Georgia-Leah was a student at drama school when she started to develop difficulties with walking. Eventually she had a seizure and fellow students dialled 999. She was diagnosed with functional neurological disorder (FND), where there are problems with how the brain receives and sends information to the rest of the body.
Georgia-Leah’s past experiences of poor healthcare for a previous mental health condition meant she was wary of services, and of asserting her rights. “I didn’t like the way they spoke to me [in mental health services]. I didn’t feel treated well,” she said. Nor did she feel she had any choice, information about her treatment, or that staff had time to spend with her. “It didn’t feel like I was being respected,” she said.
It took a long time, and at several points clinicians attempted to shunt her back into mental health services (despite the fact she had long since been discharged from mental health services), but Georgia-Leah found good healthcare for her FND.
The promise of “parity of esteem” for mental health has its origins in the first year of the Conservative-Lib Dem coalition government when then deputy prime minister Nick Clegg announced £400m to back up the recommendations of a strategy called No Health Without Mental Health.
It was a bold commitment, to equalise the service provided to the nearly one in four people who would experience a mental health condition during their lifetime. However, it wasn’t part of either party’s 2010 manifesto or in the coalition agreement, which mentioned mental health once and only in relation to veterans. It was, according to those involved in mental health policy at the time, the initiative of Paul Burstow, the Lib Dem MP serving as minister of state for health and social care.
The idea was also a powerful one and reflected the shift in public attitudes towards mental health. By 2012, parity of esteem would be the law, set out in the 2012 Health and Social Care Act and then in the 2013 NHS Constitution. A target of 2020 was set with a plan to deliver equality of access, but the target of parity was still far off, with the BMA calling for a doubling of funding in a report published the year it was meant to be achieved, noting: “Mental health services remain a long way behind most physical health services in terms of their resourcing, patients’ ability to access care and overall patient outcomes.”
But the political commitment has persisted. Subsequent iterations of the Conservative Party have kept parity of esteem in their policy platforms, with one section of their 2015 manifesto proclaiming, “We will continue to take your mental health as seriously as your physical health”, and their 2024 manifesto stating, “Mental health should have parity of esteem with physical health”. Keir Starmer’s Labour Party similarly promised, “we will reform the NHS to ensure we give mental health the same attention and focus as physical health”.
However, reality has yet to meet the rhetoric. The National Audit Office noted in 2023 that while the mental health workforce had increased by 22 per cent since 2016, referrals to mental health services rose by 44 per cent in the same period; 1.2 million people were on waiting lists and eight million with mental health needs were not in contact with any services.
Planned spending on mental health services is expected to be £15.6bn in the current financial year, but the Royal College of Psychiatrists says that figure should be closer to £36bn to achieve parity of esteem and meet the needs of people with mental health conditions.
“What everyone’s been talking about is the seven and a half million people on the waiting list, but that’s because they’re only talking about the ones with physical health problems, not the ones with mental health problems,” said Dr Lade Smith CBE, president of the Royal College of Psychiatrists.
Smith argues that there is a strong economy and public finance case for parity of esteem. “Over the last two or three years, we’ve been putting evidence to government and to the opposition parties, etc, and everyone’s starting to recognise it,” she said.
Broadly, mental health conditions emerge in the earlier part of life and, with good treatment, they can be resolved and people can live long, happy and productive lives – something that both contributes to the UK economy and reduces the healthcare burden on the NHS.
However, with long waiting lists and poor access to effective therapies, the risk that these conditions become chronic “relapsing remitting” illnesses increases.
“We thought, ‘OK, there’s going to be at least an increase in funding or a prioritisation of mental health, particularly in children and young people.’ But not only has that not happened, but there’s actually been a reduction in funding,” Smith said. Last month, the government confirmed that mental health funding would fall as a proportion of overall NHS funding.
Parity of esteem also goes beyond access to services too. It means matching achieving targets for waiting times, as is done with physical health, and a right to access to treatments certified by NICE – neither of which are currently a requirement in the UK.
“We’ve still got a system which defaults towards physical health,” said Andy Bell, CEO of the Centre for Mental Health, regardless of what government says, and partially, “regardless of what it does, the system reverts to factory settings, unless that’s very actively pursued.”
The abolition of NHS England, another big structural change that is meant to make services more directly accountable to politicians, and cuts to jobs across non-clinical roles, will also have an effect. For Bell, it is whether the short-term chaos and loss of experiences and expertise unleashed by these changes will mean that mental health is a priority for current and future politicians working with these new arrangements.
The Mental Health Investment Standard, which since 2015 has required mental health spending to increase as a proportion of NHS spending, “kept the wolf from the door”, according to Bell.
However, at the end of 2024, there were signals that the standard would be abolished and remove the safeguard from mental health spending, prompting an intervention from the former NHS England chief executive, Simon Stevens, in the House of Lords. While the standard has been retained for now, several mental health charities have accused the government of “de-prioritising mental health”.
Bell would like to see the NHS adopt a clear and transparent system for waiting times in mental health services to help drive parity of esteem. “Mental health waiting times continue to be relatively hidden, and that is ultimately what holds us back and disadvantages us by comparison to what happens in certainly the acute system, because we know that waiting time standards rightly or wrongly shape where funding goes,” he said.
“We would like an evidence-led, clinically driven approach, because they knew that that’s what works,” said Smith. She believes that without specific measures to ring-fence, protect and increase funding for mental health, patients will not get timely quality services.
“If you only fund a system to 50 per cent of the need, then what happens is that either only 50 per cent of people get good standard of care, or everyone gets a less than good standard of care,” she said.
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