Category: Mental Health

Government subverts judicial process and abandons promise on mental health ‘parity of esteem’ to strip people of PIP entitlement

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Personal Independence Payment is a non means tested benefit for people with a long-term health condition or impairment, whether physical, sensory, mental, cognitive, intellectual, or any combination of these. It is an essential financial support towards the extra costs that ill and disabled people face, to help them lead as full, active and independent lives as possible.

Before 2010, policies that entailed cutting lifeline support for disabled people and those with serious illnesses were unthinkable. Now, systematically dismantling social security for those citizens who need support the most has become the political norm.

Any social security policy that is implemented with the expressed aim of “targeting those most in need” and is implemented to replace a policy that is deemed “unsustainable” is invariably about cost cutting, aimed at reducing the eligibility criteria for entitlement. The government were explicit in their statement about the original policy intent behind Personal Independence Payment. However, what it is that defines those “most in need” involves ever-shrinking, constantly redefined categories, pitched at an ever-shifting political goalpost.

Disability benefits were originally designed to help sick and disabled people meet their needs, additional living costs and support people sufficiently to allow  a degree of dignity and independent living. You would be mistaken in thinking, however, that Personal Independent Payment was designed for that. It seems to have been designed to provide the Treasury with ever-increasing pocket money. Or as the source of profit for private providers who constantly assess, monitor, coerce and attempt to “incentivise” those people being systematically punished and impoverished by the state to make “behaviour changes,” which entail them not being disabled or ill and taking any available employment, regardless of its suitability. 

The government have already considered ways of reducing the eligibility criteria for the daily living component of Personal Independence Payment (PIP) by narrowing definitions of aids and appliances, and were kite flying further limits to eligibility for PIP last  year. 

Two independent tribunals have ruled that the Department for Work and Pensions (DWP) should expand the scope and eligibility criteria of Personal Independence Payment (PIP), which helps both in-work and out-of work disabled people fund their additional living costs. 

Following a court ruling in favour of disabled people last month, the government is rushing in an “urgent change” to the law to prevent many people with mental health conditions being awarded the mobility component of PIP. The court held that people  with conditions such as severe anxiety can qualify for the enhanced rate of the mobility component, on the basis of problems with “planning and following a journey”, or “going out”. 

The government’s new regulations will reverse the recent ruling and means that people with mental health conditions such as severe anxiety who can go outdoors, even if they need to have someone with them, are much less likely to get an award of even the standard rate of the PIP mobility component. The new regulations also make changes to the way that the descriptors relating to taking medication are interpreted, again in response to a ruling by a tribunal in favour of disabled people.

The first tribunal said more points should be available in the “mobility” element for people who suffer “overwhelming psychological distress” when travelling alone. The second tribunal recommended more points in the “daily living” element for people who need help to take medication and monitor a health condition. 

The Department for Work and Pensions (DWP) warned that it would cost £3.7bn extra by 2022 to  implement the court rulings. The government have responded by formulating “emergency legislation” to stop the legal changes that the upper tribunals had ruled on from happening. From 16 March the law will be changed, without any democratic conversation with disabled people and related organisations, or debate in parliament, so that the phrase “For reasons other than psychological distress” will be added to the start of descriptors c, d and f in relation to “Planning and following journeys” on the PIP form.

It’s worth noting that the Coalition Government enshrined in law a commitment to parity of esteem for mental and physical health in the Health and Social Care Act 2012. In January 2014 it published the policy paper Closing the Gap: priorities for essential change in mental health (Department of Health, 2014), which sets out 25 priorities for change in how children and adults with mental health problems are supported and cared for. The limiting changes to PIP legislation does not reflect that commitment.  

The new regulations are being rushed in without any dialogue with the Social Security Advisory Committee, too. 

The government have designed regulations which would, according to Penny Mordaunt, be about “restoring the policy originally intended when the Government developed the PIP assessment”.

The original policy intent was to create an opportunity to limit eligibility for those people previously claiming Disability Living Allowance (DLA) whilst they were being reassessed for PIP, which replaced DLA. And to limit successful new claims. 

Mordaunt also said in a written statement to MPs: “If not urgently addressed, the operational complexities could undermine the consistency of assessments, leading to confusion for all those using the legislation, including claimants, assessors, and the courts.

“It is because of the urgency caused by these challenges, and the implications on public expenditure, that proposals for these amendments have not been referred to the Social Security Advisory Committee before making the regulations.”

An ever-shifting, ever-shrinking goalpost

Any social security policy that is implemented with the expressed aim of “targeting those most in need” is invariably about cost cutting and reducing eligibility criteria for entitlement. The government were explicit in their statement about the original policy intent of Personal Independence Payment. 

The government has already considered ways of reducing eligibility criteria for the daily living component of Personal Independence Payment by narrowing definitions of aids and appliances, last  year. 

Prior to the introduction of PIP, Esther McVey stated that of the initial 560,000 claimants to be reassessed by October 2015, 330,000 of these are targeted to either lose their benefit altogether or see their payments reduced.

We ought to challenge a government that displays such contempt for the judicial system, and ask where the ever-reductive quest for the ever-shrinking category of “those with the greatest need” will end. 

Labour’s Shadow Work and Pensions Secretary, Debbie Abrahams MP, criticised the government’s decision to overturn the tribunal rulings, she said: “Instead of listening to the court’s criticisms of PIP assessments and correcting these injustices, this government have instead decided to undermine the legal basis of the rulings”.

Abrahams added: “This is an unprecedented attempt to subvert an independent tribunal judgement by a right-wing government with contempt for judicial process.

By shifting the goal posts, the Tory Government will strip entitlements from over 160,000 disabled people, money which the courts believe is rightfully theirs. This is a step too far, even for this Tory government.”

The government seem to think that PIP is a policy that ought to benefit only the needs of a government on an ideological crusade to reduce social security away to nothing – “to target those in greatest need” – an ever-shrinking, constantly redefined and shifting category of disability.

It is not a democratic government: they are unwilling to engage in a dialogue with the public or to recognise and reflect public needs: that’s an authoritarian elite taking public money and handing it out to a very wealthy minority group in the form of “incentivising” tax cuts, who then say to the public that providing lifeline support for disabled people and those with mental health/medical conditions is “unsustainable”.

Implications for the UK’s obligations regarding the UN convention on the human rights of disabled persons and the Equality Act

The new PIP changes, pushed through without any public conversation or democratic exchange with disabled people, are in breach of both the UN convention on the rights of disabled persons, and the UK Equality Act.

In the Equality Analysis PIP assessment criteria document, the government concede that: “Since PIP is a benefit for people with a disability, impairment or long-term health condition, any changes will have a direct effect on disabled people. The vast majority of people receiving PIP are likely to be covered by the definition of “disability” in the Equality Act 2010.

By definition, therefore, the UT [upper tribunal] judgment results in higher payments to disabled people, and reversing its effect will prevent that and keep payments at the level originally intended. The difference in income will clearly make a real practical difference to most affected claimants, and (depending on factors such as their other resources) is capable of affecting their ability to be independently mobile, access services etc – all matters covered by the UN Convention on the Rights of Persons with Disabilities as set out at the start of this Analysis.”

It goes on to say in the document: “However, this does not necessarily mean that the increased payments that would result from the judgment are a fair reflection of the costs faced by those affected, or represent a fair approach as between different groups of PIP claimants.” 

People with the following conditions are likely to be affected by the reversal of the upper tribunal’s ruling on those needing support to manage medication, monitor a health condition, or both:

Diabetes mellitus (category unknown), Diabetes mellitus Type 1 (insulin dependent), Diabetes mellitus Type 2 (non-insulin dependent), Diabetic neuropathy, Diabetic retinopathy, Disturbances of consciousness – Nonepileptic – Other / type not known, Drop attacks, Generalised seizures (with status epilepticus in last 12 months), Generalised seizures, (without status epilepticus in last 12 months), Narcolepsy, Non epileptic Attack disorder (pseudoseizures), Partial seizures (with status epilepticus in last 12 months), Partial seizures (without status epilepticus in last 12 months), Seizures – unclassified Dizziness – cause not specified, Stokes Adams attacks (cardiovascular syncope), Syncope – Other / type not known.

People with the following conditions are likely to be affected by the reversal of the independent tribunal’s ruling regarding PIP mobility awards, with conditions in the general category of “severe psychological distress”:

Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

The government’s so-called commitment to a “parity of esteem for mental health and physical health” was clearly nothing more than an empty promise – an opportunistic platitude. This is a government that says  one thing and then does exactly the opposite.

 It’s all part of a broader gaslighting and linguistic techniques of neutralisation strategy that passes as Conservative “justification” for their draconian deeds and bullying, discriminatory and uncivilised austerity regime, aimed disproportionately at disabled people.

Commenting on the Ministerial announcement (made yesterday, 23rd February), Rob Holland, Public Affairs Manager at Mencap and Disability Benefits Consortium Parliamentary Co-Chair said:

“We are concerned by these changes to the criteria for Personal Independence Payment (PIP). These risk further restricting access to vital support for thousands of disabled people. Last year, MPs strongly opposed restrictions to PIP and the Government promised no further cuts to disability benefits. Other changes have already had a devastating impact on thousands and in far too many cases people have had to rely on tribunals to access the support they need.

