The integration of mental and physical health care

Last week, UK Chief Medical Officer (CMO) Dame Sally Davies launched her annual report on public mental health, which informs national and local government policy in England.

The report calls for the integration of health-care services through a biopsychosocial framework and makes 14 policy recommendations. It has been welcomed by the Royal College of Psychiatrists (which defined six goals in response), the Faculty of Public Health, and others.

The report emphasises employment: the economic cost of mental illness is £13 billion per year. This cost is growing, with work days lost to “stress, depression and anxiety” having increased by 24% since 2009, and days lost to serious mental illness having doubled.

The CMO calls for better support from employers for staff with mental illness and recommends that training for doctors must include psychiatry. Stigma and discrimination continue to be a major issue. This is related to other difficulties that people with mental illness face: problems with sustaining social relationships, diminished opportunities for employment, and unmet needs for adequate physical and mental care. Problems experienced by children and young people have lifelong repercussions, however critics at the report's press conference suggested that the total disconnect between the Department of Education and the Department of Health render this impossible to overcome.

Critics have suggested that for the report to make any difference a much more radical vision is needed. The separation of mental and clinical health care has made integration impossible to achieve in any practical setting. Mental health has become an unattractive area of medicine to trainees, and the often mentioned parity of esteem remains elusive. Funding must be redefined such that it is a figure for health per se—not one apportioned between physical and mental health. The comorbidities of mental illness, such as obesity, heart disease, and lung disease, could then be treated in a holistic way. Perhaps the best that this report can hope to achieve is for the influence and voice of the CMO to stimulate discussion of this crisis, given that wholesale reconstruction of the system remains a distant prospect.