The moral and economic case for improving mental health care
This was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government
Health minister Norman Lamb challenges the UK's biggest companies to sign up to Time to Change.
Depression is nothing short of an eclipse on our world. Its scale is huge. Over 350 million people in the world are affected by depression. To give that massive number some context, think of the population of the United States.
Today, you have the opportunity to hear from political representatives from the US, Canada, Sweden, Denmark and Italy.
I want to thank The Economist for hosting today’s event. It is right that we have this global platform to focus on an issue which represents over 13% of the global burden of disease. Faced with these statistics no-one can underestimate the extent of the problem or the challenges that lie ahead of us.
Over the last few decades, mental health care in England has experienced a revolution.
Care has shifted into the community. New evidence-based treatments and a strong emphasis on recovery are helping people to live the lives that they want to lead. Their lives are transformed.
But there is so much more to be done, especially on common mental health conditions like depression.
We all have a part to play in achieving this. We all need to be setting an example for everyone to follow.
Moral case – IAPT, Five Year Plan, Self-Referral
In England, we are achieving change – both the pace and scale of that change is more ambitious than ever, but we’re achieving it.
Many of you may have heard about our Improving Access to Psychological Therapies programme (IAPT).
We have invested over £400 million to offer a choice of psychological therapies available to people who have mental ill-health.
It has treated over 2.6 million people, and over 1.5 million have completed that treatment.
Over 1 million people have reached recovery, with nearly 5,000 practitioners of IAPT trained to support people through the psychological therapies programme.
And at its very minimum standards offer a wealth of choice of psychological therapies: cognitive behavioural therapy, interpersonal therapy, counselling for depression and more.
I am very proud of the work we have achieved through IAPT – it is incredibly popular and is being adopted by a lot of other countries.
By the end of March next year, IAPT services will be reaching at least 900,000 people. And we have set a target that 50% of people should recover following treatment.
Our most recent data shows a recovery rate of 45%, with far more experiencing a substantial improvement.
Yet, despite all this work, there are still people who desperately need this help, but just aren’t getting it.
People still find it difficult to talk about depression. They think it would be difficult to talk to their doctor about it. Or they think it may eventually go and it’s better to carry on, regardless, even though they may be feeling great pain and battling alone with their own worries and feelings.
There is no valour in continuing to suffer without help and there is no shame in seeking support.
I want to make it easier for people to receive that help. So, we have made it possible for people to self-refer to psychological therapies.
People don’t have to seek permission from their doctor to refer them to these services.
There is no need to fear those conversations anymore – we are giving people the independence and choice to use these services if they feel that they need them.
Mental health is everybody’s business. That’s the call to action we issued in our mental health strategy in 2011. And it’s clear that three years later a great deal has been achieved.
We’ve enshrined the principle of parity of parity of esteem in legislation.
Parity is our key priority – put simply, it means that mental health needs to be given equal status with physical health.
Conditions like depression are treatable. We know what works and what doesn’t, and it is no longer acceptable that we let people live their lives in misery.
This doesn’t just have consequences for them and their families; it also has a direct and significant impact on our economy. How can it be right that if you have suspected cancer you will see a specialist within a fortnight, yet if you suffer from major depression or have a first episode of psychosis you have no such right?
And is it right that the funding behind mental health care is much more complicated than that of physical health?
It isn’t right – and we’re putting an end to it.
We published our five year vision for mental health last month.
Its changes are radical – supporting more people suffering with a mental health crisis and ending the practice of young people being treated far away from home.
But at its heart was a straightforward change – an ambition to set access and waiting time standards for all mental health services for the first time by 2020. And critically what you get access to must be evidence- based therapy.
No other country in the world is planning change on this scale. This ambition marks a major and radical departure in its intent to rebalance our health and care system.
For conditions like depression, people will be guaranteed the treatment they need in as little as 6 weeks – and they will wait no longer than 18 weeks, as an absolute max, and have access to evidenced based treatment through the IAPT programme.
IAPT is also having a significant impact on employment. Between 2008 – when the programme was created – to the present day, over 90,000 people have moved off of sick pay and benefits.
Economic case for change – Public mental health, Time to Change, RAND pilots
This statistic is a welcome one.
It’s welcome because mental health conditions are common – at any one time one in six people has a common mental health condition like anxiety or depression.
But people with mental ill-health can find it incredibly hard to stay in – or even find – employment.
Nearly half of Employment and Support Allowance claimants report a mental health problem as their primary reason for claiming benefits.
Nearly a quarter of Jobseeker’s Allowance claimants reports that they have a common mental health problem.
The estimated cost of mental health to the UK economy is between £70 and £100 billion each year, arising from sickness absence, benefit provision and loss of productivity.
That’s almost the entire funding for the NHS.
The health think tank The King’s Fund estimated a total cost of services for depression in England in 2007 – including lost employment – was £7.5 billion. By 2026, it is projected to be £12.2 billion.
The problem isn’t going away.
1.2 million people receive financial support because of their mental ill-health, and since 2009, the number of working days lost to stress, depression and anxiety has increased by 23%.
It is clear that we need to look at how we are using our resources in mental health, and think about what we can do differently.
Well, for a start, we need more focus to be put in to those resources.
This month, one of our most active mental health charities – MIND – published a report on how much local authorities spend on public mental health services. Their findings were appalling.
Local authorities spend on average 1.36% of their public health budget on mental health.
