Mental health problems and persistent back and neck pain
How can care be improved for people living with both mental health problems and back and neck pain? Q Lab brought people together to explore the issues and identify solutions.
In partnership with Mind, Q Lab explored how to improve the care of people with co-existing mental health problems and musculoskeletal pain. Participants with lived experience and five test teams contributed to an interactive guide for practitioners and a set of service principles.
Background to the Lab
From September 2018 to October 2019, Q Lab and Mind worked in partnership to explore how care could be improved for people living with both mental health problems and persistent back and neck pain.
Mental health problems and persistent back and neck pain are the two most common reasons for people to be on long-term sick leave or unable to work in the UK. A lot of attention has been given to these as individual needs, but more needs to be done to bring them together.
The topic is connected to the wider challenge of integrating care to meet people’s mental and physical health needs.
My experience is I get pushed around to different departments and none of those different specialisms see the whole. GPs are meant to see the whole, but they don’t, they don’t have the time to see the whole person.
The learning from the Q Lab and Mind’s work has useful insights for people interested in mental health problems and persistent back and neck pain. It is also useful for individuals and organisations supporting people with combined physical and mental health needs and multiple long-term health conditions.
What we did
During the Lab we worked collaboratively with
- Over 120 participants from a range of backgrounds and/or lived experience of the topic. Lab participants contributed to different in-depth research activities, including interviews, workshops, focus groups and surveys.
- Five test teams from health and care organisations across the UK to develop and test ideas in their local contexts.
Together, they helped shape the collective understanding of the topic and the learning and insights that have been published.
Test teams
We selected five test teams looking to tackle specific challenges in their settings.
- Health Innovation Network with St George’s and Kingston Hospital. Sought to develop a training programme for physiotherapists to talk about mental health with their patients.
- Health Innovation Network with Sydenham Gardens. Aimed to explore whether their approach to support people to self-manage back chronic joint pain could be adapted for people in mental health settings.
- Keele University and Midlands Partnership NHS Foundation Trust. Wanted to improve the awareness and support of the mental health needs of people living with persistent pain accessing a musculoskeletal service.
- Powys Health Teaching Board. Wanted to enhance engagement with the Pain and Fatigue Management Service.
- The Robert Jones and Agnes Hunt Orthopaedic Hospital. Aimed to support staff and patients to understand the link between pain and mental health.
The approach
Q Lab enabled teams to work through a structured and creative process, to develop, prototype and test ideas and solutions over a 6‑month period.
We used the ‘triple diamond’ [ref] NESTA. Using design principles to foster innovation policy. [/ref] design process, which allowed teams to follow the same process but take different paths, depending on their own contexts.
Explore the outcomes
Guide to support practitioners
Based on the findings generated during the Q Lab, we have produced an interactive guide to support those developing services for people living with both mental health problems and persistent back and neck pain. It includes common problems, potential solutions, ideas for overcoming barriers and examples to learn from.
The guide includes insight and practical examples from the five test teams, which will be relevant to health care professionals wanting to start improvement work in this area.
Service principles
During Q Lab, we heard from many people with lived experience of mental health difficulties and back or neck pain. We have developed a set of service principles based on what they said was important to them. These can be used to inform decisions about improving, designing or commissioning services.
Good practice is me, as the patient, being part of a dynamic conversation between those who can manage my pain and those who can support my mental health. Not a series of referral letters and letters to my GP.
Test teams
At the end of Q Lab, four test teams were awarded funding from the Health Foundation and NHS England to build on their learning and continue to develop their interventions in practice.
The funding helped teams to establish the evidence base for their interventions and continue collaborations with partners to improve outcomes for people living with mental health problems and persistent pain. It also allowed them to explore the potential to spread and scale their interventions beyond their local context.
The team embedded training and support for musculoskeletal physiotherapists across both Kingston and St George’s Hospital. The training package aimed to increase the physiotherapy team’s confidence in delivering psychologically informed physiotherapy to support patients with both persistent pain and mental health problems. By working across two sites to understand what enables the training to be successful, the team developed a training package with greater potential to be spread to other settings.
The team continued their work adapting the Joint Pain Advice model to work successfully in mental health settings. This included continuing testing with Sydenham Gardens – a community organisation – and built on their learning to test in another mental setting, the talking therapies service in Lewisham. The team developed plans for how the model could be adopted and adapted in other places.
Through testing with the Q Lab, the team developed prototypes for three interventions to improve care for people with mental health problems and persistent pain. The interventions included an evidence-based video on the links between mental health and persistent pain, a joint training programme for musculoskeletal (MSK) physios and volunteers, and a repository on local services for people to signpost to.
The team continued to develop and implement these ideas at the MSK Interface Service at the Haywood Hospital. The work was supported by a community of practice set up by the team, that included clinicians, volunteers, researchers and people with lived experience.
The team focused their testing work on understanding and improving the experience for people who didn’t engage with the Pain and Fatigue Management Service. This highlighted the need for people to have access to information early on, to help them stay motivated in the process, but also the risk of overwhelming people with education materials. Based on their learning and user insights, the team developed a digital platform to improve experience and engagement with the service. They worked with developers to supplement an existing digital platform used in other pain services, with the potential for this work to be applied more widely.
Contact Q Lab
Contact us about Q Lab at Qlab@health.org.uk
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