Scotland's public health priorities

Priority 3: A Scotland where we have good mental wellbeing

Mental wellbeing is about both feeling good and functioning effectively, maintaining positive relationships and living a life that has a sense of purpose. It is shaped by our life circumstances, our relationships and our ability to control or adapt to the adverse circumstances we face.

Good mental health improves outcomes in education, employment and health and benefits individuals, families, communities and society.

Why is mental wellbeing important?

Mental health and wellbeing is a significant public health challenge for Scotland which needs to be addressed if we are to ensure everyone in Scotland can thrive. Good mental health is profoundly important for growth, development, learning and resilience. It is associated with better physical health, positive interpersonal relationships and well-functioning, more equitable and productive societies.

Mental health is also linked to wider inequalities. Socio-economic status has a bearing on mental health and those who experience disadvantage are more likely to have poorer mental health. Considerable progress has been made in reducing the stigma associated with talking about our mental wellbeing and the rates of reported mental health conditions continue to increase, as does the use and cost of prescribed medications. Although our wellbeing as a nation remains stable we still face unacceptable inequalities. For example, young women and those living in more deprived areas having lower than average wellbeing than the country as a whole.

In 2016, there were 728 deaths by suicide in Scotland; and nearly three-quarters of suicides in Scotland are by men. There is no acceptable number of deaths by suicide and our ambition for suicide prevention is that no one should die by suicide in Scotland. Further reductions in suicide will require building resilience and social capital, at the individual and community level.

Our society is also facing new challenges to our mental wellbeing, for example social media can have both positive and negative impacts on our children and young people. Over three quarters of all mental health problems have their onset before the age of 20, and childhood and adolescence are the key stages for promotion and prevention to lay the foundations for future mental wellbeing.

How will we make a difference?

The Scottish Government’s 2017-27 Mental Health Strategy champions mental health as equally important as physical health, and calls for a preventative and early intervention approach to mental health, recognising the broad range of factors required to collectively improve wellbeing. Poverty, education, justice, social security and employment are all identified as areas beyond the reach of the NHS acting alone, where improved partnership approaches to public health can make a real difference.

The Scottish Government, NHS Health Scotland and COSLA have jointly endorsed ‘Good Mental Health for All’ as a framework which community planning partnerships, integration authorities, local authorities, NHS boards, the third sector and other partners can use to plan collaborative action to tackle the determinants of mental health and the causes of inequalities in mental health. Integration authorities are also committed to shifting investment into communities and supporting individuals in self-management. These partnerships present opportunities for local work to be informed by public health evidence and approaches.

The inter-relationship between drugs, alcohol, tobacco and mental health problems is well known. For example, there are particularly high levels of poor mental health and problems of tobacco, alcohol or drugs dependency among Scotland’s prison population. It is now well recognised that Police Scotland is dealing with increasing numbers of people in mental health distress and that this is placing significant demand on their services and that of health services.

Police Scotland estimate that they responded to around 57,000 incidents in 2015 which had a mental health aspect. Innovative partnership projects, such as the Distress Brief Intervention pilots, show how the whole system working together can offer an alternative approach.

Councils are working with partners at the local level to develop integrated approaches that balance protecting and improving our communities’ mental wellbeing with mental healthcare and treatment. Local initiatives include action to reduce stigma, to improve support in the workplace, to build more resilient communities and to tackle the inequalities in mental health which still exist.

Increasingly, integration authorities in collaboration with community planning partners, are developing preventative service responses that focus on early intervention –such as wellbeing services and peer support networks, providing access to the creative arts, environmental projects, employment and training opportunities – all of which support people to build their personal resilience and social networks.

1 in 4 Approximately 1 in 4 people in the UK will experience a mental health problem each year. ^3.1

1 in 8 men and 1 in 6 women self-reported a possible psychiatric disorder ( GHQ 4+) in Scotland. ^3.2

An estimated 90,000 people have dementia in Scotland. ^3.3

People with life-long mental illness are likely to die 15-20 years prematurely because of physical ill-health. ^3.4

Mental and substance use disorders are the third largest cause of death and disability in Scotland after cancer and cardio-vascular diseases. ^3.5

11% of young people (18 to 34) report having attempted suicide and 16% report self-harm at some stage in their lives. ^3.6

In 2012/2013, adults in the most deprived areas were five times more likely to have below average wellbeing than those in the least deprived areas (26% compared to 6%). ^3.7

Mental health problems are estimated to cost Scotland £10.7 billion taking account of social and care costs, economic outputs and human costs. ^3.8

Mental Health Stigma ^3.9

40% of people would be willing to speak to their manager about their mental health

57% would be willing to have a relationship with a person who has a mental health problem.

69% of Scots have witnessed people being treated differently or unfairly because of a mental health

90% of people would be comfortable talking to another person about that person’s mental health

94% would speak to a health professional about their own mental health problem.

There were an estimated 1,259,000 days lost due to self-reported stress, depression or anxiety caused or made worse by work in Scotland in 2017. This is around half of all working days lost due to ill health. ^3.10

In Scotland a total of 877,453 patients were dispensed at least one antidepressant during 2016/17 at a cost of £44m / year.

This is 19% of the population of Scotland aged over 15. Two thirds of these were female, one third male.

The total number of anti-depressants prescribed has increased by 75% since 2006/07.

Around 2.5 times as many anti-depressants are prescribed each year to patients living in deprived areas as those in less deprived areas. ^3.11