Publication - Impact assessment

Mental health and wellbeing delivery plan: equality impact assessment

Published: 6 March 2024
From: Director of Mental Health
Directorate: Mental Health Directorate
Part of: Health and social care
ISBN: 9781835219331

Equalities impact assessment that aims to consider how the Mental Health and Wellbeing Delivery Plan either positively or negatively affects people with different Protected Characteristics.

Supporting documents

Chapter 3: Strategic Equality Impact Assessment of Proposals and Actions in the Mental Health and Wellbeing Delivery Plan

The Delivery Plan sets out a range of actions seeking to address many of the issues raised in chapter 2. The actions are only discussed in summary here. We anticipate many of the actions will have a positive impact on the three duties of the PSED. However, this will often be dependent on future implementation of individual actions in this and future delivery plans, some of which are inherently high-level. It has therefore been necessary to adopt an iterative approach to this EQIA. More detailed EQIAs will be developed as each strategic action is progressed.

Continued engagement with stakeholders and those with lived experience will allow us to develop a deeper understanding of the intersection between protected characteristics and mental health inequalities. The Delivery Plan will be refreshed after 18 months with the opportunity to add or refine actions based on the ongoing EQIA process and future monitoring and evaluation.

This analysis is broken down by priorities within the Plan and their impact on protected characteristics.

Priority 1: Tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require.

Protected characteristic/ marginalised group

Age

Overview of impact

Actions focussed on tackling stigma and discrimination will have a positive impact on eliminating discrimination, advancing equality of opportunity and fostering good relations between protected characteristic groups, particularly for children and young people, working age and older people.

See Me's work on the Employer's Platform will help to address stigma and discrimination around mental health and wellbeing in the workplace by providing guidance on and signposting to mental health support and services available. This will have a positive impact on reducing stigma and improving awareness of support amongst working age adults.

Mind to Mind is a site aimed at continuing the national discussion around mental wellbeing. The site has a range of resources, including videos from people of different ages, including older individuals, talking about anxiety, grief and low mood. This content and messaging will have a positive impact on further breaking down the stigma, including self-stigma, around mental health across age groups. It also provides a safe space for all ages of people to access the information they need without fear of reprisal. This will reduce the barriers to accessing information and advice.

Specific action or mitigation

The next phase of development for the Mind to Mind site will increase the representation of lived experience content from people from minority ethnic communities, including content in other languages such as Urdu, Punjabi and Polish. This will not only seek to reduce stigma amongst these groups but have a specific benefit of engaging with minority ethnic groups who speak these languages. This should reduce barriers to accessing support due to a lack of accessible and inclusive communication.

Having alternative formats other than video has also accommodated for more minority ethnic people to contribute lived experience content to the site. It is anticipated these resources will help to open a culturally sensitive discussion within these communities and give people within them a place to find signposting to other culturally appropriate help where needed.

Specific action or mitigation

Monitor and evaluate actions to ensure support is reaching minority ethnic groups who are at greater risk of experiencing mental health stigma and discrimination.

Continue to prioritise representation from minority ethnic communities on Mind-to-Mind. This includes the development of both resources and signposting where needed.

Protected characteristic/ marginalised group

Religion or belief

Overview of impact

Stigma faced by some religious groups can act as a barrier to accessing mental health support. Several participants on the Mind to Mind site have spoken of how their faith comforts them and helps with their mental health and wellbeing. This representation may have a positive impact on reducing any stigma experienced by these groups.

Actions to improve our understanding of how mental health stigma is experienced and take forward actions to address it will include consideration of the experiences of religious groups. This will have a positive impact on advancing equality of opportunity.

Specific action or mitigation

Policies should be mindful of the barriers some religion and belief groups face, particularly in regard to mental health stigma, and take action to mitigate against these.

Protected characteristic/ marginalised group

Sex

Overview of impact

Specific action or mitigation

Policies should be mindful of the barriers some people living in remote, rural and island communities face, and take action to mitigate against these.

Priority 2: Improve population mental health and wellbeing, building resilience and enabling people to access the right information and advice in the right place for them and in a range of formats.

Protected characteristic/ marginalised group

Age

Overview of impact

Through a segmented approach which focusses on the different needs of different age groups within the population, we will provide options for individuals who would be excluded by a single generic approach to access support and information.

We anticipate that this will particularly benefit older people, who often experience a lack of targeted and inclusive information as a barrier to accessing support.

A significant proportion of the over 50s do not have access to the internet and thus encounter difficulty accessing information and services which are online only. Older people are also sometimes reluctant to engage with mental health services as they do not want to be labelled as experiencing cognitive decline. Therefore, we will tailor actions specifically to address these known issues, promoting equality of opportunity.

Older people, who we know disproportionately experience isolation and loneliness, will also be positively impacted by the work to champion peer support. This will also promote good relations between older people and different protected characteristic groups.

The work we will take forward to ensure that the information available to children, young people and parents will seek to address specific issues which disproportionately impact on children and young people at different stages within that age group.

Our approach will take focus on age groups within the children and young people population to address known disadvantages,

An example of this is issues relating to body image overlaid with the negative impact of social media. A study by the Mental Health Foundation (2019) found 40% of teenagers worried about their body image due to images on social media.

Actions under this priority will widen the options for support available, improving the choice and agency in support received for children and young people.

Specific action or mitigation

We aim to increase the number of resources aimed at older people on Mind to Mind during later phases of the site. However, we recognise and will consider non-digital alternatives to targeted information. We will continue to think about ways to share the messaging from Mind to Mind in non-digital formats, including on local radio, leaflets and outdoor venue posters etc.

We are developing a full EQIA for the Digital Mental Health Programme which will address in detail issues relating to access and appropriateness across age groups.

Scottish Government will undertake scoping work with Scottish Recovery Network and others to gather and share evidence on the benefits, impact, barriers and enablers of peer support/recovery for the whole population as well as for specific groups as identified in the Mental Health Equality Evidence Report, including older people.

We will work with partners to enhance mental health and wellbeing support in educational settings, through services such as school and student counselling and develop and refresh of high-level mental health and wellbeing resources, with the goal of having an inclusive and universal approach.

Protected characteristic/ marginalised group

Disability

Overview of impact

There will be positive impacts for some people with disabilities through a wider range of accessible options. This will eliminate discrimination which may arise due to lack of inclusive communication and improve equality of opportunity.

However, capturing these benefits with and on behalf of people with disabilities will require targeted work within the wider activities being taken forward. These will focus specifically on information targeted to the needs of the disabled population, inclusive communication, access to digital therapies in a range of settings and extending the range of appropriate support.

Pregnancy and maternity

Overview of impact

Pregnant woman and mothers, who we know disproportionately experience isolation and loneliness, will be positively impacted by action to champion peer support. This will also promote good relations between pregnant women and different protected characteristic groups.

Specific action or mitigation

Pregnant mothers and people in the perinatal period can be disproportionately impacted by mental health stigma. Due consideration should be given to this in the implementation of actions under this priority.

Scottish Government will undertake scoping work with Scottish Recovery Network and others to gather and share evidence on the benefits, impact, barriers and enablers of peer support/recovery for the whole population as well as for specific groups as identified in the Mental Health Equality Evidence Report, including pregnant women and mothers. Issues to be considered include:

Knowledge of peer support resources available
Accessibility of peer supports
Funding and capacity building
Knowledge and understanding of healthcare professionals
Supporting those providing peer support
Role of third sector organisations in delivering a wider range of appropriate mental health support options.

