Co-morbidities: physical health and mental health problems together
The cost to the health system and to wider society of mental health problems among people with physical illnesses is considerable. By developing a more integrated response to patients' multiple needs, there is scope to both reduce costs and improve care.
Centre for Mental Health worked with The King's Fund and the London School of Economics to review evidence on the extent of co-morbidities, their impact on the quality and cost of care and the ways in which people with both a long-term condition and a mental health problem could be better supported.
The NHS costs of co-morbidities
Mental health problems can exacerbate physical illnesses and so substantially increase the care costs - by about 45%. Overall, £1 in every £8 spent on long-term conditions is linked to poor mental health, equating to £8-13 billion of NHS spending each year.
For example, co-existing mental health problems can lead to:
- increased hospitalisation rates - patients with chronic lung disease spend twice as long in hospital if they also have a mental health problem,
- increased outpatient service use - diabetes sufferers with mental health problems access double the amount of outpatient services as those with diabetes alone,
- less effective self-management - poor mental health means that people with heart disease or other long-term conditions are less likely to look after their physical health, take medication as intended and attend medical appointments.
They also affect clinical outcomes for patients and lower quality of life. For example, studies have shown:
- depression increases mortality rates after a heart attack by 3.5 times,
- children with diabetes are more likely to suffer retinal damage if they also have depression,
- co-existing mental health problems can have a greater effect on quality of life than the severity of the physical illness.
Mental and physical health problems have traditionally been treated separately with services designed around conditions rather than patients. Growing evidence suggests that more integrated approaches, with closer working between professionals can improve outcomes while also reducing costs. (From Long-term conditions and mental health, published with The King's Fund in 2012.)
What you can do - policy
Consider the impact of co-morbid mental health problems within all guidance and policy tools aimed at improving care for people with long-term conditions, including outcomes strategies, NICE quality standards and the NHS Outcomes Framework.
Create incentives to promote collection of routine data on co-morbid mental health problems.
Redesign payment mechanisms to support the development of more integrated services for people with long-term conditions and mental health problems.
Explore opportunities to use QOF and/or COF to encourage this.
Conduct or commission further work to improve outcome measurement in mental health.
Consider what role clinical networks for long-term conditions can play in mainstreaming mental health skills across the system.
What you can do - commissioning
Mental health support should be better integrated with primary care and chronic disease management programmes, with closer working between mental health specialists and other professionals.
Commission liaison psychiatry services in acute hospitals (for more details, see Liaison psychiatry).
Clinical commissioning groups should prioritise integrating mental and physical health care more closely.
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