Tag: mental health

UN Rapporteur gathers evidence of the utter devastation caused by universal credit in Newcastle

UN Special Rapporteur on extreme poverty and human rights, Philip Alston, at the West End Foodbank in Newcastle

UN Rapporteur, Philip Alston, visited Newcastle. He has said it is not “an acceptable position” for the government to use foodbanks as a social safety net. 

Context

In July I reported that the United Nations extreme poverty and human rights Special Rapporteur, Philip Alston, was to make an official visit to the UK. 

Alston is a Professor of Law at New York University, and he works in the field of international law and international human rights law. He has extensive experience as an independent UN human rights expert. He previously chaired the United Nations Committee on Economic, Social and Cultural Rights for eight years (1991-98) and was United Nations Special Rapporteur on Extrajudicial, Summary, or Arbitrary Executions (2004-10).

His resume can be found here.

Some of the previous destinations for Alston have included Saudi Arabia, China, Ghana and Mauritania. He is currently visiting the UK, the sixth richest country in the world. His visit will focus, in accordance with his mandate, on the inverse relationship between poverty and human rights in the UK. 

Alston is set to spend twelve days in the UK visiting ten places. Yesterday he came to Newcastle. He is tasked with gathering evidence and Newcastle was the first city to introduce universal credit (UC ). The council says central government cuts and rising demand for services mean 60% has been taken from its spending capacity between 2010 and 2020. 

His itinerary is as follows:

alstons itinery

This is the third day of the fact-finding mission across the UK, and Alston met with council bosses in Newcastle and went to the country’s biggest foodbank to see first hand the impact of universal credit and the government’s swingeing cuts to local funding.

Newcastle was once a place of thriving industry, but now, more than a fifth of the city’s 270,000 population live in the most deprived 10% of wards in England and Wales in terms of income, work, education, health, housing and crime. One in five households have no one in them aged over 16 earning money and child poverty is 50% higher than the national average, according to a briefing complied by the council for Alston.

Alston examined the impact of austerity in the city and spoke with struggling residents. During a visit to Newcastle’s West End foodbank, Philip Alston said the foodbank’s users were “under a huge amount of pressure”. Despite the government’s claim that it had lifted hundreds of thousands of people out of poverty and into work, Alston said foodbanks play “a really crucial role… a real safety net so that [people] don’t quite starve”.

He added it was unacceptable, however, and said it should be the government that provides the safety net.

“To the extent that places like this succeed, you risk sending the message that government doesn’t need to play the central role and government can just outsource these things,” he said.

It cannot “just hope that a private community is going to take it up and keep people alive.” 

He added: “People feel that they have all got problems of one kind or another that brings them here, and they have a fairly shared experience in the sense that the funds that they get out of Universal Credit are not sufficient to enable them to cope.

“So the foodbank plays a really crucial role in the sense of providing that extra top up, that real safety net so that they don’t quite starve. That is very important”.  

A sample of citizen accounts outlining their harrowing experiences of universal credit

Among the foodbank users he spoke to were Denise Hunter and her son Michael, from Fenham.

The West End Foodbank in Benwell


The West End Foodbank in Benwell
 (Image courtesy of the Newcastle Chronicle)

The family use the foodbank every Wednesday and said that problems with their universal credit payments had left them struggling to survive, and fearful of the financial cost of doing basic things like boiling a kettle.

Mrs Hunter said:  “I’ve now waited for months and months for universal credit.

“Without these people here, with the free meal and everything, I couldn’t live,” she said.

Her 20-year-old son, Michael, said the controversial benefit, universal credit, had “tipped us over the edge” and said that he regularly goes hungry.

“We’ve been living where we’re to turn the heating on because it eats electric or, if you turn the oven on for cooking and have it on too long, we can’t pay the bill,” he said.

“If it wasn’t for this place I don’t know what would happen.

“If they sorted out universal credit then people would not have to come here. It makes me feel low coming here, like I can’t support my children. Sometimes I do get depressed about that.” 

Her 20-year-old son added that universal credit had “tipped us over the edge” and that he regularly goes hungry. He said “I’m scared to eat sometimes in case we run out of food.”

People on universal credit have to go online to keep their financial lifeline open, but computers need electricity – and with universal credit leaving a £465 monthly budget to stretch across the three people in Michael’s family (about £5 each a day), they can barely afford it on metered electricity. He said “I have to be quick doing my universal credit because I am that scared of losing the electric.” 

John McCorry, West End Foodbank chief executive, said that the true scale of poverty in Newcastle is “hidden” and that universal credit has “undoubtedly” had an impact.

He added: “Our wish is that the people with the power to influence and make decisions take the opportunity to see first hand what the UN delegation has, and perhaps that might shape their thinking about the future.”

Alston said: “I think the work being done here is unbelievably impressive, the people are clearly very dedicated. They have a large number of people coming in on a regular basis and, certainly in the conversations I had, people have expressed great gratitude not just for the food but what impressed me is that they see this as a community centre.

“I think one of the issues in England is the extent to which many of the places in which people used to meet together are being closed down. Places like this end up filling part of the need.”

The West End foodbank feeds about 42,000 people every year and has been giving out about 20% more food than six months ago, according to the Local Democracy Reporting Service.

The Hunters’ family’s account was just one of a long list of stark insights into life in absolute poverty delivered by the people of Newcastle to Alston during his trip to uncover what austerity is doing to the people of the UK and “to investigate government efforts to eradicate poverty”.

It is highly likely that Alston will report that the UK government is far from doing enough to meet its obligations. In 1976 the UK ratified the UN covenant on economic, social and cultural rights and in doing so, agreed that policy changes in times of economic crisis must not be discriminatory, must mitigate, not increase, inequalities and that disadvantaged groups of people must not be disproportionately affected.

The government has not honoured that agreement. 

Tracey Whitenstall, a mother of three, said that because of a 10-week delay in getting universal credit payments, she couldn’t afford her son’s bus fare and lunch money and so didn’t send him to school for several weeks as he was preparing for his GSCEs. As a result his grades slipped.

“It was the worst, him missing out on education,” she said, in tears. 

At Citizens Advice in the city centre Alston met Sharon Morton, who hasn’t had hot water or heating for a year. She washes in a way to minimise spending on boiled water. “I wash in what I call a birdbath – a little hot water in a basin and have a spruce down,” she said. 

She added “To keep warm I wrap up in layers and layers. I never thought I would be 48 and in this position.”

Thushara Chandrasiri, who has a disabled right hand said he was told by a disability benefits assessor that he could now work and was refused benefits.

“What I found disgusting was that when I said I had the condition a long time, they said you should be used to it by now,” he said. “Because I am right handed they said ‘you’ve got a left hand, use it’.”

The dehumanisation of DWP decision-making

Alston heard citizens’ accounts about the distress, serious material hardships and frustration of dealing with the universal credit syste. He heard how messages they post on online journals take days to be answered. People explained how an anonymous figure, known only as “the decision maker” was often cited in correspondence, but they never knew who this was. 

That sounds like a weirdly anonymised form of totalitarianism. Like the oprichniki of Ivan the Terrible. It’s a strategy of psychological terrorism and boot-stamping-on-a-human-face-forever type of unaccountability, which belongs in a dystopian novel about a collapsing society and a regime of extremist despots. It reminds me of the Milgram experiment, but with real starvation instead of fake electric shocks as the centrepiece of the study of conformity and obedience to authority. 

Outside of the food bank, which featured in Ken Loach’s film about austerity, I, Daniel Blake, Alston said: “When you have rates of maybe a third of children living in poverty and you have a food bank clientele at a place like this that is growing and growing and growing, you have issues here. Is the situation in the UK as good as it could be?”

The Labour leader of the city council, Nick Forbes, also briefed Alston, expressing his anger at cuts and the “pain and misery” of universal credit.

“We had people coming to us who hadn’t eaten for several days,” he said. “It angers me beyond belief that the government has simply failed to listen to warnings that are supposed to come from a pilot [study].”

In Newcastle, universal credit has caused a huge increase in demand for short-term help to pay rent and electricity, the council says. The council’s emergency housing payments budget – £100,000 in 2012 – is expected to hit £1m this year. The number of people needing emergency money for power is running at a rate 30 times higher than in 2016, before the rollout of UC began in earnest.

Alston drove to North Shields and spoke to residents at the Meadow Well estate, scene of riots in 1991 driven in part by poverty. Things had improved since then, but are getting worse again now, he heard.

Some people have to work five zero-hours jobs to make ends meet, said Phil McGrath, chief executive of the Cedarwood Trust community centre. The trust is encouraging residents to engage in local and national politics to have their voice heard. It is paying off with some people who have never voted turning out at the last general election, he said.

A former colleague of mine, Mike Burgess, who runs the Phoenix Detached Youth Project, told Alston how 18 publicly funded youth workers in the area in 2011 had dwindled to zero today. He described how a young man he worked with was in hospital for months after having a kidney removed. The jobcentre said he had to get back to work or face being sanctioned. He went to work in pain, but his employer realised he was not fit for work.

“There’s no safety net for my lad or people with mental health problems,” he said.

And that is the hidden cost facing many at the sharpest end of austerity in Newcastle.

“In the last two or three weeks we have seen a massive increase in numbers of people with mental health issues and people with breakdown,” said McGrath, blaming benefit sanctions and a lack of social and mental health workers to catch people. “People are just being ground down.”

In response to Alston’s visit the Department for Work and Pensions said, with a gaslighting flourish, that the UK government was “committed to upholding the rule of law and rules-based international systems” and insisted that on an absolute measure of poverty, “a million fewer people and children were living in hardship compared with 2010.”

When a government imposes austerity on the poorest citizens, further reducing the income of people already on the lowest incomes, it isn’t possible that they would somehow become better off.

No matter how many inadequate jobs the government claims it has created.

People in work are experiencing absolute poverty, because wages have stagnated and people are coerced by the state to take any employment available, regardless of conditions, security and wage. By reducing welfare to the point where it no longer meets people’s basic living needs, the government are fulfiling an ideological preference for supply side economics, creating a desperate reserve army of labour, which employers may exploit, which serves to push wages down further.

Now that’s a ‘poverty trap’ and ‘perverse incentives’ in action.

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Devastated mother whose children were murdered fears eviction due to cut benefit

Image result for pip esa inquiry

 

A mother of two children who were murdered by her husband says she fears being made homeless, after the heartless Department for Work and Pensions stopped her disability benefit support, despite being aware of the severe trauma she had experienced and the devastating impact it has had on her mental health.

June Martin, who has been diagnosed as suffering with post traumatic stress disorder (PTSD) and depression, was considered by the Department for Work and Pensions (DWP) to be ineligible for Personal Independence Payment (PIP), following an assessment by Independent Assessment Service – formerly known as Atos Healthcare.

June has challenged the accuracy and fairness of the PIP assessment process. She told the Sunday Post that the assessor only “wanted to know if I could spell ‘world’ backwards and hold my arms above my head.”

She said I’ve been treated like some kind of scrounger and put on trial, although I’ve done nothing wrong.

“My former husband, who murdered our children, doesn’t have to worry about keeping a roof over his head or where his next meal is coming from but now I do.

She added, tragically:I’ve been made to feel a burden on society. Maybe it would be better if I wasn’t here.”

On Saturday, May 3, 2008, June walked into her home in Buckhaven, Fife, and found the bodies of disabled Michelle and her little brother Ryan while their father, who had stabbed them 26 times, lay on his bed, pretending to be dead. June’s former husband, Rab Thomson, was found guilty of stabbing 25-year-old Michelle and 7-year-old Ryan and given a life sentence in 2008. 

However, despite her struggle to cope with the terrible trauma, the benefits assessment report describes her mental state examination as “unremarkable”.

She said: “I’m now terrified I will lose my rented flat because I can’t keep up the £35 a week I have to find to make up the difference to housing benefit.

“I must have moved over a dozen times because I haven’t been able to settle somewhere I feel safe.

“Just when I finally found a little peace and somewhere I can feel safe, I fear it’s all going to be taken from me now.

“I’ve tried far too many times to take my own life because I just feel there is nothing for me to live for and this has left me feeling like that again.”

MP Patricia Gibson described the case as “shocking” and said: “This is yet another example of the DWP letting down vulnerable people when they most need support. Those living with mental health challenges are poorly understood by DWP assessor and this has to change.”

Left bereft, extremely distressed and suicidal, June has struggled to rebuild her life. She has never recovered from her ordeal, which is absolutely understandable. She had been in receipt of £55.10 a week in disability benefits before being reassessed for PIP.

However, an independent tribunal has unbelievably upheld the DWP decision. 

A spokesperson said: “Whilst the tribunal accepts Ms Martin has mental health problems and balance problems, the nature and extent of the resulting limitations are insufficient to score the required number of points.

“As a result Ms Martin does not qualify for either component of Personal Independent Payment.”

That someone who has faced such a deeply traumatic event as the murder of her children has to then “score a required number of points” to be considered eligible for lifeline support indicates just how profoundly dehumanising and utterly unfit for purpose the disability benefit assessment process is.

June said “Neither the assessor or the tribunal last week seemed to want to know about the trauma I suffer daily reliving finding my children posed as if they were asleep in their beds, or pulling back the covers to find them stabbed to death,” she said.

