Mental health strategy has historically been seen as separate from mainstream health strategy and planning.

However, this is no longer the case, for there are a number of mental health developments that are synergistic with and potentially supportive of wider healthcare priorities.

A number of significant recommendations for mental health highlighted by Lord Darzi's review of the NHS address the interface between mental and physical healthcare. These give weight to the World Health Organisation's assertion: "There can be no health without mental health."

For example:

  • physical morbidity and mortality are substantially increased in people with severe mental illness, who die on average 10 or more years earlier. This inequality requires concerted action in primary care and from secondary mental and physical healthcare providers;

  • unrecognised mental illness, including psychiatric concomitants of long-term medical conditions (such as diabetes), "medically unexplained symptoms" at all ages, and depression and dementia in the elderly add huge avoidable costs for general hospitals;

  • improvements in maternal and child mental health require close working between maternity staff, health visitors and community-based mental health specialists to identify perinatal mental illness before it harms mother and child;

  • greater attention needs to be focused at all ages on alcohol and drug misuse, which are associated with a range of serious physical and mental illnesses;

  • the imminent national dementia strategy emphasises the need for earlier diagnosis and intervention in all health and social care settings, the achievement of which will require a concerted educational programme.

Common themes

The regional mental health group chairs identified common national themes and priorities, published as Moving Forwards: pathways to better mental health and wellbeing. This has been received constructively by the Royal College of GPs and Royal College of Psychiatrists, whose collaboration is essential.

These developments in mental health offer significant potential benefits for general healthcare. For example:

  • it has been recognised (in High Quality Care for All) that the care programme approach, which is integral to effective mental healthcare, provides a model for improved care in long-term medical conditions: systematic biopsychosocial assessment, active service user and carer involvement, multi-agency co-operation, and care co-ordination;

  • enhancement of commissioning for quality in mental health will address the substantial overlap between mental and physical ill-health, to the benefit of both;

  • attention to public mental health will provide a basis for health promotion, illness prevention and population-based strategic planning, which benefits physical and mental health jointly;

  • developing contract currencies for mental healthcare will incentivise mental health providers, for whom the absence of a payment by results system is seriously disadvantageous. This work also offers the prospect of currencies based on health needs rather than provider activity, which are capable of defining tariffs for long-term community-based treatment, which changes over time, and that recognise social care and other dimensions of comprehensive care. This model for payment by results could be applicable to long-term medical conditions and other chronic illnesses and disabilities, both mental and physical.

Clinical leadership is essential to achieve the potential benefits of these initiatives. Collaboration is needed at all levels - between primary and secondary care; mental and physical healthcare; providers and commissioners; NHS, social care and third sector organisations at local, regional and national levels. This could actually achieve high-quality healthcare for all.