Parity of esteem: valuing mental and physical health equally

Since the publication of this blog Dr Martin McShane has left NHS England.

Dr Martin McShane, NHS England’s Director for Patients with Long Term Conditions, is speaking at a Call To Action Conference in Manchester:

There is the apocryphal story of the janitor at NASA who, when asked by the President what his job was replied, “I help put people on the moon”.  How would I reply to that question in my current role? By saying, “I help create high quality care for all”.

The NHS, however, faces a series of unprecedented challenges and one of those is to address the fact that we do not yet provide high quality care for everyone – especially if you have mental health problems.

The disparity in approach between people with physical and mental health problems is inequitable and unfair.

Let me give you some facts: over 75 per cent of those with heart disease are in treatment, for people with diabetes or hypertension more than 90 per cent are in treatment. Conversely only 25 per cent of people with depression or anxiety receive treatment.

If you have mental illness it can reduce your life expectancy by 10 years because of your poor physical health, as a result individuals with mental health issues have the same life expectancy as the general population did 50 years ago.

The system is failing these individuals.  We also overlook the fact that poor physical health is accompanied by poor mental health and research shows this adversely affects outcomes.

Someone recently described this to me as professional monocular-ism – we tend to view people through one eye at a time. One eye for physical health problems, and the other eye for mental health problems. It is time the NHS developed binocular vision. We need to value the importance of mental health on a par with that of physical health.

The value of doing so will help us tackle the challenges the NHS faces. We know that if people are less anxious, have resilience and insight they are better able to manage their physical and mental health problems. We know that if we tackle the physical health of people with mental health problems we will not only enhance their quality of life but also cost to the NHS.

The challenge to be addressed is huge. To enhance the quality of life for people with long term conditions we need to be thinking beyond traditional models which focus on just the patient and professionals. We need to understand and support the importance of carers. We need to understand and mobilise the assets in communities. We need to have a system that is person centred, that starts with what is important to the individual and has meaning for them, their families and their lives.

There are many things we could do better but there are also things we must do differently.

To do this we have to think of how we can put people and carers in control. We need to think about how we can support professional collaboration. We need to think about how we can ensure best practice is used.

Finally we need to think about how commissioning can create the foundations for this. This is why we have adopted the metaphor or model of the House of Care. It takes commissioning as its foundation, best practice as the roof and places patients and carers in control as one wall with professional collaboration as the other wall. This construct creates space for person centred coordinated care which is what people have told us they want.

We need to tackle this challenge. We have put men and women on the moon now all we have to do is put mental health on a par with physical health. That is why NHS England has launched a call to action and why Parity of Esteem is one of the key themes we will be pursuing at a national, local and personal level.

Please join us in our pursuit of high quality care for all, now and for future generations.

Dr Martin McShane was previously National Clinical Director for Long Term Conditions, since the publication of these blogs he has left NHS England.


  1. Tim Sanders says:

    Does Parity of Esteem need a partner called Bust myth and stigma ? It’s notable that attempts to destigmatise depression and dementia are often based on the concept that they are organic, physical illnesses, because that seems to make it easier to own up to.

    I’m feeling very positive about the forthcoming Public Health England dementia campaign, moving away from “if you’re worried about xxx, see your GP”, towards positive messages that this is a condition you can live with, and here are some great stories about communities and services supporting people to do so.

    I know of someone who died within a year of developing memory problems, and six months of diagnosis, because they took to their house, and then their bed, and hardly ate – physical cause of death was an infected pressure sore. They had a lovely family, good neighbours and an expensive care package, but the key interventions were all too late and could only follow her decline. Though she did have a peaceful death at home thanks to her GP’s understanding.

    Only “binocular vision” shows the real risks and needs that people face.

  2. Rhiannon says:

    Having worked for 4 years in the NHS I thought it would be a very long time before I saw this matter coming to light. I am thrilled that things are changing for the better. So many of us with mental health problems (myself included) have found the disparity between mental and physical health a barrier. I’m glad that mental health is coming into the forefront and changes are being made. This makes me proud to be part of the NHS.