Parity of Esteem

In early December the British Association of Counselling and Psychotherapy announced the publication of its report called ‘Psychological Therapies and Parity of Esteem: from commitment to reality’. This includes coverage of issues such as access, choice, funding and research.

The concept is defined on the NHS website as ‘valuing mental health equally with physical health … [and] … tackling mental health issues with the same energy and priority as we have tackled physical illness.’ Commitment to parity of esteem was formalised in the Health and Social Care Act 2012.

I’m tempted to comment that we should have arrived at this conclusion a very long time ago. But while it’s a great shame that it has taken as long as it has for the validity of mental health issues to gain greater acceptance in this way – and culturally I believe we still have a long way to go – most of us will acknowledge that mental health is a subject that has commonly carried a stigma which has often made discussion of it somehow awkward or embarrassing.

Possibly this is because how we experience our own issues psychologically is so subjective and hidden from the view of others. How we think and feel is ultimately the most personal and fundamental way in which we experience the world. If we acknowledge difficulties in this area it seems to say something about us, about the essential nature of who and what we are – about our personal self that is usually so very much, very exclusively and very privately, our own. Also, aspects of mental illness often defy clear understanding or definition when contrasted with physical illness. This may – in part at least – be why there is such a wide discrepancy between the two areas in research funding

How different from a broken leg or appendicitis, to name two relatively less serious physical ordeals. Yet if such physical conditions are neglected the consequences would obviously be very serious. And so it is with our mental health.

While ‘parity of esteem’ requires that both physical and mental health be regarded on equal terms, we should also recognise that these are not at all separate and independent aspects of our wellbeing. It is well documented that our physical health can be very much affected by our psychological health – for example chronic stress leading to ulcers, and emotional neglect leading to self-damaging behaviour patterns. And vice versa – for example, if we smoke or drink excessively, if we fail to take a certain amount of exercise or get enough sleep our mental health will at some point deteriorate as a result.

The interdependence of mental and physical wellbeing also means that unhelpful behaviour patterns can develop into a vicious circle – perhaps a heavy smoker takes refuge in the habit to gain relief from stress, while the impact of smoking creates physical problems that increase stress, to offer another simple example.

Parity of esteem is clearly a worthy concept but it is also important to recognise that there is no clear dividing line between our physical and mental wellbeing. In other words, we should look after the whole person.