In October 2020 Scottish Government published the Mental Health Transition and Recovery Plan. This plan outlines the Scottish Government’s response to the mental health impacts of Covid-19. It addresses the challenges that the pandemic has had, and will continue to have, on the population’s mental health.
It lays out key areas of mental health need that have arisen as a result of Covid-19 and lockdown, and the actions that the Scottish Government will take to respond to that need. Some of the work outlined had been started before the pandemic, but is included because it continues to be relevant to our ongoing response.
The Plan describes how Scottish Government will continue to support good mental health and wellbeing, to help people manage their own mental health, and to build their emotional resilience. The overall aim is to ensure that people get the right support, at the right time, and in the right setting – this includes when mental illness does occur. Scottish Government will support mental health recovery in a way that is personal to each individual’s journey, and which focuses on their rights.
In partnership with stakeholders, we have identified a number of key areas of focus. These are areas, or groups of people, where Covid-19 and lockdown are likely to have had particular impacts on mental health. It is likely that there will be significant overlap between these sections. Each key area of focus will also require a response that covers multiple different types of need:
- Promoting and supporting the conditions for good mental health and wellbeing at population level.
- Providing accessible signposting to help, advice and support.
- Providing a rapid and easily accessible response to those in distress.
- Ensuring safe, effective treatment and care of people living with mental illness.
The Covid-19 pandemic has affected every single person in Scotland. Many people have been anxious or worried about health, family and friends, and the changes to day to day life. Some individuals, families and communities will have found the past few months very tough.
The Covid-19 pandemic has exacerbated pre-existing structural inequality in society. It has put some communities disproportionately at risk and has had a more adverse impact on the mental health of some groups of the population. We also recognise the importance of taking an intersectional approach to equality, acknowledging that individuals may face multiple discrimination and marginalisation.
Across most aspects of mental health, outcomes for women and girls are poorer than those for men and boys. Evidence suggests that the impacts of lockdown and Covid-19 are more likely to impact negatively on the mental health of women and girls for a range of reasons, including the impact of caring responsibilities.
Scottish Government has therefore made a range of commitments to improving mental health and wellbeing for women and girls:
1.We will engage with women’s organisations and the First Minister’s National Advisory Group on Women and Girls to better understand and respond to the gender-related mental health inequalities exacerbated by the Covid-19 outbreak. These include, but are not limited to:
- Stressors and trauma experienced by women in gender segregated key worker jobs
- Continuing and increased pressure on women in unpaid caring roles
- The disproportionate emotional and physical burden on women of caring for relatives of all ages, and (although not exclusively an impact on women) home schooling children
- Living with domestic violence, abuse, coercive control and toxic masculinity
- Loneliness and isolation felt by women at different stages of life (e.g. women with young babies or children, and older women living alone)
- The effects on mental wellbeing of young women and girls in a culture where they are encouraged to compare their lives to others, including the impact of social media and body image on young women.
2.Equality Stakeholder Forum. We will establish an Equality Stakeholder Forum for Mental Health. This Forum will inform the implementation of the Mental Health Transition and Recovery Plan, and provide advice on wider equalities work within mental health policy, including ongoing consideration of equality issues that affect women and girls and input from gender equality stakeholder groups.
3.Body Image – We established the Healthy Body Image for Children and Young People Advisory Group in August 2019 following the publication of the Scottish Government’s report Exploring the reported worsening of mental wellbeing among adolescent girls in Scotland. The Advisory Group published a reportin March 2020 detailing recommendations for Scottish Government to make in order to support the development of good body image and bring about positive lasting change.
4.Violence Against Women – we will engage with women’s organisations in order to identify and follow up on actions that can be taken to support women and girls’ mental health in relation to the threat and reality of violence against women. Our approach will build on existing initiatives and the principles set out in Equally Safe.
