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Three minutes with Joanna Powell

Physio Joanna Powell heads an ambitious programme at NHS England to give mental health parity of esteem with physical health

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What does ‘parity of esteem’ mean?

Put simply it is about whole person care. Everyone’s life is a journey of ups and downs – we all encounter trauma which affect both our physical and mental health.

My open menisectomy at the age of 16 led to a lifetime of repeated knee injuries, for others an abusive relationship may lead to one or more episodes of mental distress or illness.

We all experience transitions throughout our lives as we adjust to whatever life throws at us. A service that takes a parity approach to delivery will consider both the physical and mental impact of illnesses on individuals.

Why is it important?

If you have a medical condition or are physically unwell and also have a short- or long-term mental health illness, your health outcomes are likely to be worse and your care will cost more – for example one person with diabetes in four is known to be depressed or anxious (which came first, I hear you ask).

Depression and anxiety are often amenable to evidence based interventions such as psychological therapies and yet only a quarter of people with depression or anxiety are receiving any form of treatment.  

If you have either a ‘common’ or severe mental illness (SMI) you are likely to die prematurely.

Life expectancy of people with SMI living now is the same as the life expectancy for the general population living in the 1950s. This is a scandal.

Tell us about your role at NHS England

I relish variation which is just as well as every day in this role is different.

Recently a significant part of my role has focused on ensuring that parity is recognised as a priority by NHS England. I am delighted that parity features prominently in NHS England’s current business plan.

Over the next year I will be focusing on developing tools and levers to reduce the many disparities which exist between physical and mental health while encouraging commissioners to commission sustainable integrated services which deliver whole person care.

Do you think physio staff are interested enough in mental health issues?

This probably depends on the individual physiotherapist, where they work and who they work with. This is no different from any other staff group.   

I hope that the current emphasis on parity will encourage everyone to stop and think. I know that I have been shocked by many of the statistics of the impact of mental distress and illness on health outcomes.

All physiotherapists have a key role in facilitating everyone to live, not just exist. I suspect physiotherapists underestimate their contribution to preventing mental illness by enabling people to be as active as possible.

What’s it like working closely with ministers and civil servants?

I work in the medical directorate at NHS England. The team I work in is made up of a mixture of ex-civil servants and NHS staff. This gives us a good range of skills and experiences to deal with whatever we are asked to do.

I had not anticipated that I would be asked to coordinate written evidence to health select committees or draft briefings for NHS England executives to prepare them for meetings with ministers.

It is important to recognise that politicians have priorities and that managing them successfully allows everyone to get on with those things that really matter.

Do you miss being a hands-on physio?

Not as much as I thought I would. I left clinical practice in the early 2000s, a decision I found really hard to make. It was made easier by having someone to support my decision making.

Applying my clinical knowledge in new ways suits me – but I absolutely understand that the career path I have taken is not for everyone. I am always willing to help others think through key decisions such as their next career steps.

How do you look after your own mental health?

I enjoy cycling to work and spent at least one day each weekend in the lovely British countryside. I am currently in ‘training’ for my summer holiday, walking around Mont Blanc in the Alps.

I am looking forward to long summer nights sitting in my garden with my family, spotting owls, with the distant chirp of my chickens in the background.

But most of all I am learning to switch my phone off when I leave work on a Friday night only switching it on again when I return to work on a Monday morning. fl

Joanna Powell is domain team lead, parity of esteem programme, valuing mental health equally with physical health, at NHS England

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