Mental Health: Access to Work Support Service

Baroness Thomas of Winchester Excerpts

Monday 18th June 2012 Lords Chamber

Asked By

[Baroness Thomas of Winchester]

To ask Her Majesty’s Government what steps they will take to promote the Access to Work mental health support service.

[Baroness Thomas of Winchester]

My Lords, in this Shakespeare celebratory year, I have been reflecting on the mental health of some of his most colourful characters, and in particular the mental state of perhaps his most villainous king—Richard Ill. Here is part of what he says about his own appearance:

“I, that am curtail’d of this fair proportion,

Cheated of feature by dissembling nature,

Deformed, unfinish’d, sent before my time

Into this breathing world, scarce half made up,

And that so lamely and unfashionable

That dogs bark at me as I halt by them”.

Richard clearly could have done with the help of Access to Work mental health services in view of his very singular and ruthless method of accessing his particular vocation.

The House will be glad to know that that brings me to the purpose of this short debate on how the Government can promote this most laudable service, which seeks to help those with mental health conditions to remain in work, including self-employment, take up a job offer or start a work trial. But before leaving Richard Ill entirely, there is one more point which is relevant. The passage is, of course, from Richard’s opening soliloquy. Richard does not voice his self-loathing when others are present so no one knows about his deep distress. In keeping those destructive thoughts to himself, he has much in common with the vast majority of people with mental health problems today.

The Mental Health Foundation points out that Access to Work will really only succeed when the culture within organisations—whether office, factory, hospital, shop, school et cetera—is more open about, and less stigmatising of, people with mental health problems. This is backed up by a survey of 2,000 people across the UK by the Chartered Institute of Personnel and Development. About half of respondents said that they would not feel confident disclosing unmanageable stress or mental health problems to their employer or manager, and less than half were satisfied at the way in which their employer supported employees with mental health problems.

The Access to Work scheme in general is not well enough known, although things have certainly improved in the past few years. It is run by the DWP through Jobcentre Plus, and provides practical advice and support—mainly at present to disabled people and their employers to help them overcome work-related obstacles. Although help for employees with mental health problems has been available for a few years now, it was only in January of this year that the Government awarded seven contracts to run this particular intervention throughout the country to Remploy Employment Services.

We know that mental health problems account for more non-manual workers being absent from work than any other cause, and the figure is even higher when those with a secondary mental health diagnosis are included. This is well covered in the booklet Models of Sickness and Disability, written by Waddell and Aylward, which looks at the whole picture of common health problems experienced by the working-age population. They say that if current trends continue, within a few years mental health problems will be the main cause of all long-term sickness absence, incapacity for work and ill-health retirement, and will cost the UK even more than the estimated £40 billion to £48 billion per annum that it already costs. We are not talking here about severe conditions such as schizophrenia, but mild to moderate conditions such as anxiety-related or depressive disorders and stress. The authors’ conclusions are stark. They say:

“There is therefore an urgent need to improve vocational rehabilitation interventions for mental health problems. Promising approaches include healthcare that incorporates a focus on return to work, workplaces that are accommodating and non-discriminating, and early intervention to support workers to stay in work and so prevent long-term sickness”.

That is exactly what Remploy’s vocational rehabilitation consultants—VRCs—are trained to do. The key question is: who knows about this service and how do they find out about it? It is entirely a self-referral service for employees, although employers can seek advice. The sort of interventions VRCs might suggest are time management, organisation, planning or communication. Perhaps an employee needs help in making an employer aware of an existing mental health condition and would welcome the intervention of a VRC to help with the disclosure conversation. If the employee consents, then the VRC might talk to the employer about how the condition could be managed without the employee having to take time off. We all know that the longer a person is off work, the harder it is for them ever to return. The sort of changes and workplace adjustments that might be suggested include a change to working hours, flexible working, changes to the work environment, the introduction of a workplace mentor or buddy, or even additional training.

So, are there any downsides to the whole programme? The Mental Health Foundation does not think that the scheme is nearly ambitious enough. The three-year contract will cost £4.8 million and is estimated to help up to 1,600 individuals per year. Mind also believes that the service has the potential to be so valuable that funding should increase and the scheme be much more widely promoted. It also takes the view, and is not alone in this, that assessments and agreement of funding should take place before someone secures a job, so that people can go to an interview with the Access to Work offer in place, and for packages of support to be portable.

I have been conducting my own extremely unscientific survey for a few months now and have discovered that some large firms with HR departments know about and appreciate the scheme, but many smaller employers, even if they have vaguely heard about the original Access to Work scheme, do not know about its application to mental health problems. This comment from a retailer in the north of England with 30 staff bears this view out. He says:

“We are aware of the scheme generally, but would never have considered using it to help someone with mental health problems”.

Another comment, from a firm of accountants with seven employees, was that:

“I would have thought we were too small to use the scheme”.

Here is another comment, from a builder with fewer than 10 employees:

“Wouldn’t a person’s doctor recommend it? Surely an employee would have to be diagnosed with a mental health problem to qualify for help”.

The answer, of course, is no. Here is another comment on a similar theme from a fleet hire company:

“If we did have someone diagnosed medically, I would expect the GP to advise the correct solution”.

That shows a touching faith in the medical profession, which is interesting in view of the report out only today from the LSE, fronted by the noble Lord, Lord Layard, which found that three-quarters of those with depression or anxiety conditions get no treatment. Another employer, with about 40 staff, said that he had never heard of Access to Work at all, and usually got his information about employment matters from ACAS. He wondered whether the scheme would have helped with an employee with an alcohol problem. Yes, it could have helped there.

Finally, I accept that there is a much wider debate to be had about the whole question of health at work, and another about services for those with mental health problems. I hope that the Access to Work scheme will become much better known and prove so successful that it will be able to expand with a much bigger budget in the years ahead. I look forward to the rest of the debate and to my noble friend’s reply.