Mental Health First Aid in the Workplace

Luciana Berger Excerpts

Thursday 17th January 2019 Commons Chamber

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I beg to move,

That this House notes that the UK is facing a mental health crisis; further notes that, according to the Independent Review into Mental Health in the Workplace 2017 commissioned by the Prime Minister, each year 300,000 people with long-term mental health conditions lose their job; recognises that Centre for Mental Health research shows presenteeism from mental health is estimated to cost the economy £15.1 billion per annum; acknowledges this same research shows it costs the economy £8.4 billion per annum for mental health absenteeism; considers that a recent poll by OnePoll found that 38 per cent of people reported being stressed about work; observes that the Health and Safety Act 1974 made it a legal necessity for workplaces to train someone in medical first aid; and calls on the Government to change this law via secondary legislation to provide clarity that an employer’s first aid responsibilities cover both physical and mental health and to add a requirement for workplaces to train mental health first aiders.

It really is a pleasure to speak in support of this motion, alongside its co-sponsors the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Plymouth, Moor View (Johnny Mercer). The application for this debate was supported by more 60 Members from all parts of the House, and we are very grateful to the Backbench Business Committee for allocating time for our discussion today.

Following the particularly challenging moments that this House has experienced over the last few days, today’s debate is a salutary reminder that the work of this Parliament goes on, and that we are capable of debating in a constructive and collegiate fashion. Our motion addresses a real and pressing need to support people affected by mental ill health. Our argument is simple. The Health and Safety at Work etc. Act 1974 ensured that every large workplace has someone trained in medical first aid, and that is now an accepted and established part of every office, factory, warehouse, hotel and anywhere else that people work; so why not a trained mental health first aider in every workplace? We want to change the Health and Safety Act via secondary legislation so that an employer’s responsibility explicitly covers the mental health as well as the physical health of their employees. This debate is a true cross-party initiative, calling on the Government to make a small change to the law that would constitute a step towards establishing parity of esteem—real equality between physical and mental health.

[Sir Greg Knight (East Yorkshire) (Con)]

This is an excellent motion. Does the hon. Lady agree that when workplace training on first aid—including mental health first aid—takes place outside the workplace, the employer should be required to give the employee time off during working hours to attend?

[Luciana Berger]

There are many different ways in which this could be implemented. I myself have attended mental health first aid training at the workplace, but I certainly would not be averse to employers giving their staff time off for such training. I will later come to many examples showing that this is already the case with a number of employers, particularly large employers, across the country.

This debate was born out of the “Where’s Your Head At?” campaign, which was launched by campaigner Natasha Devon and supported by Mental Health First Aid England and Bauer Media, which have together collected over 200,000 names on a petition that a number of us delivered to No. 10 Downing Street. I commend those organisations for all their hard work, and pay tribute to their commitment and determination to see this positive change introduced. It really is admirable. Bauer Media—an organisation with radio stations and a number of magazines, such as Grazia—has really taken the idea forward, paying for billboards across the country to promote the campaign. I commend its social action on a matter that, as an employer, it knows would make a difference in its own workplaces.

This really would be a simple shift, but one with a huge beneficial impact on the lives of millions of British workers. No one can seriously contend that there is not a need for such a measure. Hon. Members only have to look at some of the statistics. NHS Digital suggests that one in six adults experience mental ill health, including depression, anxiety and stress-related illnesses. There are around 28 million people in work in our country, so it is not unreasonable to assume that 5 million people in work today are affected. In a recent poll, 38% of people reported being stressed about work. It is a tragedy that, according to the Stevenson-Farmer “Thriving at Work” report—a review commissioned by the Government and published just over a year ago—some 300,000 people with a long-term mental health condition are losing their jobs every single year.

