Valuing mental health equally with physical health or “Parity of Esteem”

What does parity of esteem mean?

“My family and I all have access to services which enable us to maintain both our mental and physical wellbeing.”

“If I become unwell I use services which assess and treat mental health disorders or conditions on a par with physical health illnesses.”

Why is it important?

  • Mental illnesses are very common
  • Among people under 65, nearly half of all ill health is mental illness
  • Mental illness is generally more debilitating than most chronic physical conditions.
  • Mental health problems impose a total economic and social cost of over £105bn a year
  • Yet, only a quarter of all those with mental illness such as depression are in treatment
  • We tend to view physical and mental health treatment in separate silos in health services
  • People with poor physical health are at higher risk of experiencing mental health problems…
  • …and people with poor mental health are more likely to have poor physical health

Valuing mental health equally with physical health was the theme of a recent meeting held by NHS England as part of the Call to Action events.  These slides helped to inform the debate and give some background.

What is NHS England doing?

NHS England has established a Parity of Esteem Programme in order to focus effort and resources on improving clinical services and health outcomes.  The Parity of Esteem programme is currently being developed through discussions with stakeholders but we have identified three areas as initial priorities for urgent focus during 2013/14:  These are:

  • Improving Access to Psychological Therapies (IAPT) – this is a national programme to roll out access to talking therapies for people suffering from depression and anxiety disorders.  Whilst we have made good progress in this area we also know that there is more to provide good access to these invaluable therapies which help patients manage their conditions and improve their quality of life.  We have a national ambition by end March 2015 to increase access so that at least 15% of those with anxiety or depression have access to a clinically proven talking therapy services, and that those services will achieve 50% recovery rates.
  • Improving diagnosis and support for people with Dementia – we are committed to making considerable progress towards diagnosis, treatment and care of people with dementia by 2015. We recognise that key to this is a diagnosis as this can unlock access to support services.  We have a national ambition for two thirds of people with dementia to have received a formal diagnosis and be accessing care and support by end March 2015. We are also working with NHS Choices to provide additional support for people who are newly diagnosed with dementia and their carers, with a new information and webchat service to guide people in the early stages.  See our news release.
  • Improving awareness and focus on the duties within the Mental Capacity Act – Concerns have been raised that there is a low level of appreciation of the duties and expectations of CCGs explicit in the Mental Capacity Act, a concern that spans patient groups such as those with enduring mental illness and people with dementia.  The Act is of central importance in delivering healthcare.  Where difficult decisions may need to be made in balancing the patients’ rights to make decisions about their care and treatment with the right to be protected from harm, and requiring others to act in the patient’s ‘best interests’ where they lack capacity for a particular decision.
  • Working with Time To Change to tackle stigma and discrimination – in 2015/16 we worked with Time To Change, England’s biggest programme to challenge mental health stigma and discrimination, to better understand the dynamics of relationships between people who use services and NHS professionals. Insight from research, focus groups and individual interviews, demonstrated that a high number of people using mental health services felt they experienced stigma and discrimination. We worked with mental health professionals based in trusts and service users to identify good practice and the barriers which sometimes stand in the way of positive interactions. The resulting training pack focuses on the positive changes which can improve both team culture and working practices and is available to all mental health trusts in England.

As this web page develops further information will be provided about the other priorities within the programme.

How are we co-ordinating work across the three priorities?

In order to bring about a coordinated approach across NHS England and the wider system in these three areas a Mental Health Focus and Delivery Group has been formed on a task and finish basis.  The group brings together a range of representatives from across the system in order to provide clinical and managerial leadership supporting delivery at a local, regional and national level.  The group aims to contribute collectively to the development of various areas of work to support the delivery of mental health priorities.  More information on the Focus and Delivery group, including an overview of the work that the group is overseeing.

Resources and information for commissioners

Achieving ‘parity of esteem’ will require a fundamental change in the way services are commissioned.  Consideration will need to be given to equitable distribution of resources and supporting the commissioning of services which tackle the association between physical and mental disorders.  The commissioning cycle offers the ideal framework to achieve this change of emphasis, focussing on the key elements required to achieve transformational change.

Commissioners have told us that best practice, tools and guidance, data and information and clear clinical leadership are important elements to support them in helping to deliver the national ambitions.  These pages have been designed for commissioners, and stakeholder who work with them to provide update as the work progresses and to signpost to more detailed sources of information and support.

Links to other pages and information: