Mental Health and Unemployment

Paul Burstow Excerpts

Tuesday 24th February 2015 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I beg to move,

That this House has considered mental health and unemployment.

I am grateful to the Backbench Business Committee for enabling us to have the debate, and also to those who supported the application: the hon. Member for Broxbourne (Mr Walker)—whom I, too, congratulate on receiving his OBE today—and the hon. Member for North Durham (Mr Jones).

Let me begin with a story that I think helps to illustrate what the debate is all about. It demonstrates powerfully not only that progress has been made, but that more progress is needed to ensure that we really tackle mental health issues in the workplace. This is the story of Anne-Marie, in her own words.

“I was suffering in silence because managers and colleagues didn’t know what I was going through. At work they just didn’t have the knowledge to deal with a mental health illness. So I didn’t bring it up because I was afraid of being judged or being looked down on.

If I had a broken leg, they could have physically seen it, and workplace adjustments would have been made. Every job by law has a first aider so if someone hurts or burns themselves or falls down the stairs, there is someone to assist them or professional help is available. But what happens when my mind goes into crisis? Where do I go in the workplace? I was taking my problems home and I was causing further damage to myself. But in the workplace where are there avenues for us to turn to or people to speak to?”

Eventually, Anne-Marie was away from work because of her illness. It was some time before she left hospital and returned to work, and when she did, things did not go well. She says:

“I remember returning to work and I felt so lost. I wasn’t sure what I was supposed to do and I didn’t really know where I was. I had a meeting about why I was off and how they could support me. I wasn’t in a place to tell them my needs or say ‘This is what I require’. So I just went back to work and was very unhappy, which led to me being off again.”

There are thousands of Anne-Maries all over the country: thousands of people who are having experiences of that kind. With the right occupational support, however, people can be helped to remain in the workplace—reasonable adjustments can be made—and with the right back-to-work support, people can return to work and work can be good for them. I hope that the debate will convey that message.

Anne-Marie’s story appears in an excellent report by the charity Mind called “We’ve got work to do”, and it makes the case—a compelling case, in my view—for changes in the operation of back-to-work support. For most people, work is a normal part of everyday life. An occupation and a sense of purpose can play a critical part in promoting recovery and social inclusion. Good work can be good for people’s health. I wanted to secure this debate in order to highlight the fact that more than a third of people with mild to moderate mental health problems, and nearly two thirds of people with severe mental health problems, are unemployed, although the vast majority desperately want to work.

[Kelvin Hopkins (Luton North) (Lab)]

I am extremely interested in what the right hon. Gentleman is saying, and agree with all of it. In some cases, however, work itself can be the cause of mental health issues—for instance, when there is bullying or poor management. The work that we do in the Chamber makes us feel good about ourselves, and work can do that, but it can also be a cause of mental health problems.

[Paul Burstow]

The hon. Gentleman is absolutely right. That is why I chose my words carefully. I said “Good work can be good for people’s health”, but, equally, bad work can be bad for people’s health. Poor employment practices and bullying cultures can indeed make a difference to the quality of a person’s mental health.

[Bob Stewart (Beckenham) (Con)]

Leadership in companies is crucially important, as are management and caring about colleagues. We sometimes forget about such things as care for people and leadership, but they should be inculcated in all our companies and other organisations.

[Paul Burstow]

The hon. Gentleman has underlined a point that I intend to make later, and I hope that others will do so as well. Good mental health is everyone’s business, and it is certainly part of the work of business to look after the mental health and well-being of staff. It is key to reducing sickness absence, and to improving productivity. It has so many benefits for the individual. So the hon. Gentleman is absolutely right. Leadership and culture are critical, whether in a business organisation or a public service or whatever.

The vast majority of people do want to work, and this is no small issue. Among the under-65s, nearly half of all illness is mental illness, and the cost to the UK economy exceeds £100 billion a year. The good news is that over the past five years public attitudes towards mental health have begun to change. Indeed, they have changed quite rapidly.

