Mental health and persistent pain: an introduction

In September 2018, the Q Lab and Mind embarked on a year-long collaboration to understand how care can be designed to best meet the needs of people living with both mental health problems and persistent back and neck pain.

The Q Lab focuses on specific health and care challenges and brings together organisations and individuals, to pool what is known and uncover new insights and ideas.

For some, mental health and persistent back and neck pain may sound like a niche topic. In reality, the numbers of people impacted by mental health problems and persistent back and neck pain in the UK are significant, and they are the two most common reasons for people to be on long-term sick leave or unable to work. A lot of attention has been given to these as individual needs, but more needs to be done to bring them together.

This topic – and what we’re learning as a result – is connected to the wider challenge of integrating care to meet people’s mental and physical health needs. The learning from the Q Lab and Mind’s work will provide useful insights for people interested in mental health problems and persistent back and neck pain, as well as individuals and organisations supporting people with combined physical and mental health needs and multiple long-term health conditions.

Over the coming months we will be sharing findings and resources. This essay offers a reminder of what the Q Lab is, the background and context for our work with Mind on this topic, and a flavour of what is to come.

What is the Q Improvement Lab?

The Q Lab – part of the Q initiative – provides an opportunity for individuals and organisations to collaborate and make progress on complex challenges that are affecting health and care in the UK.

The Q Lab works on a single challenge for 12 months – and in that time, convenes a group of people with experience and expertise in the topic (Lab participants). Together, we do research and sense-making, combining the best information and evidence about – and people’s experiences of – the challenge, and use this insight to support teams to develop and test ideas that have the potential to improve care. The Q Lab takes a developmental approach and aims to learn by doing, helping to build the skills and capabilities that are needed to deliver collaborative change.

The project on mental health and persistent pain is the Q Lab’s second project. The first project focussed on scaling patient-to-patient peer support and the learning and insights from this work are shared on this website. For more information on the Q Lab, take a look at What is the Q Improvement Lab? and Impact that counts essays.

Meeting the needs of people living with long-term physical and mental health problems

The Q Lab and Mind’s work aims to respond to the challenges of better meeting the needs of people living with long-term mental and physical health conditions.

Across the UK, long-term conditions are increasingly common. More than 15 million people (30% of the UK population) live with one or more long-term conditions (a condition for which there is no known cure, such as diabetes or arthritis). This will increase by another 3 million people by 2025.1 Every week, 1 in 6 adults experiences a common mental health problem such as anxiety or depression.2

Having either a physical or a mental health problem also makes you more likely to develop both – and this interrelationship goes both ways, with the conditions likely to interact and affect people in different ways.

Despite the interconnection of our mental and physical health (or more simply our minds and bodies), not enough people are receiving care that acknowledges and takes account of these needs at the same time.

This has a negative impact on individuals in lots of ways:

• Quality of life is worse for people with long-term conditions who also experience mental health problems. For example, people with long-term physical conditions are more likely to have lower wellbeing scores than those without.3
• Health outcomes are also affected. Evidence shows that health screening is worse for people with mental health problems – which means fewer people benefit from interventions to improve their physical health, such as weight management, diet, nutrition and exercise advice.4 There are also physical side effects of living with multiple conditions. For example, people with mental health problems regularly report that the physical side effects of their mental health medication have not been fully explained to them.5
• The impact of both conditions can affect many areas of someone’s life – their sense of identity, emotional wellbeing, ability to perform and thrive at work – which can also affect relationships with families, friends and carers.
• Research tells us that despite this, people are not receiving joined-up care. For example, only 1 in 5 people with arthritis reports being asked about emotional or social issues by a rheumatology professional, even though almost half would like the opportunity.6 The Mind Big Mental Health Survey 2017 found that less than half of the 8000+ respondents felt able to discuss a physical health issue at the same time as discussing their mental health, when attending primary care.7

These issues impact the health and care system – increasing costs and pressures within services. It is estimated that the effect of poor mental health on people living with long-term physical conditions costs the NHS at least £8 billion a year.8

Supporting and improving quality of life for people with mental and physical health needs is not just a priority for the NHS – it is also a public health issue. Increasingly people are living longer – but are doing so with greater health needs. In England, the economic and social burden from people living with disabilities is more significant than the impact of people dying young.9 Increased disability drives demand for statutory services and reduces productivity and employment. It is the product of, and reinforced by, health inequalities.

Shifting the status quo

There is no easy fix for systematically supporting people’s mental and physical health needs. Whole-system change will involve adapting the way services are commissioned, designed and delivered, as well as how health care professionals are trained and supported to work together across professional and/or organisational boundaries. Despite these challenges, there is growing recognition of the need to change the status quo.