“I’ve battled so very hard to try and go on, but I’ve had to accept I’ll never get over finding my babies murdered, their blood on the walls and over their toys and teddy bears.

“My disabilities are invisible. They cannot be tested by spelling a word backwards or holding my arms above my head.

“Questions were thrown at me, one after the other. I couldn’t think straight to answer them properly. I’m a mess. I don’t stand up well to questioning. I just blurt things out and I panic.

“I’d written on the official forms that my children were murdered and I found them, but I don’t remember being questioned about that or my inability to live anything like a normal life.”

June also said that the assessor and DWP failed to take into account how her mental health fluctuates from day to day.

June continued: “I don’t know from one day to the other how I will feel, sometimes from one hour to the other”, she said.

“I can get up and go to the supermarket for a loaf of bread one day, but if I hear a child crying it takes me back to the murder scene.

“A smell, a song, someone laughing like my Michelle used to laugh, brings it all back and I have to run away from it.”

A DWP spokesperson offered the usual meaningless and standardised platitudes, saying: “This is a sensitive and distressing set of circumstances and our thoughts remain with Ms Martin.

“We will continue to ensure Ms Martin is receiving all the benefits she is entitled to and gets the support she needs.”

The support that June needs is the reinstatement of her Personal Independence Payment, and an adequate level of support to meet her housing costs, not gaslighting from the DWP. 

We live in an age of ubiquitous measurement, where our health and eligibility for support is defined and decided by metric based judgments, and our behaviours and expectations are expected to conform to the government’s notion of an overarching competitive model of the market. In this horrifically cruel, impersonal and dehumanising neoliberal world, eligibility for support depends on whether you score enough points that measure arbitrary criteria of what the state thinks should be measured.

Can you say a “world” backwards? Can you touch your knees? Can you raise an arm? This framework of meaningless tick box criteria bears little resemblance to the many actions and decisions you have to make during your everyday life, and it doesn’t show anything of how someone copes or doesn’t cope. It doesn’t indicate if someone has a network of support, help from other agencies, or if they are completely isolated.

It tells us nothing of whether or not someone can consistently perform one of these prescribed and contradistinctive tasks at an assessment for lifeline support in real life. The more of these meaningless and detatched-from-everyday-living tasks you are perceived as able to perform, the less points you are awarded. If you fail to score enough points, you aren’t considered ‘eligible’ for support, regardless of how much you happen to need it. 

The accounts presented in disability assessment reports based on the rigid, inadequate point scoring system and the actual realities of disabled people’s lives are incommensurable.

The Commons Work and Pensions Committee said earlier this year that it had an “unprecedented” response when it asked members of the public to get in touch with their experiences of being assessed.

Some people said reports of their assessments included the results of physical examinations that hadn’t happened. Some reports left out crucial information provided during the interview, and some seemed to refer to entirely different people. Publishing their findings, the MPs said the number of ‘mistakes’ taking place, and the number of decisions eventually overturned on appeal, had created “a lack of trust in both benefits” and led to fears the system is deliberately rigged against claimants.

It is. The system is rigged to disallow social security awards to disabled people who need support.

Stephen Brown, head of North Ayrshire Council’s health and social care partnership, said: “The benefits system often fails to recognise the impact of trauma and its long-term debilitating nature. Our psychologists, psychiatrists and social workers have known this for years and much of their time is spent supporting people to rebuild their lives.”

To rebuild lives, we must first ensure people can meet the costs of their basic living needs – such as for food, fuel and keeping roof over their head.

 

Related

Please let’s help Peter to maintain his mobility and independence

The PIP & ESA inquiry report from the Work and Pensions Select Committee – main recommendations

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

Thousands of disabled people have already lost their specialist Motability vehicles because of Conservative PIP cuts and many more are likely to be affected.

PIP and the Tory monologue

Government plans further brutal cuts to disability support

Consultation as government seek to limit disabled people’s eligibility for Personal Independence Payment

Second Independent Review of Personal Independence Payment assessment

 


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The first digital antipsychotic pill with tracking. In an authoritarian state, what could possibly go right?

In the United State, regulators have approved the first “digital pill” with a tracking system. According the Financial Times, this is a pill with an inbuilt sensor, which opens up a new front in pharmaceuticals and the “internet of things”. 

The tablet can be tracked inside the stomach, relaying data on whether, and when, patients have taken “vital medication”. So far, the US Food and Drug Administration has given the green light for it to be used in an antipsychotic medication with the aim that the data can be used “to help doctors and patients better manage treatment.”

Patients who agree to take the digital medication, a version of the antipsychotic drug Abilify, can sign consent forms allowing their doctors and up to four other people, including family members, to receive electronic data showing the date and time pills are ingested.

Dr. Peter Kramer, a psychiatrist and the author of Listening to Prozac, raised concerns about “packaging a medication with a tattletale.”

While ethical for “a fully competent patient who wants to lash him or herself to the mast,” he said, “‘digital drug’ sounds like a potentially coercive tool.”

Other companies are developing digital medication technologies, including another ingestible sensor and visual recognition technology capable of confirming whether a patient has placed a pill on the tongue and has swallowed it. 

The newly approved pill, called Abilify MyCite, is a collaboration between Abilify’s manufacturer, Otsuka, and the Silicon Valley based Proteus Digital Health, the company that created the sensor.

The sensor, which contains copper, magnesium and silicon, generates an electrical signal when splashed by stomach fluid, “like a potato battery,” according to Andrew Thompson, Proteus’s president and chief executive.

After several minutes, the signal is detected by a Band-Aid-like patch that must be worn on the left rib cage and replaced after seven days, said Andrew Wright, Otsuka America’s vice president for digital medicine. The patch then sends the date and time of pill ingestion and the patient’s activity level via Bluetooth to a cellphone app.

Abilify is prescribed to people with schizophrenia, bipolar disorder and, in conjunction with an antidepressant, major depressive disorder. The symptoms of schizophrenia and related disorders can include paranoia and delusions, so you do have to wonder how widely digital Abilify will be accepted, given that it is designed to monitor behaviours and transmit signals from within a person’s body to communicate with their doctor.  

Dr. Jeffrey Lieberman, chairman of psychiatry at Columbia University and New York-Presbyterian Hospital, said many psychiatrists would likely want to try digital Abilify, especially for patients who just experienced their first psychotic episode and are at risk of stopping medication after feeling better.

But he noted it has only been approved to track doses, and has not yet been shown to improve compliance with treatment regimes.

He added, “There’s an irony in it being given to people with mental disorders that can include delusions. It’s like a biomedical Big Brother.”

The FT article goes on to say: “Poor compliance with drug regimes, particularly among sufferers of chronic diseases, is a pervasive problem for pharma companies and health systems, leading to lower consumption of the industry’s products and higher costs for payers when patients’ conditions deteriorate as a result of missing treatment.”

