| 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. 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. 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.” 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. 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.” | 