Protected characteristic/ marginalised group

Race

Overview of impact

There is evidence that people from minority ethnic groups are more negatively affected by lack of targeted information and inclusive communication. Actions under this priority will seek to address this, improving equality of opportunity.

The next phase of development for the Mind to Mind site will increase the representation of lived experience content from people from minority ethnic communities, including content in other languages such as Urdu, Punjabi and Polish. This should reduce barriers to accessing support due to a lack of accessible and inclusive communication.

Having alternative formats other than video has also provided options for more minority ethnic people to contribute lived experience content to the site. It is anticipated these resources will help to open a culturally sensitive discussion within these communities and give people within them a place to find signposting to other culturally appropriate help where needed.

Specific action or mitigation

Phase 2 of the development of Mind to Mind has identified minority ethnic communities as a priority group for further resources.

Although officials worked with minority ethnic-focused organisations during the development of Mind to Mind, stigma in some communities around mental health meant that some potential participants were not comfortable appearing on videos for the site, reducing the numbers of videos from people from minority ethnic backgrounds.

To mitigate this and following feedback from members of the public and stakeholders, we have widened the resources to include audio files and blogs and are considering how best to further support individuals within different communities.

Minority ethnic people can be disproportionately impacted by poverty and low income, experiences of minority stress discrimination and trauma (including racialised trauma) and stigma in accessing mental health support. Minority ethnic people would also benefit from the workforce having a better understanding of their needs, including the need for culturally sensitive support and services. Due consideration should be given to this in the implementation of actions under this priority.

Protected characteristic/ marginalised group

Religion or belief

Overview of impact

We do not anticipate any negative impacts for this group.

Specific action or mitigation

Some people contributing to the development of Mind to Mind have mentioned how important their faith is to their mental health and wellbeing and this will be reflected in their lived experience stories and content on the site.

People with certain religions and beliefs can be disproportionately impacted by experiences of minority stress discrimination and trauma (including islamophobia and antisemitism). Some minority religious groups would also benefit from the workforce having a better understanding and sensitivity to their needs for culturally sensitive support. Due consideration should be given to this in the implementation of actions under this priority.

Protected characteristic/ marginalised group

Sex

Overview of impact

Across age bands women tend to experience poorer mental health than men due to a range of social and physiological factors.

Concerns around body image have a disproportionate impact on the mental health of young women and girls. The Health and Wellbeing Census 2023 reported: "30% of girls and 55% of boys agree to the statement I am happy with my body and the way I look" and "Girls were more likely to have problematic social media use than boys" (Inchley et al., 2023).

Evidence also highlights women, particularly older women and women with young children, can also disproportionately experience loneliness and isolation. These groups will be positively impacted by the work to champion peer support. This will also promote good relations between women and different protected characteristic groups.

Among men from different age ranges and backgrounds discussions around emotions can still be regarded as taboo. This can increase self-stigma, act as a barrier for help seeking behaviour and increase mental health issues. Actions to target information will seek to address these issues.

Actions under this priority will widen the options for support available, improving the choice and agency in support received.

Specific action or mitigation

In future phases of Mind to Mind we will look to target lived experience of specific issues for women, on menopause and body image.

Guided by evidence on body image we will take a gendered approach (e.g. focus on toxic masculinity, culture ideals). This involves discussing these barriers with young people and other stakeholders, for example when working with Scottish Youth Parliament and the Scottish Children's Parliament to develop new content for the resources.

We will undertake scoping work with Scottish Recovery Network and others to gather and share evidence on the benefits, impact, barriers and enablers of peer support/recovery for the whole population as well as for specific groups as identified in the Mental Health Equality Evidence Report, including older women and women with young children.

Men are currently under-represented on the Mind to Mind site. Phase 2 of the development has identified men as a priority group for the gathering of resources. Officials have been working with mental health charities to create resources specific to men on the site, including self-stigma and social isolation and loneliness. These videos will then signpost users to the organisations in question. This will help support and guide men to appropriate existing resources and organisations who can help them with their mental wellbeing.

The marketing and partnership activity for Mind to Mind in 2023-24 will also target messaging for men, including in outdoor and sporting venues as well as working with local barber shops. Mind to Mind will also signpost to The Changing Room: Extra Time programme.

Women and girls can be disproportionately impacted by poverty and low income, and experiences of trauma (including gender based violence). Women and girls would also benefit from the workforce having a better understanding of their needs, including the need for trauma informed mental health services and understanding of the physical health issues such as menopause. Due consideration should be given to this in the implementation of actions under this priority.

Protected characteristic/ marginalised group

Marriage & Civil Partnership

Overview of impact

We do not anticipate any negative impacts for this group.

Protected characteristic/ marginalised group

Poverty and low income

Overview of impact

Access to digital therapies is an issue among those people experiencing poverty and low income. At the same time increasing the choices and range of digital therapies and support available that do not require physical travel is of benefit to those on low incomes.

Specific action or mitigation

The Connecting Scotland programme is designed to improve digital inclusion among people from low income backgrounds and we will seek to capitalise on this.

Additionally we are working to identify the best model of digital inclusion: how existing services can work with their clients to provide a device, connectivity and digital training to improve their mental health and overall wellbeing.

Whilst there is representation from those living in low income or poverty already on the Mind to Mind website, this is generic mental wellbeing advice and not specific to the challenges people from this category may face. Phase 2 of has identified those living in low income/poverty as a priority group for the gathering of resources to address these challenges.

In terms of the cost of access, although Mind to Mind is a digital resource, it is hosted on NHS inform, which is a whitelisted site. This means that it does not use up data allowances when visiting the site.

Protected characteristic/ marginalised group

Geographical location

Overview of impact

While digital therapies will have a positive impact in terms of reducing travel requirements, access to digital therapies and wider resources depends on reliable connectivity.

Specific action or mitigation

Scottish Government is working to improve wifi/mifi/broadband provision in rural areas. We will seek to align the development of digital therapies and resources with that work.

We will continue to think about ways to share the messaging from Mind to Mind in non-digital formats, including on local radio, leaflets and outdoor venue posters etc.

Priority 3: Increase mental health capacity within General Practice and primary care, universal services and community-based mental health supports. Promote the whole system, whole person approach by helping partners to work together and removing barriers faced by people from marginalised groups when accessing services.

Protected characteristic/ marginalised group

Age

Overview of impact

Actions under this priority have a particular focus on removing barriers faced by marginalised groups when accessing services. This will have a positive impact on eliminating discrimination and advancing equality of opportunity across the range of protected characteristic groups, including age.

Mental health concerns are more common amongst adolescents than in younger children and people aged between 16 - 24 are particularly vulnerable to mental health concerns.

Action to improve community mental health and wellbeing supports and services has a particular focus on children young people and their families.

The Communities Mental Health and Wellbeing Fund for adults is aimed at supporting those aged 16 and above. The Fund in its support of adults also benefits families, for example, parent support groups.

