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. The NHS Constitution still does not give equal access to mental health care and spending on mental health services is failing in many areas. 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.
  • 78% of mental health service users accessed hospital services compared with 48% of non-mental health service users.
  • 54% of mental health service users arriving at A&E came by ambulance or helicopter compared to 26% of non-mental health service users. A higher proportion of these patients were admitted and they stayed in hospital around 30% longer.
  • 71% of those admitted were classified as an emergency compared with 40% of non-mental health service users.
  • They also had more outpatient appointments.

What would parity look like?

  • Access to services - Appropriate waiting times must be established 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.
  • Liaison psychiatry - We would like to see a comprehensive liaison psychiatry service in every hospital. Liaison psychiatry services have developed in an ad hoc fashion, resulting in a postcode lottery.
  • Medically unexplained symptoms cost the NHS some £3 billion per year. Community liaison psychiatry services should be targeted to help those people.
  • The premature mortality experienced by people with severe mental health problems must be as a priority.
  • If we are to realise parity of esteem it will become the norm for people with severe mental illnesses to get regular physical health checks and for people with chronic physical health care problems to get regular mental health checks.
  • It is vital that liaison and diversion services are made available in all police stations for both children and adults.
  • 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 you can do - Commissioning


The Secretary of State should give a clear mandate to the NHS to bridge the resource gap between mental and physical health care.

NHS England should continue to work towards making parity of esteem for mental health a reality, for example by identifying opportunities to use resources differently to improve mental health support for people currently using physical health services.


Clinical Commissioning Groups should ensure that they are fulfilling their duty under the Health and Social Care Act 2012 to reduce health inequalities. Steps towards this will include commissioning high quality liaison psychiatry services in all their local hospitals and meeting NICE quality standards for the early diagnosis and effective treatment of dementia.

Health and wellbeing boards should consider how their membership reflects their local community and ensure parity of esteem between physical and mental health, by designating a mental health champion or by bringing in mental health expertise when required.

Boards should ensure that their Joint Strategic Needs Assessments examines the mental health needs of their communities and how far these are currently being met. And Joint Health and Wellbeing Strategies should seek to fill any gaps in provision.

Take up the Local Authority Mental Health Challenge - we are asking all upper tier local authorities to nominate a member ‘champion’ and in return we will offer those champions support and information to help them in this important and exciting new role. There are also ten recommended actions that will enable councils to promote mental health across all of their business. For more information see: