Mental health and physical health

Michael Parsonage explores the impact on health outcomes and costs of mental and physical ill health. Michael is Senior Policy Adviser, Centre for Mental Health, and Visiting Senior Fellow, PSSR

Managing patients with complex needs: Evaluation of the City and Hackney Primary Care Psychotherapy Consultation Service

Every day, across England, people are seeking help for distressing and painful conditions with which their family doctors are unable to help and for which no specialist service is available. Many visit their GPs, hospitals and other health services many times, yet their problems remain unresolved, at a high cost to them, to their families and to the NHS. People with medically unexplained symptoms, people with personality disorders and those with complex mental health problems frequently get‘bounced’ around the NHS, passed from one service to another, none able(or willing) to offer them the flexible, personalised and sometimes time- consuming support they require. A group of GPs in the City of London & Hackney decided to tackle this by setting up a new service for those with mental health problems they could not manage through existing primary care services who fell outside the scope of other local mental health services. The ground-breaking Primary Care Psychotherapy Consultation Service (PCPCS), implemented and run by the Tavistock and Portman NHS Foundation Trust, is the result of that innovation. It offers help for a range of needs, close to home, often in people’s own GP surgeries, rather than in remote clinics. This includes a range of psychological therapies, joint consultations with GPs, and training for primary care staff to enhance their capacity to help. As this report demonstrates, it can change people’s lives and dramatically improve their health and wellbeing

Lifetime costs of perinatal anxiety and depression

Background: Anxiety and depression are common among women during pregnancy and the year after birth. The consequences, both for the women themselves and for their children, can be considerable and last for many years. This study focuses on the economic consequences, aiming to estimate the total costs and health-related quality of life losses over the lifetime of mothers and their children. Method: A pathway or decision modelling approach was employed, based on data from previous studies. Systematic and pragmatic literature reviews were conducted to identify evidence of impacts of perinatal anxiety and depression on mothers and their children. Results: The present value of total lifetime costs of perinatal depression (anxiety) was £75,728 (£34,811) per woman with condition. If prevalence estimates were applied the respective cost of perinatal anxiety and depression combined was about £8,500 per woman giving birth; for the United Kingdom, the aggregated costs were £6.6 billion. The majority of the costs related to adverse impacts on children and almost a fifth were borne by the public sector. Limitations The method was exploratory in nature, based on a diverse range of literature and encountered important data gaps. Conclusions: Findings suggest the need to allocate more resources to support women with perinatal mental illness. More research is required to understand the type of interventions that can reduce long-term negative effects for both mothers and offspring

Peer support in mental health care: is it good value for money?

Peer support workers - people with their own lived experience of mental illness - provide mutually supportive relationships in secondary mental health services. Increasing numbers are being employed, both in this country and elsewhere. But good quality evidence on the effectiveness of this form of service delivery is in short supply and even less is known about its cost-effectiveness. This paper makes a first attempt at assessing whether peer support provides value for money, looking specifically at whether peer support workers can reduce psychiatric inpatient bed use. Because of the very high cost of inpatient care, the savings that result from even small changes in bed use may be sufficient to outweigh the costs of employing peer workers

Short-changed: spending on prison mental health care

Last year, £20.8 million was spent on mental health care in prisons through inreach teams. This is 11% of total prison health care spending or just over £300 for each member of the prison population. Prison inreach teams aim to provide the specialist mental health services to people in prison that are provided by community-based mental health teams for the population at large. But inreach teams have been hindered by limited resourcing, constraints imposed by the prison environment, difficulties in ensuring continuity of care and wide variations in local practice. Government policy for prison health care is based on the principle of equivalence. This means that standards of care for people in prison should be the same as those available in the community at large, relative to need. The level of need for mental health care in prisons is particularly high, because of the much greater prevalence of mental illness, especially severe mental illness, among prisoners than among people of working age in the general population. While more is spent per head on mental health care in prisons than in the wider community, this is not nearly enough to accommodate this much higher level of need. The resources currently available for mental health care in prisons are only about a third of the amount required to deliver the policy objective of equivalence. Spending on prison mental health care also varies widely across the country. In London and in the North East, Yorkshire and Humber, the NHS spends more than twice as much per prisoner than it does in the East Midlands and the South West. This variation cannot be explained by different levels of need or costs: it amounts to a postcode lottery in prison mental health care. Major investment is needed in the overall level of provision for mental health care in prisons and in its geographical allocation if equivalence is ever to be achieve

2-Hour Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker

Objectives The purpose of this study was to determine whether a new accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge (with follow-up shortly after discharge). Background Patients presenting with possible acute coronary syndrome (ACS), who have a low short-term risk of adverse cardiac events may be suitable for early discharge and shorter hospital stays. Methods This prospective observational study tested an ADP that included pre-test probability scoring by the Thrombolysis In Myocardial Infarction (TIMI) score, electrocardiography, and 0 + 2 h values of laboratory troponin I as the sole biomarker. Patients presenting with chest pain due to suspected ACS were included. The primary endpoint was major adverse cardiac event (MACE) within 30 days. Results Of 1,975 patients, 302 (15.3%) had a MACE. The ADP classified 392 patients (20%) as low risk. One (0.25%) of these patients had a MACE, giving the ADP a sensitivity of 99.7% (95% confidence interval [CI]: 98.1% to 99.9%), negative predictive value of 99.7% (95% CI: 98.6% to 100.0%), specificity of 23.4% (95% CI: 21.4% to 25.4%), and positive predictive value of 19.0% (95% CI: 17.2% to 21.0%). Many ADP negative patients had further investigations (74.1%), and therapeutic (18.3%) or procedural (2.0%) interventions during the initial hospital attendance and/or 30-day follow-up. Conclusions Using the ADP, a large group of patients was successfully identified as at low short-term risk of a MACE and therefore suitable for rapid discharge from the emergency department with early follow-up. This approach could decrease the observation period required for some patients with chest pain. (An observational study of the diagnostic utility of an accelerated diagnostic protocol using contemporary central laboratory cardiac troponin in the assessment of patients presenting to two Australasian hospitals with chest pain of possible cardiac origin; ACTRN12611001069943