I found myself tweeting this the other day, in amongst tweeting about book writing and the excitement of new Dr Who episodes and Great British Bake Off:
Nothing tells you government doesn’t value mental health more than: pay freezes, swingeing staff cuts, bed losses, privatisation.
— Stephen Williams (@MHNurseLecturer) September 10, 2014
Looking at governmental interventions that have affected mental health we have had years of NHS staffing cuts, resource cuts, bed losses, ‘back door’ privatisation and rhetoric and tokenism. Take Nick Clegg’s recent pledge (not a good word to associate with Mr Clegg – notorious as he is for reneging on promises) of a £50M ‘boost’ into mental health research. What does this actually do for the much vaunted ‘parity of esteem’? Well firstly from a research perspective it could help maybe fund a few randomised control trials worth of studies. This may improve understanding or enable a new therapy to be trialled. As for what this would do for the experience of the service – next to nothing I would imagine. So this kind of pledge strikes me as nothing more than a misguided and empty political piece of misdirection. Sort of – don’t look at what a terrible dangerous mess this is all in, look at the offer of shiny-shiny money – aren’t we caring and doing something about it after-all?
Let’s also consider this idea of ‘parity of esteem’ – that mental health which has pretty much from its inception within medical and health care practice always played second-fiddle to physical health services in terms of image, funding and priority. Perhaps it seems, at first glance, laudable to call for a parity? When I first heard the phrase it immediately seemed to me that this was going to be another bit of ‘rhetoric’ that would never translate into meaningful action – i.e. raising resources and funding for mental health services. The disproportionate cuts between acute services and mental health services seems to bear this assumption of mine out. (See http://www.bbc.co.uk/news/uk-england-sussex-26530733, http://www.bbc.co.uk/news/health-25777429, and http://www.bbc.co.uk/news/health-27942416 for examples of how cuts demonstrate that ‘parity of esteem’ is a hollow political promise).
Given the potentially devastating impact that mental health difficulties can have on a person’s well-being, life circumstances, relationships, emotional state, livelihood, physical health, citizenship, personal security, status, longevity and employability is it reasonable to suggest that ‘mental health’ should just be ‘on a par’ with physical health? I’m bound to argue that in some respects addressing mental health difficulties should be given priority according to its own needs and impacts, in its own right. This might mean that it needs funding above and beyond acute and physical care and that calling for a ‘parity of esteem’ is doing mental health and healthcare in general a disservice. Is acute and physical care necessarily getting the attention, funding and resourcing it needs and deserves? Somehow I doubt it given the shear depth and breadth of the services encompassed. Equality is not necessarily about “treating everybody equally”, it’s more about making adjustments that enable those persons needs to be met – tailored to obstacles that are present within that person’s life circumstances.
Ok, extended grumbling over – as you were!