Examination of Witness (Questions 222-239)
Rt Hon Rosie Winterton MP
14 DECEMBER 2006
Q222Chairman: Thank you very much for coming
before us on this mental health strategy which is our main inquiry
at the present moment. This is obviously a very interesting and
important matter and we are grateful to you for coming to see
us and help us on it. We have heard from a number of witnesses
and in fact I think that most members of the Committee would agree
that we have had a really very excellent series of witness statements
so far from a wide range of different people.
Ms Winterton: Good.
Q223Chairman: They have all been of a very high
quality, including your staff who came earlier, so we are happy
that we are getting very good advice, including, as I say, from
your own staff who came to see us on 19 October. We have focused
our inquiry on the strategy set out by the Commission, hoping
that we could make a constructive contribution by concentrating
on the policy objectives where the EU may have a worthwhile and
appropriate role and I am sure that, as a Minister in the Government,
you will be equally concerned that there is not, as it were, an
improper overlapping between the national and the European role.
We are being assisted in our work by Professor Martin Knapp who,
as you may know, is the Co-Director of Health and Social Care
at the LSE. I should give you a few housekeeping points. You are
aware, I am sure, that this is a public session and it will be
recorded for broadcasting and webcasting. A verbatim transcript
will also be taken and this will be published on the parliamentary
website and in an annex to the inquiry report. You will receive
a copy of that a few days after this session and, if there is
anything you feel ought to be altered either for clarity or to
make sure that the point you wanted to make has been correctly
recorded and so on, please do correct it, but make sure that is
done as soon as possible because we have to move fairly quickly.
If you, for any reason, want to submit supplementary evidence
after the end of the session, we would of course be delighted
to receive it. Sometimes questions do not get quite as well answered
as the witness would like or something gets left out, so we would
be delighted to hear any supplementary points you want to make.
Could you start by stating your name and your official position
for the record and then, if you want to make a statement, we would
be very happy to listen to what you have to say before we go into
our questions.
Ms Winterton: I am Rosie Winterton, Minister
of State at the Department of Health. I would just make some very
brief remarks to say that I am very glad that you are conducting
this inquiry because I know that you do not always look into every
single document that comes out of the EU and I think personally
that this is a very good indication of the new level of interest
that there is mental health. There have been some, I think, quite
remarkable changes in our delivery of mental health services in
this country, but we just need to continue to move to make sure
that we get that kind of cultural change in attitude towards mental
health services and see mental health promotion as part of not
only a kind of national agenda, but an international one as well.
As I say, I am very pleased that this is taking place and also,
looking back at some of the evidence that my officials gave and
others have given, I can see that you are conducting a very wide-ranging
and in-depth discussion about it which I think is very good.
Q224 Chairman: Thank you for that and
it leads very neatly into the first questions which are about
mental health services in England. I think we have received the
impression that in some ways we are, as it were, ahead of the
field in terms of the delivery of mental health services as compared
with other Member States, particularly of course the newer entrants.
On the other hand, a number of serious concerns have been expressed
to us, such as the lack of understanding of mental health issues
amongst the population in general. Also that sufferers from mental
health issues can be the subject of discrimination in the workplace,
for example, and that the cost of mental health or mental ill-health
to the economy, which is something, of course, that the European
Union itself has commented upon. What do you see as the biggest
successes in the development of mental health policies in recent
times and what are the main problem areas for us now? Perhaps
you could tell us something about how the Government is developing
that approach on the basis of what has already been done.
