On paper, ‘parity of esteem’ between physical and mental health has been legally established for more than five years. But that obligation has remained a distant aspiration and the NHS crisis has only accelerated the familiar sacrifice of mental health budgets in favour of acute care. ‘Asking for help’ we are frequently hear, is the first step in addressing mental ill health. Unfortunately, too many people find that, when they ask, not much help is available, beyond occasional 10-minute appointments with their GP and an offer of trying out tablets.
Rolling out cognitive behavioural therapy (CBT) for a range of low to moderate severity mental illness has successfully increased access to treatment. But patients with more severe problems often find that intensive support is effectively restricted to only those deemed at imminent risk of suicide. This leaves far too many falling between the gaps between services, with an illness too severe for routine CBT yet not high risk enough to be accepted for intensive psychological or psychiatric treatment.
Those who meet the high thresholds for inpatient treatment can end up being placed hundreds of miles from home, frequently after long waits for a bed to become available. Meanwhile, GPs feel themselves helpless to address the everyday misery caused by deprivation and adversity that we usually end up medicalising as ‘depression’.
While achieving even lip service to parity of esteem for mental health was a laudable achievement, if anything ‘parity’ underestimates the importance of mental health. The division between mental and physical health is an administrative fiction. The two are not simply connected, they are utterly interdependent and inseparable. We know, for example, that the intensity of pain is increased by depression and that loneliness, stress and deprivation are important risk factors for cardiovascular disease like heart attack and stroke, alongside smoking and blood pressure.
Unsurprisingly patients with chronic ‘physical’ disease are more likely to be depressed, but patients who are depressed are also more likely to suffer other chronic diseases and to die younger. Managing physical illness without taking into account mental wellbeing necessarily limits the prospects for successful treatment, yet this is too often the prevailing model of healthcare.
There is emerging evidence that embedding psychological therapy in the treatment of chronic diseases improves outcomes. Intuitively the concept makes sense. Sadly, right now, mental health provision is so barren that establishing services commensurate with acute need is more urgent than pioneering models of integrated physical and mental health care. Labour has committed to addressing this dire situation and to honour ‘parity of esteem’. But the party rarely hints at just how much that would cost or where health features in the pecking order alongside other pricey priorities.
Like ‘parity of esteem’, the importance of improving societal health is unanimously endorsed, but only in principle. The English NHS’s current strategy, the Five Year Forward View, makes much of prevention but the government’s attitude has remained that public health isn’t important enough to risk upsetting industry lobbyists and sneering journalists.
That Corbyn’s Labour refuses to sell out ‘the many’ to vested interests represents a unique opportunity to restore wellbeing on a national scale, but the feat of reversing our sickness trajectory will not happen just through a few policy tweaks and a little more NHS funding. Good health spanning from infancy into an independent old age is achievable for most people but calls for coherent planning and action across early years provision, social services, public transport, town planning, education, drugs policy, food, alcohol and tobacco regulation all alongside delivering a jobs economy.
As well as being told to ‘ask for help’, people with health problems need be able to access the care they need, mental and physical. Better still, we can improve national wellbeing to prevent many more falling into ill health at all.