Monday briefing: The truth about claims people ‘use’ their mental health to avoid work
Good morning, and happy Easter. Story after story in recent months – and years – has led to the same conclusion, from Conservatives and Labour alike: the British state simply cannot afford to do what it used to.
If the “magic money tree” is bare, that leaves two possibilities: either people who really need help won’t get it, or people are getting help who don’t really need it. The first of these is not an admission that the government is likely to make. And so they are forced to rely on the second.
Once you notice this theme, it’s everywhere. Jeremy Hunt says benefits must be restricted for those “who don’t even look for work”; Esther McVey says that councils facing a reduction in central government funding of 40% since 2010 are simply “wasteful”. And earlier this month, work and pensions secretary Mel Stride (above) came out with a particularly striking example – telling the Daily Telegraph that some of those being signed off work with mental health problems are “convincing themselves they have some kind of serious mental health condition as opposed to the normal anxieties of life”.
There is no dispute that more benefit claimants are reporting mental health problems. But the contention that this is because many are gaming the system is heavily contested. For today’s newsletter, I asked Tom Pollard, the head of social policy at the New Economics Foundation who spent 18 months seconded as a mental health policy adviser at the Department for Work and Pensions, to explain. Here are the headlines.
Five big stories
Israel-Gaza war | Israel has given the UN a proposal to dismantle Unrwa, its relief agency in the Palestinian territories, and transfer its staff to a replacement agency, according to UN sources. Israel has refused to deal with Unrwa since last Monday, on the basis of as-yet unproven claims of affiliations of some of the agency’s staff with Hamas or Islamic Jihad.
NHS | Almost 14,000 people died needlessly last year in England while waiting in A&E for up to 12 hours for a hospital bed, a new estimate suggests. Calculations by the Royal College of Emergency Medicine (RCEM) based on a large study of excess deaths and waiting times show that 268 people are likely to have died each week in 2023 because of excessive waits in emergency departments.
Turkey | Turkey’s main opposition party dealt an unexpected blow to Recep Tayyip Erdoğan’s rule on Sunday with a sweeping victory in Turkey’s local elections. The results were viewed as symbolic of dissatisfaction with Erdoğan, who was at the forefront of his party’s campaign to retake the Istanbul mayoralty.
Culture | The Information Commissioner’s Office is investigating the British Museum over claims it has been overly secretive about a group of sacred Ethiopian altar tablets hidden from view for over 150 years. The museum acknowledges the artefacts were looted by British soldiers but has long resisted calls for them to returned to Ethiopia.
Monarchy | King Charles attended the annual Easter Sunday service at Windsor Castle, his first major public appearance since he was diagnosed with cancer. The king, 75, smiled and waved as he joined Queen Camilla at the Easter Mattins service at St George’s Chapel. The Princess of Wales and her family were absent as she continues her cancer treatment.
In depth: ‘People don’t drop out of work because they saw a TikTok about stress’
When Stride warned that “we are labelling the normal ups and downs of human life as medical conditions which then actually serve to hold people back and, ultimately, drive up the benefit bill”, he also noted that he was “grateful for today’s much more open approach to mental health”.
It was left to Telegraph columnist Judith Woods to put the argument more emphatically: “Increasingly, every day’s a Pity Party in UK plc,” she wrote. “We are all paying the price for Generation Feeble.”
The DWP says that its reforms will cut the number of people on the highest tier of incapacity benefits by more than 370,000, and notes that research shows that having a good job improves people’s mental health. Stride (above) also said he wanted “an honest, grownup debate”. In that spirit, here’s some of the evidence about the reality of those claims.
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Why has the number of people reporting mental health problems increased?
There is little doubt that public attitudes to mental illness have changed markedly in recent years: surveys show that people are more willing to discuss mental health issues, and less likely to distance themselves from those in crisis. “In the time I’ve been working in mental health, certainly there is a bit less stigma,” Pollard says. “That means that some people are more willing to come forward.”
But there is also robust evidence that worsening economic circumstances tend to worsen people’s mental health. “There are really well-established links in peer-reviewed studies between poverty, or low-quality work, and poor mental health,” says Pollard.