[Mary Creagh (Wakefield) (Lab)]

I congratulate my hon. Friend on securing this debate. She is making a powerful case and is describing an epidemic of mental ill health that has many different sources. The Environmental Audit Committee is looking into this as part of our planetary health inquiry. When I met my local Wakefield UK Youth Parliament, I was struck by how concerned the young people were about mental health in schools, and I discovered that South West Yorkshire Partnership NHS Foundation Trust has provided mental health first aid training in schools for teachers. Does my hon. Friend agree that that needs to be rolled out across all schools so that teachers or trusted adults in schools can deal with young people and children in crisis?

[Luciana Berger]

I thank my hon. Friend for her important intervention. Of course, today we are talking about what happens in the workplace, but what happens with young people in places of education is equally critical. I sit on the Health and Social Care Committee, and we have interrogated the Government’s plans for the next generation and young people. There are plans in place to have a designated mental health senior lead in every school, and we should ensure that at least one person has that training. We could be doing better than that, but at least it is a start. I support the idea, and it is great to hear what is happening in my hon. Friend’s constituency.

Let me be very clear that we are talking about a huge number of people affected in our country every single day—our friends, colleagues and workmates who surround us. There is, of course, a huge economic cost as well as a very significant human cost. The Centre for Mental Health estimates that people with mental health conditions staying at work longer than they should costs our economy over £15 billion every single year, and that people being absent from work because of mental ill health costs our economy £8 billion a year. These are not insignificant sums. I reiterate that 300,000 people with a long-term mental health condition are losing their jobs every single year because they find themselves in an acute state, have to leave work, are not supported and get to a critical state, rather than having experienced early intervention or prevention, which might have helped them in the first place.

The Health and Safety Executive says that 15.4 million working days were lost in the last year alone because of stress, depression and anxiety, and the British Association for Counselling and Psychotherapy—I declare an interest, as I was recently appointed one of its vice-presidents— has calculated that stress is costing British businesses £1,000 per employee per year in sick pay and associated costs. That is very significant for the national economy, and for individual organisations and businesses. I do not think I need to set out any more statistics to evidence the fact that there is a clear need. Mental illness is having a significant impact on millions of workers across the country and costing our economy billions of pounds.

[Dr David Drew (Stroud) (Lab/Co-op)]

My hon. Friend is making an excellent speech. As we have all heard in our constituency surgeries, one of the real costs is that people who suffer from mental illness find it very difficult to get back into employment because of the stigma, and I have to say that the public sector is among the worst at having a bias against people with mental health problems. Does she accept that?

[Luciana Berger]

I thank my hon. Friend for making that important point. I am going to move on to talk about tackling the stigma and discrimination that we know still exist in our country. We have made some progress in the national conversation about tackling mental ill health, particularly with the younger generations, but in too many workplaces and too many communities, there is still the discrimination and taboo connected with mental ill health. As a constituency MP, I see that almost weekly. Men of an older generation feel that they are able to talk to me because I campaign on this issue and am very open about it, but they are perhaps unable to speak to their work colleagues—sometimes not even to their close family—because of the discrimination that they feel still exists. We are certainly on a journey as a country.

One objection to this proposal might be that mental health requires highly specialist medical intervention, not someone in the workplace with only a few days’ training—and of course that is absolutely true. Mental health conditions do require specialist diagnosis and treatment. That is why many of us, on both sides of the House, have been calling for more investment in this area to ensure that we have the clinicians within our NHS to address the mental health crisis in this country. But let us be very clear that this motion, with this specific initiative, is not seeking to substitute mental professionals with mental health first aiders. Mental health first aid training gives people the knowledge, the skills and the confidence to intervene early if someone is struggling with their mental health. It is not in any way intended to be a replacement for trained mental health professionals, either in the NHS or in our workplaces; rather it offers an early warning system and an opportunity for employee support. It is also, in response to the point made by my hon. Friend the Member for Stroud (Dr Drew), aimed at tackling the taboo that we often see. Raising awareness of mental ill health and placing it on an equal footing with physical ill health tackles some of the stigma and discrimination that we still have to break down.

If any colleagues would like a clearer explanation, let me say this. All of us here present would know where to go for assistance if we had a physical injury. If we had perhaps slipped, or had a burn or a cut, we could go to the officers just down there through the Chamber. Perhaps, either in this place or in a previous role, we were that first aider. But how many colleagues, or their staff would know where to go if they were struggling with their mental health? How many would have known who that person was, or if they existed at all, in their previous job? Training people in our workplaces in mental health first aid would mean that employees in workplaces right across our country had an instant answer to that question.

No one should assume that a mental health first aider is the same as a mental health professional, any more than anyone assumes that a current workplace first aider is the same as a heart surgeon, an A&E doctor or a cancer specialist. The point is that a mental health first aider provides early intervention and a critical and important signpost. They would be able to answer questions about how and where to go to get treatment. They can help to change the culture in an office or on a shop floor so that someone with a mental illness has support. They can provoke a conversation about mental health that can break down some of the stigma and prejudice. They can be a valuable first point of contact for someone struggling with their mental health in what might otherwise feel like a very lonely environment.

We do not need to talk in purely hypothetical terms. At the end of last year, the Where’s Your Head At? campaign sent a letter to the Prime Minister in support of statutory mental health first aiders. It was supported by over 40 businesses, including WHSmith, Standard Chartered and Thames Water. I am particularly proud to say that a friend of mine and good Labour colleague, Sadiq Khan, the Mayor of London, has, in the capital, done so much on mental health first aid training at City Hall and in London’s schools as part of his public health strategy. St John’s Ambulance will have trained 10,000 people by the end of this last period. Mental Health First Aid England has now trained over 350,000 people in mental health first aid. Councils are investing in this and other providers are making similar strides forward. Those who have completed the training say it is hugely beneficial to them and their co-workers. It gives people the skills, knowledge, confidence and language to spot the signs of mental ill health, provide support and make early interventions. But most critically, it is helping the people affected. It really can make a difference.

One of the elements of the mental health first aid training that I completed was about what to do if someone you work with is experiencing suicidal ideation and might be considering taking their own life. Some 6,000 people in our country have taken their own life in the past year and this particularly impacts on young men. This is an area where quite often people do not know what to say or do, but training such as this, and training from the Zero Suicide Alliance, which offers a free online half-an-hour session, are the tools that can really make a difference. In some cases, it really is a life or death situation.

A number of unions have come out in support of the change to the law we are seeking to make today. Community, The Teacher’s Union and Unite were all signatories to the letter to the Prime Minister I just mentioned, and the Communications Workers Union and the GMB have since joined calls for this change to the law.

The costs of training—another question that is often raised—are very clearly outweighed by the benefits of better mental health in our workplaces. Training can typically take place over a number of days, but it can also take place over one day—or half a day, providing opportunities particularly for small businesses and organisations to train people in mental health first aid, too. The training that I did was with the Liverpool city region Mayor, Steve Rotheram, and the senior leadership of Merseytravel in Liverpool. I have half a day left to do, but I have done almost the whole course and seen what the benefits can be. So we do not need to gaze into a crystal ball. We can talk to people who have been trained. But again, in particular, we can reflect and engage with the people who have been helped.

I would like to share some of the thoughts of organisations that have gotten in touch in recent days to share their experience of training mental health first aiders, the value they place on this important initiative and why they are supporting our call today. The insurance company AXA has trained over 100 of its staff to become mental health first aiders, so now each of its UK offices has one. It has also trained as mental health first aiders the staff of the companies that it provides insurance to, helping other businesses across the country to improve mental health in their organisations.

Another success story is that of Thames Water, where 350 employees across the organisation are trained in mental health first aid. They wear green lanyards so that they can be easily identified by the wider workforce. A further 250 employees have joined the company’s mental health online engagement forum. Thames Water has calculated that there has been a 75% reduction in work-related stress, anxiety and depression among its employees—a not insignificant impact.

Colleagues may not know—I was certainly not aware of this—that the construction industry is the sector where workers are most affected by mental ill health. In response to that, the Construction Industry Training Board has now committed £500,000 to the Building Mental Health initiative, which will train 156 construction workers as mental health first aiders. Further to this, Mates in Mind is a fantastic charity that works to address the stigma around poor mental health and improve positive mental wellbeing in the UK construction industry. It aims to have reached 75% of the construction industry by 2025.

I give these examples as evidence to colleagues that a number of businesses across the country have been proactive in their approach to mental health and are reaping the rewards. There are many more I could have shared, but I am conscious that many Members want to contribute to the debate.

This is an idea whose time has come. In a decade from now, when mental health first aiders are an established part of the workplace, we will wonder why we did not start sooner. It is good to have the Minister here today. As I am sure she recognises, this is a measure that can bring us together across party lines. The Minister and the Government have the chance to do a really important thing in supporting this motion. I should say that that is in line with their own pledges in the Conservative party manifesto in 2017. The Government have the opportunity to amend the 1974 Act and to take a clear step towards achieving real equality.

The term, “parity of esteem”, may seem meaningless, but it means real equality between physical and mental health. We legislated for that principle in the Health and Social Care Act 2012. We are now seven years down the road and still waiting to realise that ambition. The Minister will also know that the Prime Minister has been clear on this from the start of her premiership, when she made the commitment to address the inequality between physical and mental health one of the key “burning injustices” that she wanted to erase. This motion, and the policy that it seeks to implement, gives the Prime Minister and her Government the opportunity to solidify her commitment to this mission.

Unlike certain other matters that we are discussing in the House this week and over the weeks ahead, this initiative has cross-party support. It has the support of businesses and of our constituents—over 200,000 people have signed the petition. It has the support of so many mental health campaigners across the country. I sincerely hope that all Members on both sides of the House will support it here this afternoon.

--- Later in debate ---

[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.

[Luciana Berger]

I am listening very carefully to the right hon. Gentleman’s remarks, which are very pertinent. On people being in work or not in work if they are affected by a mental health condition, I was struck to learn that for my local mental health trust, Mersey Care, which provides services for the whole of Merseyside, the latest available figures—not the most recent financial year, but the previous one—show that just 3% of the patients under its care, in both the community and in in-patient services, were in any form of work. That figure is similar for patients under the care of many mental health trusts across our country. Does he believe that people outside this place might not be aware of that fact, but it is staggering and should concern us all? We should be doing everything possible to support people with mental ill health conditions into the workplace.

[Norman Lamb]

I totally agree. My plea to the Government is that, as we hopefully commit to spending more on mental health, we spend at least part of that on preventive measures. If we can get someone into work, it makes a whole difference to their lives. The evidence shows that many people who are helped back into work are then able to stay in work; reducing the burden on the NHS and the benefits system, but giving people dignity and self-respect.

Another initiative we are undertaking in the west midlands is the wellbeing premium. It was my idea, which again is being supported by the Government and I am grateful to them. The idea, which we are trialling over a year, is to give an incentive to employers to improve the way in which they support people in work by training their line managers—the most critical thing one can do—and see whether we can reduce the number of people who end up on sickness absence. The idea is to give them a temporary incentive for one or two years, for example by a reduction in the business rate or a reduction in national insurance payments. If by that we can reduce sickness absence, the number of people falling out of work through ill health and the problem of presenteeism, everyone benefits. It will be interesting to see how that succeeds.

In the west midlands, we are also pursuing the thrive at work commitment, which is trying to build a social movement of companies that all sign up to a commitment to up the level of support that they provide people, changing the culture in workplaces. A toolkit is provided to companies, and that could make a substantial difference across the region.

The action plan also has a commitment to train up 500,000 people across the west midlands in mental health first aid. That is a totally different approach to what we have been used to, which is an NHS very much focused on sickness and providing treatment for sickness after what is often a very long wait, as the hon. Member for Plymouth, Moor View pointed out. Instead, the whole focus of the system should be on prevention. If we do that, we can achieve a real breakthrough.

