The Return of Parity of Esteem

At the start of this week Theresa May set out her priorities, including a focus on mental health. Primarily this focused on child and adolescent mental health services (although without much funding) and fighting the stigma of mental health. It’s hard to be against either of these things, as it’s hard to be against the idea of “parity of esteem”. But I would argue that it’s equally easy to be in favour of much more, and we really do need so much more.

I’m not going to rehash the need for more funding for the social care budget which has been slashed year on year, nor the shortage of psychiatric beds, the problems accessing crisis teams or the ongoing issue in being able to access therapeutic services. Other bloggers are more able to do these things, more eloquent in their arguments.

I just want to raise the again the issue of parity of esteem in terms of the physical health of people with mental health problems and/or learning disabilities. And I want to do this because the problem isn’t merely stigma, it’s discrimination.

Let’s start from a given. People’s mental health is given lower priority than their physical health. Were this not the case there would be no need to call for parity. By turning this round we have a lens to see how people with mental health issues or learning disabilities are viewed and treated. We can also argue that this moves us beyond the stigma aspects of mental health or learning disabilities. The group of people that I am going to talk about are already “out”; through choice or necessity they are identified as having mental health problems or learning disabilities.

So, if we’re beyond the realm of stigma, and we’re looking at physical health, we should see similar expectations of treatment for all. We don’t. In 2014 the BMA published a report showing a 15 – 20 year shortfall in the life expectancy of people who have mental health problems or learning disabilities compared to those that don’t. True Voice ran an event on this as part of #justiceforLB’s #107days of action campaign.

The report pointed to poor training and ingrained discriminatory attitudes. Participants at our 2014 event reported huge inequalities in accessing screening and treatment. People with mental health problems or learning disabilities don’t get adequate access to health screening, aren’t treated early enough, and as a result people die too young.

We heard of the impact of cuts in social care on people’s life expectancy. Cuts in support mean that fewer people are involved in someone’s care. As well as the direct effect of lower levels of support, it means fewer champions to inform and support the health needs of certain communities. Since then cuts have deepened, support has become increasingly sparse.

We heard of women who were given insufficient support to attend breast screening appointments, who were then told that they might be screened again in three years time with no thought as to what might happen in the meantime. Cancer can advance quite far in three years.

I have come across so many instances of people reporting that the health issues of people in care settings are ignored.  Of the difficulty accessing physical healthcare in psychiatric settings. Without equal access to screening how can they possibly hope for equality of treatment or outcome? This isn’t a result of stigma, it’s a result of prejudice and undervaluing people’s lives.

There is a real need to actively promote people’s ability to know what to expect from health, and for health professionals to properly respond to people’s health needs. To be reminded that the physical health of those with mental health problems should automatically have the same weight, import, and urgency as it does in the general population.

The physical healthcare of people with learning disabilities and mental health problems is worse than that of the rest of the population. Their health outcomes and life expectancy are affected by this, people’s lives end too early. This needs to be addressed, otherwise parity of esteem between mental health and physical health will merely mean getting similarly poor support. That’s not stigma, it’s discrimination; getting a worse deal than others because of a certain characteristic.


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