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

Summary Outcome 2: People with mental health conditions, including those with co-existing health conditions, experience improved quality and length of life, free from stigma and discrimination.

Summary Outcome 2 (SO2) of the Mental Health and Wellbeing Strategy focuses on improving the quality and length of life for people with mental health conditions, including those with co-existing physical health conditions, and reducing experiences of stigma and discrimination.

Mental health conditions are associated with reduced life expectancy and higher mortality (Chana et al., 2023). They are also linked to poorer outcomes across key aspects of quality of life, including lower educational attainment, reduced employment prospects, increased risk of debt and homelessness, barriers to accessing healthcare, social exclusion, and experiences of violence, stigma, and discrimination (Campion, 2019; World Health Organisation, 2014).

Metrics for monitoring SO2 are grouped under three core components of the outcome:

1. Quality of life
2. Length of life
3. Stigma and discrimination

Table 7 presents the specific metrics grouped under each component.

Table 7. Metrics for Monitoring Summary Outcome 2

Core Components	Metrics
Quality of life	Years lived with disability (YLD) due to anxiety and depression Percentage of GP patients with a mental health condition who reported chronic or persistent pai Percentage of patients who started treatment within 18 weeks of referral to CAMHS and PT Percentage of adult mental health inpatients who received a physical health check during admission Percentage of people with a mental health condition who are in and out of work Percentage of GP patients with a mental health condition who feel able to look after their own health, compared to those without
Length of life	Excess premature mortality rate among people in contact with mental health services
Stigma and discrimination	Percentage of adults who believe mental ill health was a reason for which they have experienced discrimination or harassment in the last 12 months

The following sections present each of these components and associated metrics in detail, offering insight into baseline measures and observed changes related to SO2.

1. Quality of life

The first component of Summary Outcome 2 focuses on improving the quality of life for people with mental health conditions, including those with co-occurring health conditions. There are six metrics used to monitor this component.   

Years lived with disability (YLD) due to anxiety and depression

Years Lived with Disability (YLD), as estimated by the Scottish Burden of Disease (SBOD) study, quantifies the number of years individuals live with the disabling effects of illness or injury. YLD is calculated by multiplying the number of people with the condition by a “severity weight” — a score that shows how much the condition affects daily life. This produces an estimate of the total years of healthy life lost across the population. One YLD represents one full year of healthy life lost.

Higher YLD rates for anxiety and depression reflect a greater loss in quality of life across the population.

The 2019 SBOD study found that:

• Depression was the leading cause of ill health among men in Scotland in 2019, with a YLD rate of 1,277 per 100,000 population. Among women, the rate was slightly lower at 1,215 per 100,000 population, making it the third leading cause of ill health.
• Anxiety also ranked highly, with YLD rates of 1,075 per 100,000 for men and 1,045 per 100,000 for women, placing it as the third leading cause of disability for men and the fourth for women.

Percentage of GP patients with a mental health condition who reported chronic or persistent pain

The Scottish Government’s Health and Care Experience (HACE) survey asks GP patients whether they have experienced chronic or persistent pain [1]. Persistent pain often co-occurs with mental health conditions, and the interaction can worsen overall health outcomes and quality of life (Aaron et al., 2025).

In the 2023/24 HACE survey [2], there were notable differences between people with and without mental health conditions regarding chronic pain:

• 44% of people with a mental health condition reported experiencing chronic or persistent pain in the last three months.
• This compares to 26% of people without a mental health condition reporting chronic or persistent pain.

Percentage of patients who started treatment within 18 weeks of referral to CAMHS and PT

NHS Scotland has set a standard that 90% of patients referred to psychological therapies (PT) and Child and Adolescent Mental Health Services (CAMHS) should begin treatment within 18 weeks of referral. This standard is a key indicator of timely access to specialist mental health. Receiving care at the right time can improve quality of life for people with mental health conditions.

Quarterly data from PHS, covering the period from January – March 2023 to Jul–Sep 2025, show variation in performance across services:

• CAMHS: Performance has steadily improved, rising from 74.2% of patients starting treatment within 18 weeks in Jan-Mar 2023 to 91.5% in Jul-Sep 2025. The 90% target was first met in Oct–Dec 2024 (90.6%) and has been sustained since.
• Psychological Therapies (all ages): Performance remained consistently below target, fluctuating between 78.3% and 80.6%. The highest level over the period was recorded in Jul–Sep 2025 (80.7%), following the lowest level in Apr–Jun 2025 (78.3%). 

Figure 5: Percentage of patients starting treatment within 18 weeks of referral to CAMHS and Psychological Therapies, Scotland, Jan–Mar 2023 to Jul–Sep 2025

Waiting times performance statistics, Public Health Scotland 2025

Percentage of adult mental health inpatients who received a physical health check during admission

Data from the Scottish Government’s Mental Health Inpatient Census tracks the proportion of adult inpatients who received some form of physical health check.

On admission to an inpatient setting, patients are offered a physical health check, which usually includes basic observations such as blood pressure, weight, and other assessments to identify immediate health needs. This metric reflects a holistic, whole-person approach by capturing whether patients’ physical health is assessed during their mental health inpatient stay.

Regular physical health checks for mental health inpatients support improved quality of life by identifying and managing co-existing physical conditions that can otherwise worsen health outcomes (Hassan, Byravan & Al-Zubaidi, 2019).

In 2024, 89% of adult mental health inpatients were recorded as having received a physical health check within a day of admission during their inpatient stay, compared to 94% in the 2023 [3] census.

