 I welcome everyone. I'm Gillian Martin, a member and convener of the Health and Social Care and Sport Committee, and I'd like to welcome you all to this special online edition of the Festival of Politics 2021 in partnership with the Parliament's Think Tank Scotland's Futures Forum. This afternoon's panel is titled Prioritised Mental Health and it's held in partnership with the Mental Health Foundation. We're delighted that so many people have registered to join us online today and I look forward to hearing your comments and taking your questions from you after we've heard from our panellists. We're pleased to offer BSL interpretation for this evening's event and we'll give forward to receiving all your questions and comments. The Covid-19 pandemic has demonstrated how central our mental health is to our lives in terms of the loss, disadvantage and discrimination that thousands have experienced in the last getting on for two years now. My good is to be everything it would be two years. Anyway, we now have the opportunity to put mental health at the heart of the decisions on how we recover and move forward as a society. So who's taking the lead and how fundamental would this prioritisation be on both a personal and national policy level? Well, our panel aims to address some of these questions in the next 60 minutes and we're delighted that you're all able to join us and take part. So I would encourage you, if you have a question or comment as we go on, to use the event chat function. If you can introduce yourselves with your name and your geographical location, we're going to try our very best to get a spread of people from across Scotland and I believe that we have people from the way outside Scotland as well. So tell us where you're from and what your name is and then I'll get your questions and I'll try and pick as many as I can. First of all, I'd like to introduce our panellists. First of all, I want to say that we were going to have three panellists but Dr Linda Irvine Fitzpatrick has had to pull out sadly as she's unable to make it. So our two panellists that we have are Mark Rowland, the chief executive of the mental health foundation and Shruti Jane, the chair of the board for Sahelia, a specialist mental health and wellbeing support organisation for women and girls with experience of racism, other discrimination and gender abuse in central Scotland. Welcome to you both and thanks for joining us. So as I said, as our panellists give us an opening presentation, please let us know your questions in the chat box. But I'm going to come to Mark Rowland first of all to ask what their three-point plan would be that put mental health at the heart of decision making and how we move forward, both as members of the community and Scotland and the UK as a whole. So I'll come to Mark first. Mark Rowland. Thanks very much, Gillian. Can you hear me okay? Yes, we can. Excellent, excellent. Great to be with you. Thanks very much for the invitation. It's a huge question, isn't it? For those who are listening, who are joining this discussion, let me maybe just start with a couple of minutes about the mental health foundation because we've been around one of the few UK-wide mental health organisations working in Northern Ireland, Scotland, Wales and England and we've been around almost as long as the NHS, so almost 70 years and trying to be a progressive force to challenge thinking and to move the discussion on. So we come at this point in history, Gillian. You framed the discussion really well because we have just been through a once in a century, hopefully, event and it has thrown up huge questions for us and so now is the time to start and contribute to how we think differently about mental health and I think maybe I'll just start with saying I think the big thing for me around the pandemic is that if we didn't need to know it before, we saw that our mental health was fundamentally malleable. It was fundamentally affected by our environment and our experiences and those us who have worked in mental health for a long time know that but I think that there has been an awakening to the fact that the context of our lives is the biggest single driver to the quality of our mental health so it stands to reason that if we're going to improve our mental health we have to look at the context of our lives and what's happening to us and create the conditions where people can thrive and experience good mental health. So Gillian, you asked me what my three point plan was and I don't know how long you want me to sort of speak on this but maybe if I keep it short and then I'm sure you can come in and then we can take questions. So my three point plan is this. First of all that we have to move from seeing mental health and mental ill health primarily through a medical lens and shift to seeing it through a public health lens and so my the first point is we need a cross sectorial cross government thinking and action and coordination on mental health if we're going to have sort of mutually reinforcing policy and change that makes a difference because there isn't unfortunately a vaccine silver bullet option for mental health that's going to magically produce better outcomes so first point in the plan is it's got to be multi sectorial got to be cross government and we can talk more a little bit about what that might mean and in what ways and I know that the the mental health and transitional recovery plan that the Scottish government has put in has started that process so that would be number one I think number two would be this which is slightly more process point but earlier in the week we have at the foundation a foundation young leaders forum from around the UK young leaders diverse groups of young people and I ask them this question the same one that you've asked me and so my second point is the point that they made to me which is this that in decision making you need the people most affected involved in the conversation and they were saying to me young people disproportionately affected but it's going to be adults not not young people making the decision so how are you going to involve us how are you going to hear us how are you going to understand us how are you going to walk in our shoes and I think not just for young people but for also other people who've been disproportionately affected it's not the answers will come from the wisdom of people's experience so that's number two and then and then thirdly coming out of our own research that we've done is is is a sustained and sort of big shift in in finance in investment into community infrastructure and the vitality of our communities and lots of different ways of doing that but if if we have falling social capital falling social connections are hollowing out of the spaces for us