Parity of esteem

'Parity of esteem' is defined as 'valuing mental health equally with physical health', which would result in those with mental health problems benefitting from: 

  • equal access to the most effective and safest care and treatment
  • equal efforts to improve the quality of care
  • the allocation of time, effort and resources on a basis commensurate with need
  • equal status within healthcare education and practice
  • equally high aspirations for service users
  • equal status in the measurement of health outcomes.

Parity of esteem in legislation

The term is used primarily in England, and isn’t commonly in use outside the UK. The previous government’s 2011 mental health report No Health Without Mental Health included reference to parity of esteem for the first time, and following on from this, it was enshrined in the Health and Social Care Act 2012.

The NHS Mandate for 2014/15 directly states that "NHS England’s objective is to put mental health on a par with physical health". In February 2016, the Five Year Forward View for Mental Health made a set of recommendations for the six NHS arm’s length bodies to achieve the ambition of parity of esteem between mental and physical health.

Why is parity of esteem important?

A 'parity approach' enables NHS and local authority health and social care services to provide a holistic, 'whole-person' response to each individual in need of care and support, with their physical and mental health needs treated equally.

The relationship between physical and mental health is such that poor mental health is linked with a higher risk of physical health problems, and poor physical health is linked with poor mental health.

Measuring the parity gap

While there is not a unanimously accepted method for measuring parity, there are three common concepts in this area that are good indicators of parity: 

  • 'Excess mortality' – the negative impact mental health has on life expectancy.
  • 'Burden of disease' – mental health is the single largest cause of disability in the UK, however is not reflected in NHS budget.
  • 'Treatment gap' – the difference between the number of people thought to have a particular condition, and those receiving treatment for it.

Barriers to parity of esteem

General barriers

Stigma of mental ill health: Stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). The existence of stigma can stop people with serious mental health problems getting treated with the same vigour as if they had a physical illness.

Diagnosis: Mental health problems are less likely to be diagnosed than physical health conditions, and this overshadowing tends to work against parity of esteem.

Legal barriers

Mental Health Acts 1983 and 2007: These laws allow practices that are illegal in other medical contexts, for example, forced detention. 

Mental Capacity Act 2007: This law outlines the situations in which decisions (including medical and clinical ones) can be taken on a person’s behalf.

References

  1. Royal College of Psychiatrists. (2013). Whole-person care: from rhetoric to reality Achieving parity between mental and physical health. London: RCP. Available at: http://www.rcpsych.ac.uk/pdf/OP88.pdf 
  2. NHS England. Valuing mental health equally with physical health or “Parity of Esteem”. London: NHS England. Available at: https://www.england.nhs.uk/mentalhealth/parity/
  3. The Parliamentary Office of Science and Technology. (2015). Parity of Esteem for Mental Health. London: Houses of Parliament.
  4. Thornicroft G, (2011). The scandal of premature mortality. British Journal of Psychiatry, 199(6), 441