Skip to main content

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

  • J. B. Kirkbride (a1) and P. B. Jones (a1)

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Parity of esteem begins at home: translating empirical psychiatric research into effective public mental health
      Available formats
Corresponding author
* Address for correspondence: J. B. Kirkbride, Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge CB2 0SZ, UK. (Email:
Hide All
Addington, J, Cadenhead, KS, Cornblatt, BA, Mathalon, DH, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Addington, JA, Cannon, TD (2012). North American Prodrome Longitudinal Study (NAPLS 2): overview and recruitment. Schizophrenia Research 142, 7782.
Allardyce, J, Gilmour, H, Atkinson, J, Rapson, T, Bishop, J, McCreadie, RG (2005). Social fragmentation, deprivation and urbanicity: relation to first-admission rates for psychoses. British Journal of Psychiatry 187, 401406.
Amos, A (2012). Assessing the cost of early intervention in psychosis: a systematic review. Australian and New Zealand Journal of Psychiatry 46, 719734.
Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Ohlenschlaeger, J, le Quach, P, Christensen, TO, Krarup, G, Jorgensen, P, Nordentoft, M (2008). Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS Trial. Archives of General Psychiatry 65, 762771.
Bosanac, P, Patton, GC, Castle, DJ (2010). Early intervention in psychotic disorders: faith before facts? Psychological Medicine 40, 353358.
Brietzke, E, Araripe Neto, AG, Dias, A, Mansur, RB, Bressan, RA (2011). Early intervention in psychosis: a map of clinical and research initiatives in Latin America. Revista Brasileira de Psiquiatria 33 (Suppl. 2), s213s224.
Brown, S, Barraclough, BM, Inskip, H (2000). Causes of the excess mortality of schizophrenia. British Journal of Psychiatry 177, 212217.
Brown, S, Birtwistle, J, Roe, L, Thompson, C (1999). The unhealthy lifestyle of people with schizophrenia. Psychological Medicine 29, 697701.
Campion, J, Bhui, K, Bhugra, D (2012). European Psychiatric Association (EPA) guidance on prevention of mental disorders. European Psychiatry 27, 6880.
Caplan, B, Zimmet, SV, Meyer, EC, Friedman-Yakoobian, M, Monteleone, T, Jude Leung, Y, Guyer, ME, Rood, LL, Keshavan, MS, Seidman, LJ (2013). Prevention and recovery in early psychosis (PREP®): building a public–academic partnership program in Massachusetts, United States. Asian Journal of Psychiatry 6, 171177.
Council of Australian Governments (2012). The Roadmap for National Mental Health Reform 2012–2022. Australian Government: Canberra.
Craig, T (2003). A step too soon or a step too far? Early intervention in psychosis. Journal of Mental Health 12, 335339.
Craig, TKJ, Garety, P, Power, P, Rahaman, N, Colbert, S, Fornells-Ambrojo, M, Dunn, G (2004). The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. British Medical Journal 329, 1067.
Department of Health (2000). The NHS Plan: A Plan for Investment, a Plan for Reform. HMSO: London.
Department of Health (2001). Mental Health Policy Implementation Guide. National Health Service: London.
Department of Health (2007). Guidance on Joint Strategic Needs Assessment. Department of Health: London.
Department of Health (2011). No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages. Department of Health: London.
Egede, LE (2007). Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General Hospital Psychiatry 29, 409416.
Garety, PA, Craig, TK, Dunn, G, Fornells-Ambrojo, M, Colbert, S, Rahaman, N, Read, J, Power, P (2006). Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial. British Journal of Psychiatry 188, 3745.
Grant, BF, Hasin, DS, Chou, SP, Stinson, FS, Dawson, DA (2004). Nicotine dependence and psychiatric disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 11071115.
Gustavsson, A, Svensson, M, Jacobi, F, Allgulander, C, Alonso, J, Beghi, E, Dodel, R, Ekman, M, Faravelli, C, Fratiglioni, L, Gannon, B, Jones, DH, Jennum, P, Jordanova, A, Jonsson, L, Karampampa, K, Knapp, M, Kobelt, G, Kurth, T, Lieb, R, Linde, M, Ljungcrantz, C, Maercker, A, Melin, B, Moscarelli, M, Musayev, A, Norwood, F, Preisig, M, Pugliatti, M, Rehm, J, Salvador-Carulla, L, Schlehofer, B, Simon, R, Steinhausen, HC, Stovner, LJ, Vallat, JM, Van den Bergh, P, van Os, J, Vos, P, Xu, W, Wittchen, HU, Jonsson, B, Olesen, J (2011). Cost of disorders of the brain in Europe 2010. European Neuropsychopharmacology 21, 718779.
Hui, CL, Chang, WC, Chan, SK, Lee, EH, Tam, WW, Lai, DC, Wong, GH, Tang, JY, Li, FW, Leung, KF, McGhee, SM, Sham, PC, Chen, EY (2013). Early intervention and evaluation for adult-onset psychosis: the JCEP study rationale and design. Early Intervention in Psychiatry. Published online 28 02 2013 . doi:10.1111/eip.12034.
