Mental Health and Unemployment

Lord Beamish Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

May I say what a privilege it is to follow the right hon. Member for Sutton and Cheam (Paul Burstow)? This debate is important and it sends a message that, again, this Chamber is discussing mental health. I have said, and I will say it time and again, that the more we talk about mental health, the better. Talking about mental health on the Floor of this main Chamber sends a clear message that this House—Members from all parts of it—is taking mental health seriously.

Clearly, work is central to most people’s lives. Mountains of research suggest that the right type of work is good and positive for somebody’s mental health. In this debate, I want to focus on three main areas. The first is mental illness and the benefit system—we cannot talk about unemployment without mentioning the benefit system. The second is how we manage long-term mental health problems in the community. Realistically, there are individuals who will not be able to work or hold down full-time jobs, so we need mechanisms by which we can support them in the community. The third area, which is related to unemployment, is how mental health is dealt with in the modern workplace in the UK.

Many people may ask: why is mental health in the workplace important? Well, to coin a phrase from Bill Clinton, “It’s the economy, stupid.” Bad mental health is bad for the UK economy. The UK report on mental health in the workplace, commissioned in February 2014, estimated that it cost the UK economy some £70 billion a year—4.5% of GDP. In the current economic climate, a reduction in that figure, which was drawn up using Department for Work and Pensions data and OECD and Eurostat labour market figures, would be welcomed by the Chancellor of the Exchequer. There is also another important issue here, which is that it is good for the individual. In a decent modern society, we should ensure that people’s mental health is not harmed by the work that they do. We must remember that it is not just the individual who is harmed, but the families as well.

The right hon. Member for Sutton and Cheam talked about the number of individuals who are on employment and support allowance, some 46% of whom have mental health problems. We have heard the rhetoric over the past few years about trying to be tough on welfare claimants and about getting people off benefits. No doubt we will hear more of that in the run-up to the general election. But I am not sure that such rhetoric helps the people with mental health problems who are claiming benefits.

The evidence is clear that the work capability test has been a complete disaster for people who have mental health conditions. It has also been a complete financial disaster for the Government. It does not work for the people it is supposed to support and it does not help the taxpayer.

[Mr Jim Cunningham (Coventry South) (Lab)]

My hon. Friend mentions the situation in the workplace with regard to mental health. I was very interested in what the right hon. Member for Sutton and Cheam (Paul Burstow) said about the Health and Safety Executive enlarging its role in this area. What does my hon. Friend think about that? Does he think that it could play a role?

[Mr Jones]

I do, yes. There seems to be this feeling that business should be afraid of the Health and Safety Executive. I know from my previous life that it is good not just at dealing with stress but at driving up standards and productivity in the workplace. It ensures that the working environment is safe, so, yes, there is an opportunity there.

Like other Members, I have seen in my constituency the merry-go-round system of the work capability test. It goes a bit like this: a person is assessed by Atos, by people who have no mental health training whatever; he or she fails a fit-for-work test and is then put in a work-related group; he or she then appeals that decision and has their benefits reinstated. Then, ludicrously, within a matter of months, that person gets recalled to Atos, and they are on that merry-go-round again. That is not only bad for the individual but a complete waste of taxpayers’ money, as there is the cost not just of the assessments but of the appeals. The appeals system has been overloaded with people and has had to employ more staff, and that is not an efficient way of dealing with these individuals.

Charities in the north-east, such as Mental Health North East, have explained this expensive merry-go- round and have done very good reports on the numbers. Hundreds of people in the north-east of England are on the merry-go-round system, which has a tragic effect not only on the individuals but on their families. In some cases, it puts back people’s mental health rather than improving it. We should not shy away from the fact that there have been some cases nationally in which, because of the Atos system, people have taken their own lives. No Government should be proud of that.

People are under pressure, not just from the work capability test but from the economic downturn. Statistics came out last month that showed that the number of suicides now, at just over 6,000, is higher than it was two and three years ago. Surprisingly enough, the north-east of England is the region with the highest number of people—young men, mainly—committing suicide. I find it very uncomfortable that in 2015 we have a system that puts these pressures on individuals and that the major killer for men aged 20 to 34 is suicide. We need to address that, not just because it is the right thing to do but because of the economic case. That is 6,000 people who are not making a contribution to the economy of this country. We should also remember that 6,000 families will be hugely affected by the loss of a loved one. Each one is a personal tragedy and each one, like a ripple, has an effect on an entire community. It is important that we address the issue because we cannot have avoidable deaths going unchecked. Whatever happens after May, dealing with suicide and mental illness must be taken forward on a cross-party basis.

As for the Government’s response to the Atos merry-go-round, the right hon. Member for Sutton and Cheam (Paul Burstow) is right that after four years they have finally worked out that it is not an effective way of dealing with people with mental illness on benefits and have put in place pilot schemes that go broadly in the right direction. However, like the right hon. Gentleman, I want to ask the Minister what the time scale is for rolling them out across the country. I am also of the opinion that we need to take people who have mental health issues out of the system. I do not argue for one minute that they should not be assessed at all, but putting them through the Atos system is not the way to do it. If we can ensure that they get the individual help and care that they need, that will not only help them return to work or gain access to work but save the taxpayer a great deal of money.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

My hon. Friend is making a powerful speech, but does he not agree that at the heart of this is the knowledge that we need sensitively trained and highly professional people to deal with these individuals, not an Atos-type untrained person? That is certainly the case in my constituency. We need highly trained people, whether they come from the health sector and are fully professional or whether, as in my constituency, they come from the voluntary and social sector.

