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Andy Bell
- 1. Integrated mental and physical health support Andy Bell 16 March 2017 @Andy__Bell__ @CentreforMH
- 2. Mind the Gap The NHS spends about £14 billion treating mental ill health, and… It spends another £14 billion not treating mental ill health
- 3. The extent of co- morbidity
- 4. The costs of not treating mental ill health 4.6 million people have a long-term physical illness and a mental health condition Physical health outcomes are worse and costs are higher for this group This costs the NHS £10 billion a year Medically unexplained symptoms cost a further £3bn Mental ill health among NHS staff costs £1bn
- 5. Co-morbidity with long-term conditions 20-50% of people with cardiovascular diseases have depression People with diabetes twice as likely to have depression Anxiety ten times as prevalent among people with COPD One third of women with arthritis also have depression
- 6. The impact of co- morbidity Mortality from asthma is doubled if you also have depression People with chronic heart failure and depression eight times more likely to die within 30 months Higher mortality and more complications from diabetes
- 7. Impact on NHS costs Costs of healthcare rise by at least 45% regardless of severity of physical illness: Hospital admissions (and lengths of stay) Prescribing Outpatient attendances GP appointments
- 8. The costs of co- morbidity in hospitals Half of hospital inpatients have a co-morbid mental health problem Less than half of those are identified 15% A&E cases relate to mental illness or alcohol misuse Mental ill health costs £25m for a 500-bed hospital
- 9. Benefits of liaison psychiatry Liaison psychiatry services can: Reduce admissions from A&E Reduce lengths of stay (2-5 days per patient) Reduce readmissions and enhance independent living after discharge Build skills and confidence of hospital staff Savings estimated at £5m per hospital Cost of full coverage c. £120m nationally
- 10. Integrated care and support Structured approach to care outside hospital involving: Care coordination by a case manager Systematic management and outcome tracking Multi-disciplinary team Collaboration between primary and specialist care
- 11. A local example of integrated care Hillingdon Hospital included psychological support in a breathlessness clinic for COPD Reduced A&E presentations and bed days in six months after intervention Savings estimated at £837 per person: four times cost of intervention
- 12. Medically unexplained symptoms City & Hackney Primary Care Psychotherapy and Consultation Service Supports people with ‘complex needs’ including medically unexplained symptoms Offers advice and support to GPs in managing patients Provides direct service to patients with a range of psychological therapies
- 13. Physical health for people with psychosis 15-20 year shorter life expectancy Excess mortality related to physical ill health Smoking cessation based on NICE guidelines: Average gain of seven years of life per person who quits smoking Likely savings from reduced healthcare costs
- 14. What hinders integration? Cultural divides between mental and physical health care Separate training for professionals Different funding streams and accountability systems Benefits don’t always accrue to same organisations that carry costs Stigma
- 15. What will help? Growing body of evidence and intelligence National and local leadership New money for mental health including integration with IAPT Sustainability and Transformation Plans? Bigger voice for individuals and families
- 17. Thank you For more information: Email andy.bell@centreformentalhealth.org.uk Follow @CentreforMH @Andy__Bell__ www.centreformentalhealth.org.uk