2. Scottish Public Health Observatory 

3. Mental Health Strategy [2017-2027] 

4. Joint Strategic Needs Assessment – Health Needs of Minority Ethnic Communities
(2018)

5. The Scottish Health and Ethnicity Linkage Study3 (SHELS)

2. In 2018, on the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) that measures mental wellbeing among adults and teenagers, the mean score for Scottish adults aged 16+ was 49.4. This was the lowest value since the time series began in 2008 although the decrease has been slight and gradual. The WEMWBS scale runs from 14 (the lowest level of wellbeing) to 70 (the highest).

Nineteen percent of those aged 16+ years in Scotland in 2018 reported having a General Health Questionnaire (GHQ) score of 4 or more, an indicator of potential mental health problems. This was the highest level recorded since 2008. In 2016/17, 11% of adults had two or more symptoms of depression and 6% had previously self-harmed.

3. The guiding ambition for mental health is simple but, if realised, will change and save lives – that we must prevent and treat mental health problems with the same commitment, passion and drive as we do with physical health problems. That means working to improve:

• Prevention and early intervention;
• Access to treatment, and joined up accessible services;
• The physical wellbeing of people with mental health problems;
• Rights, information use, and planning.

4. The report found that suicide rates among the Polish community in Scotland are higher than the Scottish average. The impact of racism and hate crime which contribute to social exclusion and negatively affect mental and physical health.

5. This study shows varying patterns of psychiatric hospitalisation by ethnic group in Scotland, with the differences only partly explained by socio-economic circumstances. For South Asian and Chinese groups in particular, they suggest under and late utilisation of mental health services. The findings indicate the need for culturally appropriate and sensitive mental health services that will improve access for minority ethnic groups to community and specialist mental health services.

Poverty in Edinburgh is real and damaging, but it can be solved. By implementing the calls to action we make in this report, we think the city can set a course to end poverty in Edinburgh by 2030.

Identified six areas for action – fair work, a decent home, income security, opportunities to progress, connections, health and wellbeing – and one cultural challenge that should serve as a lens through which each action should be approached.

To end poverty in the city, the single biggest transformation Edinburgh could achieve would be to make the experience of seeking help less painful, less complex, more humane, and more compassionate. We call on City of Edinburgh Council to lead in the design and delivery of a new relationship based way of working for all public services in Edinburgh.

There is no solution to poverty in Edinburgh without resolving the city’s housing and homelessness crisis. We call on the Scottish Government, as an urgent priority, to ensure the city has the right funding and support to meet its social housing expansion needs.

1. “Advances equality of opportunity in shaping policy and delivery of services” (Public Sector Equality Duty, Equality Act 2010).

2. “Improves the physical health of people with severe and enduring mental health problems to address premature mortality” (Mental Health Strategy, 2017-2027).

3. “Inform and support people to manage and maintain their health, and to manage ill-health” (The Healthcare Quality Strategy for NHS Scotland, 2010).

4. “To reduce premature mortality for people with poor mental health” (Charter of Rights and Actions for Change, 2016).

Therefore, in order to address health inequalities effectively, consideration must be given to the associated implications and complex intersections between people with Protected Characteristics, identified as: age, disability, gender, gender reassignment, pregnancy and maternity, marriage and civil partnership, race and ethnicity, religion and belief, and sexual orientation.

• Support to strengthen self-determination regardless of a person’s apparent cognitive ability under current laws;
• Viewing autonomy as a relational or interdependent;
• Respecting of so-called ‘dignity of risk’;
• Providing an alternative to substituted decision making, paternalism and a ‘best interest’ approach
• Driven by the rights, will and preferences of the individual concerned;
• Upholding the principles of equality and non-discrimination;
• Reflecting developing human rights norms.

Edinburgh Carers Council (2020) ‘Carers Rights Event’ report.

REH Patients Council (2021) Second Patient Experience at Royal Edinburgh Hospital Report.