Specific action or mitigation

The children and young people's Community Mental Health and Wellbeing Supports and Services Framework is specifically targeted at those aged 5-24 (26 if care-experienced) and their family members. Local authorities are free to implement the services that they consider will best meet locally identified need.

Around a quarter of year 2 Communities Mental Health and Wellbeing Fund for adults projects supported the 6 priority family types identified in the Best Start, Bright Futures child poverty plan such as lone parent families, families with a disabled family member and ethnic minority families.

Older people (aged 50 or above) are a key at-risk group identified as a target group for the Communities Mental Health and Wellbeing Fund for adults and they are amongst the most common beneficiaries. This is leading to better access to community support, with a range of projects ensuring accessibility, for example, providing transport or accessible venues.

The Year 2 Monitoring and Reporting summary provides a full breakdown of beneficiaries of the fund.

Protected characteristic/ marginalised group

Disability

Overview of impact

Actions under this priority may have a positive impact on advancing equality of opportunity for some children and young people with disabilities through the provision of community based targeted support.

People with a long term health condition or disability are a key at-risk priority group for the Communities Mental Health and Wellbeing Fund for adults are amongst the most common beneficiaries. The Year 2 Monitoring and Reporting summary provides a full breakdown of beneficiaries of the fund.

Specific action or mitigation

Under the children and young people's Community Mental Health and Wellbeing Supports and Services Framework, Local authorities are free to implement the services that they consider will best meet locally identified need. This means that targeted support can be provided for disabled children and young people. We will continue to work with local authorities to encourage targeted provision for vulnerable groups and those with protected characteristics.

Work is underway to monitor the reach of Year 3 Communities Mental Health and Wellbeing Fund for adults to priority groups. We will ensure accessibility of supports to the less well represented groups.

Protected characteristic/ marginalised group

Sexual orientation

Overview of impact

Actions under this priority may have a positive impact on advancing equality of opportunity for some LGBTI+ children and young people through the provision of community based targeted support.

LGBTI+ people are a key at-risk priority group for the Communities Mental Health and Wellbeing Fund for adults. The Year 2 Monitoring and Reporting summary provides a full breakdown of LGBTI+ beneficiaries of the fund.

Specific action or mitigation

Under the children and young people's Community Mental Health and Wellbeing Supports and Services Framework, Local authorities are free to implement the services that they consider will best meet locally identified need. This means that targeted support can be provided for LGBTI+ children and young people. We will continue to work with local authorities to encourage targeted provision for vulnerable groups and those with protected characteristics.

Protected characteristic/ marginalised group

Gender reassignment

Overview of impact

The above discussion (see sexual orientation) relates to LGBTI+ communities, including those with the protected characteristic of gender reassignment.

Specific action or mitigation

The above discussion (see sexual orientation) relates to LGBTI+ communities, including those with the protected characteristic of gender reassignment.

Protected characteristic/ marginalised group

Pregnancy and maternity

Overview of impact

The Communities Mental Health and Wellbeing Fund for adults should have a positive impact on advancing equality of opportunity for women who are identified as a key at-risk priority group for the Fund. While perinatal maternal health is not specified as a priority for the Fund, some projects have been funded that support this group.

The Year 2 Monitoring and Reporting summary provides a full breakdown of beneficiaries of the fund.

Specific action or mitigation

Protected characteristic/ marginalised group

Race

Overview of impact

Actions under this priority may have a positive impact on advancing equality of opportunity for some minority ethnic children and young people through the provision of community based targeted support.

Minority ethnic people and refugees and those with no recourse to public funds are key at-risk priority groups for the Communities Mental Health and Wellbeing Fund for adults. The Year 2 Monitoring and Reporting summary provides a full breakdown of minority ethnic community beneficiaries of the fund.

The external evaluation of the Communities Mental Health and Wellbeing Fund for Adults concludes that the Fund is providing a good range of supports across the wide range of target groups, including minority ethnic groups. Many projects have helped to make supports more accessible for this group through for example translation options.

Specific action or mitigation

Under the children and young people's Community Mental Health and Wellbeing Supports and Services Framework, Local authorities are free to implement the services that they consider will best meet locally identified need. This means that targeted support can be provided for minority ethnic children and young people. We will continue to work with local authorities to encourage targeted provision for vulnerable groups and those with protected characteristics.

The external evaluation of the Communities Mental Health and Wellbeing Fund for Adults highlighted that some groups are more commonly supported than others (i.e. projects supporting older people are more common than projects supporting ethnic minorities). Work is underway to monitor the reach of Year 3 Communities Mental Health and Wellbeing Fund for adults to priority groups. We will ensure accessibility of supports to the less well represented groups with a particular consideration to Refugees and those with no recourse to public funds.

Protected characteristic/ marginalised group

Religion or belief

We do not anticipate any negative impacts for this group.

Protected characteristic/ marginalised group

Sex

Overview of impact

Actions under this priority may have a positive impact on advancing equality of opportunity for women and girls through the provision of community based targeted support.

Women, particularly women who have experienced gender based violence, are a key at-risk priority group for the Communities Mental Health and Wellbeing Fund for adults.

Whilst men are not identified as a target group, the Fund does fund a range of male focused projects such as suicide prevention work.

The Year 2 Monitoring and Reporting summary provides a full breakdown of beneficiaries of the fund.

The external evaluation of the Communities Mental Health and Wellbeing Fund for Adults concludes that the Fund is providing a good range of supports across the wide range of target groups.

Specific action or mitigation

Work is underway to monitor the reach of Year 3 Communities Mental Health and Wellbeing Funding to priority groups. We will ensure accessibility of supports to the less well represented groups.

Protected characteristic/ marginalised group

Marriage & Civil Partnership

Overview of impact

We do not anticipate any negative impacts for this group.

Protected characteristic/ marginalised group

Poverty and low income

Overview of impact

We know that living in poverty can have adverse effects on mental health and wellbeing.

Actions under this priority may have a positive impact on advancing equality of opportunity for some families living in poverty through the provision of targeted support.

Those facing socio-economic disadvantage are a key at-risk priority group for the Communities Mental Health and Wellbeing Fund for adults. They are also one of the key beneficiaries, with around half of projects in Year 2 supporting this group.

The Year 2 Monitoring and Reporting summary provides a full breakdown of beneficiaries of the fund.

Specific action or mitigation

Under the children and young people's Community Mental Health and Wellbeing Supports and Services Framework, Local authorities are free to implement the services that they consider will best meet locally identified need. This means that targeted support can be provided for those living in poverty and low income. We will continue to work with local authorities to encourage targeted provision for vulnerable groups and those with protected characteristics.

Protected characteristic/ marginalised group

Geographical location

Overview of impact

People living in remote and rural areas can often experience less consistent and available support and services due to geographical inequalities. Actions under this priority will have a positive impact on people in island and rural areas ensuring they receive more choice and agency in the support and services available closer to home.

Under the children and young people's Community Mental Health and Wellbeing Supports and Services Framework local authorities are able to use the funding to commission supports and services on the basis of local priorities. This should mean geographical inequalities are better understood and targeted.

Those disadvantaged by geographical location (particularly remote and rural areas) are a key at risk priority target group for the Communities Mental Health and Wellbeing Fund for adults. Evaluation shows the Fund is reaching this group and sharing of good practice around improving accessibility of supports is ongoing via the Fund's National Network and the National event planned for March 2024.

