Parity of esteem for mental and physical health is a red herring

Millard and Wessely acknowledge how hard it is to know what “parity of esteem” between mental health and physical health really means.1

However, they avoid direct engagement with evidence that the problem with mental health services is also to do with the services themselves. Their two main points of “tackling excess mortality and stigma” is a perfect illustration of this. 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.” However, they fail to mention that these diseases are often caused by long term use of drugs like antipsychotics, despite evidence that the long term prognosis for those with severe mental illness has got worse since the mass use of these drugs, not better.2 In addition, they do not mention that current evidence finds that the diagnosis based biomedical model of mental illnesses being “illnesses like any other” is the one consistently linked with the highest level of public stigma, being associated with unpredictability, dangerousness, and a desire for greater social distance.3 Our current approach of treating mental health problems using the same diagnosis based approaches that have been successful for many other branches of medicine is simply not evidence based.

For more effective mental healthcare, we need to go further than arguing for more resources (important as this is) and using polemics like parity of esteem. Without fundamental reform of theory and practice,4 just pouring money into potentially harmful, stigmatising, and ineffective services will not lead to the improved outcomes we are looking to achieve.5