RCPsych President responds to PM's announcement on reform of the fit note process

Statement / comment
19 April 2024

On Friday 19 April, Prime Minister, Rishi Sunak announced a review into the fit note system, in a speech where he laid out plans to tackle what he calls the UK's 'sick note culture'.

In a response to his speech, Dr Lade Smith CBE, President of the Royal College of Psychiatrists, said:

“Mental illness affects the lives of millions of people. They are serious illnesses, that impact the majority of families in the country. We are disappointed that the Prime Minister used his speech to conflate those suffering with a mental illness with a ‘sick note culture’. This language dismisses the reality of mental illness, which is concerning given the associated poor quality of life and increased mortality rates. It also reinforces the stigma the government is committed to eliminating.

“Whilst we share the Prime Minister’s concern about the rising number of people out of work for mental health reasons, it is important to note this is an unsurprising consequence of the rise in risk factors that are associated with mental illness.

“Poverty, housing and food insecurity, increased loneliness and isolation - all of which have been compounded by the pandemic - are among a number of factors that have increased over recent years. They have been associated with a dramatic rise in people struggling with mental illness. Problems that are exacerbated as people face longer and longer waits for treatments.

“If the Prime Minister is serious about reducing the number of people out of work for mental health problems he must tackle the mental illness crisis. Addressing the causes, while also providing people with the mental healthcare they need when they need it. 

“We look forward to contributing to the call for evidence on Fit Note Reform. We would also welcome the opportunity to advise which treatments will be most effective and how to increase the commissioning of mental health services to close the treatment gap and reduce the growing waiting lists.

 “However, we are concerned that a focus on sanctions and reducing access to benefits will not help. Evidence suggests sanctions have little impact on getting people with a mental illness into the labour market. Instead, they create uncertainty, hardship and debt, costing the NHS and the taxpayer more money in the long run. The Government must engage with people with lived experience to best understand what will support people’s return to work through expanding schemes such as the Individual Placement Support service.

“People with mental illness already undergo a process of assessment by skilled healthcare professionals who are best placed to determine if someone is capable of working. This includes GPs, who are specialists in assessing complex health conditions in short periods of time, as well as trained clinicians who are specifically contracted by the Department for Work and Pensions.

“We must focus on supporting people with mental illness to live healthy and productive lives by providing them with tailored support from mental health professionals, as well as reducing the barriers that vulnerable groups have with accessing the job market."

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