To conclude, let us amend the legislation and get mental health first aid to become the standard in every workplace. Critically, that should be part of a much wider programme that is focused on prevention and on building good healthy workplaces with the right culture, where people have respect, are engaged in the work they are doing and are treated with dignity. With that commitment is a dedication to the work they are doing and a commitment to raise awareness of mental ill health among all staff and to train managers properly. Through a combination of regulation and incentives, we can make a real difference for people.

--- Later in debate ---

[Luciana Berger]

I want to thank and put on the record my gratitude to colleagues who have joined us and made contributions this afternoon. I appreciate that we are extremely busy with Brexit proceedings, so I am most grateful to everyone who has made the time to be here for this important debate. I also thank those who have made interventions. In particular, I thank my hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) and my right hon. Friend the Member for North Norfolk (Norman Lamb)—I call them friends because we have worked very closely together on this and other related mental health matters—as well as my hon. Friend the Member for Dagenham and Rainham (Jon Cruddas), the hon. Member for Waveney (Peter Aldous), my hon. Friend the Member for Merthyr Tydfil and Rhymney (Gerald Jones) and the hon. Member for Strangford (Jim Shannon), and the Front Benchers, the hon. Member for Glasgow South West (Chris Stephens), my hon. Friend the Member for Burnley (Julie Cooper) and the Minister, for their responses.

I hope that my opening speech and the personal, passionate and informed speeches of other Members on both sides of the House have made clear that there is a robust moral, social and economic case for a change to the law to place on employers a legal obligation to make provision for employees to be trained in mental health first aid, in addition to the training they already have to provide for physical health first aid. That is the crux of the issue. If we expect and require businesses with 25 employees or more, including in the public and charitable sectors, to train at least one person in physical health first aid, an equal requirement should be extended to the provision of mental health first aid, if we are serious about the principle of equality for mental health.

Having listened closely to the remarks and representations that have been made, I appreciate that this should not be a tick-box exercise. The proposal is not going to fix the many challenges in mental health services and it is by no means a replacement for clinical professionals, who do a very important job, or the only thing that should happen in workplaces. It is an additional measure. I listened carefully to the Minister, who said that our workplaces should have a holistic culture of wellbeing; of course that should be the case, but the proposed provision should not be viewed in isolation.

I, along with the right hon. Member for North Norfolk, the hon. Member for Plymouth, Moor View, and just under 210,000 signatories to the “Where’s Your Head At” petition are asking the Government to enact this legislative change, to expand the legal responsibility of employers to make provision to train employees in mental first aid as well as physical first aid, and to make that positive and decisive step towards ensuring parity of esteem—parity of esteem was enshrined in law seven years ago in the Health and Social Care Act 2012—between physical and mental health in this country.

I do not think that we can be seen as impatient, as it was seven years ago that that principle was put into law. I and many others see this as one step—not the only step—that we should make. It is just one of the six principles proposed in the Thriving at Work report, which was a really important piece of work that was published one year and three months ago. This is just one step in that suite of tools at the disposal of businesses and organisations to make that difference.

I say to the Minister that it was the manifesto commitment of her party to bring forward this change. Having listened carefully to what she has said today, I can say that, obviously, she has not made that commitment yet, but, going forward, I urge her to make that change in the near future as it is one thing that could really make a difference.

Question put and agreed to.

Resolved,

That this House notes that the UK is facing a mental health crisis; further notes that, according to the Independent Review into Mental Health in the Workplace 2017 commissioned by the Prime Minister, each year 300,000 people with long-term mental health conditions lose their job; recognises that Centre for Mental Health research shows presenteeism from mental health is estimated to cost the economy £15.1 billion per annum; acknowledges this same research shows it costs the economy £8.4 billion per annum for mental health absenteeism; considers that a recent poll by OnePoll found that 38 per cent of people reported being stressed about work; observes that the Health and Safety Act 1974 made it a legal necessity for workplaces to train someone in medical first aid; and calls on the Government to change this law via secondary legislation to provide clarity that an employer’s first aid responsibilities cover both physical and mental health and to add a requirement for workplaces to train mental health first aiders.