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Mental Illness: Job Security and Inequality

Volume 798: debated on Thursday 4 July 2019

Question for Short Debate

Asked by

To ask Her Majesty's Government what assessment they have made of the role of job security and reducing inequality in tackling the prevalence of mental illness.

My Lords, it is good that we have a report from the UN rapporteur Mr Dainius Puras. I shall refer to it very briefly because it is part of the reason why I asked for this debate. Many of us are working on mental health, but Mr Puras alerts us to looking at it not simply as a thing in itself but as an expression of all sorts of other things. If you want to sort out somebody’s mental health, you need to do things other than look at it simply as a medical condition.

Apparently 16%, or one in six, of people in the UK—I do not know whether this goes for other countries—will suffer some form of mental well-being issue or have mental health problems, acute anxiety or an inability to function in life at some time in their life. That is an incredible figure. We know that with the austerity cuts that have been hitting us since 2010 there is more evidence of people suffering from mental well-being problems. We need to address that, so all of us who are involved in the fight against poverty—it is related to poverty—are asking the Government about it. If one in six people is going to hit the mental health or mental well-being barrier, as a society we will have to up our interest, support and need to dismantle all the things that bring about lack of mental well-being.

I shall briefly talk about myself. Wherever I read about mental well-being and all the slings and arrows of outrageous fortune thrown at the poor, I am astonished that I have managed to survive all the slings and arrows thrown at me and all the slings and arrows that I threw in response. I shall mention a lovely quote:

“You are who you are because of other people”.

That is from the work of Julie Hannah, I think quoting Mr Dainius Puras, but I am not so sure about that. You are who you are because of who you know. It is a brilliant quotation. I was very fortunate that every now and then I met somebody who behaved in an adult way towards me, such as my probation officer. I am so glad to hear that we are bringing probation back inside and not leaving it to the ne’er-do-wells who do not seem to be able to handle probation in the commercial sector. Probation was the service that stopped me behaving strangely in a way that would harm my mental well-being. I survived because of the people I met, such as my ex-wife. I would like to praise my ex-wife, who took me in, looked after me and helped my mental well-being. The problem is that most people are not lucky enough to be a ducker and a diver and a bobber and weaver and a cheeky chappie like John Bird. I am very fortunate, but there are a lot of people out there who do not have the succour, support and opportunities that came to me. It was lucky, but it was mainly the fact that there were people who looked at me in a particular way and helped me into work, education and sociability.

One of the good things that the rapporteur, Mr Dainius Puras, has said is that you cannot always look at mental health with a medical response. You cannot think that it is a National Health Service problem. It is not simply a National Health Service problem; it is a problem for all of us because it is a tangential series of things that need to come together. We need to ensure that people can get out of poverty because poverty is the big killer when it comes to holding people back in society. We know that there is a direct relationship between mental health and well-being and what you are doing in life. We know that the poorer the food and standard of living, the more enormous threats there are to your mental well-being. I do not think the Government need that proved once again. All we need to know is that the Government are going to up the tangential belief, not simply the medical belief—the pharmaceutical road that you take to sort out people’s mental well-being. If you have a good job, it increases the chance of you having a stable mental health existence. If you have a good job, you can pay your own way and take your family on holiday, to a museum or to the seaside and have a general sense of purpose in your life. If you are living on the edge, you are like somebody with permanent toothache. You are stuck there and it will affect your mental well-being, which will go out of the door.

Over the past six months, we have been working on a very interesting project in Northampton. We chose Northampton before the council went belly up; there was no relationship between the two; that was to do with somebody else. We chose Northampton because we wanted to do something very simple. We accepted the idea that if you want to address the questions of mental well-being, you need a supportive, stitched-together, functioning community, not a series of holes where people wander from hither to thither without any sense of purpose. We did something very simple. We got people in Northampton to start to trade together. We got the housing association working with the estate agent and the hospital working with the local bread company. We pulled them together. We were trying to lay down the first stages of re-engaging with a healthy community so that it could then move on and have the mental well-being, the jobs and all the other things that you need when you have a community.

Northampton is very interesting because we have managed to create what we call a social echo. A conference is coming up there. It is wonderful. It is an inspiration on our part, but it has been taken up by local people. A social echo is how you create businesses working in the community—for instance, providing work for long-term unemployed people who were suffering enormous mental health problems. How do you manage to get them back into work? The way you do it is by looking around the community and asking whether the housing association’s services can be sold to other players in the community so a job comes out of it.