 You can see precisely where the emphasis and priorities lie in that statement. Not a word about the poor dehumanised “patients'” wellbeing and importantly, about their choice. It’s assumed that pharma industry’s products don’t have any adverse effects at all, and that taking the medication is always in the patient’s best interest. It’s assumed that medications will improve someone’s mental health. Apparently the key to good mental health is keeping costs low to tax payers while keeping the pharma industry in business, ensuring that they can keep making profits.

Andrew Thompson, Proteus chief executive, said the technology would allow people with serious mental illness “to engage with their care team about their treatment plan in a new way”. Patients will be able to use a mobile phone to track and “manage” their medication. Worryingly, he is already in talks with other major pharma companies about using the technology in treatments for various chronic conditions.

The tablets contain a sensor, so that when they are swallowed, a signal is sent to a patch worn on the patient’s body, which in turn connects to an app on their phones, showing that they have taken their dose. The doctor who has prescribed the medicine will automatically be sent the data and patients can also choose to nominate family and care team members to receive it.

The wearable patch will also be used to track how much patients are moving around — considered a key indicator of overall health — and allows them to self-report their mood and sleep quality via the app. 

There are some problems with the assumptions behind the development of digital pill, and its proposed use. Firstly, it’s a myth that people with mental health conditions are not very good at taking their medication. Studies have shown that “compliance” with a medication regime is no worse in people with mental health conditions like schizophrenia than it is in long-term physical ailments such as asthma or high blood pressure. In fact demographic factors such as whether a person is single or in a relationship are more likely to play a role in medication compliance.

It is also a taken for granted assumption that pharmaceutical solutions are the best guarantee of positive outcomes for people with mental health conditions. Before concentrating on specific medication issues it is important to remember that medication is not the sole focus of a mental health intervention. This is because the causes of mental illness are complex and various, and quite often do not arise solely from “within” individuals, rather, it often arises because of interactions between environmental factors, circumstances, and individual predispositions and vulnerabilities (including both psychological and biological). Some psychiatrists have stated that mental illness – in all its forms – is intrinsically social.

We know, for example, that discrimination plays a part in explaining why certain groups in our society are more likely to experience poor mental health compared to others. Direct experiences of prejudice and harassment impact negatively on mental wellbeing, while indirect factors such as deprivation and social exclusion also contribute to poor mental health. Studies have highlighted the role that prejudice, stigma and discrimination can play in poor mental health.

It is only by fully acknowledging and understanding the external risk factors for poor mental health that we can develop our understanding of protective factors for good mental health at the individual, community and societal level. 

Sometimes causes are confused with effects

Despite controversies in psychiatry regarding the very complex aetiology of mental illness, including the role of sociological practices, political practices and economic conditions, it is widely held that mental illness arises “within” the individual and has a purely neurobiological origin. Yet there is no conclusive evidence to demonstrate that major mental illnesses are “proven biological diseases of the brain” and that emotional distress results from “chemical imbalances.”

One attempt to explain a physical cause of schizophrenia is the dopamine hypothesis. Dopamine is a neurotransmitter. It is one of the chemicals in the brain which causes neurons to fire. The original dopamine hypothesis stated that people with schizophrenia suffered from an excessive amount of dopamine. This causes the neurons that use dopamine to fire too often and transmit too many “messages”. High dopamine activity leads to acute episodes, and positive symptoms which include delusions, hallucinations and “confused thinking.”

Evidence for this hypothesis comes from that fact that amphetamines increase the amounts of dopamine. Large doses of amphetamine given to people with no history of psychological disorders produce behavior which is very similar to paranoid schizophrenia. Small doses given to people already suffering from schizophrenia tend to worsen their symptoms.

However, the problem with this hypothesis is that we don’t know if the raised dopamine levels are the cause of the schizophrenia, or if the raised dopamine level is the result of schizophrenia. It is not clear which comes first. 

One of the biggest criticisms of the dopamine hypothesis came when Farde et al found no difference between levels of dopamine in people with schizophrenia compared with “healthy” individuals in 1990.

Another problem is that schizophrenia is something of an umbrella term that encompasses a wide array of symptoms, and can be reached by multiple routes that may, nevertheless, impact the same biological pathways. However, there is emerging evidence that different routes to experiences currently deemed indicative of schizophrenia may need different treatments.

For example, preliminary evidence suggests that people with a history of childhood trauma who are diagnosed with schizophrenia are less likely to be helped by antipsychotic drugs. However, more research into this is needed. It has also been suggested that some cases of schizophrenia are actually a form of autoimmune encephalitis, which means that the most effective treatment may be immunotherapy and corticosteroids. People with autoimmune illness such as lupus are also at an increased risk of developing autoimmune mediated psychosis.

Some interventions, such as the family-therapy based dialogue approach, show some promise for many people with schizophrenia diagnoses. Both general interventions and specific ones, tailored to someone’s personal route to the experiences associated with schizophrenia, may be needed. It’s therefore crucial that psychiatrists ask people about all the potentially relevant circumstances and routes.

For example, suffering childhood adversityusing cannabis and having childhood viral infections of the central nervous system all increase the odds of someone being diagnosed with a psychotic disorder (such as schizophrenia) by at least two – to threefold. 

Although the exact causes of most mental illnesses are not known, it is becoming clear through extensive research that many conditions are caused by a complex combination of biological, psychological, social, cultural, political, economic and environmental factors. It’s widely recognised that poverty, social isolation, being unemployed or highly stressed in work can all have an effect on an individual’s mental health. 

Adults in the poorest fifth of the population are much more at risk of developing a mental illness as those on average incomes: around 24% compared with 14%. Those who have an existing mental illness are significantly more likely to be living in poverty, also. 

Poverty can therefore be both a causal factor and a consequence of mental ill-health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic, political 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 an engagement with this complexity. Simply medicating a person is neither sufficient nor appropriate. Nor is it ethical. Pharmaceutical companies tend to promote the assumption that mental illness is entirely biomedical. The relationship between economics and health is complex and politically fraught. But it is too important to ignore.

Psychiatric diagnosis tends to reify the complexity of people’s problems. However, in the UK, the political (mis)use of behaviourism has also resulted in the reification of social and economic problems. The government here extend the view that unemployment is evidence of both personal failure and psychological deficit. The use of crude behaviourist psychology in the delivery of social security denies the individuals’ experience of the effects of social and economic inequalities, and has been used to authorise the extension of the state and to justify state-contracted surveillance to individuals’ psychological characteristics.  

In a “business friendly” environoment, with a distinctly authoritarian government, I can’t help but wonder how long will it be before we see the increasingy intrusive Conservative state locking up or drugging patients whose diseases are defined not by organic dysfunction but by politically defined “socially unacceptable behaviours”.

