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Integrating mental and physical health in primary care

Dr Emma Tiffin is Clinical Mental Health Lead, Cambridgeshire and Peterborough Sustainability and Transformation Plan (STP), and an advocate for Improving Access to Psychological Therapies (IAPT) services within primary care.

Forty-six per cent of patients referred to our Psychological Wellbeing Service for a mental health problem also have a physical health long-term condition. These patients are used to being seen in their local GP practice, which is a familiar environment, providing both physical and mental health care, and most would choose to have their care provided here.

If the patient has a long-term condition such as diabetes or cardiovascular disease, at my GP surgery we will offer them an annual health check. This includes asking about any co-existing mental health problems. If mental health issues are identified patients are referred for talking therapy and I think are more likely to engage with treatment if this is offered at the practice location which they are used to attending.

Co-location usually means the patient doesn’t have to travel far for their psychological treatment which encourages attendance and for some patients receiving treatment in their GP surgery reduces their perception of stigma associated with having a mental health problem.

Feedback from IAPT therapists direct to GPs and the wider primary care team is another benefit of closer integration of psychological therapies into primary care and it facilitates better communication and coordination of patient care, as well as GP education and upskilling of primary care staff. For example, where patient consent is given, information on the cognitive behavioural techniques (CBT) used for the effective treatment of anxiety for individual patients can be shared more easily, as well as the management plan for that individual patient going forward.

The feedback process and the regular sharing of information between mental and physical health professionals, works well in multi-disciplinary team meetings, helping to ensure they are patient-centred. Effective communication and coordination of care in the primary care environment should also lead to an overall reduction in the number of patient referrals to secondary care, which releases capacity for patients that do need secondary care treatment.

As a GP I consider that an important part of my work is to help make patients’ access to mental and physical health care as quick and easy as possible and that includes informing patients about the options available to access treatments and normalising mental health as part of the GP offer.

Dr Emma Tiffin

Dr Emma Tiffin has worked in mental health clinical leadership roles for over 15 years. Most recently she has focused on developing a sustainable integrated community-based service model for planned and unplanned mental health care. The model includes a First Response Crisis Mental Health Service with local sanctuaries and a Primary Service for Mental Health (PRISM) which brings together specialist mental health (including IAPT), primary care and community services. She is a national adviser for the NICE programme of work developing a national community mental health pathway.

Dr Tiffin is a practising GP in Peterborough and has a weekly radio show, Health Matters, on BBC Radio Cambridgeshire. In 2016 she was awarded Health Education England’s East of England Leadership Award for Service Improvement and Innovation. The First Response Service won the Positive Practice Mental Health Award for acute/crisis care last October and in November Dr Tiffin was a runner-up for GP of the Year at the General Practice Awards. She was awarded Healthcare Leader of the Year at the 2017 national GP awards.

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9 comments

  1. Astri Griffin says:

    (I don’t think my last email went off) I have had a lifetime’s experience of being in the Mental Health system. Now 69 yrs old, off medication and enjoying leading an active life. I was wondering if I could be of some use to you, as I would very much like to help.

  2. Astri griffin says:

    Good morning.
    I have had a life time’s experience of being in the Mental Health system. I am now 69 and happy to say that I no longer need medication. (although I have a feeling that might be disputed by some doctors (none of whom know me well, but they look at my previous history.)
    I have been discharged from the service and I am enjoying leading an active life. I was wondering if you could ‘use’ me in any way, as I would very much like to help.

    • Emma Tiffin says:

      Hi Astri , thank you for this helpful offer. Your input am sure would be invaluable but probably best initially to contact your local patient engagement group, most areas have a mental health specific patient group to provide much needed input into the development of mental health services. I suggest asking your CCG as a starter. Thank you so much for getting in touch.

  3. vj says:

    As a patient who has had ongoing physical condition for 20 years and has recently struggled for the 1st time with my MH this article makes so much sense. I can’t knock my GP surgery as they have tried but I wish they all thought like you. I have been passed around secondary care, frustrated my GP and have ended up just sorting myself out with online forums/ courses. This was/is a really frightening time for me and do worry what could happen to patients who are not as strong as me. I have found charity organisations have been really helpful in my recovery and when I am 100% myself I will be giving back to these charities. I hope that all GP’s follow this in house help as a comfortable environment (my surgery) would have made all the difference.

    • Emma Tiffin says:

      Thank you for your feedback VJ and sorry to hear about your challenging experience , this is why we want to focus on providing increased mental health advice, support , services in the community , we hope this will help people access help more easily.

  4. Stuart L says:

    Dear Emma,
    Your work in the combining of mental health and primary care treatment is inspiring. I’m heading towards a workforce performance and bus. intelligence role within the NHS.
    Do you think there’s more work to be done in terms of the quality of data / analysis that you receive? I live in the South East area but i’m trying to gather some information and context on how I could add value in my region.

    • Emma Tiffin says:

      Thank you for your post , Stuart. Data is a huge challenge for us but vitally important for informing future development of effective, safe and responsive mental health (and all NHS) services. I think we have made progress but more needs to be done so very glad you are taking up this role. All the very best.

  5. Mrs Diane Gray says:

    We were at St George’s hospital in London yesterday with our son seeking help with what has been diagnosed as dystonia caused by a variety of antipsychotic and anti depressions prescribed over the last 3 and half years. My son is 47years old and was a high functioning Aspergers sufferer. His anxiety levels are unmanageable. He never took any medication until his bout of depression in 2015. He has been sectioned and detained 2 or 3 times. We were watched the TV this morning when they discussed meds not being advisable for those with autism. STOMP was mentioned. Please can you help us. Neil lost his job and is begging to get his life back. My husband is 76 and I am 74. We Struggling to cope.