Ms Winterton: I think the biggest successes
have come through the National Service Framework for Mental Health
which was issued in 1999 and I think during that time in terms
of additional investment, if you look at health and social care
together, we are talking about something like £1½ billion
more investment now which goes into mental health services than
previously. I think in the way we have been able to develop some
of the community teams, there are something like 700 new community
teams now up and running and that includes things like crisis
resolution teams and early intervention teams so that we can help
support people in the community as far as possible, but also to
get help to people at an early stage with early intervention teams
and also to have that support in crisis times. The reason why
I think that is important is because we have wanted to move away,
and I think this is very much the contrast between how we are
looking at delivering care and how in some of the other European
countries it is still very much institutionalised, if I can put
it that way, so what we have tried to do is get teams out there
so that we can support people to remain within the community with
their families and with their carers as opposed to going into
the institutional setting. Within that, there is obviously still
a long way to go and we do need to make sure that the very good
teams that are in some parts of the country are actually in all
parts of the country. That is a challenge, but I do think we have
been quite successful, through the management from the Department
and through the strategic health authorities and so on, in actually
encouraging people to set up these teams. One of the big challenges
that we face is stigma and discrimination, as you said, very much
against mental health in general, but particular groups, people
from black and minority ethnic communities, suffer considerable
discrimination and I think there are various aspects to that.
One is the ability to talk more about mental health issues which
we have tried to do through the media with some of the Shift campaigns
that we have got, talking with young people about mental health
problems and trying to work with the media in how they portray
mental health problems. I think the community aspect of the way
we deliver services is an important part of that because it is
about saying that yes, people with mental health problems can
live within the community and there is not this necessity for
them always to have to be removed, so that is a general approach
which I think helps in that. In terms of what I sometimes call
the `choice agenda in mental health', it is not necessarily about
people having treatment in different parts of the country, it
is about having different types of treatment and making sure that
what we are doing is offering people, for example, more talking
therapies, something we are hearing a lot about at the moment,
which are not always an alternative to medication, but they can
assist people very greatly and that is why we have a number of
programmes at the moment in order to increase the kind of CBT
and so on. That is a challenge, but we are, through the pilot
sites in places like Doncaster and Newham, actually looking at
how we can demonstrate that this works and what the best methods
of delivery of that should be so that we can then move towards
rolling that out more nationally. Therefore, there has been a
lot of progress, but there is a lot more to do and particularly
through things as well like the Delivering Race Equality programme,
looking at how we really tackle some of those issues about people
from BME communities not feeling that they are getting access
to services and perhaps not coming forward for services because
of a feeling that there might be discrimination there. It is tackling
it on all those fronts and also in the workplace through things
like our action on stigma and our Health, Work and Wellbeing programme
which is looking at how we get employers to play their part in
acknowledging mental health problems in the workplace, being willing
to deal with those problems and not making people feel excluded
or that they have to leave work, but that they will be given support
in work.
Q225 Chairman: I would just like to ask
one more thing and that is that when we were listening to the
voluntary sector, the people who came before us, raised the matter
of the input from the patients themselves to the style and organisation
of the services to which they could get access. Now, I do not
know whether that is something to which your Department has given
thought because I think some of them felt that it was kind of
offered to them on a `take it or leave it' basis. I am going rather
further than what the evidence actually said, but I think that
is what they were getting at, that they were not able to make
enough contribution to how they were being treated.
Ms Winterton: I think there are two issues there.
One is the individual service-user or patient and whether there
is the degree of discussion with patients that there ought to
be. It is certainly an emphasis where I know increasingly clinicians
are adopting that kind of approach because I think mental health
again is a real area where, if there is not a proper explanation
and discussion with the individual about the type of treatment
they are being given, why it is, what side-effects there might
be, then really it is incredibly difficult to get a buy-in. I
think we are changing a lot of that culture and I know, through
a lot of the international work that I do, that actually we are
quite a long way down the line in getting over that message. I
think as well that the kind of community team approach has helped
in that because with the community teams, when you are actually
bringing together the psychiatric nurse, the consultant and others
who all work in the team, they develop, I think, a much more open
attitude to what it is that the individual is needing in their
particular instance and there is more discussion of that and,
therefore, there is more involvement. In a wider sense, I know
very well that the best services are delivered if there has been
proper service-user input in a wider sense and I think that mental
health services have been quite good at that actually, maybe not
to perfection, but I know that particularly there is quite an
input from carers as well in the delivery of services. If you
look at where some of the care trusts are operating and look at
how they will try to involve service-users in the design of services,
I think there are some very good examples of how it can be done
and we do try to assist in spreading that best practice. Where
we could further improve on that, I believe very strongly that,
as we move to the future, there is an even greater role for the
voluntary sector as, for example, service-providers and I do not
think that we have acknowledged that enough. I launched a document
two years ago which talked about the ability of the voluntary
sector to join with other service-providers in the design and
provision of services and there was this kind of feeling, I think,
within the NHS that perhaps the voluntary sector was really badly
organised and badly managed and how would they deliver properly.
