Intended for healthcare professionals

Rapid response to:


Parity of esteem between mental and physical health

BMJ 2014; 349 doi: (Published 14 November 2014) Cite this as: BMJ 2014;349:g6821

Rapid Response:

Millard and Wessley [1] attempt a very worthwhile deconstruction of the important desire to put mental health on a more equal footing with physical health. They rightly acknowledge how hard it is to know what ‘parity of esteem’ means in reality as they point out that, “Mental illness has always evaded precise definition, and to claim that there are no differences between mental and physical disorders does not accord with reality.”

However, they let mental health professionals and service users down by avoiding engagement with evidence that highlights that the problem with mental health services has more to do with the services themselves. Their two main examples of “tackling excess mortality and stigma” is a perfect illustration of how far organisations like the Royal College of Psychiatrists have got from representing the best interests of patients. They correctly note that, “people with a diagnosis of severe mental illness die on average 15-25 years before those without—largely from preventable physical diseases such as heart disease and diabetes”, but neglect to mention that these diseases are often caused by the long term use of drugs like anti-psychotics, despite evidence that since the advent of mass use of these drugs long term prognosis for those with severe mental illness has got worse not better [2]. The second issue of stigma is another where the current evidence is simply not mentioned, which is that the idea that ‘mental illnesses are illnesses like any other’ is the one consistently associated with highest level of public stigma as it is associated with unpredictability, dangerousness and a desire for greater social distance [3]. Our current reliance on treating mental health as if we can use the same diagnosis based approaches that have been successful for the rest of medicine, flies in the face of the evidence.

To get more effective mental health care, we need to avoid meaningless polemics like ‘parity of esteem’ and stop simply arguing for more resources (as important as this may be). Without fundamental reform of theory and practice [4], just pouring money into potentially harmful, stigmatising and ineffective services [5], will not lead to the improved outcomes we are looking to achieve.

1 Millard C, Wessley S. Parity of esteem between mental and physical health. BMJ 2014; 349: g6821.

2. Whitaker R. Anatomy of an Epidemic. New York: Crown; 2010.

3. Angermeyer MC, Holzinger A, Carta MG, Schomerus G. Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. BJPsych 2011; 199: 367–372.

4. Bracken P, Thomas P, Timimi S, et al. Psychiatry beyond the current paradigm. BJPsych 2012; 201: 430-434.

5. Drury N. Mental Health is an Abominable Mess: Mind and
Nature is a Necessary Unity. New Zealand J Psychol 2014; 43: 5-17.

Competing interests: No competing interests

30 November 2014
Sami Timimi
Consultant Child and Adolescent Psychiatrist
Lincolnshire Partnership NHS Foundation Trust
Child and Family Service, Horizon Centre, Monson Street, Lincoln, LN5 7RZ