Mental Health and Unemployment

James Morris Excerpts

Tuesday 24th February 2015 Commons Chamber

[Paul Burstow]

That is undoubtedly true and indeed some people do not go through the recruitment process in the first instance because they believe they will be discriminated against or they are fearful of disclosure. Those are serious issues to do with lack of parity and lack of equality, and the discrimination people both impose upon themselves but that also exists within our society. It is why tackling the issue of stigma is so important and why we should celebrate the progress that has been made but also be challenging the Government to continue to support campaigns like Time To Change because they are clearly demonstrating progress.

The stigma has not gone, but it is going. Time To Change, the anti-stigma campaign set up by Mind and Rethink Mental Illness and funded as part of the Government’s mental health strategy, recorded the biggest annual improvement so far in public attitudes to mental health. It found a 7% rise in people’s willingness to work with someone with a mental health problem—from 69% to 76%. We still have to go further, but that is a mark of the progress that has been made, and I hope we can see more.

The Government have made parity of esteem between physical and mental health the clear goal of their mental health strategy, and progress is being made. However, when it comes to employment and the way people with mental health problems are supported, we still have a long way to go. Four different sets of data lead me to that conclusion. First, according to the OECD, unemployment rates for people with severe mental health problems in the UK are five times higher than for people without a mental health problem. Secondly, a clinical commissioning group outcome indicator on employment and severe mental illness was included in the 2014-15 indicator set. It published its first set of results last December, and it shows a worrying decline in the number of people in paid employment with a severe mental health diagnosis, from 43,000 to 35,000, a significant 20% drop. Thirdly, the CQC’s community mental health survey for 2014 showed that 34% of respondents on the care programme approach, and over half of respondents not on the approach, said they did not receive support from someone in NHS mental health services in getting help with finding or keeping work, but they would have liked that and would like to have been told how to access that support. Fourthly, of the 150,000 people with mental health problems on employment and support allowance who have been placed on the Work programme, just 6.7% have been helped into work. That is compared with a 25% success rate for those without a health condition.

For me, what this shows is that there is a huge amount still to do. It is worth saying that while the national average employment rate for people with severe mental health problems has dropped to 5.7%, a number of areas are achieving high levels of employment for people with severe mental illness, such as Wokingham, mid-Essex and Aylesbury, all of which are achieving employment rates of 20%.

[James Morris (Halesowen and Rowley Regis) (Con)]

Does the right hon. Gentleman agree that there should be scope for the use of individual placement and support for those with serious mental health issues? I know the Government have been piloting some individual placement and support programmes. I would be interested to hear from the Minister whether they are proving to be successful in getting people with severe mental health problems back into work.

[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.

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[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.

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[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.

[James Morris]

My hon. Friend makes an important point about individuals not having a single health condition, whether that is mental or physical. One of the challenges is the assessment of someone who has a fluctuating mental health condition, which might require a special form of assessment.

[Mr Harper]

My hon. Friend makes a good point about fluctuating conditions in the context of assessments. One change in the work capability assessment has been a recognition that fluctuating conditions, including in the mental health space, must be taken into account. Claimants should be asked questions not just about their experience on that day, but about what a typical day looks like and the extent to which their condition fluctuates.

A number of Members, including the right hon. Member for Sutton and Cheam who opened the debate, referred to how my Department and the Department of Health are working together on improving people’s employment and health prospects. He referred to the pilots that we are undertaking. There are four broad pilots, one looking at the individual placement and support model, one looking at whether peer-led group work employment intervention can improve outcomes, another investigating whether a telephone support model is effective, and an online service pilot, which was one of the recommendations from the RAND study that he mentioned. Those pilots, as he knows, have started and are moving into the next phase, which involves a larger set of pilots.

One thing that we are keen to do, which is frustrating because it means that pilots take longer, is to get robust evidence bases for those pilots. As the shadow Minister said, if one wants to roll them out on a significant scale, with my Department and the Department of Health working together, and a substantial amount of money is to be invested, a good evidence base is needed to be clear about what the outcomes will be. It is important that there are sufficient numbers of individuals going through those pilots for a robust evidence base to be developed, rather than lots of qualitative data and anecdotal evidence suggesting that they were successful.