Percentage of people with a mental health condition who are in or out of work

The Annual Population Survey from the Office for National Statistics (ONS) reports on labour market statistics for Scotland. The report provides data on people with a disability aged 16 to 64 who were employed, unemployed and economically inactive in Scotland. 

Employment is associated with better quality of life, self-esteem, and social connection for people with mental health conditions. In contrast, unemployment is linked to poorer mental health outcomes (Drake and Wallach, 2020). In 2022, 48.1% of people with a mental health condition were out of work.

In 2022, 52.5% of people who reported having mental health difficulties [4] were unemployed or economically inactive, compared with 47.5% who were employed. By contrast, 17.5% of the general working-age population in Scotland were unemployed or economically inactive in the same year.

However, it should be noted that the quality and availability of APS data are expected to decline over the coming years due to the removal of the Scottish Labour Force Survey boost and falling response rates [5]. This may limit the reliability of detailed breakdowns for people with mental health conditions, and the indicator may need to be reviewed or replaced in future monitoring reports.

Percentage of GP patients with a mental health condition who feel able to look after their own health, compared to those without

The HACE survey asks GP patients how well they feel they are able to look after their own health. Confidence in self-care (i.e. feeling able to look after one’s own health) is a form of self-efficacy, and lower self-efficacy is associated with worse health-related quality of life (Peters et al, 2023).

In the 2023/24 survey, there were notable differences between people with and without mental health conditions in their self-reported ability to look after their health. 73% of people with a mental health condition reported feeling able to look after their own health, compared with 95% of people without a mental health condition, representing a 22-percentage point gap.

2. Length of life

The second component of Summary Outcome 2 is improving the length of life for people with mental health conditions. There is one metric used to monitor this component.

Excess premature mortality rate among people in contact with mental health services

Annual data from the PHS Mental Health Quality Indicators report on premature mortality in Scotland, both for the general population and for people who have had contact with mental health services. Premature mortality is defined as death occurring before age 75.

In 2022, the premature mortality rate was 445 per 100,000 people in the general population, compared with 2,331 per 100,000 among people in contact with mental health service, more than five times higher. This data provides the baseline, and future updates will track any changes in premature mortality rates.

3. Stigma and discrimination

The third component of Summary Outcome 2 focuses on reducing experiences of discrimination and stigma among individuals with mental health conditions. The one metric used to monitor this component is:

• Percentage of adults who believe mental ill health was a reason for which they have experienced discrimination or harassment in the last 12 months

However, there is a lack of routinely published data to monitor changes in stigma over time. Currently, The Scottish Mental Illness Stigma Study (2022) offers some insight:

• The study explored the lived experiences of people with mental health conditions in Scotland. It found high levels of stigma and discrimination across various settings: from family and friends (92%), on social media (78%), and in employment (71%). While the 2022 study provides a valuable snapshot, it cannot serve as a basis for ongoing monitoring.

Percentage of adults who believe mental ill health was a reason for which they have experienced discrimination or harassment in the last 12 months

The Scottish Household Survey asks adults living in Scotland whether they experienced discrimination or harassment in the past 12 months because of their mental health.

In 2023, 15% of adults reported experiencing discrimination, up from 9% in 2022, a 6-percentage point increase. Similarly, 14% of adults reported experiencing harassment, an increase from 8% in 2022, also a 6-percentage point rise.

Reflections on Summary Outcome 2

Summary Outcome 2 of the Mental Health and Wellbeing Strategy focuses on improving the quality and length of life for people with mental health conditions, including those with co-existing physical health conditions, and reducing experiences of stigma and discrimination.

Most of the available data to monitor this outcome sets a baseline for tracking future changes. While some data from after the Strategy was published indicate small changes, these metrics primarily establish starting points rather than clear trends.

Metrics included to monitor SO2 cover a range of quality-of-life areas. In terms of health burden, mental health conditions contribute substantially to overall ill health, with anxiety and depression among the leading causes. People with a mental health condition are also more likely to report experiences of chronic or persistent pain than those without.

Access to timely care shows mixed patterns. Since the Strategy’s launch to early 2025, CAMHS waiting times have shown steady improvement and now consistently meet the national 18-week standard to start treatment. In contrast, waiting times for psychological therapies remain below standard for adults.

Other measures of quality of life remain stable or show persistent differences. As of 2024, most adult mental health inpatients continue to receive a physical health check during admission. People with a mental health condition are more likely to be out of work than the general population and are less likely to report feeling able to manage their health.

In terms of length of life, premature mortality is substantially higher for people who have had contact with mental health services compared with the general population.

Finally, in relation to stigma and discrimination, survey data from 2023 shows increases in self-reported mental health-related discrimination and harassment compared to 2022.

Data gaps

There are two overarching data gaps that limit the ability to fully monitor SO2.

• People with Mental Health Conditions - Health and Lifestyle Data: Quality of life is a broad and multidimensional concept that is not fully captured by the available data. While several metrics cover health burden, care access, and daily functioning, most focus on individuals engaging with services, leaving gaps in understanding the experiences of those not in contact with care. There is also a lack of regularly updated data on other aspects of quality of life, including life satisfaction, subjective wellbeing, housing conditions, financial circumstances, social relationships, personal autonomy, and feelings of safety. Existing data highlights elevated premature mortality rates among people with mental health conditions, but measurement is largely restricted to service users. More detailed life expectancy data disaggregated by specific mental health conditions (e.g., depression, bipolar disorder, schizophrenia, personality disorders) would provide a clearer picture of variation in outcomes across diagnostic groups.

Stigma and Discrimination: There is limited data available to track changes over time in stigma and discrimination experienced by people with mental health conditions. While one measure exists on discrimination and harassment, there are gaps in routine data on public attitudes and experiences of stigma.