7. Where are we now?
The previous 10-year Mental Health Strategy was published in 2017. It set a vision to transform the mental health of people in Scotland, how we all think about mental health and wellbeing, and the mental health services we use.
The landscape in which the 2017 Strategy was developed was markedly different. When the previous vision was set out, the global events which have unfolded since then could not have been predicted. An unprecedented global public health crisis in the COVID-19 pandemic, the cost-of-living crisis and many more significant events have contributed to making many of our lives more challenging than we could have expected when that Strategy was published.
Scottish Government's 2020 Mental Health Transition and Recovery Plan set out more than 100 actions to address some of the impacts arising directly from the pandemic, but we know the impacts on mental health have continued to evolve since then.
We know that the current system is not delivering as we would wish despite the efforts of thousands of dedicated and skilled people across Scotland. We hear from individuals, families and our workforce that there can often be issues with finding and receiving the right help, sometimes with dreadful consequences.
We must accept this reality and resolve to drive change and improvement going forward. One of the reasons we are publishing this Strategy is to lay out what we think 'good' looks like and move forward with all partners towards that vision.
It is essential to reflect that there has been progress since 2017 upon which we can build further. This has been thanks to the hard work of individuals, communities and organisations across Scotland, supported by significant commitment. We want this Strategy to build on this good work.
Some areas of progress to highlight include:
- The publication of 'Creating Hope Together' – a new long-term Suicide Prevention Strategy and Action Plan for Scotland.
- The development since 2021-22 of community-based mental health and wellbeing supports across Scotland for children, young people and families that directly help address the need for emotional support. Local authorities report that in the second half of 2022, this supported over 45,000 children, young people and their families.
- The new Communities Mental Health and Wellbeing Fund for adults supported around 1,800 awards to a wide range of community projects in its first year.
- Since NHS 24's Mental Health Hub started providing 24/7 support in July 2020, they have responded to over 250,000 calls, and they continue to receive approximately 2,500 calls a week.
- Over 800 additional mental health workers
- in settings such as A&E departments, GP practices, police custody suites and prisons.
- Significant progress on perinatal mental health programmes since 2019, including new third sector support providing peer support, counselling and befriending to over 7,000 parents, expectant parents and infants.
- Progress on reducing CAMHS waiting lists, with more children being seen more quickly and ongoing commitment to making more progress.
- Counselling support services in all secondary schools in Scotland, with over 14,500 young people accessing school counselling services between January and June 2022.
- Through the Redesign of Urgent Care Programme, Scottish Government is working with partners, including Police Scotland, to support Community Police Officers and Police Custody Officers with presentations where a person is experiencing distress or a mental health crisis and may need specialist intervention. This work includes Police Scotland as key partners in the development and implementation of the Distress Brief Intervention programme and the Enhanced Mental Health Pathway.
- The development and expansion of digital mental health support and services that offer additional support when needed, such as digital therapy apps Daylight and Sleepio, the online Mind to Mind wellbeing platform on NHS inform, and computerised Cognitive Behavioural Therapies (cCBT). Scottish Government currently reports that there are 23 cCBT treatments available, and there have been 70,000 digital therapies referrals in the last year.
- In 2022, Scottish Government launched a new 'Healthy Working Lives' mental health and wellbeing digital platform to help employers in Scotland actively support and promote mental health at work. The platform signposts employers to a wide range of mental health and wellbeing resources. These include information and advice on understanding mental health, mental health and the law and staff learning and development opportunities, as well as signposting to sources of support.
- To complement the employer platform, the 'Supporting a Mentally Healthy Workplace: National Learning Network for Employers' was established in spring 2023. There are over 300 employers engaging with the network, which aims to bring together employers of all sizes and across all sectors to share learning and experiences of supporting mental health and wellbeing in the workplace.
Significant increases in direct Scottish Government mental health funding have helped support this progress, and it rightly remains a key focus for investment.
Challenges and opportunities
The evidence clearly shows some of the key challenges to achieving the outcomes we want, some of which are closely connected to each other. It also points to opportunities we can pursue. An accompanying robust evidence narrative and equality evidence report will set out in detail what the evidence tells us about mental health and wellbeing in Scotland. A very brief summary is included here to give an indication of content.
Global health, economic and political challenges
It is important to recognise the effect that global challenges can have on the mental health and wellbeing of the general population. For many people, global events may lead to increased levels of anxiety and distress. For those already experiencing mental health issues or those facing disadvantage, this risk is likely to be even greater.
Stigma and discrimination
The effects of stigma and discrimination on mental health and wellbeing are known to be damaging and significantly impact on people's lives. Where stigma and discrimination exist in society, the impact can be significant on people's ability to maintain confidence in safe and secure relationships, find and keep employment, and have trust in healthcare settings and services as well as other important areas of life.
