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.
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.
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.
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.
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.
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.
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%.
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.
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.
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?
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.
May I say what a privilege it is to follow the right hon. Member for Sutton and Cheam (Paul Burstow)? This debate is important and it sends a message that, again, this Chamber is discussing mental health. I have said, and I will say it time and again, that the more we talk about mental health, the better. Talking about mental health on the Floor of this main Chamber sends a clear message that this House—Members from all parts of it—is taking mental health seriously.
Clearly, work is central to most people’s lives. Mountains of research suggest that the right type of work is good and positive for somebody’s mental health. In this debate, I want to focus on three main areas. The first is mental illness and the benefit system—we cannot talk about unemployment without mentioning the benefit system. The second is how we manage long-term mental health problems in the community. Realistically, there are individuals who will not be able to work or hold down full-time jobs, so we need mechanisms by which we can support them in the community. The third area, which is related to unemployment, is how mental health is dealt with in the modern workplace in the UK.
Many people may ask: why is mental health in the workplace important? Well, to coin a phrase from Bill Clinton, “It’s the economy, stupid.” Bad mental health is bad for the UK economy. The UK report on mental health in the workplace, commissioned in February 2014, estimated that it cost the UK economy some £70 billion a year—4.5% of GDP. In the current economic climate, a reduction in that figure, which was drawn up using Department for Work and Pensions data and OECD and Eurostat labour market figures, would be welcomed by the Chancellor of the Exchequer. There is also another important issue here, which is that it is good for the individual. In a decent modern society, we should ensure that people’s mental health is not harmed by the work that they do. We must remember that it is not just the individual who is harmed, but the families as well.
The right hon. Member for Sutton and Cheam talked about the number of individuals who are on employment and support allowance, some 46% of whom have mental health problems. We have heard the rhetoric over the past few years about trying to be tough on welfare claimants and about getting people off benefits. No doubt we will hear more of that in the run-up to the general election. But I am not sure that such rhetoric helps the people with mental health problems who are claiming benefits.
The evidence is clear that the work capability test has been a complete disaster for people who have mental health conditions. It has also been a complete financial disaster for the Government. It does not work for the people it is supposed to support and it does not help the taxpayer.
My hon. Friend mentions the situation in the workplace with regard to mental health. I was very interested in what the right hon. Member for Sutton and Cheam (Paul Burstow) said about the Health and Safety Executive enlarging its role in this area. What does my hon. Friend think about that? Does he think that it could play a role?
I do, yes. There seems to be this feeling that business should be afraid of the Health and Safety Executive. I know from my previous life that it is good not just at dealing with stress but at driving up standards and productivity in the workplace. It ensures that the working environment is safe, so, yes, there is an opportunity there.
Like other Members, I have seen in my constituency the merry-go-round system of the work capability test. It goes a bit like this: a person is assessed by Atos, by people who have no mental health training whatever; he or she fails a fit-for-work test and is then put in a work-related group; he or she then appeals that decision and has their benefits reinstated. Then, ludicrously, within a matter of months, that person gets recalled to Atos, and they are on that merry-go-round again. That is not only bad for the individual but a complete waste of taxpayers’ money, as there is the cost not just of the assessments but of the appeals. The appeals system has been overloaded with people and has had to employ more staff, and that is not an efficient way of dealing with these individuals.
Charities in the north-east, such as Mental Health North East, have explained this expensive merry-go- round and have done very good reports on the numbers. Hundreds of people in the north-east of England are on the merry-go-round system, which has a tragic effect not only on the individuals but on their families. In some cases, it puts back people’s mental health rather than improving it. We should not shy away from the fact that there have been some cases nationally in which, because of the Atos system, people have taken their own lives. No Government should be proud of that.
People are under pressure, not just from the work capability test but from the economic downturn. Statistics came out last month that showed that the number of suicides now, at just over 6,000, is higher than it was two and three years ago. Surprisingly enough, the north-east of England is the region with the highest number of people—young men, mainly—committing suicide. I find it very uncomfortable that in 2015 we have a system that puts these pressures on individuals and that the major killer for men aged 20 to 34 is suicide. We need to address that, not just because it is the right thing to do but because of the economic case. That is 6,000 people who are not making a contribution to the economy of this country. We should also remember that 6,000 families will be hugely affected by the loss of a loved one. Each one is a personal tragedy and each one, like a ripple, has an effect on an entire community. It is important that we address the issue because we cannot have avoidable deaths going unchecked. Whatever happens after May, dealing with suicide and mental illness must be taken forward on a cross-party basis.
As for the Government’s response to the Atos merry-go-round, the right hon. Member for Sutton and Cheam (Paul Burstow) is right that after four years they have finally worked out that it is not an effective way of dealing with people with mental illness on benefits and have put in place pilot schemes that go broadly in the right direction. However, like the right hon. Gentleman, I want to ask the Minister what the time scale is for rolling them out across the country. I am also of the opinion that we need to take people who have mental health issues out of the system. I do not argue for one minute that they should not be assessed at all, but putting them through the Atos system is not the way to do it. If we can ensure that they get the individual help and care that they need, that will not only help them return to work or gain access to work but save the taxpayer a great deal of money.
My hon. Friend is making a powerful speech, but does he not agree that at the heart of this is the knowledge that we need sensitively trained and highly professional people to deal with these individuals, not an Atos-type untrained person? That is certainly the case in my constituency. We need highly trained people, whether they come from the health sector and are fully professional or whether, as in my constituency, they come from the voluntary and social sector.
I am pleased that my hon. Friend raised that, because I was coming next to the important role there is for the community and voluntary sector. We need to explore an alternative system. If we conclude that some people cannot work, we need to be able to offer them alternatives, and like the right hon. Member for Sutton and Cheam, I am a big believer in voluntary and charitable work. If people cannot hold down a permanent job—it may not necessarily be their fault; it may be that some employers do not understand that someone who has a severe long-term mental health problem will not be able to turn up to work every day—why not allow them to do voluntary work, which both improves their position and gives something back to society? Social isolation is one of the worst things possible for people with long-term mental health conditions. Enabling such individuals to make some contribution to society would also help them.
As my hon. Friend the Member for Huddersfield (Mr Sheerman) said, the charitable and voluntary sector has a key role to play, not only in getting people back to work but in the long-term management of people with long-term mental health conditions in the community. The Government talk a lot about the community and voluntary sector, and the Heath and Social Care Act 2012 contained a provision that I considered helpful—I was scorned by some of my colleagues for thinking this—which was that third sector bodies could be commissioned to deliver local services. In practice, that has not happened because the contracts that are being let are too big and too complex, and many third sector organisations that do fantastic work locally do not have the capacity to bid for them.
The present system is a scandal. The Just for Women Centre in Stanley, in my constituency, is a great organisation run by Linda Kirk, a former business woman, and Lestryne Tweedy. The centre caters for women who are suffering from domestic violence or mental health-related issues and those who have been on probation. The model is very simple: it uses counselling and crafts to support the individual and look at their underlying mental health issues before moving on to getting them into work. The centre uses individual tailored programmes, which can lead to individuals being with the centre for two years, but the success rate is fantastic and the cost is less than £800 per job placement. That contrasts starkly with the nearly £4,000 the Government pay companies such as Ingeus and others that get people into work.
The situation is even worse than that. Not only can small charities such as the Just for Women Centre not bid for the contract but, disgracefully, if women who come to the centre are also on Ingeus’s books and the centre gets those women into work, Ingeus rings them up and asks them whether they have got into work, they say yes, and Ingeus claims the money, but the Just for Women Centre—the charity—does not get a single penny of it. I hope the Minister will look into the details of this, because it is not just happening in County Durham. We need a method whereby small charities can access the contracts, because I think they would do the work a lot cheaper and more cost-effectively.
We also need a system for managing people long-term in the community. Another fantastic centre in Durham is the Waddington Street Centre, which through education, therapy and other activities, manages people in the community. I pay tribute to Steve Wakefield and his staff, and the chair, Professor Fred Robinson. Like the Just for Women Centre, the Waddington Street Centre cannot access any of these contracts and has to rely on charitable donations. We all know that the charitable sector is being cut, so we need some method whereby those organisations can get access.
Finally, I want to focus on mental health in the workplace, because it is a subject we do not talk about much. As I said, mental health issues cost this country some 4.5% of GDP; most Chancellors of the Exchequer would salivate over the savings to be made by reducing that by 1% or 2%. The question is why mental health in the workplace is not a higher priority for the Government and for UK plc. Part of the answer is the workplace culture—the belief in this country that by working every hour God sends, we will be more productive, and also the belief that any talk of mental health in the workplace is fluffy and vague.
However, some businesses, such as BT, have taken a board-level decision to address mental health issues in the workplace. I congratulate the Communication Workers Union on its work with BT management to put in place support mechanisms and awareness campaigns on mental health and the early warning signs of problems. The results of this approach speak for themselves. In BT’s case, the number of employees off work on sickness absence because of mental health problems has decreased by 30% over the past five years. Among those who have been off work more than six months for mental health reasons, there has been an astounding 80% return rate, compared with the national average of less than 20%.
The hon. Gentleman is making a powerful speech and the examples he gives from BT are very interesting. Is it not the case that we need to flip the way we think about mental health in the workplace? It is not a problem to be managed, but an opportunity to be taken. Many people on a mental health recovery journey can be some of the most creative and productive employees in an organisation, so we need to embed that approach into HR practice and drive productivity that way.
I agree. The focus should be on mental well-being, rather than mental illness, in the workplace. I spoke to the managing director of BT and asked why the company adopted the approach that I described and whether it was aiming to be a good corporate citizen. The answer was no. The firm does it for hard, brass-tacks reasons—it is good for business. It sees the fragility of poor mental health among its employees as a risk to its business model. I am sure that is the case in other types of business too. BT has recognised that and put the appropriate mechanisms in place. We need a system for that to be rolled out among other companies in the UK.
My hon. Friend is making an incredibly powerful speech. I thoroughly agree with what he says about mental health in the workplace. Will he pay tribute to the work of organisations such as Mind that are producing training packages for dealing with mental health issues in the workplace? As he says, those are a huge cost to organisations and to the individuals involved. Mental health issues are the No. 1 cause of absenteeism from the workplace, and systematic training is needed across all workplaces.
I am listening with great interest to what the hon. Gentleman says about bringing people with mental health difficulties back into employment. I hope he will acknowledge the work done by Disability Confident, a scheme supported and run by the DWP which recently ran a presentation in my constituency. A number of large employers were brought to the presentation and for the very first time challenged with the opportunities that exist, as opposed to defining mental health issues as a problem. Does the hon. Gentleman agree that there is great scope for such an initiative to be taken beyond the pilot stage across the whole country?
Indeed. The test is to make that a must for business. The next Government of whatever shade should make it compulsory. My hon. Friend the Member for Coventry South (Mr Cunningham) referred earlier to the Health and Safety Executive, which has a key role to play in that. Mental health issues should not be seen as a threat to businesses. The challenge is to help businesses of whatever size to perform better not only by being good to their individual employees, but by being more productive as part of the economy.
There is a huge challenge here. We must take this issue seriously. It should be seen not just as one of health. It must be tackled across Government. Whichever party is in Government after May, and especially if it is my party, I will be arguing strongly that we need a cross-Government initiative so that all Departments ask what is being done to promote good mental health, not only within the Department but in the development of vital policies. If we get this right, it makes economic common sense and can grow the UK economy. That is the dynamic that will make people sit up and think about making this a reality.
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.
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.
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.
I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow) on setting the scene very well for each and every one of us. I also thank the hon. Member for North Durham (Mr Jones) for his impassioned plea on behalf of those who have mental illnesses and need employment. Several right hon. and hon. Members have made very detailed contributions. We look forward to the Minister’s response, because this issue concerns us all.
These are the sorts of debates that I like to be involved in because they are about the nitty-gritty of our constituencies and the issues that people bring to our offices every day and wish us to speak on. I deal with this issue in my office every day when we see people who are struggling to cope with mental health illnesses and problems. These are made worse by the times we live in and the pressures on those in work and those on benefits. The hon. Member for North Durham mentioned benefits. Of late, I have seen greater need in people who suffer from depression as they have had to deal with issues that they never in their life had to deal with before. Poverty.org has said that people who are working are at much lower risk of mental illness than those who are unemployed or long-term sick or disabled. The proportions of those assessed as being at high risk are between 10% and 20% for those who are working, about 30% for those who are unemployed, and 50% for those who are long-term sick or disabled.
One of the biggest issues that I see in my office is the benefits system. A lady in my office—one of my staff members—now deals with nothing but benefits issues. That is because of the enormity of the change that has come about. The hon. Member for North Durham referred to the “ESA merry-go-round”. We have all experienced that. I have had cases where constituents have had to be assessed for ESA three times in one year. I fail to understand why that happens. Is there that dramatic a change within four months, or six months? I understand the need for the system, but not the need for a regular three-times-a-year assessment of someone who is clearly ill.
I want to give an example, as we all can; the right hon. Member for Sutton and Cheam talked about one of his constituents. I will not mention any names but I will tell the story. I recently helped a young lady of 32 with her disability living allowance form. She suffers from a very serious case of chronic inflammation of the bowel. Over the past five years, she has had to go down to part-time hours, and she eventually lost her job due to her periods of sickness. This in turn has led to her suffering from depression, which has made her illness worse, and she is now at a stage where she cannot go out to work and being in the house just makes everything worse in her life. She said to me, “Even if I am well, Jim, who is going to hire me with my record? I just can’t see any light in my future.” That was a terrible thing for this young girl to say. After that appointment, where the girl said little and her mother outlined most of the illness, I asked myself, “What is the system doing to help her and others in her situation?” Undoubtedly, inability to find a job or to work is a massive factor in mental health. These constituents—there are many of them—worry and concern us. With all due respect, I seriously question that the system is right in this circumstance.
The hon. Member for North Durham referred to isolation. I want to make a point on behalf of those in rural isolation. My constituency is split about 50:50 between urban and countryside, so I am aware of the rural isolation of people who live alone, who are unemployed, who have little or no family contact, and who find every day a challenge in their homes—those who, as a result of their unemployment and rural isolation, become depressed. We have to reach those people as well. This is an issue that burdens me greatly.
The poverty.org website states:
“Research suggests a connection between the conflict and the risk of mental ill-health within Northern Ireland”.