[Mr Jones]

I am pleased that my hon. Friend raised that, because I was coming next to the important role there is for the community and voluntary sector. We need to explore an alternative system. If we conclude that some people cannot work, we need to be able to offer them alternatives, and like the right hon. Member for Sutton and Cheam, I am a big believer in voluntary and charitable work. If people cannot hold down a permanent job—it may not necessarily be their fault; it may be that some employers do not understand that someone who has a severe long-term mental health problem will not be able to turn up to work every day—why not allow them to do voluntary work, which both improves their position and gives something back to society? Social isolation is one of the worst things possible for people with long-term mental health conditions. Enabling such individuals to make some contribution to society would also help them.

As my hon. Friend the Member for Huddersfield (Mr Sheerman) said, the charitable and voluntary sector has a key role to play, not only in getting people back to work but in the long-term management of people with long-term mental health conditions in the community. The Government talk a lot about the community and voluntary sector, and the Heath and Social Care Act 2012 contained a provision that I considered helpful—I was scorned by some of my colleagues for thinking this—which was that third sector bodies could be commissioned to deliver local services. In practice, that has not happened because the contracts that are being let are too big and too complex, and many third sector organisations that do fantastic work locally do not have the capacity to bid for them.

The present system is a scandal. The Just for Women Centre in Stanley, in my constituency, is a great organisation run by Linda Kirk, a former business woman, and Lestryne Tweedy. The centre caters for women who are suffering from domestic violence or mental health-related issues and those who have been on probation. The model is very simple: it uses counselling and crafts to support the individual and look at their underlying mental health issues before moving on to getting them into work. The centre uses individual tailored programmes, which can lead to individuals being with the centre for two years, but the success rate is fantastic and the cost is less than £800 per job placement. That contrasts starkly with the nearly £4,000 the Government pay companies such as Ingeus and others that get people into work.

The situation is even worse than that. Not only can small charities such as the Just for Women Centre not bid for the contract but, disgracefully, if women who come to the centre are also on Ingeus’s books and the centre gets those women into work, Ingeus rings them up and asks them whether they have got into work, they say yes, and Ingeus claims the money, but the Just for Women Centre—the charity—does not get a single penny of it. I hope the Minister will look into the details of this, because it is not just happening in County Durham. We need a method whereby small charities can access the contracts, because I think they would do the work a lot cheaper and more cost-effectively.

We also need a system for managing people long-term in the community. Another fantastic centre in Durham is the Waddington Street Centre, which through education, therapy and other activities, manages people in the community. I pay tribute to Steve Wakefield and his staff, and the chair, Professor Fred Robinson. Like the Just for Women Centre, the Waddington Street Centre cannot access any of these contracts and has to rely on charitable donations. We all know that the charitable sector is being cut, so we need some method whereby those organisations can get access.

Finally, I want to focus on mental health in the workplace, because it is a subject we do not talk about much. As I said, mental health issues cost this country some 4.5% of GDP; most Chancellors of the Exchequer would salivate over the savings to be made by reducing that by 1% or 2%. The question is why mental health in the workplace is not a higher priority for the Government and for UK plc. Part of the answer is the workplace culture—the belief in this country that by working every hour God sends, we will be more productive, and also the belief that any talk of mental health in the workplace is fluffy and vague.

However, some businesses, such as BT, have taken a board-level decision to address mental health issues in the workplace. I congratulate the Communication Workers Union on its work with BT management to put in place support mechanisms and awareness campaigns on mental health and the early warning signs of problems. The results of this approach speak for themselves. In BT’s case, the number of employees off work on sickness absence because of mental health problems has decreased by 30% over the past five years. Among those who have been off work more than six months for mental health reasons, there has been an astounding 80% return rate, compared with the national average of less than 20%.

[James Morris]

The hon. Gentleman is making a powerful speech and the examples he gives from BT are very interesting. Is it not the case that we need to flip the way we think about mental health in the workplace? It is not a problem to be managed, but an opportunity to be taken. Many people on a mental health recovery journey can be some of the most creative and productive employees in an organisation, so we need to embed that approach into HR practice and drive productivity that way.

[Mr Jones]

I agree. The focus should be on mental well-being, rather than mental illness, in the workplace. I spoke to the managing director of BT and asked why the company adopted the approach that I described and whether it was aiming to be a good corporate citizen. The answer was no. The firm does it for hard, brass-tacks reasons—it is good for business. It sees the fragility of poor mental health among its employees as a risk to its business model. I am sure that is the case in other types of business too. BT has recognised that and put the appropriate mechanisms in place. We need a system for that to be rolled out among other companies in the UK.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

My hon. Friend is making an incredibly powerful speech. I thoroughly agree with what he says about mental health in the workplace. Will he pay tribute to the work of organisations such as Mind that are producing training packages for dealing with mental health issues in the workplace? As he says, those are a huge cost to organisations and to the individuals involved. Mental health issues are the No. 1 cause of absenteeism from the workplace, and systematic training is needed across all workplaces.

[Mr Jones]

I congratulate Mind on its mental health training. I shall come on to suggest the next step for Government. Raising the issue of stigma and talking about mental health is very important.

[Sir Andrew Stunell (Hazel Grove) (LD)]

I am listening with great interest to what the hon. Gentleman says about bringing people with mental health difficulties back into employment. I hope he will acknowledge the work done by Disability Confident, a scheme supported and run by the DWP which recently ran a presentation in my constituency. A number of large employers were brought to the presentation and for the very first time challenged with the opportunities that exist, as opposed to defining mental health issues as a problem. Does the hon. Gentleman agree that there is great scope for such an initiative to be taken beyond the pilot stage across the whole country?

