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Claims of ‘sick note culture’ distract from the real causes of mental ill health

22 April 2024
By Edward Davie

For hundreds of years people have sought to condemn the ‘idle’ and ‘feckless’ for their ills without any evidence or efficacy.

Measures to punish, coerce and humiliate the poor and sick have always proved counterproductive, while improving the circumstances of people’s lives and their environments have improved health and productivity.

The latest attempt to shift societal failings onto those suffering the most has come from the Prime Minister and the Secretary of State for Work and Pensions, who have implied that workplace absence due to mental ill health is a cultural rather than a clinical or social problem.  

Last week the Prime Minister said that ‘sick note culture’ was leading to people being signed off work for ‘over-medicalising’ normal worries by diagnosing them as mental health conditions. It follows a statement from Mel Stride who claimed that ‘mental health culture’ meant that 97% of people presenting to their GP for ‘feeling bluesy’ are signed off work. No reference was cited, or can be found, for this figure. 

There is no evidence that the dramatic rise in mental ill health is anything other than a reflection of a real increase in psychological problems that have been predicted by experts based on modelling and analysing the effects of austerity and the Covid-19 and cost-of-living crises.

Nearly a decade ago, back in 2015, the government was warned by health experts like the King’s Fund that cutting the public health grant by 26% was the ‘falsest of false economies’. Ministers were told that such cuts would undermine preventative services leading to more illness, premature death and more expensive health service use and economic inactivity. This prediction has sadly come to pass.

Since then, Public Health England has been dismantled in the midst of a global pandemic, with its successor body in charge of preventing mental health problems, the Office for Health Improvement and Disparities (OHID), reduced by about half. Former Conservative health minister Lord Bethall has been among those warning that OHID has been ‘decimated’, hampering its ability to prevent illness. 

Aside from direct cuts to public health services, wider services that support mental health have also been reduced including health visitors, Sure Start centres, youth services, libraries, leisure centres and parks, which have all seen their budgets cut drastically, as local government has lost 40% of its spending power through central government cuts.

In addition, social determinants of health, like poverty, child development and discrimination, which account for over 50% of health outcomes, have risen sharply. The latest UK Poverty Report from the Joseph Rowntree Foundation found that between 2017-22, the number of children living in destitution (without basic essentials) more than trebled to over one million. In short, poverty in the UK is deepening. As child poverty is closely associated with abuse and neglect – leading causes of lifetime mental ill health – it is tragically not surprising that the number of cruelty to children/young persons offences recorded in England and Wales has increased by nearly 400% between 2010/11 and 2022/23. 

We know that racism is another leading social determinant of mental health inequalities, with Black people in the UK experiencing significantly worse outcomes than white people due to discrimination. Hate crimes have increased by 275% between 2012/13 and 2021/22, indicating worse discrimination that drives worse mental health outcomes. Arguably, government rhetoric on creating a ‘hostile environment’ for refugees, asylum seekers and immigrants (that led, for example, to the Windrush scandal in which Black British citizens were illegally deported) has contributed to discrimination against racialised communities, with dire consequences for mental health. 

Rather than blame people who have become unwell – at least partly as a result of policies the government was warned would increase illness – ministers should focus on tackling the causes and consequences of mental health problems. It is within the Government’s power to tackle rising mental ill health by reducing poverty and discrimination, and improving access to the opportunities people need to live healthier lives. Centre for Mental Health has led the way in coordinating such a set of policies set out in A Mentally Healthier Nation endorsed by over 60 organisations involved in mental health in the UK. We must and can do better than inventing ‘cultures’, rather than addressing the very real, but solvable, problems society has created. 

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