Improving the lives of those with mental illness

  • Desired outcomes
  • Current evidence
  • Recommendations
  • Case studies

  • The WHO Mental Health Declaration for Europe [external site], the WHO Mental Health Action Plan for Europe [external site] and the European Pact for Mental Health and Well-being [PDF: 408kb] acknowledge that action to address discrimination, stigma and social exclusion related to mental health problems is a priority and a global challenge.

    Those experiencing mental health problems are at risk of serious socio-economic disadvantage.

    Discrimination, stigma and social exclusion experienced by those with mental health problems can occur in virtually all areas of life, but research points to several common areas where efforts can be concentrated for greatest gain:

    • employment, poverty and debt
    • housing and homelessness
    • leisure, recreation and education
    • physical and mental health care
    • family life and social relationships
    • safety and criminal justice
    • the media.

    Work to improve the quality of life of those experiencing mental health problems should focus on involving people in their own treatment, recovery and tackling of stigma and discrimination. Physical health is also a key focus.

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    Desired outcomes

    • Increased population awareness of mental wellbeing and mental health problems.
    • Increased numbers of people recovering to live satisfying and fulfilling lives.
    • Increased social inclusion of those experiencing mental health problems.
    • Reduced stigma and discrimination associated with mental health problems.
    • Improved physical health of those experiencing mental health problems.

     

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    Current evidence

    Discrimination and stigma:

    Discrimination and stigma are significant barriers to social inclusion, quality of life and recovery for people experiencing mental health problems and their carers.

    The Disability Discrimination Act prohibits discrimination against disabled people; however, studies have found that those experiencing mental health problems have been disadvantaged in terms of accessing insurance, welfare benefits, housing allocation, education and employment. See the Foresight report on Mental Capital and Wellbeing [external site].

    There is consensus across the expert and stakeholder communities that major benefits could result if a step-change in attitudes to mental health problems could be achieved.

    Recent work by Thornicroft on stigma, factors contributing to it, and actions needed to ameliorate it, show three core elements: ignorance, accompanied by misinformation; prejudice or negative attitudes; and discrimination or resultant behaviour. A Mental health – conceptual overview [PDF: 1.67mb] has been developed as part of the Foresight project on Mental Capital and Wellbeing [external site] which can be used as a tool for informing interventions.

    Stigma and discrimination associated with mental health problems can be compounded by discrimination related to other inequality issues, including gender, sexuality, race, and disability.

    Social inclusion: A state of science review commissioned as part of the UK Government's Foresight project on Mental capital and Wellbeing, 'Factors influencing recovery from serious mental illness and enhancing participation in family, social and working life', identified a number of areas where people with mental health problems are socially excluded.

    • People with mental health problems are more likely than the general population to be in debt, have difficulty accessing insurance and other financial services and experience inequalities in healthcare treatment and outcomes.
    • People with mental health problems constitute the highest proportion of those on disability benefits, have among the lowest employment rates, have difficulty in retaining jobs when mental health problems occur and are also disadvantaged in the housing market.

    See Mental Capital and Wellbeing [external site].
    A systematic review of vocational rehabilitation for people with severe mental illness concluded that supported employment is superior to prevocational training programmes in achieving competitive employment and spending more time in competitive employment for people with mental health problems. See the report called Vocational rehabilitation for people with severe mental illness [PDF: 664kb] for more information.

    Physical health:

    Those experiencing mental health problems are at risk of poorer physical health: they have a greater risk of heart disease, diabetes, respiratory disease and infections; this group has more smokers, more alcohol consumption, more drug misuse and reduced life expectancy. See Delivering for Mental Health [external site].

    Standards for integrated care pathways for mental health [PDF: 1.48mb] states a general physical health assessment and management of the findings are recorded for service users with serious mental health problems. It goes on to add that services should be provided that address diet, nutrition, exercise, alcohol consumption, drug misuse and sexual health in ways that are responsive to the needs of service users. This includes access to smoking cessation, clinical free dental and optical examination and flu vaccination.

    Improving the Physical Health of People with Mental Illness: Mapping and Review of Physical Health Improvement Activities for Adults Experiencing Severe and Enduring Mental Illness [PDF: 317kb]. The key aim of this report is to provide good quality information that would be helpful in building Scottish workforce knowledge and skills regarding health improvement among the severe and enduring mental illness population, and inform practice

    Recovery: Work to follow a recovery approach, encouraged at a national level by the Scottish Recovery Network [external site] and others, has been enthusiastically adopted across Scotland, evidenced in, for example, the development of local recovery networks and groups, and through roll-out of training and awareness sessions. The Scottish Recovery Network has been working since 2004 to:

    • raise awareness of recovery from long-term and serious mental health problems
    • learn more about the recovery experience, and the factors which help and hinder, and to share that learning
    • share ideas and encourage and support action nationally and locally for the promotion of recovery.

