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

For hundreds of years, people have tried to condemn the “vain” and “weak” for their ills, without any evidence or effectiveness.

Measures to punish, coerce and humiliate the poor and sick have always proven counterproductive, while improving the conditions of people’s lives and their environment has improved health and productivity.

The latest attempt to pass on societal failings to those who suffer most comes from the Prime Minister and the Secretary of State for Work and Pensions, who have suggested that absence from the workplace due to mental ill health is more likely to be a cultural rather than a clinical or social problem.

Last week the Prime Minister said the ‘sick note culture’ was leading to people being fired for ‘over-medicalising’ normal concerns by diagnosing them as mental health problems. It follows a statement from Mel Stride who claimed the ‘mental health culture’ meant 97% of people who reported to their GP because they were ‘feeling bluesy’ were out of work. No reference has been cited or found for this figure.

There is no evidence that the dramatic rise in mental health problems is anything other than a reflection of a real increase in psychological problems predicted by experts based on modeling and analyzing the effects of austerity and Covid-19 and the costs of… living crises.

Nearly a decade ago, in 2015, the government was warned by health experts such as the King’s Fund that cutting the public health subsidy by 26% was the ‘falsest of all false economies’. Ministers were told that such cuts would undermine preventive services, leading to more disease, premature deaths and more expensive healthcare use and economic inactivity. Unfortunately, this prediction came true.

Since then, Public Health England has been dismantled in the middle of a global pandemic, and the successor body charged with preventing mental health problems, the Office for Health Improvement and Disparities (OHID), has been reduced by around half. Former Conservative Health Secretary Lord Bethall was among those who warned that OHID has been ‘decimated’, hampering its ability to prevent disease.

In addition to direct cuts to public health, the wider services that support mental health have also been reduced, including health visitors, Sure Start centres, youth services, libraries, leisure centers and parks, all of which have seen their budgets drastically cut as local authorities have cut back. lost 40% of its purchasing power due to central government cuts.

In addition, social determinants of health such as poverty, child development and discrimination, which account for more than 50% of health outcomes, have risen sharply. The latest British poverty report from the Joseph Rowntree Foundation found that between 2017 and 2022, the number of children living in poverty (without basic needs) more than tripled to over one million. In short: poverty in Britain is increasing. Tragically, because child poverty is closely linked to abuse and neglect – the leading causes of mental health problems across the lifespan – it is not surprising that the incidence of cruelty against children and young people in England and Wales increased by almost 400% between 2010 and 2011. increased. and 2022/23.

We know that racism is another key social determinant of mental health inequality, with black people in Britain experiencing significantly worse outcomes than white people due to discrimination. Hate crime increased by 275% between 2012/13 and 2021/22, highlighting greater discrimination leading to poorer mental health outcomes. The government’s rhetoric about creating a ‘hostile environment’ for refugees, asylum seekers and immigrants (leading, for example, to the Windrush scandal in which black British citizens were illegally deported) has undoubtedly contributed to discrimination against racialized communities, with serious consequences for the population. mental health.

Rather than blaming people who have become unwell – at least partly as a result of policies the Government was warned would increase the disease – ministers should focus on tackling the causes and consequences of mental health problems. It is within the government’s power to tackle rising mental health problems by reducing poverty and discrimination and improving access to the opportunities people need to live healthier lives. The Center for Mental Health has taken the lead in coordinating such a range of policies, set out in A Mentally Healthier Nation, endorsed by more than 60 organizations involved in mental health in Britain. We must and can do better than inventing “cultures,” rather than addressing the very real, but solvable, problems that society has created.