Mental Health First Aid in the Workplace

Lord Beamish Excerpts

Thursday 17th January 2019 Commons Chamber

[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.

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[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.

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[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.