Underpinning the mental health strategy is the need to address inequalities, consistent with the aims and priorities of equally well [PDF: 514kb]. Mental wellbeing is influenced by biological, psychological, social and environmental factors, which interact in complex ways. Environmental factors include inequalities in life circumstances; good living environments, housing, transport, education and a supportive political structure. Community also affects mental wellbeing, such as a sense of belonging, social support, a sense of citizenship and participation in society. Perceptions of racial discrimination, for example, have been identified as a significant factor in the poor health of Black and ethnic minorities, over and above the contribution of socio-economic factors. Populations at most risk from social exclusion are more at risk of developing mental health problems, including those with limited opportunities for employment; women; racial and ethnic minority groups; refugees; sex workers; people living with disabilities, addictions or chronic illnesses; homeless people; and older people living on reduced income. There is a need to target groups facing the greatest inequalities and challenges to take account of the 9 equality strands:
For more information, NHS Health Scotland's equalities pages [external site].
The Annual Scottish Labour Force Survey 2004/05 [PDF: 502kb] found that 76 per cent of people with a mental health problem are unemployed. This figure is higher than for other groups with a disability or health condition. Minority ethnic groups are, however, less likely to have mental health problems detected by a GP. See Inside Outside: Improving Mental Health Services for Black and Minority Ethnic Communities in England [PDF: 206kb]
A report by the European Healthy Ageing Project identifies a number of cross-cutting areas for action to address equality and diversity in later life. It is vital that mental health improvement in later life takes equality and diversity of ageing into account and considers gender, sexuality, race, disability and spirituality. Such actions must be fully inclusive of the particular needs of older people from different groups. Although many older people in Scotland are healthy, a significant number are at risk of inequalities with regards to mental wellbeing and mental health problems. People at most risk are those in their 80s and 90s-plus from ethnic minority communities, with poor physical health, who are on a low income, and with limited social and community contact
A particular focus on deprived communities is needed, as people living in such areas are more likely to:
Physical and social regeneration of communities has an important role to play in mental health improvement. Objectives are to improve employability, education, health, access to local services, safety and the quality of the local environment in the most deprived neighbourhoods. Improvements in the 15 per cent most deprived areas in Scotland are to be achieved through use of a Community Regeneration Fund [PDF: 53kb].
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