    Recovery is about more than absence of symptoms. This is especially true for people who experience longer-term mental health problems. Research by the Scottish Recovery Network on recovery (Recovery Mental Health in Scotland [PDF: 1.32mb]) suggests a number of key elements:

    • The importance of developing a positive identity, supported by a hopeful outlook, involvement, control and self direction.
    • The need for recovery-supporting relationships.
    • Meaningful engagement in life roles which provide meaning and purpose, at the person's own pace and in their control.
    • The need to ensure easy access to a range of recovery-focused treatments and services.

    A state-of-science review undertaken as part of the Foresight Project called Mental Capital and Wellbeing provides a summary of the scientific evidence of how facets of recovery (a decent home, work, full relationships and a life lived without stigma and discrimination) can be achieved. The authors conclude that interventions to support people with severe and enduring mental health problems recover their lives is a relatively new phenomenon. Much of the research to date has focused on issues such as unemployment and, even here, the evidence is largely from the USA. Much of the research on interventions in other life domains is largely descriptive.

    See the Foresight Mental Capital and Wellbeing website [external site].

     

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    Recommendations

    Discrimination and stigma:

    • Outreach to people with mental health problems from welfare rights and advice services.
    • Support for local advocacy.

    With Inclusion in Mind [PDF: 271kb] offers guidance on the implementation of the duties of local authorities under Sections 25–31 of the Mental Health (Care and Treatment) (Scotland) Act 2003. These sections concern provision of care and support services as well as services to promote wellbeing and social development. These duties have implications for many services delivered by local authorities, not only those directly concerned with social care.

    see me [external site] offers a wealth of information and support with respect to challenging discrimination and stigma.

    Social inclusion:

    • With Inclusion in Mind [PDF: 271kb] offers guidance on the implementation of the duties of local authorities under Sections 25–31 of the Mental Health (Care and Treatment) (Scotland) Act 2003. These sections concern provision of care and support services as well as services to promote wellbeing and social development. These duties have implications for many services delivered by local authorities, not only those directly concerned with social care.
    • Mental health service users are best placed to define what 'social inclusion' means to them, and to decide on the scope of social inclusion. There is therefore a need to ensure that service users work closely with organisations such as housing, education, the police and leisure services.

    Physical health:

    • Expanding the provision of health improvement in addition to the right to regular physical health assessments.
    • Health improvement initiatives to give priority to those experiencing mental health problems as a key disadvantaged group.
    • Mental health services to be equipped to support health improvement by facilitating access to relevant services.

    Recovery:

    The survey, Well? What Do You Think? (2006) The Third National Scottish Survey of Public Attitudes to Mental Health, Mental Wellbeing and Mental Health Problems [PDF: 982kb], shows a low expectation of recovery in the Scottish population. There is a need to raise awareness at a public health level. This may support efforts to reduce the suicide rate.

    • Work must also be targeted at people experiencing mental health problems to raise awareness of the factors which help and hinder recovery, and share ideas and tools for self directed recovery. There is encouraging work in this area by Wellness Recovery Action Planning (WRAP) [external site].
    • Work to better engage informal carers and family members is important and should be accelerated.
    • The development of local recovery networks and groups to give local efforts a direction and encourage buy in. These groups have developed in a number of areas and activity has included the development of awareness-raising materials, training and events.
    • The development of local strategies for the promotion of recovery across all stakeholder groups.
    • Local support for the roll out of recovery awareness and Wellness Recovery Action Planning [external site] aimed at supporting people in their recovery.
    • Use of the Scottish Recovery Indicator [external site] within local services to ensure practice is based on the principles of recovery.

     

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    Case studies

    Discrimination and stigma:

    Regeneration In Argyll and Bute, two mental health clubs that used to be run by the council have been constituted as charities.

    A development company has also been established as a company limited by guarantee with the aim of stimulating economic development and the formation of new businesses.

    The NHS Board is made up of service users and representatives from community education, health, social services and the business community. Contact Maureen Beaton on 01546 604 152 for more information or, alternatively, download With Inclusion in Mind [PDF: 271kb].

    Social inclusion:

    Volunteering

    The City of Edinburgh Council contributes to the funding of the Volunteer Centre and a key staff member from the Department of Health and Social Care provides support and guidance to the centre's strategy group. As a result, every year around 300 people with mental health problems, learning disabilities or other support needs volunteer their time.

    All agencies that involve volunteers in Edinburgh are working together to create a 'compact' – an agreement identifying good practice in volunteering.

    Contact: Jean Cuthbert at the Volunteer Centre on 0131 225 0630 for more information or, alternatively, view With Inclusion in Mind [PDF: 271kb].

    Physical health:

    Open to all A Healthy Living Centre in Moray is open to the whole community and promotes good health through exercise, sharing health information and a range of other activities.

    People concerned about their mental health can self refer, utilise a range of complementary therapies and request membership of the 'exercise on referral' scheme.

    The scheme gives people improved access to a range of ways to address mental health problems and promote mental wellbeing.

    Contact: Margaret Christie 01343 567 356 for more information or, alternatively, download With Inclusion in Mind [PDF: 271kb].

    Recovery:

    The Scottish Recovery Network [external site] includes many inspiring stories which can be accessed via its website; the see me website [external site] also includes inspiring stories of recovery.

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