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WELL WHAT DO YOU THINK (2004): THE SECOND NATIONAL SCOTTISH SURVEY OF PUBLIC ATTITUDES TO MENTAL HEALTH, MENTAL WELL-BEING AND MENTAL HEALTH PROBLEMS
CHAPTER ONE: INTRODUCTION
background
Mental health should have the same status and understanding as … physical diseases and the National Programme places it at the centre of the whole health improvement agenda
Malcolm Chisholm, then Minister for Health and Community Care, 2002
1.1 A substantial proportion of the Scottish population is likely to be affected by mental health problems at some point in their lives. In 2003, depression and affective disorders were among the most common reasons for consulting a GP in Scotland and the single most common reason among the 25-44 age group (
www.isdscotland.org). Mental ill-health is costly to the Scottish economy, with around 35% of all absences from work caused by mental health problems and less than 10% of people with severe and enduring mental health problems in full time employment (ONS, 2002).
1.2 In 2003, deaths from intentional self-harm in Scotland numbered 560; suicide was the main cause of death for men aged 15-44 and women aged 15-34 (Scottish Executive, 2003a). Rates of suicide among young men, in particular, have increased by 245% over the last 30 years (Morton and Francis, 2000). In addition, over 7,000 people are treated in hospital each year following episodes of non-fatal deliberate self-harm. Young people, especially girls in their early teens, are particularly likely to receive hospital treatment for self-harm (Scottish Executive, 2002a).
1.3 Although mental health problems are not uncommon among the general population, mental ill-health is widely thought to be a taboo subject. People experiencing mental health problems and mental distress have found themselves isolated and stigmatised as a consequence of their symptoms.
1.4 In recent years, the Scottish Executive has repeatedly identified mental health as one of three key clinical priority areas for the health service in Scotland, and a range of policy documents have included aims to improve and co-ordinate service availability and delivery as part of a broader approach to improving mental health at the population level.
Towards a Healthier Scotland (Scottish Office 1999) identified the social, economic and environmental factors that influence health, including mental health, and stated that mental health would be a leading priority for NHS Scotland.
Our National Health: a plan for action, a plan for change (NHS Scotland, 2000) set out the framework for further improvement in health and health services, including work to promote positive mental health, the intention to look for ways to overcome the stigma surrounding poor mental health, and the development of a framework to address rates of suicide.
Building a Better Scotland (Scottish Executive, 2002b) signalled major investment in comprehensive action across the whole range of the Executive's responsibilities. The new Mental Health Division in the Executive (established in February 2002) works with Ministers and with all relevant stakeholders to promote attitudes and behaviour in the general public which lead to improved mental health and well-being; and to ensure that good quality mental health services are available for everyone who needs them. The new Mental Health (Care and Treatment) (Scotland) Act 2003 is intended to provide a fair and effective legal framework to support mental health service provision.
1.5 The 2003 Health White Paper
Partnership for Care (NHS Scotland 2003) emphasised the importance of linking across areas of public policy and involving all stakeholders in actions to reduce health inequalities within society, and
Improving Health in Scotland: The Challenge paper (Scottish Executive 2003b), published to accompany the White Paper, set out a framework of action for the Executive, NHS Health Scotland and partner agencies across Scotland. Actions included the establishment of a 3-year action plan for the National Programme for Improving Mental Health and Well-Being, as a key component of overall health improvement.
1.6 The National Programme was launched in October 2001 and is a key, integrated part of the Executive's health improvement and social justice strategies (
www.wellontheweb.net). The Programme works nationally and locally to raise the profile of, and to support action in, the following key areas:
Preventing suicide in Scotland
Eliminating stigma and discrimination
Raising awareness and promoting positive mental health and well-being
Promoting and supporting recovery from mental ill health
1.7 The work of the National Programme is steered by a National Advisory Group (NAG), chaired by the Deputy Minister for Health and Community Care. Through discussions with a wide range of stakeholders, including the NAG, six priority areas have been identified for action. These range across life stages and a variety of settings and complement other health improvement activities and work in other Executive policy areas, including education, employment and working life, communities, social inclusion. The National Programme action plan announced in the
Challenge document was published in September 2003 and set out the main aims and areas of activity to be addressed by March 2006 (Scottish Executive 2003c).
the national scottish survey of public atttitudes to mental health, mental well-being and mental health problems
1.8 To help inform the work of the National Programme and to collect relevant baseline data, the Executive commissioned the first National Scottish Survey of Public Attitudes to Mental Health in 2002 (Scottish Executive 2002c;
www.scotland.gov.uk/library5/health/wwdy-00.asp ). The survey was designed to be repeatable, and was intended to be used as a vehicle for tracking progress towards achievement of the National Programme's aims, specifically:
An increase in awareness and understanding of mental health and mental well-being;
Improved mental health literacy; and
Positive changes in attitudes towards people with mental health problems
1.9 In the two years since the first survey was conducted, a number of developments have altered the context within which debates on mental health take place. The National Programme has made progress in several key areas, particularly in work towards the elimination of stigma, through the national anti-stigma campaign 'see me,' (
www.seemescotland.org ) and towards establishing an infrastructure to support 'Choose Life,' the national strategy and action plan to prevent suicide (Scottish Executive, 2002a;
www.wellontheweb.net ). A Scottish Recovery Network is being developed to create awareness and understanding of the concept of recovery from mental health problems and to contribute to the development of values, conditions, environments and relationships which support recovery (
www.scottishrecovery.net). A successful programme of Mental Health First Aid training, developed in Australia and adapted for a Scottish audience, has been piloted across all service sectors and among mental health service users and their carers, and the general public. The 'Breathing Space' telephone advice and referral service for people experiencing low mood or depression, which was introduced as a pilot scheme in 2002, will be rolled out across Scotland by the end of 2004 (
www.breathingspacescotland.co.uk ). To support the continuation of the National Programme's work through to 2006, 24 million funding is being provided through the Health Improvement Fund. The 2003 Partnership Agreement reasserted the Executive's commitment to improving mental health services across Scotland (Scottish Executive 2003d).
1.10 Against this backdrop, and following a competitive tendering process, the Scottish Executive commissioned MORI Scotland to conduct the Second National Survey of Public Attitudes to Mental Health, Mental-Well Being and Mental Health Problems. Fieldwork was carried out between May and August 2004. The over-arching aims of the survey were to examine the views of a representative sample of the adult Scottish population (reflecting age, gender, income, location, race and ethnic diversity) on a range of mental health related issues, and to compare findings with other relevant survey data. The specific objectives of the research were to:
Investigate people's perceptions of their own general health and lifestyle;
Explore people's understanding of the concepts of mental health and well-being and their assessments of factors affecting their own mental health and well-being;
Investigate people's direct experience of mental health problems;
Investigate people's sources of information on mental health issues;
Explore people's attitudes to mental health problems, including the stereotypes and myths surrounding mental illness;
Explore respondents' attitudes to people who experience specific symptoms of mental ill health; and
Compare findings with the findings of the 2002 survey and, as far as data are comparable, with findings from similar surveys (and from relevant components of broader surveys) carried out in Scotland, in other parts of the UK and internationally
1.11 The following chapter of the report details the research methodology and provides information on the sample size and composition. Subsequent chapters present the main findings from the survey, making comparisons with other survey data where appropriate. The final chapter presents a broad overview of the findings.
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