(5 years, 11 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)
I beg to move,
That this House notes that the UK is facing a mental health crisis; further notes that, according to the Independent Review into Mental Health in the Workplace 2017 commissioned by the Prime Minister, each year 300,000 people with long-term mental health conditions lose their job; recognises that Centre for Mental Health research shows presenteeism from mental health is estimated to cost the economy £15.1 billion per annum; acknowledges this same research shows it costs the economy £8.4 billion per annum for mental health absenteeism; considers that a recent poll by OnePoll found that 38 per cent of people reported being stressed about work; observes that the Health and Safety Act 1974 made it a legal necessity for workplaces to train someone in medical first aid; and calls on the Government to change this law via secondary legislation to provide clarity that an employer’s first aid responsibilities cover both physical and mental health and to add a requirement for workplaces to train mental health first aiders.
It really is a pleasure to speak in support of this motion, alongside its co-sponsors the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Plymouth, Moor View (Johnny Mercer). The application for this debate was supported by more 60 Members from all parts of the House, and we are very grateful to the Backbench Business Committee for allocating time for our discussion today.
Following the particularly challenging moments that this House has experienced over the last few days, today’s debate is a salutary reminder that the work of this Parliament goes on, and that we are capable of debating in a constructive and collegiate fashion. Our motion addresses a real and pressing need to support people affected by mental ill health. Our argument is simple. The Health and Safety at Work etc. Act 1974 ensured that every large workplace has someone trained in medical first aid, and that is now an accepted and established part of every office, factory, warehouse, hotel and anywhere else that people work; so why not a trained mental health first aider in every workplace? We want to change the Health and Safety Act via secondary legislation so that an employer’s responsibility explicitly covers the mental health as well as the physical health of their employees. This debate is a true cross-party initiative, calling on the Government to make a small change to the law that would constitute a step towards establishing parity of esteem—real equality between physical and mental health.
Sir Greg Knight (East Yorkshire) (Con)
This is an excellent motion. Does the hon. Lady agree that when workplace training on first aid—including mental health first aid—takes place outside the workplace, the employer should be required to give the employee time off during working hours to attend?
Luciana Berger
There are many different ways in which this could be implemented. I myself have attended mental health first aid training at the workplace, but I certainly would not be averse to employers giving their staff time off for such training. I will later come to many examples showing that this is already the case with a number of employers, particularly large employers, across the country.
This debate was born out of the “Where’s Your Head At?” campaign, which was launched by campaigner Natasha Devon and supported by Mental Health First Aid England and Bauer Media, which have together collected over 200,000 names on a petition that a number of us delivered to No. 10 Downing Street. I commend those organisations for all their hard work, and pay tribute to their commitment and determination to see this positive change introduced. It really is admirable. Bauer Media—an organisation with radio stations and a number of magazines, such as Grazia—has really taken the idea forward, paying for billboards across the country to promote the campaign. I commend its social action on a matter that, as an employer, it knows would make a difference in its own workplaces.
This really would be a simple shift, but one with a huge beneficial impact on the lives of millions of British workers. No one can seriously contend that there is not a need for such a measure. Hon. Members only have to look at some of the statistics. NHS Digital suggests that one in six adults experience mental ill health, including depression, anxiety and stress-related illnesses. There are around 28 million people in work in our country, so it is not unreasonable to assume that 5 million people in work today are affected. In a recent poll, 38% of people reported being stressed about work. It is a tragedy that, according to the Stevenson-Farmer “Thriving at Work” report—a review commissioned by the Government and published just over a year ago—some 300,000 people with a long-term mental health condition are losing their jobs every single year.
Mary Creagh (Wakefield) (Lab)
I congratulate my hon. Friend on securing this debate. She is making a powerful case and is describing an epidemic of mental ill health that has many different sources. The Environmental Audit Committee is looking into this as part of our planetary health inquiry. When I met my local Wakefield UK Youth Parliament, I was struck by how concerned the young people were about mental health in schools, and I discovered that South West Yorkshire Partnership NHS Foundation Trust has provided mental health first aid training in schools for teachers. Does my hon. Friend agree that that needs to be rolled out across all schools so that teachers or trusted adults in schools can deal with young people and children in crisis?
Luciana Berger
I thank my hon. Friend for her important intervention. Of course, today we are talking about what happens in the workplace, but what happens with young people in places of education is equally critical. I sit on the Health and Social Care Committee, and we have interrogated the Government’s plans for the next generation and young people. There are plans in place to have a designated mental health senior lead in every school, and we should ensure that at least one person has that training. We could be doing better than that, but at least it is a start. I support the idea, and it is great to hear what is happening in my hon. Friend’s constituency.
Let me be very clear that we are talking about a huge number of people affected in our country every single day—our friends, colleagues and workmates who surround us. There is, of course, a huge economic cost as well as a very significant human cost. The Centre for Mental Health estimates that people with mental health conditions staying at work longer than they should costs our economy over £15 billion every single year, and that people being absent from work because of mental ill health costs our economy £8 billion a year. These are not insignificant sums. I reiterate that 300,000 people with a long-term mental health condition are losing their jobs every single year because they find themselves in an acute state, have to leave work, are not supported and get to a critical state, rather than having experienced early intervention or prevention, which might have helped them in the first place.
The Health and Safety Executive says that 15.4 million working days were lost in the last year alone because of stress, depression and anxiety, and the British Association for Counselling and Psychotherapy—I declare an interest, as I was recently appointed one of its vice-presidents— has calculated that stress is costing British businesses £1,000 per employee per year in sick pay and associated costs. That is very significant for the national economy, and for individual organisations and businesses. I do not think I need to set out any more statistics to evidence the fact that there is a clear need. Mental illness is having a significant impact on millions of workers across the country and costing our economy billions of pounds.
Dr David Drew (Stroud) (Lab/Co-op)
My hon. Friend is making an excellent speech. As we have all heard in our constituency surgeries, one of the real costs is that people who suffer from mental illness find it very difficult to get back into employment because of the stigma, and I have to say that the public sector is among the worst at having a bias against people with mental health problems. Does she accept that?
Luciana Berger
I thank my hon. Friend for making that important point. I am going to move on to talk about tackling the stigma and discrimination that we know still exist in our country. We have made some progress in the national conversation about tackling mental ill health, particularly with the younger generations, but in too many workplaces and too many communities, there is still the discrimination and taboo connected with mental ill health. As a constituency MP, I see that almost weekly. Men of an older generation feel that they are able to talk to me because I campaign on this issue and am very open about it, but they are perhaps unable to speak to their work colleagues—sometimes not even to their close family—because of the discrimination that they feel still exists. We are certainly on a journey as a country.
One objection to this proposal might be that mental health requires highly specialist medical intervention, not someone in the workplace with only a few days’ training—and of course that is absolutely true. Mental health conditions do require specialist diagnosis and treatment. That is why many of us, on both sides of the House, have been calling for more investment in this area to ensure that we have the clinicians within our NHS to address the mental health crisis in this country. But let us be very clear that this motion, with this specific initiative, is not seeking to substitute mental professionals with mental health first aiders. Mental health first aid training gives people the knowledge, the skills and the confidence to intervene early if someone is struggling with their mental health. It is not in any way intended to be a replacement for trained mental health professionals, either in the NHS or in our workplaces; rather it offers an early warning system and an opportunity for employee support. It is also, in response to the point made by my hon. Friend the Member for Stroud (Dr Drew), aimed at tackling the taboo that we often see. Raising awareness of mental ill health and placing it on an equal footing with physical ill health tackles some of the stigma and discrimination that we still have to break down.
If any colleagues would like a clearer explanation, let me say this. All of us here present would know where to go for assistance if we had a physical injury. If we had perhaps slipped, or had a burn or a cut, we could go to the officers just down there through the Chamber. Perhaps, either in this place or in a previous role, we were that first aider. But how many colleagues, or their staff would know where to go if they were struggling with their mental health? How many would have known who that person was, or if they existed at all, in their previous job? Training people in our workplaces in mental health first aid would mean that employees in workplaces right across our country had an instant answer to that question.
No one should assume that a mental health first aider is the same as a mental health professional, any more than anyone assumes that a current workplace first aider is the same as a heart surgeon, an A&E doctor or a cancer specialist. The point is that a mental health first aider provides early intervention and a critical and important signpost. They would be able to answer questions about how and where to go to get treatment. They can help to change the culture in an office or on a shop floor so that someone with a mental illness has support. They can provoke a conversation about mental health that can break down some of the stigma and prejudice. They can be a valuable first point of contact for someone struggling with their mental health in what might otherwise feel like a very lonely environment.
We do not need to talk in purely hypothetical terms. At the end of last year, the Where’s Your Head At? campaign sent a letter to the Prime Minister in support of statutory mental health first aiders. It was supported by over 40 businesses, including WHSmith, Standard Chartered and Thames Water. I am particularly proud to say that a friend of mine and good Labour colleague, Sadiq Khan, the Mayor of London, has, in the capital, done so much on mental health first aid training at City Hall and in London’s schools as part of his public health strategy. St John’s Ambulance will have trained 10,000 people by the end of this last period. Mental Health First Aid England has now trained over 350,000 people in mental health first aid. Councils are investing in this and other providers are making similar strides forward. Those who have completed the training say it is hugely beneficial to them and their co-workers. It gives people the skills, knowledge, confidence and language to spot the signs of mental ill health, provide support and make early interventions. But most critically, it is helping the people affected. It really can make a difference.
