Parity of esteem: Addressing the inequalities between mental and physical healthcare

Abstract

SummaryParity of esteem means valuing mental health as much as physical health in order to close inequalities in mortality, morbidity or delivery of care. There is clear evidence that patients with mental illness receive inferior medical, surgical and preventive care. This further exacerbated by low help-seeking, high stigma, medication side-effects and relatively low resources in mental healthcare. As a result, patients with severe mental illness die 10–20 years prematurely and have a high rate of cardiometabolic complications and other physical illnesses. Many physical healthcare guidelines and policy recommendations address parity of esteem, but their implementation to date has been poor. All clinicians should be aware that inequalities in care are adversely influencing mental health outcomes, and managers, healthcare organisations and politicians should provide resources and education to address this gap.Learning Objectives• Understand the concept of parity of esteem• Be aware of the current inequalities in mental healthcare• Appreciate how parity of esteem may be improved

A Novel Landscape for Understanding Physical and Mental Health: Body Mapping Research with Youth Experiencing Psychosis

“…The traditional separation of physical and mental health, as popularised by Descartes' philosophy of mind-body dualism, has led to a corresponding lack of integration between care delivered by professionals focused on physical health versus mental health. It is therefore imperative that mental health practitioners include physical health in their assessment and treatment recommendations (Mitchell, Hardy & Shiers, 2017;Vancampfort, Stubbs, Ward, Teasdale & Rosenbaum, 2015a, 2015b.…”

End of life care for people with severe mental illness: Mixed methods systematic review and thematic synthesis (the MENLOC study)

“…Comprehensive services of this type are exactly as should be expected by all members of the population, 12,14 but the importance of this for people with severe mental illness at the end-of-life is worth restating for the purposes of promoting parity of esteem. Whilst parity is an international goal, 3 even when research and other evidence in this area is presented for use by policymakers it typically neglects to address end-of-life care specifically. 98 A practical strategy to promote comprehensive care in which a high level of confidence exists is the use of capable advocates, able to increase the referral of people with severe mental illness to palliative care services, and to help make sure palliative care is provided and received.…”

“…1 Premature death in this group has been described as a human rights disgrace, 2 driving international and national efforts to tackle disparities. The phrase 'parity of esteem', used across the world 3 and first introduced in the UK in England's Health and Social Care Act 2012, 4 refers to the principle that people with mental health difficulties should have access to care of the same standard and timeliness as that enjoyed by people with physical health difficulties. International guidance 5 emphasises the importance of high-quality palliation and support for all, irrespective of underlying condition.…”

Parity of esteem: evaluating inequalities in older adult healthcare

“…This evaluation does prompt further investigation into the clinical decisions of doctors working in older adult mental healthcare. The British Medical Association's parity of esteem recommendations highlighted by Mitchell and colleagues (Mitchell 2017) are positive steps forwards in the junior doctor training pathway. We have struggled to find an effective solution to the inequality in admission clerking present at The Harbour.…”

“…In a previous issue of BJPsych Advances , Mitchell, Hardy & Shiers published an in-depth evaluation and provoking article concerning parity of esteem in mental and physical healthcare (Mitchell 2017). It is of utmost importance not only to understand the concept of parity of esteem, but also to be aware of its damaging effects and make strategies to combat these in order to provide safe patient care.…”