Dr Catherine Calderwood, Scotland’s chief medical officer.
BENEFIT sanctions introduced by the UK Government may have had an “adverse impact” on the mental health of the poorest Scots, a new report by the country’s Chief Medical Officer has said.
Scotland‘s top doctor Catherine Calderwood has published her annual report, with this stressing the need to “truly improve health and reduce inequalities”.
It told how Scotland “would be one of the healthiest countries in Europe” if everyone enjoyed the same level of health as those living in the most affluent areas.
It also warned of the “potential adverse impact on mental health” of the introduction of sanctions to the benefits system.
The Scottish Health Survey has gathered data on anxiety levels among adults since 2008.
“Examination of these data before and after the new welfare sanctions regime were introduced indicate a potential adverse impact on mental health,” the Chief Medical Officer’s report said.
“Among adults living in households in receipt of job seeker’s allowance (JSA) or income support (IS) in 2008-11 (before the change), 19 per cent had moderate to severe anxiety symptoms.
“Among those in a similar position in 2013-15 (after the change), the proportion was 30 per cent. Adults living in households not receiving JSA/IS, who were unlikely to be affected by these changes, showed only a minimal increase in anxiety symptoms over the same period “Together, these findings suggest that mental health has worsened in recent years amongst those most affected by economic and labour market insecurity, and by welfare reform.
“This highlights the importance of a secure household income and good work to mental health and wellbeing.”
While the report said there had been a “long-term decline in death rates in Scotland”, it added that “this decline in mortality has not in general been as rapid as the rest of the UK or other European countries”.
It noted the onset of multi-morbidity – when a person has multiple long-term health conditions – occurs on average 10 to 15 years earlier in people living in the most deprived areas of Scotland compared to the most affluent.
The report called for more action to be taken to encourage smokers to quit, with 10,000 deaths a year – about a fifth of all fatalities – and 120,000 hospital admissions linked to smoking.
It said Scotland “has made great progress in protecting people, especially children, from the harms of tobacco smoke and in smoking prevention”, with smoking levels among school children now at an all-time low.
It added: “Greater emphasis is now needed in encouraging more smokers to quit.
“The challenge is to get more smokers to seek support from NHS stop-smoking services – where their likelihood of success is more than doubled compared to trying to quit without support.”
With increased financial, academic and social pressures, there’s arguably never been a more stressful time for students – and that can have a big impact on their overall mental well-being.
Nearly five times as many students as 10 years ago disclose mental health conditions to their universities, according to a report by the Institute for Public Policy Research (IPPR), resulting in an increase in the need for access to their institutions’ mental health services.
However, an increase in demand means that many services are only able to offer students short-term solutions, such as brief counselling sessions or medication. Some students are also having to wait over four months for treatment at some universities.
Andrew, 19, a second-year history student at the University of Warwick, says he has been on the waiting list for his university’s counselling programme for over a year.
He said: “I didn’t want to sell myself as a suicide risk and I may have underplayed that to the extent that they thought ‘oh well, he’s fine, we’ll leave him’.
“Because I have a diagnosed condition, it means they’d have to commit to me every week for three years. I think they were looking more to help people with short-term issues.
“Being put on a waiting list alienates you from seeking help, this is the problem. It’s painfully clear when you talk to someone from the university counselling programme that they just didn’t have enough staff for the number of students.”
University counselling services are struggling to meet the overwhelming demand. The results of an IPPR survey of 58 UK higher education providers shows 94% have experienced an increase in demand for counselling services over the past five years, while 61% have seen demand increase by over 25%.
Dr Martin Cunningham, a GP and member of the Student Health Association, said: “The services are working at full stretch. The number of students presenting themselves with mental health issues has shot up and the services are working very hard, but they are funded in such a way that it is really short-term work.”
A lack of resources can mean that when students do receive counselling, it is sometimes not focused on long-term solutions.
Former physics and animations student Bertie, 25, who attended the universities of Kent, Sussex and UWE, said: “I’d receive counselling once every week or once every other week. I’d feel a bit better that day or for a few hours afterwards but apart from that, it was just back to the same.”
Other students report being offered medication as a form of treatment, without any strategies for dealing with mental health issues in the future.