One of the elements of the mental health first aid training that I completed was about what to do if someone you work with is experiencing suicidal ideation and might be considering taking their own life. Some 6,000 people in our country have taken their own life in the past year and this particularly impacts on young men. This is an area where quite often people do not know what to say or do, but training such as this, and training from the Zero Suicide Alliance, which offers a free online half-an-hour session, are the tools that can really make a difference. In some cases, it really is a life or death situation.
A number of unions have come out in support of the change to the law we are seeking to make today. Community, The Teacher’s Union and Unite were all signatories to the letter to the Prime Minister I just mentioned, and the Communications Workers Union and the GMB have since joined calls for this change to the law.
The costs of training—another question that is often raised—are very clearly outweighed by the benefits of better mental health in our workplaces. Training can typically take place over a number of days, but it can also take place over one day—or half a day, providing opportunities particularly for small businesses and organisations to train people in mental health first aid, too. The training that I did was with the Liverpool city region Mayor, Steve Rotheram, and the senior leadership of Merseytravel in Liverpool. I have half a day left to do, but I have done almost the whole course and seen what the benefits can be. So we do not need to gaze into a crystal ball. We can talk to people who have been trained. But again, in particular, we can reflect and engage with the people who have been helped.
I would like to share some of the thoughts of organisations that have gotten in touch in recent days to share their experience of training mental health first aiders, the value they place on this important initiative and why they are supporting our call today. The insurance company AXA has trained over 100 of its staff to become mental health first aiders, so now each of its UK offices has one. It has also trained as mental health first aiders the staff of the companies that it provides insurance to, helping other businesses across the country to improve mental health in their organisations.
Another success story is that of Thames Water, where 350 employees across the organisation are trained in mental health first aid. They wear green lanyards so that they can be easily identified by the wider workforce. A further 250 employees have joined the company’s mental health online engagement forum. Thames Water has calculated that there has been a 75% reduction in work-related stress, anxiety and depression among its employees—a not insignificant impact.
Colleagues may not know—I was certainly not aware of this—that the construction industry is the sector where workers are most affected by mental ill health. In response to that, the Construction Industry Training Board has now committed £500,000 to the Building Mental Health initiative, which will train 156 construction workers as mental health first aiders. Further to this, Mates in Mind is a fantastic charity that works to address the stigma around poor mental health and improve positive mental wellbeing in the UK construction industry. It aims to have reached 75% of the construction industry by 2025.
I give these examples as evidence to colleagues that a number of businesses across the country have been proactive in their approach to mental health and are reaping the rewards. There are many more I could have shared, but I am conscious that many Members want to contribute to the debate.
This is an idea whose time has come. In a decade from now, when mental health first aiders are an established part of the workplace, we will wonder why we did not start sooner. It is good to have the Minister here today. As I am sure she recognises, this is a measure that can bring us together across party lines. The Minister and the Government have the chance to do a really important thing in supporting this motion. I should say that that is in line with their own pledges in the Conservative party manifesto in 2017. The Government have the opportunity to amend the 1974 Act and to take a clear step towards achieving real equality.
The term, “parity of esteem”, may seem meaningless, but it means real equality between physical and mental health. We legislated for that principle in the Health and Social Care Act 2012. We are now seven years down the road and still waiting to realise that ambition. The Minister will also know that the Prime Minister has been clear on this from the start of her premiership, when she made the commitment to address the inequality between physical and mental health one of the key “burning injustices” that she wanted to erase. This motion, and the policy that it seeks to implement, gives the Prime Minister and her Government the opportunity to solidify her commitment to this mission.
Unlike certain other matters that we are discussing in the House this week and over the weeks ahead, this initiative has cross-party support. It has the support of businesses and of our constituents—over 200,000 people have signed the petition. It has the support of so many mental health campaigners across the country. I sincerely hope that all Members on both sides of the House will support it here this afternoon.
Johnny Mercer (Plymouth, Moor View) (Con)
I pay tribute to the hon. Member for Liverpool, Wavertree (Luciana Berger). She is right that it is wonderful to be in this place today with the noise dialled down, so that we can work on and think carefully about one of the most important issues in this country. Mental health is the No. 1 challenge for millions of people in this country every day. If we can meet that challenge in some way by working in the collaborative way that she talked about, that is wonderful. I am really pleased that she has secured this debate and that the Minister is here to listen to it. I also pay tribute to the right hon. Member for North Norfolk (Norman Lamb). The three of us have worked together on a number of issues. Like in any team, there are those who lead from the front and do all the heavy lifting and hard work, and that is definitely not me. I want to say a massive thanks to them for their efforts in getting us here today.
When I came into this place in 2015, I talked about how I wanted to end in this Parliament the stigma around mental health. I have found since then that there is still this—it is hard to understand—air around suicide that people do not want to talk about or address, but it remains the biggest killer of men under 44 in this country. Unless we talk about it, we will not come up with ways that interdict and meet the challenge.
Liz Twist (Blaydon) (Lab)
I thank the hon. Gentleman for giving way and congratulate my hon. Friend the Member for Liverpool, Wavertree on securing the debate. Does he agree that we need not only to encourage people to talk through industry schemes such as Mates in Mind; we also need to listen? That is why the move towards mental health first aid workers is so important.
Johnny Mercer
The hon. Lady is right. There is no point in getting people to come forward and talk about mental health, which can be very difficult, if we do not have the services or access to them to help them, after they have made themselves vulnerable in that way. That is why I am so keen to keep our foot to the gas and ensure that we start delivering on this. We have made progress—that is undeniable—but clearly there is a long way to go, and I will come on to that.
I want to address the point about legislation. As someone who does a lot of work in the armed forces community and on the armed forces covenant, I know that people will say, “Why legislate?” I have learnt in this place that we can have a number of good ideas and initiatives that we can encourage people to do but, ultimately, this is too big a challenge to be left to personalities involved in companies at different times. Sometimes we have to legislate for it. This is not a problem for the companies that already do this, but sometimes the most vulnerable people in our communities deserve the Government legislating and letting them know that we are on side.
Tim Loughton (East Worthing and Shoreham) (Con)
I am sorry that I was not here for the beginning of the speech by the hon. Member for Liverpool, Wavertree (Luciana Berger). I was having my own health and wellbeing check with our excellent service here. The practice nurse was particularly keen to know about my stress levels, given the experience we have all had in the last week, but I am good for another few years.
My hon. Friend may know that I am the co-chair of the all-party parliamentary group on mindfulness, which is a simple way of looking after employees’ mental health. Before Christmas, we held a seminar here involving military figures. He knows, from his experience, the high level of mental health issues among that group. I am glad to say that the Army is now seriously looking at how this measure can be introduced, and why wouldn’t it? This is a win-win situation: if an employer looks after its employees and its workforce, they tend to do a better job, and they look after the company or Army unit better as well.
Johnny Mercer
I thank my hon. Friend for his intervention. He is right; the military has come a long way. It gets a hard time, but the Army in particular has come a long way on the importance of mindfulness and how much easier it is to keep a healthy mind than get better from a mental illness. I thank him for all the work he does on that. We all come to this place for different reasons, but there is no doubt that the mental health challenge of a decade and a half of combat operations has ripped apart the circle of friends that I grew up with, so I have a real passion for getting this right.
As the hon. Member for Liverpool, Wavertree says, we need to look at this in a slightly different way in this country. We are very good in this place at talking from the Front Bench about what we are putting into services in terms of money and priority, and that is extremely important, but we need to turn the telescope around and ask what it actually feels like to be in the community waiting for access to child and adolescent mental health services or mental health treatment. That is the true metric of what we do in this place. I strongly encourage the Government to look at that approach.
Why am I so interested in this? As everybody now knows, I have had OCD for a long time. Obviously, I like to pretend that it is some sort of distant memory, but my close friends and family know that it is not. It is much better, but there is no doubt that, if there had been mental health first aid when I was a boy, growing up and going into the military, my life would have been completely changed. We cannot underestimate how important it is to intervene early, when someone is so much more likely to get better. I will never forget the Saturday afternoon when I ended up in the Maudsley, thinking, “How did I end up here? How did this all start?” If policies like this had been talked about 20 years ago, millions of lives would have been very different.
I talk about this because it sends a powerful message: you can get better. People think that they are managing their mental health for the rest of their life, they reach their zenith and that is it. I cannot over-emphasise how wrong that is. Clearly managing a mental health challenge is a difficulty, but it can absolutely be done, and the chances of doing that are exponentially increased by early intervention. If we can get into workplaces and say to people, “We take mental health as seriously as physical health,” we will affect millions of lives, which is ultimately what we come to this place every week to do.