I am an incredibly practical person. I have never done anything complex. I always describe my work as very dumb. When it came to working with homeless people, I did not address their mental well-being or the fact that they had been troubled and harmed in their early lives; I addressed the fact that they were getting themselves into trouble and into crime. I created a crime prevention programme so that people would stop committing crimes because I thought it was important to remove crime from their lives, and then you could address the mental well-being issues and all the other issues. You could start pulling them together in other ways.

I have now got to sit down.

I thank the noble Lord, Lord Bird, for introducing this debate and for the opportunity to take part in it. This is, in many cases, a tricky subject because mental ill-health is unfortunately still poorly understood by some. Nevertheless, I welcome the emerging change of attitude towards it and the Government’s commitment to provide extra funding of £2 billion in real terms.

Attitudes in society are slowly improving but have to be set against the huge impact that mental ill-health has on the people who suffer from it. It frequently leads to a downward spiral of unemployment, poverty and family breakdown, as well as deteriorating health and well-being. It is silently endured. People feel marginalised and in some cases, I am afraid, excluded from society.

As we know, poor mental health is a leading cause of worklessness and sickness absence, but I want to pay particular attention to those in the criminal justice system, to which the noble Lord, Lord Bird, alluded earlier. People in prison typically have poorer health and suffer from mental impairment. The attempt to cope is particularly prevalent among men, who keep their emotions under wraps. They try to balance social issues such as poverty and indebtedness. Often, they are unemployed or have been made redundant, or they have never been employed. Many are poorly educated and homeless or their homes have been repossessed, and many come from deprived backgrounds. What challenges to cope with.

Prisoners with mental health issues who slip through the net and whose needs are not adequately addressed might be more likely to reoffend. We know that two-thirds of the country is now covered by criminal justice liaison and diversion services, whereas three years ago only one-quarter was covered. The probation service plays a crucial part in delivering those services, with much more emphasis on face-to-face interviews, getting to know a person well and not laying bare another statistic. We need to ensure that all other organisations are part of that delivery mechanism, particularly local authorities, which have renewed responsibilities for public health.

When looking for a new beginning with a new job or perhaps a return to work, some people unfortunately encounter workplaces that refuse to make any allowances. Instances of that happening will reduce with new initiatives to support the workplace. Research has shown that employers who embrace a duty of care and invest in health initiatives to support the health and well-being of their employees have the potential to see a significant return on their investment. Mental health support in the workplace can save UK businesses up to £8 billion per year. It has also been shown that getting people into work can help reduce a huge economic burden for them and their families.

Therefore, we must give a big push and mark the first opportunity that people have on leaving prison to hold an ambition, possibly for the first time. We must make it really pay for them, and make it happen not only for them but for their families. They simply cannot do it alone. They need all-out support for their mental well-being. Getting that precious job can and should be a real step change, and it is about providing support and helping them to keep that job.

In conclusion, we have to broaden the debate. I look forward to a development pathway to improve mental health provision across all criminal justice settings, with support programmes such as Access to Work, backed up by the full integration of all agencies, so that we have a transparent and effective monitoring procedure and a review of its effectiveness.

My Lords, I too thank the noble Lord, Lord Bird, for bringing forward this debate, for his distinctive introduction of a kind that we always enjoy when he speaks in the House, and for his tireless work in trying to support people who, for all sorts of reasons, find themselves disadvantaged. I pay tribute to him.

Inequality, unemployment and mental ill health are three interconnected, intersecting areas which are important to address if we are to have a flourishing and thriving society in which all can participate. As we know, mental ill health is one of the two main disabilities affecting participation in work. I am glad that the Government have decided that the NHS long-term plan will assist people with mental health issues into work. That plan recognises that mental health problems disproportionately impact on people living in poverty and those who face various forms of discrimination. This is a huge step forward in the visibility and awareness of this issue, and I hope that it really will help us move ahead.

In my own area of work, I note that last year poor mental health was identified by clergy in this country as the number one social issue that they had to grapple and deal with. That is what we are picking up as happening on the ground. It is in all our interests that we look at this issue to make sure that all people have access to safe, stable and well-paid work, which is why I commend the TUC’s Dying to Work campaign. As many noble Lords will know, it addresses the particularly difficult situation of those who have been diagnosed with a terminal illness but who either want to work, because it is an important way of them coping with some pretty devastating news, or simply have to work for financial reasons, as they are still trying to support a family.

When people face the emotional stress, fear and uncertainty of being diagnosed with a terminal illness, they often face a lot of difficulties at work, especially if they have a long-term or progressive disease. This can be an horrific situation if unsympathetic or obstructive employers simply do not understand what is happening when people are at a particularly vulnerable point. That is why the TUC’s voluntary charter is to be applauded. Indeed, it is shocking to think of people being dismissed or forced out of jobs that they love at a time of such acute personal difficulty.

I am pleased to be part of a Church that has always taught the innate value of human life and its unique dignity for all people. That is why it is even more important that, when people face a terminal illness, they should be given the support and respect that they need. This initiative is part of the progress that we are making.

The intersection between inequality in employment and mental health manifests itself in other areas. As the Mental Health at Work 2018 report made clear, we know that those who are poorly paid or in insecure work, as well as black and minority-ethnic people, face worse than average mental health problems. The Church has worked with BAME people to put together a mental health toolkit that recognises the issues this community faces—for example, overdiagnosis of schizophrenia, overprescription of drugs and under-engagement by healthcare professionals, all of which have huge impacts that we need to address. The toolkit is designed to reduce stigma, disseminate crucial information and continue to confront racism wherever it is found.

At a time when we know that young people from BAME backgrounds are almost twice as likely to be unemployed as their white counterparts, it is vital that we explore the reasons behind that. There is a need to support those with mental health issues, which are sometimes wrongly used by bosses as a barrier to employing these people. This lack of access to mental health support cannot continue. Indeed, at a time of high unemployment, when we need more people for the sake of the economy, it is in everybody’s interests that it does not continue.

In the 2014 NHS Five Year Forward View, published by NHS England, a commitment was made to work towards a more equal response across mental and physical health, achieving parity of esteem by 2020. That was five years ago and time has moved on very rapidly. Although there are of course issues around some communities accessing physical healthcare, they appear to be less acute than in the mental health equivalents. Can the Minister clarify the progress towards this aim, set out back in 2014, and what steps are being taken to mitigate the impact of accessing this care?

Of course, this is much bigger than just the responsibility of government; we cannot take just a top-down, centrist approach to tackling the problem. One of the privileges of my job as I travel around Bedfordshire and Hertfordshire visiting charities is to see so many groups trying to work in innovative ways. I think particularly of some of the charities getting people into gardening and working on allotments. My right reverend colleague the Bishop of Carlisle, who is sitting next to me, appeared last month in various national newspapers launching an initiative at Lambeth Palace to help communities think about using gardening, gardens, allotments and suchlike to help people with mental health problems.

We need to get a much wider commitment to addressing this problem. Yet again, there is an economic disparity between those with and without access to green spaces. We in the Churches are trying to encourage people—and, indeed, our churches and churchyards—to work with mental health charities to create spaces where people can get experience and make a contribution to society.

There is so much more to be said, but we have limited time. I hope that we can learn that we need to address this multifaceted, complex issue and work together to help those with mental health problems.

My Lords, I am grateful to my noble friend Lord Bird for calling this debate. I remind the House of my interests as listed in the register.

In 2016, the Five Year Forward View for Mental Health, which has already been mentioned, stressed that mental health problems disproportionately affect people living in poverty, people who are unemployed and those who already face discrimination. In 2018, the report on mental health at work by the Prince’s Responsible Business Network highlighted the links between financial insecurity, poor mental health and poor work performance.

My concerns are for those who struggle the most with all these issues: people with learning disabilities, of whom less than 6% are in paid employment compared with nearly three-quarters of non-disabled people. These are some of society’s poorest and least empowered people, people who are often left without a voice and without hope.

I trust that the Minister’s response will recognise that the concerns highlighted by my noble friend are most severely experienced by persons with learning disabilities. I have spoken before about some of the barriers to employment that they face, such as the low aspirations of many employers, teachers and parents and a scarcity of role models—people like themselves in work—all of which lead to low aspirations among people with learning disabilities themselves. They also face other challenges, such as in managing time, money and travel.