The reality, when you looked at the evidence, was that they were
very well organised and very well managed, but they were also
very good at reaching out to people who sometimes got worried
by contact with the statutory sector, so what I have been trying
to look at, and encourage, is that bringing in of the voluntary
sector to work with the statutory sector in the actual provision
of services. I think, if we can do a lot more of that, we will
have that greater input.
Q226 Baroness Greengross: Minister, I
think we all want to see the Helsinki Declaration implemented
well, and I just want to ask you really whether you think that
the EU should be involved in this way in helping to make that
happen and whether there is a lot of added value in that or whether
just individual countries working with the WHO would get the same
effect? In other words, is there a lot of added value to this?
Ms Winterton: I think that anything that sends
out the message that this is a very important area that we need
to address can only help, frankly, and I launched the Green Paper
during our Presidency, so perhaps you might say, "Well, she
would say that, wouldn't she?", but I do think we can back
up the WHO and use some of the structures that we have just to
give that added impetus to it. They are very similar conclusions
in a sense, the importance of good mental health for wider society,
links with overall prosperity, the tragic waste that there is,
if people do not have help, to the economy as a whole and the
effect on the whole, wider society, so I think it can actually
give a lot in terms of sending out that message that yes, this
is something that all institutions take very seriously.
Q227 Baroness Greengross: Do you think
that this platform approach, which is the one which the Commission
is taking, is effective or will be effective?
Ms Winterton: I know that during the consultation
process there have been a number of meetings that have taken place
and that has given the opportunity again for service-users to
be able to put their views forward. I think that it will be, if
it is decided to continue that process, a good way of exchanging
information and ideas. Just going back to the points that you
were making about the input of service-users, actually there is
quite a lot where it would be important for service-users to know
what happens in other countries as well and I think there is quite
a lot of empowerment that could happen through that process and
particularly in trying perhaps to encourage service-users in other
countries to push for some of the changes that we have seen and
which have been successful and probably vice versa as there are
other countries that have done good prevention campaigns, for
example, that we could perhaps learn from.
Q228 Earl of Dundee: What has the Government
done to advise people about the qualities of lifestyle that can
best help to maintain mental health?
Ms Winterton: Well, we have in many senses a
lot of work which takes place at local level as opposed to kind
of big, national campaigns, but what we have tried to do, through
things like the Choosing Health White Paper and through
the Work, Health and Wellbeing Paper, is to draw attention
to the importance of good mental health. Also, through things
like Delivering Race Equality, we have actually issued guidance
about promoting mental health wellbeing amongst the BME communities.
The message that we are really trying to get across is that this
is a widespread problem and that we have to change the attitude
of people feeling that they cannot come forward to seek assistance,
so we can put in place the services and we can look at, and I
think this is important as well, rolling out things like talking
therapies where we talk about things like mild to moderate depression
where again people may not always feel that they can share that.
Then, at the local level, through things like public health strategies,
it is about how we can get people to do things like more exercise
and to eat well, all of which is actually linked to good mental
health. Therefore, in a sense it is about a general message of
wellbeing for the individual and of preventing people getting
into situations where, for whatever reason, their mental health
can deteriorate and that can often be linked to lifestyle, but,
as I have said, rather than big, national campaigns, we are trying
to encourage people to work out what is going to work best in
their local area, but again important work with employers to start
talking to their employees about having a healthy workplace, including
a healthy mental health workplace.
Q229 Earl of Dundee: In your evidence
to the Commission, you rank mental health as one of your top three
clinical priorities, the others being coronary heart disease and
cancer. In addition to what you are already doing, whether it
is at local or national level, and the message you are sending
out, do you feel that so far your communication to the public
on mental health is as strong as you would like and that it is
as strong as you may be already giving a message about in order
to help people against cancer and coronary heart disease?
Ms Winterton: I think it could be stronger.
I think we always need to learn whether there is more that we
can do. The National Service Frameworks for older people and for
younger people do have promoting good mental health as part of
their strategies as well. I think there is a real difficulty in
really getting it absolutely right as to how you can make it as
effective, for example, as a stop smoking policy because some
of it is so much about individual circumstances and how an individual
is at any particular time. I think that the message that we really
have to get over, if we were to say, "How do you promote
mental wellbeing most effectively?", is to talk about the
fact that this is something that for many, many people, it does
happen to people at various points in their lives and, therefore,
coming forward and talking about it should not be a problem. Those
are some of the ways in which I think you can promote it. There
is a lot of talk at the moment, is there not, about the kind of
`happiness culture', how you promote happiness. I think there
are other things that we could do, for example, through the kind
of Social Exclusion Unit work that we have done which is about
looking at the impact that poor housing will have on mental health,
the impact of being unemployed, the fact that that will contribute
towards mental ill-health, so it is about emphasising how all
these outside factors can impact on a person's mental health and
making sure that, through very often local strategies, whether
it is urban renewal or just generally, trying to improve people's
quality of life will, therefore, improve mental health as well.
Q230 Earl of Dundee: What examples of
good practice in the prevention of mental ill-health across Europe
are you aware of and for which England compares well?
Ms Winterton: In other countries?
Q231 Earl of Dundee: Yes.
Ms Winterton: Well, I know that Spain has had
some very good preventative mental health projects and I think
France has as well, particularly in the employment field. I think
we need to look at some of those examples and see whether they
would apply within our country as well and learn from some of
those.
Q232 Earl of Dundee: Is the Government
in the process of studying these examples?
Ms Winterton: Yes, we do have exchanges of information
the other way too and I was last night with people from some of
the big mental health trusts. The people from Oxleas Mental Health
Trust were telling me that there were people from Germany and
Spain who were actually taking jobs with the Trust so that they
could learn about community mental health services because they
wanted to take the experience back home. I think Italy have sent
people over to look at what we are doing in the Essex Partnership
Trust in terms of employment practices and how they have managed
to get people back to work. There are examples where we can learn
from each other certainly.
Q233 Lord Trefgarne: I would like to
ask you, if I may, about care in the community. Care in the community,
I think it is fair to say, has been the sort of flavour of the
month for a very great many years, but you have rightly pointed,
and justifiably pointed, to the increased impetus which you and
your colleagues have given it in comparatively recent times. All
the same, care in the community has never been a total success.
One of the problems is of course that a few of the people whom
we are concerned with are probably not suitable for care in the
community, and I am thinking, for example, of people who have
been in an institution for a very long time and just are not capable
of taking any sort of individual place in the community. Therefore,
I wonder what your view is as to the adequacy of the present provision
of community care facilities within your area of responsibility
and whether there is anything further we need to do in that regard
Ms Winterton: I am sure there is more that we
need to do. As I said earlier, I think in terms of the teams that
we have been able to put in the community, that has been a success
story and, as I say, particularly things like early intervention
teams and crisis resolution teams and so on, there is a lot that
we can point to to say that has almost revolutionised the way
that we deliver care. That was sort of a battle for quite a long
time because I think people were worried about making those sorts
of changes, but now, when you actually sit down with teams and
where, dare I say it, psychiatrists are actually themselves going
out to people's homes, it just suddenly seems to make so much
sense because you are actually seeing people within their own
environment and not in a sense summoning people to somewhere which
is totally alien to them, but actually going out into the community.