[Mr Jones]

Indeed. The test is to make that a must for business. The next Government of whatever shade should make it compulsory. My hon. Friend the Member for Coventry South (Mr Cunningham) referred earlier to the Health and Safety Executive, which has a key role to play in that. Mental health issues should not be seen as a threat to businesses. The challenge is to help businesses of whatever size to perform better not only by being good to their individual employees, but by being more productive as part of the economy.

There is a huge challenge here. We must take this issue seriously. It should be seen not just as one of health. It must be tackled across Government. Whichever party is in Government after May, and especially if it is my party, I will be arguing strongly that we need a cross-Government initiative so that all Departments ask what is being done to promote good mental health, not only within the Department but in the development of vital policies. If we get this right, it makes economic common sense and can grow the UK economy. That is the dynamic that will make people sit up and think about making this a reality.

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[Mr Kevan Jones]

Does the hon. Gentleman agree that we need to tailor-make back-to-work programmes and recognise that on some occasions it might take longer to get people capable of working? We also need a system that allows people with long-term mental health issues who are not going to work at least to make some positive contribution to society.

[Adam Afriyie]

The hon. Gentleman has hit the nail on the head—that is precisely it. The distribution of traits within mankind and the British population is like a bell curve. Every person is unique. There are very few identical twins. Certain mental health conditions require a longer period of adjustment before people are able to participate in the workplace or in voluntary activities that make a contribution to society. Any system must be flexible enough to recognise that difference.

On the feeling that one’s life is out of one’s control, let us imagine—I will create a caricature here—someone from a tough background with literacy difficulties, perhaps dyslexia, who has just gone through a divorce and is presented with forms up to 70 pages long when trying to get some form of support from the state. The idea that someone who is in a very difficult state can navigate this incredibly complex system is tantamount to mental cruelty. There have been cases in the press recently where parents of children with difficulties have had to deal with a stream of health workers, disability benefit support staff, jobcentre workers and council workers knocking on their door. That can create a huge amount of stress and a sense that life is beyond one’s control. We have to be mindful of that and ensure that public services fit people who are going through a mental health episode.

I want to say some positive things about mental health, unemployment and employment. Mental health challenges are part of the normal human condition. Probably one in four of us here will struggle with a mental health challenge at some point in our lifetime. I am sure that all MPs have seen people in their surgeries who present with a problem—for example, they are unemployed and are having difficulties finding work and navigating the benefits system—and realise that there is something more behind the initial problem. Sometimes it will be depression, bipolar or paranoia, and they will need further assistance and support.

If we are to have a society that is at ease with itself, the stigma of mental health conditions needs to disappear. It is part of our job—not just in this debate, but in our daily lives—to ensure that we are relaxed about talking about mental health conditions, no matter what they are. In many cases, I welcome the idea that people joke about mental health conditions. I do not mean that people should do so in a derogatory way, but that jokes are part of our normal discourse. Whether in Parliament, in Westminster or in a business, people stand by a coffee machine and talk about so and so breaking a leg when they were skiing. Everyone has a laugh about it, asks the person how they are and then writes their name on the cast. I do not want mental health challenges to be part of a sort of corridor whisper. We should be able to laugh and talk—“so and so is having a bit of trouble at the moment”—and be very relaxed about them, because they are part of our human condition.

Another positive thing about people with mental health challenges in the workplace is this: yes, British Telecom has recognised the benefits of employing people who may have challenges, but a raft of smaller firms have also recognised those benefits. In my working career in the world of business in the 20 years before I entered politics—I suppose this is work as well—I came across many enlightened small businesses that, on many occasions, competed for people with mental challenges such as depression or bipolar. I will try to put this subtly. When somebody is struggling with bipolar and is in a good period, they can be exceptionally creative and productive. That is very useful, provided one recognises that when they are in a down period they need flexibility and understanding. A lot of small businesses would benefit from recruiting people with certain mental health challenges for particular roles in their organisation.

It is my experience, from having observed businesses over the years, that those that recognise these challenges and show flexibility actually perform exceptionally well. So even being less altruistic, this is a great opportunity to create work forces that are up to the mark, dedicated and loyal and which go the extra mile in the good times, because people with mental health challenges are a great resource on which to draw. As others have said, however, it would be helpful to have guidelines or suggestions, perhaps from the public sector but certainly from bodies such as Mind and others, on how to work with people with mental health challenges, particularly for small businesses.

I hope that Opposition Members will bear with me for a moment, because I want to touch on the coalition’s welfare changes, many of which were initiated under the previous Labour Government. In many respects, we should take our hats off to the direction of travel. One of the greatest pressures is to be young and unemployed and to feel unwanted, as it can exacerbate the feeling of isolation from society. However, although the welfare changes that the coalition has made or is seeking to make might not be perfect, they do represent the correct direction of travel. I know that many Opposition Members agree. If we can help somebody into work—not in a brutal way—we can give them that sense of meaning, control and well-being that comes from knowing that even if they have a mental health challenge they are still welcome in the work force. These are positive things that MPs can do to enfranchise the large minority that struggles from time to time.

[Mr Jones]

I do not disagree with the hon. Gentleman—if it is the right type of help. However, as the hon. Member for Strangford (Jim Shannon) and I mentioned, for someone suffering from a long-term mental health condition, this merry-go-round system we have is pretty brutish and needs refining. Otherwise, it will not only waste taxpayers’ money but create a lot of unhappiness and fear among people with long-term mental health issues.

[Adam Afriyie]

I think we agree. Indeed, I was about to focus on how we could significantly improve the way the system works for people with mental health challenges. First, on public services, particularly welfare-to-work arrangements, we need to be very finely attuned to the processes undertaken. Somebody with a mental health challenge might initially appear to be absolutely fine, but if they are put through a very mechanistic—the hon. Gentleman said “brutish”—process that makes no allowances for such challenges, it can do more harm than good.