I pay tribute again to the hon. Member for Liverpool, Wavertree and the right hon. Member for North Norfolk, who have done a lot of the heavy lifting on this. There are not many people here today, but in some ways, that does not matter. There will be people following this intensely because they have a mental health challenge. They may be 15, 16 or 17-year-old young boys, like I was, who never talk about it and who learn about what is going on through their phone but do not even talk to their parents. When I spoke about my OCD in the Evening Standard, I had loads of phone calls the next day, but the best one was from a 16-year-old boy who said he had never spoken to his parents or anyone about it.
There will be a lot of people watching this debate who were devastated when it was cancelled before Christmas. They are the people we are here for, and that is why people like me speak out. It is not easy to speak about individual issues in this House, but I want to say to boys and girls who are watching this now and may be struggling: don’t think for a minute that because there are not lots of people here, and there is not the raucous shouting that we have seen in the last few days, this is in any way less important to many of us in this place. Just because we are quieter, it does not mean that we do not hear you.
There is a mental health revolution going on in this country—we have seen it start and people are talking about it. The Government have committed to parity of esteem. We are flicking over from meeting one in four mental health needs at the moment to one in three. Clearly there is a big unmet need and we have further to go, but it is an unstoppable direction of travel, and today is another point on that march.
I sincerely hope that the Government can take forward these recommendations. I slightly disagree with the hon. Member for Liverpool, Wavertree only on one point: parity of esteem does mean something. However, she is right: it does not if people in our communities do not feel it. It is not good enough here to say, “Parity of esteem is a wonderful thing. Haven’t we done well? We’ve put it into Government legislation.” It is meaningless unless the people who use the services actually feel like they are treated in the same way and have the same access to treatments as those with physical health problems. I commend the hon. Member for Liverpool, Wavertree and the right hon. Member for North Norfolk for the march we are taking on this, together with the stuff we have done on money and mental health. In this Parliament of immense turbulence, for those who are watching—the quieter ones, whom I have spoken about—this march will continue. They have some wonderful advocates in this place and we keep going.
Jon Cruddas (Dagenham and Rainham) (Lab)
It is good to see the subject of mental health in the workplace being discussed this afternoon, and I obviously congratulate colleagues from all parties who have secured the debate. To echo the point made in both speeches so far, given the recent discussions here, it is good that Members can come together and discuss subjects of national significance in a spirit of fraternity.
It seems to me that there are two basic elements to today’s debate: first, how to implore employers to accept their responsibilities to do more; and, secondly, to take the opportunity to showcase good practice in our communities, where employers are stepping up to the challenges in offering mental health first aid.
As we know, the backdrop is that we are increasingly aware of the scale of the mental health challenges we face. For example, one in four of us will experience a mental health issue at some point in our lives, according to the World Health Organisation. As has been mentioned, the report by Lord Dennis Stevenson and Paul Farmer, “Thriving at work”, has highlighted the costs of poor mental health provisions in the workplace. They suggest that some 300,000 people with long-term mental health issues lose their jobs every year, that poor mental health costs employers billions of pounds each year and that the economy in turn loses billions per year as a result.
The numbers are staggering and quite extraordinary, but the subject of our discussion is not really a question of overall economic utility; it is the suffering of our fellow citizens, and what a good society and what good employers should be doing about these profound challenges. We should think of it this way: a Business in the Community publication, “Mental Health at Work”, has found that 15% of employees face dismissal, demotion or disciplinary action after disclosing a mental health issue at work, which could mean that this reality applies to some 1.2 million people of working age in the UK. It has also told us that just 11% of employees felt able to disclose mental health issues to their line manager. These figures are appalling, so things have to change. That is why employers must do more to address these issues.
On the other hand, as I said, we should use this debate to highlight new initiatives where employers are stepping up to meet their responsibilities. I therefore want to reference the workplace mental health work of a company at the heart of my constituency—the Ford Motor Company.
Throughout last year, many Members may have seen or caught sight of the “Elephant in the Transit” film, which the Ford Motor Company put out, which was aired in TV ad breaks, in cinemas and, more generally, across social media in order to raise awareness of mental health issues. It is a short film—I would guess of only 30 seconds—and contains a pretty simple but very smart message. Basically, there are two young, working class lads in a Transit, and between them sits this massive elephant as the lads chat about their plans for the weekend. One clocks that his mate is not quite right—he has learned to see the signs—so he pulls over the truck to talk to him about it all. It is spot-on, and it really is aimed at a key demographic in this area—young, working-class males. In this instance, Ford has teamed up with Time to Change. It has sought to cut through the stigma, especially among young, working-class males, so that we can more openly discuss mental health issues.
This is not an isolated initiative on Ford’s behalf. It has also been working with Mental Health First Aid England to launch a training programme to reduce stigma, to encourage people to speak out more about mental health and to find safe, non-confrontational spaces to talk. The idea is that, through this training, Ford dealers and managers will understand how to act as a first point of contact for a colleague developing or experiencing a mental health issue.
The training is to teach people to spot the signs of mental health issues, offer initial first aid help and guide a person towards the appropriate support, as well as about how to listen non-judgmentally, reassure and respond, even in a crisis. The training can also help stop preventable issues arising by building a supportive culture around mental health. It is to equip Ford’s key people in these roles with the skills to talk about mental health with confidence and without judgment. The way the company want to normalise the topic of mental health among their workers has impressed me, so today we should acknowledge such initiatives.
Ford has also backed the “Where’s Your Head At?” campaign—it was mentioned earlier—which is calling for change in workplace health and safety laws to protect mental health in the same way as physical health. If successful, it will ensure that every workplace provides mental health first aid as well as physical first aid, helping those in need at the earliest possible opportunity. Again, Ford has been working with Mental Health First Aid England for the training. Overall, I think we can agree that it is the responsibility of British employers to ensure that provision for mental health issues in the workplace meets the necessary standards.
I have to admit that I have many times taken chunks out of employers for what they have not done, and that includes the Ford Motor Company many times, compared with what they should be doing. Given that tendency, it is up to me to highlight good practice by the self-same employers. It seems to me that these initiatives by Ford should be acknowledged and put on the record in the debate today. More generally and simply put, it is good that we have time to talk about this subject this afternoon. Thank you, Madam Deputy Speaker, for giving me a few minutes to make a few points.
Peter Aldous (Waveney) (Con)
I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger), the right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) on securing this debate, and the Backbench Business Committee on granting it.
For many, first aid in the workplace has too often in the past been a green box that is kept in the corner and which, if we are lucky, is opened very occasionally when someone cuts a finger or scalds themselves when making a cup of tea. However, it is much more than that: not only can there be more serious physical illnesses to which we have to attend, such as a broken limb or a heart attack, but there are mental health challenges of which we need to be increasingly aware.
Very often, workplaces are highly stressful settings, which can accentuate mental health challenges. It is important that we put in place measures to reduce stress, to help pick up those first signs of mental illness and to ensure that people needing treatment and support receive it as quickly as possible. This is not only vital for those who are feeling unwell, but good for their employers.
I chair the all-party group on first aid, the secretariat for which is provided by St John Ambulance. I was on its management board in Suffolk before I came to this place. Mental health first aid training is increasingly being provided by St John Ambulance, which by the end of 2018 had provided 5,000 people with the skills to become mental health first aiders in their workplace, and this figure is due to rise to 10,000 this year. This is a good start, but it needs to be put in the context of 1 million physical first aiders in the workplace, requalifying on a three-year cycle. There is clearly a lot of work still to do.
I shall first highlight the research carried out by St John Ambulance, which shows clearly why we need to step up our game, and then I will move on to outline some cases that illustrate the benefits of embedding mental health support in the workplace. St John Ambulance carried out two surveys in 2018—one of 1,000 employees responsible for booking general first aid courses, and the other of 800 people who attended general first aid courses. The findings of the first survey prompted a variety of conclusions.
First, one in four people in work have left a job due to mental health problems. A further 43% of people considered leaving a job due to stress or mental ill health, yet fewer than one fifth of the organisations in which they worked had mental health policies in place. Conditions including depression and stress had caused nearly a quarter of respondents to miss work for a day or longer, and six out of 10 people asserted that their employer should do more to address mental health issues.
Individual responses from employees who took part in the research included a variety of comments:
“The company I work for are pretty archaic;”
“I believe my manager would mock me;”
“They recognise it as a valid condition but see it as an inconvenience.”
Nearly two thirds of people said that they would feel uncomfortable asking for a mental health sick day. On a more positive note, more than a third of people said that their employer recognised stress as a valid condition and worked to help, but more than a quarter said that bosses did little or nothing to help. In the second survey, more than half the respondents were unaware that employees have rights if treated unfairly by their bosses on mental health grounds, and nine out of 10 felt that organisations should have a mental health policy.
Both items of research indicate why the recent initiative by the Health and Safety Executive is so important. It has long been assumed that an employer’s responsibility for supporting mental health is covered by a standard risk assessment that takes into account all health and safety needs. In practice, however, due to the stigma attached to mental health, that simply has not been happening, and 44% of people do not feel able to tell their employer when they are feeling anxious or depressed at work, with most citing “embarrassment” as the main barrier.
