Mental Health and Unemployment

Kate Green Excerpts

Tuesday 24th February 2015 Commons Chamber

[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]

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.

[Kate Green]

Will the Minister also comment on, or ask his officials to look into, the report I received from the individual placements and support service in south Manchester that Work programme providers were being rewarded for work that was being carried out and funded by the NHS? It sounded as though the public purse was paying twice and the Work programme provider was getting a reward for very little, if any, activity.

[Mr Harper]

Yes. I listened carefully to what the hon. Lady said, and I will look into that specific example as well.

My right hon. Friend the Member for Sutton and Cheam referred to the Work programme. It is true that in its earlier phase the success rates for those on ESA as opposed to JSA were not very impressive—one in 24, I think. However, more recent cohorts have been more successful, and about one in 10 people have been getting into sustainable work. Obviously we want that performance to continue.

It is very apposite, Mr Speaker, that you are in the Chair as I draw my remarks to a close, because I know—I do not think it is a secret—that you take a close personal interest in this area. I remember when you allowed a discussion on mental health to run for a fairly reasonable length of time in the last session of DWP questions. You feel that it is a very important area. You referred to the changes we had made in law to reduce the stigma for the many Members of Parliament who might have a mental health problem. Earlier I referred to the hon. Member for North Durham and my hon. Friend the Member for Broxbourne, who spoke very openly in the House about their experiences.

The Government take this issue very seriously. There is a lot of working across Departments, not just with my Department and the Department of Health, but with the Home Office, where, as Members will be aware, the Home Secretary has been pressing a great deal to make sure that police cells are not seen as places of safety for those who develop a critical mental health problem. Work is being done by other Ministers across Government. We are moving in the right direction, but we are not complacent. Although some progress is being seen in the unemployment figures, there is still a considerable gap, and there is more work to do. I think there is a shared sense of purpose across the House about the direction of travel, and I want us to continue to move in that direction through to the general election and beyond.