Notes from meeting: Tuesday 10th March

MEETING ON MENTAL HEALTH AND WELFARE REFORM

Chair: Lynne Jones MP, All Party Parliamentary Group on Mental Health

Speakers
Bob Grove, Sainsbury Centre for Mental Health
Vicki Nash, Head of Campaigns and Policy, Mind

Bob Grove, SCMH

Bob stated that a significant proportion of people with mental health problems remain out of work. This is often more to do with the reaction to the illness than the illness itself. Stigma and discrimination, and fear of stigma and discrimination are the two biggest barriers to people with mental health problems finding employment. It is important to recognise that mental health is a continuum. There will be people experiencing depression and anxiety who will be recently out of work. At the severe end, there will be people who have been out of work for many years.

There are 1 million people long-tem unemployed, and two thirds of these are disabled by common mental health problems. The Government’s announcement this week that more money will be ploughed into access to psychological therapies is welcome. There has also been some success with Pathways, which has worked very well for people with mental health problems. However, generic disability programmes have show disappointing results for people with mental health problems.

For those with severe and enduring mental illness, there is strong evidence that Individual Placement and Support works in getting people into paid employment. In these cases it is important that there is a genuinely individual approach to the client, that they are placed appropriately and rapidly, and supported intensively into their role.

The real hurdle is moving from unemployment to work. The process can sap people’s confidence. People with mental health problems need appropriate support, and employers need support during the transition stage. We know a lot about what works and what doesn’t:

• No one should be written off. Evidence suggests that people with mental health problems want to work.
• There is no evidence that conditionality works for people with mental health problems. This was reiterated most recently in the Gregg Review.
• It is imperative that we have a trained workforce with expertise t manage this
• Interventions are not without risk, and this must be recognised. Personal Advisers should be adequately trained to assess and manage risk.

In summary, the picture is mixed. This welfare Reform Bill will hopefully offer the opportunity for improvement.

Vicki Nash, Head of Campaigns and Policy at Mind

Mental health problems affect 1 in 4 people, a huge constituency. While Mind are supportive of the overall aim of the reforms – to support people back to work – in a recession it is important to provide a safety net, as well as a ladder back into employment.

The Bill as it stands is inadequate. There is a lack of clarity in many areas. It has largely ignored the findings of Dame Carol Black’s review, and there is a disproportionate focus on compulsion. The emphasis on the role of secondary legislation and regulations makes it particularly hard to engage with.

For example, frequent reference is made to ‘good cause’ throughout the Bill, but no attempt is made to define it. We believe there should be an explicit definition on the face of the Bill.

Further to that, the timeframe for giving ‘good cause’ currently stands at 5 days. For someone experiencing mental distress this is too short a time. Given the penalty is closure of someone’s entire claim, there is a real need for this timeframe to be extended.

The Bill also gives enhanced powers to Employment Advisers, yet there is nothing on the face of the Bill to ensure that these new powers are matched by adequate knowledge and training. It is clear that Advisers’ knowledge of mental health problems needs to be excellent. Currently, many lack the requisite understanding of mental health problems to make appropriate decisions for people. Mind would like to see a nationally accredited mental health training module form a key part of Advisers’ training.

A greater investment needs to be mad in Access to Work. Take up amongst people with mental health problems is extraordinarily low. Yet the Government are currently rejecting any amendment that seeks to address this in the Welfare Reform Bill. The Return on Investment from Access to Work is clear – it is cost effective and removes barriers to work. The current Bill as it stands is all stick and no carrot. People want to work, but they need to be appropriately supported and understood. We need to remember that it is not work that is good for people per se, but that good work is good for people.

Questions and comments

Baroness Meacher expressed disappointment that there seemed to be no comprehension from the Government as to why people who want to work aren’t working. People do want to engage, but are terrified of the system and of the employer discrimination that exists.

Croydon Mind representative: Sanctions are frightening for people. Also, a lot of people are simply not aware that sanctions exist – if people are ill they are not opening the mail for example, and are unaware of procedure. These people are living on ridiculously low levels of income.

Laura Penny, service user and carer: People are scared of going back to work, especially as there is little provision for people to ask for flexible or part-time working. There seems to be no support for people to do this.

Bob Grove responded to these comments by acknowledging that when people want to go to work they don’t necessarily want to work full-time. This is reasonable and logical, yet there is no provision for that in the system. It shouldn’t be beyond the Government to provide this.

Baroness Murphy raised the issue of what goes on locally in benefits offices. Training and understanding of staff is so crucial, and yet we hear of such diverse experiences from claimants. We need to address how this is implemented.

Lord Carlile of Berriew drew on his own experience establishing a charity in Wales to emphasise how the voluntary sector can make successful interventions in this area. We need more blue-sky thinking. There is a real concern that this Bill as it stands represents another raft of rules for people already intimidated by officialdom.

Neil Balmer, Royal College of Psychiatrists raised the point of forced treatment and action plans for work-related activity including ‘health interventions’. The Government assures us no one will be sanctioned for failing to take medication, but there is nothing on the face of the Bill to prevent this. It also leads to an issue around blurring of consent.

John Hannah, British Psychological Society was struck by earlier comment about stigma and discrimination. Where will the stick fall on employer? We need to be engaging with bodies like the CBI to promote positive inclusive practice.

Robert Westhead, Shift was concerned that conditionality around health-related interventions should be seen as an infringement of civil rights. This would never happen with a physical condition. Reporting ‘good cause’ within 5 days also seems ridiculous, and far too short a time if someone is very ill. It is important to remember that people with mental health problems want the same things from life as other citizens – very often people want to work.

Baroness Meacher raised the issue of early intervention in employment. Employers need to intervene when people first go off sick from work. There needs to be a link between employment and increased access to psychological therapies and external referrals. There is scope to reduce long term unemployment here and keep people well.

Lynne Jones MP commented that the Government were not demonstrating good practice in employment themselves. There is good practice out there – BT for example, have banned the use of pre-employment questionnaires which employers can use to discriminate against people with mental health problems.

Further comments were made in the discussion:

• We need to move away from the 2 ticks system. Disability awareness has to be universalised for this to work and there must be an onus on employers. Where are their incentives at the moment?
• There are opportunities in the forthcoming Equality Bill to address mental health as covered by the DDA. At the moment it doesn’t stand up and fluctuating conditions are not taken into account.

Meeting ends.