Well I know I’ll be ripped apart for this, but it is based on my observation as a GP for over 25 years.
Depression and anxiety is very subjective. There’s no test for it. If a patient says the feel a certain way, doctors have no choice but to believe them. If they say they feel too depressed/anxious to work, we can’t prove otherwise, so we have to give them a sick note. Even if they decline medication or counselling, we still have to give them sick notes.
I’ve had patients who have been on long term sick for years due to depression, and not taken a single antidepressant or had any kind of talking therapy. In that time they’ve had marriages, kids, divorces, new relationships, holidays, house moves - all the usual stuff - but they never work.
In general these are people with pretty shit lives - bad childhood, low income upbringing, dysfunctional families - so they have plenty of reasons to be unhappy and anxious.
But often I find myself thinking they’d be much happier if they actually had a job, which would give them a sense of achievement, a feeling of positivity, and also more money than the tiny amount of benefit they get. But the longer someone is out of work, the harder it is to imagine working again. People get used to a certain life and they’re wary of changing it. There’s also a big fear that once you relinquish your benefits, you may not be able to reactivate them if the job goes wrong.
Personally I think there should be more obligation to do “therapeutic” work - people on long term sickness benefit should be encouraged to take on small supervised roles. I recall an alcoholic patient of mine, an apparently hopeless case, never managed to stop drinking for more than a few weeks. The longest dry period he ever had was when he worked in a charity shop - he ended up as the store manager, and he was happy and fulfilled for years, until an electrical fire burnt the shop down and it never reopened. He started drinking again and never worked again.
I realise this goes massively against the MN belief that everyone on sick leave is completely incapacitated, and that anyone saying otherwise is an evil bastard!