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The Royal College of Psychiatrists Improving the lives of people with mental illness

Landmark report on achieving parity between mental and physical health published

Embargoed until 26 March 2013

A major report demonstrating how parity between mental and physical health can be achieved is published today (26 March) by the Royal College of Psychiatrists – the week before new NHS structures come into force.


The report, Whole-Person Care: From Rhetoric to Reality, defines parity as valuing mental health equally with physical health. It highlights the significant inequalities that exist between physical and mental health care, including preventable premature deaths, lower treatment rates for mental health conditions and an underfunding of mental healthcare relative to the scale and impact of mental health problems.


It also highlights the strong relationship between mental health and physical health. Poor mental health is associated with a greater risk of physical health problems, and poor physical health is associated with a greater risk of mental health problems.


Professor Sue Bailey, President of the Royal College of Psychiatrists, said: "Much has been done to improve mental health in the last 10 years but it still does not receive the same attention as physical health, and the consequences can be serious. People with severe mental illness have a reduced life expectancy of 15-20 years, yet the majority of reasons for this are avoidable. Achieving parity of esteem for mental health is everybody’s business and responsibility. I therefore urge the government, policy-makers, service commissioners and providers, professionals and the public to always think in terms of the whole person – body and mind – and to apply a ‘parity test’ to all their activities and to their attitudes. This report is the first stage of an ongoing process over the next five to ten years, that will deliver parity for mental health and make whole-person care a reality."


The report makes a series of key recommendations for government, policy-makers and health professionals, as well as the new NHS structures coming into force on 1 April including the NHS Commissioning Board, Clinical Commissioning Groups and Public Health England. Recommendations include:


  • The government and the NHS Commissioning Board should work together to give people equivalent levels of access to treatment for mental health problems as for physical health problems, agreed standards for waiting times, and agreed standards for emergency/crisis mental healthcare.
  • Action to promote good mental health and to address mental health problems needs to start at the earliest stage of a person’s life and continue throughout the life course.
  • Preventing premature mortality – there must be a major focus on improving the physical health of people with mental health problems. Public health programmes must include a focus on the mental health dimension of issues commonly considered as physical health concerns, such as smoking, obesity and substance misuse.
  • Commissioners need to regard liaison doctors (who work across physical and mental healthcare) as an absolute necessity rather than an optional luxury. NHS and social care commissioners should commission liaison psychiatry and liaison physician services to drive a whole-person, integrated approach to healthcare in acute, secure, primary care and community settings, for all ages.
  • Mental health services and mental health research must receive funding that reflects the prevalence of mental health problems and their cost to society. Mental illness is responsible for the largest proportion of the disease burden in the UK (22.8%), larger than that of cardiovascular disease (16.2%) or cancer (15.9%). However, only 11% of the NHS budget was spent on NHS services to treat mental health problems for all ages during 2010/11.
  • Culture, attitudes and stigma – zero-tolerance policies in relation to discriminatory attitudes or behaviours should be introduced in all health settings to help combat the stigma that is still attached to mental illness within medicine.
  • Political and managerial leadership is required at all levels. There should be a mechanism at national level for driving a parity approach to relevant policy areas across government; all local councils should have a lead councillor for mental health; all providers of specialist mental health services should have a board-level lead for physical health and all providers of physical healthcare services should have a board-level lead for mental health.
  • The General Medical Council (GMC) and Nursing and Midwifery Council (NMC) should consider how medical and nursing study and training could give greater emphasis to mental health. Mental and physical health should be integrated within undergraduate medical education.

The College was asked to produce the report by the Department of Health and the NHS Commissioning Board Authority following a request from the Minister for Care Services.


Norman Lamb, Minister for Care and Support, said: "I have made it clear that our goal – and that of the health and care system – is to make sure that mental health has equal priority with physical health. I am delighted that Professor Bailey has been able to bring so many experts together to consider how we might do this, and to produce a report which challenges all of us to think about the contribution we can make. It is very encouraging to see that a number of organisations have made specific commitments to put mental health on a par with physical health as part of this work. I will consider these findings and recommendations carefully to think through what more the Government can do. I would urge others in the health and care system to do the same."


To produce the report, the College convened a parity of esteem working group, which had a wide membership from Medical Royal Colleges, national clinical leaders, mental health charities, social care, service users and carers and individual experts who advised on particular aspects of policy and research. Other experts contributed on an invited basis and a full list of contributors is available in the report.

Professor Lindsey Davies, President of the Faculty of Public Health, said: "For too long, mental health has not had equal status with physical health among doctors. As a result, the physical health of people with mental health needs has been sidelined. We fully support this paper and agree that individuals should be treated holistically. That means looking at people’s physical and mental health, their social care needs and all the other wider factors that impact on their wellbeing. There's some way to go before we in the public health profession are fully playing our part in achieving this. At FPH, we are doing this by addressing how we cover mental health and wellbeing in our curriculum, and through the practical resources on mental wellbeing that we provide public health professionals. As local authorities in England take on responsibility public health next month, we need them to fully realise the expertise and skills that public health professionals bring."

Paul Farmer, Chief Executive of Mind, said: "People often tell us about the stark differences they have experienced in accessing NHS services for physical and mental health care, feeling they have to ‘settle for less’ with their mental health. One person told us they get immediate attention for slightly high blood pressure, but face indifference and long waits about their mental health needs unless they are suicidal. Others have told us that they experience far better treatment in A&E for physical symptoms than when they need emergency help in a mental health crisis or for self-harm injuries. This is not acceptable. So we're particularly pleased to see the report's recommendations on equivalent levels of access and waiting times, specifically in emergency and crisis mental health care."


Paul Jenkins, Chief Executive of Rethink Mental Illness, said: "The Government says it wants to put mental health on a par with physical health, but this report shows how much work needs to be done to make that a reality. Nowhere is this more apparent than in the fact people with severe mental illness on average die 20 years younger than the rest of the population because they don’t get the support they need for their physical health. Last year The Schizophrenia Commission highlighted that mental health accounts for 23% of illness but receives only 13% of the NHS budget, and it is vital that we address this disparity. This report shows clearly what needs to change. We urge the Government to take these recommendations on board and to put its words into action."


Sean Duggan, Chief Executive of the Centre for Mental Health, said: "Parity between mental and physical health is key to making the NHS more efficient, more effective and more humane. For too long our mental health has been overlooked. Children and adults alike have not received the timely help they need when they become unwell. And the physical health of people with a mental illness has been overshadowed. Today’s report sets out some clear objectives and some welcome commitments to putting this right. The disparities we face today require change at every level, from national decisions about how money is spent to the everyday work of health and care professionals. But by starting on the journey today we can make great progress and start offering people with mental health conditions a fairer chance in life."

For further information, please contact:
Sarah Nevins
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Claire McLoughlin
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OP88: Whole-Person Care: From Rhetoric to Reality – achieving parity between mental and physical health was published by the Royal College of Psychiatrists on 26 March 2013


Note to editors:

The Health and Social Care Act 2012 secured explicit recognition of the Secretary of State for Health’s duty towards both physical and mental health. In conjunction with a clear legislative requirement to reduce inequalities in benefits from the health service, these place an obligation on the Secretary of State to address the current disparity between physical and mental health. However, the concept of ‘parity of esteem’, a principle which underpins all six objectives of the English Mental Health Strategy, No Health without Mental Health, is not well understood. The Department of Health therefore asked the RCPsych to establish an expert working group to consider the issues in detail, to develop a definition and vision for ‘parity of esteem’ and to produce recommendations for how to achieve parity of esteem between mental and physical health in practice.


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