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Mental Health (Incapacity Benefit)

11 am

Chris Bryant (Rhondda) (Lab): I am delighted that all Members with constituencies in London are staying for this debate because it is of such interest to them.

Incapacity benefit is claimed by roughly one in five people of working age in my constituency, so its reform will probably be one of the most important issues for my constituents over the next few years. That is true of nearly all the former mining constituencies—not only in south Wales, but across the whole country.

One of our biggest problems relates to those who suffer from mental health problems and are on incapacity benefit. According to the figures, 920,400 of the 2,398,700 people who claim it are on incapacity benefit because of mental health problems. In other words, 38 per cent. of people on incapacity benefit across the UK are on it because of mental health problems; that is the largest group by a considerable way. The next largest group is made up of those with musculo-skeletal problems, who represent only 20 per cent. of those on incapacity benefit.

If we are to tackle the ongoing problems with incapacity benefit, we shall have to look closely and analytically at issues of mental health as they affect incapacity benefit. Part of the problem is that only 24 per cent. of those with mental health problems in this country are in work; that is the lowest level of employment among all the disabled groups. If we want to care best for those who suffer from mental health problems, we need to find a way of getting them into work.

The category of mental health problems covers an enormous range of issues, from schizophrenia to anxiety, stress, depression and alcohol and drug dependency. The most recent figures on how much the different mental health categories cost in incapacity benefit are for the year 2003–04. Phobic anxiety disorders cost £282 million, reaction to severe stress £103 million, depression—whether episodic or long-term—£1.036 billion and other mental health problems £613 million.

It is interesting that incapacity benefit claims for stress and depression have grown dramatically during the past eight years, despite the fact that most surveys of mental health in the UK suggest that there has not been a dramatic increase in the number of people suffering from them. That may be because these days we have a greater understanding of stress and depression and the effect that they can have on people, or for a series of different reasons, but some research still has to be done.

We know that during the past 10 years there has been a significant increase in mental health problems in one area: that of alcohol dependence. That increase has put severe stress on some of the alcohol and drug dependency treatment services, although I am glad to say that their capacity has risen significantly during the past 10 years. However, that is just a small part of the equation. If the Government are serious about mental health issues and if they are to get more people into work, they will have to look at this nugget of people dealing with severe stress and depression.

We could just say, "These people have mental health problems and the state should be generous to them. After all, we want to make sure that people have
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adequate finances and are able to care for themselves whatever disability they have. What is the problem?" Well, there is a problem. One in six men who are out of work for six months will develop a serious mental health problem—in fact, probably a major depressive illness. When I say depressive illness, I do not mean somebody feeling down on a Friday afternoon or Monday morning, but a serious depressive illness. We have a duty to try to ensure that as many people as possible get into work because, on the whole, it is the best route towards sound mental health.

We have a vicious circle. So often, when someone goes on to benefits they find their life very circumscribed. They are no longer in a working environment; they no longer have a social life connected to work. Their income is very limited. All of that adds anxiety and stress to their situation. That can perpetuate the cycle of depression and exacerbate mental health problems. It is a well documented fact that quite a lot of people come on to incapacity benefit with other conditions—perhaps musculo-skeletal problems—and, by virtue of being on incapacity benefit for six months, a year or two years, end up developing a mental health problem either as well as, or instead of, the original problem that made them incapable of seeking work. We must turn around that vicious circle.

Another problem is that the system is open to abuse. I do not subscribe to the sneering attitude that some newspapers have adopted towards stress and depression, because they are very real conditions. The system is, however, open to abuse. In most of our constituencies, the surface does not have to be scratched to find examples of people who are swinging the lead and playing the game for all it is worth. Unfortunately, because this area is perhaps less immediately identifiable, it is all too easy for that to happen. Why is that a problem in itself? Not only because fraud is obviously wrong but, more significantly, because it undermines the whole system of incapacity benefit and the generosity that we should rightly afford to those who are genuinely disabled.

We also know that a person who is on incapacity benefit is 35 times more likely to commit suicide than someone who is in a job.

Mr. Elfyn Llwyd (Meirionnydd Nant Conwy) (PC): I congratulate the hon. Gentleman on raising this issue. One of the problems in this field is the fact that the forms available for incapacity benefit rely on physical descriptors of illnesses, rather than what the hon. Gentleman is now addressing.

Chris Bryant : I absolutely agree with the hon. Gentleman. This is an example of where the Government need to look specifically at the cohort of people who are on incapacity benefit—not in any retributive way, or to try to assault the figures, but simply to assist us in helping people achieve what they, mostly, say that they want. In fact, of all those on incapacity benefit, the category of people who are most likely to say that they would like to get into work are those who are on it for mental health reasons. So the more we can do to ease the system—to offer incentives so that people can get into work, and make it possible for them—the better.

I shall now say where I suspect that some of the answers may lie. First and foremost, we still need better and more mental health services. There has been a step
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change in the last eight years, and I would like, briefly at least, to blow not only the Westminster Government's trumpet but that of the Welsh Assembly Government. They have invested a considerable amount of time, effort and money in improving our mental health services. We now have 25 per cent. more consultant psychiatrists, 42 per cent. more clinical psychologists and 13 per cent. more mental health nurses, which is excellent.

We still have a problem of recruitment and retention in mental health services, however. It is a very stressful area of work. Eleven per cent. of clinical psychologist places are still vacant. We have a considerable way to go to ensure that we recruit and retain more people in the service.

Part of the problem is that it is all too easy for the media to create a degree of hysteria surrounding every single incident where someone who has been seen by the mental health services is involved in some kind of violent attack. Somehow or other, the newspapers end up blaming the psychiatrist, the consultant psychiatrist or the hospital, whereas, in many of these cases, the chaotic lifestyle of the individual makes it very difficult to provide adequate and suitable mental health services. We need to retreat from the culture of blame that sometimes surrounds this issue, if we are to make sure that we recruit more.

Mr. Wayne David (Caerphilly) (Lab): A moment ago, my hon. Friend referred to the National Assembly for Wales, which is putting more emphasis on economic development at the tops of the south Wales valleys, the area in which there is the greatest concentration of incapacity benefit claimants. Does he recognise the important link between what happens here at Westminster at an all-British level and the Welsh Assembly in respect of economic development and reducing the number of people on incapacity benefit?

Chris Bryant : Absolutely. My hon. Friend makes a good point. Given that his constituency is a near neighbour to mine, he knows about the issues in my constituency. It is no coincidence that the areas with the highest level of incapacity benefit in the country were formerly mining or shipyard constituencies. That is why it is incumbent on the Government to take a holistic approach in Scotland, England and Wales to bring together the agencies that can make a difference.

In Wales, the NHS spends 12 per cent. of its budget on mental health services, which is a higher percentage than in England. I congratulate the Welsh Assembly on such action because it is all too easy to forget mental health services. Pressure is often on to provide more money for a hospital or acute services, not mental health services, so I applaud what the Welsh Assembly has done. Rhondda has a new drug and alcohol rehabilitation unit in Llwynypia. It has cut the waiting list for drug and alcohol dependency treatment enormously from about 18 months—if people were allowed on the waiting list four years ago—to about three or four months. We still have some way to go to reduce the waiting list for treatment to three or four weeks, which is what I want.
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I applaud the fact that such a service is in place, but we still have significant difficulty in providing other therapies that can make a real difference to people's lives, such as counselling and psychotherapy. They might be available in Chelsea, Westminster or other parts of the country, but not on the doorstep in the south Wales valleys. It is well documented that we still need more support in such matters and one of the difficulties of achieving it is that we already have a population, especially the men, that does not like to talk about such issues. Young people tend to self-medicate with alcohol and drugs, and that causes bigger problems. The danger that stems from such action is that the only game in town is the taking of antidepressants. While such drugs have played a significant role in improving mental health over the past 15 years, I believe that we pop pills too readily and we need to find other ways in which to tackle the problem.

If we are to deal with the problem, changes must also be made to incapacity benefit. Through the pathways to work programme that was piloted in Bridgend and Rhondda, the Government were right to give incentives to everyone on incapacity benefit to gain employment. That is just as true for those with mental health problems because part of the danger in the past has been that attending work is regarded as much riskier financially than being on benefit, because that is guaranteed. That is particularly so because rates increase when people have been recipients of benefit for more than a certain period. The danger is that people have been frightened out of starting work because, if they lost their job, they would have to start at the beginning.

The Government have been absolutely right to change the rules and to put in place return-to-work credit, which makes it possible for many people to attend work as well as making work financially attractive. We should provide mental health training for all staff involved in the pathways to work programme who carry out job-focused interviews. If issues arising from stress and depression are not properly understood by the people on the front line, they can be made worse by the process of undertaking a job-focused interview.

We must also integrate mental health services into the pathways to work programme much earlier in the system. Will the Minister explain whether the Department has carried out research into how the own-occupation test—the test that allows a person to be in receipt of incapacity benefit and one that is usually adjusted on the basis of the person's own statement and that of a general practitioner—works specifically for those with mental health problems? My suspicion is that it is all too easy for a GP to sign the person off and say, "Oh, go on to incapacity benefit," instead of providing time and ensuring that they receive counselling or psychotherapy support. That may not be the right thing for the person's mental health, let alone their life.

