HC Deb 15 December 1994 vol 251 cc1166-84

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Wood.]

10.1 pm

Dr. Jeremy Bray (Motherwell, South)

I am grateful to you, Madam Speaker, for putting at the top of tonight's agenda the subject of employment rights after manic depression.

Each kind of disability has its own problems, challenges and opportunities but of none is that more true than of manic depression. I mean nothing but encouragement for concerns about other kinds of disability and for disability in general in raising this much-neglected part of the subject.

The Government's consultation document on disability said that a workable employment right should be based on a definition that, in principle, covers physical, sensory and mental impairments. I hope that the promised Bill, code of practice, notes of guidance and national disability council will deal more fully with mental illness than did either the consultation document or the Minister's statement on 24 November.

In the index of the House's proceedings I can find no record of the House of Commons having had a debate specifically on manic depression, or any aspect of it, in the past 10 years. More broadly, on mental illness, including depression, a recent Gallup survey showed that the general public believe that people with mental illness, including depression, should be at the bottom of the national health service priority list.

There is much straight ignorance. In still too many cases people are discharged from hospital without their families being told of the nature of their illness or even the necessary continuing drug regime. Neighbours and social workers unschooled in the symptoms of mental illness put outrageously anti-social behaviour down to avoidable malice. But, mercifully, many ordinary people are extraordinarily understanding, forgiving and helpful.

Attitudes are changing. In the past generation, there has been a much greater acceptance into the community of the mentally handicapped, who are more easily recognised than the mentally ill. In my constituency experience—first in a constituency on Teesside and later in Scotland—the changed attitude to mentally handicapped people has owed much to Catholic influence.

Mental illness is less easily recognised, but attitudes to it also appear to be changing. The younger generation show greater understanding and support than their elders. The sight of so many homeless people sleeping rough on our streets after discharge from psychiatric hospitals has been a great shock, giving the sense of, "There, but for the grace of God, go I."

It is more widely appreciated that mental illness is as genuine as physical illness, and that it is not malingering. Indeed, evidence is accumulating on the possible physical causes and symptoms of different types of mental illness. During a visit last week to the Institute of Molecular Medicine at Oxford, as part of the inquiry into human genetics by the Select Committee on Science and Technology, it was interesting to speak to researchers who are applying the ideas and methods currently being pursued in developing somatic cell therapy for principal physical diseases such as cancer and cardiovascular diseases, to mental illnesses and handicap.

In addition to a normal distribution of human attributes generally, manic depression often appears to carry with it a heightened sensitivity and awareness, which has a wider function in day-to-day society and in the family, the community, the work group, business, democracy, committee, Parliament or football team. Employers take advantage of the energy, vitality, productivity and enterprise of people vulnerable to manic depression when their condition is under control. They may be qualities that we all need, but they can get out of hand in a manic depressive. Those are matters not only for objective medical and psychiatric research but for social accommodation and public understanding and for campaigning and organisation, of which we need to take account in framing social policy.

One per cent. of the population will suffer from manic depression during their lives, and another 1 per cent. from schizophrenia. Many more people suffer from acute, disabling depression, without manifesting the full symptoms of the manic depressive. About 20 per cent. of women and 10 per cent. of men can be expected to suffer from depression at some time during their lives.

Suicide is overwhelmingly associated with depression. Each year there are more than 100,000 attempted suicides in this country, of which 4,000 are fatal. That figure compares with 3,500 road deaths. Christmas is an especially difficult time for mentally ill people, when so many activities and services are closed.

The experience of each sufferer from manic depression is unique, but between the swings into manic elation and acute depression, manic depressives behave like anyone else. Their wish is to be accepted in society and to contribute to it fully, in every way, in work, at home and in their wider social life; often they succeed.

The characteristics of manic depression are frequently not noticed by people who already have a difficult enough job coping with normal problems—social workers, housing and social security officials, personnel managers, employers and trade union officials. I confess that it was many years before I learnt some of the obvious signs of mental illness myself, when constituents in trouble came to see me.

According to the Royal College of Psychiatrists and the Royal College of General Practitioners, who can be expected to be objective about those matters, surveys show that 50 per cent. of those people suffering from clinical depression do not visit a doctor at all, and of those who do a further 50 per cent. are not diagnosed.

The cost of not treating depression has been estimated by the Office of Health Economics at about £3 billion per annum—nine times the £333 million cost of treating depression.

In his statement on 24 November, the Minister for Disabled People said: Greater employment opportunities are at the heart of enabling disabled people".—[Official Report, 24 November 1994; Vol. 250, c. 741.] On 26 November, the Manic Depressive Fellowship held a useful forum on employment, which I attended. I shall tell the House about some of the things that were said and points that were made, there and elsewhere, by people who have suffered from manic depression.

Some people have to live with episodes of manic depression throughout life, but others are able or enabled to control it. They suffer from only a temporary incapacity, but they remain vulnerable. Care can be effective, but mental illness is not a high priority for community care in many parts of Britain. Manic depression is an illness that begins in adult life or late adolescence, so appropriate continuing and adult education is as necessary as appropriate school education is for other disabilities. Strategies for completing studies and achieving a professional or vocational qualification are important.

The perception of manic depressives is that if they go along to the jobcentre and say that they have had an episode of manic depression they will be steered towards low-paid, unskilled work. That is a common experience of graduates, accountants, lawyers, teachers, business managers and other professionals. Their true capabilities are not recognised or thought to be recoverable.

