Introduction
Despite the publication of a number of governmental policy documents asserting the need for parity of esteem between mental and physical health care,1,2 it remains the case that patients with severe mental illness often receive a service that is inadequate to meet their needs or improve outcomes.3,4 The costs to individuals and society are large, with over £11 billion spent by the NHS in England annually on functional illness and comorbidity arising from mental and physical health problems5 and an estimated total societal cost of schizophrenia in England of £6.7 billion.6 The need to integrate physical and mental health care was highlighted in the NHS's Five Year Forward View and was subsequently described as the ‘new frontier for integrated care’ by the King’s Fund.5,7 The term ‘triple integration’ was used by Simon Stevens to describe new models of care proposed in the Five Year Forward View; models in which integration of primary and specialist care, physical and mental health, and health and social care occurred.7 This article presents a case study that offers a model of integrated care.
Pitsmoor Surgery serves a population with twice the city average and three times the national average of severe enduring mental illness (SEMI). The Primary Mental Health Care Project (PMHCP) was set up by one of the project partners in the mid-1990s, as it was recognised that the needs of this population were being insufficiently met by the services available at the time. The project provides a holistic model of care to patients aged >16 years, suffering with a variety of enduring mental health problems, from severe depression and anxiety to schizophrenia, personality disorder, and bipolar disorder. The project aims to promote psychological, social, and physical wellbeing among its clients. The surgery employs and manages the project staff directly and is part-funded by the …