Introduction

Connecting the dots: tackling mental health inequalities in Wales

This is the introduction to the Health and Social Care Committee ‘Connecting the dots: tackling mental health inequalities in Wales’ report.

 

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On this page:

— Introduction

— Background

— Our inquiry

— Listening to lived experience

— Language and terminology

— Report contents

 

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Introduction

Background

1. The Centre for Mental Health describes a ‘triple barrier’ of mental health inequality, which affects large numbers of people from different sections of the population:

• Some groups of people are disproportionately at risk of poor mental health. This is often linked to wider inequalities in society.
• Groups with particularly high levels of poor mental health can have the most difficulty accessing services.
• When people do get support, their experiences and outcomes are often poorer.[1]

2. These inequalities existed before the COVID-19 pandemic, but the pandemic has made them worse.

 

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Our inquiry

3. To ensure our work on mental health inequalities was led by the evidence and lived experience, we took a two-phase approach.

4. During the first phase we called for written evidence,[2] held focus groups with people with lived experience or who are at risk of experiencing mental health inequalities,[3] and held scene-setting evidence sessions[4] to explore:

• Which groups of people are disproportionately affected by poor mental health in Wales? What factors contribute to worse mental health within these groups?
• For the groups identified, what are the barriers to accessing mental health services? How effectively can existing services meet their needs, and how could their experience of using mental health services be improved?
• To what extent does Welsh Government policy recognise and address the mental health needs of these groups? Where are the policy gaps?
• What further action is needed, by whom/where, to improve mental health and outcomes for the groups of people identified and reduce mental health inequalities in Wales?

5. During the second phase we held further oral evidence sessions,[5] visited projects working to promote and support mental health in their communities,[6] held a private informal discussion with neurodivergent people,[7] and held focus groups with key workforce groups[8] and members of the Welsh Youth Parliament[9] to explore four emerging themes:

• Mental health and society: the wider determinants of mental health, and the role of society and communities in promoting and supporting mental health.
• Community solutions: the role of communities in promoting and supporting mental health, and social prescribing.
• The impact of mental health inequalities on neurodivergent people. While many groups and communities are at risk of mental health inequalities, during the first phase of our work we heard significant concerns about the impact of such inequalities on neurodivergent people. Neurodivergent people are a diverse group, many of whom may also experience inequalities relating to their other characteristics. We decided, therefore, that looking at the experiences of this group would also help us to explore broader themes that affect other groups, including a lack of joined up services, limited awareness and training, and diagnostic overshadowing.
• Role of the healthcare and wider workforce: including mental health and equality awareness across the whole workforce, training, joined up working within the health service and with other organisations, and the role of GPs as the ‘front door’ to mental health services.

6. We also sought updates from the Deputy Minister for Mental Health and Wellbeing (“Deputy Minister for MHW”) on the implementation of recommendations made by the Fifth Senedd Health, Social Care and Sport, and Children, Young People and Education Committees in their work on mental health and wellbeing.[10]

7. In September 2022 we held an evidence session with the Deputy Minister for MHW and the Deputy Minister for Social Services (“Deputy Minister for SS”) to explore all of the issues.[11]

 

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Listening to lived experience

8. We want people to be at the heart of health and social care, and at the heart of our work. Our approach to evidence gathering reflects this, providing a range of ways for people with lived experience and expertise to contribute. To maintain this as we prepared our report and recommendations, we established an online advisory group comprising people from across Wales with a range of different experiences. We are grateful to all advisory group members for their views, experience, expertise and constructive challenge.[12]

9. We are grateful to everyone who shared their experiences and expertise with us. Part of our role is to shine a light on people’s experiences and amplify their voices. We can only do this by listening to and understanding their stories, but we are very aware that this may sometimes be difficult for people and can risk retraumatising them. Throughout our inquiry we have worked with partner organisations to ensure that everyone who took part in our stakeholder sessions, focus groups, visits and advisory group has been supported by people they know and who have the right expertise. We also included information about sources of mental health and emotional support in our inquiry communications.[13]

 

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Language and terminology

10. We recognise that where language and terminology do not resonate with people or communities it can exacerbate stigma or be a barrier to people accessing help or support. Ashra Khanom of the Neath Port Talbot Black Minority Ethnic Community Association explained:

“At one of the young persons' workshops, one of the girls said, 'We don't want to talk about mental health because people call us "broken"', and one of the boys said, 'In school and everything, there's pressure to succeed, and your family saying'—especially with ethnic minorities—'if you don't succeed, you're going to be discriminated against. Life is just more difficult, and a challenge'. So, everybody's like pushing, pushing for them to be useful to society, be perfect, not 'broken', as they were saying, and that was such a big issue for them. The boys were saying they would never seek mental health support from their GP because they didn't want to seem weak. Also, we talked around the language of mental health, and people were saying, 'If you use "mental health" with us, it's a barrier for us, because it's too strong a term'. That's what their words were. They said, 'Use words like "stress", "worry", "feeling unwell"', which we were surprised about as well, and somebody said, 'Do you know what? Why can't we have mental health as one group and mental illness?'”.[14]

 

11. Dr Julie Bishop of Public Health Wales (“PHW”) agreed that the term ‘mental health’ is too often used to talk about mental illness, distress or poor mental health. She suggested that terms such as ‘mental wellbeing’ could be more appropriate when “trying to focus people and the wider system on thinking about what we can do to create the conditions to build good mental health as a preventative action”.[15]

12. Our aim is to be inclusive and evidence-led. This includes the language and terminology we use when considering issues relating to mental health and wellbeing, and to specific groups and communities. We have drawn on NHS guidance,[16] and on input from our advisory group and others who have contributed to our work. We acknowledge that people are individuals with their own views and preferences, and that there may not always be consensus on the ‘right’ or ‘preferred’ terms. But, throughout our report, we aim to use language that recognises and affirms the identities of the people and groups affected by the issues we have considered, which is consistent with the social model of disability, and which avoids perpetuating stigma.

 

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Table of Contents

— Chair's foreword

— Recommendations

— Summary

— Introduction

— Mental health inequalities

— Person-centred services

— Mental health is 'made' in communities

— Social prescribing

— Workforce

— Coordinated cross-government action

— Reform of the Mental Health Act 1983

— Annex: Mental health and emotional support