Public Mental Health- Supporting Policy Development

What is public mental health policy?

Public mental health policy is a population-based approach directed at the prevention and treatment of mental health disorders and the promotion of mental wellbeing. Mental health is an integral component of public health and has a significant impact on social, human and economic capital. 

Large-scale research studies and theory development have helped to identify causal links between socioeconomic factors such as poverty, unemployment, housing, stigma and poor mental health.

Neglecting mental health risks undermining efforts to address health inequalities.

Given the complex and multi-faceted nature of pathways influencing mental health outcomes, which cut across a range of policy areas, sectors and disciplinary fields, systems approaches are well placed to grapple with this, informing policy design and guiding the implementation of effective mental health interventions. 

Policy landscape - Scotland

Health has been a devolved matter in Scotland since 1999. Improving mental health outcomes and addressing mental health inequalities have been long standing national priorities.

In 2011, the Commission On The Future Delivery Of Public Services (Christie Commission) urged the Scottish Government to prioritise ‘prevention and early intervention’ as part of public service reform to address inequalities. This was followed by the development of Health and Social Care partnerships which aimed to overcome organisational silos by bringing together NHS and local authority-led services.  Efforts are said to have been hampered by cuts to funding (Social work in Scotland - Accounts Commission), resulting in a continued emphasis on ‘crisis management’, with disproportionate attention being paid to mental illness and treatment. 

In 2018, the mental wellbeing of adults in Scotland was reported to be the lowest since 2008; this was further impacted by the COVID-19 pandemic and rates are yet to return to pre-pandemic levels - Uncertain Times: Anxiety in Scotland and how to tackle it - Mental Health Foundation Scotland 2023.

Levels of anxiety and depression are reported to be twice as high in the most deprived areas of the country when compared to the least deprived- Scottish Health Survey 2019 - Volume 1.

Poor mental health and wellbeing is associated with a range of factors including poverty, education, unemployment, physical illness, stigma, crime and violence.

The ‘Mental health and wellbeing strategy’ published in June 2023 marked a shift in recent mental health policy developments. It outlines a preventative framework which aims to eliminate inequality and stigma by addressing socio-economic factors (e.g. poverty and stigma) through a ‘whole systems’ approach.

There is a commitment to cross-government, cross-sector collaboration and the leveraging of lived experience to inform policy development and implementation. To support this process, Public Health Scotland are leading a collaborative programme of work (Wider Determinants of Mental Health Programme) to better understand and take action on the wider determinants of mental health.

Systems approaches to public mental health

SIPHER is supporting the Scottish Government, Public Health Scotland and other Scottish partners to apply systems thinking and tools to better understand and take action on the wider determinants of mental health and wellbeing. 

Public Health Scotland sought the expertise of SIPHER on how best to utilise systems thinking and practice to collaboratively identify points in the mental health system that could be best targeted to enact meaningful change. 

As one of three project partners on the Wider Determinants of Mental Health Programme, alongside Scottish Government and COSLA, SIPHER has been:

  • supporting relevant teams within Public Health Scotland to develop their knowledge and skills in relation to ‘systems thinking’, through interactive workshops.  
  • co-producing a plan for a programme of work including developing the methodology for a systemic inquiry into the wider determinants of mental health
  • helping to conduct the systemic inquiry. 

It is hoped that the collaborative and participatory nature of this programme will mean that stakeholders are motivated to take ownership over the actions identified. 

SIPHER support - tools and approaches

On the Wider Determinants of Mental Health Programme SIPHER is working alongside stakeholders from different policy areas, sectors and organisations with lived and professional expertise.

The systemic inquiry utilises a ‘soft systems’ methodology and includes: 

  • Desk based research to understand the current research landscape, data quality, gaps and existing work on the wider determinants of mental health
  • Problem definition workshops with stakeholders utilising the rich picture method to better understand the problem(s), their role/experience within the mental health system and system boundaries. This method can help stakeholders to understand their role in the broader mental health system, surface different conceptualisations of the problem and support shared understanding. 
  • Participatory systems mapping workshops: to identify interlinkages between different parts of the mental health system, causal pathways and confirm system boundaries. This can help stakeholders to identify opportunities for greater collaboration.
  • A process of refinement to decide which part of the system should be focused utilising a framework which accounts for factors such as the severity of issues, stakeholder priorities, feasibility and resources. 
  • The development of a co-produced theory of change outlining the actions that need to happen to achieve the desired outcome(s) and who will be responsible for taking these forward.
  • A process of testing the impact of the actions outlined and refining the approach where necessary to achieve the desired change. 

The findings of the Wider Determinants of Mental Health Programme will inform, and support the implementation of, the delivery plan for the Scottish Government Mental Health and Wellbeing Strategy.

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