1. The 10 Essential Shared Capabilities for Mental Health Practice
NHS – Education for Scotland
The 10 Essential Shared Capabilities for Mental Health Practice
Welcome!
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2. What are the 10 Essential Shared Capabilities (ESCs)?
NHS – Education for Scotland
What are the 10 Essential Shared Capabilities (ESCs)?
Working in partnership.
Respecting diversity.
Practising ethically.
Challenging inequality.
Promoting recovery.
Identifying people’s needs and strengths.
Providing service user-centre care.
Making a difference.
Promoting safety and positive risk taking.
Personal development and learning.
The 10 ESC’s:
attitudes, behaviours, expectations and relationships;
describing the values and principles that should be demonstrated in the way mental health services are commissioned, planned and delivered;
deriving from and reflecting how people who use mental health services and those who support them want to be treated, and the way they expect to be treated;
outlining values and principles that should influence the actions and outcomes people working in mental health services should be seeking, with and on behalf of people using mental health and social care services.
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3. NHS – Education for Scotland
Why Are We Here?
To support cultural change.
To promote rights-based, recovery focused practice.
To become action focused.
To develop knowledge, skills & attitude.
Pilot learning materials for the ESCs were developed and evaluated with more than 600 people from a wide range of roles and settings in England. The materials were very positively evaluated and, importantly, people said they made a positive difference to their practice.
On the basis of this evaluation and a review of the materials, we have further developed the original materials for use in Scotland.
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4. Rights, Relationships and Recovery Culture and Values
NHS – Education for Scotland
Rights, Relationships and Recovery Culture and Values
- All MH nurses have access to values based training.
- Embed values based practice in personal development plans.
- Use recovery audit tools.
- Train in Recovery methods.
- Help maximise contact time.
This slide and the next two slides are taken from the Progress Report published in July 2007.
The 10 ESCs!
Scottish Government MH Delivery and Services Unit and SRN are producing the Scottish Recovery Indicator and will pilot this year.
A National Framework for recovery training is being developed.
NHS Greater Glasgow and Clyde have implemented recovery based models in some services.
NHS Border, Forth Valley, Fife, Lothian and Lanarkshire are redesigning services.
Other boards waiting for training materials and audit tool.
Nursing staff are considering WRAP (Wellness Recovery Action Plan) training.
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5. Rights, Relationships and Recovery
NHS – Education for Scotland
Rights, Relationships and Recovery
Practice and Services
Create national CPD Programme.
Develop recovery models for inpatient units.
Promote continuity of Care.
Develop practice networks.
Develop competency based framework.
Support nurses to deliver therapies.
Create nurse consultants.
National conference held. Options being considered.
A capability framework in acute and crisis care is out for consultation.
Several Boards are using or considering the TIDAL model.
Access to training in psychosocial and psychological therapies is extremely variable. Some training in Borders and Forth Valley. NHS Dumfries and Galloway are at the planning stage.
Nurse consultant posts agreed in Greater Glasgow and Clyde (eating disorders). Ayrshire and Arran (psychosocial/psychological interventions). Generally progress is slow.
It would seem that barriers are being put in front of nurses once they have trained to become prescribers.
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6. Rights, Relationships and Recovery
NHS – Education for Scotland
Rights, Relationships and Recovery
Education and development
Attract the right people.
Opportunities to develop and learn.
Involve users and carers in programme design.
Develop role of Health care Support Workers.
Nursing leaders.
More research and Evaluation.
Develop robust learning climate.
NES facilitating national framework for pre-registration MH nursing programmes.
NES also working on an education and training framework for mental health support workers.
‘Flying Start’ a web based programme was launched in 2005 for newly qualified nurses.
A number of Boards provide access to leadership courses – often confined to senior staff.
The quality of clinical supervision is variable.
Links established with universities to help foster research and learning.
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7. Delivering for Mental Health
NHS – Education for Scotland
Delivering for Mental Health
Improve patient and carer experience of mental health services.
Respond better to depression, anxiety and stress.
Improving the physical health of people with mental illness.
Better management of long-term mental health conditions.
Delivering for Mental Health National Standards for Crisis Services, November 2006.
Commitment 1; Develop a tool in respect of equality, social inclusion, recovery and rights. Piloted in In general use by 2010.
Commitment 2; A training programme for peer support workers by 2008, with PSWs employed in 3 board areas later that year.
Commitment 3; A formal assessment using a standardised tool and matched therapy for new patients presenting with depression.
Commitment 4; increase availability of evidence based therapies for all age groups.
Commitment 5; A physical health assessment every 15 months for all patients with severe and enduring mental illness.
Commitment 6; develop standards for ICPs for schizophrenia, bi-polar disorder, depression, dementia and personality disorder by end of 2007.
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8. Delivering for Mental Health
NHS – Education for Scotland
Delivering for Mental Health
Early detection and intervention in self-harm and suicide prevention.
Manage better admission to, and discharge from, hospital.
Child and Adolescent services.
Enhancing specialist services.
Commitment 7; Key frontline MH services, primary care, and A and E staff to be trained in using suicide assessment tools. 50% target by 2010.
Commitment 8; ensure that the crisis standards are achieved by 2009.
Commitment 9; establish acute in-patient forums across all Board areas.
Commitment 10; a named MH link person available to every school; basic MH training to be offered to all those working with looked after and accommodated children.
Commitment 12; implement the new Care Programme Approach for all restricted patients by 2008.
Commitments too in the areas of MH and substance abuse and dementia.
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9. NHS – Education for Scotland
Legislation
Regulation of Care (Scotland) Act 2001
Code of practice for Social Services Workers 2005
