Article Text

SP0115 The link between long-term conditions and mental health
  1. C. Naylor
  1. The King’s Fund, London, United Kingdom


Mental health problems are common among people with rheumatological conditions and other long-term health problems. For example, depression and anxiety are significantly more prevalent among people with arthritis than in the general population. This has profound implications both for patients and for the planning and delivery of health services.

Research evidence demonstrates that there is a strong two-way interaction between mental and physical health. Co-morbid mental health problems can exacerbate long-term conditions, leading to poorer clinical outcomes and lower quality of life. In some cases the presence of mental health problems can have a larger effect on quality of life than the severity of a person’s physical illness.

The cost implications for the health care system are highly significant. Our review of international evidence indicates that co-morbid mental health problems raise total health care costs by at least 45 per cent for each person with a long-term condition and co-morbid mental health problem. We estimate that between 12% and 18% of all health service expenditure on long-term conditions is linked to poor mental health.

There is also an interaction with social conditions. People with long-term conditions and co-morbid mental health problems disproportionately live in deprived areas and have access to fewer resources of all kinds. The interaction between co-morbidities and deprivation makes a significant contribution to generating and maintaining inequalities.

Health services in many countries are not organised in a way that allows them to respond to the challenge posed by mental health co-morbidity among people with long-term conditions. In many systems, existing structures make it difficult to provide coordinated support for patients’ multiple needs. In the case of long-term conditions and mental health, high quality care is hindered by a professional, institutional and cultural separation between mental and physical health. This creates fragmented services in which opportunities to improve quality and efficiency are often missed.

A growing evidence-base suggests that care for large numbers of people with long-term conditions such as rheumatology could be improved by better integrating mental health support with primary care and chronic disease management programmes, with closer working between mental health specialists and other professionals. The evidence also suggests that in several cases, interventions designed to close the gap between mental and physical health care can deliver significant financial returns by improving patients’ physical health and reducing the costs related to their care.

Better support for the emotional, behavioural and mental health aspects of physical illness could therefore improve the lives of many people with rheumatological and other conditions, while also helping health care systems to find the efficiencies needed in response to the current challenging financial conditions.

This presentation will be based on original research published in the United Kingdom by the King’s Fund and the Centre for Mental Health. The research involved a review of research studies from several countries. The presentation will explore the impact of co-morbid mental health problems across long-term conditions generally, including rheumatology as a case study.

The full report is available to download from the King’s Fund website at:

Disclosure of Interest None Declared

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.