The London Mental Health Fact Book Better integration of services saves lives and money When acute hospital staff and mental health services work together there can be benefits for patients’ physical and mental health and the wider economy By Dr Steven Reid, Clinical Director for Psychological Medicine, Central and North West London NHS Foundation Trust Modern medicine is leading to increasing specialisation, an emphasis on technology and a focus on shortened inpatient stays. This can mean acute hospital staff find it difficult to explore and address their patients’ psychological problems as they work to meet ever-tighter treatment and discharge targets. Yet, if left untreated, mental health problems in acute inpatients can actually result in delayed discharge, higher costs and increased mortality. Liaison psychiatry addresses the mental health needs of the many people attending acute hospitals in emergency departments, inpatient and outpatient settings. But some ask why should this be made a priority service? There is a growing body of evidence that shows the personal, economic and social benefits of tackling issues both physical and mental via a programme of integrated care. The links between mental and physical health are not purely academic – and are frequently closer than some might think. Over 25 per cent of people admitted to hospital also have a mental health problem. In older adults (over 65), where delirium and dementia are more prevalent, the proportion rises to 60 per cent. Deliberate self-harm is one of the five most common reasons for an emergency medical admission– over 150,000 Emergency Department (ED) attendances year on year 80 per cent of all hospital bed-days are occupied by people who have both physical and mental health problems. So, in addressing people’s mental health needs over the long term they become less likely to be admitted with physical health problems compounded by mental ill-health. Mental health problems also substantially increase the costs of physical health care. Overall, it is estimated that co-existing mental health problems cost the NHS around £13.5bn a year in extra spending on physical health services. Nearly half of this total falls on general and acute hospitals. For a typical 500-bed general hospital, this is equivalent to extra costs of around £25m a year. A reasonable objective for a liaison psychiatry service in a typical general hospital would be to generate savings of up to £5m a year, particularly by reducing lengths of stay among older inpatients. These savings would be over and above any improvement in health outcomes for the patients themselves. A joint approach to managing the physical and mental aspects of patient care should be seen as a prime example of the oft-quoted need for better integration of services. 16
London Mental Health Fact Bbook
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