Integrating mental health therapy into primary care

Primary care services are often the first point of contact for people experiencing mental health problems and plans set out in the NHS Long Term Plan build on the ambitions of the Five Year Forward View for Mental Health. The Long Term Plan ambition will see the number of people with anxiety disorders or depression who can access talking therapies through Improving Access to Psychological Therapies (IAPT) services increase by an additional 380,000 a year to reach 1.9 million adults and older adults by 2023/24. The Long Term Plan will continue to expand access to IAPT services for adults with common mental health problems, with a focus on those with long-term conditions.

To support this ambition, the NHS Mental Health Implementation Plan 2019/20 – 2023/24 provides a new framework to ensure delivery, at the local level, on the commitment to pursue the most ambitious transformation of mental health care in England. This transformation of mental health will also strengthen the primary care workforce which will offer a broader range of services for patients.

Improving Access to Psychological Therapies (IAPT)

Psychological therapies, provided through the IAPT programme, have high levels of success and support people to get on with their lives, including getting back to work. Psychological therapy has been shown to improve outcomes for people with a range of long-term conditions such as diabetes and chronic obstructive pulmonary disorder who also have a mental health problem such as depression or anxiety. There is also strong evidence for the use of therapies to support people with medically unexplained symptoms.

From 2018/19 all areas are expected to commission IAPT services which provide integrated psychological therapies for people with long-term health conditions, these are known as IAPT-LTC services. These will aim to ensure people with LTCs have the same access to National Institute for Health and Clinical Excellence (NICE)-recommended psychological therapies as other people. They will bring together mental and physical health providers so they can work in a coordinated way to achieve the best outcomes for all people, irrespective of their diagnosis.

There is a compelling case for delivering care in an integrated way to ensure that a person’s mental and physical health needs are met together. Integrating care:

  1. enhances the whole team’s capability to provide more comprehensive, accessible and holistic care. This can reduce costs through encouraging the prompt uptake of treatment and decreases the likelihood of people not attending appointments,
  2. promotes mental health awareness and faster diagnosis – identifying and addressing a person’s needs more quickly and accurately can reduce the number of frequent attenders and repeat assessments,
  3. promotes coordination and encourages the development of a single, jointly-developed care plan; this can lead to greater efficiencies and improved relationships within teams and services,
  4. is more cost-effective and can reduce a person’s use of physical health services.

Thirty-seven early implementer sites are leading the way in integrating psychological therapies with physical health care, helping people to achieve better health outcomes. Although the national evaluation of the impact of integration will not be available until late 2018, all sites are expected to carry out local evaluations and initial findings from a few of these show promising results. Cambridgeshire and Peterborough CCG analysed the self-reported outcome measures of 446 people who went through the integrated pathway and found that A&E attendances fell by 61%, hospital inpatient admission fell by 75%, and GP appointments for diabetes, cardio-vascular and respiratory fell by 73%.

Benefits of integrated mental health services in primary care

There are numerous examples of innovation and good practice where primary care and mental health professionals have embraced the opportunity of integrating physical and mental health provision. Where this is taking place the benefits seen include:

  • co-location of mental health therapists in GP practices gives an opportunity for psychological help and support at an early stage, helping to secure improvements in both physical and mental health,
  • by using NICE-approved psychological therapies in primary care settings and addressing mental health issues earlier, talking therapies help to improve patients’ health outcomes so they become less reliant on primary and emergency care. This holistic support can also help patients to self-manage their long-term conditions more confidently,
  • for older adults, the availability of mental health therapy in primary care settings means they can be treated for common conditions such as anxiety or depression at the time they present with physical health needs. Older people achieve good outcomes from IAPT treatment, sometimes better than people under 65,
  • co-location provides an opportunity for physical and mental healthcare professionals to share knowledge and good practice in order to focus on care for patients holistically,
  • mental health therapists have the opportunity to attend regular GP practice meetings as part of the extended primary healthcare team, supporting with general advice.

For further information please contact Strategic Communications: Mental Health team on 0113 825 3387.

Find out more

Intended for GPs, practice managers and commissioners Guidance on co-locating mental health therapists in primary care contains guidance on integrating mental and physical healthcare services, highlights organisational and financial issues, and provides case studies and blogs which exemplify good practice. For further information please contact Strategic Communications: Mental Health team on 0113 825 3387.