Briefing on the Scottish Government consultation 'Towards a mentally flourishing Scotland'

The Scottish Government has published a discussion paper about the future direction for mental health improvement for 2008-11. Associated with this paper, the Scottish Government has asked all health boards to hold local discussion events with community planning partners and a wide range of stakeholders. If you have any comments on the briefing below, please contact Kate Fearnley, Health and Community Care Director, kfearnley@alzscot.org

Briefing - "Towards a Mentally Flourishing Scotland: The Future of Mental Health Improvement in Scotland 2008-11"

Introduction

This briefing outlines the Scottish Government's proposal for the future direction for mental health improvement and population mental health for 2008-11. The proposals build on the work of the National Programme for Improving Mental Health and Wellbeing.

The full document is at http://www.wellscotland.info/news/item.php?id=220 and is part of a consultation process involving national and local events for stakeholders.

The paper poses three key questions which the consultation events will address:

1. What shared objectives and actions for local delivery should be made for 2008-11 that would be deliverable, measurable and valuable?
2. What national supports would help you to meet these objectives and actions?
3. How can progress be tracked and performance assessed?

An Action Plan will be developed by the Scottish Government for national and local implementation from April 2008 until March 2011.

The scope of the proposal includes work across Government and with stakeholders to improve mental health, tackle health, social and economic inequalities, prevent, treat and care for mental illness and improve the quality of life for people living with mental illness.

A key objective is to extend the reach of mental health improvement outwith the healthcare system, as part of supporting improved public wellbeing.

The paper defines mental health or wellbeing as the ability to cope with life’s problems and make the most of life’s opportunities, to cope in the face of adversity and to flourish in all environments; to feel good and function well, both individually and collectively. Mental health problems means having difficulties with our mental health which affect everyday life. Mental illness refers to clinically identifiable illnesses or conditions that affect cognitive functioning. Someone can experience mental illness and still have good or flourishing mental wellbeing, and conversely, someone may have significant mental health problems, but no clinically identifiable mental illness.

The main themes for population-based mental health improvement
Population mental health addresses the needs of the whole population, covering risk and protective factors and addressing underlying issues that can help or hinder mental health and wellbeing. It also involves targeting efforts at people, families, groups, communities and geographical areas at greatest risk of poor mental health and who may have complex and multiple needs.

The proposal is about enhancing people’s mental health and wellbeing, reducing the occurrence of mental health problems and mental illness and improving the quality of life of people living with on-going mental health problems or illness.

Three main themes

1. Promotion of mental health – by increasing protective factors and reducing risk factors.
2. Prevention of mental health problems & mental illness, co-morbidity and suicide – including prevention of common mental illnesses such as depression and anxiety and on the interaction between mental illness and other health conditions.
3. Supporting improvements in the quality of life, social inclusion, health, equality and recovery of people who experience mental illness, to including addressing stigma and discrimination, recovery and promoting equality of opportunity in areas such as employment, housing and recreational activities.

Main target groups
The underpinning focus is addressing inequalities, as good mental health and wellbeing and mental health problems and mental illness are not equally distributed across the population. Work should be targeted to groups who need it most. Relevant illustrative target groups given for local and national action include:

• People in institutional settings
• People such as veterans or the homeless, who may not be reached by traditional approaches
• People with physical and/or mental illness, alcohol/drug problems
• People without access to key assets or resources
• People and groups who experience discrimination.

Alzheimer Scotland comment: People with dementia may fall into any of these, and the first category is particularly important.
It is also important that this list is not seen as exhaustive – older people are a key group especially at risk of dementia, and people with dementia area group at particular risk of depression and of a number of factors which may impact on mental wellbeing, including poverty and isolation

Efforts to promote mental wellbeing should also range across the life course from the early years to later life. The best research evidence suggests that particular attention and emphasis is given to children and young people.

Alzheimer Scotland comment: There should also be a focus on older people as this is a group at particular risk and because demographic change means that the number of older people is growing. This means that the need for mental health improvement interventions for them and for support to manage conditions such as dementia, is also growing rapidly.

There should also be work in a range of settings including workplace, educational, sport, recreational, cultural settings and institutional settings. There are likely to be significant overlaps in the target groups and settings for promotional work.

Suggested actions for local areas for 2008-11

A set of suggested actions for local areas is provided.

Since 2001, the National Programme has been focused on national actions with a main emphasis on process and outputs – for example, getting attention to the issues, increasing skills and capacity through training, commissioning research, promoting awareness, public and community campaigns. There is now a shift towards outcomes as well as process and towards local work.

