Paper 13
Ayrshire and Arran NHS Board
Monday 2 February 2015
Mental Health and Wellbeing Strategy
Author:
Anne Clarke, Assistant Director
Sponsoring Director:
Dr Carol Davidson, Director of Public Health
Date: 14 January 2015
Recommendation
The Board is asked to approve the Mental Health & Wellbeing Strategy following a three
month formal consultation period.
Summary
This Mental Health & Wellbeing Strategy (Appendix A) has been developed using the
national outcomes framework which is informed by evidence gathered by NHS Health
Scotland, including economic analysis, where it exists. This local long-term (12 year)
strategy clearly defines the direction of travel for mental health and wellbeing work. There
will be four accompanying action plans, each lasting a period of three years.
Some of the outcome areas already have local activity underway and where that is the
case, that outcome area has been acknowledged but has not been included for action
within this strategy.
This has resulted in there being three main areas of work:
 Sustaining inner resources
 Increasing social connectedness and trust in families and communities
 Creating mentally healthy environments for working and learning.
A life-course approach is adopted and each of these three sections is addressed for:
 infants
 children & young people
 working age adults
 older people.
Key Messages:
 Everyone has mental health
 There is no health without mental health
 Mental health can be promoted and maintained in the same way as physical health can
 Good mental health is a necessary platform to support positive lifestyle choices
 Inequalities and life circumstances affect mental health in the same way as they affect
physical health.
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Glossary of Terms
CHP
CMT
CPPs
NHS A&A
2 of 5
Community Health Partnerships
Corporate Management Team
Community Planning Partnerships
NHS Ayrshire & Arran
1
Progress to date and next steps
1.1
This draft Mental Health & Wellbeing Strategy (Appendix A) has been developed
by the multi-agency Mental Health Leadership Group, comprised of staff from NHS
A&A and North and South Local Authorities. During the development process the
group engaged with a number of colleagues who have an interest in mental health
and wellbeing at 6 stakeholder events in autumn 2013.
1.2
Following that, the draft strategy was presented to CMT in December 2013, and, as
it was deemed to be a Community Planning issue, was thereafter submitted to the
Strategic Alliance. The Strategic Alliance agreed that it was relevant for Community
Planning partners and advised that the route to CPP Boards was via the various
constituent parts of the (then) CHPs. Thus, there has been a process of
engagement with Officer Locality Groups (both adults and children), CHP forums,
CHP committees and mental health partnerships. Many members of the groups
that were engaged with are of the view that the actions for such a strategy require
to be integrated into existing plans. The Mental Health Leadership Group agrees
that this is the ideal approach, and recognises that such arrangements make
performance management challenging.
1.3
The consultation process is now complete and the Mental Health Leadership Group
is seeking approval for the Mental Health & Wellbeing Strategy for implementation.
2
Consultation Process
2.1
The draft Ayrshire Mental Health and Wellbeing Strategy was approved by Ayrshire
& Arran NHS Board for public consultation at its meeting on 19 May 2014. To avoid
the summer break, a three month public consultation period on the strategy
commenced on 1 September 2014 and concluded on 28 November 2014.
2.2
A short summary consultation document and an online survey monkey
questionnaire with four key questions were developed. The summary document
containing the survey monkey link and a copy of the full strategy were distributed
widely utilising email, NHS Ayrshire & Arran’s intranet and public website.
2.3
An information poster and flyer to advertise the consultation and inform the public
about how to get involved were developed as the main feedback methods. Paper
copies of A3 posters and A5 flyers were issued as part of the formal consultation
plan, via professional committees, GPs, pharmacists, opticians, dentists and various
other networks. Paper copies of the questionnaire were also distributed.
2.4
During the consultation period the draft strategy was presented to several
committees including the former CHP Committees and various groups within the
Community Planning Partnerships.
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3
Consultation Feedback
3.1
A total of 40 responses were received as a result of the consultation. This equated
to 31 responses via survey monkey, seven responses from group discussions or
group feedback, one individual response and one formal written response. A paper
detailing the responses and changes made to the strategy as a result of the
consultation has been produced and is attached.
3.2
In summary, the majority of respondents agreed that the actions contained in the
Mental Health & Wellbeing Strategy were the right actions.
3.3
Many respondents provided helpful detailed comments, however, the majority of
these comments were about the detail of implementation of the strategy and its
action plan rather than any major concerns about the general content (Questions 2
& 3).
3.4
Consequently, although minor amendments have been made to Volume I, the final
strategy has remained relatively unchanged from the consultation draft. The first
three year action plan is attached. This plan will outline in greater detail the activity
that will be carried out during the first three years of the strategy to address the
three priority areas.
3.5
The Mental Health Leadership group will oversee and monitor implementation of the
three year action plan. Actions that are to be undertaken will be performance
managed using the Covalent system. However, it is recognised that the majority of
activity required to drive this strategy forward will be undertaken by partnership
groups. Based on feedback from a range of partnership groups sought during the
engagement and consultation phases of the strategy’s development, actions for
partnership groups relating to mental health and wellbeing will sit within their
respective locality plans. The Mental Health Leadership Group will seek high level
updates from partnership groups on the progress of these actions in relation to the
strategy’s key outcome areas. This information, along with key population mental
health data based on NHS Health Scotland’s National Mental health Indicator Sets,
will be used to test and refine the evidence-based theories of change outlined in
Volume 2 of the strategy.
3.6
Following approval by the NHS Board, the Strategy will also be presented to the
three Community Planning Partnership Boards.
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Monitoring Form
Policy/Strategy Implications
This is a proposed new Mental Health Strategy for
Ayrshire and Arran for the next 12 years
Workforce Implications
There is no implication for a change in the number of
the workforce, but there is an expectation that, over the
12 year period, many staff will increase their
understanding, knowledge and skill in relation to
mental health and wellbeing
Financial Implications
There are potential costs implicit in some of the
evidence informed proposals, however, each of these
will be addressed on a “case by case” basis. For
example, resource will be required to provide additional
support for young people in the education setting
Consultation (including
Professional Committees)
Formal consultation on the strategy has been
undertaken.
Risk Assessment
1) Current economic climate is so challenging for
mental wellbeing that simply maintaining status quo
could be considered an achievement
2) There is a risk of “losing” activity if it is integrated
into other plans; creating a system to track activity
emanating from this strategy will require close
collaboration
Best Value
- Vision and leadership
- Effective partnerships
- Governance and
accountability
- Use of resources
- Performance management
This strategy is entirely dependent on good partnership
working, and all manner of partnerships are necessary
to drive this forward.
Compliance with Corporate
Objectives
This proposed Strategy is number 4.2 in the strategic
priority matrix
Single Outcome Agreement
(SOA)
Social isolation, asset-based community work,
parenting support are all included in all three SOAs
Progress is reported via the Covalent Performance
management system and reviewed quarterly through
Public Health governance processes
Impact Assessment
A single Impact Assessment has been completed and is included as an appendix.
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April 2015 to March 2027
Mental Health and
Wellbeing Strategy
Document Version:
Draft 1.0
Version Date:
November 2014
Review date
April 2027
Approval Process:
Ayrshire & Arran NHS Board
Author(s):
Anne Clarke, Assistant Director of Public Health
Mental Health Leadership Group
Approval Process:
Ayrshire & Arran NHS Board
Consultation Process:
September 2014 to November 2014
Distribution Process:
DMT, CMT, NHS Board, Community Planning Partners,
Health and Social Care Partnership SIBS
Implementation Plan:
To be developed separately
1. Introduction
1.1
This is the second mental health and wellbeing strategy that has been
produced in Ayrshire and Arran. The work is led by NHS Ayrshire & Arran,
but a strategy like this involves a range of partners, agencies, communities
and individuals across the area. Improving mental health and wellbeing is for
the whole population.
1.2
The constituent parts of good mental health and wellbeing have been
identified and, irrespective of the context or external circumstances, these are
immutable. The six areas that require to be considered for optimum mental
health and wellbeing are:






Promoting health and healthy behaviours
Sustaining inner resources
Increasing social connectedness, relationships and trust in families and
communities
Increasing social inclusion and decreasing inequality and discrimination
Increasing financial security and creating mentally healthy environments
for working and learning
Promoting a safe and supportive environment at home and in the
community.
The strategy will consider all these areas.
1.3
The strategy does not encompass mental health services or issues relating to
mental illness. There is already a progressive national strategy for people
who experience mental health problems (Mental Health Strategy for Scotland
2012-2015)1. Instead this local strategy focuses on ensuring that people in
Ayrshire and Arran recognise that we all have mental health and wellbeing
and that it can be maintained and improved, like all other aspects of health.
Like other aspects of health, mental health is also more vulnerable to
damage/illness if there are inequalities and mental wellbeing is not explicitly
supported.
There are well recognised factors that promote mental wellbeing and those
which are challenges to our mental wellbeing. The overall aim of this strategy
is to help strengthen the factors that promote mental wellbeing at both
individual and community level. The strategy adopts an approach that follows
the life-course from pre-birth to older people. The areas identified for action
are all based on the best evidence that is currently available and is fully
described in the attached appendices to the strategy.
1
Mental Health Strategy for Scotland 2012 – 2015, Scottish Government, 2012
http://www.scotland.gov.uk/Publications/2012/08/9714
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2. Background
2.1
Mental health and wellbeing is affected by a wide range of factors that we
experience in our lives, such as forming and sustaining relationships, going to
work and school, being able to participate in leisure activities and feeling part
of the wider community. All aspects of our lives and the lives of those around
us can be affected by our mental health and vice versa.
2.2
The state of our mental health is linked to a number of factors such as
whether we experience social isolation, deprivation, unemployment or social
discrimination. Whilst there have been many positive developments
addressing these risk factors for mental health (such as Equality legislation)
there are a number of risk factors that remain in this area. These include high
levels of unemployment, homelessness, low educational achievement and
poor vocational skills. There is also evidence that being employed promotes
mental health and wellbeing. However it needs to be secured well paid work.
Conversely insecure, unpredictable shift work and low paid jobs can be
detrimental to an individual’s mental health and wellbeing.
2.3
NHS Health Scotland has described how all this fits together (Table 1, below).
This strategy focuses on the achievement of the intermediate outcomes (6
boxes in the lower section of the triangle).
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Table 1
3. Policy Context
3.1
Because of the complexity of mental health and wellbeing, there is a large
number of policy initiatives that also impact on the mental health and
wellbeing of individuals and communities. It is not the intention of this
strategy to attempt to encompass these, but the list below identifies those that
are likely to have the biggest impact on mental health and wellbeing.






The Economic Strategy
Equally Well Implementation Plan
Child Poverty Strategy
Getting It Right For Every Child
Early Years Framework
Delivering a Healthy Future: Children & Young People’s Health
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









More Choices, More Chances
Achieving our Potential
Carers and Young Carers Strategies
Health Works
Reshaping Care for Older People
Good Places, Better Health
Safer Lives, Changed Lives
Volunteering Strategy
Keys to Life Strategy
Strategies for changing health behaviours: Active Living, Healthy Eating,
Tobacco Control, Drugs & Alcohol, Sexual Health & Teenage Pregnancy.
This list is not exhaustive but it does demonstrate the breadth of factors that
affect mental wellbeing.
3.2
Some contextual issues are likely to have a bigger impact than others; for
example, there is already a developing body of evidence that is demonstrating
a negative impact of the welfare reforms on the mental health and wellbeing
of individuals and communities. Therefore, all possible support mechanisms
need to be invoked to try to maintain current levels of wellbeing.
3.3
To address such a wide range of issues, this mental health and wellbeing
strategy needs to be “owned” by Community Planning partners and driven
forward through that mechanism. Table 2 (below) demonstrates the wide
range of agencies and partners who have a role in supporting mental health
and wellbeing. Community Planning Partnerships are the optimum context for
supporting this work, which will be driven forward by the Mental Health
Leadership Group.
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Public Health
Department
(mental health
leadership group)
Local Authority
services
Alcohol & Drug
Partnerships,
Licensing Boards
Health & Social
Care Partnerships
Community
Planning
Third sector amd
private sector
Workplaces,
NHS Acute Services
Community groups,
Independent
Contractors:
General practice;
community
dentistry,
pharmacy,
optometry
Criminal Justice,
Police,
Prison
Table 2
4.
Vision for mental health and wellbeing in Ayrshire and
Arran
4.1
The organisational mission statement for NHS Ayrshire & Arran is Working
Together for the Healthiest Life Possible for the People of Ayrshire and Arran.
This strategy is part of the contribution to the mental health and wellbeing
dimension of that mission statement.
4.2
The overall, long-term aim of the mental health and wellbeing strategy is to
contribute to healthy life expectancy and reduce inequalities in wellbeing.
This will be done by:




4.3
Increasing quality of life
Improving mental wellbeing
Reducing mental illness
Reducing suicide.
The challenge associated with each of these cannot be over-estimated, so
this strategy sets out a direction of travel for the next twelve years that intends
to move Ayrshire and Arran towards the achievement of the long-term aim.
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4.4
Outlined above (Table 1) are the intermediate outcomes which this strategy
will work towards:





Promoting health and healthy behaviours
Sustaining inner resources
Increasing social connectedness, relationships and trust in families &
communities
Increasing social inclusion and decreasing inequality and discrimination
Increasing financial security and creating mentally healthy environments
for working and learning
Promoting a safe and supportive environment at home and in the
community.
4.5
As already identified in paragraph 3.1, there are numerous national and local
strategies that are being implemented by a wide range of organisations and
individuals. It is not intended of the Mental Health and Wellbeing Strategy to
concern itself with overseeing how these strategies are being managed, and
there is an expectation that the range of healthy behaviours will continue to be
promoted locally. The evidence is that these activities will contribute to mental
wellbeing and good mental wellbeing is a platform for healthy behaviours such
as healthy eating, drinking sensibly and being physically active.
4.6
Sustaining inner resources: This intermediate outcome refers to an
individual’s capacity and ability to be resilient. It relates to purpose and
meaning for individuals i.e. the feeling that one is making some sort of
contribution and that there is a reason to get up each day. This section is
about helping people to develop a range of coping skills to deal with everyday
stresses and using the evidence of “what works”, the strategy will identify this
as one of its most important priority areas.
4.7
Increasing social connectedness, relationships and trust in families and
communities: This intermediate outcome identifies that one of the most
important aspects of maintaining our wellbeing (both mental and physical) is
our degree of social connectedness. Evidence is strong – and growing – that
the more social connections people have with each other, the less likely they
are to experience episodes of ill health and are likely to have a better sense of
wellbeing. This is a very important area for development, although it is very
challenging to support.
There is a considerable swell of opinion at this time that asset-based
community development is a mechanism by which local social connections
can be encouraged. This strategy will support such initiatives, using current
available evidence to inform action.
4.8
Increasing social inclusion and decreasing inequality and discrimination: This
outcome is about ensuring that those who are marginalised can be helped to
be more integrated into mainstream society. Being (or feeling) excluded has a
considerable negative impact on people’s mental wellbeing, so those
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individuals are at greater risk of experiencing poorer mental health. There are
many groups of people who may be considered marginalised within our
mainstream society in Ayrshire and Arran. For example, individuals and
families affected by: homelessness, any sort of disability, who are lesbian,
gay, bi-sexual and/or transsexual, mental health problems, prisoners/exoffenders, substance misuse problems, unemployment, or living in poverty,
long term conditions.
This strategy is concerned with developing the mental wellbeing and
resilience of all these groups and in working towards increasing their social
connectedness (as described above). Some of this will be by working directly
with a group (e.g. prisoners) and the work already mentioned in relation to
asset-based community development will support the second aspect. The
strategy recognises the links between ‘Good Work’ and health and the
importance of supporting people into employment. However, this is part of the
employability agenda which is being driven by a number of partner agencies,
who are in a key position to promote the mental wellbeing of their clients and
support them into work.
In terms of addressing stigma for people with mental health problems, that is
highlighted as a priority area (Commitment 4) of the national strategy for
mental health and that will be taken forward under its auspices.
Major strands of work flowing from this strategy may require to undergo an
Equality Impact Assessment (EQIA) to identify any disproportionate impacts
which may arise. This will allow reasonable adjustments to be made to
mitigate the impact on those who may experience inequality, discrimination,
social exclusion or disadvantage.
4.9
Increasing financial security and creating mentally healthy environments for
working and learning: This is an important area of work for mental health and
wellbeing, but this strategy intends to address financial inclusion in the same
way as the work around healthy behaviours. Partners and NHS staff are
increasingly recognising the importance of ensuring that everyone is able to
access all the financial support that they are entitled to. Financial inclusion
teams are working across Ayrshire and Arran, particularly with some of the
more disadvantaged groups. Like the outcome on healthy behaviours, this
strategy anticipates that this will continue and that contribution to wellbeing
will continue to be made.
Conversely, healthy environments for working and learning will be a major
focus of our attention. The education setting (nurseries, schools, special
schools, colleges and universities) are all environments that can have a big
impact – both positively and negatively – on people’s mental health and
wellbeing. This strategy will ensure that there is continuing activity in these
settings both at a (school/university) community level and also for children
and young people as individuals.
The workplace too is an environment which can influence people’s wellbeing.
It is recognised that there is a wide range of factors that can affect that:
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workload, colleagues, managers, work location, inflexible systems and lack of
support for caring responsibilities and so on. This strategy acknowledges that
there is a raft of other players involved in this agenda and that many of the HR
policies in a workplace can contribute to mental wellbeing. Instead, this
strategy will focus solely on the mental health and wellbeing dimensions of the
workplace, including the role of work itself. The Public Health Department
Workplace Team offer a range of services to local employers including
training on an array of mental health and wellbeing topics such as Mentally
Healthy Workplaces Training for Line Managers, Resilience Workshops and
Mental Health Toolbox Talk Facilitator Training. The team also support
workplaces to promote a positive work life balance for their employees by
advising and supporting the development of mental health and wellbeing
policies and flexi working practices. Employers can access specific specialist
advice in carrying out Stress Risk Assessment; the team can provide tools
and resources to assist in this process.
4.10 Promoting a safe and supportive environment at home and in the community:
People have a fundamental need to feel safe when out and about in the
community or in one’s own home. If that does not exist, then mental wellbeing
can be compromised and individuals may begin to experience mental health
problems.
There are a number of reasons for people not feeling safe in their
communities; fear of violence, physical layout of public spaces, poor lighting,
and lack of public transport or public transport that is not adequately staffed.
Other people feel unsafe at home because of abuse either within the home or
from neighbours. There are a number of community safety partnerships
across Ayrshire and Arran and it is our intention to acknowledge the
considerable contribution that their work makes to mental health and
wellbeing and then to assume that this will continue to be delivered. This
strategy will therefore not make further mention of this dimension of mental
wellbeing.
4.11 Acknowledging that there is much work underway elsewhere that contributes
to mental health and wellbeing, this strategy will therefore focus on the
following:



