Exploring Parity of Esteem in Mental Health Care

The provided content discusses mental health services and parity of esteem between mental and physical healthcare. The articles highlight concerns about the rising number of self-harm hospital admissions among children, lack of mental health beds, and delays in discharges contributing to a crisis in mental health care. Additionally, there is a focus on the importance of addressing mental health as a public health priority and the need for parity of esteem between mental and physical healthcare. The content also touches on issues of service user involvement and recovery in mental health services.

Advancing Professional
Decision Making in
Health or Health Care
systems

INTRODUCTION
The health and social care system of England is recently facing a problem of mental
health crisis. The problem at NHS is that mental health is not given importance in comparison to
physical health. The mental health system of the nation is being forced to do more with less
resources. According to the conclusion of a 2012 London School of Economics Study mental
illness accounted for 23 per cent of NHS's disease burden. However, it got only 13 per cent of
the cash (How mental illness loses out in the NHS, 2012). Several reasons explain mental health
crisis in England. The mental health wards are being shut. There is a national bed shortage
Patients have to travel hundreds of miles to obtain treatment or mental health issues. More to
that, the wards are often over crowded. There is an increase in the incidents of violence against
mental health workers. Furthermore, the pressure on the staff as well as the service users has
been increased with cuts to community service budgets (Appelbaum, 2003).
This is a problem because illness should be alleviated wherever possible. Moreover,
mental illness decreases the life expectancy of people and is associated with increased chances of
physical illness (Aslam and Bhui, 2012). Parity of esteem between mental and physical health is
a significant issue because the number of mental health patients is increasing. Mental health
conditions are a common problem in UK. One in every four persons in UK suffers from this
issue every year. According to the results of household survey, 15 per cent adults suffered from
common mental disorders, 3 per cent from post traumatic stress disorder while 0.4 per cent
suffered from psychosis disorders like schizophrenia (Results of a household survey, 2009).
The present essay aims to provide insights into the problem of parity of esteem between mental
health and physical health and proposed possible solutions for it.
(a) Description of organizational problem and its importance
Parity of esteem is a principle by which mental health should be given equal priority to
physical health (Parity of esteem, 2015). This suggests that mental health issues must be tackled
with the same energy as issues of physical health are tackled. However, the situation is not so in
England. NHS is facing the problem of parity of esteem between mental and physical health.
Mental health issues are not being given equal status and importance as is given to physical
health problems.
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The extent of the problem can be judged from the fact that little or no treatment is
provided to 3 in 4 people who suffer with a mental health problem in England. This suggests
presence of large gaps with respect to health outcomes. This has resulted into the issue that
people with mental health problems die 15 to 20 years earlier, on an average, as compared to the
general population of the country (Bailey and Smith, 2014). Patients of mental health issues are
forced to travel long distances for obtaining care and treatment. The number of patients traveling
to seek emergency treatment was 1, 301 in 2011 which increased to 3, 024 in 2013. this indicates
that the number of service users who had to travel to seek care and treatment for mental health
issues has almost more than doubled in two years. The worst affected areas are Kent and Sussex.
In Kent, 334 people were sent out of the country in 2013. this number of significant as compared
to just 20 patients being sent out in the year 2011- 2012. in Sussex, the number o patients who
sent out of the area increased from 28 in the year 2011- 2012 to 227 in the year 2013- 2014
(Buchanan, 2014). Although, some of the trusts of NHS are managing and reducing the number
of patient that are being sent out of area for care and treatment,. However, it is disgrace that
people with mental health problems have to travel hundreds of miles away from family and
friends, for receiving treatment.
NHS mental health services of the country are in crisis in terms of quality and availability
of services. Patients are sifted to inappropriate settings even when they are acutely unwell. A
national bed shortage suggests that either they are shunted to a hospital hundreds of miles away
or are left in a bed and breakfast accommodation (du Toit, 2004). Some mental health patients
are admitted to other settings such as deaf ward owing to lack of beds. This makes them feel
even more stressed and anxious. According to Lisa Rodrigues, chief executive of the Sussex
Partnership NHS Foundation Trust, these issues not increase the number of detained patients but
are also responsible for making people stay in hospital for longer (Buchanan, 2014). These also
undermine the mental health patients' chances of recovery. Moreover, there have been
inappropriate admissions for out – of – area beds. The extent of crisis can be judged from the
situation that people overdosed on order to obtain a bed because according to them it was the
only way to get a bed in mental health trusts. Further to this, people are being inappropriately
discharged to bed and breakfast accommodation after long spells in psychiatric hospitals. The
lack of acute beds available for mental health patients puts them at serious risk (Gleeson and
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O’Flaherty, 2013). An investigation by Community Care magazine fund that there has been a 12
per cent decline in the total beds available. It was also fond that since 2012, 7 people have killed
themselves as they were told that there are no beds available in the hospital for them (Siddique
and Meikle, 2015).