We are deeply disappointed as a coalition of over 80 organisations representing disabled people that we were not consulted about these proposals and their potential impact. The Government must ensure the views of disabled people are properly considered before they proceed with these changes.”

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The full ministerial statement can be read here.

Download a copy of the new regulations here.

Related

PIP disability benefit test ‘traumatic and intrusive’

PIP and the Tory monologue

Government guidelines for PIP assessment: a political redefinition of the word ‘objective’

I don’t make any money from my work. I am disabled because of illness  and have a very limited income. But you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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Critique of the ‘Origins of Happiness’ study. Psychologists Against Austerity respond

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Clinical psychologists have widely criticised Labour peer and economist, Richard Layard, over research he led that claims failed relationships and physical and mental illness were bigger causes of misery than poverty. 

“Happiness scholars” and authors of the study report, Andrew Clark, Sarah Fleche, Richard Layard, Nattavudh Powdthavee and George Ward say:

“Understanding the key determinants of people’s life satisfaction will suggest policies for how best to reduce misery and promote wellbeing. This column discusses evidence from survey data on Australia, Britain, Germany, and the US which indicate that the things that matter most are people’s social relationships and their mental and physical health; and that the best predictor of an adult’s life satisfaction is their emotional health as a child.”

In the their study, the Origins of Happiness, the authors call for a new focus for public policy: not ‘wealth creation’ but ‘wellbeing creation.'”

The authors say: “Most human misery is due not to economic factors but to failed relationships and physical and mental illness. Eliminating depression and anxiety would reduce misery by 20% while eliminating poverty would reduce it by 5%. And on top of that, reducing mental illness would involve no net cost to the public purse.” 

So the authors propose the delivery of more Cognitive Behavioural Therapy (CBT), whilst income redistribution and social justice perspectives are considered trivial and insignificant because they are deemed too costly. Layard in particular enthusiastically endorses CBT, which he regards as the modern evidence-based psychological therapy of choice. Layard was one of the key signatories of The Depression Report, and one of the main campaigners, along with David Clark, for the Increasing Access to Psychological Therapies (IAPT) programme, which has entailed the mass provision of CBT.

CBT is a cheap, short-term, goal-oriented treatment that practitioners claim takes a “hands-on, practical approach to problem-solving.” Its goal is to change patterns of thinking or behaviour that are claimed to be behind people’s difficulties, and so change the way they feel about their circumstances. However, I have critiqued this approach more than once. 

I’ve also critiqued the use of quantitative methodology and survey methods more generally in policy-making, as such methods frequently fail to pay due regard to authenticity, reliability and validity, inclusion and full participation: quantitative methods tend to be used non-prefiguratively. (See for example: The importance of citizen’s qualitative accounts in democratic inclusion and political participation.)

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Happiness is a neoliberal warm gun: depopulating policy

CBT is of course premised on the assumption that interpreting situations “negatively” is a bad thing, and that thinking positively about bad events is beneficial.

The onus is on the individual to adapt by perceiving their circumstances in a stoical and purely “rational” way. CBT is primarily about self-governance techniques.

So we need to ask what are the circumstances that the authors are expecting people to accept stoically. Socioeconomic inequality? Absolute poverty? Sanctions? Work fare? Being forced to accept very poorly paid work, abysmal working conditions and no security? The loss of social support, public services and essential safety nets? Starvation and destitution? Political authoritarianism? The end of democracy?

It’s all very well challenging people’s thoughts but for whom is CBT being used, and for what purpose? It seems to me that this is about helping those people on the wrong side of draconian government policy to accommodate that, and to mute negative responses to negative situations. CBT in this context is not based on a genuinely liberational approach, nor is it based on any sort of democratic dialogue. It’s all about modifying and controlling behaviour, particularly when it’s aimed at such narrow, politically defined and specific economic outcomes, which extend and perpetuate inequality. In this context, CBT becomes state “therapy” used only as an ideological prop for neoliberalism.

CBT is too often founded on blunt oversimplifications of what causes human distress – for example, it is currently assumed that the causes of unemployment are psychological rather than sociopolitical, and that particular assumption authorises intrusive state interventions that encode a Conservative moral framework, which places responsibility on the individual, who is characterised as “faulty” in some way. The deeply flawed political/economic system that entrenches inequality isn’t challenged at all: its victims are discredited and stigmatised instead.

Yet historically (and empirically), it has been widely accepted that poverty significantly increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics and circumstances (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, requires engagement with this complexity. (See: Elliott, I. (June 2016) Poverty and Mental Health: A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy. London: Mental Health Foundation).

In the social sciences there is a longstanding and unresolved debate over the primacy of structure or agency in shaping human behaviour. Structure is the recurrent patterned social, economic and political arrangements which influence or limit the choices and opportunities available to citizens. Agency is the capacity of individuals to act autonomously and independently of “outside forces” to make their own free choices. 

Layard et al. dismiss the importance of context on human behaviours, cognitions, perceptions, attitudes and states of mind, and the study is premised and proceeds as if this controversy has been resolved. It hasn’t. 

Such an approach crucially overlooks conflict, the impacts of political decision-making, economic arrangements, social structure, prevailing cultural norms and ideologies, for example.

Rather predictably, Layard’s approach to research (for he’s an economist, not a psychologist, hence his approach shares more in common with the behavioural economists from the cost-cutting, antidemocratic Nudge Unit) conflates human needs and wellbeing with narrow ideological (antiwelfarist, “small state” neoliberal) outcomes, by removing any consideration of the complex interactions, constraints and impacts of the economic, social, cultural and political context on human happiness. Layard’s neuroliberal approach therefore may be read as an endorsement of existing socioeconomic inequalities. 

Furthermore, definitions of “happiness” are culturally specific. They are susceptible to culturally (and politically defined) dominant moral judgements. The happiness imperative may be regarded as an artifact of modern history, not as an inherent feature of the human condition. Across cultures and time, happiness has most frequently been defined as “good luck” and arising because of favourable external conditions. Some definitions place notions of a virtuous life and “hard work” as essential and central qualities of happiness. It’s worth noting that from 1997 to 2001, Layard was an adviser to New Labour and one of the key architects of the “New Deal” and “Welfare to Work” policies. He certainly has clearly defined ideological inclinations.

In those countries with a dominant ideology that is founded on competitive individualism, such as the US and the UK, the definitions of happiness and wellbeing based on chance and context were replaced by definitions focused on favourable internal feelings and states. In other words, happiness came to be regarded as an inner state that we have some personal control over. The significant rise in the availability and popularity of “self help” literature in the western world is a testament of this view that the happiness of citizens is a personal responsibility, and not a political one.

A central theme in this individualist approach is a relentless optimism about the capacity of individuals to improve their own mental health, and accept things as they are in order to bask in earned and fully deserved human happiness and fulfilment. The starting point of the self help perspective, (dating back to Samuel Smiles and his moralising, conservative disquisitions on Thrift and Self help: the austerity ideologue of mid Victorian laissez faire) is that the world is basically okay, the problems arising at an individual level are simply because of how we choose to perceive it – this is reflected in an emphasis on the necessity of changing the way you see and think about the world, particularly in neoliberal economies. It’s very clear why CBT is so appealing to the UK Conservative government. It doesn’t challenge the status quo at all. 

Establishing happiness as a metric is only meant to serve a political end. Indeed, it may even be regarded as a form of political gaslighting. I’m not alone in my concern that “happiness” research could be used to advance authoritarian aims. Studies show that in European elections since 1970, the subjective “life satisfaction” of citizens is the best predictor of whether the government gets re-elected  – this apparently is much more important than economic growth, social conditions, unemployment or inflation.

CBT is the modern descendant of the discredited, ever so quantitative behaviourist tradition, spearheaded by B.F. Skinner, who views persons as nothing more than empty and simple mediators between behaviour and the environment. Integral to this perspective of behaviourism is the concept of behaviour modification through rewards or “consequences.” This has been politically translated into a reductionist economic language of incentives and outcomes. (Stimulus => response.)

This is paralleled with the growth of nudge, which is a technocratic behaviourist solution and ideological prop in the form of behavioural economics, which is also all about generating public policies that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes.

Even the likes of Oliver James (author of Affluenza and The Selfish Capitalist, among other works) critique the symptoms of neoliberal policies rather than the disease: neoliberalism itself.

This is precisely why independent research findings consistently highlight the value of adopting less idiomatic and more value neutral historical, political, cultural and linguistic perspective in the study of public happiness.

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I think it’s fair to say that mental illness is not caused by just one thing. Poverty can be one factor or trigger that interacts with a complexity of other events, such as adverse life events, genetic predisposition, poor physical health or substance abuse. But so far, the strongest evidence suggests that poverty can lead to mental illness, especially disorders such as depression.

