What does the Major Conditions Strategy mean for mental health?

A photograph of the Houses of Parliament in London
By Mary Sadid, NSUN’s Policy Manager, and Kieran Lewis, NSUN’s Rights and Migration Policy Officer

At the beginning of this year, the government announced the scrapping of the 10 year plan for mental health, alongside a number of other condition-based strategies. In its place, a Major Conditions Strategy (MCS) has been announced that focuses on six main condition groups impacting the populations’ health. Mental health is one of these workstreams, with the strategy focussing on what can be delivered over the next 5 years in health services. Critically, there is no additional funding behind the strategy, with resourcing pulled from existing budgets.

Consultation on the strategy has now come to an end, with last year’s already flawed consultation for the mental health and wellbeing plan apparently informing the mental health strand of the MCS. 

The strategy has three stated aims: addressing recent falls in life expectancy, alleviating pressure on the health system, and reducing ill-health related inactivity in the labour market. 

We are concerned that the strategy’s aims appear to primarily focus on improving people’s health as a means to a better economic end. This direction of travel is flawed when critical policy areas like housing and social security do not appear to be made with the public’s health in mind and the associated resourcing in no way reflects the scale of the challenge at hand. 

In conjunction with the recent Health and Disability White Paper, recent policy announcements, including the announcement that the Health Disparities White Paper will no longer be published, reflect a government that is negligent about the risks to marginalised groups who face ever worsening material and social conditions which in turn impact quality of life and life expectancy.

As life expectancy falls in the UK, it feels important to remember that people who live with what is referred to as serious mental illness or SMI live on average 15-20 years less than those without this experience. Strategies like the MCS must reflect this reality. 

Productivity by way of health

Working-age inactivity due to ill-health has been identified as a ‘fiscal risk’. Research from the Office for Budget Responsibility puts the cost of ‘increase in working-age inactivity due to long-term sickness since the pandemic’ at £15.7 billion.

A number of recent policy developments including the Health and Disability White Paper clearly target this pattern, and the groups who make up these figures. 

Whilst these policies aim to address the question of productivity, they also appear to sidestep the causes of ill health and old age related absence from the workforce. 

The integration of DWP employment advisors with IAPT (Improving Access to Psychological Therapies, now referred to as “NHS Talking Therapies”) services is one example of policy that puts productivity at the heart of spaces that are supposed to be about care and support, and therefore compromises them. In 2022 the government announced £122 million going towards this integration. At a time of dangerous levels of underfunding, throwing money only at workfare is simply another symptom of social harm. As Jay Watts writes, “it suggests a resurgence of the striver/skiver discourse that equates worklessness with worthlessness, with those in pain only valuable if they show constant job readiness.”. 

Ill health is positioned as an inconvenience, as something to be managed out of. Instead of care, the architecture of neglect is growing and increasingly embedded across different state systems. This means that when people interact with systems that on their surface should offer support, they are likely to experience harm. These harms can take the form of benefit refusal, an extraordinary burden to navigate the system and prove you are in need, the risk of being seen as a fraud, scrounger, or cheat, and many many other serious consequences of systems that can and should serve those who need them. 

The upcoming Major Conditions Strategy, in its apparent refusal to properly address or engage with mental ill-health in all its complexity, appears to further embed this pattern of problematising people’s experiences rather than the social and material conditions that produce and maintain them.

How does the Health and Disability White Paper connect? 

This logic of productivity by way of health is, of course, not a one-off feature of developments like the MCS, but a cornerstone of the Government’s understanding of health and social care. The recent Health and Disability White Paper exemplifies this logic as it outlines plans for a system that focusses on welfare in name only.

The proposed changes would scrap work capability assessments (WCAs) in favour of a higher-stakes personal independence payment (PIP) assessment  –  the controversial and deeply flawed process currently used to identify people who face additional living costs because of their disabilities. It is estimated that those who are ineligible for PIP and are also unable to work could lose out on £350 per month. There are currently no plans to adapt PIP assessments to accommodate their proposed new function.

Elsewhere, in the name of ‘[focussing] on what people can do, rather than what they cannot’, disabled people’s benefits would come with conditions imposed by under-qualified job centre ‘work coaches’, responsible for deciding whether or not they are able to work.

In the context of a system in which DWP contractors already produce unacceptable numbers of flawed benefit assessment reports and the Department itself refuses to release information about the impact of its own errors, these changes would worsen a system that has already been responsible for countless benefit-related deaths over recent decades in the name of productivity.

What do we want to see instead?

Today’s social problems are complex, painful and can have fatal consequences, as shown by projects like Deaths by Welfare. While strategies like the MCS should present opportunities to develop meaningful solutions to such problems, all too often their foundations and approach completely fail to meet the challenge at hand. It is hard to have any faith at all that government plans and strategies are going to create real, meaningful change. It leads us to ask: what is there to be gained when we engage with bad faith policy?

We want to see services and support systems that aren’t just aiming to deliver the bare minimum, but that give people quality of life, dignity and choice. This has to include levels of entitlement to social security that reflects the increased cost of living with distress and dealing with the manifestations of sanism and ableism across social and physical environments. 

We want to see genuine ambition when imagining what the lives of people living with long term mental distress can and should look like: a thoughtful and rich policy and practice landscape that moves beyond containment and control. 

We are currently in an in-between place, with a general election looming. Recent developments like the planned Major Conditions Strategy reflect the ongoing reluctance to adequately fund necessary and safe levels of support for people in distress. There is a growing tendency to problematise ill health and its economic consequences, singling out those who are unwell and ‘economically inactive’. Ultimately, what we continue to lose sight of is care.