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Healthy Minds
Strategic Framework for Promoting Mental Health
of Adults in Greater Glasgow and Clyde
Final Version, February 2015
This paper sets out a framework to guide and support
planning and delivery of mental health improvement for
adults in Greater Glasgow and Clyde, in
acknowledgement of the high priority placed on mental
health as a public health challenge.
It is has been developed in partnership with a network of
partners across Greater Glasgow and Clyde, supported by
the Greater Glasgow and Clyde Mental Health
Improvement Network.
The framework has been ratified by both the Greater
Glasgow and Clyde Mental Health Strategic Performance
Group and by the Greater Glasgow and Clyde Health
Improvement and Inequalities Group, and is offered as a
resource to guide planning and delivery of adult mental
health improvement across the range of health and social
care partnerships of Greater Glasgow and Clyde.
This framework should be seen as complementary to the
pre-existing Greater Glasgow and Clyde Child and Youth
Mental Health Improvement Framework that was ratified
by the Child and Maternal Health Strategy Group in 2012.
These two strategic frameworks are intended to support
the development of a comprehensive life-course approach
to promoting population mental health and tackling
inequalities.
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Healthy Minds – Strategic Framework for Promoting Mental
Health of Adults in Glasgow Greater Glasgow and Clyde
Final Version – February 2015
Review Date – February 2018
Paper prepared by: Dr Trevor Lakey, Health Improvement and Inequalities
Manager – Mental Health, Alcohol and Drugs, GGCNHS on behalf of GGC
Mental Health Improvement Network and GGC Mental Health Improvement
Team.
“A key message is that if we are to prosper and thrive in our changing society
and in an increasingly interconnected and competitive world, both our mental
and material resources will be vital. Encouraging and enabling everyone to
realise their potential throughout their lives will be crucial for our future
prosperity and wellbeing.”
Mental Capital and Wellbeing – Foresight Report, UK Government, 2008
1.
Introduction and Scope of the Paper
The purpose of this paper is to provide an update on the opportunities to develop
mental health improvement for adults and to introduce a framework to guide action
planning within Greater Glasgow and Clyde. The new framework is offered as a
follow on to the approaches set out in the previous policy paper for Greater Glasgow
and Clyde, “No Health Without Mental Health”. This paper does not seek to provide a
comprehensive analysis of mental health issues within the Board area, nor does it
offer detailed proposals on potential future approaches. The focus is on providing a
framework for analysis, action planning and delivery across a wide range of service
areas and partnerships.
2.
Mental Health Improvement Across the Life-Course
There is a strong case, building on a wealth of international evidence, for adopting a
life-course approach to the promotion of population mental health. For example it is
clear that early life experiences are crucial influence for many aspects of mental and
physical health. For example, there is major evidence that adverse childhood
experiences can have profound impacts on health in later life, including heightening
risks of depression and suicide1 and there are significant programmes focused on
parenting support and allied activity underway.
Similarly, the vital importance of good mental health during childhood and
adolescence is well established – being crucial during childhood, but also having a
major influence on experiences and outcomes in later life2.
1
http://www.cdc.gov/violenceprevention/acestudy/index.html
See for example the Foresight programme on Mental Capital
https://www.gov.uk/government/publications/mental-capital-and-wellbeing-making-the-most-ofourselves-in-the-21st-century
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Both the early years, and the child and youth mental health agenda are major
development areas in their own right, with significant multi-agency actions underway
(a comprehensive update on progress on child and youth mental health improvement
was presented in May 2014 to the Child and Maternal Health Strategy Group).
3.
Policy context and case for action on adult mental health
Globally, it is now recognised that mental health problems represent one of the
biggest public health challenges, with the WHO noting that mental health conditions
account for 23% of the global burden of disease, compared with 16% each for cancer
and coronary heart disease.
The policy approach taken in Scotland over the last decade has helped to create
significant momentum for enhanced responses to mental health issues, including the
introduction of a number of important programmes, such as the Choose Life Suicide
Prevention Strategy, the See Me campaign addressing stigma, the Scottish Recovery
Network and the Breathing Space telephone support resource – these being
complemented by comprehensive local actions. Building on these initiatives recent
years have seen additional policy focus on promoting mental health, including
Towards a Mentally Flourishing Scotland, and most recently the Mental Health
Strategy for Scotland, 2012-20153. This latter strategy has for example placed
emphasis on the importance of social prescribing approaches to population mental
wellbeing.