There is overwhelming evidence of the need to embed a culture of mental health aid and support in the workplace. Last month St John Ambulance hosted a national conference with speakers and delegates drawn from such diverse sectors as construction, banking, retail, education, local government and the armed forces. Case studies included wellness programmes, a universal approach to mental health first-aid training, sleep training, talking groups for people as they tackled changing life circumstances, and the development of positive mental health champions. In one organisation, referrals to counselling by health professionals have fallen by 48% as a result of its initiatives, while another cited a 75% drop in absence due to work-related illness. The obvious impact on the bottom line has enabled senior leadership to buy into those programmes, which are now regarded as crucial to its success.
Having provided physical first-aid training for employers over many years, it is the experience of St John Ambulance that mandatory regulation will be necessary if every organisation is to give mental ill health the attention it deserves. It believes that further work is needed, especially among SMEs, to establish the right framework for such regulation. Extensive consultation will be required, and progress must be made in recognising the necessary impact on employees and employers. The Government must set out a firm timetable through which to consider proposals from experts, employees and employers, and they must consult on proposals for regulations to deliver parity of esteem, as called for by the Health and Social Care Act 2012, and implied by the Stevenson and Farmer report, “Thriving at Work”.
Norman Lamb (North Norfolk) (LD)
After yet another week of fractious and angry political discourse, what a pleasure it is to work with two honourable friends—I use that term advisedly—the hon. Members for Plymouth, Moor View (Johnny Mercer) and for Liverpool, Wavertree (Luciana Berger) on an issue of incredible importance. It is important that those watching or reading about this debate recognise that it is possible for right hon. and hon. Members to focus on important issues such as mental ill health, as well as fractious arguments over Brexit.
I thank the hon. Member for Plymouth, Moor View for what he said about his experience of OCD. Interestingly, OCD has also affected my family as our oldest son was diagnosed with it as a teenager. He has since spoken about his experience, and I speak with his authority and approval. What the hon. Gentleman said about the importance of people in his position speaking out about such conditions is important. I remember the moment when, as a teenager, Archie said to me, “Why I am the only person who is going mad?” For a parent to hear that from their child is awful and incredibly distressing, and it makes one realise what a teenager must be going through if that is how they feel about their situation. Of course that is an entirely false perspective, because one then realises that so many others are experiencing their own challenges, and when that realisation dawns, it makes it much easier for individuals to speak out. I thank the hon. Gentleman for what he said and for talking to the press about this issue, because cumulatively that makes a difference.
The Time to Change campaign has been incredibly powerful in helping to normalise mental ill health, and every time someone in a public position speaks out, it becomes a little easier for another teenager to seek help and not be frightened about opening up. I join the hon. Member for Liverpool, Wavertree in acknowledging the work of Natasha Devon, who is a great campaigner for mental health issues, and I thank Bauer Media and Mental Health First Aid England for championing this important cause.
On the cost of mental ill health, I wish to focus first on the cost to the individual, because it is often not recognised by those who do not experience it just how painful and disabling mental ill health can be. If someone is experiencing anxiety, depression or a condition such as OCD, their life is completely dominated by that. They often cannot enjoy life or be happy, and whenever we speak about the economic cost of mental ill health, we must focus on the most important thing, which is the cost to individuals of the ill health that so many experience.
Alongside that, however, there is a significant cost to employers—not just private sector employers, but the public sector, charities and so forth. Health and Safety Executive data show that 57% of days off work through ill health are due to mental ill health of one sort or another, and not confronting that represents an enormous cost to employers. This is not just about time off work, because many people end up falling out of work and on to benefits, and others turn up to work but under-perform—the concept of presenteeism—because they are not feeling on top of their game, or because they are obsessed by anxieties or concerns that prevent them from performing their work responsibilities effectively.
Addressing mental ill health is a win-win-win for everybody, because this issue affects not just individuals, but employers and even the Government, who gain as a result of us taking it more seriously. If someone falls out of work because of mental ill health, they end up claiming benefits, and that is an enormous cost to the Government and also impacts on the NHS. Everybody benefits by us taking this issue more seriously. The question then is how best to achieve an advance. The hon. Member for Waveney (Peter Aldous) made a very important point when he said that we need to think carefully about how we frame that.
Under existing law, employers are under duties to protect the mental health and wellbeing of their workforce. The Institution of Occupational Safety and Health makes that point very strongly in its brief for this debate. It makes the point that under the Health and Safety at Work Act etc. 1974 and associated regulations, employers are under a duty to manage the psycho-social risk to their employees at work. There is also the duty under the Equality Act 2010 to make reasonable adjustments where people are suffering from some sort of disability, including mental ill health. I also applaud the Health and Safety Executive for the new guidance it issued in November 2018. For the first time, it includes a section on mental health. That is important. These are all advances worth acknowledging. I would also like to acknowledge the work of Paul Farmer and Lord Stevenson, which was commissioned by the Government. Their report “Thriving at Work” recommends mental health core standards for every employer.
None the less, the first aid legislation is very much framed in terms of physical health. It is very important to establish clearly in legislation—just as we did in the coalition Government, where we legislated for parity of esteem in the NHS—a very important principle for the workplace: an equality in the importance of both physical and mental health in the workplace. I want to stress that it is about much more than just mental health first aid, vital though that is—I totally endorse all the comments made by the hon. Member for Liverpool, Wavertree.
I want to highlight the potential risks, as the hon. Member for Waveney made clear, of not getting this right. There is a risk of the tick-box exercise, where an employer can just say, “Yes, we have trained someone up in mental health first aid. We’ve done nothing else, but we have ticked the box and therefore we have met the regulation.” That would be a failure for all of us if that was the outcome of this exercise.
The more fundamental point is that the approach we should be taking is about preventing ill health in the workplace. The whole focus should be on creating healthy workplaces, where people are treated with dignity and respect. It is vital that employees across the workforce have the opportunity to raise their awareness and understanding of mental health. Alongside that, however, we have to think about the causes of stress and anxiety in the workplace. Often, it is due to unhealthy workplaces, where people are not respected and where there is a bullying culture. Depressingly, we see that quite often in the NHS. That has to be confronted, because that is the cause of so many people feeling anxious, distressed and depressed as a result of what happens at work.
Mr Kevan Jones (North Durham) (Lab)
Does the right hon. Gentleman agree that there are very simple things companies can do—BT and quite a few others do this—to improve work-life balance? For example, they can ensure that people do not have to answer emails late at night or over weekends, or, when people have bereavements, they have a sensible bereavement policy that supports the individual, rather than just allows for a number of days for an individual to get over it.
Norman Lamb
That is an incredibly helpful intervention. I totally agree with the right hon. Gentleman. It is about getting the whole culture in the workplace right on flexible working, understanding that parents sometimes have responsibilities to their children and carers have responsibility for an elderly loved one. Not working ludicrous hours of the day and night is also incredibly important. How we achieve the legislative change is very important. It is vital that we raise awareness through mental health first aid, but we also need a fundamental focus on the prevention of mental ill health in the workplace.
In the remaining minutes, I want to focus on some of the things we did in the west midlands. After I was chucked out of the Department of Health by the electorate in 2015, I was asked to chair a commission on mental health in the west midlands. Our whole focus was on how to prevent mental ill health and take a more public mental health approach. We focused particularly on the workplace. We first focused on how to get people who had experienced mental ill health and had been out of work—often for years and years—back into work. Work is actually good for people. Meaningful work, where we gain a sense of dignity and self-respect, is really important. We are undertaking—with £8.5 million of Government support, I should say—a randomised control trial, applying a strong evidence-based approach called individual placement and support. We give people intensive support to get them ready for employment, get them into a proper job and then support them in that job. We are looking at how we can apply that in primary care, so we capture people earlier, and give them access to someone who can train them and support them for employment. We want to change the mind set of GPs, so they are not just thinking about the sickness of their patient but how they can help them to recover and get back into work—that is critical.
I hope that as a result of the randomised control trial, we will be able to learn lessons which we can then apply across the country. If we can get lots of people with severe and enduring mental ill health back into work, we will achieve something very significant. Sadly, at the moment this extraordinarily strong, evidence-based approach is the exception rather than the rule. Most people across the country do not get access to it. The Government have made a commitment to double the numbers, but that is still a very small proportion of the total. It needs to be expanded rapidly.
Mr Kevan Jones
Is the problem that mental wellbeing is not hardwired into Government policy? Some policies, for example Department for Work and Pensions work capability tests and others, actually work against individuals. Voluntary work is very useful in getting people back into work, but at the moment there are limits around what people can do while they are still on benefits. Does the right hon. Gentleman think that some flexibility on that would help this process?
Norman Lamb
I absolutely do. I was going to say, “Don’t talk to me about the work capability assessment, because it will get me very angry.” We need reform of the welfare system to help to facilitate people returning to work, rather than just treating them as second-class citizens, as it often does.
Luciana Berger
I am listening very carefully to the right hon. Gentleman’s remarks, which are very pertinent. On people being in work or not in work if they are affected by a mental health condition, I was struck to learn that for my local mental health trust, Mersey Care, which provides services for the whole of Merseyside, the latest available figures—not the most recent financial year, but the previous one—show that just 3% of the patients under its care, in both the community and in in-patient services, were in any form of work. That figure is similar for patients under the care of many mental health trusts across our country. Does he believe that people outside this place might not be aware of that fact, but it is staggering and should concern us all? We should be doing everything possible to support people with mental ill health conditions into the workplace.