The ECC report highlighted several key issues and outline a need for better carer identification and for professionals to have a better understanding of what information can be appropriately shared with a carer, rather than using confidentiality to not share information with the carer. They highlight the need for more funding for carer services and a complete overhaul of the current complaints systems to improve it, recommending a different system, Care Opinion, a route for carers to raise complaints or suggestions about services.

The REH Patients Council second patient experience report puts forward a convincing argument for why a human right based approach to care and treatment which is fully compliant with the UNCRPD should be taken at the Royal Edinburgh Hospital. It outlines a need to move away from substituted decision making to supported decision making. There should be training for staff on trauma informed approaches and an evaluation of all hospital policies especially on the use of restraint, restrictions, and non-consensual treatment. The report puts forward the need for better patient involvement in decisions around development of their own care and treatment plans as well as better information for patients on wards including about their care and treatment plan.

• Ensure that the face to face model of service delivery is an option for people who use advocacy services.
• Ensure that staff have training to help advocacy partners with sensory impairments. This could include the use of BSL, Makaton, Talking Mats and other alternative communications.
• Explore the potential of additional independent advocacy services for people from LGBT+ communities and other minority groups.
• Explore the potential of advocacy workers having translation skills in several languages including Spanish and Polish.
• Explore if there can be a dedicated service for carer advocacy that helps carers with issues on benefits and finance.
• Look into gaps for people with autistic spectrum condition, eating disorders or people who present at accident and emergency.

Scottish Independent Advocacy Alliance- Principles, Standards & Code of Best Practice (October 2019)

The Principles, Standards & Code of Best Practice document recognises that all independent advocacy organisations share the same principles. It has been developed to be used across Scotland, to ensure that independent advocacy is being delivered consistently and is of the highest possible standard. In this respect it has a safeguarding role, ensuring that people who access independent advocacy can have confidence in the help and support they receive.

This document also aims to safeguard independent advocacy itself by setting standards and promoting best practice, thereby helping to ensure that independent advocacy is understood, valued and effectively resourced. These Principles, Standards & Code of Best Practice provide important foundational statements on practice. It remains the responsibility of independent advocacy organisations, commissioners and funders to put measures in place to ensure that the Principles, Standards & Code of Best Practice are adhered to. Independent advocacy organisations should have their own organisational policies and procedures that reflect this document.

Notable increases in suicidal thoughts from Wave 1 to Wave 2 were also found for several subgroups:

• Men: A higher proportion of men reported suicidal thoughts in Wave 2 (16.3%) than in Wave 1 (10.2%). This is an increase greater than among women, who reported 9.6% in Wave 1 to 10.5% in Wave 2. It should be noted that despite men’s significant increase at Wave 2, higher rates of suicidal thoughts were reported among women than men.
• Young men (18-29 years): A higher proportion of young men reported suicidal thoughts in Wave 2 (34.4%) than Wave 1 (21.5%), though this should be regarded with caution due to the pronounced drop in sample size between Waves 1 and 2.
• Those with a pre-existing mental health condition: a higher proportion of respondents in this subgroup reported suicidal thoughts in Wave 2 (36.7%) than Wave 1 (25.2%).

Wave 2 of the Scottish COVID-19 Mental Health Tracker Study found that nearly a quarter of respondents reported levels of depressive symptoms indicating a possible need for treatment (24.1%) and a sixth (16.9%) reported anxiety symptoms of a similar level. Rates of depressive and anxiety symptoms did not significantly change from Wave 1 to Wave 2. However, rates of suicidal ideation in the week prior to completing the survey increased from Wave 1 (9.6%) to Wave 2 (13.3%).

A number of subgroups saw changes to rates of moderate to severe depressive symptoms from Wave 1 to Wave 2, including:

• Men’s rate of depressive symptoms increased from Wave 1 to Wave 2
• Women’s rate of depressive symptoms decreased from Wave 1 to Wave 2