Mental Illness: Job Security and Inequality
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The Parliamentary Under-Secretary of State, Department for Work and Pensions (Baroness Buscombe) (Con)
My Lords, I thank the noble Lord, Lord Bird, for securing this debate. As usual, these Questions for Short Debate are too short as there is so much to say. I believe I have some good responses to all noble Lords, and I will do my best to answer their questions as I go through.
Both employers and the Government have a stake in the nation’s mental health. The Government provide the necessary health support, offer a safety net when they are out of work, and can ensure that employees have the right rights. Employers increasingly recognise that they have a crucial role to play in creating the healthy workplaces for employees to remain in work and thrive, in providing a supportive environment where employees can discuss health issues without stigma, and in helping people to return to work in the right way when they fall ill.
Mental health is a matter of national importance, and we are committed to improving mental health services by investing record levels in them, with annual spending reaching £11.98 billion last year. Targets in improving access to psychological therapies, or IAPT, are being exceeded. In March 2019, 99% of those completing treatment waited less than 18 weeks for their treatment to start in England against a target of 95%. In March 2019, 88.9% of people completing treatment waited less than six weeks against a target of 75%. In February 2019, this figure was 88.6%.
Under the NHS long-term plan there will be a comprehensive expansion of mental health services, with an additional £2.3 billion a year by 2023-24. This 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. As the noble Lord, Lord Bird, said, early intervention is vital. We are going further by piloting a four-week waiting time standard for treatment, training a brand new dedicated mental health workforce for schools, and teaching pupils what good mental and physical health looks like. We encourage all NHS staff to undertake suicide prevention training with all NHS organisations to facilitate this.
The Secretary of State for Health and Social Care wrote to social media and internet providers on 26 January to express concern about suicide and self-harm content. He held a follow-up round table with them on 7 February 2019 to discuss the impact of the internet, particularly suicide and self-harm content, on mental health and well-being. Another round table was held on 29 April to discuss progress, and social media companies agreed to join and fund a strategic partnership with the Samaritans. That is close to my heart, as I used to chair the advisory board of the Samaritans. I do not think any noble Lords touched on social media, but it is a crucial part of the whole story behind mental health.
We know that too many people with a mental health condition do not participate as fully in the key activities of society, including work. The figures are stark: almost one in five working-age people in England has a common mental health condition, rising to almost one in two for people on out-of-work benefits. We know that people unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety.
However, it is not good enough for people to be in work. I agree with the noble Baroness, Lady Sherlock: they need to be in good-quality work. The UK is leading the way internationally as we tackle challenges that have arisen as a result of new business models. The Government’s Good Work Plan represents the largest upgrade to employment rights in a generation. As laid out in the plan, we will legislate to improve the clarity of employment status checks to reflect the reality of modern working relationships; bring forward proposals on a single enforcement body for employment rights; introduce a right to request a more predictable and stable contract for all workers; and legislate to ensure workers get the full value of the tips they earn, except for those deductions required by tax law. Extending the right to a written statement to workers and making it a day one right will give people a better understanding of the employment relationship they are entering into and more information up-front about their rights and protections. Introducing a right to request a more predictable contract will help give workers more personal and financial security if they are seeking more predictable hours.
Good work supports our good health. It keeps us healthy, mentally and physically. It enables us to be economically independent and gives us more choices and opportunities to fulfil our other ambitions in life. Our Improving Lives: The Future of Work, Health and Disability Command Paper, published jointly in November 2017 by the Department of Health and Social Care and the Department for Work and Pensions, sets out a comprehensive strategy for achieving the Government’s challenging target of seeing 1 million more disabled people in work by 2027. Given the scale of this ambition, a key part of our programme is to achieve transformational change by focusing action in three key areas: welfare, workplace and health.
Employment rates are at historic highs. When I went to the UN in New York a couple of weeks ago, I was proud to be able to say that employment for people with disabilities has risen by around 950,000 in the past five years. I said that we in the United Kingdom focus on ability, not disability. I agree so much with what the noble Baroness, Lady Hollins, said: those with disabilities have so much to contribute. If an employer is not employing someone with a disability, they had better watch out because they will find that the person they should be employing is employed by someone else. It is the right thing to do.