Where I think we need to look—
Q234 Lord Trefgarne: But for some people
of course, they are in environment which is an institution.
Ms Winterton: Of course, and where I think we
need to do even more work is when we look at things like how we
can get supported housing, for example, for people who want to
live in the community or who perhaps, as you say quite rightly,
have been living in institutions for many, many years, some of
them for really quite tragic reasons when you look at the background,
and it is about how we make sure that people can make that transition
and make it successfully. I have seen a number of schemes, as
I say, where people have moved into, for example, supported housing,
have been helped through employment schemes to do perhaps a small
amount of work, but something which actually brings some structure
to people's lives and I think that is the area that we need to
continue to move into. It is important, I have to say, to make
sure that, in doing that, we continue to work on reducing stigma
and discrimination because sometimes there are some very difficult
issues around actually placing people in the community because
people can have really quite the wrong impression of what people
are going to be like, and that is a very important part of the
stigma and discrimination reduction as well that we need to make
sure is there.
Q235 Lord Trefgarne: My Lord Chairman,
I cannot help but mention it, that in 1982 I was the Parliamentary
Secretary for the Department of Health and Social Security and
I visited Leavesden, which was then, I think, the largest mental
hospital in the country. It had been opened in 1915 and there
were some women in there who went in in 1915, and this was in
1982, only because they were unmarried mothers.
Ms Winterton: I have met the same. It is terrible.
Lord Trefgarne: I do not know if there are still
any there.
Baroness Neuberger: There are a few.
Q236 Baroness Howarth of Breckland: I
want to ask a supplementary. Clearly we are ahead of Europe in
the institutionalisation in much of Europe, but I want to put
this in the context of the Mental Health Bill which is coming
forward and the concern that there is an imbalance between community
care and the assessment of dangerousness which clearly is there
in the Bill. I just wondered whether there was anything that we
see in Europe or what your view is about how we can move forward
because dangerousness is what makes people worried about stigma
if we look at what has happened in the press in terms of a few
cases which have caused huge concern, and how, as Europeans, we
can really tackle that imbalance and if we could give a lead.
Ms Winterton: It is quite interesting when you
look at where there is mental health legislation in place across
Europe and, in terms of the detention rates per hundred thousand,
I think we are kind of in the middle when it comes to detention.
I know that there are countries like Spain at the moment who do
not have any mental health legislation, but who are actually looking
in the future actually to bring some in because of the problems
of maybe people going through the criminal justice system instead
of through the mental health system because there is not appropriate
legislation in place. We at the moment, and this is, I think,
one of the very important changes in terms of the Mental Health
Bill itself, are lagging behind some other countries in terms
of having the ability to support people in the community under
mental health legislation. You probably know, for example, and
I know they are not entirely separate, that Scotland has just
recently brought in legislation which supports people in the community.
I think that there are two things that we have to remember on
that. When we look at the support which is available in the community,
I think it is absolutely vital that our mental health legislation
keeps up with the changes that there are in service provision
and that we can adequately support people in a community setting,
but prevent some of the kind of `revolving door' syndrome which
occurs when people are perhaps detained, go out into the community,
do not take medication, do not stay in touch with mental healthcare
professionals, deteriorate, go back into hospital and go out again.
I have psychiatrists who say to me, "I know that somebody
is going into the community and they will be back again in two
months' time", and I think in some instances that does lead
people to deteriorate to such an extent that they either become
a danger to themselves more seriously or, in a very few cases,
a danger to other people. Now, if we can, through the Mental Health
Bill, provide that support in the community so that we can make
sure that people continue to take medication, continue to stay
in touch with the services, then we can do two things: (a) we
can help manage risk more effectively; and (b) we can reduce stigma
and discrimination. One of the things that I think is the most
difficult is that, if people feel that they have a mental health
legislation system which is not robust enough to handle risk and
to be able to say that it can give support to people in the community,
then people feel, and some people have said to me, that they start
to think that anyone with schizophrenia is really dangerous, and
of course that is not true. It is about saying, "Yes, we
have a system which can ensure that we get treatment to people
who need it", and I think that is the crucial part which
sometimes gets left out of this debate. It is not all about public
safety, it is actually about making sure that people get the treatment
that they need and the tragedies that you see, the parents and
the carers that I meet who say, "Why can't you do more to
actually help me manage my son", daughter, husband or whatever,
"who is going through this terrible deterioration? There
is nothing you can do to help me unless you say that they have
got to be taken back into a hospital situation", so I think
it is getting those balances right that will help to reduce stigma
and discrimination and looking too at how some of these situations
are managed in other countries as well.