Data Protection Act 1998
Access to Medical Reports Act 1985
Human Rights Act 1998
Adults with Incapacity (Scotland) Act 2000
Mental Health Care and Treatment (Scotland) Act 2003
Social Work Scotland Act 1976
Sex Discrimination Act 1975
Disability Discrimination Act 1995
Race Relations Act 1976
Race Relations Amendments Act
A range of complimentary (and sometimes competing) frameworks exist to direct our behaviours And actions.
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10. NHS – Education for Scotland
MODULE 2
10 Essential Shared Capabilities (ESCs)
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11. 10 Essential Shared Capabilities (ESCs)
NHS – Education for Scotland
10 Essential Shared Capabilities (ESCs)
Working in partnership.
Respecting diversity.
Practising ethically.
Challenging inequality.
Promoting recovery.
Identifying people’s needs and strengths.
Providing service user-centre care.
Making a difference.
Promoting safety and positive risk taking.
Personal development and learning.
The 10 ESC’s:
On a surface reading, all capabilities will probably seem sensible and may reflect your current attitude and practice. Reflecting on yourself, your role and your practice in relation to the ESCs can be challenging, but it will provide you with a greater insight into mental health work and enable you to explore and reflect on the basis of mental health care. We use the word ‘care’ here in its fullest sense, not in a narrow service or professional definition.
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12. NHS – Education for Scotland
Learning outcomes
Describe the 10 ESCs and how they relate to mental health.
Reflect on yourself and your practice in relation to the ESCs.
Understand how the ESCs relate to and support the delivery of mental health policy and legislation in mental health practice in Scotland.
Start to think about further developing your practice in line with the ESCs and recognise how they can help you to improve your experience of mental health work and the experiences of the people you work with.
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13. Working in Partnership
NHS – Education for Scotland
Working in Partnership
Value service users as equal in their care and treatment.
Acknowledge the positive part families, friends and carers can play in the service user’s support network.
Engage people as partners in care in a way that maximises their role in decision making and making choices.
It also involves working positively with any tensions created by conflicts of interest or aspiration that may arise between partners in care.
One of the principles of the Mental Health (Care and Treatment) (Scotland) Act 2003 is ‘participation’, which is closely linked to the idea of partnership (the principles are explored in more detail later in the module).
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14. NHS – Education for Scotland
Respecting Diversity
Practice and Services
Respecting diversity is about working in partnership with service users, carers, families and colleagues to provide care and interventions that not only make a positive difference, but also do so in ways that respect and value diversity, including age, race, culture, disability, gender, spirituality and sexuality.
NB The ‘Fair for All’ document and the principles of the Mental Health (Care and Treatment) (Scotland) Act 2003
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15. NHS – Education for Scotland
Practising Ethically
Practising ethically involves the rights and aspirations of service users and their families and carers, acknowledging power differentials and minimising them whenever possible. It also focuses on providing care and treatment that is accountable to service users and carers within the boundaries prescribed by law and professional, national and local codes of ethical practice.
The law – the Mental Health (Care and Treatment) (Scotland) Act 2003 and other relevant pieces of legislation.
Codes for professional groups like nurses and social workers, such as the Nursing and Midwifery Council Code of Conduct.
Policy, such as Delivering for Mental Health (SEHD, 2006).
Professional values statements, including those set out in Rights, Relationships and Recovery – the Report of the National Review of Mental Health Nursing in Scotland (SEHD, 2006).
Importantly, our own individual values and beliefs.
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16. Challenging Inequality
NHS – Education for Scotland
Challenging Inequality
Challenging inequality involves addressing the causes and consequences of stigma, discrimination, social inequality and exclusion on service users, carers and mental health services. It also focuses on creating, developing or maintaining valued social roles for people in the communities in which they live.
The ‘See Me’ campaign is run by an alliance of five Scottish mental health organisations:
Highland Users Group (HUG)
The National Schizophrenia Fellowship (Scotland)
Penumbra
The Royal College of Psychiatrists (Scottish Division)
Scottish Association for Mental Health.
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17. A Scottish Government survey (SEHD, 2006) showed that:
NHS – Education for Scotland
A Scottish Government survey (SEHD, 2006) showed that:
Half of the respondents said they would not want anybody to know if they developed a mental health problem.
Most people in the survey said they thought the media portrayed people with mental health problems negatively.
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18. More research findings
NHS – Education for Scotland
More research findings
41% of people with mental health problems living in Scottish communities have experienced harassment, compared with 15% of the general public.
A 2001 study found that only 37% of employers said they would in future take on people with mental illness, compared to 62% who would take on physically disabled people, 78% who would employ long-term unemployed people, and 88% who would appoint lone parents.
64% of young people say they would be embarrassed to disclose a mental health problem to a prospective employer.
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19. NHS – Education for Scotland
Promoting Recovery
Promoting recovery involves working in partnership to provide care and treatment that enables service users and carers to tackle mental health problems with hope and optimism and to work towards a valued lifestyle within and beyond the limits of any mental health problem.
People can and do recover from mental health problems.
Recovery is a common human experience.
Recovery is a process or journey, rather than an end point.
The concept of ‘recovery’ encompasses more than just recovery from illness or an absence of symptoms.
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20. It’s Important to note what recovery doesn’t mean. It is not:
Cure.
Something mental health workers ‘do’ to people.
A new word for ‘rehabilitation’.
A model.
‘Something we have always been doing anyway.’

