Mental Health First Aid in the Workplace

Debate between Norman Lamb and Lord Beamish

Thursday 17th January 2019 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

After yet another week of fractious and angry political discourse, what a pleasure it is to work with two honourable friends—I use that term advisedly—the hon. Members for Plymouth, Moor View (Johnny Mercer) and for Liverpool, Wavertree (Luciana Berger) on an issue of incredible importance. It is important that those watching or reading about this debate recognise that it is possible for right hon. and hon. Members to focus on important issues such as mental ill health, as well as fractious arguments over Brexit.

I thank the hon. Member for Plymouth, Moor View for what he said about his experience of OCD. Interestingly, OCD has also affected my family as our oldest son was diagnosed with it as a teenager. He has since spoken about his experience, and I speak with his authority and approval. What the hon. Gentleman said about the importance of people in his position speaking out about such conditions is important. I remember the moment when, as a teenager, Archie said to me, “Why I am the only person who is going mad?” For a parent to hear that from their child is awful and incredibly distressing, and it makes one realise what a teenager must be going through if that is how they feel about their situation. Of course that is an entirely false perspective, because one then realises that so many others are experiencing their own challenges, and when that realisation dawns, it makes it much easier for individuals to speak out. I thank the hon. Gentleman for what he said and for talking to the press about this issue, because cumulatively that makes a difference.

The Time to Change campaign has been incredibly powerful in helping to normalise mental ill health, and every time someone in a public position speaks out, it becomes a little easier for another teenager to seek help and not be frightened about opening up. I join the hon. Member for Liverpool, Wavertree in acknowledging the work of Natasha Devon, who is a great campaigner for mental health issues, and I thank Bauer Media and Mental Health First Aid England for championing this important cause.

On the cost of mental ill health, I wish to focus first on the cost to the individual, because it is often not recognised by those who do not experience it just how painful and disabling mental ill health can be. If someone is experiencing anxiety, depression or a condition such as OCD, their life is completely dominated by that. They often cannot enjoy life or be happy, and whenever we speak about the economic cost of mental ill health, we must focus on the most important thing, which is the cost to individuals of the ill health that so many experience.

Alongside that, however, there is a significant cost to employers—not just private sector employers, but the public sector, charities and so forth. Health and Safety Executive data show that 57% of days off work through ill health are due to mental ill health of one sort or another, and not confronting that represents an enormous cost to employers. This is not just about time off work, because many people end up falling out of work and on to benefits, and others turn up to work but under-perform—the concept of presenteeism—because they are not feeling on top of their game, or because they are obsessed by anxieties or concerns that prevent them from performing their work responsibilities effectively.

Addressing mental ill health is a win-win-win for everybody, because this issue affects not just individuals, but employers and even the Government, who gain as a result of us taking it more seriously. If someone falls out of work because of mental ill health, they end up claiming benefits, and that is an enormous cost to the Government and also impacts on the NHS. Everybody benefits by us taking this issue more seriously. The question then is how best to achieve an advance. The hon. Member for Waveney (Peter Aldous) made a very important point when he said that we need to think carefully about how we frame that.

Under existing law, employers are under duties to protect the mental health and wellbeing of their workforce. The Institution of Occupational Safety and Health makes that point very strongly in its brief for this debate. It makes the point that under the Health and Safety at Work Act etc. 1974 and associated regulations, employers are under a duty to manage the psycho-social risk to their employees at work. There is also the duty under the Equality Act 2010 to make reasonable adjustments where people are suffering from some sort of disability, including mental ill health. I also applaud the Health and Safety Executive for the new guidance it issued in November 2018. For the first time, it includes a section on mental health. That is important. These are all advances worth acknowledging. I would also like to acknowledge the work of Paul Farmer and Lord Stevenson, which was commissioned by the Government. Their report “Thriving at Work” recommends mental health core standards for every employer.

None the less, the first aid legislation is very much framed in terms of physical health. It is very important to establish clearly in legislation—just as we did in the coalition Government, where we legislated for parity of esteem in the NHS—a very important principle for the workplace: an equality in the importance of both physical and mental health in the workplace. I want to stress that it is about much more than just mental health first aid, vital though that is—I totally endorse all the comments made by the hon. Member for Liverpool, Wavertree.

I want to highlight the potential risks, as the hon. Member for Waveney made clear, of not getting this right. There is a risk of the tick-box exercise, where an employer can just say, “Yes, we have trained someone up in mental health first aid. We’ve done nothing else, but we have ticked the box and therefore we have met the regulation.” That would be a failure for all of us if that was the outcome of this exercise.

The more fundamental point is that the approach we should be taking is about preventing ill health in the workplace. The whole focus should be on creating healthy workplaces, where people are treated with dignity and respect. It is vital that employees across the workforce have the opportunity to raise their awareness and understanding of mental health. Alongside that, however, we have to think about the causes of stress and anxiety in the workplace. Often, it is due to unhealthy workplaces, where people are not respected and where there is a bullying culture. Depressingly, we see that quite often in the NHS. That has to be confronted, because that is the cause of so many people feeling anxious, distressed and depressed as a result of what happens at work.

[Mr Kevan Jones (North Durham) (Lab)]

Does the right hon. Gentleman agree that there are very simple things companies can do—BT and quite a few others do this—to improve work-life balance? For example, they can ensure that people do not have to answer emails late at night or over weekends, or, when people have bereavements, they have a sensible bereavement policy that supports the individual, rather than just allows for a number of days for an individual to get over it.

[Norman Lamb]

That is an incredibly helpful intervention. I totally agree with the right hon. Gentleman. It is about getting the whole culture in the workplace right on flexible working, understanding that parents sometimes have responsibilities to their children and carers have responsibility for an elderly loved one. Not working ludicrous hours of the day and night is also incredibly important. How we achieve the legislative change is very important. It is vital that we raise awareness through mental health first aid, but we also need a fundamental focus on the prevention of mental ill health in the workplace.

In the remaining minutes, I want to focus on some of the things we did in the west midlands. After I was chucked out of the Department of Health by the electorate in 2015, I was asked to chair a commission on mental health in the west midlands. Our whole focus was on how to prevent mental ill health and take a more public mental health approach. We focused particularly on the workplace. We first focused on how to get people who had experienced mental ill health and had been out of work—often for years and years—back into work. Work is actually good for people. Meaningful work, where we gain a sense of dignity and self-respect, is really important. We are undertaking—with £8.5 million of Government support, I should say—a randomised control trial, applying a strong evidence-based approach called individual placement and support. We give people intensive support to get them ready for employment, get them into a proper job and then support them in that job. We are looking at how we can apply that in primary care, so we capture people earlier, and give them access to someone who can train them and support them for employment. We want to change the mind set of GPs, so they are not just thinking about the sickness of their patient but how they can help them to recover and get back into work—that is critical.

I hope that as a result of the randomised control trial, we will be able to learn lessons which we can then apply across the country. If we can get lots of people with severe and enduring mental ill health back into work, we will achieve something very significant. Sadly, at the moment this extraordinarily strong, evidence-based approach is the exception rather than the rule. Most people across the country do not get access to it. The Government have made a commitment to double the numbers, but that is still a very small proportion of the total. It needs to be expanded rapidly.

[Mr Kevan Jones]

Is the problem that mental wellbeing is not hardwired into Government policy? Some policies, for example Department for Work and Pensions work capability tests and others, actually work against individuals. Voluntary work is very useful in getting people back into work, but at the moment there are limits around what people can do while they are still on benefits. Does the right hon. Gentleman think that some flexibility on that would help this process?

[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.

Policing and Crime Bill

Debate between Norman Lamb and Lord Beamish

Monday 13th June 2016 Commons Chamber

[Mr Kevan Jones]

Does the right hon. Gentleman share my concern about detention at home, which I raised in Committee? Although it is welcome that this Bill will try to reduce the number of people going into police cells, the de facto position may be to take people home because of the lack of beds elsewhere, even though that might not be the best place for the individual concerned.

[Norman Lamb]

The hon. Gentleman is absolutely right. The fear is that that will become the default position in some localities because of the lack of resources available. That would be a big mistake. In circumstances where section 136 is used, surely the person should be taken to a health-based place of safety. A real effort is under way around the country—it is showing signs of success—through the use of approaches such as the street triage service, to reduce substantially the use of section 136 at all and to deal with issues in a more informal way. However, where it has to be used, we must make sure that the person is taken to the right place.

Mental Health

Debate between Norman Lamb and Lord Beamish

Wednesday 9th December 2015 Commons Chamber

[Mr Kevan Jones]

I commend the right hon. Gentleman for his work. Does he agree that those leaders now need to translate that action into policy, both at a national and a local level?

[Norman Lamb]

I totally agree. We have to set the framework, put the funding in place and deliver services on a local basis. How can anyone in this Chamber possibly justify this: if someone has suspected cancer, they have a right to an appointment with a specialist within two weeks of referral by their GP, but a youngster with an eating disorder has no such right, yet we know that their condition can kill? That is a scandal and an outrage and it must change. There must be equality of access.

When someone does get access to treatment, too often it is a lottery. As we discussed last Friday, we have the continuing scandal—the hon. Member for North Durham (Mr Jones) referred to this earlier—of people being shunted around the country in search of a bed. That would never happen to someone suffering from a stroke or a heart condition. It is inequality of access to treatment, and it is a complete scandal.

