Towards a Mentally Flourishing Lanarkshire

TOWARDS A MENTALLY FLOURISHING LANARKSHIRE

Report of a consultation event held on

February 4th2008

CONTENTS

Introductions3

Presentations4

Workshops9

3.1 Early Years10

3.2Young People13

3.3OlderPeople 15

3.4Employment, education and training 18

3.5Equality and diversity 21

3.6People with alcohol or drug problems 24

3.7Recovery, renaissance, social inclusion stigma discrimination 26

3.8Suicide and self harm 28

3.9Spirituality 31

3.10Inequalities in mental health & mental health improvement 32

Evaluation …………………………………………………………………………34
Press Release 36

1.INTRODUCTION

Action taken in Lanarkshire since 2001 to support the National Programme for Improving Mental Health and Well Being has led to many improvements. Lanarkshire is now seen as one of the leading areas in Scotland in this area of work.

The National Programme is now entering the next phase of its work, which involves a greater emphasis on local action to deliver the objectives of nationally agreed policy. This is set out in the discussion document Towards a Mentally Flourishing Scotland: The Future of Mental Health Improvement in Scotland. ( It highlights three main themes for future work:

promoting and improving mental health and mental wellbeing;
preventing mental health problems , mental illness co-morbidity and suicide;
supporting improvements in the quality of life, social, inclusion, health, equality and recovery of people who experience mental health problems or mental illness.

All of this work will be underpinned by action to reduce inequalities.

To contribute to the national debate on the future of mental health improvement and wellbeing, NHS Lanarkshire, North Lanarkshire Council, South Lanarkshire Council and Lanarkshire Links organised a convention which took place in Airdrie on February 4. Around 160 delegates attended from a wide range of backgrounds and sectors including housing, regeneration, voluntary sector, police, addictions, schools, health and social work. Service users and members of the public were also represented. This reflects the reality that mental health improvement is everyone’s business and not something that is restricted to the NHS and local authorities.

They listened to a series of presentations on the future plans and took part in themed workshops which explored potential action that could be taken locally, the support needed to make this a reality and how progress can be measured. It was a very successful day which provided a wide range of ideas to contribute to the national debate.

This report provides a summary of the day’s proceedings.

2.PRESENTATIONS

Alan Lawrie, Executive Director of South Lanarkshire Community Health Partnership, opened his presentation by quoting from a Japanese proverb “none of us are as smart as all of us together.” That is why it was important to get as many views as possible on the best way forward.

Delegates would be asked to focus specifically on identifying

shared actions for local delivery;
the support that will be needed to achieve these objectives;
ways to measure progress.

Alan said Lanarkshire is a place of incredible history but also of significant challenge. One in four people in Lanarkshire – a total of 100,000 – will experience mental health problems at some time in their lives. Rates of depression are rising and affect some 75,000 people. One in 10 children will have experienced mental health problems and 80 people in Lanarkshire commit suicide every year.

There is high levels of deprivation in parts of Lanarkshire that impact on people’s mental and physical health. A total of 140 Lanarkshire neighbourhoods are classed as being amongst the most deprived areas in Scotland. Although unemployment figures are improving slowly through initiatives such as Pathways to Work, they are still above the Scottish average. Addressing the issue of health inequalities remains a huge challenge in Lanarkshire.

The good news is that Lanarkshire has developed a co-ordinated approach to addressing stigma and suicide and promoting recovery. That has been seen in local progress in support of the See Me Campaign which has resulted in local football clubs, employers, the media, the police and fire service all signing up to the campaign. Lanarkshire is one of the leading areas in Scotland for training in suicide prevention.

Alan said the conference marks the start of a new chapter towards a mentally flourishing Lanarkshire.

Gregor Henderson, Director of the National Programme for Improving Mental Health and Wellbeing, gave an introduction to the discussion document Towards a Mentally Flourishing Scotland which proposes the future direction for the next three years. He began by congratulating everyone in Lanarkshire for what has been achieved so far.

Lanarkshire, he said, has established itself as one of the leading areas in Scotland for mental health improvement.