Patients of mental health are held in police custody due to shortage of beds. Many
mentally ill teenagers were detained in cells. This is because due to shortage of beds, police
custody was the only setting that could be used as a place of safety for adults when their behavior
was extreme and could not be managed elsewhere (Hayes, 2006). The question of parity also
arises with respect to safety of mental health patients. Many of these vulnerable people were
discharged from hospital without proper information about their condition. People who were
admitted to hospital for being engaged in self harming and suicidal behavior, were offered only a
crisis support phone number when they left the hospital (Siddique and Meikle, 2015). The bed
crisis also has significant impact on children suffering with mental health problems. In majority
of the cases, children are sent away from their families. This further worsens their conditions.
There has been institutional bias against mental health with respect to waiting time
targets. 18 week maximum waiting time was established in the last decade in England. However,
it applied only to physical health. Mental health was not included in it. Whereas patients with a
physical health crisis such as chest pain are usually rapidly assessed and provided appropriate
treatment, patients with mental health issues are not (Hilton, 2015). Even people with suicidal
tendencies or those experiencing a psychotic episode have to wait for a long period of time. Even
then, they are not able to receive adequate treatment and assessment. This indicates that people
with mental health problems are not assessed quickly enough. Also, services are not available to
them all the time as and when they need it. There is limited provision with respect to access to
treatment for mental health problems. Only 24 per cent of people with a common mental health
disorder receive treatment (Kirkbride and Jones, 2013.). It is difficulty for people to access
cognitive behavioral therapy, psychoanalysis or long term psychological therapies. There is
limited provision of psychological therapies in NHS. The range of evidence based therapies is
also limited. Kids wait for over a period of two years and are then admitted to adult psychiatric
wards.
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Psychiatry is treated as a lesser branch of medicine by some medics. Also, some mental
disorders are dismissed as not in the category of real illnesses. A & E, maternity services, cancer
etc. are considered to be a priority to mental health. Care Quality Commission report indicates
that children and young people suffering from mental health problems do not receive the care
and support they need (Kisely, 2005). 10 per cent of children and young people suffer from a
mental disorder. There are many more of them who are dissatisfied or unhappy with their life
and need support. However, due to lack of parity between mental and physical health, a large
proportion of these people are not above to obtain the required support at the time when they first
need it. As a result of this, they do not come to the attention of service until they reach a crisis
(Knudsen and Thornicroft, 2006).
The problem o parity between mental and physical health at NHS is important. Mental
health includes psychological, emotional and social well being. It is important area in heath care
as it determines how a person handles stress, makes choices and relates to health. While
experiencing mental health problems, a person's thinking, mood and behavior could be affected
(Lasonen, 2006). Positive mental health is essential for a person to realize his full potential, cope
with stresses of life, work productively and be able to contribute to the community in a
meaningful way. However, it has been a longstanding criticism in the health and social care
system in England that people suffering from mental health problems fail to receive same
services and quality of care as compared to people with other types of illnesses.
(b) Root causes of problem
Rising demand for mental health
The demand for mental health health services is rising. An average of more than 1 million
antidepressants were prescribed by doctors per week in 2013. this is double the number of
medicines prescribed a decade ago. Since the year 2003, there was a 14. 8 per cent increase in
the overall Net Ingredient Cost (NIC) of prescriptions. Moreover, the number of patients getting
help for severe mental illness was 1.75 million in the year 2013- 2014. this suggests that there
was a 10 per cent increase in the number of adults seeking mental health services last year (Lees,
Procter and Fassett, 2014). Another reason for the increase in number of mental patients was
detention under Mental Health Act. There was a 5 per cent increase in the number of Mental
Health Act detentions to hospitals. In the year 2013- 2014, the Act was used 53, 176 times to
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detain patients for longer than 72 hours (McNicoll, 2014). there has also been an increase in the
number of children admitted t hospitals for self harm. Admission of girls aged 10- 14 increased
by 93 per cent from 3090 in 2009- 2010 to 5953 in 2013- m2014. Similarly, there was a 45 per
cent rise in the number of boys (Kotecha, 2014).
