The NHS could improve care and reduce costs by improving how it treats patients suffering from both mental and physical health conditions, a new report says.

A more integrated approach to treating them - rather than approaching conditions separately - could help the 4.6m people thought to have both a long-term physical condition and mental health issues.

“Between 12 and 18 per cent of all NHS expenditure on long- term conditions is linked to poor mental health and wellbeing - between £8bn and £13bn in England each year,” says the report, produced by the King’s Found and the Centre for Mental Health.

Patients who have a mental health issue alongside a long-term condition are likely to have longer hospital stays, increased outpatient visits and less effective self-management, adds the report, Long-Term Conditions and Mental Health: The Cost of Co-morbidities. Overall, mental health problems increase the total cost of healthcare for the individual by at least 45 per cent.

In some cases, having mental health problems are likely to result in worse outcomes for physical conditions - including a 250 per cent increase in mortality rates after a heart attack. There is also a strong link with deprivation.

Chris Naylor, the report’s lead author and fellow at the King’s Fund said: “The prevailing approach towards improving care for people with long-term conditions is at risk of failing unless we look at patients’ needs as a whole, including their mental health needs. To achieve this, mental health provision cannot simply be tacked on to physical care but needs to be an integral part of it.”

The authors suggests a number of steps which could improve integration:

*clinical commissioning groups could use levers such as CQUIN to push providers towards more integrated care

*care pathways for people with long term conditions could include support for mental health support

*liaison psychiatry could be strengthened

*the amalgamation of mental health trusts and PCT provider arms in some areas could offer opportunities to take more integrated approaches

*NHS payment systems could ultimately be redesigned to promote integration.