Mental Health and Unemployment

Andrew Bridgen Excerpts

Tuesday 24th February 2015 Commons Chamber

[Paul Burstow]

Yes; I want to come on to that, and I look forward to hearing what the Minister has to say about the pilots, where they have got to and the intentions going forward. It is inescapable that back-to-work support that is designed primarily around physical health problems and disabilities is poor at meeting the needs of people with mental health problems. Where the support is well-designed, it has so far not got the reach or take-up necessary to make a difference. The Access to Work mental health support service was described in the Sayce review as

“the best kept secret in Government”,

because despite its success rates—90% retention rates, for example—very few people have been helped: just over 2,500 people with a mental health problem since the service started in 2011, on the most recent data I could find. The potential is good, but more needs to be done to ensure the take-up of such programmes, so that people can benefit from the advantages that they provide.

Over the past two years, I have had the opportunity to chair an independent commission on mental health for the think-tank CentreForum and to co-chair a task and finish group on mental health and employment with Marjorie Wallace, the chief executive of the charity SANE. That group’s work has led to the NHS adopting an employment-based indicator, and to the development of a new commissioning incentive for NHS organisations to provide for adults who are in contact with secondary mental health services to help them to gain or retain employment. The group is also helping with the drafting of a new National Institute for Health and Care Excellence quality standard on schizophrenia containing a specific reference to employment.

[Andrew Bridgen (North West Leicestershire) (Con)]

I have been listening with great interest to my right hon. Friend’s speech. Does he agree that the incidence of mental health problems increases the risk of unemployment? Does he also acknowledge that unemployment itself has the capacity to induce and exacerbate mental health problems in those who find themselves in the distressing situation of being unemployed?

[Paul Burstow]

The short answers are yes and yes. In particular, severe mental health problems such as schizophrenia can lead to an increase of 65% in the likelihood of not being in employment unless properly supported. There is clearly an issue there.

SANE’s report into schizophrenia and employment revealed that, of those who were not engaged in employment or related activities, 59.4% said they would like to be. About 45% of people who receive a diagnosis of schizophrenia recover after one or more episodes, but about 20% show unremitting symptoms and disability, with the remaining 35% showing a mixed pattern with varying periods of remission and relapse. There are therefore issues about how we should tailor support for people with those conditions. Even though health care professionals acknowledge the importance of work, they often hold the view that people with schizophrenia would be better suited to low-skilled, low-responsibility or non-competitive work, but that is a fallacy. It is a mistake and it needs to be challenged vigorously. We need tailored programmes that fit the individual’s circumstances, abilities and needs.

The evidence of the beneficial nature of work for people with schizophrenia includes increasing social skills and enhancing the opportunity for the development of friendships; learning new skills; financial rewards; and the stabilisation of the condition. Employment brings clear health benefits for people with schizophrenia. Research shows that those in paid employment are over five times more likely to achieve functional recovery than those who are unemployed or in unpaid employment.

Last year, the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), along with Ministers from the Department for Work and Pensions, launched a programme to pilot better ways of co-ordinating mental health services and employment services. The pilots are testing a number of different approaches based on the recommendations of the RAND report. This work points the way to a more tailored approach to meeting the needs of people with mental health problems. As I said earlier, the Work programme helps just 6.7% of people with mental health problems into work. In some cases, the way in which different parts of the back-to-work system works has the unintended effect of pushing people further away from the workplace, and that is not what anyone wants.

So what is next? First, the goal needs to be clear. We have said that we want to close the scandalous 20-year life-expectancy gap that exists in regard to mental health, and we must do more to tackle that issue. We also need to close the opportunity gap. Currently, just 5.7% of adults in contact with secondary mental health services are in paid employment, yet in some areas employment rates are as high as 20%. The goal should be to achieve at least a 20% rate of employment by 2020 across the whole country. That means building on the learning from the pilots. It also means acting on the evidence of what works. In particular, it means much more use of the individual placement and support that my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) has just mentioned.

Individual placement and support has been shown to be twice as likely as any other employment support scheme to enable people with severe mental health problems to enter work. IPS works to secure paid employment that matches the person’s interests and aspirations by co-producing a plan of action, rather than requiring them to undertake certain activities. Support continues once the person gets a job and, as these schemes are often based in secondary mental health care services, they are integrated with the person’s health support. A recent psychological well-being and work report by RAND for the Government estimated the cost-benefit ratio at 1:41 for this approach. In other words, the Government save £1.41 for each pound they spend on IPS models. Where IPS is in use, it is delivering very positive outcomes. For example, WorkPlace Leeds, which is part of Leeds Mind, provides a specialised service, using individualised, tailored and collaborative approaches to enable clients to meet their goals. WorkPlace Leeds uses the IPS model, including CV building; interview skills; job searching; tailored applications; confidence-building; one-to-one sessions; advice on benefits; and practical assistance to overcome barriers such as child care difficulties or public transport issues. It also offers peer employment support interventions to develop confidence and a shared understanding of the struggle to get back to work. It recognises that there are no quick fixes, that the journey can be a long one and that it can sometimes take a lot of support for clients to achieve goals—I am thinking of things such as volunteering or training along the way. Work is the focus—that is the outcome people are striving for—but there is a recognition that the journey is important and needs to be properly supported. Perhaps that story of what happened to Anne-Marie could have been different if she had had access to that sort of support when she returned to work.

That support is delivered in partnership with the mental health, social care and housing services, all of which play a crucial part, and with the secondary mental health service. WorkPlace Leeds has also worked in partnership with Jobcentre Plus to identify the gaps in service provision—that is crucial to the evolution of services in this area. In other words, there is a joining up at the local level, with a devolved approach that actually seems to work. The annual cost of this approach in Leeds has been put at £5,819, compared with the £13,700 cost to the Work programme of supporting an employment and support allowance claimant.

So I hope that one thing that will come out of the pilots—I look forward to hearing the Minister’s aspiration for this Government and indeed future Governments—is that a future Government will put in place a programme to improve access to IPS, rather like previous Governments introduced a programme to improve access to psychological therapies. We need that level of drive and determination to make sure that this evidence-based practice becomes the norm, not the exception it is at the moment.

Finally, surveys have found that mild to moderate mental health problems, including stress, anxiety and depression, are the most common reasons why people are signed off work. The figure cited is that this costs the economy £26 billion every year: That is an average of more than £1,000 for every employee, so it is in everybody’s interests and it is everybody’s business to make sure that we properly support people in the workplace. Although there are great employers who really get mental health and its impact on their employees, as well as their business, and do take the necessary steps, there is still so much more to be done.

In bringing my remarks to a conclusion, I wish to ask the Minister whether we could make better use of the Health and Safety Executive, a sometimes maligned body which some years ago developed new tools relating to stress audits, which could be used by employers. If the company in Anne-Marie’s story had used a stress audit, it may well have identified some of the things it could change before she got to a crisis and had to leave work. I hope that the Minister will be able to say more about how the HSE and the work it has done in the past could be updated and become part of its day-to-day practice in the future.

With that, I hope that today’s debate will not only generate a useful exchange across the Chamber, but demonstrate again that there is a commonality of purpose: a recognition that for far too long these issues of mental health had not been given the time, focus or priority they should get, that they are getting that now and that we will make progress in the next Parliament. If we do not, we are not just costing our society a huge amount—we are costing individuals a fortune.