21. The keys to working in a recovery-focused way include:
HOPE, one of the most important factors in recovery.
A belief in recovery.
Holding and demonstrating values and practices that reflect this belief.
Taking what people can do and want (their strengths) as a starting point.
Developing care so that service users can increase their role in directing their own care and treatment.
Creativity and positive risk taking.
The use of tools such as person-centred planning, strengths-based approaches and wellness recovery action planning.

22. Identifying Peoples Needs and Strengths
NHS – Education for Scotland
Identifying Peoples Needs and Strengths
Identifying people’s needs and strengths involves working in partnership to gather information to agree health and social care needs in the context of the preferred lifestyles and aspirations of service users, their families, carers and friends.
Carry out (or contribute to ) assessments that focus on the strengths and needs of the person using services and the family, friends and carers who support them.
Work in a way that acknowledges the personal, social, cultural and spiritual strengths and needs of the person.
Work in partnership with the people’s network to collect information to assist understanding of the person and his or her strengths and needs.
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23. Providing Service User-Centred Care
Providing service user-centred care involves negotiating achievable and meaningful goals, primarily from the perspective of service users and their families and carers. It also involves influencing and seeking the means to achieve these goals and clarifying the responsibilities of people who will provide help, including systematically evaluating outcomes and achievements.

24. ‘Most helpful strategies and supports’
NHS – Education for Scotland
‘Most helpful strategies and supports’
Friends, partners, family.
Other service users/people with similar problems.
Mental health professionals.
Counsellors/therapists.
People encountered in day centres, drop-ins, voluntary sector projects.
The ‘ Strategies for Living’ Team at the Mental Health Foundation asked service users to identify anybody, or anything they had found helpful or supportive at a time in their life when they were distress. This was to identify service users’ strategies for living with mental distress (Faulkner and Layzell, 2000)..
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25. Strategies Personal strategies Peace of mind.
Thinking positively, taking control.
Medication.
Physical exercise.
Religious and spiritual beliefs.
Money.
Other activities
Hobbies and interests.
Information.
Home.
Creative expression.

26. NHS – Education for Scotland
Making a Difference
Making a difference involves facilitating access to and delivering the best quality, evidence-based, values-based health and social care interventions to meet the needs and aspirations of service users and their families and carers.
What evidence should be informing practice? Basically, we are looking at:
Clinical guidelines.
Best practice statements.
Integrated care pathways.
Importantly, the lived experience of people whom have experienced mental health problems and mental health services and the experiences of their families and carers.
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27. Promoting Safety and Positive Risk Taking
NHS – Education for Scotland
Promoting Safety and Positive Risk Taking
Promoting safety and positive risk taking involves working with people to decide the level of risk they are prepared to take with their health and safety. It encompasses working with the tension between promoting safety and supporting positive risk taking, including assessing and dealing with possible risks for service users, carers, family members and the wider public.
Positive risk taking is not about neglecting risks and compromising people’s safety. Rather it involves weighing up the potential benefits and harms of exercising one choice of action over another.
Developing plans and actions that reflect the positive potentials and stated priorities of the service user.
Using available resources and support to achieve the desired outcomes and to minimise potential harmful outcomes.
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28. NHS – Education for Scotland
Perkins (2007) points out that often mental health professionals feel that their job is to protect the people they work with – protect them not only from physical harm, but also from failure. But if any of us are to do the things we want to do, we have to risk the possibility of being unsuccessful.
None of us would have friends or partners if we had not risked the possibility of being rebuffed or rejected.
None of us would have qualifications if we had not risked the possibility of failing our examinations.
None of use would have jobs if we had not risked the possibility of being turned down.
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29. The Factors that need to be in place for Positive Risk Taking to Take place
Having enough information to exercise choices and make decisions.
Holding some control over the direction of your destiny.
Having a degree of power and control.
Being able to work with others positively to inform your decisions.
Having options to make constructive use of opportunities.

