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Ian Hulatt: 'Parity in mental and physical care would achieve a great deal'


Services need to recognise and address the needs of the whole person, says Ian Hulatt

Life can be changed by three little words, can’t it? I guess I’m thinking of ones such as “it’s not you” (usually followed in quick succession by “it’s me”). Or maybe it’s that dreaded “I need space” that we may fear or even have shamefully used. Yet there are three words that can change your life for ever, perhaps such as “it’s showing positive” or maybe the most life-changing of all, “I love you”. Three little words that not only are a joy to hear but they open up a new world. They are also words that demand a response.

So let me offer you three words that could be a real game changer in the world of healthcare. The three words are “parity of esteem”. Sound kind of cute, sort of fluffy and maybe a bit vague, don’t they? However, if taken seriously, they could transform the way we experience and deliver healthcare.

This term is found in the English Mental Health strategy No Health Without Mental Health and was further expressed in the Health and Social Care Act of 2012, which put a responsibility on the health secretary to secure improvement “in the physical and mental health of the people of England”.

The term parity of esteem is recognition that there is a longstanding lack of parity between physical and mental health services provision. This has been described as a “mental health treatment gap”.

“It’s recognised that if you have received a label of a serious mental illness such as schizophrenia, you can expect to live 20 years less than someone without that label”

What does this gap look like in reality rather than rhetoric? A good place to start may be the issue of crisis. If a person develops acute chest pain in a public place and needs an ambulance, there are agreed times to be met with regard to its arrival and clearly stated requirements on transfer, treatment and even targets on how long all that should take.

What, however, if the crisis is of a mental health nature? Could you expect a prompt response? Would you receive appropriate care and treatment, or would your “removal to a place of safety” involve the presence of the police and all that could entail?

Crisis is one issue often considered a good example of the lack of parity; there are also basic issues such as how long you will live. It’s recognised that if you have received a label of a serious mental illness such as schizophrenia, you can expect to live 20 years less than someone without that label. The reasons are complex and multifaceted but would we accept the same in diabetes and see it as an unavoidable consequence? Of course not.

The issue of parity of esteem is so very far reaching that it is amazing what it could provide were it attained. Consider the level of human suffering and economic cost of the failure to give mental health equality to physical health. Also, consider the effects of raising to parity expenditure on research and service provision, and the outcomes that would follow. Imagine if we considered that professionals in mental health services were as “good” as their equivalents in physical health.

Imagine if this parity saw the integration of mental health interventions into primary care and, instead of liaison teams visiting emergency departments, mental health services were integrated into them.

If we saw this parity realised we could see services that recognise and address the needs of the whole person rather than a fragmented approach entrenched in well-defended silos.

Those three little words could change your world and mine.

Ian Hulatt is mental health adviser at the Royal College of Nursing


Readers' comments (4)

  • omg, I have been saying this for about 40 years, and questioning why we divide mind and body in western medicine. Also to use the concept of 'as the mind makes us physically ill, so it should make us better too'.

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  • mind/body split is British healthcare not western medicine. in mainland Europe many countries with modern healthcare systems have an an integrated care model. why is Britain, who claims to be one of the richest countries in the world, so complacent backward in medicine and in its thinking in so many other things?

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  • I believe that its about time we adopted a holistic approach to health care and people with mental health problems get the services they are entitled to and are treated in a humane way

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  • In my local hospital there is a concept of integrated care and mental health is just another department like any other speciality. The staff emphasis this strongly to any newcomers who might be unfamiliar with this idea to try and reduce discrimination against and stigmatisation of the patients. They believe that mental health should not be in a separate institution so that patients as far as possible remain, like all other patients, in the centre of their community.

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