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Mental Health

I am very grateful to the noble Baroness, Lady Neuberger, for introducing this debate. I probably should, as always in these situations, declare an interest as the chair of a mental health trust in East London and more recently as the chair of a mental health initiative for young people, spearheaded by the Paul Hamlyn Foundation and the Mental Health Foundation—which is relevant to this debate. Our starting point is of course that mental health is a significant issue for every business in Britain. As the noble Baroness, Lady Neuberger, mentioned, one in six workers will experience depression or anxiety in any year. Yet, as she also mentioned, employers vastly underestimate its importance. Indeed, employers even assume that they do not have anyone at all with a mental health problem. I have to confess that in our trust, although we have encouraged openness on this matter with our staff for some period—certainly since I have been there—we have made slow progress in this area. I will come back to that point later. Such is the stigma of mental illness that, even within a mental health trust, employees will carry on soldiering on and concealing their problems for long periods at considerable cost to the employer in reduced productivity. I am aware that many of our nurses are underperforming quite drastically. If we could get at the mental health issues of those nurses, we may make considerable progress. Help for employees, and therefore employers, is potentially on the way. That is the good news and I applaud the Government’s commitment to a considerable increase in spending on evidence-based psychological therapies—I emphasise evidence-based—in the most recent Comprehensive Spending Review, building up to £70 million in the third year. However, I also want to draw the Committee’s attention to the significant risk that much of this money may not be spent on these evidence-based therapies. It is important that strategic health authorities, and at the end of the day PCTs, follow the professional guidance issued by the Department of Health to ensure that the money really is used to the best effect. If it is spent on therapies that have been shown to be pretty ineffectual, it would be a terrible waste. Can my noble friend the Minister assure the Committee that his department will do all that it can to ensure that the funds are spent as the Government intended? Another important point is the relevance of these evidence-based therapies to the achievement of the Government’s target to reduce the number of people claiming incapacity benefit—or is it employment support allowance now? I am sorry I have slightly lost track of the time frame—by 1 million over 10 years. If this is to be achieved, employers need ready access to evidence-based therapies so that employees suffering from severe distress, depression or anxiety can readily be referred for treatment at an early stage. At the same time employers need to change their internal policies so that anyone going off sick is not left alone on the basis that the manager must not interfere, as this would be harassment, and is followed up by the occupational health people—and, in the case of a smaller employer, somebody within the firm—without delay to identify the problem and, where appropriate, to refer them for evidence-based therapy. The noble Baroness, Lady Neuberger, mentioned the incredible success of BT. It is phenomenal. BT has reduced its mental health sickness absence by a third through its Work Fit programme. Other employers would do extremely well for themselves if they followed BT’s example. Employment coaches, otherwise known as employment support workers, also need to be available to those at risk of losing their jobs due to mental health problems, but also to ensure that appropriate support is provided to line managers. It is no good supporting just the employee; you must also support managers. Why should they have any experience of these issues? If all these pieces of the jigsaw can be brought together, the benefits to employers, employees and the taxpayer would be extraordinarily significant. We would see a dramatic fall in the number of benefit claimants. As regards incapacity benefit or employment support claimants, every general practice needs practitioners of evidence-based therapies. Lots of general practitioners have counsellors of one sort or another, who I am sure are very helpful. You can just shift somebody off to see the counsellor rather than the doctor, and that makes sense, but if you really want these people to cease coming to your practice for a while, or, you hope, indefinitely, you have to have a change of mentality. We have to have people in general practice providing therapies that we know will help to cure the person. We know that about 50 per cent of people suffering from depression can be cured through these evidence-based therapies and will remain well for at least two years—if longer studies were done, I think they would show lengthier cures—and that the success rate for those with anxieties is higher still. A more challenging area for public sector involvement is that of the secondary mental health services. Here the need is for every community team to have an employment coach with the right skills to work with employers. This probably does not mean OTs but rather people used to working with employers who have advertising or PR skills and are helped to understand mental health issues with which they may be less familiar. If mental health trusts did this, they would enable people to go through the route of voluntary work within their trust and ultimately perhaps to jobs within it, or indeed elsewhere. Again, this employment support should be linked to the provision of evidence-based therapies. They have to go together. It is no good having one and not the other. In East London we have employment coaches and psychological therapists in all our community teams, but I have to confess that this has happened only within the past 12 months due to a thoroughgoing push from certain people within the trust. Does the Minister know to what extent this is now common practice across all mental health trusts? It is probably unreasonable to ask him that, but it certainly would be very interesting to know because that should be the case. The Healthcare Commission now has a target for local authorities, through their mental health trusts, to increase the proportion of mental health service users in employment year by year. Although there is no specificity there, the idea that you will be marked ““good”” only if you increase the proportion each year is pretty promising and a good start. There is good evidence that the initiatives discussed here are the best way to achieve that target. Again, I recognise that this is somewhat outside the Minister’s remit, but cross-departmental work on these matters will be essential if the target of a 1 million fall in the number of benefit claimants over 10 years is to be achieved. Therefore, what progress has been made with the Department of Health in progressing those agendas? I had not planned to mention the role of the foundation trust model in all this, but I think I will. Others may be aware that we now have something called a board of governors or a member’s council elected by our community. We also have thousands of members, many of whom are service users of our trust. We have had to think how to involve our membership. Our trust has come up with precisely the solution that we are talking about today—it seems eminently sensible for every other mental health trust to do the same—the members need to be invited and encouraged to become involved in voluntary work and, ultimately, in employment. We are right at the beginning of this; we became a foundation trust only on 1 November; but we feel that there is a lot of interest in this and it may be something that we need to encourage nationally. It could be quite a significant way forward for people in the secondary sector. I realise that large numbers of people are not in the secondary mental health sector, they are in the primary care sector, but we could really make progress through that foundation trust model that, when we started, we had not thought of as a major issue. My final point is one that I raised during our debates on the Welfare Reform Bill last year. The Minister may guess what I am going to mention. I hope that his heart will not sink to hear me mention the words ““linking rules”” again, but the issue remains as pressing as ever. For noble Lords unfamiliar with this territory, the aim of the linking rules is to ensure that anyone on incapacity benefit who finds a job and who, within two years loses the job, can restore those benefits, supposedly without delay—unless things have changed since I was involved in those matters. I am concerned that in such circumstances, someone still needs to complete a form, and there are inquiries to be made, before benefits are restored. Also, housing benefit is considered quite separately. In reality, those procedures can take weeks, perhaps months, especially for people with mental health problems who are likely to have fallen out of a job because of a recurrence of those problems. They will be lying in bed, they will not be picking up the phone, answering letters, making sure that they are filling in forms or getting someone else to do it for them. When we last debated these issues, the DWP was considering the possibility of aligning the reclaim process for housing benefit with that for employment support allowances. I have not completely given up hope of further improvements to the linking rules themselves for employment support allowances. It may be reasonable to limit those special provisions to people with mental health problems, because if your mind is working all right, you can probably deal with those matters, even if you have to sit in a wheelchair; but if your mind is not helping you at all, the linking rules do not answer the problem. Has the Minister managed to make any progress since last summer with those matters? I look forward in anticipation to his reply.