Healthy Minds

Strategic Framework for Promoting Mental Health
of Adults in Greater Glasgow and Clyde

Final Version, February 2015

This paper sets out a framework to guide and support planning and delivery of mental health improvement for adults in Greater Glasgow and Clyde, in acknowledgement of the high priority placed on mental health as a public health challenge.

It is has been developed in partnership with a network of partners across Greater Glasgow and Clyde, supported by the Greater Glasgow and Clyde Mental Health Improvement Network.

The framework has been ratified by both the Greater Glasgow and Clyde Mental Health Strategic Performance Group and by the Greater Glasgow and Clyde Health Improvement and Inequalities Group, and is offered as a resource to guide planning and delivery of adult mental health improvement across the range of health and social care partnerships of Greater Glasgow and Clyde.

This framework should be seen as complementary to the pre-existing Greater Glasgow and ClydeChild and Youth Mental Health Improvement Framework that was ratified by the Child and Maternal Health Strategy Group in 2012. These two strategic frameworks are intended to support the development of a comprehensive life-course approach to promoting population mental health and tackling inequalities.

Healthy Minds – Strategic Framework for Promoting Mental Healthof Adultsin Glasgow Greater Glasgow and Clyde

Final Version – February 2015

Review Date – February 2018

Paper prepared by: Dr Trevor Lakey, Health Improvement and Inequalities Manager – Mental Health, Alcohol and Drugs, GGCNHS on behalf of GGC Mental Health Improvement Network and GGC Mental Health Improvement Team.

“A key message is that if we are to prosper and thrive in our changing society and in an increasingly interconnected and competitive world, both our mental and material resources will be vital. Encouraging and enabling everyone to realise their potential throughout their lives will be crucial for our future prosperity and wellbeing.”

Mental Capital and Wellbeing – Foresight Report, UK Government, 2008

  1. Introduction and Scope of the Paper

The purpose of this paper is to provide an update on the opportunities to develop mental health improvement for adults and to introduce a framework to guide action planning within Greater Glasgow andClyde. The new framework is offered as a follow on to the approaches set out in the previous policy paper for Greater Glasgow and Clyde, “No Health Without Mental Health”. This paper does not seek to provide a comprehensive analysis of mental health issues within the Board area, nor does it offer detailed proposals on potential future approaches. The focus is on providing a framework for analysis, action planning and delivery across a wide range of service areas and partnerships.

2.Mental Health Improvement Across the Life-Course

There is a strong case, building on a wealth of international evidence, for adopting a life-course approach to the promotion of population mental health. For example it is clear that early life experiences are crucial influence for many aspects of mental and physical health. For example, there is major evidence that adverse childhood experiences can have profound impacts on health in later life, including heightening risks of depression and suicide[1] and there are significant programmes focused on parenting support and allied activity underway.

Similarly, the vital importance of good mental health during childhood and adolescence is well established – being crucial during childhood, but also having a major influence on experiences and outcomes in later life[2].

Both the early years, and the child and youth mental health agenda are major development areas in their own right, with significant multi-agency actions underway (a comprehensive update on progress on child and youth mental health improvement was presented in May 2014 to the Child and Maternal Health Strategy Group).

3.Policy context and case for action on adult mental health

Globally, it is now recognised that mental health problems represent one of the biggest public health challenges, with the WHO noting that mental health conditions account for 23% of the global burden of disease, compared with 16% each for cancer and coronary heart disease.

The policy approach taken in Scotland over the last decade has helped to create significant momentum for enhanced responses to mental health issues, including the introduction of a number of important programmes, such as the Choose Life Suicide Prevention Strategy, the See Me campaign addressing stigma, the Scottish Recovery Network and the Breathing Space telephone support resource – these being complemented by comprehensive local actions. Building on these initiatives recent years have seen additional policy focus on promoting mental health, including Towards a Mentally Flourishing Scotland, and most recently the Mental Health Strategy for Scotland, 2012-2015[3]. This latter strategy has for example placed emphasis on the importance of social prescribing approaches to population mental wellbeing.

Health Scotland, has also provided significant input and impetus to the area of mental health improvement, with developments including policy work, comprehensive work on datasets, research and evaluation, evidence into action work, and workforce development roles (such as leading on delivery of Scottish Mental Health First Aid programme).

This paper does not attempt to replicate the detailed work programmes and resources available via Health Scotlandand allied national agencies, but the Greater Glasgow and Clyde Mental Health Improvement Team is available to help broker links to this wider set of resources and knowledge, as required. This new resource is be geared to providing guidance to Community Planning Partnerships, Health and Social Care Partnerships and other local partnership arrangements.