30. It should become part of the culture of training
Adequate resources to enable creative work.
Limiting the duration of the decision.
Having team and service mechanisms.
Individual and collective accountability and responsibility is clearly defined.
The ‘organisation’ also holds responsibilities.

31. Personal development and learning
NHS – Education for Scotland
Personal development and learning
Personal development and learning involves keeping up to date with changes in practice and participating in lifelong learning and personal and professional development opportunities for self and colleagues through supervision, appraisal and reflective practice.
Keeping up to date with changes in the way services are delivered.
Taking part in learning throughout your life.
Making sure you (and the people you work with) get advice and support through supervision, regular reviews of progress and opportunities to think about the way things are done.
Access to education and training opportunities.
A personal/professional development plan that takes account of your hopes and aspirations and is reviewed regularly.
To understand the responsibilities of the service in supporting you in meeting goals set out in the development plan.
To understand your personal responsibility to achieve the goals set out in your development plan.
To recognise the importance of supervision and reflective practice and integrate both into everyday practice.
To b proactive in seeking opportunities for personal supervision and personal development and learning.
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32. NHS – Education for Scotland
MODULE 3
Involving service users and carers
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33. Learning Outcomes After completing the module you will be able to:
Describe the links between service user involvement, carer involvement and the 10 ESCs.
Discuss service user and carer involvement at individual, organisational and strategic levels.
Explore local approaches to increasing service user and carer involvement.
Present ideas on how this improved approach can be achieved

34. NHS – Education for Scotland
Policy, Legislation and local strategies related to service user and carer involvement 
Changing Lives Implementation Plan (SEHD, 2006)
Framework for Mental Health Services (Scottish Office, 1997)
Delivering for Mental Health (SEHD, 2006)
Community Care and Health (Scotland) Act 2003
The Mental Health (Care and Treatment) (Scotland Act 2003)
Voices of experience (VOX)
Policy developments in Scotland since devolution have encouraged public sector bodies to be more accountable to service users and carers. NHS boards have a legal duty to involve the public in planning services.
Mental health services have been required to involve service users and their carers since the production of the Framework for Mental Health Services (Scottish Office, 1997)
This is reflected in the national plan for mental health service improvement, Delivering for Mental Health.
Carers’ rights are identified in the Community Care and Health (Scotland) Act These include rights to carers’ assessments, that carers be treated as partners in care by professionals and a duty on NHS boards to develop a carers’ information strategy.
The Mental Health (Care and Treatment) (Scotland) Act 2003 – puts service users and their carers at the centre of the mental health care and treatment system.
A new national service user organisation called Voices of eXperience (VOX) has been formed to deliver improvements in people’s experience of service.
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35. NHS – Education for Scotland
Levels of Involvement
Individual
Organisational
Strategic
Involving individuals in their care and treatment in ways that meet their needs, give them choices and engage them in all steps of the process. Equally, carers want to be recognised, listened to and supported as partners in providing care.
Organisational involvement can mean quite practical, hands-on, joint work involving service providers and service users and carers.
Often strategic involvement is about influencing service commissioners, multi-agency planning partnerships and committees (such as Community Planning Partnerships) and local funding bodies.
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36. Developing People’s Confidences
Listening to their needs and aspirations.
Providing information.
Working to develop constructive relationships with people.
Basing assessments and plans on individuals’ strengths.
Including people in planning.

37. NHS – Education for Scotland
“ Writing an advance statement has made me feel that I have taken control of my care and treatment. I feel more empowered and the whole process has given me an opportunity to think through my mental health history and what works for me”
An example of personal involvement can be found in making an Advance Statement (as recognised by the Mental Health Act), which is an agreement on what happens if the person becomes unwell.
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38. Core components of effective service-user involvement
NHS – Education for Scotland
Core components of effective service-user involvement
It is essential to involve people in assessment, reviews and discussion making around their care, support and treatment.
Having the information they need to be involved.
Knowing what options and choices are available to them.
Feeling free to express views and wishes.
Being listened to and understood and having their views respected.
Being able to influence what happens and make decisions that matter.
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39. Barriers to Service User and Carer Involvement
NHS – Education for Scotland
Barriers to Service User and Carer Involvement
Individual
Serviced-related
Societal
People lose hope and confidence through their period of mental health. Losing touch with friends, relatives and communities they may feel excluded.
Some service users and their carers have had negative experiences of mental health services.
Discrimination and setbacks can have negative effects on someone’s desire to keep trying to engage in activities related to their well-being
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40. Actions that can contribute to developing people’s confidence include:
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Actions that can contribute to developing people’s confidence include:
Listening to their needs and aspirations
Providing information
Working to develop constructive relationships with people
Basing assessments and plans on individuals’ strengths
Including people in planning
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41. NHS – Education for Scotland
“ Power is the ability to influence and control people, events and processes …. it is an ever-present phenomenon
The quote is from Thomson (1998).
Power is an important issue in involving service users and carers.
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42. Good Practice in Strategic Involvement
NHS – Education for Scotland
Good Practice in Strategic Involvement
Support organisations that help individuals to be involved.
Set up meetings at convenient times and locations.
Acknowledge individuals’ backgrounds and circumstances, including diversity of age, culture, race, disability, gender, sexuality and spirituality, and take these into account when asking for involvement.
Find out about training and development opportunities that will facilitate greater involvement
Be aware of and use person-centred approaches to commissioning services.
Examples of good practice in strategic involvement show that time and effort spent in facilitating individuals’ and groups’ active participation results in better-informed contributions and stronger partnerships.
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43. Good Practice in Strategic Involvement - cont.
Provide information in a timely and accessible manner.
Set out tasks clearly.
Run meetings and events in ways that promote participation.
Allow enough time meetings for debate and consultation.
Involve service users in decision-making processes from the beginning and make it clear how, where and when decisions are made.
Have a jointly agreed approach to involving service users and carers which covers practical aspects, such as payments and expenses, and difficult points such as ways of resolving differences of opinion.

