Parity of Esteem and Systems Thinking. A Theory Informed Qualitative Synthesis

Background: UK policy recognises the interdependence of physical and mental health, but the failure to define Parity of Esteem (PoE) in any depth, challenges its implementation. There are at least two shortcomings in current PoE implementation; the lack of specificity in its operational components and progress indicators and the sub-optimal ‘siloed’ approach to its redress. Methods: : This is a descriptive qualitative study employing 27 qualitative interviews and the World Health Organisation (WHO) system domains as a framework for the thematic analysis. Results: : Examining the current strengths and challenges of systems in mental and physical healthcare using the WHO domains and macro, meso and micro levels, identifies specific actions to redress inequity between mental and physical health provision. Conclusion: The evidence suggests that moving PoE from rhetoric towards reality requires new configurations with a systems orientation, which uses macro, meso and micro levels to analyse and understand the complexity of relations within and between domain levels and reorienting funding, training and measurement. This requires embedding new competencies, infrastructures and practices within an effective learning healthcare system.