imogencaird, Author at Centre for Mental Health Practice Policy and Law Research

The Digital Divide: Virtual Versus In-person Meetings

This blog was written by Kate Fennell. Kate is a professional doctorate candidate, Fellow of the Higher Education Academy, and social work lecturer on the integrated Allied Health Professions and Social Work Masters programme at Edinburgh Napier University.

Whilst information and communication technologies had been adopted in health & social care (H&SC) practice long before the pandemic, the abrupt need to close non-essential workplaces accelerated the use of digital platforms for health consultations and interprofessional meetings. For many services, these online meetings have continued beyond the pandemic. Teleconference, MS Teams etc are convenient for collaborative meetings as a means to manage limited resources and reduce travel for both H&SC staff and people who use services, especially in geographically remote areas. Across the UK and Scotland, tribunal hearings were conducted using audio and video technologies, which helped to avoid significant delays (Byrom & Beardon, 2021) during the pandemic. However, there are also many disadvantages associated with Telecare and other remote IT use, as reported by the Covid Public Inquiry (McKay et al, 2024), with particular groups of people being digitally excluded.

My particular interest in this topic relates to research being conducted as part of a professional doctorate. As many of you will know, I’m undertaking an in-depth system level analysis of meaningful participation within the Adult Support and Protection Case Conferences (ASPCCs). As a reminder, the Adult Support and Protection (Scotland) Act 2007 mandates public bodies to investigate situations of harm and to support and protect adults at risk. One of the fundamental principles of the legislation is to involve the person in the adult protection process. The ASPCC is an interprofessional, multi-agency meeting which is convened to explore risk and develop a support and protection plan. It is now customary practice for the individual at risk to attend these meetings. But attendance does not necessarily equate to meaningful participation and attendance can be tokenistic.

Thirty-one research participants contributed to focus groups and semi-structured interviews conducted across Scotland. The research sample comprised adults at risk of harm, social workers, independent advocacy workers, ASPCC chairs and mental health officers. I am currently at the coding/thematic analysis stage of this research.

What I have learned is that despite an overwhelming view that individuals are better able to participate within face-to-face, in-person meetings, many ASPCCs continue to take place online. There are a number of reasons for this. In some circumstances, virtual case conferences do suit some individuals. Online meetings can provide a safer environment for those who have had previous unpleasant experiences of multi-disciplinary meetings e.g., hospital discharge, child/adult protection case conferences and mental health tribunals. Some people in receipt of services would rather avoid hospital or social work offices. Attending from their own home allows them more choice and control over the degree of their involvement, as they can mute their audio, switch off their camera and leave when they choose. Some people with impaired mobility or who have other difficulties in travelling to health or social work centres, may find remote meetings more accessible. However some research participants with mobility issues said that they would still rather attend these meetings in person.

For many people subject to adult support and protection measures, virtual meetings are inaccessible and exclusionary. For some with sensory loss, cognitive impairment or mental health symptoms, engaging with disembodied faces on a screen is very challenging. It is difficult to read people’s body language on a small screen. Gestures such as nodding, smiling and other forms of non-verbal affirmation signalling are lacking. Digital emojis while useful, cannot replace the in-person contact and the physical presence of being in the room with others. An inability to develop a rapport with others inhibits meaningful participation and engagement. Lack of technological knowledge or equipment and Wi-Fi issues are additional barriers to be considered.

The most frequently acknowledged benefits of remote ASPCCs are related to efficiency and increased attendance by GPs and other healthcare professionals. These points are echoed in Driscoll et al’s (2020) study on multi-agency safeguarding arrangements and in Byrom and Beardon’s (2021) evaluation of the impact of Covid on MH Tribunals in England and Wales. These may be the most compelling reasons for the continuation of on-line ASPCCs.

Without exception, every participant in the current research study said that decisions regarding the optimal platform should be person-centred and determined by the person’s individual circumstances, their needs and preferences. People should be offered the choice of how they wish to attend their meeting. The question remains as to whether virtual meetings can truly offer a psychological safe space in which attendees can meaningfully contribute and participate.

I would be interested to hear people’s views of the virtual vs in-person debate and your experiences of these online H&SC meetings.

References

Byrom, N., & Beardon, S. (2021). Understanding the impact of COVID-19 on tribunals. The Legal Education Foundation.