There are multiple policy connections for the mental health agenda – too numerous to cite here – but the following policy perspectives are particularly relevant to this discussion:

  • With Inclusion in Mind – the Local Authority’s Role in Promoting Wellbeing and Social Development[4]linked closely to duties contained within the Mental Health (Care and Treatment) (Scotland) Act 2003, local authority roles in promoting wellbeing and social development.
  • Christie Commission (Commission on the Future Delivery of Public Services[5])which makes a robust case for tackling inequalities and focussing resources on preventative measures as a key objective of public sector reform
  • Health Promoting Health Service – where there is a renewed appetite within Scottish Government to support health promotion efforts as mainstream elements of delivery of mental health care

While provision of a detailed analysis of mental health issues for the Board area is beyond the scope of this paper, the list below provides a flavour of the range of data sources that are available to guide future action:

  • Economic impact work, such as the finding that social and economic cost of mental health problems in Scotland has been estimated at £10.7 billion per annum, 9 per cent of Scotland’s GDP
  • Detailed mental health specific data, including at neighbourhood level for some indicators, from Glasgow Centre for Population Health’sMental Health Profile– including inequality analyses. These show steep social class gradients for most mental health conditions
  • Stark inequalities in terms of life expectancy and morbidity levels for people with mental health problems
  • Young adults an area of concern – e.g. the Princes Trust Macquarie index – shows major impact of unemployment on mental health
  • Mounting evidence of loneliness and isolation as a major public health challenge – including, but not limited to older people – being socially isolated should be considered as a priority risk factor in terms of impact on mortality[6]
  • There is mental health needs information available on a wide range of groups and communities, such as prisoners and their families, refugees and asylum seekers, LGBT community members
  • Considerable evidence of the importance of tackling mental health issues for people with all forms of long term conditions
  • Data on the impact of stigma on the lives of people with mental health problems, with Time to Change noting 9 out of 10 people with mental health problems report experiencing stigma

4.Introducing the Framework for Adult Mental Health Improvement

Building on positive feedback received on a Child and Youth Mental Health Improvement Framework (devised in 2012), an adult version of this framework has been developed, led by the Greater Glasgow and Clyde Mental Health Improvement Network and the GGC Mental Health Improvement Team. The framework is in now in final format, and will be reviewed in approximately three years time.A range of additional support resources and evidence will bemade available to partners as a means of supporting the on-going development agenda.

This Framework has been designed as a way of bringing together the full range of activity that has been demonstrated as having value in the promotion of good mental health for adults. It builds on the range of policy initiatives summarised above in section 2 and on the growing body of international evidence of effective interventions.

It is designed to be ‘read’ in a bottom-up way, starting with consideration of underlying determinants such as socio-economic factors, moving through social environment issues like challenging stigma and discrimination, then considering health promotion and primary prevention activities, with the upper ‘tier’ of actions being secondary preventative and recovery oriented.

5.Brief illustration of each category of action – rationale and examples of activity underway

In order to guide on use of the framework, Appendix 1, below, provides more detail on each domain of action, including a brief rationale for each and some examples of actions underway in each area. The examples cited are a very small flavour of the major breadth of work underway across Greater Glasgow and Clyde partnerships, with every area already having significant activity and resource in place.

One of the purposes of this framework is to help build on pre-existing activity, to galvanise more comprehensive, sustained approaches to promoting population mental health, drawing on the emerging evidence-base of effective interventions and the evolving picture of population needs and assets.

6. Provisional checklist to guide action planning for mental health improvement of adults – linked to the six domains in the framework

Provided below, using the framework as a guide are a number of potential issues and questions that can guide planning and delivery for adult mental health improvement in the Board area, including at local level:

Overarching issues

The overall consideration is: how will the Board, relevant partnerships and planning arrangements, promote mental health and prevent mental ill health, promote recovery and prevent suicide?

6.1Does adult mental health improvement feature in key policy and planning arrangements? Does this include targeting towards population groups with enhanced risk of poor mental health? Is there clearly identified investment to support this activity?

6.2How do we get a comprehensive picture of mental health issues, needs, trends and potential assets across Greater Glasgow and Clyde (or specific areas / localities) as a means of guiding priorities for action? Are there opportunities to draw together intelligence better?

6.3Are there comprehensive arrangements in place to consult and engage with diverse views and experiences from communities in shaping approaches to mental health improvement?

Tackle Underlying Determinants and Promote Equity

6.4Is there an effective focus on mental health across areas such as anti-poverty, financial inclusion, social inclusion, regeneration and community engagement policies? Could these be strengthened and made more explicit?

6.5Has explicit attention been given in addressing the needs of diverse groups and populations, including adopting approaches such as equality impact assessments (EQIAs)?

