Response to Scottish Government Mental Health and Wellbeing Strategy Consultation

A Mental Health and Wellbeing Strategy for Scotland.

The Scottish Government operates a consultation process through which individuals and organisations can submit their views on a wide range of policy and legislation issues. One of the areas currently out for consultation relates to the national Mental Health and Wellbeing Strategy, which reflects an intention to revisit and update the comprehensive mental health strategy position statement that was published in 2017. Anyone reading these documents can see that the Scottish Government takes mental health seriously, and has developed detailed initiatives that address many aspects of this topic. While retaining a focus on services delivered through the NHS, existing policy also acknowledges the importance of education, housing, policing and other areas of government-funded provision, as well as the contribution made by third sector organisations. The consultation process – which closes on 9th September – invites responses from organisations, individual practitioners, service users and carers. It is clear that there is a lot of good work being done, and that a lot of people are being helped.  It is also evident that the Government recognises that there is room for improvement. 

The experience of mental health problems, and the struggle to maintain a sense of wellbeing and a good life, are challenges faced by all individuals and families. In principle, everyone in Scotland has something to offer in respect of the questions raised in the present mental health and wellbeing consultation. As a recipient, practitioner and teacher of counselling and psychotherapy, I would like to offer a perspective that considers broader possibilities for moving forward, rather than focusing on specific areas of provision.

On the whole, these Scottish Government documents describe the process of managing mental health as involving the selection and application of interventions delivered by mental health professionals. Although it does not spell this out, what this means in practice, is being referred for a course of brief cognitive-behavioural therapy or receiving a prescription for anti-depressant medication. While there is evidence that these particular interventions can be helpful, their effectiveness depends on the active participation of the patient. For example, anti-depressant medication does not in itself cure or resolve depression. What happens, instead, is that it can create a window of enhanced mood and energy that provides the person with a chance to re-shape troubled aspects of their life.

Also, long-term use of antidepressant medication can be harmful – the person needs to be willing to talk to their GP about when and how to taper it off.  In addition, as recognised by the Scottish Government policy documents, people suffering from anxiety, depression or any other mental health condition, generally engage with other sources of help under their own initiative. A lot of the time, this consists of simply talking to other people, or being open to the various forms of assistance offered by people close to you who can see you are suffering. But there are also a huge number of specific self-help strategies that can be activated: physical exercise, change of diet, reading, being in nature, yoga, membership of a faith community, and many more.  

For me, one of the weaknesses of existing policies in the area of mental health and well-being is that they do not devote sufficient attention to the ways that people function as active self-healers supported by active carers. Scottish Government policy seems to be organised around an implicit assumption that treatment choices and pathways always need to be created and managed by professionals. Certainly, there will always be those who are so depleted at a particular point in time, disadvantaged, or socially isolated, that they need and want their GP, nurse or social worker to make these decisions on their behalf. But, for most of us, it makes more sense to view our mental health struggles from a recovery perspective that involves continually making use of whatever resources are available to enable us to come to terms with adverse experiences that we have undergone.

It would be a wonderful thing if the Scottish Government could invest in systems for making information about mental health/wellbeing services and resources readily available on-line, in a standardised easy-to-follow format. To be useful, this information would need to include details of how to access a service (Do I need a GP referral? Can I just phone them? Is it free?), exactly what it is the service offers, and what the waiting times might be. On the whole, such information is not readily found in respect of most counselling, psychotherapy and other mental health services, in terms of being available in one place, in a standard format that allows the person seeking help to weight up the pros and cons of different options. A huge array of other activities that are potentially relevant – wild swimming groups, reading groups, various types of befriending networks and support groups – may not be easy to track down on the internet, or may be described in ways that do not highlight their possible value in relation to different types of personal recovery trajectory. 

