Copyright newstatesman
In 2013, “parity of esteem”, the commitment to hold and treat physical and mental health in equal regard, was enshrined in the NHS constitution. This came following the passing of the 2012 Health and Social Care Act, which put the principle in law. Thirteen years later, however, the consensus within health policymaking circles is that there is still a long, long way to go for mental health interventions – in terms of funding, resource and strategisation – to be on an equal-footing with physical ailments. To many, the irony is that, even with this lopsided arrangement, the NHS isn’t doing enough to deal with people’s physical issues. The “NHS elective waiting list”, standing at 7.4 million (as of August 2025), only accounts for those in need of physical treatment. Less attention is put towards the 1.7 million on the separate list for mental health. Of course, many of those facing physical ailments – through, for example, delays in accessing treatment – could go on to develop issues with their mental health, and vice versa. There is one recurring word and policy intervention that has dominated discussions around health in recent years: prevention. Particularly in terms of preventing young people from falling ill at a young age, potentially condemning them to an unproductive, unfulfilling life. The latest figures show that 948,000 people aged 16 to 24 are “Neet” – not in education, employment or training – which is equivalent to 12.5 per cent of all people in that cohort. Its causes are multiple and often overlapping: key among them being poor mental health. Over a quarter of Neet young people (26 per cent) identified poor mental health as being a key driver behind their status, a survey from the National Centre for Social Research (NCSR) found. Studies have shown that being Neet can have a detrimental effect on physical and mental health, and increase the likelihood of unemployment, low wages, or low quality of work later on in life. Although Keir Starmer’s party has, as one of its central tenets of government, pledged to build an NHS that’s “fit for the future”, there is still an underlying feeling that what has been put forward does not go far enough. The success (or otherwise) of the policy would have impacts far beyond the brief of the Department for Health and Social Care. How is Labour meant to achieve its other missions for government – particularly the highest growth in the G7, and breaking down opportunity barriers for young people – if the current physical-mental-sickness bind persists? “We’ve made such progress in pushing towards parity of esteem between physical and mental health,” Danny Beales, the Labour MP for Uxbridge and South Ruislip and a member of the Health and Social Care select committee, told me during a panel discussion at the Labour Party Conference last month. Beales flagged the recent work his select committee has done on community-based mental health services. “Many people that we’ve spoken to in our review talk about only being able to access support when they’re very acutely mentally unwell,” he said. “And as soon as they feel better, there’s almost a kind of punishment, [in that] the support that they receive is withdrawn, and suddenly they’re back in the community, struggling to access support.” The consensus is clear: our current policy frameworks are not fit for purpose. It not only has a health-based impact for people but an economic one for the country. “We know, through our analysis, that [poor] mental health costs England around £300bn every year,” Kadra Abdinasir of the Centre for Mental Health charity said during the same discussion. That cost “shockingly”, Abdinasir continued, is nearly twice the total budget of the NHS. “If we want to take productivity seriously and improve it, we have to make use of the resources that we already have by shifting [policy] focus towards preventing mental ill-health, and intervening earlier.” The scale, causes and effects are clear. But the government’s plan to overcome the challenges of Neet individuals and, indeed, their older contemporaries, has had a mixed response. In July, the government launched the NHS ten-year health plan. It aims to seize “the opportunities provided by new technologies, medicines and innovations to deliver better care for all patients – wherever they live and whatever they earn – and better value for taxpayers”. Its headline pledges on mental health are to put £120m towards 85 dedicated mental health emergency departments; expand mental health teams in education settings; and roll out more, localised, neighbourhood health services. The plan, while having some positive proposals, “falls far short of the transformative vision or commitment we need for the nation’s mental health”, in the view of Andy Bell, chief executive of the Centre for Mental Health. The plan says “very little” about how the gap between physical and mental health will be closed: “Mental health waiting lists are still given less importance than those for physical health care,” added Bell. “There is little in this plan that will prevent mental ill health.” The most pressing request was for a holistic strategy on mental health. The government needs to “step-up”, Bell argued, “and commit to a cross-government mental health plan”. Despite the numerous calls from politicians and the third sector in recent years, a cross-governmental plan to tackle the health-productivity spiral is yet to truly materialise. Cross-departmental collaboration is acutely necessary if we are to tackle Neet young people, and productivity in particular. The top five “risk factors” for Neet status – from the aforementioned NCSR study – were: post-16 caring responsibilities (Health and Social Care); single-parent households, and social renting (Housing and Local Government); anti-social behaviours (Home Office); and parents having no qualifications (Education). Beales said: “I hear all the time from parents in my constituency [about] their child with mental health issues, who may or may not be out of work, [or] applying for PIP, or struggling to get CAMHS [Children and Adolescent Mental Health Services] appointments for two or three years. That can’t be an acceptable state of being if we want to get young people back into work or training to support them to live their best possible life and achieve their potential. “It can’t just be about tweaking the benefit system. It has to be about a more active benefit system; more active joined-up state system; health and mental health system, working with the welfare and job support system. At the moment, the state is far too siloed.” This article first appeared in the Spotlight on Healthcare supplement, published on October 27. You can find a PDF of the whole supplement here.