Everyone present knows of the 30-year conflict in Northern Ireland, during which a great number of people were affected emotionally and mentally by what took place. The website states that
“the greater the extent to which someone’s area or life is affected by it, the greater the likelihood that they have poorer mental health. How far the conflict explains the overall levels of mental ill-health in Northern Ireland is less clear…Among those who chose to answer questions about their experience of the conflict, 7% indicated that they themselves had been injured during it, while a further 36% indicated that a close relative or friend had either been injured or killed. Putting these two figures together implies that in the early years of this decade, around half a million people had been affected by the conflict in this way.”
That gives an idea of the magnitude of what took place in Northern Ireland: it has affected those of us who came through it.
The figures show that mental health is a greater issue in Northern Ireland than in other parts of the United Kingdom. When someone is under pressure or stress and worried about whether they will live or die, they turn to drink, drugs or other things, and that affects their lifestyle. Ultimately, a great number of people in Northern Ireland suffer from depression and mental health issues because of our country’s past.
There is an advert in Northern Ireland—I suspect there are similar ones across the whole of the United Kingdom—that shows a young boy who is the life and soul of the party. He is the one telling the jokes and who is involved in everything that is going on, but when he leaves his friends and goes home, the door closes and he becomes a different person. Sometimes a person’s outward appearance can be bubbly and seemingly cheerful, but the fact is that, when they return home on their own, depression sets in. Colleagues in the workplace can address such issues, and that is also a job for family and friends.
The Prince’s Trust has found that between 10% and 20% of teenagers from Northern Ireland will suffer from depression at some point in that short period of their lives. More than one in three—35%—of youngsters there had experienced mental health issues, compared with the United Kingdom national average of almost one in five, which is 19%. There is a greater level of depression among younger people in Northern Ireland than anywhere else. The Prince’s Trust also revealed that long-term unemployed 16 to 25-year-olds are twice as likely as their peers to be prescribed anti-depressants and believe that they have nothing to live for. We have a role to play in addressing that.
I will mention the suicide rate later. Unfortunately, a large number of young people who were unable to cope with life took what they felt was the only way out. I know that the Minister’s response to the debate will be positive—it always is—and I would like him to address what we can do together to try to solve some of the problems. I look forward to hearing his contribution.
Ian Jeffers, director of the Prince’s Trust in Northern Ireland, has said that the trust’s report comes at a time when long-term youth unemployment has shot up by 197% since the start of the recession in 2008. Having said that, it would be remiss of me not to mention February’s unemployment rates, which show a clear drop of 17.9% in unemployment among young people over the past 12 months, so steps are being taken to create employment opportunities. If we look at overall employment in Northern Ireland, we see that almost 10,000 jobs have been created over a recent period.
Ian Jeffers says:
“Unemployment is proven to cause devastating, long-lasting mental health problems among young people…Thousands wake up every day believing that life isn’t worth living, after struggling for years in the dole queue. Across Northern Ireland, 5,450 young people are facing long-term unemployment”—
there is still work to do—
“and there is a real danger that these young people will feel hopeless, as well as jobless.”
The research highlighted that people suffering from depression would be less likely to ask for help in that circumstance.
The poll, which gives a very accurate flavour of what is happening, revealed that more than one in three, or 34%, of young people said that they always or often feel down or depressed, compared with a national average of 32%, and the long-term unemployed are significantly more likely to feel that way. One in four, or 29%, said that they feel like an outcast, compared with 24% nationally, and the report found that the long-term unemployed are significantly more likely to feel that way. More than one in five, or 21%, admitted that they feel like a “waste of space”. How often have Members heard that comment? It may have been said frivolously on many occasions, but such young people react in a much more difficult and serious way. That figure is against a national average of 17%, and the long-term unemployed are more than twice as likely to feel that way.
The youth charity the Prince’s Trust has said that it will support 58,000 disadvantaged young people this year. About 280 of those surveyed were not in education, employment or training, 166 had been unemployed for more than six months and 135 had been jobless for a year or more. Almost one in five young people looking for a job at present cannot find one in today’s marketplace.
I believe that it is our job to look at and address the issue of people who are not qualified. There is a problem in Northern Ireland among young Protestants who for some reason do not have the educational qualifications that they should have. I understand that it is a devolved matter, but I suspect that there are other parts of the United Kingdom where people do not have the qualifications they need.
The statistics are horrifying; yet they are not a complete shock. The number of young people who come to my office for benefit and housing help is very sad, when I think of how much I loved having my first job and getting my first pay cheque. We have a generation of young people who are waiting on their benefit cheque with nothing else to live for. Is it any wonder that we have a serious problem with mental health issues?
Suicide in the community is a great worry for all of us as elected representatives. Every one of us has dealt with families—with people we know personally, or with their families—who have lost loved ones who took their own lives because they felt that there was no way forward. I have asked myself this question, as many others have probably done: if I had known, could I in some way have persuaded that person not to do what he or she did? It is always a very difficult question to answer, but the fact is that we do not know. All we can do is to do our best in this world: to speak to the people who come to see us and to try to give them some hope that they can look forward with positivity. Those are some of the issues, but if such people are coming off the back of terrible depression or terrible pressure, they do not know where they can go next.
The Northern Ireland Statistics and Research Agency states on its website that 14,968 deaths were registered in Northern Ireland in 2013, of which 303 were suicides—the second highest number on record in Northern Ireland after the 313 recorded in 2010—and just over three quarters, or 229, of the suicides in 2013 were young men. That highlights why this debate on mental health and unemployment is so important. It is a chance for the House to shine a light on how we can help such young people to move from their mental health problems into employment, and how we can help them to achieve their vision, goal and challenge for the future.
The link between unemployment and mental health issues is clear, and it is time that strategies were put in place to deal with those issues. Are we getting this right at present? I do not believe we are, but that does not mean that we should stop trying. For the sake of families throughout the United Kingdom of Great Britain and Northern Ireland, we must and we can do better.
I was not sure whether I would make it to this debate, given my other responsibilities, but I am very glad that I have. I thank the Backbench Business Committee for scheduling the debate, and the right hon. Member for Sutton and Cheam (Paul Burstow) for opening it.
This is an important debate, not only for those with mental health challenges who are unemployed, but because it is something that I think strikes at the heart of what we are all doing in politics. With millions of people affected—one in four people will be affected by a mental health challenge in their lifetime—this issue lies at the heart of what it is to be human, to be British, and to be part of a democratic society. Right now in this Chamber, across the House, in our offices and across the country, probably one in six or seven people is struggling with some form of mental health challenge. That says to me that it is part of the normality of the human condition, and surely as Members of Parliament and Government, and as law makers, we must bear that in mind when making the laws of the land.
Across the Conservative Benches, and perhaps across the House, it often seems that our objective in politics is to seek the greatest level of utility for the greatest number of people. It strikes me, however, that GDP growth, incomes, salaries, and the growth in physical goods and services that we consume, is not necessarily the best aim. Indeed, I am not sure that that is the fundamental aim we all share, and it seems that a better motto, modus operandi and objective—one that I suspect we all share—would be to create the greatest level of happiness for the greatest number of people. It is not that as politicians we can work out how to make people happy—that would be preposterous and ridiculous—but some things are certain to make people unhappy, or to create stress and the sense of a lack of control that leads to a greater prevalence of mental health challenges.
When I first arrived in Parliament in 2005 I co-wrote a pamphlet entitled “The Forgotten”. My chapter was on those with depression who, almost by virtue of that condition if they are going through an experience at the time of an election, are kind of disfranchised from society and the democratic process. One of my burning passions is to ensure that everyone, no matter what their background or mental health condition, is able to participate in the democratic process, and is also never forgotten.
We certainly do not know how to create happiness—I would be very nervous if anyone suggested that they know how to create happiness for somebody else. However, when it comes to public services and law making we can do a lot to remove the causes of unhappiness, depression, or the exacerbating factors that lead to greater levels of depression and mental health challenges.
On the causes of mental health challenges, there is certainly a degree of genetic propensity—that is becoming ever clearer as scientific research progresses. There are also specific causes of such challenges in life, such as bereavement, certainly of a close family member. I thank the hon. Member for Strangford (Jim Shannon) for his comments on the fact that in troubled zones during times of war or conflict the incidence of mental health challenges rises immediately because of changes to what is going on around people. Mental health challenges can be brought forward or exacerbated by accidents, or by the loss of a job or a divorce. Those are known causes or accelerating factors for mental health challenges, and are things for us to consider when making policy.
One area is almost entirely within our control—this is why I am delighted to participate in the debate today—because we can have an impact on the welfare and benefits system, and on how the state enables or helps people to find employment, or to get training or education. I was particularly mindful and supportive of many of the comments made by the hon. Member for North Durham (Mr Jones) about the systems we introduce for getting people back into work, or identifying whether they have challenges. One of the greatest forms of stress and pressure—which can cause depression and trigger other mental health challenges—is a feeling that our life is out of our control. We have a complicated benefits system, and people have to jump through many hoops to achieve recognition within it.
Does the hon. Gentleman agree that we need to tailor-make back-to-work programmes and recognise that on some occasions it might take longer to get people capable of working? We also need a system that allows people with long-term mental health issues who are not going to work at least to make some positive contribution to society.
The hon. Gentleman has hit the nail on the head—that is precisely it. The distribution of traits within mankind and the British population is like a bell curve. Every person is unique. There are very few identical twins. Certain mental health conditions require a longer period of adjustment before people are able to participate in the workplace or in voluntary activities that make a contribution to society. Any system must be flexible enough to recognise that difference.
On the feeling that one’s life is out of one’s control, let us imagine—I will create a caricature here—someone from a tough background with literacy difficulties, perhaps dyslexia, who has just gone through a divorce and is presented with forms up to 70 pages long when trying to get some form of support from the state. The idea that someone who is in a very difficult state can navigate this incredibly complex system is tantamount to mental cruelty. There have been cases in the press recently where parents of children with difficulties have had to deal with a stream of health workers, disability benefit support staff, jobcentre workers and council workers knocking on their door. That can create a huge amount of stress and a sense that life is beyond one’s control. We have to be mindful of that and ensure that public services fit people who are going through a mental health episode.
I want to say some positive things about mental health, unemployment and employment. Mental health challenges are part of the normal human condition. Probably one in four of us here will struggle with a mental health challenge at some point in our lifetime. I am sure that all MPs have seen people in their surgeries who present with a problem—for example, they are unemployed and are having difficulties finding work and navigating the benefits system—and realise that there is something more behind the initial problem. Sometimes it will be depression, bipolar or paranoia, and they will need further assistance and support.
If we are to have a society that is at ease with itself, the stigma of mental health conditions needs to disappear. It is part of our job—not just in this debate, but in our daily lives—to ensure that we are relaxed about talking about mental health conditions, no matter what they are. In many cases, I welcome the idea that people joke about mental health conditions. I do not mean that people should do so in a derogatory way, but that jokes are part of our normal discourse. Whether in Parliament, in Westminster or in a business, people stand by a coffee machine and talk about so and so breaking a leg when they were skiing. Everyone has a laugh about it, asks the person how they are and then writes their name on the cast. I do not want mental health challenges to be part of a sort of corridor whisper. We should be able to laugh and talk—“so and so is having a bit of trouble at the moment”—and be very relaxed about them, because they are part of our human condition.
Another positive thing about people with mental health challenges in the workplace is this: yes, British Telecom has recognised the benefits of employing people who may have challenges, but a raft of smaller firms have also recognised those benefits. In my working career in the world of business in the 20 years before I entered politics—I suppose this is work as well—I came across many enlightened small businesses that, on many occasions, competed for people with mental challenges such as depression or bipolar. I will try to put this subtly. When somebody is struggling with bipolar and is in a good period, they can be exceptionally creative and productive. That is very useful, provided one recognises that when they are in a down period they need flexibility and understanding. A lot of small businesses would benefit from recruiting people with certain mental health challenges for particular roles in their organisation.
It is my experience, from having observed businesses over the years, that those that recognise these challenges and show flexibility actually perform exceptionally well. So even being less altruistic, this is a great opportunity to create work forces that are up to the mark, dedicated and loyal and which go the extra mile in the good times, because people with mental health challenges are a great resource on which to draw. As others have said, however, it would be helpful to have guidelines or suggestions, perhaps from the public sector but certainly from bodies such as Mind and others, on how to work with people with mental health challenges, particularly for small businesses.
I hope that Opposition Members will bear with me for a moment, because I want to touch on the coalition’s welfare changes, many of which were initiated under the previous Labour Government. In many respects, we should take our hats off to the direction of travel. One of the greatest pressures is to be young and unemployed and to feel unwanted, as it can exacerbate the feeling of isolation from society. However, although the welfare changes that the coalition has made or is seeking to make might not be perfect, they do represent the correct direction of travel. I know that many Opposition Members agree. If we can help somebody into work—not in a brutal way—we can give them that sense of meaning, control and well-being that comes from knowing that even if they have a mental health challenge they are still welcome in the work force. These are positive things that MPs can do to enfranchise the large minority that struggles from time to time.
I do not disagree with the hon. Gentleman—if it is the right type of help. However, as the hon. Member for Strangford (Jim Shannon) and I mentioned, for someone suffering from a long-term mental health condition, this merry-go-round system we have is pretty brutish and needs refining. Otherwise, it will not only waste taxpayers’ money but create a lot of unhappiness and fear among people with long-term mental health issues.
I think we agree. Indeed, I was about to focus on how we could significantly improve the way the system works for people with mental health challenges. First, on public services, particularly welfare-to-work arrangements, we need to be very finely attuned to the processes undertaken. Somebody with a mental health challenge might initially appear to be absolutely fine, but if they are put through a very mechanistic—the hon. Gentleman said “brutish”—process that makes no allowances for such challenges, it can do more harm than good.
I do not disagree, but one of the fundamental flaws that I and others have been raising for several years is that Atos assessors are not mental health trained. Having assessors with expertise in mental health would be a huge step forward in helping those individuals, yet the Government have ignored the matter for the last few years.
I am not sure the Government have ignored it. I have been in meetings where it has been carefully discussed, so it is certainly on the agenda. I agree with the hon. Gentleman’s general point, however, and I am sure we will get to it on the other side of the upcoming election. Thus far, the focus has been on shaping the overall system in the right way, but unquestionably it will need refinement to ensure that in the first level of interaction the system quickly identifies people who might require a greater focus on their mental health and well-being than the average person.
I can give the hon. Gentleman the commitment that once we are through this short period before the election, and if we are both fortunate enough to be here afterwards, I will be happy to work with him and others in the Chamber to ensure that mental health conditions are better recognised or integrated within the process. We had a huge mountain to climb just to change the system in the first instance, but greater sensitivity is certainly needed now.
