Mental Health

Two maxims neatly capture the mood of mental health care in Scotland today. First, since the mind can affect the welfare of the body and vice versa, “there can be no health without mental health”. If we are to achieve full health it must be in both mind and body.

Secondly, for every single person who experiences mental ill-health, there will be several family members, friends, colleagues or neighbours, who may also be affected by that experience. So, “mental health is everyone’s business”. Over the course of a lifetime, as many as one in four people will suffer personally from mental health problems. The rest, however, will be affected indirectly. No longer can we reassure ourselves that ‘mental illness’ happens to other people. As GK Chesterton said, “we are all in the same boat and we owe each other a terrible loyalty”.

Contemporary mental health developments in Scotland emphasise a longstanding interest in the role of social factors in health and illness, dating back to the early days of the NHS. In 1953, RD Laing and colleagues at Gartnavel Hospital, Glasgow established a project where staff and patients could spend time conversing informally, cooking and doing art work, in comfortable surroundings. By emphasising the importance of normal social interaction for recovery, they began to dismantle the institutional ethos of hospital care. In the 1960s, Dingelton Hospital became world famous for its innovative therapeutic community, where frank and open discussion was encouraged and traditional barriers between ‘staff’ and ‘patients’ were broken down. Dingelton went on to become one of the first hospitals to develop a community mental health programme in the Borders.

Today, mental health care in Scotland embraces a wide range of medical and psychological therapies, all delivered within a holistic framework, involving both patient and family. The focus has shifted from a narrow concern with the treatment of ‘mental illness’ to an emphasis on the promotion of mental health and wellbeing. This is highlighted by NHS Health Scotland’s development of ‘mental health indicators’, which address both positive mental wellbeing as well as various mental health problems. These will help measure the ‘mental wellbeing’ of the country as a whole as well as at the level of individual patients.

Delivering Mental Health (2006) offered a challenging view of the future, proposing to change the way services are delivered, shifting the emphasis from hospital to community services, and developing constructive partnerships between the NHS, local authorities, user and carer groups and the voluntary sector.

For many years mental health care was seen as the ‘Cinderella’ service. With greater emphasis on collaboration and co-operation we may find that everyone can go to the Ball.

Professor Phil Barker
University of Dundee

Group of young people talking. 
Credit: Getty Images

Voice's of Experience

It is very hard to imagine what it was like to be mental health patient at the start of the NHS.

People were still labelled "lunatics" and were shut away in asylums. There was repressive social control where patients had practically no rights, and the resulting institutionalism led many into lethargy and apathy with no aspirations of recovery.

The contrast with the past could not be starker.

Times have changed, but there is now much greater understanding and a real commitment to listening to individuals with real experience of mental health problems, and working with them as equal partners to develop mental health services for the future.