Designing care for people with mixed mental and physical multimorbidity

Most people with long term health problems have more than one condition, and, for many, multiple conditions are the norm.1 In stark contrast, the healthcare system is organised to deal with single conditions2 and to separate mental and physical healthcare, complicating attempts to provide integrated care for both aspects of health.

In a linked article, Coventry and colleagues (doi:10.1136/bmj.h638) report findings from a cluster randomised controlled trial of integrated collaborative care for adults with diabetes or heart disease and comorbid depression.3 Collaborative care models generally use non-medical case managers (in this case a psychological wellbeing practitioner) working with a patient’s designated doctor or nurse, often with additional input from a mental health professional (in this case a psychological therapist). The intervention was associated with moderate improvements in depressive symptoms, self management, and satisfaction compared with usual care. There were no significant differences between groups in physical health, quality of life, or functional outcomes.

After four months, patients managed with collaborative care had depression scores that were 0.23 points lower than control patients on the symptom checklist depression subscale (SCL-D13). The difference was significant, equating to an effect size of 0.3. The …