Iyer, SN, Mangala, R, Thara, R, Malla, AK (2010). Preliminary findings from a study of first-episode psychosis in Montreal, Canada and Chennai, India: comparison of outcomes. Schizophrenia Research 121, 227233.
James, S, Das, D (2012). Tobacco smoking in the Leicestershire Early Intervention in Psychosis Service: patient survey and service development. Early Intervention in Psychiatry 6, 110110.
Joint Commissioning Panel for Mental Health (2012). Guidance for the Commissioning of Public Mental Health Services. Royal College of Psychiatry: London.
Kelly, M, O'Meara Howard, A, Smith, J (2007). Early intervention in psychosis: a rural perspective. Journal of Psychiatric and Mental Health Nursing 14, 203208.
Kirkbride, JB, Barker, D, Cowden, F, Stamps, R, Yang, M, Jones, PB, Coid, JW (2008). Psychoses, ethnicity and socio-economic status. British Journal of Psychiatry 193, 1824.
Kirkbride, JB, Errazuriz, A, Croudace, TJ, Morgan, C, Jackson, D, Boydell, J, Murray, RM, Jones, PB (2012 a). Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLOS ONE 7, e31660.
Kirkbride, JB, Fearon, P, Morgan, C, Dazzan, P, Morgan, K, Tarrant, J, Lloyd, T, Holloway, J, Hutchinson, G, Leff, JP, Mallett, RM, Harrison, GL, Murray, RM, Jones, PB (2006). Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center ÆSOP Study. Archives of General Psychiatry 63, 250258.
Kirkbride, JB, Jackson, D, Perez, J, Fowler, D, Winton, F, Coid, JW, Murray, RM, Jones, PB (2013). A population-level prediction tool for the incidence of first-episode psychosis: translational epidemiology based on cross-sectional data. BMJ Open 3, e001998.
Kirkbride, JB, Jones, PB, Ullrich, S, Coid, JW (2012 b). Social deprivation, inequality, and the neighborhood-level incidence of psychotic syndromes in East London. Schizophrenia Bulletin. Published online 12 12 2012 . doi:10.1093/schbul/sbs151.
Kirkbride, JB, Stubbins, C, Jones, PB (2012 c). Psychosis incidence through the prism of early intervention services. British Journal of Psychiatry 200, 156157.
Kohn, R, Saxena, S, Levav, I, Saraceno, B (2004). The treatment gap in mental health care. Bulletin of the World Health Organization 82, 858866.
Koike, S, Nishida, A, Yamasaki, S, Ichihashi, K, Maegawa, S, Natsubori, T, Harima, H, Kasai, K, Fujita, I, Harada, M, Okazaki, Y (2011). Comprehensive early intervention for patients with first-episode psychosis in Japan (J-CAP): study protocol for a randomised controlled trial. Trials 12, 156.
Lasser, K, Boyd, JW, Woolhandler, S, Himmelstein, DU, McCormick, D, Bor, DH (2000). Smoking and mental illness: a population-based prevalence study. Journal of the American Medical Association 284, 26062610.
Laursen, TM, Munk-Olsen, T, Vestergaard, M (2012). Life expectancy and cardiovascular mortality in persons with schizophrenia. Current Opinion in Psychiatry 25, 8388.
Lawrence, D, Kisely, S, Pais, J (2010). The epidemiology of excess mortality in people with mental illness. Canadian Journal of Psychiatry 55, 752760.
Lee, MS, Ahn, SR, Park, JI, Chung, YC (2012). Development of an early psychosis intervention system in Korea: focus on the continuing care system for first-episode psychosis treatment in Seoul. East Asian Archives of Psychiatry 22, 105109.
Lester, H, Birchwood, M, Bryan, S, England, E, Rogers, H, Sirvastava, N (2009). Development and implementation of early intervention services for young people with psychosis: case study. British Journal of Psychiatry 194, 446450.
Lester, H, Khan, N, Jones, P, Marshall, M, Fowler, D, Amos, T, Birchwood, M (2012). Service users’ views of moving on from early intervention services for psychosis: a longitudinal qualitative study in primary care. British Journal of General Practice 62, e183e190.
Lester, H, Marshall, M, Jones, P, Fowler, D, Amos, T, Khan, N, Birchwood, M (2011). Views of young people in early intervention services for first-episode psychosis in England. Psychiatric Services 62, 882887.
Lord, O, Malone, D, Mitchell, AJ (2010). Receipt of preventive medical care and medical screening for patients with mental illness: a comparative analysis. General Hospital Psychiatry 32, 519543.
Mahmmood, MA, Fisher, H (2006). The incidence of first episode psychosis in inner London: findings from the Lambeth Early Onset (LEO) service. Schizophrenia Research 86, 0548.
Mangalore, R, Knapp, M (2007). Cost of schizophrenia in England. Journal of Mental Health Policy and Economics 10, 2341.
Marshall, M, Lewis, S, Lockwood, A, Drake, R, Jones, P, Croudace, T (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Archives of General Psychiatry 62, 975983.