Driscoll, J., Lorek, A., Kinnear, E., & Hutchinson, A. (2020). Multi-agency safeguarding arrangements: overcoming the challenges of Covid-19 measures. Journal of children’s services, 15(4), 267-274.

McKay, C., Stavert, J., Johnston, L., Murray, J., Rek, J., Breen, C., Zarins, A. Woodrow. A., Anderson, L. & King, M. COVID-19 Public Inquiry: Research Report for Portfolio 3 The Provision of Health and Social Care Services Adult Social Care. Centre for Mental Health Practice, Policy and Law Research, Edinburgh Napier University

Napier Researchers Attend IASSIDD 17th World Congress in Chicago

In August, Natasha Spassiani (Associate Professor in disability and health equity) and Sam Abdulla (Lecturer in learning disability nursing) attended the IASSIDD 17^th world congress in Chicago. Established in in 1960, the International Association for the Scientific Study of Intellectual and Developmental Disabilities is the oldest global association dedicated to understanding and improving the quality of life for people with intellectual disabilities.

Sam presented initial findings from his professional doctorate, which explores the professional development of early career and student learning disability nurses in practice placement and Natasha shared her work understanding the experiences of people with intellectual disabilities accessing emergency care. Together, they also facilitated a roundtable discussion in collaboration with colleagues from the university of Illinois in Chicago – Dr Joy Hemmel (Professor in Disability and Human Development and director of graduate studies) and Robin Jones (Director Great Lakes ADA Centre). Exploring the barriers and supports to achieving deinstitutionalisation for people with learning disabilities, the roundtable drew in a diverse audience – with attendees from Japan, Singapore, the UK, the US, the Czech Republic and Pakistan! Finally, the pair also presented a participatory research project which identified barriers and supports to medicine concordance.

The conference closed with impassioned calls from people with learning disabilities, and attendees from the global south to ensure that we live up to the ideals of inclusion. To ensure that presentations are delivered in a range of languages, that information is accessible, that smaller, less prominent voices aren’t pitched against those esteemed colleagues who can draw in the larger audiences. If we as researcher, clinicians and academics in intellectual disability won’t ensure that intersectional identities are able to take their full space, how can we claim to be working inclusively?

The focus of our discussion was that of deinstitutionalisation, when we think of institutions we immediately go to the physical spaces, to four walls, lack of choice, lack of freedoms, of ways of living and being that aren’t authentic to those who are subjected to the institution. However, when we inadvertently or indirectly create environments where diverse voices do not have space, we create an institution of another kind, where we restrain thoughts and ideas.

Despite this, conferences are an opportunity for us to create connections and to reconnect with friends and colleagues from across the world to create energy, for ideas to spark and maybe, for change to happen.

@NSpassiani @SamAbdulla

Research Project on Trainee Counsellors is Looking for Research Participants

Project: Free Labour and precarity in mental health provision: trainee counsellor’s experiences across the UK.

Researchers: We are Dr Mariya Ivancheva, Strathclyde University and Dr Jennifer O’Neil, Edinburgh Napier University. We are Education, Work and Employment researchers. Mariya has a counselling background and Jennifer has researched/published on counselling practitioners working experiences previously.

Participants: We are interested in interviewing trainee counsellors on accredited postgraduate programmes. You will have the opportunity to discuss your experiences of training, placement and transition to employment and professional career in the UK context. Your views are important in informing this research and shaping future practice.

Research: This project, sponsored by BACP, investigates the structural conditions of counselling placements in the UK through the lived experiences of trainee counsellors and insight into the trainee programmes rationale and structure. We aim to inform future training and placement design in a way that captures trainee counsellors’ voices and illuminates the structural challenges they experience within a dynamically developing professional field.

Data: All data will be anonymised and saved following GDPR protocols. The findings from the interviews will be published as a policy brief, presented at conferences and in journal articles. They will serve as key documents in a knowledge exchange programme with diverse stakeholders to help formulate policy demands for improved funding and placement design in the sector.

Information: Please contact us at J.Oneil@napier.ac.uk and M.Ivancheva@strath.ac.uk if you would like to take part and/or have any further questions.

Ethics: This project has full ethical approval from the University of Strathclyde. For more information, please contact ethics@strathclyde.ac.uk

The Acceptability of Cognitive Behavioural Therapy (CBT) for Autistic adults: A mixed-method study with autistic adults and clinicians.

This blog post was written by PhD student Chloe Kennedy. If you would like to find out more, please contact here.