I’m a critic of state entanglement with psychiatry AND psychology. For people with mental health problems in the UK, policies are being formulated to act upon them as if they are objects, rather than autonomous human subjects. Such a dehumanising approach has contributed significantly to a wider process of  social outgrouping, increasing stigmatisation and ultimately, to further socioeconomic and mental health inequalities. Most government policies aimed at ill and disabled people more generally are about cutting costs and removing lifeline support. This has been increasingly justified by a narrative that focuses on problematising sick role behaviours, rather than on the real impacts of illness and the additional needs that being chronically ill invariably generates. 

Earlier this year, George Freeman, Conservative MP for Norfolk and chair of the Prime Minister’s Policy Board, defended the government’s decision to subvert the judicial system, by disregarding the rulings of two independent tribunals concerning Personal Independence Payment (PIP) for disabled people. The government ushered in an “emergency” legislation to reverse the legal decisions in order to cut cost. In an interview on Pienaar’s Politics, on BBC 5 Live, Freeman said: 

“These tweaks [new regulations to cut PIP eligibility] are actually about rolling back some bizarre decisions by tribunals that now mean benefits are being given to people who are taking pills at home, who suffer from anxiety”.

He claimed that the “bizarre” upper tribunal rulings meant that“claimants with psychological problems, who are unable to travel without help, should be treated in a similar way to those who are blind.”

He said: “We want to make sure we get the money to the really disabled people who need it.”

He added that both he and the Prime Minister “totally” understood anxiety, and went on to say: “We’ve set out in the mental health strategy how seriously we take it.” 

He said: “Personal Independence Payments reforms were needed to roll back the bizarre decisions of tribunals.” 

Freeman’s controversial comments about people with anxiety “at home taking pills” implies that those with mental health problems are somehow faking their disability. He trivialises the often wide-ranging disabling consequences of mental ill health, and clearly implies that he regards mental illnesses as somehow not “real” disabilities.

His comments contradict the government’s pledge to ensure that mental health and physical health are given a parity of esteem, just months after the Prime Minister pledged to take action to tackle the stigma around mental health problems. 

Yet people with the following mental health conditions are likely to be affected by the reversal of the Independent Tribunal’s ruling on PIP mobility awards – those in particular who suffer “overwhelming psychological distress” when travelling alone:

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).

Freeman’s comments signposts the Conservative’s “deserving” and “undeserving” narrative, implying that some disabled people are malingering. However, disabled people do not “cheat” the social security system: the system has been redesigned by the government to cheat disabled people.

When people are attacked, oppressed and controlled psychologically by a so-called democratic government that embeds punishment at the heart of public policies to target the poorest citizens, it’s hardly surprising they become increasingly anxious, depressed and mentally unwell.

An era of technocratic solutions for social problems

Some psychiatrists see a strengthening of psychiatry’s identity as essentially “applied neuroscience”. Although not discounting the importance of the neurological sciences and psychopharmacology, they have argued that psychiatry needs to move beyond the dominance of the current dominant technological paradigm. Such critical practitioners say that psychiatry ought to primarily involve engagement with the non-technical dimensions of their work such as relationships, meanings and values. Psychiatry has operated from within a technological paradigm that, although not ignoring these aspects of work, has kept them as secondary concerns.

Psychiatry sits within a predominantly biomedical idiom. This means that problems with feelings, thoughts, behaviours and relationships can be fully grasped with the same sort of scientific tools that we use to investigate physical problems with our kidneys, blood cells, lungs, and so on.

While psychiatry has generally focused a lot of attention on neuroscience, neuroscientists themselves have become more cautious about the value of reductionist and deterministic approaches to understanding the nature of human thought, emotion and behaviour.

The dominance of this paradigm can be seen in the importance attached to classification systems, causal models of understanding mental distress and the framing of psychiatric care as a series of discrete interventions that can be analysed and measured independent of context.

More recently, models of cognitive psychology, based on “information processing”, have been developed that work within the technological idiom. Psychiatry stubbornly operates within a positivist tradition, and subscribes to the following assumptions: mental health problems arise from faulty mechanisms or processes involving abnormal physiological or psychological events occurring within the individual, these processes can be modelled in causal terms.

These processes are regarded as not being context dependent. They reside “within” the individual. Technological interventions are instrumental and can be designed and studied independently of experiences, subjective states, relationships, and values. However, in 2013, psychiatrist Allen Frances said that “psychiatric diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests”.

Many people within the growing service user movement seek to reframe experiences of mental illness, distress and alienation by framing them as human experiences, rather than biomedical events, simplistic causal relationships and “scientific” challenges. In a study of users’ views of psychiatric services, Rogers et al found that many service users did not really value the “technical” expertise of professionals. Instead, they were much more concerned with the subjective experience and human elements of their encounters such as being listened to, taken seriously, and treated with dignity, kindness and respect.

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The Extraction of the Stone of Madness by Hieronymus Boschfrom around 1494.

In his work, History of Madness, Michel Foucault says “Bosch’s famous doctor is far more insane than the patient he is attempting to cure, and his false knowledge does nothing more than reveal the worst excesses of a madness immediately apparent to all but himself.” 

I have to say I have never seen a person by looking at a brain.

It’s not all “in here”, it’s “out there”: the problem with locating mental illness “within” the individual

To paraphrase R.D Laing, “insanity”, mental illness and psychological distress may be seen as a perfectly rational adjustment to an insane world. Laing examined the nature of human experience from a phenomenological perspective, as well as exploring the possibilities for psychotherapy in an existentially distorted world. He challenges the whole idea of “normality” in society. 

It simply isn’t effective or appropriate to treat distress arising because of, say, socioeconomic problems or difficult relationships with psychotropic drugs alone, administered to people experiencing the consequences of political decision-making, the adverse consequences of socioeconomic organisation, exclusion, stigma, abuse or damaging parenting practices. 

Coping with past or current traumatic experiences such as abuse, bereavement or divorce will also strongly influence an individual’s mental and emotional state which can in turn have an influence on their wider mental health. Psychological interventions are therefore a crucial and integral part of effective treatment for mental illnesses.

However, in the UK, the current political-psychological model also locates social problems “within” the individual. The government plan to merge health and employment services. In a move that is both unethical and likely to present significant risk of harm to many patients, health professionals are being tasked to deliver benefit cuts for the Department for Work an Pensions. This involves measures to support the imposition of work cures, including setting employment as a clinical outcome and allowing medically unqualified job coaches to directly update a patient’s medical record.

The Conservatives have proposed more than once the mandatory treatment for people with long term conditions (which was first flagged up in the Conservative Party Manifesto) and this is currently under review, including whether benefit entitlements should be linked to “accepting appropriate treatments or support/taking reasonable steps towards “rehabilitation”.  The work, health and disability green paper and consultation suggests that people with the most severe illnesses in the support group may also be subjected to welfare conditionality and sanctions.