[Mark Tami (Alyn and Deeside) (Lab)]

I hope the right hon. Gentleman is right that there has been a change, but many Members still have people coming to see us who have admitted they have a mental health issue when they have applied for jobs and who are sure that is one of the reasons why they did not get to the next stage of the job interview.

[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.

[Andrew Bridgen (North West Leicestershire) (Con)]

I have been listening with great interest to my right hon. Friend’s speech. Does he agree that the incidence of mental health problems increases the risk of unemployment? Does he also acknowledge that unemployment itself has the capacity to induce and exacerbate mental health problems in those who find themselves in the distressing situation of being unemployed?

[Paul Burstow]

The short answers are yes and yes. In particular, severe mental health problems such as schizophrenia can lead to an increase of 65% in the likelihood of not being in employment unless properly supported. There is clearly an issue there.

SANE’s report into schizophrenia and employment revealed that, of those who were not engaged in employment or related activities, 59.4% said they would like to be. About 45% of people who receive a diagnosis of schizophrenia recover after one or more episodes, but about 20% show unremitting symptoms and disability, with the remaining 35% showing a mixed pattern with varying periods of remission and relapse. There are therefore issues about how we should tailor support for people with those conditions. Even though health care professionals acknowledge the importance of work, they often hold the view that people with schizophrenia would be better suited to low-skilled, low-responsibility or non-competitive work, but that is a fallacy. It is a mistake and it needs to be challenged vigorously. We need tailored programmes that fit the individual’s circumstances, abilities and needs.

The evidence of the beneficial nature of work for people with schizophrenia includes increasing social skills and enhancing the opportunity for the development of friendships; learning new skills; financial rewards; and the stabilisation of the condition. Employment brings clear health benefits for people with schizophrenia. Research shows that those in paid employment are over five times more likely to achieve functional recovery than those who are unemployed or in unpaid employment.

Last year, the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb), along with Ministers from the Department for Work and Pensions, launched a programme to pilot better ways of co-ordinating mental health services and employment services. The pilots are testing a number of different approaches based on the recommendations of the RAND report. This work points the way to a more tailored approach to meeting the needs of people with mental health problems. As I said earlier, the Work programme helps just 6.7% of people with mental health problems into work. In some cases, the way in which different parts of the back-to-work system works has the unintended effect of pushing people further away from the workplace, and that is not what anyone wants.

So what is next? First, the goal needs to be clear. We have said that we want to close the scandalous 20-year life-expectancy gap that exists in regard to mental health, and we must do more to tackle that issue. We also need to close the opportunity gap. Currently, just 5.7% of adults in contact with secondary mental health services are in paid employment, yet in some areas employment rates are as high as 20%. The goal should be to achieve at least a 20% rate of employment by 2020 across the whole country. That means building on the learning from the pilots. It also means acting on the evidence of what works. In particular, it means much more use of the individual placement and support that my hon. Friend the Member for Halesowen and Rowley Regis (James Morris) has just mentioned.

Individual placement and support has been shown to be twice as likely as any other employment support scheme to enable people with severe mental health problems to enter work. IPS works to secure paid employment that matches the person’s interests and aspirations by co-producing a plan of action, rather than requiring them to undertake certain activities. Support continues once the person gets a job and, as these schemes are often based in secondary mental health care services, they are integrated with the person’s health support. A recent psychological well-being and work report by RAND for the Government estimated the cost-benefit ratio at 1:41 for this approach. In other words, the Government save £1.41 for each pound they spend on IPS models. Where IPS is in use, it is delivering very positive outcomes. For example, WorkPlace Leeds, which is part of Leeds Mind, provides a specialised service, using individualised, tailored and collaborative approaches to enable clients to meet their goals. WorkPlace Leeds uses the IPS model, including CV building; interview skills; job searching; tailored applications; confidence-building; one-to-one sessions; advice on benefits; and practical assistance to overcome barriers such as child care difficulties or public transport issues. It also offers peer employment support interventions to develop confidence and a shared understanding of the struggle to get back to work. It recognises that there are no quick fixes, that the journey can be a long one and that it can sometimes take a lot of support for clients to achieve goals—I am thinking of things such as volunteering or training along the way. Work is the focus—that is the outcome people are striving for—but there is a recognition that the journey is important and needs to be properly supported. Perhaps that story of what happened to Anne-Marie could have been different if she had had access to that sort of support when she returned to work.