Delivering mental health and wellbeing supports and services
There are many challenges to delivering sustainable mental health supports and services in Scotland, including specialist services such as CAMHS and psychological therapies. These challenges include a changing population with a greater prevalence of long-term conditions, a rise in people presenting with more complex mental health needs, and a significant increase in children and adults seeking a diagnosis and requiring support for neurodevelopmental needs.
Post-pandemic, we have the opportunity to work with partners in a range of settings to reassess how care is delivered. From our recent experience, we also have a greater understanding of the potential for digitally delivered mental health and wellbeing care to augment existing services and offer additional options for access to support. In addition, there is a programme of work on digital inclusion being undertaken with a particular focus on mental health and housing to better understand potential barriers to digital access and how these might be addressed. Whilst there is still a need for accessible non-digital formats of support, care and treatment – and there is still work to do to fully understand its impact and potential – this opens up possibilities and potential avenues to address some of this rise in demand.
Primary and community care
Mental health has been and always will be an essential part of General Practice, with mental health issues a common feature of consultations. It is estimated that one-third of GP consultations have a mental health component – approximately 8 million consultations a year – with the proportion higher in areas of high deprivation. While no published data confirm these figures, they are consistent with what the Royal College of General Practitioners hears from members, with many GPs reporting higher numbers of mental health-related consultations following the pandemic and the associated stresses, isolation and loneliness. Pressures on practices mean that some patients find it difficult to arrange appointments with their GP. Some people also struggle with phone consultations or may face a long wait for an appointment.
A key challenge is ensuring accessible, high-quality, comprehensive mental health and wellbeing services are available for all communities through GP practices. This also means ensuring communication needs are met, such as through the use of interpreters and digitally accessible information, and that people receive an improved experience and better outcomes.
We now have the chance to consider how to fully ensure access to mental health and wellbeing support, care and treatment into how we operate within our primary care settings. This will ensure services and clinical models are fit for purpose, with a continually improving response whenever anyone asks for help for their mental health. There is a need to ensure round-the-clock support is available for anyone experiencing or affected by a mental health crisis. This support, care and treatment should be available in a range of accessible formats, both digital and non-digital.
The mental health and wellbeing system remains under significant pressure. This is having an impact on the workforce's wellbeing and capacity to deliver support effectively and safely, as well as being able to attract, train and retain the workforce.
These pressures also impact the ability of the whole system to engage with long-term strategic planning for their workforce. Some of these challenges are specific to those working in particular roles, and will depend on individual circumstances. For example, we know that some challenges can be exacerbated in remote, rural and island areas.
Psychological trauma and adverse childhood experiences
At some point in our lives, many of us experience trauma or adverse childhood experiences which can impact on our mental health and wellbeing, as well as our access to universal life chances such as education, health, housing and employment. In recognition of this, Scottish Government and COSLA have a shared ambition for a trauma-informed and responsive workforce and services across Scotland. This involves services that recognise the prevalence of trauma and respond in ways that reduce the impact of trauma on accessing services and that support recovery.
The Promise tells us that children and young people who are care experienced are one and a half times more likely to suffer anxiety at age 16; and adults who are care experienced are one and a half times more likely to experience multiple disadvantage (homelessness, substances use, mental health or offending). In taking a preventative approach to mental health the importance of relationships, stability and a non-stigmatising engagement is key. The timely and consistent availability of support before crisis point and available for parents and carers at all stages of their parenting journey can aid nurtured caring relationships and help keep families together.
Social and economic benefits of investing in mental health
People with mental health problems can fall into a spiral of adversity where unemployment, income and relationships are affected by their mental health experiences, creating a poverty and poor mental health trap. There is a strong economic case for investing in early intervention and prevention, as the costs of poor mental health and wellbeing are clear. These include lost or unstable employment, reduced productivity, debt and money worries, poor physical health outcomes, and interactions with the criminal justice system.
Quality data and evidence around mental health in Scotland
While much routinely collected data and published research studies on mental health and wellbeing are available, there remain gaps in the knowledge. There is also a need for more data and evidence that captures specific experiences, perspectives and outcomes of equality groups. This is explored in more detail in the Equality Evidence Report accompanying this Strategy.
There are different systems for providing data used within and across health care, social care and the third sector. Although this results in variations in the availability and accessibility of data, robust methods to gather, analyse and share it should be encouraged. This is being explored in the context of Scotland's Data Strategy for Health and Social Care.
The lived experience of individuals and practitioners brings a rich and diverse type of evidence, and we want to ensure it is sought and appropriately gathered. This can contribute to significant improvements to policies and services, actively support collaboration with clinicians and researchers, and support shared learning of what works.
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