Such a move has extremely serious implications. It would be extremely unethical and makes the issue of consent to medical treatment very problematic if it is linked to the loss of lifeline support or the fear of loss of benefits. However this is clearly the direction that government policy is moving in and represents a serious threat to the human rights of patients and the independence of health professionals.

The digital pill in an age of surveillance has potential implications for civil liberties

For people with severe and enduring mental health problems, it is crucial that their context is also considered, and it’s important that people are provided with support with their living circumstances, and taking into account their wider social conditions, also. 

Furthermore, there is the important issue of drug tolerability to consider. Antipsychotic drugs are also associated with adverse effects that can lead to poor medication adherence, stigma, distress and impaired quality of life. For example, the stiffness, slowness of movement and tremor of antipsychotic-induced parkinsonism (See Dursun et al, 2004) can make it difficult for a patient to write, fasten buttons and tie shoelaces. Some antipsychotic medications can affect facial expressions, which flatten nonverbal communication and may impact on ordinary social interactions, potentially leading to stigma and further isolation.

Side effect or symptom?

The impact of drug side-effects on patients has not been sufficiently studied. Researchers have stressed the importance of the patient’s subjective experience, in which adverse effects have a role, and are considered and included in the assessment of drugs, though this doesn’t always happen. Although adverse effects are an important outcome, with many antipsychotics, they account for less treatment discontinuation than lack of efficacy; this finding has been noted in naturalistic studies and in Randomised Controlled Trials (RCTs). 

Both older and newer antipsychotic drugs can cause:

  • Uncontrollable movements, such as tics, tremors, or muscle spasms, blank facial expression and abnormal gait (risk is higher with first-generation antipsychotics)
  • Weight gain (risk is higher with second-generation antipsychotics)
  • Photosensitivity – increased sensitivity to sunlight
  • Anxiety
  • Drowsiness
  • Dizziness
  • Restlessness
  • Dry mouth
  • Constipation
  • Nausea
  • Vomiting
  • Blurred vision
  • Low blood pressure
  • Seizures
  • Low white blood cell count
  • Sexual dysfunction in both men and women
  • Menstruation problems in women and feminising effects such as abnormal breast growth and lactation in men. These latter problems are caused by the effect that the newer drugs have on a hormone in the blood called prolactin
  • Osteoporosis
  • Some neuroleptic drugs have withdrawal effects which can be very unpleasant

In addition some side effects of the newer antipsychotics may be confused with the symptoms of schizophrenia, such as apathy and withdrawal.

Antipsychotics can also cause bad interactions with other medications.

Bioethic considerations

One of the serious bioethic considerations is whether the digital medicine could be used coercively, on people against their will or as part of probation, healthcare or welfare conditions, for example.

Otsuka has said: “We intend that this system only be used with patient consent.”

However, here in the UK, the government have been kite-flying the idea of social security support being made conditional to imposed “health” regimes for a while. 

The Conservatives have already made proposals to strip obese or those who are ill because of substance misuse of their welfare benefits if they refuse treatment. This  violates medical ethics. The president of the British Psychological Society responded, at the time, Professor Jamie Hacker Hughes, said people should not be coerced into accepting psychological treatment and, if they were, evidence shows that it simply would not work.

He went on to say: “There is a major issue around consent, because as psychologists we offer interventions but everybody has got a right to accept or refuse treatment. So we have got a big concern about coercion.”

Hacker Hughes lent his voice to a chorus of criticism following the announcement of an official review to consider how best to get people suffering from obesity, drug addiction or alcoholism back into work. 

The government consultation paper, launched in 2015, that raised concerns acknowleged that strong ethical issues were at stake, but at the same time also questioned whether people should continue to receive benefits if they refused state provided treatment.

The government regard work as a health outcome, and believe that welfare creates “perverse incentives” that prevent people from finding employment. However, international research and evidence demonstrates that this is untrue, and that generous welfare states tend to be correlated with a stronger work ethic.

Hacker Hughes said claimants with obesity and addiction problems often faced complex mental health issues. But he warned the government against using sanctions to force people to accept interventions.

“It’s a problem firstly because we don’t believe people should be coerced into accepting any treatment, and secondly there is a problem because the evidence shows that if you are trying to change people’s behaviour, coercion doesn’t work,” he said.

There is a well-documented link between being out of work and psychological problems, but Hacker Hughes pointed out that the government’s plan risked “confusing the symptoms with the cause.”

Paul Atkinson, a London-based psychotherapist and member of the Alliance for Counselling and Psychotherapy, called the government’s proposals an outrage. He said: “It’s the same psychology from the government of punishing rather than working with people. Under a regime like welfare and jobcentres at the moment it is going to be felt as abuse, punitive and moralistic.”

Yes, and that’s because it is.

The government introduced “ordeals” into the welfare system to deter people from claiming the social security that most have paid for via national insurance and tax contributions, in order to “deter” what they see as “welfare dependency”. Yet labor market deregulation, anti-union legislation and other political decisions have also driven down wages, leaving many in work in poverty, also. The government’s “solution” to in-work poverty was to introduce further conditionality, in the form of extremely punitive financial sanctions for people who need to claim in-work welfare support, to “ensure they progress in work”. It is assumed that the problem of low pay resides “within the individual” rather than being the consequence of structural and labor market conditions, the profit incentive, “business friendly” political decision-making and board room choices. Ultimately, it’s down to the unequal distribution of power.

A gaslighting state: punitive psychopolicy interventions

No-one seems to be concerned with monitoring the impact of the government’s “behavioural change” agenda. Strict behavioural requirements and punishments in the form of sanctions are an integral part of the Conservative ideological pseudo-moralisation of welfare, and their  “reforms” aimed at making claiming benefits much less attractive than taking a low paid, insecure, exploitative job. 

Welfare has been redefined: it is preoccupied with assumptions about and modification of the behaviour and character of recipients rather than with the alleviation of poverty and ensuring economic and social wellbeing. Furthermore, the political stigmatisation of people needing benefits is designed purposefully to displace public sympathy for the poor, and to generate moral outrage, which is then used to further justify the steady dismantling of the welfare state. (See Stigmatising unemployment: the government has redefined it as a psychological disorder.)

However, the problems of austerity and the economy were not caused by people claiming welfare, or by any other powerless, scapegoated, marginalised group for that matter, such as migrants. The problems have arisen because of social conservatism and neoliberalism. The victims of the government’s policies and decision-making are being portrayed as miscreants – as perpetrators of the social problems caused by the government’s decisions, rather than as the casualities.

