Personal opinion Piece in [UK] Telegraph by Neil O’Brien whose day job is as Director of Policy Exchange [an independent think tank working for better public services, a stronger society and a more dynamic economy.]
He sketches out how the epidemic of mental illness is growing in Britain , similar pattern to that decribed by Robert Whitaker . Neil O’Brien is observing and asks questions from an economic and public policy perspective.
The remarkable rise of mental illness in Britain
Ed Miliband has been talking about mental illness, arguing that celebrities should stop demeaning the mentally ill. He talked about how it costs our economy tens of billions of pounds a year.
He’s right that it’s a really important subject, with big economic implications.
Between 1995 and 2005 about half a million extra people registered for Incapacity Benefit (IB) because of a mental illness, taking the total to about 1.1 million. (Shown in the top graph). Claims for mental illness grew even faster than other Incapacity Benefit claims.
Since 2005 the numbers claiming incapacity benefits for other reasons have fallen back about 15 per cent, but the numbers claiming for a mental illness have still been inching up – although the big surge has ended. (Shown in the second graph).
The combination of those two things means that the proportion of claims for incapacity benefits accounted for by mental illness has gone up and up. In fact it’s now mental illness – rather than, say, a bad back or a broken arm – that’s now the number one reason why people claim sick benefits.
NB – There’s a gap in the data because of the conversion from Incapacity Benefit to Employment and Support Allowance (ESA).
What’s going on? Did lots of people suddently develop mental health problems in the 1990s? It’s difficult to compare statistics from before Incapacity Benefit replaced Invalidity Benefit and Sickness Benefit in 1995.
But if we look at the proportion of working days lost to different types of illness shows that the rising importance of mental illness started in the 1970s or 1980s. (shown in the graph below). The number of claims for Invalidity Benefit for a mental illness went up about 47 per cent in the seventies, and 57 per cent in the 1980s.
What else do we know about this huge change in our society? Younger people are much more likely to be incapacitated by mental illness rather than other causes. In fact 60 per cent of young (25-34) men claiming IB or ESA are doing so for a mental illness, compared to 31 per cent of 55-59 year olds.
Looking at specific problems, depression is the most common reason for claiming (accounting for 509,000 claims last year). 128,000 people claimed for an anxiety disorder, and while other big causes were neurosis (56,000) alcoholism (56,000), schizophrenia (53,000), retardation (49,000), severe stress (49,000), and drug abuse (42,000). And people have these problems for a long time. More than a quarter of those claiming IB for depression or anxiety disorders have been claiming for more than 10 years.
One reason for the increase is surely that there is less of a stigma attached to mental illness than in the past (though there’s still a stigma). So people are more likely to come forward if they have problems, and doctors are more willing to diagnose mental illnesses than in the past.
But is there also a bigger underlying problem? Are people more likely to suffer mental health problems than in the past?
Its a complicated question, and changing demographics obviously affect the headline numbers.
Some studies suggest that there hasn’t been much change in the total rates of mental illness since the 1990s, but others suggest there was an increase between the 1970s and the 1990s. Richard Berthoud reports data from the General Household survey suggesting that the rate of mental illness among working age people was more than a third higher around the turn of the century, compared to the mid seventies.
Is it all to do with de-industrialisation?
Looking at all disability, not just mental illness, Richard Berthoud found that long-term economic changes affect disability rates, even if short term fluctuations in the economy don’t:
Disabled people are very sensitive to long-term geographical variations in the health of regional labour markets; while non-disabled people have similar prospects, wherever they live. But disabled people’s employment is hardly affected by booms or busts in the national economy.
And there is a pretty clear geographical link between economic wellbeing and mental health – the map below from a 2007 Oxford Economics report shows how the problem is more severe in the less wealthy parts of Britain, with south Wales showing up as a particular hotspot for mental illness.
Is some of it to do with the difficulty of testing and diagnosing mental illness, compared to other types of sickness? Tightened medical tests and changes to the rules do seem to have made a difference to the numbers claiming incapacity benefit overall – at least for men – as the graph below from this IFS paper looking at the 1995 reform shows:
But mental illnesses are much harder to test for than a broken arm – particularly if they are fluctuating conditions. So I could imagine that tighter rules on claims have pinched more on other types of claims than mental illness, which would push up the relative proportion of claims for mental health. On the other hand, mental health charities argue that the current test for claimants (the Work Capability Assessment) isn’t high quality enough, and misses some mental illness.
All of the above is mostly a description of the problem, and I don’t know what the solution is. But mental illness is one of the biggest challenges facing the welfare state, and one which which we’ve only really begun to explore.
If, over time, we could reduce the number of people suffering from mental health problems, it would obviously reduce a lot of real misery. And the problem is so now large that it would also make a real difference to the economy too. The numbers who can’t work because of mental health problems (1.1 million) are not much off the total number claiming unemployment benefits (1.5 million), and the mental health charity mind argue that it mental health problems cost the economy £77 billion per year in England alone.
So we’re talking serious misery, but serious money too. Hopefully politicians will keep interested, and keep searching for solutions.