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Listen
Building Community Well-Being
An Exploration of Themes and Issues
4. Improving mental health and well-being: responsibilities for action
This section considers responsibilities for action to achieve improvement in mental health and well-being within local communities and explores the type and order of change that would be required to deliver on the priorities identified above. The section covers: public service providers in general and schools in particular, as the project elicited much material about the role of schools; planners and decision makers locally and nationally; employers; society as a whole in Scotland; and individuals.
Public service providers
The role of public service providers emerged as a central theme of many of the discussions in local areas.
Interaction between public services and the individuals, families and communities they serve
In many ways the experiences that were recounted in the discussion process indicated a loss of trust in public services. This manifested itself in a number of ways but common to what was described was people feeling misunderstood by decision makers, sometimes that decisions made are alien to their way of life, leading to a sense of things being done to them, not with them.
What would help?
- Recognising particularism, promoting localism, not prescribing global solutions, finding ways of providing services on a human scale
- Respecting the natural affinities that people have with geographical place, with historical associations, often runs counter to way in which administrative processes demarcate entities which are designated as communities
- Supporting community development is essential in enabling local communities to take an active part in identifying and working on local issues that affect mental health and well-being. Communities need champions to represent their interests and views - be they community development workers, committed and supportive officials or elected members. Funding and measures of performance and outcome need to be tied in, to further community-defined objectives
- Closing the gap between promise and practice and getting better at communicating with communities, not one-off information exercises
- Promoting organisational and working practices that nurture and earn trust and respect
- Aligning systems to achieve the outcomes desired: funding, monitoring and measurement, inspection and audit
Representation and accountability
The trust that public services engender was related in part to issues of representation and accountability.
What would help?
- Uncovering ways in which involvement can be worthwhile, including more informal ways of involving people
- Moving beyond the preoccupation with the sorts of structures required to promote representation, in order to give greater attention to the quality of participation, recognising the need for this to be evolving and dynamic
- Tackling situations where processes to get community involvement and representation are 'stuck', by thinking creatively to find new ways of influencing design and development of services
- Demonstrating real commitment to hear, value and respond to communities, closing the feedback loop - to achieve this needs capacity building for decision makers
Long sightedness
Attaining improved mental health and well-being in local communities requires commitment and vision of what can be achieved, driven by outcomes, where corporate responsibility is linked to investment. It means resisting the lure of new initiatives when it is clear that innovation at the margins does not challenge the more deep seated problems within large public organisations in their relationships with their local communities.
It also entails tackling issues of equity and power. For example community planning holds promise as a way of bringing together a range of agencies and sectors to focus on local populations, but it does not necessarily address the balance of power between the statutory and the voluntary sector, or between public organisations and local communities.
Realising the importance of relationships and networks
At the core of work to improve the mental health and well-being of communities is the legitimate and necessary role of public agencies in strengthening connections and building bridges. To make this a reality presupposes:
- Demonstrable commitment in organisational and working practices to the centrality of relationships - values, attitudes, behaviours that promote quality relationships, time, presence, respect
- Reinstating the importance of holism and of process: requires moving away from practices that tend to give primacy to content not process of encounters and that tend to manage complexity through categorisation (labelling and compartmentalising)
- Building individual and community confidence and capacity. This begs questions about the skills and qualities that are required of staff to fulfil these functions and about how to prepare and support staff
Attention to process
A repeated plea was for agencies to protect capacity for reflexivity. A critical issue to examine is why services keep acting in ways which inhibit improvement of mental health and well-being improvement in communities. Attention is needed to the steps required to implement and sustain the change in attitudes and behaviour that remain core to effective achievement of the mental health and well-being outcomes that are sought. This means giving credence to processes for learning and adaptation - we know that structural change is not the answer.
We could achieve more by making more effective use of the learning emerging from experience, with enhanced opportunities for communication and co-ordination. This includes recognising the value of informal contacts and opportunities to build familiarity and ease between services.
Schools
Schools were characterised as having to hold constantly in tension the drive for attainment and achievement with a wider social mission to nurture and support the development of young people.
What would help?
- Policy makers, leaders and senior managers in education need to give clear messages and ensure that working practices within schools demonstrate commitment to well-being and to pupil support
- Attitudes and ethos within schools are of critical importance for the well-being of pupils. This points to the continuing need to pursue a culture that communicates respect for and belief in each individual and to counter the attitude of 'Why bother? They aren't going to succeed anyway.'
