Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health

Abstract

There is increasing recognition that parity of esteem between mental and physical health disorders is essential to improve the course, outcome and quality of life of individuals within different populations. Achieving this parity now underpins the objectives of several nations. Here, we argue that parity of esteem between mental and physical health can only be realized when parity of esteem also exists across mental health disorders, particularly in terms of service commissioning and planning. Using first-episode psychosis and early intervention in psychosis services as a motivating example, we demonstrate how carefully conducted psychiatric epidemiology can be translated to develop precise forecasts of the anticipated incidence of first-episode psychosis in different populations, based on an understanding of underlying local needs and inequalities. Open-access prediction tools such as PsyMaptic will allow commissioners of mental health services to more effectively allocate resources across services, based on empirical evidence and local need, thus reducing inequalities in access to mental health care.

Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis

“…There are now more than 200 EI for psychosis services worldwide (Jackson & McGorry, 2009), yet there has been little discussion on the specific areas in which these services should be located and how limited resources should be allocated. It has been argued that delivery of EI for psychosis service should be based on realistic models of the predicted incidence of psychosis in different communities (Kirkbride et al 2013; Kirkbride & Jones, 2014). As a result of this, a tool known as PsyMaptic (Psychiatric Mapping Translated into Innovation for Care) was developed and this can predict the incidence of FEP based on geographical information (Kirkbride et al 2013).…”

Migration and risk of psychosis in the Canadian context

“…The linked study highlights the essential need to provide routine data of sufficient quality and detail for the precise estimation of incidence and prevalence of psychotic disorders among all subgroups of the general population. 12 It is only on the foundation of robust epidemiologic estimates of incidence of psychiatric distress that the vital care provided through clinical services and public mental health policy can be optimized to promote better mental health and well-being for all residents in Canada, including first-generation immigrants and refugees.…”

Discussion of “Hunting the Real”

“…Low income Africana persons tend to experience heightened amounts of co-morbidities across physical and mental domains that make them more vulnerable to poor health outcomes, (Williams et al, 2019). Among those with psychotic symptoms, there are high rates of unhealthy lifestyle behaviors such as smoking, alongside low rates of health care, advice and support for healthy lifestyles, (Kirkbride & Jones, 2014). This often means that among low income populations there is less early intervention following the onset of psychotic conditions.…”