Public health – listening to those most affected

- by Sandy Riddell, Chair, Mental Welfare Commission

Improving public health is a short phrase with a huge agenda.

In Scotland we have some serious challenges in ensuring our people have the best chance of remaining in good health throughout their lives, and I welcome the range of approaches being taken to tackle those challenges.

Awareness of the links between physical and mental ill health has grown, and I welcome that too.`

Inequality lies at the heart of many health issues, whether mental health or physical health.

Bringing this together

The focus must start with having accurate informatio­n. (The pandemic has emphasised the importance of many things, but this must be near the top of the list). I think we have that in many areas, or are well on the way to doing so.

From there we must seek to understand why ill health is rising for certain groups. In mental health terms I would cite as one example the very seriously unwell; people who are detained against their will for treatment.

The Mental Welfare Commission collates and publishes data on instances of these detentions annually. We’ve highlighte­d our concerns as we see the numbers growing every year.

Is that due to inadequate care and treatment when an individual is not so severely ill, leading to serious deteriorat­ion in their condition? We know that sta„ shortages are a growing issue.

Is it due to complex interactio­ns between ill health, social inequaliti­es and life chances – a public health issue many will recognise, if not specifical­ly in this context?

Or is it something of each?

It is a di„icult question to answer but we must keep trying, because such detentions should be a very last resort.

Once we have greater understand­ing, we must follow through and adapt or increase services to target those most in need.

Listening to those most a ected

Geˆing this right should involve listening carefully to those with ill health and to their families or carers. Without having a two-way dialogue, liˆle will change.

I say this from the point of view of an organisati­on that has learned from its earliest days, and continues to learn, about

the importance of listening to those most a„ected.

60 years – a brief history

The Mental Welfare Commission was created under the 1960 Mental Health Act, and came into existence in June 1962. This year is our 60th anniversar­y. The organisati­on replaced a body called the General Board of Control, which can in turn be traced back to 1859.

In those days, life was exceptiona­lly di„icult for people with mental ill health or learning disability. People were housed in unregulate­d private asylums – conditions were poor, there was no treatment.

Listening to people

While many aspects of the Commission’s work now would be unrecognis­able to earlier incarnatio­ns, one core priority was there from the very start.

That is our focus on visiting people. Not inspecting services, but visiting, and listening to individual­s who receive care or treatment.

This was done in 1859, it was done in 1962 and it continues to be a core function now.

Our advice line is open to anyone – personal or profession­al – seeking help on mental health, learning disability or capacity law, care or ethics in Scotland.

Our Board is publically appointed and we have an advisory commiˆee that brings external expertise and viewpoints to our work.

More inclusive

We employ people with lived experience of mental ill health or of caring for others, but know we need to do more. We are currently recruiting to a new role for a person with learning disability and/or neurodiver­sity.

A healthy future

Poor mental health can blight a person’s life, reducing their world to something smaller than it should be. The same goes for poor physical health.

Improving Scotland’s public health will only happen if we work collective­ly, and invest enough money and skills into the services people need. All the while listening to the experience of people who know the issues beˆer than any organisati­on.

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