Mental Health and Wellbeing Strategy: Initial Monitoring Report and Monitoring Framework

Short-term Outcome 9: People are empowered to participate in the decisions that affect their health, treatment and lives

Short-term Outcome 9 (STO9) of the Mental Health and Wellbeing Strategy focuses on people feeling empowered to participate in decisions that affect their health, treatment, and lives.

Metrics to monitor this outcome are structured under two components:

1. Health and treatment

2. Lives

Table 25 presents the specific metrics grouped under each component.

Table 25: Metrics for Monitoring Short-term Outcome 9

The following sections present each of these components and associated metrics in detail, offering insight into baseline measures and observed changes related to STO9.

1. Health and Treatment

The first component on Short-Term Outcome 9 refers to people feeling empowered to make decisions on their health and treatment. There are two metrics used to monitor this component.

Percentage of GP and out-of-hour patients reporting feeling in control of their care

The HACE survey asks patients attending their GP and out-of-hours services for a mental health reason about their experiences of being supported to participate in decisions about their care. This includes whether staff helped them feel in control, whether they felt able to make an informed choice, and whether they felt involved in decisions about their treatment and care.

In the 2023/24 HACE survey:

• 61% of GP patients reported that staff helped them feel in control of their treatment and care for a mental health reason.
• 70% of GP patients felt able to make an informed choice about their treatment and care.
• 71% of GP patients felt they were involved in decisions about their treatment and care.

Of those who attended out-of-hours services:

• 56% reported that staff helped them feel in control of their treatment and care for a mental health reason.

Number of people with advance statements registered per year with the Mental Welfare Commission for Scotland

The Mental Welfare Commission (MWC) publishes an annual report providing a detailed analysis of how the Mental Health Act was used across Scotland, including advance statements.

Advance statements are written statements made by a person when they are well, setting out the care and treatment they would prefer or would dislike should they become mentally unwell in the future. Since 2017, each time someone either writes or withdraws a statement, health boards should notify the Mental Welfare Commission for Scotland.

In 2023/24, 150 new advance statements were registered with the Mental Welfare Commission, compared with 161 new statements in 2022/23.

2. Lives

The second component on Short-Term Outcome 9 is people feeling empowered to make decisions on their lives. There is one metric used to monitor this component.

Percentage of adults living in Scotland who feel they can influence decisions affecting their local area, would like to be more involved, and believe their neighbourhood is a place where local people take action to improve it

The Scottish Household Survey asks adults living in Scotland about how much influence they feel they have over decisions in their local area, whether they would like to be more involved in decisions in their local area, and if they believed their neighbourhood is a place where local people take action to help improve the area.

In 2024:

• 19% of adults felt they could influence decisions affecting their local area, compared with 18% in 2022.
• 33% said they would like to be more involved in decisions made by their council, the same as in 2022.
• 59% of adults agreed that local people take action to help improve their neighbourhood, down from 63% in 2022.

Reflections on Short-Term Outcome 9

Short-Term Outcome 9 of the Mental Health and Wellbeing Strategy focuses on people feeling empowered to participate in decisions that affect their health, treatment, and lives. Most of the available data is from 2023 and 2024, providing an early baseline for monitoring. A small number of measures, particularly those from the Scottish Household Survey, allow comparison with 2022 and show only limited changes at this early stage.

Evidence from primary care suggests that many individuals feel supported to participate in decisions about their care. Survey data indicate that most patients attending GP and out-of-hours services for mental health reasons feel involved in decision-making and able to make informed choices. The registration of advance statements also provide structured opportunities for individuals to express preferences and exercise choice in their treatment and support.

Broader measures of civic participation, drawn from the Scottish Household Survey, show that levels of influence over local decision-making remain low, with only small changes since 2022. The proportion of adults who feel able to influence local decisions has risen slightly, the proportion wanting to be more involved is unchanged, and the proportion who believe people take action to improve their neighbourhood has decreased. These patterns suggest that opportunities for people to participate in decisions affecting their daily lives remain uneven across Scotland.

Data gaps

There is one overarching data gap that limits the ability to fully monitor STO9.

Health and lifestyle data specific to people with mental health conditions: Lack of data on people feeling empowered to be in control of their health and treatment outside of engaging with mental health services.