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:
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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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.
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:
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:
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].
Discrimination and stigma:
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.
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.
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].
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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