Scottish Government

Building Community Well-Being
An Exploration of Themes and Issues

3. Changes required to improve mental health and well-being

Mental health and well-being in the workplace

Workplace themes were subtly different in each of the three local areas:

• Livingston was portrayed as an area with high employment but an underlying sense of job insecurity because of a cycle of economic regeneration and decline, inward investment and closure of key employers locally. Many young people go directly into low-paid insecure work after school
• In the East End of Glasgow there are high levels of unemployment and the focus has been on regeneration, skilling people up and enabling access back to work
• Badenoch and Strathspey was described as having a high level of seasonal employment in the tourist industry, with the insecurity and low wages and income levels associated with that. Many young people leave the area and the absence of good quality jobs and career prospects is seen as a key contributing factor

Discussions in the three local areas indicated aspects of employment practices and features of work settings that were perceived to contribute to the well-being of employees. Work remains, for many people, a highly social experience and the interaction with colleagues/customers/the public is valued. For some people it is clear that the workplace provides a real sense of belonging, identity and of having a valued role.

Employees of a large retail company described the steps this employer had taken to reinforce employee loyalty by promoting social activities and by developing a flat management structure with good communication. This company also invested in local community activities and was keen to be perceived as a stakeholder in the local community.

However, work can also be a source of guilt and anxiety. Perhaps not surprisingly the discussions, which included conversations with a considerable number of public sector employees working in health and social care services, drew attention to a central challenge that many experienced in finding a manageable accommodation between the demands of work and of home life. Flexible hours and conditions of employment enable people to find the best way for them of marrying their work responsibilities with family and home responsibilities. A different illustration of how employers can be supportive of home and family pressures faced by employees was the example of a local drugs support agency in West Lothian which was given access to the workplace to provide drugs awareness training sessions with employees who had teenage children.

When people experience difficulties that affect their well-being at work, it is important that they know where to get help and support so that they can keep their job. There continues to be concern that it is not acceptable to have time off work due to mental health issues.

In the East End of Glasgow, where levels of unemployment remain high, the case was made for greater attention to support for people to get (back) into work, without putting benefits at risk. Reference was made to the need for a range of options to ease people back into employment, for example transitional employment placements.

In all three areas, participants in the discussions suggested a need to look at how aspirations for work and careers are developed through schools, further education and training, to ensure that people of all ages, but particularly young people leaving school, have wider choices that extend beyond low paid, unskilled work. This would entail creating more opportunities for apprenticeships and a stronger orientation toward training and skills development.

It was also felt however, that the importance of paid work should not detract from voluntary work, as a cornerstone of much of community-led development and as a means of gaining skills and confidence.

To build on: promoting mental health at work

ASDA in West Lothian encourages flexible working arrangements to enable staff to accommodate home life with work demands. This includes a range of different shifts and breaks to cover school holidays. The company also allows women to continue working over the age of 60. Employees feel that this flexibility allows them to make choices about how they work, to address the work/home life balance.

West Lothian Council has conducted a health audit of its employees. This highlighted key groups of staff experiencing high levels of stress and led to the development of a computerised Stress Audit tool for use by staff and managers to identify stress-related problems and to plan a programme of remedial actions.

Priorities for action in the workplace:

• Making employers more aware of their responsibilities for employee well-being and making the case that this makes good sense in terms of employee loyalty and performance
• Identifying and promoting employment practices that convey respect for individual employees whatever their position or status within the organisation
• Developing the tools and resources that employers can use to implement good practice policies on mental health and well-being
• Increasing the flexibility of working conditions
• Putting in place mechanisms to provide support to promote job retention for those who experience mental health problems at work
• Proactive development of range of options to enable people to get back to work following unemployment/ill health

Mental health and well-being in local communities

Thriving communities

'Surviving' - getting by and managing to cope - was seen as a necessary but not sufficient precondition for thriving. In aiming to promote the well-being of communities it is important that we do not overlook issues of inequality and ensure that structural/material influences on mental health and well-being are addressed, in tandem with actions to promote skills, coping and resilience.

In this vein, against a backdrop of local low wage economies and relatively high/seasonal unemployment, communities in the East End of Glasgow and in Badenoch and Strathspey made reference to the importance of local strategies for debt management. Decent jobs, good housing and sound transport systems were regarded as prerequisites for communities to thrive.