cut on budgets
One of major root cause for the problem of parity between mental health and physical health is
the cut on budgets. After a peak of funding for Child and Adolescent Mental Health Service
(CAMHS) in 2010, there was a decrease in the funding by £50 million in the first three years of
the coalition. In year 2015, it was revealed by ITV news and children mental health charity
Young Minds that there was a total funding cut of £85 million from mental health budgets of
trusts’ and local authorities’ for children and teenagers since the year 2010. this indicates a drop
of £35 million in the lest year. 75 per cent of trusts admitted that they had cut their mental health
budgets between 2013- 2014 and 2014- 2015 (Siddique and Meikle, 2015). This trend is
continuing in all areas of mental health. There has been a fall in the average proportion of total
budgets allocated to mental health. It can be analysed that a change of 1 per cent in the mental
health is a big number (Limb, 2014). This is to be compensated in the form of less staff and
removing whole services.
Disparity in funding is now considered to be of critical importance. This results into bed
pressures, longer waits for children etc. It is due to this that 92 per cent of people with physical
health problems are available to receive the care they need as compared to only 36 per cent with
mental health problems (Millard and Wessely, 2014). Moreover, the funding picture in NHS is
alarming. Funding for mental health trusts as decreased by 8 per cent during Coalition's reign.
The mental health trusts are responsible for provision of most of the mental health hospital and
specialist care. It was also found that there was an 8 per cent decrease in the spending on
children's mental health between the years 2010 and 2013 (Miller, 2015). further to this, council
spending has been slashed. CAMHS budgets have been frozen or cut down by over half of
councils in England since the year 2010. This has majorly impacted the services within the
country which have to be closed.
Mental health receives around 13 per cent of the NHS budget. However, mental illnesses
account for a quarter of the disease burden. Most of the GP have to deal with the mental health
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issues which are beyond their competence. Lack of funding adds to this problem (Robb and
Davis, 2015). People with mental health problems are likely to recover if they get an early
intervention. However, less funding does not support it. The counseling services have been
squeezed. Staff has been cut and the growth in many services has not been sufficient to meet the
rising demand for mental health issues.
Despite the commitments of the government that mental health should be given parity of
esteem with physical health, there has been a severe cut in the the amount that is spent on these
services as compared to other sectors (Ruohomaki, 2010). Moreover, the charities have warned
that the decision of NHS to cut tariffs for mental health by 1.8 per cent would take a huge toll on
the lives of people suffering from mental disorders.
Lack of funding results in a national bed shortage in the area of mental health. The
consequence was that mental health patients who required hospitalization had to be admitted to
hospitals which were out – of – area. It also led to shuffling of patients from ward to ward so that
beds could be made free. Both these practices not only makes it difficult for for the carers and
families to maintain contact but also introduces discontinuity in care (Raffe and et.al., 2001).
This worsens the conditions of mentally ill patients thus adding to the disparity between mental
and physical health. Funding pressure has contributed to closure of more than 2100 beds since
the year 2011. As people face problems in accessing beds or alternatives to admission, there have
been series of deaths. It also led to acutely unwell adults. Moreover, lack of funding resulted in
unsuitable physical environments for mental health patients. Some of the mental health wards are
located in old and poorly maintained buildings. As a result, it becomes difficult for the staff to
meet patient needs (Talbott, 2007). This also leads to compromised patient safety as there was
presence of ligature points which are risky for suicidal patients. There are several mental health
wards which could not comply with the requirement for all accommodation to be same sex.
According to Royal Collage of Psychiatrists' commission, funding cuts has led to
restructuring of community teams (McNicoll, 2015). As a result of this, some services are no
longer operating as they intended to. Thus, the burden on community psychiatric nurses has
increased. Moreover, crisis resolution teams only had time to assess rather than treat mentally ill
patients. This has highlighted an urgent need to reassess the way funding is allocated to mental
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health. This is because it is critical for the services to have adequate resources for delivery of a
more proactive and planned care to mental health patients.
