Integrated care still the holy grail for mental health services

The lack of integrated care and services for people with mental ill health has been the subject of two reports in the past week and has again highlighted the need for a change in thinking to ensure good practice becomes standard practice.

On the face of it, last week’s report by the Mental Health Foundation (MHF), ‘Crossing Boundaries: Improving integrated care for people with mental health problems’, contained little that isn’t already widely known.

For instance, it reminded us that good integrated care for people with mental ill health remains the exception rather than the rule and that current support for people with mental ill health is based on the flawed notion that physical and mental health care are separate concerns.

Neither of those points is a revelation. Nor was the MHF’s resulting call for a fundamental change in thinking about healthcare. They want commissioners and practitioners to recognise the benefits of integrated, holistic approaches that involve not just health and social care, but also bring in education, employment, housing and anti-poverty services.

Indeed, as the MHF’s Simon Lawton-Smith admitted, the need for an integrated approach to supporting people with mental ill health was identified 65 years ago when the NHS was founded.
But just because we have heard all this before – many times – does not mean it doesn’t need to be said again. It does, because integrated care remains a mirage for many people with mental ill health.

There is also a wealth of research and other evidence that shows the value of integrated working across services in improving outcomes. Indeed, a report released this week by the Bradley Commission emphasised the importance of community groups working with the criminal justice system to ensure people from black and minority ethnic communities are offered effective mental health support in the justice system. It highlighted the work of the African Caribbean Community Initiative in Wolverhampton and PLIAS Resettlement in London as successes in this field.

Effective integration takes time, obviously. To get services that have in many cases, and for many years, existed in silos to work together will not be easy. There are professional boundaries, funding issues and co-location problems to name but three major difficulties among the many that have to be tackled. But, tricky though it may be to make progress, things have to change – the evidence is there that integration works and, if some services can manage it, there is no reason why others can’t.

As the MHF says, it is down to the people involved – commissioners, managers and practitioners – from all areas of service to work together to implement good practice on the ground. Again, in no sense a revelation. But something that has to be re-emphasised because integrated care just isn’t as widely available as it should be.