Repainting a house that’s on fire: an open letter to Rishi Sunak

Mr Rishi Sunak,

Good afternoon.

As I brace myself for my own experiences with the NHS later this afternoon, I couldn’t help but mull over the implications of your latest proposal regarding mental health and fit notes. This latest proposal of yours seems to have spectacularly missed the mark, which to be fair, is how you have been running the country, so no surprises there. Now, with all due respect (what little remains), your intent to transition the responsibility of issuing fit notes for mental health conditions from GPs to occupational health specialists strikes me as a solution glaringly divorced from the crux of the problem.

It’s somewhat like repainting a house that’s on fire – visually appealing in the short term but disastrously and stunningly ineffective for the structural integrity needed in the long run.

Let’s dissect this while I have the time, shall we? (I would suggest you sit down; I have had a fair bit of time to put together this post, so do go on a bit)

Misplaced priorities: a band-aid on a bullet wound

Your policy that you’re so keen on foisting upon us suggests a tightening of criteria to reduce the number of people “off work sick” due to mental health conditions like anxiety and depression. While the facade of this plan gleams with efficiency, it crumbles under even the tiniest bit of scrutiny (again, no surprise there).

The current NHS mental health waiting list stands as an absolutely shameful and terrifying testament to a system completely overwhelmed and utterly under-resourced after 14 years under your party’s stewardship, with almost two million individuals waiting for mental health care. Shifting the burden to “occupational health specialists” without an urgent, simultaneous, and substantial increase in support and resources for mental health services is like handing someone a bowler hat in a hurricane and feeling puzzled and annoyed when they still get soaked.

The illusion of reducing economic inactivity

The core of your speech seemingly elevates economic motivations under the guise of public health concerns, with the assertion that “good work can improve health.” While employment does indeed offer some benefits for mental well-being, it is far from a panacea for mental illness, no matter how fervently you and your party would like to convince us that it is. This narrow-minded and futile simplification that stricter fit note assessments will miraculously drive people back to the workforce not only trivialises the profoundly intricate nature of mental health conditions but also perilously and likely purposefully overlooks the vital necessity for holistic treatment and robust support systems.

Suggesting that pushing individuals into work is a universal remedy reveals a disheartening disconnect from the realities faced by people living with mental health challenges and a flippant disregard for the expert care they require.

Financial aspects and policy failures

Moreover, Mr Sunak, while you articulate concerns about the fiscal implications of rising costs in disability and health benefits, it’s imperative to acknowledge that these costs are not spontaneous anomalies that have come out of nowhere but direct results of years of relentless and purposeful systemic neglect and underfunding of mental health services under your government’s watch.

The escalation from £43bn to £69bn in expenses is symptomatic of a broader crisis, one fermented by chronic policy failures that have left our mental health infrastructure on its knees. It’s disingenuous to frame these costs merely as burdens without recognising that they are the predictable outcomes of your government’s choices – choices to prioritise austerity over investment in public health and short-term savings over long-term sustainability.

This not only underscores desperate fiscal myopia but also reflects an abject and repeated failure to invest in preventive measures that could have mitigated these costs. A truly economically prudent approach would acknowledge that every pound saved today at the expense of mental health is a future surcharge – compounded with interest in the form of increased dependency, lost productivity, and the immense human cost of untreated mental health conditions.

By acknowledging this linkage, we can finally begin to understand the financial narrative not as a tale of sudden and inexplicable fiscal burden but as a longstanding consequence of neglected public health policy. This understanding should catalyse not just a reevaluation of current proposals but a profound and urgent redirection towards genuinely bolstering the mental health support systems that can alleviate both individual suffering and economic strain. Addressing the

Root causes of rising mental health issues

Now, beyond the mechanics of fit notes and healthcare policy, this entire exercise sidesteps a critical, far more fundamental question: Why exactly are we witnessing such a marked increase in cases of depression, anxiety, and overall mental health deterioration? It is essential, and I really cannot stress this enough, to consider the societal, economic, and environmental factors that have been contributing to this uptrend.

We must ask ourselves about the quality of work available, the impacts of social isolation, economic instability, and the pervasive effects of digital saturation in our lives. Simply adjusting the mechanisms of medical certification perilously fails to address these underlying causes that are pushing more and more people towards mental health crises. True leadership would look to mitigate these stressors at their source rather than merely managing their manifestations in the workforce.

A call for constructive dialogue and action

Mr Sunak, while your recognition of the importance of discussing mental health openly is, of course, commendable (and the standard position we all should take), the path you propose seems paved with good intentions but lined with the usual pitfalls. It’s time to redirect the narrative towards enhancing the availability and accessibility of mental health services rather than tightening the grip on who qualifies for time off.

Should we not envision a policy framework supporting those in need rather than pushing them further into the shadows of stigma and stress? Should we not invest in a mental health infrastructure that builds resilience and recovery rather than gatekeeping the already scant resources?

As you consider the future steps for our nation’s health policy, I implore you to consider a course that marries fiscal prudence with fundamental compassion and actual strategies to address the reason for the sharp rise in mental health conditions.

Let’s not reduce policy to soundbites that resonate more with austerity than empathy. We have an opportunity here, Mr Sunak, to set a global standard for how societies can support their most vulnerable.

Let’s aim for that.

Or, as an alternative, just call a general election because, to be perfectly frank, I and about 81 per cent of the rest of the country are sick to the back teeth of you and your party.

Thank you for your time and attention. I look forward to your thoughtful engagement on this critical issue.