44. NHS – Education for Scotland Values-based practice
MODULE 4
Values-based practice
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45. Learning outcomes After completing the module you will be able to: Explain what values-based practice (VBP) means in mental health and social care by:
Describing the 10 pointers to good process in VBP.
Explaining the relationship of VBP to the 10 Essential Shared Capabilities (ESC’s).
Beginning to apply VBP in your work.

46. The values base for mental health nursing
NHS – Education for Scotland
The values base for mental health nursing
Relationships
Rights
Respect
Recovery
Reaching out
Responsibility
Relationships
Putting positive working relationships supported by good communication skills at the heart of practice.
Maximising time to build relationships and challenging systems that detract from this.
Recognising when relationships are unhelpful and taking steps to address this.
Rights
Based on principles in legislation, safeguards and codes of conducts.
Respect
For diversity of values and placing the values of individual users at the centre of practice.
Listening to what people say and not basing practice on assumptions about what people need.
Seeing the whole person and not just his or her symptoms.
See the person as the ‘expert’ in his or her experience. For the contribution of families and carers.
Recovery
Promoting recovery and inspiring hope – building on people’s strengths and aspirations.
Increasing capacity and capability to maximise choice.
Reaching out
To make best use of resources available in the wider community and to other agencies involved in mental health care.
Being pro-active about opportunities for change and mobilising opportunities to work with others to bring about change.
Responsibility
At corporate, individual and shared levels to translate the vision and values into practice by evolving current frameworks for practice and challenging and shaping institutional systems and procedures to accommodate this.
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47. Changing Lives – Core Values of Social Work in Scotland
NHS – Education for Scotland
Changing Lives – Core Values of Social Work in Scotland
Respecting the right to self determination
Promoting partnership
Taking a whole-person approach
Understanding each individual in the context of family and community
Identifying and building on strengths
Scottish Government 2006
We can see that there are areas of similarity and difference in the two professional values statement.
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48. Values- based practice
NHS – Education for Scotland
Values- based practice
The theory and capabilities for effective decision making in health and social care builds in a positive way on differences and diversity of values
Working in a positive and constructive way with differences and diversity of values.
Putting the values, views and understandings of individual service users and carers at the centre of everything we do.
Understanding and using our own values and beliefs in a positive way.
Respecting the values of the other people we work with and being open and receptive to their views.
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49. The 10 Pointers to Good Process in VBP (Woodbridge and Fulford)
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The 10 Pointers to Good Process in VBP (Woodbridge and Fulford)
Practice Skills
Awareness
Reasoning
Knowledge
Communication
Being aware of the values in a given situation.
Thinking about values when making decisions.
Knowing about values and facts that are relevant to a situation.
Using communication to resolve conflicts/complexity.
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50. The 10 Pointers to Good Process in VBP
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The 10 Pointers to Good Process in VBP
Models of Service Delivery
User Centred
Multidisciplinary
Considering the service user’s values as the first priority.
Using a balance of perspectives to resolve conflicts.
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51. The 10 Pointers to Good Process in VBP
NHS – Education for Scotland
The 10 Pointers to Good Process in VBP
Values-based practice and evidence based practice
The Two feet Principle
The squeaky wheel Principle
Science and Values
All decisions are based on facts and values; evidence-based practice and values-based practice therefore work together.
Values shouldn’t just be noticed if there’s a problem.
Increasing scientific knowledge creates choices in health care; this can lead to wider differences in values.
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52. The 10 Pointers to Good Process in VBP – cont.
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The 10 Pointers to Good Process in VBP – cont.
Partnership
In values-based practice, decisions are taken by service users working in partnership with providers of care.
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53. Equality and diversity: respecting difference
MODULE 5
Equality and diversity: respecting difference

