Clare Haughey MSP made a welcome return to the Cross Party Group on Health Inequalities on 30th October, this time in her role as Minister for Mental Health. Previously a Co-Convenor and active member of the CPG, the Minister happily agreed to VHS publishing the presentation she gave, so please read on to see what she had to say.
“Thank you for your kind introduction and I am delighted to have been able to have been invited here to address you on a subject that matters to all of us, that of health inequalities, and in particular mental health inequalities.
I would like to talk to you about the causes of mental health inequalities and then about what we are doing and can do to address those causes.
Alongside the causes of physical health inequalities, that are, no doubt, familiar to you all, that of gender, poverty, social isolation, our physical environment and personal lifestyle choices, mental health inequalities also include factors like a lack of parity of mental and physical health care, sexuality, gender identity and ethnicity. These factors are why the Scottish Government is committed to creating a fairer Scotland for all who live here. Differences in ethnicity, sexuality, or gender identity, for example, should not be barriers to receiving high quality services to treat any health problem, mental or physical.
The Scottish Government wants Scotland to be a country where everyone, regardless of their background, gets the help that they need, when they need it and this has informed our policies on mental and physical health, but there is still more work to do and we are taking action to ensure that this work continues.
We are aware we do so in the face of continuing UK Government welfare cuts and attempts to take Scotland out of Europe which has brought us further economic uncertainty, but we are committed to taking every action possible. And this will be through the positive actions and also through protecting people against the worst effects of welfare cuts through our investment of one hundred million pounds every year.
Working to improve mental health care is not just the preserve of the NHS or social care, but it is also the responsibility of the wider public services. This has to happen to harness the broadest range of opportunities to improve the population’s mental health and to reduce the factors that contribute to mental ill health.
Poverty is the single biggest driver of poor mental health. The Fairer Scotland Action Plan sets out how we will help tackle poverty, reduce inequality and build a fairer and more inclusive Scotland. We will work with partners in local government, the third sector and communities to deliver this ambition and to recognise the importance of this activity in delivering good mental health for the whole population of Scotland.
Not having a job is the single biggest inequality that people with mental health problems can face and we know that security of income can help reduce stress and anxiety in those suffering from mental ill health. We will use our new employability powers to work across health and employability services to support people with mental health problems to stay in work and to support people to get back into work. We will also encourage employers to support the mental wellbeing of their employees.
Social security spending has failed to keep up with the rising cost of living. By 2020/21 social security spending in Scotland will have reduced by three point seven billion pounds as a result of UK Government welfare reforms since 2010.
In Scotland the Benefit Freeze was the reform that led to the biggest reduction in spending, of around one hundred and ninety million in 2018/19, and around three hundred and seventy million by 2020/21.
Since the Benefit Cap was lowered in 2016, around three thousand five hundred Scottish households have been capped each month. The policy has disproportionately affected families with children. Of those families whose legacy benefits are capped, eighty nine percent contain children, while sixty four percent are lone parent households.
Our overarching aim is to create an integrated work and social security system in Scotland that is based on dignity, fairness and respect. This will be a system that helps to support those who need it and when they need it. We will ensure that this works for people with mental health problems.
Due to the more stringent eligibility criteria introduced with PIP, twenty five percent of people who had pre-existing DLA entitlement were not awarded PIP following the reassessment process between April 2013 and April 2018
There is weak evidence that UC conditionality helps people find a job, whilst some evidence shows that it causes deterioration of claimants’ mental health and increases reliance on food banks.
To help people on lower incomes the Scottish Government has put aside over one hundred and twenty five million for welfare reform mitigation and protecting those on low incomes and over three hundred and fifty million for Council Tax Reduction in 2018/19.
Over the coming years, we will use our new social security powers to provide better support for people on low incomes. This includes introducing the Best Start Grant, the Job Grant and the new Income Supplement.
We do this in the knowledge that for every pound spent on mitigation measures, there is a pound less that can be spent on boosting the economy, encouraging job creation and lifting people out of poverty, but we do it in because, as long as the UK benefit cuts continue, it is necessary. While UK Government policies are making matters worse for people on low incomes, we in Scotland will take action to support them.
What we really want to do is change deep seated, multi-generational, deprivation, poverty and inequalities. This is the landscape we face and I am certain that we can rise to the challenge.
These multi-generational changes that relate to mental health inequalities also relate to improving the physical health of those suffering from mental ill health. We know there is a link between physical and mental health, and that people with poor mental health often experience physical ill health. Tackling this inequality will help support parity and accessibility to, and availability of, services, as well as supporting prevention and earlier interventions work. Tackling it will also help to ensure non-discrimination in a human rights-based approach.
At the heart of our Strategy is a commitment, passion and drive to prevent and treat mental health problems with the same vigour as we do physical health problems.
We estimate that only one in three people who would benefit from treatment for a mental illness currently receive that treatment. We also know that people with lifelong mental illness can die 15 to 20 years prematurely. That is a major health inequality and we cannot accept it.
This is why we want to ensure equitable provision of screening programmes, so that the take up of physical health screening amongst people with a mental illness diagnosis is as good as the take up by people without a mental illness diagnosis. We have also committed to work with partners who provide smoking cessation programmes to target those programmes towards people with mental health problems.
We want mental and physical health to have parity of esteem in practice. It is there in law already, but people’s lived experience and our data suggest that there is a way to go. Achieving parity will not be easy, but it is vital. Without that parity of esteem between mental and physical health, the stigma that often surrounds mental ill health cannot be completely eradicated and while there is still stigma surrounding mental ill health, those with mental health problems will remain on an unequal footing.
While the causes of mental health inequalities are many and complex, they can be exacerbated further where people do not feel welcome, or do not see themselves represented. It can be hard for them to open up about mental health problems and to believe that they will be listened to.
The challenge is huge, we will face barriers we can see, and new ones as yet unknown. We may even face cynicism and a lack of interest from some quarters. But this government is up to that challenge and will work with anyone and everyone who wants to make Scotland a fairer and more prosperous place.
Thank you once again for the opportunity to address you this evening and I hope that you are able to continue with your valuable work in making Scotland a fairer and healthier place to live.”