In the UK, there are around 700,000 autistic people (National Autistic Society). Research shows that autistic people are at increased risk of experiencing a co-occurring disorder, such as anxiety (Hollocks et al., 2019).

Cognitive Behavioural Therapy (CBT) is considered the ideal treatment for such disorders (Clark, 2011), but may be less effective for autistic adults than the general population or autistic children (Weston, Hodgekins & Langdon, 2016).

Acceptability, known as the extent to which people delivering or receiving an intervention consider it to be appropriate (Sehkon et al., 2017), can influence intervention uptake, adherence, effectiveness and implementation. However, our scoping review showed that acceptability is rarely a primary research aim, typically only measured in part and research lacks use of appropriate theory. So, there is need for a theory-driven study focusing on CBT acceptability in real-world practice.

This PhD project thus aims to identify the extent to which CBT for autistic adults is (un)acceptable to autistic adults and clinicians in routine practice, and to understand why it is acceptable/unacceptable to consider potential adaptions to CBT. The study aims to achieve this through an acceptability-specific online survey with optional interviews and focus groups.

The findings from this could help in development of evidence-based adaptions to CBT for autistic adults and improve understanding of CBT acceptability from both sides of the therapy experience. The study is now open for recruitment and we would love to hear from all autistic adults and clinicians with experience of delivering or receiving CBT that can participate to make sure the potential impact of this project becomes a reality.

National Autistic Society. (no date). What is Autism? https://www.autism.org.uk/advice-and-guidance/what-is-autism

Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological medicine, 49(4), 559-572.

Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International review of psychiatry, 23(4), 318-327.

Weston, L., Hodgekins, J., & Langdon, P. E. (2016). Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: A systematic review and meta-analysis. Clinical psychology review, 49, 41-54.

Sekhon, M., Cartwright, M., & Francis, J. J. (2017). Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC health services research, 17(1), 1-13.

Scotland ten years post-Cheshire West: the advantages and disadvantages of not legislating!

Introduction

It’s been ten years since the UK Supreme Court Cheshire West[1] ruling, so where are we in Scotland in terms of responding to this?

Well, one could argue that at least we haven’t tied ourselves in the Deprivation of Liberty Safeguards and halted Liberty Protection Safeguards knots that our cousins South of the Border seem to have. However, in fairness to such cousins, that is probably because whilst we have considered how to address the issues the judgment raised we haven’t actually done anything concrete yet! That being said, the Scottish Government’s current programme of reform for mental health and capacity law will result in steps to address the issues, and the importance of doing this swiftly was recently brought into even sharper relief by, somewhat ironically, the English and Welsh Court of Protection Aberdeenshire Council v SF[2] ruling.

ECHR issues

In a nutshell, Article 5(1)(e) ECHR allows the deprivation of liberty of ‘persons of unsound mind’. This is, of course, subject to safeguards, such as the ability to challenge the lawfulness of this through a court or tribunal and to be discharged as soon as the reason for detaining the person has ceased and/or it is not lawful (Article 5(4) ECHR). The 2004 European Court of Human Rights Bournewood^[3] ruling made it clear that Article 5 is engaged where a person lacks capacity to consent to a deprivation of their liberty and they are therefore entitled to Article 5 protections.

The Court stated that a deprivation of liberty engaging Article 5 is where a person is under continuous supervision and control and is not free to leave^[4]. This was confirmed by the UK Supreme Court in Cheshire West^[5] – its ‘acid test’ for a deprivation of liberty – which also made it clear that the Article 5 reach extends to all health and social care situations. We also know that simply dealing with the issue about how a deprivation of liberty can be authorised is insufficient. Article 5(4) challenge safeguards must be practical and effective for persons with mental disabilities^[6]. Whilst this might not dictate that automatic judicial review occurs it certainly means that the ability to challenge the lawfulness of a deprivation of liberty must be within the realistic grasp of the person subjected to it.

What this means for Scotland

Bournewood and Cheshire West led to a questioning of the Article 5 ECHR compatibility of Adults with Incapacity (Scotland) Act 2000 (AWIA) measures where adults who lack capacity are deprived of their liberty, and also those under section 13ZA of the Social Work (Scotland) Act 1968 (SWSA) (allowing local authorities to move adults who lack capacity to residential care). Detention under the Mental Health (Care and Treatment) (Scotland) Act 2003 is, however, largely Article 5 compliant although questions arise about Articles 5 and 8 ECHR compatibility and non-consensual treatment whilst on Short Term Detention Orders[7], and levels of restriction whilst in low secure facilities, as well as the reminder that the lawfulness of detention on the basis of mental disorder depends on the availability of suitable care and treatment[8].

