stressA wellbeing think tank has published a new report calling for the legal enforcement of ‘parity of esteem’ for mental and physical health.

The report by 2020health, ‘Whole in One - Achieving equality of status, access and resources for people with depression’, makes a series of recommendations that seek to ensure people have the right to more support from the NHS, local authorities and employers to prevent or treat mental illness. 

The proposals include changes to the way the National Institute for Health and Care Excellence (NICE) appraises mental health treatments and enforces recommendations to ensure all services and medications are made available for patients, as well as publication of local expenditure on local psychological support (Improving Access to Psychological Therapies (IAPT) programme) to identify whether targets have been met and whether spend is proportional to established needs.

Further key recommendations from the report include:

NICE to ensure legally-binding recommendations become standard for mental illness treatments to achieve parity with treatments for physical illness

Healthcare bodies to have a legal requirement to fund a range of services to meet local population mental health needs

Promote employer’s obligations under the 1974 Health and Safety at Work Act to support mental wellbeing in the workplace.

The think tank’s report argues that achieving parity of esteem is not just a point of principle but critical for UK plc. Mental illnesses are estimated to cost the UK business economy around £30 billion a year with self-reported depression the single most important cause of workplace absenteeism in the UK.

Commenting on the report, Norman Lamb, Minister for Health said: “Following the All-Party report on ‘Parity in progress’, I welcome 2020health’s ‘Whole in One’ report which highlights ways to legally embed parity of esteem for people with depression. I am passionate about improving prevention and services for people with mental illnesses and know that we need radical improvements to ensure people get the help, support and treatment that they need, when they need it.”

Julia Manning, chief executive of 2020health, added: “Parity of esteem has been talked about since the last election, but to become a reality it requires legal force behind it. In addition to this, while we continue to treat mental illnesses such as depression as separate from physical illnesses, we perpetuate the myth that ‘mental’ illness isn’t physical, despite many symptoms being experienced physically. Continuing to use the term ‘mental’ conjures up images of people being mad, sad or bad, when the reality is that they are simply ill, just like someone with arthritis, diabetes or ‘flu.”

Raising employers’ awareness

As well as recommending improvements to the NICE appraisal process so that mental health treatments have the same chance of success as physical health treatments, the report urges the government to raise awareness of employer’s obligations under the Health and Safety at Work Act to support mental wellbeing in the workplace. The Act places a duty on all employers’ to ensure employees “health, safety and welfare at work” but in reality it is not enforced to support the mental health of workers. 

Future measures could include the Health and Safety Executive exercising the Act to ensure legal force is brought on employers’ provision of prevention and support for mental illnesses in the workplace where practicably possible. 2020health is also recommending the government funding of local Workforce Mental Health Consultants to promote prevention and early intervention in the workforce, and enforce employers’ responsibility.

In terms of treatment and services, the authors further noted that the NHS spends only 13% of its budget on mental health services, and funding for mental health services has been falling in real terms for children and young adults, for working age adults and for older people. The government’s flagship mental health policy, the IAPT programme, has seen service expansion, but local investment varies widely, ranging from under £2 to over £14 per head of population.

Emer O’Neill, chief executive of the Depression Alliance added: “It is well-documented that spending on mental illness is not proportional to the devastating impact that mental health problems can have on people’s lives. However, what is particularly worrying is that the gap between spend as a proportion to burden has been increasing since ‘parity of esteem’ was enshrined in the Health and Social Care Act. We need to do something radical to turn the tide, and using legal force to ensure employees’ rights are protected, and guidance and guidelines for health authorities are created and followed would be a crucial step.”