Health Scotland, has also provided significant input and impetus to the area of mental
health improvement, with developments including policy work, comprehensive work
on datasets, research and evaluation, evidence into action work, and workforce
development roles (such as leading on delivery of Scottish Mental Health First Aid
programme).
This paper does not attempt to replicate the detailed work programmes and resources
available via Health Scotland and allied national agencies, but the Greater Glasgow
and Clyde Mental Health Improvement Team is available to help broker links to this
wider set of resources and knowledge, as required. This new resource is be geared to
providing guidance to Community Planning Partnerships, Health and Social Care
Partnerships and other local partnership arrangements.
There are multiple policy connections for the mental health agenda – too numerous to
cite here – but the following policy perspectives are particularly relevant to this
discussion:
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With Inclusion in Mind – the Local Authority’s Role in Promoting Wellbeing
and Social Development4 linked closely to duties contained within the Mental
Health (Care and Treatment) (Scotland) Act 2003, local authority roles in
promoting wellbeing and social development.
http://www.scotland.gov.uk/Publications/2012/08/9714
http://www.scotland.gov.uk/Publications/2007/10/18092957/0
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Christie Commission (Commission on the Future Delivery of Public Services5)
which makes a robust case for tackling inequalities and focussing resources on
preventative measures as a key objective of public sector reform
Health Promoting Health Service – where there is a renewed appetite within
Scottish Government to support health promotion efforts as mainstream
elements of delivery of mental health care
While provision of a detailed analysis of mental health issues for the Board area is
beyond the scope of this paper, the list below provides a flavour of the range of data
sources that are available to guide future action:
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Economic impact work, such as the finding that social and economic cost of
mental health problems in Scotland has been estimated at £10.7 billion per
annum, 9 per cent of Scotland’s GDP
Detailed mental health specific data, including at neighbourhood level for
some indicators, from Glasgow Centre for Population Health’s Mental Health
Profile – including inequality analyses. These show steep social class
gradients for most mental health conditions
Stark inequalities in terms of life expectancy and morbidity levels for people
with mental health problems
Young adults an area of concern – e.g. the Princes Trust Macquarie index –
shows major impact of unemployment on mental health
Mounting evidence of loneliness and isolation as a major public health
challenge – including, but not limited to older people – being socially isolated
should be considered as a priority risk factor in terms of impact on mortality6
There is mental health needs information available on a wide range of groups
and communities, such as prisoners and their families, refugees and asylum
seekers, LGBT community members
Considerable evidence of the importance of tackling mental health issues for
people with all forms of long term conditions
Data on the impact of stigma on the lives of people with mental health
problems, with Time to Change noting 9 out of 10 people with mental health
problems report experiencing stigma
4.
Introducing the Framework for Adult Mental Health Improvement
Building on positive feedback received on a Child and Youth Mental Health
Improvement Framework (devised in 2012), an adult version of this framework has
been developed, led by the Greater Glasgow and Clyde Mental Health Improvement
Network and the GGC Mental Health Improvement Team. The framework is in now
in final format, and will be reviewed in approximately three years time. A range of
additional support resources and evidence will be made available to partners as a
means of supporting the on-going development agenda.
This Framework has been designed as a way of bringing together the full range of
activity that has been demonstrated as having value in the promotion of good mental
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http://www.scotland.gov.uk/Publications/2011/06/27154527/0
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2910600/
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health for adults. It builds on the range of policy initiatives summarised above in
section 2 and on the growing body of international evidence of effective interventions.
It is designed to be ‘read’ in a bottom-up way, starting with consideration of
underlying determinants such as socio-economic factors, moving through social
environment issues like challenging stigma and discrimination, then considering
health promotion and primary prevention activities, with the upper ‘tier’ of actions
being secondary preventative and recovery oriented.