It was therefore considered vital that aspirations to improve community mental health and well-being were taken forward through robust joint local strategies and implementation processes. What was perceived to be needed were mechanisms to identify and to address local needs for: affordable housing; employment opportunities and skills development; a viable infrastructure of services and amenities, including shops, transport links, schools, leisure facilities and health and social care services. There was recognition that local plans had to link into area/city-wide structures for strategic planning.

In the East End and in Badenoch and Strathspey, a strong sense emerged from the discussions that local people felt removed from wider processes of planning and decision making and had little confidence in decisions made elsewhere. This was played out in different ways: in the East End there was perceived to be a need for local bodies to take stronger strategic leadership and work with wider structures; in Badenoch and Strathspey, some groups expressed their lack of faith that national policy makers had an appreciation of the issues and concerns of rural and remote areas. In addition there was a sense of disillusionment with the formal structures for community involvement and representation and a growing sense of urgency among community groups to find new grounds for engagement and participation.

What matters for local communities?

• Meaningful and effective involvement of local people in regeneration and development
• Public services have a key role in promoting equity: this includes ensuring that the voice of marginalized groups is heard and in combating stigma, discrimination and antisocial behaviour; taking steps to achieve equality of opportunity
• Joined up planning to promote co-location of services; to ensure that transport is aligned with service provision
• Local infrastructure of services and resources: the availability of shops, schools and public amenities, provided by organisations that are trusted, credible and effective so that local people have confidence in how services are run
• Absence of key local services in rural areas can mean people have to uproot themselves to go to where they can get support

Community identity

The question of community identity remained complex. As noted earlier, people recognised multiple allegiances to a variety of communities/networks but also often talked passionately about the issues of a particular community of place. What was evident was the mismatch between the 'natural' affinities that people might have with a particular place and the boundaries drawn by service organisations. The organisation and administration of public services were regarded by some participants as being shaped by considerations of administrative convenience and efficiency, rather than bearing much relation to the lived experience of local individuals and communities. It was clear that for a variety of reasons, including territoriality, available services might not be used because they are not perceived as 'local'. A further linked factor was the preference for services that were provided on a human scale.

In addition, the tendency for public sector organisations to compartmentalise the population by age groups and its services by function was at odds with the holistic response that some people wanted. This led some groups to explore what it might take, to create service capacity to provide a holistic cradle to grave, community-focused response.

Places to go, things to do

Stress was put on the importance of activities, particularly for those not of working age:

• Older people were eager to find constructive and enjoyable activities that kept boredom at bay, engaged and developed their interests and skills and provided social contact
• Range of different groups stressed the importance of physical activity for fitness, as a way of meeting people and as a source of achievement and confidence
• Parents were concerned that there should be activities for children and young people which would satisfy the dual need to keep young people safe and give them sufficient freedom

In Livingston reference was made in several discussions to the importance of public spaces and open spaces in creating opportunities for people to come together: a plea was lodged for a park in the centre of Livingston that would encourage use by families among others. Livingston was repeatedly described as a 'town without a heart' which needed a focal point for people to mingle and pass time, separate from the commercial interactions of the shopping mall. It was interesting therefore, that Livingston FC was perceived as a success in providing a draw for families by actively promoting a family-friendly environment at matches.

Connectedness

A common issue in the discussions that took a different shape in each area was the issue of how social and economic changes impacted on the relationships and connections between groups within local communities, for example:

• In Badenoch and Strathspey, reference was made to: the effects of holiday home ownership on the availability of affordable housing for local people; the migration of younger people from the area; the social isolation arising from poor transport links
• The relatively recent development of Livingston had meant a high proportion of people had moved there, and did not have extended family around them. The relative youth of the population meant that many young people could grow up with limited contact with older generations. Older people in the town described their sense of sadness at the lack of opportunity to reach across the generational divide and find common ground with younger people
• In Glasgow's East End, territoriality was a long-standing feature of some people's lives that influenced their opportunities and choices

This theme of disconnection and fragmentation raises questions about the role services can/could play in creating/reinforcing/countering such trends. First, it was not always evident that service interventions are designed in ways which enable individuals and families effectively to navigate life transitions. Indeed sometimes it appeared that the nature of interventions might in themselves exacerbate difficulties and undermine capacity to cope and to grow through the experience.

Secondly, there may be opportunities to think creatively about the nature of links and relationships that people can build with one another, and to harnessing new technology not to supplant but to complement face-to-face interactions?

A third dimension may to consider how best to ensure that communities have capacity to provide localised and personalised help, to act as guides, mentors and brokers, sources of information and signposts for those who are in need of advice and support.

