Samaritans Scotland responds to Mental Health in Scotland consultation

A ten year strategy for mental health provides the opportunity to transform mental health in Scotland. In order to do just that, we need a bigger, bolder vision says Samaritans Scotland.
 
1 Our framework sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years.
Are these the most important priorities?
No
 
If no, what priorities do you think will deliver this transformation?:
Samaritans Scotland welcomes the opportunity to respond to the Scottish Government’s consultation on a proposed framework for the next ten years of mental
health in Scotland. Samaritans is the leading suicide prevention charity in the UK and ROI. Last year we dealt with around 5.4 million contacts from people who
needed our trained listening volunteers across the nations, including around 300,000 of those in Scotland. We also play a role in encouraging and supporting
suicide prevention activities at local and national levels based on our insight and expertise in this area.
 
We are members of the Scottish Mental Health Partnership, a coalition of third sector mental health organisations, service providers and professional bodies
working together to promote mental health awareness and improve outcomes for people experiencing mental health problems.
 
While there has been success in bringing down suicide rates in Scotland over the past decade, there were still 672 deaths by suicide in 2015 and the rate in
Scotland remains higher than the UK as a whole. Suicide is the single biggest killer of men under 50 in the UK and of young people aged 20-34. The data also
shows a strong and clear relationship between deprivation and the overall suicide rate in Scotland, with those in the most deprived 20% of the population three
times more likely to take their own life than those in the least deprived 20%.*
 
We do not believe that these priorities will deliver a transformation in mental health. We, along with members of the Mental Health Partnership, feel that there is a
distinct lack of vision in the proposed framework. The Scottish Government’s stated aim is to ‘transform’ mental health in Scotland and a 10-year view provides a
real opportunity to do just that. However, that aim is not reflected in this document. If taken forward in this form, we believe there would be little change in
Scotland’s mental health after a decade of work, which is a truly wasted opportunity. We would therefore strongly welcome the Scottish Government delaying the
publication of the strategy in order to allow for time to consult fully and consider what it would like to see in ten years’ time.
 
In order to travel towards a mentally healthy Scotland we need to move from a system of crisis management to ensuring that Scotland is mentally well. That
fundamentally means moving from solely looking at service provision to the emotional health and wellbeing of Scotland’s communities. The priorities set out in the
framework are not ambitious enough to deliver that result. That is not to say they must simply be an over-reaching statement of intent, rather we can look to the
longer term while setting out specific actions against timelines and necessary funding. Public Health England’s Five Year Forward View for Mental Health is a
good example of a detailed approach which works towards transforming the mental health of a nation.
 
While suicide is not merely an issue of mental health, it is one the many different factors which can interact in complex ways to result in someone taking their own
life. While we strongly welcome the commitment as part of this strategy to a new and distinct Suicide Prevention Strategy, we feel there is merit in including a
commitment to suicide prevention and actions to support a continuing reduction in suicide within the Mental Health Strategy. Such a link across from the Mental
Health Strategy to the Suicide Prevention strategy makes sense for the 59% of people in the ScotSID report who had a mental health drug prescription in the year
prior to taking their own life. To work most effectively the mental health and suicide prevention strategies should not sit entirely separately; rather government
strategies work best when they complement and take account of each other, particularly in these overlapping areas.
 
Addressing the link between suicide and deprivation:
One area which would clearly benefit from this is the link between suicide and socioeconomic deprivation. Despite success in bringing down suicide rates in
Scotland over the past decade, the difference in the rates between the most and least deprived people in Scotland persists. Socio-economic position can be
defined in many ways – by job, class, education, income, or housing. Whichever indicator is used, people at the bottom are at higher risk of suicide. Indeed, our
Men, Suicide and Society report found that disadvantaged men are 10 times more likely to take their own life than affluent men.** This clear and persisting link
between socioeconomic deprivation and suicide means that it is time to start tackling suicide as both a mental health and an inequality issue. Given the range of
factors that can contribute to this, it would make sense for this to be addressed across both mental health and suicide prevention strategies. We would therefore
welcome a strategic commitment that links across both strategies to tackle this in the most effective way.
 
Community outreach:
Samaritans Scotland, like many other third sector organisations provides a key service to communities across Scotland. This includes operating a listener scheme
in all Scottish prisons, our UK wide partnership with Network Rail and being there to help children and young people prepare for life's challenges by running
workshops and providing materials for schools. We also support secondary schools in the aftermath of a suicide, through our Step by Step service. Some of our
branches provide a referral service which allows GPs, mental health units and Police to refer an individual to Samaritans, as well as our volunteers attending A&E
departments to support those experiencing real emotional distress.
 
