Make parity a reality, not an afterthought

In a recent HSJ comment, Michael White observed that after many past disappointments, “Cinderella” is finally going to the ball.

His observation followed a series of announcements from the government, from political parties and from NHS England about their plans to bring about greater parity between mental and physical health.

‘The NHS faces £1.2bn in the costs of perinatal mental illness, yet for an estimated £280m we could put NICE compliant services in place across the country’

From April, we will have specific waiting time standards for Early Intervention in Psychosis and Improving Access to Psychological Therapies services for adults.

Both are supported by additional funding, while NHS England’s planning guidance, reinforced in a recent interview with Simon Stevens, specifies that clinical commissioning groups should achieve real terms increases in mental health spending next year.

As well as immediate action to reduce long waiting times and reverse cuts in funding, the government has mapped out some longer term goals, including a broader range of access standards, better crisis care, improved support for children’s mental health and action to enhance suicide prevention.

Parity of esteem

The term “parity of esteem” has been used widely since 2011 to illustrate the intention of the government’s strategy, No Health Without Mental Health.

Perhaps because it has never been clearly defined, “parity” has taken on a range of meanings and prompted diverse responses across the country.

In some places, it has been the driving force behind multiagency efforts to enhance mental health support, while in others it has barely registered in mainstream decision making and budgeting.

Achieving parity for mental health across the NHS will require concerted action in every corner of the system and every part of the country. It cannot be ignored or sidelined by a single CCG, health and wellbeing board or local council.

It will entail targeted reinvestment in mental health interventions that can demonstrate good value in an increasingly tough economic climate.

Guidance from the National Institute for Health and Care Excellence on mental health conditions is rarely followed in full despite clear evidence of the cost effectiveness of the interventions it recommends.

Recently published figures show that in 2011-12 just 0.38 per cent of the NHS budget was spent on psychological therapies: an improvement on the 0.21 per cent figure five years before but far below the level of investment required to meet the level of need in the population.

The costs to the NHS and its partners of endemic underinvestment are increasingly apparent. Some £10bn is spent on the extra costs of treating people with long-term physical conditions as a result of comorbid mental health conditions that are rarely even identified, let alone treated.

The NHS faces a further £1.2bn in the costs of perinatal mental illness, yet for an estimated £280m we could put NICE compliant services in place across the country, making much better use of public money and averting a lifetime of costs for women and their children.

Reinvestment in cost effective mental health care is of course only part of the picture for achieving parity. We also need to rewire parts of the system that have reinforced the disparities we see today.

Rewiring the system

The development of meaningful access standards for mental health interventions is a crucial first step in the “rewiring” journey. Learning from experiences elsewhere in the system, this will need to be coupled with:

• clear entitlements to cost effective interventions;
• routine data collection to get an accurate picture of progress (in terms of outcomes as well as access); and
• robust systems to ensure that faster access does not create compromises on quality or staff wellbeing.

‘Too often mental healthcare has been an afterthought of health policy’

The way health services are commissioned and paid for also needs to change. Too often mental healthcare has been an afterthought of health policy, bolted on belatedly to systems designed with other things in mind.

As well as developing new payment systems for mental health services, we need to look more broadly at how money moves through the whole system and examine how it could support parity, encourage earlier intervention and reward services that promote recovery.

And we need to enable much greater pooling of resources with social care, public health, housing, employment, education and criminal justice services.

Parity cannot be achieved by mental health services in isolation. It will mean embedding mental health in long term conditions services – for example routinely assessing patients’ mental health needs and offering timely, cost effective interventions.

It will require concerted action to improve physical healthcare for people with severe mental health problems. And it should mean that new managed care systems developed in the wake of the NHS Five Year Forward View include mental health from the outset.

‘Equal care for equal need could be a hallmark of the NHS if it embraces parity’

Parity between physical and mental health will bring about significant health, social and economic benefits.

From supporting women during pregnancy and helping children in schools to enjoy better mental health, to offering respectful and timely support to someone in a crisis, equal care for equal need can be a hallmark of the NHS of the future if it embraces parity wholeheartedly and makes the changes necessary to achieve it.

Andy Bell is deputy chief executive of the Centre for Mental Health