Closure of lots of mental wards
Growing disparity between mental and physical health is caused due to closure of several
mental health wards. People receiving treatment for mental health services are badly affected by
the closure of mental health wards. Despite warnings from doctors, health officials and nurses,
there has been closure of several wards due to lack of resources (Thomas, 2015). The has
resulted into overstretched mental health wards which received less help and assistance from the
government. NHS cuts have threatened a number of geriatric and mental health wards. Several
key areas of mental health across 300 acute hospitals in England are likely to be affected by
recent or planned closures. Mental heath wards are being significantly cut back or closed at eight
hospitals. This has limited the provision of mental health services to the patients thus adding to
the problem.
There has also been closure of specialist mental health services such as eating disorder
clinics. This has led to a rise in the waiting lists for psychiatric assessments and psychological
therapy. Several university medical health centres have also closed. As a result of this, it has
become difficult to cope with high numbers of students with serious and complex mental health
problems. Lack of resources has also led to squeezing of university support services (Timimi,
2014). This has been due to reductions in staffing. Resources have limited the ability of
university counseling and mental health services to address the ever increasing numbers of
clients suffering from increased levels distress. Most of the services have been forced to restrict
the range of mental care services they offer to students. This suggests that the range of mental
health services for young people has been reduced thus adding to the problem of parity between
mental ans physical health.
mismanagement from decision making level
The mental health treatment gap which is deepened due to lower treatment rates,
premature mortality of people with mental issues, and under-funding or mental health care can
be considered to be a result of mismanagement from poor decision making (Weinstein, 2010).
The number of mental health patients in UK are increasing thus making mental health issues as a
common problem in the country. This increase required the management of NHS to make
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appropriate decisions for providing mental health services to an increased patients. This initiated
the necessity of appropriate funding, staffing, training, and expansion of services. The Directors
and Senior managers of NHS were required to demonstrate appropriate decision making with
respect to the urgency of the situation.
However, the present state of mental health in NHS indicates that loopholes were present
at the decision making level which made the problem of mental health a crisis in UK.
Mismanagement was evident in various areas such as accommodation, waiting times, detentions
due to Mental Health Act, out – of – area admissions, bed shortage etc. (Weinstock, 2015). In
some areas of England, the children suffering from metal health issues had to be locked up by the
police because there was unavailability of safe places to assess or treat them. The management
failed to ensure appropriate settings for mental health patients which could improve their
condition. Rather, they were forced to be treated and admitted in inappropriate settings which
worsened their condition by increasing stress and feelings of anxiety. Proper management would
have provided enough assessment and treatment places to people suffering from mental
disorders.
Further, in the areas where mental health units existed, they were either full or faced the
problems of staff shortages. Also, there was closure of substantial number of beds thus
contracting mental health services even more. This depicts mismanagement with respect to the
staffing levels and accommodation capacity of wards (Wilkinson and Pickett, 2011). With the
increase in mental health patients in UK, decisions were required to be made in the areas of
increasing staff number, mental wards and beds. As mental health issues have become one of the
most common problem in UK, proper management at the decision making level is essential. This
could have involved opening of more mental health services, expansion of the capacity of wards,
setting up of additional beds in the hospitals and trusts (Wolf, 2003.). However, the pathetic
condition of the mental patients who have to travel miles away from their home to get treatment
shows loopholes in the decision making.
Some of the mental wards are in such state that it is risky to admit mentally ill patients
with suicidal tendencies there. These wards have not been maintained and face the problems of
poor lighting, inadequate facilities and infrastructural issues. Such situations make it difficult for
the staff to provide appropriate services to the service users (Aslam and Bhui, 2012). Moreover,
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reduced staffing increases the work load on existing staff thus making them tired and frustrated.
As a result of this, the staff becomes less competent to address the increased demand for mental
health services. The consequences of this are born not only by the staff but also by the patients
who are shuffled from one setting to another.
The issues of mismanagement do not end here. These are further aggravated by rise in
mental health detentions thus making the services struggle even more. According to The
Guardian, detentions under Mental Health Act rose around 10 per cent within a year. There was a
total of 25, 117 patients who were subjected to the act of whom around 19, 656 patients were
detained (Gani and Meikle, 2015). This suggests that people were unable to get help regarding
their mental problems early enough. As a result of this, they become more unwell and reach the
crisis point. It can be analysed that detentions under Mental Health Act are done only in that
situation when a person is extremely unwell. It can be critically evaluated that if patients are not
being treated at the required time due to closure of wards and bed shortages, it is obvious that
their condition would worsen. Appropriate management at the decision making level could have
been observable had the mentally ill patients been treated early enough and Mental Health Act
was used as last resort (Gleeson and O’Flaherty, 2013). This would have reduced the number of
detentions and wards would bot have been filled beyond their capacity.