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[Mr Jones]

I do not disagree, but one of the fundamental flaws that I and others have been raising for several years is that Atos assessors are not mental health trained. Having assessors with expertise in mental health would be a huge step forward in helping those individuals, yet the Government have ignored the matter for the last few years.

[Adam Afriyie]

I am not sure the Government have ignored it. I have been in meetings where it has been carefully discussed, so it is certainly on the agenda. I agree with the hon. Gentleman’s general point, however, and I am sure we will get to it on the other side of the upcoming election. Thus far, the focus has been on shaping the overall system in the right way, but unquestionably it will need refinement to ensure that in the first level of interaction the system quickly identifies people who might require a greater focus on their mental health and well-being than the average person.

I can give the hon. Gentleman the commitment that once we are through this short period before the election, and if we are both fortunate enough to be here afterwards, I will be happy to work with him and others in the Chamber to ensure that mental health conditions are better recognised or integrated within the process. We had a huge mountain to climb just to change the system in the first instance, but greater sensitivity is certainly needed now.

Four or five years ago, in Windsor, I knocked on the door of a very elderly lady. She had found in her letter box a form connected with a consultation on whether a local development should proceed. She was clearly struggling with a mental health condition at the time, and was agonising over whether she should fill in the massive form. There was another form from the council, and another relating to planning. I almost did not have the heart, but just about had the heart, to say to her, “The form is merely about a consultation, and, given the hundreds of forms that will be sent back, what you write on this one may have only a very small impact on the outcome. You might be better off seeing your family, having relatives to visit, and actually enjoying your life.”

What I gleaned from that encounter was that having to deal with lengthy forms and deeply bureaucratic processes may—unnecessarily, in many cases—take away the quality of people’s lives, particularly when those people are unemployed. That, I believe, should be a secondary focus for us, and for any future Government. We should think about the way in which we ask people to participate in our bureaucratic procedures to obtain assistance and return to work. We should ask ourselves whether the length of forms is a problem, and whether matters could be dealt with a little more quickly on the telephone or face to face, given that that some people might be struggling with a challenge at the time.

I know that we are having a quiet afternoon in the Chamber today, but I think that we have a responsibility to continue to talk about this issue—not only in debates such as this, but in the context of every brief that we may hold, every Committee in which we may participate, and every Bill that we may examine. We must keep at the forefront of our minds the fact that a very large proportion of the British population are struggling with mental health challenges. Every policy that we create must be designed to reflect that, and to accommodate such people.

Here is one more idea that may be of use at some point in the future. I love the idea of the market. I love the idea of businesses competing to hire employees, and I love the idea that competing small businesses—as well as one or two larger ones—that are desperate to hire staff at a time of low unemployment will one day place an imprimatur on their websites and recruitment pages, declaring that theirs is a mental health-friendly working environment. Indeed, it would be curious if they did not do so. I believe that if small and medium-sized businesses—indeed, all businesses—do not take that route, they will be hamstringing themselves and preventing themselves from taking advantage of the best employees that they can recruit from the marketplace.

This is my vision for politics. I want to see a country that is at ease with itself, and with people from different backgrounds and different walks of life. A country that is at ease with itself must acknowledge that, at any one time, a large minority of its population will face mental health challenges, but that those people are equally part of society. The policies that we create in this place must be user-friendly, and take account of people from all sorts of backgrounds and with all sorts of conditions.

I am optimistic about the future. Why? Because there is no doubt that Labour, Liberal Democrat, Independent and Conservative Members all recognise that the issue of mental health represents a serious challenge for a large proportion of the population, and I am confident that any future Government will pay more attention to it than we have in the past.

[Kate Green (Stretford and Urmston) (Lab)]

I thank all Members who have contributed to what I think has been a very interesting and rich debate. I especially thank the right hon. Member for Sutton and Cheam (Paul Burstow) for introducing, in a wide-ranging speech, all the issues on which others have expanded.

There is clearly widespread concern about the poor employment outcomes and poor employment experience of people with mental health disorders. Those concerns are wide-ranging. There is obviously a concern about the poor employment rate among people with mental health problems and the fact that unemployment is both a cause and a result of poor mental health. Particular concerns were rightly highlighted by the hon. Member for Strangford (Jim Shannon) about the implications for young people who experience unemployment at the very start of their adult lives. There are also concerns about people with mental health illnesses being dismissed or exiting work prematurely, about a lack of not just joining the workplace but progression in the workplace—relatively reduced chances for promotion—about lack of support in the workplace for people with mental health problems and, as was highlighted in the debate this afternoon, about so-called presenteeism, which is damaging for both the health and well-being of the individual and business productivity.

Such concerns about the cost both to the individual and society have been highlighted a number of times this afternoon. Poorer mental health outcomes are suffered by poorer people, who are less likely to be in employment. We also know that 39% of sickness absence is as a result of mental health problems, amounting to 11.3 million working days lost to our economy each year.

We have also heard concerns about the wider context in which mental health problems in the workplace arise and are then addressed. There are problems with people accessing therapies and treatments to deal early with mental health difficulties, and we have rightly heard quite a bit about stigma and discrimination and what can be done to tackle that.

I welcome the comments from the hon. Member for Broxbourne (Mr Walker) about the importance of dealing with mental health difficulties among children and young people and intervening early to address them. Many mental health problems begin in childhood—before the age of 18—yet we know that only 6% of spending on therapeutic mental health services is through child and adolescent mental health services, so there is clearly a massive imbalance in the way in which we are spending our resources to address the problems in the pre-adult years, as compared with picking up the pieces afterwards when so much damage has been done.