Norman Lamb
I totally agree. My plea to the Government is that, as we hopefully commit to spending more on mental health, we spend at least part of that on preventive measures. If we can get someone into work, it makes a whole difference to their lives. The evidence shows that many people who are helped back into work are then able to stay in work; reducing the burden on the NHS and the benefits system, but giving people dignity and self-respect.
Another initiative we are undertaking in the west midlands is the wellbeing premium. It was my idea, which again is being supported by the Government and I am grateful to them. The idea, which we are trialling over a year, is to give an incentive to employers to improve the way in which they support people in work by training their line managers—the most critical thing one can do—and see whether we can reduce the number of people who end up on sickness absence. The idea is to give them a temporary incentive for one or two years, for example by a reduction in the business rate or a reduction in national insurance payments. If by that we can reduce sickness absence, the number of people falling out of work through ill health and the problem of presenteeism, everyone benefits. It will be interesting to see how that succeeds.
In the west midlands, we are also pursuing the thrive at work commitment, which is trying to build a social movement of companies that all sign up to a commitment to up the level of support that they provide people, changing the culture in workplaces. A toolkit is provided to companies, and that could make a substantial difference across the region.
The action plan also has a commitment to train up 500,000 people across the west midlands in mental health first aid. That is a totally different approach to what we have been used to, which is an NHS very much focused on sickness and providing treatment for sickness after what is often a very long wait, as the hon. Member for Plymouth, Moor View pointed out. Instead, the whole focus of the system should be on prevention. If we do that, we can achieve a real breakthrough.
To conclude, let us amend the legislation and get mental health first aid to become the standard in every workplace. Critically, that should be part of a much wider programme that is focused on prevention and on building good healthy workplaces with the right culture, where people have respect, are engaged in the work they are doing and are treated with dignity. With that commitment is a dedication to the work they are doing and a commitment to raise awareness of mental ill health among all staff and to train managers properly. Through a combination of regulation and incentives, we can make a real difference for people.
Gerald Jones (Merthyr Tydfil and Rhymney) (Lab)
I rise to speak briefly in support of the motion. In doing so, I congratulate the three Members who brought the application for the debate to the Backbench Business Committee. In particular, I pay tribute to my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) for the work she has done over a long period on this important issue.
As we know, poor mental health impacts on so many people across our country at various points in their lives. As we have heard, it will likely impact on one in four of us to a varying degree at some point in our lives. We know that more support is required to help people suffering from mental ill health in the workplace—support to halt people from deteriorating and to help them back to better mental health. I took part in a mental health first aid training course in a previous employment. It was a worthwhile experience that opened my eyes to the things to look out for and put me in a better position to provide help and support to colleagues. I recommend it to anybody.
I fully appreciate—it was the reason for this debate—that not all employers across the UK offer this training to employees, and that should change. Evidence suggests that 83% of employees in workplaces where mental health first aid is offered have seen an improvement in signposting to mental health support. That is significant. We also know that it helps anyone experiencing a period of poor mental health to talk. From speaking to organisations such as Merthyr and the Valleys Mind in my constituency, I know how important it is to have that opportunity to talk to someone. That is hugely important in the context of work colleagues, so for employers to treat support for mental health on a parity with physical health would be a big step forward. As we have heard a number of times during the debate, talking would also help raise awareness across society and help in some way to end the stigmas of the past.
We know that periods of mental ill health can affect anyone, regardless of age, gender or background. We know that there are serious issues with post-traumatic stress disorder and other mental health issues in our armed forces. We know that the issue affects a lot of men, particularly young men. Suicide is still the biggest cause of death for men under 45. If there was more awareness, particularly in workplaces, and especially those that are male-dominated, it would do much to support those suffering from mental ill health and provide an opportunity to intervene at an early stage.
Having more support for mental health in the workplace makes sense from a financial perspective, as workplace mental health issues cost the UK economy billions of pounds a year. However, while the financial position is of concern, the cost to individuals, their families and their quality of life is much more concerning. We know that some 300,000 people with long-term mental health conditions lose their jobs every year. Left untreated, mental ill health impacts on a person’s relationships with friends and family and ultimately their quality of life. As I have highlighted, many have said in recent years that mental health should have the same focus as physical health, although for a variety of reasons that does not yet appear to be happening.
As we heard from my hon. Friend the Member for Liverpool, Wavertree, the Health and Safety at Work etc. Act 1974 made it a legal necessity for workplaces to train someone in medical first aid. If we are to have parity of mental and physical health, we need to make changes. As the motion states, the Government should change the law to provide a clear direction to employers regarding their responsibility not only for physical health but for mental health.
Workplaces would benefit from having trained mental health first aiders. It would provide not only a financial benefit to the economy, but a positive impact on many people’s wellbeing. I hope the Government will take note and act quickly.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on securing this debate, and I thank her for setting the scene so well. I thank right hon. and hon. Members from all parts of the Chamber for their valuable contributions. I echo the comments of others in the Chamber about what a joy it is to have a debate on a subject on which we can all agree. We agree on the strategy and the way forward. I am reminded of the programme I watch on a Sunday night—“Call the Midwife”. Perhaps others watch it, too. There is always a real tragedy at the beginning of the programme, but at the end, things always turn out well. I hope that Brexit turns out the same. We will see how it goes.
Most of us in the Chamber have a good understanding of the impact that mental health issues have on people’s emotional and physical state. In the short term, mental health problems alter personality traits and the behaviour of individuals. In the long term, they can lead to suicidal thoughts. In the worst-case scenario, they can eventually drive a person to commit suicide. There were 318 suicides registered in Northern Ireland in 2015, which was the highest since records began in 1970. People often have trouble coping with mental health issues, which of course will translate into their work life. Mental health cannot be compartmentalised. That is not the key to working and living with mental health problems.
Mr Kevan Jones
It is too tempting not to intervene on the hon. Gentleman. Is he aware—I am sure he is—that Northern Ireland has a particular issue? When I was a Minister in the Ministry of Defence, I was shocked to see that even though the violence of the troubles was 20 or 30 years ago, there is still a legacy of mental illness from those times.
Jim Shannon
The right hon. Gentleman has obviously had sight of my notes, because I was going to refer to that point later. He is absolutely right. The 30-year terrorist campaign has a legacy, and it affects us. I will mention that in my comments.
When I was first elected in 2010, I took in a new part of my constituency, Ballynahinch, which I very quickly found out had some serious problems in relation to suicides. They were mostly among young people, and unfortunately they seemed to be cluster suicides, if I can use that terminology. A number of young people took their lives, but the community very quickly reacted in Killyleagh and Ballynahinch. Church groups, community groups and interested individuals came together and addressed those issues. With Government Departments, they helped to reduce the level of suicides. It was particularly stressful to be confronted with that as an MP so early in his parliamentary term.
One in six workers suffer from anxiety, depression and unmanageable stress each year, causing 74% of people with a mental health problem to take more than a year out of work. In 2015, 18 million days were lost to sickness absence caused by mental health conditions. Mental health issues affect both the work and the lifestyle of countless people. Urgent action must be taken to educate employers about the difficulties that result from mental illnesses, mainly to help those who are struggling in the workplace but also to benefit those employers, for whom that may mean cost outlays. It follows that not only is a happier worker a more productive worker, but there should be a natural decrease in sickness periods. Other Members have mentioned that.
If employers are to take steps to promote and improve people’s wellbeing in their workplaces, they need to be able to identify an instance in which someone may be struggling with mental health problems, but it is not always easy to do so. I understand that, because I have talked to many people who seem to be smiley, jokey and happy, and may be the life and soul of the party, but when they go home they are very different. Sometimes we do not really know what is happening. In the workplace, there needs to be someone who can see through the façade to the real person underneath.
Some 49% of workers said that they would not be comfortable disclosing a mental health issue at work. Others in the workplace should be educated to ensure that they can recognise individuals who are dealing with such problems. They should be trained in mental health issues—and that should include mental health first aid—so that the workplace can become a positive environment.
Given that two in five employers admit that they have seen a rise in mental health problems, it is important for workplaces to foster a culture of support and openness for those needing help, making them feel reassured about seeking assistance from fellow employees. The Scottish Association for Mental Health, backed by the Scottish Government, has adopted a programme on physical activity. I can say with all honesty and sincerity that the Scottish Government, and their Health Department in particular, lead on health issues in general, including mental health issues. I know that the hon. Member for Glasgow South West (Chris Stephens) will probably mention this, but I think it important for us to recognise good practice wherever it may be, and I hope that we can replicate it in other parts of the United Kingdom of Great Britain and Northern Ireland. Better together, that is what I always say.
I believe that the Department for Work and Pensions must take the lead, and that all workplaces should be supplied with a mental health toolkit as standard practice. It should be issued not just to those who request it, but to all who are paying tax for a business. That could be modelled on the content of the current publications by Public Health England, Business in the Community and the Samaritans—what a good job they do to address these issues. Every one of us will know what really tremendous work they do in our constituencies, and I cannot praise the volunteers highly enough. To engage employers to participate in initiatives such as “Time to Change” and be educated further on the subject of mental health, there must be a move from the Department, and help must be garnered from it.