Developing and sustaining inner resources, especially of marginalised
groups
Increasing social connectedness, relationships and trust in families and
communities
Creating mentally healthy environments for working and learning.
Each of these will be further developed to specify more precisely what should
happen in relation to these, based on the best evidence that is currently
available.
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5. The Approach
5.1
In order to manage these three priority areas, above, each area will be
addressed by taking a “life-course” perspective. There are four “categories” to
help do this:




Infants
Children and young people (this may occasionally be sub-divided further)
Working age adults
Older people.
The tables below outline priority areas for activity over the next 12 years. It is
recognised that, in some cases, the process of change and implementation
may take some time and some resources but these areas for activity have
been identified from the best available evidence. These are the areas for
activity that will have the greatest chance of positively impacting on the mental
health of people in Ayrshire and Arran.
6. Examples of Possible Activities
All of these areas for activity impact on mental health and wellbeing. Activities
have been linked to the outcome that it most closely aligns with, but all of the
activity contributes to mental wellbeing. For example, “parenting programmes” or
“asset based approaches” could be mentioned several times but is recorded only
once. Please note the activities listed below.
All of the above will be underpinned by:



A focus on marginalised groups
Training for staff working in universal services to promote infants, children’s
and young people’s social, emotional and psychological wellbeing. This
applies to all stages of staff experience i.e. in training (teachers, nurses) or
when in post and is relevant to all categories and disciplines. This will include
specific information portals, use of Intranet, LearnPro, online learning
environments, face to face sessions, drop-in/advice sessions, seminars.
Communication/media/social media plan.
Infants, children and young people
6.1
Priority area 1 – Developing and sustaining inner resources, especially of
marginalised groups
Desired Intermediate Outcome(s)
Appreciation of own skills, attributes
and environment
Activities based on evidence
School-based programmes to promote
mental health and wellbeing
Community based activities and
volunteering opportunities
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Ability to effect change including
increasing control and mastery, selfefficacy, self determination
Increased confidence, increased
positive sense of self
Responding to difficulties and
challenges/problem solving teams and
activities/play
Information for prospective mums and
dads
Antenatal and perinatal support to
promote bonding and attachment
Parenting approaches and
programmes
Information for parents from early
years to adolescence
Childcare and nursery settings
6.2 Priority area 2 – Increasing social connectedness, relationships and trust in
families and communities
Desired Intermediate Outcome(s)
Increased participation, engagement
and attendance for all
Increased social interaction for all
Better parent/guardian child
relationship
Parental relationship, peer
relationship, friendship for all
Activities based on evidence
Children’s involvement in asset based
community approaches
Raising awareness of positive role of
adults
Intergenerational activities
Awareness of benefits and risks of
social media networking
Promoting attachment and bonding
through play
Supporting breastfeeding
6.3 Priority area 3 – Creating mentally healthy environments for working and
learning
Desired Intermediate Outcome(s)
Mentally Healthy Nurseries and
Schools
Activities based on evidence
Counselling and advice services for
children and young people
Promoting mental health and
wellbeing aspects of Curriculum for
Excellence
Supporting Early Years Collaborative
stretch aims
Mental health training
Supporting re-engagement with
education for those who are
marginalised from mainstream
education
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All of these areas for activity impact on mental health and wellbeing. Activities
have been linked to the outcome that it most closely aligns with, but all of the
activity contributes to mental wellbeing. For example, “volunteering” could be
mentioned several times but is recorded only once.
Working aged adults/older people
6.4
Priority area 1 – Developing and sustaining inner resources, especially of
marginalised groups
Desired Intermediate Outcome(s)
Increased meaning, purpose,
optimism and hope
Increased resilience
Increased individual mental health
6.5
Activities based on evidence
Activities that promote mental health
and wellbeing
Volunteering, ‘Good Work’ i.e. secure
and adequately paid work.
Tools specifically designed to help
individuals improve and maintain their
mental health and wellbeing e.g.
Steps for Stress, Mindfulness, 5
Ways to Wellbeing, Wellness
Recovery Action Planning (WRAP®)
etc
Creating organisational cultures in
workplaces that support mental health
and wellbeing
Social prescribing
Public information campaigns
Training for professionals and
volunteers to support people with
mental health problems
Priority area 2 – Increasing social connectedness, relationships and trust in
families and communities
Desired Intermediate Outcome(s)
Increased participation engagement
and attendance for all
Better parent/guardian child
relationship. Parental relationship.
Peer relationship, friendship for all
Increased trust in the community by
all
Activities based on evidence
Asset-based community development
Environmental and green-space
improvements
Support healthy relationships
Activities referenced in the children
and young people section
Social support interventions
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6.6
Priority area 3 – Creating mentally healthy environments for working and
learning
Desired Intermediate Outcome(s)
Increased learning and development
for all
Increase mentally healthy workplaces
Activities based on evidence
Encouraging a range of learning
opportunities, both formal and
informal
Workplace policies and procedures
that support employees’ mental
health and wellbeing
Programmes to support employees
Programmes to support employers
7. Monitoring and evaluation framework
The Mental Health Improvement Strategy for Ayrshire and Arran is an outcomesfocused strategy to promote positive mental wellbeing and reduce common mental
health problems (and their associated harms) among the population of Ayrshire and
Arran. To assess the impact of the strategy we will need to be able to monitor and
evaluate:


Population level changes in relation to key outcome areas for mental health
improvement.
Performance management of specific services or interventions.
This section details the different levels of data required to assess these factors and
proposes a framework for monitoring and evaluating Ayrshire and Arran’s
forthcoming Mental Health Improvement Strategy and its associated Action Plan. A
flowchart for planning monitoring and evaluation activities is also presented in Figure
4.
7.1
Contribution analysis
The proposed framework is consistent with the use of logic modelling and
contribution analysis as an approach to programme development, performance
management and evaluation (Mayne 2001; Mayne 2008; Scottish Government
2011). The six key steps to contribution analysis are as follows:
1. Set out the attribution problem to be addressed: identify and build consensus
around the key outcomes or targets.
2. Develop a theory of change and risks to it: this can be achieved through the
development of one or more logic models which set out the expected short,
intermediate and long term outcomes, and the activities which would deliver
these outcomes. Logic models should also consider the level of control which
agencies may have over specific outcomes. Three levels of control can be
identified – direct control (e.g. the delivery of outputs such as the number of
training sessions held); direct influence (e.g. short-term and intermediate
outcomes, such as changes in participants knowledge and behaviour), and
indirect influence (e.g. longer-term impacts on the population). The logic model
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should also consider external factors which may influence whether an outcome is
achieved or not achieved.
Gather the existing evidence on the theory of change: this may include
demographic information, epidemiological data and existing evidence of
effectiveness.
Assemble and assess the contribution story, and challenges to it: this will
involve building consensus that the contribution story and associated theory of
change is credible, and establishing robust baseline data to measure future
progress against. It will also identify areas where evidence for effectiveness
and/or current data collection activities are weak.
Seek out additional evidence: this may include the evaluation of specific
components of the strategy, gather further expert opinion, or synthesising existing
evidence.
Revise and strengthen the contribution story: as more evidence is gathered
it is advisable to return to Step 4 to review the strengths and weaknesses of the
contribution story and revise it accordingly.
3.
4.
5.
6.
Proposed action Feedback will be sought from a range of partners with
regard to the extent to which activities within Ayrshire and Arran are contributing
to the strategy’s stated aims and objectives, and the extent to which the
strategy’s theory of change has been found to be an accurate model for mental
health improvement. The theory of change and related areas for activity will be
revised on the basis of this feedback and other available evidence.
7.2
Intermediate and long-term outcomes
Intermediate and long-term outcomes are related to population level changes in
mental health and wellbeing (for example, mental wellbeing as measured by the
Warwick-Edinburgh Mental Wellbeing Scale) and are usually dependent on the
achievement of a number of short-term outcomes. They are also subject to greater
external effects (for example, UK-wide welfare reforms or global recession) and less
amenable to rapid change than short-term outcomes. As a result it is difficult to
attribute the achievements of a specific service or intervention to these outcomes.
Instead they are better suited as indicators of whether an overall strategy is meeting
its stated aims and objectives. The parameters for these outcomes are set out
nationally the Outcomes Framework for Scotland’s Mental Health Improvement
(NHS Health Scotland 2010), and relate to the national mental health indicators for
adults (NHS Health Scotland 2007) and children & young people (NHS Health
Scotland 2012).
7.3
Short-term-outcomes and outputs
Short-term-outcomes are related to changes in knowledge, attitudes and individual
behaviours. They less broad and esoteric than intermediate and long-term
outcomes, and thus they are usually easier to measure. They can be measured
Page 13 of 17
within a 1-2 year time-frame, and are more easily demonstrated to be directly
attributable to a specific service or intervention. The parameters for short-term
outcomes are also set out in the Outcomes Framework for Scotland’s Mental Health
Improvement but do not have national indicators as they will relate to a specific
service or intervention.
Outputs describe the amount or volume of service or intervention delivered (for
example, the number of Mental Health Directorate service users that have developed
a Wellness Recovery Action Plan). Outputs are important for the performance
management of work programmes but do not infer anything of the quality of the
service delivered on their own. Where high quality processed evidence is available
for a specific service or intervention outputs can, however, be used as a proxy
indicator that outcomes are being achieved.
Proposed action For activities where high quality processed evidence is not
available, evaluation should be considered to assess short-term outcomes. For
activities where high quality processed evidence is available, outputs should be
used in conjunction with the corresponding evidence base to estimate the
impact of the activity. Key reporting mechanisms to be evaluation reports and
Public Health Performs (Covalent). These findings will be used in the
performance management of Action Plans and identify any areas of slippage in
the overarching strategy.
Page 14 of 17
Figure 4: Proposed flowchart for planning monitoring and evaluation activities
Mental Health & Wellbeing Strategy
Population Mental Health Indicators
Children & Young
Adults
People
Have we seen changes in mental health and wellbeing
at a population level?
Volume 2
Action Plan
Contribution
stories
Evidence-base
Public Health
controlled actions
What activities did
we predict would
need to happen?
What have we
learned from
elsewhere?
Have we done
What have we
what we intended
learned locally?
to do?
Follow-up population mental health reports
Covalent
Evaluations
Review of contribution stories
Has theory of change been implemented?
Have expected results occurred?
Have alternative explanations and other contextual
factors been assessed and significant contributions
Refine and adapt strategic direction
Page 15 of 17
Appendix 1: Glossary of Terms
Health inequalities - differences in health status between individuals or groups, as
measured by - for example, life expectancy, death rates or disease. Health inequalities
are preventable and unjust differences in health status experienced by certain
population groups. People in lower socio-economic groups are more likely to experience
chronic ill-health and die earlier than those who are more advantaged. Health
inequalities are not only apparent between people of different socio-economic groups,
they exist between different genders and different ethnic groups.
Social connectedness - involves the quality and number of connections a person has
with other people in a social circle of family, friends and acquaintances.
Social inclusion- A socially inclusive society is defined as one where all people feel
valued, their differences are respected, and their basic needs are met so they can live in
dignity. Social exclusion is the process of being shut out from the social, economic,
political and cultural systems which contribute to the integration of a person into the
community (Cappo 2002).
http://www.copmi.net.au/images/pdf/Research/social-inclusion-fact-sheet.pdf
The Early Years Collaborative - there is one in every NHS Board area in Scotland. It is
a coalition of Community Planning Partners, including social services, health, education,
Police and third sector professionals, who are working together to improve outcomes for
children under the age of eight years.
Social prescribing (sometimes called community referral) - is a mechanism for
linking patients with non-medical sources of support in the community. These might
include opportunities for arts and creativity, physical activity, learning new skills,
volunteering, mutual aid, befriending and self-help. It may also include support with, for
example, employment, benefits, housing, debt, legal advice or parenting problems.
Intergenerational work - aims to bring people together through purposeful, mutually
beneficial activities which promote greater understanding and respect between
generations and contributes to building more cohesive communities. Intergenerational
practice is inclusive, building on the positive resources that younger and older people
have to offer to each other and those around them. Intergenerational work is not just
about having contact between generations, it is about having a mechanism or an
approach that enables both groups to learn from each other and share experiences for
mutual benefit.
Page 16 of 17
Social support - means having friends and other people, including family, to turn to in
times of need or crisis to give you a broader focus and positive self image. Social
support enhances quality of life and provides a buffer against adverse life events. Social
support can take different forms:

Emotional (sometimes called non-tangible) support refers to the actions
people take to make someone else feel cared for.

Instrumental support refers to the physical, such as money and housekeeping.

Informational support means providing information to help someone.
Page 17 of 17
April 2015 to March 2018
Mental Health and Wellbeing Action Plan
Document Version:
Draft 9
Version Date:
January 2015
Review date
March 2018
Approval Process:
Ayrshire & Arran NHS Board
Author(s):
Anne Clarke, Assistant Director of Public Health
Mental Health Leadership Group
Approval Process:
Ayrshire & Arran NHS Board
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Introduction
This is the first three-year action plan for Ayrshire and Arran’s Mental Health &
Wellbeing Strategy 2015-2027. The strategy focuses on three key outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and
communities.
3. Creating mentally healthy environments for working and learning.
Broad areas for activity have been identified across these three outcome areas based
on the current evidence for mental health improvement. Actions have been mapped
against these key outcome areas and areas for activity. The following tables contain
activity area columns which are letter coded. A descriptor for each of these letters can
be found at the end of the Action Plan.
Mental health improvement is everyone’s business and the objectives of the strategy
can only be achieved by adopting a partnership approach and it being implemented
through partnership structures. The strategy and this action plan have been developed
by the Mental Health Leadership Group (MHLG) and Children & Young People’s Mental
Health Group (CYPMHG), which are multi-agency and multi-disciplinary groups chaired
by NHS Ayrshire & Arran’s Public Health Department. The role of these groups is to
facilitate mental health improvement activities, and to monitor and evaluate the
strategy’s implementation.
The action plan has been split into three sections to reflect the wide range of partners
with a remit for mental health improvement, the limited resources within the MHLG and
CYPMHG and the stated preference of partners to incorporate mental health
improvement actions within their own locality plans rather than duplicating actions
across two plans. Actions in this document are therefore limited to those that are being
led by the MHLG/CYPMHG or within NHS Ayrshire & Arran’s Public Health Department.
It is therefore anticipated that partners will similarly have explicit actions for mental
health improvement in their local plans.
Section 1 focuses on mental health improvement activities that are being led by
MHLG/CYPMHG or within NHS Ayrshire & Arran’s Public Health Department.
Section 2 focuses on the partnership groups upon whose contribution mental health
improvement activity is reliant. It outlines the planning and advocacy role of
MHLG/CYPMHG members as representatives on these groups where their role is to
support the inclusion of mental health improvement activities in various plans and to
ensure that actions are developed in line with the evidence base outlined in Volume 2 of
the strategy.
Section 3 focuses on the public mental health intelligence functions that are required to
monitor and evaluate the strategy and its associated action plans.
Page 1 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Performance management of the action plan
Many of the actions identified within this plan are high-level and will have accompanying
project plans that support the implementation of the action. Covalent will be used as the
Performance Management tool for this action and the supporting activity for each action,
along with any milestones, will be overseen by that process.
Page 2 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas
Develop and deliver Wellness
Recovery Action Planning (WRAP)
workshop programme
Continue to develop and maintain the
Ayrshire WRAP facilitator network
Health Promotion WRAP Facilitators
Officer - CDU
Health Promotion WRAP Facilitators
Officer - CDU
Years 1-3
Years 1-3
1
Working
age adults
a
Older
people
1
Working
age adults
Older
people
b, c
Promoting Mental Health
Improvement Training (PMHI):

Develop a network of PMHI
Health Promotion
Officer –
CDU/Health
Promotion
NHS Health Scotland/
Local small/ medium
businesses/Local
authorities/Ayrshire
Year 2
1, 3
Working
age adults
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 3 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas


trainers
Facilitate and evaluate delivery
of PMHI training locally
Maintain a network of PMHI
trainers and local delivery of
this training.
Officer – Mental
Health
College
Deliver the Ahead for Health
programme within workplaces
engaged with the Healthy Working
Lives (HWL) programme
Health Promotion Local employers
Officer – HWL
working towards HWL
award
Identify whether there is a need for a
local mental health training pathway
to be developed
Health Promotion Mental Health Services/
Officer –
local authorities/ Third
CDU/Health
sector
Promotion
Officer – Mental
Health
If a need is identified, then develop
pathway and distribute appropriately
a, b , c
3
Working
age adults
d
Year 2 - 3
3
Year 2 - 3
d
Working
age adults
Older
people
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 4 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas
Continue to deliver Steps for Stress
resource work with adult services
Health Promotion Fresh Airshire/ Local
Officer – Mental
Authorities/Ayrshire
Health
College
Year 1 - 2
1
a, k, n, q
Implement the AHEAD project which
aims to empower individuals within
communities to build trust and
relationships between statutory
service providers and local
communities to enable service
changes which promote more
innovative efficient use of resources
Assistant
Director – Public
Health
Health Promotion
Year 1 - 3
Managers/ Local
authorities/ Access to
Employment/community
builders
2
Working
age adults
Older
people
Working
age adults
Older
people
e, f, g
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 5 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas
Implement the AHEAD project which
aims to empower children and young
people within communities to build
trust and relationships between
statutory service providers and local
communities to enable service
changes which promote more
innovative efficient use of resources
Assistant
Director – Public
Health
Facilitate the development of social
prescribing activity in Primary Care
across Ayrshire and Arran:
Co-production
Manager
Health Promotion
Year 1 - 3
Managers/ Local
authorities/ Access to
Employment/community
builders
2
Dalmellington GP
Practice/ The Zone
1, 2
e, f, g
Year 1
Identify potential social prescribing
opportunities
Years 2-3
Children &
young
people
Working
age adults
Older
people
h, i, j
Implementation of social prescribing
activity across Ayrshire and Arran
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 6 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas
Develop and deliver mental health
improvement drama to schools to
promote positive mental health and
wellbeing and reduce stigma
Identify what primary schools are
doing to take forward the mental
health and wellbeing component of
Curriculum for Excellence/Raising
attainment for all
Explore the possibility and feasibility
of delivering WRAP in schools for
Health Promotion Health Promotion
Officer – Mental
Practitioners/Local
Health
authority – Education
Department/Ayrshire
College
Year 1
Health Promotion Health Promotion
Officer – Mental
Practitioners/ Education
Health
Department Health &
Wellbeing Coordinators/Ayrshire
College
Year 1
Health Promotion Education Department
Officer - CDU
Health & Wellbeing Coordinators
Year 2 - 3
1,3
Children &
young
people
m, i
3
Children &
young
people
m, n
1, 2
Children &
young
people/
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 7 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas
children, parents and staff
Scope the possibility/feasibility of
utilising the Looking After Me
resource in schools/further education
Deliver Steps for Stress related work
within the school/wider education
setting
Health Promotion Health Promotion
Officer - CDU
Practitioners/ Education
Department Health &
Wellbeing Coordinators/ Ayrshire
College
Year 2
Health Promotion Health Promotion
Officer – Mental
Practitioners/Education
Health
Department Health &
Wellbeing Coordinators/Ayrshire
College
Year 1
a, m, o, p
Working
age adults
1
Children &
young
people
a, m, n
1
a, k, n, q
Children &
young
people/
Working
age adults
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 8 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas
Explore the use social media to
promote positive mental health and
wellbeing to children and young
people
Health Promotion NHS Greater Glasgow
Officer – Mental
& Clyde/ Young Scot/
Health
Dialogue Youth
Support colleagues within education
to deliver mental health improvement
sessions to parents and carers
CAMHS Primary
Mental Health
Worker
Year 3
2
Children &
young
people
r
Nicola Tomkinson/
Maggie Dhinsa/Fiona
Smith/ Education
Department Health &
Wellbeing Coordinators Parents/
Carers/ HP
Practitioners
Year 1 - 3
1,3
Working
age adults
j, n, q, s
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 9 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 1 – Mental Health Improvement Activities
Action
Reporting Lead
Support
Timescale Outcome Lifecourse
areas
stages
Activity
areas
Work with local schools to share good
practice in relation to mental health
and wellbeing
Health Promotion Nicola Tomkinson/
Years 1-3
Officer – Mental
Carolann Swanson/
Health
Fiona Smith/ Education/
CAMHS/ Education
Department Health &
Wellbeing Coordinators/HP
Practitioners
1, 3
Children &
young
people/
Working
age adults
b, o
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 10 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 2: Public Mental Health Planning & Advocacy
Action
Reporting lead
Support
Timescale Outcome
areas
Lifecourse
Stages
Activity
areas
Continue and maintain representation on
partnership groups with a remit for mental
health improvement, advocating for mental
health & wellbeing within planning and delivery
decisions
Mental Health
Leadership
Group (MHLG)
and Children &
Young People’s
Mental Health
Group
(CYPMHG)
members
N/A
Years 1-3
All
All
Review and identify opportunities and priorities
for mental health improvement planning and
advocacy, for example within the Early Years
Collaborative in relation to Infant Mental Health
and working with dads
MHLG and
CYPMHG
members
N/A
Years 1-3
All
All
Use mental health improvement “best buys” as
priorities for planning and advocacy activities
MHLG/CYPMHG N/A
Years 1- 3
All
All
Plan and deliver three Children & Young
Health
Promotion
Years 1-3
All
Children &
young
CYPMHG
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 11 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 2: Public Mental Health Planning & Advocacy
Action
Reporting lead
Support
Timescale Outcome
areas
Lifecourse
Stages
Activity
areas
People’s Mental Health seminars per year
Officer – South
Locality
members
Review one Rural 21 plan in each locality to
identify opportunities for health improvement
including mental wellbeing
Locality Health
Promotion
Managers
Community
development
staff
Years 1 –
3
All
All
Support the implementation of the Health
Improving Care Establishment with LA
colleagues, focusing on the mental health &
wellbeing aspects :
 In North Ayrshire
 South Ayrshire
 East Ayrshire
Locality Health
Promotion
Officers
Staff at
residential
homes
Years 1 3
All
Children &
young
people
Lead the co-production Steering group, within
the context of the Person- Centred Programme
Board with a view to developing co-produced
services which positively impact on the
Anne Clarke
Years 1 3
All
All
people
LAAC nurses
Members of
Co-Production
Group
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 12 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 2: Public Mental Health Planning & Advocacy
Action
Reporting lead
Support
Timescale Outcome
areas
Lifecourse
Stages
Activity
areas
population’s mental wellbeing
Support the implementation of the Health
Promoting Health Service focusing on the
mental health & wellbeing aspects
Health
Promotion
Officer – South
Locality
Health
Promoting
Health Service
Steering
Group/ Health
& Social Care
Partnerships
Years 1- 3
All
All
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 13 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 3: Public Mental Health Intelligence
Action
Reporting
lead
Support
Timescale Outcome
areas
Lifecourse
Stages
Activity
areas
Review use of national MH indicators locally
Senior Public
Health
Research
Officer1
Sonya Scott
Years 1-2
Monitoring
and
evaluation
All
Update population mental health and
wellbeing report
Senior Public
Health
Research
Officer1
Sonya Scott
Year 3
Monitoring
and
evaluation
All
Maintain evidence base for strategy’s theories
of change
Senior Public
Health
Research
Officer1
MHLG and
CYPMHG
members
Years 1-3
Monitoring
and
evaluation
All
Review theories for change to inform second
action plan
Senior Public
Health
Research
Officer1
MHLG and
CYPMHG
members
Associated
partnership
groups
Year 3
Monitoring
and
evaluation
All
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 14 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 3: Public Mental Health Intelligence
Action
Reporting
lead
Support
Timescale Outcome
areas
Lifecourse
Stages
Activity
areas
Use Public Health prioritisation tool to direct
Mental Health Leadership and Children &
Young People’s Mental Health Groups’
evaluation activities
Senior Public
Health
Research
Officer1
MHLG and
CYPMHG
members
Years 1-3
Monitoring
and
evaluation
All
Evaluation of the Asset-Based Community
Development programme (AHEAD)
Senior Public
Health
Research
Officer 2
Scottish
Marketing
Gateway/ North
Ayrshire
Council/ South
Ayrshire
Council/
Glasgow Centre
for Population
Health
Years 1 3
Monitoring
and
evaluation
All
Develop public health intelligence for people
with mental health problems
Specialty
Registrar/
Senior Public
Health
Research
Mental Health
Services
Years 1-2
Supporting All
activity
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 15 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Section 3: Public Mental Health Intelligence
Action
Reporting
lead
Support
Timescale Outcome
areas
Lifecourse
Stages
Activity
areas
Update AthenA with mental health
improvement information
Officer1
Project Coordinator
MHLG and
CYPMHG
members /
Public Health
AthenA
Administrators
Years 1-3
Supporting All
activity
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and communities.
3. Creating mentally healthy environments for working and learning.
Page 16 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Activity areas based on evidence
a
Tools specifically designed to help individuals improve and maintain their mental
health and wellbeing (e.g. Steps for Stress, Mindfulness, 5 Ways to Wellbeing,
Wellness Recovery Action Planning [WRAP]).
b
Creating organisational cultures in workplaces that support mental health and
wellbeing.
c
Training for professionals and volunteers to support people with mental health
problems.
d
Workplace policies and procedures that support employees’ mental health and
wellbeing
e
Asset-based community development
f
Volunteering, ‘Good Work’ i.e. secure and adequately paid work
g
Children’s involvement in asset based community approaches
h
Social prescribing
i
Activities that can promote mental health and wellbeing
j
Creating organisational cultures that support mental health and wellbeing
k
Public information campaign
l
Environmental and greenspace improvements
m
School-based programmes to promote mental wellbeing
n
Mental wellbeing component of Curriculum for Excellence
o
Responding to difficult ties and challenges/problem solving teams and
activities/play
p
Support healthy relationships across the life stages
q
Training for professionals and volunteers to support people with mental health
problems
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and
communities.
3. Creating mentally healthy environments for working and learning.
Page 17 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
r
Awareness of benefits and risks of social networking
s
Information for parents from early years to adolescence
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and
communities.
3. Creating mentally healthy environments for working and learning.
Page 18 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
List of Reporting Leads with Job Titles
Name
Job title
Nicola Tomkinson
Health Promotion Officer - CDU
Maggie Dhinsa
Health Promotion Officer – Mental Health
Lindsey Murphy
Health Promotion Officer - HWL
Anne Clarke
Assistant Director – Public Health
Irene Campbell
Co-production Manager
Carolann Swanson
CAMHS Primary Mental Health Worker
Mental Health Leadership Group members:
Anne Clarke, Assistant Director – Public Health (Chair), NHS A&A
Andrew Hale, Equality and Health Policy Officer, North Ayrshire Council
Irene Campbell, Co-production Manager, NHS A&A
Maggie Dhinsa, Health Promotion Officer – Mental Health, NHS A&A
Eleanor Eade, Risk & Safety/Health Improvement Officer, South Ayrshire Council
Marla Baird, Equality & Inclusion Manager, Ayrshire College
Andrew Pulford, Senior Public Health Research Officer1, NHS A&A
Sonya Scott, Specialty Registrar, NHS A&A
Fiona Smith, Health Promotion Officer – South Locality
Helen Strainger-Boyce, Performance Manager, NHS A&A
Nicola Tomkinson, Health Promotion Officer - CDU, NHS A&A
Children & Young People’s Mental Health Group:
Anne Clarke, Assistant Director – Public Health (Chair), NHS A&A
Laura Doran, Principal Clinical Psychologist, NHS A&A
Marisa Forte, Clinical Psychologist for Community Paediatrics, Medical Paediatrics and
Neonatal, NHS A&A
Jane MacQuarrie, Principal Clinical Psychologist, NHS A&A
Elaine Moore, Clinical Midwifery Manager Inpatient/Outpatient, NHS A&A
Andrew Pulford, Senior Public Health Research Officer, NHS A&A
Ruth Deery, Professor of Maternal Health, University West of Scotland
Sonya Scott, Specialty Registrar, NHS A&A
Fiona Smith, Health Promotion Officer – South Locality, NHS A&A
Suzanne Thomson, Team Leader – CAMHS, NHS A&A
Carolann Swanson, CAMHS Primary Mental Health Worker, NHS A&A
Kathleen Winter, Public Health Practitioner (Child Health), NHS A&A
Locality Health Promotion Managers:
Brenda Knox, North Locality
Lesley Reid, South Locality
Sharon Hardie, East Locality
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and
communities.
3. Creating mentally healthy environments for working and learning.
Page 19 of 20
Mental Health and Wellbeing Strategy: Action Plan 2015 – 2018
Locality Health Promotion Officers:
Joanne Inglis, North Locality
Maureen Kater, South Locality
Kevin Lyle, East Locality
Deborah Wason
Senior Public Health Research Officer 2
Mhairi McMillan
Project Co-ordinator
Outcome areas:
1. Developing and sustaining inner resources, especially of marginalised groups.
2. Increasing social connectedness, relationships and trust in families and
communities.
3. Creating mentally healthy environments for working and learning.
Page 20 of 20
Section A:
Standard Impact Assessment Process Document
NHS Ayrshire & Arran Standard Impact Assessment Process Document
Please complete electronically and answer all questions unless instructed
otherwise.
Section A
Q1: Name of Document
Ayrshire and Arran Mental Health and Wellbeing Strategy 2015- 2027
Q1 a: Function
Guidance
Policy
Project
Service
Other, please detail
Strategy
Q2: What is the scope of this SIA
NHS A&A
Wide
Service Specific
Discipline Specific
Other (Please Detail)
Whole population of Ayrshire &
Arran
Q3: Is this a new development? (see Q1a)
Yes
No
Q4: If no to Q3 what is it replacing?
Towards a Mentally Flourishing Ayrshire and Arran
Q5: Team responsible for carrying out the Standard Impact Assessment? (please list)
Members from the Mental Health Leadership Group: Anne Clarke, Maggie Dhinsa, Nicola
Tomkinson, Fiona Smith, Andrew Hale, Eleanor Eade and Catrina O’Neil
Q6: Main SIA person’s contact details
Name:
Maggie Dhinsa
Telephone Number:
01294 323503
Department:
Public Health
Email:
[email protected]
ot.nhs.uk
Q7: Describe the main aims, objective and intended outcomes
This strategy aims to improve the mental health and wellbeing of the whole population of Ayrshire
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
and Arran by contributing to healthy life expectancy and reducing inequalities in wellbeing. It will take
a life course perspective to increase quality of life, improve mental wellbeing and contribute to a
reduction in mental illness.
Q8:
(i) Who is intended to benefit from the function/service development/other(Q1a) – is it staff,
service users or both?
Staff
Service Users
Other
Please identify: Whole population of
Ayrshire and Arran
(ii) Have they been involved in the development of the function/service development/other?
Yes
No
(iii) If yes, who was involved and how were they involved? If no, is there a reason for this
action?
Comments:
 The strategy was developed using robust evidence from the National Mental Health Outcomes
Framework which fully complied with EDIA regulations during its development processes.
(iv) Please include any evidence or relevant information that has influenced the decisions
contained in this SIA; (this could include demographic profiles; audits; research; published
evidence; health needs assessment; work based on national guidance or legislative
requirements etc)
Comments:
 As previously mentioned the strategy is underpinned by the National Mental Health Outcomes
Framework, which in turn has a fully developed evidence base for all aspects of the
framework.

This strategy is accompanied by a Population Health Report which draws on local and national
data in order to present a coherent picture of the mental health and wellbeing of adults in
Ayrshire and Arran as an aid to strategic planning. The national indicator and outcomes
frameworks have been used to assist with this. This report was produced by a Senior
Research and Evaluation Officer within the Public Health Department.

There is a monitoring and evaluation plan in place for the strategy which includes Covalent,
the population mental wellbeing indicators and analysis of the theories of change which
underpin the strategy.
Q9: When looking at the impact on the equality groups, does it apply within the context of the
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
General Duty of the Equality Act 2010 see below:
In summary, those subject to the Equality Duty must have due regard to the need to:
•
eliminate unlawful discrimination, harassment and victimisation;
•
advance equality of opportunity between different groups; and
•
foster good relations between different groups
Has your assessment been able to demonstrate the following: Positive Impact, Negative /
Adverse Impact or Neutral Impact?
What impact has your
review had on the following
‘protected characteristics’:
Positive
Adverse/
Negative
Neutral
Comments
Provide any evidence that supports
your answer for positive, negative or
neutral incl what is currently in place
or is required to ensure equality of
access.
Age

This strategy is taking a life course
perspective which includes: infants,
children and young people, working
aged adults and older people in
order to increase their quality of life,
improve their mental wellbeing,
reduce mental illness and reduce
suicide which could benefit this
Equality Target Group (ETG).
Disability (incl. physical/
sensory problems, learning
difficulties, communication
needs; cognitive impairment)

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on developing and
sustaining inner resources,
especially of marginalised groups.
Wording on the consultation
document was approved by
Communications Department and
information regarding requesting in
another format was made available.
Therefore an easy read version was
not produced nor requested.
However, staff did host consultation
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
discussion sessions to a range of
different stakeholders thus
presenting the information in a user
friendly format.
Gender Reassignment

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on developing and
sustaining inner resources,
especially of marginalised groups.

Marriage and Civil
partnership
This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on developing and
sustaining inner resources,
especially of marginalised groups.
Pregnancy and Maternity

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on increasing social
connectedness, relationships and
trust in families and communities.
Race/Ethnicity

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on developing and
sustaining inner resources,
especially of marginalised groups.
Wording on the consultation
document was approved by
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
Communications Department and
information regarding requesting in
another format or language was
made available. During the
consultation period no requests were
received for any other languages.

Religion/Faith
This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on increasing social
connectedness, relationships and
trust in families and communities.
Sex (male/female)

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran which could benefit this ETG.
Sexual orientation

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on developing and
sustaining inner resources,
especially of marginalised groups.
Staff (This could include
details of staff training
completed or required in
relation to service delivery)

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area three which
focuses on creating mentally healthy
environments for working and
learning.
Cross cutting issues: Included are some areas for consideration. Please amend/add as
appropriate. Further areas to consider in Appendix B
Carers

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one and two
which focus on developing and
sustaining inner resources and
increasing social connectedness,
relationships and trust in families
and communities.
Homeless

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on developing and
sustaining inner resources,
especially of marginalised groups.
Involved in Criminal
Justice System

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran. It has three main outcome
areas that could benefit this ETG, in
particular outcome area one which
focuses on developing and
sustaining inner resources,
especially of marginalised groups.
Language/ Social Origins

An easy read version of the strategy
has been developed for the
consultation period which is
available in a range of languages,
larger print, Braille, audio tape or
other format as required.
Literacy

An easy read version of the strategy
has been developed for the
consultation period which is
available in a range of languages,
larger print, Braille, audio tape or
other format as required.
Low income/poverty

This strategy recognises that low
income/ poverty can negatively
impact upon mental health and
wellbeing and that it is important for
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
steps to be taken to address this.
Mental Health Problems

One of the aims of this strategy is to
contribute to a reduction in mental
illness.
This strategy has three main
outcome areas that could benefit this
ETG, in particular outcome area one
which focuses on developing and
sustaining inner resources,
especially of marginalised groups.
Rural Areas

This strategy is aiming to improve
the mental health and wellbeing of
the whole population of Ayrshire and
Arran, including rural areas. It has
three main outcome areas one of
which focuses on increasing social
connectedness, relationships and
trust in families and communities.
Q10: If actions are required to address changes, please attach your action plan to this
document. Action plan attached?
Yes
No
Q11: Is a full EQIA required?
Yes
No
Please state your reason for choices made in Question 11.
 There are no adverse or negative impacts on any of the protected characteristic groups
mentioned above.
If the screening process has shown potential for a high negative impact you will be required
to complete a full equality impact assessment (see guidelines).
Date SIA Completed
22 / 10 / 2014
Date of next SIA
Review
Signature
Department or Service
Print Name
Maggie Dhinsa
Public Health
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
Please keep a completed copy of this template for your own records and attach to any appropriate
tools as a record of SIA or EQIA completed. Send copy to [email protected]
Section B:
Standard/Full Impact Assessment Action Plan (EQIA)
Name of document being
EQIA’d:
Date
Issue
Ayrshire and Arran Mental Health and Wellbeing Strategy 2015-2027
Action
Required
Lead
(Name,
title, and
contact
details)
Timescale
Resource
Implications
Comments
DD / MM /
YYYY
DD / MM /
YYYY
DD / MM /
YYYY
DD / MM /
YYYY
DD / MM /
YYYY
DD / MM /
YYYY
Further
Notes:
Signed:
Date:
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
Section C: Quality Assurance
QA Section
Lead authors details?
Name:
Anne Clarke
Telephone Number: 01292 885915
Department:
Public Health
Email:
[email protected]
Does your policy / guideline / protocol / procedure have the following on the front cover?
Version Status

Review Date

Approval Group

Type of Document (e.g. policy, protocol, guidance etc)
Lead Author

Yes
Does your policy / guideline / protocol / procedure have the following in the document?
Contributory Authors

Consultation Process

Distribution Process

Implementation Plan
X
Is your policy / guideline / protocol / procedure in the following format?
Arial Font

