The 3 Dimensions for Long-term Conditions (3DLC): Integrating mental, physical and social care in long-term conditions King’s College Hospital

Common mental health disorders are more prevalent in people with long-term conditions, such as diabetes, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD). These conditions require significant self-management but there is no integrated psychological or social care for these patients.

Treating psychiatric co-morbidities has been shown to reduce morbidity and mortality in people with long-term conditions. The 3 Dimensions of Care for Diabetes (3DFD) programme is an initiative that has effectively integrated psychological and social support within diabetes services. 3DFD has demonstrated clinically significant improvements in glycaemic control, depression, anxiety, social outcomes and subsequently, significant financial savings. 

3 Dimensions for Long-term Conditions (3DLC) has scaled up 3DFD by integrating medical, psychological and social care for people in Lambeth and Southwark who have other long-term conditions (cardiac failure and COPD) and a mental health and/or social problem, where their co-morbidity is impacting on self-management.

The project involved adapting the current physical health model across primary, community and secondary care, and supporting an integrated care delivery system that encompasses social and psychological support.

The project team worked with staff and patients to develop care pathways that integrate a biopsychosocial model for heart failure, resistant hypertension and COPD. There is also a separate diabetes arm within the community mental health team. 

So far, over 2,000 patients (46% with COPD, 31% with hypertension and 28% with heart failure) have been screened for anxiety and depression, with 752 referrals received and 504 assessments offered.

The service is now well established within the long-term conditions clinical teams. There has also been interest from other services in adopting the 3DLC stepped care model and approach.

Contact details

• Professor Khalida Ismail, Professor of Psychiatry and Diabetes, King’s College London, khalida.2.ismail@kcl.ac.uk
• Dr Sean Cross, Consultant Liaison Psychiatrist, Department of Psychological Medicine, King’s College Hospital, sean.cross@slam.nhs.uk
• Dr Carol Gayle, Consultant Diabetologist, Kings College Hospital, carol.gayle@nhs.net