That support is delivered in partnership with the mental health, social care and housing services, all of which play a crucial part, and with the secondary mental health service. WorkPlace Leeds has also worked in partnership with Jobcentre Plus to identify the gaps in service provision—that is crucial to the evolution of services in this area. In other words, there is a joining up at the local level, with a devolved approach that actually seems to work. The annual cost of this approach in Leeds has been put at £5,819, compared with the £13,700 cost to the Work programme of supporting an employment and support allowance claimant.

So I hope that one thing that will come out of the pilots—I look forward to hearing the Minister’s aspiration for this Government and indeed future Governments—is that a future Government will put in place a programme to improve access to IPS, rather like previous Governments introduced a programme to improve access to psychological therapies. We need that level of drive and determination to make sure that this evidence-based practice becomes the norm, not the exception it is at the moment.

Finally, surveys have found that mild to moderate mental health problems, including stress, anxiety and depression, are the most common reasons why people are signed off work. The figure cited is that this costs the economy £26 billion every year: That is an average of more than £1,000 for every employee, so it is in everybody’s interests and it is everybody’s business to make sure that we properly support people in the workplace. Although there are great employers who really get mental health and its impact on their employees, as well as their business, and do take the necessary steps, there is still so much more to be done.

In bringing my remarks to a conclusion, I wish to ask the Minister whether we could make better use of the Health and Safety Executive, a sometimes maligned body which some years ago developed new tools relating to stress audits, which could be used by employers. If the company in Anne-Marie’s story had used a stress audit, it may well have identified some of the things it could change before she got to a crisis and had to leave work. I hope that the Minister will be able to say more about how the HSE and the work it has done in the past could be updated and become part of its day-to-day practice in the future.

With that, I hope that today’s debate will not only generate a useful exchange across the Chamber, but demonstrate again that there is a commonality of purpose: a recognition that for far too long these issues of mental health had not been given the time, focus or priority they should get, that they are getting that now and that we will make progress in the next Parliament. If we do not, we are not just costing our society a huge amount—we are costing individuals a fortune.

--- Later in debate ---

[Mr Charles Walker (Broxbourne) (Con)]

I am grateful for the opportunity to speak in this important debate.

Mental health in the workplace is undoubtedly hugely important, but mental health is a continuum throughout life. It starts in the earliest years when it is a matter of the relationship between a baby and their mother and father. If we can improve those early years, we improve children’s chances of having good mental health throughout their lives.

Mental health is about resilience and building resilience. I am sure that you, Madam Deputy Speaker, will be concerned, as I am, that headmasters in primary and secondary schools now talk about the levels of self-harm in their schools. It is extraordinarily worrying that young children at primary and secondary school are self-harming. They feel so desperate, so out of control, so out of touch, perhaps, with their peers, that the only way they can relieve that pressure is through harming themselves, through cutting themselves. Of course, mental illness manifests itself in other ways, such as depression and a feeling of isolation.

If we are to enable workplaces to flourish, we need to ensure that our young people can flourish. I urge the Government, in looking at the mental health piece, to see it as a joined-up continuum. Without good mental health in the early years and in schools, we will not have good mental health in the workplace, despite the best efforts of employers.