Services and resources

Issues relating to the range and quality of local services arose in Highland and in Glasgow in particular. In the East End discussions conveyed strong concern about the paucity in the range and quality of local services and amenities and the lack of a viable sustainable local infrastructure. Regeneration of employment opportunities and the development of social housing were key long-term strategies. There was also considered to be a case for taking legislative action to ensure that local residents could secure access to a defined set of services and amenities.

A cogent argument was put forward for developments within local communities to be undertaken by those agencies and services which are perceived as credible and successful by the local community. The creation of new vehicles (such as Healthy Living Centres) for local service delivery was a cause for concern among some. Linked to this was the need to ensure that respected local agencies such as SIPS are enabled to take an active role in community developments, which extends beyond their responsibilities to share out resources.

Listening to communities

Strengthening local communities and investing in their development creates greater capacity for representation and participation. Without creative ways of reaching and engaging with local communities, the same familiar faces come forward, diminishing confidence in the process and excluding other interests.

Discussion highlighted certain preconditions for effective engagement with communities:

• Motivation to become involved is greater where it relates to issues that are of direct immediate concern
• There is a need to look at what may need to change to allow community-generated issues to come to the fore and to reconsider the process of negotiation required to shape priorities
• There is also need to ensure that there are identified processes to resolve conflicts and not to allow these to fester
• Much can be learnt from the processes and experience of SIPS and tenants movements that can be imported to health improvement work
• Public sector organisations have an important role in enabling disadvantaged or marginalised groups to be able to speak up for themselves and to address hidden problems and issues, such as domestic violence

To build on: local community initiatives

Calton and Dalmarnock Credit Union, Glasgow

The Credit Union is an important resource for local people, working to ease worries about money and helping provide for the future. It makes up for the withdrawal of local banking facilities with branch closures. As a membership organisation, there is a strong sense of community ownership. Reliance on volunteers leads to skills development and builds confidence in local people.

Affordable Health and Fitness Project, Badenoch and Strathspey

The multiagency Cairngorm partnership established this project to promote health and fitness. The project employs a qualified physical activity co-ordinator to work with a range of local community groups and with individuals referred for health reasons.

Gaalbaat, West Lothian

Gaalbaat is a small project focusing on health, fitness and beauty for women from ethnic minority communities in West Lothian. It aims to combat social isolation and build confidence and social contact. Gaalbaat is supported by the Community Safety Officer in the local Police Service and by the Council's Equality Officer. The group was formed to encourage women from ethnic minorities to take part in health and fitness activities. It is now often approached by local services as a way of making indirect contact with women who might not otherwise directly access services and resources.

Priorities for action in local communities

• Greater attention to what is local and particular, to align services and developments with natural affinities of citizens to places and to cultures
• Capacity building with decision makers to engage effectively and listen
• Developing the role of public services in providing formal support for informal networks
• Making use of opportunities within community planning and health improvement to take a more holistic approach to community needs
• Recognising and nurturing capacity for voluntary activity with local communities as a resource to tap

Mental health and well-being of people who use care and support services

Discussions in each of the three local areas involved groups who used health and social care services, and those who were carers of people who used services. These discussions explored people's views about services to address health care and support needs as well as the wider issues about mental health and well-being. Discussions in some places were strongly coloured by deeply held feelings of frustration and disappointment at shortfalls and deficiencies in service provision. This dissatisfaction had several aspects:

• The repeatedly expressed need for more flexibility in the hours when services are available, particularly outside of standard office hours. This issue was raised by people with mental health problems
• Loss of faith in service providers arising from the experience of some sets of carers of being worn down by having to fight for services, of being 'fobbed off' and having to 'keep going back'
• Continuing gaps in information, involvement and communication to enable people with support needs to make choices, to take part in shaping the development of services and to get a response when they participate in consultation exercises
• The need to tackle barriers that impede access, including language and cultural barriers, with greater availability of interpreters, using trusted groups and organisations as a way of bringing services closer to people from ethnic minority communities
• Limited opportunities for inclusion in mainstream places, activities and resources, e.g. support for people with a learning disability to use community facilities or to get into work

In relation to the steps that can be taken to maintain well-being, people talked about the importance of social and physical activity, good food, time for themselves, finding ways of relieving stress and opportunities to develop and learn.