What would make this information even more useful for those seeking help would be evidence of how effective the service or activity has been, in terms of evaluations made by previous users. One of the most significant developments within the field of counselling, psychotherapy and mental health over the past twenty years has been the adoption of brief questionnaires that clients or patients complete at every visit. This kind of data has provided to be a useful way for clients and therapists to keep track of whether progress is being made, or whether they need to consider some kind of change to how they are working together. It also generates data around the proportion of case seen in a clinic or service that have recovered/improved, stayed the same, or deteriorated, over the course of treatment. Although these brief measures are not perfect, there is a broad agreement within the mental health professions that they provide a generally accurate estimate of outcomes. All NHS mental health and psychological therapies services, the majority of counselling services, and maybe about half of private practice therapists, already use such tools. However, these data are seldom made available to potential service users: it is extremely difficult, at the present time, to learn about the extent to which different mental health services actually help people. Most of us have figured out how to search for, and interpret, consumer ratings and reports for different products and services, and for schools and universities, and know how to balance such data with other sources such as word of mouth recommendations. Such publicly-available information would similarly be useful in terms of deciding on which mental health and wellbeing resources and activities might be worth trying. In setting up a mental health and wellbeing resources website, the Government could require that each organisation that is included should provide user/consumer reviews appropriate to its aims and activities, and – ideally – evidence of how it responds to such feedback. 

It is important for information about emotional support, learning, and recovery activities to be organised on a local basis. Some services are available on-line and therefore equally accessible anywhere in the country, and other activities operate as events or residential blocks that operate on the basis that participation will likely involve some travelling. But the majority of mental health and well-being activities – weekly counselling, being a member of a choir, creative arts or community garden group, yoga classes, befriending visits,  involvement in support networks – are locality-based. It is also likely that new activities and services, that fill gaps in existing provision, are usually developed by small groups of people who are in immediate contact with each other and identify a local need. This issue is particularly relevant for individuals and families who are marginalised in some way, for instance in respect of cultural heritage or gender identity, or through experiencing multiple life difficulties that do not readily fit into a single category. A further initiative that the Scottish Government could at least trial on a pilot basis, therefore, would be to establish community-run mental health and wellbeing advisory groups, responsible for collecting and disseminating information about local mental health and wellbeing resources and activities, supporting the production and utilisation of appropriate outcome data, and looking more widely in the community at whose needs are not being met. 

A crucial dimension of a mental health strategy for the next 5 years and beyond, is concerned with the ways that people are likely to be affected by the climate crisis. There already exists a substantial literature on the increasing incidence and severity of climate anxiety, grief and trauma in many countries. There are important aspects of the emotional and psychological consequences of climate breakdown that are not readily assimilated into contemporary mental health theory and practice. For example, although human beings can draw on thousands of years of accumulated knowledge around how to cope with loss and bereavement through the death of a loved one, the extent to which these strategies are readily applicable to the loss of biodiversity and coastal landscapes is far from clear. The Scottish Government has started the process of formulating a response to these issues, in the form of its policy statement on mental health needs during the covid-19 pandemic.  An international survey of how different countries adapted to mental health aspects of the covid-19 lockdown, found that many low income countries fared better than more prosperous neighbours in the Global North because their care systems were more flexible. It makes sense for mental health provision in Scotland to embrace this kind of ability to imagine and enact novel ways of responding to potentially overwhelming societal crises at times of great uncertainty about whether it might ever be possible to reclaim earlier modes of functioning. 

Ultimately, mental health and wellbeing are about living a life that is meaningful, convivial and joyful, and in balance with the other-than-human world. Without detracting from the usefulness of medical approaches in some circumstances, it is obvious that the history and cultural traditions within which we live on a day-to-day basis, and our land itself, afford us many life-enhancing opportunities. Most people understand that despair and suffering are not illnesses to be treated, but instead represent potential openings for personal growth and learning. And that more family-owned weekend huts, or ceilidhs and libraries, have the potential to be just as valuable as more therapists and more prescriptions for antidepressant medication. 


Comments (10)

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  1. Gerard Carlin says:


  2. 220909 says:

    I’ve submitted to the consultation a series of poems I wrote back in 2006, when I was diagnosed as being ‘mentally ill’ and which I later distributed in pamphlet-form as ‘suggestions for the promotion of good mental health’. The writing helped me escape that diagnosis, which I came to see as an expression of the bio-power of the psychiatric profession and its attempts, on behalf of society, to conform my behaviour to within the bureaucratic parameters by which it defines ‘normality’. Thankfully, my deviance wasn’t sufficiently radical to warrant my being ‘sectioned’ or else I’d have been lost.

    I have a Foucauldian mistrust of the whole institution of ‘mental health’. As I’ve noted in my covering letter to the Mental Health Directorate (the name says it all!), our society would be better served by the Scottish government putting more resources into treating and providing asylum from its intolerance than into the further medicalisation of difference.