The Year 2 Monitoring and Reporting summary provides a full breakdown of beneficiaries of the fund.

Action to address the geographical inequalities and unique challenges faced by those living in remote, rural and island communities will have a particular benefit.

Specific action or mitigation

Acknowledging the unique challenges to accessing support and services experienced by those living in remote, rural and island communities, we will work with the Scottish Rural Mental Health Forum in 2023/24 to gather and share evidence, to provide strategic insight into the barriers faced by rural and island communities and build their resilience.

Future initiatives should recognise difference in local demographics and support flexibility to meet local need.

People living in remote and rural areas can be impacted by loneliness and isolation. Due consideration should be given to this in the implementation of actions under this priority.

Priority 4: Expand and improve the support available to people in mental health distress and crisis, and those who care for them, through our national approach on Time, Space, Compassion.

Protected characteristic/ marginalised group

Age

Overview of impact

Actions under this priority will have a positive impact on advancing equality of opportunity and promoting good relations among and between different groups for people of various ages.

The aim of Creating Hope Together, the Suicide Prevention Strategy is to reduce the number of suicide deaths in Scotland whilst tackling the inequalities that contribute to suicide. This will have a positive impact on advancing equality of opportunity for all ages. Whilst it does not directly address unlawful discrimination, the Strategy seeks to highlight the risk and protective factors around suicide which can occur at any age. It sets out actions to specifically support children and young people, and older people, recognising their needs – and the responses required – may be different from the others in the adult population.

The Suicide Prevention Strategy aims to build equality of response and access to support, across groups who may be affected by suicide. There may be an indirect effect through work on reducing stigma around suicide that will promote good relations between those of different protected characteristic groups. A full EQIA for the Suicide Prevention Strategy is published here: Creating Hope Together: Scotland's Suicide Prevention Strategy 2022–2032: Equality Impact Assessment Record (www.gov.scot)
While self-harm can affect anyone at any age, children and young people are particularly affected and they will be one of the groups to receive particular focus within our work to publish a Self-Harm Strategy.

The Distress Brief Intervention (DBI) programme will have a positive impact on advancing equality of opportunity for all ages particularly for young people as the age at which people can be referred to core DBI has been lowered to 16 as standard.

We will provide funding during financial year 2023-24 to develop and enhance trauma-informed support for all children, young people and their families experiencing distress and crisis. In line with The Promise, this will include an increased focus on support for those with experience of care or on the edges of care. New or enhanced support would be available across all areas of Scotland and address an identified gap in service provision for distress and crisis support for under 16s. An increased focus on support that meets the needs of care experienced children and young people will ensure that services are able to respond to the specific needs of this group.

The Mental Health Unscheduled Care (MHUC) pathway has been introduced across Scotland to provide access to urgent or unscheduled mental health and/or distress care and support to anyone who may require it. The pathway design is tailored to specifically meet the needs of children and young people and older people.

Specific action or mitigation

We will continue to gather and use relevant data relating to age to help target activity to promote suicide prevention. Through the multi-agency reviews work we will build our understanding of a range of factors including age and support required for higher risk groups e.g. middle-aged men and older women. We intend to also gather data for suicide attempts.

We will help to ensure that relevant staff such as pastoral / guidance staff, school nurses and counsellors in education settings are skilled and responsive to signs of suicidal concerns, whilst ensuring proactive approaches to supporting children and young people at key transitional stages, as part of a continuum of care.

We plan to engage further with equalities groups to better understand and address issues identified.

A targeted test of change for the Distress Brief Intervention Programme is underway for 14/15-year-olds.

We know that the Children and Young People's MHUC pathway is not always as streamlined as that for adults. Children and Young People may be admitted when presenting out of hours because of no alternative. Actions are being progressed to improve access to unplanned care for children and young people in the out of hours period. Work has commenced on how to access urgent mental health care and support in the in hours and out of hours period, including tailored information for children, young people and their parents/guardians.

We are aware that certain groups, such as adolescents and older adults, are at risk of having their mental health concerns dismissed or attributed to another (existing) condition, such as a learning disability or old age. MHUC will seek to address this diagnostic overshadowing by working with our stakeholders on developing mitigations to prevent these at-risk groups from having their urgent mental health concerns overlooked.

Through monthly MHUC Network meetings, we will continue to identify opportunities and challenges with our stakeholders regarding the provision and delivery of unscheduled mental health support. In-depth discussions on the local pathways will be held on an annual basis, allowing for the exploration of key issues. Work is being progressed to begin collecting protected characteristic demographic data for unscheduled care to ensure that this programme of work is underpinned by robust data, providing insight into service users access and outcomes.

Protected characteristic/ marginalised group

Disability

Overview of impact

Actions under this priority will have a positive impact on eliminating unlawful discrimination, advancing equality of opportunity and promoting good relations among and between different groups for people with disabilities.

Suicidal ideation is typically higher among people with disabilities; therefore, we envisage they will benefit from the Suicide Prevention Strategy which aims to reduce the number of suicide deaths in Scotland whilst tackling the inequalities that contribute to it. Whilst it does not directly address unlawful discrimination, the Strategy seeks to raise awareness that disabled people may be at higher risk of suicide and sets out principles that will be taken to support someone with a disability.

We know that for both boys and girls there are moderate and statistically significant associations between disability status and self-harm, with the prevalence of self-harm being more than 50% higher among adolescents with a disability when compared to their nondisabled peers. Action to publish Scotland's first dedicated Self-Harm Strategy and Action Plan will have a positive impact on disabled people. Recognising prevalence amongst this group, it will commit to an inclusive set of actions, taking a tailored approach to reaching and deepening understanding of self-harm in diverse communities and settings.

Action to achieve full coverage of the Distress Brief Intervention programme will have a positive impact on advancing equality of opportunity. In addition to support with distress, DBI can also signpost to other resources to help meet people's needs this can ensure that people have the appropriate supports in place which may be particularly beneficial to people with disabilities.

The MHUC pathway has been introduced across Scotland to provide access to urgent or unscheduled mental health and/or distress care and support to anyone who may require it.

More accessible and free support may also help overcome some of the barriers to support posed by poverty and deprivation.

Specific action or mitigation

Specific action or mitigation

We will work with Perinatal and Early Years Mental Health policy – including the new strategic board for children and families' mental health - to develop approaches and mental health support to ensure suicide prevention is considered during the perinatal period.

We plan to engage further with equalities groups to better understand and address issues identified.

Protected characteristic/ marginalised group

Race

Overview of impact

Actions under this priority will have a positive impact on eliminating unlawful discrimination, advancing equality of opportunity and promoting good relations among and between different groups for minority ethnic people.

Racism and racial discrimination can have a significant negative impact on a person's mental health. It can trigger the onset of poor mental health, difficulty processing traumatic events and suicidal ideation and attempts. We envisage minority ethnic people will benefit from the Suicide Prevention Strategy which aims to reduce the number of suicide deaths in Scotland whilst tackling the inequalities that contribute to it. Whilst it does not directly address unlawful discrimination because of race, we will work with trusted organisations to build knowledge and implement changes which will aim to have a positive impact. There may also be an indirect effect through work on reducing stigma around suicide that will promote good relations between different groups.