What specific practical help is offered to manic depressives under the access to work programme? It is good that the Department of Employment is willing to spend money on the disabled who need easily identifiable physical aids, but what will it do to boost the skills, performance and self-confidence of those whose productivity has been undermined by mental illness?

The Government's talk of civil rights education for the disabled makes no reference to the existing battery of legislation on mental health. Episodes of illness can provoke irresponsible behaviour which can endanger the safety of the patient and of others. Fortunately, patients can recover from manic depressive episodes, and from a medical and psychological point of view those people are fully able to resume their usual responsibilities. Unfortunately, much of society and some aspects of the law presume that once a person has gone mad, he will always be mad. People are awaiting the new mental health Bill with keen interest. I trust that its scope will be wide enough to accommodate the debate needed and to enact the conclusions that are reached.

If manic depressives are honest about their illness to their employers, or in seeking work if they are out of work, they find that the only work options that they will be offered are jobs well below their capabilities. To overcome that prejudice, many patients lie or tell less than the full truth. Consultant psychiatrists and general practitioners actively encourage manic depressives to do that. The practice has helped a good many manic depressives to very senior positions. Suggestions are made now about how to fill in gaps in curriculum vitae with less than the full truth.

Is it not right that people should have the right to say nothing of a long past episode of mental illness? If a discharged prisoner can legally keep silent about his record, why should not a discharged mental patient? Any legal requirement to tell people of mental health records should not extend back further than five years.

As long as the patient does not become ill in the workplace, the practice of lying or omitting to tell the truth can prove satisfactory to the employee and to the unwitting employer. However, if a patient becomes ill at work, or his psychiatric case history becomes known some other way, problems may occur. Neither the employee nor the employer would have made contingency plans to cope with the event of a mental health emergency, and the employee would have committed a breach of contract by lying or by telling only part of the truth.

We need a clear legal framework that is fair to employees and to employers, but the industrial tribunal may not be the best place to resolve a dispute regarding a psychiatric patient. Industrial tribunals are pretty traumatic for those who are mentally stable. They would be horrendous for a psychiatric patient. Who would want their psychiatric case history to be laid before the tribunal, let alone read out in open court? There needs to be some legal remedy against employers who use the illness to discriminate. The mutual responsibilities of employer and employee are not clear and the lack of clarity acts as an effective artificial bar to the labour market.

The manic depressive is vulnerable in other ways. Far from easing someone who has been ill for a long time back into employment, the social security benefit system makes re-entry both difficult and risky. It is often better for someone who is getting over an episode of manic depression to re-enter the employment market gradually and cautiously. The possibility exists of retreat back to benefit should the move be premature or too stressful. If such people fail to hold down a job, they should not have to face all over again the barriers, delays and humiliations that the benefit system inflicts. The means should be found to provide people who are prepared to try entering employment after a long and severe illness with a safety net—that they will be able to return to invalidity benefit without waiting six months and going on the much lower income support.

In theory, the disability working allowance should offer a well-supported route upwards into employment but with a safety net for those people whose illness recurs. In practice, however, few manic depressives claim the allowance. Severe problems are connected with it. Its receipt depends on the understanding of the employer. That may be fine if a person is in a wheelchair or suffers from Down's syndrome but, as I have already said, the mentally ill are faced with major problems in relation to what to tell employers.

The number of manic depressives entering employment via the allowance route is minuscule. People who take that route are often no better off financially than they were when on benefit. Someone who has been covered for six months by a doctor's sick note should be on invalidity benefit and can do therapeutic, part-time work—for example, for a charity—and earn up to £15 per week pocket money without losing benefit. That would bring the disposable income of a single person up to £79 in round figures. In addition, one would be entitled to housing benefit and council tax rebate, both of which are valuable benefits.

If people on the allowance begin to work again, at most they will be only £1 to £2 better off than they were on invalidity benefit. The problems of the combined effects of tapers and clawbacks are well known, but they are especially crippling to vulnerable people. They amount to a 97 per cent. tax on additional earnings of more than £50 per week. It is small wonder that only 3,500 people with all kinds of disability are on the allowance. About the only thing that can be said in favour of the allowance is that, if people on it cannot sustain a job, it provides a safety net. They can go back immediately to the benefits to which they were formerly entitled.

Those problems have been argued for many years in relation to many sorts of disabled people, but fresh problems exist in the Social Security (Incapacity for Work) (General) Regulations, which were laid before the House on 24 November 1994 and which, no doubt, we shall debate soon under the affirmative procedure. The regulations omit people with severe mental health problems from the list of persons with a severe condition who are to be treated as incapable of work, despite an undertaking given to a number of organisations that persons with severe mental illness would not be subjected to the work test.

The effect of the regulations as drafted will be that persons with severe mental problems will be subjected to a work test, regardless of their mental state. The questionnaire that will be used to assess them has been widely criticised as inappropriate. Administering the questionnaire is likely to cause extreme distress to many severely ill patients. I cannot believe that the Government would allow the regulations to be the last word. I look forward to what the Minister has to say.

Good practices and pioneering projects on employment operate in many parts of the country and in many different fields. They play an invaluable role for those recovering from mental illness. Counselling and staff support schemes are now operated by some employers, offering confidential support to help individuals in employment to deal with problems that may be affecting their performance at work.

The cost of mental health problems to British employers is enormous. The Health and Safety Executive estimates that sickness certificates attribute 30 to 40 per cent. of absences from work to some form of mental or emotional disturbance. The Scottish Association for Mental Health has reviewed the experience of the counselling and staff support schemes. Obviously, such schemes can play an important role in keeping people well and productively employed.