54. Learning outcomes After completing this module, you will be able to:
NHS – Education for Scotland
Learning outcomes After completing this module, you will be able to:
Reflect on what equality and diversity mean to you.
Describe current issues in inequalities in Scotland that impact on mental health.
Examine equality and diversity in relation to mental health services in Scotland.
Discuss broader issues in relation to health inequalities in Scotland that are relevant to mental health.
Reflect on your own experiences and practice in relation to equality and diversity issues.
According to Fair for All, diversity is about:
‘….the recognition and valuing of difference’.
In other words, it is about respecting and valuing the things that make us unique as individuals. These could include our physical appearance and size, our habits, preferences, beliefs, customs and traditions, our family background and upbringing, our dialect or language and so on. These variations also reflect in the way individuals and communities think about mental health.
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55. Some examples of the inequalities that exist
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Some examples of the inequalities that exist
People with mental health problems are two times more likely to die from coronary heart disease and four times more likely to die from respiratory disease than the general population in Scotland.
These issues are drawn from the resource “Equal Mind”, (SCDMH 2005)
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56. Some examples of the inequalities that exist - cont.
NHS – Education for Scotland
Some examples of the inequalities that exist - cont.
Mental health problems affect more women than men, and a relatively greater number of women experience depression and anxiety.
Alcohol and drug misuse levels are higher in men.
The suicide rate among men is nearly three times that for women.
Women, may be more prepared to acknowledge difficulties and may seek help more readily than men, who tend to under-report depression and anxiety.
Suicide is one of the leading causes of death among young men.
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57. Some examples of the inequalities that exist – cont.
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Some examples of the inequalities that exist – cont.
The rate of depression among gay men is as much as eight times that found in the general population.
Up to two thirds of lesbian women have been found to suffer from depression.
Bi-sexual and transgender people are also at particular risk of depression.
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58. Some examples of the inequalities that exist – cont
Young people who are gay, lesbian or bisexual are 6-11 times more likely to attempt to take their lives than their heterosexual peers.

59. Some examples of the inequalities that exist – cont
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Some examples of the inequalities that exist – cont
Pakistani and Bangladeshi women have higher rates of common mental health disorders than white women.
There are limited numbers of Scotland-specific studies and statistics on black and minority ethnic people’s experience of mental health and services. This and the following statistics are mainly drawn from information gathered in England, may reflect similar trends here.
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60. NHS – Education for Scotland
Black and Minority Ethnic peoples’ experience of mental health and services
Disproportionately high numbers subject to compulsory treatment.
Afro-Caribbean people have a 60% higher rate of depression than white people.
There are also disproportionately high numbers admitted to mental health hospital in-patient units.
Afro-Caribbean men are twice as likely to suffer from depression than white men.
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61. Black and Minority Ethnic peoples’ experience of mental health and services – cont.
The incidence of attempted suicide and self harm among young Asian women is higher than it is among their English counterparts.
Black and minority people who declare their mental health problems speak of experiencing racism and discrimination on a recurrent basis.

62. Inequalities in people’s mental health, have been linked to:
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Inequalities in people’s mental health, have been linked to:
Socio-economic status
Life circumstances
Social identity
Health status
Socio-economic status – living in poverty, for example, and/or living in a socio-economically disadvantaged community.
Life circumstances – for example being homeless, in care or in prison.
Social identity – Being a woman, being a man, coming from a black or minority ethnic community, being lesbian or gay, or being old or young.
Health status – being physically disabled.
Facilitators’ Toolkit

63. Six Inequality Strands
NHS – Education for Scotland
Six Inequality Strands
Gender
Race or ethnicity
Religion or spiritual beliefs
Sexual orientation
Disabilities
age
Gender – including those who are transgender.
Race or ethnicity – including refugees, asylum seekers and gypsy or travelling people.
Sexual orientation – being lesbian, gay or bisexual.
Disabilities – including mental health problems.
Facilitators’ Toolkit

64. NHS – Education for Scotland
Issues highlighted by Service Users representing different equalities issues
Discrimination and prejudice.
Lack of trust.
Inappropriate services.
Services’ lack of cultural competence.
The need for services to give greater importance to service users’ experience.
People’s desire for more person-centred, holistic services.
These issues identified by local and national organisations e.g. Lesbian, Gay, Bi-sexual and Transgender (LGBT), Resource Centre for Ethnic Minority Health and Centre for Health and Well Being.
Facilitators’ Toolkit

65. Issues impacting on men’s mental health
NHS – Education for Scotland
Issues impacting on men’s mental health
Rates of unemployment
Physical health
Issues of masculinity
The reality of men and women’s lives in different. It’s different in terms of their life experience and the socio-economic and environmental factors that affect mental health.
Men respond more negatively to unemployment.
It has been suggested, that higher rates of suicide among men may be linked to their reluctance to express distress.
Facilitators’ Toolkit

66. We need to make sure that mental health services for men:
NHS – Education for Scotland
We need to make sure that mental health services for men:
Are flexible.
Focus on the whole person.
Avoid stereotyping men as being unfeeling or uncommunicative.
Build up trust, particularly through modelling values and behaviours around positive well-being.
The Breathing Space service, for example, ticks many of these boxes. It is a confidential phone service targeting young men who are experiencing difficulties and unhappiness in their lives.
Facilitators’ Toolkit

