“What should ‘parity of esteem’ mean? Although central to mental health initiatives since 2011, it is hard to pin down.” Don Redding responds to Inpatient Survey results
If you go into hospital with mental as well as physical health needs, you are likely to have a significantly poorer experience of care than people with only physical health needs.
Looking in detail at sub-groups among the nearly 78,000 patients who responded to the 2016 Adult Inpatient Survey for England, Picker and the Care Quality Commission found that people with a self-reported mental health condition gave poorer scores than those with only physical conditions, across a range of composite domains.
These patients were less likely than people with only physical conditions to report that information sharing was good; that care was coordinated (for example, by hospital staff working well together), and that they had confidence and trust in the healthcare professionals.
Emotional support during a hospital stay is inadequate for many people. Only 58% of all respondents said they ‘always’ received enough of it, and only 38% of people who had worries or fears said they could ‘definitely’ find someone on the hospital staff to talk to about them.
Scores here were even lower for people with a mental health condition. Not surprisingly, then, they were less likely to report being treated with dignity and respect, or to say that person centred values were upheld; and they gave lower ratings of their overall hospital experience.
This raises questions about what the campaign phrase ‘parity of esteem’ should mean. Although it has been central to mental health initiatives since 2011, it is hard to pin down.
The Mental Health Foundation defines it as ‘valuing mental health equally with physical health’; and says this should result in equally high aspirations for these service users and for the improvement of their care.
Too often, however, the parity agenda seems to have been reduced to trying to get equal status for mental health services, as opposed to service users. Funding streams, tariffs, access arrangements have been the focus.
The mental health taskforce for the Five Year Forward View reported service users’ demand that “their mental health needs should be treated with equal importance to their physical health needs, whatever NHS service they are using.”
It found that in 2016 only one in six of the 179 acute hospitals had comprehensive liaison mental health services; and recommended investment to spread this to all hospitals by 2020-21, including half of them providing 24 hour cover.
That provides a tangible focus for a national improvement agenda. But for people using hospital services it is not enough.
‘No Assumptions’, the narrative for coordinated care created by service users working with National Voices and TLAP, expresses the demand for ‘flexible, responsive care for my physical and mental health needs at the same time’. In an acute hospital setting this may include:
- ‘Those who work with me bring optimism to my care and treatment, so that I can be optimistic that care will be effective;
- ‘Services and professionals listen to me and do not make assumptions about me;
- ‘The staff I meet are trained to understand mental health conditions and able to help me as a whole person.’
Locally, therefore, for trusts that want to improve the experience of this group of patients, it should be a workforce and skills agenda, not just the provision of liaison services.
National Voices is the coalition of charities that stands for people being in control of their health and care. Learn more about how National Voices help people and organisations to improve the knowledge, understanding, skills and confidence they need to engage more effectively and to make their approaches more person-centred. Visit the National Voices website or follow them on twitter @NVTweeting. You can also follow Don Redding on twitter @MightyDredd