The Government recognise the crucial role of employers in creating mentally healthy workplaces. Too many people fall out of work because of their mental health, so we are asking employers to do more to prevent this. Last week the Government announced that a consultation on new measures to help employers better support disabled people and those with long-term health conditions in work will also be published next month. These measures will include reforming statutory sick pay, so that it is better enforced, more flexible—to encourage a phased return to work—and covers the lowest paid. As part of this consultation, the Government will consider how to achieve the appropriate balance of incentives and expectations on employers to create healthy, inclusive workplaces, and encourage employers to invest in occupational health support.
The Government remain committed to finding ways to help employers, especially SMEs, support their employees to return to work promptly from sickness absence. By working with our partners, including employers, this Government can continue to tackle poor mental health. This is part of building a country that works for everyone, and reflects what we have done as a result of the Stevenson-Farmer review, referenced by the noble Baroness, Lady Jolly. This was an independent review, set up in January 2017, into how employers can better support all employees, including those with mental health or well-being issues. It also set out a compelling business case for action, with a central recommendation that all employers should adopt a set of six core mental health standards to encourage an open and transparent organisational culture that supports employees’ mental health. These standards included developing mental health awareness among employees, encouraging open conversations—which are so important—about mental health and routinely monitoring employee mental health and well-being. It recommended that all public sector employers and private sector companies with more than 500 employees deliver mental health enhanced standards, including increasing transparency and accountability through internal and external reporting. Momentum is building around the challenge for all employers to adopt the core standards that lay the foundations for good workplace mental health, and for larger businesses to adopt the enhanced standards. Officials are working with a range of partners, including the Chartered Institute of Personnel and Development, large employers and charities, to monitor and review the effectiveness of the voluntary framework.
The Civil Service has embraced the framework. We are working with all government departments to support them in their ambition to publish against the framework in full this year. It will take time before we can truly call all our workplaces healthy and inclusive, but we have been encouraged by the level of engagement with and commitment to this agenda. In response to the question from the noble Baroness, Lady Jolly, the Minister responsible for this review and its outcomes is my honourable friend Justin Tomlinson, the Disability Minister.
We also have to think about those who are out of work. The Government are committed, as far as possible, to supporting into work people with mental health conditions who are out of work. All our work coaches across the Jobcentre Plus network now receive training on supporting people with health conditions and disabilities. Additionally, the rollout of the Health and Work Conversation across the UK supports work coaches in continuing to build engagement with claimants who have disabilities and health issues. The Government continue to invest in mental health-related trials and studies; this includes doubling the number of employment advisers, improving access to psychological therapies and launching a £4.2 million challenge fund to build the evidence base of what works to support people with mental health and musculoskeletal conditions.
We are doing more. We have to think about people with debt. In response to a consultation, we are going ahead with a breathing space scheme. Debt causes enormous stress. This policy will make a real difference in supporting people with debt. In addition, the NHS provides services to people experiencing the symptoms of debt problems and financial difficulties.
Reducing inequality is so important as inequality can cause or exacerbate poor mental health. However, the policies of this Government are highly redistributive. This year, low-income households will receive, on average, over £4 in public spending for every pound they pay in tax, while the highest-income households will, on average, contribute over £5 in tax for every £1 they receive in public spending. Income inequality is lower now than it was in 2010.
Much has been done to increase awareness and reduce the stigma of mental health. The DWP is working increasingly closely with the Department of Health and Social Care but, as the noble Lord, Lord Bird, said, it must be joined up and be cross-government. Also, as the right reverend Prelate said, it is not just about government. We have to think beyond government to all those who can offer support, including our religious institutions. How can they support, and what can we use to help those with mental disabilities?
Finally, my noble friend Lady Redfern referred to those leaving prison. I have been in discussion with Secretary Acosta, the US equivalent of the Secretary of State for Work and Pensions, about what we are doing and what they are doing about employing people who have been in prison and what to do with people with disabilities. I heard a story of somebody in prison who was very well off; he had committed a financial crime. While he was in prison, none of the other prisoners ever asked him for money but almost every one asked him for a job. So much of this is about people having something meaningful to do, as well as being in a supportive society that recognises and understands mental health and is, not before time, removing a stigma, to support more people in a way that I hope will encourage the noble Lord, Lord Bird.