One University of Kent student, who wished to remain anonymous, said: “They recommended I take SSRIs (selective serotonin reuptake inhibitors) but I didn’t want to take any medication.
“I wish I was offered alternatives to medication and counselling that actually advised me on steps I could take in the future.”
Alan Percy, chair of the Heads of University Counselling Services, a specialist group of the British Association for Counselling and Psychotherapy (BACP), stressed that university counselling services are facing pressure to have their students’ needs met immediately.
“This means that many student services offer short-term fixes which are less helpful in the longer term,” he said.
“However, there is no magic solution. The danger would be for all the emphasis to be on services to offer speedy appointments but not to be able to offer the appropriate level of professional counselling for those who need it.”
Levels of mental illness, mental distress and low wellbeing among students in higher education in the UK are increasing,and are high relative to other sections of the population.
The University of Kent says it is working with the NHS to enable easier access to mental health services.
“When a student requests counselling, they are asked to complete a self-assessment form which then enables us to triage clients, where those with the most urgent need are given the highest priority,” it said in a statement.
“We also offer a daily crisis drop-in centre and self-help services such as Big White Wall, a 24/7 online mental health and well-being service.”
The University of Warwick also said it provides an extensive range of mental health services for its students, adding: “We have recently committed over £500k extra to support Well-being Support Services, including additional outreach workers alongside an enhanced range of services available to students.”
Jackie Doyle-Price, minister for Mental Health and Inequalities, said her department spent £11.6 billion on mental health services last year and is pledging to work with Universities UK to make sure students feel supported.
She said: “University is a pivotal time in people’s lives, which is why we are working closely with university leaders to make good mental health central to their student services.”
Should teenagers face annual screenings for depression? Under new guidelines from an American doctors’ group, all children aged 12 and above would be questioned about their mental health every year.
On Monday the American Academy of Pediatrics (AAP) published new guidancethat adolescents should be examined every year from the age of 12 to ensure those with depression can get timely help.
Meanwhile, on Friday, the UK government finished consulting on a green paper on adolescent mental health, which focuses on early intervention and suggests schools should play a more central role. Strategies include mental health awareness training for school staff and incorporating mental health into personal, social and health education lessons.
Many teenagers are not diagnosed until adulthood, and doctors believe helping vulnerable teenagers early on could help prevent them suffering in silence. Mental health campaigners have said screening for depression is just one piece of the puzzle.
“My depression started during my childhood and worsened from the age of 13, and I was admitted into hospital at 14,” said 21-year-old mental health campaigner May Gabriel.
Gabriel said if she had been screened for depression at 12 she might have received treatment before she became so ill she attempted to take her own life.
“Many young people are not sure where or how to get help, or even that they may need help, and integrating mental health with regular services in this way would enable more young people to get help.”
Sarah Kendrick, of children’s mental health charity Place2Be, said more than half of all mental health problems start before the age of 14.
“It is by picking up on problems early and helping children and young people to build their resilience that we can equip them with the tools they need to cope with life’s difficulties and to thrive as adults,” she said.
“Continuous support, and an open environment in which [children] are encouraged to talk about their feelings, enables early identification of any problems or challenges.”
Universal screening as advocated by the AAP would involve doctors giving teenagers questionnaires on their emotional wellbeing to complete as part of regular checkups.
“Teenagers are often more honest when they’re not looking somebody in the face,” Dr Rachel Zuckerbrot, a child psychiatrist and professor at Columbia University who authored the guidelines, told NPR.
However, many campaigners believe integrating discussions about mental health into conversations in schools and improving the help available are integral to solving the issue.
An NSPCC spokesperson said screening for mental health conditions could help normalise conversations about depression, but must be accompanied by easy access to support services.
“The government must build on the proposals in its recent green paper to ensure all children who need it can access high-quality and timely mental health support,” they said.
“The big question is what happens when you screen positive [for depression],” mental health writer and campaigner Mark Brown said.
“I assume that in the US that means a referral to a specialist covered by health insurance. In the UK, a referral … for every young person who screened positive would have no chance of working, given current resources.
Some experts also have reservations about the recommended age of 12, particularly as UK doctors are hesitant to prescribe antidepressants to minors.