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Mental Health

asked Her Majesty’s Government in light of the Sainsbury Centre for Mental Health report on the cost to business of mental ill health at work, what support they are providing to business to deal with mental ill health at work; and what plans they have to ensure that the public sector leads in this area. The noble Baroness said: The Sainsbury Centre report, Mental Health at Work, was what alerted me to these serious issues and led me to table this Question. I need to declare an interest as an advisor to the trustees of the Sainsbury Centre, but I also have some experience of this, having been the chair of an NHS trust for four years and having seen several of my employees, numbering in the teens, who confessed to me after I had stepped down that they had been mentally ill during the time they were employed by the trust but had felt nervous about confessing to management that that was the case—and this was in an NHS trust where 25 per cent of its functions were dedicated to mental health services. It is that situation which has made me very concerned about these issues. The Sainsbury Centre report, Developing the Business Case, found that the cost to business of mental ill health at work is £25.9 billion in the UK each year, which is just over £1,000 for every employee in every workplace, and the equivalent of £1.3 billion just in the NHS, because I suspect that my trust was no by means alone. More than half of that cost is the result of lost productivity in people who turn up for work. The term that is used—the noble Lord, Lord Ramsbotham, has already told me that he thinks it is a terrible word—is ““presenteeism””. It means being present at work but not being of much use. It has been calculated that sickness absence costs £8.4 billion a year. Around 40 per cent of all sick days are taken for mental health problems, up to a total of some 70 million working days. Reduced productivity amounts to about £15.1 billion and accounts for 1.5 times as many working days lost as sickness absence, but costs more because presenteeism is relatively more common among higher paid workers; lower paid workers are more likely to take time off sick. Staff turnover costs £2.4 billion a year, which represents the costs inherent in replacing around 200,000 employees who leave their jobs because of mental ill health. This is a really huge issue and it is important to recognise that only 15 per cent of these costs are caused by work-related mental distress. Most mental distress arises for other reasons and from other causes; stress and distress are very different things. I turn again to the horrible word, presenteeism. Employees may take time off from work because of ill health, or they may turn up for work as usual, sometimes because they feel duty bound, sometimes because they are worried about what people will say if they do not, and sometimes because they do not want to admit that they have a mental illness. However, they function at less than full capacity because they are feeing terrible. It is much more difficult to measure presenteeism than it is to calculate straightforward absence from work, but studies have been carried out in the United States, Australia and Canada. The key finding is that presenteeism is a much more important cause of lost output than sickness absence, with some studies suggesting that it is six times as costly as absenteeism. The Sainsbury Centre has taken a rather conservative view of all this because little information is available on what really goes on in the UK. As an estimate, it has chosen to double the cost of absenteeism, but it still means that it is a huge cost. We know perfectly well that mental health matters to every business in Britain. One worker in six experiences depression or anxiety in any one year. If you add in drug and alcohol problems and severe mental illness, this rises to one in five. We also know that most employers vastly underestimate the importance of mental health. A Shaw Trust survey of senior managers found that half thought that none of their staff would ever have a mental health problem. A report that will come from the Sainsbury Centre for Mental Health and the Employers’ Forum on Disability fairly shortly will show that most employers think that their workplace has less mental ill health than society as a whole. If they all think that, something very strange is going on. This is a wonderful example of denial that tells us a great deal about stigma and the desire to bury the facts. This is obviously partly about stigma; people are afraid of telling their employers and colleagues if they are distressed. They are much more likely to come into work when they are unwell with a mental illness or from mental distress than if they have a physical health problem. However, the figures are likely to be an underestimate, if anything. Large numbers of people who present to their GPs or to occupational health services with medically unexplained physical symptoms may well have mental health problems that neither they nor their GPs recognise. The report says that employing people with mental health problems is a good thing, not a bad thing. It is impossible anyway to say that one should not employ them, given the prevalence of the distress. We also know that working is good for people with mental illness. A recent Chartered Institute of Personnel and Development survey of employers found that 61 per cent reported a positive experience of employing people with a history of mental health problems, and that only 15 per cent reported a negative experience, which is probably lower than the normal rate of dissatisfaction with new employees in general. We also know that having a mental illness does not make a person unemployable. The former Norwegian Prime Minister, Kjell Magne Bondevik, served two successful terms, despite having time off with depression. His openness about suffering from depression during his first term did not stop him winning a second term. We also know that employers can cut the cost of mental ill health through good management of their staff. BT has reduced its mental health sickness rate by a third through its Work Fit programme, which offers support to staff experiencing distress. We also know that a few simple and quite inexpensive measures to reduce stress and support people who become unwell can save thousands of pounds in lost output and precious skills. We also know what the keys to reducing mental distress at work are. First is the recognition that work is good for health. Evidence is clear that being in work makes people healthier, both physically and mentally, and being out of work reduces life expectancy as severely as smoking and obesity—by about 10 years. Preventing work-related mental distress, such as ensuring that staff do not have unrealistic expectations, tackling bullying at work and so on, makes a huge difference. Giving workers greater control over how they work probably makes the biggest difference of all. Raising awareness of the possibility of mental illness among line managers makes a great difference, as does giving them more knowledge about mental health and helping them to respond confidently and in good time to staff who appear to be distressed. Improving access to help also makes a great difference. That is particularly true of speedy access to psychological therapies, especially to CBT, cognitive behavioural therapy. I very much hope that the Minister will be able to give me lots of good news about that. That makes all the difference between staying at work and going off sick and ultimately losing your job. Providing effective rehabilitation for those who need time off work also helps a lot, but you must maintain regular contact during periods of absence. That is crucial to give the person concerned hope and a clear goal for coming back. Supporting mental well-being is likely to be different in small businesses than in large ones. Big employers have human resources departments and occupational health services, and can organise staff training and so on. However, small businesses can do their part and it would be really wonderful if the Government could give a bit of lead on that by encouraging small businesses to allow flexible working and encourage them to keep in touch with staff who are off work to help them to return. We know a great deal. The real problem is that we do not act on it. That is why this report is so important. I really hope that the Government, and the Minister on behalf of the Government, can do something about what goes on in the public sector. The public sector employs millions of people and it has contracts with businesses that employ millions more. Mental ill health among staff costs the NHS over £1 billion, which is equivalent to a quarter of the entire mental health budget for England. I think that the noble Baroness, Lady Meacher, has experienced that as much as I have in the NHS. It seems to me that public services should be required to demonstrate good practice as employers and in contracts with providers, and that they should be required to support the mental well-being of staff. At the moment, you see them responding less than well when people become unwell. Public services should be doing more to actively seek applications for ordinary jobs at all levels from people who admit to having a mental health problem. I wonder whether the Minister will be able to tell us that the Government will do a little more about that and that they, through the public sector as an employer, will do more to make it possible for people to admit that they have a mental illness, so we have less presenteeism and we can get rid of that horrible word. Can he say whether the Government will ask the public sector to set a lead in its employment practices and contracting practices? That is what has to happen if we want to make a difference to stigma and if we want to reduce the cost of all this.