Under the government’s plans, therapists from the NHS’s Improving Access to Psychological Therapies (IAPT) programme are to support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses.

Again, we really must question the ethics of linking receipt of welfare with “state therapy,” which, upon closer scrutiny, is not therapy at all. Linked to such a narrow outcome – getting a job – this is nothing more than a blunt behaviour modification programme. The fact that the Conservatives plan to make receipt of benefits contingent on participation in “treatment” worryingly takes away the fundamental right of consent.

Not only is the government trespassing on an intimate, existential level; it is tampering with our perceptions and experiences, damaging and isolating the poorest, burdening them with the blame for the consequences of their own policies whilst editing out state responsibilities towards citizens. (See the The power of positive thinking is really political gaslighting, and IAPT is value-laden, non-prefigurative, non-dialogic, antidemocratic and reflects a political agenda.)

It’s very important that we don’t overlook the importance of context regarding psychological distress. The idea that mental “illness” arises strictly “within” the individual, therefore, requiring medicine as treatment, as opposed to, say, different socioeconomic policies, is a controversial one. People’s mental health is, after all, at least influenced by the social, political, cultural and economic spaces that they occupy. 

The current government has a 7 year history of decontextualing structural inequality and poverty, using narratives that “relocate” the causes and effects of an unequal distribution of power and wealth. Such narratives are about coercing the responsibility, internalisation and containment of social problems within some targeted individuals in some marginalised social groups. This process always involves projection, stigmatising, outgrouping and scapegoating. 

Earlier this year, the UK Council for Psychotherapy (UKCP) said that government policies – in particular, the Conservatives’ draconian “reforms” of social security payments and austerity regime – were to blame for a steep rise in the rates of severe anxiety and depression among unemployed people, as benefit cuts and sanctions, together with an extremely punitive and coercive welfare conditionality regime, “are having a toxic impact on mental health”.

It’s hardly ethical, appropriate or effective to impose a medical treatment on people who are suffering because of policies that bring about financial and psychological insecurity, hardships and harms.  

We have witnessed an ongoing attempt by the Conservatives to “rewrite the welfare contract” for disabled people, which has become a key site of controversy within UK welfare reform, and fierce debates about the circumstances in which the use of  conditionality may, or may not, be ethically justified. And denial from the government that their welfare policy is causing some of our most vulnerable citizens harm, hardship and distress. 

Wilkinson and Pickett’s key finding in their work, The Spirit Level: Why More Equal Societies Almost Always Do Better is that it is the inequality itself, and not the overall wealth of a society that is the key factor in creating various pathologies. The authors  show that for each of eleven different health and social problems: physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage pregnancies, and child wellbeing, outcomes are significantly worse in more unequal rich countries. The evidence also shows that poorer places with more equality have better overall social outcomes than wealthy ones marked by gross inequality. (See also The still face paradigm, the just world fallacy, inequality and the decline of empathy, for further discussion about how neoliberaism itself creates profound psychological trauma, and builds social “empathy walls”).

Theresa May has pledged new initiatives to end “stigma” around mental health and encourage schools and employers to provide mental health support. Despite government assurances mental health services would receive equal treatment to physical health, 40% of NHS trusts saw cuts to mental health services across 2015-2016.

But in the absence of genuine funding commitments, the Prime Minister has faced charges of hypocrisy from mental campaigners, for not doing anywhere near enough to address the root causes of problems faced by disabled and mentally ill people. 

At one point in 2014, there were no mental health beds available for adults in the whole of England, while an NSPCC survey published in October 2015 found that more than a fifth of children referred to child and adolescent mental health services (CAMHS) in England were refused access to support. 

There have recently been a number of high-profile cases reported more than once in the media across the UK when the necessary kind of hospital bed could not be found for mental health patients in England. The NHS Confederation’s Mental Health Network – the representative body for NHS-funded mental health service providers – also heard evidence from its members last year that “there are occasions when there are no routine acute mental health assessment beds available across the country.”

Importantly, Psychologists Against Austerity have said: “Addressing mental health is not just about ensuring more ‘treatment’ is available and stigma is reduced, although they are important. It is fundamentally also about the evidence that ideological economic policies, like the continued austerity programme, have hit the most vulnerable citizens the hardest and have been toxic for mental health.”

The government’s “employment and support programme” for sick and disabled people coincided with at least 590 “additional” suicides, 279,000 cases of mental illness and 725,000 more prescriptions for antidepressants – and one mental health charity found that at least 21 per cent of their patients had experienced suicidal thoughts due to the stress of the draconian Work Capability Assessments. 

It’s crucially important that a positive therapeutic alliance based on trust is developed  between doctors and patients. Specific problems with the therapeutic alliance include doctors failing to acknowledge patients’ concerns, an example of which is the failure to respond to patients who talk about their auditory halluci­nations in schizophrenia (McCabe et al, 2002). Furthermore, doctors appear not to appreciate the degree of distress caused by certain antipsychotic side-effects (Day et al, 1998). There is, therefore a fundamental need for doctors to listen more effectively to patients and elicit their particular concerns about their illness and its treatments. In fact Poor doctor-patient relationships have been cited by recent research as a key factor that influences a patient’s attitude towards treatment.

Critics of psychiatry commonly express a concern that the path of diagnosis and treatment is primarily shaped by profit prerogatives, echoing a common criticism of general medical practice, particularly in the United States, and increasingly, in the UK, where many of the largest psychopharmaceutical producers are based.

It’s an inbuilt “cognitive bias”. 

This critique is not meant to imply that physiological factors in mental illnesss can or should be ignored. However, as I’ve pointed out, the biomedical model avoids the personal, social, cultural, political and economic dimensions of mental illness, in the same way that the political behaviourist (behavioural economics, used in public policy) model does.

One concern is that both the behaviourist and biomedical model protects those formulating provision and care from the pain experienced by those needing support. The temptation to retreat into objectification of those identified as mentally ill may also be a factor in a state cost cutting exercise. 

The UK government has already demonstrated a worrying overreliance on individualistic approaches to socioeconomic problems that prioritise citizen responsibility and “self help”. The behavioural turn has been powerfully influenced by libertarian paternalism – itself a political doctirne, despite its claims to “value-neutrality”.

The Conservatives’ neoliberal policies increasingly embed behaviour modification techniques that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes through rewards or “consequences.” Rewards, such as tax cuts, are aimed at the wealthiest, whereas the most vulnerable citizens who are the poorest are simply presented with imposed cuts to their lifeline support as an “incentive” to not be poor. Taking money from the poorest is apparently “for their own good”, according to the government, as it reduces “dependency”. 

“Dependency” and “need” have somehow become conflated, the government have resisted urges to acknowledge that some citizens have more needs than others for a wide array of reasons, including their mental health status.