The Scottish Courts appear to have accepted that Article 5 ECHR compatibility can be achieved through appropriate guardianship powers[9]. However, this has seemingly glossed over the fact that there is an absence of accompanying Article 5(4) safeguards. In 2024, the Court of Protection Aberdeenshire Council v SF ruling helpfully pointed this out! Nor would the argument that guardians are effectively the person giving consent to the deprivation of liberty hold given the lack of Strasbourg endorsement here.

In response to Cheshire West, the Mental Welfare Commission for Scotland also issued guidance in 2014 warning against the use of Section 13ZA SWSA where the person is being moved to a care setting where they will be, or are likely to be, deprived of their liberty[10]. This essentially mirrors 2007 Scottish Government guidance containing a similar warning[11].

**Post-Bournewood and Cheshire West actions in Scotland**

Prior to the Scottish Mental Health Law Review (2019-2022) the Scottish Law Commission and Scottish Government both considered and consulted on the issues raised by Bournewood and Cheshire West. The recommendations made, and draft Bill provided, by the Scottish Law Commission[12] were ultimately not taken forward. Surprisingly, although there have been several ‘near misses’ in terms of Bournewood/Cheshire West situations reaching court hearings none, rather surprisingly given the time lapse, have been judicially considered in Scotland with Aberdeenshire Council v SF, in England in 2024, being the first.

The need to address the Bournewood and Cheshire West ‘gaps’ therefore fell to the Scottish Mental Health Law Review. By this stage, frustration was mounting over the lack of action to address these particular human rights concerns[13], although they are admittedly complex which involve a need to both achieve ECHR compatibility whilst not creating unnecessary levels of bureaucracy. Moreover, so far we have of course only considered ECHR requirements in this article. CRPD challenges to the denial of the exercise of legal capacity and deprivation of liberty on the basis of a diagnosis of mental disability and related impairment (based on mental capacity assessments) is something else that requires consideration given that the UK is a CRPD state party and because the Scottish Government intends that CRPD rights, along with those in other international human rights treaties, will, to some extent at least, become legally enforceable in Scotland. This was a fundamental issue that was considered by Scottish Mental Health Law Review and reflected in its recommendations[14].

Its reasoning and recommendations on deprivation of liberty can be found in Section 3 of Chapter 8 of its Final Report. Whilst a full reading of this section of the report is strongly advised, it in essence recommended that in the short term the Scottish Government should establish a legislative framework for situations where a person may be deprived of their liberty that:

Respects the wishes of a person who cannot make an autonomous decision but can, with support, express a will and preference to remain in their current living arrangements (even where these arrangements would otherwise constitute a deprivation of liberty).
A practical and effective standalone right of review available to the adult deprived of their liberty, or a person acting on their behalf (where the adult is not subject to any order) and the ability of the Mental Welfare Commission to intervene where it has concerns.
Powers of Attorney may grant advance consent to deprive the granter of their liberty, subject to safeguards.
A court or tribunal may authorise a Decision Making Representative, or an intervention order, to deprive the person of their liberty.
Where a person cannot consent to their care arrangements, even with support, and is being deprived of their liberty but does not have a welfare attorney or a Decision Making Representative, a court/tribunal may grant a Standard or, to preserve life or health, an Urgent Order for Deprivation of Liberty, either lasting for only as long as needed to achieve the protection required, with regular review dates and a right of appeal at the time of granting.
Before proceeding to apply for a Standard Order for deprivation of liberty, an evaluation of the human rights implications must be completed.

The Review also stated that in the longer term this framework should be revised as its Human Rights Enablement, Supported Decision Making, and Autonomous Decision Making recommendations are developed.

Although, in relation to the recommended attorney and Decision Making Representative powers to authorise a deprivation of liberty, there is a lack of direction from the European Court of Human Rights on the Article 5 compatibility of such measures (as well as Article 12 CRPD questions of these measures not representing the will and preferences of the person at the time of the authorisation), the Review envisaged that provided that rights protecting measures are in place, this ensures that the will and preferences of the granter are represented. The Aberdeenshire ruling reinforces the need for such rights protection measures.