The final thing that we still need to change is the culture of despair that sometimes surrounds mental health issues. Old-fashioned attitudes to mental health have improved over the past 15 or 20 years. The number of hospital beds for people with mental health problems has gone down dramatically. Some people may say that that is terrible, but I think that it is a good thing. In the past, we used to lock up people with mental health problems. We have now learned much better strategies
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for providing them with a life in the community. Sometimes the community is not quite ready for that, and there is always more work that we can do in that respect, but we need to ensure that the old cliché of mental health services being a Cinderella service is genuinely something of the past.

We also need to put an end to the sneering attitudes that all too often pervade this issue. It is pointless to say, "Stress and depression don't really exist. People are just saying that they want to go on incapacity benefit because they can't be bothered to work." That attitude will never help us to achieve the real change that we need and which people with mental health problems need—opportunities for them to get into work.

The issue of mental health problems is not just about what people once might have thought of as the mad or the bad; it affects nearly every family in the land. I hope that, over the coming months, we see changes to the incapacity benefit system that will allow more of my constituents who have mental health problems but would like to get into work, to achieve that goal.

11.17 am

The Parliamentary Under-Secretary of State for Work and Pensions (Mrs. Anne McGuire) : I congratulate my hon. Friend the Member for Rhondda (Chris Bryant) on initiating the debate. I also thank the hon. Member for Meirionnydd Nant Conwy (Mr. Llwyd) and my hon. Friend the Member for Caerphilly (Mr. David) for their contributions; I shall pick up on the two points that they made. The speech by my hon. Friend the Member for Rhondda highlighted not only his assiduous research on this matter, but his commitment to dealing with some of the complicated issues involved. The concern that he expressed is what anyone who examines these issues comes to feel.

I think that we all agree that addressing the number of people with mental illness on incapacity benefit is one of the biggest challenges that we face. As my hon. Friend mentioned, nearly 1 million people are on incapacity benefit because of a mental or behavioural disorder. That means that there are now more mentally ill people claiming incapacity benefits than there are people on jobseeker's allowance. Overall, mental health problems account for 30 to 40 per cent. of work-related health problems, sickness absence, long-term incapacity and early retirement.

It is fair to say that that situation imposes a heavy cost on us all. Estimates vary, but it could be anything up to £45 billion a year. For example, the CBI estimates that there is lost output of £4 billion a year from time off sick because of depression. The lower employment rate for people with mental health problems, which my hon. Friend highlighted, implies further lost output of £9 billion. Public expenditure on mental health services accounts for a further £8 billion. We also have to add the cost of state benefits and the time given by carers.

Of course, those figures do not even begin to describe the impact on the individuals involved, whose loss of employment can often exacerbate their mental illness. The Government genuinely believe that we can and must start to address the issue seriously. Huge numbers of people with mental health problems suffer misery and social isolation. It is the job of any Government to empower such people to take back control of their lives.
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Our approach is not to stigmatise that group of people further by blaming them and labelling them as workshy or feckless or to call them fraudsters. I know that my hon. Friend has sympathy with that approach.

Despite what one might believe from reading some of the more lurid headlines in the tabloid press, there has not been a big rise in the number of people coming on to our books with mental illness. In 1997, 220,000 people a year started to claim incapacity benefit on the basis of a mental health condition. In 2004, the figure was 233,000.

As my hon. Friend highlighted, people with mental or behavioural disorders make up about 39 per cent. of IB claimants. The overall rise in the number of people on benefits with mental health conditions is quite simple to explain—indeed, I think that my hon. Friend alluded to it: it is difficult for them to get back to work. That is often because of a lack of support to help them to cope with their condition and move back to work. Sometimes it is because of the wider benefit and work-related barriers that they face, which my hon. Friend mentioned. We cannot estimate the size of the significant problem of lack of understanding by employers and fellow workers. Although they have a strong desire to work again, employment rates for people with mental health conditions are low. The labour force survey shows that people with mental health problems have the lowest employment rate of any disabled group. That is doubly concerning because there is increasingly good evidence that work could be part of the recovery process for people with mental health conditions.

Mental health problems can become much worse because of the isolation and loss of status that accompanies long-term unemployment. Many who start with chronic, pain-related conditions such as back or neck pain end up developing secondary mental conditions such as depression over the years.

