DR MAX PEMBERTON: It's time to prescribe some tough love: How work can help cure the mental health epidemic

A job is fundamental to our wellbeing. Of course there are the financial rewards, but work should be about so much more than our wages. It gives us purpose, structure and routine and can boost our self-esteem and mental health.

Yet I am constantly surprised that so many fail to appreciate the importance and value of working. Only last week Mel Stride, the Work and Pensions Secretary, said that Britons must get back to what he termed the ‘old fashioned belief’ that work is good for us.

Stride was addressing the rising numbers — especially among the young — who are unemployed due to mental health issues. That satisfaction from working is considered ‘old fashioned’ is both troubling and disheartening.

The irony is that while many people don’t work (or are on long-term sick leave) due to mental health issues, there is good evidence that the best treatment for mild to moderate depression and anxiety is... work!

Waking up knowing you have work ahead of you is often the best antidote to dealing with the other challenges of life. Not only does it not cost anything, it brings you into contact with other people and it actually pays!

I see many patients struggling with their mental health and I despair that they have spent years — sometimes all their life — out of work. For many of them a job would be far more beneficial than any pill I could prescribe. But what I often encounter is an attitude that work is for other people, and that mental health difficulties automatically make employment impossible.

When I was at medical school, I lived with a group of friends in a flat on a council estate. It was well planned, with low-rise blocks, plenty of green space and trees. Our neighbours were lovely, but it gradually dawned on me that nobody in the household worked. The mother had a bad back, the father suffered with ‘stress’ and the two sons in their early 20s had depression. All claimed benefits.

As a doctor I see people battling the most debilitating and life-changing illnesses who simply cannot work because their daily existence is blighted by their condition. They deserve every piece of help the state has to offer.

But that wasn’t the case with my neighbours, whose daily lives weren’t hindered in any way. I’d watch every day as the sons and their friends played a game of football in front of the flats. And it isn’t the case with many others either.

One patient I saw recently had been told she was not eligible for Disability Living Allowance because she was capable of working. She called me a ‘sucker’ because I had a job and then added that if I didn’t write a supportive letter for her appeal, she’d harm herself and I would be to blame.

Believe me, I am the last person to belittle the impact of mental illness and the way it can devastate lives. But it’s rare to see people who are so incapacitated by depression that they can’t actually work at all.

W e know that unemployment and depression are intrinsically linked, with the unemployed far more likely to suffer depression than those in work. And those suffering long-term depression will often be moved from unemployment benefit to sickness benefits, where they languish. Lifting people out of this spiral of hopelessness, and instilling the idea that work will help them, is a tough challenge. Yes, jobs can sometimes be dull and tiring, but I firmly believe it’s better than the alternative.

That’s why we must continue to emphasise the value and importance of work to health and wellbeing. In the long term, doing so will not just reduce the numbers of people claiming benefits, it will also be therapeutic — a sensible and compassionate way of improving people’s mental wellbeing.

Tough love? Yes. But sometimes it’s needed.

Joe Wicks and I disagree on diets

Fitness coach Joe Wicks has blamed ultra-processed food on the explosion of youngsters being diagnosed with ADHD. Wicks said that he ‘ran on sugar’ as a child and that he thinks his love of foods such as Wagon Wheels and jam sandwiches are what caused his own behavioural issues.

Food plays an important role in things such as mood, but there is no evidence to show that food or drink that are high in sugar have any real effect on children’s behaviour.

However, I do agree with him that there are external factors at play in much of the ADHD epidemic. I worry that things such as smartphones and multi-screening (watching TV while also being on your tablet etc), along with social media, where children are bombarded with short snippets of information in quick succession, are in part to blame for the apparent collapse in their attention spans.

The French government have announced they are going to start fining patients who miss their GP appointments.

They have a different healthcare system to us, but it’s an idea that’s been floated here over the years, and I do understand why. The NHS wastes incredible amounts of taxpayers’ money each year on missed appointments — £220 million on GP appointments alone and a total of about £1 billion when hospital appointments are included.

My view is that as long as we continue to see appointments as ‘free’, we don’t feel they come at a cost to us and therefore we don’t value them.

I’ve tried my best to investigate and understand the no-shows at my own clinic, to see how we can improve things. I’ve spent a lot of time calling patients up in the evening and asking them why they didn’t turn up. Many of them had rather pathetic excuses (a discount day at Selfridges which they ‘couldn’t miss’ was one!)

However, I also found that there were a number of people who had genuine reasons and quite a few incidences where the admin staff had messed up. Letters do go astray, phone lines are permanently busy. How can we ever be sure the patient is truly to blame?

Fines will just result in complaints and refusals to pay, and then what? It’s likely the NHS could end up spending more money chasing these fines than we could ever make from them.

Dr Max prescribes: A pen and paper

A brilliant bit of research last week looked at the best way to manage anger. The study found that going for a run, taking deep breaths and screaming into a pillow all helped. But the most effective was writing down what made you angry on a piece of paper, and then throwing it away! The method is so effective it eliminated feelings of anger ‘almost entirely’, scientists found.

A mother wants ketamine to be upgraded to Class A after her son died. Clare Rogers is right to say it is more dangerous than many think. When not deadly it can still cause severe bladder problems — sometimes the bladder has to be removed.