Mental Health and Physical Health & Long Term Conditions

1. Mental Health and Physical Health& Long Term Conditions

2. Mental health problems predict physical disease (1) • People with psychotic disorders die on average 25 yrs earlier than the general population (Parks et al 2006) • Self report of depression in population studies increases mortality by 50% (Mekletun et al 2007) • Diagnosis of neurotic disorder in general practice increases mortality over next 11 years by 70% (Lloyd et al 2006)

3. Mental health problems predict physical disease (2) Depression associated with increased mortality from • cardiovascular disease • cancer • respiratory disease • nervous system disease • accidents

4. Mental health problems predict physical disease (3) Depression associated with increased morbidity from • cardiovascular disease • back pain • irritable bowel • tension headache • insomnia

5. Plenty of studies show that physical illness can affect mental health Mental Illness Physical Illness

6. The impact of long-term conditions (LTC) and co-morbidity • More than 15 million people in England (30% of population have one or more long-term conditions (DH 2011). • Co-morbidities are the norm in later life. • Evidence consistently demonstrates that people with LTC are two to three times more likely to experience mental health problems than the general population. • Much of the evidence relates specifically to affective disorders such as depression and anxiety, though co-morbidities are also common in dementia, cognitive decline and some other conditions.

7. The overlap between long-term conditions and mental health problems

8. Health-related quality of life scores associated with single and multiple long-term conditions

9. Mental Health and Older People-the costs • Co-existing mental health problems in people with LTC leads to significantly poorer health outcomes and reduced quality of life. • Costs to the health care system are also significant – by interacting with and exacerbating physical illness, co-morbid mental health problems raise total health care costs by at least 45% for each person with a long-term condition and co-morbid mental health problem • This suggests that between 12% and 18% of all NHS expenditure on long-term conditions is linked to poor mental health and wellbeing – between £8 billion and £13 billion in England each year. • In terms of NHS spending, at least £1 in every £8 spent on long-term conditions is linked to poor mental health and wellbeing.

10. Other costs/impact of LTC • Chronic diseases are now the most common cause of death and disability in England. • People with LTC tend to be heavy users of health care resources, accounting for: • At least 50 % of all GP appointments, • 64% of outpatient appointments and • 70% of all inpatient bed days • 18% of people with LTC are in receipt of state-funded social care

11. Monthly costs per patient with and without mental health problems (based on client claims data from Beacon Health Strategies, prior to Beacon engagement)

12. Proportionate increase in per patient medical costs associated with depression and anxiety relative to people without a mental health problem (based on US claims data for more than 9 million people, Melek and Norris 2008)

13. A word about Medically Unexplained Symptoms (MUS) • Physical symptoms that have no currently known physical pathological cause • Studies have shown that MUS account for 20% -30% of consultations in primary care • 52% in secondary care   • Up to 70% have depression and/or anxiety disorders medically unexplained symptoms

14. There may be trouble ahead..

15. King’s Fund, July 2016 ‘The NHS is going through the biggest financial squeeze in its history. Since 2010, its budget has effectively been frozen, increasing by just enough to cover inflation. Increasing demand for care means that services are under huge pressure.. Looking further ahead, pressure to spend more will grow as the costs of treatment rise, public expectations increase and the population continues to age’.

16. In 2015/16, NHS is under unprecedented strain…. • 8% patients, more than 1.85 million, spent longer than four hours in A&E across the year, the worst performance since 2003/4 • Number of patients waiting for hospital treatment has risen to 3.7 million, (increase of 17% (500,000 patients), and highest number since 2007 • By March 2016, 5,700 patients were delayed in hospitals, an increase of 15% over the year and the highest number since 2008.

17. Question? How can we address sustainability of NHS and Social Care by targeting interventions aimed at improving mental health and wellbeing in people with LTC/co-morbidity and patients with MUS?

18. LTC/Mental Health/Mental Illness:What can we do? Growing evidence that addressing the psychological and MH needs of people with LTCs leads to improvements in both mental and physical health. Also possible to reduce the number of people with LTC who go on to develop MH problems. Psychosocial interventions effective and cost-effective in improving mental well-being and in reducing prevalence mental illness e.g. addressing the psychological needs of people with diabetes improves clinical outcomes, quality of life, relationships with health care professionals and carers, dietary control and overall prognosis

19. What can we do (2) ? Interventions that have been shown to be cost-effective: • Reducing social isolation and loneliness • Befriending • Training in the use of the internet to increase social support • Walking and physical activity programmes • Learning and volunteering • Debt advice • Home insulation and improved central heating have resulted in 40-50% decrease in depression and anxiety

20. What can we do for MUS? A recent systematic review of MUS found that interventions targeting GP’s diagnostic and patient management skills as well as CBT for patients have the potential to improve patients’ health status and to reduce costs .

21. Where best to intervene?

22. The role of Primary Care • 90% of all NHS interactions take place in primary care (most depression also managed in primary care -91%) • Primary care on front-line in dealing with MH of older people, supporting families, and managing people with complex co-morbidities (including LTCs) • Services provided by GPs often highly valued by patients although access remains problematic in some/many cases • Depression is under-detected in older people, with only 1 in 6 older people with depression discussing their symptoms with their GP, and less than 1/2 of these receiving adequate treatment. • MUS account for 20% -30% of consultations in primary care

23. Social Prescribing • Involves the use of non-medical interventions, sometimes called ‘social prescribing’ or ‘community referral’, to improve mental health and wellbeing. • Provides a significant opportunity to strengthen resilience in older people and/or people with LTC • Ideally best positioned in primary care • Social prescribing supports improved access both to psychological treatments and to interventions addressing the wider determinants of mental health

24. Social prescribing • http://www.centreforwelfarereform.org/uploads/attachment/339/social-prescribing-for-mental-health.pdf