Susceptibility of people with long term illness to depression and anxiety is not recognised, report says

BMJ 2012; 344 doi: (Published 08 February 2012) Cite this as: BMJ 2012;344:e950
  1. Nigel Hawkes
  1. 1London

A failure to recognise that people with long term conditions are often also depressed and anxious makes for poorer outcomes and substantially increases the cost of caring for them, say the healthcare think tank the King’s Fund and the independent Centre for Mental Health in a new report.

People with diabetes, heart disease, arthritis, and chronic obstructive pulmonary disease have a much greater chance of also having mental health problems that worsen their prognosis. Yet the “silo based care” offered by the NHS means that these mental health problems often go untreated or even unrecognised, the report says.

The results are damaging and expensive, it says. For example, depression increases mortality after a heart attack by a factor of 3.5, and patients with chronic obstructive pulmonary disease spend twice as long in hospital if they have a mental health problem, shows research collected for the report. Overall, the evidence indicates that 30% of people with long term conditions also have a mental health problem—a total of 4.6 million people in England.

Research in the United Kingdom and abroad indicates that the cost of treating long term physical conditions is 45% to 75% higher if they are accompanied by a mental health condition. The Department of Health for England estimates that 70% of NHS costs relate to long term conditions, so the report calculates from these two propositions that between £8bn (€9.6bn; $12.6bn) and £13bn a year of spending is attributable to the mental health comorbidity in this group. This is not the extra cost of mental health treatment but the increased demand on physical health treatments attributable to the comorbidity.

Opportunities exist to improve mental and physical health at the same time, the report suggests, but existing healthcare provision often fails to realise them. “A separation of mental and physical health is hardwired into institutional arrangements, payment systems and professional training curricula,” the report says.

“As a result, co-morbid mental health problems commonly go undetected among people with long-term conditions, and where problems are detected the support provided is often not effectively linked or coordinated with care provided for physical problems.”

The report calls for mental health to be integrated into chronic disease management programmes, with primary care being the focus for action. This should be a priority for all clinical commissioning groups and should not be left to the mental health professions alone. Payment systems need to be redesigned to support this integration, possibly by using the Quality and Outcomes Framework.

Chris Naylor, the report’s lead author and a fellow at the King’s Fund, said, “The prevailing approach towards improving care for people with long term conditions is at risk of failing unless we look at patients’ needs as a whole, including their mental health needs. To achieve this, mental health provision cannot simply be tacked on to physical care but needs to be an integral part of it.”

Sean Duggan, chief executive of the Centre for Mental Health, said, “Failing to support the mental health of people with long term physical conditions is costing the NHS billions of pounds at a time it can ill afford to spend money unwisely. Untreated or poorly managed mental ill health among this group is cutting lives short, reducing quality of life, and increasing health inequalities. Responding better, by contrast, will save lives, increase fairness, and cut costs.”


Cite this as: BMJ 2012;344:e950


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