Budget cuts and under- funding of NHS trusts are another areas which depict
mismanagement at the decision making level. NHS professionals are being forced to do more for
less at the time of rising demand (Hilton, 2015). This had put the existing metal health services
under high pressure. In order to improve the condition, decisions are required to be taken to
increase investment in the mental health in England rather than cutting on the budgets.
Staffing
A total of 3300 posts of front line mental health nurses were lost a a result of inadequate
funding. This has created shortage of staff. Moreover, links have been found to exist between
mental health staffing problems and ward suicides (Bailey and Smith, 2014). Half of the suicides
occurred when inexperienced staff carried out checks on patients. These include health care
assistants or agency workers who were not familiar with the patients. Also, some of the deaths
occurred when the wards were understaffed or the staff were troubles due to busy periods.
Experienced staff is an important aspect in patient safety. Presence of less experienced staff and
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lack of adherence to the protocols can be considered as the reasons behind the suicides by mental
patients. This is because observation is a skilled task which can efficiently be carried out by
experienced workers (Lees, Procter and Fassett, 2014).
Reduced staffing levels have increased the pressure on existing staff in mental health. Majority
of the staff works for extra hours. They also suffer work related stress thus leading to potential
harmful errors, near misses or incidents. The cases of violence at work from patients and
relatives also increased.
General Adaptation Syndrome (GAS) - Theory of Stress
Hans Selye proposed General Adaptation Syndrome (GAS) known as the theory of stress. As per
this model. There is a three stage bodily response to the stress which is experienced by a person.
These stages are the following: Alarm- At this stage the body of person reacts by giving a fight or flight response. Resistance – This stage is characterized by the body focusing more on mobilizing the
resources to the stressor.
 Exhaustion- It is the third stage. At this stage, all the resources of the body are exhausted
which eventually leads to disease (Thompson, 2002).
The theory can be related to nurses' condition in mental wards where they are struggling
to cope with staff shortages, lack of resources and an increased demand for mental health
services.
Loss of skills/ training
For mental illness, there are several specific psychological and social interventions which
are efficacious. These include social skills training, vocational training, family intervention,
cognitive- behavioral therapy etc. Appropriate psychiatric training is essential to be provided to
the staff (Miller, 2015). However, the problem of parity between mental health and physical
health has grown due to lack of training in the necessary skills. Considering the increased
demand for mental health services, it should be a priority to bring about improvements in the
training of primary health care providers so that they are able to assess or manage mental
disorders. But, lack of funding does not support this.
Leadership analysis at mental health England
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Leadership is considered to be then most influential factor in shaping organizational
culture. It ensures the development of necessary leadership strategies, behaviors and qualities
which are fundamental. However, mental health in England lacked efficient leadership which
resulted in problems of direction, alignment and commitment within teams. Safe, high quality
and compassionate care is emphasized by effective leaders. But, absence of effective leadership
resulted into the problem of parity of esteem between mental and physical health in England
(Aslam and Bhui, 2012). As a result of this, integrate approach towards giving equal importance
to mental health issues in England could not be developed. In this regard, it is important to
consider that the approach of national leadership bodies was not appropriate enough to
emphasize on development of adequate mental health services. Mental service organizations
were not supported which acted as a hindrance in improving high quality patient care (Thomas,
2015. Only effective leadership could have provided the right balance between individual skill
development and capacity building of mental health service.
(c) Developing possible solutions
After reviewing the organizational problem of parity of esteem between mental health
and physical health, as well as the root causes of the problem, the following solutions can be
proposed:
Implementation of transformational mental health crisis care model
In order to deal with the mental health crisis in NHS in England, there is a need to
transform the structure of service. This could be done with the help of mental health crisis health
model. Having identified the root causes of the problem, transformation changes are required to
mental health crisis care (Robb and Davis, 2015). However, in supporting the delivery of the
model, as key role will be played by NHS. The model should focus on formulating a good crisis
plan, acting early enough so as to prevent people from reaching the crisis point, commissioning
mental health services ad measuring quality in crisis care. The model should focus on the
following areas:
 Enabling prevention and early intervention services- The mental health in England
has reached to a crisis state because people were not treated early enough. Therefore,
the model should focus on provision of early intervention service (Thomas, 2015).