Font Size 12

Signatures
Lead Author:
Date:
DD / MM / YYYY
Signatures
QA Check
Date:
01/12/2014
Once both signatures above are complete the document can be sent to the approving group for
approval (Sections A&C only).
Outcome areas:
4. Developing and sustaining inner resources, especially of marginalised groups.
5. Increasing social connectedness, relationships and trust in families and communities.
6. Creating mentally healthy environments for working and learning.
Mental Health and Wellbeing Strategy
Public Consultation
August 2014 - November 2014
Analysis of
Consultation Feedback
Document Version:
Final version
Version Date:
28/11/14
Author(s):
Nicola Tomkinson, Health Promotion Officer
Approval Process:
Mental Health Leadership Group
1. Background
The draft Ayrshire Mental Health and Wellbeing Strategy 2014-2024 was approved
for public consultation by the NHS Ayrshire & Arran Board on the 4 th April 2014.
Thereafter, a three-month public consultation period on the strategy and action plan
commenced on 1st September 2014 and concluded on 28th November 2014.
The Mental Health and Wellbeing has been developed by the multi agency Mental
Health Leadership Group comprised of staff from NHS Ayrshire and Arran and two
Local Authorities. During the development process the group engaged with a
number of colleagues who have an interest in mental health and wellbeing.
2. Consultation Feedback Methods
The list below provides a brief overview of the key feedback methods for ease of
reference.
Consultation Questionnaire: In addition to volumes I and II of the strategy, a short
summary document and an online survey monkey with four key questions were
developed as the main feedback methods (for details see Appendix 1). The
summary document and survey monkey were published widely utilising email, NHS
Ayrshire & Arran’s intranet and public website and two of the Local Authorities
websites. Hard copies of the summary document were also printed and distributed
at a various public or staff events.
Mail shot/ Formal Written Response: The consultation questionnaire including a
link to the full strategy was distributed utilising several internal and external
networks. Individual members of the Mental Health Leadership Group circulated the
consultation amongst their networks.
Attendance at Invited Presentations: A number of presentations were undertaken
by invitation at existing meetings. There were also a number of informal
presentations and discussions arranged with groups. A full list of these
presentations can be found within Appendix 2.
3. Analysis of Consultation Responses
A total of 40 responses were received as a result of the consultation. This equated
to 31 responses via survey monkey, 7 responses from group discussions or group
feedback, 1 individual response and 1 formal written response from East Ayrshire
Community Planning Partnership Joint Officers’ Group.
4. Conclusion
The majority of respondents agreed that the actions contained in the Mental Health
and Wellbeing Strategy are the right areas for action. Many respondents provided
helpful detailed comments. However, the majority of these comments were about
the detail of the implementation of the strategy and its action plan rather than any
major concerns about the general content.
In spring 2014 many groups from the Community Planning Partners and former CHP
Committees had presentations and discussions about the strategy and their potential
contribution. The strategy was well received. Minor amendments have been made
to volume I and the final strategy has remained relatively unchanged from the
consultation draft. The table in Appendix 3 provides the detail of the consultation
responses.
Appendix 1
Survey Monkey Questions for Mental Health and Wellbeing Strategy
Consultation
Question 1: These are the areas for activity that the strategy intends to focus on:
 Helping individuals develop their mental health.
 Increasing opportunities for individuals to engage positively with
one another within their own communities and building
relationships and trust in families and communities.
 Creating mental healthy environments for working and learning.
Is there anything that you feel is important that is not covered in these
areas of activity?
Question 2: Do you / your organisation have any projects / proposals that would
contribute to the proposed area of activity?
Question 3: How do you think you could be involved or contribute if you aren’t
already?
Question 4: Are there any additional comments you would like to make?
Appendix 2
Attendance at meetings or groups
North Ayrshire Health and Wellbeing Co-ordinators Network
East Ayrshire Community Planning Partnership Joint Officers’ Group
Parents of infants, children and young people:
 Forehill Primary School, Ayr
 Forehill Nursery School, Ayr
 Castlepark Early Years Group
 Shortlees Nursery Parents Group
Appendix 3Local Response to Consultation Comments Submitted
1.
These are the areas for activity that the strategy intends to focus on:



Helping individuals develop their mental heath
Increasing opportunities for individuals to engage positively with one another within their own communities and building relationships and trust in
families and communities.
Creating mentally healthy environments for working and learning.
Is there anything that you feel is important that is not covered in these areas of activity?
[38.71% Yes, 51.61% No, 9.68% Not sure]
Comments from Survey Monkey
Part of Strategy it relates to
Response (to be completed by strategy author)
Amend strategy
Healthy diet…eating healthy improves
wellbeing. Vitamin and mineral
deficiencies can lead to increased
depression. Healthy body, weight
improves mental health as body image
may be a stress factor.
Part 4 (4.5)
Noted. Out with the scope of this strategy.
There are numerous national and local strategies
being implemented that contribute to the Promoting
Health and Healthy Behaviours outcome e.g. local
Healthy Weight Strategy.
I think good employment and decent
income are also important to mental
health and wellbeing. It would be
important that advocacy for these
areas are captured in your creating
mentally environments.
Part 4 (4.9)
Noted. Out with the scope of this strategy.
There are numerous national and local strategies
being implemented addressing financial security
and employability.
Y
Included sentence
highlighting the
relationship between
mental health and
wellbeing and healthy
diet in Part 4.5.
Y
Changed the strategy
(part 4.8) to highlight
the role of employment
and employability in
relation to mental
wellbeing.
Everything covered.
Engaging and educating adolescents
on mental health early
support/intervention.
Throughout
Part 6 (6.1, 6.3)
Noted with thanks
Agree.
Priority Area 1 aims to develop and sustain inner
resources of young people. Priority area 3 aims to
support mentally healthy learning environments e.g.
schools.
Treatment interventions are not in the scope of this
strategy.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Part 4.9 was also
amended to make
clearer areas of work
that will be undertaken
to address the mental
health and wellbeing
dimensions of the
workplace.
N
Strategy Amended
Y/N
Y
Y
N/A
N
Appendix 3Local Response to Consultation Comments Submitted
More awareness in secondary school
environments.
Part 6 (6.3)
Agree. Priority area 3 aims to achieve this. The
action plans which will accompany the strategy will
outline specific activities.
Y
Update introduction to
part 6 highlighting the
activities are examples
only.
Y
More social activities suited to young
teenagers. Areas to go.
Part 6 (6.2)
Noted. Priority area 2 may contribute towards this.
However, there are also other local strategies that
may contribute to the delivery of social activities for
young people. The action plans which will
accompany the strategy will outline specific
activities.
N
N
Y
Strategy amended in
part 4.9 highlighting the
areas of work that the
Healthy Working Lives
Team carry out the
mental health and
wellbeing dimensions of
the workplace including
the promotion of work
life balance and
encouraging employers
to address
organisational
demands.
Y
Amended the strategy
part 4.8 highlighting
importance of the
employability on mental
health and wellbeing.
Y
N
N
The psychological model of stress is
too many demands vs not enough
capacity to cope. The strategy
focuses on building resilience but in
think more consideration should be
given to how to reduce demands on
people at all stages of life. On an
individual and organisation level we
need to get people thinking about
changing the balance of their lives.
Part 6 (6.4, 6.6)
Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
Agree - Tools that will be used in relation to building
resilience will increase awareness and
understanding about the importance of balance and
give people the skills to improve this area of their
life.
Priority area 3 aims to create mentally healthy
environments for working and learning. This could
include encouraging these environments to
consider the demands placed on people.
Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
There is little mention of the help
available for people who are
unemployed and trying to get back to
work, although there is mention of
workplace policies etc.
Part 4 (4.9)
Providing positive and flexible
supports for those experiencing mental
health issues.
Part 6
Agree and noted. Out with this strategy. There are
other local strategies that address the employability
agenda.
This strategy focus solely on the mental health and
wellbeing dimensions of the workplace within the
outcome area- creating mentally health
environments for working and learning.
Outcome priority areas 1 and 2 (Sustaining inner
resources and increasing social connectedness)
would encompass those who are unemployed.
All areas of the strategy aim to provide positive
supports for people in various aspects of life in
order to improve mental health and wellbeing. This
strategy does not exclude people with mental
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
N
Appendix 3Local Response to Consultation Comments Submitted
health problems. However, this strategy does not
encompass issues relating to mental health
services or issues relating to mental illness (part
1.3).
Creating a better general
understanding of the issues
surrounding mental health to help to
remove the stigma attached to it.
Part 4 (4.8)
Noted. Out with this strategy.
Outcome priority area 1 will contribute to raising
awareness and understanding of mental health and
wellbeing. However, this strategy does not address
stigma of mental illness specifically. The national
Mental Health Strategy for Scotland 2012 – 2015
has a commitment to address stigma (commitment
4, page 16.)
N/A
N
Social environments should be
included as individuals with mental
health problems are often isolated and
excluded from mainstream activities
because they don’t fit in.
Part 4 (4.8)
N
N
Recognising the number of individuals
in education who report absence from
work due to work related stress,
workload being a main contributor.
Part 4 (4.9)
Agree.
Outcome priority area 2 aims to increasing social
connectedness for the whole population of Ayrshire
and Arran. In particular this outcome is about
ensuring those who are marginalised which
includes individuals with mental health problems
and various other groups of people.
Noted.
This strategy aims to create mentally healthy
environments for work for all sectors.
Y
Working, learning and recreation.
Part 4 (4.9)
Y
Strategy amended in
part 4.9 highlighting the
areas of work that the
Healthy Working Lives
Team carries out in
relation to stress in the
workplace and
encouraging employers
to address
organisational
demands.
N
Part 6 (6.1, 6.2)
This strategy will focus on creating mentally healthy
environments for working and learning.
Outcome priority area 1 and 2 may also address
some areas of recreation e.g. community based
activities, environmental and green space
improvements. However, there are also local
strategies which aim to address recreation.
Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
N
Appendix 3Local Response to Consultation Comments Submitted
Council is not protecting the
environment and creating stress by
approving unwanted industrial and
leisure developments in my village.
Part 4 (4.10)
Noted. Out with this strategy
N
N
Unemployment is highlighted as a risk
factor, however, low paid /
insecure/poor quality employment is
also a risk factor (section 2.2). It may
be worthwhile making links to the
theory of causation within the strategy
and how each of the areas
(fundamental causes, environment
and individual factors) impact on
mental health?
Part 2.2
Noted.
Y.
Part 2.2 has been
updated to highlight the
importance of ‘good
work’ on mental health
and wellbeing.
Y
Section 7.1 (now part 6.4) could
meaningful activity include good work
as well as volunteering?
Part 6 (6.4)
Noted. Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
Y
Y
Within section 7 (now part 6) should
activities to tackling stigma be
included?
Part 6
Tackling Stigma directly is not covered by this
strategy (part 4.8). There are other local and
national strategies and action plans that tackle this
issue.
The national Mental Health Strategy for Scotland
2012 – 2015 has a commitment to address stigma
(commitment 4, page 16.)
N
N
Strategy Amended
Y/N
N
2.
Do you/your organisation have any projects/proposals that would contribute to the proposed areas of activity?
[51.61% Agree, 35.48% Do not Agree; 12.90% Not sure]
Comments from Survey Monkey
Part of Strategy it relates to
Response (to be completed by strategy author)
Amend strategy
Healthy eating encouraged by
initiatives such as Jumpstart, dietetic
referrals. Perhaps cooking groups
amongst high poverty areas and teens
should be rolled out again. People
with low incomes often have low
cooking skills and therefore buy
expensive take-aways.
Part 6 (6.1)
Noted.
N
There are numerous national and local strategies
being implemented that contribute to the Promoting
Health and Healthy Behaviours outcome e.g. local
Healthy Weight Strategy.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
BBV Support Groups are currently
being rolled out across Ayrshire to
invoke support for those affected by
BBVs. Mental health is a main priority
area for those affected and their
families.
Part 6
Noted
Y
Noted
Y.
Strategy (part 4.8)
updated. List of
marginalised groups
extended to include
people with long term
conditions.
N
Would like to develop a social group
setting in South Ayrshire for
teenagers.
Lots of work is being done across NHS
A&A and the 3 local authorities in
Mindfulness. While there has been
some investment in this, the majority
of the people involved are carrying out
groups etc while still having full work
commitments in their “normal” work
role.
One idea would be to grant staff in
NHS A&A an allocated time away from
work each per week to take part in
health promoting exercise/activity
approved by their line managers.
Every JobCentre has a Disability
Employment Adviser to help people,
including those with MH issues into
work. There is also specific support
for people going into work from the
Access to Work (ATW) scheme and
other programmes.
Not sure. Communication of staff
training through Inter Agency calendar
in South Ayrshire.
Flexible Intervention Service (FIS) –
North Ayrshire Council.
Healthy Start Clubs in primary schools.
Befriender scheme for lonely
vulnerable people. Volunteering
opportunities at our community
allotment project based at Eglinton
growers.
Activity for Health – exercise on
referral programme. Assisting people
to become more active within South
Ayrshire Sports Development Team.
Part 6
Part 6
Noted
N
N
Part 6
Noted.
This comment has been passed onto the NHS A&A
Health, Safety and Wellbeing Group
N
N
Part 6
Noted
N
N
Part 6
Noted
N
N
Part 6
Noted
N
N
Part 6
Part 6
Noted
Noted
N
N
N
N
Part 6
Noted
N
N
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
N
Appendix 3Local Response to Consultation Comments Submitted
Employers should take cognizance of
the professionalism of education
personnel, teachers in particular, and
should allow more professional
autonomy.
Breaking Ground Horticultural Therapy
Group located within Eglinton Country
Park running on a weekly basis, and
proposals to enhance the visitor centre
courtyard within Eglinton for learning,
community and recreational wellbeing.
I want you to stop further unwanted
development in Fairlie.
A project to help service users make
the leap for exercising in a clinical
environment, to the community by
accompanying them for a number of
sessions in the community.
Programmes to support employees –
will there be an appendix/further
information of things available i.e.
HWL programme, MH training for
managers? It may be worthwhile
having ‘workplace programmes to
support employees’ and also
‘workplace programmes to support
employers’.
3.
Part 6
Noted
N
N
Part 6
Noted
N
N
Part 6
Noted. Out with the scope of this strategy.
N/A
Part 6
Noted
N
N
Part 6 (6.6)
Noted. Action Plans will provide more detail of
activity to be carried out by the Mental Health
Leadership Group and the wider Public Health
department. However, it is also recognised that
there is a lot of other good work to promote mental
health and wellbeing being carried out by other
agencies and partners.
Y
Part 4.9 has been
updated to outline the
examples of activities
that will address the
mental health and
wellbeing dimensions of
the workplace being
carried out by the
Public Health
Workplace team. Part
6.6 updated to include
programmes for
employers.
N
Amend strategy
Strategy Amended
Y/N
How do you think you could be involved or contribute if you aren’t already?
[13 answered, 18 skipped]
Comments from Survey Monkey
Part of Strategy it relates to
Response (to be completed by strategy author)
Cooking groups. This could be done
Part 6
Noted
at primary and secondary schools for
children and parents/or local
community halls. Healthy eating for a
healthy body and mind. Groups help
these people to socialise which is also
a benefit.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
Already do so.
A parent voice to strategies and
development for mental health in
South Ayrshire
Would like to be invited to stakeholder
consultation events/launch.
Not sure as someone who has a
mental health condition interested to
see what the outcome of this strategy
will be.
Dale Meller from NAC is contact for
the FIS pilot.
Carry out more home visits to
vulnerable adults.
We presently have mental health
referrals from NHS colleagues.
I am involved in the Teachers’ Union
Workload Campaign.
Part 6
Part 6
Noted
Noted
Part 6
Noted
Part 6
Noted
Part 6
Noted
Part 6
Noted
Part 6
Noted
Part 6
Noted
I have had mental health problems in
the past and am willing to talk to
others about my experience.
Part 6
NotedIndividuals who have experienced stigma are
involved in many aspects of the campaign, and
includes those who are willing to speak to the
media about the impact stigma has had on their
lives. If you would like to become a See Me media
volunteer please access the following website for
more information: www.seemescotland.org
Eglinton Country Park is a valuable
resource for many outdoor recreational
and educational pursuits.
I joined Fairlie Safer Roads campaign
and visit community council meetings
to find out what is going on.
Perhaps some input from general
practice may be helpful.
Part 6
Noted
Part 6
Noted
Part 6
Noted
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
4.
If you would like to give any additional comments
[13 answered, 18 skipped]
Comments from
Part of Strategy it relates to
Response (to be completed by strategy author)
Amend strategy
No mention in the strategy of better
housing for people…work with
councils?
Part 4 (4.10)
Noted. Out with the scope of this strategy. Other
local strategies and partnerships address this issue.
N
No mention of creating job
opportunities (although volunteering is
mentioned)..working with local
businesses to increase opportunities
for in-house training. People often
have poor mental health as lack of
jobs means lack of money….and no
reason to get out of bed. Deprivation
is a huge factor in Ayrshire.
Throughout
Noted. Out with the scope of this strategy.
Y
Strategy amended to
make reference to the
importance of
employment and the
employability agenda.
Part 4 (4.8), Part 2 (2.2)
Y
No proper drug rehabilitation
services….this has a huge impact on
the patient and their families. People
can go into hospital for 6 weeks..even
the mental health nurses say this isn’t
adequate…
Throughout
Noted. Out with the scope of this strategy.
Need a much better health promotion
campaign for the teens to prevent
them going down this path…
youth clubs and cafes should be
opened to fill their time.
Part 4, Part 6
Noted. Outcome priority areas 1, 2 and 3 aims to
improve the mental health and wellbeing of
Children and Young People. Activities listed in Part
6 of the strategy are examples only. This is not an
exhaustive list.
Increasingly common so early
education/advice/support etc required
especially to encourage more ‘selfhelp’ approaches etc.
Part 4 (4.6), Part 6 (6.1, 6.4)
Noted. Outcome priority area 1 aims to develop and
sustain inner resources, which includes
encouraging self help approaches.
Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
N
N
Feel there needs to be better
communications between social work,
health care and school environments.
Part 4 (4.9)
Noted. Out with the scope of this strategy.
It would be hoped that the new Integrated health
and social care partnerships would contribute to
improved communication between these agencies.
N
N
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Strategy Amended
Y/N
N
Appendix 3Local Response to Consultation Comments Submitted
Great length, likely to be read easily by
stakeholders.
Throughout
Noted with thanks.
N/A
N
Diagram on page 5 appears to be a
Venn diagram but this does not fit with
the contents of the diagram. Could
perhaps be better presented as a
‘spider’ diagram.
Part 3 (3.3)
The Venn diagram illustrates the relationship
between all the agencies linked to the Community
Planning Partnership. The diagram highlights the
interrelated and interdependent relationships
between all the partners which are especially
important to a complex area of work such as
promoting mental health and wellbeing.
N
N
Ref 4.8 – there are other groups of
people who are marginalized i.e. older
adults, people with an offending
background (who have not necessarily
been to prison) etc. These could
either be included, or a few words
added to indicate the list is not
exhaustive.
Part 4 (4.8)
Agreed and noted. There are other marginalised
groups the ones listed are only examples.
Y
Part 4.8 has been
updated to include exoffenders to the list.
N
Also substance MISuse is sometimes
seen a pejorative, in my experience
substance use is sufficient and more
appropriate.
Part 4 (4.8)
The terminology used in this strategy is in line with
that used within the local Alcohol and Drug
Strategies.
N
N
Y
Y
Full stop missing after “dimension of
mental wellbeing” on page 8.
Part 4 (4.10)
Noted
Section 4 – some times subtitles are
underlined e.g. 4.5 to 4.10 others are
not e.g. 4.1 to 4.4, 4.11. It is not clear
why this is and it looks a little unusual.
Would hope that this strategy would
give a better understanding of mental
health and offer more help to those
that need it.
I think it is vital that children, parents
and educators are prioritized. We are
waiting far too long to engage with
these groups – and having experience
of a child with additional support needs
I have been gravely concerned at the
lack of understanding within the
Part 4
Noted. The Subtitles that are underlined were to
highlight the Outcome priority areas. Understand
this could be confusing, will remove lines.
Y
Y
Throughout
Noted with thanks.
N/A
N
Throughout
Noted .
N/A
N
This comment has been passed onto the Mental
Health Services.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
education system and the complete
lack of “joined-upness” between all
agencies. The right hand truly does
not know what the left is doing and the
poor child and their parents/carers are
left in the middle having to constantly
fight of their children’s future – as if it’s
not hard enough already dealing with
all their issues.
There is currently training for NHS and
other organizations on Employability
and Health (Maggie Vooght and Anne
McGuire). MH is often raised as a
barrier to employment and there is a
good deal of information available.
The addition of staff training would be
beneficial as mental health learning
needs are high within South Ayrshire
and to support implementation of the
strategy training would be required.
More activity based projects are
needed as not everyone enjoys group
activities.
Levels of presenteeism as well as
absenteeism in the workplace have a
negative impact on the quality of work
done. More needs to be done to train
managers to recognize signs and
symptoms of stress and to adopt a
supportive attitude in the workplace.
Part 4 (4.9)
Noted
N/A
N
Part 6 (6.6)
Noted for action plan. Outcome Priority 3 highlights
an outcome as Increased Learning and
Development for All.
N
N
Part 6
Noted.
Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
Noted for action plan.
N
N
Y
Part 4.9 has been
updated to outline the
examples of activities
that will address the
mental health and
wellbeing dimensions of
the workplace being
carried out by the
Public Health
Workplace team,
including training for
managers
N
N
Part 4 (4.9) and part 6 (6.6)
It is a well documented fact that green
Part 6 (6.5)
Agree. Outcome Priority 2 Area 2 highlights an
spaces, views of nature, and
example of activity would be Environmental and
closeness to plants is beneficial for our
green space improvements. It would be hoped that
mental and physical wellbeing. The
this would be implemented through one of the
outdoor spaces need to be utilised to
action plans that will accompany this strategy.
their full potential. This may involve
investing time and money to improve
and enhance green spaces, but this
ultimately improves community areas
and environments.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
N
Appendix 3Local Response to Consultation Comments Submitted
Local council needs to stop approving
unwanted developments in village of
Fairlie which are causing severe stress
and loss of amenity and continuing
deterioration in quality of life.
I think moving the schools mental
health support workers into mental
health rather than the school nursing
structure is counter to the aims of the
strategy as it will inevitably make staff
part of the mental health silo rather
than the holistic school nursing
approach
I think it is very important for children
and young people to be able to access
mental health support within schools
from specifically trained mental health
advisors. This needs to be a priority
with government figures estimating
that at any one time in Scotland 10%
of children under the age of 19 years
have mental health problems which
are so significant that they impact not
only on their day to day function but if
left unresolved increase the risk of
problems in adulthood. If we
concentrated more on early detection
and intervention then it would be
hoped that we would reduce the
numbers continuing onto adult
services.
Part 4 (4.10)
Well written strategy and reminder of
how important this is to all of us
5.
Noted. Out with the scope of this strategy.
N/A
N
Noted. Out with the scope of this strategy.
N/A
N/A
Part 6
Agree.
Comment passed to Mental Health Services
N/A
N/A
Throughout.
Noted with thanks.
N/A
Response (to be completed by strategy author)
Amend strategy
Strategy Amended
Y/N
Noted.
The Children and Young People’s Mental Health
N
N
Other responses received (not via Survey Monkey)
Comments from
Part of Strategy it relates to
Comments from groups of professionals:

The committee welcomed this
strategy but felt that it should be
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
made explicit that no-one from
within Mental Health Services was
on the Mental Health Leadership
Group

Social inclusion, social
connectedness and social
prescribing – members suggested
that definitions for these terms
should be provided in the glossary
especially as social inclusion and
social connectedness seemed
very similar
Group is a sub-group of the Mental Health
Leadership Group which has various
representatives from Mental Health Services.
Members of the Mental Health Leadership group
and Children and Young People’s Mental Health
Group also sit on the a vast number of Mental
Health Service related groups and are responsible
for being the link person to cascade pertinent
information e.g. Physical Health and Mental
Wellbeing Group
A representative from Ayrshire College has also
recently joined the Mental Health Leadership group.
Throughout
Agree. Glossary of terms will be added to strategy.
Y
Y
Noted and added.
Y
Y
Part 3 Policy Context

The Committee suggested that
Keys to Life should also be
included in the draft strategy with
regard to reducing health
inequalities

The Committee noted the breadth
of activity contained within the
strategy and welcomed the focus
within the action plan on three key
areas.
The strategy is clear and focuses on
very clear area that should impact on
mental wellbeing.
Throughout
Noted with thanks
N/A
Throughout
Noted with thanks.
It will be helpful to see associated
implementation/action plans that will
be developed because some of the
activities are quite broad and not too
specific as how these activities are
going to achieve the outcomes.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
N/A
N
Appendix 3Local Response to Consultation Comments Submitted
Comments from Survey Monkey
Part of Strategy it relates to
Response (to be completed by strategy author)
Amend strategy
Strategy Amended
Y/N
Part 5 and Part 6
Noted. The strategy does not exclude any groups.
All Outcome Priority Areas of the strategy could be
targeted to these groups. Activities in Part 6 (6.1,
6.2, 6.3) are only examples this is not an exhaustive
list. In particular, Part 6.1 outlines examples of
activities for marginalised group
Y
Strategy changed to
refer to individuals and
families affected by.....
Y
See paragraph 4.8.
Part 4.8, Part 6
Noted. This strategy does not exclude any groups.
All Outcome Priority Areas of the strategy could be
targeted to these groups. Part 4.8 highlights a
number of marginalised groups including those
people who may experience homophobia. However,
this is not an exhaustive list. The strategy aims to
develop mental wellbeing and resilience for these
groups and the rest of the population of Ayrshire
and Arran. The activities in Part 6 are only examples
this is not an exhaustive list. Parts 6.1 and 6.4
outline examples of activities to develop and sustain
inner resources for people, especially of
marginalised group.
N
N
Noted. Outwith this strategy. There are other local
strategies that address the employability agenda,
but accept the point.
This strategy focus solely on the mental health and
wellbeing dimensions of the workplace within the
outcome area- creating mentally health
environments for working and learning.
Outcome priority areas 1 and 2 (Sustaining inner
resources and increasing social connectedness)
would encompass those who are unemployed.
Y
Strategy amended to
make reference to the
importance of
employment and the
employability agenda.
Part 4 (4.8), Part 2 (2.2)
Comments from groups of professionals:
Response to Question 1:
 Targeted interventions for
vulnerable young people, for
example children who are affected
by domestic abuse or parental
substance misuse
 Targeted interventions for
vulnerable children and adults in
respect to the protected equalities
characteristics, for example in
relation to homophobia
Y
 Employability should feature within
the identified priorities for working
age adults
The Strategy makes reference to all types of
 There should be greater recognition
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Y
Y
Appendix 3Local Response to Consultation Comments Submitted
of the impact of poverty and
deprivation on mental health and
wellbeing across all age groups
inequalities and their detrimental impact (paragraph
reference 4.8) including material deprivation; but
paragraph has been strengthened to reiterate point.
 The identified training within priority
area 3 for working age adults
should be extended to all staff
rather than managers
Response to Question 2:
The activity of the new East Ayrshire
health and social care partnership will
be integral to delivery of is strategy. In
addition, a number of other Community
Planning Partners have a clear
contribution to make, including Police
Scotland (for example, in relation to the
impact of domestic abuse) and the third
sector (who deliver a wide range of
community based projects which
impact on mental health and
wellbeing).
We would also be keen to see the new
Strategy, as it relates to children and
young people, link directly to
Education's Health and Wellbeing
Throughout
Noted for action plan. Activities listed in Part 6 are
examples only. This is not an exhaustive list. The
following activities highlighted in part 6.6 could
encompass training for all staff:
Encouraging a range of learning
opportunities, both formal and informal
Programmes to support employees
The accompanying action plans will provide more
detail.
Y
Part 4.9 has been
updated to outline the
examples of activities
that will address the
mental health and
wellbeing dimensions
of the workplace being
carried out by the
Public Health
Workplace team,
including Resilience
Workshops, Mental
Health Toolbox Talk
Facilitator training. This
is not an exhaustive
list. Part 6 of the
strategy has been
amended to highlight
that the activities in this
section are examples
only.
Y
Agreed and noted.
This strategy highlights that due to the complex
nature of improving mental health and wellbeing it is
essential that it is “owned” by Community Planning
Partners (part 3.3). The strategy aims to provide a
framework for the direction of travel in relation to
this area of work. It recognises that there are many
strategies, policies and strands of work currently
being implemented that will contribute to this
agenda.
N
N
Agreed – and it is heartening to see actions already
contained in the Education Department’s Health and
Wellbeing Framework that contributes to the mental
health and wellbeing of children and young people.
N
N
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
Framework and to the broader activity
being taken across our schools and
educational establishments in relation
to the Curriculum for Excellence.
Agreed – contribution of many others noted in
paragraph 4.8.
Y
Strategy amended to
make reference to the
importance of
employment and the
employability agenda.
Part 4 (4.8), Part 2 (2.2)
Y
Throughout
Noted with thanks and agree that the optimum route
for implementation is through existing structures.
Meaningful CPP involved is the aim.
N
N
Throughout
Noted.
The Mental Health Leadership group will oversee
and monitor implementation of a three year action
plan. Actions that are to be undertaken will be
performance managed using the Covalent system.
However, it is recognised that the majority of activity
required to drive this strategy forward will be
undertaken by partnership groups. Based on
feedback from a range of partnership groups sought
during the engagement and consultation phases of
the strategy’s development, actions for partnership
groups relating to mental health and wellbeing will
sit within their respective locality plans. The Mental
N
N
Having recognised the significance of
employability in relation to mental
health and Wellbeing, the work of local
employability agencies will also
contribute in this regard, including
Skills Development Scotland,
Department for Work and Pensions,
Ayrshire College, east Ayrshire Council
Economic Development and Third
Sector agencies.
Response to Question 3:
The identified priorities within the
Mental Health and Wellbeing Strategy
require to be embedded within local
community planning partnership
arrangements, from an East Ayrshire
perspective this would be through the
Wellbeing Delivery Plan which also
acts as the Strategic Plan for the East
Ayrshire Health and Social Care
Partnership. Meaningful Community
Planning Partnership involvement at
every stage is essential for the
successful delivery of the new
Strategy.
Response to Question 4:
As a community Planning Partnership,
we note the overlap between the
identified priorities within the draft
Mental Health and Wellbeing Strategy
and, for example, the GIRFEC
Wellbeing indicators. Further
consideration requires to be given to
the wider strategic context within which
this strategy will sit, to ensure that
there is not duplication, or at least to
recognise shared priorities which can
be addressed through a co-ordinated
multi-agency approach. Embedding the
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
strategy within the local community
planning partnership delivery
arrangements will be essential to
achieving results.
Moving forward, the key questions are
how this strategy will be delivered and
how the activity to deliver the strategy
will be co-ordinated, monitored and
reported. Neither of these questions
can be answered without positioning
this new strategy firmly within the
existing Community Planning
framework and the final Strategy must
be developed collaboratively within this
context. A joined up and cohesive
approach is required to maximise the
benefit of Partner resources and to
reduce duplication of service across
the different providers.
As we are currently finalising the new
Wellbeing Plan, which will also act as
the East Ayrshire Health and Social
Care Partnership Strategic Plan from
April 2015, it is essential that the
Mental Health and Wellbeing Strategy
should be embedded within this work,
as a matter of urgency, rather than
being taken forward in isolation by NHS
Ayrshire and Arran
Health Leadership Group will seek high level
updates from partnership groups on the progress of
these actions in relation to the strategy’s key
outcome areas. This information, along with key
population mental health data based on NHS Health
Scotland’s National Mental health Indicator Sets, will
be used to test and refine the evidence-based
theories of change outlined in Volume 2 of the
strategy.
Part 7
Y
Part 7 of the strategy
has been included to
outline the monitoring
and evaluation process
for the strategy.
A member of the Mental Health Leadership Group is
part of the writing group of the East Ayrshire Health
& Social Care Plans. None of the work to date has
been done by NHS Ayrshire & Arran in isolation and
that approach will be continued.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Y
Appendix 3Local Response to Consultation Comments Submitted
Comments from Survey Monkey
Part of Strategy it relates to
Response (to be completed by strategy author)
Amend strategy
Strategy Amended
Y/N
Section 6 (6.1)
Noted. Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
N
N
Section 6 (6.3)
Noted.
N
N
Section 6 (6.1, 6.3)
Noted.
N
N
Section 6 (6.3)
Out with the scope of this strategy
This comment has been passed to Early Years,
Children and Families Service.
N/A
N
Noted.
N/A
N
Noted. Out with the scope of this strategy.
There are numerous national and local strategies
being implemented that contribute to the Promoting
Health and Healthy Behaviours outcome e.g. local
Healthy Weight Strategy.
Y
Strategy updated to
include a sentence
highlighting the
relationship between
mental health and
wellbeing and healthy
diet in Part 4.5.
N
Comments from Parents of nursery aged children:
This group felt that:
 There should be a stronger
emphasis on supporting children to
deal with things that arise in their
lives, for example bereavement.
 Nursery and school staff should
have more/better training on how to
support children going through a
difficult time.
 There should be a stronger
emphasis on supporting CYP to
deal with bullying, as well as better
support for staff who are worrying
about children and young people in
their care who are going through
child protection procedures.
 It should be considered how
nursery children are assessed for
their readiness for school, not just
academically, but, and more
importantly, emotionally.
The group wished to be kept updated
on any actions that Forehill PS to take
to improve the health and wellbeing of
their children as a result of this
strategy/action plan.
This group felt that the following points
should be considered:
 Access to good food for infants,
children and young people
Part 6 (6.1)
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted

Engaging with people with
additional support needs to ensure
integration and inclusion
Throughout
Noted. This strategy does not exclude any groups.
However, there are also local and national
strategies that will contribute to the mental health
and wellbeing of people with additional support
need e.g. We Want Good Health…the Same as
You. This strategy contains specific actions aimed
at engaging with people with learning disabilities
and improving their mental health and wellbeing.
N
N

Social media awareness – ensure
parents are aware of this as they
have a responsibility for their
children
Provide support for grandparents
with information about infant mental
health
Part 6 (6.1, 6.2)
Noted. Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
N
N
Part 6 (6.1, 6.2)
Noted. Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
N
N
Part 6 (6.4)
Agree. More detail will be provided in the
accompanying action plan eg social prescribing and
promoting mental health and wellbeing tools
N
N
Agree and noted. Activities listed in Part 6 of the
strategy are examples only. This is not an
exhaustive list.
N
N
Noted. Activities listed in Part 6 of the strategy are
examples only. This is not an exhaustive list.
Y
Strategy (4.9) has been
updated to highlight the
work carried out by
Public Health’s
Workplace team in
relation to training for
managers and
employees.
Y
N
N

For Working age adults and older
people:
 GP referral for people to take part
in mental wellbeing programmes

