It is great to see the Government has heeded messages on the importance of directly addressing mental ill- health in its Autumn Statement. Putting more money into the NHS, and specifically providing an additional £600 million for mental health treatment services is undoubtedly positive and much needed (though some have argued that the money promised simply off-sets the cuts the mental health sector has already seen). However, there is a concerning possibility that any benefits of these changes will be negated by the lack of investment in preventing mental ill health and supporting social inclusion. The Mental Health Policy Group for example raised concerns that the continued pressures on social care and housing could have a major impact on people with mental health problems and their families.
Along with investment in treatment (and the investment in NHS provision of talking therapies is particularly welcome) we need to think abut the other individual and societal factors which can impact upon mental health - positively or negatively. As mental health conditions are often experienced by people of working age, the relationship with employment is paramount. UK employment rates for people with mental health conditions remain stubbornly low, while many others are trapped in low paid or insecure work. This may only exacerbate the problems, as both unemployment and poor quality work can contribute to poor mental health, and as such improving access to good quality work is a vital part of the mental ill-health prevention and management story.
In addressing the employment difficulties experienced by many people with mental health conditions we must look at the whole picture of what effects people's ability to achieve and sustain employment. This includes not only issues around access to social care and housing, but also importantly the continuing stigma about poor mental health and what it means for work (and particularly some employer's attitudes), and the difficulties employers themselves experience when trying to support employees with mental ill-health to stay in work.
The welfare system is an important source of employment support fort people with mental health conditions - four out of ten new disability benefit claims are primarily related to mental health, while many claimants with physical health conditions also have comorbid mental illnesses such as depression. Mental health charities and others have raised concerns about the impact that recent changes in back to work support and welfare are having on people with mental health conditions. Possible harm associated with the Work Capability Assessment has recently made headlines again, and the Work Programme has had little success in helping claimants with mental health conditions into work. The Autumn Statement has done little to counter this with the announcement that job-search conditionality will be extended to more claimants - leaving those who have been assessed as not currently fit for work facing similar conditionality to those who have not declared a health condition.
More positively, the Chancellor also promised greater 'support' to claimants affected by this change, it is what this support looks like that will really matters - how it differs from what is currently offered and whether it will be sufficient to overcome the substantial and wide-ranging barriers that these claimants face to sustainable employment. Government investment in the new Department of Health and Department for Work and Pensions 'Work and Health Joint Unit', for which mental health and employment is a priority area is welcome. This includes investment in an 'innovation fund' to be used to test programmes which are hoped to support people with mental health and other health conditions to get into and stay in work - building on from the recent psychological health and wellbeing pilots. Hopefully this means more and better evidence on 'what works' to support people with mental health conditions to feel ready and be able to work. The announcement of a work and health 'white paper' in the new year with a specific focus on employers, indicates that the emphasis is shifting away from individual responsibility and taking greater heed of the broader role that workplaces can play in supporting job retention, health promotion and vocational rehabilitation.
Other areas of concern include the end of ring-fenced public health budgets at local level and the removal of the local government grant with increased reliance instead on business rates. This is likely to impact on the ability of local authorities to provide both prevention and back to work support to residents. Health related unemployment or underemployment are already acute concerns in many local authority areas, some of which have already taken concerted action (e.g. Manchester and Leicester) in particular to support those for whom the Work Programme has made little real difference. The many benefits of locally driven employment support, as outlined in The Work Foundation's recent policy paper, include knowledge of the local labour market and health needs, and an improved ability to work collaboratively with local partners and local employers. These should be a primary consideration when developing the proposed 'Work and Health' programme when the Work Programme is re-commissioned in 2017. Further to this, the above changes make the case even stronger for making workforce health part of the local economic growth agenda, led by Local Enterprise Partnerships (LEPs) and Growth Funds. These should be encouraged to focus some of their energy not only on creating new jobs, but also healthier jobs - and healthier workforces to fill them. In doing so they would contribute to increasing the self-sufficiency and productivity of local economies.
Mental ill-health is a considerable challenge for our society - for the individuals who experience it and their families, as well as in terms of productivity and economic development. Though there are developments to be welcomed in the Autumn Statement, when looking at the bigger picture concerns remain about government understanding of the nuances and the broad range of factors which influence the onset of mental ill-health and recovery, help people to participate in and contribute to society and to find good quality sustainable employment which is so often positive for mental health.