The range of care across the pathway includes:
- Primary care management of ‘active monitoring’ and positive diagnosis, management of common mental health problems, guided self-help strategies and programmes, motivational interviewing.
- Psychological interventions at the primary/ secondary care interface, including integrated/stepped/collaborative care models with planned and coordinated care, interdisciplinary working and clear access points to services.
- Interventions for those with severe problems to improve physical health, e.g. smoking cessation69 averting weight gain [CBT] and weight reduction.70
- Invitation letters for physical health checks may be responded by more than 60% of those with severe problems. 71
- Psychological care input into long-term conditions and acute hospital multidisciplinary teams.
- Development of liaison psychiatry services in acute hospitals to provide assessment, treatment, advice, consultation and management of complex cases.
Outcomes can be improved:
- If health promotion programmes specifically address the common relevant issues; poor attention, concentration and motivation, social anxiety and fear and suspicion of other people. People with mental health problems are less likely to benefit from mainstream screening and public health programmes.
- Regular health checks can also improve detection rates but those who need them most are least likely to access them. Closer links between primary and secondary care e.g. assertive outreach teams bringing service users to primary care or facilitating home visits can substantially improve detection and support intervention 72.
- Pro-active ‘recovery-focussed’ prescribing can reduce metabolic and other side effects.
- ‘Hand-held’ records shared between primary and secondary care for psychosis do not seem to work nor do primary care facilitators.
- Collaborative working with secondary care mental health services has the potential to improve health care (see Case for Change: Severe Problems).
- Community mental health teams can engage with people with long-term mental health problems; care coordinators and/or Support, Treatment and Recovery workers can bring them to health centres or facilitate home visiting
- Assertive outreach teams have been shown to be able to engage the most difficult group of patients and can similarly collaborate with primary care