There has been a lot about parity of esteem recently and it appears to be used in a variety of ways to basically say that mental and physical health should be viewed and treated equally within health care. However, I was recently asked by a very senior Health Education England director whether frontline staff and patients/service users actually knew what it meant. I confessed I didn’t know if they would and then reflected that perhaps they wouldn’t as it appears to have become a label for a range of thoughts – a bit like ‘Transforming Community Services’ if anyone remembers that.
So what do we mean by parity of esteem? Valuing Mental Health and Physical Health equally has been proposed but this leads to a few other points which include:
Parity of Expectations - Individuals should have the same expectations of mental health services as they would for physical health services
Parity of Funding – currently mental health receives less than half the level of funding that might be expected, given the relative morbidity of mental illness
Parity of Value - Good mental health and the treatment of mental illness is valued in and of itself, as well as for the contribution that it makes to people’s physical health, the economy or any other area
Parity of Attention - Commissioners, Service Providers and System Leaders need to devote the same time, energy and resources to improving mental health as they do to physical health
So what can we do? Psychological professionals work across the full range of health and social care settings and are well-placed to consider the person holistically. There have been training initiatives that have sought to educate health and social care staff in recognising mental health difficulties and assessing appropriately and being able to access appropriate interventions for individuals. Also, formulation based approaches can include the impact of physical health or ill-health on how an individual manages the world around them. Directly working with individuals who have physical and mental health difficulties e.g. people with long term conditions can also improve individuals overall well-being. As psychological professionals, I’m sure that many of us are undertaking these activities on a regular basis and looking for opportunities to do more. Clearly, more does need to be done.
However, I have also wondered how good is our knowledge of the impact of physical health conditions on individuals’ psychological well-being? We have perhaps been trained in Making Every Contact Count and perhaps also have some knowledge of the impact of psychotropic medication on our clients but how much do we think about the physical health of the people who use our services. Do we know about how someone’s physical health will have an impact on how much information they can take in at a session or whether they have the energy to work effectively? Also, are we able to offer our services flexibly e.g. duration of appointments, timing of appointments? Also, are we aware of the potential range of contributing factors that can contribute to how someone can present in services. A recent conversation about psychosis highlighted this for me. Psychosis is not a diagnosis but rather a collection of symptoms that can be caused or triggered by (amongst others) hypoxia, adverse childhood experiences, dementia/delirium, substance use/misuse. Are we able to have an overview of this to be able to appropriately signpost if required?
Therefore, to ensure true parity of esteem I think we need to look at what we need to learn from our colleagues whose focus is physical health as much as we need to be able to offer them our experience to provide truly person-centred approaches. So to go back to what does parity of esteem mean anyway and how would we explain it – recognising the equal contribution of biological and psychological factors on an individual and responding to both in an equally accessible and valued way (but we do need to include social factors too).
PPN colleagues have also presented on Parity of Esteem at the Health Education North West stakeholder event in June. There’s more information available on http://nw.hee.nhs.uk/2015/06/03/2-june-2015-stakeholder-forum/