It has been suggested that as well as becoming involved with mental health organisations, companies should review their absence policies and make keeping-in-touch arrangements, as evidence suggests that 12.7% of all sickness absence days in the UK can be attributed to mental health conditions. There must be tools to enable employers to create an employee assistance programme. I have read research indicating that in the few businesses that use such a programme, 25% of employees say that their organisation encourages staff to talk openly about their mental health issues. Research shows that the more people do that, the easier it becomes to deal with their problems. We are always hearing that “it’s good to talk”, and that is so true, but many of the people we meet may not have anyone to talk to.
Such programmes not only help the individuals who are suffering with mental health problems, but benefit companies. Better mental health support in the workplace can save UK businesses up to £8 billion per year. If we do the job right we can save money, and so can the businesses, because they will have a happier and more productive workforce.
Three quarters of all mental health problems are established by the age of 24, when people are entering long-term careers. That is another factor that we should recognise at that early stage. As many as 300,000 people a year lose their jobs because companies are not sure how to provide the help and support that they need. In the past year, 74% of people have felt stressed as they have been overwhelmed or unable to cope owing to the demands of their career. Managers should be able to spot the signs of common mental health conditions, but that happens only when they receive dedicated training. Others have referred to the need for such knowledge of what is happening. Many managers are blind to, or uneducated about, the symptoms of mental illnesses, and it is all too easy in the busy working world to be consumed by a goal and not to see the elements that are in play around us. We would never send an engineer into a dangerous environment without the necessary training, so why should we assume that companies can automatically notice when an employee’s health is plummeting?
I am sure that you, Mr Deputy Speaker, are like the rest of us in this regard: we often eat at our desks. However, that does not mean that everyone else has to do it. We have to recognise that sometimes it is good to get away from our desks and go for a walk, and have our minds on other things for a time. The benefits of regular breaks and eating lunch away from desks, and creating a positive workplace state of mind, should be promoted to those who have a busy life and seek to cram things into every second at the risk of their mental health.
As we heard a moment ago from the right hon. Member for North Durham (Mr Jones), Northern Ireland in particular is struggling with the issue of mental health owing to a lack of resources. When compared with 17 other countries, Northern Ireland was shown to have the second highest rates of mental health illness, 25% higher than those in England. That is certainly largely due to 30 years of the troubles and the legacy of the terrorist campaign, but it is more than that. We must address those issues and do better in enabling people to lead high-quality lives with the tools to handle stress and daily life. A massive step in that regard would be creating mental first aid as standard in workplaces.
Workplace mental ill health costs employers about £26 billion a year, and many places are struggling to find the large amount of money that is needed to improve their awareness of mental health. A report for the NHS found that mental illness accounts for nearly half of all ill health in people younger than 65, and that only a quarter of people in need of treatment currently get it.
This is a health issue, but it is important for four Departments to come together with a strategy, because it is not just about health. It should also involve the DWP, the Department for Education and the Department for Business, Energy and Industrial Strategy. Companies need to be given more support and funds, as does the NHS to help those who are suffering in the long term, as it is currently unable to provide the materials needed. Action needs to be taken, because the number of sick days due to mental health issues is increasing rapidly owing to negative work environments: 89% of employees with mental health problems say that it affects their work lives hugely. That needs to change, for the betterment not only of business and the economy but of those who are struggling with mental health issues.
I look forward to the comments of both the Minister and the shadow Minister. I am convinced—as, I think, is everyone in the Chamber—that we shall hear a positive and helpful response from the Minister.
Chris Stephens (Glasgow South West) (SNP)
Let me first praise the hon. Member for Liverpool, Wavertree (Luciana Berger) for securing the debate and for making an excellent speech. Let me also congratulate her, because she may well be the first person to have a motion passed in the House this week: every other motion seems to have been voted down.
I want to talk about some of my personal experiences. Before I came to this place, I was a trade union activist. When dealing with mental health issues, I had to remind employers of the provisions of the Equality Act 2010 and reasonable adjustments, and to make them understand the nature of a particular condition and what can happen as a result of it. I used to encourage managers to ensure that first aiders were aware that someone might have such a condition. In particular, they needed to know if an employee was taking a specific medication because of the possible side effects. Medication can have an impact on behaviour and performance.
The hon. Member for Dagenham and Rainham (Jon Cruddas) produced some shocking statistics on issues such as dismissal. In my view, much of that is due to aggressive management policies on attendance, not just in the private sector but in the public sector. When someone has been absent for a certain number of days, that can trigger an interview leading to the removal of sick pay or other forms of disciplinary action. That makes people go into what has been referred to as presenteeism. People also feel that, because they have been off for a certain number of days, if they are off another day, they will get the treatment. If we are going to have attendance management policies, they should be based on facts; they should not be aggressive and done just on the basis of trigger points.
I associate myself with the remarks by the right hon. Member for North Norfolk (Norman Lamb) about bullying. Bullying and harassment in the workplace is an issue and impacts on people’s mental health. So I strongly support the motion’s proposals to ensure that first aiders have adequate training. That is very much encouraged in trade unionised workplaces. I know hon. Members across the House will agree with me that trade unions play a vital role in trade unionised workplaces, ensuring that an employee with a mental health condition is looked after and given the proper support and that employers understand their conditions. This reminds me that one of the favourite books in the Glasgow Unison office was the “MIMS” book, which explained every piece of medication and their side effects. It was used as a tool to explain to employers the behaviour of those on medication or with a mental health condition and other problems that can arise, and to explain how to address those in a way that was fair and appropriate.
The hon. Member for Strangford (Jim Shannon) encouraged me to promote the health service in Scotland and the 10-year mental health strategy, and I will talk briefly about that. Between January and June last year, there were a number of courses. There were 43 one-day courses on healthy workplaces for NHS managers, and 552 people were trained. There was training for trainers; 28 people are now delivering more courses. There were eight workshops on resilience and wellbeing; 97 people were trained on that. There were also three managers’ competency workshops; 36 people were trained on that.
In Scotland there is a 10-year mental health strategy. It seems to be working. Out of 40 actions, 13 are complete and 26 are progressing and ongoing. These training programmes are vital, as the hon. Gentleman said. The workplace training programmes deal with topics such as surviving the pressures of work-related stress, managing organisational stress and getting the Health and Safety Executive on board with those arrangements.
There is an opportunity for the UK Government to look at their good work plan as well in relation to ensuring that mental health issues in the workplace are dealt with appropriately. Issues to do with insecure work are not yet being tackled by the Government. That can have a real impact on someone’s mental health and wellbeing. There are issues about how the DWP deals with some of these issues, which I hope the Government will look at. For example, someone who refuses a zero-hours contract job could be sanctioned under universal credit, but if someone is on a legacy benefit they would not be sanctioned. The pressures of the DWP system of benefit conditionality can often be punitive.
Karen Lee (Lincoln) (Lab)
I often get letters from people on zero-hours contracts. They might, for argument’s sake, get up at 5 o’clock in the morning and spend an hour cycling to a job only to find out there is not a day’s work for them. That puts them under such stress and causes so much more anxiety, and pressures their mental health. Does the hon. Gentleman agree that this is just one of the drawbacks of zero-hours contracts? We hear such a lot about how wonderful it is that everybody is in work, but if we scratch the surface we see it is not actually quite that simple.
Chris Stephens
I strongly agree. I do not know if the hon. Lady has had the opportunity to look at the Workers (Definition and Rights) Bill, which I have introduced and deals with some of those issues. People on zero-hours contracts or working parents turn up at work with an expectation that they are going to be working for a certain amount of hours—four, perhaps—and are told they will instead be working for eight hours and then have to deal with childcare; or they turn up and, as the hon. Lady said, find they are not required that day. That must have an impact on someone’s mental health and wellbeing.
I ask the Government to look at the punitive measures in terms of benefit conditionality. That is also a recipe for people to be recycled into unsuitable, potentially exploitative work just to avoid a sanction.
I support the motion. I ask the Government to look at these issues about the clear and direct impact on the mental health of workers and possibly changing some policies in that regard. I thank all Members who have spoken so far for their excellent contributions.
Julie Cooper (Burnley) (Lab)
I congratulate my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) on securing this debate and pay tribute to her for the excellent work she does in this area. I also thank the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Plymouth, Moor View (Johnny Mercer) for helping to secure this important debate, and particularly pay tribute to the hon. Gentleman for sharing his personal experiences, which are very powerful. My mother suffered with OCD all her life and regularly said to me, “If I had a damaged leg I would have got help and sympathy, and there would have been no stigma attached.” So I thank the hon. Gentleman for raising this issue.
Debates such as this with a particular end in sight—to raise awareness and end stigma—are important. I join with Members, in this wonderful spirit of co-operation in all corners of the House, in saying to anyone out there suffering with mental ill health and to their family members that many of us in this place are sincerely dedicated to effecting good change.
We have heard powerful contributions from all sides of the House on the impact that mental health issues can have on people’s lives, and indeed on our economy. For the one in four people who will experience mental health issues, there are serious consequences in all areas of their lives, including at work. It is estimated that 5 million workers, nearly one in seven, are experiencing a mental health condition. Women in full-time employment are twice as likely to have a common mental health problem as full-time employed men, and 300,000 people with a long-term mental health condition lose their job every year. The human cost of this is hard to calculate; these are people who have lost their livelihoods because they cannot get the support they need.
While the human cost is difficult to quantify, we do know that there is an enormous economic cost overall. For the whole of the UK it costs up to £99 billion a year. The Mental Health Foundation found that over 12% of sick days in the UK can be attributed to mental health conditions. The Health and Safety Executive reported that 15.4 million working days are lost each year to work-related stress, anxiety and depression—more than are lost to physical ill health. Mental ill health hits smaller businesses hard, and research from the insurance sector found that it costs small and medium-sized enterprises £30,000 in recruitment costs, training time and lost productivity to replace a staff member. There is another side to presenteeism. As the TUC points out, UK workers with mental health problems also contribute to the economy, adding £226 billion to the UK’s GDP in 2016 alone. They are contributing despite living with mental ill health, so it is only right, at the very least, that society gives something back to them. Despite them often suffering illness, their work supports our economy, so our society must support them.
Mental health does not exist in isolation. It is fundamentally bound up with how we live our lives, and the stresses and strains of modern life take their toll. In my constituency of Burnley, one in five people report feeling anxious or depressed, which is higher than the national average. As many Members have said, incidents of suicidal thoughts and outright acts of suicide have risen worryingly since 2000, with the number of people who self-harm more than doubling over the intervening period. Workplace conditions can be responsible for such strains. Indeed, three quarters of adults say that they are stressed about work. As a former employer, I say to employers out there that the best thing that they can do to improve productivity and profitability is to invest in the health and wellbeing of their workforce, including mental health, which is paramount. Sadly, mental health support is severely lacking for many workers and access to services that prevent mental health problems is getting worse.
Mental health services are still a long way from reaching the promised parity of esteem. Mental health trusts have less money to spend on patient care in real terms than they did in 2012. That underfunding is leading to delays for people who are trying to access services. In some areas of the country, people are waiting four months to access basic talking therapies—four months without the support that they need to stay in work. When it comes to mental health in the workplace, as research from MIND and others has shown, we can actually put a number on the cost of failing to fund mental health services adequately. Poor mental health at work is estimated to cost the taxpayer between £24 billion and £27 billion a year, which is made up of NHS costs, benefit costs and lost tax revenue. Those costs can be avoided if our mental health services are properly funded to give people the support they need.
Just as work can be the cause of stress and, ultimately, mental ill health, work is also where mental ill health can manifest itself. Today’s discussion has shown us one way that support at work could be provided. Mental health first aid, much like physical first aid, can provide a first port of call when mental health problems arise. We have heard already today about the value of early intervention. My hon. Friends the Members for Dagenham and Rainham (Jon Cruddas) and for Liverpool, Wavertree raised specific examples of where companies have invested proactively in employing and training mental first aid workers, and we heard that Thames Water has seen a three quarters reduction in sickness absence related to mental health issues.
It is clear that mental health first aid can work, but there is no duty on employers to provide it. Labour’s view is that there should be. In 2012, the Government encouraged employers to offer mental health first aid, but we still have not seen it taken up as widely as it should have been. The amount of Government resources for mental health first aid training is clearly not enough to embed mental health first aid. Last year, the review of workplace mental health by Paul Farmer and Lord Stevenson recommended that all employers put in place systems to support workers with mental health conditions. As we have heard today, mental health first aid can play a key role in that. At the time, the Government accepted the recommendations of the Farmer and Stevenson review, including those about the role of employers. Will the Minister tell us what action the Government are taking to put the recommendations into practice?
The debate today has called for a change in the law, and Labour joins that call. The Government must come forward with proposals to support employers to ensure that mental health first aid is provided. This matter is too important to be left to the good will of employers. Legislation is required.
Mental health first aid alone will not be enough, however. Its role will also be to refer people on to professional mental health services when that is appropriate. Mental health first aid is not a solution when the wait for professional mental health services could be months. It must be part of a wider network of support, alongside clinical services that give people appropriate and timely support. If this Government are serious about tackling the burning injustice of mental ill health, there must be less tinkering around the edges, and a comprehensive new system of support that can intervene as soon as possible when problems emerge. The human cost and economic impact of what is becoming a mental health epidemic can no longer be ignored, and the Government must demonstrate that they take this seriously and act now.
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I should like to thank all the contributors to the debate. It has been marked by a lot of enthusiasm and passionate advocacy in support of improved mental health. In particular, I would like to pay tribute to the hon. Member for Liverpool, Wavertree (Luciana Berger), the right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) for securing the debate and for bringing their characteristic ambitious agendas into play, alongside their well-informed and passionate advocacy on behalf of them. It can often be challenging to respond to all three of those Members, but on this occasion I have really enjoyed listening to their contributions and I agreed with much of what they said.
We all share the same objective, which is to secure support as early as possible for people who are suffering mental ill health and, more specifically, to enable more people with mental ill health to stay in work. That is good for their health—as long as it is good work and they are well supported—but it is also good for the economy when more people are encouraged to work. That was clearly illustrated by the figures cited by the hon. Member for Liverpool, Wavertree for those receiving care from Mersey Care, which bring into stark relief the size of the challenge. They show that only 3% of those patients are in work, which is something we should all reflect on. It underlines the importance of ensuring that we get better at supporting people who are suffering mental health challenges and at encouraging them into work.
I am pleased to be joined on the Front Bench by the Minister for Disabled People, Health and Work, my hon. Friend the Member for Truro and Falmouth (Sarah Newton). She is also responsible for the Health and Safety Executive, which obviously has a big role to play in this agenda. She has been listening carefully to all Members’ contributions today. She and I are united in an objective to ensure that we keep more people with all kinds of disability in work, and that we get those who are currently excluded from the workforce into it. We have a wide package of measures that we are taking forward in that regard, some of which have been referred to today.
The Government are committed to building a country that works for everyone, and that must include ensuring that disabled people and people with mental health conditions can go as far as their talents can take them. Too many people with a mental health condition are unable to do that, and that is a burning injustice that must be tackled. As the right hon. Member for North Norfolk pointed out, people who are unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety. That statistic illustrates why it is good for society, as well as for the individual, that we tackle this issue. The good news is that staying in or returning to work after a period of mental ill health really does aid mental health recovery. It really does make perfect sense.
Norman Lamb
The Minister will be aware of the objective in the five year forward view to double the number of people who get access to individual placement and support. Can she indicate how that programme is going? If she cannot do so now, will she write to me?
Jackie Doyle-Price
I can say that we are making progress, but I would prefer to write to the right hon. Gentleman with more details, if I may. I have seen some of that individual placement and support in operation, and it is hugely inspiring. In those mental health trusts that are giving one-to-one support, people are finding that the reward and discipline of going to work really does aid their recovery, even in some of the most challenging cases. I will write to the right hon. Gentleman with more information on that.
Mr Kevan Jones
Will the Minister liaise with colleagues in the Department for Work and Pensions? As I said to the right hon. Member for North Norfolk (Norman Lamb), voluntary work is a helpful access point for people who want to get back into work, and the current limitations on people being allowed to do certain voluntary work hinder some who want to take that route into work.
Jackie Doyle-Price
I completely agree with the right hon. Gentleman, and my hon. Friend the Minister for Disabled People, Health and Work agrees too. Employers are often risk-averse about using voluntary work, and we in government need to ensure that we are making it easy for people to apply for those routes. My hon. Friend says she will write to the right hon. Gentleman on that matter.
A number of points have been raised in this debate. On the issue of mental health first aid in schools, I can advise the hon. Member for Wakefield (Mary Creagh), who is not in her place, that the Government have a commitment to ensuring that at least one member of staff in each primary and secondary school receives mental health first aid training. We have currently reached 1,537 schools with that training.
I am delighted to hear from my constituency neighbour, the hon. Member for Dagenham and Rainham (Jon Cruddas). Like him, I am well aware of much of Ford’s activity, and it is good to hear what it has been doing in this regard.
My hon. Friend the Member for Waveney (Peter Aldous) highlighted the work of St John Ambulance in promoting mental health first aid and, again, I commend its work. The right hon. Member for North Durham (Mr Jones) made the excellent point that this is a cross-governmental issue. I have mentioned DWP, but the five year forward view carries the message that this issue must be tackled across Government, and we remain focused on delivering exactly that.
The Prime Minister has set out an ambitious set of reforms to improve mental health. We have heard references to parity of esteem, and I reiterate to all hon. Members that the fact that parity of esteem is written into legislation is not the end; it is just the start. The truth is that, in delivering true parity of esteem, we have to manage a programme of behavioural change throughout our services and, indeed, throughout society. Frankly, none of us should ever be complacent about whether we have achieved it. Parity of esteem will take a lot of time, and it is great to see just how much energy is being applied to it.
We have heard a number of references to Time to Change, and it is clear that the cultural transformation in society has been massively aided by Time to Change and that destigmatisation is really helping with delivery. None the less, we have a big role to play in service provision. We are creating 21,000 new posts in the mental health workforce. We are implementing the first waiting time ambitions for mental health so that people have faster access to the care they need. We have recently published the first review of mental health legislation in a number of years. And, of course, we are massively improving early intervention by investing in more services in schools.
