Integrated neighbourhood health services: an opportunity to address a hidden health crisis

This copy first appeared as an article in the Health Services Journal (HSJ). The KHP authors are listed at the end of the piece. 

If integrated neighbourhood health services are to succeed, they must deliver for those most marginalised by society.

Among these groups, the 500,000 people living with severe mental illness (SMI) - schizophrenia, bi-polar disorder and psychosis - face one of the starkest and least recognised health inequalities in the UK. Mental health still makes up less than a tenth of the NHS budget, but accounts for over 20% of the disease burden, and due to recent loosening of the mental health investment standard, which had previously protected ICB mental health investment, the share of NHS spending on mental health is expected to decline in 2025/26.

Our latest research, funded by the Maudsley Charity reveals a hidden health crisis: individuals with SMI die 15-20 years earlier than the general population but only 11% of the public correctly estimate the impact of SMI on life expectancy. Despite national policy attention for more than a decade this mortality gap is widening. Crucially, it is driven by preventable physical health conditions, such as cardiovascular disease, diabetes, and respiratory illness. People with SMI more likely to experience lifestyle factors that contribute to bad health, such as smoking, low physical activity and poor diet often driven by food insecurity. The public correctly perceive smoking rates to be significantly higher in people with SMI (the actual rate is 40%, compared to 11.9% in the general population), though they tend to overestimate the figure.

These lifestyle factors are not choices - they are often symptoms of untreated SMI. Negative symptoms of schizophrenia, including a lack of motivation or and not wanting to look after your own needs, directly impact a person’s ability to engage in health-promoting behaviours. People are also less likely to have high blood pressure recognised and treated, and a more likely to have a delayed diagnosis of cancer. This makes access to effective physical health treatment more critical.

Likewise, optimising mental health medication (antipsychotics, mood stabilisers and antidepressants) reduces the risk of mortality in SMI. In schizophrenia, long-acting injections and clozapine are associated with lower mortality, morbidity and reduced hospitalisation. Evidence shows that if you should be on clozapine but are not, the mortality risk is doubled. 25% of people with SMI are living with physical health conditions that, with proactive evidence-based care and community support should be treatable if not altogether preventable. 

Integrated neighbourhood health services offer a unique opportunity to reimagine healthcare for this group – addressing clinical and social factors and reducing acute care costs. But without explicit prioritisation of mental health – particularly severe mental illness – they risk perpetuating the inequalities which they are being set up to solve. By raising awareness of this stark health inequality, and embedding mental health expertise within neighbourhood services, services can tackle stigma and the systemic barriers that are perpetuating inequity. 

Good care for severe mental illness requires multi-agency collaboration to improve quality of life – housing, employment, social care, primary care services and digital integration for continuous monitoring. Evidence-based models already exist, and neighbourhood models must build on these successes. Done properly, integrated neighbourhood services would have the potential to offer proactive outreach to help people marginalised by society to access the health initiatives already on offer – cancer screening, blood pressure checks, information about healthy eating and housing services, but also community connection. 

Experts by experience, senior leadership from across King’s Health Partners, charities, community organisations, and policy makers joined a roundtable on November 12 2025 to produce an action plan for change. One of the first themes to emerge was that neighbourhood health services must prioritise people with SMI if we are to deliver on the NHS’s prevention and community care ambitions. Experts identified integrated neighbourhood services as a critical lever for transformation, enabling person-centred care that can tackle the multifaceted causes of premature death. 

To achieve this, NHS leaders must take collective responsibility for addressing this inequality. This needs to be actioned through three steps. The first is through setting direction: adopt physical health outcomes and mental health outcomes for people with SMI as a critical success factor of integrated neighbourhood health services. Secondly, embed international guidelines for proactive physical health management in SMI and learn from evidence-based community models. The third is recognition of SMI as a health inequality group to be embedded in national and local datasets for monitoring access and outcomes within physical health pathways. 

Without these steps, the mortality gap will continue to grow, and integrated neighbourhood health services will fail those who need them most. The challenge is urgent, but the solution could be within reach. Integrated neighbourhood services are a structural innovation that offer the NHS an opportunity to deliver on the promise of prevention, equity, and community-based care. However, they will only be effective in reducing the mortality gap if the principle of parity of esteem is upheld. When services fail people with severe mental illness, they fail to tackle prevention effectively. 
If we are serious about tackling health inequality, we must start where the imbalance is greatest - and that means placing severe mental illness higher on our national health agenda.

Sources for risk levels: cardiovascular disease, diabetes, COPD, dental problems, obesity, cancer.

Authors:
Prof Matthew Hotopf CBE, Deputy Executive Director, King’s Health Partners, Chief Academic Officer, South London and Maudsley NHS Foundation Trust.

Sarah Holloway, Chief Executive, Maudsley Charity.

Amy Clark, Senior Policy Fellow, The Policy Institute, King’s College London.

Olivia Lerche, Head of Communications, King’s Health Partners.