Action to publish Scotland's first dedicated Self-Harm Strategy and Action Plan may have a positive impact on minority ethnic people as it will commit to an inclusive set of actions, taking a tailored approach to reaching and deepening understanding of self-harm in diverse communities and settings.

Actions to build our understanding of the barriers faced by those with No Recourse to Public Funds will include testing increased peer support, in partnership with third sector partners, using a new community-based peer model. Developing culturally competent trauma informed peer support will allow more effective support as it takes account of the needs of the target group that traditional models often don't account for, including difference in culture. Earlier funding allowed the Simon Community to work on developing a model of peer support for destitute asylum seekers. Working in this way may also alleviate some barriers to accessing support, as some people who have the exhausted asylum process can fear interactions with services due to consequences such as removal. This policy should result in improved support for the NRPF group via the mechanism of peer support.

The MHUC pathways has been introduced across Scotland to provide access to urgent or unscheduled mental health and/or distress care and support to anyone who may require it. The pathway design is tailored to specifically meet the needs of children and young people and older people. In addition to this, there may be certain population groups whose pathway to seeking unscheduled mental health care and support may contain more barriers and challenges compared to others, such as those with no or little knowledge of the English language.

Specific action or mitigation

We will work with relevant groups and people with lived experience to build our understanding of the prevalence, barriers and effective interventions for different communities, including minority ethnic people. We plan to engage further with equalities groups to better understand and address issues identified.

We know lack of accessible information acts as a barrier to minority ethnic groups accessing information and support. Therefore, we will provide reliable and easily digestible information in different formats about suicide and suicide prevention to communities, including to community-based organisations and locations, such as sports and youth organisations, libraries, welfare agencies and community centres. This includes providing accessible information for everyone, including people who do not have English as their first language.

We will draw on learning from the model of peer support to improve future service provision by 2025 as we take forward Action 7 of the Ending Destitution Together (EDT) strategy.

Further development of the community peer support available to people with NRPF will provide a culturally competent environment and lead to improved support and signposting to available information in an accessible way.

We are working with equality organisations and the DBI Central Team to support DBI practitioners to build their confidence in collecting equality data for people referred to the programme. Over time this will improve the robustness of the data.

NHS 24 and Health Boards have access to interpreting services.

In terms of communication difficulties when seeking help or during the assessment process, work has commenced on how to access urgent mental health care and support, with long-term plans of producing tailored messaging for different equalities groups recognising their specific challenges Work is being progressed to begin collecting equalities demographic data for unscheduled care.

The evidence and consultation stages of our EQIA will ensure that we develop the MHUC pathway to reduce as many of these barriers and challenges as possible. This action will contribute to improving the following issues in relation to MHUC:

Experiences of minority stress, discrimination and trauma, and training for support of equalities groups: we are aware that some minority ethnic groups' experiences of living in hostile and/or stressful environments have distinct impacts on their mental health. While this action does not tackle or address this social determinant, we will work with our stakeholders on the MHUC Network and colleagues within Scottish Government to ensure that emergency services and Health Boards provide regular training in relation to cultural competency and sensitivity.

Lack of targeted/inclusive information: we are aware that some minority ethnic groups, including immigrants and refugees/asylum seekers are unaware of the available services or how to access them, causing a barrier to accessing urgent mental health support. We will develop tailored and targeted messaging to address the inequities that some equalities group may experience with accessing services. This tailored and targeted messaging will take into consideration the content and format requirements that some equalities group might need.

Choice and agency in support received: we know that a lack of agency or choice in what services are made available or how support is provided may impact some minority ethnic group's experiences of using services. We will explore with stakeholders on the MHUC Network whether there are measures or resources that can be introduced to mitigate this.

Protected characteristic/ marginalised group

We will undertake tests of change to understand more about the needs of groups with heightened risk of suicide, which is likely to include working with trusted intermediaries. This work is still to be fully scoped, however there is potential learning to allow for focussed suicide prevention approaches to support people from island communities; which complements existing work taking place in West Highlands and Skye.

We are aware that many resources can be central based leaving island and rural communities excluded. One of our geographic pilots is based in the Highlands and Islands to inform our work.

We will continue ongoing engagement with rural and island Boards to understand their specific challenges and barriers to implementing and developing the MHUC pathway locally, including resourcing shortages, challenges around transporting people off-island, and providing care closer to home where people may have difficulties accessing the assessment location. Work is being progressed to begin collecting data for unscheduled care which will provide further insight into inequalities experienced by the island population.

Priority 5: Work across Scottish and Local Government and with partners to develop a collective approach to understanding and shared responsibility for promoting good mental health and addressing the causes of mental health inequalities, supporting groups who are particularly at risk.

Protected characteristic/ marginalised group

Age

Overview of impact

Actions focus on the social determinants that impact on people's mental health and wellbeing at population level. However, we anticipate some of groups will be impacted indirectly.

Therefore, we anticipate actions to address the social determinants of mental health may have a positive impact on eliminating discrimination, advancing equality of opportunity, and promoting good relations between protected characteristic groups, across the range of protected characteristics as they seek to tackle the underlying causes of poor mental health.

This will depend on how the actions are scoped and implemented.

Actions will benefit children and younger people as it seeks to complement work being taken forward across the Scottish Government, including tackling child poverty.

Specific action or mitigation

We will take forward a range of priority actions on mental health and wellbeing to support the Best Start, Bright Futures Tackling Child Poverty Delivery Plan; the Promise; Whole Family Wellbeing Funding and national approaches to Fair Work, as well as actively ensuring that there is a focus on these in our wider mental health and wellbeing policies. These will benefit children and young people, particularly those facing greatest socio-economic disadvantage.

The focus of this work is to identify and implement a range of measures to address the social determinants causing mental health inequalities. Consideration should be given to the issue of loneliness and isolation disproportionately experienced amongst older people.

Protected characteristic/ marginalised group

Disability

Overview of impact

There is a potential for positive impact on people with disabilities. This will depend on how the actions are implemented.

Specific action or mitigation

The focus of this work is to identify and implement a range of measures to address the social determinants causing mental health inequalities. Consideration should be given to people with disabilities, particularly on the issues of poverty and deprivation and experiences of minority stress, discrimination and trauma, including hate crime, which people with disabilities disproportionately experience.

Protected characteristic/ marginalised group

Sexual orientation

Overview of impact

There is a potential for positive impact on LGBTI+ people. This will depend on how the actions are implemented.

Implementation of the Veterans Mental Health and Wellbeing Action Plan may positively impact veterans services making them more LGBTI+ inclusive.

Specific action or mitigation

A high proportion of veterans in Scotland live in Scotland's most deprived areas. Action to implement the Veterans Mental Health and Wellbeing Action Plan will support those veterans living in poverty and low income. Better signposting to mental health and other services (such as help with employability or housing) for veterans will contribute to better mental health outcomes for veterans living in low income/poverty.

All Boards are to provide trajectories for meeting the standard on waiting times in their Annual Delivery Plans.

CAMHS and Psychological Therapy waiting times (which have a separate over 65 category) will be monitored through monthly management information.

Boards which are not on trajectory, or continue to have poor performance for these age groups, will receive tailored improvement support and meetings with local senior management teams will be set up.