I declare an interest as the editor and co-author of several wordless books about work, funded by the DWP as part of its drive to reduce the disability employment gap. The books were published by the charity Books Beyond Words, which I founded and chair. With simple tools such as these and the provision of training to Jobcentre Plus staff and employers in how to use them, an otherwise marginalised group can be empowered to overcome the barriers that I have described. We can help people to embark on a journey to inclusion and prosperity, and help employers to become more confident in employing people with different abilities and understanding the cultural value of their inclusion in the workplace.

Let us consider for a moment some of the unequal aspects of life faced by people with learning disabilities and the consequent effects on their mental wealth and mental health—for example, the dangers of loneliness that for any of us accompany exclusion from ordinary life chances, including work or other meaningful occupations.

Last year, I co-launched the BELONG manifesto, which includes six ways in which people can feel good about themselves: for example, having a reason to get out of bed in the morning. They are the same determinants of good mental health as were spelled out in the report of the special rapporteur in the 41st session of the Human Rights Council last month. The manifesto says —let us think about this in the context of people with learning disabilities—that we would all belong when,

“the institutionalisation of people … has ended … there is enough money to spend on food and essentials … there are opportunities to make some choices in life … there is an end to being bullied … and everyone can access healthcare, education and employment”.

The ability to earn money as opposed to being on benefits can give a sense of independence and self-esteem that can lead to a sense of purpose in one’s life; a secure job can provide routine and structure. However, the attributes that persons with learning disabilities can bring to a job are too often underrecognised. We know that job insecurity contributes to anxiety, depression, low self-esteem and social isolation. These are health issues that persons with learning disabilities and autism experience to a higher degree than the non-learning-disabled population.

The Government’s statistics already indicate that just under a million more disabled persons have entered the workforce in the last five years. In a recent adjournment debate in the other place on the topic of unemployment in people with autism, the Minister for Disabled People confirmed that the Government are working with the Office for National Statistics to factor people with autism into the Labour Force Survey. I hope that the Minister will take this up so that it might be applied to people with learning disabilities too. Simple considerations by employers such as recognising the difficulty people may have in completing online applications or performing at interviews designed for those without disabilities should be readily addressed.

There are examples of good progress in encouraging and supporting people into work, such as the Government’s Access to Work scheme. Such schemes are welcome because they can address the need to provide for individual, often complex, needs and provide coaching and work experience opportunities. The Autism Alliance has developed a disability toolkit providing information on autism and other impairments for jobcentres.

There are also exemplary employers who successfully tap into this ready and waiting pool of workers. Dimensions, a nationwide support service for people with learning disabilities, has employed people with learning disabilities in campaign adviser and quality auditor roles. My Life My Choice based in Oxfordshire employs people with learning disabilities as experts by experience to review care provision for suitability for persons with similar needs to their own.

One may say that these are specialist employers, but that need not be the case. In the United States, Walmart has pioneered the employment of disabled people, including those with learning disabilities, in its stores and distribution centres. There could be a greater drive to encourage similar, employer-led, larger-scale schemes here too.

Can the Minister describe what proportion of intended spending to realise the vision of Improving Lives is earmarked for people with learning disabilities and autism? Will Her Majesty’s Government commit to specifically include learning disability within their poverty and labour force data collection, so as to measure success in supporting this group of people to access work and escape poverty?

Relatively small, short-term costs in the form of adequate training, mentoring schemes and other bespoke support provision can reap great, long-term rewards for the people I have talked about, their communities and our economy. I suggest that the Government need to do more to address this pressing need.

People may have particular needs which must be met if they are to be present and play a part in the workforce. A very moving moment for me was when I heard about an employer working with a Mencap scheme who thought he was doing a favour by offering a work placement to a man with a learning disability but discovered that the presence of this man in the office led to a change of culture and people generally being nicer to each other because of his inclusion. This led to the organisation determining that it would always include someone with a learning disability in the office environment. Sometimes, the focus on productivity and efficiency can mean that we forget some of the softer skills that people can bring to the team environment in the workplace.

My Lords, this has been a varied debate with interesting contributions: the noble Baroness, Lady Redfern, talked about the criminal justice system and how all this fits in; the right reverend Prelate the Bishop of St Albans talked about discrimination and how wearing that can be, as well as the importance of work at the end of life and the TUC voluntary charter; and the noble Baroness, Lady Hollins, spoke of how less than 6% of people with a learning disability are in employment.

I should declare my interests as set out in the register. The organisation I chair also works towards placing those it cares for in appropriate work settings.