67. Factors that may impact on women’s mental health
NHS – Education for Scotland
Factors that may impact on women’s mental health
Poverty
Employment
Domestic abuse
Childhood sexual
There is a higher proportion of women in lower grades in all professions in Scotland.
Estimates suggest 20-25% of women have experienced childhood sexual abuse, compared to 6-7% of men.
Facilitators’ Toolkit

68. NHS – Education for Scotland
“There does not appear to be a single area of mental health care in this country in which black and minority ethnic groups fare as well as, or better than, the majority white community. Both in terms of service experience and the outcome of service interventions, they fare much worse than people from the ethnic majority.”
The quote is from “Inside Out” a Department of Health document, 2003.
Minority ethnic disadvantage cuts across all aspects of deprivation. Taken as a whole, minority ethnic groups are more likely than the rest of the population to live in disadvantaged areas, be unemployed, have low incomes, live in poor housing, have poor health and be victims of crime.
Facilitators’ Toolkit

69. Additional Black and Ethnic Minority issues
NHS – Education for Scotland
Additional Black and Ethnic Minority issues
Under-reporting of psychological distress.
Asylum seekers.
Lower rates of treatment.
Experience of services and outcomes of service interventions.
Gypsy and travelling people.
Studies indicated a high level of under-reporting of psychological distress from some minority ethnic communities, such as Asian communities.
Research has shown that asylum seekers’ levels of psychological distress while in the UK may be higher than those experienced while imprisoned and tortured in their own country.
There are lower rates of treatment for people from minority ethnic background who have some of the more common mental health problems.
Women from Gypsy and travelling people communities are subject to discrimination and consequently report experiences of anxiety and distress.
Facilitators’ Toolkit

70. NHS – Education for Scotland
Customs, ethical values and attitudes, hierarchical roles, family systems and loyalties are important foundations in the lives of minority ethnic people. They are elements of culture: the learned behaviour of a group of people in perceiving, interpreting, expressing and responding to the social realities about them.
The ‘equality and diversity-blind’ position assumes that equality is about ‘treating everybody the same’. But, we are all different, with different experiences of life, society and family, and have very different needs.
Equality is about equal respect, but not necessarily about having the same treatment.
To better attend to minority ethnic individuals’ needs, services and their staff need to increase their awareness of what minority ‘culture’ is, its possible impact on people’s lives, on their health in general and mental health in particular, and on their understanding of what mental health is.
Facilitators’ Toolkit

71. NHS – Education for Scotland
“Institutional racism is present throughout the NHS and greater effort is needed to combat it. Until that problem is addressed, people from black and minority ethnic communities will not be treated fairly. The cultural, spiritual and social needs of patients must be taken into account.”
The Bennett Inquiry in England in 2002 investigated the death of a black man in a secure unit in Norwich and presented 22 recommendations, mainly on racial issues. This has resulted in significant measures being implemented in England that, while not mandatory in Scotland, are relevant to us.
Facilitators’ Toolkit

72. A Closer look at Mental Health Inequalities
NHS – Education for Scotland
A Closer look at Mental Health Inequalities
Spirituality, religion and mental health inequalities.
Scotland is a religiously and culturally diverse country. We need to recognise this to address the spiritual and religious needs of people we support in mental health services.
The Scottish Government has stated that spiritual care, which includes but is not limited to religious care, must be provided in an equal and fair way for those of all faith communities or none.
NHS boards have produced a spiritual care policy and work is underway to develop culturally competent standards for spiritual and religious care.
Most NHS boards now have a Department of Spiritual and Religious Care staffed by a chaplaincy team.
Facilitators’ Toolkit

73. A Closer look at Mental Health Inequalities cont.
NHS – Education for Scotland
A Closer look at Mental Health Inequalities cont.
Sexual orientation and mental health inequalities.
Experience of stigma, discrimination and homophobia can occur throughout an individual’s life – in school, in the workplace, when accessing services and in local communities.
Fifty-seven percent of respondents in a study of gay men in Edinburgh said they’d experienced some form of harassment over the previous year.
A study of lesbian women and gay men in Glasgow revealed 85% had experienced verbal abuse and 60% had been threatened with violence.
Facilitators’ Toolkit

74. A Closer look at Mental Health Inequalities cont.
NHS – Education for Scotland
A Closer look at Mental Health Inequalities cont.
Disability and mental health inequalities.
Inequalities in this are can be considered in different ways as impacting on:
People who experience mental health problems.
People who experience mental health problems and physical disabilities.
People for whom have a physical disability has negatively impacted on their mental health.
The Disability Discrimination Act 1995 encompasses people with physical or mental impairments with substantial and long-term adverse effects.
Facilitators’ Toolkit

75. A Closer look at Mental Health Inequalities cont.
NHS – Education for Scotland
A Closer look at Mental Health Inequalities cont.
Hearing impairment.
38% of people with hearing impairment living in the community experience some form of mental distress. People with hearing impairment also experience higher rates of depression and anxiety than hearing people, although rates of diagnosed schizophrenia are similar across groups.
Hearing-impaired people with mental health problems find difficulty accessing services.
Facilitators’ Toolkit

