Scottish Government

CHAPTER ONE: INTRODUCTION

Policy background

1.1 According to the World Health Organisation ( WHO), 450 million people worldwide are affected by mental, neurological or behavioural problems at any time ( WHO, 2003). In Western society depression, anxiety and stress are the most common mental health problems. Indeed, the WHO anticipates that depression will be the number one disability by 2020.

1.2 In Scotland, around a quarter of the population can expect to experience a mental health problem at some point in their lives. While this rate is in line with the UK average, other evidence suggests that Scotland faces distinct challenges in terms of tackling mental ill-health. For example, the rate of prescription of anti-depressants is higher in Scotland than in other parts of the UK and, indeed, increased from 1.5 million in 1995-1996 to 2.8.million in 2000-2001 (Munoz-Arroyo, Sutton & Morrison, 2006). Other evidence suggests that between a quarter and one third of all GP consultations in Scotland are related to mental health problems. The economic impact of mental ill-health cannot be understated. In 2004/05, the total cost of mental health problems in Scotland was £8.6 billion ( SAMH,2006). And, according to the Health and Safety Executive, stress-related illness alone loses the UK industry 13 million days a year costing £3.7 billion annually to society as a whole ( SEU, 2004).

1.3 Throughout Europe, the scope of mental health policy has broadened to include mental health promotion and prevention as well as the treatment of mental disorders (Muijen, 2006). This is illustrated by the consensus reached at the WHO European Ministerial Conference on Mental Health, where the 52 member states endorsed the Mental Health Declaration and Action Plan for Europe ( WHO Regional Office for Europe 2005). The declaration highlights 12 areas for action and a number of priorities - among these, increasing awareness of the importance of mental wellbeing and the need to tackle stigma, discrimination and inequality are particularly pertinent.

1.4 The WHO conference invited the European Commission, a collaborating partner of the conference, to contribute to implementing the Action Plan, in line with its competencies. In response, the Commission produced the Green Paper Improving the Mental Health of the Population: towards a Strategy on Mental Health for the European Union (European Commission, 2005). The paper proposes to establish an EU-strategy on mental health which would add value by: constituting a framework for exchange and co-operation between Member States; helping to increase the coherence of actions in the health and non-health policy sectors in Member States and at the Community level; and allowing the involvement of a broad range of relevant stakeholders into building solutions. Following a consultation on the Green Paper, the Commission is currently drafting a Communication setting out a strategy on mental health.

1.5 In parallel with these developments, the Scottish Executive has continued to place mental health as a priority in its health agenda. The Health White Paper Partnership for Care ( NHS Scotland, 2003) highlighted the importance of linking across areas of public policy and involving all stakeholders in actions to promote good mental health and reduce health inequalities within society. Improving Health in Scotland: the Challenge (Scottish Executive, 2003), published to accompany the White Paper, set out a framework of action for the Scottish Executive, NHS Health Scotland and partner agencies. More recently Delivering for Health (Scottish Executive, 2005) and Delivering for Mental Health (Scottish Executive, 2006) signalled the Scottish Executive's continuing commitment to promoting mental wellbeing and resilience in the general population, and improving the physical health and mental wellbeing of those who experience mental ill-health. The latter is organised around 14 delivery commitments ranging from improving patient and carer experience of mental health services to the better management of long-term mental health conditions and early detection and intervention in self-harm and suicide prevention.

1.6 The National Programme for Improving Mental Health and Wellbeing is a key component of the Executive's action in this area. The Programme was launched in October 2001 with the aim of helping to improve the mental health and wellbeing of everyone living in Scotland and to improve the quality of life and social inclusion of people who experience mental health problems and illness. Since 2003, the main aims of the National Programme have been to raise awareness and promote mental health and wellbeing; eliminate stigma and discrimination; prevent suicide; and promote and support recovery from mental ill-health.