    1. Wul says:

      I packed in a well-paid, bureaucratic job a while back to work with timber and soil. The “professional” job involved sitting for 8hrs per day at a screen and phone, in low-ceilinged, open-plan offices lit by fluorescent strips, ” delivering services” to desperate people with about 1/10th of the money and staff needed to do the job properly.
      I got to work by burning £200/month of petrol (about £600 at today’s prices) and spending 10hrs/week in my car in a procession of other people doing the same. I’d get home hoping my kids were asleep, because I didn’t have the energy to talk to them.

      At some point, I realised this was an insane way to live and changed my life radically (a lot less money for one thing). It was the job or me. I’m not proud of this change because it felt like the job had broken me and I chose an easier life, which left my family poorer.

      I suspect there are many (particularly men?) who have made changes like this before the crazy way that we organise our society sends them completely daft. I think you are onto something with your concept of asylum.
      A caring and healthy society should be offering alternative ways of living other than “work more”, “consume more”, “increase growth”, “gain status”. There needs to be realistic opportunities to live quietly, meaningfully, harmoniously, safely, harmlessly.

      1. 220911 says:

        Good on you, Wul!

        However, given the current ideological constitution of society and, in particular, its dominant work ethic, I don’t think we should pin our hopes on it becoming more caring any time soon. What we call ‘mental ill health’ is largely a refusal of that constitution and its normality, an act of resistance, which is why we demonise it and seek to rehabilitate its ‘victims’ to our normality.

  3. SleepingDog says:

    I suggest a priority should be trauma-reduction, from various kinds of safeguarding to restructuring society, not only for individual wellbeing but also because a traumatised political class is currently dragging us to hell.
    Poster boy for child trauma, Charles III, however is set up as some kind of paragon, an implausible role model, his background completely unvetted by his rubber-stamping Privy Council. Since much trauma stems from political corruption, social cheating and unsustainable privileges, as well as want, cruelty and neglect, these should also be tackled as part of any Scottish government mental health and well-being strategy. Environmental health and human mental health are mutually supportive, which is one reason I support a constitutionally-encoded biocracy.

    1. Dave says:

      Sleeping Dog. It will never happen under British F.M. NU-S.N.P. Leader Sturgeon. She does everything possible to NOT delay but in fact STOP our independence. The 2nd referendum was last year when she received the mandate from the Scottish people to DECLARE independence. She had a record number of seats to do that. As usual she stalled by saying it was for another referendum. Then worried about the rise of ALBA she had to make it look like she was doing something for Independence so by conning the NU-S.N.P. membership by selling them of holding another referendum she succeeded on another long delay. Her strategy:

      Part 1) Beg Boris continually for permission to allow us to hold another illegal referendum. INDY DECLARATION DELAY.
      Part 2) Have Ian Blackford beg Boris do the same. FURTHER DELAY.
      Part 3) Ask the English supreme court if they would give permission. FURTHER DELAY.
      Part 4 Ask the English supreme Court if the NU-S.N.P. could intervene. FURTHER DELAY.
      SCOTLAND as a SOVEREIGN COUNTRY does not need permission from any foreign government to do anything.

      Also remembering that Ms. Sturgeon has BLACKTED OUT ALBA, THE ISP and any true independent party. She refuses to work with them.
      The obvious perception is that she is working with Westminster. Perhaps a seat in the house of Lords ?
      Let’s also remember that we are being conditioned not to say anything negative about F.M. Sturgeon as it would damage our Independence goal. ABSOLUTE NONSENSE. That is just another lie to keep us in line and shut up. Over 8 years and still a colony because we have shut up.
      Where’s the 600 K pounds for the purpose of Independence ? Where’s the 22 BILLION pounds which GERS ‘gave’ the S.G. last year to cover our deficit ? Since F.M. Sturgeon didn’t contest or even protest that fictitious amount it must be true.
      The NU-S.N.P. Members and supporters need to WAKE UP.
      Just a reminder in closing. The Murrells are NOT the YES leaders. FACT: We have only 2 MPs at Westminster both from ALBA, fighting for Scotland and OUR independence. We all need to get behind them. It is about time that the NU-S.N.P.s there crossed the floor to ALBA and DO THE JOB THEY WERE ELECTED FOR.

