Parity of Esteem

 Rosaline Kelly 8 Nov 2018

What exactly do we mean by parity of esteem?


I also wrote about an absolute need to equate the importance of mental health and mental health service provision with physical health and physical health service provision. And this is what we call parity of esteem. This means giving equal priority and value to mental health and physical health needs, so that people with mental health problems will have equal access to care and treatment, the same levels of dignity and respect from health and social care staff, and the same quality of physical health care as those without a mental health problem.


Significantly, evidence tells us that people with serious mental illness are more likely to die 15-20 years before the rest of the general population. This is referred to as the mortality gap. There are many complex reasons for this, including discrimination and stigma, poor life chances, poor physical health and lifestyle choices, the use of long-term medication, and the way in which mental health services are structured.  

So, what are we, as nurses, doing about this? In April 2018, the RCN launched a UK-wide project following a debate at RCN Congress. The RCN has committed to working to ensure that people with complex mental health problems receive the same care and achieve the same outcomes as those with physical injuries and illnesses. The RCN aims to be a leader on equity in health and nursing practice, engaging in innovative, new and bold ideas about how its members can deliver effective and holistic services.

 Our key objectives include: 

• pushing for increased funding for mental health services on a basis of equity with physical health services
• improved training; consistency, competency and curriculum support
• identification of areas where access and innovation around physical health has made a difference.

There are opportunities for nurses and nursing teams to get involved in this programme of work. Please access the RCN website to find out how.

As part of meeting the objective of identifying areas where access and innovation around physical health has made a difference, the RCN in Northern Ireland will be facilitating a best practice seminar in the spring of 2019. This event will share learning from across the HSC trusts on addressing the physical health needs of a person with serious mental illness, with a focus on how to evaluate and evidence the impact of interventions. Keep an eye on the RCN Northern Ireland webpages for further information.

We can focus on parity of esteem in three ways:

  1. Those with serious mental illness are dying 20 years before the rest of us. We must do something to improve the quality of life and life expectancy of this population in terms of how their mental health is treated and improved, and how their physical health needs are addressed by mental health professionals (such as through a reduction in the use of anti-psychotic medication).
  2. Those working outside the mental health field need an improved understanding and the knowledge and skills to recognise the factors involved in, and the impact of, poor physical health in this patient population, including their own role in reducing the mortality gap.
  3. Acknowledging the interdependence of good physical and mental health.

 Physical health + mental health = the whole package

We need to stop seeing mental health care as a separate component of care delivery. Physical health and mental health are interdependent. In order to care holistically and treat an individual, we have to consider the whole person. If we are serious about equity, serious about reducing stigma, serious about person-centred care, serious about reducing the mortality gap, then the mutual impact of physical ill health and mental ill health must be addressed as a package. 

Who is that person with psoriasis? What is the emotional well-being impact of this condition? 

Who is that person with depression? Where are they in their journey of living with depression? What will this diagnosis of psoriasis mean to their mental health and well-being?

What can I do as a nurse to help the whole person?

 Who is that person with psoriasis? What is the emotional well-being impact of this condition?  

I believe that it is absolutely essential that every nurse holistically understands that good mental health and good physical health are part of the same package. I’m not sure that we are as good as we can be with this. As a matter of routine, nurses, no matter their area of practice or specialty, must be considering the impact that physical ill health has on a person’s mental health, and vice versa.

Assessments, examinations, observations and treatment/care plans must involve acknowledgement of and conversations about physical health, mental health and emotional well-being and how they impact on each other, to be truly holistic. This must happen as a matter of course, at every contact, and time must be allowed for this in every contact.

This approach can address stigma, aid both physical and mental health recovery, build relationships, empower the nursing voice as an advocate for parity, and help reach that goal of equity for mental and physical health.


Rosaline Kelly

Rosaline Kelly

RCN Senior Professional Development Officer

Page last updated - 08/11/2018