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The person experiencing mental health problem and his family member should know
who to contact 24/7 to get a speedy access to the service.
 Developing an effective crisis planning process- the problem of parity between
mental and physical health in NHS indicated loopholes in the decision making and
planning process. Therefore, an effective crisis planning process should be developed
which takes into account all the critical aspects that could be strengthened to make
NHS capable to address increased demand for mental health services (Timimi, 2014).
This should include financing, opening of new mental services, quality mental health,
staffing, waiting times, liasion with other services, preventing out – of – area
admissions etc. Adequate funding is a priority for NHS. The planning process needs
to ponder upon and identify areas from where financing can be obtained. Possible
future strategies also need to be covered within the planning process. Availability of
beds, well maintained infrastructure, adequate facilities are other areas included in it.
 Suicide Mitigation- This is another important area which transformational mental
health crisis model should address. Not only the conditions of mentally ill patients are
becoming worse but the mental health is also facing issue of ward suicide. early
intervention is required for averting crisis (Wilkinson and Pickett, 2011). The
transformational changes will be focused upon combining compassion and clinical
governance so that lives could be saved. This indicates the need for appropriate
staffing levels and staff training. Furthermore, NHS will have to focus on both risk
management and risk mitigation. As the mental health system is suffering from lack
of resources, safe and effective triage would be a suitable strategy to be adopted
(Steen and Steen, 2014). This will help in rationing patient treatment efficiently when
the resources are insufficient. It can be analysed that referral and response to people
at risk of suicide is a priority and should be included in the model. Safety plans
should be prepared which will lay emphasis on collaborating with people at the risk
of suicide as well as their carers. This will foster hope, build resilience and
resourcefulness so that the risk of suicide can be mitigated (Coffey, Pryjmachuk, and
Duxbury, 2015).
Increasing staff numbers
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Mental health in NHS is suffering with the problem of staff shortage considering the
increase in demand for mental health services. Overcrowded and understaffed psychiatric wards
result into patients being fearful about their safety. Hence, it is proposed that more staff should
be appointed in mental health England. Efforts should be made to provide more front line mental
health staff, mental health nurses and psychiatrists to this area of NHS this is required to provide
the mentally ill people access to psychological therapies which are of acceptable standards
(Docherty and Thornicroft, 2015). It will also help in improving daily one – to – one contact with
the nursing staff which will lead to better and quick recovery. Moreover, adequate staffing levels
will ensure optimum patient observation. Recruitment of additional staff will be assistive in
reducing the pressure on existing staff.
Enhancing staff morale
Psychiatric inpatient wards are highly stressful places to work. In order to maintain
positive patient experiences in metal wards, good morale among staff is an essential requirement.
Mental health wards in England are understaffed. Hence, the existing staff suffers from the issue
of work stress, compromise on patient safety, increased incidence of violence at work etc. All
this has impacted the quality of mental health care. In order to sustain and address the needs of
increased mentally ill patients, the staff morale needs to be boosted (Kaplan, Moody and Gee,
2014). Moreover, as more staff needs to be recruited in the area of mental health, NHS should
focus on designing jobs so as to increase autonomy, well structured and clear operational
protocols, improving responses to violence and increasing employee voice. This will be helpful
in boosting the morale of the existing staff as well as attracting more applicants to be recruited in
the mental health in England. Furthermore, in order to deal with the pressures that mental health
in NHS is facing, there should be composition of front line ward team and relationships within it.
Other areas of focus should bee management and leadership context within the ward (Jones,
2014).
Provision of advance training to current staff
It has been identified that mental health in England faces the problem of ward suicides.
Majority of these suicides have been linked to the dependence on inexperienced and unskilled
staff. Observation is a skilled task. The responsibility of patient observation cannot be handled to
a staff who has not been trained adequately (Chidanyika and McSherry, 2015). Therefore, NHS
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should provide appropriate training to the staff. In order to deliver high standards of care, there is
a need to not only increase the number of nurses but also to develop a workforce with the right
balance of skills. This is essential so that the staff is fully prepared to meet the complex needs of
patients suffering from mental issues. Investment should be made in training so that this crucial
area of care can be provided with adequate levels of staff.