If unequal access, treatment or experience of services is identified within data analysis based on age following improvements in collection, this will be picked up in our engagement with Boards.

We will pilot and implement the core mental health standards, including a standard that supports transitions between children's and adult services.

Protected characteristic/ marginalised group

Disability

Overview of impact

Actions under this priority will have a positive impact on eliminating unlawful discrimination and advancing equality of opportunity for people with disabilities and on promoting good relations between different protected characteristic groups.

Actions on waiting times will aim to improve timely access across all groups including those living with disabilities.

The core mental health standards developed outline expectations of a rights based approach to care and highlight the importance of choice and agency in accessing services. Meeting these standards will bring particular benefit to people with disabilities who can often lack agency or choice in what services are available and how support is provided. Disabled people will also benefit from core standard 4.4. which aims to ensure all staff have completed equalities and diversity awareness training.

If individuals have difficulty understanding or consenting to treatment offered (e.g. associated with having learning difficulties or dementia), they can get support from a carer or professional. Services will also consider peer support workers as roles that can aid recovery for others, and those with lived experience should be considered as valuable members of the community who can help shape services and systems.

Any treatment plans or recommendations about psychological practice offered will be provided in a format that people can understand. Where possible, this will be developed jointly with professionals, to help individuals understand their needs.

Disabled people may also face barriers in accessing services, particularly in rural areas. There is a need for better data, so that we can see where there is variability in access and work with Boards to improve. Action to include limiting long-term conditions as an intersectional variable in forthcoming patient experience surveys will help towards this.

Action to deliver a Scottish Benchmarking Network will also provide benefit to people with disabilities as it will allow comparisons between the main service portfolios of specialist providers of care for people with a learning disability and autistic people and quantify the nature and shape of services provided. This will help identify any unequal service provision or experience for those with a Learning Difficulty and use this to inform future policy and decision making.

Specific action or mitigation

We will pilot and implement the core mental health standards. This will include standards that support choice in the care people receive and promote staff diversity training.

If unequal access, treatment or experience of services is identified for disabled people in forthcoming patient experience surveys this will be picked up in our engagement with Boards.

Protected characteristic/ marginalised group

Sexual orientation

Overview of impact

Actions under this priority will have a positive impact on eliminating unlawful discrimination and advancing equality of opportunity for people who identify as LGB+ and on promoting good relations between groups with different protected characteristic.

Actions on waiting times will aim to improve timely access across all groups including LGB+ people whose mental wellbeing scores are lower on average than that of the heterosexual population.

LGB+ people will also benefit from specific core standards on providing care in an environment free from stigma and giving consideration to people's experiences, personal circumstances and requirements. Core standard 4.4 also aims to ensure all staff have completed equalities and diversity awareness training.

LGB+ people can experience a higher prevalence of eating disorders. Through the implementation of the National Specification for the Care and Treatment of Eating Disorders in Scotland which will ensure that characteristics such as sexual orientation are not a barrier to accessing support for an eating disorder.

LGB+ people may also face barriers in accessing services, particularly in rural areas. Action to report on sexual orientation as an intersectional variable in patient experience surveys will help to identify and work with Boards to eliminate any differences in access, treatment and experience.

Specific action or mitigation

We will pilot and implement the core mental health standards. Including standards supporting stigma free care, patient choice and staff diversity training.

If unequal access, treatment or experience of services is identified for LGB+ people in patient experience surveys this will be picked up in our engagement with Boards.

Protected characteristic/ marginalised group

Gender reassignment

Overview of impact

The above discussion (see sexual orientation) also relates in part to people with the protected characteristic of gender reassignment.

Whilst the CAMHS and Psychological Therapies waiting times do not include specialist gender reassignment services, all eligible for CAMHS/Psychological Therapies treatment will benefit from shorter waiting times.

Specific action or mitigation

Island and rural Boards to provide trajectories for meeting the standard in their Annual Delivery Plans. CAMHS and PT waiting times will be monitored through monthly management information. Boards which are not on trajectory, or continue to have poor performance for these age groups, will receive tailored improvement support and meetings with local senior management teams will be set up.

We also have a specific programme of engagement with island and rural Boards to understand the unique issues that they face and to work with them to resolve.

We will pilot and implement the core mental health standards. This will include standards that support care being delivered close to home and transitions.

We will provide geography as an intersectional variable for service access and patient experience data, which will enable identification of any unequal access, treatment or experience in robust analysis.

Priority 7: Ensure people receive the quality of care and treatment required for the time required, supporting care as close to home as possible and promoting independence and recovery.

Protected characteristic/ marginalised group

Age

Overview of impact

It is anticipated this work will indirectly have significant benefits in the long term as improvements to the planning landscape are made.

We have an increasing population of older people with complex health and social care needs in prison. Therefore we anticipate action to improve access to appropriate mental health support in prison will have a positive impact on advancing equality of opportunity for older people.

Whilst not targeting specific groups, action to ensure support for those with co-occurring mental health and substance use conditions receive improved care across Scotland will benefit those who have higher rates of substance use and mental health conditions. As young people have higher rates of substance use and 75% of mental health conditions are established by age 25, we anticipate this action will have a positive impact on advancing equality of opportunity for young people, ensuring they get the support they need.

Action on establishing standards (quality statements) for and improving the built environment of in patient mental health settings will be beneficial to older people by ensuring buildings are accessible to patients (e.g. accommodating those with mobility difficulties), are set up to promote improved communication (e.g. by promoting an environment that facilitates communication between patients and staff), and also ensure patient privacy and dignity.

Specific action or mitigation

Trauma, equalities and risk-informed approaches to improving services will be essential to identifying and supporting groups who face specific challenges. To maximise the positive impact we have included a specific action around mainstreaming equality into planning to make it explicit that the mechanisms we develop will need to be able to work with, gather and use equalities data as part of parcel of good planning functions. However, the benefit is unlikely to be realised in the first 18 months.

Reference to equality should be built into the terms of the National Strategic Oversight group. Specific EQIAs for these actions should be kept live and under review.

Continue to monitor and target action to ensure that all people in prisons can access mental health care and treatment.

Protected characteristic/ marginalised group

Disability

Overview of impact

Actions under this priority will have both neutral and positive impacts on eliminating unlawful discrimination, advancing equality of opportunity and promoting good relations among and between different groups for people with disabilities.

Actions focussed on improving the governance, planning and delivery of mental health services are anticipated to have a long term positive impact on promoting equality of opportunity for protected characteristic groups, including people with disabilities.

Action to improve access to appropriate mental health support in prison targets the whole prison population, a population who have often already experienced multiple health and social inequalities. We anticipate work will have a positive impact on promoting equality of access to support across a range of protected characteristic groups, including disabled people.

Whilst not targeting specific groups, action to ensure support for those with co-occurring mental health and substance use conditions receive improved care across Scotland will benefit those who have higher rates of substance use and mental health conditions. Therefore actions should have a positive impact on advancing equality of opportunity for those with a mental health condition which falls under the protected characteristic of disability in the Equality Act 2010.

Action on establishing standards (quality statements) for and improving the built environment of in patient mental health settings will be beneficial to people with disabilities by ensuring buildings are accessible to patients (e.g. accommodating those with mobility difficulties), are set up to promote improved communication (e.g. by promoting an environment that facilitates communication between patients and staff), and also ensure patient privacy and dignity.

