Commissioning an integrated mental and physical health

service for people with Long Term Conditions and

Medically Unexplained Symptoms

Dr Theresa Eynon MRCPsych MRCGPCLAHRC Clinical Translation Fellow WLCCG

The Mind the Body and the NHS

Change the behaviour and the thoughts will follow

Outcomes or process?

Monitor the outcomes and the service will improve

Session Plan

Overlapping problems

Why not?

Patients who because of lifestyle and social conditions tend to be high users of services in an unplanned way. They are often labelled as using services “inappropriately” but this can be because of a lack of understanding, or chaotic life events. It prevents them from getting the best from the support available to them. They include patients with mental health problems, learning disabilities, and drug or alcohol addictions.

Pro-Active care: Exclusions

85yr old lady

Foot Pain

I have no reason to go out anymore

Painful feet

Seeking medical help and avoiding movement

Low mood

Little dog dies

Medieval Mind

GP clinic helps with MUS?

Effective psychosocial interventions identified in reviews tend to show three characteristics:

◦ They have a clear structure/model/plan.◦ They have a focus on problems of relevance to

the patient/client.◦ They build on the relationship with the

practitioner.

Service characteristics

They will be supported to self care, have more confidence and control over their condition and understand the impact it will have on their lives.

There will be a genuine shift towards addressing a person’s full range of needs, including psychological and emotional support, rather than simply focusing on a medical model.

(Department of Health, 2010)

LTCs: In a Good Service...

Who could help this person?

What skills will they need?

How could you measure whether or not the team had helped this patient?◦ Wellbeing measures, PHQ9, GAD7◦ Physical measures HbA1C, BMI, walking distance◦ Social measures WASA, return to work, PROM◦ Service measures LTC6

How would we know?

Patient Centred Outcomes

diabetic reviewincreased metformin 3m ago

increased HbA1C 8.0 increased weight 7k BMI 40.1 Painful knees 

Mrs Drucker has diabetes

Five Areas Model (after Williams 2001)

Motivational interviewing skills

Simplified behavioural CBT models suitable for primary care

Patient centred outcome models

Compassionate mind or intelligent kindness?

Upskilling professionals

What are the organisational and professional barriers to providing person-centred outcome measured services?

How could these be overcome?

What training do professionals need to have to help them integrate physical and mental health care?

Barriers to person-centred care

Hugh Griffiths – DoH at PRIMHE 2011

We need to measure outcomes that matter in people’s lives

The person at the centre care is in the best position from which to measure the effectiveness of “person-centred” care services

Commissioning for outcomes