Millard and Wessley  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 . 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 . 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 , just pouring money into potentially harmful, stigmatising and ineffective services , will not lead to the improved outcomes we are looking to achieve.
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Competing interests: No competing interests