5.Perinatal Mental Health – We will continue our flagship work to support women and their families in the perinatal period through the Perinatal and Infant Mental Health Programme Board as well as deliver the actions in the 2020/21 Perinatal and Infant Mental Health Delivery Plans. This includes specific work to establish a Perinatal and Infant Mental Health Equalities working group and develop a Raising Awareness and Reducing Stigma Strategy.
6.Women’s Health Plan – We will embed specific mental health actions and commitments within the Women’s Health Plan.
Gender Inequality in Mental Health
- World Health Organization Department of Mental Health and Substance Dependence. Gender Disparities in Mental Health(World Health Organization, Geneva, 2013)
- Shoukai Yu. Uncovering the hidden impacts of inequality on mental health: a global study Transl Psychiatry. 2018; 8: 98. Published online 2018 May
Mental health impacts of Covid-19 – women and girls
- Wave 1 findings of the Scottish Covid-19 Mental Health Tracker Study suggest particular sub-groups within the sample, including women, are reporting higher levels of mental health problems and financial concerns than the sample average.
- Key findings relating to women include:
- Women (27.6%) were more likely to meet the cut-off for depressive symptoms indicating moderate to severe depression than men (25.3%).
- Women (22.1%) reported higher rates of moderate to severe anxiety symptoms than men (15.8%).
- A greater proportion of women reported high GHQ-12 scores than did men (40.8% vs. 30.3%).
- No differences on mental wellbeing were found between men (average score 21.55) and women (average score 21.07).
- Women reported higher levels of loneliness than men (5.32 vs. 5.02)
ISER Working Paper Series 2020-08 ‘The gender gap in mental wellbeing during the Covid-19 outbreak: evidence from the UK.’ Ben Etheridge, Lisa Spantig. Institute for Social and Economic Research, University of Essex
- Those with high childcare duties have shown noticeable deteriorations in wellbeing, with women more affected than men.
- Social factors are important in understanding the gender gap in wellbeing on aggregate. Women report more friends in previous years, and they currently report higher levels of loneliness. Given that these factors are strongly related to declines in well-being they are crucial in explaining differential impacts by gender.
- The results suggest that lockdown is impacting mental well-being less through its effect on the labour market or wider economy, and more through the direct loss of social interaction. Differences in family and caring responsibilities play some role 7 but analysis suggests much of the gender gap in well-being can be explained by gender differences in social factors and increased feelings of loneliness.
- Women in general and BAME women in particular expressed more concern about access to NHS treatment and medicine over the coming months.
- Around 2 in 5 people said they were finding social isolation difficult to cope with, although still high this was lowest among white men (37.4%).
- Life satisfaction and happiness were lowest for BAME women, and anxiety was highest for all women compared to men. Average life satisfaction before the coronavirus pandemic (July to September 2019) was 7.7, while average happiness was 7.5, and average anxiety was 2.9. Scores for BAME women in the current survey were 5.1, 5.3 and 5.4 respectively.
- Work-related anxiety for those working outside the home was highest among BAME people, with 65.1% BAME women and 73.8% of BAME men reporting anxiety as a result of having to go out to work during the coronavirus pandemic.
- Of those who were now working from home, A higher proportion of BAME people (41.0% of women and 39.8% of men) reported working more than they did before the pandemic, compared to white people (29.2% of women and 28.5% of men).
- Nearly half of BAME women (45.4%) said they were struggling to cope with all the different demands on their time at the moment, compared to 34.6% of white women and 29.6% of white men.
Covid-19 impact on girls:
Teen Covid Life Survey and the How You Doing Children’s Parliament Survey. Both are based on an open rather than a representative sample but indicate that the mental wellbeing of girls, particularly older girls, has fared worse than that of boys during the pandemic.
 Mental Health Foundation (2017). While your back was turned: how mental health policymakers stopped paying attention to the specific needs of women and girls. London: Mental Health Foundation
The role of substantial childcare (based on data from Understanding Society – large scale UK longitudinal study): https://www.iser.essex.ac.uk/research/publications/working-papers/iser/2020-08.pdf