To help people make the transition back to work, we need to ensure that the right services are available in jobcentres, GP practices and the wider NHS, and among employers; and there should be greater co-ordination of those services, with GPs supporting patients alongside employers, helping them to focus on the return to work and allowing them back into work whenever possible. We also need services in the wider NHS to help people to manage their conditions, and at jobcentres to help them find work. I assure my hon. Friend that we are starting to do that.

In the Department for Work and Pensions we have started to change fundamentally what it means to claim IB, particularly through the pathways to work initiative. In that respect, I want to reassure the hon. Member for Meirionnydd Nant Conwy regarding some of the tests for people with mental illness going on to IB: those capacity tests seriously take into account the impact of mental health conditions on people's capacity to work, and were drawn up in consultation with the Institute of Psychiatry to ensure that we did not miss anything. Through that initiative, we have started actively to intervene and support people back to work.

My hon. Friend the Member for Rhondda may be interested to note that when the pathways initiative was designed, we had the experiences and issues of people with mental health conditions at the forefront of our mind. The initiative offers a combination of sustained
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and highly skilled personal adviser support to people to stay engaged with the idea of getting back to work. I assure my hon. Friend that all pathways personal advisers get a full training package, which includes mental health awareness, so we are starting to look at some of the issues that he highlighted.

There are new NHS condition management programmes, which help people to understand how to manage their mental and physical health conditions more effectively, and to develop positive coping strategies to avoid or reduce the occurrence of depression or pain.

I can tell my hon. Friend the Member for Caerphilly that I was in the Rhondda not long ago, helping the First Minister, Rhodri Morgan, with the launch of a joint initiative between the Government and the Welsh Assembly called "Want to Work". That initiative is about trying to ensure that whenever possible we co-ordinate our efforts in support of the individual. As my hon. Friend said, there is no point in different pockets of work being done unless they are pulled together in the best interests of the individuals concerned. That work has already been started, and similar work is being undertaken by the Scottish Executive.

We are looking at improved financial incentives to ensure that, in most cases, work pays much more than benefit. We want to encourage local GPs to be supportive and take a more proactive attitude to people's fitness to work. During my visit to the launch of "Want to Work", a general practitioner from the area highlighted the fact that he had become part of a system that signed people off sick without understanding the impact on the individual or knowing what that person did. One of the great liberating things for him, now that he is working with Jobcentre Plus and employers and dealing with other aspects of the health service, is that he can take a far more holistic approach to what is good for patients who are claimants and long-term unemployed. I found that most encouraging.

Lynne Jones (Birmingham, Selly Oak) (Lab): Will my hon. Friend give way?

Mrs. McGuire : No; I need to respond to my hon. Friend the Member for Rhondda.

Pathways continues to show extremely encouraging results and it is making a profound difference to the lives of many people on IB with mental health conditions. Hon. Members will, I am sure, be aware of a number of
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case studies, but I shall highlight one. Kathy last worked more than 20 years ago; she had severe depression and anxiety, and she had to care for a disabled child. When it came to employment, she felt that she had been abandoned. Her personal adviser at Jobcentre Plus referred her to the local NHS condition management programme to improve her confidence and to help her cope with any negative feelings. At the end of that programme, Kathy had the confidence to apply for a post in a local nursing home as an events organiser. She loves her new job, and is apparently £4,000 a year better off than when she was on benefit. I am sure that many similar stories could be told by people throughout the country.

As Jobcentre Plus is raising its game, so is the NHS. The mental health service has improved greatly over the last five years as a result of the national service framework and additional funding. New treatments have been introduced and new workers are being recruited and trained; in particular, staff are being trained and employed by GPs to deliver cognitive behavioural therapy. In 2004, the National Institute for Clinical Excellence published guidelines on depression and anxiety, strongly supporting the case for cognitive behavioural therapy. Those who are knowledgeable in such matters are aware that that is a far more effective method than other talking therapies such as psychotherapy or counselling.

In addition, the Health and Safety Executive is focusing on improving awareness of best practice in sickness absence management. We have extended the Disability Discrimination Act 1995 to remove the need for mental illness to be "clinically well-recognised". That was a great leap forward in working with people with mental illness. The HSE has a crucial role in managing sickness and in encouraging employers to look at ways to manage sickness absence in order to ensure that people do not get to the point of needing incapacity benefit. We must work more closely on that.

None of that takes away from the need for a profound change in how we look at incapacity benefit during the rest of this decade. The comments of my hon. Friend the Member for Rhondda and other hon. Members will be most helpful in developing the Green Paper that is due to be published later this year. Finally, I reassure my hon. Friend that we share his commitment to addressing issues that unnecessarily blight the lives of so many people and so many communities.

11.29 am

Sitting suspended till half-past Two o'clock.

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