Mental health and wellbeing in the Scottish islands: A review of the literature

The main aim of this literature review was to describe the state of the art of research on mental health and wellbeing in the Scottish islands.
A mapping review was conducted to profile research activity in relation to six island groupings:
1. Shetland Islands
2. Orkney Islands
3. Western Isles (Outer Hebrides)
4. Isle of Skye and The Small Isles
5. Islands off the Argyll coast (including Isle of Mull, Jura, Islay, Bute)
6. Islands off the North Ayrshire coast (including Isle of Arran, Great Cumbrae).
Research works were identified through searches of academic databases and organisations’ websites, conducted in January and February 2022.
A total of 80 works, linked to 53 studies published between 1977 and 2022, were identified with relevant content on the topics of mental health and wellbeing that was attributable to one or more of the Scottish islands. The works were comprised of 38 journal articles, 34 reports, two book chapters, and six PhD theses. Most were empirical in nature, with a few commentaries, conceptual and methodological pieces.
Relevant works were found for each of the island groupings, although the coverage was variable in terms of both the number of works (and associated studies) and nature and extent of the focus on mental health and wellbeing, and/or the island context. The Western Isles were represented in the largest proportion of the works and associated studies identified. Surprisingly, relatively few studies included the Orkney Islands.
Only a portion of the overall works were explicitly interested in the connections between island life and mental health and wellbeing. Those that explored these connections generally showed that there were variations between and within different island communities, and between islands and other places. The topics most commonly examined were: telehealth interventions, social prescribing initiatives, and participation in cultural and community-led projects.
While the heterogeneous nature of the works did not lend themselves to a narrative review or synthesis of the evidence, some common themes were identified in the process of classifying and summarising the literature. These included issues with
and concerns about access to specialist mental health services and support, stigma, confidentiality, alcohol consumption, suicide rates, and digital inequalities and engagement. They also included insights about the importance of belonging and feeling connected to communities, the 'double-edged sword' of living in small communities, and the experience of minority stress or similar if not considered to be an accepted or equal member of a community. They also revealed strong interest in and support for different forms of connections that sustain mental wellbeing, and community-led and place-based approaches to mental health and wellbeing.
Based on the findings, ten priorities for future research are suggested:
1. The survey of adult residents in all Scottish islands (Wilson et al., 2021) is repeated periodically to provide longitudinal data for analysis over time, enabling examination of the impact of the Covid-19 pandemic on mental health and wellbeing, and also expanded to include children and young people.
2. In-depth qualitative research with island residents and service providers, examining their experiences of and responses to mental health issues within and across different island communities, to identify the characteristics that are considered to make some communities supportive and resilient, and others less so.
3. The use of sampling frameworks that include island populations in wider studies of people with mental health conditions where possible, with data being analysed and reported by geographical sub-populations (providing this does not risk identifying individuals).
4. Research investigating the factors involved in deaths by suicide in the Scottish islands, and measures to prevent them in this context.
5. Research on the mental health and wellbeing of care staff.
6. Research on models of service delivery for relatively small numbers of island residents with specialist needs, including access to specialist staff (e.g. eating disorders, self-harm) and places of safety.
7. Research investigating which configurations of in-person and remote mental health consultations works best, for whom, in what circumstances, for island residents - and how this can be facilitated in flexible and responsive services models of care. This research needs to consider the needs and preferences of various groups, including children and young people; older people; men; and minority groups (e.g. LGBT, migrants).
8. Research examining the social and place-based determinants of mental health and wellbeing in island populations.
9. Research that builds on existing international research investigating the benefits of the natural environment and cultural activities for mental health and wellbeing, for example, by examining the effects of participating in associated activities in the Scottish islands for residents and for visitors.
10. Research investigating in more detail the nature of 'connected' communities, to establish empirically the ways in which they are created (and eroded) over time and how they relate to the experience of community mental health and wellbeing, as well as to apply existing or develop new theories explaining the observed variations, associations, and contradictions. A place-based approach would enhance understanding of the inter-play of different contributory factors in island communities, considering the uniqueness of given island populations, their relations with neighbouring islands and/or mainland communities, and arrangements with associated health and social care systems.