Many employers in Scotland operate staff support schemes in all or some of their establishments. They include British Telecom, United Distillers, Scottish Mutual, BBC Scotland and Marks and Spencer. The Working Well trust in Tower Hamlets supports employment and training in printing, clothing manufacturing, office services and shops and is now branching out with a new project in Bath. The Mental After Care Association runs a wide range of activities nationwide, some of which are directed at employment and training.

Another route that many manic depressives find useful is the voluntary work that is available in a wide variety of organisations. It offers them a start on the road back to regular employment. It is often not the content of the work but the availability of a supportive working community that is important.

Those who have been mentally ill want to return to a normal social and working life. They do not want to be stranded in a ghetto. The contracting-out revolution has made work insecure for a great many people and the mentally ill are not the only ones who suffer. However, on the way back into employment, the contracting-out revolution makes it possible for some people gradually to re-enter the labour market in some skilled and professional areas. Good employment practices for contracting out services by the fully fit require clear task setting, milestones, delegated responsibility and an interest in and encouragement of progress. Those are doubly important for those who have been mentally ill.

Perceptive and enterprising practices are not limited to large firms. One of the best worked-out schemes that I have seen is in Context, the firm that is recording for posterity on compact disc our proceedings in the House. The employment offered by some firms is not undemanding. Some firms in the market for new high-tech skills realise that people who have had a breakdown can learn fast and perform well.

The Royal College of Psychiatrists and the Royal College of General Practitioners, in their current comprehensive defeat depression campaign, are seeking to raise awareness at work, to promote health education for employees, to address the organisational forums that create stress and to provide effective occupational health services. The Government should join forces with all those and other firms and agencies, many of whose activities they are already supporting in one way or another, to create a pilot scheme or schemes geared directly to the needs of manic depressives and their employers. They have done that with particular groups of the physically disabled. The evidence and experience gained can provide the basis for a national scheme that can be backed up with the proposed legislation and code of practice. It needs to be run by a multidisciplinary team and, of course, implementation should be done by those already active in and responsible for educating, training and re-establishing the manic depressives in employment. In that way, employers can get back-up when they need it and of the kind that they need.

The scope of individual schemes needs to be considered. At the point of delivery in a firm, a scheme covering a wider field—covering depression and mental illness generally—would have a wider scope and be more often used than a scheme for specific mental illnesses such as manic depression. The treatment needs of different illnesses differ greatly and it would be necessary to be able to call on those able to deal with the special needs of each of them.

In the guidance notes and in implementing the Government's code of practice, there would be scope for those several different kinds of people, who are all called disabled but whose particular problems, challenges and opportunities need to be addressed separately, to be served by a coherent set of schemes. Manic depression would be a good place to start because it has been neglected, because there is a potential to be realised and because there are people throughout the community who have a deep understanding of the condition that is so near to the centre of each of us.

10.25 pm
The Minister of State, Department of Employment (Miss Ann Widdecombe)


Mr. Ian McCartney (Makerfield)

Would the Minister like to speak first? I do not mind, it is near Christmas.

Miss Widdecombe

indicated dissent.

Mr. McCartney

First, I congratulate my hon. Friend the Member for Motherwell, South (Dr. Bray) on his success in the ballot. I congratulate my hon. Friend not on the lucky draw but on the subject that he selected. For many years before I became a Member of the House, I was a voluntary advocate for people suffering from mental illness and stress. Indeed, in my family today, through my wife, that role of working with people who suffer from mental stress continues.

I welcome this opportunity, therefore, especially as this is my first speech in my new portfolio as spokesperson for employment. Previously, I had been spokesperson for health. I did not expect my first debate in my new capacity to be so directly related to my previous portfolio as Labour party spokesperson on occupational and mental health. Although it is late in the evening and few other hon. Members are here to support either the Minister or me, I welcome a debate in which we can have a dialogue on the serious issues that my hon. Friend raised.

It is important to set a background to mental stress at work and what has been happening during the 1980s and 1990s. We now know from various reports that upwards of 1 million British workers suffer from work-related stress as a direct result of Government activities and the labour market changes in the 1980s and 1990s. Employees in full-time work are now working harder and longer hours than ever before. Redundancy, short-term working, part-time working, temporary or part-time and temporary low-paid jobs produce a sense of a loss of security and an overwhelming sense of insecurity at work. That has led to—it is continuing—increased stress at work, including manic depression.

That is the view of not just the Labour party, the trade unions, the advocacy groups representing people at work with a mental illness, the Royal College of Psychiatrists, the Royal College of Nursing and the Health Select Committee; it is shared across a range of activities. Interestingly, a recent report, highlighted in The Times, was produced by Professor Cooper of the university of Manchester's institute of science and technology on behalf of the Health and Safety Executive—an organisation directly responsible to the Government, which advises them on stress at work and on health and safety issues in general. Professor Cooper, in his report to the Health and Safety Executive, said: the situation was probably worse in Britain than in America as the country had gone through greater change. That relates to the Labour market changes imposed by the Government. He said: The Thatcher era had been marked by technological and economic change and the country was also facing substantial social changes. The incidence of work-related stress had increased markedly in the past 20 years and more people were taking sick leave because of anxiety … `Those on the shopfloor work till they drop while senior managers take a few days off every now and then'". That report was produced by an eminent professor, on behalf of the United Kingdom's most eminent independent Government-related body dealing with health and safety.