Marshall, M, Rathbone, J (2011). Early intervention for psychosis. Schizophrenia Bulletin 37, 11111114.
McCreadie, RG (2003). Diet, smoking and cardiovascular risk in people with schizophrenia. British Journal of Psychiatry 183, 534539.
McCrone, P, Park, A-L, Knapp, M (2011). Early intervention for psychosis. In Mental Health Promotion and Mental Illness Prevention (ed. Knapp, M., McDaid, D. and Parsonage, M.), pp. 1617. Department of Health: London.
McGorry, P (2012). At issue: Cochrane, early intervention, and mental health reform: analysis, paralysis, or evidence-informed progress? Schizophrenia Bulletin 38, 221224.
McGorry, P, Johanessen, JO, Lewis, S, Birchwood, M, Malla, A, Nordentoft, M, Addington, J, Yung, A (2010). Early intervention in psychosis: keeping faith with evidence-based health care. Psychological Medicine 40, 399404.
McGorry, PD, Edwards, J, Mihalopoulos, C, Harrigan, SM, Jackson, HJ (1996). EPPIC: an evolving system of early detection and optimal management. Schizophrenia Bulletin 22, 305326.
McManus, S, Meltzer, H, Campion, J (2010). Cigarette Smoking and Mental Health in England: Data from the Adult Psychiatric Morbidity Survey 2007. National Centre for Social Research: London.
Mihalopoulos, C, Harris, M, Henry, L, Harrigan, S, McGorry, P (2009). Is early intervention in psychosis cost-effective over the long term? Schizophrenia Bulletin 35, 909918.
Mihalopoulos, C, McCrone, P, Knapp, M, Johannessen, JO, Malla, A, McGorry, P (2012). The costs of early intervention in psychosis: restoring the balance. Australian and New Zealand Journal of Psychiatry 46, 808811.
Mitchell, AJ, Malone, D, Doebbeling, CC (2009). Quality of medical care for people with and without co-morbid mental illness and substance misuse: systematic review of comparative studies. British Journal of Psychiatry 194, 491499.
Mortensen, PB, Juel, K (1993). Mortality and causes of death in first admitted schizophrenic patients. British Journal of Psychiatry 163, 183189.
Moussavi, S, Chatterji, S, Verdes, E, Tandon, A, Patel, V, Ustun, B (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370, 851858.
Pelosi, A (2009). Is early intervention in the major psychiatric disorders justified? No. British Medical Journal 337, a710.
Pelosi, AJ, Birchwood, M (2003). Is early intervention for psychosis a waste of valuable resources? British Journal of Psychiatry 182, 196198.
Perkins, DO, Gu, H, Boteva, K, Lieberman, JA (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. American Journal of Psychiatry 162, 17851804.
Raven, M, Stuart, GW, Jureidini, J (2012). ‘Prodromal’ diagnosis of psychosis: ethical problems in research and clinical practice. Australian and New Zealand Journal of Psychiatry 46, 6465.
Rossler, W, Salize, HJ, van Os, J, Riecher-Rossler, A (2005). Size of burden of schizophrenia and psychotic disorders. European Neuropsychopharmacology 15, 399409.
Royal College of Psychiatrists (2012). Joint Call for Parity of Esteem on World Mental Health Day. Royal College of Psychiatrists: London.
Royal College of Psychiatrists (2013). Whole-Person Care: From Rhetoric to Reality. Royal College of Psychiatrists: London.
Saha, S, Chant, D, McGrath, J (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? Archives of General Psychiatry 64, 11231131.
The White House (2013). Background on the National Conference on Mental Health. Office of the Press Secretary: Washington, DC.
Tiffin, PA, Glover, G (2007). From commitment to reality: early intervention in psychosis services in England. Early Intervention in Psychiatry 1, 104107.
Valmaggia, LR, McCrone, P, Knapp, M, Woolley, JB, Broome, MR, Tabraham, P, Johns, LC, Prescott, C, Bramon, E, Lappin, J, Power, P, McGuire, PK (2009). Economic impact of early intervention in people at high risk of psychosis. Psychological Medicine 39, 16171626.
van Os, J, Driessen, G, Gunther, N, Delespaul, P (2000). Neighbourhood variation in incidence of schizophrenia. Evidence for person–environment interaction. British Journal of Psychiatry 176, 243248.
Veling, W, Susser, E, van Os, J, Mackenbach, JP, Selten, J-P, Hoek, HW (2008). Ethnic density of neighborhoods and incidence of psychotic disorders among immigrants. American Journal of Psychiatry 165, 6673.
Wade, D, Harrigan, S, Edwards, J, Burgess, PM, Whelan, G, McGorry, PD (2006). Course of substance misuse and daily tobacco use in first-episode psychosis. Schizophrenia Research 81, 145150.
Zammit, S, Lewis, G, Rasbash, J, Dalman, C, Gustafsson, J-E, Allebeck, P (2010). Individuals schools, and neighborhood: a multilevel longitudinal study of variation in incidence of psychotic disorders. Archives of General Psychiatry 67, 914922.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed