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01st August 2019

Challenging Mental Ill Health Stigma – Change starts with us!


Mental ill health can happen to anyone, it doesn’t discriminate and it’s not like a visible illness. The issue of mental health and wellbeing has long been a concern and part of the national and international conversation, from stigma to promoting wellbeing, the ambition is for better services, treatment and legal protection for those with severe and ensuring mental ill health.

During my time at the Care Inspectorate as a Health Improvement Advisor and National Advisor, how to apply national strategies and plans and translate this into developing and sharing good practice at service level has always been a high priority for me. As a new member of the QCS team of contributors, I hope to share with you my thoughts, experiences and make sure you are kept up to date on emerging themes, issues and of course the planned changes to the Adults with Incapacity (Scotland) Act 2003.

Before we think about closer to home in Scotland, it’s worth thinking about how global objectives have influenced Scottish mental health strategy.

The World Health Organisation published their Comprehensive Mental Health Action Plan 2013–2020 and focused on four objectives. The action plan calls for changes. It calls for a change in the attitudes that perpetuate stigma and discrimination that have isolated people since ancient times, and it calls for an expansion of services to promote greater efficiency in the use of resources.

The four primary objectives of the action plan are to:

  • Strengthen effective leadership and governance for mental health.
  • Provide comprehensive, integrated, and responsive mental health and social care services in community-based settings
  • Implement strategies for promotion and prevention in mental health.
  • Strengthen information systems, evidence, and research for mental health.

This action plan, in turn, has influenced the Mental Health Strategy for Scotland, published in 2017 states, “our guiding ambition for mental health is simple but, if realised, will change and save lives – that we must prevent and treat mental health problems with the same commitment, passion and drive as we do with physical health problems.” That means working to improve:

Prevention and early intervention;

  • Access to treatment, and joined up accessible services;
  • The physical wellbeing of people with mental health problems;
  • Rights, information use, and planning

But where are we now with this strategy. Increasingly we are seeing famous personalities sharing their experiences of mental ill health working hard to breakdown the stigma associated with mental health.  But research still indicates that two-thirds of people surveyed said they have no-one to talk to or could not find the right time or place when it comes to personal conversations on topics such as mental health, money problems and relationships.

We still need to do more to break down this barrier and the stigma associated with mental ill health. We can bring about this change one person at a time, by challenging the negative images and words used in the media helping to break down discrimination and prejudice.  Now think about your own use of words about mental ill health or any behaviours that we consider that lie beyond the bounds of our comfort zones. Change starts with us.

On a practical level we can influence that change by looking at how we promote wellbeing for people who use our services. Scotland has, as part of its suite of policies on well-being ‘Getting It Right for Every Child’ (GIRFEC). Within the model, is the SHANARRI Wheel:

  • Safe
  • Healthy
  • Achieving
  • Nurtured
  • Active
  • Respected
  • Responsible
  • Included

A question that is often asked is “Why can’t we have a GIRFEC for adults”? The answer is quite simple, there are no barriers to using the SHANARRI Wheel for adults and it's as good as place as any to begin to look at our own well-being, as well as that of our residents, to promote mental health and well-being.

Can we honestly say that we meet these for the people who use our care services or even ask the questions outside of the assessment process?

*All information is correct at the time of publishing. Use of this material is subject to your acceptance of our terms and conditions.

Susan Donnelly

Scottish Mental Health

Susan began her nursing career in 1980, as a student nurse, then worked in Mental Health as a Staff Nurse, Ward Sister/Charge Nurse and Clinical Nurse Specialist. She moved to Regulation and Inspection in 1997, as a Senior Nurse with the former Greater Glasgow Health Board and moved to the Care Inspectorate (formerly known as the Care Commission) in 2002 initially as an Inspector then as the Professional Adviser for Mental Health and latterly held the post of Improvement Adviser.

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