Q237 Baroness Neuberger: That leads directly
into the question that I want to put to you. I have to say, however,
that I think that some of us would say that the emphasis on dangerousness
in the mental health legislation might conceivably add to questions
of stigma and I would like you to address that, but I wanted to
ask you more particularly where do you think the advances have
actually been made in tackling stigma and discrimination by the
Five-Year Shift programme over the past two years and where have
we done better than Europe? It was very interesting hearing from
the voluntary sector organisations where they thought we had done
better, but equally where they thought we had not spent enough
on anti-stigma programmes, so perhaps you could say whether you
think that we could teach them things in Europe about anti-stigma
programmes.
Ms Winterton: In terms of some of the real successes
in the Shift programme, I think a lot of the work with the media
has been quite successful and some of the campaigns that, for
example, the BBC have done, particularly targeted at young people,
have been effective. I think the work that we are doing with employers
as well has been a good thing because we have had some really
quite high-profile business people who have been good enough to
share their own kind of personal experiences and then put together
advice for managers, for example, on how to just be so much more
open about the whole issue of mental health. Big employers, like
Royal Mail and BT, have been very good in talking about how they
have dealt with those issues and it has become something, I believe,
that people actually talk about now as opposed to thinking that
they cannot approach somebody whom they know may be having a problem
in the workplace because it is embarrassing or of course they
would not want anybody to know, but it is about encouraging people
to be able to come forward and say, "Yes, I do have this
issue", and, instead of people saying, "Well, the best
thing for you to do is go home and have a rest", they say,
"What can we do to make your working life easier? Maybe you
need a change of office at the moment or just tell us if you want
to have some time off to have counselling. We can handle it".
Those kinds of things make a real difference. I think sometimes
there is an issue about whether you can have huge, as I have said,
national campaigns, advertising campaigns or whatever, which sometimes
people feel would work, but I feel more strongly that you have
got to actually have something that tackles what is happening
to people in their everyday lives and get through it that way
and that is why I think the workplace is extremely important.
I think changing the attitude of clinicians in talking to people
and involving them much more in their treatment so that people
do not kind of run away from it and moving services into the community
is all part of that. I think there are things that we can learn
from other countries and, as I say, I think Spain has done some
good work on mental health promotion and linking it with substance
mis-use, and again some of the employment work that has gone on
in France is something that we do need to look at. In terms of
dangerousness and the Mental Health Bill, it is always difficult
to try to get the balance right here. We do try to talk about
the fact that this is about getting appropriate treatment to people,
but we cannot run away from the fact that there are some of those
issues out there, like if people deteriorate to the extent, and
I always do emphasise that this is usually about, where they are
a risk to themselves, not a risk to other people. What we cannot
do is ignore the fact that there have been some of these cases
and, if we did, I think it would look as though we were kind of
neglecting a duty to tackle it. We have tried to put it in the
context of how we can not only use mental health legislation,
although that is an important part of it, but we look at the issue
of treatability. I know people feel very strongly about personality
disorder and whether we are trying to bring thousands more people
under the Mental Health Bill detention, and that is certainly
not the case, but we cannot run away from the fact that there
have been times when people have said, "I am not treatable"
and, therefore, they cannot be detained. That is an issue we need
to tackle, but it is also an issue whereby under the Mental Health
Alliance lobby last week, some of my constituents came down and
incidentally one of them actually said, "I have actually
looked at the Bill", and he said, "I do think it is
quite important that you do tackle some of these issues about
the revolving door and make sure that people do not feel that
there is not a strong system because, otherwise, I get discriminated
against because I have a mental health problem". Also one
woman there said, "Rosie, I am constantly told that, because
I have a personality disorder, I can't be treated, and I am not
getting treatment". I think we do need to use the Mental
Health Bill and the changes that we are making about treatability
to say that there are treatments available and to overcome some
of that culture which is about denying people treatment for, quite
frankly, some of the wrong reasons.
