Jennifer Trueland – Rethinking mental health in Scotland
23rd February 2016
We asked health writer Jennifer Trueland to talk to the Scottish Mental Health Partnership about their new briefing paper that calls for a radical change in our approach to mental health in Scotland.
Arguably, there’s never been a better time for a serious rethink of the way we look at mental health in Scotland. A major reorganisation of health and social care is underway, politicians of all the major parties say they recognise that mental health is a priority – and what’s more, a new mental health strategy is currently in the making.
Perhaps that’s why leaders in the field are calling for major change. In a briefing paper published this month, the Scottish Mental Health Partnership (SMHP) is calling for a radical shift in Scotland’s approach to mental health.
The partnership – made up of 14 national organisations (see end) – wants to see a change from a system whose primary focus is crisis intervention, to one where everyone’s mental health and wellbeing counts.
It is also calling for a high level, independent commission to inform the future direction of mental health policy – and says that short-termism should be ditched, in favour of a long term vision that lasts a decade or even longer.
“The key thing is to shift the emphasis from thinking about services that are for people who are in crisis, and who are ill, to thinking about mental health and wellbeing,” says Gordon Johnston, Chairperson of Voices Of eXperience (VOX), which represents people with lived experience of mental health problems, and a member of the partnership.
“I think a commission to take a real look at what the situation is now, and where we should be going, is a great idea. One of the issues about mental health is that it’s complex, and has an impact on lots of different areas, from employment and finance to the benefits system. We need to see where there are currently gaps, and what needs to be done to fill them.”
Mr Johnston, an author of psychological thrillers and also chair of Bipolar Scotland, says we need to be looking at the bigger picture, such as how contributing factors to mental ill health – for example, loneliness or isolation – can be tackled. “This can’t be done in short-term cycles,” he adds.
Toni Giugliano, public affairs manager with SAMH (the Scottish Association for Mental Health), another SMHP member, agrees it’s important to move away from bite-sized or short-term strategies. “We want transformational change, and we want to see a ten-year vision,” he says. “Strategies seem to go around in three-year cycles; but we want to get away from the political cycle and the short-term approach. We believe that a longer term view is vital, albeit with key milestones along the way, because with that comes ambition.”
The briefing paper contains a series of key ‘asks’ (see box). Perhaps one of the most striking is the call for the Scottish Government to set up a high level, independent commission of enquiry to lead and inform the transformation needed to place mental health and wellbeing at the heart of Scotland’s future. This would carry out a root and branch review of all public and third sector services that support mental health and wellbeing from the perspective of people accessing them, and draw on best practice from across the world to develop a vision of what mental health promotion, prevention, support and treatment should look like by 2020 and 2030. It would also clarify the steps necessary to ensure that mental health is considered across all policy areas, not just the obvious ones like health and social care.
Alastair Cook, who chairs the Royal College of Psychiatrists in Scotland, says it’s time for a serious step change. “Civil servants are currently consulting on what should be in Scotland’s next mental health strategy. We think that there needs to be a bold vision, and we think now is a good time to create that vision.
“In Scotland, we’ve got the new health and social care partnerships coming on board this year, in England, we’ve just had the report of the task force on mental health, which calls for change. I think there’s a political understanding that you can’t have good health without good mental health. The political will is there, there’s organisational change going on – it’s time.”
He sees the way forward as a big step forward in the journey started in Scotland in 1999, with the then Scottish Executive’s framework for mental health services. “That pushed us into multi-agency strategic planning, and from hospital to community-based services,” he says. “We’ve made a lot of progress, but the model of care is still quite institutional. It’s as if we’ve moved the services [into the community] but we’ve not moved the ethos.
“The next step – and it’s a big step – is changing the focus from crisis care to thinking about prevention; to building resilient communities that support people, and recognising the importance of mental health across all policies.”
Dr Cook was instrumental in setting up the SMHP because he felt it was important to have a forum for groups with an interest in mental health to work on issues they had in common. “We wanted to pull a group together to think about the strategy and the next steps, but not from a governmental perspective,” he adds.
Mr Giugliano believes the SMHP works because organisations bring their own specialist perspective and expertise to the table – but share an overall goal. “Different partners bring different things – some have more of a service-user focus, some are providers, some are more policy-focused. Ultimately, we’re working together because we all care about mental health, and the more we work together, and speak with one voice, the better.”
Judith Robertson, programme director with See Me, which is working to end stigma and discrimination around mental health, believes the SMHP is important in providing a unified voice for mental health organisations across Scotland. “Through the partnership, organisations can work together on a shared agenda to transform mental health provision in this country,” she says.
This new paper is a case in point, she adds, because it brings together valuable perspectives from a range of groups.
“The main calls of the new briefing paper are an important collaboration between people with lived experience and mental health organisations. The need for prevention and early intervention mirrors the views of people that we speak to all over Scotland.”
So what happens next? According to Simon Bradstreet, director of the Scottish Recovery Network, which is also a member of SMHP, one priority is persuading those who are currently scribbling away at the new mental health strategy that it’s time to be bold. “This could be a once-in-a-generation opportunity,” he says. “We urge our policy-makers to seize it and make it work.”
The members of the Scottish Mental Health Partnership (SMHP) are:
- Action on Depression
- Bipolar Scotland
- British Psychological Society
- Mental Health Foundation
- Royal College of GPs
- Royal College of Psychiatrists in Scotland
- Scottish Association for Mental Health (SAMH)
- Scottish Independent Advocacy Alliance (SIAA)
- Scottish Recovery Network (SRN)
- See Me
- Support in Mind Scotland
- Voices Of eXperience (VOX)