Debate: Parity of esteem

A longstanding criticism of health and social care is that people with mental health problems often fail to receive the same access to services or quality of care as people with other forms of illness. Responding to these concerns, through the Health and Social care Act 2012, the Government created a new legal responsibility for the NHS to deliver ‘parity of esteem’ between mental and physical health, with a pledge to achieve it by 2020.

Parity of esteem is defined as 'valuing mental health equally with physical health', and is described as ensuring that people with mental health problems receive equal access to the most effective and safest care and treatment; equal efforts to improve the quality of care; the allocation of time, effort and resources on a basis commensurate with need; equal status within health care education and practice; equally high aspirations for service users; equal status in the measurement of health outcomes.

A number of new initiatives and projects were introduced as a consequence of this new approach, including waiting time targets, crisis services, funding, and specific programmes of care.

The parity of esteem agenda within Wales is linked to the Well-being of Future Generations (Wales) Act 2015 and a recent parity of esteem focus on the mental health and well-being agenda, within the Together for Mental Health delivery plan, has enabled significant funding to be ring-fenced.

In March 2017, the Scottish Government released its new ten-year Mental Health Strategy which recognises parity of esteem between physical and mental health as its “guiding ambition”. Included in the strategy is a commitment to ensuring equal status for mental and physical health within resource allocation, healthcare education, measurement of outcomes, quality improvement and service user aspiration. RCN Scotland will monitor the actions which follow the strategy in order to assess the extent to which this commitment is realised.

It is estimated that the level of mental ill health in Northern Ireland is 25% higher than in the rest of the UK. However, just 6-8% of the Health and Social Board commissioning is spent on mental health services. Health and wellbeing 2026: delivering together is the Department of Health’s vision for the reform and modernisation of health and social care services.

The politicial commitment also remains visible in England, as evidenced by this year’s Mandate to NHS England inclusion of explicit references to mental health, with top-line deliverables including working with system partners to deliver the Mental Health Five Year Data Plan, the Mental Health Workforce Strategy, the Future in Mind recommendations, and supporting Westminster Government priorities and commitments to improving mental health for children and young people, and prisoners and offenders in the community.

However, our branch members are reporting that many of the promises made in the early phase have yet to come to fruition, exposing clear gaps between the rhetoric and the reality.  A good example is of patients waiting days for an appropriate bed, and then having to travel hundreds of miles when one does become available. This would never happen to a patient with a physical illness requiring acute intervention.

Given the scale of the challenges involved, improving outcomes among people with mental health problems and achieving parity requires a serious commitment by governments. Sufficient funding will need to be available to help develop new approaches to mental health care, and to ensure that mental health services are better connected to those providing services looking after physical health, and to any other necessary public services.

Workforce shortages in some mental health professions must be addressed. Investment will also need to be made in the training and education aimed at giving GPs, nurses and other staff across the NHS, the skills necessary to help ensure that people with mental health problems receive the same care, and are able to achieve the same outcomes, as those with physical illnesses or injuries.

We would suggest that without these staffing and funding issues being addressed there will continue to be a lack of parity between physical and mental health care, and patients with mental health illness will continue in to be failed, receiving neither the range of services or the level of care that they need.