Physical and Mental Health

Mental HealthThis chapter emphasizes that innovation at the interface between physical and mental health has often been driven by individual clinical champions working, at least initially, in relative isolation from the rest of the system. To be sustainable, the work of these clinical innovators needs to receive support from senior leaders within local organizations and must be reinforced by consistent messages from this leadership. A powerful catalyst for cultural change is direct contact between professionals working in different parts of the system—specifically, those traditionally responsible for physical health and those specializing in mental health. Given this, service models that create opportunities for skills transfer between mental and physical healthcare professionals have particular potential. Physical and mental health are closely dependent on each other. Evidence reviewed in this chapter demonstrates that having a physical health condition significantly increases the risk of developing a mental health problem and vice versa. More broadly, mental health is a vital component of health and well-being and is influenced by the activities of all parts of the healthcare system. It is for this reason that the World Health Organization has long argued that there is “no health without mental health” (Herrman H, Saxena S, Moodie R. Promoting mental health. Concepts, emerging evidence, practice. World Health Organisation, 2005). Despite this interdependency, it often remains the case that the institutional architecture of health systems, the design of reimbursement systems, and the training and education of professionals all tend to reinforce structural and cultural barriers between mental and physical health care. As described below, these barriers mean that mental and physical health is often treated as if existing in isolation of each other. When thinking about this dimension of integrated care, there are three separate but closely related issues that require consideration: 1. Comorbidity between long-term physical health conditions and mental health problems is highly common and has a significant effect on outcomes. 2. Psychological distress is frequently expressed in the form of physical symptoms—so-called medically unexplained symptoms that lack an organic cause and are often challenging to manage. 3. All physical illness can have an important psychological or emotional component, regardless of whether or not a diagnosable mental health problem is present. The first two of these issues relate to defined client groups, whereas the third is a cross-cutting issue applicable to any form of health care. All three have profound implications for integrated care. In this chapter, we will focus largely on the specific needs of people with comorbid conditions and/or medically unexplained symptoms. However, many of the principles discussed are also relevant to the wider issue of the psychological and emotional aspects of health.