In its high level 2023[15] response to the Review’s recommendations the Scottish Government accepted such recommendations in broad terms. It announced a 10-year programme of reform of mental health and capacity law specifying various priorities throughout this period, one of the first being adults with incapacity law reform, including the deprivation of liberty challenges. We understand that the Scottish Government will shortly consult on proposed changes to the law here and that these will include enhancing AWIA guardianship provisions to ensure greater respect for a person’s autonomy but also to specifically recognise that guardians may be empowered to authorise deprivations of liberty with accompanying Article 5(4) safeguards. The outcome and resultant legislation are therefore awaited.

Jill Stavert

[1] P (by his litigation friend the Official Solicitor) (Appellant) v Cheshire West and Chester Council and another (Respondents); P and Q (by their litigation friend, the Official Solicitor)(Appellants) v Surrey County Council (Respondent) [2014] UKSC 1 (Cheshire West) .

[2] Aberdeenshire Council v SF [2024] EWCOP 10.

[3] HL v UK (2005) 40 EHRR 32.

[4] Ibid, para 91.

[5] Cheshire West at 49, per Lady Hale.

[6] MH v UK (2013) ECHR 1008.

[7] X v Finland (2012) ECHR 1371.

[8] Rooman v Belgium (2019) ECHR 105.

[9] K v Argyll and Bute Council (2021) SAC (Civ) 21.

[10] This 2014 guidance is also reflected in the Commission’s Deprivation of Liberty: Advice Notes, updated March 2021, https://www.mwcscot.org.uk/good-practice/guidance-advice

[11] Scottish Government (2007), Guidance for Local Authorities (March 2007) Provision of Community Care Services to Adults with Incapacity, CCD5/2007, https://www.gov.scot/publications/adults-incapacity-scotland-act-2000-code-practice-local-authorities-exercising-functions-under-2000-act/pages/12/

[12] Scottish Law Commission (2014), Report on Adults with Incapacity, (Scot Law Com No 240), https://www.scotlawcom.gov.uk/law-reform/law-reform-projects/completed-projects/adults-with-incapacity/

[13] See, for example, Law Society for Scotland (2021), Our 2021 priorities: Incapacity, mental health and adult care and protection, https://www.lawscot.org.uk/news-and-events/blogs-opinions/our-2021-priorities-incapacity-mental-health-and-adult-care-and-protection/

[14] Scottish Mental Health Law Review (2022), Final Report, Chapter 8, section 3.

[15] Scottish Government (2023), Scottish Mental Health Law Review: Our Response, https://www.gov.scot/publications/scottish-mental-health-law-review-response/

The Future of Mental Health Law: A Comparative Analysis of Law Reform Debates in Scotland, Northern Ireland, Ireland, England & Wales

The Convention on the Rights of Persons with Disabilities (CRPD) is an international human rights treaty which came into force in May 2008. It requires that parties to the convention promote, protect and ensure the full enjoyment of human rights by persons with disabilities.

Since the adoption of the Convention, many countries around the world have sought to reform their mental health laws, policies and services so they align with the CRPD. This includes engagement with the principles derived from the CRPD and adoption or amendment of relevant laws and policies. There are differences, however, across countries and authorities with respect to engagement and interpretation of human rights obligations and how mental health law and the promotion of the human right to mental health looks. Human rights arguments, along with rising rates of compulsory mental health treatment, have prompted major reviews of mental health laws across the United Kingdom and beyond.

Professor Penelope Weller is working on a project which will analyse the current law reform debates in Scotland, Northern Ireland, Ireland, England, Wales and the Republic of Ireland. Across these countries, all have reviewed the existing legislation and are at varying stages of reform.

Reform status across the UK and Republic of Ireland

In Scotland, the Scottish mental health law review (Scott review) was completed in 2022 and responded to in June 2023 by Scottish Government.[1] The Scottish Government announced in 2023 a programme to implement the new approach over a period of 10 years.

In England and Wales, following the Independent Review of the Mental Health Act 1983 (Wessely Review), the Reforming the Mental Health Act white paper was published in August 2021. The Government is due to develop a new bill, but the timeframe for this remains unclear.[2]

In Northern Ireland, the Mental Capacity Act (NI) 2016 fuses together mental capacity and mental health law, as recommended by the Bamford Review of mental health and learning disability. [3][4] The Act is yet to be fully implemented.

