Supporting people to thrive

The College's President, Dr Lade Smith CBE, has written this blog post as part of the College's contribution to International Day of Persons with Disabilities.

People living with severe mental illness can be productive in society and this is too often ignored.  As a profession, psychiatrists have a unique role in advocating for a person-centred welfare system that is fair and supports people to reach their potential.  

We all understand that if someone’s leg is injured then they might need to use crutches while they recover, but some of us still struggle to accept the idea that something similar could happen to our mind, in terms of the illness and recovery cycle. I can assure you that few things in life take more effort than overcoming mental illness.

On International Day of Persons with Disabilities, it is important to reiterate our commitment to building a society where people with severe mental illness are supported to thrive.

Too many people with severe mental illness don’t get the help they need to stay well and end up living in or on the edge of poverty, which makes it more difficult for them to contribute to society. We need to invest in their potential if we want to create a fairer society that takes advantage of all they have to offer.  

The Government recently took a welcome step towards a fairer welfare system, by increasing investment in NHS Individual Placement Support. This programme provides people with severe mental illness who are able to work, with the tailored support they need they need to return to the workplace.

RCPsych was quick to welcome this. We have been calling on this investment for years.

However, the Government have also complained that there are too many people away from work because of mental health problems who could work if they wanted to, questioning the validity of their diagnoses. For the avoidance of doubt, the situation over the past few years, with the pandemic and the cost-of-living crisis has created the very conditions that make people mentally sick. It is no surprise then that there has been a significant increase in mental illness, particularly amongst young people.

It has been suggested that people with mental illness could better optimise the opportunity to work from home. Mental illness doesn’t stop when people are at home and being isolated often exacerbates mental health problems.  In fact, many patients would be more likely to get back to work if reasonable adjustments were made in the workplace. 

The existing welfare benefits system, with work capability assessments and job coaching is rigorous and already a source of stress for many of my patients, who dread having to complete job applications they find too difficult, or demonstrate why they aren't able to work.

The evidence is clear. Punitive sanctions push people into debt, or even homelessness. Withdrawing benefits also puts people with mental illness at greater risk of thoughts of self-harm and suicide. This not only has a substantial impact on their health and impacts their family, but also ends up costing other services more money in the long run. 

It is true that we can’t turn a blind eye to the number of people who feel so debilitated by mental illness that they are unable to work. Mental illness has overtaken mobility as the leading cause of impairment among working aged disabled people. Being out of work can add to feelings of isolation, which in turn can lead to suicidal ideation.

People with severe mental illness should return to work if they are able to do so. Purposeful activity is good for mental health. To support this, we must see a return to person-centredness in our welfare system, and a desire to treat those who are out of work with compassion and fairness. This is not just ethical, but also the most effective way to help people back to work.

In the long-term, we need to start considering good mental health as fundamental to the UK’s productivity. 

Half of mental illness can be prevented by early intervention. If we want to turn the tide on NHS waiting lists, we need to invest in our children’s mental health to help them fulfil their potential.

The rise in the number of working aged people out of work with mental illness is yet another demonstration that prevention is better than cure.