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" All agencies have a responsibility to enable people to develop and use the skills to recognise problems when they arise, and learn how to take positive action to sustain and safeguard their own mental wellbeing "

Mental wellbeing and mutuality

People in distress can have difficulty making friends, struggle with getting and keeping jobs, retire early and die prematurely. Distress can come on its own, show itself through drug or alcohol problems or be an unwelcome addition to physical health problems. Evidence has shown that high quality diagnosis and treatment of mental illness by the health service is vital, but it is not enough. Attention to the underlying causes is also necessary if they are not to become the commonest reasons for ill-health and disability in Scotland in ten years time. Concern about the loss of human potential, illustrated by the global burden of depression and levels of distress such as self-harm1 has increased interest in understanding why some populations are mentally healthier than others.

[ Box 1 ] The Foresight Report on Mental Capital & Wellbeing, (2008)2
  • Developing resilience in children and fostering a lifelong capacity for learning.
  • Acknowledging and utilising the experience of older people and encouraging them to play an active role in society.
  • Utilising and not depleting mental capacity of older people.
  • Encouraging the general population to live for the long-term.
  • Early identification of mental health risks - prevention.
  • Best practice for treating difficulties that exist.
  • Improving the evidence base.

Inequalities in mental wealth follow a similar, but not identical, pattern to inequalities in material wealth. Despite hard times and terrible experiences, some people and some populations develop mental health problems less frequently and recover more quickly than would be expected. These populations have higher levels of mental wellbeing and mental capital (see Box 1); levels of trust in other people and active involvement in the local communities are also higher. Society is also more likely to be organised so that, even in the worst of times, people's basic needs for housing, lifelong learning, healthcare, productive activity, and physical security are met.

[ Box 2 ]

What is Mental Wellbeing?
Mental wellbeing - which is sometimes referred to as emotional or psychological wellbeing - is a dynamic state that refers to an individuals' ability to develop their potential, work productively and creatively, build strong, positive relationships with others and contribute to their community4.

What is Mental Capital?
Mental capital can be defined as the stock of cognitive and emotional resources which each individual has at their disposal - a kind of 'emotional bank account' containing individuals' flexibility and efficiency at learning; and their social skills and resilience which can be drawn upon to cope with the stresses and strains of life. In difficult times the stock can become depleted. It can also be invested in and added to4.

The treatment and care for people with mental health problems has already improved dramatically but greater investment in developing and testing interventions to tackle inequalities in mental wealth across Lothian are required. Several specific interventions that individuals and communities are helping us design and deliver are underway.

How do we improve mental wellbeing?

We have to promote a much better understanding of mental health and illness as a society. Programmes such as the 'See Me' campaign are already reducing some of the stigma associated with mental illness.

[ Figure 1 ] A logic model for integrating mental health into chronic disease prevention and health promotion.

A logic model for integrating mental health into chronic disease prevention and health promotion

Source: Lando, J. (2006)3

  • Prevention: Steps to build positive mental wellbeing and prevent its loss are essential. National Institute for Clinic Excellence (NICE) Guidelines focus on building mental capital to strengthen protective factors for positive mental health. These include promoting self esteem and reducing stress. Action to reduce preventable mental health disorders is also needed5. Even simple change can help: for example, there is evidence that a healthy diet and increased exercise can help encourage a positive frame of mind6, 7.
  • Treatment: Psychological therapies can address the underlying causes of a mental health difficulty. Such improvements in patients' mental health have been shown to have a lasting effect. Psychological interventions (for example, Cognitive Behavioural Therapy) can improve psychological wellbeing and lower relapse rates8, 9, 10. The estimated UK cost of £0.6 billion per year to provide psychological therapies to those who might benefit is modest compared with the £12 billion per year currently lost due to individuals' inability to work as a result of anxiety or depression11.
  • Recovery: Individuals who are recovering from a mental health difficulty should be well supported and Lothian is working with the National Recovery Network on promoting and sustaining recovery. User-led initiatives are a vital part of this12.

Who should be responsible for mental wellbeing?

There are many stakeholders in mental wellbeing, including employers, education providers, government, Health Boards, Local Authorities, the voluntary sector, commercial interests, as well as individuals and their families and communities.All of these have a mutual responsibility for mental wellbeing.

At strategic level, evidence for the value of improving psychological wellbeing is being reflected in clinical guidelines and policy. In Scotland, Delivering for Health has highlighted the importance of psychosocial factors and lifestyle choices

The Scottish Government has made a commitment13 to:

  • Increase the range of practical help and treatments available for people with depression;
  • Reduce suicide rates in Scotland by 20% by 2013; and
  • Reduce the number of re-admissions (within one year) for those who have had a hospital admission of over seven days by 10% by the end of December 2009.

It has also identified two key actions to achieve these goals:

  • Working with GPs to ensure the provision of formal, standardised assessment of patients presenting with depression and therapy appropriate to level of need; and
  • Increasing the availability of evidence-based psychological therapies.

NHS Lothian can play a key role in helping to deliver these goals and targets locally. For example, work is already underway to increase access to psychological therapies and to enhance the provision of training for GPs and other practitioners in these areas.

At a more local level, communities and individuals must become aware of what they can and should do to build local mental capital. NHS Lothian staff are working to increase awareness among the general public. This includes support for suicide prevention14 and for social marketing campaigns that continue the drive for de-stigmatisation of mental health issues. NHS Lothian has also launched innovative programmes that develop approaches to mental health first aid and is a Scottish partner in the European Alliance Against Depression. The European Alliance Against Depression works with key local agencies and practitioners to raise awareness of depression and how it can be managed successfully.

Ongoing activity and campaigns include:

  • 'See me' - promoting recognition;
  • Police prevention strategy;
  • Employability;
  • Maternal mental health/perinatal mental health;
  • Equally Well - 'Support from the Start' project in East Lothian;
  • School drop-ins;
  • Keep Well - expansion to include the Access Practice;
  • Black and Minority Ethnic (BME) mental health project;
  • Prison leavers.

Collaboration between all partners - recognising the mutual responsibilities they share - will ensure continued progress. Furthermore, all agencies have a responsibility to enable people to develop and exercise the skills to recognise problems when they arise, and learn how to take positive action to sustain and safeguard their own mental wellbeing. In this way, they contribute to better mental wellbeing not only for themselves, but for those around them, their families, friends and communities.

Key messages

  • The Scottish Government, health boards, local authorities, the voluntary sector, care professionals and the communities they serve must put an appropriate priority on mental wellbeing.
  • Actions aimed at prevention of, and intervention to reduce, mental health difficulties need to be taken. Such actions should also seek to foster and support the building of mental capital.