Last week, the UK Prime Minister Rishi Sunak announced plans to review the fit note system for people who aren’t well enough to work, with a focus on mental health. His speech given on 19 April 2024 continued a rhetoric from the Conservative party regarding mental health that is concerningly stigmatising and inaccurate.

In a speech given in central London on Friday, Mr Sunak said he would target Personal Independence Payments (PIP) if he won the next election, claiming the rising number of people signed off from work due to “mild conditions” such as anxiety and depression was “not sustainable”.

FACT: While some people experience milder cases of anxiety and depression, these conditions can also be severe, rapidly escalating to become debilitating. Anxiety and depression can also be combined with other physical conditions causing a person to not be able to work. There is a difference between feeling sad and clinical depression and a difference between feeling anxious and anxiety disorder. However anxiety and depression left untreated can be a cause of further physical illness and worsening mental illness. It is also very common for someone who has a mental health condition to also have at least one other coexisting physical health condition, if not more. Examples include, a link between hypermobility and anxiety discovered by MQ researchers or a link between Cardio-vascular disease and depression.


The five-point plan Mr Sunak announced included removing responsibility for issuing sick notes from GPs, instead handing the duty to so-called specialist work and health professionals in a bid to end the “sick note culture”.

FACT: Mr Sunak’s statements come at a time when 1.9 million people are on waiting lists for mental health support in the UK. And while the overall budget for the NHS has increased, spending on mental health care has remained comparatively unchanged. 


Mr Sunak said his stance was part of a “moral mission” to get people back to work as his government would “significantly reform and control welfare”.

FACT: From 2021 to 2022 the rate of adults being signed off work due to sickness or injury increased by 2.6% according to the Office of National Statistics (ONS). The rate of sickness absence from work is now at the highest level since 2004. Universal Credit claimants (or those classified as unable to work) are more likely to list a mental or behavioural disorder as one of the reasons. However, when a person is assessed as being unfit for work, mental health is usually only one of many reasons recorded. In fact, comorbidities along with suicide are reasons why people with severe mental illness die 10-20 years earlier than other people.


Among the Conservatives’ planned changes was a consultation on a “more objective and rigorous approach” in the benefits system. This includes benefits stopping if someone does not comply with conditions set by a work coach. Another was a promise to “tighten” the work capability assessment (WCA).

FACT: While being in work can be good for mental health, and there is more the workplace can do to improve the mental health of employees, in some cases being signed off work can be beneficial and can prevent worsening mental health and subsequent physical health conditions developing, which in turn leads to further costs to the economy.


Mr Sunak also pledged for new legislation to prevent “fraudsters” from exploiting “the natural compassion and generosity of the British people”.

FACT: mental illness and mental health distress is neither made up nor a fraud. Research continues to show evidence of genetic and biological differences. Using the word “fraud” when discussing mental health further demonises at risk and vulnerable groups already marginalised and lacking support when suicide rates are increasing.  Isolation and shame is known to contribute to the risk of suicide. The suicide rate in England is currently the highest in a quarter of a century. Last year there were 5,579 recorded suicides in England (ONS), the most since 1999 and a 5.5 per cent increase on the 5,284 in 2022.


Mr Sunak highlighted the growing number of people struggling with anxiety and depression, saying new cases have doubled since 2019 and “We need to be more ambitious about helping people back to work and more honest about the risk of over-medicalising the everyday challenges and worries of life.”

FACT: Something that Mr Sunak’s comments omit are the clear link between COVID-19, procedures taken during the pandemic and mental health statistics. For example, people who were hospitalised with COVID-19 are more likely to have a diagnosis of depression or an anxiety disorder than others. Anxiety and depression levels continued to rise in 2022 and cases amongst young people rose during the pandemic. It’s only through research and funding for research that we can reach better understanding of causes, preventions and treatments (such as this groundbreaking MQ study) for anxiety and depression.


“Rishi Sunak is saying that mental illness is not serious and debilitating. Parity of esteem is dead.” James Downs, MQ ambassador


Mr Sunak’s statement follows comments from members of his party including the Secretary for Work and Pensions, Mel Stride, who last month said in an interview with The Telegraph Newspaper, that “mental health culture has gone too far” and “we are labelling the normal ups and downs of human life as medical conditions which then actually serve to hold people back and, ultimately, drive up the benefit bill.”

FACT: Last year the UK Government scrapped the 10-year mental health plan. Following this, MQ and other mental health experts called on the Government to reinstate the cancelled 10-year Mental Health Strategy after a report by the All-Party Parliamentary Group (APPG): The Major Conditions Strategy: A 10-year failure for Mental Health. In a letter hand-delivered to 10 Downing Street on Thursday 20th July last year,


Mr Stride’s comments, like Mr Sunak’s focused on fit notes and the NHS. Mr Stride also said “If {people} go to the doctor and say ‘I’m feeling rather down and bluesy’, the doctor will give them on average about seven minutes and then, on 94 per cent of occasions, they will be signed off as not fit to carry out any work whatsoever.” 

FACT: Demand for services has rapidly escalated with mental health care providers overwhelmed. Referrals to Children and Adolescent Mental Health Services (CAMHS) has risen by 353% since 2016 and regardless of age, many people in need of support are waiting too long for desperately needed treatment from NHS staff who are overworked and reduced. 


Labour’s shadow health secretary Wes Streeting responded to Mr Sunak’s comments saying the Conservatives are “attempting to make mental ill health another front for their culture wars”. Mr Streeting called this “not just tone deaf, it’s shameless and irresponsible.”

The opposition’s plans for mental health, Mr Streeting says, differ: “Instead of attempting to cover up the scale of the problem, the next Labour government will give people the support they desperately need.”

FACT: Over 30 mental health organisations, including MQ Mental Health Research joined together last year to call on all political parties to make a commitment to mental health in their election manifestos. This was outlined in a Mentally Healthier Nation report. We, along with the other signatories in this report, believe that a long-term comprehensive cross-government plan is essential to protect and promote the whole of the UK’s mental health.


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