Access to good current information
about what is available locally to
help individuals develop their
mental health
 Training for managers and staff to
have an understanding of mental
health issues and possible impact
to staff and others
Part 4 (4.9) and part 6 (6.6)
 Promotion to a range of courses
Section 6 (6.4)
Noted.
and signposting to services to
Action plans will include these types of activities.
promote mental health to take into
This strategy does not exclude any groups. There
account parents and kinship carers
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
with additional support needs.
Delivered by statutory/nonstatutory/volunteers etc –eg mellow
parenting, family support worker,
supports parents groups including
kinship carers, dedicated social
worker for early years providing a
signposting service, Quarrier family
support service, interagency work
with community food group
(Barnardos), comm. Learning
development run classes for
signing, money matter,
This group felt that the strategy was
important and agreed with the overall
content of the strategy.
They felt that there are a lot of activities
taking place in their community that
contributed to promoting mental health
and wellbeing, such as clubs, parenting
classes, physical activity. However, it
was felt that:
 Other areas across Ayrshire may
not have access to such support
and it is important that everyone
has similar access.
 Some people in the area do not
engage with the activities. It would
be good to have ideas how to
encourage others to get involved.
are also local and national strategies that will
contribute to the mental health and wellbeing of
people with additional support need e.g. We Want
Good Health…the Same as You. This strategy
contains specific actions aimed at promoting mental
wellbeing of parents and carers of people with
learning disabilities.
Throughout
Noted with thanks.
Section 6
Noted.
N
N
N
N
Section 6
Noted.
Asset based work is designed to engage those who
do not usually join such activities. Evaluation is
currently being carried out.
Section 6 (6.1)
Noted for action plan.
Areas that were highlighted for action
were:
 Primary aged children should get
more talks about bullying and how
to cope better, highlighting the
Section 6 (6.2) and 6 (6.5)
Noted for action plan.
importance of talking to someone
you trust.
 Provide support for parents to have
better relationships with their
Section 6\\ (6.5)
Noted.
children-encouraging families to
Community builders from asset based work are
talk more.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
N
N
N
N
N
N
N
N
Appendix 3Local Response to Consultation Comments Submitted
 More opportunities for having a
coffee and a chat.
running pop up cafes.
Throughout
Noted with thanks.
N
N
Throughout
Noted with thanks.
N/A
N
Part 6 (6.3)
Noted. Outcome priority area 3 aims to address this
eg providing mental health training. Action plans will
provide more detail of activity.
N
N
N
N
N
N
N
N
They felt they could contribute to the
strategy by acting as a health
champion in their community. They
could spread the word about the
importance of looking after your mental
health and wellbeing and encouraging
others to get involved in activities.
Comments from Primary School Staff:
The group felt that the strategy covered
mental wellbeing comprehensively and
in language that was similar to terms
used within education.
The important issues for them were:
 Responding to difficulties – they
perceived an increase in pupils
presenting with mental health,
emotional or behavioural problems.
They did not feel that teaching staff
always have the training to deal
with this or have somewhere to
refer onto.
This comment has been passed onto Mental Health
Services.
 Resilience – the group perceive
that there were issues around
resilience and pupils’ readiness for
school, ability to deal with
challenges, work out problems
individually or in teams, assess
risks, and deal with disappointment.
Part 6 (6.1)
Noted. Outcome priority area 1 aims to address
resilience. Action plans will provide more detail of
activity.
 Early years/parenting/community
factors – the group reported that
the school was making efforts to
join up with other areas but more
could still be done on this.
Throughout
Noted with thanks.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
 Transitions – the group identified
transitional periods as being
important. Most notably transitions
from primary to secondary but also
within phases of education (e.g
from one year group to the next).
Part 6 (6.1, 6.3)
 Application of knowledge – the
group felt that pupils had a good
level of knowledge when it came to
health and wellbeing but that this
was not always translated into
behavior.
Part 6
 Staff support – school staff were
seen as highly committed and this
could contribute to staff stress
levels. The group also saw the
need for investment and
development of staff to respond to
mental wellbeing issues.
Part 6 (6.4, 6.6)
Our school undertakes a wide range of
activities that are in line with the areas
for activity outlined in the strategy:
 Opportunities for pupils to take on
responsibilities and be involved in
decision making (e.g. pupil
councils, playground leaders,
sports ambassadors, peer
mediators etc).
 Pupil – self assessment – pupils
are encouraged to evaluate what
they are good at and where there is
room for improvement.
 Outdoor play and learning (from
tent building as a team problem
solving activity to residential trips).
 Parenting – Forehill currently run
PEEP parenting programme and
Creation Station programme where
parents and children work together
to produce art.
 Community volunteering
opportunities
Part 6
Noted for action plan.
Some programmes over the next few years will
focus on children at this stage.
N
N
N
N
N
N
Noted.
Noted. Activities highlighted for Outcome Priority
Areas 1 and 3 aims to contribute to addressing
these issues.
Noted.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
 SHANARRI indicators – nursery
assess every team, primary
undertakes pupil survey
 Careers – STEM ambassadors,
World of Work, developing links
with Ayr College.
Questions asked from this group:
Responses given at event:
Where is the money coming from to do
all of this?
Throughout
There is no funding attached to this strategy. A lot
of good work is already happening and we
(everyone) need to continue to build on this.
N
N
How will this strategy be taken forward
locally?
Throughout
This strategy is required to be owned and driven
forward primarily through our Community Planning
Partners, although everyone has a role to play in
promoting the mental health and wellbeing of the
whole population of Ayrshire and Arran.
N
N
What about all the good work that does
not get continued due to fixed term
funding?
Throughout
This can and does happen however as mentioned
previously there is no set funding attached to this
strategy. Everyone, including school staff, have a
role to play, particularly in promoting the mental
health and wellbeing of children and young people.
N
N
Throughout
Noted with thanks.
N
N
Throughout
Noted with thanks.
N
N
Throughout
Noted with thanks.
N
N
Individual Responses:
I do not propose to comment on any of
the detail. The strategy seems robust
and fully inclusive.
Public Health continues to embrace the
idea of partnership working and I think
this is only to be welcomed. Mental
health affects us all and so we all have
a responsibility in our own way to work
towards achieving the best mental
health for every-one.
I note NHS Ayrshire & Arran continues
to work towards achieving the six
outcomes. However while they will take
lead responsibility for three of these,
other agencies with more expertise in
their specific areas will take the lead in
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Appendix 3Local Response to Consultation Comments Submitted
those areas and again I think this is
only to be welcomed.
We do live in exciting time as we
humans push ever more forward the
limits to our knowledge and
understanding by continuously
exploring our world – our habitat - both
on our planet and in space. I
sometimes wonder how many people
do truly appreciate the enormity of our
universe. Nonetheless our appetite to
discover and to know remains
insatiable. As you know we just landed
a probe on a comet 300 million miles
away – a piece of ice and rock –
hurtling through space at an incredible
speed while rotating violently on its
own axis! An amazing achievement!
st
But this new 21 century world also
creates new pressures and stresses
which can impact on our mental health.
As we all work towards improving the
mental health of our community I trust
the strategy will indeed prove fit for
purpose and that it will drive things
forward while at the same time it will be
sufficiently flexible to adapt to the new
challenges which will undoubtedly arise
in these times of rapid change.
Mental Health and Wellbeing – Response by Nicola Tomkinson & Mental Health Leadership Group
Responses as at 1/12//2014
Ayrshire and Arran’s Mental
Health & Wellbeing Strategy
2014-2016
Volume 2 – Supporting Evidence
Version No:
DRAFT v0.2
Prepared by
Andrew Pulford
Senior Public Health Research Officer
Effective from
05-11-2013
Lead reviewer
Anne Clarke
Senior Manager – Public Health
Dissemination Arrangements
Mental Health Leadership Group
DMT
CMT
1 Introduction
This report presents the supporting evidence for Ayrshire and Arran’s Mental Health
& Wellbeing Strategy 2015-2027. This includes a summary of Ayrshire and Arran’s
population mental health and wellbeing; the rationale and evidence base for key
outcomes and activity areas; and the monitoring and evaluation framework for the
strategy.
2 Ayrshire and Arran’s Population Mental Health &
Wellbeing
This summary is intended as a broad-brush overview of the detail which is presented
within the report Ayrshire and Arran’s Mental Health & Wellbeing 2013 (NHS
Ayrshire & Arran 2013) and draws on local and national data to try and present a
coherent picture of the mental health and wellbeing of adults in Ayrshire and Arran
as an aid for strategic planning.
There are a wide range of factors which can impact on an individual’s mental health
ranging from personal characteristics and behaviours (such as inner resilience or
lifestyle choices) through to community and environmental factors (such as social
connectedness or access to green spaces). NHS Health Scotland (2010) has
developed an evidence-based framework of six outcome areas which encapsulate
this range of factors and have been used as the basis for the development of this
strategy (Figure 1).
Two sets of national mental health indicators – one for adults and one for children
and young people - have also been developed by NHS Health Scotland (2007;
2012). Where possible these have been mapped against the six outcome areas and
used as the primary source of data for measuring mental health in Ayrshire and
Arran.
Table summaries of the adult indicators are presented by the national indicator and
outcomes frameworks (Figures 2 and 3). As a single indicator value is not possible
for many of the children and young people’s indictors, no table summary has been
produced for this indicator set.
Page 1 of 24
Figure 1: Outcome areas for mental health improvement (NHS Health Scotland 2010)
Sustaining inner
resources
Meaning, purpose,
optimism and hope
Promoting health
and healthy
behaviour
Physical health and
ill health
Increasing social
connectedness
relationships and
trust in families
and communities
Increasing social
inclusion and
decreasing
inequality and
discrimination
Increasing
financial security
and creating
mentally healthy
environments for
working and
learning
Promoting a safe
and supportive
environment at
home and in the
community
Trust
Social inclusion
Learning and skills
development
Physical
environment
Social networks and
social support
Participation
Financial security
Safety
Relationships
(including family
relations and peer
relationships)
Inequality,
discrimination and
stigma
Mentally health
schools
Violence
Resilience
Individual mental
health
Mentally healthy
workplaces
Page 2 of 24
2.1 A life course approach to health improvement
This strategy takes a life course approach to health improvement which uses four
key stages:
Infants
(0-5
years)
Children
& young
people
Working
age
adults
(6-15
years)
(16-64
years)
Older
people
(65
years +)
The age ranges used for these four groups should be seen as a broad guide and will
not always match up exactly with the data presented this report or with the definitions
used by different organisations and services. What is important here is the logical
progression from one life course stage to the next. An individual must be an infant
before s/he can become a child, and there are quite clear developmental markers for
this progression that tend to occur at around the same age for most people. The
transition from young person to adult is less clear cut with different definitions being
used in different circumstances. Older people are generally defined as individuals
aged 65 years and older. However, with increasing life expectancy this is becoming
a less homogenous group than has previously been the case.
There are also various groups within each life course stage that are known to
experience inequalities with regard to mental health and wellbeing. These include
but are not limited to: people living in areas of multiple deprivation; people with
severe and enduring mental health problems; people with addiction problems;
people with learning disabilities; people within minority ethnic groups; people within
the lesbian, gay and transgender community; people experiencing homelessness;
prisoners; looked after and accommodated children; and unpaid carers.
2.2 Infant, child and young people’s wellbeing
2.2.1 Sustaining inner resources
Positive individual mental health is measured in the children and young people’s
indicator set by mental wellbeing, pro-social behaviour, happiness and life
satisfaction. Ayrshire and Arran adolescents report the same level of mental
wellbeing as the Scottish average. Boys, 13 year olds and children living in less
deprived report higher levels of mental wellbeing compared with girls, 15 year olds
and children living in more deprived areas. Seventy per cent of 13 and 15 year old in
Ayrshire and Arran report ‘normal’ pro-social behaviour, a similar proportion to
Scottish average. Girls, 13 year olds and children living in less deprived areas report
higher levels of pro-social behaviour compared with boys, 15 year olds and children
living in more deprived areas. No board level data is currently available for life
satisfaction or happiness. Most Scottish adolescents report high levels of life
Page 3 of 24
satisfaction, however, fewer than half report feeling very happy with their life at
present.
Common mental health problems such as anxiety or depression are estimated in
less than one in ten Scottish adolescents. However, about a quarter of Ayrshire and
Arran adolescents are classed as having a ‘borderline’ or ‘abnormal’ score for
emotional and behavioural problems. Boys are more likely to display conduct
problems, while girls are more likely to display emotional symptoms, but no gender
difference is apparent for hyperactivity/inattention. These emotional and behavioural
problems tend to be higher among 15 year olds and children living in more deprived
areas, compared with 13 year olds and children living in less deprived areas.
Incidence of suicide is lower among Scottish children than in its adult population but
has followed a similar time trend of increased incidence in the 1990s and early
2000s, followed by a reduction of incidence in the last ten years.
2.2.2 Promoting health and healthy behaviours
No board level data is currently available for the physical health indicators within
the children and young people indicator set. However, the physical health of over
nine out of ten Scottish children aged 15 years and under was perceived to be good
or very good. Very little difference was observed in relation to gender or age with
regard to self-reported physical health. Fifteen per cent of Scottish children aged 15
years and under have a long-standing physical condition or disability, with about half
of these being classed as limiting their daily activities.
Health behaviours included in the children and young people’s indicators are:
healthy weight, diet and physical activity, alcohol, tobacco and drug use; sexual
health. Board level data is not currently available for healthy weight, diet and
physical activity. The majority of Scottish children aged 2 to 15 years are reported
as meeting the recommended level of physical activity in the previous week, though
girls aged 13-15 years are least likely to meet the recommended level. Fifteen per
cent of children aged 2 to 15 years are classed as obese or morbidly obese, while
most Scottish children within this age range had not eaten five or more portions of
fruit or vegetable in the previous day. Alcohol, tobacco and drug use all appear to
have reduced among Ayrshire and Arran adolescents between 2002 and 2010.
Boys are more likely to use alcohol and drugs, while girls are more likely to smoke.
Alcohol, tobacco and drug use all appear to be more common among 15 year olds
and children living in more deprived areas, compared with 13 year olds and children
living in less deprived areas. With regard to sexual health, there has been little
change in the rate of pregnancies among girls aged 15 years and younger in
Ayrshire and Arran over the past 20 years. Ayrshire and Arran has generally been
similar to or higher than the Scottish rate over this period. Just under two thirds of
Scottish 15 year olds report using a condom on the last occasion that they had
sexual intercourse. Boys appear to be more likely to report condom use than girls.
Page 4 of 24
2.2.3 Increasing social connectedness
No board level indicator data is currently available in relation to family
relationships. However, the majority of Scottish adolescents report that they find it
easy or very easy to talk to their parents about things that really bother them, and
most also report having a meal with one or more parents four or more time per week.
The proportion of Scottish adolescents who find it easy to talk to their parents
reduces with age, with under half of 15 year old girls finding it easy to talk to their
father.
With regard to peer relationships, the majority of Ayrshire and Arran adolescents
report having three or more close friends, with little variation by gender, age group or
deprivation quintile. The majority of Scottish adolescents find it easy or very easy to
talk to their best friend about things that really bother them. However, 16% of
Ayrshire and Arran adolescents are classed as ‘borderline’ or ‘abnormal’ on the peer
relationship problems scale of the Strengths and Difficulties Questionnaire. Boys, 13
year olds and those living in the most deprived SIMD quintile are more likely to
display peer relationship problems, compared with girls, 15 year olds and those living
in the least deprived SIMD quintile.
2.2.4 Social inclusion
Around one fifth of children in Ayrshire and Arran are classed as living in relative
poverty, a similar proportion to the Scottish average.
About 2% of children and young people aged 17 years and under in Ayrshire and
Arran are recorded as being looked after by the local authority in the past year.
South Ayrshire has a slightly lower rate of children looked after by the local authority
compared with the East and North Ayrshire.
About one fifth of Ayrshire and Arran pupils and are recorded as having additional
support needs in the past year. South Ayrshire has a higher rate of pupils with
additional support needs compared with the East and North Ayrshire.
Data for homelessness applications for persons aged 16-17 years is not currently
available at board level, however, about 2% of Scottish young people aged 16-17
years are recorded as having made a homelessness application in 2011-12.
2.2.5 Financial security, working and learning
Around two-thirds of Ayrshire and Arran adolescents report that they like school a
bit or a lot. Girls, 13 year olds and pupils in the less deprived quintiles appear to like
school more, compared with boys 15 year olds and pupils in more deprived quintiles.
There is a 93% attendance rate for primary and secondary pupils in Ayrshire and
Arran and a 4% exclusion rate.
Educational attainment in mathematics and reading and writing is measured at
three key stages. Almost 90% of P3 pupils in Ayrshire and Arran, just under half of
P7 pupils and around a quarter of S2 pupils are recorded as having 'well-established'
Page 5 of 24
or better skills at the expected levels for their stages in mathematics. Sub-national
data is not currently available for reading and writing, but at a Scottish level 77% of
P3 pupils, 49% of P7 pupils and 41% of S2 pupils were recorded as having 'wellestablished' or better skills at the expected levels for their stages in reading and
writing. About nine out of ten school leavers in Ayrshire and Arran are recoded as
being in positive and sustained destinations nine months after leaving school.
2.2.6 Safe and supportive environment
No board level data is currently available for the indicators within this outcome area.
Children and young people’s perceptions of their neighbourhood appear to be
generally quite high. The majority of Scottish adolescents feel that they could ask for
help or a favour from neighbours, that they can trust people where they live, that
people will talk to each other in the street, that there are good places to spend their
free time, and that generally the area they live is a good place to live.
Perceptions of community safety were slightly lower with around half of Scottish
adolescents always feeling safe in the area they live in.
2.3 Adult mental health and wellbeing
2.3.1 Sustaining inner resources
Positive individual mental health is measured in the adult indicator set by mental
wellbeing and life satisfaction. Mental wellbeing should be seen as the key outcome
for the Mental Health Improvement Strategy into which other outcomes should feed.
Mental wellbeing in Ayrshire and Arran appears to be slightly lower than Scottish
average. Of particular concert are the differences in mental wellbeing observed in
relation to deprivation and inequality, and lower levels of wellbeing in older people.
Life satisfaction appears to be fairly high in Ayrshire and Arran, and no different from
Scottish average.
Common mental health problems such as anxiety and depression affect a
significant minority of adults in Ayrshire and Arran, and appear to be slightly higher
among females and working age adults. Mental illnesses which generally require
treatment and care from specialist mental health services, such as schizophrenia
and bi-polar disorder, are not considered within the scope of this report.
Self-harming behaviours are often associated with mental health problems and can
be considered as a spectrum of behaviours which includes self harm, problematic
alcohol and drug use, and deaths by substance misuse or suicide at its most
extreme. Self-harm is reported by a small minority of adults and is higher among
women and younger adults. Around one in ten adults in Ayrshire and Arran are
estimated to be alcohol dependent, similar to the Scottish average. Alcohol
dependence is likely to be highest among males, adults aged 25-43 years and adults
living in areas of higher deprivation. Drug-related deaths have increased both locally
and nationally over recent decades, and are most common among men and those
Page 6 of 24
aged 25-44 years. However, it should also be noted that the rate of drug-related
deaths are increasing faster among women than men. Incidence of suicide has
decreased both locally and nationally in recent years after a high point in the 1990s
and early 2000s. Suicide rates are higher among males and adults aged 30-49
years. despite the reduction in the last ten years the incidence of suicide still high
compared with other Western European countries.
2.3.2 Promoting health and healthy behaviours
Over three quarter of adults in A&A perceive themselves to be in good or very good
physical health, a similar proportion to the Scottish average. No gender difference
is apparent, however, self-reported health status decreases with age. Adults living in
less deprived areas tend to have better health and adopt healthy behaviours. In
contrast to their self-reported health status, almost half of adults in Ayrshire and
Arran have a long-standing physical illness or disability – and over half of these
conditions which limit their daily lives. This is slightly higher than Scottish average.
Prevalence of long-term conditions is higher among males, older people and people
living in areas of deprivation.
There a range of health behaviours which improvement in would also be likely to
improve people’s mental health and wellbeing. A minority of adults in Ayrshire and
Arran meet guidelines for physical activity or healthy eating. Males, younger adults
and those living in areas of lower deprivation are more likely to meet physical activity
recommendations. The majority of adults in Ayrshire and Arran report that they drink
within the maximum weekly recommended limits and do not use illicit drugs.
However, there is good evidence that alcohol consumption is under-reported in
lifestyle surveys (Scottish Public Health Observatory 2009) and it is also likely that
use of illicit drugs may also be-under-reported due to their legal status. No obvious
age pattern is observed except that over 75s more likely to drink within limits.
People in areas of deprivation are more likely to drink within the recommended limits
but unit consumption considerably higher among those who do drink. Reported illicit
drug use is higher among 16-24 years olds than older age groups, and is also higher
in areas of deprivation
2.3.3 Increasing social connectedness
Board level data is not currently available for social contact and social support.
National data suggests that social contact levels are levels are high, and highest
among younger and older adults. However, social support levels appear to be much
lower, with less than half of Scottish adults reporting that they have a primary
support group of three or more people that they could rely on in a crisis. Social
support appears to be higher among younger adults than older adults.
Twelve per cent of adults in Ayrshire and Arran report regular provision of care for
someone and 28% of adults report volunteering. These are both similar to the
Scottish average and are more common among women and older working age
adults. Volunteering appears to be higher in less deprived areas. While doing things
for others is generally associated with positive mental health, it should be noted that
Page 7 of 24
caring is often done out of necessity and can impact negatively on a person’s mental
health and wellbeing.
Board level data is not currently available for adults’ feeling of involvement in their
local community. About one quarter of Scottish adults report feeling involved in
their local community. There was little difference between males and females, while
feeling of involvement was higher among older adults compared with younger adults.
2.3.4 Social inclusion
No board level data is currently available for the indicators within this outcome area.
Scotland is becoming less equal in terms of income. There is a growing body of
evidence that income inequality in impacts developed countries negatively on a
range of health outcomes, including mental health (Wilkinson &Pickett 2009). The
majority of Scottish adults feel that they do not have influence over decisions
made in their local area. No gender difference is apparent, while older adults are
more likely to feel that they can influence local decisions. A minority of Scottish
adults report experiencing discrimination or harassment.
2.3.5 Financial security, working and learning
No board level data is available for the indicators within this outcome area, apart
from worklessness, financial management and financial inclusion.
Access to educational activities is high in Scotland. Most Scottish adults have at
least one academic or vocational qualification and half participated in some form of
adult learning in the last year.
Employment is generally seen to be associated with positive mental health,
however, it can also be a source of stress where excessive demands are placed on
employees. Scottish adults report moderate satisfaction with their work-life balance
but a minority report stress and unrealistic demands on their time at work. Males
and middle-aged adults report lower satisfaction and higher work stress than women,
but less unrealistic demands on their time, compare with women and younger adults.
The majority of adults feel they have some control over how they do their work. This
proportion is slightly higher among males than females, lowest among 16-24 year
olds compared with other age bands. The majority of adults fell that they are
supported by their manager and colleagues. Perceived support is slightly higher
among women than men. Adults aged 16-24 years report the highest level of
manager support, while 25-44 years report the highest level of colleague support.
While it appears that work-life balance could be improved for currently economically
active Scottish adults, around a quarter of adults in Ayrshire and Arran who are
economically inactive want to work.
Just under half of Ayrshire and Arran households report managing financially very
or quite well. Nationally, female and younger households are less likely to be
managing financially, along with households in most deprived areas and single
parent households. Financial inclusion levels as measured by having access to a
bank account, building society account, credit union account or post office card
Page 8 of 24
account are high with almost all Ayrshire and Arran households having access to a
bank account or similar Financial inclusion levels are lowest among Scottish
households living within the 15% most deprived areas suggesting that there is a
minority of households whose financial security is further compromised by lack of
access to suitable financial services.
2.3.6 Safe and supportive environment
In terms of perception of neighbourhood, the majority of Scottish adults rate their
neighbourhood as a good place to live; have a somewhere that they can go to
escape problems/stresses and feel the have access to greenspace in their
neighbourhood which they and their family can use; and feel that their home is in
good condition and is not overcrowded.
Community safety findings are mixed with just under half of Ayrshire and Arran
adults reporting that they trust most people generally and that just over half trust
most people in their neighbourhood. At a Scottish level, no gender difference is
apparent but higher levels trust are reported by older adults. Around three quarters
of Ayrshire and Arran adults feel safe walking alone in their neighbourhood at night,
and over 90% fell safe alone in their own homes at night. Neighbourhood safety was
higher for Scottish men than women. Over half of Scottish adults feel that crime is
common in their area, though a much lower proportion had experienced violent or
non-violent crime in the last year. A small minority of adults report having been
physically or emotionally abused by a partner or ex-partner in the past year,
however, this is almost certainly
an underestimate.
Colour-coding for indicator summaries
(Figures 2 and 3):
National indicator data
presented at board level
National indicator data
presented at national level OR
local proxy data presented
Indicator not yet defined
Page 9 of 24
Figure 2: Summary of adult mental health by indicator framework
Area
Unit