76. A Closer look at Mental Health Inequalities cont.
NHS – Education for Scotland
A Closer look at Mental Health Inequalities cont.
Age and mental health inequalities.
Health issues impact most at the extremes of age range. Children and older people are more likely to experience poor health and health inequalities.
Facilitators’ Toolkit

77. Further issues related to age
NHS – Education for Scotland
Further issues related to age
Poverty and isolation.
Ability to access services.
Culturally competent services for black and ethnic minority older people are severely limited.
Depression.
Alzheimer’s disease.
long-stay hospital settings.
Poor physical health.
Poverty and isolation – Ability to access services
Ability to access services, in particular preventative services, is lower in comparison with other members of the population.
Black and ethnic minority older people
The lack of language support may create serious risks in service delivery; depression affects 10-15% of people aged 65 years and above in the UK; it is also a major cause of suicide amongst older adults in Europe.
Alzheimer’s
There are more new cases of Alzheimer's disease in Europe each year than there are cases of stroke, diabetes or breast cancer.
Long-stay hospital settings
In some long-stay hospital settings, residents have no access to primary care services to meet their physical health needs.
Poor physical health
The adverse effects of some mental health medications contribute to poor physical health.
Facilitators’ Toolkit

78. Multiple inequalities
NHS – Education for Scotland
Multiple inequalities
A young woman in Scotland may:-
Be born into a family of low socio-economic status.
Have parents who have had limited educational opportunities.
Have had no role models in her life to direct her through her teenage years.
Have experienced physical and emotional abuse.
People may experience double or multiple disadvantages, which exist in may guises. Inequalities can sometimes proverbially be seen as being like an onion, with multiple layers of ‘disadvantage’ covering and containing the human being inside.
Black and minority ethnic people, especially those who are non-white, may be subjected to discrimination based on ‘race’, as described above. But other layers of disadvantage made up of some or all of the other inequality strands can also co-exist.
Facilitators’ Toolkit

79. Multiple inequalities – example – cont.
NHS – Education for Scotland
Multiple inequalities – example – cont.
Have a learning difficulty or physical impairment.
Have a long-term health condition such as asthma or diabetes.
Be from a black and minority ethnic community that faces racism and discrimination.
Have recognised that she is sexually attracted to other women.
A young women in Scotland might say that her cultural values and expectations may serve to protect her in many ways; others, however, might not be helpful in a Western, Scottish society and may only serve to further isolate her.
Facilitators’ Toolkit

80. Legislation and Policy
Tackling inequalities is not optional – it is statutory due to separate pieces of legislation
The Race Relations (Amendment) Act 2000
The Disability Discrimination Act 2005
The Equality Act 2006

81. Developing socially inclusive practice
MODULE 6
Developing socially inclusive practice

82. Developing socially inclusive practice
Learning outcomes
After completing this module, you will be able to:
- Challenge the processes that lead to inequality and exclusion;
- Adopt assessments and interventions that are inclusion focused and user centred;
- Understand the importance of working in partnership with mainstream community organisations.

83. Closing the Opportunity Gap objectives
NHS – Education for Scotland
Closing the Opportunity Gap objectives
To increase the chances of sustained employment for disadvantaged groups.
To improve the confidence and skills of the most disadvantaged children.
To reduce the vulnerability of low-income families to financial exclusion.
‘Closing the opportunity gap’ is the approach used to a tackle poverty and disadvantage in Scotland. Six Closing the Opportunity Gap objectives were launched in 2004, several of which are relevant to people who experience or may be at higher risk of developing mental health problems because of the social and economic factors outlined.
Facilitators’ Toolkit

84. Closing the Opportunity Gap objectives – cont.
NHS – Education for Scotland
Closing the Opportunity Gap objectives – cont.
To regenerate the most disadvantaged neighbourhoods.
To increase the rate of improvement of the health status of people living in the most deprived communities.
To improve access to high-quality services for the most disadvantaged groups.
The social inclusion agenda therefore requires mental health services to pay attention to all aspects of a person’s life and to assist the person to engage in things that make life rewarding. These can include leisure, recreation and cultural activities as well as support with relationships, lifelong learning opportunities, training, voluntary activity and assistance in obtaining or retaining open employment.
Facilitators’ Toolkit

85. NHS – Education for Scotland
Withdrawal & rejections from society
Mental health problems
Unemployment
A Cycle Of Exclusion
Debt
Homelessness
Loss of social networks
Worsening mental health
While each person’s journey into an excluded life is unique, the themes of access, standard of living and relationships often appear. An alternative way to think about this journey was given by the Social Exclusion Unit (2004) in the following diagram.
Facilitators’ Toolkit

86. Working beyond the mental health service
NHS – Education for Scotland
Working beyond the mental health service
Getting to know the person.
Getting to know the community.
Building capacity in mental health services.
Building capacity in community organisations.
Support for the whole of life.
Getting there and settling in.
Sustaining participation.
Although a whole range of approaches can be used Bates and Dowson (2005) provided a succinct summary.
Facilitators’ Toolkit