Specific action or mitigation

Protected characteristic/ marginalised group

Sexual orientation

Overview of impact

Actions under this priority will have both neutral and positive impacts on eliminating unlawful discrimination, advancing equality of opportunity and promoting good relations among and between different groups for LGBTI+ people.

Actions focussed on improving the governance, planning and delivery of mental health services are anticipated to have a long term positive impact on promoting equality of opportunity for protected characteristic groups, including LGBTI+ people.

Action to improve access to appropriate mental health support in prison targets the whole prison population, a population who have often already experienced multiple health and social inequalities. We anticipate work will have a positive impact on promoting equality of access to support across a range of protected characteristic groups, including LGBTI+ people.

Whilst not targeting specific groups, action to ensure support for those with co-occurring mental health and substance use conditions receive improved care across Scotland will benefit those who have higher rates of substance use and mental health conditions. Rates of substance use are higher amongst people who are lesbian, gay, bisexual and transgender. Rates of mental health conditions are also high within this group. This group is therefore likely to proportionally have higher rates of mental health and substance use diagnosis. We anticipate action will have a positive impact on advancing equality of opportunity for LGBTI+ people, ensuring they get the support they need.

Specific action or mitigation

Gender reassignment The above discussion (see sexual orientation) also relates to LGBTI+ communities, including those with the protected characteristic of gender reassignment.
The above discussion (see sexual orientation) also relates to LGBTI+ communities, including those with the protected characteristic of gender reassignment.

Protected characteristic/ marginalised group

Pregnancy and maternity

Protected characteristic/ marginalised group

Age

Overview of impact

The Independent Review of Forensic Mental Health Services highlighted a lack of low secure inpatient care can result in young people being placed in adult Intensive Psychiatric Care Units (IPCUs). Young people requiring medium secure care, including those with a learning disability, are currently placed in specialist provision in England which inevitably takes them away from their support networks. The implementation of the Review's relevant recommendations as part of this delivery plan alongside the establishment of the National Secure Adolescent Inpatient Service will seek to rectify this, eliminating discrimination and advancing equality of opportunity for children and young people.

The forensic population is ageing and there is an increase in older adults entering the system for the first time as a result of historic offences. The Scottish Government's census found 9% of people receiving forensic mental health services in NHS Scotland facilities in March 2019 were 65 or older. The Forensic Network's annual inpatient census data indicates that the number of over-65s has risen by 50% in the years from 2013-2019, from 14 to 21 individuals in total. Over the same time period, the number of people aged 56-65 has risen by 27%, from 48 to 61 individuals.

The work on implementation of the Review's relevant recommendations as part of this delivery plan will seek to address the needs of this growing group.

Specific action or mitigation

The implementation of recommendations 52-55 of the Independent Review of Forensic Mental Health Services alongside the establishment of the National Secure Adolescent Inpatient Service will create more specialist, age appropriate care for young people; significantly reduce the need for young people to be placed in England for specialist provision; improve alignment with local CAMHS; and support the transition for those young people who need to transition into adult forensic inpatient units.

Implementation of recommendations 56 and 57 of the Independent Review of Forensic Mental Health Services will seek to develop an older adults' pathway that reflects the care and risk management needs of this group and improve staff skills and confidence in the area of older adults health needs.

Protected characteristic/ marginalised group

Disability

Overview of impact

The Independent Review of Forensic Mental Health Services heard concerns that people with a learning disability are diverted to secure inpatient settings for offences that might not have been severe enough to receive a prison sentence in the criminal justice system. It also heard of people being subject to these restrictions in hospital for longer than any prison sentence that may have been imposed for a comparable offence. The work on implementation of the Review's relevant recommendations as part of this delivery plan will seek to address these issues.

Specific action or mitigation

Implementation of recommendations 43 to 50 of the Independent Review of Forensic Mental Health Services will seek to improve the support of people with learning disabilities in the criminal justice system; gather more evidence of the experience of offenders with learning disabilities compared to offenders from the rest of the population; align learning disability services within forensic services with community learning disability services; improved staff support to provide services to offenders with learning disabilities; and improvements to community accommodation for offenders who have learning disabilities.

Sexual orientation

We do not anticipate any negative impacts for this group.

Gender reassignment

We do not anticipate any negative impacts for this group.

Pregnancy and maternity

We do not anticipate any negative impacts for this group.

Race

We do not anticipate any negative impacts for this group.

Religion or belief

We do not anticipate any negative impacts for this group.

Protected characteristic/ marginalised group

Sex

Overview of impact

The Independent Review of Forensic Mental Health Services devote a full chapter of its final report to the disadvantages women face in terms of access to and quality of forensic mental health care. The work on implementation of the Review's relevant recommendations as part of this delivery plan will seek to address these issues.

Specific action or mitigation

Work to progress recommendations 3 and 4 of the Independent Review of Forensic Mental Health Services will seek to significantly meet the care needs across the forensic mental health system; and to provide high secure provision in Scotland meaning women that level of secure care will no longer need to be placed in England.

Poverty and low income

We do not anticipate any negative impacts for this group.

Geographical location

We do not anticipate any negative impacts for this group.

Priority 9: Strengthen support and care pathways for people requiring neurodevelopmental support, working in partnership with health, social care, education, the third sector and other delivery partners. This will ensure those who need it receive the right care and support at the right time in a way that works for them.

Protected characteristic/ marginalised group

Age

Overview of impact

Actions under this priority will have a positive impact on eliminating unlawful discrimination, advancing equality of opportunity and promoting good relation among and between different groups for people of various ages.

We know that neurodivergent people and people with learning disabilities have high rates of mental ill health and face systematic inequalities to accessing the right care and support. Including long waiting times to access diagnostic services.

Strengthening these pathways will ensure timely access to, diagnostic services for neurodivergent people and building workforce capacity including necessary training to deliver them, which will also help address stigma and negative assumptions from wider society towards neurodivergent communities.

It fits in with our continued commitment from the Towards Transformation Plan to explore how services and supports can better the meet the mental health and wellbeing needs of these communities.

We anticipate this will particularly benefit adults who can no longer access children and young people's services, through the establishment of adult neurodevelopmental pathways.

We know people with learning disabilities face significant challenges in accessing physical and mental health care, and don't feel empowered to highlight mental health and wellbeing challenges in these settings. Through the roll out of annual health checks for adults with learning disabilities across all NHS Boards, efforts to engage this community around their mental health will be improved. Therefore addressing a number of access barriers for learning disability communities.

The target group is inclusive of 16-18 year olds, so would bring direct benefit to these young people. These health checks sit alongside improving primary care practitioners' understanding and awareness of people with learning disabilities needs, which should promote good relations between different protected characteristic groups.

Action to consult on and advance proposals to enshrine a human-rights based approach to providing support for neurodivergent people and people with learning disabilities in a Learning Disabilities, Autism & Neurodivergence Bill ("LDAN Bill") should have positive impacts on all protected characteristic groups, across all ages. We envisage it will have a positive impact on a range of mental health inequality drivers. It has the aim of to ensure that the rights of neurodivergent people, and people with learning disabilities, are respected, protected and championed.