Towards a Mentally Flourishing Scotland seeks to build on the infrastructure and the momentum for change that has already been generated but it does signal a change of focus towards better defined local action. The document proposes that local areas agree commitments for local action, identify the support needed to deliver these and establish ways to measure the progress being achieved. There will be a special focus in all of this work on reducing health inequalities.

This is based on evidence that shows that mental health can be improved, just as physical health can be. The strategy takes a population approach to tackle the issues that are known to contribute to poor mental health such as stigma, poverty, unemployment, isolation, lack of purpose and control. It also includes a greater focus on addressing the things that keep us well and make us resilient to be able to handle the challenges that life throws up. In that way individuals, families and communities will be supported to improve their mental wellbeing which Gregor said will pay off in other areas such as reductions in alcohol consumption, drug misuse and violence, increased productivity at work and better performance at school.

He said the Scottish Government’s priority is to improve health and tackle health inequalities. Responding to the challenge of health inequalities is crucial. People in disadvantaged communities are more likely to suffer from poor mental health and it is vital that support is provided to help them enjoy the same opportunities as the rest of the population.

In the past, mental health has been seen largely as the responsibility of the NHS and the focus was very much on people who were mentally ill. Getting them better was the goal and little attention was paid to the rest of the population. However, the National Programme has changed that thinking and spread the idea of a continuum of mental health from poor mental health (languishing) through to positive mental health (flourishing.) Within this continuum, it is possible for example, for someone with symptoms of mental illness to be flourishing at particular times. The overall aim is to move as many people as possible up the scale and, by doing so, improve the mental health of the whole of Scotland.

We know what contributes to mental well being. It includes having a positive sense of self; good coping skills; supportive relationships; a sense of social belonging; financial security; and having a safe and secure living environment.

Work carried out in Scotland has produced a scale that can be used to measure mental wellbeing. It has shown that 14% of people have good mental well being, 73% have average and 14% poor. This scale will be able to be used by local areas to measure wellbeing in their area and track it over time.

Gregor said there is no simple answer to improving mental health. It will require using different interventions in different communities. Evidence shows that work in early years and family life is important in promoting mental wellbeing and ensuring children have a good start in life. Education and workplace settings are also important. Helping people back into employment and engagement with arts and cultural activity can be crucial. While clinical services will always be important, there is a world of opportunity outside such services.

The national consultation on Towards a Flourishing Scotland will run until the end of February/beginning of March. Each NHS Board area in Scotland has been asked to respond and, once these are analysed, a final report will be produced, together with an action plan. This is expected around June. Investment of £6 million a year for the next three years will support local areas in implementing the plan.

Gregor concluded by saying that the Scottish public is now much more literate and aware of mental health problems because of the work carried out through See Me, Choose Life and other programmes. What is needed now is to promote the same literacy around mental wellbeing.

Professor Phil Hanlon from the University of Glasgowprovided an absorbing and wide ranging overview of work that has contributed to our understanding of positive mental health. He told, for example of a psychiatrist who was one of the few people to survive the horrors of the Auschwitz concentration camp. One of the ways he coped with the conditions was by trying to see beauty wherever he could - even if it was only a fish head in the soupy gruel he was given to eat. Developing an ability to see good in things is an important factor in mental wellbeing.

Phil said positive mental health is a complex thing. It is not about effervescence but more about having an inner resource to find things to be grateful for and to appreciate. Optimism is important but, again, it does not mean having a simple, sunny view of things. It involves believing in the possibility of improvement, even if things are not going well.

Understanding what lies behind mental wellbeing is important because rates of depression and suicide are on the rise. History shows that mental wellbeing improved in line with rising national wealth through the 1950s and 1960s. However it started to level off in the decade after 1976 and has been declining since then. At a time when, as a country, we have never been wealthier, increasing numbers of people suffer from poor mental health. This translates into rising rates of alcohol and drug problems, obesity, sexually transmitted infections and other problems.

Phil said this is a manifestation of a deeper cultural malaise related to individualism (people feel isolated and alone) and consumerism (the pressure to buy the latest things many of which people do not need). The increasingly target driven, competitive world of work can also contribute to this by leaving people feeling they are not achieving. He contrasted this with the days of traditional industries in places like Lanarkshire where work was hard and life was short. At the same time, people had a coherence about their lives and had greater purpose and meaning.

