Updated March 2021
by David Bradwell
Good mental health is a fundamental part of individual, communal and societal wellbeing. In the UK, mental health disorders account for almost a quarter of the total burden of ill health. There is a well-documented burden of mental health disorders following disasters, including evidence from previous viral outbreaks https://www.nuffieldfoundation.org/project/covid-19-social-study. Institute for Fiscal Studies analysis of longitudinal data from the Understanding Society study found that, taking account of pre-pandemic trajectories, mental health has worsened substantially (by 8.1% on average) as a result of the pandemic https://www.ifs.org.uk/uploads/The-mental-health-effects-of-the-first-two-months-of-lockdown-and-social-distancing-during-the-Covid-19-pandemic-in-the-UK.pdf. Moreover, groups have not been equally impacted; with young adults, women and those from socially disadvantaged backgrounds being hit hardest. This briefing will look at the related issues of mental wellbeing, mental health services, and suicide, before suggesting further reading and potential questions you can ask election candidates.
While mental ill health can affect anyone, evidence suggests that it is not equally distributed across the population. Adults living in the most deprived areas are twice as likely to have common mental health problems as those in the least deprived areas (22% versus 11%) http://www.healthscotland.scot/media/1626/inequalities-briefing-10_mental-health_english_nov_2017.pdf. There were more than twice as many GP consultations for anxiety in areas of deprivation than in more affluent areas (62 versus 28 consultations per 1000 patients in 2010-2011) http://www.healthscotland.scot/health-topics/mental-health-and-wellbeing/overview-of-mental-health-and-wellbeing.
The link between social status and mental health problems is thought to result from the level, frequency and duration of stressful experiences and the extent to which social and individual resources and sources of support reduce their impact.
Stressful experiences occur across the life course and include:
- poor housing
- family conflict
- childhood adversity
- chronic health problems
- social isolation.
Many of these experiences have been exacerbated during the pandemic. In addition to presenting new or enhanced stressors, the pandemic has diminished many of the mechanisms people typically use to cope with stress. Coping mechanisms such as exercise, access to outdoor space, meeting with family and friends, or feelings of achievement through work or volunteering have reduced or stopped during the pandemic. Again, this change has often been more severe in less affluent areas.
Mental Health Services
While mental health is determined by much broader factors than access to mental health services, these are critical for people experiencing mental illness. Services were already stretched with many providers reporting an inability to meet the demand rising prior to the pandemic, and lockdown is adding pressure that is likely to increase in future  … Continue reading.
The Royal College of Psychiatrists reports almost half of psychiatrists have seen increases in urgent and emergency cases during lockdown, but also that a similar proportion have seen falls in routine appointments Psychiatrists see alarming rise in patients needing urgent and emergency care and forecast a ‘tsunami’ of mental illness (rcpsych.ac.uk). There are fears people are staying away until they reach crisis point, which will result in a flood of exacerbated and untreated mental illness after the pandemic. The charity Mind has found that almost a quarter of people who tried to access mental health services during a fortnight in April failed to get any help Mental health charity Mind finds that nearly a quarter of people have not been able to access mental health services in the last two weeks | Mind.
Over the last decade, suicide rates in Scotland have been declining (falling by 19% in 10 years), but the last two years have seen suicide rates begin to rise again. In Scotland, roughly two people die by suicide every day. While suicide affects all communities, we know that particular groups are at increased risk. As with mental ill health more broadly, suicide is also strongly linked to poverty, with people living in our most deprived communities over three times more likely to die by suicide. Men are three times more likely to die by suicide than women. 43% of probable suicides in Scotland in 2018 were people aged 35-54 years old. Worryingly, in 2019 we saw an increase in young people dying by suicide.
While these background factors are important, it is true that many people who experience these background factors do not seek to end their life, and that there are others who are not in these at-risk communities that do. The Integrated Motivational Volitional (IMV) model, favoured by the Scottish government, identifies experiences of defeat, humiliation and entrapment, as being significant in motivating suicidal thoughts.
Suggested questions for candidates
- How will you / your party work to promote better mental health and wellbeing for the whole population?
- How will you / your party prevent mental ill health and distress in communities and groups at highest risk?
- How will you / your party provide an appropriate choice of support, care and treatment in the right place and at the right time for those experiencing severe mental ill health?
- Scotland’s Mental Health Partnership: Scottish Parliament Election Manifesto 2021
- SAMH 2021 Manifesto
We would like to know how this guidance was useful and what should be added or changed for future publications.
If you have questions, suggestions or comments please email us.
Article updated March 2021 by David Bradwell