No health without mental health

Imagine a world where physical and mental health needs are treated equally…

What does ‘Parity of esteem’ mean?

‘Parity of esteem’ simply means that physical and mental health are valued equally.

It is a term which is becoming more commonly used in the UK and, bit by bit, people are beginning to understand the importance of nurturing mental health in the same way they do physical health. But a lot more action is needed to achieve true parity in the real world.

Mental illness is a serious public health issue which places significant strain on an already over stretched healthcare system. As with physical health, it is everyone’s responsibility to take a proactive approach to mental health to prevent crises. Early intervention both in workplaces and the community at large is vital. Ignoring this will ultimately lead to an unsustainable pressure on the NHS, and our future generations, as well as a compound negative effect on the financial bottom line.

The chicken or the egg

It is not possible to separate out mental health from physical health and vice versa.

Poor physical health increases the risk of mental illness.

The risk of depression is doubled for people with diabetes, hypertension, coronary artery disease and heart failure, and tripled in those with stroke, kidney failure or lung disease.

In turn, mental health issues can seriously impair the immune system, leading to vulnerabilities and poor physical health.

And so the cycle continues.

The World Health Organisation (WHO) forecast for 2030

Just like physical illness, mental health issues are a normal part of life. In a typical year, approximately one in four people experience at least one diagnosable mental health issue. The World Health Organisation forecasts that by 2030, depression will be the single leading cause of the global burden of disease.

According to the Royal College of Psychiatrists, there is no health without public mental health. They make the following *case for action:

“Mental illness is the largest single source of burden of disease in the UK. No other health condition matches mental illness in the combined extent of prevalence, persistence and breadth of impact.”

*(Position statement 4 2016, available at

A brief history

The original reference to the term ‘Parity of esteem’ was made in the 2011 Government mental health strategy “No Health Without Mental Health.” This was the first public health strategy to give equal weight to both mental and physical health.

This made it clear that the Government’s success should be measured by the nation’s wellbeing, not just by the state of the economy.

“The title of this strategy, No Health Without Mental Health, perfectly captures our ambitious aim to mainstream mental health in England. We are clear that we expect parity of esteem between mental and physical health services.”

Cameron and Cleg coalition 2011.

“The title of this strategy; 'No Health Without Mental Health', perfectly captures our ambitious aim to mainstream mental health in England. We are clear that we expect parity of esteem between mental and physical health services”

Cameron and Cleg coalition 2011.

‘Parity of esteem’ was enshrined in law by the Health and Social Care Act 2012.

Stigma and the fear of stigma

The stigma associated with mental ill health is a huge barrier to parity of esteem.

Stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). The existence and fear of stigma can stop people with serious mental health problems getting treated with the same vigour as if they had a physical illness. Mental Health first aid addresses stigma, including self-stigmatisation and delivers a set of tools which aim to remove these barriers.

Accurate diagnosis can also be a barrier. Mental health problems are less likely to be diagnosed than physical health conditions, and this overshadowing tends to work against parity of esteem. Not getting a diagnosis can prolong suffering or delay recovery.

Mental Health first aid will not teach you to diagnose. But it will teach you when and how to support and signpost an individual to appropriate professional help, as well as understanding what help is available and how to better manage your own mental health.

Inequality of care

A recent report from The Royal College of Psychiatrists; ‘Whole-Person Care: From Rhetoric to Reality’, highlights the significant inequalities that exist between physical and mental health care. This includes preventable premature deaths, lower treatment rates for mental health conditions and an under funding of mental healthcare relative to the scale and impact of mental health problems.

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.

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.

Just because you cant see it, it does not mean it doesn't exist.

What does parity of esteem look like?

It starts with equal access to the most effective, safest care and treatment. Equal efforts to improve the quality of care, the allocation of time, effort and resources proportionate with need. Equal status within healthcare education and practice. Equally high aspirations for service users. And equal status in the measurement of health outcomes.

The government requires NHS England to work towards parity of esteem to mental and physical health through the NHS Mandate.

That’s the plan. So how is it working out?

We can see that the Government is saying all the right things about achieving parity of esteem, but the reality is still a long way off.

This difference between the treatment of mental and physical health is called the ‘parity gap’.

Understanding the parity gap

To know how much further there is to go, we need to measure the current parity gap. As yet there are no unanimously accepted methods, however there are three common concepts that serve a good indicator:

  • 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, but is not reflected in NHS budget.
  • Treatment gap: The difference between the numbers of people thought to have a particular condition, and those receiving treatment for it.

Mental health problems account for 28% of the burden of disease but only 13% of NHS spending. One of many areas where parity of esteem has not yet been realised.

Do your bit. Support the NHS

Strong links between mental and physical health have a major impact on healthcare costs. It costs the NHS £11 billion to treat mental and physical illness separately when they should be treated together. Demonstrate your commitment to equality between mental and physical health by training and equal number of mental health first aiders as physical first aiders.

How can we help bridge the parity gap?

Health policy for England is complex, and mental health policy is no exception. Reducing the parity gap is a huge challenge but can be achieved. We believe our courses contribute towards the following key areas:

  • Raising awareness and promoting mental health and wellbeing
  • Reducing the period of untreated mental ill health through earlier detection
  • Eliminating stigma and discrimination
  • Preventing suicide through raising awareness of risk factors
  • Promoting and supporting recovery and social inclusion for people who have experienced mental ill health

“Having the same health and safety requirements for physical and mental health first aiders at work is a great place to start for organisations who want to contribute to reducing the parity gap.”