Specific action or mitigation

Specific action or mitigation

Action development and implementation should be mindful of the additional barriers to accessing support and specific needs of minority ethnic people. Pathways should be developed working alongside neurodivergent communities and communities with learning disabilites in an intersectional manner. Stakeholders should be supported to participate in the development of these pathways.

We will collaborate with people with lived experience, including minority ethnic people, to develop consultation proposals for a LDAN Bill. We will also develop a robust Equality Impact assessment alongside any LDAN Bill.

Protected characteristic/ marginalised group

Religion or belief

Overview of impact

Specific action or mitigation

Pathways should be developed working alongside neurodivergent communities and communities with learning disabilities in an intersectional manner.

Protected characteristic/ marginalised group

Sex

Overview of impact

We know neurodivergent people and people with learning disabilities may face different barriers to accessing support depending on their sex. There are no specific actions under this priority that have a particular focus on men or women. Given the inclusive approach to many actions, positive impacts may be possible and it is unlikely there will be any negative impacts on the basis of sex.

Specific action or mitigation

Action development and implementation should be mindful of the additional specific barriers to accessing support that men and women people face. Seeking to understand changes needed to effectively meet the mental health needs of neurodivergent people and people with learning disabilities by developing pathways working alongside these communities in an intersectional manner. Stakeholders should be supported to participate in the development of these pathways.

We will collaborate with people of different sexes with lived experience to develop consultation proposals for a LDAN Bill. We will also develop a robust Equality Impact assessment alongside any LDAN Bill.

We will also work with younger people (including in educational settings) to challenge preconceptions around dementia and address the negative assumptions to those with younger onset dementia. This work is already underway through the entity Brain Health Scotland.

Specific action or mitigation

Through a new Strategic Board for Children and Families Mental Health, we will work with Suicide Prevention policy to explore how specific groups across children/young people and the perinatal period may be at higher risk of, or present behaviours of, self-harm, suicidal ideation and suicide attempts/completing suicide. We will use this understanding to contribute to and support ongoing work which aims to improve targeted responses for these groups.

Stakeholder feedback has suggested exploring the duration of community perinatal mental health services relation through to the second postnatal year. We will explore data and get stakeholder input in relation to the second year in the postnatal period.

Continue to ensure that adult survivors (16+) continue to receive high quality services from our funded organisations and monitor any impact that this may have on the families of survivors where possible. Ensure that older people are receiving equal representation within survivor support.

We know older adults experience inequalities such as loneliness and isolation, diagnostic overshadowing and lack of targeted and inclusive information. These inequalities should be considered in the development of the Dementia Delivery Plan.

We will mitigate gaps in our understanding around age and dementia by continuing to engage with young people with/caring for those with dementia to address the specific needs of younger people.

Protected characteristic/ marginalised group

Disability

Overview of impact

Actions under this priority will have a positive impact on advancing equality of opportunity for people with disabilities.

Whilst there are no specific actions under this priority that have a particular focus on people with disability, we know that individuals with a disability
are more likely to experience abuse than their non-disabled peers and are less likely to disclose abuse. Therefore actions to provide services to those who experienced childhood abuse, which promote sustained recovery through person centred, trauma informed support and treatment may have a positive impact on people with disabilities who have experienced abuse. In most cases it will depend on how the action is developed and implemented. The current policy provides funding to organisations who support those with disabilities. However, we must continue to ensure these supports are reaching disabled people.

The impacts of dementia, including cognitive impairment and potentially loss of capacity, can qualify as disabilities. The Dementia Strategy aims to make a positive difference by promoting and monitoring inclusion, building working relationships with those who have a comorbidity such as Parkinson's disease, people with Down's Syndrome or a learning disability, people with hearing or sight loss. It also seeks to ensure dementia training and education reflects that people with an intellectual disability and those with sensory loss (who are living with dementia) know their experience best and preferences of diagnosis to long term care.

Specific action or mitigation

Barriers to accessing services experienced by disabled people should be considered in the development and implementation of actions on survivor support. We will monitor and evaluate to ensure that adult survivors who have disabilities are receiving the same support as their non-disabled peers.

The Dementia Strategy commits to continually engage with priority sub-groups to fill gaps in our evidence, such as the number of individuals with an intellectual disability who are diagnosed and receiving dementia-specific support.

Protected characteristic/ marginalised group

Sexual orientation

Overview of impact

There are no specific actions under this priority that have a particular focus on LGBTI+ people, but given the inclusive approach to many actions, positive impacts may be possible. It is unlikely there will be any negative impacts on the basis of sexual orientation. However further work is needed to ensure services are accessible and responsive to LGBTI+ needs.

We know that attitudes among older people towards our LGBT+ communities are less likely to be positive, that older people who are LGBT+ are more likely to live alone, be single, or not have children. Up to 72% of frontline health and social care staff have not received any training on the needs of these communities. While we do not have a clear understanding of the numbers of our LGBT+ communities living with dementia, we have heard through previous focus groups facilitated by LGBT Health & Wellbeing that these challenges in around stigma and understanding translate to poorer mental health and wellbeing outcomes, as they form an "invisible population" within the dementia community.

The Dementia Strategy sets out positive steps/aim to educate the workforce and unpaid carers on the specific issues faced by LGBTI+ people with dementia and make better use of the wide variety of tools available to drive impact such as: Proud to Care: LGBT and Dementia: LGBT+ Dementia Toolkit.

Specific action or mitigation

Seek to understand needs of LGBTI+ people when developing and implementing actions and we will monitor the impact of actions on groups that face additional barriers.

Specific action or mitigation

Engage with people with lived experience from faith and belief groups in the implementation of the Dementia Strategy Delivery Plan.

Protected characteristic/ marginalised group

Sex

Overview of impact

Actions under this priority will have a positive impact on eliminating unlawful discrimination, advancing equality of opportunity and promoting good relations between different protected characteristic groups for both women and men.

We know women in certain life stages, particularly young mothers, can experience increased loneliness and isolation which has a negative impact on their mental health and wellbeing. Action to launch a new fund to invest in perinatal and infant mental health services, building on the success of the Perinatal and Infant Mental Health Main Fund and Small Grants Fund, will help increase access to support, reduce isolation and improve parent-child relationships. There are also multiple third sector charities available to support men and families through the perinatal and postnatal period, we will further support and improve access to these services.

People in the perinatal period also experience stigma around their mental health. Actions will seek to tackle stigma through the promotion of existing resources and we will ensure that our policy work is responsive to changes in our understanding of stigma.

Our new dementia strategy sets out that 65% of people living with dementia in Scotland are women. Evidence about why women are more likely to develop dementia is growing and this will be reflected in how we deliver the strategy. We also know that up to 70% of care partners are women, with subsequent potential impacts on their health and wellbeing, as well as their socio-economic participation.

Specific action or mitigation

Contact

Email: MentalHealthStrategyEngagement@gov.scot

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Information

Chapter 3: Strategic Equality Impact Assessment of Proposals and Actions in the Mental Health and Wellbeing Delivery Plan

Priority 1: Tackle mental health stigma and discrimination where it exists and ensure people can talk about their mental health and wellbeing and access the person-centred support they require.

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Priority 2: Improve population mental health and wellbeing, building resilience and enabling people to access the right information and advice in the right place for them and in a range of formats.

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