Chaos theory
According to the chaos theory, by recognizing chaotic and fractal nature of the world, an
individual can gain new insights, power and wisdom. Following this, the person can avoid
actions which may be detrimental to his long term well being. The chaos theory can be applied to
the mental health nurse (Kroll, 2015). Job in mental health involves unpredictable situations and
constant changes. The theory can be useful in helping the nurses to handle difficult situations
with mentally ill patients during the times of peak workloads due to staff shortages. The theory
explains that a chaotic environment is natural and it is essential to handle work-shifts, poor diet
and lack of sleep.
Clinical leadership
One of the root causes of problem of parity of esteem between mental and physical health
was lack of effective leadership. Hence, one possible solution for the problem can be
implementation of managerial and clinical leadership. In order to achieve parity, political and
managerial leadership is required at national and local level (Bailey and Smith, 2014). The
leadership should be able to recognize priorities in mental health which are to be addressed by
the government urgently. Clinical leadership will help in bringing a culture change in provision
of mental health services.
Potential challenges of implementing proposed solutions
The root causes of the problem of parity between mental and physical healthy can be
addressed with the proposed solutions. However, it is important to consider that implementation
of these solutions will not be free from potential challenges (Gerada, 2014). Following are the
challenges that can be faced while implementing the proposed solutions:
 Problems in allocation of funds- Even when the spending of NHS has been protected
in theory, challenges may be encountered in covering the various priorities of the
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service under the given funds. It is feared that the spending would not stretch to all the
areas of mental health services (Knudsen and Thornicroft, 2006).
 Lack of support- Another challenge that could be faced while implementing proposed
solutions is lack of government support from local councils and centre government.
The solutions aim at improving all the areas of services ranging from shortage of beds,
staffing levels to future plans (Miller, 2015). However, lack of government support
may not enable achieving the required goals in these areas of service.
 Planning budget- Challenges may also be faced while planing budgets. Already,
mental health in NHS was facing the issue of budget cuts. In contrast to this, the
proposed solution demands diversion of more funds to this area of care. Funds will be
required for appointing additional staff, opening new mental health services,
developing liasion between mental health and other services, providing training to the
staff, installing better infrastructure and facilities etc. (Robb and Davis, 2015).
Considering the existing conditions of funds allocation, budget planing regarding the
transformational mental health crisis care model may be a challenge.
 Parity of attention- The proposed solutions for improving condition of mental hath in
England may face the challenge of parity of attention. The proposed solutions of
mental health crisis care plan would require devotion of same time, energy and
resources from commissioners, system leaders and providers (Thomas, 2015).
However, if this is not done, it is feared that mental health will be able to come at par
with the physical health. There is required parity of resources to bring about the
implementation of the proposed solutions. However, the need for parity of resources is
not limited to just funding. Rather, it includes the full range of efforts as well as time
that is devoted by NHS organizations. Challenges may be faced in obtaining the same
level of commissioning expertise from clinical commissioning groups in terms of
numbers of people, expertise and seniority.
CONCLUSION
From the essay it can be concluded that parity of esteem is a burning issue in UK. It has
gained attention of the health officials and health care authorities of England owing to the great
deal of problems that being encountered by mental health patients. In England, mental health
16

issues are not tackled with the same energy as are issues of physical health. The problem is that
people with mental heath issues have to travel hundreds of miles away from their homes to get
treatment. Due to shortages of bed, they are shuffled from wards to wards thus adding to their
misery. Many of the mentally ill patients are not able to obtain treatment. moreover, some of the
patients are admitted to inappropriate settings such as police custody as it is the only safe place
for them due to over filled mental ward. This suggests that NHS mental health services of the
country are in crisis in terms in terms of quality and availability of services. The are various root
causes of this problem of parity – of – esteem between mental and physical health. These
includes, rising demand for the mental health, cuts on budgets closure of Lots of mental wards,
mismanagement from decision making level, staffing issues, loss of skills and training.
Possible solutions can be implementation of transformational mental health crisis care
model, increase in staff number, enhancing staff morale, provision of advance training to current
staff. However, the implementation of proposed solution may be confronted with various
challenges. These includes problems in fund allocation, lack of support from the government and
local councils, planning budget, parity of attention.
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