Mental Health Policy in Scotland An overview

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• Scotland
• Population 5.1m
• 32 Local Authorities
• (Social Work, Education, Housing,
• Employment Support)
• 15 Health Boards
• (Secondary Care Hospitals and
• Community Services)
• State Hospital (220 Beds)
• 42 Community Health Partnerships
• (Primary Care)
• NGOs
• User and Carer Groups

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Scale of the Challenge

• One in four people will suffer a mental health
  problem at some time in their lives.
• 30 of GP consultations (primary care) are for a
  mental health problem.
• 2 rate of psychosis.
• Anti-depressant prescribing rise x10
• Influence of substance misuse.
• Suicide rate of 17 per 100,000 population
• Unemployment, physical health, incapacity
  benefits (social exclusion and inequalities)

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Finances

• Mental Health Services
• 952 million euros per year on services (187 euros
  per head of population)
• Balance of care 60 40
• Central Government Service Development Funds
• 60 million euros per year (12 euros per head)
• Public Mental Health Funds
• 13 million euros per year (9 euros per head)
• Mental Illness - Cost to the Economy 11 bn euros
• (15 in care costs only)

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Presentation

• A Proposition
• Recent Scottish Mental Health History
• Current Mental Health Policy in Scotland
• Challenges and Opportunities
• Care Programmes Some Considerations
• Lessons Learned?

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A Proposition

• Mental health and mental illness need to be
  understood and addressed within the social,
  political, environmental and economic context
  within which they take place.
• Without this approach, attempts to improve
  services and improve the quality of life of
  people experiencing significant mental illnesses
  will only be partially successful.

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Recent Scottish History

• Late 1990s mental health policy a mental
  health services framework
• 1999 New Scottish Parliament (political
  interest)
• Review of policy (need for a comprehensive policy
  a population approach)
• Review of legislation (stigma, discrimination,
  principles, rights and reciprocity)
• Grass roots and user and carer concerns
• Move away from maintenance agenda to one of
  inclusion, recovery, living life

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(No Transcript)
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Current Mental Health Policy 1

• Promotion of positive mental health and
  well-being
• Public awareness and literacy of mental health
  problems and mental illness (anti-stigma and
  discrimination, mental health first aid)
• Prevention (including suicide prevention)
• Modern care and treatment services (QOL and
  recovery orientation for severe mental illness)
• New Legislation - Care and Treatment Act
  (safeguards, reciprocity, appeals)

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Current Mental Health Policy 2

• Self help and social prescribing
• Improving the quality of life of people
  experiencing illness (Section 26)
• Arts and culture
• Physical health and activity
• Educational opportunities
• Vocational focus and employment support

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Challenges

• Poor information systems
• Setting of standards but poor performance
  monitoring (lack of explicit targets and
  outcomes)
• Underdeveloped care pathways (right time, right
  place, right mix of interventions, client
  centred?)
• Acute inpatient mix and lack of continuity of
  care
• Gaps in services
• Joint Working
• Workforce issues (support, capacity and skills)

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Opportunities and Risks

• Influence of wider policy agendas
• Role of Government leadership? facilitate,
  support innovation and development
• Balancing risks and rights (Mental Health
  Tribunal) and getting real on scale
• Moving from deficit model to capacity

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Care Programmes some FAQs

• Patient or person (with a life history)?
• Diagnosis, disorder or living life day to day
  (QoL)?
• Professionally led or client centred?
• Maintenance or recovery outcomes?
• Risk averse or risk management?
• Exclusion or inclusion? (Outcomes keep it
  simple)

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Some Lessons

• Care programmes are a tool and care is a
  means to an end.
• Opportunities can be created
• Make the case for a wider approach (lobbying,
  social marketing, real life stories)
• Create a powerful coalition
• Develop and communicate a vision
• Involvement is key there is no substitute
  (involve those with experience)
• It is possible to change the social context!

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Shifts in attitude 2002-04
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CONTACT

• www.wellontheweb.net