[Mr Jones]

There is an issue with the number of beds, but does the right hon. Gentleman also accept that one of the problems is that people are in those beds for far too long? One of the crisis points in London is access to adequate housing so that people can be discharged into the community.

[Norman Lamb]

I was so pleased that the hon. Gentleman made that point in his speech, and I pay tribute to him for the work he has done. The answer is not simply to have more beds; we should also be reducing the length of stay, which often is not therapeutic for the individual. Getting them into secure housing is central to their health and wellbeing.

Child and Adolescent Mental Health Services

Debate between Norman Lamb and Lord Beamish

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

I pay tribute to the hon. Gentleman for the work he did in his campaigning on the Mental Health Act and more recently as a Children’s Minister in the Department for Education. I know his passion for the subject and I share his view that it is intolerable that children and young people should go to adult wards. It has been a long-standing issue—it is not new—but it should not happen, just as it should not be the case that children are still placed in police cells. That is why I take the view that we need to ban it in law so that it cannot happen, and there are consequences if it ever does happen.

[Mr Kevan Jones (North Durham) (Lab)]

I do not question the Minister’s commitment to mental health. He is a great champion of parity of esteem, but he is part of a Government who are cutting money for mental health services. For young people in 2015 to be put in police cells is totally unacceptable. To pick up the point made by the right hon. Member for Sutton and Cheam (Paul Burstow) about CAMHS, is it not time not only for a fundamental review but for a new system, including the abolition of the present CAMHS system?

[Norman Lamb]

I am grateful to the hon. Gentleman for his generous remarks—perhaps he ought to talk to his Front-Bench colleagues about my commitment. He is absolutely right to highlight the fact that although there is quite a mixed picture across the country, in many areas there has been disinvestment in children’s mental health services. They are local decisions, and they are not decisions that I accept. That is why I made the serious point about the absolute importance of introducing waiting time and access standards, including in children’s mental health services. We need data so that we can monitor performance against those standards, and we need a payments system that does not disadvantage mental health. I also share his view that we need to change the way services are organised and commissioned so that we focus much more on prevention.

Oral Answers to Questions

Debate between Norman Lamb and Lord Beamish

Tuesday 25th February 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for his question. Indeed, I share the concerns that he raises, and I have recently met my hon. Friend the Minister responsible for benefits specifically because I have those concerns. There needs to be much closer working between mental health services and the benefits system locally.

[Mr Kevan Jones (North Durham) (Lab)]

The Minister knows that early intervention therapy or talking therapies can relieve pressure not only in access to beds, but in helping individuals. He has just told the House that he will look at assessments of waiting times. Will he tell the House exactly what force or lever he will have to ensure that local trusts implement such targets?

[Norman Lamb]

I think it was a big mistake to leave out mental health when the 18-week maximum waiting time limit was introduced for physical health services. To me, that is inexplicable, so I am determined to correct it: from next year, there will be waiting times standards for mental health. Indeed, when the Care Quality Commission inspects and regulates providers, it will ensure that those access standards are met, in the same way as applies for physical health.

Mental Health

Debate between Norman Lamb and Lord Beamish

Thursday 16th May 2013 Commons Chamber

[Mr Jones]

The hon. Gentleman makes a very good point: schools are important in this regard, and it is important to get young people to talk about the issue. I have a fantastic charity in my constituency called If U Care Share, run by Shirley Smith. It was created following the tragic circumstances in which Shirley’s 19-year-old son hanged himself. Her organisation goes into schools, youth groups and football clubs—Shirley is working with the Football Association and others—to get people talking about their emotions. We need to get more of that kind of work going.

The workplace is important. Although he is not in the Chair at the moment, I want to pay tribute to Mr Speaker, as well as to the House of Commons Commission. Following our last debate on this issue, they earmarked some funding for our own mental health in this place. Dr Ira Madan, the head of the unit across the road that MPs and staff can access, has told me that that was valuable in that it allowed her to assist Members with mental illness, and that there had been an uptake of the services since the money was made available. I would recommend that anyone who wants to go and have a chat with her should do so, as she is a very good and open individual. We must give credit to Mr Speaker and the Commission for that funding, because that was not an easy decision to make, especially as he was getting criticism from certain newspapers for giving special treatment to MPs. It is not special treatment; it is a vital service. Unfortunately, it is still not open to many MPs because of the stigma that surrounds mental illness.

[Norman Lamb]

I pay tribute to the hon. Gentleman for the incredible contribution that he has made to this subject over the past year or so. It was encouraging to hear what he said about Mr Speaker’s actions, and I want to alert him to the fact that I am trying to get every Government Department to sign up to Time to Change, so that they can all make the commitment to be an exemplar. If we are talking about what employers in the private sector should do, it seems to me that we should be taking the lead here.