Four or five years ago, in Windsor, I knocked on the door of a very elderly lady. She had found in her letter box a form connected with a consultation on whether a local development should proceed. She was clearly struggling with a mental health condition at the time, and was agonising over whether she should fill in the massive form. There was another form from the council, and another relating to planning. I almost did not have the heart, but just about had the heart, to say to her, “The form is merely about a consultation, and, given the hundreds of forms that will be sent back, what you write on this one may have only a very small impact on the outcome. You might be better off seeing your family, having relatives to visit, and actually enjoying your life.”
What I gleaned from that encounter was that having to deal with lengthy forms and deeply bureaucratic processes may—unnecessarily, in many cases—take away the quality of people’s lives, particularly when those people are unemployed. That, I believe, should be a secondary focus for us, and for any future Government. We should think about the way in which we ask people to participate in our bureaucratic procedures to obtain assistance and return to work. We should ask ourselves whether the length of forms is a problem, and whether matters could be dealt with a little more quickly on the telephone or face to face, given that that some people might be struggling with a challenge at the time.
I know that we are having a quiet afternoon in the Chamber today, but I think that we have a responsibility to continue to talk about this issue—not only in debates such as this, but in the context of every brief that we may hold, every Committee in which we may participate, and every Bill that we may examine. We must keep at the forefront of our minds the fact that a very large proportion of the British population are struggling with mental health challenges. Every policy that we create must be designed to reflect that, and to accommodate such people.
Here is one more idea that may be of use at some point in the future. I love the idea of the market. I love the idea of businesses competing to hire employees, and I love the idea that competing small businesses—as well as one or two larger ones—that are desperate to hire staff at a time of low unemployment will one day place an imprimatur on their websites and recruitment pages, declaring that theirs is a mental health-friendly working environment. Indeed, it would be curious if they did not do so. I believe that if small and medium-sized businesses—indeed, all businesses—do not take that route, they will be hamstringing themselves and preventing themselves from taking advantage of the best employees that they can recruit from the marketplace.
This is my vision for politics. I want to see a country that is at ease with itself, and with people from different backgrounds and different walks of life. A country that is at ease with itself must acknowledge that, at any one time, a large minority of its population will face mental health challenges, but that those people are equally part of society. The policies that we create in this place must be user-friendly, and take account of people from all sorts of backgrounds and with all sorts of conditions.
I am optimistic about the future. Why? Because there is no doubt that Labour, Liberal Democrat, Independent and Conservative Members all recognise that the issue of mental health represents a serious challenge for a large proportion of the population, and I am confident that any future Government will pay more attention to it than we have in the past.
I thank all Members who have contributed to what I think has been a very interesting and rich debate. I especially thank the right hon. Member for Sutton and Cheam (Paul Burstow) for introducing, in a wide-ranging speech, all the issues on which others have expanded.
There is clearly widespread concern about the poor employment outcomes and poor employment experience of people with mental health disorders. Those concerns are wide-ranging. There is obviously a concern about the poor employment rate among people with mental health problems and the fact that unemployment is both a cause and a result of poor mental health. Particular concerns were rightly highlighted by the hon. Member for Strangford (Jim Shannon) about the implications for young people who experience unemployment at the very start of their adult lives. There are also concerns about people with mental health illnesses being dismissed or exiting work prematurely, about a lack of not just joining the workplace but progression in the workplace—relatively reduced chances for promotion—about lack of support in the workplace for people with mental health problems and, as was highlighted in the debate this afternoon, about so-called presenteeism, which is damaging for both the health and well-being of the individual and business productivity.
Such concerns about the cost both to the individual and society have been highlighted a number of times this afternoon. Poorer mental health outcomes are suffered by poorer people, who are less likely to be in employment. We also know that 39% of sickness absence is as a result of mental health problems, amounting to 11.3 million working days lost to our economy each year.
We have also heard concerns about the wider context in which mental health problems in the workplace arise and are then addressed. There are problems with people accessing therapies and treatments to deal early with mental health difficulties, and we have rightly heard quite a bit about stigma and discrimination and what can be done to tackle that.
I welcome the comments from the hon. Member for Broxbourne (Mr Walker) about the importance of dealing with mental health difficulties among children and young people and intervening early to address them. Many mental health problems begin in childhood—before the age of 18—yet we know that only 6% of spending on therapeutic mental health services is through child and adolescent mental health services, so there is clearly a massive imbalance in the way in which we are spending our resources to address the problems in the pre-adult years, as compared with picking up the pieces afterwards when so much damage has been done.
Concerns were also expressed about the extent to which programmes that should be helping are not doing so. We heard quite a lot about difficulties with the benefits system and problems with some of the work support programmes, which mean we cannot be complacent about an employment rate of 37% among people with mental health problems against an overall employment rate of 77%.
As we heard, in most cases being in work is beneficial for mental health, although in her 2013 report for the Government on mental health and work Dame Carol Black rightly set out a number of caveats to that, including the quality of the job and the degree of autonomy or control that is enjoyed by an employee. However, we also know that people who are not working because of a mental health problem represent the largest proportion of those who would like to be in employment. The reasons why they are not working are partly to do with lack of access to the therapies and care that would make work possible.
We have heard on many occasions of significant delays in accessing so-called talking therapies, and we must be concerned that one driver of the rise in the number of people being placed on the support group of employment and support allowance because of mental health problems may be that people cannot get access to the health care they need.
We must also pay attention to the particular anxiety identified by the independent reviewer, Dr Paul Litchfield, about the very large number of young people in the support group or the work-related activity group of ESA who have mental health difficulties. The fact that we are parking some of those young people on to a benefit without properly intervening early, and the fact that the way in which the system operates exacerbates and encourages a disregard of early intervention, is something I know the Minister expressed his own concerns about in his appearance before the Select Committee recently.
Repeated reports have recommended the much more effective joining up of employment support and mental health services. I very much welcome the introduction of specific indicators for mental health and employment in the NHS outcomes framework, but we also know that there are long delays in accessing therapies and that doctors can be reluctant to identify a mental health problem or sometimes fail to recognise that a patient could work or that work would be beneficial for that individual. The introduction of the fit note offers doctors the opportunity to provide more useful fitness advice to patients with mental health conditions, but there remains a significant challenge to ensure that health care service professionals support rather than work against the grain of increasing and sustaining employment.
We also know that stigma and employers’ fear play an important part in the poor employment outcomes of those with mental health disorders. Half of employers say that they would not employ someone with a mental health condition, although I strongly suspect that a large majority of them in fact already do so. Too often, sickness absence as a result of a mental health problem leads to dismissal under capability procedures or to early exit or early retirement. The introduction of fees for employment tribunals under this Government makes it harder for an individual who has been forced out of work to gain redress, which I guess could make it more likely that employers will put people under pressure to leave a job.
As has been said, we need the workplace environment to be much more effective in supporting people with mental health disorders. A few days ago, I met representatives from my own union, the Union of Shop, Distributive and Allied Workers, and they highlighted some of the difficulties that their members were facing at work. They talked about the stressors that people face at work, including unrealistic performance targets, zero-hours contracts and the insecurity associated with them, low pay and the difficulty of balancing family and working life.
Those problems are not confined to one particular industry sector. Workers in the public sector—teachers, probation officers, police officers and people in the armed forces, for example—also experience high levels of pressure and stress. We should also note that those pressures cut across all levels of jobs, from the most senior to those in basic and entry-level jobs. In fact, stress is particularly high among lower-paid workers who do not enjoy autonomy and control over how their working day is spent, or who feel that they have low status at work. Stress levels among low-paid and more junior workers can be particularly high.