Age range
Year
Est
High Level Constructs
1.1
Mental wellbeing
A&A
Mean score
16+
2008-11 (p)
49.2
1.2
Life satisfaction
A&A
Mean score
16+
2008-11 (p)
7.5
1.3
Common mental health problems
A&A
%
16+
2008-11 (p)
16
1.4
Depression
Scotland
%
16+
2010/11
7
1.5
Anxiety
Scotland
%
16+
2010/11
9
1.6
Alcohol dependence
A&A
%
16+
2008-11 (p)
11
1.7
Drug-related deaths
A&A
Rate per 100,000
All ages
2007-11 (p)
10.5
1.8
Suicide
A&A
Rate per 100,000
All ages
2007-11 (p)
14.1
1.9
Deliberate self-harm
Scotland
%
16+
2010/11
2
Contextual Constructs - Individual
2.1
Adult Learning
Scotland
%
16-59/64
2009
50
2.2
Physical activity
A&A
%
16+
2008-11 (p)
37
2.3
Healthy eating
A&A
%
16+
2008-11 (p)
19
2.4
Alcohol consumption
A&A
%
16+
2008-11 (p)
78
2.5
Drug use
SW CJA
%
16+
2010/11
6.3
2.6
Self-reported health
A&A
%
16+
2008-11 (p)
73
2.7
Long-standing physical condition or disability
A&A
%
16+
2008-11 (p)
46
2.8
Limiting long-standing physical condition or disability
A&A
%
16+
2008-11 (p)
29
2.9
Spirituality
n/a
n/a
n/a
n/a
n/a
Emotional intelligence
n/a
n/a
n/a
n/a
n/a
2.10
Contextual Constructs - Community
3.1
Volunteering
A&A*
%
16+
2011
28
3.2
Involvement in local community
Scotland
%
16+
2009/11 (c)
26
3.3
Influencing local decisions
Scotland
%
16+
2009/11 (c)
21
3.4
Social contact
Scotland
%
16+
2009/11 (c)
94
3.5
Social support
Scotland
%
16+
2009/11 (c)
89
3.6
Caring
A&A*
%
16+
2008-11 (p)
11
3.7
General trust
Scotland
%
16+
2008-11 (p)
46
3.8
Neighbourhood trust
Scotland
%
16+
2008-11 (p)
58
3.9
Neighbourhood safety
A&A
%
16+
2009-10 (p)
72
3.10
Home safety
A&A
%
16+
2009-10 (p)
95
3.11
Non-violent neighbourhood crime
Scotland
%
16+
2009/10
14
3.12
Perception of local crime
Scotland
%
16+
2009/10
59
Scotland
Gini score
n/a
2010/11
0.3
A&A
%
16-59/64
2011
24
Contextual Constructs - Structural
4.1
Income inequality
4.2
Worklessness
4.3
Education
Scotland
%
16-59/64
2009
88
4.4
Discrimination
Scotland
%
16+
2009/11 (c)
11
4.5
Racial discrimination
SW CJA
%
16+
2010/11
13
4.6
Harassment
Scotland
%
16+
2009/11 (c)
7
4.7
Financial management
A&A
%
16+
2009-10 (p)
47
4.8
Financial inclusion
A&A
%
16+
2009-10 (p)
99
4.9
Neighbourhood satisfaction
Scotland
%
16+
2008
92
4.10
Noise
Scotland
%
16+
2009
12
4.11
Escape facility
Scotland
%
18+
2009
80
4.12
Greenspace
Scotland
%
16+
2009
67
4.13
House condition
Scotland
%
16+
2009
83
4.14
Overcrowding
Scotland
%
16+
2009
14
4.15
Stress
Scotland
%
16+
2009/11 (c)
14
4.16
Work-life balance
Scotland
Mean score
16+
2009/11 (c)
6.4
4.17
Demand
Scotland
%
16+
2009/11 (c)
26
4.18
Control
Scotland
%
16+
2009/11 (c)
64
4.19
Manager support
Scotland
%
16+
2009/11 (c)
65
4.20
Colleague support
Scotland
%
16+
2009/11 (c)
78
4.21
Partner abuse
Scotland
%
16+
2010/11
3
4.22
Neighbourhood violence
Scotland
%
16+
2009/10
4.23
Attitude to violence
Scotland
Mean score
18+
2009
3
3.2
Page 10 of 24
Figure 3: Summary of adult mental health by outcomes framework
Area
Unit
Age range
Year
Est
Sustaining Inner Resources
1.1
Mental wellbeing
A&A
Mean score
16+
2008-11 (p)
49.2
1.2
Life satisfaction
A&A
Mean score
16+
2008-11 (p)
7.5
1.3
Common mental health problems
A&A
%
16+
2008-11 (p)
16
1.4
Depression
Scotland
%
16+
2010/11
7
1.5
Anxiety
Scotland
%
16+
2010/11
9
1.6
Alcohol dependence
A&A
%
16+
2008-11 (p)
11
1.7
Drug-related deaths
A&A
Rate per 100,000
All ages
2007-11 (p)
10.5
1.8
Suicide
A&A
Rate per 100,000
All ages
2007-11 (p)
14.1
1.9
Deliberate self-harm
Scotland
%
16+
2010/11
2.9
Spirituality
n/a
n/a
n/a
n/a
n/a
2.1
Emotional intelligence
n/a
n/a
n/a
n/a
n/a
2
Promoting health and healthy behaviours
2.2
Physical activity
A&A
%
16+
2008-11 (p)
37
2.3
Healthy eating
A&A
%
16+
2008-11 (p)
19
2.4
Alcohol consumption
A&A
%
16+
2008-11 (p)
78
2.5
Drug use
SW CJA
%
16+
2010/11
6.3
2.6
Self-reported health
A&A
%
16+
2008-11 (p)
73
2.7
Long-standing physical condition or disability
A&A
%
16+
2008-11 (p)
46
2.8
Limiting long-standing physical condition or disability
Increasing social connectedness
A&A
%
16+
2008-11 (p)
29
3.4
Social contact
Scotland
%
16+
2009/11 (c)
94
3.5
Social support
Scotland
%
16+
2009/11 (c)
89
3.6
Caring
A&A*
%
16+
2008-11 (p)
11
3.1
Volunteering
A&A*
%
16+
2011
28
3.2
Involvement in local community
Scotland
%
16+
2009/11 (c)
26
Increasing social inclusion
4.1
Income inequality
Scotland
Gini score
n/a
2010/11
0.3
3.3
Influencing local decisions
Scotland
%
16+
2009/11 (c)
21
4.4
Discrimination
Scotland
%
16+
2009/11 (c)
11
4.5
Racial discrimination
SW CJA
%
16+
2010/11
13
4.6
Harassment
Scotland
%
16+
2009/11 (c)
7
88
Financial security/environments for working and learning
4.3
Education
Scotland
%
16-59/64
2009
Adult Learning
Scotland
%
16-59/64
2009
50
4.16
Work-life balance
Scotland
Mean score
16+
2009/11 (c)
6.4
4.15
Stress
Scotland
%
16+
2009/11 (c)
14
4.17
Demand
Scotland
%
16+
2009/11 (c)
26
4.18
Control
Scotland
%
16+
2009/11 (c)
64
4.19
Manager support
Scotland
%
16+
2009/11 (c)
65
4.2
Colleague support
Scotland
%
16+
2009/11 (c)
78
4.2
Worklessness
A&A
%
16-59/64
2011
24
4.7
Financial management
A&A
%
16+
2009-10 (p)
47
4.8
Financial inclusion
A&A
%
16+
2009-10 (p)
99
Scotland
%
16+
2008-11 (p)
46
Scotland
%
16+
2008-11 (p)
58
2.1
Promoting a safe and supportive environment
3.7
General trust
3.8
Neighbourhood trust
3.9
Neighbourhood safety
A&A
%
16+
2009-10 (p)
72
3.1
Home safety
A&A
%
16+
2009-10 (p)
95
3.11
Non-violent neighbourhood crime
Scotland
%
16+
2009/10
14
3.12
Perception of local crime
Scotland
%
16+
2009/10
59
4.9
Neighbourhood satisfaction
Scotland
%
16+
2008
92
4.1
Noise
Scotland
%
16+
2009
12
4.11
Escape facility
Scotland
%
18+
2009
80
4.12
Greenspace
Scotland
%
16+
2009
67
4.13
House condition
Scotland
%
16+
2009
83
4.14
Overcrowding
Scotland
%
16+
2009
14
4.21
Partner abuse
Scotland
%
16+
2010/11
3
4.22
Neighbourhood violence
Scotland
%
16+
2009/10
4.23
Attitude to violence
Scotland
Mean score
18+
2009
3
3.2
Page 11 of 24
3 Rationale for key outcomes and activity areas
This section sets out the evidence and rationale for the key areas of activity within
the Mental Health & Wellbeing Strategy which have been identified as necessary for
the strategy’s key outcomes to be achieved. Mental health improvement is
inherently complex and while these activities are viewed as being necessary
conditions for the strategy’s outcomes, none are likely to be sufficient in isolation. As
such the rationale also discusses potential links between different activity areas,
risks to them not happening as planned, and external factors which are largely
outwith the direct control of local organisations and groups but are expected to have
a significant impact on people’s mental health and wellbeing.
3.1 Infants, children and young people
3.1.1 Sustaining inner resources
There are a range of early years activities that can support to promote bonding and
attachment. Information for prospective mums and dads about getting to know
their baby which is evidence-based is a useful basis for this, however, it is
acknowledged that the provision of information on its own is unlikely to have a
significant impact on bonding and attachment. It is also acknowledged that existing
information has largely been developed with mothers in mind, and that information
for prospective fathers is an area for further development. Antenatal and perinatal
support to promote bonding and attachment is well established in Ayrshire and
Arran, utilising both universal and targeted approaches depending on families’
circumstances. This support should complement the provision of evidence based
information to parents and activities to promote mental health and wellbeing at later
developmental stages.
Parenting approaches and programmes have a high level of evidence from early
years into later developmental stages and are regarded as a best buy for mental
health improvement. The Solihull Approach has now been rolled out across the
three CHP areas in Ayrshire and Arran providing a universal approach to parenting
which focuses on bonding, attachment and reciprocity. There are also a number of
evidence-based parenting programmes offering more targeted support to families
which have been adopted in different CHP areas. This strategy advocates the
adoption of an evidence-based programme and appropriate implementation rather
than taking a prescriptive stance on which programme should be adopted. In
addition to these activity areas, it is useful to have evidence-based information for
parents of children moving on from early years through to adolescence. Again, it is
acknowledged that the provision of information should be to complement other
activities.
Outside the family sphere, educational settings provide a key role in developing
children’s mental health and wellbeing. Childcare and nursery settings provide a
strong opportunity for the development of a range of factors which promote good
mental health and wellbeing in pre-school children, such as sense of agency,
confidence, social interaction, language development. For older children, schoolPage 12 of 24
based programmes to promote mental health and wellbeing would be expected to
be delivered in line with Curriculum for Excellence. These may directly address
mental health issues or develop protective factors for individual mental health and
wellbeing without explicitly defining themselves as mental health programmes.
The wider community setting also provides an important role in mental health
improvement, encompassing the kinds of activities and volunteering
opportunities outlined in the adult section for Sustaining Inner Resources.
Although this strategy does not incorporate mental illness, it is recognised that there
is a potential gap in terms of responding to difficulties in children displaying mental
health problems or emotional and behavioural problems which are not at a stage of
severity that would require specialist Child and Adolescent Mental Health Services.
This is seen as a potential area for development.
3.1.2 Increasing social connectedness
Activities to support healthy relationships across the life stages are a key aspect
for developing social connectedness and are discussed in more detail in the Working
Age Adults & Older People section for this outcome area.
In the early years there are already strategies in place which will promote attachment
and bonding through breastfeeding and play, and this strategy will seek to make
appropriate links to support these activities. There is some evidence to support the
theory that breastfeeding increases bonding and attachment. However,
breastfeeding rates in Ayrshire and Arran have remained persistently low with
mothers in more deprived areas being less likely to breastfeed. Play is important for
learning social interaction and cognitive development. Although activities are likely
to be focused on early years, it is important to note that play has inherent values
across the life course. This idea links into the promotion of activities that support
good mental health and wellbeing for children and adults.
The adoption of asset-based approaches to community development is discussed in
detail in the corresponding section of this strategy for Working Age Adults & Older
People. It is expected that children and young people should be directly
involved in asset-based approaches. Linked to this approach are activities to
raise awareness of the potential positive role of all adults and promote
intergenerational activities. Awareness of the potential positive role of all adults
was identified by NHS Greater Glasgow & Clyde as a priority within their mental
health improvement strategy, and is being delivered as the “One Good Adult”
campaign. It also links with the Scottish Government’s “Getting it Right for Every
Child” (GIRFEC) approach which aims to ensure that anyone providing that support
puts the child or young person – and their family – at the centre. The assumption
being made for this area of activity is that in any given situation, a child or young
person should be able to count on at least one adult to act in their best interests.
There is also a risk to this approach in that what constitutes a child’s best interests
may be viewed subjectively, and consideration of this will be part of the approach.
Intergenerational activities are one way through which positive relationships can
be promoted between children and adults, and these would also be seen to link with
Page 13 of 24
activities which promote good mental health and wellbeing. The evidence base for
these two activity areas is quite limited and is likely to require local monitoring and
evaluation.
Social networking websites are likely to continue to increase in popularity with
children and young people, and while they have the potential to enhance social
connectedness they also have the potential to increase bullying and harassment. It
is therefore important that parents have an awareness of benefits and risks of
social networking to children and young people. It is anticipated that such
activities will focus on parent/child communication rather than the technological
details of social networking.
3.1.3 Mentally healthy environments for working and learning
Education is associated with positive mental health and wellbeing across the life
course. Following on from the activity areas relating to nursery and child care
settings outlined in the Sustaining Inner Resources outcome area, ensuring
children’s readiness for school is seen as a key aspect of creating mentally
healthy environments for working and learning. This is one of the stretch aims within
the Early Years Collaborative and it is expected that the local Collaborative will drive
this area of activity. It is also expected that targeted work will be necessary to
ensure equality of access to education for children who may be regarded as being
more vulnerable and/or living in areas of deprivation.
During school-age years it is expected that the mental health and wellbeing
component of Curriculum for Excellence will be the main driver for developing
mentally healthy environments for working and learning. To minimise pressure on
schools’ time this activity area should build on existing work and look to address
mental health and wellbeing across the curriculum.
Counselling and advice services accessible via the educational setting for
children experiencing common mental health or behavioural and emotional problems
– but who do not require specialist intervention from the Child & Adolescent Mental
Health Service (CAMHS) - has been identified as a service gap in Ayrshire and
Arran. The establishment of such a service would have a significant cost attached to
it, however, it is hoped that it would reduce pressure on CAMHS, education and
other services for children and young people.
There are also a number of mental health training programmes available for
professionals and volunteers to support children and young people, such as
Scottish Mental First Aid for Young People. There is little high-level evidence on the
effectiveness of such training, however, there is an assumption that it will increase
the early identification of people at risk of mental health problems and/or suicide.
Again, such programmes tend to be led nationally and there currently appears to be
a lack of capacity for training to be delivered locally. This kind of training tends more
towards support for people who require specialist services and as such is more
suited towards service-based strategies rather than this population-based one.
Page 14 of 24
Where children have experienced difficulties and have disengaged with school,
activities to support re-engagement with education are seen as being vital. This
activity area also links to activities relating to lifelong learning opportunities in the
adults section for this outcome area.
3.2 Working age adults and older people
3.2.1 Sustaining inner resources
There are a wide range of activities that can promote mental health and
wellbeing through promoting healthier lifestyles, encouraging social connectedness,
learning new skills and knowledge, and providing opportunities to help others. Such
activities may include physical activities, arts and crafts or outdoor pursuits.
However, this list is far from exhaustive and this strategy does not set out to be
prescriptive about specific activities. Instead it makes an assumption that anyone
could find an activity which improves their mental health and wellbeing. Such
activities can often be undertaken as an individual or as part of a group – both are
valid and may provide slightly different benefits. Given the wide range of activities
that could be considered for improving mental health and wellbeing it is challenging
to develop an overall body of evidence in relation to mental health improvement,
however, there is a growing body of evidence that such activities can be effective.
There is an assumption made that while some types of activity may confer particular
effects (e.g. creative activities), what is more important is that the individual derives
enjoyment and increased sense of self from his or her participation. A large number
of activities are currently provided by local authorities, third sector agencies and
community groups, however, the link to improved mental health and wellbeing is
often not explicit. NHS Ayrshire & Arran does not typically provide such activities but
supports the provision of mentally healthy activities and seeks to facilitate access
and provide further evidence for the link between such activities and mental health
and wellbeing.
NHS Ayrshire & Arran’s Primary Care Directorate undertakes social prescribing for
patients who have been identified as potentially benefiting from participation in such
activities. This is a more targeted form of referral into some of the types of activities
discussed in the previous paragraph. There is a growing body of evidence for social
prescribing, although as noted previously different prescribed activities may confer
different benefits.
Volunteering is a particular area of interest within this strategy as it has the potential
to improve mental health and wellbeing of both volunteers and those they provide
assistance to. There is an increasing body of evidence linking volunteering with
improved mental health and wellbeing, however, no causal relationships have as yet
been established. There is review level evidence which shows an association
between volunteering and social connectedness among older people. Opportunities
for volunteering in Ayrshire and Arran are largely provided through third sector
agencies and community groups, while NHS Ayrshire & Arran and local authorities
can provide indirect support for volunteering opportunities. This strategy’s focus on
asset-based approaches provides opportunities for increased access to volunteering.
Ayrshire and Arran’s aging population potentially increases both the supply of and
Page 15 of 24
demand for volunteers, with the availability of older volunteers being dependent on
having a healthy older population. However, such opportunities should be seen in
context of budget cut backs to statutory services and the linkage of benefits to
unpaid work programmes under the Welfare Reform Act (2012). These
developments run the risk of creating an unpaid workforce which may not achieve
the same benefits to mental health and wellbeing as volunteering is expected to. For
working age adults more generally there is a risk that there may not be real or
perceived capacity for volunteering due to pressure on their work/life balance. There
is also a potential risk of inequality of access to volunteering, with more affluent
adults being more likely to have the resources to undertake formal volunteering
opportunities while adults living in more deprived areas may be more likely to
undertake informal volunteering and caring roles. The distinction should also be
acknowledged between volunteering and caring. Although caring can confer similar
positive effects on mental health and wellbeing, it should be recognised that there is
also an element of necessity associated with caring which, without appropriate
support, can lead to stress and poorer mental health for carers.
In addition to the range of activities which are generally seen as promoting good
mental health and wellbeing, there are also a range of tools specifically designed
to help individuals to improve and maintain their mental health. These can
range from basic tools such as the New Economics Foundation’s “five ways to
wellbeing” through to more structured, taught techniques such as Wellness Recovery
Action Planning (WRAP) and Mindfulness. There is a growing body of evidence for
such tools. We cannot assume equal effect for different tools, however, an
assumption is made that – as with more general activities for promoting mental
health and wellbeing - there is no “one size fits all” and that a range of available tools
is beneficial. In particular it is likely that while more basic tools will be of relevance
for the whole population, more structured programmes would be beneficial for people
experiencing mental health problems. Sixteen per cent of adults in Ayrshire and
Arran are estimated to have common mental health problem, which would require
significant increase in access to such programmes. The NHS, local authorities and
third sector all have a role in promoting and delivering training in using these tools.
Service providers working with people with mental health problems or poor mental
wellbeing have an indirect role in terms of which tools they endorse and signpost
service users towards.
Public information campaigns are a traditional part of health improvement
strategies and play a role in raising awareness of specific topics, however, there is
little evidence to show their effectiveness in achieving outcomes. As such, this
strategy recommends that the main drive on mental health and wellbeing public
information campaigns is led nationally from bodies such as NHS Health Scotland
and the Scottish Government. Local activity should be limited to complementing
national campaigns which are focused on promoting positive mental health and
wellbeing.
Training for professionals and volunteers to support people with mental health
problems and in suicide awareness has also typically been a feature of mental health
strategies. There is little high-level evidence on the effectiveness of such training,
however, there is an assumption that it will increase the early identification of people
at risk of mental health problems and/or suicide. Again, such programmes tend to
Page 16 of 24
be led nationally and there currently appears to be a lack of capacity for training to
be delivered locally. This kind of training tends more towards support for people who
require specialist services and as such is more suited towards service-based
strategies rather than this population-based one.
Such training feeds into a wider strategic aim of creating organisational cultures
that support mental health and wellbeing. The contribution of a wide range of
professionals and volunteers from across the public and third sectors is vital for
mental health & wellbeing improvement. Activities will promote the added-value that
public and third sector services provide in terms of mental health and wellbeing
improvement, should promote the wellbeing of staff/volunteers as well as the people
they work with, and should focus more on positive mental wellbeing at a population
level rather than individual level mental health problems. At present this is based on
plausible theory and builds on previous work with local authority staff – however,
activities and outputs need further development.
3.2.2 Increasing social connectedness
There is a considerable swell of opinion at this time that asset-based community
development is a mechanism by which local social connections can be encouraged
and resilience can be fostered at a community level. This strategy will support such
initiatives, using current available evidence to inform action as it becomes available.
Asset-based approaches typically focus on geographical communities, however, it is
important form an equalities point of view that all sections of the community have the
opportunity to participate. As it is expected that the greatest impact will be on those
directly involved in such programmes, there is a risk that those with good mental
health and wellbeing will be most able to contribute. There is a specific activity area
within the Infants, Children & Young People Section of this strategy relating to their
involvement in asset-based approaches. Consideration should also be given to the
effective inclusion of communities of interest, especially those whose voices might
otherwise be marginalised. Implementing asset based approaches in Scotland will
be a complex undertaking and will require capacity and commitment to work across
traditional professional and organisational boundaries.
Although the exact actions within asset-based programmes will be determined by
communities themselves, it is expected that environmental improvements to
communities, such as development of green spaces, improvements to housing and
regeneration of the built environment, will play a role in this approach. Greenspace
Scotland have developed an outcomes framework for the health and wellbeing
benefits of green spaces (www.greenspacescotland.org.uk). There is a growing
body of evidence linking housing condition and mental health and wellbeing.
There is review level evidence of the effect of neighbourhood environments on
mental health and wellbeing. There is a role for both communities and local authority
departments in the development of these areas. NHS Ayrshire & Arran has a direct
role in terms of making environmental improvements to its own estate, and a
supportive role of these activities more generally.
Another area of activity which is expected to link to asset-based approaches to
community development is to build community empowerment to influence
Page 17 of 24
service provision. A key assumption of asset-based approaches is that they do not
replace statutory service provision. There is therefore a direct role for community
planning partners to work with communities to these ends. There is also an
opportunity within forthcoming integration of health and social care services. Within
the NHS there are links to the drive towards shifting the balance of care towards
anticipatory and community-based healthcare, co-production and providing personcentred care. This area of activity is linked to promoting organisational cultures that
support mental health and wellbeing and promoting socially inclusive services.
Supporting healthy relationships is an important activity area, however, it is also a
very personal and challenging area to address with planned activities only being
expected to go some way toward supporting healthy relationships. There are
arrange of activities within this area such as promoting mutual respect and selfesteem, recognising different family structures and promoting positive forms of
conflict resolution (such as mediation). There are links between healthy
relationships and mentally healthy environments for working and learning via the
promotion of a healthy work/life balance. There are also a number of activity areas
within the Infants, Children & Young People section of the strategy around
supporting parent/child relationships and developing an understanding of healthy
relationships. In important part of promoting healthy, mutually respectful
relationships is the work already underway within the Gender Based Violence
agenda.
3.2.3 Mentally healthy environments for working and learning
Learning is beneficial to mental health and wellbeing throughout the life course and
should not end at one’s completion of formal education. While all people are
expected to benefit from access to a range of learning opportunities, a greater
impact is expected among population groups who tend to have lower educational
attainment levels. For example there is evidence to suggest that increasing young
mothers’ educational attainment is associated with improved mental health and
wellbeing. There is, however, a risk that those who least require access to learning
opportunities will be most able to access them. Learning opportunities can include
both formal educational activities (such as further or higher education) and informal
learning (such as unaccredited courses or self-directed learning). Informal learning
opportunities can be seen to be linked to activities which promote good mental
health and wellbeing within the Sustaining Inner Resources outcomes area and also
promote social connectedness. Formal educational activities, meanwhile, are more
likely to promote access to employment.
Specific groups – such as people with mental health problems, long-term
unemployed people, and people with long-term chronic conditions – may require
formal support to access to employment. For example, there is review level
evidence which suggests that supported employment is superior to pre-vocational
training for people with mental health problems. Such approaches can also be seen
to link with the recovery agenda. There is an assumption made that the expected
short-term and intermediate outcomes for this activity area will only be realised if
supported employment is voluntarily accessed and the employment is stable and of
Page 18 of 24
quality. There is a risk that where benefit entitlement is dependent on participation of
work programmes, mental health and wellbeing benefits may not be realised among
people who are not able to take on paid employment. In these cases other options
such as volunteering should be made available. There are also risks within the job
market at present which relate to the availability of jobs, increasing rates of in-work
poverty and potential stigma against certain population groups from employers.
There is NICE guidance available on promoting mentally healthy workplaces. It
is expected that specific actions will relate to this and recommendations from the
Foresight Mental Capital and Wellbeing Project. Activities are relevant for all
employees and employers, however, employers' needs will vary according to size
and sector. The Healthy Working Lives Award will drive some of the activity in this
area, however, it is acknowledged that only certain employers are engaged with the
award scheme. NICE guidance emphasises organisation-wide approaches,
however, it is acknowledged that such changes will be challenging to facilitate –
particularly in economic downturn. There are links with activities to support mentally
health organisations within the sustaining inner resources outcome area.
Although it is not intended that financial inclusion be focused on directly within the
strategy’s associated action plans, it is important to acknowledge that financial
security plays a key role in promoting mental health and wellbeing across the life
course. Although everyone benefits from financial security, financial inclusion
activities are likely to be focused on specific groups who are known to be less
financially secure. Much of these activities are likely to be around benefit
maximisation and ameliorating the expected negative impacts of the Welfare Reform
Act. However, financial advice and benefits maximisation will only go so far toward
meeting outcomes related to financial security and it is expected that access to
stable, quality employment will exert greater influence on mental health and
wellbeing.
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4 Monitoring and evaluation framework
The Mental Health Improvement Strategy for Ayrshire and Arran is an outcomesfocused strategy to promote positive mental wellbeing and reduce common mental
health problems (and their associated harms) among the population of Ayrshire and
Arran. To assess the impact of the strategy we will need to be able to monitor and
evaluate:

Population level changes in relation to key outcome areas for mental health
improvement.

Performance management of specific services or interventions.
This section details the different levels of data required to assess these factors and
proposes a framework for monitoring and evaluating Ayrshire and Arran’s
forthcoming Mental Health Improvement Strategy and its associated Action Plan. A
flowchart for planning monitoring and evaluation activities is also presented in Figure
4.
4.1 Contribution analysis
The proposed framework is consistent with the use of logic modelling and
contribution analysis as an approach to programme development, performance
management and evaluation (Mayne 2001; Mayne 2008; Scottish Government
2011). The six key steps to contribution analysis are as follows:
1. Set out the attribution problem to be addressed: identify and build consensus
around the key outcomes or targets.
2. Develop a theory of change and risks to it: this can be achieved through the
development of one or more logic models which set out the expected short,
intermediate and long term outcomes, and the activities which would deliver
these outcomes. Logic models should also consider the level of control which
agencies may have over specific outcomes. Three levels of control can be
identified – direct control (e.g. the delivery of outputs such as the number of
training sessions held); direct influence (e.g. short-term and intermediate
outcomes, such as changes in participants knowledge and behaviour), and
indirect influence (e.g. longer-term impacts on the population). The logic model
should also consider external factors which may influence whether an outcome is
achieved or not achieved.
3. Gather the existing evidence on the theory of change: this may include
demographic information, epidemiological data and existing evidence of
effectiveness.
4. Assemble and assess the contribution story, and challenges to it: this will
involve building consensus that the contribution story and associated theory of
change is credible, and establishing robust baseline data to measure future
progress against. It will also identify areas where evidence for effectiveness
and/or current data collection activities are weak.
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5. Seek out additional evidence: this may include the evaluation of specific
components of the strategy, gather further expert opinion, or synthesising existing
evidence.
6. Revise and strengthen the contribution story: as more evidence is gathered
it is advisable to return to Step 4 to review the strengths and weaknesses of the
contribution story and revise it accordingly.
Proposed action Feedback will be sought from a range of partners with
regard to the extent to which activities within Ayrshire and Arran are
contributing to the strategy’s stated aims and objectives, and the extent to
which the strategy’s theory of change has been found to be an accurate model
for mental health improvement. The theory of change and related areas for
activity will be revised on the basis of this feedback and other available
evidence.
4.2 Intermediate and long-term outcomes
Intermediate and long-term outcomes are related to population level changes in
mental health and wellbeing (for example, mental wellbeing as measured by the
Warwick-Edinburgh Mental Wellbeing Scale) and are usually dependent on the
achievement of a number of short-term outcomes. They are also subject to greater
external effects (for example, UK-wide welfare reforms or global recession) and less
amenable to rapid change than short-term outcomes. As a result it is difficult to
attribute the achievements of a specific service or intervention to these outcomes.
Instead they are better suited as indicators of whether an overall strategy is meeting
its stated aims and objectives. The parameters for these outcomes are set out
nationally the Outcomes Framework for Scotland’s Mental Health Improvement
(NHS Health Scotland 2010), and relate to the national mental health indicators for
adults (NHS Health Scotland 2007) and children & young people (NHS Health
Scotland 2012).
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Proposed action An epidemiological report on the mental health &
wellbeing of the people of Ayrshire and Arran will be produced every four
years, in line with NHS Health Scotland’s Scotland’s Mental Health
epidemiological updates (NHS Health Scotland 2012a&b). Subsequent
reports will monitor the strategy’s progress against its aims and objectives.
The national mental health indicators draw on national data sources but
consideration was given during their development to ensure that sub-national
data was available where possible (NHS Health Scotland 2008). For
indicators where the national data source cannot be disaggregated to a local
level, it is proposed that either (a) robust local data is used instead; or (b)
national data is presented with a local narrative (for example, would we expect
to be significantly different from the national picture).
4.3 Short-term-outcomes and outputs
Short-term-outcomes are related to changes in knowledge, attitudes and individual
behaviours. They less broad and esoteric than intermediate and long-term
outcomes, and thus they are usually easier to measure. They can be measured
within a 1-2 year time-frame, and are more easily demonstrated to be directly
attributable to a specific service or intervention. The parameters for short-term
outcomes are also set out in the Outcomes Framework for Scotland’s Mental Health
Improvement but do not have national indicators as they will relate to a specific
service or intervention.
Outputs describe the amount or volume of service or intervention delivered (for
example, the number of Mental Health Directorate service users that have developed
a Wellness Recovery Action Plan). Outputs are important for the performance
management of work programmes but do not infer anything of the quality of the
service delivered on their own. Where high quality processed evidence is available
for a specific service or intervention outputs can, however, be used as a proxy
indicator that outcomes are being achieved.
Proposed action For activities where high quality processed evidence is not
available, evaluation should be considered to assess short-term outcomes. For
activities where high quality processed evidence is available, outputs should be
used in conjunction with the corresponding evidence base to estimate the
impact of the activity. Key reporting mechanisms to be evaluation reports and
Public Health Performs (Covalent). These findings will be used in the
performance management of Action Plans and identify any areas of slippage in
the overarching strategy.
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Figure 4: Proposed flowchart for planning monitoring and evaluation activities
Mental Health & Wellbeing Strategy
Population Mental Health Indicators
Children & Young
Adults
People
Have we seen changes in mental health and wellbeing
at a population level?
Volume 2
Action Plan
Contribution
stories
Evidence-base
Public Health
controlled actions
What activities did
we predict would
need to happen?
What have we
learned from
elsewhere?
Have we done
What have we
what we intended
learned locally?
to do?
Follow-up population mental health reports
Covalent
Evaluations
Review of contribution stories
Has theory of change been implemented?
Have expected results occurred?
Have alternative explanations and other contextual
factors been assessed and significant contributions
Refine and adapt strategic direction
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References
Friedli L & Parsonage M (2007) Mental health promotion: building an economic case
Friedli L & Parsonage M (2009) Promoting mental health and preventing mental
illness: the economic case for investment in Wales
Mayne J (2001) “Addressing attribution through contribution analysis: Using
performance measures sensibly” in The Canadian Journal of Program Evaluation;
16:1
Mayne J (2008) Contribution analysis: An approach to exploring cause and effect –
LIAC Brief 16
NHS Ayrshire & Arran (2013) Ayrshire and Arran’s Mental Health & Wellbeing 2013
NHS Health Scotland (2007) Establishing a core set of national, sustainable mental
health indicators for adults in Scotland
NHS Health Scotland (2008) Monitoring of mental health locally: Sub-nationality of
data for the national mental health indicators for adults
NHS Health Scotland (2010) Outcomes framework for Scotland’s mental health
improvement
NHS Health Scotland (2012) Establishing a core set of national, sustainable mental
health indicators for children and young people in Scotland
NHS Health Scotland (2012a) Scotland’s mental health: Adults 2012
NHS Health Scotland (2012b) Scotland’s mental health: Adults 2012 (Technical
Report)
Scottish Government (2011) Social Science Methods Series – Guide 6: Contribution
analysis
Scottish Public Health Observatory (2008) How much are people in Scotland
really drinking? A review of data from Scotland's routine national surveys
Wilkinson R & Pickett K (2009) The Spirit Level: Why Equality is Better for
Everyone (Penguin)
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