Have the major Scottish political parties prioritised mental health in their manifestos?

Although nearly half of all ill-health among people under 65 years of age is attributable to mental ill-health, it is estimated that only about a quarter of those with mental health problems are in treatment (Centre for Economic Performance, 2012).   In addition, a recent analysis has revealed the historic and chronic under-funding of mental health research in the UK (MQ Research, 2015). Add to this the rising rates of suicide in the UK; there are approximately 6,000 deaths each year, with more than three quarters of all suicide deaths accounted for by men (ONS, 2015). The personal costs of suicide are devastatingly clear but many people do not know that the economic burden of suicide is also vast. Take Scotland, for example: it is estimated that the economic and social cost of each death by suicide is £1,290,000 (Platt et al., 2006).   Taken together, it is self-evident, therefore, that the challenge of improving mental health research and treatment is urgent and long overdue. In recent months, mental health has become more visible on the political agenda. However, I was keen to look beyond the media representation to investigate to what extent mental health features in the manifestos of the four major Scottish parties (based on having MPs and/or MSPs). To do so, I simply searched for any mention of mental health in their manifestos. Here’s what I found:

Scottish Conservatives (http://www.scottishconservatives.com/wordpress/wp-content/uploads/2015/04/Scottish-Manifesto_GE15.pdf)

There are two mentions of mental health in their manifesto. They will “provide significant new support for mental health benefiting thousands of people claiming out-of-work benefits or being supported by Fit for Work.” The only other reference to mental health is in terms of using social impact bonds and payment by results with a focus on mental health (as well as youth unemployment and homelessness).

Scottish Greens (http://www.scottishgreens.org.uk/wp-content/uploads/downloads/2015/03/SGP-Westminster-2015.pdf)

There is only a single mention of mental health in their manifesto. The Scottish Greens aim to improve both physical and mental health by tackling poverty and health inequalities including via the Living Wage as well as affordable housing and a fairer social security system.

Scottish Labour (http://www.scottishlabour.org.uk/blog/entry/the-scottish-labour-manifesto-2015)

There are 12 clear references to mental health in the Scottish Labour manifesto. They highlight the scale of the challenge of mental health as well as the 10-fold increase in young people waiting more than a year to be treated by mental health services. They also mention the issues of parity of esteem with those with physical health problems as well as the need to address the, often debilitating, consequences of mental health stigma. They pledge to invest £200 million in a new Mental Health Fund to help those who are vulnerable and to “improve child mental health by focusing on prevention and early intervention.”

Scottish Liberal Democrats (http://www.scotlibdems.org.uk/manifesto2015)

A document search yields at least 17 hits for mental health within the Scottish Liberal Democrat manifesto. A guarantee of equal care for mental health is on the front page of their manifesto. The Lib Dems pledge that the Scottish Parliament will have the resources it needs “to make sure mental health has equal status with physical health”. There is also specific mention of helping “people struggling not to harm themselves” by providing emergency help at A&E. In the context of helping people find work, they pledge to help provide work placements tailored for those with mental health problems. They also pledge to fund the NHS properly, “ending the discrimination against mental health which has existed too long, and delivering equal care.” They also highlight the scale of mental ill-health, the stigma faced by many and the difficulty accessing services. They propose to expand the provision of psychological treatments as well as developing “new provision to support young people who need urgent mental health support”. If pilots as successful, they may also role out the provision of trained mental health professionals in A&E departments. They also plan to simplify and streamline back to work support for those with mental health problems. Furthermore, they will also establish “a world-leading mental health research fund, investing £50 million to further our understanding of mental illness and develop more effective treatments.” Support for veterans with mental health problems is also mentioned.

 Scottish National Party (http://votesnp.com/docs/manifesto.pdf)

Mental health is mentioned four times in the SNP manifesto. Within the context of ensuring fairness in the welfare system, they “will demand an urgent review of the conditionality and sanctions regime” taking account of the “needs of people with mental health issues.” They also pledge to increase the £15 million already committed to a mental health innovation fund, stating that they will “increase this investment to £100 million over the next 5 years”. They will also focus on treatments in the primary care sector and aim to focus on investment in child and adolescent mental health services.

Comment

Mental health appears to be a priority for Scottish Labour, the Scottish Liberal Democrats and the Scottish National Party. It is encouraging to see the specific pledges made by each of these parties in terms of the provision of mental health services. However, as a researcher who knows first hand how poorly funded mental health research is, I was particularly pleased to see the Scottish Liberal Democrats pledge to establish a world class mental health research fund – with funding ear-marked. Whoever (and in whatever configuration) is in power after May 7^th, it is incumbent on each of us to hold the Government to their election promises!

Disclaimer: I acknowledge that my search strategy was crude but each manifesto was subject to the same ‘analysis’, and therefore, I believe it provides a valid (albeit high level) overview of the each party’s pledges on mental health. Due to idiosyncrasies of search functions in pdfs, I may have missed one or two mentions of mental health in the manifestos that contained multiple references to mental health.