There are lots of opportunities for us to intervene to improve workplace support. We have heard some helpful and imaginative suggestions and examples this afternoon. I hope that the Minister will comment on the role of the Health and Safety Executive in relation to this agenda. There is a real opportunity for managers to work with trade union workplace representatives to address some of the issues. There is also an important role for the public sector, as an exemplar employer, to adopt appropriate strategies to support staff as well as proactively recruiting those with a history of mental ill health, as was rightly suggested by the hon. Member for Windsor (Adam Afriyie).
Sir Stephen O’Brien, who is chair of the Barts Health NHS Trust, was recently commissioned by the Leader of the Opposition to advise my party on a mentally healthy society. He has suggested that accreditation schemes could do more. In addition, we need to pay attention to manager training and to providing information in the workplace to enable people to self-refer to mental health services, as well as to the positive use of the fit for work scheme, which is something the USDAW representatives told me that people were quite fearful of. The scheme could be helpful in supporting people to get back into work quickly, and I hope that employer bodies will take positive steps to engage with and reassure their workers about the way in which they are using the new scheme.
The Government also have an important role in supporting into employment those who are out of work as a result of a mental health problem. Despite the raft of initiatives and pilots described in the Government’s disability and employment strategy, the number of people being placed in the employment and support allowance support group is rising, and labour market programmes that ought to be getting more people back into work are continuing to let them down. The Work programme has been a failure for those with a mental health condition, as the right hon. Member for Sutton and Cheam pointed out, getting just 6.7% of them back into work. The black-box approach and the national contracting regime have shut out specialist provision, as we heard from my hon. Friend the Member for North Durham (Mr Jones) and others. We have also seen a 20% reduction in the number of specialist disability employment advisers in jobcentres. As the Minister acknowledged in a written ministerial statement on 18 December, the Access to Work programme last year suffered from significant delivery problems, which will have inhibited access to some of the support that could have been provided through the mental health component of the programme. That could have enabled more people, more quickly, to have functioned better at work.
There is a problem with the Work programme’s absence of a specialist programme for people who have been placed on ESA for mental health and indeed other chronic health conditions and disabilities, which means they are not getting the tailor-made support they need. That is why Labour has said that we would introduce a specialist programme of work support for those who have been on ESA for more than three months, which would mean that by commissioning that support locally, we will be able to make much better use of the kind of specialist organisations mentioned by my hon. Friend the Member for North Durham that have expertise in mental health and employment, and will be able to offer appropriate support.
I agree with the comments made about the opportunity presented by the individual placement and support programmes run from a number of NHS trusts. I had the privilege of visiting the IPS team in south Manchester a few months ago, where I heard about the successes it achieves, both in placing people into, and sustaining them in, work, and in reducing the incidence of hospitalisation. We know, including from an international study—the equalise study—that such interventions can be cost-effective compared with other vocational support for some people, yet too often people are being referred to this kind of support too late. I will be interested to hear the Minister update us on the Government’s thinking on IPS and what the current learning is. I would also be interested if he commented on what I was told in south Manchester, which was that the NHS is funding these IPS programmes but if Work programme providers have referred or introduced someone to that IPS service, the Work programme provider claims the outcome payment. It seems mad that the Department for Work and Pensions is paying a Work programme provider when all the work is being done and all the cost is being borne in the NHS. I hope the Minister might be able to say something about that.
That is exactly what is happening to the charity I mentioned in my contribution. It is doing all the work and the Work programme provider is doing nothing for individuals, apart from making a phone call at the end to ascertain whether that person has actually got a job and then claiming the money from the Government.
That is absolutely not how those contracts should be working. If subcontracting to specialist organisations is taking place from the Work programme, the organisations to which those subcontracts are being let should be properly rewarded. We face a number of problems in this area. First, a lot of local organisations do not have the opportunity or the wherewithal to participate in these programmes at all. As my hon. Friend says, those that can or try to participate find that the programmes are utterly economically unviable for them because they are not paid for the work they do.
Finally, I wish to pick up on the discussion introduced by a number of colleagues about the operation of the benefits system, and how that bears on those with mental health conditions and their chances for employment. The hon. Member for Windsor was absolutely right to talk about the complexity and forbidding nature of some of the system. I hope the Minister is not going to tell me that universal credit is going to resolve all that, because I do not think it will. In particular, as the hon. Gentleman rightly said, the gateway into the system is as much a part of the problem as the way in which the benefits system is designed. Although it is right that moving people into employment is in many cases going to be good for their mental health, moving them into poorly paid jobs which leave them still struggling to make ends meet will not make them feel that their well-being is being holistically addressed. Poorly paid, poor-quality jobs are, in the long run, just not going to be consistent with good mental health. I also say to the Minister—and he will know this—that there has been a massive upsurge in sanctioning benefit claimants under this Government, which must mean that a number of those who are being caught are those with mental health problems.
Of course there must be conditions for benefits and sanctions for wilful non-compliance, but inappropriate sanctioning causes not only financial hardship for many but huge anxiety and stress. Despite repeated protestations from Ministers that there are no targets for sanctions in Jobcentre Plus, we hear again and again anecdotal reports that such targets—at least at managerial level—do exist. It is also true that the new regime is now much more punitive. Sanctions bite harder and last longer and a culture has grown up in which claimants are being sanctioned inappropriately.
Just a couple of weeks ago, I was told of a case in the west midlands of a Work programme participant who was unable, because of his mental health condition, to discuss his situation in a public forum, as was required by his provider. The resulting anxiety left him unable to engage at all with the Work programme and he was sanctioned for 14 days.
It would be useful to know what analysis Ministers are undertaking of the people affected by sanctions who have a mental health condition. It is really quite shocking that we have so little information on their fate when a sanction has been imposed. I want to be clear that, under a Labour Government, there will be no targets for sanctions, that we will insist that assessors and decision makers at every stage of the process from the work capability assessment to the imposition of conditions to decisions about sanctions properly take account of the mental health of the claimant, and that expert advice will be available to ensure that relevant information is considered, with penalties on assessors for poor advice.
May I also highlight the concerns that arise from the recent regulations to allow data-sharing in relation to universal credit recipients with a range of other service providers, including housing associations, credit unions and debt advice agencies? Constituents have said that they are concerned that this could lead to data-sharing about their mental health, which they have not authorised and do not want to happen. The Minister must be clear about what protections will exist when the new regulations take effect.
In conclusion, I am glad that we have had this debate this afternoon and that we have shared our aspirations for the best employment chances and rights at work for those who suffer mental illness. As we all know, warm words will not be enough. There must be a rigorous focus on access, support and measurable outcomes. One in four of us will suffer mental illness at some point in our lifetime. We cannot afford the waste of potential when, so often, worklessness is the result.
I thank the Backbench Business Committee for approving this debate and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Broxbourne (Mr Walker) and the hon. Member for North Durham (Mr Jones)—but like my hon. Friend the Member for Broxbourne I will call him my hon. Friend for the purpose of this debate—for securing it.
I am afraid, Madam Deputy Speaker, that I will try your patience by congratulating my hon. Friend the Member for Broxbourne on his OBE, which he collected this morning. I can see from your furrowed brow that you were not aware of that, but you are now. He has been congratulated rather a lot today, but I felt that it would have been remiss of me not to do so from the Dispatch Box.
