Parity of Esteem

Mental Health

Valuing mental health equally with physical health

Inquiry into Parity of Esteem 2014/15

The All Party Parliamentary Group on Mental Health (APPGMH) is a group of MPs and Peers from all political parties who are interested in mental health. It meets about five times a year to hear from people with mental health problems, Government Ministers and healthcare professionals. The group is chaired by James Morris MP and the vice chairs are Mike Thornton MP and Gloria De Piero MP. Mind, Rethink Mental Illness and the Royal College of Psychiatrists support the group with administrative tasks.

The APPG on Mental Health has carried out an inquiry into ‘parity of esteem’, to assess how the Government is meeting its objective to give mental health equal priority to physical health. They published their report (Parity in Progress?) in March 2015. The Government – through its mandate to the NHS – has committed to achieving parity of esteem for mental health. NHS England and wider partners now have responsibility for delivering this work nationally.

The APPG focused on three areas in its inquiry:

  1. Reducing premature mortality for people with mental health problems. Recommendations in the Report included:
    • The introduction of an objective for a national reduction in premature mortality that progress can be measured against.
    • Mental health professionals to receive physical health training.
    • Tailored support to help those with mental health problems stop smoking.
    • Better management of the side-effects of anti-psychotic medication, including clearer information provision and regular health checks.
    • Greater clarity for providers on their responsibilities for monitoring and managing the physical health of those with mental health problems.
  2.  Improving the quality of mental health emergency care. Recommendations in the Report included:
    • Mental health training should be delivered to all professionals who may meet a person in crisis.
    • The use of joint crisis plans should be increased.
    • A wide range of community based support services should be commissioned by CCGs, with sufficient mental health inpatient beds available in the local area
    • The next government should commit to implementing the Crisis Care Concordat beyond 2015.
    • A national network of liaison and diversion mental health services should continue to be funded.
  3. Mental wellbeing as a public health priority. Recommendations in the Report included:
  • Mental health education should form a key part of the PHSE curriculum.
  • All Joint Strategic Needs Assessments should include information about local mental health needs.
  • There should be a designated mental health champion on each Health and Wellbeing Board.
  • There should be national investment in evidence-based parenting programmes.

On this latter point the inquiry noted that despite mental health problems affecting one in four people, local authorities only spend 1.36% of their public health budget on mental health. It found that mental health was not appropriately prioritised by Health and Wellbeing Boards and that Joint Strategic Needs Assessments  rarely collect data on local mental health.
In the preface to the report Gloria De Piero MP, Vice-Chair of the All Party Parliamentary Group on Mental Health, says: “We should all care about mental health. Anyone can develop mental health problems no matter what their age or background. Every year one in four people will experience a mental health problem. That is why ensuring people are able to access the appropriate services at the right time is fundamental to achieving ‘parity of esteem’ between mental and physical health. The Labour Party is absolutely committed to providing fairer access to mental health services.”

For me, the big questions are who is accountable to make parity of esteem a reality and why is it taking so long? In their report the APPG says more should be done to address the institutional bias against mental health, including an independent review to be undertaken into:

  • How the Government holds NHS England to account in meeting its commitment to parity of esteem as set out in the NHS Mandate; and
  • How NHS England holds Clinical Commissioning Groups (CCGs) to account in meeting their commitment to parity of esteem as set out in the NHS Mandate.

This review would set out what action(s) should be taken if any breach of the Mandate is found.


“To date it has been a very frustrating contracting round and unfortunately highlights the institutional prejudice that exists towards mental health services. It has not been recognised at the centre that there will need to be a significant cultural shift if parity of esteem is to even start to be delivered.” (Finance Director, Mental Health Trust)

In March 2015, we surveyed NHS mental health foundation trusts and trusts to find out whether commissioners are planning to meet the requirement in the planning guidance to increase their real term investment in mental health services. We found that the majority of respondents (53%) were not confident that their commissioners would meet the planning guidance requirement on funding.
Commissioners need to be held to account over their spending decisions, particularly where they are not investing in services in line with planning guidance. We would urge NHS England to check through the planning process the level of increase in mental health spend that each commissioner is planning for, and to hold commissioners to account where they are not able to demonstrate they are increasing their real term investment in mental health services.

In order for the public to have absolute transparency over investment decisions that commissioners are making, both CCGs and local area teams should publish their spending on mental health services in a publically accessible format.

(The information above is provided by NHS Providers, which is the membership organisation and trade association for the NHS acute, ambulance, community and mental health services that treat patients and service users in the NHS.)

Let’s see some action in terms of holding this government accountable to address the institutional bias against mental health, through this government holding NHS England and the CCGs accountable. Gloria De Piero MP says ‘The Labour Party is absolutely committed to providing fairer access to mental health services.’ Hopefully we will see our new Labour Leader, and our new Shadow Minister for Mental Health, Luciana Berger MP, raising the issue of the institutional bias against mental health and pressing for some real quotas and targets from this government to ensure their commitment, and ensure real change, fairness and parity. It’s long overdue.