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Parity of esteem – what are we trying to achieve? – Martin McShane

As Mental Health Awareness Week comes to a close, Dr Martin McShane, NHS England’s director for people with long term conditions, gives his definition of Parity of Esteem:

Much has been said in the last few years about ‘parity of esteem’. It has almost become a slogan, trotted out in the same breath by politicians and clinicians whenever mental health care and improvements to services are mentioned.

It has come to mean different things to different people who work with or for the NHS and I doubt whether it means anything at all to the public, our patients or their families – and yet we hear the slogan so often.

In essence, ‘parity of esteem’ is valuing mental health equally with physical health. But in my view, it is more than just that and, if we can all agree a definition of parity of esteem, what exactly is it that we are trying to achieve and how are we going about it?

To me parity of esteem means tackling mental health issues with the same energy and priority as we have tackled physical illness.

It is about changing the experience for people who require help with mental health problems.

It is about putting funding, commissioning and training on a par with physical health services.

And parity of esteem is about tackling and ending the stigma and prejudice within the NHS which stops people with serious mental health problems getting treated with the same vigour as if they had a physical illness such as, say, diabetes.

That stigma can be demonstrated like this: if you fall down and break your hip, an ambulance will be with you in eight minutes to give emergency care at the scene before taking you to A&E. If, however, you suffer an acute psychotic episode in the street, you are just as likely to be attended by a police car and taken to a cell.

We must end the stigma associated so often with mental health. We must raise awareness of the importance of mental health care and recognise the inadequacies of how we have regarded mental health in the past. This means raising awareness within the NHS itself. And we must create parity for mental health care in reality – rather than just issuing rhetoric and paying lip service to it.

The statistics surrounding mental health are salutary. Notably, the fact that 75 per cent of all chronic mental health problems start before the age of 18, and yet currently research suggests only a quarter of children and teenagers aged up to 15 with mental health problems receive help from any services.

Parity is also about tackling the physical illnesses of people with severe mental health problems. Currently they have the same life expectancy of people who lived in the 1950s – some 10 to 15 years shorter than average. This has to change.

So how can we tackle these issues and deliver parity in reality? Well, we have established five work streams to help commission better value care:

  • Information – doctors cannot make a diagnosis without tests. In the same way commissioners, the people responsible for planning and funding care, need good information to make the system better.
  • Commissioning development – we need to raise the level of skills and capabilities to secure services that deliver the Parity of Esteem agenda.
  • Improving physical health for people with serious mental illness.
  • Improving clinical services – the data we have on Improving Access to Psychological Therapies is fantastic and we are a world leader in measuring outcomes in this area. We need to use this to ensure clinical services are effectively co-ordinated in meeting both physical and mental health needs. We also need to listen to people with dementia and their carers, who have told us: “You may not be able to cure us but you can care for us better”. And we can improve the delivery of mental health services for children and young people through a transformation in Child and Adolescent Mental health Services (CAMHS).
  • Improving crisis care and waiting times – the crisis concordat works towards ensuring there is access to crisis services and that at all times these are responsive and as high in quality as other emergency services.

There is overwhelming economic evidence to show that if we address mental health with the same urgency that we use for physical health, then we can not only improve the outcomes for people with mental health problems but also save money and give tax payers much better value for every pound we spend.

For Parity of Esteem, now read: “Valuing mental health care equally.”

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One comment

  1. Just as with the Mid Staffs enquiry and the findings that the Francis Report stated, the NHS (hopefully) had to take a long-hard-look at itself (and, more relevantly, hopefully, again) learn some very hard lessons, and put those lessons into practice.

    I use the language ‘hopefully’ because I really fear that there still persists at the heart of the NHS structure too many people that feel they do not need to do anything personally to address issues raised in the Francis Report, and other findings like it.

    These individuals are quite happy simply to attend their place of work, and, ultimately, purely justify their monthly salary. If we start to engage with exactly what Matin McShane is saying, change has to happen. Not only that, it makes economic sense to address mental health issues across the board from acute conditions, to those needing psychological therapies.

    Simply, happier stable individuals, among other things, not only create and maintain better social cohesion and development, they contribute much more in terms of the economic well-being of their family, community and to national betterment.

    We really do need to ask, just who is that is benefitting from maintaining the way the NHS has dealt with mental health issues in the past. There needs to be a process of acknowledgement, learning from that, and implementing real change.