Living in poverty causes chronic distress and struggle. Failure to meet basic human needs certainly has an impact on human and social potential – Abraham Maslow explored how our cognitive priorities are reduced when our physiological needs are not met or our survival is threatened. Struggle and distress may have an ultimate biological impact on brain function. According to one controversial hypothesis, schizophrenia is the result of chronic experience of social adversity and defeat, which disturbs the dopamine level and function in the brain, for example.

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A report published by the World Health Organization this year strongly suggests that poor individuals are twice as affected by mental health conditions compared to rich individuals. The report concludes: “Whilst the relationship between poverty and mental health is complicated, individual measures taken to reduce global poverty are likely to have positive impacts on mental health issues in underprivileged populations.”

Regardless, a society may be judged on how it treats its most disadvantaged citizens. The harrowing problems of poverty, as described in Charles Dickens’ David Copperfield, and social rehabilitation, or lack of it, as portrayed by Victor Hugo in Les Misérables, sadly remain as pressing today.

The statement from Psychologists Against Austerity

The Origins of happiness study overlooked the social and political context of mental health, say campaign group Psychologists Against Austerity. This lets politicians and the architects of austerity off the hook.

The London School of Economics (LSE) study, led by Layard, was published in early December. The report claims that eliminating depression and anxiety would be a cheap way to reduce misery by 20 per cent, while eliminating poverty would be more difficult – and, besides, it would only reduce unhappiness by 5 per cent.

Psychologists against austerity (PAA) have condemned the stark and simplistic dichotomy presented in the report between income and mental illness as predictors of life satisfaction.

In a response published online, the group, which is made up of practising mental health professionals, highlighted the fact “some media reports have gone further, apparently taking the results to imply that there is no causal relationship between poverty and mental illness”, and blamed the researchers for not making the complex relationship between poverty and mental health clearer. According to the psychologists, the two things “are related in a complex variety of ways, with both causally influencing the other”.

The group of psychologists said it was easy for the researchers to downplay the link in their findings, because the relationship is not as simple as happiness being dependent on income alone.

“Living in poverty is more stressful, with fewer buffers, so challenges are more likely to be catastrophic,” their statement said. “People living in poverty have less agency and control over their lives, and live with lower status, often accompanied by stigma, powerlessness and shame.”

Layard’s emphasised that as UK average incomes have increased, the country has not got happier. But PAA point out that in addition to becoming richer, Britain has also become a profoundly more unequal society since the 1980s.

The original study states that relative poverty is more important than absolute poverty in mental health terms, but does discuss this in detail.

Decades of previous research supports PAA’s statement, and many individual psychologists and academics agree with the anti-austerity group’s statement. 

The study “lets politicians off the hook, it lets austerity off the hook” by treating mental illness as if it exists in a void and is not intrinsically linked to societal factors, director of clinical psychology at Canterbury Christ Church University, Dr Anne Cooke, told the Guardian:

“It says that all that doesn’t matter, making a better society doesn’t matter, just offering technical treatments,” she said. “I am one of the people that offers technical treatments and I think they can be extremely helpful to some people but that argument is being stretched beyond the point at which it applies.”

Dr Peter Kinderman, president of the British Psychological Society, has said he welcomed Lord Layard’s call for a focus on national wellbeing through investment in mental health services. But he added, speaking to the Guardian, that he had misgivings about how the study had treated mental illness as a distinct variable from human misery.

Layard’s work has previously led to David Cameron’s adoption of national “wellbeing” statistics, and he was also a driving force behind the adoption of the Improving Access to Psychological Therapies to increase access to “talking therapies” on the NHS.

That latter policy was particularly controversial because it established finding work as an outcome of psychological treatment, which critics said may not be a suitable outcome for some and encouraged a policy of forcing people into work which may not be appropriate for them. PAA and other campaign groups have previously called aspects of the scheme’s implementation “profoundly disturbing”, attacking 2015 plans by then-chancellor George Osborne to link welfare and therapy by placing IAPT therapists in job centres. Layard, who is an economist rather than a psychologist, is now calling for a “new role for the state” that “swaps wealth creation for wellbeing creation” through targeted mental health interventions.

The LSE study has worried psychologists because Layard is highly influential with policymakers. The Labour peer’s recommendations previously led David Cameron to adopt national wellbeing statistics, and Lord Layard was also a driving force behind the Improving Access to Psychological Therapies (IAPT) scheme to increase access to “talking therapies” on the NHS.

Dr Jay Watts, a clinical psychologist, told the Guardian Layard’s call “negates decades worth of data linking mental health to poverty”.

“It’s ripe for misuse … in the current political climate,” she added.

Dr Anne Cooke said there were better ways to improve wellbeing than by focusing on isolated mental health interventions. Policy should take a more holistic public health approach, she proposed.

“Cholera wasn’t eradicated by developing new treatments, it was eradicated by improving drains back in pre-Victorian times.

What [Layard] neglects is the people at the bottom of the pile who are really, really struggling, and in current circumstances there are a lot of them. People who you see at food banks for example, who are in incredible distress and certainly would – most of them or a lot of them – meet the criteria for an anxiety disorder or depression,” she said.

But it’s largely a response to their circumstances. If we do something about that, rates of mental illness in the population are going to come down a lot more effectively than providing a lot more therapy.”

Meanwhile, PAA suggested that rather than doing nothing to help the most disadvantaged people, the study could actually contribute to perpetuating poverty.

“Discussions of mental health that leave out a thorough analysis of poverty and income inequality may be used uphold policies that maintain disadvantage and oppression in society,” the group said.

You can read PAA’s full response here

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Adults in the poorest fifth are much more likely to be at risk of developing a mental illness as those on average incomes: around 24% compared with 14%.

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Related

The Psychological Impact of Austerity – Psychologists Against Austerity

Psychologists Against Austerity: mental health experts issue a rallying call against coalition policies 

The power of positive thinking is really political gaslighting

I don’t make any money from my work. But you can contribute by making a donation and help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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Nothing about us without us? Are you bonkers?

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This is an excellent article from The Alliance for Counselling & Psychotherapy. It de-individualises and de-stigmatises mental illness by placing it firmly in the context of neoliberalism, which is a doxa  –  an over-arching political and economic dominant narrative and mode of social organisation. Neoliberalism has a dire impact on increasing numbers of citizens, and on those who are a part of already marginalised social groups in particular.

A doxa is something that comes to be regarded as common sense;  it is taken for granted “knowledge” in society. It is the experience by which “the natural and social world appears as self-evident.” As an over-arching and self referential, self perpetuating idiom of belief, it is difficult to challenge from “within” the idiom. Yet neoliberalism is just one choice of social organisation amongst several alternatives. It isn’t a rational or democratic choice, since it is increasingly detrimental to the majority of ordinary people.

R.D Laing once said that: “Insanity is a perfectly rational adjustment to an insane world.” That has probably never been more true than it is now. How can therapists address these real and pressing issues? One thing is certain, it isn’t by claiming value neutrality and by simply “treating” individuals. Kitty.

allianceforcp's avatarThe Alliance for Counselling & Psychotherapy

In May this year, I joined members of the Mental Health Resistance Network at an event at the Old Vic. It was a panel debate on the state of mental health provision in the UK, one of their Voices Off events linked to the production of Harold Pinter’s The Caretaker. The original panel was Luciana Berger MP, Shadow Minister for Mental Health; Paul Farmer, CEO of Mind; and Simon Wessely President of the Royal College of Psychiatrists. MHRN members protested that there were no service user speakers, and eventually Peter Beresford and Alice Evans were invited onto the panel.

Inspired by the desperate lack of service user voices, mental health activists rapidly got together a zine to distribute at the meeting – a passionate collection of first-hand experiences of living on the sharp end of mental health disability in the UK. Jay Watts of the Alliance contributed a cartoon…

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Andrew Samuels on Jobcentre Therapy and the Psy-Organisations

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allianceforcp's avatarThe Alliance for Counselling & Psychotherapy

Letter submitted to Therapy Today (the BACP journal) but not published.

I’d like to respond to Catherine Jackson’s interesting article ‘Colocation or collusion? How ethical are the Government’s proposals for closer working between IAPT services and Jobcentre Plus?’ (Therapy Today, April 2016, pp.8-9).

Catherine’s title suggests that the issue is generating heat and, at the end of this letter, I make a suggestion for a dialogical, relational next step.

What Catherine wrote illustrates the usual dilemma that the large professional organisations find themselves in with regard to Government policies – in this case, the many linkages between employment on the one hand and psychological therapies on the other. If bodies such as BACP, UKCP, BPC, BPS and BABCP are too robust in their criticism of Government policies, they will be labelled as ‘the awkward squad’ and ‘the usual suspects’. Doors in Whitehall close, requests for meetings go…

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Young people’s mental health champion axed by government because she was critical

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Natasha Devon MBE, former Government mental health champion and schools adviser speaking at our ‘Good Mental Health in Schools – What Works?’ conference on 28th April 2016.

The Government’s appointed mental health champion, Natasha Devon, who has been highly critical of how extensive academic testing of young people impacts negatively on their wellbeing, creating anxiety and stress, has had her role axed by the Department for Education (DfE).