Concerns were also expressed about the extent to which programmes that should be helping are not doing so. We heard quite a lot about difficulties with the benefits system and problems with some of the work support programmes, which mean we cannot be complacent about an employment rate of 37% among people with mental health problems against an overall employment rate of 77%.

As we heard, in most cases being in work is beneficial for mental health, although in her 2013 report for the Government on mental health and work Dame Carol Black rightly set out a number of caveats to that, including the quality of the job and the degree of autonomy or control that is enjoyed by an employee. However, we also know that people who are not working because of a mental health problem represent the largest proportion of those who would like to be in employment. The reasons why they are not working are partly to do with lack of access to the therapies and care that would make work possible.

We have heard on many occasions of significant delays in accessing so-called talking therapies, and we must be concerned that one driver of the rise in the number of people being placed on the support group of employment and support allowance because of mental health problems may be that people cannot get access to the health care they need.

We must also pay attention to the particular anxiety identified by the independent reviewer, Dr Paul Litchfield, about the very large number of young people in the support group or the work-related activity group of ESA who have mental health difficulties. The fact that we are parking some of those young people on to a benefit without properly intervening early, and the fact that the way in which the system operates exacerbates and encourages a disregard of early intervention, is something I know the Minister expressed his own concerns about in his appearance before the Select Committee recently.

Repeated reports have recommended the much more effective joining up of employment support and mental health services. I very much welcome the introduction of specific indicators for mental health and employment in the NHS outcomes framework, but we also know that there are long delays in accessing therapies and that doctors can be reluctant to identify a mental health problem or sometimes fail to recognise that a patient could work or that work would be beneficial for that individual. The introduction of the fit note offers doctors the opportunity to provide more useful fitness advice to patients with mental health conditions, but there remains a significant challenge to ensure that health care service professionals support rather than work against the grain of increasing and sustaining employment.

We also know that stigma and employers’ fear play an important part in the poor employment outcomes of those with mental health disorders. Half of employers say that they would not employ someone with a mental health condition, although I strongly suspect that a large majority of them in fact already do so. Too often, sickness absence as a result of a mental health problem leads to dismissal under capability procedures or to early exit or early retirement. The introduction of fees for employment tribunals under this Government makes it harder for an individual who has been forced out of work to gain redress, which I guess could make it more likely that employers will put people under pressure to leave a job.

As has been said, we need the workplace environment to be much more effective in supporting people with mental health disorders. A few days ago, I met representatives from my own union, the Union of Shop, Distributive and Allied Workers, and they highlighted some of the difficulties that their members were facing at work. They talked about the stressors that people face at work, including unrealistic performance targets, zero-hours contracts and the insecurity associated with them, low pay and the difficulty of balancing family and working life.

Those problems are not confined to one particular industry sector. Workers in the public sector—teachers, probation officers, police officers and people in the armed forces, for example—also experience high levels of pressure and stress. We should also note that those pressures cut across all levels of jobs, from the most senior to those in basic and entry-level jobs. In fact, stress is particularly high among lower-paid workers who do not enjoy autonomy and control over how their working day is spent, or who feel that they have low status at work. Stress levels among low-paid and more junior workers can be particularly high.

There are lots of opportunities for us to intervene to improve workplace support. We have heard some helpful and imaginative suggestions and examples this afternoon. I hope that the Minister will comment on the role of the Health and Safety Executive in relation to this agenda. There is a real opportunity for managers to work with trade union workplace representatives to address some of the issues. There is also an important role for the public sector, as an exemplar employer, to adopt appropriate strategies to support staff as well as proactively recruiting those with a history of mental ill health, as was rightly suggested by the hon. Member for Windsor (Adam Afriyie).

Sir Stephen O’Brien, who is chair of the Barts Health NHS Trust, was recently commissioned by the Leader of the Opposition to advise my party on a mentally healthy society. He has suggested that accreditation schemes could do more. In addition, we need to pay attention to manager training and to providing information in the workplace to enable people to self-refer to mental health services, as well as to the positive use of the fit for work scheme, which is something the USDAW representatives told me that people were quite fearful of. The scheme could be helpful in supporting people to get back into work quickly, and I hope that employer bodies will take positive steps to engage with and reassure their workers about the way in which they are using the new scheme.

The Government also have an important role in supporting into employment those who are out of work as a result of a mental health problem. Despite the raft of initiatives and pilots described in the Government’s disability and employment strategy, the number of people being placed in the employment and support allowance support group is rising, and labour market programmes that ought to be getting more people back into work are continuing to let them down. The Work programme has been a failure for those with a mental health condition, as the right hon. Member for Sutton and Cheam pointed out, getting just 6.7% of them back into work. The black-box approach and the national contracting regime have shut out specialist provision, as we heard from my hon. Friend the Member for North Durham (Mr Jones) and others. We have also seen a 20% reduction in the number of specialist disability employment advisers in jobcentres. As the Minister acknowledged in a written ministerial statement on 18 December, the Access to Work programme last year suffered from significant delivery problems, which will have inhibited access to some of the support that could have been provided through the mental health component of the programme. That could have enabled more people, more quickly, to have functioned better at work.

There is a problem with the Work programme’s absence of a specialist programme for people who have been placed on ESA for mental health and indeed other chronic health conditions and disabilities, which means they are not getting the tailor-made support they need. That is why Labour has said that we would introduce a specialist programme of work support for those who have been on ESA for more than three months, which would mean that by commissioning that support locally, we will be able to make much better use of the kind of specialist organisations mentioned by my hon. Friend the Member for North Durham that have expertise in mental health and employment, and will be able to offer appropriate support.

