Filling the chasm: Reimagining primary mental health care

Centre for Mental Health, December 2018

Report from the Centre for Mental Health exploring a number of local initiatives which are bridging the gap between primary care and secondary care services, supporting people who fall into this ‘grey area’ due to having more complex needs, not meeting secondary care thresholds, or presenting with multiple or medically unexplained symptoms.  It looks at

  • Identifying the opportunities for prevention and promotion of mental health
  • Maximising social interventions for mental health
  • Culture change – embracing the holistic approach
  • Empowering the person – moving ‘from patient to person’
  • Bridging the gap between primary and secondary care

Click here to view the full report.

Consultation liaison in primary care for people with mental disorders

Cochrane Database of Systematic Reviews, September 2015

This Cochrane review finds evidence that consultation liaison improves mental health for up to three months; and satisfaction and adherence for up to 12 months in people with mental disorders, particularly those who are depressed.

Click here to download the full review.

Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease

BMJ, 16 February 2015

The objective of this study was to test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions.

The design of the study was a  cluster randomised controlled trial in 36 general practices in the north west of England.

 Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses.

19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval −0.41 to −0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support.

The study concludes that collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity.

Click here to read the full text article.

The community care chest is running out of cards

BMJ, 13 August 2014

Most people blame the present problems of the NHS in England on its bungled reorganisation by the former health secretary Andrew Lansley. But while the Health and Social Care Act 2012 may deserve its place as top bungle, it’s a close run thing with Transforming Community Services, one of Labour’s last acts in office before it was voted out in 2010. Community services in England were certainly transformed but not in a good way: the result is sad, if you believe in the vital necessity of these services. Join a fairly small club if you do. And while it’s often claimed that Lansley was driven by ideology, Transforming Community Services really was. Service commissioners couldn’t be providers, so they were instructed to rid themselves of their provider arms: health visitors, district nurses, physiotherapists, chiropodists, providers of contraception and sexual health, and sundry others. GPs think the right place for many of these services is in primary care. Acute care trusts think they ought to be integrated with hospitals. Both can make a case, but rather than doing one or the …


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