As we reflect on the highs and lows of World Mental Health Day 2018 (held on 10 October), it’s always a chance to analyse how close UK society is to achieving equality between mental and physical health provision. Known as parity of esteem, uniting these two branches of health with equal budgets, staffing levels and community care seems like a pipe dream at times, but politicians, health workers and campaigners continue to strive for it.
So are we moving any closer to parity of esteem in the UK?
Moving Towards Parity of Esteem
- There is now a Minister for Suicide Prevention: Jackie Doyle-Price has become the first person to hold this role, following her previous title of Minister for Mental Health and Inequalities.
- Time to Change, led by Mind and Rethink Mental Illness, continues to roll out local support hubs, consisting of stigma-busting champions and private and public organisations working in the community. Eight of these hubs are funded, and a further 25 are ‘organic’, receiving support and official status from Time to Change, but no funding. The application process to launch a funded hub in your area runs until 16 November 2018.
- Matt Hancock, Secretary of State for Health and Social Care, announced the government’s “commitment to achieving equality between mental and physical health” at the Global Ministerial Mental Health Summit in London this month.
Moving Away from Parity of Esteem
- The National Audit Office noted this month that government progress on supporting children and young people’s mental health is too slow. Jenny George, the NAO’s Director of Local Service Delivery and User Experience, highlighted ” slow progress in the NHS managing to recruit more staff so they can see more children,” and government “aims to increase access from a quarter of young people with mental health conditions able to access services, up to a third.” That leaves two thirds of children and young people without the services they need.
- In a survey published last month, the Royal College of Nursing discovered 57% of mental health nurses think the UK had been unsuccessful or very unsuccessful at achieving parity of esteem between mental and physical health. 38% reported their workplace was unsuited to meeting the physical needs of those with serious mental illnesses.
- The Big Mental Health Survey, completed by 8,000 people trying to access GP support for mental health issues, revealed uncertainty and booking difficulties. 32% of those making a mental health-related appointment found their health deteriorated between booking and actually seeing their GP. 33% waited six days or more, and a further 14% weren’t sure if seeing a GP was the right course of action.
- The number of consultant psychiatrists in NHS England has only risen by 3.3% in the last five years, compared to 21% for the rest of the health service, the Royal College of Psychiatrists has announced this month. With such a gap between the wider health service and psychiatry, it’s unsurprising that patients can wait for months or even years to see a specialist.
- A report by the Care Quality Commission (CQC) noted that the number of children attending A&E for mental health treatment has doubled since 2010. It also drew attention to the lack of service provision for children with complex additional needs as well as a mental health condition, revealing there are no mental health unit beds for learning disabled children in London, the South East or the South West of England.
- Universal Credit, the single benefits system set to cover traditionally separate benefits like child tax credits, housing benefit, income support, jobseeker’s allowance and working tax credits, continues to threaten the mental wellbeing of claimants. The Mental Health Nurses Association called for an end to Universal Credit in an open letter to Work and Pensions Secretary Esther McVey, referring to the policy as ‘punitive’ and citing the ‘damage to lives of people living with mental illness’. Major mental health charities such as Mind and Rethink have campaigned hard to show the negative effects of Universal Credit and benefits assessments on those with mental health issues.
Parity of Esteem Between Mental and Physical Health: The Verdict
Though there are many calls for parity of esteem in physical and mental health, there is still a long way to go. Whilst private mental health services and talking therapy have shorter waiting times and can adapt quicker to patients’ needs, we realise private treatment isn’t an option for everyone, and it may only be possible short-term or for talking therapy rather than medication and any inpatient care. But when people of all ages are faced with endless waiting lists, bed shortages and even difficulty in seeing their GP or a psychiatrist, resorting to A&E visits, private referrals or support from charities, it’s clear there is a major service shortfall.
This delay in services, along with other pressing factors like money worries, unemployment or co-existing physical issues, can make someone’s mental health deteriorate faster or further than if they received timely and appropriate treatment – ideally a combination of medication (where necessary) and talking therapy, perhaps group CBT, individual treatment, or family therapy.
We hope for major steps towards parity of esteem in 2019 and beyond, so the whole of society can benefit.
Written by guest contributor Vikram Das for Dr Chrissie Tizzard, Chartered Consultant Psychologist, PsychD, BSc, MSc, C.Psychol, C.Sci, AFBPS. Dr Tizzard is the Clinical Director of Christine Tizzard Psychology (ctpsy.co.uk).