“Parity of esteem”

“Parity of esteem” is the principle by which mental health must be given equal priority to physical health. It was enshrined in law by the Health and Social Care Act 2012.

The government requires NHS England (the body which commissions primary care along with other key services) to work for parity of esteem to mental and physical health through the NHS Mandate.

There are however many areas where parity of esteem has not yet been realised. Mental health problems account for 28% of the burden of disease but only 13% of NHS spending.

Why is this a problem?

Apart from the obvious point that any illness should be alleviated where possible, mental illness reduces life expectancy – it has a similar effect on life-expectancy to smoking, and a greater effect than obesity.

  • Mental ill health is also associated with increased chances of physical illness, increasing the risks of the person having conditions such as coronary heart disease, type 2 diabetes or respiratory disease.
  • Poor physical health increases the risk of mental illness.
  • The risk of depression is doubled for people with diabetes, hypertension, coronary artery disease and heart failure, and tripled in those with stroke, end-stage renal failure and chronic obstructive pulmonary disease.
  • Children experiencing a serious or chronic illness are also twice as likely to develop emotional disorders.

What would parity look like?

  • Access to services – Appropriate waiting times must be established for a wider range of mental health services so that people with mental health problems know the maximum waiting time for treatment as people with physical health problems do.
  • Parity of treatments – Many psychological therapies are NICE approved and recommended but the NHS Constitution does not entitle people to them in the same way we are entitled to NICE-approved drugs.
  • The premature mortality experienced by people with severe mental health problems must be as a priority – we’re tackling this through Equally Well UK.
  • It is vital that people using mental health services have 24/7 access to a crisis team and that these teams are not scaled back to cut costs.

What’s happening now?

The NHS’s key vehicle for redressing the inequality between mental and physical health is the Five Year Forward View for Mental Health, which detailed a range of priorities, including:

  • Expanding the Increasing Access to Psychological Therapies (IAPT) programme so that 25% of people with a common mental health problem have access
  • Doubling access to Individual Placement and Support to help people with severe mental illness to secure meaningful employment
  • Increasing access to specialist perinatal mental health support in all parts of England
  • Reducing premature mortality for people living with severe mental illness (for more on this, see Equally Well UK)

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