A DfE spokesperson said that Ms Devon’s role, which was to raise awareness and reduce the stigma around young people’s mental health problems, had been axed to avoid “confusion.” The department has denied that the decision to unappoint Natasha as the mental health tsar for schools last August, was a political move designed to silence criticism of government policies. However, Natasha has been told that she can no longer make any comments publicly about her role.

Ms Devon has also criticised former education secretary Michael Gove – she said that he was “despised and divisive” and “refused” to accept a link between mental health, academic competition and performance.

The DfE has maintained that the decision was not based on Devon’s “frank” nature, (a strange way of describing integrity) but because “a cross-governmental champion was recognised as being the preferred option.”

Natasha has highlighted the negative impact of the academic pressures facing young people, and said she knew her opinions would not be popular “in some circles”, but felt she had to be brave and speak out, as an advocate for young people.

Last week, in her last public appearance, Ms Devon addressed a headteachers conference saying: “Time and time again over recent years, young people – and the people who teach them – have spoken out about how a rigorous culture of testing and academic pressure is detrimental to their mental health.

At one end of the scale we’ve got four-year-olds being tested, at the other end of the scale we’ve got teenagers leaving school and facing the prospect of leaving university with record amounts of debt. Anxiety is the fastest growing illness in under-21s. These things are not a coincidence,” she warned.

Devon said: “We have started to misuse words like ‘character, resilience and grit’ as though struggling with a mental illness is a defect in the individual, rather than a response to a culture which makes it difficult to enjoy good mental health.”

The former mental health champion for schools in England took up the post last August. Ms Devon, who was awarded an MBE in 2015 for her work helping young people conquer mental health and body image issues, said she had not been paid for the role as it was important she remained independent and objective.

She warns that the new, paid mental-health champion could “be paid effectively to toe the party line” though she hoped the new champion would be a “positive force for good,” but she was “sceptical”.

She said: “When I first took the role, I said to the department what I want to do is… bring the concerns of young people and the people who teach them to government level.

So it’s not actually me that’s being silenced, it’s young people and teachers.

I think the government knows that young people don’t vote, or if they do they are very unlikely to vote Tory, and they have historically ignored their needs and the price they have paid is now we have seen a crisis in their mental health.”

Natasha further commented: “I can confirm that I am no longer authorised to comment as the Government’s mental health champion for schools. The DfE have extended an opportunity for me to continue working on the peer-to-peer project they were seeking my advice on.”

Sarah Brennan, the chief executive of YoungMinds, said: “We are very surprised and sad that Natasha’s role as mental health champion has ended. She’s done a superb job of drawing attention to the crucial importance of mental health and wellbeing in schools.”

More than 40,000 people have signed a petition protesting against primary school tests aimed at seven-year-olds as part of more rigorous assessment processes. Many critics have claimed that children are being tested too early and their education is limited by being focused towards examinations rather than broader learning, resulting in “exam factories.”

Luciana Berger, mental health shadow minister, said Devon had spoken out “openly and honestly about the challenges facing children’s mental health under this Tory government.”

She added: “If she has been silenced then this raises serious questions over the government’s commitment to listening to the evidence and acting in the best interests of young people’s mental health and wellbeing.

Ministers must explain themselves as a matter of urgency. Nicky Morgan [the education secretary] claims to be in ‘listening mode’ but it would appear that this does not extend to those that do not agree with her.”

News of Devon’s departure came the day after hundreds of parents chose to keep their children at home on Tuesday in a day of protest against tougher primary school tests, which they say are causing stress and anxiety in schools. This was part of the national “Let Our Kids be Kids” campaign, which is a response to concerns raised about the tough new exams introduced by the government. Campaigners protesting against Standard Assessment Tests (SATs) in primary schools say that children are “over-tested, over-worked and in a school system that places more importance of test results and league tables than children’s happiness and joy of learning.”

This is education that is geared towards constant assessment, competition, homogeneity, social stratification and labeling, rather than dialogue, cooperation, engagement, diversity and inspiration. Young people are being acted upon by the state, and treated as passive agents, rather than as active participants in the learning process.

Devon’s criticism went beyond mental health in the classroom. In an article for the Times Educational Supplement she accused the government of engineering “a social climate where it’s really difficult for any young person to enjoy optimal mental health”. She said: “Young people’s mental health is getting worse, but the government doesn’t want to address the social inequality that causes it.

It isn’t simply that we are hearing about mental ill-health more these days: our mental health is, beyond empirical doubt, getting worse. ”

 

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Related

Young people’s mental health is getting worse, but the government doesn’t want to address the social inequality that causes it

Nicky Morgan proposes a retrogressive, enforced segregation of pupils based on ability

The Psychological Impact of Austerity – Psychologists Against Austerity

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Infantilizing the nation – an insight into Conservative ‘paternalism’

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                                               hqdefault                                                 Young Bullers

 

Paternalist parenting classes? Heaven forbid

The Prime Minister claims that every family needs help in improving behaviour and discipline. Ironically, this is from a politician who claims to despise the “nanny state”. He much prefers the Bullingdon brand of paternalist interference in people’s everyday lives. Cameron is also recommending “parenting classes” for all, which is understandable given his own strong instincts as a parent. He left his own child in a pub, after all.

Of course Cameron feels that it’s other people that need parenting and discipline. After all, this is a man who spent his early adulthood involved in bizarre initiation rituals, patriarchal debauchery, recklessly banqueting, getting drunk, trashing college rooms and pubs, listening to Supertramp and smoking pot with James Delingpole and vandalising restaurants. In 2013, it was reported that members of the Bullingdon Club were required to burn a £50 note in front of a beggar as part of an “initiation ceremony”. How encouraging to see the elite showing responsibility, compassion, a concern for social justice and cohesion, equality and alleviating poverty, at an early age.

Now that’s a real deviant subculture.

The draconian sentences handed down to the rioters in 2011, advocated by Cameron –  like the 23-year-old student with no previous convictions who was jailed for the maximum permitted six months after pleading guilty to stealing bottles of water worth £3.50 from Lidl in Brixton, for example –  shows only too well that he believes there is one rule for the Oxford elite and another for the rest of the society. Punishment is a central component of the social order and a means by which social order is produced and maintained.

Actually, defining others as deviant is, too. It’s a Conservative means of enhancing social power and status differentials by degrading the rule-breaker’s status and power.

Cameron’s response to the riots reflects a characteristically Bullingdon conservative disdain: an authoritarian, strict and oppressive approach towards perceived, labelled and stigmatised subordinates. Conservatives have always seen the social world as being organised in terms of hierarchies of worth. Smashing up a pub or restaurant and causing 10k worth of damage is no problem if you can cough up the costs on the spot to keep your thuggish behaviour private, hidden away from the scrutiny of the legal system and the public. Money talks and bullshit struts.

The Conservatives inform us that it is bad parents that cause poverty, opting for a rhetoric of authoritarian populism, creating cardboard monsters, manufacturing folk devils and moral outrage for the tabloids, making excuses for the consequences of their own prejudiced and damaging policy-making.

The establishment is a kind of Moebius strip of finger-pointing, arrogant, moralising privileged and feckless bullies passing the buck. And importantly, these wayward boys and girls always get their own way. They can’t democratically govern the country; they lack the social skills, motivation, developmental and emotional capacity to actually engage in any genuine and democratic dialogue with ordinary people, so they rule. Conservatives have always prefered the simplicity of a socio-economic system defined by inherited social ranks.

Cameron says that the government’s Life Chances Strategy – an “initiative to target tackle child poverty” – will include a plan for “significantly expanding parenting provision”. It will also recommend ways to “incentivise” all parents to take up the offer of classes. The hope is, presumably, that if the middle class take Cameron up on his offer of state parenting instructions, the process of social norming will provide the foundation of state-defined “correct behaviours” for the insubordinate working classes, who are perpetually caught up, according to the Tories, in a pathological cycle of something or other, and therefore need state therapy from elitist antipodean role models to set them straight and put them in their place. It’s the new behaviourism: do as we say, but not what we do.

It seems that poverty is to be addressed with nothing more than a paternalist brand of cheap psychopolitics. The government won’t be dipping their hands into the treasury, which is what’s needed. Instead they prefer to employ shabby techniques of persuasion aimed at indoctrinating a Conservative world-view and enforcing conformity as a replacement for genuinely needs-led and evidence-based policies.

At no point does Cameron mention any commitment to improving people’s standard of living, or ensuring that families have a basic level of income in order to meet their fundamental needs, such as food, fuel and shelter – because struggling to meet basic material needs are the main barriers for people experiencing poverty. It’s sobering to consider that the Tory obsession with the work ethic, embodied in their mantra “making work pay”, is nothing more than a meaningless glittering generality, that purposefully diverts attention from elitist policy-making, and subsequent growing poverty and inequality.

Around half of those who are in poverty and of working age live in a household where at least one person works. The steady drop in real wages since 2010, according to the Office for National Statistics, is the longest for 50 years.