Figure 1. Healthy Minds – Adult Mental Health Improvement
Framework, Greater Glasgow and Clyde
Respond
Better to
Distress
Promote
Wellbeing and
Resilience with
People &
Communities
 Improve responses to
people in distress, both from
services and wider
community, including action
to prevent suicide and better
support for people who self
harm
 Develop social connection,
tackle isolation, build resilience,
strengthen use of community
assets - including social
prescribing, strengthen self care
and peer support
Promote Positive Attitudes,
Challenge Stigma and
Discrimination
Tackle Underlying
Determinants and
Promote Equity
Promote
Wellbeing for
People with
Long Term
Conditions
Promote
Wellbeing
and
Resilience
through
Work
 Promote holistic health
for people with long term
conditions – “healthy
body, healthy mind”,
promote recovery
approaches and social
inclusion
 Promote mental health,
wellbeing and resilience at
work; address
employability issues,
including those affected by
mental ill health
 Promote positive attitudes to mental health and to people
with mental illness, raise awareness of mental health issues,
reduce stigma and discrimination and promote inclusion,
including better access to mainstream services
 Address underlying determinants of good mental health,
including financial inclusion, nurturing early years, healthy
environments, active citizenship and participation, and
ensure focus on promoting wellbeing of diverse communities
5.
Brief illustration of each category of action – rationale and examples of
activity underway
In order to guide on use of the framework, Appendix 1, below, provides more detail
on each domain of action, including a brief rationale for each and some examples of
actions underway in each area. The examples cited are a very small flavour of the
major breadth of work underway across Greater Glasgow and Clyde partnerships,
with every area already having significant activity and resource in place.
One of the purposes of this framework is to help build on pre-existing activity, to
galvanise more comprehensive, sustained approaches to promoting population mental
health, drawing on the emerging evidence-base of effective interventions and the
evolving picture of population needs and assets.
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6.
Provisional checklist to guide action planning for mental health
improvement of adults – linked to the six domains in the framework
Provided below, using the framework as a guide are a number of potential issues and
questions that can guide planning and delivery for adult mental health improvement in
the Board area, including at local level:
Overarching issues
The overall consideration is: how will the Board, relevant partnerships and planning
arrangements, promote mental health and prevent mental ill health, promote recovery
and prevent suicide?
6.1
Does adult mental health improvement feature in key policy and planning
arrangements? Does this include targeting towards population groups with
enhanced risk of poor mental health? Is there clearly identified investment to
support this activity?
6.2
How do we get a comprehensive picture of mental health issues, needs, trends
and potential assets across Greater Glasgow and Clyde (or specific areas /
localities) as a means of guiding priorities for action? Are there opportunities
to draw together intelligence better?
6.3
Are there comprehensive arrangements in place to consult and engage with
diverse views and experiences from communities in shaping approaches to
mental health improvement?
Tackle Underlying Determinants and Promote Equity
6.4
Is there an effective focus on mental health across areas such as anti-poverty,
financial inclusion, social inclusion, regeneration and community engagement
policies? Could these be strengthened and made more explicit?
6.5
Has explicit attention been given in addressing the needs of diverse groups and
populations, including adopting approaches such as equality impact
assessments (EQIAs)?
Promote Positive Attitudes, Challenge Stigma and Discrimination
6.6
What activities that challenge stigma and discrimination for people with
mental health problems are underway and how can these be strengthened?
Promote Wellbeing and Resilience with People & Communities
6.7
What programmes aimed at promoting community resilience and social
connection and talking isolation are in place and how could these be
strengthened?
6.8
Is there scope to better utilise community assets, e.g. through initiatives like
social prescribing?
Promote Wellbeing and Resilience through Work
6.9
What workplace related health improvement activity is underway and is there
scope to strengthen the mental health aspects of this?
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6.10
How comprehensive and effective are employability approaches to support
people with mental health problems?
Respond Better to Distress
6.11
What scope to further progress the work of the Choose Life programmes in the
Board area and wider suicide prevention activity; are there plans to address
wider issues of support for people in distress, including people who self harm
and addressing needs of carers?