He likened the different components of a person’s life – their public life (job, where they live) their cultural life (interests, activities) and their inner life - to three legs of a stool. Human beings run into trouble when any one of these is out of balance with the rest and they lack the inner resources to cope with the consequences.

However, the science of mental wellbeing shows there are things that can be done to counter this. Exercise has been found to be about as effective as anti-depressants, mindfulness (focussing on the moment) is useful and simple techniques such as writing down three positive things that happened during a typical day can all promote positive mental health.

He said we need to examine and address inequalities and the insidious effects of individualism and consumerism. There is a need to develop skills to dissect and examine what is important in mental wellbeing. The good news is that there is an increasing body of evidence and no shortage of practitioners willing to put it into practice.

Andy Milne, Chief Executive of the Scottish Urban Regeneration Forum said there is a clear understanding now that there is no good health without positive mental health. Regeneration has a clear part to play in this as it is now seen in a much wider context than just housing and employment but encompasses improvements in education, culture and health as well. To make regeneration sustainable, all agencies need to ensure that their activities are linked, targeted and pro-active.

He said a flourishing community did not necessarily have to be a wealthy community. It would be somewhere where people have a sense of place, with internal support networks and links to external support if and when required. Tackling inequality is vital in delivering such a vision as specific action to prevent drug taking, for example, will be of little value unless inequality is addressed.

He identified three particular problems that require action:

low self esteem which has a deep psychological effect on how people see themselves;
social isolation which affects communities as well as individuals;
structural factors such as crime, homelessness and lack of services.

Poverty is strongly linked to all of these issues. However Andy questioned if forcing people to take low paid jobs is the answer. He said not all jobs are good for health and inequality can be exacerbated by moving people into low quality work which can reinforce differences in their status and wellbeing.

He cited the Homeless World Cup as an example of positive change which used the international language of football to help people move forward in their lives. It demonstrates that change is best achieved by working in areas people are interested in. Almost three quarters of those taking part in the Homeless World Cup have changed their lives for the better and just over a third have secured regular employment. The same is true in working with communities where it is important to identify what the community sees of value and build on that. Simple events such as barbecues and quiz nights are a way of encouraging people to get involved.

There are three levels of activity that are important:

local delivery and capacity building – there is a need for local investment to support communities to flourish. However, Andy said he is concerned that insufficient resources are going in to supporting work on the ground;
community planning – the Scottish Government sees community planning as delivering better organised, better targeted services. Andy said if it works it will be great but it is a different approach from the traditional view of community planning which involved building capacity in communities;
national and international context – this principally involves addressing inequality and requires political will to take the necessary action.

In conclusion, he said there is much greater awareness today of the issues around poverty and inequality. There is also agreement that agencies need to work in partnership if they are to achieve their objectives. Regeneration has an important role to play in this as it is about much more than building houses and clearing land. Its main goal is to improve health and wellbeing.

Unfortunately, Professor Steve Platt, Director of the Research Unit in Health, Behaviour and Change at the University of Edinburgh, could not attend the conference to give his presentation on measuring mental health and well being. However, a paper was presented describing the work that has been carried out in Scotland to develop what is being seen as the world’s first validated indicators to measure mental health and wellbeing.

The work has involved developing indicators to measure both mental health problems and positive mental health. There are a total of 55 indicators which include aspects of healthy living, general health, spirituality, social networks and support, feelings of safety, discrimination, financial security, equality, social inclusion, working life and the physical environment in which people live. It has also included developing a new way to measure mental wellbeing – the Warwick-Edinburgh Mental Wellbeing Scale. This is based on a series of questions that will be included in the Scottish Health Survey from 2008 onwards. It will provide an assessment of the positive mental health of the Scottish population and will be used to measure progress over time. It will also help to inform decision making about priorities for action and investment, as well as enabling comparison to be made between different population groups and different geographical areas. The indicators can also be used locally to provide a baseline of the mental health of the population of areas such as Lanarkshire which can inform future action. Further information is available at

3.WORKSHOPS

There were two workshop sessions (morning and afternoon) where groups were asked to address questions relating to specific areas of interest. Each group was asked to focus on

The shared objectives and actions that are needed to create a Mentally Flourishing Lanarkshire;
The national supports that would assist in meeting these objectives;
How progress can be assessed and tracked.