In Ireland, Assisted Decision-Making (Capacity) Act 2015 came into force in April 2023.[5] An expert review of Mental Health Act 2001 was completed in 2014. In 2021 the government published a Draft Heads of a Bill to amend the Mental Health Act, with reform of the Mental Health Act 2001 due in 2023.

How we realise human rights for those with psychosocial disabilities is to be addressed in mental health law has become the focus of global reform. In October 2023, WHO-OHCHR published its guidance on mental health, human rights and legislation.[6] The guidance recognises that the full implementation of a human rights approach in mental health law may take some time to achieve. While significant change is underway, it is important to assess whether the reforms in each jurisdiction are moving toward the principles espoused by WHO and the United Nations. What is clear is that ongoing reform will be necessary to achieve the paradigm shift in law that is envisaged.

About Professor Penelope Weller

Penelope joined the Centre for Mental Health Practice, Policy and Law Research at the end of August and is at Edinburgh Napier as a Visiting Academic. She is a law professor from RMIT University in Melbourne and an international expert in the field of Human Rights Law, Health Law, Mental Health and Capacity Law and the Convention on the Rights of Persons with Disabilities (UNCRPD).

Whilst here, Penelope is conducting a review in collaboration with Professor Jill Stavert on reform of mental health law across the UK, funded by the British Academy.

References

[1] What are the next steps? – Scottish mental health law review: our response – gov.scot (www.gov.scot)

[2] Reforming the Mental Health Act white paper 2021 | Local Government Association

[3] Mental Capacity Act 2016 | Department of Health (health-ni.gov.uk)

[4] Bamford Review of Mental Health and Learning Disability | Department of Health (health-ni.gov.uk)

[5] gov.ie – Assisted Decision-Making (Capacity) Act 2015 (www.gov.ie)

[6] Mental health, human rights and legislation: guidance and practice. Geneva: World Health Organization and the United Nations (represented by the Office of the United Nations High Commissioner for Human Rights); 2023

New WHO-OHCHR guidance and Scotland’s Human Rights Record in Mental Healthcare

Mental health care is an essential component of healthcare systems worldwide. However, the treatment of individuals with mental health conditions has often been marred by human rights abuses, stigma, and discrimination. In response to these issues, the World Health Organization (WHO) and Office of the United Nations High Commissioner for Human Rights (OHCHR) have developed guidance to improve laws addressing human rights abuses in mental health care. This post provides a brief overview of the significance of the guidance in promoting the rights and well-being of individuals with mental health conditions, and how Scotland’s own record compares.

The WHO-OHCHR Guidance

The guidance underscores the importance of placing human rights at the heart of mental health care policies and practices, recommending revision or enaction to mental health legislation to align with international human rights standards, such as ending forced treatment and institutionalisation.

It recommends a shift away from institutional care and promotion of community-based mental health services which allows individuals to receive care and support in a more integrated, inclusive, and less restrictive environment, fosters social inclusion and recovery.

The guidance also covers informed consent and advance directives, and effective mechanisms for monitoring and oversight to ensure compliance with human rights standards.

Significance of the Guidance

The WHO-OHCHR guidance reaffirms the fundamental human rights of individuals with mental health conditions and offers a framework for their protection. It has the potential to influence legislation and policies at a global level, encouraging countries to align their mental health laws with human rights standards. It also promotes a paradigm shift from outdated, coercive approaches towards more humane and inclusive community-based care and recognises that the presence of mental ill-health is not justification for limiting a person’s rights and freedoms and access to support and services.

Scotland’s Record

The Scottish Mental Health Law Review, commissioned in 2019, considered and recommended ways to better protect and promote the human rights of people through mental health, capacity and adult support and protection legislation. It is hoped that this work will help to bring about a huge difference in the lives of people who experience mental and intellectual disabilities by making sure they get the support they need and giving them more say in their own lives. It can also be used globally as a model for other countries who are trying to incorporate the CRPD and follow WHO-OHCHR guidance into law, practice and policy.

Conclusion

The WHO-OHCHR guidance represents a milestone in the fight for the rights and well-being of individuals with mental health conditions. By championing human rights, promoting community-based care, and challenging stigma, this guidance offers a pathway to a more compassionate, inclusive, and just mental health system. It is a call to action for governments, healthcare providers, and society at large to ensure that mental health care respects the dignity and autonomy of every individual. The Scottish Mental Health Law Review’s recommendation also sought to do this and although these recommendations preceded the WHO-OHCHR guidance very much aligns with the guidance’s approach.

