Baroness Maclean of Redditch (Con)

My Lords, I am extremely grateful to the House for allowing time for this debate and to all noble Lords who will be speaking. Something has gone wrong when more than one in five adults in England now live with a common mental health condition such as anxiety and depression, with diagnoses of ADHD and autism also climbing steeply; among young people, it is one in four. The Adult Psychiatric Morbidity Survey shows it climbing from one in six a generation ago. Today, nearly half of young people who are NEET—not in education, employment or training—are classed as disabled. The single largest reason is a mental health condition such as anxiety, and four in five of those on health-related universal credit are there for a mental health or neurodevelopmental condition. But here is the bit that should make us ask questions: while these conditions have surged, the most serious illnesses—schizophrenia, bipolar disorder and the psychoses, together with the most severe learning disabilities—have stayed almost flat. Were we truly in the grip of a new epidemic of disease, we would expect it at the most serious end as well. This strongly suggests that what has changed is not our human biology but our understanding and where we draw the line between health and sickness. Of course it is right to look at many factors for this and I do not dismiss them—although time does not allow me to explore, for instance, the impact of the pandemic or social media—but I do not hear us in our debates talk about something that I believe is very important, so I want to mention it this evening. It is the importance of what we used to call grit, self-sacrifice and discipline. It was integral to our culture and to what it meant to be British. It meant that work was not a curse, nor only a wage, but a calling and a source of deep pride. Our Protestant work ethic laid the foundations for so many things that we revere today. It built the mills and dug the mines; it underwrote the Victorian gospel of self-improvement; it built the chapels and friendly societies; and it was the spirit that rebuilt our bombed cities after the war. I am sure that some will accuse me of turning back the clock or trying to, and they will point to government schemes in schools and interventions in businesses, mental health counselling and awareness days. But if all those schemes actually worked, they would be reducing mental health problems and sickness benefits, not driving them up, and today we would not be spending twice as much on working-age welfare as we do on defence. The OBR expects spending on sickness and disability benefits alone to climb past £100 billion by the end of this decade, and just last week, the Defence Secretary and the junior Minister resigned from their posts because neither of them could in all conscience defend this position. I believe the reason that we have been so willing to sign people off work for mild conditions is that we have forgotten that work is the best way to heal from many troubles. As Barry Ingleton, who runs the Synolos mental health charity in Oxfordshire, puts it: “Not every emotion is an illness, but every emotion deserves to be heard”. He works with clients with serious mental health conditions, but they go on to find purpose and joy in meaningful roles. We do not talk enough about the culture behind our Protestant work ethic and how any kind of work, including all kinds of manual labour, done well can give dignity and purpose to a life. Of course, we should experience emotions; that is what being human means. But an emotion is an emotion, not a life-limiting condition meaning you are permanently ill or disabled. In the policy space, I am honest that the last Government did not get everything right. But this Government know they have the support of our Benches to do the right thing on welfare, and they must start by telling the truth about these common mental health conditions, including neurodiversity and the benefits system. I hold two psychology degrees, for my sins, and before politics I spent 30 years running a small business in Birmingham. I understand what people get from work and how a good employer accommodates someone going through a hard time—and it is not by mandating more mental health awareness days, or taxing businesses more. Many professionals are raising this alarm. Sir Simon Wessely, a former president of the Royal College of Psychiatrists, warns against the “overmedicalisation” of normal emotion. The neurologist Dr Suzanne O’Sullivan argues that “our obsession with medical labels is making us sicker”, not better. Alan Milburn’s review, commissioned by the Government, describes a system in which a life on benefits for mental health conditions is more lucrative and far less hassle than work. We seem to have come to confuse workplaces, schools and universities with therapeutic services. Yes, I agree that we originally needed to remove stigma from mental health, but we have overcorrected. We started with being kind and well-intentioned, but it is cruel to tell people that they are so fragile, ill or even neurodivergent—a label that simply means the brain is different but is now stretched so wide that it can accommodate almost everybody—that they cannot ever work. I do not blame people for doing what the system incentivises them to do. But our system now means that those with the most serious conditions are at the back of the queue for the help that the state should rightly provide. I think this is morally wrong. I ask the Minister, who has a huge amount of experience: do the Government accept that reform is desperately needed to reduce the ballooning rise in less serious mental health and neurodiversity conditions that underpin our out-of-control welfare bill? Does she agree that it is time for a truthful conversation about the best form of help for these conditions, so that our budget can be targeted at the most vulnerable, seriously ill and disabled?