Last year, citizens advice bureaux in the United Kingdom answered 882,257 queries about employment problems. That is an astonishing figure for a voluntary organisation, and it does not count those who consulted trade union or other employment organisations or sought the help of their doctors, the Royal College of Psychiatrists or advocacy groups. It suggests the existence of a deep-seated, underlying problem in the British economy: people's sense of insecurity is manifesting itself in stress and mental illness.

Again, that is the view not just of the organisations that I mentioned. A recent report in The Guardian by Tim Radford stated that in Britain workers were suffering the worst levels of stress in Europe. It stated: British white-collar workers have the lowest 'feelgood' factor in Europe, according to a survey of office workers". The survey was carried out throughout the world, but Mr. Radford referred particularly to Europe. He said: More than half claim stress has increased in the past two years, and 16 per cent. admit it has caused them to take time off. Thirty-seven per cent. do not feel appreciated at work, against a European average of 29 per cent. Confidence in management ability is 53 per cent., against 69 per cent in other European countries.

British workers felt that their jobs were less safe—they felt less secure about being able to remain in employment—than their European counterparts, which led to increased mental stress at work.

The Policy Studies Institute's survey of 1993, which I am sure the Minister read, revealed two startling facts. About one in three employees reported significant stress levels owing to working conditions, while 54 per cent. felt that their level of stress had increased over the past five years. The Department of Health and the CBI estimate that sickness absence related to stress and mental disorder is costing the United Kingdom economy a staggering £56 billion per annum. That does not count on-costs such as medication, benefits, high staff turnover and poor judgment leading to bad decision making.

The Department of Health also states that mental illness is one of the main three causes of certificated sick leave, with a consequent loss of 91.5 million working days in the British economy. In 1993, the number of working days lost through strikes was 649,000. Those, too, are staggering figures.

The situation has become so acute that the International Labour Organisation, which brings together union, employer and Government representatives, has said that the time has clearly come for a shift in attention in occupational health prevention activities away from a 'physical hazards only' perspective to a focus which includes full attention to psychosocial hazards". In layman's terms, that points to a large increase in the number of people suffering from mental illness and stress in the workplace. We need to ensure that organisations such as the Health and Safety Executive, and indeed the Government, bear in mind the key subject of mental stress when making policy: it is as important and damaging in the workplace as accidents and other forms of illness. The Trades Union Congress and its general secretary, John Monks, have identified occupational stress as one of the top five health and safety priorities. Mr. Monks and various trade unions have a team to advise them on how to tackle the problem through the development of prevention strategies.

A research review of occupational stress by Professor Tom Cox for the Health and Safety Executive reported that there was too strong a focus on caring for or curing individuals and that only a minority of organisations appeared to be directly and deliberately addressing the management of occupational stress. Professor Cox, on behalf of the Health and Safety Executive, said that there was a need for intervention policies in industry, involving employers and employees, to create a programme for the prevention of stress and a comprehensive package of care in the workplace. Where stress had not been prevented, it was necessary to ensure that sympathetic policies were followed so that individuals suffering from mental stress were able to continue in work, either full time or part time, as described in detail by my hon. Friend the Member for Motherwell, South.

I shall deal now with the discrimination suffered by citizens with a disability such as manic depression. My hon. Friend the Member for Motherwell, South spent a great deal of time outlining the problem, and rightly so. The level of discrimination against those suffering from mental illness or a perceived mental illness is a challenge for policy makers of all political persuasion. One and a half million people with disabilities are without a job and are not in training. People with a psychiatric history experience severe discrimination in the employment market. Those recovering from mental distress need help to find ways back to work and may need support in the workplace so that they can work on equal terms with other employees.

A survey of users and ex-users of mental health services carried out by MIND, the National Association for Mental Health, found that there was a massive exclusion of such people from the workplace as a mental health disability was seen as relevant to the ability to do a job. Sixty-three per cent. of people felt that their job prospects were affected by their history while the unemployment rate among ex-patients was found to be sometimes as high as a staggering 62 per cent. The most poignant fact to come out of the survey was that one third of those suffering from mental stress said that finding a job was the single most important thing that could assist them back to health and help them to regain their dignity.

Why is employment such a low priority for health and social services funding? Users of mental health services regard employment and training as high priorities, but, of the 554 projects funded by the mental illness specific grant, only 19 are employment related. That is a travesty, and the problem is compounded by the fact that the Employment Service restricts the funding of rehabilitation programmes to 13 weeks' crude targeting of the funding criteria. It is leading to severe discrimination against users and former users of mental health services.

There is a danger under community care that the Government will declare that many people are too well to be dealt with by the health services but too unemployable to be helped by the Employment Service, which means that they will fall between two stools and fail to get access to employment and training opportunities.

People suffering from mental illness require the Government to initiate an action plan. They need urgent policy initiatives by the Departments of Employment, Health and the Environment to rectify the lack of co-operation between Government-funded agencies and to provide employment and training opportunities. We need a redefinition of mental distress at work as an occupational health issue, which would mean enforceable codes of good practice involving support at work. I shall explain what is required in a moment, but it is important at this stage to point out that, as my hon. Friend the Member for Motherwell, South said, there are employers—large and small—that already have in place model agreements with their work force to ensure that there is a policy for the prevention of stress and mental illness and that, when people are suffering, there is a code of practice agreed between the employers and employees.

The Post Office has one of those codes of practice, which I advise other employers to read. It represents a way forward with regard to preventing mental stress or dealing with it so as to ensure continuity of employment for the individuals concerned, if possible, or at least to ensure that they are treated with dignity in the workplace during a period of mental stress.

The first aspect of the code is interesting, as it clearly shows the responsibility of the Health and Safety Executive, through the Health and Safety at Work, etc. Act 1974. It says: The parties to this agreement recognise that stress at work is a health and safety problem and that employers have a duty under Section 2 of the Health and Safety at Work Act to take all reasonably practicable measures to prevent stress at work. Under Section 7 of the Act employees have a duty not to endanger themselves or others and to co-operate with their employer in meeting statutory requirements. The Post Office is an employer that implicitly accepts that causing mental stress and mental illness at work because of poor conditions of employment is a breach of health and safety legislation. It is to be commended for accepting that responsibility.

The code says much more. It specifically sets out positive measures that the employer will take to ensure that an individual suffering from mental stress can remain in the workplace during a period of treatment, with opportunities to work full or part time, by agreement. There are also practical measures to be taken by the employer to eradicate aspects of workplace activity that are leading to mental stress or to an escalation of mental stress, culminating in illness. That is a major step forward and the Post Office, and its employees represented through their unions, are to be congratulated on that model agreement.

Some of the other aspects of an action plan to ensure good support and good practice at work are as follows: extending paid sick leave; provision for retraining or other assistance to enable an individual to continue his or her job or to undertake another job; contacting appropriate Government services and health services for advice, and discussing with an employee whether he or she can continue in the same job or needs to receive special assistance to continue in work. Counselling, too, must be a major aspect of that activity. Those employed in counselling by the employer must, none the less, be independent of the employer and must provide a confidential counselling service to the individual concerned.

There should be provision for special arrangements when employees return to work—for example, flexibility in the times of leaving and arrival; a phased return to work, allowing individuals to come back, probably part time, extending attendance to full time later; extending rest periods for people who wish to continue in work while receiving treatment for their illness, which may be stress related; and exploring the possibility of finding an alternative job, or part-time work, when an employee is unable to continue with his or her existing job.

Those are all practical ideas, and if they were adopted by most employers in the United Kingdom, they would go a long way towards meeting many of the needs described by my hon. Friend the Member for Motherwell, South on behalf of sufferers from depression who are in employment and wish to remain in employment, or who are out of work but wish to return to the work force.

It is also important to examine other aspects of the way in which we organise our employment and training services in the community, to ensure that those services are designed to meet the needs of people with disabilities, especially people who suffer from mental illness or mental stress from time to time. The Department of Employment must act as a facilitator and catalyst at the local level to bring together the Department, local authorities and other agencies to ensure that there is a strategic responsibility at local level for collaboration on, and provision of, specialist resources for employment opportunities for people with mental illness. There must be a direct link between health, social care and employment.

As I said earlier, the report by MIND stated that one of the most important aspects of the social care of mental illness was the ability to have access to training and worthwhile employment; bringing social care and employment together had a dramatic effect in improving an individual's overall health. That is particularly important for people who suffer from manic depression.

To help mental health services users become involved in, or to re-enter, the labour market, all training and enterprise councils should employ specialist disablement resettlement officers. I support the TEC movement and I know that many TECs do that. However, determining the level of that input in a particular TEC is usually left to a reliance on the keenness of the individuals on the ground.

We must ensure that such provision does not simply rely on a commitment at local level by individuals in a TEC. All TECs must have minimum levels of standards in terms of the deployment of disablement resettlement officers to ensure that there is a coherent strategic approach to retraining and re-entry to the marketplace by people suffering from mental illness.

It is therefore important to consider the record of TECs in the provision for disabled people. Where we can improve things, we should surely do that. We should give TECs tasks with regard to this difficult area of the employment market. We should clearly define the right to quality assessment of rehabilitation and training for work or college-based schemes for people with mental illness. It is essential that they can enter, and have easy access to, training, but it must be quality training and it must fit in with the employment needs of the individual.

There is nothing worse than for someone suffering from a mental illness to be put into a scheme that is going nowhere and has poor training and, at the end of it, poor opportunities for entering the marketplace and for getting employment. That is a rejection and it undermines the well-being and mental health of the person concerned.

For many people who have suffered mental illness in the past and are looking for a way back into the workplace, proper training schemes are an important aspect of that rehabilitation programme. I would welcome the Minister of State's comments on the specific action that she would like TECs to take to become involved in that aspect of activity with regard to mental stress at work and getting people with mental illness back into the workplace.

My hon. Friend the Member for Motherwell, South quite rightly raised the issue of anti-discrimination legislation. We look forward to seeing precisely what is in the Government's mind with regard to their Bill this Session. As a minimum standard, I hope that it will ensure the prohibition of discrimination in respect of selection, promotion or dismissal of people suffering from mental stress in employment.

It is important that the Government use that Bill as a clear message to employers not to use mental stress as an easy means to sack employees. Instead, employers should take the positive attitude of prevention of mental stress at work and model agreements between themselves and the employees and employee representatives to ensure that, when mental stress arises, it is eradicated and that it is not, in any circumstances, used as an easy method of dispensing with individuals or a group of individuals in the workplace.

The marginalisation and exclusion of people with a mental health problem, or a perceived mental illness, from the labour market is an overwhelmingly significant factor in undermining their rights to participate in society as a whole. In 1995 and for the remainder of the decade, we will still see, tragically, the continuation of the mass lock-out of people with a mental illness. We will also see the insidious and damaging health effects of long-term mass unemployment.

Of the 1 million people in the United Kingdom who have been unemployed for more than a year, many have experienced or will experience an impairment of their mental health—distress, feelings of depression, anxiety, irritability, sleep loss, inability to concentrate, a lack of or loss of confidence, and a strain in close personal relationships. They are direct consequences of unemployment and the Government's failure in labour force strategies.

It is an appalling indictment that young people may be passive about their plight in terms of unemployment, but that belies the major strains in family relationships and deep-seated feelings of anger which will eventually manifest themselves in individual or collective actions of hostility. Alienation is linked like an umbilical cord to mental health and suicide. The suicide figures, as my hon. Friend said, are a sobering indictment on society. Many young people feel total hopelessness about their lives and their ability to be seen as a meaningful part of society, and they end up taking their lives because of the alienation of unemployment in the community.

I hope that I have demonstrated that the Labour party is genuinely in the business of advocating co-operation with employers, employees, users and ex-users of mental health services, to ensure appropriate, genuine access, free from discrimination, to training, rehabilitation and employment opportunities. I hope that the Minister will rise to the occasion and give a clear indication that the Government, at long last, will take seriously the growing scandal of mental stress at work and, with it, the cost in human terms and to the British economy.

10.51 pm
The Minister of State, Department of Employment (Miss Ann Widdecombe)

I congratulate the hon. Member for Motherwell, South (Dr. Bray) on obtaining the debate and on using it for the purpose that he chose. He put his case in a sensitive, moderate and thoughtful way, which contrasted somewhat with the ranting which emanated from the Opposition Front Bench.

Before addressing the general issues surrounding mental illness and manic depression in so far as they relate to employment, I shall refer to some specific points that have been raised. One or two specific points were more properly for my right hon. Friend the Secretary of State for Health, my right hon. Friend the Secretary of State for Education with respect to one point, and my hon. Friend the Minister for Social Security and Disabled People. Nevertheless, because there is rather more interdepartmental co-operation than the Opposition spokesman gave us credit for, I will be able to answer other points raised under those other departmental responsibilities.

Clearly, how the consultative document will translate into law is a matter on which I cannot give detailed advance notice tonight, even if I had all the details at my disposal. However, there will indeed be guidance to employers about the implications of employing people with different types of mental illness and the types of reasonable adjustment that could be made in respect of employing them. We do not yet know whether that will be guidance or a formal code, as the hon. Gentleman requested, but there will be guidance, and it will not just be on mental illness en bloc. There will be guidance in respect of different types of mental illness. I hope that the hon. Gentleman is reassured on that point.

I support what the hon. Gentleman said about the public perception of depression. I think that that spills over into employers' perceptions of depression and how it affects the individual's ability to work. I hope that the disability legislation which we will be introducing in the current Session will focus employers' minds on the issue.

The hon. Gentleman raised the question of access to work and suggested that, whereas the scheme does very well by the physically disabled, perhaps it is less efficient in assisting those with mental illness. The scheme makes provision for support workers to attend in the workplace people with mental problems, or those who have had problems in the past. The support workers smooth people's transition into work, set up communications with colleagues and support them when they perhaps feel uncertain in the early stages.

However, the Government are always interested to hear further suggestions about what else the access to work scheme could provide. It is a highly successful scheme which has been broadly welcomed and generally praised, and we would be delighted to consider any suggested refinements to it. I am always willing to receive representations from the hon. Gentleman, either by correspondence or in person— as I told him earlier in the day.

The hon. Gentleman drew a comparison between a prisoner and a mental patient in terms of the information that must be revealed when applying for employment. He suggested that mental conditions did not need to be declared after five years. I point out to him that, even in the case of discharged prisoners, in some occupations it is possible to make inquiries about a person's previous convictions. I am sure he will agree that one cannot make a sweeping generalisation: in certain circumstances—particularly where the safety of others is concerned— it may be appropriate to inquire about someone's medical history, including his or her mental medical history.

The hon. Gentleman asked for a clear legal framework on discrimination. I hope that he will not be disappointed with the Government's disability legislation. He queried whether tribunals were the best place to hear claims for discrimination on grounds of mental disability.

The advantages of tribunals are that they are cheap, informal and, despite the hon. Gentleman's reservations, they are probably the simplest court in which to operate. It is possible to be represented either fully legally or at a lesser level, and I think that, if we are to make sense of anti-discrimination laws as they apply to disability, our tribunals already have ample experience in interpreting the niceties of discrimination law in respect of sex and race. Those bodies have experience in dealing with both employers and complainants.

Obviously at the moment I cannot set out the details of what redress will be available to complainants, how it will be available, and what the procedures will be. That will be made known when the legislation is finalised and brought before the House.

The hon. Gentleman queried the working of the disability working allowance. I share his disappointment at the low take-up generally—quite apart from the low take-up among those with mental illnesses. The figure is somewhat higher than he suggested: it is now 4,562. The Policy Studies Institute has released an encouraging report which states that, although take-up is low, the trend seems to show that the allowance is reaching the people whom it is meant to target. There is a note of cautious optimism there. Nevertheless, the Government have seized on the fact that the take-up of disability working allowance has not been as rapid or impressive as we would have liked. Therefore, various initiatives have been taken to ensure that DWA customers are better off in work rather than, as the hon. Gentleman suggested, possibly facing some sort of poverty trap.

We have now raised the threshold for single people from £43 to £54.75 a week. When that is implemented, it will raise the point at which single people float off DWA from just over £108 a week to £120 a week. We have also addressed the rate for couples and lone parents, whose allowances will be increased from £63.75 to £73.40 a week. We have also decided that DWA recipients with less than £8,000 in savings will now qualify for remission from NHS charges, bringing them into line with those receiving income support and family credit.