To build on: working with service users and carers

Mental Health Advocacy in West Lothian is a collective advocacy project. The project enables local users of mental health services to have a voice in local service development and to take part at national level. The work is rooted in the experiences of local service users across the area. A network of advocacy representatives drawn from mental health services across West Lothian acts as a conduit for ideas and information, linking into service planning and development locally.

Priorities for action

• More attention to what services can do to promote and develop capacity for self-help and peer support
• Evidence of progress in how local agencies respond to the expressed needs of those who use services

Mental health and well-being of children and young people

Regardless of the age group and setting, discussions about mental health and well-being often honed in on concerns about younger generations, their prospects for the future and the resources they required to thrive as they developed into adults.

There was much discussion about the difficulties and challenges that young people face growing up in our society. Growing up in modern times can be a frightening and bewildering process. What is important is to enable children and young people to be able to find a language and a vocabulary to discuss their fears and anxieties without having to resort to harmful means of self-expression. For example it is important to ensure that as they grow up, young people learn how to consult a health care worker about a health issue, and get used to doing this without their parents.

It was noted that young people often lack role models or 'guides' within their local community, to learn about managing transitions and about coping with loss, change and challenges. The increasing atomisation of our communities was seen to make it more difficult to create intergenerational contacts and support. Fear about the safety of children and young people can lead adults to shield them from experiences and opportunities that are important for learning and for developing independence. Discussions also highlighted the worries held by parents and grandparents that the lack of good prospects locally for housing and employment would drive young people away. Behind that also was a lack of hope and of a sense of the future.

Key issues that emerged from these raft of discussions with local community groups and with people working in services included:

• The importance of the attitudes and values embodied in service relationships with young people. Young people have tended to have limited opportunity to participate, or to shape and influence what services offer
• Looking at what can be done to support young people in a range of settings, not only through and in schools, and the importance of working with young people on their territory and on their terms
• Recognising the weight that young people attach to peer relationships and giving greater attention to peer support as a resource to be harnessed
• The need to be prepared to commit to long-term planning, to allow innovation at the margins to be integrated into mainstream strategic thinking and working practices.

Overall, promoting the mental health and well-being of children and young people was thought to require:

• Creating conditions where children and young people are able to thrive
• Working to the principle that children and young people have the right to participate and to be treated with respect
• Awareness-raising to confront the myth that childhood is a time of happiness and health
• Provision of information and advice on a broad array of issues in relation to health and well-being
• Means of identifying problems early and facilitating access to support and help, from a range of sources
• Promotion of emotional health, opportunities for children and young people to develop coping skills, reinforcement of self-worth
• Training required for staff who work with young people to be able to tackle this agenda effectively
• Ensuring effort is targeted at groups of young people at increased risk, e.g. looked-after children. This should also include interventions upstream to prevent family breakdown and support families and communities

Investing in the well-being of children and young people: to build on

A Youth Counselling Service has recently been established in the New Community Schools in East Renfrewshire, funded by the Changing Children's Services Fund. This aims to make school more accessible for young people and to make it easier for them to talk about issues. The service is self-referring and can act as a conduit to specialist help. It is intended that counselling staff will also have a training and development role to enhance staff skills and to develop the curriculum in mental health.

Family First has a network of seven projects across Highland. The project in Badenoch and Strathspey works with families to develop their capacity to become independent and confident contributors to their community. The project offers a support service provided by trained volunteers to families with children under the age of 4. Volunteers, who act as befrienders, help reduce the isolation young families can experience. For families who have special needs, volunteers augment the support provided by other services.

The Social Inclusion Partnership in West Lothian has a particular focus on assisting young people moving from school into work. Local research into the barriers to employment for young people indicated that employers found young people coming straight from school into work to have low self-confidence and self esteem. The SIP was encouraged to undertake preventive work and to develop job readiness with young people.

Priorities for action

• There needs to be a commitment among services who work with children and young people to build personal influence, self efficacy and confidence from the earliest age
• Building capacity among decision makers to engage with and listen to young people within our local communities
• Greater support for parents of teenagers and for teenagers. Parents face difficult challenges in the teenage years in judging the level of attention and supervision and support their young person requires to thrive
• Reviewing the pastoral care and support for young people in schools
• Enhancing capacity for peer support among young people in a range of settings
• Developing a greater range of amenities and resources that young people would use: clubs and places to meet informally with minimum supervision; facilities such as skate park, internet café, holiday schemes: balancing the need to ensure young people are safe and at the same time can enjoy freedom appropriate to their age