More should be done to ensure mental health treatments are on the same level as treatments for physical health, a new report has found.
More promotion of good mental health and improved funding into research into mental illness are all also crucial for ensuring parity of esteem between the two healthcare disciplines, the report, titled Whole-Person Care: From Rhetoric to Reality has recommended.
The report, by the Royal College of Psychiatrists, highlights the significant inequalities that still 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 it.
It also highlights the strong relationship between mental 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.
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 April 1 including the NHS Commissioning Board, Clinical Commissioning Groups and Public Health England. These include:
• 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 life
• 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 a 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 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 services to treat mental health problems 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 and Nursing and Midwifery Council 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.
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 on-going process over the next 5 to 10 years, that will deliver parity for mental health and make whole-person care a reality.”
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.
“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."
Dr Andrew McCulloch, chief executive of the Mental Health Foundation welcomed the report. He said: “A whole-person approach which embraces integrated and holistic care is vital if the inequalities in health experienced by people with a mental illness are to be addressed.
“We are encouraged by the call for greater investment in mental health research, which is currently disproportionately low in relation to the disease burden. It is vital that the National Institute for Health Research breaks down the barriers presented by single disease group silos and instead focuses on systems that facilitate multidisciplinary and cross-sector working.
“It is refreshing to see an emphasis on the training of professionals who need to understand the complex links between mental and physical health, especially within medically unexplained illnesses which usually have an underlying psychological component.
“The current lack of parity is unjust and falls worryingly short of Government commitments, therefore we await the Minister’s response to this report with interest.”