Although it’s true that a “good job” can be good for mental heath, precarious minimum wage employment can have the opposite impact, as this study shows. This research shows how cold homes negatively affect mental health; this evidence review shows links between job loss and depression and rising suicide rates during periods of economic downturn.
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Are people ‘convincing themselves they have some serious condition’?
The argument made by Stride and his allies that mental health awareness has “gone too far” evokes images of gen Z’ers posting videos claiming a mental health problem when in reality they are “a bit low”. The ONS reported that recent increases in economic inactivity have been driven primarily by younger adults. Meanwhile, the Time To Change mental health campaign found that more people considered stress or grief as mental illnesses in 2017 than in 2009.
But that effect is likely to be less powerful among those claiming benefits than those in more stable economic circumstances – and younger adults are often the most economically vulnerable. “People on low incomes are often also those who may not trust services or face stigma in their communities,” Pollard says. “So they may not come forward with a problem, and only seek help when they’re at crisis point.”
Meanwhile, other factors push in the opposite direction: whatever advances have been made, there are still significant taboos around discussing mental health, with more than half of those living with mental illness in the UK saying they feel shamed because of it.
“My experience is that it is not common for people to go to the length of dropping out of work because they saw a video on TikTok talking about stress,” Pollard says. “It doesn’t chime with reality. I’m sure there are examples of people using the system nefariously, but on the whole most people associate working with being well, and most people want to be well.”
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Are people being signed off work too easily?
Stride claimed that if people “go to the doctor and say ‘I’m feeling rather down and bluesy’”, they will be given an average of seven minutes for an appointment – “and then, on 94% of occasions, they will be signed off as not fit to carry out any work whatsoever”.
But that 94% figure may not be right. It comes from NHS data between April 2021 and September 2023 that covers all fit notes, not just those given for mental health reasons: I asked the DWP for a figure for mental health issues specifically, and they couldn’t provide one. They said that 37% of fit notes issued from October 2022 to September 2023 with a known diagnosis were for mental and behavioural disorders.
GPs, meanwhile, complain that the brevity of appointments is the result of a vastly unmanageable workload, not because they aren’t trying to assess claims properly. Dr Victoria Tzortziou Brown, vice chair of the Royal College of GPs, says that “today’s GPs and their teams are incredibly and increasingly thinly stretched”, delivering 4.7m more appointments this January than in January 2019, with 3% fewer GPs.
In any case, says Pollard, “there is this idea that there’s an easy path to a life on benefits from that point, with a flick of a switch – but after you get signed off by a GP, then you have to be assessed by the benefits system. The work capability assessment (WCA) often leaves people in limbo for six months or more, and then a lot of people are put off by the long form they have to fill in, or get told that they have to work.”
DWP data shows that, on top of whatever number are rejected by GPs, more than 14% of those claiming a mental or behavioural disorder were found to have “no limited capability for work”. In the end, the rejection rate is significantly higher than Stride implied.
We should also note that while 69% of people who received WCA decisions in 2022 and 2023 had mental and behavioural disorders, that is often alongside another health problem: research by the IPPR thinktank found that three-quarters of those who are economically inactive because of their health have two or more conditions. And if you have a disability or illness that is stopping you from working, it stands to reason that it may affect your broader wellbeing.
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What impact does this approach have on the way the system operates?
Stride’s comments were the observations of a single minister, on a single day – but the follow-up since is evidence of how even those who miss a story like this may find it affecting how they are viewed. “It’s hard to be precise about how this filters down to people’s day-to-day experience,” Pollard says. “But it does seem likely to add to the general atmosphere of suspicion.”
In 2019, Pollard wrote about his conclusions from his time at the DWP, and said that an approach predicated on motivating people to return to work through the threat of cutting off their benefits “creates fundamental barriers to engaging people from ‘harder-to-help’ groups”.
“There is already this adversarial tone to these relationships,” he says now. “People feel they’re under suspicion, and that doesn’t create a conducive environment for getting that person back to work. A lot of this narrative risks fuelling that stigma again.”
