Post on 31-Mar-2015
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