Increasingly, services are moving towards delivering care using the ‘Biopsychosocial Model’ – a model that acknowledges and recognises the combined biological, psychological and social factors that determine our health and wellbeing.

There is also a drive to increase provision of mental health services, and to support the delivery of better integrated services – through new models of care, strategic transformation partnerships, and the recent commitment in the NHS Long Term Plan that every area will be served by an integrated care system by 2021. Charity and campaigning organisations are collaborating to promote the importance of mental and physical health, for example the Equally Well UK initiative, and many organisations are developing and delivering holistic models of care, that meet people’s physical and mental health needs.

The Health Foundation, who deliver the Q Lab, have funded a wide portfolio of improvement projects that aim to provide more holistic and joined-up care for people living with long-term physical and mental health conditions, including the recent successful programme 3 Dimensions for Long-term Conditions. This programme has integrated mental, physical and social care support in long-term conditions across community and secondary services in London. Find out more at: www.health.org.uk/improvement-projects/integrating-mental-physical-and-social-care-in-long-term-conditions 

From mental and physical health to persistent back and neck pain

When Mind and the Q Lab agreed to collaborate, we knew that improving care for people with mental and physical health was the right area to focus our work. It is an important topic that’s ripe for improvement.

It also allows us to build on the great work that’s happening already. For example, we drew on Mind’s work on reducing stigma for people with mental health through Time to Change (which works to end mental health discrimination by changing the way we all think and act about mental health problems) as well as their successful programme Building Health Futures that explored ways to improve the wellbeing, resilience and confidence of people with heart disease, diabetes and arthritis who may be at risk of developing mental health problems.10

In order to undertake rapid research and develop and test ideas and solutions in practice in just 12 months, a more defined scope was needed. Through reviewing the evidence and speaking to a range of people in this field, a more focussed topic – improving care for people living with both mental health problems and persistent back and neck pain – was identified.

As you’ll go on to read in the next essay Challenges and opportunities to improve, many of the challenges and solutions we identify are either connected, or directly speak to, the challenges of bringing together physical and mental health care provision.

What we aim to achieve

The Q Lab and Mind have worked with others to understand the problem deeply, from a range of perspectives, drawing on data, evidence and experience. Our learning is shared in this essay collection to increase people’s awareness and understanding of the topic, and importantly to increase momentum for change – by highlighting opportunities and practical insights that are useful for people working in and with health and care.

The outputs take into account the evaluation of the Q Lab – conducted by the Innovation Unit – which has provided insights on the types of resources that are most useful for people working to improve health and care, in order to act on the findings.

(If you’d like to find out more about the impact we aim to achieve, take a look at the Impact that counts essay from our first project.)

What to expect from this essay collection

This essay collection presents the findings from the Q Lab and Mind, and the organisations and individuals who have worked with us on this challenge. The learning is shared as openly as possible, as we collectively seek to identify challenges and opportunities that have potential for use in services and organisations across the health and care system.

The next Lab essay in this collection – Challenges and opportunities to improve – brings together the outputs from surveys, workshops and interviews involving over 150 people. If you have lived or professional experience in mental health and persistent back and neck pain, the insights in this essay may be familiar to you and we hope it is a useful tool for you to share and build support for your work. If you are new to the topic – and want to understand more – this essay will provide an overview of the known problems and potential solutions and practical ideas that have worked elsewhere, that may be relevant for you to consider locally.

At the time of writing this essay, we have just started to work with four organisations – Health Innovation Network, Robert Jones and Agnes Hunt Orthopaedic Hospital, Powys Teaching Health Board and Keele University with Midlands Partnership NHS Foundation Trust – to build on our initial sense-making of the topic and translate that into practical actions to improve care.

Over the next six months you can also expect to see from us:

1. Practical ideas and solutions to address this topic that have been shown to work elsewhere, with advice about how this could be translated to different contexts.
2. Information on using design approaches to develop and test ideas in practice, curating learning from supporting four organisations to test ideas with the potential to improve care for people living with mental health problems and persistent pain.
3. Ideas on developing skills for collaborative improvement – including a framework for the skills and attitudes for collaborative and creative problem solving (co-produced with Nesta).
4. Learning from delivering the Q Lab – with stories of how the Lab approach and ethos is helping to deliver impact to health and care in the UK – and what this means for others seeking to deliver change at scale, and for the evolution of the Lab in the coming year.

Next steps

• Discover what the Q Lab and Mind have learned about mental health and persistent pain in Challenges and opportunities to improve
• Know someone who might be interested in this essay? Share it!
• To connect with people interested in transforming care for people with mental health and persistent back and neck pain, join the Q Lab online group.
• If you have ideas about what you’d like us to produce in the future, get in touch at QLab@health.org.uk