What else we’ve been reading
Why won’t Liz Truss (above) go away? David Runciman’s superb piece for Saturday magazine makes a surprisingly apt comparison with Brian Clough, and notes: “She still carries such an aura of spectacular failure that any public appearance looks like a triumph of will.” Archie
A federal raid and multiple civil claims of sex trafficking and sexual abuse have put the spotlight on Sean “Diddy” Combs, formerly known as P Diddy. Edward Helmore tracks the career of the hip-hop mogul and the often ignored signs of troubling behaviour towards women. Nimo
Cissy Jones’s livelihood as a voice artist working primarily in video games was severely threatened by artificial intelligence. She knew there was no putting the genie back in the bottle, so Jones fought back by creating an AI company that coexists with actors. David Smith spoke with voice actors about their fears and hopes about this new frontier in the video game industry. Nimo
This is a wonderful essay by Andrew O’Hagan, author of the forthcoming novel Caledonian Road, about leaving home: how he dreamed of it, what it meant to his parents, and how the rite of passage has transformed in the 30 years since. Archie
A decade ago, Lee Tilghman was a queen bee of influencing, earning $15,000 per post through her wellness content and aesthetic. Her life has changed dramatically since those days – Deborah Linton asks what prompted the shift. Nimo
Sport
Premier League | Manchester City and Arsenal played out a 0-0 draw at the Emirates, the first time in 58 matches that City have been held goalless at home. This was “a game that wasn’t really a game, a decider that decided very little, beyond keeping the Premier League title race still tantalisingly open,” wrote Barney Ronay. The result was good news for Liverpool, who finished the day top of the league after beating Brighton 2-1 thanks to a second-half winner from Mohamed Salah (above).
Continental League Cup | Arsenal’s 1-0 victory over Chelsea in the final of the Continental League Cup was overshadowed by Frida Maanum’s off-the-ball collapse deep into injury time. Maanum, seemingly unresponsive and requiring oxygen, was later said to be conscious, stable and talking to medical staff.
Boating | Organisers of the Boat Race have contacted Oxford to get more information on the cause of the sickness bug that struck down several members of their men’s team. River Action UK found dangerously high levels of E coli bacteria on the River Thames course.
The front pages
On this Easter Monday the Guardian print edition leads with “Plan to scrap non-dom status ‘is full of loopholes’ for super-rich”. “Sunak’s small boats plan ‘at risk’ from Home Office indecision” says the i, while the Financial Times has “Companies launch wave of bonds to hedge against US election volatility”. “King’s show of strength” – that’s how the Daily Mirror covers Charles’s appearance at an Easter service in Windsor, “his first tentative steps back into public life” since his cancer diagnosis. “Get well soon! King jokes: ‘I’m doing my best!’” – that’s the Daily Express. We’ll give the Sun its due: “Return of the king”. His majesty is the main picture on other front pages as well. The Daily Telegraph places this story alongside him: “Council tax to double for 80pc of second homes”. In the Daily Mail it’s “250 needless deaths each week due to agonising waits in A&E” while the Times says “Long waits in A&E kill 250 people every week”.
Today in Focus
The birdwatcher fighting racism in public spaces
A Central Park birdwatching incident went viral after Christian Cooper filmed a white woman threatening him. Now he is using his platform to share his passion for nature
Cartoon of the day | Edith Pritchett
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The Upside
A bit of good news to remind you that the world’s not all bad
Throughout his childhood, David Smith had an aptitude for history. He would turn bedsheets into togas so he could pretend to be a Roman and spent school holidays learning hieroglyphics.
He wanted to channel this passion into teaching but ended up dropping out of college and picking up odd-jobs. Smith’s life changed when he posted a picture of himself in a cheap Henry VIII costume (the Tudor era was always his favourite) on social media. Smith was inundated with messages from people suggesting he join a re-enactment group, so he did. One £2,000 historically accurate costume later, the jobs came rolling in.
Soon after Smith was travelling around the country most weekends, performing as Henry at special events. Now, he is doing his dream job, working in schools as Henry full-time.
Sign up here for a weekly roundup of The Upside, sent to you every Sunday
Bored at work?
And finally, the Guardian’s puzzles are here to keep you entertained throughout the day. Until tomorrow.