1.7 To help inform the work of the National Programme, as one part of the Executive's Health Improvement actions, the Scottish Executive commissioned the first National Scottish Survey of Public Attitudes to Mental Health, Mental Wellbeing and Mental Health Problems in 2002. The main topic areas covered in the survey were as follows:

• self-assessed general health and lifestyle
• understanding of factors affecting mental health and wellbeing
• experience of mental health problems
• attitudes to mental illness and to people experiencing mental health problems
• sources of information on mental health issues
• awareness of Scottish Executive mental health improvement initiatives and promotional activity

1.8 The survey was designed to give a baseline set of data at the beginning of the National Programme's work and for the survey to be repeatable in order that it could be used to track progress and help influence future work towards the achievement of specific outcomes and objectives, namely:

• increased public awareness and understanding of mental health, mental wellbeing mental health problems and mental illness
• improved public mental health 'literacy'
• positive changes in attitudes towards people who experience mental health problems and illness.

1.9 The survey was run again in 2004 using a slightly altered version of the questionnaire to reflect progress in the National Programme's agenda.

1.10 Since the 2004 survey was conducted, there have been a number of developments in the mental health improvement policy arena in Scotland with the number of campaigns, initiatives and promotional activity associated with the mental health improvement agenda growing. Most notably:

• the Scottish Recovery Network ( SRN) was launched towards the end of 2004 with the aim of engaging communities across Scotland in debates and action on how best to promote and support recovery ⁴ from long-term mental health problems
• during the same period, training for suicide intervention using ASIST (Applied Suicide Intervention Skills Training) and the 'Breathing Space' advice line for people experiencing low mood or depression were rolled out across Scotland
• 'see me…', the national anti-stigma campaign, developed a campaign aiming to reduce and eventually eliminate stigma and discrimination around mental health in the workplace
• Scotland's Mental Health First Aid training was launched nationally in 2005, following the evaluation of a pilot study
• 'HeadsUpScotland', the national project for children's and young people's mental health was funded by the National Programme for two years from May 2004 to April 2006 and funding extended for 2006-08
• £8.4 million of additional funding was allocated to 'Choose Life', Scotland's national strategy for suicide prevention and reduction, for the period 2006-2008
• 'Artfull', the initiative to promote the arts in improving mental health and wellbeing was launched in 2006
• Funds were invested in the Health Promoting Schools Unit to progress support and actions on the promotion of emotional and mental wellbeing within schools

1.11 Against this backdrop, the third National Scottish Survey of Public Attitudes to Mental Health, Mental Wellbeing and Mental Health Problems was commissioned in 2006. As in 2004, the questionnaire was refined for the 2006 survey to take account of the policy developments outlined above.

The 2006 survey - research aims and objectives

1.12 As in 2002 and 2004, the overall aims of the survey were to examine the views and experiences of a representative sample of the adult Scottish population (reflecting age, gender, income, location, race and ethnicity diversity) in relation to a spectrum of mental health-related issues; and to compare findings with other relevant survey data. Specific objectives of the 2006 survey were to:

• Investigate people's perceptions of their own general health and lifestyle
• Explore people's understanding of the concepts of mental health and wellbeing, and their assessment of factors affecting their own mental health and wellbeing
• Investigate people's direct experience of mental health problems and recovery from mental health problems
• Investigate people's sources of information on mental health issues
• Explore people's awareness and understanding of promotional activity associated with mental health improvement work through the National Programme's main initiatives and areas of work
• Explore people's attitudes to mental health problems, including the stereotypes and myths surrounding mental illness
• Explore people's attitudes to those who experience specific symptoms of mental ill-health
• Compare findings with the 2002 and 2004 surveys and, as far as data are comparable, with findings from similar surveys (and from relevant components of broader surveys) carried out in Scotland, in other parts of the UK and internationally

1.13 The next chapter describes the methodology adopted for the research and Chapter 3 describes the profile of the survey sample. Subsequent chapters present the main findings from the survey, making comparison with the 2002 and 2004 surveys, as well as drawing comparisons with other similar surveys conducted elsewhere in the UK and overseas.