Furthermore, since 2010, the decline in UK wage levels has been amongst the very worst in Europe. The fall in earnings under the Coalition is the biggest in any parliament since 1880, according to analysis by the House of Commons Library, and at a time when the cost of living has spiralled upwards.

Ah, and Cameron uttered that inane managementspeak word again – “incentivise”. It never bodes well when Conservatives use that word. It means he has been listening to the psychobabbling of the Nudge Unit, again. Welfare sanctions, which are the punitive withdrawal of lifeline benefits from people who need to claim welfare support to meet their basic needs are claimed to “incentivise” people to find a job, despite empirical evidence to the contrary, and the cuts to child tax credit, limiting support to just two children, are based on the charming and archaic eugenicist idea that poor people ought to be “incentivised” to have fewer children.

Rich people are apparently “incentivised” by large cash carrots, but poor people just get the brutal, merciless stick. What a classic example of flagrant Conservative ideological incoherence.

Psychopolitical paternalism doesn’t address poverty, it is simply a way of apportioning blame, of abdicating political responsibility and ensuring that poor people accept the Conservative and neoliberal decree that they somehow deserve to be poor.

Cameron claims that:

“Families are the best anti-poverty measure ever invented. They are a welfare, education and counselling system all wrapped up into one. Children in families that break apart are more than twice as likely to experience poverty as those whose families stay together. That’s why strengthening families is at the heart of our agenda.”

The announcement from Cameron was welcomed by Relate, whose chief executive, Chris Sherwood, said:

“Relationship support can help to reduce family breakdown, which is a key driver of poverty and can result in poor outcomes for children.”

Actually, family breakdown is quite often a consequence of poverty, not a cause of it. Back in 2010, Fergus Drake, director of UK programmes with Save the Children expressed an unease that many of us felt, regarding the Conservative’s feckless drive to offload the responsibility for poverty onto poor people, who are casualities of the consequences of neoliberalism, which extends discriminatory economic policies. He said:

“We would say poverty causes family breakdown rather than vice versa. If you are worried about putting food on the table, or being able to turn on the heater so you can have a hot bath, the stress that causes to a relationship can make things really difficult.”

Poverty isn’t caused by family breakdown, it’s caused by discriminatory policies and social insititutions that extend and perpetuate inequality. We are now the most unequal country in the European Union, and even more unequal than the US. If Cameron really wanted to address childhood poverty, he would ensure that people have enough to meet their basic needs, instead of steadily withdrawing welfare support and cutting public services. He should end the class-contingent austerity that his government have imposed on only the poorest people.

Tim Nichols, of the Child Poverty Action Group, agrees that the Conservatives should be careful not to confuse causes and consequences. He says:

“We don’t think that this is robust strategy. Tackling child poverty can’t be done without more redistribution.”

Cameron is talking ideologically-driven nonsense, reflecting traditional Tory prejudices. This government has become obsessed with moralising about and manipulating individual agency, which is increasingly seen as being to blame for high levels of poverty and social exclusion in the UK, which are created entirely by callous, discriminatory political policies. Political gaslighting does not help people out of poverty.

People are poor because they don’t have enough money to meet their needs. That is what Cameron needs to acknowledge and address.

Parenting and elitist-authoritarian ideology

Cameron’s paternalist-authoritarian turn was evident back in 2010, when he said that:

“Discipline is the foundation of a good education. Headteachers need to decide on exclusions.”

Most people that have worked in either formal or informal education settings are very aware that using punishment and threats is very counterproductive. Making young people suffer in order to change their future behaviour can often elicit temporary compliance, but this strategy is highly unlikely to lead to conversion or to help children become ethical, responsible decision makers in the long term. Punishments don’t involve any engagement of deliberative processes.

Punishment, even if referred to euphemistically as “consequences,” tends to generate oppositional behaviours, anger and defiance.  Furthermore, it models the use of power rather than reason and damages the important trust-based relationship between adult and child.

Authoritarian models of parenting are emotionally and physically traumatising. There’s an Old Testament brand of harshness in conservative authoritarian approaches to human behaviours.

Authoritarian parents often have prejudices based on wealth and what may be defined as “achievement”, gender, class and race. They tend to be highly competitive, lacking warmth and empathy. They teach their children to compete at all costs, and to win by whatever means. Most authoritarians are behaviourists, with a preference for punishments rather than rewards to control others.

Authoritarians tend to advocate corporal punishment, they see freedom as chaotic, they can’t tolerate ambiguity or recognise the complexities and subtleties of human conduct, and they tend to advocate capital punishment.

Because authoritarian parents expect absolute obedience, children raised in such settings are typically very good at following rules.

However, they often lack self-discipline. Children raised by authoritarian parents are not encouraged to explore and act independently, so they never really learn how to set their own limits and personal standards.

Whilst developmental experts agree that rules, boundaries and consistency are important for children to have, most believe that authoritarian parenting is too punitive and lacks the warmth, unconditional love, safety, trust and nurturing that children need.

Of course public schools also foster authoritarianism and elitism. Boarding school: the trauma of the ‘privileged’ child by Joy Schaverien explores the emotional deprivation and abuse that many experience as a result of public school culture. Psychotherapist Nick Duffell (2000) wrote a book based on workshops he has conducted over ten years with adults who attended boarding schools as children. He has identified many lasting pathological psychological patterns common in those he calls Boarding school survivors.

In his recent work: Wounded Leaders: the Psychohistory of British Elitism and the Entitlement Illusion, Nick says:

“A cherished national character ideal, eschewing vulnerability and practising a normalised covert hostility based on bullying in the dorm adversely affects even those who did not have the privilege of such an education. It leaves Britain in the social and emotional dark ages, led by “the boys in the men that run things.

This specific culture of elitism, protected by financial interests and the “It never did me any harm” syndrome, means that Britain is unlikely to foster the kind of leadership necessary in our world of increasing complexity, which needs a communal mindset and cooperative global solutions. But worse, new scientific evidence shows that this hyper-rational training leaves its devotees trapped within the confines of an inflexible mind, beset with functional defects, presented here as the Entitled Brain.”

It’s a sobering thought that so many boarding school survivors – psychologically and emotionally damaged individuals – are involved in running the country and determining the terms and conditions of our lives.

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Conservative governments are bad for your health

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proper Blond 

Context: the politics of blame

Increasing employment and pushing ill and disabled people into work are key elements of the UK Government’s public health and welfare “reform” agendas. The arguments presented for this approach are primarily economic and particularly, moralistic. The reasoning presented is not founded on biological, psychological or sociological evidence. The government maintains that work is the most effective way to improve the wellbeing of individuals, their families and their communities. There is a perception that unemployment is harmful to physical and mental health, so the corollary has been assumed – that work is beneficial for health. 

However, that does not necessarily follow, and to claim that it does is distinctly unscientific and irrational. As the Conservatives themselves have often pointed out in less appropriate circumstances in order to avoid democratic accountability and responsibility, there is a difference between an association and a causal relationship.

There is a clear ideological context from which the welfare “reforms” proceeded, and the politically-directed media campaigns that have purposefully stigmatised and outgrouped unemployed people demonstrates quite clearly that reducing welfare support is not about a politically calculated extension of social inclusion and social justice policies, Conservative bonhomie, or overall concern for the wellbeing of welfare recipients and people who are disabled.

The government are attempting to entrench neoliberal ideology in our culture by co opting GPs, social workers and other professionals as agents of the state. The idea that “work is a health outcome” has been embedded in policies such as the Orwellian renaming of sick notes (now “fit notes”), which are designed to explore what work a person who is absent from work because of illness may undertake.  However, the government intend a much more far-reaching outcome than simply attempting to reduce the sick “role” and recovery time. The government’s “behavioural change” agenda has become a centrally-orchestrated programme for governance. The provision of public goods and crucial support, from housing and discretionary housing payments to employment benefits and disability support is becoming increasingly conditional. 

Political rhetoric, aimed at perpetuating an extremely divisive and intentionally misleading “strivers and skivers” dichotomy is designed to undermine public support for the welfare state and the other gains of our post-war settlement – the NHS, legal aid and social housing for example – also betrays the lack of coherence, rationality and empirical support for the Conservative’s “reforms.” Furthermore, the extremely targeted, class-contingent and punitive nature of the Conservative austerity programme indicates that the welfare “reforms” were founded on traditional Tory prejudices, rather than on any genuine causal relationship based on empirical evidence and social or economic necessity.

This explains why the government have persistently ignored the many evidence-based concerns raised by academic researchers, campaigners and opposition MPs that their austerity policies are having an extremely harmful effect, most often on our poorest and most vulnerable citizens.

The Conservatives are ideologically bound to notions of a small state, minimal levels of political responsibility and intervention, minimal levels of government spending, the heavy promotion and administration of privatisation, competition, fiscal austerity, deregulation and free trade in order to enhance the role of the private sector in the economy, all of which are the central strands of the neoliberal hegemony. Conservative ideology runs counter to any notion that all citizens must be treated fairly, which also means that they must be given equal economic opportunities and provided with a adequate minimum standard of living. Neoliberal ideology is incompatible with a human rights-based society.