[Mr Jones]

I have spoken at a few events with the Minister, and I want to thank him for his interest in, and understanding of, this subject. Getting Government Departments signed up to Time to Change would be a very good move, and he should please ask if he requires any assistance from me.

I want to talk about an issue that affects many of our constituents—namely, the work capability test and the ongoing issue with the company Atos. Is work good for people’s mental health? Yes, it is. Should people be in work if they can work? Yes, they should, with the right support. The problem with the work capability test, however, is that it is still not looking at people with mental illness with any sympathy or understanding.

I believe that individuals with long-term mental illnesses should be taken out of the current work stream, and that there should be a dedicated system for dealing with such people. I am not saying that we should write them all off and leave them at home without making any assessment, but we cannot continue with the present ludicrous system in which they are assessed by the same people who assess claimants with bad backs and other injuries. There are assessors with no expertise at all in mental illness. The assessment process is leading to some people’s conditions being made worse, and, in some cases, to people taking their own lives. One of my constituents has taken an overdose because of the trauma of being asked to attend an interview.

--- Later in debate ---

[Norman Lamb]

I am grateful to the hon. Gentleman for his intervention. I was going to mention his contribution, even though I was not present to hear it, for which I apologise. As a Member of Parliament, concerns have been raised with me about the suitability of those tests for people with mental health problems, and I was going to suggest that I should talk to the appropriate Minister at the DWP. I am of course happy to do that. Someone else made the point that this is not a question of not addressing the need to help people get back into work. Work is particularly important in relation to people suffering from mental ill health, and the idea that we should simply leave them undisturbed and out of work for the rest of their lives is totally wrong. The way in which we handle this is incredibly important, however, and if we have more to learn in that regard, we should be prepared to learn the lessons.

[Mr Kevan Jones]

I made the point in my speech that work was good for people with mental illness. The problem is that the present system is inefficient and costly, and that it is creating absolute agony for many people. I know that the Minister has a great understanding of, and a deep passion for, the subject of mental health, and I urge him to put pressure on the DWP to change the system. We are not asking that people should be excluded completely from work capability tests; we are just asking for the system to be changed.

[Norman Lamb]

I am grateful to the hon. Gentleman for reminding me that he, too, had made that point. I knew that someone else had talked about it, but I could not remember who it was. I take his point; I have heard it.

My hon. Friend the Member for Southport (John Pugh) made a thoughtful speech in which he talked about reminiscences. Oh! He has gone! Even though it pains me, as a Norwich City supporter, to talk about Everton, it appears that Everton and even Southport have done some very good work in these areas. My hon. Friend talked about a continuum of mental health. That was a good point, well made. He also mentioned community treatment orders and the need to look at how they are working. I will certainly reflect on that.

My hon. Friend the Member for Battersea (Jane Ellison) made a powerful contribution about the mental health aspects of female genital mutilation, a most horrific experience suffered by so many young girls. I really pay tribute to her for the work that she has done on that issue. The fact that there are 66,000 females in this country who have suffered this assault was an extremely striking point.

The hon. Member for Finchley and Golders Green (Mike Freer) talked about waiting times for access to treatment. He asked if he could gently challenge the Minister—I appreciated that approach. On the mandate for the NHS Commissioning Board, NHS England has been very clear that we expect it to assess the scale of the problem of access, including for IAPT. Other Members have raised the question of whether we are meeting the IAPT programme’s four-week target. We want the NHS Commissioning Board to assess the scale of the problem with a view to setting access standards.

One of the big problems relating to what I regard as the institutional bias against mental health is that on one side of the equation we have the 18-week maximum waiting time for physical health, which is a very powerful political driver of where the money goes, yet we have nothing equivalent for mental health on the other side. That, to me, is a lack of parity of esteem. For people with mental health problems, early access is particularly important to ensure that their condition can be halted, if possible, and the deterioration stopped. The hon. Member for Finchley and Golders Green made a good point there, and he also rightly talked about the importance of consistency and continuity of care.

I want to mention four of the most important things that this Government are doing to create the environment and incentives for improving mental health across the system as a whole. The first is the Health and Social Care Act 2012, which creates a “parity of esteem” so that mental and physical health share the same importance, as we have discussed this afternoon. Changing the law is just the start, but it sends a clear signal—that mental health is important, and that the health and care system can and must play a leading role in changing attitudes across society as a whole.

Secondly, there is the mandate the Secretary of State has issued to NHS England. It shows the importance we have ascribed to mental health and makes it clear where improvements are needed. The mandate makes clear our overarching goal—that mental health must have equal priority with physical health across all aspects of NHS work. In particular, we have highlighted the need to close the gap in outcomes between people with mental illness and the population as a whole, as well as the absolute imperative to ensure that people can access the services they need when they need them. Neither of these facets of good mental health treatment is entirely up to scratch at the moment. I think we all recognise that.