We are investing more through the 10-year plan, and the Prime Minister has announced that the NHS budget will grow by over £20 billion. In turn, in the long-term plan published last week, the NHS confirmed that there will be a comprehensive expansion of mental health services, with an additional £2.3 billion in real terms by 2023-24. The ambition is that that will give 380,000 more adults access to psychological therapies and 345,000 more children and young people greater support in the next five years.
We are ambitious, although I do not pretend that, by putting it into law, we have suddenly achieved parity of esteem. We are on a journey in how we commission and deliver services and, of course, in how we behave across society. There is still much to do, not least in the workforce. Destigmatising mental ill health is contributing to understanding and challenging the prejudice and stigma, but we still need to do more.
We have heard much reference to the Farmer-Stevenson review. The Prime Minister appointed them to advise us on how employers can better support all employees to remain and thrive in work. We set out a broad-ranging strategy further to support disabled people and people with health conditions, including mental health ones, to enter into and thrive in work. We did that through our response, where we accepted all those recommendations; indeed, the leadership council to deliver that met only this morning. The work and health unit, which I lead jointly with the Minister for Disabled People, Health and Work, will be overseeing progress on those recommendations, which range from short-term deliverables to longer-term reform. That will include looking at potential legislation in due course.
The key Thriving at Work recommendation is that all employers, regardless of size or industry, should adopt six core standards that lay the basic foundations for an approach to workplace mental health. The review also recommended that all public sector employers, and private sector companies with more than 500 employees, deliver mental health enhanced standards. Those include increasing transparency and accountability through internal and external reporting of their performance against those standards. The Prime Minister accepted those recommendations that apply across the civil service and NHS England. The civil service, as an employer of 420,000 employees, really should be leading by example on this. Equally, the NHS, as both the provider of services and as a large employer, should be leading the way.
The Government have also taken action to work with partners to develop a framework to support organisations to record and report their performance on disability and mental health in the workplace. Last November, we published that voluntary framework, which highlights transparency and reporting as the effective levers in driving the cultural change we need to develop. But we know that every line manager, supervisor and leader has a crucial role to play in supporting employees to stay well and stay in work, which is why the work and health unit is also working with partners to identify the support and skills that line managers need, across all sizes of organisation, to create inclusive and supportive workplace environments. So we are exploring how we in government can share those examples of best practice, so that all employers get better at this. Many of them will recognise that they need the tools to do the job, because no one knows what they do not know, and we in government have a role to play in spreading that good practice.
We recognise that mental health first aid has a role to play in the Government’s ambitious strategy to transform workplace mental health. Mental health first aid is a helpful training resource to educate people to care not only for others, but for themselves. It also helps to improve understanding about mental health and mental illness; to build that culture and better understanding within organisations; and to encourage people to stay well and get the support they need to manage any mental health symptoms and problems. I was also struck by what the right hon. Member for North Norfolk said: on its own, it is not enough. We would not want to have legislation that became a floor of service in mental health.
A number of references have been made to Thames Water and its success in delivering mental health first aid, all of which is true, but mental health first aid is just part of its embedding a supportive workplace culture for those with mental ill health; it is not the only tool that the company uses. It has introduced mental health first aiders across the business, but it has also expanded its internal clinical occupational health team to support the business in case management, health screening, health surveillance and well-being. The occupational health team now processes an average of 100 referrals a month, 98% of which are for non-work-related issues. Up to 80% of the cases referred every month are for those still in work, which shows that people are accessing longer-term care; this is about keeping them in work, rather than just their getting mental health first aid. We need to be careful about honing in on one simple measure of supporting mental health in the workplace, rather than encouraging a more holistic culture of supporting wellbeing.
I can also advise the House that the Health and Safety Executive, working together with Mental Health First Aid England, has recently published revised guidance for employers on their compliance with the Health and Safety (First-Aid) Regulations 1981. The guidance clarifies for employers the existing requirement to consider mental health alongside physical health when undertaking a first aid needs assessment. The findings from the needs assessment will help direct employers to decide what measures they need to put in place.
The advice of the Health and Safety Executive is that the Stevenson and Farmer review recommendations go way beyond the provision of mental health first aid. The Government’s view is that the best way to secure employer action, to enable those experiencing mental ill health to remain and thrive in work, is to engage with employers to adopt a comprehensive approach based on the Thriving at Work mental health standards. Mental health first aid is not an exclusive way of delivering employer action, but it can form part of it.
To improve information and advice for employers, we are supporting Mind and the Royal Foundation to continue developing their mental health at work online gateway, which we launched on 11 September 2018. The online platform is aimed at employers, senior management and line managers but is accessible to anyone, and it helps them to find help and support for colleagues, to challenge stigma and to learn more about mental health in the workplace. The guided search tool helps with the development of toolkits, blogs and case studies to help everyone in their journey to improve the workplace. Mental Health at Work is a UK-wide initiative that supports people across all workplaces, in all sectors, of all backgrounds, and in all regions.
In conclusion, by working with our partners, including health professionals and employers, this Government are working to change culture and professional practice fundamentally, to tackle poor mental health and to ensure that disabled people and people with health conditions can reach their full potential, not only in the workplace but across society as a whole.
I thank all Members for their contributions and for their interest in the subject. We need to continue to discuss the issues and to encourage good practice. We have heard many good examples today, but we need to consider debating the issues so that we genuinely foster a culture at work that supports people with disabilities and with mental ill health to get jobs and to stay in work.
Luciana Berger
I want to thank and put on the record my gratitude to colleagues who have joined us and made contributions this afternoon. I appreciate that we are extremely busy with Brexit proceedings, so I am most grateful to everyone who has made the time to be here for this important debate. I also thank those who have made interventions. In particular, I thank my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) and my right hon. Friend the Member for North Norfolk (Norman Lamb)—I call them friends because we have worked very closely together on this and other related mental health matters—as well as my hon. Friend the Member for Dagenham and Rainham (Jon Cruddas), the hon. Member for Waveney (Peter Aldous), my hon. Friend the Member for Merthyr Tydfil and Rhymney (Gerald Jones) and the hon. Member for Strangford (Jim Shannon), and the Front Benchers, the hon. Member for Glasgow South West (Chris Stephens), my hon. Friend the Member for Burnley (Julie Cooper) and the Minister, for their responses.
I hope that my opening speech and the personal, passionate and informed speeches of other Members on both sides of the House have made clear that there is a robust moral, social and economic case for a change to the law to place on employers a legal obligation to make provision for employees to be trained in mental health first aid, in addition to the training they already have to provide for physical health first aid. That is the crux of the issue. If we expect and require businesses with 25 employees or more, including in the public and charitable sectors, to train at least one person in physical health first aid, an equal requirement should be extended to the provision of mental health first aid, if we are serious about the principle of equality for mental health.
Having listened closely to the remarks and representations that have been made, I appreciate that this should not be a tick-box exercise. The proposal is not going to fix the many challenges in mental health services and it is by no means a replacement for clinical professionals, who do a very important job, or the only thing that should happen in workplaces. It is an additional measure. I listened carefully to the Minister, who said that our workplaces should have a holistic culture of wellbeing; of course that should be the case, but the proposed provision should not be viewed in isolation.
I, along with the right hon. Member for North Norfolk, the hon. Member for Plymouth, Moor View, and just under 210,000 signatories to the “Where’s Your Head At” petition are asking the Government to enact this legislative change, to expand the legal responsibility of employers to make provision to train employees in mental first aid as well as physical first aid, and to make that positive and decisive step towards ensuring parity of esteem—parity of esteem was enshrined in law seven years ago in the Health and Social Care Act 2012—between physical and mental health in this country.
I do not think that we can be seen as impatient, as it was seven years ago that that principle was put into law. I and many others see this as one step—not the only step—that we should make. It is just one of the six principles proposed in the Thriving at Work report, which was a really important piece of work that was published one year and three months ago. This is just one step in that suite of tools at the disposal of businesses and organisations to make that difference.
I say to the Minister that it was the manifesto commitment of her party to bring forward this change. Having listened carefully to what she has said today, I can say that, obviously, she has not made that commitment yet, but, going forward, I urge her to make that change in the near future as it is one thing that could really make a difference.
Question put and agreed to.
Resolved,
That this House notes that the UK is facing a mental health crisis; further notes that, according to the Independent Review into Mental Health in the Workplace 2017 commissioned by the Prime Minister, each year 300,000 people with long-term mental health conditions lose their job; recognises that Centre for Mental Health research shows presenteeism from mental health is estimated to cost the economy £15.1 billion per annum; acknowledges this same research shows it costs the economy £8.4 billion per annum for mental health absenteeism; considers that a recent poll by OnePoll found that 38 per cent of people reported being stressed about work; observes that the Health and Safety Act 1974 made it a legal necessity for workplaces to train someone in medical first aid; and calls on the Government to change this law via secondary legislation to provide clarity that an employer’s first aid responsibilities cover both physical and mental health and to add a requirement for workplaces to train mental health first aiders.