Mental health and wellbeing strategy

6. Addressing mental health inequalities

We will lay out actions in our Delivery Plan which are designed to make substantial progress towards tackling mental health inequalities. These actions will continue to evolve over time.

"Health inequalities are the unjust and avoidable differences in people's health across the population and between different population groups." Source: Scottish Parliament Health Inequalities Inquiry 2022

Some groups of people have poorer mental health than others. These health inequalities are a symptom rather than the cause of the problem. The causes of health inequalities arise from the unequal distribution of income, wealth and power, which can impact on wider life chances and experiences.

These societal conditions put some groups at greater risk of poor mental health than others. These conditions are commonly known as 'social determinants' and include traumatic and adverse experiences such as poverty, discrimination, loneliness, unemployment, lack of adequate housing, and lack of social and cultural opportunities.

Social and structural inequality in society means that those who face the most significant disadvantages in life also face the greatest risks to their mental health. This includes marginalised groups who experience discrimination, racism or exclusion (social, political, economic or environmental) solely based on age, race, sex, sexual orientation, disability or other

characteristics protected by the Equality Act 2010.^[1] There are also other groups, such as veterans, refugees, children, young people, adults and families who are care experienced, people affected by substance use or those experiencing abuse or homelessness and those engaged in the justice system. People in prison often have a combination of mental and social care needs, arriving in prison disproportionately from the most deprived areas in Scotland, and with higher mental health needs relative to the non-prison population. Many people in these marginalised or hidden groups experience discrimination from parts of society, creating multiple discrimination and leading to significant marginalisation. This can be traumatic and cause long-term damage to their mental health and considerable adverse mental health impacts beyond those that the rest of the population face.

Poverty is the single biggest driver of poor mental health, and we know that people living in poverty carry a higher risk of suicide, as do those who are unemployed or socially isolated.^[2] Many people also face the additional barrier of digital exclusion, meaning it is harder to access advice, support and services.

In many cases, these same groups of people also often experience less access to effective and relevant support for their mental health. When they do get support, their experiences and outcomes can be poorer. These inequalities in mental healthcare can exacerbate mental health inequalities.

Disabled people are more likely to report lower mental wellbeing than those with no condition and are amongst those who need support and services to be accessible and inclusive in a range of formats, including non-digital. This includes people with learning disabilities, those with sensory loss and those with a long-term physical health condition. A large proportion of autistic people also experience mental ill health in their lifetime.^[3]

Women and girls are disproportionately impacted by poverty, which can lead to social isolation, anxiety, depression and stress. Greater caring responsibilities and the everyday threat of violence against women and girls can also adversely impact mental health. Childbirth is also associated with an increased risk of mental ill health in mothers.

Periods of transition often put extra stress on children and young people's pre-existing resilience and coping strategies. The late teenage years are a point when mental wellbeing can decline, particularly for young women, and can also be the point of onset of serious mental illness. Teenage years are also a stage in life where the increased use of online communities and social media can impact mental health, especially for young women. Experiences of bullying, harassment and abusive behaviour put young people at higher risk of poor mental health.

Scotland also has an ageing population. The proportion of 'older adults' (65 years old and over) in the population has increased from 16% in 2000 to 19% in 2020.^[4] This is expected to continue increasing over the next decade, putting more pressure on public services. Older adults, particularly those living in remote, rural and island areas, are more likely to experience loneliness and can also face barriers in accessing support and services, exacerbated by a lack of access to transport. Research from both NHS Grampian and Scotland's Rural College highlights the disproportionately higher rates of depression amongst agricultural communities, with suicide rates amongst farmers among the highest of any occupational group.

Experiencing minority stress, racism, discrimination and trauma has a significant negative impact on mental health and wellbeing and can disproportionately impact lesbian, gay, bisexual, transgender and intersex (LGBTI) people, minority ethnic groups, and disabled people. LGBTI and minority ethnic people also have reported that staff can lack cultural competency, sensitivity and understanding of their specific needs.^[5]

Evidence suggests that only around half of veterans experiencing mental health problems seek help. Stigma is one of the main reasons for this, and levels of help-seeking are particularly low in those with post-traumatic stress disorder. The specific needs of veterans must be taken into account when planning support and services.^[6]

We must take an intersectional approach, recognising that people are multi-faceted. Different experiences or aspects of their identity interact to affect their mental health, so we can most effectively understand and tackle structural inequality and health inequalities, including racialised and gendered inequality. We need support, services, care and treatment that are person-centred, anti-racist, culturally and gender sensitive, age-appropriate, fully inclusive and in a range of formats.