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Background

Mental health is a national public health priority for Scotland. To date, there has been no assessment of the overall mental health of Scotland’s population, without which it is difficult to determine whether mental health is improving in Scotland or to track progress.

NHS Health Scotland was therefore commissioned by the Scottish Government’s National Programme for Improving Mental Health and Well-being to establish a core set of national, sustainable mental health indicators to support the Scottish Government’s drive on mental health improvement.

Final adult mental health indicator set

The initial focus has been on indicators for adults and the national indicator set is now finalised. These indicators cover both positive mental health (mental well-being) as well as mental health problems and are structured under constructs (categories) of two types:

1. High level constructs of mental health status — outcome measures.
2. Contextual constructs — covering the risk and protective factors and the consequences of mental health, which may be at an individual, community or structural level.

They will provide a summary mental health profile in Scotland, and a way of monitoring the state of mental health and well-being in Scotland, at a national level and will help inform decision-making about priorities for action and resource allocation.

The final report sets out the background, objectives, process and achievements of this work. It also includes the rationale and an overview of the evidence-base for the indicators as well as the list of the indicators and their data sources Final report adult mental health indicators.

The final briefing paper provides a summary of the final output from the work including the recommendations, the indicators, their measures and associated data source.

A rationale paper documents clearly the thinking and reasons behind, and constraints involved in, decisions that have been taken during the course of the work Rationale paper October 2007.

Analyses of existing data for the indicators is also ongoing. A report on trends for those indicators where data is currently available is being produced and will be available spring 2008 and will appear on the ScotPHO website.

Process

The work has used a mixed approach taking into account current data, policy, evidence, expert-opinion and theory. It has drawn on expertise from across a range of sectors. Vital to this have been links with people who have either developed or are in the process of developing indicators in areas of relevance to the measurement of mental health and well-being. Notably this includes areas such as community development, social capital and quality of life.

There were six key stages to this project:

1. Determine a desirable set of defined mental health and well-being indicators;
2. Review relevant Scottish data currently collected nationally, to maximise the use of data already gathered;
3. Identify and establish consensus on a set of practical indicators for which data are currently available;
4. Identify additional data needs and recommend new data that should be collected to fill the gaps between the set of practical indicators and the desirable set;
5. Explore approaches to collect the recommended new data, and work to develop the data collection systems for desired indicators where they do not currently exist through influencing data collection systems to ensure that these adequately cover mental health and well-being; and
6. Ensure the sustainable collection of both current and new data for the indicator set.

Supporting documents from the work

A paper that set out preliminary thinking behind, and rationale for, proposed constructs under which the indicators for adults could be developed was consulted on in February 2006 Consultation paper February 2006

Comments received were used to move the indicators work forward. This included the production of the final Rationale paper October 2007.

Five seminar events were organised in partnership with NHS Boards or local networks/alliances across Scotland in March/April 2007. These were held to discuss progress on the development of the national mental health indicators in Scotland. These stimulated further debate around the final choice of indicators and led to further refinement of the final indicator list. The following report summarises these events and the feedback and discussion around specific issues posed to delegates for consideration Report on Dissemination Events March/April 2007.

An article in the Journal of Public Mental Health 2006 described the indicators programme in its entirety: JPMH 2006 (Volume 5 Issue 1 p42-48)

Initial documents to the work include a background paper and an options appraisal paper. The latter discusses the various options available to ensure that data required for the mental health indicators set are obtained from surveys sustainably.

Information summarising progress and future activities at various stages of the work are also outlined in the following:
Briefing note September 2005
Briefing note update March 2006
Briefing note update (overview of work) December 2006

Future

Work will now move to establishing indicators for children and young people. An event to present the adult mental health indicators data report and to launch the children and young people's mental health indicators work will be held on 21st April 2008 in Glasgow. Further information can be found in the following flyer and draft programme. To book a place at this event please complete the following registration form.

Measuring positive mental health (mental well-being):

WEMWBS

Assessing the positive mental health of the population requires validated scales that reflect current concepts of positive mental health. The adult mental health indicators work highlighted the fact that there is a need for such scales which capture current thinking and which are validated for use in Scotland, and elsewhere in the UK. Researchers at Warwick and Edinburgh Universities were therefore commissioned to validate (for the UK) Affectometer 2, a scale previously identified as promising for assessing population positive mental health, and to develop a revised and shortened scale, The Warwick-Edinburgh Mental Well-being Scale (WEMWBS). WEMWBS is a 14 item scale which covers both hedonic and eudaimonic perspectives. Initial validation used student populations but more recently, the WEMWBS was used in two national Scottish surveys (2006 September wave of the Health Education Population Survey (HEPS) and the 2006 Well? What do you think survey?). Data analyses showed that WEMWBS performed equally well in the general population as in student groups.

Information on this research and WEMWBS is contained in the following:
Briefing note Affectometer 2 and WEMWBS validation

Research report on validation of Affectometer 2 and development of WEMWBS Monitoring positive mental health in Scotland: validating the Affectometer 2 scale and developing the Warwick-
Edinburgh Mental Well-Being Scale for the UK

An article in Health and Quality of Life Outcomes 2007 describes the development and validation of WEMWBS to date including analysis of the population survey data HQLO 2007 Volume 5 issue 63

Using WEMWBS

We welcome the use of WEMWBS. It is free to use but is copyrighted to NHS Health Scotland and the Universities of Warwick and Edinburgh. Permission is required for use. Dr Kulsum Janmohamed (Sumi) K.Janmohamed@Warwick.ac.uk, working with Professor Sarah Stewart-Brown at the University of Warwick, is maintaining a register of use and is the person to contact when seeking such permission and for answers to questions on using WEMWBS.

Should you decide to use WEMWBS, we ask that when you seek permission for use from Sumi, that you indicate how you are planning to use WEMWBS and after use that you feed back to Sumi on how WEMWBS has performed. Sumi is also the person to contact should you have more technical questions regarding the scale and its use.

If the scale is reproduced, it must include the copyright statement which appears with it and no changes to its wording, response categories or layout must be made. Any report regarding use of WEMWBS also needs to include the following text:
"The Warwick-Edinburgh Mental Well-being Scale was funded by the Scottish Executive National Programme for improving mental health and well-being, commissioned by NHS Health Scotland, developed by the University of Warwick and the University of Edinburgh, and is jointly owned by NHS Health Scotland, the University of Warwick and the University of Edinburgh."

If you have comments on the indicators project or require further information please contact Jane Parkinson – jane.parkinson@health.scot.nhs.uk

Last update 28th February 2008

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