Democracy exists partly to ensure that the powerful are accountable to the public, and particularly to our most vulnerable citizens. This government have blocked that crucial exchange, and show disdain for human rights, the welfare state and the NHS, all of which provides ordinary people and the most vulnerable citizens basic protection from those in power.

Conservatives despise human rights and rights-based social provision. They absurdly claim that welfare provision causes vulnerability, and a “culture of dependency,” despite the fact that there is absolutely no empirical evidence to support this view. History has consistently taught us otherwise. The Conservative’s policies are expressions of contempt for the lessons and empirical evidence from over a century of social history and administration.

Tory rhetoric is designed to have us believe there would be no poor people if the welfare state didn’t somehow “create” them. If the Conservatives must insist on peddling the myth of meritocracy, then surely they must also concede that whilst a neoliberal system has a few beneficiaries, it also creates situations of insolvency and poverty for many others. That is what a system based on competitive individualism is about: it creates a few “winners” and a lot of others lose.

Conservative cuts are based on nothing more than the ridiculous myth that poverty is somehow a lifestyle choice or a moral failing which people can be punished or starved out of. The new Tory neoliberal “paternalists” really seem to believe that if they make life for poor people insufferable, they will simply be “incentivised” to choose to be wealthier. It’s a thinly disguised revamp of the ill-conceived 1834 Poor Law deterrence principle of “less eligibility” – that was supposedly aimed at “making work pay” too. But it didn’t. It’s not possible to frighten and punish people out of poverty. Only a Conservative government would claim to be making work pay by cutting welfare down to the bare bones, rather than increasing wages. The welfare cuts have actually had the effect of driving down wages too.

Of course, by framing the issue of poverty in terms of personal responsibility and morality, the Conservatives have stifled debate and restricted public discussion in the hope that people won’t recognise the wider structural inequalities and economic failings, for which this government are solely responsible.

Debbie Abrahams said: “The Conservatives point the finger at sick and disabled people for the rise in spending. They are still shamelessly spinning their tired “shirkers” and “strivers” narrative, designed to whip up public support for cuts to the most vulnerable. But this divisive rhetoric can no longer conceal the fact their economic strategy has failed. It is the government’s failure that has led to rising social security costs. 

As we saw at the Autumn Statement (2016), borrowing is up, growth is down, deficit targets have been hopelessly missed and wages have flat-lined. At the same time, the government has refused to tackle the driving forces behind increased social security spending, from low pay to high housing costs. Instead, the government is slashing support to those who need it most, exacerbating the financial strain so many are facing this Christmas, and failing its own targets in the process.   

[…] Research by the Joseph Rowntree Foundation suggested that we need to be building 80,000 affordable homes a year to meet demand and keep the current spend on housing benefit stable. This government managed a pathetic 30,000 homes last year. It is this refusal to build enough homes that keeps the housing benefit bill growing. People are left struggling to find somewhere affordable to live, and the state is forced to subsidise the sky-high rents charged by private landlords 

We could also look at tax credits, which currently make up more than £20bn a year in the spending under the cap. Tax credits top up working people’s pay where it is insufficient. Wages today are lower than they were in 2008, and won’t even return to the levels of 2008 until 2021. A record six million workers are paid less than the living wage. This is why tax credit costs have risen – because the government has had to increase the amount spent on topping wages up. 

Labour founded the welfare state to give pensioners and disabled people dignity, to prevent homelessness, children going hungry, and to cover for periods of unemployment or ill-health. It was never designed to be spending tens of billions substituting for low-wage employers or subsidising rip-off landlords.”

Economic productivity is the new health outcome

The claim that “work is good for you” is allegedly based on “scientific evidence” that people in work tend to be healthier than those claiming unemployment and sickness benefits. However, to draw the conclusion that “employment is good for you” from the data is an example of inferring causality inappropriately, from what is only an association. Yet it is being used to prop up Conservative justifications for dismantling the welfare state.

Unemployment has been linked to increased rates of sickness, disability and mental health problems, and to decreased life expectancy. The claim has also been made that it results in an increased use of medication, medical services, and higher hospital admission rates. However, surely it makes much more sense to say that sickness, disability and mental health problems, the use of medication, medical services, and higher hospital admission rates all cause unemployment, rather than the converse. This government seem to have a major problem accepting the fact that sometimes, people really are simply too ill to work.

Most people who are too ill to work are obviously not as healthy as those who can work. That is hardly controversial. However, that doesn’t mean that work itself is good for your health, it just means those who don’t work tend to have worse health than those who do. People don’t work because they have poor health.

Linking ill health with “worklessness” is an ideological preference which ignores other variables. It is much more likely that the “reforms”, which have reduced welfare provision to inadequate levels – leaving people all too often unable to meet their basic needs – is bad for health, rather than being out of work. 

But the Conservatives have used this “evidence” of an association between poor health and unemployment to make an inference based on a “causal link” that hasn’t actually been empirically verified. Iain Duncan Smith has made the claim, for example, that “work is good for you.” He has even claimed that work can make people’s health problems “better.” But that isn’t very likely to be true. It’s akin to claiming that chatting and exercise is a cure for multiple sclerosis, lupus, blindness or cancer. Or that a work coach on prescription will cure rheumatoid arthritis, a disc prolapse or schizophrenia.

This is why I visit my doctor when I am ill, and not Iain Duncan Smith or the government.

The claim that work is good for your health is simply a part of Tory justification narratives for cutting support for sick and disabled people, and hounding people who need to claim benefits. Yet this axiom informs current UK policy towards increased benefit conditionality, harsh sanctions, compulsory work experience and the “workfare” or “work-for-benefits” thinking which the Conservatives favour. However, this is an approach that can never work, unless, of course, the aim is to completely dismantle the welfare state. Oh, hang on…

The biopsychosocial model

The biopsychosocial model (BPS) of ill health is not without controversy, although many see it as more pragmatic or humanistic than the medical model of illness, which came to be regarded as reductionist and deterministic. The biopsychosocial model is the conceptual status quo of contemporary psychiatry, and many believe that it has played an important role in combatting psychiatric dogmatism.

The biological component of the model is based on a traditional allopathic (bio-medical) approach to health. The social part of the model investigates how different social factors such as socioeconomic status, culture and poverty impact on health. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking.

Of course a major criticism is that the BPS model has been used to disingenuously trivialise and euphemise serious physical illnesses, implying either a psychosomatic basis or reducing symptoms to nothing more than a presentation of malingering tactics. This ploy has been exploited by medical insurance companies (infamously by Unum Provident in the USA) and government welfare departments keen to limit or deny access to medical, social care and social security payments, and to manufacture ideologically determined outcomes that are not at all in the best interests of patients, invalidating diagnoses, people’s experience and accounts, and the existence of serious medical conditions. (See also: Getting rich on disability denial, and  A Tale of two Models by Debbie Jolly.)

Unum was involved in advising the government on making the devastating cuts to disabled people’s support in the UK’s controversial Welfare Reform Bill. (See also: The influence of the private insurance industry on the UK welfare reforms.)

This is a government that tends to emphasise citizen responsibilities over rights, moralising and psychologizing social problems, whilst quietly editing out government responsibilities and democratic obligations towards citizens.

For example, poverty, which is caused by political decisions affecting socioeconomic outcomes, is described by the Conservatives, using elaborate victim-blame narratives, and this is particularly objectionable at a time when inequality has never been greater in the UK.

Poverty may only be properly seen in a structural context, including account of the exclusion and oppression experienced by those living in poverty, the global neoliberal order, the gender order, the disability, racial, sexual and other orders which frame social life and precipitate poverty in complex and diverse ways. It’s down to policy-makers to address the structural origins of poverty, not the poor, who are currently regarded as the “collateral damage” – casualities – of politically imposed structural constraints.

Conservative governments are unhealthy

The effects of loss of income on people who can’t work because of illness is a confounding factor, too. How is it possible to isolate the devastating impacts of the Conservative “reforms” and the steady dismantling of the welfare state on unemployed people from the misleading generalisation that unemployment is bad for health? Surely if the Conservatives genuinely believed their own claims, they would be more inclined to increase rather than radically decrease provision and support for unemployed people.

Of course, not all work is beneficial. The review that led to the widespread folk tale that work is good for you is based on research involving people who had common and minor illnesses, and fulfilling, secure jobs. That doesn’t reflect the experiences of many people.

Not all jobs are rewarding and positive experiences, and some work can cause serious risks to health.

Doctor Frank Scheer, a neuroscientist at Harvard Medical School and Brigham and Women’s Hospital in Boston, says:

“There is strong evidence that shift work is related to a number of serious health conditions, like cardiovascular disease, diabetes, and obesity.

These differences we’re seeing can’t just be explained by lifestyle or socioeconomic status.”

Shift work and poor quality working environments and employment conditions are also linked to stomach problems and ulcers, hypertension, depression, musculoskeletal disorders, chronic infections, diabetes, general health complaints, all-cause mortality and an increased risk of accidents or injury. Long working hours are equally linked with a detrimental impact on health, according to medical research – see: The impact of overtime and long work hours on occupational injuries and illnesses: new evidence from the United States.