The truth is, as my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and my hon. Friend the Member for North Durham (Mr Jones) have identified, the longer one is out of work, the less chance there is of rejoining work. A couple of years ago, President Obama’s mental health adviser came to speak in the United Kingdom, and a huge amount of work has been done in the United States about exclusion from the workplace. It is simply the case that if people have a mental health crisis at work and leave that workplace for even a short period, their chances of returning are diminished, and the longer they are away, the less chance they have of getting back into any form of work. We need to be mindful of that. I congratulate the Minister for recognising that. I know that he is doing some important thinking in this area. An article yesterday in the Evening Standard described the efforts, led by the Minister, to ensure that people who have been out of work for a long period have the pathways back into work.

Why is work important? It is important because a lot of the time it is fun. It is not fun all of the time; nothing is fun all of the time. But a lot of the time work is fun. It is challenging. It is where we socialise. It is where we meet and make friends. It is where we become part of a team. It is where we achieve. It is where we have success. It is sad to think that there are people who have mental health problems—a period of mental unwellness—who are excluded from this environment, from all those successes, all the things that we enjoy and, on occasions, take for granted.

My hon. Friend the Member for North Durham—I call him my hon. Friend because I have known him for so many years and we have talked about this on so many occasions that it would be churlish to call him anything but my hon. Friend—made a very insightful and incisive point: what does success look like? Success will not always be going straight into a full-time job. Actually, success might be never going back into a full-time job. Success for one individual might be leaving their home and going out to do some voluntary work for the third sector, perhaps starting off by working one or two days every couple of weeks, moving to one day a week, and then to three or four days a week. It means engaging with the community, being part of a team and being valued and appreciated as an individual. I hope that the option of progressing back into full-time work will be available to all people, but let us not set that as the only benchmark, because for some it will be unobtainable. We need to ensure that there is a way back to some form of engagement in the workplace that meets the spiritual and emotional needs of people recovering from a mental health setback.

A number of colleagues have rightly focused on the efforts of British Telecom, and I would also like to mention Legal & General. They recognise that mental health impacts on all their performers, including their high performers. A good employer should not want to lose anyone for the wrong reasons, but they certainly do not want to lose their best and most productive employees. I do not think that there is anything wrong with British Telecom making a commercial decision that it is in its interests to ensure that it supports its work force. Indeed, it is to be applauded for doing so.

As my hon. Friend the Member for North Durham and my right hon. Friend the Member for Sutton and Cheam observed, where are the other employers? We know that they are out there, because it cannot just be two—BT and Legal & General. They need to make some noise. We do not want them to be shy. We want them to stand up, shoulder to shoulder, and say, “This is important to us.” If more companies said that, others would want to stand up and say it too, and then we will get a movement going—we like nothing more in this place than getting a movement going. We will have many voices saying in unison, “This is important to us.” Those voices might employ just a few people locally, but they employ up to tens of thousands nationally.

As has already been observed, we cannot separate mental well-being from physical well-being. Many employers now have company gyms and all sorts of schemes to get their employees fit and healthy physically, but mental well-being is just as important—perhaps even more so—and that is where more focus and emphasis is needed.

We must also ensure that people who are going through a period of difficulty and turmoil have good coping mechanisms and strategies. Again, the employer can be at the forefront of that. It is not always the case, but too often people who are struggling can find that their coping mechanisms revolve around substance abuse and misuse, and that is in no one’s interests—not the employee’s, not their family’s and not their employer’s. We need employers to be at the forefront by not only looking at their staff’s physical health, but placing a huge premium and emphasis on their mental well-being.

[Paul Burstow]

My hon. Friend is making some incredibly important points. What does he think about a possible requirement—voluntary or otherwise—on companies to report on their human capital, because it is an important risk factor for investors if companies do not properly look after their staff and have higher turnover rates as a result? I wonder whether that might push employers to focus on these matters more.

[Mr Walker]

My right hon. Friend makes a very good point, and I will conclude my speech by answering it. Most companies like to talk about the importance they place on human capital, but I suspect that very few do it very well. That is why I think it is so important for good employers to stand up and say, “This is what we are doing and it can be audited, so you can prove for yourselves that we are doing what it says on the tin.” I am not into naming and shaming companies, or coercion—that is the wrong way to go—but there has to be a premium and a reward placed on good practice. I join my hon. Friend the Member for North Durham in saying to Government that we need to give that some thought. We do not want to come up with a stick; we want to come up with carrots so that good employers are celebrated, and celebrated loudly.