There were 11 groups in total. Delegates were assigned to a group depending on their specialist background. The areas of focus were:

Early Years
Young People
Older People
Employment, education and training
Equality and diversity
People with alcohol or drug problems
Recovery, renaissance, social inclusion, stigma and discrimination
Suicide and self harm
Spirituality
Inequalities in mental health and mental health improvement
Strategic approaches to improving mental health (graphic artist workshop therefore no written feedback available)

The groups were chosen to enable focussed discussion and feedback from a life course and settings perspective but also included disadvantaged and target groups.

This is a summary of the main conclusions of the different groups.

3.1EARLY YEARS

Objective / What action should be taken to meet this shared objective? / What national supports would help to meet agreed objectives? / How can progress (locally and nationally) be tracked and performance assessed?

Improve the mental health of 0-8 yr olds and families.

Identify supports to ensure inclusion, family friendly policies and financial support.
Work with employers to promote family friendly policies and ensure appropriate support is available to those employers who wish to develop and implement such policies effectively.
Provide consistent information.
Develop and enhance screening processes, planning and support.
Examine benefits of increasing community supports i.e. peer support programmes.
Increase competency, confidence and capacity of those working with 0-8 years and families to promote well-being.
Ensure Promote prevention
Publicise universal message.
Promote / /consolidate inter agency working.
Develop community infrastructure via planning to ensure the local environment is conducive to promoting children and family well-being i.e. access to green space, leisure and community activities.

Create a national support network.
Provide information to help raise awareness.
Re-examine current health information and advice.
Establish a national website.
Develop indicators for child and family wellbeing.
Develop a consistent resource focussed on promoting well-being, mental health literacy, self-esteem which is included in nursery and primary school curriculum as standard. Ensure appropriate level of resourcing for the health promoting schools and nursery programmes as this provides the infra-structure and basis for delivering this.
Develop appropriate training programmes for those working with this age group.
Embed appropriate training in pre- registration courses for public health nurses, nursery teachers, teachers and so on.
Develop social marketing materials delivered via the media to raise general public awareness, which is supported by local action.
Use the evidence base to inform the interventions which the Scottish Government are suggesting should be delivered.

Create a single national measurement that can be used in all localities.
Develop a well-being scale appropriate to measure and track improvements in the well-being of early years.
Develop a more robust the evaluation of activities to promote well-being as part.
Process outcomes could be used such as:
Number of nurseries and primary schools registered with health promoting nurseries and schools and number of these schools using mental health and well-being curricular resource.
Number of employers with family friendly policies – assessed via Health Working Lives.
Number of professionals undertaking mental health and well-being training appropriate for this age group.

Reduce children’s experience of inequalities.

Provide support for diet and nutrition.
Develop a clearly defined pathway to navigate through the health system.
Target initiatives at high risks groups ensuring there is an evidence base to support each intervention.

Invest in research to clarify what the message should be.
Provide guidance informed by evidence base.

National measure should be used in a way that allows the analysis of the data to measure improvements across and within communities i.e. What is the increase in well-being in those in deprived communities versus those who are not.
Measure uptake and effectiveness of intervention in deprived communities and groups.

Improve parental mental health in the ante and post natal period and provide parenting support beyond that, when required.

Provide consistent support (same person) to families throughout the ante and post natal period.
Strengthen links with maternity hospitals.
Change perception of what is required as a parent with a focus on well-being and staying well.
Improve screening in ante-natal period and implement pathway of care from conception through to 2 years.
Improve knowledge and competency of those working with expectant parents, families, babies and toddlers.
Don’t forget fathers.

Provide a core module on positive mental health for staff training and development.
How can parent line be made more attractive to parents who require someone to talk to?
SEE ME to focus on reducing stigma around post-natal and ante-natal mental health period.
Social marketing to give a more balanced perspective of parenthood.

Measure satisfaction with services throughout the ante-natal and post-natal period.
Measure implementation of a pathway of care.
Measure well-being through the post-natal and antenatal period.
Consider using specific measures such as those which measure post natal depression or bonding with child.
Remember to include fathers in measurement.

3.2YOUNGER PEOPLE