Staff not structures key to integrated mental health care, report says

Good integrated care for people with mental ill health remains the exception rather than the rule, and the commitment of commissioners and frontline staff to cross-boundary working is the single biggest factor in making it standard practice, a report has found.

The report, ‘Crossing Boundaries: Improving integrated care for people with mental health problems’, by the Mental Health Foundation (MHF) highlights that current support for people with mental ill health is based on the flawed idea that physical and mental health care are separate issues.

As a result, the MHF has called for a fundamental change in thinking about healthcare, and for commissioners and practitioners to recognise the benefits of integrated, holistic approaches that involve not just health and social care services, but also education, employment, housing and poverty.

The report is based on the results of a year-long Inquiry, which considered more than 1,200 responses from mental health service users, carers and family, and health professionals and looked at published evidence on integrated care.

In terms of how current care provision can be better integrated, the Inquiry identified two underpinning essentials:

• Having the right people in the organisation – leaders who will drive forward integration at a strategic level and staff who understand and respect the roles and responsibilities of other professions and are willing to work with patients and across organisational and professional boundaries
• Cross-boundary inter-professional training and education – there is a pressing need for more inter-professional education and training on mental health, both in terms of its genesis and indivisibility with physical health. This must be on-going with continuing professional development.

Enabling integrated care

The Inquiry also identified 9 areas where good practice can play a role in facilitating integrated care for people with mental ill health:

1. Information-sharing systems
2. Shared protocols
3. Joint funding and commissioning
4. Co-located services
5. Multidisciplinary teams
6. Liaison services
7. Navigators
8. Research
9. Reduction of stigma.

Simon Lawton Smith, head of policy at the MHF said: “The need for an integrated approach to supporting people with mental health problems was identified 65 years ago when the NHS was founded. Failure to provide integrated care is not a failure of understanding what needs to be done, it is a failure of actually implementing good practice in organisational strategies and the day-to-day business of organisations and staff.

“We identified 9 structural factors that can help to establish effective integrated care for people with mental health needs. While these are all helpful, the key message from our inquiry is that it is the quality of people involved that makes or breaks integrated care – leaders with a determination to drive forward integrated care at an organisational level, and staff who understand the holistic nature of health care and are have no professional defensiveness about working closely with colleagues in other disciplines and with patients and families.”