Parity of Esteem (PoE) is a policy concept that strives to bring equality between two (or more) groups.
One notable example is its use within the Good Friday Agreement in an attempt to bring equal rights to the citizens of northern and southern Ireland. In its simplest form PoE as related to health means bringing equality between physical and mental health which was first mentioned in government policy in 2011. In later policies the government set an ambitious target of delivering PoE this year (2020).
The term has gained widespread appeal and praise for its moral aspirations and trying to address the inequitable position of mental health funding and services. Nevertheless, it has been criticised for its vagueness. Therefore, the way in which PoE has been understood and put into action is likely to differ greatly among the many agencies and actors tasked with its achievement. Yet, the one area of consensus amongst these stakeholders is that we do not have equality, and therefore nor do we have PoE. My PhD research seeks to understand exactly what successes and failures have occurred in the name of PoE. The findings of my recent literature review confirm that the topic has not been the focus of any empirical research. In this blog, I outline my findings based on the grey literature and my observations as a mental health nurse over the past ten years.
Firstly, we know that currently (and historically) services and professionals have been divided into those that deal with mental health and those that deal with physical health. Although we also know that any individual can present with physical and mental health conditions simultaneously. Moreover, a person who has a physical health condition is more likely to have a mental health condition, and vice versa. This creates a problem in achieving equality as these are not two distinctive groups of individuals. Therefore, this places the responsibility of achieving PoE on all health services. Nevertheless, my analysis of policy documents suggests that greater importance is placed on mental health and primary care NHS trusts achieving this rather than physical health services.
Secondly, many activities that are advocated to promote equality focus on providing greater integration between services, in addition to calls for more holistic care solutions that seek to provide support for both physical and mental health conditions. However, this has been the focus of policy and practice for many years and dates back to at least the 1950s. Consequently, PoE appears to bring nothing particularly new or innovative to the table.
What PoE has brought is a pledge from government to tackle the inequality faced by those with a mental health condition, despite the journey to equality being fraught with complexity and a lack of clarity. Perhaps the most logical measure of PoE is comparing the funding of mental health services with that of physical health services within the NHS. When the burden of disease (the economic and human cost) for mental health is compared to NHS spend on mental health an approximate 50% shortfall can be seen. This crude measure of PoE does not give the full picture as the barriers to achieving PoE are not confined to funding alone but require changes in the education of practitioners in addition, to the healthcare and legal systems that practitioners work within. What is needed is clarity on the meaning of PoE, its inputs, activities and outcomes. In 2020 with the apparent failure of PoE, a renewed pledge is needed that can be clearly articulated and measured. My research will engage a variety of stakeholder from a national level to the end user through a series of interviews. The aim of my research is to illustrate the theory behind PoE, and in doing so develop an understanding of the potential causal pathways that could transform PoE from a desire to a reality.