New mental health and wellbeing strategy
The Royal Society of Edinburgh (RSE), Scotland’s National Academy, in conjunction with the Young Academy of Scotland (YAS), welcomes the opportunity to respond to the Scottish Government’s consultation on a New Mental Health and Wellbeing Strategy. We are well placed to offer supporting evidence to this consultation by drawing on our varied expertise in Psychiatry, General Practice, Public Mental Health, Population Health, Historical Geography relating to health and psychiatric asylums, Architecture and Urban Design as it relates to health, Geographies of Health (including mental health), and Third Sector Leadership.
The definitions of “mental health,” “mental wellbeing,” and “mental health conditions” used within the Strategy may benefit from further clarification and strengthening.
The RSE broadly agrees with the proposed vision for the Mental Health and Wellbeing Strategy. However, we have some reservations about how the vision and the outcomes of the strategy will be evaluated to measure success, how the articulation of the vision relates to those with severe mental health conditions, and its efforts to incorporate the wider determinants of mental health.
The RSE agrees with the four key areas of focus stated in the consultation paper. However, we contend the strategy needs to go further on accessibility. For example, mental health services and support need to be accessible for disabled people, and data shows that the lack of inclusive services and the impact of living with disability, including learning disabilities, can contribute to mental health challenges.
The RSE welcomes the key aspects of the strategy in addressing harmful drug and alcohol use in the proposed outcomes. However, it overlooks the importance of other unhealthy commodities, particularly tobacco, gambling, and ultra-processed food.
The RSE recognises the profound impact inequalities have on mental health and wellbeing, with major risk factors for developing adverse mental health linked to poverty, poor education, unemployment or poor conditions within employment, and social isolation or exclusion.
The RSE contends that the strategies for improving mental health may need to give more attention to the potential of social prescribing as well as focusing on medical treatment.
The RSE has recently suggested how the built environment can be utilised to promote community health, with our suggestions focused on promoting social inclusion. We noted that design guidance might be considered to ensure integrated and socially supportive environments in new developments that are built-in by design to encourage more accessible neighbourly/neighbourhood connections for vulnerable people.
The RSE understands that the Bank of England forecasts a recession by the end of 2022. Consideration on how to mitigate the potential impact this will have on the mental health and wellbeing of the population is crucial. Evidence suggests that stresses experienced during economic recessions significantly impact the mental health of the populations affected.
The RSE recognises the current and unsustainable pressure on primary health care facilities. In our recent response to the Government’s health inequalities inquiry, we called for a multifaceted range of support in primary care, including non-medical support such as financial advisors and social practitioners.
The RSE understands that a strategy for supporting mental health should foster a life course perspective. Research undertaken at the Centre for Research on Environment, Society & Health, University of Edinburgh, has emphasised the importance of taking a life-course perspective, particularly in relation to environmental factors affecting health and wellbeing.
The RSE recognises the value of frontline services that provide support to families, such as schools, health visitors, social workers, midwifery services and GP services. We believe that the government’s priority should be to ensure these services have the resources to provide support to families that require it, particularly for those experiencing ACEs.
There needs to be a levelling up of services across Scotland. It is useful to consider the inequalities across ‘places’ as well as amongst social groups.
The RSE welcomes the strategy’s intent to recruit more frontline workers. However, we believe that more support should be put in place for early career workers to encourage retention of the existing workforce.