We welcome meaningful debate about how to improve the nation’s mental health and respect that there is a breadth of opinion about debates related to welfare in particular.

However, the Centre for Social Justice’s (CSJ) latest report, Change the Prescription: Update 2025, falls short of the evidence-based and compassionate approach that people living with severe mental illness need and deserve, and we have been extremely concerned by politicians referring to it in the media recently. 

Much of the content risks reinforcing stigma, underplaying structural drivers of mental illness, and promoting recommendations that could cause further harm if adopted in policymaking. 

Misunderstanding the realities of access to support 

The report questions the prescription of antidepressants and appears to treat fit notes and disability benefits as impediments to recovery. Yet it fails to acknowledge the severe and growing gaps in community-based services that have been documented for years as a key problem in our mental health care system. 

Our research shows that people living with severe mental illness often face months or even years without appropriate care. In our Right Treatment, Right Time survey, 42% of respondents needed urgent care while waiting for treatment, and 26% were hospitalised as their condition worsened. Without medication or interim support, many people would simply be left to deteriorate.

A recent Guardian report describes how a service near Blackpool identified a serious issue with children not turning up to mental health appointments because their parents could not afford the journey on public transport. When this was addressed, failure to attend dropped almost to zero and attendance at A&E for mental health crisis dropped by 59%. This example demonstrates not only the impact of accessible community services, but another way in which poverty can impact mental health. 

Ignoring poverty and deprivation as key drivers of mental illness 

While the CSJ rightly identifies lifestyle factors that can protect good mental health, it inexplicably downplays the impact of poverty and deprivation, despite these being some of the strongest predictors of poor mental health outcomes. 

NHS data shows that Mental Health Act detentions are 3.5 times more likely in the most deprived areas compared to the least. The Joseph Rowntree Foundation have conducted extensive research showing the negative impact of poverty on mental health outcomes for both children and adults. 

The CSJ assessment of factors impacting mental health was far from thorough and read like a case of cherry picking a few factors, while ignoring other much more obvious ones. 

Policymaking that ignores this will fail to reach those most at risk.

Assumptions about families and mental health 

The report conflates family breakdown with dysfunctional family environments, ignoring the reality that a single-parent household can be more supportive and protective than a household affected by domestic abuse or conflict, both of which can have a significant impact on mental health for both parents and children. While we support the expansion of Family Hubs, using the welfare system to financially incentivise parents to remain together risks trapping people in unsafe environments and could have serious unintended consequences. 

Using and misusing data on mental health and benefits 

The quoted figure that seven out of ten assessments awarding Universal Credit Health are for mental and behavioural disorders is correct. However, the report neglects to mention that the classification of mental and behavioural disorders includes people who have dementia, schizoaffective disorders and learning disabilities, as well as anxiety, depression and ADHD. It is impossible from the publicly available data to claim or imply what proportion of the seven out of ten can be attributed to which conditions. 

The CSJ’s report implies that people receiving basic-rate Personal Independence Payment (PIP) for conditions such as anxiety, depression, or ADHD must have “mild” issues. In reality, the vast majority of people living with mental illness receive no benefits at all, especially those with more mild forms of illness. The CSJ’s assumptions grossly underestimate the complexities of these conditions and ignores the many barriers that people with severe mental illness face when trying to access benefits in the first place, as outlined in our Set Up To Fail report on people’s lived experience of the benefits system.
 
Inconsistently lumping ADHD in with mental illnesses throughout the report may also be wrongly inflating the figures, rather than reflecting diagnostic realities. ADHD is a neurodevelopmental condition, not a mental illness, and should not be used as a rhetorical or statistical device to prove a point.

Does the overmedicalisation argument stand up?

The report conflates over-prescription with over-diagnosis, which are distinct issues. Prescribing antidepressants does not necessarily mean depression is being overdiagnosed but may simply reflect that many people are struggling and there are too few accessible alternatives available. 
 
While it's true that we still don’t fully understand how some psychiatric medications work, many people find them helpful. Lack of full understanding is not in itself a justification to discourage their use, particularly in the absence of robust alternatives. 

False trade-offs: Treatment vs. Benefits

The suggestion that benefits spending could be redirected into NHS Talking Therapies or social prescribing is deeply flawed. People do not choose between treatment and financial security - they need both. We would never suggest taking away cancer patients' benefits to fund chemotherapy. Why, then, propose this for people with mental illness? 
 
While NHS Talking Therapies work well for some, they are not a universal solution. Engagement levels are lower among racialised communities, and people with severe mental illness often struggle to access or benefit from the model. There needs to be a comprehensive offering of services that work for all communities, mental health care is never one size fits all.

Where the report does get it right

We do agree with some of the report’s recommendations. More coordinated care pathways, better use of data (with robust safeguards), and a strategy for social prescribing could all make a positive difference, providing the right infrastructure exists. 
 
But such policies must be underpinned by reality: social prescribing only works when there are services to refer people to. Care pathways only help when they are accessible and well-funded. Better data will require investment in digital technologies and skills.  

We need holistic, evidence-based reform, not ideologically driven rhetoric 

The CSJ questions whether something else is going on with the increasing mental illness in Britain, and we agree that this is a nuanced and difficult conversation. However, this report’s binary framing, pitting medication against social support and benefits against treatment, risks setting back the public conversation on mental health. People with severe mental illness need integrated, compassionate care rooted in evidence, not selective data and ideological prescriptions.

We need investment in services that support people holistically, recognising that mental illness does not exist in a vacuum, but in the context of people’s lives, environments, and experiences. We need to cut waiting lists, not benefits to avoid causing further harm.