Background and policy context

Smiling woman

An overview of what we mean by ´mental health´ and ´mental health improvement´ and an introduction to the policies and drivers that form the context for this work.

Mental Health Strategy for Scotland 2012-15

In August 2012, the Scottish Government’s mental health division (external link) introduced the Mental Health Strategy for Scotland 2012-15 (external link). It sets out a range of key commitments across the spectrum of mental health improvement, services and recovery to ensure delivery of effective, quality care and treatment for people with a mental illness, their carers and families. Prior to its launch, NHS Health Scotland’s work in mental health improvement had been in response to ´Towards a Mentally Flourishing Scotland´ (external link).

The strategic direction for mental health improvement and public mental health has evolved from a number of policy areas including:

  • mental health
  • public health
  • social justice and social inclusion
  • education
  • enterprise and life long learning
  • arts, sports and culture.

The public health policy in Scotland has increasingly identified mental health as an integral part of the wider agenda for health improvement.

What do we mean by mental health?

There are many different definitions of the term mental health. More often than not it is used to denote mental illness and related issues of treatment. In this instance it is used as an umbrella term to cover both illness and wellbeing. Mental wellbeing is an area often overlooked and misunderstood. However, there is growing international recognition of the benefits of addressing mental wellbeing in a comprehensive approach to mental health.

Mental illness

A diagnosable illness such as depression, anxiety and schizophrenia which significantly interferes with an individual´s cognitive, emotional or social abilities.

Mental wellbeing

There are many different definitions of mental wellbeing but they generally include areas such as life satisfaction, optimism, self-esteem, mastery and feeling in control, having a purpose in life, or a sense of belonging and support.

What do we mean by mental health improvement?

Mental health improvement (sometimes called mental health promotion) involves any action to improve mental health. The Mental Health Improvement Group within NHS Health Scotland developed the Mental Health Improvement Terminology and Working Understandings paper to ensure that clarity of mental health terminology is consistent across the organisation. It should be noted that this paper sets out the terminology and definitions used by NHS Health Scotland staff but recognises that other models and paradigms are held and used by other individuals, professions and organisations.

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Factors that can influence the development of mental illness

Table adapted from the World Health Organisation (WHO) (2004) ´Prevention of mental disorders: effective interventions and policy options: summary report´.

Risk factors:

Social, environmental and economic determinants of mental health

  • isolation and alienation
  • lack of education, transport, housing, recreational facilities
  • neighbourhood disorganisation, violence and crime
  • socio-economic disadvantage
  • poverty, poor social circumstances
  • work stress, unemployment
  • poor nutrition
  • social or cultural injustice and discrimination
  • peer rejection
  • violence and anti-social behaviour.

Protective factors:

  • empowerment
  • positive interpersonal interactions
  • social support and attachment to community networks
  • social responsibility and tolerance
  • access to social services and a variety of leisure activities
  • social participation and inclusion
  • economic security and access to meaningful employment.

Individual and family determinants of mental health

Risk factors:

  • parental mental illness
  • loneliness, social isolation
  • parental substance misuse
  • low birth weight, birth complications
  • personal loss – bereavement
  • stressful life events
  • physical, sexual and emotional abuse
  • family conflict/discord/violence
  • substance misuse.

Protective factors:

  • ability to cope with stress
  • physical activity
  • good parenting, stable and supportive family environments
  • feelings of security, mastery and control
  • self-esteem
  • good physical health
  • social skills
  • positive attachment and early bonding
  • pro-social behaviour.

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Mental health improvement at different levels

Mental health improvement works at a variety of levels:

Strengthening individuals

Mental health can be improved by increasing emotional resilience through interventions designed to promote self-esteem, life and coping skills like communication, negotiating, relationship and parenting skills, physical activity and stress management.

Strengthening communities

It can also be improved by increasing social support, inclusion and participation, improving community safety, neighbourhood environments, promoting childcare and self help networks, developing health and social services which support mental health, improving mental health within schools and workplaces through anti-bullying strategies and mental health or stress strategies.

Reducing structural barriers to mental health

Mental health can be improved through initiatives to reduce discrimination and inequalities to promote access to education, meaningful employment, housing, services and support.

Each level is relevant to the whole population including individuals at risk and people experiencing mental health problems. All settings and related services therefore have a potential to influence mental health, including workplaces, housing, transport, health services, justice services, education and life long learning, community services, sport and leisure, etc. In addition mental health improvement is applicable across all stages of life: infants, children, young people, younger adults and older adults.

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