I agree with the comments made about the opportunity presented by the individual placement and support programmes run from a number of NHS trusts. I had the privilege of visiting the IPS team in south Manchester a few months ago, where I heard about the successes it achieves, both in placing people into, and sustaining them in, work, and in reducing the incidence of hospitalisation. We know, including from an international study—the equalise study—that such interventions can be cost-effective compared with other vocational support for some people, yet too often people are being referred to this kind of support too late. I will be interested to hear the Minister update us on the Government’s thinking on IPS and what the current learning is. I would also be interested if he commented on what I was told in south Manchester, which was that the NHS is funding these IPS programmes but if Work programme providers have referred or introduced someone to that IPS service, the Work programme provider claims the outcome payment. It seems mad that the Department for Work and Pensions is paying a Work programme provider when all the work is being done and all the cost is being borne in the NHS. I hope the Minister might be able to say something about that.

[Mr Kevan Jones]

That is exactly what is happening to the charity I mentioned in my contribution. It is doing all the work and the Work programme provider is doing nothing for individuals, apart from making a phone call at the end to ascertain whether that person has actually got a job and then claiming the money from the Government.

[Kate Green]

That is absolutely not how those contracts should be working. If subcontracting to specialist organisations is taking place from the Work programme, the organisations to which those subcontracts are being let should be properly rewarded. We face a number of problems in this area. First, a lot of local organisations do not have the opportunity or the wherewithal to participate in these programmes at all. As my hon. Friend says, those that can or try to participate find that the programmes are utterly economically unviable for them because they are not paid for the work they do.

Finally, I wish to pick up on the discussion introduced by a number of colleagues about the operation of the benefits system, and how that bears on those with mental health conditions and their chances for employment. The hon. Member for Windsor was absolutely right to talk about the complexity and forbidding nature of some of the system. I hope the Minister is not going to tell me that universal credit is going to resolve all that, because I do not think it will. In particular, as the hon. Gentleman rightly said, the gateway into the system is as much a part of the problem as the way in which the benefits system is designed. Although it is right that moving people into employment is in many cases going to be good for their mental health, moving them into poorly paid jobs which leave them still struggling to make ends meet will not make them feel that their well-being is being holistically addressed. Poorly paid, poor-quality jobs are, in the long run, just not going to be consistent with good mental health. I also say to the Minister—and he will know this—that there has been a massive upsurge in sanctioning benefit claimants under this Government, which must mean that a number of those who are being caught are those with mental health problems.

Of course there must be conditions for benefits and sanctions for wilful non-compliance, but inappropriate sanctioning causes not only financial hardship for many but huge anxiety and stress. Despite repeated protestations from Ministers that there are no targets for sanctions in Jobcentre Plus, we hear again and again anecdotal reports that such targets—at least at managerial level—do exist. It is also true that the new regime is now much more punitive. Sanctions bite harder and last longer and a culture has grown up in which claimants are being sanctioned inappropriately.

Just a couple of weeks ago, I was told of a case in the west midlands of a Work programme participant who was unable, because of his mental health condition, to discuss his situation in a public forum, as was required by his provider. The resulting anxiety left him unable to engage at all with the Work programme and he was sanctioned for 14 days.

It would be useful to know what analysis Ministers are undertaking of the people affected by sanctions who have a mental health condition. It is really quite shocking that we have so little information on their fate when a sanction has been imposed. I want to be clear that, under a Labour Government, there will be no targets for sanctions, that we will insist that assessors and decision makers at every stage of the process from the work capability assessment to the imposition of conditions to decisions about sanctions properly take account of the mental health of the claimant, and that expert advice will be available to ensure that relevant information is considered, with penalties on assessors for poor advice.

May I also highlight the concerns that arise from the recent regulations to allow data-sharing in relation to universal credit recipients with a range of other service providers, including housing associations, credit unions and debt advice agencies? Constituents have said that they are concerned that this could lead to data-sharing about their mental health, which they have not authorised and do not want to happen. The Minister must be clear about what protections will exist when the new regulations take effect.

In conclusion, I am glad that we have had this debate this afternoon and that we have shared our aspirations for the best employment chances and rights at work for those who suffer mental illness. As we all know, warm words will not be enough. There must be a rigorous focus on access, support and measurable outcomes. One in four of us will suffer mental illness at some point in our lifetime. We cannot afford the waste of potential when, so often, worklessness is the result.

--- Later in debate ---

[Mr Harper]

I am grateful, Madam Deputy Speaker, that you were also able to join in the congratulations to my hon. Friend and embarrass him still further.

It has been a very good debate. It is an important matter for our constituents because mental health conditions are very common, with one in six people being affected at some time in their life. That statistic has been mentioned a few times, including by my hon. Friend the Member for Windsor (Adam Afriyie) who put on record his contribution on the subject early in his parliamentary career. All Members made the clear link between mental health—whether good or bad—and someone’s employment position. Many Members also highlighted the fact that labour market outcomes are poorer for people with mental health conditions than for the population as a whole and those with health conditions in general. As my right hon. Friend the Member for Sutton and Cheam and others said, the vast majority of people with mental health conditions want to work.

I listened carefully to the statistics that my right hon. Friend quoted about people with severe mental health problems. In the spirit of trying to cheer him up a little, noting that he referred to some positive data from the Time to Change campaign about the changing views of employers on mental health, let me reassure him that although I am not in any way complacent, as the gap between those with a mental health problem working and those generally working is significant and far too wide, there was at least some improvement between the last quarter of 2013 and the last quarter of 2014, when the employment rate for those with a variety of common mental illnesses went up by 2.6%, with a further 70,000 people in employment. That is obviously positive and a step in the right direction. I will not overclaim for it, as it is just a step, but perhaps it shows that the good work of the organisations involved with the Time to Change campaign means that employers are open both to keeping people who develop a mental health problem in work and to employing people with mental health problems. We might be seeing the start of improvement in those employment figures, but I do not want to claim more than that.

