Rishi Sunak wants to frame a benefits crackdown in tomorrow’s Autumn Statement in compassionate terms, with ministers saying people with mobility problems and mental illnesses can no longer be ‘written off’ thanks to advances in technology making it easier to work from home. Instead, they will be expected to look for work or face benefits sanctions.

The ‘carrot and stick’ approach being proposed will include a promise to claimants that their right to benefits won’t be reassessed if they look for work, as well as better support in the package of reforms being developed by work and pensions secretary Mel Stride.

In lots of ways, this is compassionate: being out of work is miserable, especially when you have a mental health problem that means you are still capable of working and earning some of the time. A government review back in 2017 by the respected mental health campaigners Paul Farmer and Dennis Stevenson found the annual cost to employers of mental illness was between £33 billion and £42 billion, while the cost to the government was between £24 billion and £27 billion – and the wider economy £74 billion and £99 billion. It identified a problem with ‘presenteeism’ whereby people were physically at work but too ill to perform their job properly, and said the number of people leaving work with mental health problems could be reduced by 100,000.

It shouldn’t be the case that you have to be very, very lucky to be able to have a job when you’re mentally ill

Six years on and we’ve had three different iterations of Conservative government since. None of them have found fit to implement much of what the Stevenson/Farmer review recommended. That report suggested that the public sector could lead the way in improving the way its employees are managed. Somewhat laughably, given what has happened since, it singled out the National Health Service as one of those employers, saying there was a need for ‘particular focus to be given to areas of the public sector at highest risk of stress and trauma’ and the need to establish clear accountability for supporting their mental health. Many of the post-Covid measures introduced in NHS trusts to help staff dealing with the stress and trauma of the pandemic – and indeed of their ongoing working conditions – have been scaled back. There seems to be a blame game going on between those in government who think providers should be doing more, and the providers themselves who point out that their staff might be less traumatised if they weren’t surrounded by vacant posts.

Society has in many ways become kinder to people with mental illness, but largely when they aren’t actively inconvenient or awkwardly ill: basically, you can be a bit sad but anything beyond that is asking too much. Mental illness has also been influencer-ified: it’s now something we all talk about but largely in terms of something that can be overcome if you have the right ‘self-care’ routine. This means anyone with a prognosis of a lifetime of illness or a very long recovery still doesn’t get much of a look in.

I’ve written about my own personal return to work after acute mental illness: in my case, The Spectator did everything it possibly could (and probably more) to keep me in work. Looking back over the period of illness that started for me in 2016, there were times when I returned to work far too early, whether that was from home or coming into the office, and I wasn’t the only person who suffered as a result of those false starts. Like so many people, I was in a London borough where the NHS waiting lists for counselling were so long they were closed, so I funded it myself from my savings – and then a charity connected to my work funded more a few years later. My experience is extremely unusual, and even seven years after I first fell ill, I’m not sure much has changed more widely. I’m mostly sure that I was just very, very lucky.

Workplaces have not, for instance, yet managed to develop widespread good practice for managing employees with mental illnesses that aren’t going to go away and who may need regular adjustments in order to keep working. Some have started to offer funded counselling for employees, while others have allowed the growth of home working to give those who are struggling but still want to work a bit of space to do so in a way that suits their condition best. The problem with home working, though, is that not only is someone less visible in the office and less likely to be considered for promotion, they are also quite easy to forget, meaning line managers don’t check in on them and make sure that they’re actually as well as they claim to be.

The 2017 review made suggestions on how the government could help with this, joining up what it described as ‘fragmented occupational health and practical support available from Access to Work, the Fit for Work Service and other NHS services to create an integrated in-work support service’. It also suggested a new flexible model for Statutory Sick Pay to help people who want to return to work in a phased way. There have been changes since: the Fit for Work Service was scrapped back in 2018 as part of the government’s work, health and disability reforms. The phasing of statutory sick pay has been rather more tortuous: a government consultation in 2021 concluded that phased payments would help people with mental health problems as well as musculoskeletal conditions. But it also said it was ‘not the right time to introduce changes to the sick pay system’. Since then, MPs across the Commons, including Conservatives Jonathan Gullis, Robert Buckland and Priti Patel, have been pressing Jeremy Hunt for sick pay reform.

Perhaps tomorrow’s Autumn Statement will bring that reform, along with what will be an essential expansion in the talking therapies and occupational health support that most people starting back into work after time off with a mental illness will need. It shouldn’t be the case that you have to be very, very lucky to be able to have a job when you’re mentally ill. But it’s taking a very long time for ministers to keep up their side of the bargain.