Suicide is Everybody’s Business

Nadine Dougall

Trigger warning – content refers to suicide and risk factors relating to suicidal thoughts.

World Suicide Prevention Day is hosted on 10th September every year. During this same week, the number of deaths by suicide in 2022 was published by the National Records of Scotland. This latest data showed that deaths were very slightly up at 762, with females increased by 18 and males decreased by nine on the previous year. As part of the Academic Advisory Group to Scottish Government, I provided some analysis and commentary to this data release.

Working with suicide data can be a humbling and emotional experience. As someone personally affected by suicide, it is an all too powerful reminder that behind every number was a person and research has estimated that up to 135 people are deeply affected by each death.

Despite the very small increase in overall deaths in 2022, suicide remains a massive concern and much more needs to be done. This is especially the case in our communities of highest deprivation, where the suicide rate is about three times greater than areas of least deprivation. Our national suicide prevention strategy ‘Creating Hope Together’ aims to bring down numbers of suicide and tackle deprivation to reduce inequalities between our communities.

However, suicide is everyone’s business, and we all have a part to play. One in five in the UK have suicidal thoughts during their lifetime. That means we likely know someone at work, home or in our friendship groups who is having, or will have, suicidal thoughts. Perhaps you have experienced such thoughts, but don’t realise how common it is.

Having suicidal thoughts does not necessarily mean we have poor mental health, but instead may be a natural reaction to distressing problems and situations. Usually there is no single reason that may lead us to think about suicide but rather a range of reasons or factors, which all contribute to how we may be feeling.

Many of us will experience significant issues that are known risk factors for suicidal thoughts and behaviours, including unemployment, work or money problems, relationship breakdowns, conflict, violence, experiencing disability or pain, life-changing events, significant childhood adversity and abuse, living alone or isolated, and using significant amounts of drugs and/or alcohol.

We also know from research that these risk factors may be offset by a range of beneficial experiences in childhood and adulthood, such as having a supportive and trusted adult around during childhood or being in a positive relationship as an adult.

What leads any of us to having suicidal thoughts is complex. One model of suicide (the ‘IMV Model’) recognises that biology, psychology, environment and culture all play a part in this complexity. Crucially, the IMV Model seeks to understand what causes the development of suicidal thoughts, and what are the factors that increase the chance of suicidal behaviour. It also identifies that a sense of defeat, feeling a burden to others, or feeling trapped can all lead to the (often rapid) development of suicidal thoughts.

The IMV Model acknowledges common pathways to suicidal thoughts and behaviours but also identifies potential areas for prevention and intervention. To create more hope around suicide, we need to make it easier to tell others and share our thoughts. In turn, this will likely have the effect of making us feel better, not to mention playing a small part in reducing stigma. This is part of the national suicide prevention strategy.

National suicide prevention programmes such as ‘Creating Hope Together’ no longer focus on individual risk factors as they have poorly predicted suicide in the past. Instead, they focus on broader ways of improving general population well-being, addressing causes and reducing stigma of poor mental health, and improving service response to support people with problems.

It is with the greatest of hope that ‘Creating Hope Together’ can achieve an impact and we see reduced numbers of suicide and reducing inequality over the coming years.

Every suicide is preventable, and our lives are valuable. For many of us, life may be overwhelming at times, and we may feel trapped in situations with no easy solutions. However, there is always hope even if things do not feel hopeful.

If you need help please do not hesitate to contact:

Breathing Space

Breathing Space is Scotland’s mental health helpline for individuals experiencing symptoms of low mood, depression, or anxiety, and offers free and confidential advice for individuals over the age of 16. They can be contacted on 0800 83 85 87, 6pm to 2am Monday to Thursday; and from 6pm Friday throughout the weekend to 6am Monday.

Samaritans

Samaritans provide confidential non-judgemental emotional support 24 hours a day for people who are experiencing feelings of distress or despair. You can contact Samaritans free by phoning 116 123 or via email on jo@samaritans.org

NHS24 Mental Health Hub

Telephone advice and support on healthcare can be obtained from NHS24 by phoning 111; the Mental Health Hub is open 24/7.

Acknowledgements:

With grateful thanks to Jan Savinc, and his expertise in R syntax to provide summary statistics and interpretations from the national suicide data release.

Dedication:

In memory of my nephew Connel Arthur, forever 21.

Nadine Dougall is Professor of Mental Health and Data Science at Edinburgh Napier University.