Some local authorities will spend little or nothing on preventing mental health problems this year.
And many areas had no clear plan for tackling poor mental health.
When we live in a society where one of the biggest killer of men under the age of 50 is suicide, these findings demonstrate the inequality between physical and mental health.
Similar can be seen in the workplace.
So, how can we enhance the role of the employer to support mental wellbeing?
And why should employers be interested?
Well – it makes economic sense. Employers want their employees to be happy and healthy so they can come to work and help their business prosper – it’s enlightened self-interest.
And there is some inspiring work on this across the country.
A few months ago, I visited Devon – home of the English Riviera, Dartmoor and, perhaps lesser known, the Mindful Employer initiative.
It is a simple agreement that says employers will provide support to any staff member experiencing mental health difficulties and will not discriminate against employees with mental ill-health.
It is hugely popular. Over 1,200 employers have signed up to the voluntary charter and they range from very small local independent shops in the South West, to Morrison’s, the energy firm E-ON and the Nationwide Building Society. It has spread as far as Australia, New Zealand and Canada.
This is impressive.
Their work is inspiring, and I want more organisations to do similar.
And whilst so many organisations want to be able to support their employee’s mental health, many of them don’t know where to start, or how to begin those conversations.
The stigma of mental health is stubborn – the silence is often deafening. But employers shouldn’t be afraid of having that conversation with their workforce.
The Time to Change campaign, funded by the Department of Health with Comic Relief and the BIG Lottery Fund and spearheaded by the charities Mind and Rethink Mental Illness was set up to tackle discrimination and remove the stigma associated with mental illness.
Research published in the medical journal The Lancet earlier this year has shown that the campaign is having a positive effect on public attitudes and that stigma and discrimination in relation to mental health would probably be more common without the campaign.
This is progress, but it isn’t enough.
We need to tackle that stigma wherever people spend their day – on the high street, in our communities and, especially, at work.
We want employers to be leading the way in dealing with depression.
My department has been heading this change. We were the first Whitehall department to sign up to Time to Change to become an exemplar employer when it comes to mental health and we now have 100% Time to Change sign up across all government departments. But what about organisations outside of the South West London postcode?
I want organisations to be following our example, in signing up to a scheme of work where they guarantee that they will support the mental health of their employees.
I have issued a challenge to the biggest companies in the UK to sign up to Time to Change. On World Mental Health Day, I wrote to every single FTSE 100 companies to support our Time to Change Campaign.
The 6.5 million people who support them to be in that elite club work in incredibly demanding circumstances. It is only right that they get support and advice about their mental health.
I know it’s possible for these big companies to achieve this. Barclays, with nearly 140,000 employees, have signed up to Time to Change.
And I’m pleased that more and more FTSE 100 companies continue to sign up: Friends Life and Direct Line Group have already signed up and Diageo PLC, HSBC, National Grid and the Royal Bank of Scotland group have agreed to sign up before the end of the year.
So far, 262 organisations have signed the Time to Change pledge – and more FTSE 100 have been in contact with us to find out more about the campaign.
Now we need the others to follow their lead. If they haven’t signed up to Time to Change, I expect them to have a thorough independent plan to support their employees’ mental health.
My Department will continue to fund Time to Change in 2015-16 so that they can continue to push out their message. We have already achieved so much through this partnership, and I want to take it further.
But we need to also think about people who are currently out of work due to mental health issues, and help them find work.
When I asked the research institute RAND Europe to suggest how we can improve the health and job prospects of people with common mental health problems, the findings were sobering.
They found that mental health and employment services simply aren’t joined up.
They found that employment and health needs aren’t regularly assessed – so even if services are working well, it can be difficult to tell.
And, overall, they found that the interaction between mental health and employment services is complex.
There may be no magic bullet – but this complexity needs to be addressed.
We have set up pilot projects to do just that.
Last month, I visited one of these pilots.
It offers support to people with common mental health problems like depression who are on benefits. It helps them find work and also offers talking therapies.
They get tailored, one-to-one support from an employment specialist using the Individual Placement and Support model to help them find jobs that suit them.
They might not find the right job straight away, and they might need to ease themselves into working, perhaps only doing just a few hours a week initially.
This will help them get back in to employment with appropriate support to help them when things get difficult.
We know this method works for people with severe and enduring mental health problems. We want to see if it can be effective when combined with psychological therapies to help people recover from common mental health problems like depression.
Last month we launched two further pilot projects that support unemployed people with these conditions.
One specifically provides group work that aims to help people who lack confidence about looking for work and who find it difficult to cope with the setbacks and disappointments involved in job seeking.
The programme helps people develop strategies to cope with the difficulties of finding a job. It is vital support that many people who have been out of work for such a long time need .
We have come a long way towards parity of esteem for mental health.
But we have a long way to go yet before mental health gets the attention it needs.
There is a clear moral and economic case for improving care, helping people get the right support, making sure they can lead a normal life, free of stigma and discrimination.
When we give people the tools and the help they need to make changes in their lives – we are not only bolstering their self-respect, we are helping them contribute to society,
We are making the people who may have felt worthless have a purpose again. We are giving their lives back to them.
I am incredibly proud of our country’s work to help people with depression, but I also know that we could be much better.
If we want to tackle this we need to form strong links with mental health services, communities, employers and local areas to support mental wellbeing.
I am determined to do this, and I know you are, too. It’s an excellent reason to get up in the morning.