- Attention to the development of guidance and pastoral support in secondary schools, recognising the powerful influence of peer relationships and peer support
- Ensuring that young people have opportunities in the course of their time in school to prepare themselves for adult life, which involves looking at problems in supportive and enabling ways
- Forging stronger links and lines of communication between schools and agencies who have the ability and experience to support troubled young people, as part of a 'whole system' approach
- Developing awareness and capacity to identify when young people are encountering difficulties and get them help
- Tackling the barriers that affect young people's willingness to confide in staff. Schools need to be able to dispel concerns about confidentiality of information disclosed to a member of staff and to counter perceived impact of 'staff room gossip'. Young people may prefer to talk to a same gender guidance teacher or counsellor about sensitive issues
If schools are an increasingly important vehicle for promoting the learning, development and well-being of young people, we may need to consider further the traditional notions we hold of functions, roles and boundaries and look again at the skills and knowledge based required by:
- Teaching staff in schools
- Services, supports and resources attached to/located in schools, designed to enhance capacity of young people to engage with education, address issues and problems and enhance coping and resilience
- Services and supports in the local community that work with young people and their families, along a spectrum from early intervention, advice and support through to specialist care and treatment
Employment and economic development
From the discussions with people in employment or seeking employment, the following considerations arise for those with responsibility for employment or for economic development:
- Employment practices and an ethos within organisations that convey respect for employees as people are central to the experience of well-being at work
- Changes in attitudes and in practices are required to give more emphasis to enabling people to stay in work (beyond traditional retirement age, when they encounter problems)
- Economic development and promotion stands to gain by efforts to improve 'soft' skills and boost confidence and self efficacy
Civic society
The capacity building work drew attention to a number of wider questions and propositions that merit debate within Scotland to explore the aspirations that we hold for our collective future.
For continuing debate:
- How can we reconcile the drives for achievement, attainment and acquisition with humanistic values that attach weight to the individual qualities (identity, self-confidence and self worth) and interpersonal and collective values (trust, respect, empathy and tolerance)?
- How do we move ahead in ways which enable individuals, communities, professions and organisations to rediscover a sense of action and agency rather than fatalism, and look to the future with hope?
- Are we prepared to value diverse intelligences, not only academic learning and knowledge acquisition but also team-based learning, emotional and spiritual intelligence in all tiers of education and learning, including professional training and development?
- What would it take to recognise and celebrate diversity and address prejudices and stereotypes that arise from fear of 'difference'?
- What can we do individually?
- Raise awareness of mental health and well-being in places where it would not ordinarily get attention. Talk up mental health to elected members and representatives. Make the case to employers and planners that what they do has an impact on mental health and well-being and that improving well-being has benefits for them
- Get better at connecting and communicating what we are doing already that contributes to improved well-being
Decision makers: local and national
Mental health and well-being should be seen as everybody's business, for example on the agenda of multiagency organisations like SIPS and an integral feature of partnership processes, such as community planning and health improvement planning. In pursuing the goals of improved mental health and well-being, there is scope to use existing policy ideas and initiatives as magnets to draw in different sectors - in education, using the ideas of health promoting schools; in local government, the concept of local authorities as public health organisations, the emphasis on promotion and prevention in For Scotland's Children, principles of social justice.
Critical issues for decision makers to address include:
- Processes for representation and accountability and, in particular, capacity of decision makers to engage with and hear what is being said and to respond
- Support for local issues through strategic local developments rooted in the identified needs of local communities
- More co-ordination and integration, less ringfencing
- Willingness to take a long-term view, guided by a collective vision of what is to be achieved, investing in prevention and promotion, encouraging risk-taking
- Opportunity to create incentives to generate the outcomes required and to reward promising practice
- Targeting resources at the 'right' level - more should go into preventive work, to reduce pressures on other parts of the system
- Giving priority to work that has a collective, social focus as so much of what has been funded in the past has centred on interventions and supports for individuals
- Preparedness to invest and support change and build capacity to work in the ways required
- Do not lose sight of the need to address inequalities. Promoting individual efficacy, building confident individuals and communities is one strand: the other is attending to wider structural issues and barriers
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