Parity of esteem can be achieved with a shift in attitudes
Mental health nurses need to be advocates for the right to equal treatment, which may mean challenging their own practices as well as those of others
‘Parity of esteem’ first entered the vocabulary of mental healthcare in the 2011 government report No Health Without Mental Health.
Translated, parity of esteem means to give equal value or regard to mental health as is given to physical health. Yet evidence suggests that we are some distance from achieving this.
In terms of physical health in severe mental illness (SMI), rather than parity we have disparity. People with mental illness receive less screening for breast, cervical and prostate cancer than the general population, less preventive care such as smoking cessation – in spite of higher rates of smoking – and different standards of treatment. For example, fewer prescriptions for several common medications for medical disorders.
Moving beyond the rhetoric to making it a reality will be a challenge
Can parity of esteem be achieved? The answer needs to be ‘yes’. Moving beyond the rhetoric to making it a reality will be a challenge for everyone. Attitude change is important for combating stigma and diagnostic overshadowing, which can raise unconscious barriers to treatment.
Funding needs to be ring-fenced for equipment, and specific clinical pathways for comorbidity must be developed and commissioned.
Investment in training and education is required – for ‘physical health’ staff, in stigma and diagnostic overshadowing; and for mental health staff, in identifying and monitoring physical conditions.
Parity of esteem is a matter of social justice and basic fairness
Attaining parity of esteem is a matter of social justice and basic fairness, for when access to treatment is unequal, outcomes are predictably unequal. Mental health nurses need to be advocates for the right to equal treatment, which may mean challenging our own practices as well as those of others.
General population life expectancy at birth in the UK in 2021 was about 81 years. Evidence suggests that people with SMI have a life expectancy 20% lower than those without. This would mean dying prematurely at about 64 years, equating to a life expectancy from the 1940s. Surely this is unacceptable in 2023?
- British Journal of Psychiatry (2012) Differences in the prescribing of medication for physical disorders in individuals with v. without mental illness: meta-analysis.
- British Journal of Psychiatry (2011) Physical health disparities and mental illness: The scandal of premature mortality.
- HM Government (2011) No Health Without Mental Health, Department of Health, London.
- Lancet Psychiatry (2020) Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people.