Parity of Esteem Between Mental and Physical Health

Dr Chris MillardDr Chris Millard is a Wellcome Trust Research Fellow at the QMUL Centre for the History of the Emotions. His PhD explored the history of attempted suicide as a cry for help, and he is now researching the history of Munchausen syndromes. In this post he writes about his three-month secondment to the Parliamentary Office of Science and Technology in 2014.

For three months during the summer of 2014, I left my research post at The Centre for the History of Emotions to do something a little different. The Wellcome Trust have an arrangement with the Parliamentary Office of Science and Technology (POST), a body that produces non-partisan briefings on scientific issues for MPs and Peers.  The Trust (among other funding bodies) sends people for a three-month period to research and write a ‘scientific’ briefing of interest to Parliamentarians.

I proposed – and was assigned – a briefing on ‘parity of esteem’ between mental and physical health. In other words, I was to summarise expert opinion (from psychiatrists, physicians, social workers, sociologists, nurses, service users, survivors and others) and lay out the ‘state of the art’ on attempts to get mental health problems treated with the same esteem as physical ones.

This issue has been in the news on and off since 2011, when amendments were proposed to the Health and Social Care Bill (now Act) (2012), to explicitly mention the NHS’s commitment to mental, as well as physical health. Recently its profile has risen further: Nick Clegg and the Liberal Democrats are making ‘Parity of Esteem’ one of their key General Election campaign issues. In addition, maximum waiting times for mental health therapies (a key issue for parity) have just been introduced, largely as a result of tireless work by activists and campaigners.

A great advantage of working for Parliament is that important people are much more likely to speak to you. Instead of saying ‘I’m a junior academic, would you mind talking to me…’ you can say: ‘I’m producing a briefing for the UK Parliament: which issues do you think should be included?’ People tend to get back to you after that voicemail! I was also able to walk to work through the Palace of Westminster, and to invite guests to some of the many pubs and bars within. ‘House of Lords Gin’ is truly delicious. Small perks perhaps, but enjoyable nonetheless.

On a more serious note, people were incredibly passionate about parity of esteem. People would rail against the injustice of people with mental health diagnoses having a life expectancy 10-20 years lower than the general population – people dying of preventable physical illnesses, some of which are related to the medication they are prescribed. There was dismay that some cuts to health services fall disproportionately upon mental health (one of which has since been discontinued), or that complicated changes to the way general practice is organized might jeopardize care for those diagnosed with severe mental illnesses such as schizophrenia. It was a little daunting to have to summarize all these concerns into a four-page briefing (which will be published shortly).

Perhaps the most rewarding thing about the fellowship at POST was being able to make contacts with people who continue to campaign for parity. The people at Rethink Mental Illness were especially helpful, and I was also able to attend the launch of a major new report on Understanding Psychosis (free full text) by the British Psychological Society which has led to more connections, contacts and useful references.

The most high-profile result of my time at POST was being invited (somewhat out of the blue) to co-write an Editorial for the British Medical Journal on the issue of parity of esteem, by the current President of the Royal College of Psychiatrists, Professor Simon Wessely. This piece has stimulated passionate debate, to which we have responded.

It feels strange, invigorating and not a little terrifying to be involved in such a public debate. However it has only strengthened my conviction that the arts and humanities can bring much to the table in political debates. The practice of psychiatry is bound up with the history of psychiatry, and parity of esteem has been an issue for much of the 20th century. The persistence of stigma, inequality and fear are problems that can be opened up by historians, and presented to a broad audience.

One of the greatest challenges in mental health is to get over the sectarian and fractious nature of the debates between disciplines, professions and professionals. ‘Parity of esteem’ is not a perfect formulation of the myriad problems that beset mental healthcare. For one thing, it can sometimes reinforce the separation of mental and physical problems, when they are often so interrelated as to be indistinguishable. However, parity is flexible, inclusive, and entails no commitment about what mental illness is, merely that we should respond with compassion, improved provision, and more integrated problem-solving (‘joined-up care’ is the currently favoured phrase).

At a time when the state is being rolled back (with disastrous consequences), we are seeing an increased politicization of mental health concerns. Parity of esteem can be a part of that effort, to show how mental health is an issue of fairness, of ethics, of funding, but above all, of the tireless work and compassion of all who work towards ending inequality in all its forms.