At the end of last year, I attended a round table on health and ageing at the European Parliament. We looked at the human rights of the older person. It gave me an interesting insight into policy-making in the context of our human rights. I decided to pursue this line for this debate, so I hope noble Lords will excuse me if this sounds a little unusual.

Last week, mental health was discussed at the 41st session of the UN Human Rights Council. The noble Lord, Lord Bird, referred to this in his opening speech, and I thank him very much for instigating this debate. At the UN, the special rapporteur argued that good mental health and well-being cannot be defined by the absence of a mental health condition but must be defined instead by the social, psychosocial, political, economic and physical environment that enables individuals and populations to live a life of dignity, with full enjoyment of their rights in the pursuit of their potential.

One of our human rights is that of health, which of course includes good mental health, along with others such as participation in democracy, provision of adequate and suitable housing and education, a family life, access to justice, participation in society and workers’ rights. In many parts of the world, these are observed in the breach, but here in the UK—a wealthy nation and one of the founder signatories of the Universal Charter of Human Rights—there is no excuse if they are not observed.

There are protective factors such as social inclusion, community resilience, LGBT rights and rights for workers, as well as, interestingly, access to good housing and green spaces. On the other side of the coin are risk factors, including social exclusion, violence against the person, bullying, discrimination and poor working conditions. It is clear to see that these two kinds of factors are the determinants of good and bad mental health. They are easy to recognise and we can readily identify components of each, yet we struggle to amplify those protective factors and reduce the risk factors. All this fits neatly with the title and thrust of this debate.

This rights-based approach gives us a framework to work with. States have an obligation to respect, protect and fulfil all our rights, including our right to good mental health. National Governments may directly contravene the obligation by cutting benefit levels, failing to make suitable housing available and restricting education opportunities. In areas of low employment, we should not be surprised to find a greater than average incidence of poor mental health.

In England, health and well-being boards convened by local authorities are well placed to look at this issue in their local areas. Consisting of representatives from local government, health, police, the local LEP and the voluntary sector, they are well placed to identify risk factors for their areas and work together to mitigate them. Similarly, they are able to identify the local protective factors. Local authorities and the LEPs should identify local opportunities and local risks.

In 2017, Public Health England produced a toolkit to understand health and well-being at a local level, acknowledging that stable and rewarding employment is a protective factor for mental health, and unemployment and unstable employment are risk factors. This toolkit helps the health and well-being boards to produce their joint strategic needs assessment, which needs to be done on an annual basis. Of course, any local plan to improve mental health should be determined with the active involvement of service users and carers, and the local voluntary sector.

The noble Lord, Lord Stevenson of Coddenham, and Paul Farmer, the chief executive of Mind, wrote an excellent report called Thriving at Work, a review of mental health and employers, which was welcomed by both the Department of Health and Social Care and the Department for Work and Pensions. Its vision was to embed the following changes within 10 years:

“Employees in all types of employment will have ‘good work’, which contributes positively to their mental health, our society and our economy … Every one of us will have the knowledge, tools and confidence, to understand and look after our own mental health and the mental health of those around us … All organisations, whatever their size, will be … equipped with the awareness and tools to not only address but prevent mental ill-health caused or worsened by work; … equipped to support individuals with a mental health condition to thrive, from recruitment and throughout the organisation; … aware of how to get access to timely help to reduce sickness absence caused by mental ill health”.

And this would,

“dramatically reduce the proportion of people with a long term mental health condition who leave employment each year and ensure that all, who can, benefit from the positive impacts of good work”.

Can the Minister tell the House how far away we are at the moment from having a sustainable welfare and support system operating in tandem with the health system and partners across all authorities in England? Could she tell the House what stage we have reached with the vision of Paul Farmer and the noble Lord, Lord Stevenson? And who is the Minister responsible?

My Lords, I thank the noble Lord, Lord Bird, for using the initiative he described to us at the start to seize the opportunity of securing this debate and giving us the chance to talk about these issues. I thank all noble Lords who have spoken, for some very interesting speeches. I thank the right reverend Prelate the Bishop of St Albans for some really thoughtful reflections on the interaction between mental health and employment, issues around stigma and discrimination, and the role of the Church and communities. There is so much more that one could go into.

