Leading think tank 2020health claims equal treatment for depression needs legal force, UK

2020health, a leading UK wellbeing think tank, has published a new report, 'Whole in One - Achieving equality of status, access and resources for people with depression', which calls for the legal enforcement of "parity of esteem", the term used in the NHS for valuing mental health equally with physical health. Around one in six employees suffer from a mental illness such as depression, anxiety or mood disorder at any one time and one in four will experience such illness during the course of a year¹.

Key recommendations from the report include:

• NICE (National Institute for Health and Care Excellence) to ensure legally-binding recommendations become standard for mental illness treatments to achieve parity with treatments for physical illness
• Healthcare bodies to have a legal requirement to fund a range of services to meet local population mental health needs
• Promote employer's obligations under the 1974 Health and Safety at Work Act to support mental wellbeing in the workplace.

In the wide ranging report, the think tank makes a series of recommendations that together seek to ensure people have the right to more support from the NHS, Local Authorities and from their employers to prevent or treat mental illness. The proposals include changes to the way NICE (the NHS drug rationing body) appraises mental health treatments and enforces recommendations to ensure all services and medications are made available for patients, as well as publication of local expenditure on local psychological support (Improving Access to Psychological Therapies programme) to identify whether targets have been met and whether spend is proportional to established needs.

2020health's report argues that achieving parity of esteem, is not just a point of principle but critical for UK plc. Mental illnesses are estimated to cost the UK business economy around £30 billion a year². Self-reported depression is the single most important cause of workplace absenteeism in the UK.

Julia Manning, Chief Executive of 2020health, said "Parity of esteem has been talked about since the last election, but to become a reality it requires legal force behind it. In addition to this, while we continue to treat mental illnesses such as depression as separate from physical illnesses, we perpetuate the myth that 'mental' illness isn't physical, despite many symptoms being experienced physically. Continuing to use the term 'mental' conjures up images of people being mad, sad or bad, when the reality is that they are simply ill, just like someone with arthritis, diabetes or 'flu."

The Rt. Hon. Norman Lamb, Minister for Health said, "Following the All-Party report on 'Parity in progress' last week, I welcome 2020health's 'Whole in One' report which highlights ways to legally embed parity of esteem for people with depression. I am passionate about improving prevention and services for people with mental illnesses and know that we need radical improvements to ensure people get the help, support and treatment that they need, when they need it."

As well as recommending improvements to the NICE appraisal process so that mental health treatments have the same chance of success as physical health treatments, the report urges the government to raise awareness of employer's obligations under the Health and Safety at Work Act to support mental wellbeing in the workplace. The Act places a duty on all employers' to ensure employees "health, safety and welfare at work" but in reality it is not enforced to support the mental health of workers. Future measures could include the Health and Safety Executive (HSE) exercising the Act to ensure legal force is brought on employers' provision of prevention and support for mental illnesses in the workplace where practicably possible. 2020health is also recommending the government funding of local Workforce Mental Health Consultants (WMHC) to promote prevention and early intervention in the workforce, and enforce employers' responsibility.

The report found that there is no legal requirement for healthcare bodies to make evidence-based talking therapies available, or to follow NICE guidance in giving service users a choice of therapy. Mental health treatments are also far less likely to be appraised by NICE meaning there is not the same legal imperative for healthcare bosses to make them available to patients. Furthermore, the think tank has questioned if NICE is undermining the principles of the NHS Constitution which is also enshrined in the Health and Social Care Act 2012, by not capturing the wider societal benefits of mental health treatment such as maintaining or returning to work.

In terms of treatment and services, the authors noted that the NHS spends only 13% of its budget on mental health services, and funding for mental health services has been falling in real terms for children and young adults, for working age adults and for older people. The government's flagship mental health policy, the Improving Access to Psychological Therapies (IAPT) programme, has seen service expansion, but local investment varies widely, ranging from under £2 to over £14 per head of population.

Emer O'Neill, Chief Executive of Depression Alliance said, "It is well documented that spending on mental illness is not proportional to the devastating impact that mental health problems can have on people's lives. However, what is particularly worrying is that the gap between spend as a proportion to burden has been increasing since 'parity of esteem' was enshrined in the Health and Social Care Act. We need to do something radical to turn the tide, and using legal force to ensure employees rights are protected, and guidance and guidelines for health authorities are created and followed would be a crucial step."