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Mental Health

I start by expressing my gratitude to the noble Baroness, Lady Neuberger, for calling this debate today and to all noble Lords for devoting their time to this very important issue. I fear that 12 minutes is too short to do full justice to the weight of noble Lords’ contributions, but I shall try. I am also indebted to the Sainsbury Centre for Mental Health for its policy paper on developing the business case and for all its ongoing work on the mental health agenda, particularly in its links with employment. The Government are committed to ensuring that 2008 marks a step change in the way we approach the health of the working age population and in particular support for people with mental health conditions. It is central to our aspiration of achieving an 80 per cent employment rate that we improve the health of our working age population, reduce sickness absence and drive down the number of people falling out of work and on to welfare benefits. This success will mean healthier and more productive employees and a stronger economy. We recognise the changing dynamic of British business and the corresponding shift in the nature of ill health and sickness absence for working age people. Mental ill health is now the greatest single cause of sickness absence. As the noble Baroness, Lady Neuberger, explained, the Sainsbury Centre for Mental Health estimates that it accounts for 40 per cent of all sickness absence—some 70 million days a year. The impact on business is more than £25 billion a year, including £15 billion from—I hesitate to say—presenteeism, with employees staying in work but performing below par. Mental health conditions are also the single biggest cause of people claiming incapacity benefit—a higher figure than the number of people claiming jobseeker’s allowance. Dame Carol Black’s recent review of the health of Britain’s working age population rightly drew attention to the challenges. An accompanying report from the Royal College of Psychiatrists highlighted that mental health problems cost the British economy more than £40 billion each year. The evidence is clear that work is generally good for health, and that is true for mental health as well as physical health. The Government have made considerable progress in working to address those challenges—as the noble Baroness, Lady Linklater, said, it is not rocket science—but we must go further. We must help all employers to manage mental health conditions at work by tackling the stigma associated with mental ill health; and wherever possible prevent such conditions developing in the first place. The noble Lord, Lord McColl, graphically challenged us on some prevailing attitudes and on the prejudices which, sadly, still persist. We must further improve the access to mental health support services for those who develop conditions, helping people to stay in work or to return to work as quickly as possible. We have been looking at ways to improve the support that is available to employers, both to ensure that they understand what they can do to prevent mental ill health being caused by work and to help them manage staff with mental health conditions, whatever the cause. The Health and Safety Executive developed its excellent management standards for identifying and managing the risks so that work-related stress can be prevented. The HSE is also supporting employers by developing improved information and guidance through its website. As part of Dame Carol Black’s review, PricewaterhouseCoopers considered the economic case for business investment in wellness. The evidence from 50 employer case studies suggests that the initial programme costs can quickly be translated into financial benefits. PwC is now working on developing a toolkit that will allow employers to quantify the financial benefits of their wellness interventions. We intend to pilot this toolkit in the summer, and we will encourage employers in both the public and private sectors to take part in this pilot and to use the toolkit to move towards reporting on health and well-being in the boardroom. We have also been looking at de-stigmatising mental health conditions in the workplace. The Department of Health, in partnership with Shift, has taken forward the successful ““Action on Stigma”” campaign, which tackles the stigma and discrimination that people with mental health conditions too often face. The early focus has been on the public sector audience, addressing our wish that government—central government departments, executive agencies and NHS trusts—should be an exemplar, as it is absolutely right that they should, but increasingly Shift has been invited to engage with blue chip companies to support business in tackling discrimination and promoting healthy workplaces. We need to go further in improving the support for those with mental health conditions to help them stay in work or to return to work quickly. Since 1997, the Government have made a record investment in mental health services. Real terms investment in adult mental health services has increased by nearly a third in the past five years alone. We now have over 60 per cent more consultant psychiatrists, 70 per cent more clinical psychologists and at least 20 per cent more mental health nurses than in 1997. As the noble Baroness, Lady Meacher, said, last October we announced a significant investment to deliver the Improving Access to Psychological Therapies programme, rising to £173 million in the third year. That will enable the training of more than 3,000 extra therapists to deliver psychological interventions for up to 900,000 more people over those three years. My department is working closely with the Department of Health on this, and we will make sure that it links with