Mental health and general practice: intertwined futures

Mental health professionals were eagerly anticipating NHS England’s Implementation Plan, which would propose how the Mental Health Taskforce Report, Five Year Forward View for Mental Health, would be implemented. The plan’s significance could go beyond mental health: the best opportunities are related to how general acute hospitals and general practitioners can support people with mental problems.

The Taskforce report makes the recommendation that mental health should be more closely integrated with the rest of the health system. This will allow psychological and physical health to be considered together. The King’s Fund supports this principle and is working to help it with our ongoing projects and Learning Network.

The Sustainability and Transformation Fund will partially fund these approaches in the first few years. For the first few years, these approaches will be partially paid for by Bringing physical and mental healthcare together. We argued that the best opportunities for integration are in developing new strategies for mental health care within general practice settings as part of wider efforts to redesign primary and out-of-hospital care. This recommendation was also made in our research on pressures in general practice. This aspect of care should be improved, as 90 percent of adults with mental illness are treated according to general rules.

In general practice, the implementation plan includes some important measures. The General Practice Forward View announced the headline goal of 3,000 new mental healthcare therapists in GP offices. According to the project, this will help alleviate the pressure that general practices are under due to unmet mental needs. This is something that’s definitely needed. While this additional capacity may be helpful, I have concerns.

First, co-location is not always synonymous with integration. This is a statement that is made often but is still worth repeating. Our research into specialists who work in non-hospital settings has shown that drag-and-drop approaches do not have the greatest impact on bringing about changes. Mental health professionals in general practice are better able to alleviate pressure and improve care if they’re part of the primary care team. This will allow for an exchange of knowledge, skills, and information between mental health workers and GPs. This will allow primary care professionals the opportunity to gain confidence and increase their ability to manage mental health problems within general practice and to ensure the physical needs of those with mental health problems can be met.

Second, it is important to ensure that mental health therapists who work in general practice receive the right training and supervision. According to the implementation plan, much of the capacity increase will be aimed at people who have co-existing physical and mental health conditions or other complex symptoms. It is unclear whether the “top-up” training envisaged by the plan will suffice. Most evidence-based models of working with these groups of patients tend to include ongoing supervision by mental health specialists who have specific expertise in this area. The ‘early implementation’ sites will have to test different approaches.

The intense pressures that many GPs face are a major factor in the change of general practice. The General Practice Forward View builds on the trend of GPs working together with other professionals in practice groups, federations, and new care models that are being tested at vanguard sites. The high level of unmet mental health needs among patients using GP services and their impact on staff and patients alike makes it important to integrate primary care with mental health.

The Five Year Forward View for Mental Health Implementation Plan places the responsibility of bringing about the many planned changes on the shoulders of those who lead the 44 Sustainability and Transformation Plan footprints in England. STPs are a key lever for change, and the plan does a good job of identifying them. However, there is a danger that general practice and mental healthcare will be overshadowed by STPs focusing on the challenges faced by acute hospitals. STPs must not only address these issues but also catalyze the transformation of services beyond hospitals. In order to bring about this transformation, we must consider the futures of both general practice and mental health as part of the same discussion.

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