Parity of Esteem is most often used, in the UK at least, in reference to the way mental health is treated by health and social care services.
The Royal College of Psychiatrists define it as “Valuing mental health equally with physical health”.
So, put simply, it means equality.
How are mental health problems treated differently from physical health?
The picture is complex, but a few clear example of how mental health is treated unequally to physical health include:
- Mental health services receive less funding. It accounts for 28% of the burden of disease yet it only receives 13% of NHS spending. (Source: Centre for Mental Health)
- You are more likely to be asked to leave your area for mental health care than for a physical health problem. (Source: Guardian)
- You will wait longer for treatment if you have a mental health problem. (Source: Mind)
- If you have a mental health problem, you can be treated against your will, a practice illegal in all other health contexts. (Source: NHS)
- If you have a mental health problem you are more likely to be left until you are at crisis point and need emergency care. (Source: Centre for Mental Health)
- You are more likely to receive no treatment at all. (Source: Guardian)
- If you have a severe mental health problem, your physical health also becomes devalued, to the extent that you will die 10-20 years earlier. (Source Oxford University)
What is being done around Parity of Esteem?
The Mental Health Taskforce
The Mental Health Taskforce was a group of experts, including those with direct experience of mental health problems, who drew up a national strategy to improve mental health services. These included not just the NHS, but all services involved in supporting people with mental health problems and it had ‘parity of esteem’ as one of its core principles.
The strategy they drew up is called theFive Year Forward View which, although a little unwieldy for the casual reader, is the first time there has really been a strategic approach to improving mental health care, with full involvement from patients and service users.
Many are optimistic about the strategy making real progress, but others worry the context in which it is happening (i.e. swathing cuts and an NHS in crisis) will stifle this valuable opportunity.
We have seen high profile anti-stigma campaigns over the past decade which have prompted real improvements in public attitudes.
However, research related to the anti-stigma campaign Time to Change shows that some professionals still have discriminatory beliefs and attitudes. This is worrying as this is possibly where it most matters in getting people the healthcare support they need.
Health and Social Care Act 2012
The Health and Social Care Act 2012 included a legal requirement for the NHS to treat mental and physical health equally, however this is yet to have much impact.
More funding (?)
Perhaps as testament to how important mental health care now is in the public consciousness, every few months the Conservative government, and the coalition government before it, announce a new chunk of money for mental health.
Unfortunately, this is often just an accountant’s illusion. That money is either taken from another sorely underfunded, often mental health-related budget, or never emerges.
The King’s Fund has been watching closely, and a report late last year showed that 40% of mental health care trusts (who provide 80% of mental health care) actually had their budgets cut.
What needs to be done around Parity of Esteem?
Most commentators agree that, while the NHS remains so chronically and devastatingly underfunded, there is not much chance of real equality being achieved.
Likewise, while the attitudes of professionals, particularly commissioners, remain behind the rest of the public we cannot reach equality.
We must also not forget that mental health problems are often the result of, or at least made worse by, things like unemployment, poor living conditions, isolation and discrimination.
If we are fully committed to helping people recover from or live well with mental health problems we must listen to the research and address these issues as well.
Parity of Esteem – Further reading
Parity of Esteem – what are we trying to achieve? by Martin McShane for NHS England
Parity of Esteem by Centre for Mental Health
Has the Conservative Government achieved parity of esteem? by Full Fact
‘The chronic underfunding of mental health care is a stigma proving hard to reverse’ by Alex Langford in Community Care
Mental health trust funding down 8% from 2010 despite coalition’s drive for parity of esteem by Andy McNicoll in Community Care
NHS mental health funding falls in England – FoI figures by Sarah Bloch for BBC News
Trust finances raise concerns about the future of the Mental Health Taskforce recommendations by Helen Gilburt for The King’s Fund
Is there ‘parity of esteem’ between mental and physical health? by Chris Naylor for The King’s Fund
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