  4. dave says:

    One of the major factors of mental illness is the conditioning of Scots that we are a useless, stupid bunch of eejits who can’t do anything unless told to do so by the ENGLISH GOV’T. This very subtle programme starts at the PRIMARY school level. Since 1707 Scottish history and culture have gradually been erased and replaced by English/British history and culture. Statues of English heroes have been erected all through Scotland while our heroes have never been heard of. The current English strategy is to BLACKOUT ‘ SCOTLAND’ and replace it with the U.K. or ENGLAND.
    e.g. Edinburgh is the most beautiful city in the U.K. thereby erasing SCOTLAND.

    Going back to the first sentence. When we are taught that our Scots language is an English accent the conditioning of being ashamed of our LEID has started. The term WORKING CLASS used by the English aristocrats has become a derogatory term used to keep Scots divided by insinuating that ‘WORKING CLASS’ people are somehow less intelligent than the rest of us. The correct term is WORKING PROFESSION.

    Fact: When a Scot does well for him/herself they are ridiculed by a great number of their fellow Scots. The remarks are of a jealous, envious, bitter and angry nature. We are taught to be humble and never acknowledge our accomplishments. WHAT NONSENSE IS THAT ?
    The result is an ASHAMED Scot who can never realize his/her dreams. ‘YE CANNAE DAE THAT’. By consciously feeding that negative into the subconscious the belief becomes fact. That has to effect anybody’s mental health in both mental and physical ways. Outlets are drunkenness. drugs and the jealousy of fellow Scots mentioned at the beginning of this paragraph. The deliberate strategy to fuel the destruction of our culture by the English aristocrats is carried out EVERY single day in the ENGLISH owned Scottish media with 100% NEGATIVE reporting. e.g. Read the Daily Record and you will find every HEADER starts with: A Scottish man steals. Scottish woman beats her bairns, Scottish gang brawls etc. There is NEVER any POSITIVE news about any Scot or Scottish achievement as it is BLACKED OUT. Other English owned Scottish media simply follow the English BLACKOUT in keeping with their Westminster strategy of ‘ put Scotland down at every opportunity’

    The HEADER changes when the crime is in England. Oh yes the English city is mentioned but most people never read the fine print just the HEADERS. There are tons of other put-downs which can be mentioned.

    So at least 50% of Scots feel ashamed of their heritage because they don’t know it. That has a profound impact on their well being.

    The fault lies with the BRITISH F.M. NU-S.N.P. Leader Sturgeon. She has, in conjunction with Westminster, put a BLACKOUT on our history and culture as well as our true rich economical state. SCOTLAND is one of the richest countries in the world. People in Scotland look up to our leaders for true information on all things.

    It is devastating to know nothing except how useless. stupid and totally incompetent we are. Also how we must humbly beg our English colonial masters for crumbs just to stay alive while these masters remove trillions of Scottish pounds to London. Good nourishing food is getting beyond the reach of a great number of Scots as they simply can’t afford it. These things are directly connected to mental health problems.

    The British F.M. Sturgeon has done nothing to correct any of those CRITICAL issues and never will. But then she gets paid thousands of English pounds per week from our Scottish taxes and revenues collected by the English Gov’t. The NU-S.N.P. MPs at Westminster are in the same boat as they sit humbly, ashamed with their heads down as they are laughed at and ridiculed by the 600 or so English MPs.

    While Independence will not cure all the mental issues it will reduce them considerable. Happiness and laughter is a known ‘medicine’.

    The current Scottish gov’t will always BLACKOUT anything of the connection between independence and MENTAL health issues as that does not fit F.M. Sturgeon’s agenda. As she said herself Scotland will always be part of BRITAIN as long as she is F.M.

    IT IS TIME FOR Ms. Sturgeon and her Husband ,who she appointed, Mr.Murrell to RESIGN from the NU-S.N.P. so a PROUD SCOT can take over and do what her or she were voted in for.

    1. 220911 says:

      See you’re still at the auld bigotry, dave.

    2. 220911 says:

      ‘The b*st*rd*n English’, eh?

    3. Alec Lomax says:

      How’s the weather in Bath, Stu? Sorry, I meant Dave.

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