--- Later in debate ---

[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.

[Paul Burstow]

I agree that we need a robust evidence base on which the roll-out takes place, but individual placement and support has already been the subject of randomised controlled trials. There is a very good evidence base that should be used to roll it out.

[Mr Harper]

The right hon. Gentleman is right about that. That is why the access to psychological therapies work is already under way and, as I said, is being rolled out further. One of the issues is how well the pilots can be scaled, given that some pilots require skilled mental health professionals, of whom there are a limited number—by which I do not mean a small number, but finite capacity—looking at models which enable us to scale the pilots up more quickly. We want to make sure that we have a good evidence base for pilots that look promising.

The hon. Member for Strangford (Jim Shannon) referred to some very specific experiences in Northern Ireland. It is worth putting on the record—he knows this because we have had this conversation before—that quite a lot of welfare and health services are devolved to the Northern Ireland Executive. It is right for him to raise his constituency experience here in the House, but the delivery of those services is not under my control or that of my colleagues in the Department of Health. Those services are under the control of the Northern Ireland Executive. I will be meeting the Minister in due course as we are keen for our experiences to inform how the Northern Ireland Executive rolls out those services, and vice versa. If we can learn from each other, we are happy to do so.

--- Later in debate ---

[Paul Burstow]

I thank the Minister for his very full response to the speeches by the hon. Members for North Durham (Mr Jones), for Broxbourne (Mr Walker), for Strangford (Jim Shannon) and for Windsor (Adam Afriyie), and to those who intervened in this wide-ranging debate. I also thank the shadow Minister for her response.

The hon. Member for Broxbourne talked about work being fun and purposeful. That is an important message to get across. We need to make it clear that most people with a mental health problem do want to work, and that message has come across very clearly in the debate. That means that our benefits and back-to-work systems need to work for people with mental health problems. Some of those issues and challenges have been well described and debated. The approaches have to be tailored and personalised, and grounded in very clear evidence. I welcome what the Minister said about the promising news from the pilots so far.

I accept the Minister’s gentle chiding about my use of the phrase, “UK plc”. He is absolutely right that we need to focus on all types of business entity, from sole traders all the way up to major corporations. However, there are still far too few businesses taking a lead in this area. We have heard about BT, Royal Mail and others. Perhaps the whole of the FTSE 100 should step up and give a lead, and those companies should do what they need to be doing to give good mental health to their employees.

My hon. Friend the Member for Windsor talked about happiness and said that we should measure it. The Government are measuring well-being as part of the work of the Office for National Statistics. In the CentreForum work I have been doing, we struggled about what we would call the report, as often happens. We called it, “The pursuit of happiness”, because the focus on well-being is absolutely key, and we made a recommendation about the importance of the kitemark to those who are striving to be mental health-friendly employers.

My hon. Friend the Member for Broxbourne talked about how critical the first 1,001 days are to shaping a person’s life, making them more resilient and capable of dealing with adversity, and making it less likely that their mental health will be at risk. That life-course approach is absolutely key to this Government’s strategy and I think it will endure whoever is in government after the general election.

Not only has this House debated mental health probably more often in this Parliament than during any previous Parliament; it has done so in a positive and constructive way. It has not treated it as something to fear and dread; it has cast a much more positive perspective on it, and that is due to those hon. Members who have talked about their own lived experience and those of us who have a policy interest in it and are determined to see change. I hope that the next Parliament will not just continue talking about the issue—which it really must—but go on to make sure that we step up the pace of change, because there is so much we can do for those who suffer from mental health problems. It will be good for the country if we do that, and it will be good for them, too.

Question put and agreed to.

Resolved,

That this House has considered mental health and unemployment.