Derek, aged 90, who has prostate cancer, diabetes and depression, and Margie, aged 79, who has diabetes, high cholesterol, breathing difficulties, and severe depression. Both Derek and Margie’s wellbeing had been impacted by life events, such as the illness and absence of a loved one, or strained relationships within their family, leading to a total lack of support. Furthermore, both Derek and Margie were reluctant to seek help for their mental health problems. These case studies are not the exception; they are fast becoming the norm, and demonstrate the complex interplay between physical, mental and social dimensions to an individual’s ill-health and potential recovery. Delivering mind and body care seeks not only to improve overall wellbeing for patients such as Derek and Margie, but crucially wellbeing as defined by them, which is in turn reflected in better health outcomes.
How do we achieve value through integrated care?
We define value as outcomes that matter to patients, service users and carers over the costs of achieving those outcomes, across the complete pathway of care. Missed comorbidities such as Margie and Derek’s come at a high cost, both financially, individually and to society. According to a report by The King’s Fund, between 12% and 18% of all NHS expenditure is linked to poor mental health, most commonly in the form of depression or anxiety disorders, which if left untreated can significantly exacerbate physical illness and drive up the costs of care.
Perhaps most importantly, failing to spot comorbidities such as cancer with depression, can come at a huge individual cost to the patient, who may be seeing healthcare professionals in different settings, with little understanding of how these illnesses could be interacting with each other. Recent research has shown that 60% of patients seen at our mental health trust, South London and Maudsley NHS Foundation Trust, were also seen at least once at our physical health trusts, Guy’s and St Thomas’ or King’s College Hospital NHS Foundation Trusts over the course of a year. Even more sobering, is the fact that someone with a severe mental illness or learning disability has a 15-20 year shorter life expectancy compared to those without, largely due to co-existing physical ill-health. In other words, by failing to better integrate mental and physical healthcare, we are failing our patients.
But what does this mean in practice?
In 2016, Dr Carol Gayle led a pilot trial of 3 dimensions for diabetes (3DFD), a service which provided an integrated ‘bio-psycho-social’ model of diabetes care. Research shows that diabetes is associated with nearly every psychiatric disorder. The 3DFD service included providing patients with help for everything, from managing medication and psychiatric liaison to social interventions such as housing support. Data from the pilot study showed there was a 45% drop in Accident & Emergency (A&E) visits, 43% fewer hospital admissions, 22% fewer hospital bed days, and a saving of £850 per patient in 12 months. By treating the whole person, helping them manage not just the physical symptoms but also their mental health, and providing support for social issues, we can maximise the chances of a full recovery, and ensure patients receive the right care, at the right time, and in the right place. This model is now being tested in heart failure, hypertension and chronic obstructive pulmonary disorder, and soon to be rolled out across haematology pathways.
As a partnership we are working to catalyse a system-wide transformation to bring mental and physical care together. Part of driving this cultural change is about providing the tools that frontline clinicians need to support changes in practice. One of these tools is our IMPARTS (Integrating Mental & Physical healthcare: Research Training & Services) project which screens patients for symptoms of anxiety and depression alongside their physical health needs at Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts. The initiative is running in services ranging from limb reconstruction and rheumatology to eczema and kidney transplantation. Data show that nearly one in four of patients screened have symptoms of a probable major depressive disorder and/or generalised anxiety disorder. As a result, many of these patients have received some form of care or treatment to address their psychological needs. More than 20,000 patients have been screened so far.
The IMPARTS project team recently asked all clinical staff involved with IMPARTS to complete an online survey. Clinicians believed the way in which patients’ mental health needs are being met has significantly improved since IMPARTS implementation. 82.5% of respondents felt that IMPARTS helps them meet patient needs well or very well. Overwhelmingly, clinicians reported that the introduction of IMPARTS has had a positive impact on their daily practice: 95.3% were either extremely or quite satisfied with IMPARTS.
These are just a few of the ways in which we are building an integrated care system at King’s Health Partners, based around individual need rather than system preference. As ever, we’re hoping to continue to expand the work our Mind & Body Programme is doing, and thereby instill value in the healthcare we deliver to patients. If you’d like to get involved, you can join our network of Mind & Body Champions to shape how our organisations can best deliver mind and body care, and make a real difference to the way we care for the people in our community.