Each batch of new statistics reveals the scale of Britain’s mental health crisis. This week, we learnt that the number of people claiming health benefits because they are deemed too sick to look for work has, for the first time, topped three million. Since the start of 2022, nine-in-ten new claims have been for people with ‘mental and behavioural disorders’. Anxiety and depression are the two most common mental health conditions.
‘Here’s some money, now go away,’ is the blunt message that has been sent to three million citizens
Last year alone, doctors signed off 956,000 ‘fit notes’ citing mental health as the primary reason people were unable to work, far exceeding any other condition. Yet as GPs are under no obligation to explain why someone is incapacitated, and 72 per cent of these bizarrely-named notes provide no reason why someone cannot work, we can safely assume the real number is likely far higher.
These figures matter. Supporting more than three million people deemed unable to work comes at a cost. Since 2022, more than 1.5 million new Universal Credit claims have been awarded to people with mental and behavioural disorders. The proportion of those in receipt of Universal Credit health benefits who have no requirement to look for work has doubled from 39 per cent in 2019 to 78 per cent today. The Office for Budget Responsibility forecasts that the cost of sickness and disability benefits will rise to £110 billion a year by the start of the next decade if caseloads continue their current trajectory.
Right now, there is little reason to think that anything will change. This week, research carried out by the BBC found that hundreds of doctors have never refused a request to sign someone off work for mental health issues. Of the 752 GPs who responded to the BBC’s survey, an astonishing 540 said they had never turned down a patient asking for a ‘fit note’ because of poor mental health.
These GP certificates, seemingly doled out unquestioningly, are the first step to people leaving employment and claiming sickness benefits. According to the Department for Work and Pensions, eight in ten Britons on incapacity benefits now receive up to £5,000 a year in extra cash without needing to look for a job at all. It is perhaps unsurprising then that some doctors report patients becoming aggressive if they are not signed off work. One GP told the BBC that a patient had refused to leave the practice without a fit note.
With just a brief appointment slot to assess and reach a decision about potentially aggressive patients, it is perhaps understandable that GPs avoid arguments and reach for the fit notes. And whereas many physical conditions can be objectively verified – my leg is either broken, or it is not – no x-rays or stethoscopes can tell whether someone is genuinely suffering from anxiety or depression.
To this extent, doctors are on the sharp end of a cultural malaise. For more than a decade now, mental health awareness-raising campaigns have encouraged people to look inwards, to contemplate their mental state and to know it is OK not to be OK. At school, at university, and through social media, young people are taught to see themselves as vulnerable and that their normal emotional states are really signs of illness. And life can, of course, be tough. Working from home can leave people isolated and lonely, yet still worrying about paying the bills. For all these people, the GP’s surgery becomes their first port of call.
Signing people off work – perhaps indefinitely, and with generous benefits – no doubt seems like an act of kindness to some doctors in a hurry. But it does no one any favours. It not only places an unsustainable strain on taxpayers, it also fails to help those in need.
Time and again, evidence shows that the longer people are out of work, the more difficult it is for them to return to employment. The best way to find a new job is to already be working. Doling out sick notes and parking patients on benefits might seem compassionate – it is, after all, easy to be generous with other people’s money – but consigning people to a life of unemployment, with no expectation they will ever work again, risks telling them their lives are devoid of meaning or purpose. ‘Here’s some money, now go away,’ is the blunt message that has been sent to three million citizens.
Neither is this system helping those whose mental health problems are far more serious than anxiety and depression. A sick note, an increase in benefits, and no need to find work leave severely mentally ill people free to disengage from medical appointments and society more broadly. This does nothing to improve their condition.
Neither doctors nor the benefit system has created our unsustainable mental health crisis, but nor are they doing anything to help us get out of this mess. We urgently need to rethink how we diagnose mental illness and what we expect from those labelled unwell.