to connect with people in our lives and find the support that we need which we people signal is really important if we don't invest in that we aren't going to see a very significant change in the protective factors for me for people's mental health so perhaps I will just stop stop there and and and pause and then happy to come back on any of those points. I can imagine that people listening to it there'll be things that they want to dig deeper into in those three points and I've made a note of them and I want to come to Shruti now and put the same question but Shruti I mean like Mark has done I'm really grateful to hear a little bit about your organisation first and then come to the what you think the three men or it should be. Thank you so firstly just thanks for the invitation the Scottish Parliament and the mental health foundation to join the panel this evening as we talk about centering mental health and our recovery from Covid so Helya's been around for nearly 30 years now and we started up in Edinburgh and we then had a service based in Glasgow from 2014 and our work has been with women and girls who are over the age of 12 who are from an ethnic minority background so they could be known as visible minorities in Scotland our women experience a wide range of issues that impact their mental health this could be because they're isolated they're depressed or they're traumatised through their experience of racism or the discrimination or of gendered abuse so that might include domestic violence, female genital mutilation and forced marriage so as a service we provide a mental well-being service by combating the effects of discrimination and abuse we try and reduce the stigma of mental health with individuals and within communities and we try and improve access to mainstream services and you can imagine the latter is the most challenging for us so just turn into your question now which which as Mark said is a really big question what would our three-point plan be to put mental health at the heart of decision making and I frame this very much in the context of what would we do as Helya as a specialist community organisation working in Scotland on this so our first point would be I think you'll probably find that my three points are very similar to what Mark has shared but my first point would be around how we describe and talk about mental health so we have begun to see a shift in this during the pandemic but we think there's much more work that needs to be done so at Helya when a woman comes to us we see the whole person we seek to improve the quality of their whole life by increasing their physical, mental and spiritual health and wellbeing so not just even to treat the illness or the mental ill health we look at the whole being and what's affecting them in their lives might it be something in their family might it be something within their community or might it be something that they've experienced within their experience of accessing services or not being able to access services and we look at how we can support them so my point of reference there was really a broader definition around mental health looking at how we can prevent mental health rather than kind of treat mental health the second point I think is we would like to see a change in our policies services and supports are designed and delivered so it hasn't been working for a while now we've been around for nearly 30 years so we would be really keen for the mainstream and decision makers to work with us and organisations with us to help them to understand our priorities and our needs really typical deep rooted structural inequalities that have had an unequal impact on mental health as I said our knowledge is built on nearly 30 years of experience our involvement should be on a meaningful basis as experts and our expertise should be central to how policies are designed and how services and supports are delivered my third point is that finally organisations like Sahelia operate from within communities we have developed and trusted relationships to support people in a dignified manner in a way that mainstream services struggle and it's been widely recognised through the pandemic that the third sector has been able to act with speed, creativity and flexibility in responding as well as supporting some of the most marginalised groups who often fall through the gaps of mainstream provision we will continue to do what we can but we would like to see the local and the national take significant steps to safeguard organisations like ours in the community but also to build up our long-term capacity in this work we are just as important in providing health and mental health support just as much as clinics and hospitals and joined up services in the community are very much needed so we feel there's like a real opportunity to shape what we do and how we do differently you think that now is the time thank you both and we're getting questions coming in i'm going to come to audience questions in a second but i want to i want to pick up on something the third point that you both made and that's about resources been put down the line to get community level and support in the third sector and i think that's really important because one of the things that i think that we often can in political terms and in the media talk about mental health services being of that clinical type and waiting lists and there's not enough infrastructure there but ignoring the fact that quite a lot of the early intervention and community support that's available for people is probably the best chance we have of stopping people actually needing that medical support and that you know you talked about isolation and loneliness and trauma and community but also there might be missing a lot of people that they wouldn't necessarily go to the doctor for a mental health issue but we'll maybe quite happy to go you know as it is you say if they've had traumas a result of abuse to an organisation like yourselves then so this seems a no-brainer to me why is it not happening you know i mean is it because you're it's very difficult for you to evidence it as as being a the kind of the the applications for the pots of money do they do they miss what you're doing is that is that seem to be the major um sumblin bloc there or is there something else but can i come to shruti first and then mark i think i think that's a really good question and it's something that we've been asking for years and years it's it's you know the funding climate is is one part of it it's been very hard as a third sector organisation to access funding it always has been that case and it's become harder since we weren't able to access European funds for example um and um some trusts and foundations have experienced um you know kind of uh you know reductions and their kind of services that they've been able to offer out as well um i think i think i mean this is really complex it's a really complex question to answer but but from our experience we feel that there's some real systemic issues that that need to be addressed um and the systemic issues is around um you know the way that services um in the third sector are funded and how those organisations can access the funding so we are constantly working um on at least 10 funding applications at any one time and that is fairly just to survive um and we do that whilst also trying to deliver service as well so that's that's extremely challenging so there's something around the long-term nature of funding that is available but also the ease of how you can be able to access some of that funding um there is something around i think a recognition of what third sector organisations do do so we find that um some people think that we we sit around and drink tea and eat biscuits um with our service users and we do do that we do some of that because that's part of the welcoming service that we provide for women who've come to this country some of them have had really traumatic journeys um it's still experiencing trauma it's still at risk of danger in their communities in Scotland so they hear about sehalia from their friends um and they come to us so you know we do offer them a cup of tea and a cup of a biscuit and we sit down with them but we do so much more than that you know we we provide spaces for them to be able to to connect with others um from their community connect with others who might have had the same experiences some of them come to us to learn activities um and engage in gardening activities and through that we can begin to experience how their mental health has been impacted and using our experience years of experience we can begin to unpick some of the trauma that they are currently experiencing and the services that they might need we know about the issues you know that it takes to access services you know it's it's the interpretation barriers so we provide um a minimum we we regularly use 14 languages every day in delivering our services but we can't offer up to 49 different languages just across our staff um both across Glasgow and Edinburgh and no one mainstream service can can provide that or offer that um so there are some basic barriers like interpretation in terms of being able to access these services um there's a lack of mainstream specialist support so if you talk about FGM for example we used to be we used to have a specialist FGM worker within the NHS in Glasgow now we don't know if that exists anymore but Glasgow was where there are a high number of cases around kind of gendered abuse through FGM um and for that you do need a specialist treatment but um it's extremely complex um and I do you find that the work that we've been having to do is to raise awareness of the complexity of the cases that we deal with within just one woman but yeah we work with several women every day um to raise awareness within the mainstream of what is required but actually what Sahelia offers is is is that specialism in terms of some of the language support that we can provide but also that experience of the handling those cases as well so it's quite a complex situation you know in terms of a lack of understanding of what what are our users need but also um a lack of what a third sector organisation does deliver and how we actually save save lives and then a lack of um flexibility within the system and some of the systemic issues there for a third sector organisation like ours to be able to access mainstream funding continue to provide kind of long long-term services yeah yeah mark thanks thanks very much I mean Virginia I think you put your finger on one of the biggest questions around health policy and also the function of effective government that we face as a society which is how do we address take a public health approach and address complex social problems at their source rather than waiting for the problems to develop in acuteness and all of the social cost that goes along with that and people and and it is a truism that people talk about preventative action and public health and it doesn't get invested in it it doesn't get prioritised and I think I just offer a few few reflections when I used to work in international development and we used to fly to very remote parts of of the world and we get in these little little six-seater planes and the pilot would turn around to us and everyone would be sitting just would be sitting on one side and saying no no you've got to spread out on the plane otherwise this flight this plane ain't going to fly and our health system is a bit like that we have a disproportion of the acute need that needs to go in but it people need the support in their lives but the proportion of funding is flowing to the point of the point of need and we've got very small resource by comparison I think you know if you look at the size of public health Scotland as a proportion of the NHS funding it's tiny it's really really small and and I think there are a few reasons why the our health plane is lopsided towards treatment over preventative action first is that that public health is quite a new form of social science it's a fairly new form on the block that on medical traditions go far back much further than than the sort of late 19th century where public health emerged and then public mental health the idea that you can actually create the conditions where people can prevent or avoid the experience of poor mental health is again very new the the second I think is that it's complex and that if you are going to put this the right kind of support around people's lives it does take coordination and collaboration between parts of the communities and parts of the way government functions and government structure is not set up for that it's set up with government departments with clear portfolios with clear targets so there's something about the fact that this is a new area of social science something about the structure of our governing bodies that make this difficult and then thirdly there is the long-term time frame that public health interventions take to deliver results which of course the political system is not really set up for and that's not politicians fault you can't blame politicians for uh delivering there is a requirement to do that so we're not saying it's got to be one or the other we're talking about a balance playing not one in which people don't have services and support when they need it because that's morally not acceptable so I think those those factors are there and I think just I was really struck by what Shruti said when she said look we're not just about cups of tea and and yet so much of the work we do particularly in Scotland with minority ethnic communities and refugees that it's really simple safe spaces that we're providing to hear people's stories peer support it's not complicated it's almost like the simplicity of it is a bit big beguiling and I was with the you know and and and it is hard to measure Jillian you know I think I think it's hard to be able if you when you succeed and I was with someone this weekend who really felt that the support that was put around him between the ages of 8 and 14 where he felt acute anxiety and acute panic attacks but the education and support that was put around him actually enabled him to step into adulthood without experiencing those issues on a on an ongoing basis that's a success story but it's really hard to tell them and it's really hard to celebrate them and it's hard to evidence what exactly it was that enabled that path for him which has led him to be able to take a fulfilling and and a productive life but one in which he wasn't the devil by poor mental health that that's something that is hard to measure but we need to be capturing those stories and sharing that success more effectively yeah you can't you can't measure the crises that have been avoided because they've been avoided so should you come back to me and I'll take a quick break for your mic to be unmuted we go thanks yeah so I absolutely agree with that point around we need to become better at understanding what the need is and you know what success does look like and the impacts that organisations and actions across the system can take place because this this isn't going to be easy as I said we haven't we haven't got it right and what we need is change across the system and the system is complex there's many people working within that system and and kind of working to improve mental health so there is as I said a need to recognise the complexity of the issues involved but third sector organisations have some of that information to hand and over the 30 years you know we've we've been we've been saying to the mainstream these are the issues and this is what you can do differently to better support migrant women and girls in the areas that we're working in Scotland and we haven't been heard so you know and that that can be frustrating because we're doing that on top of actually trying to save lives so do you think at a structural level we need to get better at capturing what does work and what doesn't work by engaging in a dialogue with the sector organisation and that goes back to one of my points and my three-point plan so it's it's who are the experts in this and it's about bringing those experts to the table and it isn't necessarily people's lived experience because that can be quite traumatic and we can almost adopt a case study approach you know by doing that but certainly as an organisation we would be happy to be one of the experts around the table working with government to shape and design some of the policy that actually makes a difference for our women and our girls again based on our experience there was something around the numbers so we do certainly in Scotland need to become much better in recording data particularly ethnicity data so we and that will help us to have a full understanding of some of the structural inequalities faced by minority ethnic women in Scotland but alongside the numbers we need the stories and again that goes back to my point around bringing some of the experts to get together but that that's that's a long term that we think that you know that absolutely needs to happen so that data doesn't exist at the national level some of that data exists at the local level and again it goes back to who's around the table and how are we working together to achieve the outcomes that we want to achieve You're saying some fairly familiar themes are coming out data in Scotland is a problem disaggregated data is a real problem when you're putting policies into action if that data is not there to support it then that can often be a barrier so thank you very much for that I'm going to go to a question from one of our audience this is from Shona and Shona is asking has it helped that sports people like Simone Biles for example have been more vocal about their mental health to prioritise mental health in the public and policy makers your thoughts on that mark um that yeah I think it is enough can I can I just I am not really optimistic though about the fact that public health is hard preventive but the steps we can make society there are some really simple steps I know we can make you know and I find it amazing that mental health literacy isn't part of the curriculum around in the standard curriculum for our kids for example that's that is we will look back and go do you remember when we used to have kids in education we used to think that um educational standards was the only thing that mattered and we we used to think that actually kids coming out of school without a really strong understanding of emotional literacy and how to manage their own mental health we didn't we didn't actually teach that do you remember and they will go yeah Croms wasn't that and and we will get to that point and that's so there are some really really tangible stuff that we can do that would make a difference and and I'll just to say we we've just done a a really interesting study with with the London School of Economics on the economic case of preventive action and the returns are fantastic the evidence is building of what happens when you put anti-bullying programmes into schools what happens when you do early identification and provide support what happens when you provide support for parents in those first few years so I just wanted to say it is difficult as I mentioned how difficult it is but the evidence is building and the policy opportunities are really significant in this space and I think to come to the question you need for that to happen politicians need and need a culture where they understand how important mental health is and what I think the sports stars and you know members of the royal family and celebrities have done is they've helped to give permission to all of us to be able to articulate what is actually happening in our inner lives and be able to bring that a little bit closer to what you see from the outside and so I I think because so much of the experience of poor mental health is linked to a deep sense of shame and it is and stigma it has been incredibly powerful for people to speak so so so confidently and so powerfully and we work with the you know actors like David Hairwood or sport people like the former head of the PFA Clark Carlisle and and he they are they are really powerful ambassadors aren't they and it just it's just so important particularly in mental health that you we can see people and say it's it's okay and I feel validated in my own experience and when we work in communities the work that I think the work that Shruti is doing the work that we are often doing with with marginalised or at risk groups it's actually in some ways what's actually happening psychologically is very similar you're providing a space where you're signalling that your experience is legitimate it's it's okay to be heard and what those when people come and tell their stories in the public domain is contributing in a slightly more diluted way that same permission to own our own stories and be able to share them and and and have the right to be heard I think it's it's a really it's a really welcome step forward yep Shruti yep so I would I think that's a great question actually it's in great belief for individuals to be able to step forward and to share their their experience of mental health I think I've read a few places that you know would want to do that that you know that you're some some way along the journey of healing so that's that's quite powerful as well to to kind of have that acknowledged and I agree with the points around kind of mental health literacy and I think that's hugely important in schools both for workplaces as well I still think we've got a huge huge way to go in workplaces and organisations to normalise mental ill health and to prioritise the importance and mental well-being within those spaces and I I yeah I know that there's still a lot of stigma around mental health and workplaces and not everybody can feel that they can they can speak up about their experiences and indeed managers you know don't sometimes don't know how to spot spot the signs of mental ill health or even know how to handle a conversation or a situation with an individual who might be kind of experiencing and you know sort of in health and trauma so I think we've got a long way to go across the piece but certainly what the pandemic has done is put mental well-being and mental health up there again you know in organisations I certainly know that from where I work in my day job from a earlier point of view we absolutely we obviously support the mental health and well-being of women in communities and we we very much recognise that the women within the communities are the experts so we we have champions for well-being programme which is where individuals who have looked after their own mental health and their family's mental health are able to understand their mental health rights their human rights and they are able to go out into the community and begin to kind of challenge some of the stigma that exists particularly within Black and Asian minority ethnic communities around mental health and depression and anxiety and that's been really powerful because they've been able to act as advocates they've been able to share their own experiences and they've actively kind of challenged some of the abusive cultural practices that that lead to to support kind of mental health within communities so that's been a really powerful programme for us and and I guess in a small way and can kind of speak to the examples of some of the celebrities you know who've been speaking out about their experience and we run a young Sahelia programme which is for young women and I know from speaking to the youth workers there that when they have seen an individual in the in the kind of public light who shared their experiences it's something that they've resonated with really strongly and it's been really a motive you know and they've brought that into the safe space that we've created for them and again it's encouraging you know open conversations about these things which is really really good. Thanks for that and I think that mentioning workplaces in particular I think there's still an awful lot of work to be done in helping employers deal with the mental health of the people who work for them and understand you talked about literacy around that because it still feels very much that a person is sticking the head above the carpet even admitting to some the person who's effectively in charge of their their living that they might be struggling with their mental health and need certain things from their employers in order to be able to still function and and look after themselves and I think that's an area that still needs an awful lot of work. I'm going to I'm going to roll two questions of that from from the audience that there's two individuals Kathy from Edinburgh and Graham and Dumfries talking about climate change so I'm going to roll them into one Kathy it's optimistic to think of the future of the pandemic because I once in a century event but with climate chaos and the fragility of the planet there will be many more challenges to our physical and mental health what challenges do you think climate chaos will bring for mental health and Graham's asking a similar vein what plans are in place to tackle eco anxiety and related mental health issues around the climate crisis so both are asking what we've got you know obviously the pandemic has an effect on our mental health but the big the big crisis if you think pandemics a crisis we've got this looming crisis of of you know eco anxiety is that is the phrase that Graham used so sure to have you had a chance to think about that you and how it might relate to some of the that some of the people that that that you may imagine that you possibly have some women who have maybe come to live in Scotland as a result of the impact of climate change where they've lived before yeah sorry my mother think he was getting muted and unmuted and so I'm back now but yeah so you know some some of our service users have come from countries where they've you know they've experienced war or the settlements and I think some might have experienced kind of climate crisis as well and some have experienced really traumatic journeys to to arrive to Glasgow, Edinburgh or somewhere else in Scotland but I guess what we've as I kind of earlier on is that when an individual comes to us we we very much look at the whole of the individual and the whole person to try and understand where they've but if you know the experiences that they've had but also what kind of what services they might need and I guess you know we have seen COVID and we never thought a COVID would happen and we are you know as one of the quest people who ask the questions and said that you know we might experience something very similar again in the future and and we have got you've got the climate crisis on hands and I can only see you know a greater number of people with kind of eco anxiety you know kind of in Scotland and maybe some of those might access our services certainly you know we work with refugees and asylum seekers and we might see an increase from communities and from some of the countries of origin there as well it's something that we haven't hugely been you know considered because a lot of our work is based around gendered abuse and also racism as well but it's something that I do think that we need to be mindful of particularly since as I said some of our service users come from countries who might be affected by climate crises. Yeah it strikes me that the effect of the anxiety around the the climate crisis might manifest itself in a lot of young people you know because the licks of me in my 50s I haven't got I've had the most probably of the life I'm going to get but if you're a young person and you're looking to your future then what your life's going to be like when you're 50 as well so I guess that's another thing. Mark do you have any thoughts on that? Yeah lots of thoughts it was really interesting we did last year's mental health awareness week which we've run for since the year 2000 I think we picked the theme of nature and the link between our natural environments and our mental health and how important it is to be able to tie these two things together because I think they are the two big social issues of our day. In the our ongoing pandemic study we found that particularly in Scotland actually people's access to nature was one of the key ways that the most important way they've they talked about supporting their mental health so we've got to be able to tie up I think it's going to be really important that we add mental health as a string to the bow for protecting and taking action on climate so it needs to be done for its own sake in terms of the future of our planet but we need to strengthen every argument we can including it's really clear that we can't experience good mental health with the destruction of biodiversity and an unstable climate and I think one of the things that came through from the pandemic study one of the things that we've learned is that even if you are not directly affected by the pandemic the the environment of uncertainty will affect your mental health and that's why young people who had the least to worry about in terms of the physical risks of the of COVID had the highest rates of anxiety because they hadn't they they had the least control and they also had the least they were most susceptible to this context of uncertainty and unpredictability and in our study in the qualitative studies quite a few people who who we talked with groups who had particular risk factors who were either living with existing mental health problems or living with existing long-term physical conditions they did say look this pandemic's been tough but I've learned how to handle tough situations in a way that young people haven't had the opportunity to reframe and get that perspective so with the climate crisis we we know we have to be able to understand how do we face the problem straight on and not be overwhelmed by the size of the problem then there are psychological steps we can take to get the best of that balance and I think that's going to be really crucial not least the the fact that we can identify what we can do it's so important that we aren't we have a sense of agency in it and with COP26 coming up we've got a chance to use our voice take whatever action we can right to our political leaders do what we can in our local environment to increase biodiversity and you know they're just so linked they're just so linked so every time every time we engage with nature every time we take a step to protect nature or enhance nature that step itself is also great for mental health so the question is well made we we do need to hold on to hope in order to both catalyze the action we need and to protect our mental health so I would say with the climate crisis we need to be able to see the problem call for action and at the same time have a or way of holding hope out that we can that we we we need to push our political leaders for the change that's necessary and that it will be made because without without hope it's it becomes difficult to be able to manage climate anxiety or any any form of uncertainty in a way that just sort of limits the the threat or the risk to our mental health and that that is a point that's well made because in the one hand in terms of how things like the climate crisis portrayed in the media it has to be hard hitting because it is a crisis you need to wake people up and decision makers but at the same time in terms it can see so and or seem so enormous and unfixable for the individual to know well what can I do that becomes almost too much to for you to be able to handle mentally so that's a point well made. I've got a question for Shruti from Moustak from Leicester and it's how can we break down mental health barriers for BAME communities? Yeah so this is a big question and you know we've been trying to do this for nearly 30 years up here in Scotland and it's not hasn't really worked so I'd say there's something around tackling stigma within minority ethnic communities themselves so there's still quite a lot of stigma and you know a lack of awareness around what mental health is but actually mental health is important and it is just as important as your physical health so it goes back to one of my points very early on around you know we are beginning to see kind of more broadly this bigger shift towards recognising that mental health and wellbeing is important and it isn't just focusing about the illness and we need to treat an illness but we've still got some way to go with that with some not all ethnic minority communities. My second point there was just around kind of tackling some of the stigma that exists within the communities but also particularly with women recognising and getting them to believe that they actually have a right to good mental health and to good mental health and wellbeing so that can be quite a long process in terms of you know you have an individual who you might have experienced quite a significant amount of trauma complex trauma most of the time to you know being treated again as a whole person so that's their mental and their physical and their spiritual health but then you know going through that realisation and that awareness around what their human right is and their human right to health and then being able to you know ask for help as well but then when you begin to move to that step as I mentioned earlier that there are still significant barriers for ethnic minorities to be able to access mainstream health services so you know this gets to the point where you know the community can't provide any more support and services and an individual really does need kind of specialist support we still have barriers in being able to access the mainstream and if an individual is able to access mainstream they can sometimes experience cultural and sensitivity and racism and there can be you know a significant amount of mistrust and distrust within services particularly if an individual is kind of waiting on an immigration status so it's it's really complex you know for a particular individual and this is the kind of complex cases that we we kind of build and work with every day so I think in order to break down the barriers I go back to one of my earlier points is that there needs to be a recognition around the complexity that that's that's kind of involved here but also the journey that an individual has to go through and also some of the cultural sensitivities that exist but there needs to be worked on within the communities to break down barriers but there's also work that needs to happen between third sector organisations who are specialists in supporting ethnic minority communities and working with the mainstream to effectively build bridges and to be able to kind of develop and build services and support that can really help so it isn't it isn't just a one action it's a number of actions and it's it's a whole kind of system approach that you effectively need to take there's further complexity within this because there's diversity within the diversity so you know what might happen with one individual from the south asian community will be very different to another experience for a woman from a different kind of south asian community and again that's built on an earlier point that I made that it's so complex working within ethnic minority community and it's recognising that complexity and being able to respond to that complexity so I haven't really got a straightforward answer for that other than it is complex and it will require a series of actors to take action but the bridges need to be built within the third sector and the mainstream to really kind of begin to affect some change here we've got we've got a lot of work to do a lot of work thank you Mike did you want to come in in the back of that thank you thanks and I thought that was an excellent answer shoot here and very lots of insight and maybe just just from from my perspective also just to add the point that it's not just on it's certainly not on minority ethnic communities to do all the work themselves and I think the process over the last 18 months as a leader in a mental health organisation is recognising how much more work can be done through transforming white-led organisations and white communities to be able to understand the the experience specifically around discrimination and racism and its connection to to poor mental health and I think the and the way in which systemic racism impacts life chances and how hard those of us who stand up and say well we were against racism need to work to be able to redress the balance but for better outcomes and and I think whether that's in recruitment processes within our organisations whether it's in the content that we're creating that is relevant and accessible for diverse communities to be able to be reaching so I just wanted to to add that that I think if we're going to break the barriers down within Black Asian and minority ethnic communities that's going to be a collective effort with all of all of us on board and certainly not not not not not left with those who often face some great discrimination to find the way the way through so I think I've probably got enough time to ask another question and apologies to those who put in questions that I haven't been able to get to but I'm trying to get a spread of themes and we've got a question from Arlie narrowly doesn't say if she's from but I'm guessing it's from a rural area because she's asking something that's you know I as a rural MSP completely I would be asking this myself how do we improve mental health facilities to access for those in rural areas for example those in the highlands and islands we have to travel to the large cities Aberdein Glasgow for treatment etc this is a real this is a real pressing issue and it often does come down to money doesn't it you know but you know we've got very very remote areas and some of whom are having to take actual flights in order to get the treatment that they need and it's been a problem for a long time so your thoughts on that maybe I come to mark first and then Shruti you can maybe come from your perspective yeah just again I just come back to I think there's a that we would let's start with what are the assets in any community or place that can be used in that place to support people's mental health and in in I was in in the islands in the highlands and islands last summer and there's tremendous what I saw was tremendously close knit communities there is social isolation there is poverty there is there are some risks to mental health which I'm sure need to be addressed and I think the first the first thing I would say from an outsider's perspective is to say can can we identify what are the assets in those communities that can help protect people's mental health and I think sometimes that those are underestimated those social links those those networks those historic wisdom in communities that can and need to be drawn drawn out on and then but I think the the other part of the equation is that those communities that face the greatest risk do require the greatest resource and and I think it's it's important in public health terms to be mapping where the need is and then understanding what additional resource need need to be deployed in order to provide that extra support so I think the the answers I'm sure will are not you know not for me to to to prescribe but I think there is some principles around identifying the assets in community mapping who is struggling and why mapping out with the community what the possible answers are and and within that sometimes it will be professional help but not arriving at that answer as the first and only one but looking at at all of all of the options that we have available and including of course what what we can do in terms of digital digital support which is now you know possible my wife is a therapist and some of the best outcomes that she has with her clients are with people who she has never met and specifically for young people we are seeing some support online which enables young people to open up in a way that they find difficult in a face-to-face context but can do digitally and I think that's something that we need needs to be needs to be explored as well especially for rural and remote communities and it does keep on coming back to this in the community what's in the community how can we support things already there in the community the point that Triti made straight away about some more support for the third sector on coming back to that don't we? Triti your thoughts on the rural aspect of things? Yes I agree with a lot of what Mark has said I want to have too much to say this as an organisation as a healer we don't work in rural communities we work across the MA corridor so that's where our experience lies but I do know from the work that I do in public health that there are significant mental health issues in rural communities absolutely I think you know it's important to look at what exists within the communities so what what kind of physical infrastructure but also social infrastructures exist so you know on what can we build on what is the community saying that they need in addition to what already exists and I think you've both made the point that resource will be needed so it's about you know if we think about prevention and building on the expertise and those structure and support services within the community what can we build on there with the resources I think what what Covid has shown us is that you know we do have most of us do you have you know digital access although this might not be great in some rural areas so there is something just to think about you know is digital access and infrastructure up up to speed in rural areas I don't know enough about that it's getting there it's getting there but it's by no means started I wouldn't want to make the assumption that everyone has what I have and I just know that the work that we do at Sahelia but you know IT has been a solution to so many during lockdown and that's something that we've been able to utilise so we've been able to transfer a lot of our activities and counselling and case work online but it hasn't actually worked for all of our service users some haven't got the literacy to be able to use IT and some haven't actually got access to IT to be able to to use it and some actually live in highly controlled home environments um or they aren't the priority for use of IT so the priority will often go to men um for some you know IT has actually been used as a weapon of abuse yeah so you know I think it can be very easy to say um let's look at digital digital support digital infrastructure and digital access but if we think really broadly across you know all of the needs across all communities that might exist in any one place then you know we need to that's when it becomes really complex again but that's when we really need to talk you know two communities about what is needed what is what is the greatest need and and to be able to try and meet that need and and that does mean resources but it also means different ways of working um again very much building on on what community and infrastructure what do you exist um so this is the the difficult part where I have to bring the event to to close when you've opened up so many things that we can talk about in depth for for hours and hours when I asked you both that I think you're prepared for this we want a minute from you on what you would like to leave the audience with from your perspective around the centering mental health should we we'll come to you first and they'll come to mark yeah for me um moving mental health must be part of a whole systems approach to change determinants and mental health if you take that public health approach um it interacts with other inequalities in society um and it puts some people so in our case women and girls are far higher risk of poor mental health than others so we need to tackle inequalities but we need to look at tackling all of them um we don't live in silos so we can't develop policy in this way um we also need to tackle structural inequalities so again you know a lot of our women experience racism within the system um so we're not only going to find the answer solely in mental health services again we need to look across the system but we need to tackle the inequalities that are deep rooted within the system um it isn't going to be easy and there is I've made this point several times but there is a need to understand the complexity of the issues involved um and the people who understand some of the complexity of the issues involved so the causes and some of the consequences of mental health and what is needed are third sexual organisations and absolutely as we move forward you know and kind of recovery and renewal particularly around mental health but looking across the kind of broader whole whole systems approach um third sexual organisations need to be at the table there need to be part of that kind of you know decision making that policy making and the design of new services as well as the delivery of new services you know we need to be there from the outset we can't just be there picking up the pieces you know we want to be um sharing the expertise that we have um and make this point already but Sahili has been doing this for nearly 30 years we have a really deep understanding of what is required and we want to share that and mark a minute from you thank you I thought that was an excellent answer Shruti and I think you know when um if I if you we have to learn as a society how to help uh to help our young people learn how to be human and how and those young people can help uh us adults to learn how to be human too and and and I think um we have come out of this pandemic recognising that our health is our number one asset or number one priority and mental health is the number one driver of disability and it's the number one predictor of our physical health so our mental health is is people have recognised that and you know both in Scotland and in England and in Wales for the first time we are seeing cross sectoral plans being put in place to put policy in place and so those plans are beginning and I'm quite optimistic that we can translate that into a real understanding of how to take a public health approach and I think the gains of doing so uh would be huge I think it would be the biggest step forward for us as a society and it's it's a step we've got to collectively push for and be ambitious for and and to ensure that we make progress happen. I want to thank you both Shruti Jane and Mark Rowland for for your incredible contributions given certainly given me enough a lot to think about and thank the audience as well for some great questions. Can I also thank Helen Dunipace and Heather Graham who have been providing our BSL interpretation as well today and take the opportunity to remind you that this is the final year in this year's October festival politics but we're going to be running free online festival events from next month so keep on checking the festival politics website because there'll be other opportunities to join in these discussions and that's it thank you very much good night