Inequalities in Health have always been a concern for epidemiologists. In situations where premature mortality seems preventable, social justice makes inequality a concern for all public health professionals. Before the traumas of World War I revealed that anyone might develop a mental illness, a common clinical belief was that psychiatric disorders were mainly hereditary or the result of some congenital, constitutional weakness – as depicted by Charlotte Bronte in Jane Eyre and the “bad blood” of the first Mrs. Rochester.
Few people were surprised in 1913 that people with mental illness often died at a younger age than their neighbours living in the same community. At that time most British adults died before they reached a pensionable age. But after the Armistice of 1918, hundreds of thousands of young adults who had left Britain reasonably sane, now had mental illnesses that interested the Ministry of Pensions. Factors that determined the severity of illness, recovery of function and inclusion in work became of public interest.
In 2018 the Centre for Mental Health estimates there are 15-20 ‘stolen’ years lost for people living with severe mental illness, compared to other people in the same community. Even for people living with ‘common’ mental illnesses like depression or alcoholism, life is generally shorter. Most former patients are not dying of exceptional incidents (like the fire started by the fictional Mrs. Rochester). The precursors to premature mortality in populations with both severe and common mental illness are in fact physical. They include: smoking, diabetes, heart disease and cancer. Since my days as research co-ordinator for the Bethlem Royal & Maudsley Hospitals I have also been concerned about related, aggravating factors observed alongside mental illness – poverty , bad housing, unemployment and loneliness.
When I was a member of the Department of Health Steering Group for No Health Without Mental Health in 2010 – 2011, we all agreed on the radical proposal for policy-makers and service commissioners to have a Parity of Esteem (valuing mental health equally with physical health), for physical and mental health needs across the English population. I have been waiting a long time to see much joined-up planning but the Health and Social Care Act 2012 did include the Secretary of State’s duty to promote a more comprehensive service. It stated that:
“The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—
(a) in the physical and mental health of the people of England, and
(b) in the prevention, diagnosis and treatment of physical and mental illness.”
Based on the 2012 Act, the Mental Health Foundation considered the importance of Parity of Esteem. They also offered advice on measuring the parity gap.
They said that while there is not a unanimously accepted method for measuring parity, there are three common concepts in this area that are good indicators. They are:
- Excess mortality – the negative impact mental health has on life expectancy
- Burden of disease – mental health is the single largest cause of disability in the UK, however is not reflected in NHS budget
- Treatment gap – the difference between the number of people thought to have a particular condition, and those receiving treatment for it.
There followed an NHS report called, ‘A Call to Action: Achieving Parity of Esteem; Transformative Ideas For Commissioners’. However, sustainability and transformation plans did not deliver an answer to the “stolen” years with mental illness.
Equally Well
Equally Well is a concept that began in New Zealand “to support the physical health of people with a mental illness“.
Helen Lockett from Equally Well New Zealand welcomed participants to the launch event for Equally Well UK, hosted in London by the Royal College of Nursing on 13 September 2018.
The UK collaboration is led by the Centre for Mental Health and involves about 50 organisations, including Professional bodies (like the Faculty of Public Health), NHS England, Public Health England and a number of not-for-profit organisations. A clear summary of the intentions for this collaboration were given in the BMJ. Personally, I felt there was a lot of goodwill at the launch and I hope there will be a commitment to long-term collaboration, between all of those organisations.
I’m a member of FPH’s Public Mental Health Special Interest group (SIG) and we support the Equally Well “Charter for Equal Health” which I highly recommend everyone reads. We share their belief that “if you have a mental health problem, it shouldn’t mean you have any less right to good physical health”.
Written by Woody Caan FFPH, Editor of the Journal of Public Mental Health and member of FPH’s Public Mental Health SIG. To find out more about the SIG, click here.
PHE produced this helpful report on physical health co-morbidities with severe mental illness: https://www.gov.uk/government/publications/severe-mental-illness-smi-physical-health-inequalities/severe-mental-illness-and-physical-health-inequalities-briefing