Parity of esteem. A big phrase. We are all signed up to it. But what does it really mean? I was thinking about this after hearing of Robin Williams’ death. Such a tragedy. Depression is a life threatening illness in its most severe forms. A man who seemingly has so much felt such despair that death was the only deliverance from the pain. WE don’t treat it as such and yet mental illness kills people just like cancer does.
When we talk about illness and pain we still divide our thinking into physical and mental causes. Why? The brain is physical, mental illness is about the brain and chemicals … and yet in our thinking we consider them differently. Someone with a mental health problem is still seen as somehow responsible in some way for their illness. And yet every illness has both physical and psychological components. When as a GP I talk to patients about a psychological component to their symptoms they rush to the view that I am saying it is somehow less valid ,less real, their fault. Our belief system leads us to believe mental health issues are based somehow in weakness, a flaw in our constitution and yet those with mental illness are some of the strongest and bravest people I have ever known.
We talk freely about our family members struck down by cancer but we are less willing to talk about those with depression, psychosis or substance misuse. On some level that remains private, uncomfortable.
There is a strong history of mental illness in my family. So I have watched people I love struggle to survive and witnessed how we as a society respond. Gemma was young when she developed severe depression. Her school was, it seemed, a caring and supportive place. At the same time there was another pupil who developed cancer. The contrast in the way the school handled their response to both pupils was illustrative of the deeply held values that are part of our culture. Both were very ill. Both had life threatening illnesses. Both had long periods in hospitals 50 miles away. Both missed many months of school. One had a computer bought for her, work sent to her, regular visits made to her, cards sent to her, regular updates of her progress in her form and support to her siblings and extended family. The other had nothing. This I believe was not because the school was uncaring or unkind. It just didn’t occur to those in charge. They treated these two poorly girls completely differently, one was “ill” the other “troubled”.
WE as a society raise money for cancer sufferers, run for them, swim for them, build beautiful new shiny buildings full of state of the art equipment for them, but we don’t do the same for those people with mental illness, many of whom still languish in old poorly equipped facilities. They remain on the “edge” of our health services and the “edge” of our generosity as a society. Within the NHS doctors and nurses still draw lines around mental and physical illness rather than seeing people as individuals with complex problems, we as clinicians still perpetuate the belief system that underpins the prejudice.
I read today that more ex-service men have taken their own lives than died in Afghanistan. I am not surprised. But are we outraged as a society about that? WE should be.
Parity of esteem is a grand ambition. WE can do our best as a CCG to make sure we do that. We can write it into our plans, benchmark our investments, include it in our specifications. But for things to change we must all be prepared to do everything differently. To challenge long held beliefs and social norms. Gemma’s family accepted mutely the response of the school, the neighbourhood, the extended family. We must all fight individually to expose the unconscious prejudice that is still as strong now as it was 15 years ago when Gemma was at school. What happened to Gemma? Well finally she found a psychiatrist who cared enough to discover what was important to her, who didn’t tell her as others had that she must have modest ambitions for herself because she was somehow permanently damaged by her illness. He allowed her to believe she could succeed and she has. She went to Cambridge, got 3 degrees and is deputy head of department in a large sixth form college in London after 3 years of teaching and is planning a Phd. More importantly she is well and happy. The health service is a lottery and no more so than in mental health. The struggle to find good care took 8 years.
One day I hope Gemma will write her own story. It will be heart breaking to read. For now she is getting on with her life. The scars are there though, forever in her life, made worse because the journey was so hard, the support so thin. I sent this blog to her to ask her permission to publish it, she commented “ I’ve found it much easier to come out to people about my sexuality than tell them about my depression”. That I think says it all. We, as an NHS and a society, continue to fail so many. We need to start by being honest and open about mental health, to have parity of esteem in every conversation, every interaction with staff, colleagues, friends. We need to challenge every unconsciously unkind thoughtless comment or decision. Small steps yes, but without change in the way we think as a society nothing will really change.... The NHS can lead but it cannot go it alone….
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