References

Centre for Economic Performance (2012). How mental illness loses out in the NHS. A Report by the Centre for Economic Performance’s Mental Health Policy Group. http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf

MQ Research (2015). UK mental health research funding: MQ landscape analysis. http://www.joinmq.org/news-opinion/entry/new-analysis-reveals-historic-under-funding-of-uk-mental-health-research

ONS (2015). Statistical Bulletin. Suicides in the United Kingdom, 2013 Registrations. http://ons.gov.uk/ons/rel/subnational-health4/suicides-in-the-united-kingdom/2013-registrations/suicides-in-the-united-kingdom–2013-registrations.html

Platt, S et al (2006). Evaluation of the first phase of Choosing Life: The national strategy and action plan to prevent suicide in Scotland: Annex 2 – The Economic Costs of Suicide in Scotland in 2004. Edinburgh: The Scottish Government http://www.gov.scot/Resource/Doc/146980/0038521.pdf

£1 doesn’t mean the same thing to all:

One remarkable moment in the electoral campaign was David Cameron’s reassurance to the UK public that the proposed Conservative budget cuts amounted to a £1 reduction for every £100 – something that every family or business could cope with. I guess in a society where the principle of equality is cherished and where policies are geared towards improving equality and minimizing inequality then such reassurances are well grounded.

Equality is related to better physical health, greater feelings of trust and lower levels of violence. Inequality measured by how much richer the top 20 percent than the bottom 20 percent is in each country, is related to increased rates of mental illness (r=0.73) and drug problems (r=0.63).

Psychosocial factors are key in understanding the associations between income inequality and health where social hierarchical organisation favours those ranked highly and disfavours those ranked at the bottom. Internal threats arising from the experience and perception of inequality increase stress through feelings of shame, threat and distrust, which acts on psycho-neuro-endocrine mechanisms. External threats acting on the person include exposure to antisocial behaviour, reduced civic participation, less social capital and reduced social cohesion increase feelings of disconnectedness, loneliness and paranoia.

Not just perception of rank but the availability of resources within systems are key to understanding the health effects of social hierarchies. Lynch and colleagues (2000) argued “the effect of income inequality on health reflects a combination of negative exposures and lack of resources held by individuals, along with systematic underinvestment across a wide range of human, physical, health, and social infrastructure” reflecting the manifestation of the sum of historical, cultural and political-economic processes.

In the past 30 years alcohol and drug-related deaths, violent deaths and suicide have increased to a greater extent in Scotland compared to the rest of the UK and Europe. Physical health inequalities have increased in Scotland relative to the rest of the UK evidenced by premature death due to cardiovascular disease, cancer and stroke. McCartney and colleagues have shown that these increasing inequalities are associated with the Index of Economic Freedom (or in other words the extent to which neoliberal or monetarist economic policies predominate).

So £1 isn’t the same to every individual and neither is £1 the same to every community or every nation within the UK. Problems of inequality and its terrible consequences cannot solved by austerity. Austerity can only further hit the more vulnerable groups in our society who already experience greater risks of disconnection, alienation and hopelessness. What’s happened in Scotland during the last 30-years in terms of inequality and what is happening in Scotland during this election provides an important opportunity for UK based parties to start to seriously rethink the impact of policies that increase inequality, and the associated costs to us all. Maybe adopting a principle of Equality in the UK would be a good start.

References:

Lynch, JW., Davey Smith, G., Kaplan, GA. & House, JS. Income inequality and mortality: importance of health of individual income, psychosocial environment or living conditions. BMJ. 2000 April 29; 320(7243): 1200–1204.

McCartney, G, Walsh, D., Whyte, B., & Collins, C. (2011) has Scotland always been the ‘sick man of Europe’? An observational study from 1855 to 2006. European Journal of Public Health, Vol. 22, No. 6, 756–760

Health and wellbeing – for some, but not others:

Watch the news – any news – and you may have noticed that there is an election this week! Key battlegrounds have been the NHS, migration, austerity and welfare. Of course, these all get intertwined. We are told by some parties that migrants are coming to the UK – indeed “flooding” the UK – to reap the benefits of our NHS. This, despite the fact that a report commissioned by the Department of Health found evidence of health tourism at best limited. On the other hand, the NHS depends on migrant workers across all professional groups, and may become increasingly reliant on overseas workers to meet the many pledges of increased staff made by parties of all colours.

However, what we have not discussed nearly enough is the awful situation we see unfolding in the Mediterranean and the role that our foreign and domestic policies play in exacerbating that situation. Only the horror of hundreds of migrants drowning in the Med in the last month or so led to the re-instatement of the Mare Nostrum search and rescue missions, something that the Tory/Lib Dem Coalition Government pulled the UK out of, citing the operation as an “unintended ‘pull factor’”. As someone involved in migrant health research and – I hope – as a decent human being, I have to ask is this really true? Is the UK such a Utopia that men, women and their children (small, newborn and unborn) feel it is worth spending a small fortune to board a rickety boat or dingy and set out across hundreds of miles of open sea?

Rather – what is driving this movement of people? Amnesty International ‘s report today sheds some light on the conditions that drive people to move. Shockingly graphic, it describes Syria’s “Circle of Hell”, describing the situation daily facing civilians in Aleppo. Little wonder then that the boat alternative seems worth a try ….. And yet, too often our media glosses over the bigger picture that contributes to this movement of people, preferring instead to talk about “illegal” migrants and benefits seekers.

The WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Clearly, for those now living in war-torn settings, this has long since ceased to be a reality. The UK has a wider responsibility, as part of the EU, to set policies and play a role that may help resolve some of the currently intractable situations that make the WHO definition unattainable for millions of people. In doing so, there needs to be more discussion about the way in which foreign policy, immigration policy and commitments to international aid intersect. We also need to be ready to welcome those in greatest need to the UK and to our NHS.