I thank the noble Baroness, Lady Hollins, for another piece of articulate advocacy on behalf of those with learning disabilities and autism. I loved that story about an employee and the impact that one person with learning disabilities can make. It reminded me so much of the lessons taught to us by the late and much-lamented Jean Vanier on how much we could all benefit by taking them on. I also thank the noble Baroness, Lady Jolly, for a really interesting approach, talking about risks and interventionist factors and how we could use those on a rights-based agenda, as well as the existing health and LEP programmes we have to tackle these issues.

I am being quite literal. I want to look at the title of the debate and ask: do job security and inequality impact on mental health? What does the evidence say? There are two questions. First, does inequality have an impact? Yes, it does. There is clear evidence, summarised well by the Equality Trust, that a much higher percentage of the population suffers from mental illness in more unequal countries; for example, the evidence from the USA is that rates of depression in US states are associated with income inequality. The evidence and the academic side are clear. While I am here, it is worth noting that poverty is also a significant driver of stress and poor mental health, a point made by the right reverend Prelate. The 2016 report from the Mental Health Foundation and the JRF found that:

“Poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health”.

Secondly, what about job insecurity? Various studies have looked at the impact of the nature of employment on mental health. I read one just this morning. Research by Menéndez-Espina et al, published in February, observed that,

“job insecurity … has direct effects on the different areas of mental health evaluated, in men as well as in women”.

Of course, the report of the UN rapporteur, which we have already heard about, draws attention to the fact that the way work is organised has profound and lasting social and psychological repercussions.

Does the UK have a problem with either inequality or job security? Yes, it does. The Equality Trust shows that, according to the most recent data from 19 OECD member states in the Luxembourg Income Study dataset, the UK is the fifth most unequal country and the fourth most unequal in Europe. Figures from 2016 show that the poorest fifth of society has only 8% of the total income, whereas the top fifth has 40%. The figures for wealth are even worse. We are not talking about poverty, but the figures on poverty show that it is rising and the problem is getting worse for those in and out of work.

What about job insecurity? A recent spate of company closures from retail to steel has put many people out of work and made other people very nervous about what is happening to their jobs. Also, we have 850,000 workers on zero-hours contracts, two-thirds of them stuck on them for more than a year. A TUC-commissioned poll of workers on zero-hours contracts found that more than half had had shifts cancelled with fewer than 24 hours’ notice. Nearly three-quarters had been offered work with fewer than 24 hours’ notice. More than a third have been threatened with not being given shifts in the future if they turn down work. It also found that only 12% get sick pay, only 7% would get redundancy pay and 43% do not get any holiday pay.

This is really stressful and insecure work. If you have no idea how many hours you will get each week, you do not know whether you can pay your rent or feed your kids. If you do not get sick pay or any other pay, you will be afraid to turn down work. You will go to work when you are sick or injured because you do not have any alternative. If you are threatened with not being given work if you turn down shifts, you will go even if you are not up to doing it. That is bad for people’s physical and mental health. Other TUC analysis found that those on zero-hours contracts were twice as likely to be working night shifts or seven-day weeks. They earn less per hour as well. This is not good work.

What is the Minister going to do about it? First off, does she accept this association between job insecurity and inequality on the one hand and mental ill-health on the other? If she does, I have some serious questions to ask. What might she do about it? Will the Government look again at the rights extended to workers on insecure jobs? Why should they not get the full range of rights that other workers do? If she is in the position to, will she look again at whether people should be presumed to be employed, with the burden of proof going on to the employer to show that they are not? Does she recognise that, in fact, most workers’ rights have been won by trade unions over the years? History shows that. The reduction in collective bargaining and unionisation in many sectors has been clearly associated with a reduction in rights. What will the Government do about that? Will she consider revisiting some of the anti-union legislation or making it easier for people to organise to get the rights they deserve?

Also, what will the Government do about addressing the fall in living standards, especially for those in low-paid work? What are they going to do about the inequality that has been revealed by the studies I have mentioned? Will the Government look again at the way they use the tax and benefits system to address inequality? What will they do about those who are in work, or those who want to get into work, but are struggling with mental health? All the evidence we have heard from people is that the nature of the assessment process they have to go through to get help—with PIP, for example, to get help with moving into work or trying to get help because they cannot work—actually makes people’s mental health worse.

I have personally sat down with someone who had an appalling time applying for PIP. She was turned down, but she got it on appeal. She said that the process was so bad for her mental health that she would never again apply for it, no matter how desperate she got. I know that that is a single case, but I have heard over and again that people find the process so stressful that something has to be done about it.