There is a growing and potentially corrosive problem of low paid, poor quality, precarious and temporary work which threatens levels of social inclusion and, ultimately, the health of the workforce.

Research shows unambiguously that the psychosocial quality of bad jobs is worse than unemployment. Peter Butterworth examined the mental health implications of those moving from unemployment into employment and found that:

“Those who moved into optimal jobs showed significant improvement in mental health compared to those who remained unemployed. Those respondents who moved into poor-quality jobs showed a significant worsening in their mental health compared to those who remained unemployed.”

Overall, unemployed respondents had poorer mental health than those who were employed. However the mental health of those who were unemployed was comparable or superior to those in jobs of the poorest psychosocial quality. (See: The psychosocial quality of work determines whether employment has benefits for mental health: results from a longitudinal national household panel survey.)

More recently, in a letter to the Guardian, the UK’s leading bodies representing psychologists, psychotherapists, psychoanalysts, and counsellors called on the Government “to immediately suspend the benefits sanctions system. It fails to get people back to work and damages their mental health.

Findings from the National Audit Office (NAO) show limited evidence that the sanctions system actually works, or is cost effective.

But, even more worrying, we see evidence from NHS Health Scotland, the Centre for Welfare Conditionality hosted by the University of York, and others, which links sanctions to destitution, disempowerment, and increased rates of mental health problems. This is also emphasised in the recent Public Accounts Committee report, which states that the unexplained variations in the use of benefits sanctions are unacceptable and must be addressed.”

The impact of poverty on health

The largest study of poverty conducted in the UK has laid out the dire extent of British material deprivation – and seriously undercut the government’s claim to be lifting people out of poverty through work.

The Poverty and Social Exclusion in the UK (PSE) project details how, over recent years, the percentage of households living below society’s minimum standard of living has increased from 14% to 33% – despite the fact that the economy has increased in size over the same period. The study found that low wages are a central cause of widespread deprivation. For many people, full-time work is not enough to lift them out of poverty; almost half of the working poor work 40 hours a week or more. And one in six adults in paid work (17%) is poor, suffering low income and unable to afford basic necessities.

Commenting on the study’s findings, Professor Jonathan Bradshaw of the University of York said they showed many parents who work full time still have to make huge sacrifices to try and protect their children from deprivation.

“We already know from DWP data that the majority of children with incomes below the the relative income poverty threshold have a working parent. The PSE survey shows that the majority of deprived children, those lacking two or more socially perceived necessities, and very deprived children (lacking five or more socially perceived necessities) have a working parent.

We found that 65% of the deprived and 58% of the very deprived children had a working parent, and 50% of the deprived and 35% of the very deprived had at least one parent working full-time. Child poverty is not being driven by skivers, but is the consequence of strivers working for low earnings while in-work benefits are being dissipated by government austerity measures.”

Responding to the findings, Clare Bambra, a professor at Durham University, said that the research was a shameful picture of “the devastating and far-reaching human costs of inequality and poverty in the UK today.”

She said:

“It’s shameful for a rich country like ours to be tolerating such levels of poverty especially amongst our children and young people. The mantra that work sets people free from poverty has been shown to be a grand old lie.

We will be living with the long term consequences of this social neglect for decades to come – there are clear links between poverty and reduced life expectancy and higher rates of ill health, especially concentrated in deprived areas and the north.

These findings show us the true cost of austerity.”

Public health experts from Durham University have denounced the impact of Margaret Thatcher’s policies on the wellbeing of the British public in a comprehensive study which examines social inequality in the 1980s.

The study, which looked at over 70 existing research papers, concludes that as a result of unnecessary unemployment, welfare cuts and damaging housing policies, the former prime minister’s legacy includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of wellbeing.

The research shows that there was a massive increase in income inequality under Baroness Thatcher – the richest 0.01 per cent of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and UK poverty rates went up from 6.7 per cent in 1975 to 12 per cent in 1985.

Baroness Thatcher’s governments wilfully engineered an economic catastrophe across large parts of Britain by dismantling traditional industries such as coal and steel in order to undermine the power of working class organisations, say the researchers. They suggest this ultimately fed through into growing regional disparities in health standards and life expectancy, as well as greatly increased inequalities between the richest and poorest in society.

Professor Clare Bambra from the Wolfson Research Institute for Health and Wellbeing at Durham University, co-author of the research report, commented:

“Our paper shows the importance of politics and of the decisions of governments and politicians in driving health inequalities and population health. Advancements in public health will be limited if governments continue to pursue neoliberal economic policies – such as the current welfare state cuts being carried out under the guise of austerity.”

Thatcher’s policies  have been condemned for causing “unjust premature deaths.” Cameron’s policies are even more class-contingent and cruel.

I think there is a growing body of empirical evidence which indicates clearly that Conservative governments are much worse for public health, prosperity and wellbeing than unemployment.

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Pictures courtesy of Robert Livingstone

I don’t make any money from my work. I am disabled because of illness and have a very limited income. The budget didn’t do me any favours at all.

But you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others. The smallest amount is much appreciated – thank you.

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Psychologists Against Austerity campaign – call for evidence

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I was delighted to be invited recently to join and contribute to several ongoing projects with Psychologists against austerity.

Psychologists Against Austerity is a national campaign that highlights the psychological costs of austerity policies. We take the position that the austerity policies are an ideological choice by the Government and not necessary or inevitable economic measures. Psychologists are often in a position to see the effects that social and economic changes have on people and communities.  We draw attention to these human costs, which in the long-term will have additional social and economic repercussions.

It is our public and professional duty to speak out against the further implementation of austerity policies, as these have direct psychological impacts. We draw on academic research as well as our professional and personal experience to identify the damaging psychological costs of austerity measures, and we have produced a briefing paper detailing this research evidence base. We also outline an alternative vision for a society that creates the conditions for people to have ‘freedom to live a valued life’.

We call for social policy that works towards a more equitable and participatory society. We argue for a community-led approach to mental and emotional wellbeing that develops collective responses to individual needs and strengthens communities; one that supports and liberates, rather than punishing people in times of need.

We have identified five key ‘Austerity Ailments’ based on robust and long standing psychological evidence. They are: 

Humiliation and Shame

Fear and Mistrust

Instability and Insecurity

Isolation and Loneliness

Being Trapped and Powerless

You can read the evidence in full in our briefing paper.

Everyday Austerity

We would like to hear your stories about how the cuts have affected you and your service. We want the wider public and politicians to understand the real life costs of public sector cuts. It can be hard to speak up alone, so we are collating everyone’s stories – together we have more power and a louder voice. We all have stories of frustration, fear and anger, so please use this as a way to tell the world about how the cuts have impacted on you and/or the people you work with. We are interested in stories from everyone who works in, uses, or needs Psychology services.

We may use these stories in other contexts, such as publication and media.

Please visit our page to tell us about your experiences here

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Research finds strong correlation between Work Capability Assessment and suicide

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In England between 2010 and 2013, just over one million recipients of the main out-of-work disability benefit, Employment Support Allowance (ESA) had their eligibility reassessed using a new stringent functional (as opposed to medical) checklist – the Work Capability Assessment.

Doctors, disability rights organisations, mental health chaities and individual campaigners, such as myself, have raised concerns that this has had an adverse effect on the mental health of claimants, but there have been no population level studies exploring the health effects of this or similar policies, until now.

Research, conducted by B Barr, D Taylor-Robinson, D Stuckler, R Loopstra, A Reeves, and M Whitehead, has established a link between the Work Capability Assessment (WCA) and suicide. The research, published in the Journal of Epidemiology and Community Health (which is peer-reviewed,) and carried out by social scientists from a variety of backgrounds, from the universities of Oxford and Liverpool, scrutinised the rates of mental health issues and suicide in different local authorities in England.

The study found that the authorities with a greater number of people undergoing WCAs also have more people reporting mental health problems, more people being prescribed antidepressants, and more people taking their own lives. The research found that every 10,000 assessments led to around six suicides.

For comparison in terms of statistical significance, isotretinoin, an acne medication which was notoriously linked to suicides, is associated with around four extra deaths per 10,000 treatments.

The researchers estimate that for every 10,000 people reassessed, you would expect to see an additional six suicides (95% confidence interval (CI) 2 to 9), an extra 2,700 reports of mental health problems (95% CI 548 to 4,840) and 7,020 extra antidepressants prescriptions (95% CI 3,930 to 10,100). By convention, 95% certainty is considered high enough for researchers to draw conclusions that can be generalised from samples to populations.

There have been more than 1 million assessments since the WCA was introduced, which suggests that there may be more than 600 people who have taken their own lives who would otherwise have not. The researchers say: “Our study provides evidence that the policy in England of reassessing the eligibility of benefit recipients using the WCA may have unintended but serious consequences for population mental health.”

There have been earlier claims and evidence that the Department for Work and Pension’s (DWP) reforms have led to deaths. However, the DWP has persistently refused to release data which would make it possible to assess whether the death rate for people found fit for work is higher than would be expected.

