Whether Britain faces an epidemic of bad mental health or of idleness, the solution is the same
Long Lockdown takes many forms, all of them baleful. One of its grimmest aspects is that the proportion of the working age population in employment still has not returned to its pre-pandemic rate. The number of people off work with assorted sicknotes and invalidity claims has risen since Covid by 700,000, reaching 2.8 million.
This week we learned that two thirds of incapacity benefits applications now involve mental or behavioural disorders, and that 20,000 claimants are being added to the rolls each month. Meanwhile, the backlog of people waiting for mental health treatment on the NHS stands at an astonishing 1.9 million.
Quite apart from the individual suffering represented by those figures, there is a colossal national cost. We are spending around £30 billion each year on various incapacity benefits. By the end of the decade, on present trends, it will be £48 billion. To put those numbers in context, the price of taking two pence off National Insurance – a cut that was itself a response to the worklessness crisis – is £10 billion a year.
What is going on? Were hundreds of thousands of us driven insane by two years of lockdown? Have we become a nation of Rab C Nesbitts, gaming the benefits system by feigning invisible conditions? Or is it that we are belatedly opening up about disorders we used to suffer in silence?
Before answering, stand back and consider how quickly the crisis has come upon us. At the Chalke Valley History Festival a couple of years ago, I listened awestruck to a Second World War airman describing how he had been shot down and interned in a POW camp before escaping and returning to the fray. When he finished, a young woman in the audience asked whether he had been offered any counselling after his trauma. “Counselling?” replied the veteran, genuinely baffled. “Oh, no, dear, we had enough on our plates with the Germans”.
You might see his attitude as admirably stoical or as heart-breakingly repressed. Either way, it is all but incomprehensible to a generation taught to focus on the inner self. Powerful campaigns by members of the Royal family and assorted celebrities have succeeded in removing stigma from mental health problems. We have gone, in a dizzyingly short time, from being a buttoned-up people who regarded emotional display as self-indulgent to a people who talk endlessly about their mental wellbeing.
Talk has consequences. In one survey, 65 per cent of British adults claimed to have experienced some form of mental health problem. The number of patients taking anti-depressants has surged, and there is so much of the stuff in our waste water that it is reportedly affecting fish in the Channel.
Which seems likelier? Have conditions that were previously festering in the dark been exposed to fresh air and sunshine? Or is mental disability becoming more widespread out of a kind of tragic fashion?
The answer, though saying so always causes great offence, is a bit of both. Awareness of mental health has, on balance, been positive. Schools are geared up to recognise and treat sufferers. We are much likelier to acknowledge the value of people with personality disorders in the workplace.
At the same time, opening up about mental health encourages some people to medicalise what are, in reality, emotional states that everyone experiences.
Listen to the way our language has shifted. Clinical depression is a wretched affliction that leaves sufferers overcome by waves of hopelessness. But the word “depression” is also now used to signify nothing more than the sadness that is part of the human condition.
Some people say “I’m depressed” when they mean “I’m unhappy”. Others say “I have anxiety” when they mean “I’m nervous”. Yet others say “I have PTSD” when they mean “I have had a nasty experience”.
In such a climate, it is hardly surprising that more people might believe they have a psychiatric disorder. Yes, some are now being diagnosed with conditions that would otherwise have gone undetected. But others are using the phrase “mental health” to mean, in effect, “feelings”.
When I described it as a fashion, I was not being flippant. Psychiatrists know that social media can be a spread vector for mental disorders. When an online community sacralises psychiatric conditions (we live in an age when suffering is the highest virtue), some teenagers, craving acceptance, might start to display symptoms.
The surge in benefits claims has not happened in a vacuum. We are in a cultural moment when both claimants and assessors are primed to assume that a self-diagnosed mental disorder is debilitating.
Any benefits system is bound to have unintended outcomes. We are made, as Kant said, of crooked timber. Under any conceivable set of rules, some deserving people go without, and some undeserving people qualify. Pointing to such people makes a powerful emotional argument; but they are inescapable, wherever we draw the line.
The reforms introduced by Iain Duncan Smith made taking a job more attractive, and living on benefits less so. Even with this latest rise, Britain still has proportionately more adults in work than the EU, and more than under the last Labour government.
But, precisely because the rules were tightened after 2010, some workshy people switched to incapacity benefits, which are not conditional on looking for a job, and which can be paid on top of universal credit. Look online and you find numerous guides to what to say if you want to be put on various benefits: you get this number of points for not being able to sit still at a desk, this many for not knowing what to wear and so on.
At the same time, there may well have been a real upsurge in anxiety and depression. For the better part of two years, we told people that it was dangerous to set foot outside their homes. Young people, denied social lives, were forced online.
My own guess, though, is that the single biggest driver of these numbers is neither skiving nor lockdown-induced psychosis, but a wider societal decision to expand the definition of mental health, to accept self-diagnosis, and to treat any behavioural disorder as the equivalent of a physical disability.
Oddly enough, it doesn’t matter which of these explanations is correct. The solution is often the same: a job. If people are pretending to be ill, they should work. If they have clinical anxiety or depression then, in many cases, the worst possible thing is to pay them to stay at home, feeling superfluous.
The psychiatrist Clay Routledge argues that focusing on what others need from you is the best way to keep your mental stability. “This conclusion may be surprising in an era that extols the necessity of ‘self-care,’ but the more people direct their energy toward having a positive impact on the lives of others, the more they will reap benefits for their own mental health.”
Ministers know it. Mel Stride, the quietly effective Work and Pensions Secretary, is tightening the work capability assessment procedure, a move the OBR says will cut the number of claimants by 371,000. But this is not primarily about saving money; it is about saving people.
Winston Churchill battled all his life with what he called the “Black Dog” of depression. The only way he could fend off that shadowy hound was by throwing himself into activity – writing, speech-making, politicking.
What we do is a big part of who we are. When we ask children “What do you want to be?” we don’t invite the answer “a Liverpool fan” or “a jazz aficionado”. We expect them to name a profession.
The tragedy of the current numbers is that, instead of finding identity in work, and in the people who depend on them because of that work, many of our fellow citizens are finding identity in their conditions. It is a burden for taxpayers, for their families and, above all, for them.
But we know, in most cases, how to lift that burden. The best therapy of all can be a steady job.
