It is time to stop treating mental health as a “cinderella” issue

Dr Ed Mitchell, Clinical Fellow to Martin McShane, NHS England’s Director for Long Term Conditions, outlines new moves to give mental health parity with physical health issues:

When the historians of the future write about healthcare in the twenty-first century, they will remark upon one of the more curious aspects of our healthcare system – the way we separate physical and mental health.

Odd, they will think, that we should arbitrarily divorce these two aspects of our health and wellbeing. They will think it even odder given the increasing evidence of what a huge effect each has upon the other.

We might hope this curious separation was simply destined to provide a footnote in some future history book. Unfortunately, it has far reaching and serious effects on people right here, right now, today.

Mental illness causes almost a quarter of our burden of disease (22.8 per cent), yet receives only 11 per cent of NHS funding. (For comparison, cancer causes 15.9 per cent of that burden).

Whilst 92 per cent of people with diabetes are in receipt of treatment, only 28 per cent of people with mental illness get treatment for their problems. Yet we know that people with serious mental illness are at risk of dying up to 25 years earlier than those without such illness.

At a time when we are focusing on cost-pressures in the health service, having a co-morbid mental health problem increases the costs of services for a patient with a long term condition by 40 to 75 per cent. More than a third of GP consultations are related to mental health (approximately 150 million consultations per year). Up to 40 per cent of A&E attendances across London are related to mental health, drugs, and alcohol.

So, as these statistics demonstrate, we know that mental health has a major human and financial cost, yet it’s still very much the ‘Cinderella’ sister to physical health. It’s time to do something about it.

NHS England, the Department of Health, The Royal College of Psychiatrists, and a range of third sector and patient organisations have come together to address ‘Parity of Esteem’ for mental health. This initiative will place emphasis on the design of health services to address the mental health of people with physical disorders, and the physical health of those with mental disorder.

We know there is a huge amount we can do in NHS England to influence the parity agenda, including fostering capability and leadership in mental health within CCGs, ‘industrialising’ improvement in the care of people with psychosis, promoting value-based commissioning and care for people with mental disorder, and getting mental health informatics right so we can commission the right services for the right people.

But we can’t do this alone. The people who provide mental health services day in and day out are our partners in this.

Often we talk of a ‘purchaser-provider’ split in the NHS, as if those providing services should have nothing to do with those commissioning them. That kind of ‘silo-thinking’ won’t improve services. We need to work together to integrate good physical healthcare for people with mental disorder, and to start building mental health and wellbeing into services and pathways for people with physical disorder.

Most importantly, we need to co-design these services with the people who use them day in and day out.

The National Clinical Director for Mental Health at NHS England, Geraldine Strathdee, recently spoke with the Foundation Trust Network – the voice of NHS acute hospitals, mental health, ambulance services, and community services organisations – on valuing mental health (Geraldine’s slides ‘Valuing mental health’ are available to view here).

Her argument was not that we have a dearth of evidence-based guidelines and standards in mental health – indeed, quite the opposite. We have over a hundred NICE Health Technology appraisals, NICE guidelines, Public health related guidelines and Quality standards.

The problem is that we haven’t learned from those that can, and have, implemented these guidelines – and spread ‘what good looks like’. There is still too much variation, with some pockets of great practice.

At the recent Future of Health conference we learned from each other, and from service users, about great examples of integrated care – we need to do this not just at conferences once a year, but every day. Providers, commissioners and service users need to work together to make today’s exceptional practice tomorrow’s normal practice.

It is often not easy to look outside our own organisations and learn from others. But if we don’t do so we’ll continue to fail to provide for the health needs of some of the most vulnerable people in society.

Ed Mitchell

Ed Mitchell is a junior doctor training in psychiatry, and currently one of Sir Bruce Keogh’s clinical fellows, working in Domain 2 (Enhancing the quality of life for people with long term conditions). He has a particular interest in integrating physical and mental health. Before studying medicine on the graduate entry course at Oxford, he was a Fulbright fellow at Harvard University and a junior research fellow at Pembroke College, Oxford.


  1. shirley says:

    Great news but it never happens! As soon as you are identified as having MH problems, everything else wrong with your health is attributed to it.

    Mental health guarantees a prescription, if one drug doesn’t work, doctors just work there way through the BNF until they find one that does, or the patients gives up.

    Doctors need to look at the causes, not just the symptoms, and many depressions are caused by the lack of real understanding and the frustration that nobody is really listening!

    Mental health needs a revolution, treatments have changed but mental health care is poorer now than it was in the 50’s. Staff are too busy with bits of paper, no time to talk to patients, not enough staff, too much time spent in the office.
    Medication may help, but it doesn’t solve problems and sadly my view of modern psychiatrists is that anyone can be a psychiatrist, just buy the ICD10 and the BNF because that is what all their decisions are based on … a multiple choice quiz!!

    Really great to see someone wanting to make a change and I wish you every success, you are a breath of fresh air!

  2. helen says:

    At last a clinician who is prepared to address the issue of lack of NHS funding to treat patients with mental health problems. In our present climate of looking at ways to reduce the total NHS budget, this must be something that is addressed. Many patients with mental health problems go on to develop clinical problems which not only need treating in the short term but can go on to become long term issues.

    Surely the time has come when it is recognised that given the appropriate help from the outset, these patients would be provided with a better quality of life, and should contribute to preventing their long term illnesses and commensurate intensive treatment, thus saving the NHS money in the long term.

  3. Vikki Tweddle says:

    i really like your article . very well articulated. couldnt agree more. work in mental healthe for 30 years. we are getting there. at least talked about openly now but a way to go

  4. Jackie Hardy says:


    I am a mental health thriver but it has taken me years to become a thriver as opposed to a survivor. Mental health is the poor relation re funding, however as you say over a third of patients coming to their gp are coming re mental health. However gps need more training in this area and need to be better to signposting on to mental health orgs or support groups. More funding is needed for peer led support groups and orgs. I only found out what support was available after hospital admission and with signposting maybe I would never have to be admitted.

    You clearly get it so please keep up the good work.
    Take care j