I am grateful, Madam Deputy Speaker, that you were also able to join in the congratulations to my hon. Friend and embarrass him still further.
It has been a very good debate. It is an important matter for our constituents because mental health conditions are very common, with one in six people being affected at some time in their life. That statistic has been mentioned a few times, including by my hon. Friend the Member for Windsor (Adam Afriyie) who put on record his contribution on the subject early in his parliamentary career. All Members made the clear link between mental health—whether good or bad—and someone’s employment position. Many Members also highlighted the fact that labour market outcomes are poorer for people with mental health conditions than for the population as a whole and those with health conditions in general. As my right hon. Friend the Member for Sutton and Cheam and others said, the vast majority of people with mental health conditions want to work.
I listened carefully to the statistics that my right hon. Friend quoted about people with severe mental health problems. In the spirit of trying to cheer him up a little, noting that he referred to some positive data from the Time to Change campaign about the changing views of employers on mental health, let me reassure him that although I am not in any way complacent, as the gap between those with a mental health problem working and those generally working is significant and far too wide, there was at least some improvement between the last quarter of 2013 and the last quarter of 2014, when the employment rate for those with a variety of common mental illnesses went up by 2.6%, with a further 70,000 people in employment. That is obviously positive and a step in the right direction. I will not overclaim for it, as it is just a step, but perhaps it shows that the good work of the organisations involved with the Time to Change campaign means that employers are open both to keeping people who develop a mental health problem in work and to employing people with mental health problems. We might be seeing the start of improvement in those employment figures, but I do not want to claim more than that.
We are doing a lot, but clearly there is also more to do. I want to pick up on a couple of points mentioned by the shadow Minister, the hon. Member for Stretford and Urmston (Kate Green). I absolutely agree with her comment early on in her remarks referring to employers who say that they would not employ someone with a mental health problem. She was absolutely right that if they employ a reasonable number of employees they almost certainly do, although they might not know that they do. Perhaps the employee does not know that they have a mental health problem either.
The statistics suggest that anyone who employs more than six people is likely to have at least one member of staff with a mental health problem. Perhaps they ought to look around their workplace, think about the people they employ who have a mental health problem and think about how well they support that person, not out of any sense of altruism, although it is of course the right thing to do, but, as the hon. Member for North Durham said, because it is the right thing to do for the business. The person will be more productive, will stay working for that business for longer and will be beneficial. That was a point well made.
Looking at the cast of characters in the Chamber, I recall clearly that three years ago my hon. Friend the Member for Broxbourne, the hon. Member for North Durham and my right hon. Friend the Member for Sutton and Cheam, who was then the Health Minister, participated in a debate in which my hon. Friend and the hon. Gentleman spoke about their own personal experiences. They were both nervous during the debate about how their comments would be taken outside this place. I followed it quite closely, and it was heartening to see that their remarks were taken positively, not just by the organisations that one would expect—those that are familiar with these issues—but more widely and, interestingly, among members of the public. They kicked off an interesting process and since then a number of other right hon. and hon. Members have talked about their own experiences both inside and outside the House. It is right that more Members are encouraged to do that.
The hon. Member for North Durham put it very well when he said that the more we talk about these issues, the more we are open about them, the more the House debates about them and the more we talk about mental health issues in the same matter- of-fact way—I mean that in the most positive sense—as we do about physical health issues, without making a huge drama about them, the more employees and employers will be encouraged to have those sensible conversations in the workplace.
Members spoke about a number of support mechanisms. My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) mentioned the improving access to psychological therapies programme and the shadow Minister referred to the various talking therapies that are available. Those programmes have a proven record of delivering and were started by the Labour party when it was in government. They have been continued by us and expanded. By next month, they will have been expanded so that 15% of people who could benefit will have access, covering about 900,000 people a year. Next year, we will introduce for the first time access standards and waiting time standards in mental health services, and an £80 million investment will ensure that 75% of people will receive the IAPT treatment within six weeks, and more than 50% of people who are experiencing their first episode of psychosis will receive a treatment within two weeks. There is more to do, but I think that that is significant progress.
The hon. Member for North Durham talked about the work capability assessment and the performance of Atos in delivering that. With just a teeny bit of partisanship, I will remind him that it was his party’s Government who introduced the work capability assessment and appointed Atos as the contractor. We inherited that arrangement and spent quite a long time putting it right. I detected in what he said that he is not the biggest fan of Atos, so he will be pleased to know that it is exiting the contract to deliver that service in Great Britain. In fact, Maximus takes over next week, and ahead of that, in the next few days, Members will receive a communication from that company. The hon. Gentleman will be pleased to learn that one of the areas that Maximus takes very seriously and has itself highlighted, and where it is keen to improve WCA performance, is mental health. I hope that he will engage with Maximus, using his local expertise and his personal experience, to help to improve that performance.
I am glad to see the back of Atos, but the fact is that for the past God knows how many years, the key issue raised has been the people doing the assessments. I have no problem with people with mental illness going through an assessment, but people with no mental health experience whatsoever have been responsible for concluding whether those individuals are fit for work. I just hope that the new provider employs people with mental health backgrounds to do those assessments, because that would be a huge step forward. It would be better for the Government and, more important, better for the individuals affected.
The hon. Gentleman makes a perfectly good point. One of the things that Maximus plans to do is to increase the number of people it employs who are mental health specialists. I think it was the hon. Member for Huddersfield (Mr Sheerman), who is no longer in his place, who said that the people who undertake work capability assessments are not qualified, but that of course is not correct: they are all properly accredited health care professionals, although it is true that not all are mental health care professionals. Among other things, Maximus proposes to increase the number of mental health specialists it has, as well as the number of health care professionals with knowledge of specific health conditions, including but not only mental health conditions; and to ensure that it has across its organisation mental function champions to discuss mental health cases with other health care professionals, to bring that expertise to bear.
That is a welcome move, but may I make a little suggestion? If Maximus is going to employ people with mental health backgrounds to conduct assessments, will the Minister ensure that anyone going for an assessment who has a clear mental health condition—it is why they are on employment and support allowance, for example—is assessed only by someone who has that expertise? That will save a lot of time and money for Government and will help the individual.
It may not be that clear. Often, people going for an assessment do not have just a single health condition. It is important to remember that the assessment is not a medical diagnosis; it is about the impact of somebody’s health condition or disability on their ability to work. The assessor is not carrying out a diagnosis of a mental health problem; the assessment is about the impact of the condition on an individual’s ability to work.
The hon. Gentleman should look at the communication he gets from Maximus. I am sure that the company will be delighted—I mean that genuinely—to hear from him about his constituents’ experience, because it is genuinely committed to improving the performance of the work capability assessment. Of course, Maximus has experience in delivering health care assessments through other contracts around the world. The signs are positive for how the company will engage with the contract.
My hon. Friend makes an important point about individuals not having a single health condition, whether that is mental or physical. One of the challenges is the assessment of someone who has a fluctuating mental health condition, which might require a special form of assessment.
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.
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.
We understand that that is the situation. In my contribution I referred to the Prince’s Trust and some of its good work with vulnerable young people, which the shadow Minister also referred to. Is there any intention to roll out such work on the UK mainland to give vulnerable young people the help that they need at the coalface of their lives?
I do not have a specific answer that I can give the hon. Gentleman immediately, but I will take that point away and look at it further. I listened carefully when he was setting it out for the House and there were some positive aspects to that approach.