We currently receive no direct funding from Scottish Government to provide our service, yet our more than 1000 volunteers give 260,000 hours of their time a
year, valued at over £3.5 million. A similar story is true of many other third sector organisations, who provide key services to the community. We believe that the
outreach work that these organisations provide will be central to transforming mental health in Scotland. Rather than continuing to focus on primary care we must
look to making mentally healthier communities, which ultimately are supported and transformed through outreach.
 
2 The table in Annex A sets out a number of early actions that we think will support improvements for mental health.
Are there any other actions that you think we need to take to improve mental health in Scotland?:
Yes. Suicide is often considered to be a combination of vulnerability, environment and life events. In order to really address suicide rates then we need to promote
protective factors which will help people to cope with life’s challenges. A key strand of this has to be focused at our young people, ensuring that they are equipped
to build resilience against suicide’s risk factors throughout life. While we are therefore encouraged to note the proposals for ‘prevention and early intervention’ for
young people within the proposed framework, we need to go to go much further on prevention. If we promote protective factors that allow people to adequately
cope with some of life’s challenges, then this really could save lives.
 
Similarly, while the proposal to promote good mental health through work with children’s services is to be welcomed, we feel there would be real merit in going
further. Schools are in a unique position to promote mental health among young people and therefore the promotion of emotional health and resilience in schools
can act as a key form of prevention and early intervention across the population. While Curriculum for Excellence includes health and wellbeing as one of the
eight areas contributing to experiences and outcomes, a clear focus as part of the curriculum on developing emotional awareness could have a lasting impact
across generations.
 
Young people in Scotland have some of the highest rates of health and social inequality in Europe and North America (including life satisfaction).*** Affluence
should not be a determinant of how the happiness or wellbeing of a child in 21st Century Scotland, yet we know that the less affluent you are the more likely you
are to take your own life in Scotland.**** In this way, suicide remains an unjust and avoidable difference in length of life that results from being disadvantaged.
There is however evidence to suggest that protective factors can offset health inequalities, with schools and the school environment acting as a key protective
factor.***** By promoting emotional awareness within schools we can encourage a supportive environment whereby children learn how to face life’s challenges. In
giving prevention this focus and commitment we can work towards ensuring that the health and wellbeing of our young people is not determined by the salary or
education status of their parents -nor is the length of their life.
 
3 The table in Annex A sets out some of the results we expect to see.
What do you want mental health services in Scotland to look like in 10 years' time?:
We want to see mental health in Scotland move from crisis management towards prevention and the promotion of good mental health and wellbeing for all. We
want to see mentally well young people equipped with the emotional skills to deal with life’s challenges and support each other. We want to see more equal
communities in regard to health and wellbeing and far fewer of them affected by suicide.
That is all out of our reach if we continue to focus overwhelmingly on services for those who present with mental ill health.
 
Summary:
Samaritans Scotland, as many others, want to see a bigger, bolder vision. Rather than focusing, once again, our resources on health services, we have the
opportunity with a ten year look forward to reach for a step change in mental health. The Scottish Government should be bold enough to take the time to really
consider what this should look like and not commit itself to producing a strategy before the end of 2016.
 
  • We believe there is merit in featuring suicide prevention as a priority within a Mental Health Strategy, as part of a wider focus towards mentally healthy communities.
  • Outreach work within communities is key to transforming mental health in Scotland as should be considered as part of a more ambitious vision.
  • The link between suicide and socioeconomic deprivation can most effectively be tackled across both mental health and suicide prevention strategies.
  • We need to extend the well intentioned work across prevention for young people through children’s services. Schools are in a unique position to promote mental health and emotional well-being among young people and allow them to gain crucial protective factors.
  • The Scottish Government is being bold in looking toward the next ten years. It needs to be bold enough to take sufficient time to consider that ten-year vision properly.
 
Keith Walker, Chair of Samaritans Scotland Board and Inverness branch volunteer
Fiona Cochrane, Aberdeen branch Vice-Chair
James Jopling, Executive Director for Scotland
 
* Scottish Suicide Information Database (ScotSID) Report 2016: http://www.isdscotland.org/Health-Topics/Mental-Health/Related-Publicati...
*** Health behaviour in school-aged children (WHO, 2016): http://www.euro.who.int/en/hbsc-report-2016
**** Scottish Suicide Information Database (ScotSID) Report 2016: http://www.isdscotland.org/Health-Topics/Mental-Health/Related-Publicati...
***** Health behaviour in school-aged children (WHO, 2016): http://www.euro.who.int/en/hbsc-report-2016
 
You can view the consulation at: http://www.gov.scot/Publications/2016/07/7151 
 
For more information please contact Jen Gracie, Policy and Communications Officer at j.gracie@samaritans.org 
 

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