Promote Positive Attitudes, Challenge Stigma and Discrimination

6.6What activities that challenge stigma and discrimination for people with mental health problems are underway and how can these be strengthened?

Promote Wellbeing and Resilience with People & Communities

6.7What programmes aimed at promoting community resilience and social connection and talking isolation are in place and how could these be strengthened?

6.8Is there scope to better utilise community assets, e.g. through initiatives like social prescribing?

Promote Wellbeing and Resilience through Work

6.9What workplace related health improvement activity is underway and is there scope to strengthen the mental health aspects of this?

6.10How comprehensive and effective are employability approaches to support people with mental health problems?

Respond Better to Distress

6.11What scope to further progress the work of the Choose Life programmes in the Board area and wider suicide prevention activity; are there plans to address wider issues of support for people in distress, including people who self harm and addressing needs of carers?

Promote Wellbeing for People with Long Term Conditions

6.12Are the range health and social care needs of people with long term conditions fully addressed, and are the needs of their carers addressed?

Appendix 1 – Framework for Adult Mental Health Improvement – Domains of Action and Current Examples of Activity

Action Domain and rationale / Brief descriptor / Examples of actions
Tackle Underlying Determinants and Promote Equity
Rationale: Strong evidence of the links between poverty, disadvantage and challenging social circumstances on mental health status; evidence of stark inequalities in mental health across different social groups / Address underlying determinants of good mental health, including financial inclusion, nurturing early years, healthy environments, active citizenship and participation, and ensure focus on promoting wellbeing of diverse communities / Anti-poverty programmes like Healthier Wealthier Children; mental health training for financial inclusion workers; action on regeneration and the built environment including community involvement in urban design and greenspace initiatives; community media programmes like Mind Waves providing an active voice in sharing news and perspectives; focus on needs of minority groups as part of the overall approach
Promote Positive Attitudes, Challenge Stigma and Discrimination
Rationale:While there have been some signs of progress over the last decade, stigma and discrimination remain powerful negative influences in people’s lives – spanning home, community, services, employment spheres / Promote positive attitudes to mental health and to people with mental illness, raise awareness of mental health issues, reduce stigma and discrimination and promote inclusion, including better access to mainstream services / Awareness raising and staff training on mental health related issues; mental health service user engagement initiatives, including research into impact of stigma; public awareness raising campaigns and initiatives, like the Mental Health Arts and Film Festival; linking with the approaches of the See Me national programme
Promote Wellbeing and Resilience with People & Communities
Rationale:Being socially connected and resilient, both as individuals and communities, are now recognised to be powerful influences on mental health and wider wellbeing
Connects closely to the resilience programme led by Glasgow Centre for Population Health / Develop social connection, tackle isolation, build resilience, strengthen use of community assets - including social prescribing, strengthen self care and peer support / Programmes aimed at building social connection and community building, like Gal Gael, the REVIVE group in Ardenglen Housing Association
Tackling isolation for older people – e.g.Good Moves programme including focus on physical activity
Emerging evidence that new technologies can play a part in helping to build capacities, resources and connections for communities, such as digital assets mapping, digital storytelling, online support forums
Promote Wellbeing and Resilience through Work
Rationale:Good quality work represents an important force in promoting positive mental health, while unemployment and poor quality work are toxic influences / Promote mental health, wellbeing and resilience at work; address employability issues, including those affected by mental ill health / Employability programmes aimed at supporting people with mental health problems
Action to address in-work poverty
Further development of the Healthy Working Lives agenda with respect to mental health actions for staff and managers.
Respond Better to Distress
Rationale: Strong evidence of the links between poverty, disadvantage and challenging social / Improve responses to people in distress, both from services and wider community, including action to prevent suicide and better support for people who self harm / Range of suicide prevention activities underway, coordinated via the Choose Life Programmes and at Board level– workplan in place –.
New training initiative around self harm in place across GGC
Promote Wellbeing for People with Long Term Conditions
Rationale:People with long term mental health problems have significantly poorer health outcomes with an up to 20 year gap in life expectancy; similarly people with other long term conditions are at higher risk of mental health difficulties / Promote holistic health for people with long term conditions –“healthy body, healthy mind”, promote recovery approaches and social inclusion; important to include a focus on carers’ wellbeing as part of this agenda / The Health Promoting Health Service model is attempting to improve holistic health improvement approaches to people with long term conditions, such as current pilot work on physical activity promotion with mental health services; also initiatives like Branching Out (using greenspace as therapy), and use of creative arts approaches like Theatre Nemo; scope to connect further with a wide range of community assets and resources, like sports facilities, walking schemes, arts and cultural activities

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[2] See for example the Foresight programme on Mental Capital

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