The parity of mental and physical health

The parity of mental and physical health

person working remotely on their laptop

Dr Jose Garcia-Lobera, an EMCC UK member and medical clinician, writes about the equality of mental health and physical health in our wellbeing, and the importance of this in improving coaching outcomes.

One of the things that has helped raise the profile of mental health in the UK over the last few years is the concept of ‘parity of esteem’. This is the principle by which mental health must be given equal priority to physical health. It was enshrined in law by the Health and Social Care Act 2012, which created a new legal responsibility for the NHS to give equal emphasis to people’s mental health and wellbeing and to their physical health needs.

Why is parity of esteem relevant to coaches and mentors?

From my experience as both a frontline GP, and someone responsible for commissioning services and deciding how the NHS should use its resources at a local level, giving equal emphasis to an individual’s physical and mental wellbeing is fundamental. It is crucial to improve outcomes, increasing life expectancy and reducing pain and suffering. Therefore parity of esteem is more than trying to tackle the stigma that is often associated with mental health. It is about closing the gap between physical and mental health, and taking a holistic view that includes them both.

Nobody would go into a coaching session with an intense pain that made it difficult to concentrate, or with a physical health problem that would make it difficult to give a coachee the level of attention that they needed and that you wanted to give. If you don’t feel right with your physical health you would take some rest and look after yourself, and in some cases would take treatment and seek further advice and help. But do we behave in the same way with our mental health? Are we confident and aware of exercising parity with ourselves?

It is equally important to acknowledge that if you are feeling distressed, anxious or depressed, you are unlikely to be able to give your best, and that if these are problems that have gone on for a while, the most sensible thing to do is to get help.

The same approach must be taken with coachees. It is essential to have an awareness of mental health, as some coaches may feel less confident in this area, but also because of the considerable stigma that is still frequently associated with mental health problems. This can lead to people being much less open to feelings of weakness and guilt, and to a lack of understanding about the causes of problems and awkwardness about offering help and support.

Coaching is not therapy, and it is important to remember that coaches (and coachees through contracting) must be aware of the boundaries and seek help and support if necessary. The excellent recent EMCC UK guide from Dr Fiona Day, Coaching, mentoring and mental health, is very clear and gives a lot of useful information on how to increase the skills and confidence when dealing with mental health.

No health without mental health

It might have been said often, but it’s still true: there is no health without mental health. Parity of esteem should be a guiding principle in our approach to mental health both in trying to understand others, and also in understanding our own thoughts and actions. Applying the same principle to our work as coaches enhances the two core coaching skills of awareness and responsibility – as described by Sir John Whitmore in his book Coaching for Performance: The Principles and Practice of Coaching and Leadership.

Increasing awareness for both ourselves as coaches, and for our coachees, about the importance of the psychological sphere and the great impact on all aspects of our lives and our performance, would enhance the coaching relationship and provide the coachee with more tools for the journey. It reinforces the importance of taking a holistic approach, considering always the biological, psychological, social and spiritual aspects of the individual.

It is important also to recognize that the coaching conversation is likely to influence the reality (reality is the R of John Whitmore’s GROW model) or ‘the conversation for choice’ (in Tim Gallwey’s book, The Inner Game of Work) in a number of different ways. Broadening our perspective and taking a holistic view will therefore give more opportunities, and hence potentially a more rewarding coach-client relationship. Coaches need to be aware of that ongoing changing balance between all the different aspects of the individual, how they interact, and how they change as a consequence of the interaction with internal and external factors and stimuli.

Increasing responsibility, using parity as a guiding principle, means we are better equipped to influence the will of the coachee, and is likely to widen the range of options, as well as improving our ability to connect some of the key elements and influence the next steps.

A deeper level of engagement

We can see evidence of this better approach in health coaching. One example is the COM-B behaviour change model (Michie at al, 2011, and The Behaviour Change Well Framework by Michie S, Atkins L, West R, 2014). This model (below) recognises that behaviour occurs as an interaction between the three necessary conditions: capability, opportunity and motivation. Interventions need to change one or more of them, resulting in a new configuration and reducing the risk of it reverting.

person working remotely on their laptop

I believe it is important to acknowledge that coaching can, and often will, take us and coachees to a deeper level of engagement, where assumptions, values and motivational roots become clearer. This is the catalyst for significant and sustained change, in line with the Four Levels of Engagement by Hawkins and Smith. Applying the principle of parity, we will broaden our perspective beyond the psychological aspect into other factors, such as social, physical or spiritual, that will act as enablers or barriers to change. Essentially, parity of esteem means it is important that they should all be given equal thought and consideration.

There could perhaps be a criticism that I am stretching the concept of parity of esteem too far. After all, it is an idea developed to address a long-term imbalance between mental and physical health. But it is important to recognise that parity is about equality, and so, when we use it as a guiding principle, it is equality we are promoting. It is also a helpful way to think about whether we are seeing not just our coachees, mentees and clients, but also ourselves, in a truly holistic way.

In these challenging times when Coronavirus has brought uncertainty, confusion and concern to our lives, it is more important than ever to acknowledge that mental health is as important as physical health, and that it’s OK not to be OK. That we have to be gentle and show compassion to others and to ourselves. That fluctuation in our health will be the norm. That experiencing stress is not a sign of weakness or inability, it means we are human.

In other words, it means that now is a good time to make sure we are applying the coaching principles and competencies we use with others to ourselves. I have experienced this myself. Using my coaching skills in my clinics has enriched the conversations with my patients immensely, increasing awareness and responsibility, resulting in a better experience for patients and a more rewarding job for me as clinician.

Dr Jose Garcia-Lobera is a GP and executive coach. He is Chair and Clinical Lead for Mental Health at the NHS Southend Clinical Commissioning Group

Photo: Priscilla Du Preez