Both the assessment and appeals process itself, which is widely reported to be stressful, and the financial hardship that occurs when people are denied disability benefits, could result in negative health effects. There is good evidence that loss of income, particularly for people already on low incomes, increases the risk of common mental health problems.

People undergoing a WCA are likely to be particularly vulnerable to the adverse mental health consequences of this policy because a very high proportion have a pre-existing mental health problem. Furthermore, those with physical chronic illness are more prone to mental health problems such as reactive depression, and sometimes, forms of depression that are associated with the illness itself.

The research included efforts to rule out other possible causes of suicide – to eliminate potential confounding variables and bias – for example, there is no similar effect found in people over 65, who are not subject to the WCA – and so the results suggest that the link between the WCA and suicide is not due to “confounding” factors, but is most likely causal.

The Department for Work and Pensions has rejected the study’s findings. A spokesperson said in a statement: “This report is wholly misleading, and the authors themselves caution that no conclusions can be drawn about cause and effect.” 

However, the DWP have no grounds for their own claim whatsoever. Whilst correlation isn’t quite the same thing as cause and effect, it often strongly hints at a causal link, and as such, warrants further investigation. It certainly ought to raise concern from the DWP and ministers, regarding the negative impact of policy on many of the UK’s most vulnerable citizens.

The association with the WCA and its adverse effects is, after all, more clearly defined than the one between the drug isotretinoin and suicide, and the drug was withdrawn in the US and some European Member States.

In the UK, it is now (as of November last year) prescribed only under strict monitoring conditions, and patients are provided with warnings about the possibility of adverse psychiatric effects. No such warning and monitoring exists regarding the possible adverse psychiatric effects of the WCA. In fact the government have stifled both enquiry into a causal link and discussion of even the possibility there may be such a causal link, despite being presented with much evidence of a strongly indicated correlative association.

Dr Benjamin Barr, one of the researchers from Liverpool University, said that a causal link was likely: “Whilst we cannot prove from our analysis that this is causal, there are various reasons why this is a likely explanation,” he said.

He agreed that a study looking specifically at people who had undergone a WCA would be more precise, but added that the DWP has not released that information.

Dr Barr said: “If the DWP has data on this they should make it openly available to independent analysis.” He added that the DWP has so far chosen not to run a trial of its own into a link between WCAs and suicides.

The researchers found that those local areas where a greater proportion of the population were exposed to the reassessment process experienced a greater increase in three adverse mental health outcomes – suicides, self-reported mental health problems and antidepressant prescribing.

These associations were independent of baseline conditions in the areas, including baseline prevalence of benefit receipt, long-term time trends in these outcomes, economic trends and other characteristics associated with risk of mental ill-health. These increases followed – rather than preceded – the reassessment process.

The report concluded that the study results have important implications for policy. The WCA and reassessment policy was introduced without prior evidence of its potential impact or any plans to evaluate its effects. Given that doctors and other health professional have professional and statutory duties to protect and promote the health of patients and the public, this evidence that the process is potentially harming the recipients of these assessments raises serious ethical issues for those involved.

The Royal College of Psychiatrists has also said the research was of “high quality”, adding that it called into question the wisdom of the Government’s reforms.

Last year, coroner Mary Hassell told the DWP she had concluded that the “trigger” for Michael O’Sullivan’s suicide was his fit for work assessment.

“During the course of the inquest, the evidence revealed matters giving rise to concerns. In my opinion, there is a risk that future deaths will occur unless action is taken,” she wrote in the document, known as a Prevention of Future Deaths or regulation 28 report.

At the inquest, Hassell said O’Sullivan had been suffering from long-term anxiety and depression, “but the intense anxiety which triggered his suicide was caused by his recent assessment by the Department for Work and Pensions [benefits agency] as being fit for work and his view of the likely consequences of that”.

The inquest heard that the DWP assessing doctor, a former orthopaedic surgeon, did not factor in the views of any of the three doctors treating O’Sullivan. The coroner said O’Sullivan was never asked about suicidal thoughts, despite writing them down in a DWP questionnaire.

Previously, the loss or reduction of benefits has been cited by coroners as a factor in deaths and suicides of claimants.

The DWP have so far failed to respond coherently, other than with a denial of a “causal” link.

You can read the full research report here.

It’s not the only time that Conservative austerity policies have been implicated in causing harm to citizens. Nor is it the only time that Conservatives have responded with utter indifference to the disproportionately negative impact of their policies on the poorest people. 

A study from Durham University, which looked at over 70 existing research papers, concluded that as a result of unnecessary recession, unemployment, welfare cuts and damaging housing policies, Margaret Thatcher’s legacy includes the unnecessary and unjust premature death of many British citizens, together with a substantial and continuing burden of suffering and loss of wellbeing.

The research shows that there was a massive increase in income inequality under Baroness Thatcher – the richest 0.01 per cent of society had 28 times the mean national average income in 1978 but 70 times the average in 1990, and UK poverty rates went up from 6.7 per cent in 1975 to 12 per cent in 1985. Suicides increased.

Co-author Professor Clare Bambra from the Wolfson Research Institute for Health and Wellbeing at Durham University, commented: “Our paper shows the importance of politics and of the decisions of governments and politicians in driving health inequalities and population health. Advancements in public health will be limited if governments continue to pursue neoliberal economic policies – such as the current welfare state cuts being carried out under the guise of austerity.”

David Cameron’s government has gone much further than Thatcher ever did in cutting essential support and services for protected social groups, such as sick and disabled people, and poorer citizens.

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Pictures courtesy of Robert Livingstone

British Psychological Society and charity consortium campaign for reform of WCA gains momentum

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I reported previously that the British Psychological Society (BPS) have called for the reform of the highly controversial Work Capability Assessment.

The BPS have cited a growing body of evidence that seriously ill people are being inappropriately subjected to the Work Capability Assessment (WCA). Psychologists also argue that the WCA does not effectively measure fitness for work and that its application is producing inappropriate outcomes for claimants.

The Society’s call for reform has gained momentum, with more than  20,000 people signing a petition to the Department for Work and Pensions (DWP) and representatives of the charities Mind, the National Autistic Society and Rethink Mental Illness delivered the petition on Thursday, 5 November.

The highly problematic WCA is used to determine whether someone applying for employment and support allowance is “fit for work.” The charities say flaws in the test are causing a great deal of stress and anxiety. In some cases people are being wrongly assessed as fit for work, which can have devastating financial and personal consequences.”

Professor Jamie Hacker Hughes, President of the British Psychological Society, said:

“The Society has repeatedly asked for a meeting with ministers at the DWP so that we can express our concerns over the WCA – so far without success. We are particularly concerned that the government’s benefits policy may misuse psychological tools and techniques. We want to ensure policies are informed by appropriate psychological, theoretical and practical evidence.”

The Society published a briefing paper in June.

A Judicial Review of the WCA was instigated by two anonymous claimants with mental health problems, who were represented by the Public Law Project.

In May 2013 the Upper Tribunal made an “interim” judgment that the WCA puts people with mental health problems, learning disabilities and autism at a “substantial disadvantage”. It was a landmark ruling.

The Tribunal panel ruled that the DWP had failed to make reasonable adjustments, according to the Equality Act, to ensure people with mental health problems were treated fairly by the system. This failure meant such claimants were placed at a substantial disadvantage.

Directors of the three charities, Mind, the National Autistic Society and Rethink Mental Illness, all backed the case and welcomed the judgment, calling on the government to stop assessing people’s fitness for work under the current system until the issue was resolved.

The DWP immediately appealed against the judgment, stating there was no intention of halting the WCA process, but in December 2013 the Court of Appeal upheld the Upper Tribunal’s interim ruling.

The Tribunal held further Hearings in 2014, which were focused on whether or not there is a “reasonable” adjustment that the DWP should have put in place.

The Upper Tribunal confirmed its earlier ruling that the WCA puts people with mental health problems, learning disabilities and autism at a “substantial disadvantage”. However, it did not find, at this point,  that the claimants had been personally discriminated against.

As a result, the court said it could not compel the DWP to trial changes to the WCA. They also said that they did not have enough information to determine whether or not there is a reasonable adjustment which could be put in place for people with mental health problems.

However, the court said that there still may be reasonable adjustments that the DWP can make to the WCA, and has encouraged the DWP to trial changes “as soon as possible”.

Paul Jenkins, CEO of Rethink Mental Illness, said:

“This ruling proves once and for all that this cruel and unfair process is unlawful. The judges have independently confirmed what our members have been saying for years – the system is discriminating against some of the most ill and vulnerable people in our society, the very people it is meant to support.

The work capability assessment process is deeply unfair for people with a mental illness – it’s like asking someone in a wheelchair to walk to the assessment centre.”

Professor Malcom Harrington’s first review – published in back in November 2010 – had previously criticised the way the WCA process failed to properly account for and accommodate people that have chronic illnesses with fluctuating symptoms and people with mental health problems, and he recommended changes, including placing mental health experts in all test centres.

His recommendations have not been implemented.

Pictures courtesy of Robert Livingstone