That is an amazing canter through what is there, but I suggest that if we take seriously the association between job insecurity and poor mental health, and between inequality and poor mental health, it is not enough simply to buy a much bigger box of sticking plasters. We need to tackle the root causes.

My Lords, I thank the noble Lord, Lord Bird, for securing this debate. As usual, these Questions for Short Debate are too short as there is so much to say. I believe I have some good responses to all noble Lords, and I will do my best to answer their questions as I go through.

Both employers and the Government have a stake in the nation’s mental health. The Government provide the necessary health support, offer a safety net when they are out of work, and can ensure that employees have the right rights. Employers increasingly recognise that they have a crucial role to play in creating the healthy workplaces for employees to remain in work and thrive, in providing a supportive environment where employees can discuss health issues without stigma, and in helping people to return to work in the right way when they fall ill.

Mental health is a matter of national importance, and we are committed to improving mental health services by investing record levels in them, with annual spending reaching £11.98 billion last year. Targets in improving access to psychological therapies, or IAPT, are being exceeded. In March 2019, 99% of those completing treatment waited less than 18 weeks for their treatment to start in England against a target of 95%. In March 2019, 88.9% of people completing treatment waited less than six weeks against a target of 75%. In February 2019, this figure was 88.6%.

Under the NHS long-term plan there will be a comprehensive expansion of mental health services, with an additional £2.3 billion a year by 2023-24. This will give 380,000 more adults access to psychological therapies and 345,000 more children and young people greater support in the next five years. As the noble Lord, Lord Bird, said, early intervention is vital. We are going further by piloting a four-week waiting time standard for treatment, training a brand new dedicated mental health workforce for schools, and teaching pupils what good mental and physical health looks like. We encourage all NHS staff to undertake suicide prevention training with all NHS organisations to facilitate this.

The Secretary of State for Health and Social Care wrote to social media and internet providers on 26 January to express concern about suicide and self-harm content. He held a follow-up round table with them on 7 February 2019 to discuss the impact of the internet, particularly suicide and self-harm content, on mental health and well-being. Another round table was held on 29 April to discuss progress, and social media companies agreed to join and fund a strategic partnership with the Samaritans. That is close to my heart, as I used to chair the advisory board of the Samaritans. I do not think any noble Lords touched on social media, but it is a crucial part of the whole story behind mental health.

We know that too many people with a mental health condition do not participate as fully in the key activities of society, including work. The figures are stark: almost one in five working-age people in England has a common mental health condition, rising to almost one in two for people on out-of-work benefits. We know that people unemployed for more than 12 weeks are between four and 10 times more likely to suffer from depression and anxiety.

However, it is not good enough for people to be in work. I agree with the noble Baroness, Lady Sherlock: they need to be in good-quality work. The UK is leading the way internationally as we tackle challenges that have arisen as a result of new business models. The Government’s Good Work Plan represents the largest upgrade to employment rights in a generation. As laid out in the plan, we will legislate to improve the clarity of employment status checks to reflect the reality of modern working relationships; bring forward proposals on a single enforcement body for employment rights; introduce a right to request a more predictable and stable contract for all workers; and legislate to ensure workers get the full value of the tips they earn, except for those deductions required by tax law. Extending the right to a written statement to workers and making it a day one right will give people a better understanding of the employment relationship they are entering into and more information up-front about their rights and protections. Introducing a right to request a more predictable contract will help give workers more personal and financial security if they are seeking more predictable hours.

Good work supports our good health. It keeps us healthy, mentally and physically. It enables us to be economically independent and gives us more choices and opportunities to fulfil our other ambitions in life. Our Improving Lives: The Future of Work, Health and Disability Command Paper, published jointly in November 2017 by the Department of Health and Social Care and the Department for Work and Pensions, sets out a comprehensive strategy for achieving the Government’s challenging target of seeing 1 million more disabled people in work by 2027. Given the scale of this ambition, a key part of our programme is to achieve transformational change by focusing action in three key areas: welfare, workplace and health.

Employment rates are at historic highs. When I went to the UN in New York a couple of weeks ago, I was proud to be able to say that employment for people with disabilities has risen by around 950,000 in the past five years. I said that we in the United Kingdom focus on ability, not disability. I agree so much with what the noble Baroness, Lady Hollins, said: those with disabilities have so much to contribute. If an employer is not employing someone with a disability, they had better watch out because they will find that the person they should be employing is employed by someone else. It is the right thing to do.

