Brexit and Scotland’s mental health
27th July 2016
SAMH’s Public Affairs Manager, Carolyn Roberts
Since the EU referendum result, there has been speculation, consternation, jubilation and occasionally fabrication about what it might all mean. But little has been written so far about the implications for mental health in Scotland. This paper builds on existing policy work to set out four areas in which mental health might be affected. It aims to inform debate and help to make sure mental health isn’t neglected as we move towards a post-EU UK. It does not take a view on whether Brexit is positive or negative, but does reflect SAMH’s belief that rights and healthcare systems should be protected and properly funded.
Rights
People with mental health problems in Scotland have specific rights. Some of these, such as the right not to be treated in a degrading manner, stem from the European Convention on Human Rights (ECHR). These rights can be enforced through the UK courts, because they have been translated into the UK Human Rights Act. Leaving the EU would not automatically unsubscribe the UK from the ECHR, so it’s possible that British citizens could still enforce their rights by going to court in Strasbourg. However, our new Prime Minister Theresa May has made no secret of her desire to leave the ECHR and instead create a UK Bill of Rights (1).
The Scotland Act 1998 prevents the Scottish Government from passing laws that violate the ECHR. This probably means that rights under the Mental Health (Care and Treatment) (Scotland) Act, which governs when and how people can be detained because of their mental health, could not be diluted, although there is some debate over this. But laws stemming from Westminster, which retains control over areas like employment law and most welfare benefits, might no longer have to comply with the ECHR. And cross-border issues could become even more complicated than they already are. For example, the Scottish Government is updating regulations underpinning the Mental Health Act. The aim is to allow people detained under mental health legislation in other EU countries to be treated here, and to create procedures for such people to cross borders within the UK. Will these new regulations need to be unpicked post-Brexit? And if, as some have proposed, Scotland does remain in the EU, how will that affect cross-border provisions?
The Equality Act may also be affected. The TUC notes that EU law helped to defend most of the rights in the Act when the Coalition Government floated the idea of scrapping it in 2010. And the TUC goes on to speculate that Brexit could lead to lower compensation in discrimination cases and a more narrow interpretation of equality rights – a particular worry in mental health, which is already poorly understood in the workplace.
Healthcare
There is widespread recognition that EU nationals make a major contribution to staffing health and social care services. Around 8% of doctors in the UK come from the European Economic Area (EEA) (2). And about 6% of social care staff in the UK come from elsewhere in the EU. It has not been possible to source comparable figures for Scotland, although Scotland has proportionally fewer EU nationals than the UK (3) . However, Eve Hepburn of the Centre for Constitutional Change points out that Scotland’s ageing population, comparatively low birth rate and demographic challenges mean that posts may become difficult to fill. There are already concerns about Scotland’s ability to recruit to mental health roles, with 10% of general psychiatry vacancies unfilled for six months or more (4).
Helen McKenna of the King’s Fund has proposed that NHS and social care providers should retain the ability to recruit EU staff when there are not enough resident workers to fill jobs.
Departing from the EU will presumably also mean an end to the current reciprocal healthcare system. This could well be a problem for people who experience mental health crises while away from home: could they run up large bills for treatment and support?
Economy
If the mooted economic shocks of Brexit materialise, mental health could suffer. Mark Brown at One in Four suggests that the single biggest risk to the NHS is recession, and with the Fraser of Allander Institute reporting that Scotland is already flirting with recession and warning of the economic risks of Brexit, the potential for funding losses is a serious concern.
The President of the Royal College of Psychiatrists at a UK level commented prior to the referendum that Brexit would cut funds available to the NHS, and also stated,
I don’t believe there is a single scientist who does not think that being in the EU makes it easier to develop new treatments for mental disorder, and then to make them available.
Helen McKenna at the King’s Fund also points out that Brexit could affect the development of medicines. EU rules currently regulate medicines and medical devices, as well as clinical trials. These rules will have to be repealed or incorporated into UK law, and McKenna reports concerns the UK might lose out on some trials that would otherwise benefit patients.
The EU is a major funder of employability projects in Scotland. In Glasgow alone, with matched funding ESF offers £1.1m of employability spend for mental health. This is a funding stream that has been reducing for some time and will end by 2018, but Brexit presumably means Scotland will not receive a share of any replacement scheme.
Complexity
Beyond the policy specifics, there is a further factor for Scotland. Times were tricky enough for the Scottish Government, as they grappled with new powers from the Smith Commission, including the creation of new tax, welfare and employability systems. Ken Gibb and Des McNulty at Policy Scotland point out that the scale of the challenge is now unprecedented.
“They [the new powers] are as nothing compared to the requirements for expert analysis, negotiation and co-ordination across the thousands of often inter-related substantive areas affected by EU withdrawal”.
Gibb and McNulty highlight the need for Scottish Government ministers to ride out economic risks, deliver competent government and potentially plan a new independence referendum campaign. With all of this going on, as well as direct negotiations with the EU itself, how much energy and resource will be available for mental health? Many elements of the Mental Health Act 2015 still need to be enacted. And we are due a new mental health strategy this year. In the SNP’s 2016 manifesto they committed to SAMH’s call for an Ask Once, Get Help Fast mental health system. Ministers now need to deliver this, but the distractions will be immense.
Kirsty Hughes at Friends of Europe has outlined the possible options for Scotland, including the possibilities of executing some fancy footwork to continue our membership of both the UK and EU, or moving swiftly to a second independence referendum. Plus there is the possibility of a general election, if Theresa May decides to make the most of the traditional honeymoon period for a new PM.
Right now, the only certainty is uncertainty. SAMH will be doing our best to make sure Scotland’s mental health is not sidelined in the constitutional stooshie that’s approaching.
With thanks to Kirsty Hughes at Friends of Europe and Marguerite Regan at the Mental Health Foundation for suggesting sources to inform this article. Views are author’s own.
- For a detailed discussion of the Brexit’s effect on mental health-related rights see Felicity Auer, Mental health: focus, Legal Action May 2016
- Health Service Journal, GMC reassures EU doctors working in UK, Adrian O’Dowd, July 2016
- Scottish Parliament Information Centre, The Impact of EU Membership in Scotland, 2015
- ISD Scotland, NHS Scotland Workforce Information, March 2016