Promote Wellbeing for People with Long Term Conditions
6.12
Are the range health and social care needs of people with long term conditions
fully addressed, and are the needs of their carers addressed?
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Appendix 1 – Framework for Adult Mental Health Improvement –
Domains of Action and Current Examples of Activity
Action Domain and
rationale
Brief descriptor
Examples of actions
Tackle Underlying
Determinants and Promote
Equity
Address underlying
determinants of good
mental health, including
financial inclusion,
nurturing early years,
healthy environments,
active citizenship and
participation, and ensure
focus on promoting
wellbeing of diverse
communities
Anti-poverty programmes like
Healthier Wealthier Children; mental
health training for financial inclusion
workers; action on regeneration and
the built environment including
community involvement in urban
design and greenspace initiatives;
community media programmes like
Mind Waves providing an active
voice in sharing news and
perspectives; focus on needs of
minority groups as part of the overall
approach
Promote positive
attitudes to mental health
and to people with
mental illness, raise
awareness of mental
health issues, reduce
stigma and
discrimination and
promote inclusion,
including better access
to mainstream services
Awareness raising and staff training
on mental health related issues;
mental health service user
engagement initiatives, including
research into impact of stigma; public
awareness raising campaigns and
initiatives, like the Mental Health Arts
and Film Festival; linking with the
approaches of the See Me national
programme
Develop social
connection, tackle
isolation, build resilience,
strengthen use of
community assets including social
prescribing, strengthen
self care and peer
support
Programmes aimed at building social
connection and community building,
like Gal Gael, the REVIVE group in
Ardenglen Housing Association
Rationale: Strong evidence of
the links between poverty,
disadvantage and challenging
social circumstances on
mental health status; evidence
of stark inequalities in mental
health across different social
groups
Promote Positive
Attitudes, Challenge
Stigma and Discrimination
Rationale: While there have
been some signs of progress
over the last decade, stigma
and discrimination remain
powerful negative influences
in people’s lives – spanning
home, community, services,
employment spheres
Promote Wellbeing and
Resilience with People &
Communities
Rationale: Being socially
connected and resilient, both
as individuals and
communities, are now
recognised to be powerful
influences on mental health
and wider wellbeing
Emerging evidence that new
technologies can play a part in
helping to build capacities, resources
and connections for communities,
such as digital assets mapping,
digital storytelling, online support
forums
Connects closely to the
resilience programme led by
Glasgow Centre for Population
Health
Promote Wellbeing and
Resilience through Work
Rationale: Good quality work
represents an important force
in promoting positive mental
Tackling isolation for older people –
e.g.Good Moves programme
including focus on physical activity
Promote mental health,
wellbeing and resilience
at work; address
employability issues,
including those affected
by mental ill health
Employability programmes aimed at
supporting people with mental health
problems
Action to address in-work poverty
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health, while unemployment
and poor quality work are toxic
influences
Respond Better to Distress
Rationale: Strong evidence of
the links between poverty,
disadvantage and challenging
social
Promote Wellbeing for
People with Long Term
Conditions
Rationale: People with long
term mental health problems
have significantly poorer
health outcomes with an up to
20 year gap in life expectancy;
similarly people with other
long term conditions are at
higher risk of mental health
difficulties
Further development of the Healthy
Working Lives agenda with respect to
mental health actions for staff and
managers.
Improve responses to
people in distress, both
from services and wider
community, including
action to prevent suicide
and better support for
people who self harm
Range of suicide prevention activities
underway, coordinated via the
Choose Life Programmes and at
Board level – workplan in place –.
Promote holistic health
for people with long term
conditions – “healthy
body, healthy mind”,
promote recovery
approaches and social
inclusion; important to
include a focus on
carers’ wellbeing as part
of this agenda
The Health Promoting Health Service
model is attempting to improve
holistic health improvement
approaches to people with long term
conditions, such as current pilot work
on physical activity promotion with
mental health services; also
initiatives like Branching Out (using
greenspace as therapy), and use of
creative arts approaches like Theatre
Nemo; scope to connect further with
a wide range of community assets
and resources, like sports facilities,
walking schemes, arts and cultural
activities
New training initiative around self
harm in place across GGC
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