We are doing a lot, but clearly there is also more to do. I want to pick up on a couple of points mentioned by the shadow Minister, the hon. Member for Stretford and Urmston (Kate Green). I absolutely agree with her comment early on in her remarks referring to employers who say that they would not employ someone with a mental health problem. She was absolutely right that if they employ a reasonable number of employees they almost certainly do, although they might not know that they do. Perhaps the employee does not know that they have a mental health problem either.

The statistics suggest that anyone who employs more than six people is likely to have at least one member of staff with a mental health problem. Perhaps they ought to look around their workplace, think about the people they employ who have a mental health problem and think about how well they support that person, not out of any sense of altruism, although it is of course the right thing to do, but, as the hon. Member for North Durham said, because it is the right thing to do for the business. The person will be more productive, will stay working for that business for longer and will be beneficial. That was a point well made.

Looking at the cast of characters in the Chamber, I recall clearly that three years ago my hon. Friend the Member for Broxbourne, the hon. Member for North Durham and my right hon. Friend the Member for Sutton and Cheam, who was then the Health Minister, participated in a debate in which my hon. Friend and the hon. Gentleman spoke about their own personal experiences. They were both nervous during the debate about how their comments would be taken outside this place. I followed it quite closely, and it was heartening to see that their remarks were taken positively, not just by the organisations that one would expect—those that are familiar with these issues—but more widely and, interestingly, among members of the public. They kicked off an interesting process and since then a number of other right hon. and hon. Members have talked about their own experiences both inside and outside the House. It is right that more Members are encouraged to do that.

The hon. Member for North Durham put it very well when he said that the more we talk about these issues, the more we are open about them, the more the House debates about them and the more we talk about mental health issues in the same matter- of-fact way—I mean that in the most positive sense—as we do about physical health issues, without making a huge drama about them, the more employees and employers will be encouraged to have those sensible conversations in the workplace.

Members spoke about a number of support mechanisms. My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) mentioned the improving access to psychological therapies programme and the shadow Minister referred to the various talking therapies that are available. Those programmes have a proven record of delivering and were started by the Labour party when it was in government. They have been continued by us and expanded. By next month, they will have been expanded so that 15% of people who could benefit will have access, covering about 900,000 people a year. Next year, we will introduce for the first time access standards and waiting time standards in mental health services, and an £80 million investment will ensure that 75% of people will receive the IAPT treatment within six weeks, and more than 50% of people who are experiencing their first episode of psychosis will receive a treatment within two weeks. There is more to do, but I think that that is significant progress.

The hon. Member for North Durham talked about the work capability assessment and the performance of Atos in delivering that. With just a teeny bit of partisanship, I will remind him that it was his party’s Government who introduced the work capability assessment and appointed Atos as the contractor. We inherited that arrangement and spent quite a long time putting it right. I detected in what he said that he is not the biggest fan of Atos, so he will be pleased to know that it is exiting the contract to deliver that service in Great Britain. In fact, Maximus takes over next week, and ahead of that, in the next few days, Members will receive a communication from that company. The hon. Gentleman will be pleased to learn that one of the areas that Maximus takes very seriously and has itself highlighted, and where it is keen to improve WCA performance, is mental health. I hope that he will engage with Maximus, using his local expertise and his personal experience, to help to improve that performance.

[Mr Kevan Jones]

I am glad to see the back of Atos, but the fact is that for the past God knows how many years, the key issue raised has been the people doing the assessments. I have no problem with people with mental illness going through an assessment, but people with no mental health experience whatsoever have been responsible for concluding whether those individuals are fit for work. I just hope that the new provider employs people with mental health backgrounds to do those assessments, because that would be a huge step forward. It would be better for the Government and, more important, better for the individuals affected.

[Mr Harper]

The hon. Gentleman makes a perfectly good point. One of the things that Maximus plans to do is to increase the number of people it employs who are mental health specialists. I think it was the hon. Member for Huddersfield (Mr Sheerman), who is no longer in his place, who said that the people who undertake work capability assessments are not qualified, but that of course is not correct: they are all properly accredited health care professionals, although it is true that not all are mental health care professionals. Among other things, Maximus proposes to increase the number of mental health specialists it has, as well as the number of health care professionals with knowledge of specific health conditions, including but not only mental health conditions; and to ensure that it has across its organisation mental function champions to discuss mental health cases with other health care professionals, to bring that expertise to bear.

[Mr Jones]

That is a welcome move, but may I make a little suggestion? If Maximus is going to employ people with mental health backgrounds to conduct assessments, will the Minister ensure that anyone going for an assessment who has a clear mental health condition—it is why they are on employment and support allowance, for example—is assessed only by someone who has that expertise? That will save a lot of time and money for Government and will help the individual.

[Mr Harper]

It may not be that clear. Often, people going for an assessment do not have just a single health condition. It is important to remember that the assessment is not a medical diagnosis; it is about the impact of somebody’s health condition or disability on their ability to work. The assessor is not carrying out a diagnosis of a mental health problem; the assessment is about the impact of the condition on an individual’s ability to work.

The hon. Gentleman should look at the communication he gets from Maximus. I am sure that the company will be delighted—I mean that genuinely—to hear from him about his constituents’ experience, because it is genuinely committed to improving the performance of the work capability assessment. Of course, Maximus has experience in delivering health care assessments through other contracts around the world. The signs are positive for how the company will engage with the contract.

--- Later in debate ---

[Mr Harper]

I do not have a specific answer that I can give the hon. Gentleman immediately, but I will take that point away and look at it further. I listened carefully when he was setting it out for the House and there were some positive aspects to that approach.