Q238 Lord Wade of Chorlton: During the
evidence that we took from your Department, they told us then
about the proposals for the Health, Work and Wellbeing programme
and we have also had in the evidence the suggestion that some
employers should be required to formulate a policy for handling
mental health issues at their place of work. We would be grateful
if you could bring us up to date with how this Health, Work and
Wellbeing programme is progressing and in what ways can this help
to generate a code of good practice for employers for handling
mental health issues at their place of work and are those examples
that other Member States might be able to use?
Ms Winterton: I think one of the successes of
the programme, although there is a still a long way to go, has
been to bring my Department, the DWP and the Health and Safety
Commission together to really kind of make sure we have got joined-up
strategies on this. Through our stakeholder council, where we
have got business, we have got trade unions, we have got voluntary
organisations and others, they are all saying, "What part
can we play in getting over this message?", which I think
has been a very difficult one, but I am quite surprised that there
has been a receptiveness to the idea that work is good for you.
My constituency is an ex-mining constituency and there was a time,
because there were massively higher rates of unemployment when
the pits closed, when people would go on incapacity benefit and
there was certainly a feeling that people were doing that because
there was not really anything else to do and people felt that
that was the only way that they could cope with some of these
problems. I think in changing the culture, first of all, through
the Pathways to Work projects which are saying that so many people
on incapacity benefit actually have a mental health problem and,
if they do not start off with one, they are probably going to
develop one after six months simply because of the kind of lack
of structure and the problems that there are with self-esteem
and so on, carrying that through to the Health, Work and Wellbeing
programme has, therefore, been easier than it might otherwise
have been, and the message, saying that work is good for mental
health, but also in times like this, when we do want to maximise
everyone's potential and skills and keep them at work, employers
are increasingly recognising that, if they do give assistance
to people and can get over the message about talking to people
about their mental health and providing them with support, the
loyalty is tremendous from those people who feel that they have
had support at a very difficult time in their lives. I think in
terms of taking that through to a code of practice, the first
thing we have done is to try to put out our action on stigma which
is about encouraging employers to have a healthy workplace, starting
with the NHS and government departments that we are encouraging
to take part in this, but also some of the big employers, getting
people to kind of sign up to saying, "We are adopting the
guidance to say this is how we can have a mental health strategy
for our workplace". Beyond that, of course I think that the
Disability Discrimination Act with mental health becoming part
of that will actually play quite a good part in ensuring that
employers sign up to it.
Q239 Lord Wade of Chorlton: Just as a
follow-on to that: clearly, as far as physical disability is concerned,
there are now codes of good practice of various industrial systems
you can use to prevent physical illness from happening in the
place of work particularly. Do you see a similar code of practice
being established in mental health, offering guidance to employers
of the sorts of approaches which can be taken to avoid their employees
developing mental health problems?
Ms Winterton: Well, it would be interesting
to see whether, as a result of the Disability Discrimination Act,
that leads automatically to a code of practice, and that is something
that I would like to look further into. Certainly, as I say, the
guidance that we are putting out is obviously voluntary at the
moment and I think it will be quite interesting to see how many
employers go along with that and how easy, or otherwise, they
find it to implement. I think one of the issues we really need
to explore is that, because with mental health there is so much
that is about the individual, you might have to have something
which was really quite broad, so it did not necessarily capture
everything that you wanted it to, but it is something that I would
like to take away and look at certainly.
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