Practical insights on mental and physical health

Since autumn 2018, the Health Foundation has been working in partnership with Mind, the mental health charity, to explore how care can be improved for people living with both mental and physical health problems that are long-term.

The work has been led by the Q Lab, an initiative working with members of the Q community and others to explore, develop and test ideas to address complex problems facing health and care.

What did we know already?

Across the UK, long-term conditions are increasingly common. More than 15 million people in England live with a long-term condition and this will increase by another 3 million people by 2025. People with long-term physical conditions are two to three times more likely to experience a mental health problem than those without.

The rise in multi-morbidity poses a significant challenge to the way care is delivered in the UK. As my colleagues have written about recently, we know we are not doing enough to meet this growing challenge.

What have we done so far?

To understand this topic in depth, the Q Lab and Mind teams explored conditions that are common across the UK but where the interrelationship is less well known or understood. We focused on the experiences of people living with common mental health problems (like anxiety and depression) who also experience persistent back and neck pain.

Over 6 months our research included a survey, over 40 interviews, focus groups and workshops, with a diverse group of over 100 people collaborating.

What have we learned?

We recently published the findings of this research, which brings to life some of the key challenges facing people living with multiple conditions and shines a light on areas of service provision that can be improved.

In particular, I was most struck by these findings:

• There is a complex interrelationship between physical and mental health conditions. The connection between mental health and persistent back and neck pain goes both ways and this is explained by a number of biological, psychological and social factors that interact with each other and are unique to each individual. The health system needs to acknowledge this complexity and build this into the way services are designed and run.
• Our research found that there is a significant gap in how confident health professionals are to raise and discuss both mental health and physical health with patients. While it can’t be expected that every physiotherapist is also a psychologist, there is a responsibility on educators, service managers, clinical leads and individual clinicians to ensure that discussing health and wellbeing, and knowing where to refer patients for expert help, is part of the job.
• People with diagnosed mental health problems, or who regularly present to health services with persistent pain, may face stigma that can lead to an inappropriate focus on their mental health. This can result in misdiagnosis or downplaying of physical conditions that are deemed to be psychological or are considered of secondary importance, which can in turn lead to missed opportunities to provide appropriate treatment and support.

Where do we go from here?

The challenges outlined in the Q Lab’s research are well known. But responding to them and addressing them is hard, which is why we are supporting teams from organisations across the UK to develop and test local interventions to improve care.

• Health Innovation Network with Sydenham Gardens and Bromley, Lewisham and Greenwich Mind are adapting the successful Joint Pain Advice (JPA) approach developed to support people managing chronic pain, to two new community settings supporting people with mental health problems.
• Health Innovation Network with St George’s Hospital and Kingston Hospital are looking to embed a training and mentoring package for physiotherapists to support better conversations about mental health wellbeing with their patients.
• Keele University with Midlands Partnership NHS Foundation Trust have identified a dual approach to improve patients’ access to services: improving training and awareness among clinicians (via training package & signposting) and providing better support for patients coming to appointments.
• Powys Health Teaching Board are testing new ways to improve awareness and engagement of the service amongst referrers and patients.
• Robert Jones and Agnes Hunt Orthopaedic Hospital are looking to better embed mental health support into their physiotherapy outpatients and will begin by increasing awareness about local services that people can signpost to.

Improving care doesn’t always mean whole-scale integration and expensive service transformation projects. There are simple questions that every health service can ask:

• How many people in our service have combined mental and physical problems? How will this impact their health outcomes?
• How confident are our staff and patients to discuss mental health and wellbeing?
• How strong are our links with local mental / physical health services? What could we do to strengthen this relationship?

Further information and stay in touch

We’re capturing the learning from the teams and later this year we will share the findings about what it takes to implement these ideas in practice.

You can follow this work, and what is being learned through this process, on the Q website. To receive updates from the Q Labs, email us at QLab@health.org.uk

If you are interested in how others are looking to work across boundaries, then check out the ideas that are being submitted as part of Q exchange – the Q community funding programme.

Libby Keck (@libbykeckhealth) is Programme Manager for the Q Lab.

Notes

• Ecceleston C, Crombez G, Fonatine J, Beirens K & Van Damme S (2009), ‘The unbearable lightness of somatisation: a systematic review of the concept of somatisation in empirical studies of pain.’, in Pain (145: 31-35)