The Government recognise the crucial role of employers in creating mentally healthy workplaces. Too many people fall out of work because of their mental health, so we are asking employers to do more to prevent this. Last week the Government announced that a consultation on new measures to help employers better support disabled people and those with long-term health conditions in work will also be published next month. These measures will include reforming statutory sick pay, so that it is better enforced, more flexible—to encourage a phased return to work—and covers the lowest paid. As part of this consultation, the Government will consider how to achieve the appropriate balance of incentives and expectations on employers to create healthy, inclusive workplaces, and encourage employers to invest in occupational health support.

The Government remain committed to finding ways to help employers, especially SMEs, support their employees to return to work promptly from sickness absence. By working with our partners, including employers, this Government can continue to tackle poor mental health. This is part of building a country that works for everyone, and reflects what we have done as a result of the Stevenson-Farmer review, referenced by the noble Baroness, Lady Jolly. This was an independent review, set up in January 2017, into how employers can better support all employees, including those with mental health or well-being issues. It also set out a compelling business case for action, with a central recommendation that all employers should adopt a set of six core mental health standards to encourage an open and transparent organisational culture that supports employees’ mental health. These standards included developing mental health awareness among employees, encouraging open conversations—which are so important—about mental health and routinely monitoring employee mental health and well-being. It recommended that all public sector employers and private sector companies with more than 500 employees deliver mental health enhanced standards, including increasing transparency and accountability through internal and external reporting. Momentum is building around the challenge for all employers to adopt the core standards that lay the foundations for good workplace mental health, and for larger businesses to adopt the enhanced standards. Officials are working with a range of partners, including the Chartered Institute of Personnel and Development, large employers and charities, to monitor and review the effectiveness of the voluntary framework.

The Civil Service has embraced the framework. We are working with all government departments to support them in their ambition to publish against the framework in full this year. It will take time before we can truly call all our workplaces healthy and inclusive, but we have been encouraged by the level of engagement with and commitment to this agenda. In response to the question from the noble Baroness, Lady Jolly, the Minister responsible for this review and its outcomes is my honourable friend Justin Tomlinson, the Disability Minister.

We also have to think about those who are out of work. The Government are committed, as far as possible, to supporting into work people with mental health conditions who are out of work. All our work coaches across the Jobcentre Plus network now receive training on supporting people with health conditions and disabilities. Additionally, the rollout of the Health and Work Conversation across the UK supports work coaches in continuing to build engagement with claimants who have disabilities and health issues. The Government continue to invest in mental health-related trials and studies; this includes doubling the number of employment advisers, improving access to psychological therapies and launching a £4.2 million challenge fund to build the evidence base of what works to support people with mental health and musculoskeletal conditions.

We are doing more. We have to think about people with debt. In response to a consultation, we are going ahead with a breathing space scheme. Debt causes enormous stress. This policy will make a real difference in supporting people with debt. In addition, the NHS provides services to people experiencing the symptoms of debt problems and financial difficulties.

Reducing inequality is so important as inequality can cause or exacerbate poor mental health. However, the policies of this Government are highly redistributive. This year, low-income households will receive, on average, over £4 in public spending for every pound they pay in tax, while the highest-income households will, on average, contribute over £5 in tax for every £1 they receive in public spending. Income inequality is lower now than it was in 2010.

Much has been done to increase awareness and reduce the stigma of mental health. The DWP is working increasingly closely with the Department of Health and Social Care but, as the noble Lord, Lord Bird, said, it must be joined up and be cross-government. Also, as the right reverend Prelate said, it is not just about government. We have to think beyond government to all those who can offer support, including our religious institutions. How can they support, and what can we use to help those with mental disabilities?

Finally, my noble friend Lady Redfern referred to those leaving prison. I have been in discussion with Secretary Acosta, the US equivalent of the Secretary of State for Work and Pensions, about what we are doing and what they are doing about employing people who have been in prison and what to do with people with disabilities. I heard a story of somebody in prison who was very well off; he had committed a financial crime. While he was in prison, none of the other prisoners ever asked him for money but almost every one asked him for a job. So much of this is about people having something meaningful to do, as well as being in a supportive society that recognises and understands mental health and is, not before time, removing a stigma, to support more people in a way that I hope will encourage the noble Lord, Lord Bird.