Over the past few weeks we have heard the term ‘parity of esteem’ used a lot, in relation to mental and physical health. It is an important phrase with an important meaning, but how many of us really know what it means? And would parity of esteem actually improve the way mental health services are delivered?
The NHS defines the term as meaning:
“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.”
Professor Sir Simon Wesseley, incoming president of the Royal College of Psychiatrists, has highlighted this issue in The Guardian recently, as he took up his post, challenging Health Secretary Jeremy Hunt on his pledge to ensure mental health services achieve the same level of provision as physical health services . He believes the gap is already so great that finances will never be able to close the gap. If less than a third of people with cancer received any treatment at all, wouldn’t we be up in arms? What if they had to wait 6 months for a scan? These are the figures for those suffering with depression, a condition that can worsen, result in life-threatening illnesses and at its most severe, death.
On the Radio 4 programme ‘All in the Mind’ yesterday, Clinical Psychologist Martin Seager, who spoke so eloquently at the Taunton Association for Psychotherapy Conference in 2013, said that the well-known statistic that 1 in 4 of us will experience mental ill-health is misleading, and could even increase stigma. He feels that this discussion on parity of esteem hides the real issue – that we all experience mental and physical health or ill-health. There is a mental health aspect to physical health, and vice versa. Looking at those two NHS definitions above therefore, the first seems more appropriate, and is one that many therapists would endorse.
Simon Wesseley continued:
“The whole of our healthcare system is about separating mental and physical. You couldn’t devise a system better suited to separating the mental and the physical if you tried……..Most people have quite complicated views of their illness anyway…….They are not resistant to doctors offering cardiac tests and counselling for a recent divorce at the same time.” He has seen psychiatrists on general medical wards work with great success.
“But we know people with physical health problems who also have mental health problems cost about 45% more than those who don’t. That’s absolutely and unequivocally clear. The cost of their care goes up. They comply less with treatment, they come back more often, they have lower satisfaction and they have more complications.”
So the President of the Royal College of Psychiatrists is calling for more holistic treatment across the health service, which could achieve significant savings if implemented. Parity of esteem is surely all about keeping physical and mental health separate, thereby perpetuating the myth that we can be mentally ill but physically healthy, or physically ill but without mental health needs. Doesn’t this, as Seager suggests, increase the possibility that mental ill-health will remain stigmatised and disconnected from, and in competition with (for resources, time etc) with other health services?
We would love to know your views!