About a third of NHS mental health trusts in England are using individual placement and support. The Department of Health is grant funding the Centre for Mental Health to extend IPS further, and my Department and the Department of Health are working with the Centre for Mental Health to try IPS with schizophrenia. From his expression, my right hon. Friend the Member for Sutton and Cheam appears to be familiar with that programme. One of the aims is to encourage at a local level my Department and Jobcentre Plus to work closely with the health service, and there are examples of such close working.

The fit for work service was referred to by several Members, including my hon. Friend the Member for Broxbourne, who said that the longer people were out of work, the less chance there was of return. The fit for work service, to which the shadow Minister also referred, which is obviously at a relatively early stage, is about helping employers and employees manage the sickness absence programme.

I was tempted to advertise another service that we offer earlier, but I resisted. When my right hon. Friend the Member for Sutton and Cheam opened his speech with the story of Anne-Marie, I thought that it was a good example of where she and her employer would have benefited from the mental health support service, which is part of Access to Work, which is clearly not as well known as it ought to be. As he said, it has a job retention rate of around 92%. It assesses an individual’s need to identify strategies that they can use to cope with their mental health problem, looks at a personalised support plan, either for returning to or remaining in work, and gives employers advice. That is important, particularly for small employers that do not have the capacity to have occupational health support in place.

As it happens, tomorrow I will be speaking at a disability confident mental health focus event, which is being supported by Mind, Remploy and the Business Disability Forum, and hosted by Royal Mail, specifically to raise awareness about the mental health support service. A significant number of employers are coming, and I have named several employers, including Royal Mail, who are committed to this.

Leadership has been referred to, and I attended an event with a KPMG senior partner—I hope it is in order to mention the company given that I used to work for it, although it was a long time ago—who has been open about his own mental health problem. It was heartening that he referred to the fact that the senior management of that organisation had created an environment in the business where, as a senior member of the management team, he felt comfortable with being open about his mental health problem. I know from talking to other members of staff that the fact that he has been able to do that and has been well supported by that employer has had a powerful effect on encouraging others in that environment to be open about their mental health problems. So there are other employers who recognise that. The right hon. Member for Hazel Grove (Sir Andrew Stunell) is not in his place, but he referred to a Disability Confident event that he has run. My right hon. Friend the Member for Sutton and Cheam is also interested in this area, and I hosted a Disability Confident event in my own constituency a couple of weeks ago. I have written to all right hon. and hon. Members to encourage them to do the same in their constituencies, partly to engage with those small and medium-sized employers that might otherwise be unfamiliar with the campaign.

My right hon. Friend the Member for Sutton and Cheam wrote an article for PoliticsHome today entitled, “I don’t like Mondays—how work can affect mental health”. My only criticism of the piece is that he urged UK plc to take action. I know what he meant, but it is worth remembering that we are also talking about UK Ltd, because half the work force is employed by small and medium-sized enterprises, and they do not always have the human resources support or access to services that larger businesses have.

My hon. Friend the Member for Broxbourne referred to BT. The head of occupational health and well-being there, Dr Paul Litchfield, has produced two independent reports for the Government. I waited until he had concluded that work, and therefore had only one hat on, before visiting BT, where I had a very positive experience. The hon. Member for North Durham spoke very positively about its programme. He is right that BT puts a lot of effort into supporting employees with mental health problems, and not only because it is the right thing to do, but because it is absolutely in its business interest. It has a very high staff retention rate. It keeps almost everybody who develops a mental health problem at work, and the vast majority in their existing roles, although sometimes they have to change role. I heard four individuals give powerful testimonials about the support they had received from the company. I thought that it was incredibly positive that they felt so open in discussing some quite difficult issues they had had in front of their management chain. They clearly work in a very positive environment.

I will mention universal credit before drawing my remarks to a conclusion, because the hon. Member for Stretford and Urmston would think it remiss of me not to do so. I do not pretend that universal credit solves every problem on the planet, but I think that there are two areas where it is very positive for mental health. The first is the way that it has been set up, because it is about getting work coaches to engage with people earlier, looking at what support they need. If someone falls out of work and approaches the jobcentre—I think this is the thrust of the point made by the hon. Member for North Durham—we want the support to be delivered earlier in the process, rather than later. Universal credit has been set up in such a way that it is about having that conversation, looking at what someone can do and delivering support earlier, which I think will help. It is not the only solution, but I think that it will make things better.

[Mr Kevan Jones]

I agree with the Minister, but will he also address the point I made about companies being paid by the Government to support individuals into work, even though that work is actually being done by the voluntary and community sector? If those companies are claiming to have helped those people and are getting paid for it, even though the work was actually done by the voluntary and community sector, that is a very serious issue.

[Mr Harper]

The hon. Gentleman anticipates my remarks, because I had not yet got to that point. There are two points that arise from what he said, and he was supported in that by the shadow Minister. The first relates to the ability of smaller private sector companies and the voluntary sector to be subcontractors to prime providers, and we will consider how to make that easier as we look to develop what follows the Work programme. The second point—the central one—is about ensuring that Work programme providers are paid only when they have done the work. He raised a specific concern about a third sector organisation in his constituency. If he can give me a little more detail, I will look into it. If a Work programme provider has done nothing at all, it should not pretend that it has done so in order to claim a payment. Either it should not be paid, or it should effectively be subcontracting with the smaller provider. If the smaller provider is very successful, clearly we would want it in the programme, working with the prime provider. If he gives me some more details, I will absolutely task officials with looking into it. It is not very sensible for the taxpayer to be paying someone for work they have not done. Moreover, we should be making sure that the money goes to support those who are successful at getting people back into work so that they can improve their organisations and become more successful and sustainable.