our Pathways to Work programme, which is now available across the country. We are providing funding to test private and voluntary sector delivery of employment support within the IAPT programme itself. Employment advisers will help individual customers to remain in, or quickly return to, work, or find jobs that are more suitable for them. As the noble Baroness, Lady Meacher, said, we need to go further in improving the integration of health and employment programmes to ensure that those out of work with mental health conditions have the best possible support to consider a return to work and that employers have the appropriate information and support to make the necessary adjustments that can make a return to work possible. Yesterday’s survey from the CBI illustrated the considerable employer support for the introduction of what Dame Carol Black described as ““fit notes””. We have been working with a wide range of stakeholders to create a revised medical certificate that is more positive and supports GPs in providing the best possible advice to their patients. More helpful fitness-for-work advice can also help employers to facilitate an earlier return to work, by switching the focus from what people cannot do to what they can do. We are doing so in replacing incapacity benefit with the employment and support allowance. The Department of Health has already agreed to pilot a fit for work service, as recommended by Dame Carol. The DWP has set up a vocational rehabilitation task force to determine what incentives and disincentives currently exist and how we might better encourage employers to provide such services. The CBI survey also highlighted the significant challenge that is still facing the public sector in tacking sickness absence. All government departments now report their sickness absence to the Cabinet Office on a quarterly basis, and we are committed to reducing current levels by promoting good health and well-being and by addressing the causes of long-term sickness absence. Good line management and a renewed focus on improving support for those with mental health conditions will be a critical part of that. As several noble Lords have commented, it is absolutely right that the Government take the lead in this area. There are examples of good sickness management practice in some government departments, as well as examples of not so good practice in others, and we have heard some of those this afternoon. To reflect the importance of mental health support for the future health of Britain’s working age population, we have asked Dame Carol Black to support us in producing, for the first time, a co-ordinated, cross-government strategy for mental health and employment. It will build on our current work to address and meet the challenges faced by people with mental health problems, helping to improve their employment chances. Providing improved support to employers, linking mental health and employment programmes, tackling stigma and discrimination and the other issues mentioned today will all be considered as we develop this strategy. Dame Carol has agreed to take the lead on that work, supported by a group of eminent experts from the business, medical and academic worlds, including my noble friend Lord Layard. The Government are committed to the challenge of reducing the impact of mental health issues on business, reducing sickness absence and improving more generally the health of the working age population. The noble Lord, Lord Ramsbotham, referred to the five identified components of an effective work-based programme in the Sainsbury centre report. Across government, work is under way on each of those components. The recognition by employers that work is, on the whole, good for mental and physical health lies at the heart of our health, work and well-being programme. The HSE’s stress management standards address issues of prevention, Shift’s action on stigma, awareness training and improving access to psychological therapies for increased help. The vocational rehabilitation task force helps the focus on effective rehabilitation. There is still much to do, and now is the time to make extra progress. In the words of the noble Baroness, Lady Neuberger, the word ““now”” means that it is time to do it. In the remaining time, I will pick up on the specific questions that were asked. My noble friend Lady Meacher asked about the linking rules again. I will write more fully on that. I am afraid that we are not yet in agreement with her on the issue of not having to have a claim in the system to access that. We are looking at making sure that the claim process and the reclaim process can be as smooth and effective as possible. On the mental health of the prison population, there has been extra investment each year in mental health in-reach services and additional funding over three years for support in training for prison officers and staff on mental health. The figure is £600,000; the noble Lord may think that it should be more than that, but we are seeking to focus on that. The noble Baroness, Lady Meacher, asked what we are doing to encourage employment support workers within psychological therapy services. I touched on that a little, but the IAPT programme is working with the NHS to encourage the provision of employment support workers in IAPT services. The programme is rolling out at present and the first services will come on stream in September 2008. The DWP is also testing the provision of employment support workers in psychological therapy teams. I hope that noble Lords will acknowledge that that is some real progress with real opportunities in future on a range of matters on which we now have a real focus. I again thank the noble Baroness for raising this important issue and all noble Lords who have contributed.