Among the suggested priority actions under the themes of promotion, prevention and support, the most relevant to people with dementia are below. After the consultation the Scottish Government will develop specific actions, objectives and commitments for implementation from April 2008-11.

Promote and improve mental health and promote and improve mental wellbeing
Efforts to promote and embed the skills, attributes, belief, values and circumstances that increase resilience, self-efficacy, a sense of mastery, coherence and control, individually and collectively. Work must include the promotion of mental wellbeing for people living with, and/or recovering from, physical and mental illnesses and address the specific challenges faced by people subject to discrimination.

Alzheimer Scotland comment: This is important in supporting people living with dementia to help them experience good mental wellbeing. Carers are also a group who would benefit form this kind of support.

Part of this approach could include ensuring that key workers are mental health and mental wellbeing literate, so that this becomes an embedded part of their work and practice. Mental health and wellbeing literacy should include a recovery-oriented approach, so that people with a mental illness are enabled to lead and direct their own wellbeing and recovery.

Alzheimer Scotland comment: Workers also need to be dementia-literate, and this should be explicitly recognised in the strategy.
There should be a recognition that the terminology used in mainstream mental health is not always the same as that used in the dementia field – for example the term ‘recovery’ does not have the same level of acceptance and may be misunderstood.
The proposed focus on children and young people should not be to the exclusion of older people.

Prevention: Raise efforts around prevention of mental health problems, mental illness and suicide
There is a continuing debate around the extent to which nature or nurture affects mental health and mental wellbeing; both have a significant part to play. Work in this arena should therefore promote the determinants of good mental health and mental wellbeing. It should also tackle the main risk factors for mental health problems, mental illness and suicide through increased prevention activities.

Alzheimer Scotland comment: It is important that attention is paid to the risk factors for dementia, although the timescale involved may mean that it is many years before the impact may be seen. There is good and increasing evidence that behaviours and lifestyle choices in middle age (including diet, physical activity, mental stimulation, social activity, smoking) affect the risk of developing dementia in later life. Given the predicted 75% increase in cases of dementia by 2031, immediate action is needed to minimise the impending dementia epidemic.

For people who have a diagnosis of dementia and for their carers, good anticipatory care is vital in avoiding unnecessary problems and crises. Dementia-specific capacity building, training and self-help work aimed at individuals, groups and communities can help develop the ability to live well with dementia.

Support: improve the quality of life, social inclusion, health, equality and recovery of people who experience mental illness

Further work is required on addressing stigma, prejudice and discrimination, especially for those who have a diagnosis under the general heading of psychoses. Greater equality of opportunity is also required. Increasing access to mental health and mental illness literacy can also help in enabling people to have the information, education and knowledge they need to keep well and support, enable and encourage people to seek help earlier, before problems get worse or a crisis arises.

In developing improved mental health literacy, the Government wishes to see “greater public understanding that it is possible to recover, symptom-free from mental illness, and that it is also possible to live life fully and well with a long term mental illness. Valuing people’s lived experience of living with mental illness is a key part of this agenda.”

Alzheimer Scotland comment: There is strong evidence of the need to tackle both stigma and understanding in dementia. Alzheimer Scotland is already active in campaigning in both areas and the work needs to continue on a wider scale.

Care needs to be taken that broad messages about mental health do not mislead in relation to dementia – for example, it is not possible to “recover, symptom-free” from dementia, which is a progressive, and eventually fatal, illness. However, it is possible to live well with a diagnosis of dementia.

There is a need for support for self-management/self care which is specific to the needs of people with dementia, for example on managing memory loss and diminishing cognitive capacity.

Further suggested actions include:

• developing a local capability to improve capacity and provide leadership of, and support for, mental health improvement as a core part of mainstream planning and service delivery across each of the key themes
• Support for the key role for Community Health (and Social Care) Partnerships in mental health promotion and prevention actions
• The need to connect local strategic and delivery work with the overall three main expectations and emphasise how inequalities will be addressed.

National functions and national supports
Views on what national functions and support activities would assist local delivery are invited. Examples given include:

• research, evidence and evaluation
• providing evidence-based training, capacity building, skills and competency building
• programmes
• providing opportunities for networking and learning-
• communications, social marketing and support to the media
• national indicators, data and review.

Kate Fearnley
Health and Community Care Director
19 December 2007