Getting rid of sick notes isn’t the answer to our mental health crisis
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“We can’t allow fraudsters to exploit the natural compassion and generosity of the British people,” said Rishi Sunak last week, with a stomp of his Adidas Sambas and a stunning lack of self-awareness. For Sunak wasn’t referring to allegations that Mark Menzies, one of his MPs, had persuaded a hard-working party supporter to cash out thousands of pounds to pay some “bad people”, but to new plans to tackle “sick note culture”. The Government wants to clamp down on grifters taking advantage of the system, though naturally Sunak made no mention of those in charge of it.
His idea is to remove the powers of GPs to hand out sick notes. Instead, those who claim to be unwell will have to see “work and health” specialists, who will “have the dedicated time to provide an objective assessment of someone’s ability to work and the tailored support they need”. The message here is not made explicit but it is clear: we will prioritise getting you to work over getting well, because we don’t actually believe there is anything wrong with you in the first place.
How far we are from 2013, when the Prime Minister, then known as plain old David Cameron, had it written into the NHS constitution that mental health would have parity with physical health. Hope sprang eternal that the Government would take the crumbling mental health system and create something that actually worked, enabling the one in four of us who will suffer from a mental health issue each year to get better and be able to lead happy, functioning lives, with untold benefits to the country as a whole. It’s a simple premise, but one that tends to work: give unwell people help to get better, and they tend to become healthy members of society, who go to work and pay the taxes that fund not just the NHS, but the likes of Menzies.
Instead, Sunak has decided to show his “natural compassion and generosity” by effectively making it even harder for the mentally ill to get help. Instead of investing in provision so that GPs are able to offer solid help instead of sick notes, he chooses to paint those suffering with depression as workshy scroungers who are too lazy to go to an office. He does the work of mental illness for it, and he insults over-worked health professionals in the process.
How do you prevent a sick note culture? You provide alternatives to sick notes that allow people to get well. Instead of stripping overworked GPs of their abilities, you give them more time. You create a system that allows people to get an appointment at their local surgery before the end of the year, and when they get there, you don’t immediately start a clock on each appointment. You allow the GP the time to talk with the patient about what is wrong. How is their diet, their sleep, their work? The GP is able to access treatment for the patient immediately, be it talking therapies or psychiatric care. The patient then has hope and a plan in place, and is able to go to work in the knowledge that they will soon have help.
Well into the 21st century, this shouldn’t be radical, pie-in-the-sky stuff, but sadly it is. Of course there are people who take advantage of the system. They have always existed, and are unlikely to go away – it’s frankly deluded to imagine otherwise.
But we have come to a very sad place indeed when the Prime Minister speaks to the nation in a way that implies everyone off work with a mental health issue is a lying, lazy fraudster on the make. The vast majority of people who go to their GP speaking of a mental illness will be terrified, alone and desperate. They would do anything to be able to wake up in the morning and go to work without thinking about it. They go to their GPs not for a sick note, but for help. They want a way to escape the horrors in their heads, the part of their brain that tells them they are terrible people, the worst in the world. They want their GP to reassure them that they are suffering from an illness, and that there is treatment for this illness.
But we live in a country where that treatment is scarce, and where over 6,000 people die by suicide each year. So instead, GPs are left with a choice: send away the patient with nothing, not even a tiny shred of hope, or give them a sick note and a prescription for antidepressants, which at least kicks the problem down the line for a short while.
Dr Katie Bramall-Stainer, the chairman of the British Medical Association’s GP committee, was scathing about the Prime Minister’s plans. “Fit notes are carefully considered before they are written, and a GP will sign their patient off work only if they are not well enough to undertake their duties,” she said. “We do recognise the health benefits of good work, and that most people do want to work, but when they are unwell, people need access to prompt care. With a waiting list of 7.5 million – not including for mental health problems – delays to diagnostics, and resulting pressures on GP practices, patients cannot get the treatment they need to be able to return to work.”
Hear, hear. When you have a sick note culture, you have a sick society, but that isn’t the fault of the people – it’s the fault of a government that seems to be out of ideas and imagination. The sooner we are able to sign them off, the better.
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