About a third of NHS mental health trusts in England are using individual placement and support. The Department of Health is grant funding the Centre for Mental Health to extend IPS further, and my Department and the Department of Health are working with the Centre for Mental Health to try IPS with schizophrenia. From his expression, my right hon. Friend the Member for Sutton and Cheam appears to be familiar with that programme. One of the aims is to encourage at a local level my Department and Jobcentre Plus to work closely with the health service, and there are examples of such close working.
The fit for work service was referred to by several Members, including my hon. Friend the Member for Broxbourne, who said that the longer people were out of work, the less chance there was of return. The fit for work service, to which the shadow Minister also referred, which is obviously at a relatively early stage, is about helping employers and employees manage the sickness absence programme.
I was tempted to advertise another service that we offer earlier, but I resisted. When my right hon. Friend the Member for Sutton and Cheam opened his speech with the story of Anne-Marie, I thought that it was a good example of where she and her employer would have benefited from the mental health support service, which is part of Access to Work, which is clearly not as well known as it ought to be. As he said, it has a job retention rate of around 92%. It assesses an individual’s need to identify strategies that they can use to cope with their mental health problem, looks at a personalised support plan, either for returning to or remaining in work, and gives employers advice. That is important, particularly for small employers that do not have the capacity to have occupational health support in place.
As it happens, tomorrow I will be speaking at a disability confident mental health focus event, which is being supported by Mind, Remploy and the Business Disability Forum, and hosted by Royal Mail, specifically to raise awareness about the mental health support service. A significant number of employers are coming, and I have named several employers, including Royal Mail, who are committed to this.
Leadership has been referred to, and I attended an event with a KPMG senior partner—I hope it is in order to mention the company given that I used to work for it, although it was a long time ago—who has been open about his own mental health problem. It was heartening that he referred to the fact that the senior management of that organisation had created an environment in the business where, as a senior member of the management team, he felt comfortable with being open about his mental health problem. I know from talking to other members of staff that the fact that he has been able to do that and has been well supported by that employer has had a powerful effect on encouraging others in that environment to be open about their mental health problems. So there are other employers who recognise that. The right hon. Member for Hazel Grove (Sir Andrew Stunell) is not in his place, but he referred to a Disability Confident event that he has run. My right hon. Friend the Member for Sutton and Cheam is also interested in this area, and I hosted a Disability Confident event in my own constituency a couple of weeks ago. I have written to all right hon. and hon. Members to encourage them to do the same in their constituencies, partly to engage with those small and medium-sized employers that might otherwise be unfamiliar with the campaign.
My right hon. Friend the Member for Sutton and Cheam wrote an article for PoliticsHome today entitled, “I don’t like Mondays—how work can affect mental health”. My only criticism of the piece is that he urged UK plc to take action. I know what he meant, but it is worth remembering that we are also talking about UK Ltd, because half the work force is employed by small and medium-sized enterprises, and they do not always have the human resources support or access to services that larger businesses have.
My hon. Friend the Member for Broxbourne referred to BT. The head of occupational health and well-being there, Dr Paul Litchfield, has produced two independent reports for the Government. I waited until he had concluded that work, and therefore had only one hat on, before visiting BT, where I had a very positive experience. The hon. Member for North Durham spoke very positively about its programme. He is right that BT puts a lot of effort into supporting employees with mental health problems, and not only because it is the right thing to do, but because it is absolutely in its business interest. It has a very high staff retention rate. It keeps almost everybody who develops a mental health problem at work, and the vast majority in their existing roles, although sometimes they have to change role. I heard four individuals give powerful testimonials about the support they had received from the company. I thought that it was incredibly positive that they felt so open in discussing some quite difficult issues they had had in front of their management chain. They clearly work in a very positive environment.
I will mention universal credit before drawing my remarks to a conclusion, because the hon. Member for Stretford and Urmston would think it remiss of me not to do so. I do not pretend that universal credit solves every problem on the planet, but I think that there are two areas where it is very positive for mental health. The first is the way that it has been set up, because it is about getting work coaches to engage with people earlier, looking at what support they need. If someone falls out of work and approaches the jobcentre—I think this is the thrust of the point made by the hon. Member for North Durham—we want the support to be delivered earlier in the process, rather than later. Universal credit has been set up in such a way that it is about having that conversation, looking at what someone can do and delivering support earlier, which I think will help. It is not the only solution, but I think that it will make things better.
I agree with the Minister, but will he also address the point I made about companies being paid by the Government to support individuals into work, even though that work is actually being done by the voluntary and community sector? If those companies are claiming to have helped those people and are getting paid for it, even though the work was actually done by the voluntary and community sector, that is a very serious issue.
The hon. Gentleman anticipates my remarks, because I had not yet got to that point. There are two points that arise from what he said, and he was supported in that by the shadow Minister. The first relates to the ability of smaller private sector companies and the voluntary sector to be subcontractors to prime providers, and we will consider how to make that easier as we look to develop what follows the Work programme. The second point—the central one—is about ensuring that Work programme providers are paid only when they have done the work. He raised a specific concern about a third sector organisation in his constituency. If he can give me a little more detail, I will look into it. If a Work programme provider has done nothing at all, it should not pretend that it has done so in order to claim a payment. Either it should not be paid, or it should effectively be subcontracting with the smaller provider. If the smaller provider is very successful, clearly we would want it in the programme, working with the prime provider. If he gives me some more details, I will absolutely task officials with looking into it. It is not very sensible for the taxpayer to be paying someone for work they have not done. Moreover, we should be making sure that the money goes to support those who are successful at getting people back into work so that they can improve their organisations and become more successful and sustainable.
Will the Minister also comment on, or ask his officials to look into, the report I received from the individual placements and support service in south Manchester that Work programme providers were being rewarded for work that was being carried out and funded by the NHS? It sounded as though the public purse was paying twice and the Work programme provider was getting a reward for very little, if any, activity.
Yes. I listened carefully to what the hon. Lady said, and I will look into that specific example as well.
My right hon. Friend the Member for Sutton and Cheam referred to the Work programme. It is true that in its earlier phase the success rates for those on ESA as opposed to JSA were not very impressive—one in 24, I think. However, more recent cohorts have been more successful, and about one in 10 people have been getting into sustainable work. Obviously we want that performance to continue.
It is very apposite, Mr Speaker, that you are in the Chair as I draw my remarks to a close, because I know—I do not think it is a secret—that you take a close personal interest in this area. I remember when you allowed a discussion on mental health to run for a fairly reasonable length of time in the last session of DWP questions. You feel that it is a very important area. You referred to the changes we had made in law to reduce the stigma for the many Members of Parliament who might have a mental health problem. Earlier I referred to the hon. Member for North Durham and my hon. Friend the Member for Broxbourne, who spoke very openly in the House about their experiences.
The Government take this issue very seriously. There is a lot of working across Departments, not just with my Department and the Department of Health, but with the Home Office, where, as Members will be aware, the Home Secretary has been pressing a great deal to make sure that police cells are not seen as places of safety for those who develop a critical mental health problem. Work is being done by other Ministers across Government. We are moving in the right direction, but we are not complacent. Although some progress is being seen in the unemployment figures, there is still a considerable gap, and there is more work to do. I think there is a shared sense of purpose across the House about the direction of travel, and I want us to continue to move in that direction through to the general election and beyond.
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.
That this House has considered mental health and unemployment.