We have also adjusted child care elements. Earnings up to £40 a week will now not be taken into account when we calculate entitlement to family credit, housing benefit, council tax benefit and DWA. There have been various other initiatives which I will not go through in detail. I shall write to the hon. Gentleman about those if he is interested.

The hon. Gentleman also raised the question of the statutory instrument which has been laid, and the issue of the procedures which those claiming invalidity benefit must go through if they are mentally—

Dr. Bray

Incapacity benefit.

Miss Widdecombe

The hon. Gentleman is quite right. He raised the issue of the procedures that those claiming incapacity benefit have to go through if they are suffering from mental illness or disability. It is true that those procedures were not specified in the regulations, as it was not believed to be necessary to do so. It was never intended that the same questionnaires would have to be filled in by those suffering from mental illness. My hon. Friend the Minister for Social Security and Disabled People has written to the Royal College of Psychiatrists to offer reassurance on that point and to say that, since the matter has caused concern, the explanation will now be made explicit through necessary amendments.

Dr. Bray

Will it be made explicit by including mental illness among the types of illness which do not require a works test?

Miss Widdecombe

I will have to write to the hon. Gentleman on that point, as that is the responsibility of my hon. Friend the Minister for Social Security and Disabled People. I have been told that he has written today to the Royal College of Psychiatrists to offer the necessary reassurances, and to make it clear that those would be made explicit. I cannot comment on the exact nature of the wording to the hon. Gentleman and therefore I will have to write to him. I also entirely endorse the hon. Gentleman's support for supported employment and for sheltered workshops. I very much value those schemes, as do the Government. I endorse what he says about the efficiency of the schemes in dealing with people who are suffering from the type of disability that he mentioned.

I turn now—with some reluctance, I must admit—to the speech of the hon. Member for Makerfield (Mr. McCartney). May I first congratulate him on his appointment, and secondly apologise for just not noticing him? He and I share one disadvantage, which is that when we are sitting behind the Dispatch Box, we disappear.

Mr. McCartney

The Minister should get a high chair.

Miss Widdecombe

Perhaps the hon. Gentleman should get a high chair, as I totally failed to notice him.

Having noticed the hon. Gentleman and listened to his speech, I must say that I thought it introduced a jarring note into what had been, up to that point, a series debate. The hon. Gentleman tried to lay the blame for mental illness, suicide and just about every other disaster which could befall an individual at the door of the Conservative Government. I regard that as a trivialisation of an extremely serious subject, which had been receiving a proper debate in the House until that moment.

Mr. McCartney

Will the Minister give way ?

Miss Widdecombe

I listened to the hon. Gentleman—

Mr. McCartney


Madam Deputy Speaker (Dame Janet Fookes)

Order. The hon. Member for Makerfield (Mr. McCartney) knows full well that if the hon. Member who has the Floor does not give way, he must resume his seat.

Miss Widdecombe

Thank you, Madam Deputy Speaker.

Since the hon. Gentleman raised so many issues, some of them should be addressed. We heard the old myth that part-time work is a source of stress and is somehow second-rate work. That assumption completely ignores the results of the labour force survey, which is completely independent and is not written by the Government. That survey found that 87 per cent. of those who are in part-time work are not in that work because they could not find a full-time job. I should have thought that, given the subject of the debate, the hon. Gentleman would have welcomed the availability of part-time work because it offers opportunities for precisely the type of people we have been talking about—people suffering from specific types of illness—to ease themselves back gently into the workplace.

Mr. McCartney

Will the Minister give way?

Miss Widdecombe

No. I listened in silent disbelief to the hon. Gentleman's rant and I now intend to address his points without taking any further nonsense from him.

The hon. Gentleman then said that the British feel very much worse than their European colleagues because of their employment situation. What an extraordinary comment, when we have a lower than average European unemployment rate and a high percentage of part-time work. It is all very well making comparisons of how workers feel appreciated at work, but the first and most important thing is to ensure that they have work in the first place. We appear to be doing rather well on that point.

The hon. Gentleman then called for a proper Government strategy. I can only conclude that he has never read "The Health of the Nation", in which we made mental illness one of the five key areas; set targets for improving the health and social functioning of mentally ill people; set a target to reduce the suicide rate of the mentally ill by 33 per cent. by 2000; and set out a three-year public information strategy to try to combat stigma and attitudes, in which we aim to increase understanding, reduce stigma and help users to understand their rights and responsibilities.

The hon. Gentleman then raised the issue of training—at that point I had sympathy with his remarks. The training and enterprise councils operating agreement requires TECs to ensure that suitable high-quality training for work is made available to all participants who are shown by assessment to have disabilities or other special needs. That specifically includes people with mental health problems. I agree with him that we must monitor that agreement carefully to ensure that it is realised in the practice as much as in the theory. I share that aspiration.

People with disabilities, including those with mental health problems, are eligible for training for work, regardless of how long they have been unemployed. They also have recruitment priority for suitable places. About 11 per cent. of people who start training for work have a disability; that is an encouraging statistic, but it is one on which we could obviously build.

The hon. Gentleman spoke about interdepartmental co-operation. An inter-agency group has been set up by the Government, which advises on improving mental health in the workplace. The Government are working to improve employers' awareness of mental health issues. In November 1994, which was not a million years ago, we published the "ABC of Mental Health in the Work Place". In October, the Secretary of State chose the subject of mental health to speak on at the Confederation of British Industry conference. In July, the Department of Health ran a stand on mental health in rural areas at the royal agricultural show. None of that detailed attention is the mark of a Government who are ignoring the issue.

