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Tackle mental health problems among those with long-term conditions, says thinktank

8041611-article-womaninbedFollowing NICE clinical guidelines can help improve the care of people with long-term conditions who also have mental health problems, a leading thinktank says.

People with long-term health conditions such as diabetes or heart disease are two to three times more likely to experience mental health problems than the general population.

Currently, around 4 million of the 15 million with long-term conditions have mental health problems.

Since £1 in every £8 spent on long-term conditions is linked to poor mental health, it is estimated that dealing with co-existing mental health problems costs the NHS in the region of £8-13 billion.

A new report by The King's Fund says following certain steps, such as those outlined in NICE guidelines, can ensure that mental health problems are identified and tackled more appropriately, improving care and potentially saving the NHS billions.

The report suggests poor mental health problems complicate physical health conditions. This leads to more time spent in hospital, poorer clinical outcomes, lower quality of life and a need for more intensive support from health services.

To tackle the issue, it calls for earlier detection of mental health problems in those with long-term conditions, in line with NICE clinical guidelines.

It says that a collaborative approach to services is important. This is because integrating services can improve outcomes without additional costs and can also lead to potential cost savings.

The report refers to NICE's clinical guideline on depression with a chronic physical health problem, which provides advice on the identification and treatment of depression in those with long-term health conditions.

The clinical guideline says that healthcare professionals should be alert to possible depression among patients with long-term conditions.

Healthcare professionals should ask patients questions to determine the level of their depression, in particular among those with a history of the condition and those with a long-term physical health problem with associated functional impairment.

The clinical guideline also recommends that a collaborative approach to care should be provided in primary or secondary care.

This should include case management which is supervised and has support from a senior mental health professional.

There should be close collaboration between primary and secondary physical health services and specialist mental health services, and the care model should feature a range of interventions.

This includes patient education, psychological and pharmacological interventions, medication management and long-term coordination of care and follow-up.

Chris Naylor, Fellow of Health Policy at The King's Fund and the report's author, said: "The NICE clinical guidelines on depression with a chronic physical problem are really useful as they are the first time national guidelines that have addressed a group with combined physical and mental health problems.

"The guidelines say that for a subset of people with acute problems, what you need is a collaborative care model with case management and routine checking up on mental health needs."

He added: "The issue of integrating mental health and primary care is what the collaborative care model is about. NICE guidelines do a good job of explaining why that care model can be beneficial for patients."

A range of implementation tools are available to support the use of NICE's clinical guideline. These include audit support and an online education tool.

10 February 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.