Mental health and wellbeing delivery plan: equality impact assessment

Chapter 1: Background and Scope

Introduction

This EQIA is set out in four chapters:

• The first chapter sets out the background to the Strategy and the Plan and the scope of this EQIA.
• The second chapter summarises what we know about mental health and wellbeing related to the protected characteristics, drawn from the Report.
• The third chapter takes a strategic look across the policies and proposals in the plan to identify impacts related to the PCs and set out where specific actions or mitigations have been taken or are needed to enhance positive impacts or mitigate potential negative impacts.
• The fourth chapter sets out a conclusion and recommendations for further consideration by the Mental Health and Wellbeing Leadership Board.

Background

Work has been underway for a number of years to improve mental health and wellbeing support for people in Scotland. The Scottish Government's last Mental Health Strategy 2017-2027 (MHS) was published in 2017 and set out to transform the mental health of people in Scotland, the way they thought about mental health and wellbeing and the mental health services they use.

In 2020 an unprecedented global health crisis, the Covid-19 pandemic, affected all our lives in ways none of us could imagine. The Mental Health Transition and Recovery Plan (T&R Plan) was published in October 2020 in response to the pandemic and set out over 100 actions to address its impacts on mental health and wellbeing.

The T&R Plan intended to better reflect the needs of the population during and in the aftermath of the pandemic and related lockdowns. It explicitly acknowledged that the pandemic has exacerbated pre-existing structural inequalities within our society, putting some communities disproportionately at risk of more negative impacts on their mental health. It committed to make the mental health of these groups a priority and set out specific actions, including engagement with these groups, to better understand and respond to the mental health inequalities which impact them.

The Scottish Government established a Mental Health Equality and Human Rights Forum, with stakeholder membership representing a range of protected characteristics, to provide advice on the development and implementation of mental health policy within the T&R Plan. The Scottish Government also invested in a range of policies to tackle inequalities, including the Communities Mental Health and Wellbeing Fund for adults which supported grass roots community groups in building resilience and tackling social isolation, loneliness and the mental health inequalities made worse by the pandemic and, more recently, the cost crisis.

In this context, reviewing progress against these plans has allowed us to take stock of what has been achieved and consider what has changed and where things can be improved. The Strategy has tackling inequalities at its core.Itrecognises that the risks of poor mental health are not equally distributed and that those who face the greatest disadvantages in life also face the greatest risks to their mental health.

Causes of health Inequalities

The causes of health inequalities arise from the unequal distribution of income, wealth and power, which can impact wider life chances and experiences. These 'social determinants of health' are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age. For example, people living in financial hardship are at a greater risk of lower mental wellbeing. Social inequalities associated with poor mental health can also relate to being part of a marginalised group, disadvantaged community or protected characteristic. Experiences people may face such as prejudice, racism, discrimination, emotional or physical abuse or trauma can increase the risk of having a mental health problem and often interact with each other.

In addition, these same groups of people can also experience barriers to accessing support and services and, when they do access them, existing approaches can often be less effective and relevant for their mental health. This means their experiences and outcomes can be poorer. These inequalities in mental healthcare can exacerbate mental health inequalities.

The Scope of the EQIA

The EQIA is an improvement process which helps to determine whether our policies, practices and new proposals will impact on, or affect different groups or communities positively or negatively. Under the PSED due regard needs to be given to the need to: eliminate discrimination; advance equality of opportunity; and foster good relations between people who share protected characteristics.

The EQIA process has put equalities at the heart of decision making in the development of the Strategy and Plan. The evidence review (Chapter 2) highlights a range of mental health inequalities caused by the interrelationship between three key drivers:social determinants;accessbarriers to support and services; andless effective or relevant support and services. All of these interact leading to poorer experiences and outcomes. Tackling these key drivers strongly aligns and often goes beyond the duties under the PSED.

The Strategy provides a positive framework for future decision making, influencing the key drivers of inequalities and delivering a more inclusive society. In turn, the Plan includes a range of actions that will impact on these key drivers. Achieving the desired outcomes is dependent on the scope and 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.

Undertaking an EQIA is a live and iterative process. The analysis presented in this EQIA is a high-level summary consideration of the impact of these actions on protected characteristic groups. Specific EQIAs on strategic actions will continue to be developed. We will review this EQIA throughout the lifespan of this Delivery Plan with a view to informing future work.