I should now like to consider the serious speech of the debate and to answer the points raised by the hon. Member for Motherwell, South. We recognise that manic depression is a serious mental illness and a serious disability. It causes profound changes in mood. It can swing an individual from severe depression and deep lethargy to high elation and over-activity. Such mood changes significantly affect a person's ability to function in all aspects of life, including the workplace. The illness typically follows the pattern of remission and relapse, but it can generally be controlled by mood-stabilising medication. Consequently, people who even have severe manic depression can often function perfectly well for much of the time.

People who have the illness are covered by the same employment legislation as those with other disabilities and they can benefit from Government help that is available to disabled people in the labour market. Current legislation on the employment of disabled people is contained in the disabled persons employment legislation that we introduced this year, under which the quota scheme was established. Hon. Members may recall that the scheme imposes a duty on all employers with 20 or more employees to employ registered disabled people as 3 per cent. of those employed. It is abundantly clear, however, that the scheme is not working as intended and does not meet the needs of disabled people.

The quota scheme does not take account of people who become disabled while in employment as the enforceable duties relate only to recruitment and dismissal. In addition, many disabled people think that the entire approach of the scheme stereotypes and stigmatises them.

People with disabilities are increasingly asserting the wish to be treated as individuals and to train and work alongside non-disabled people. They wish to earn their own living in productive jobs on the basis of their abilities. This change in the aspirations of disabled people has increased their reluctance to register as disabled. There are now only about 1 per cent. of registered disabled people in the labour force, many fewer than would allow the 3 per cent. quota to operate as it was originally designed.

My hon. Friend the Minister with responsibilities for disabled people has therefore announced that we intend to replace the quota scheme with a new statutory right that will protect disabled people from unjustifiable discrimination in employment. We know from the response to our consultation document, which was published in July, that the measure will win the support of many disabled people and their representatives. It will be a major step forward in improving the work position of people with disabilities.

The legislation that we propose to introduce will make it unlawful for an employer to treat a disabled person less favourably than a non-disabled person unless there are justifiable reasons for the difference of treatment. Employers will be required to make a reasonable adjustment to the workplace or to working practices where to do so would help to overcome the practical effects of an individual disability.

Under that legislation, disabled people who consider that they have been the victims of discrimination in employment will be able to make a complaint to an industrial tribunal, as I have already said. The proposals and remedies will be broadly the same as those in relation to complaints under other discrimination legislation. The Advisory, Conciliation and Arbitration Service will similarly offer the full range of its conciliatory services. We shall be consulting on a statutory code of practice to accompany the new Bill. We shall take into account representations such as those made by the hon. Member for Motherwell, South this evening. The consultation will be painstaking and thorough. We shall want to be sure that the code takes account of the views and needs of the fullest range of people with disabilities and their representative organisations, and of employers, on good employment practice.

Dr. Bray

I am glad to hear the Minister's intentions. I hope that she will listen also to my hon. Friend the Member for Makerfield (Mr. McCartney). I assure the hon. Lady that he is a sensitive, active and able advocate on behalf of the causes of which she is speaking.

Miss Widdecombe

I recognise the hon. Gentleman's courtesy to his colleague. I shall read what the hon. Member for Makerfield said. If I can extract anything from it that appears to be a sensible proposal, I shall, of course, take it into account. Most of it, however, will be lost in the rhetoric of how the Government are responsible for all ills.

Mr. McCartney


Miss Widdecombe

The speech was indeed rather pathetic—I found it so.

The new right will apply to persons with a physical or mental impairment that is long term or recurring and has a substantial effect on the person's ability to carry out normal day-to-day activities. It will not, therefore, apply to someone with a temporary disability, such as a broken leg, but people with a long-term substantial or recurring depressive illness—hence manic depression—would be covered.

More generally, the Government would always encourage employers to treat all their employees with the consideration due to them, and to adopt fair and objective personnel policies which maintain a high degree of employee morale and commitment. A comprehensive framework of statutory employment protection rights exists to safeguard employees against unreasonable treatment by their employers, and naturally that applies to individuals with a disability in the same way as it does to other employees. The Government have recently extended and enhanced those rights, including especially provisions in the Trade Union Reform and Employment Rights Act 1993.

We are committed to safeguarding legitimate rights of employees, but we must be careful not to damage employment opportunities by imposing excessive financial and administrative burdens on employers. We are satisfied that the current employment protection legislation strikes the correct balance between the rights of employees and the costs to employers, but we stand by our long-term policy of educating and persuading employers to implement good practice in the employment of disabled people.

We aim to enable disabled people to progress as far and as fast as their talents and capabilities allow. The Employment Service network of placing, assessment and counselling teams will continue their work with employers, providing specialist advice and helping them to adopt good policies and practices. Significant progress has already been made, with more than 950 employers now using the disability symbol—twice as many as did so this time last year.

We have debated much tonight about what should be done, but perhaps one should also consider what has been achieved and pay tribute to that. I believe that he introduction of disability working allowance, the carer's premium in income support, the improvements that we made during the passage of the TURER Act, the disability symbol, the work done by placing, assessment and counselling teams and the continuing support that we give to Remploy and other organisations provide solid evidence of our commitment to disabled people. More than 53,000 disabled people were helped to find work last year by Employment Service advisers.

The debate has been useful, and for the most part constructive. I repeat my congratulations to the hon. Member for Motherwell, South. I am glad to be able to share many of his aspirations and I hope that, in turn, he will give a genuine and enthusiastic welcome when our Disability Bill comes before the House.

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