Defining human agency and rationality in terms of economic outcomes is extremely problematic. And dehumanising. Despite the alleged value-neutrality of behavioural economic theory and CBT, both have become invariably biased towards the status quo rather than progressive change and social justice.

Behavoural economics theory has permited policy-makers to indulge ideological impulses whilst presenting them as “objective science.” From a libertarian paternalist perspective, the problems of neoliberalism don’t lie in the market, or in growing inequality and poverty: neoliberalism isn’t flawed, nor are governments – we are. Governments and behavioural economists don’t make mistakes – only citizens do. No-one is nudging the nudgers.

It’s assumed that their decision-making is infallible and they have no whopping cognitive biases of their own. One assumption that has become embedded in the poliical narrative is that an adequate level of social security to meet people’s basic survival needs is somehow mutually exclusive from encouraging people to find a suitable job.

In the current political context, it’s easy to see how the medicalisation of political, economic, cultural and social problems may be politically misused, especially by an authoritarian government, and in an ideological era that extolls the virtues of a “small state” and austerity, to exempt the state completely from its fundamental responsibility towards the prosperity, health and wellbeing of citizens.

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Neoliberalism


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A bad job is worse for your mental health than unemployment, say UK’s top psychologists

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Last month, the following letter was sent to the Independent, titled The DWP must see that a bad job is worse for your mental health than unemployment:

“We, the UK’s leading bodies representing psychologists, psychotherapists, psychoanalysts, and counsellors, call 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.

Vulnerable people with multiple and complex needs, in particular, are disproportionately affected by the increased use of sanctions.

Therefore, we call on the Government to suspend the benefits sanctions regime and undertake an independent review of its impact on people’s mental health and wellbeing.

But suspending the sanctions system alone is not enough. We believe the Government also has to change its focus from making unemployment less attractive, to making employment more attractive – which means a wholesale review of the back to work system.

We want to see a range of policy changes to promote mental health and wellbeing. These include increased mental health awareness training for Jobcentre staff – and reform of the work capability assessment (WCA), which may be psychologically damaging, and lacks clear evidence of reliability or effectiveness.

We urge the Government to rethink the Jobcentre’s role from not only increasing employment, but also ensuring the quality of that employment, given that bad jobs can be more damaging to mental health than unemployment.

This should be backed up with the development of statutory support for creating psychologically healthy workplaces.

These policies would begin to take us towards a welfare and employment system that promotes mental health and wellbeing, rather than one that undermines and damages it.

Professor Peter Kinderman, President, British Psychological Society (BPS)

Martin Pollecoff, Chair, UK Council for Psychotherapy (UKCP)

Dr Andrew Reeves, Chair, British Association for Counselling and Psychotherapy (BACP)

Helen Morgan, Chair, British Psychoanalytic Council (BPC)

Steve Flatt, Trustee, British Association of Behavioural and Cognitive Psychotherapies (BABCP)”

“Making work pay” for whom?

pie wealth

It’s a draconian, crude behaviourist and armchair technocratic government that would claim to “make work pay” by decreasing social security support for the poorest members of society, rather than raising wages to meet the rising costs of living. This approach was justified by claims that poor people became “dependent” on benefits because the welfare state provides “perverse incentives” for people seeking employment. However, there is no empirical evidence of these claims. Keith Joseph, a leading New Right advocate of the welfare dependency theories, set out to try and establish evidence dependency during the Thatcher era, and failed. Both Thatcher and Joseph wanted to extend Victorian bourgeois values of thrift, self-reliance and charity among all classes.

Such an approach has benefitted no-one but wealthy employers motivated by a profit incentive, as people who are out of work or claiming disability related benefits have become increasingly desperate. These imposed conditions have created a reserve army of labour, which has subsequently served to devalue labour, and drive wages down. We now witness high levels of in-work poverty, too. The Victorian Poor Law principle of less eligibility had the same consequences, and also “made work pay.” It’s shameful that in 2017, the government still believe that it is somehow effective and appropriate to punish people into not being poor. Especially when the government’s own policies are constructing inequality and poverty.

Last week I wrote about the Samaritans report: Dying from inequality: socioeconomic disadvantage and suicidal behaviour, which strongly links socioeconomic disadvantage and inequality with psychological distress and suicidal behaviours. The report reiterates that countries with higher levels of per capita spending on active labour market programmes, and which have more generous unemployment benefits, experience lower recession-related rises in suicides.

Research has consistently found that in countries with a generous social safety net, poor employment (low pay, poor conditions, job insecurity short-term contracts), rather than unemployment, has the biggest detrimental impact on mental health. This is particularly true of neoliberal states with minimal and means tested welfare regimes. It seems health and wellbeing are contingent on the degree to which individuals, or families, can uphold a socially acceptable standard of living independently of market participation, and on the kind of social stratification  (socioeconomic hierarchies indicating levels of inequality) is fostered by social policies.

Furthermore, despite the government’s rhetoric on welfare “dependency”, and the alleged need for removing the “perverse incentives” from the social security system by imposing a harsh conditionality framework and a compliance regime – using punitive sanctions – and work capability assessments designed to preclude eligibility to disability benefits, research shows that generous social security regimes make people more likely to want to work, not less.

The government’s welfare “reforms” have already invited scathing international criticism because they have disproportionately targeted cuts at those with the least income. Furthermore, the government have systematically violated the human rights of those with mental and physical disabilities. In a highly critical UN report last year, following a lengthy inquiry, it says: “States parties should find an adequate balance between providing an adequate level of income security for persons with disabilities through social security schemes and supporting their labour inclusion. The two sets of measures should be seen as complementary rather than contradictory.”

However, the UK government have continued to conflate social justice and inclusion with punitive policies and cuts, aimed at coercing disabled people towards narrow employment outcomes that preferably bypass any form of genuine support and the social security system completely. 

See – UN’s highly critical report confirms UK government has systematically violated the human rights of disabled people.

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Kitty.

 


 

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IAPT is value-laden, non-prefigurative, non-dialogic, antidemocratic and reflects a political agenda

arnstein-ladder-citizenship-participation

Arnstein’s ladder of citizen participation and inclusion. It represents the redistribution of power that enables marginalised citizens, presently excluded from the political and economic processes, to be purposefully included in the future.

The government’s Work and Health Programme, due to be rolled out this autumn, involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access to Psychological Therapies (IAPT), Jobcentre Plus and the Work Programme.

But the government’s aim to prompt public services and commissioned providers to “speak with one voice” is founded on traditional Conservative prejudices about people who need support. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive mental health provision.

What’s on offer is psychopolitics, not therapy. It’s about (re)defining the experience and reality of a marginalised social group to justify dismantling public services (especially welfare). In linking receipt of welfare with health services and state therapy, with the single politically intended outcome of employment, the government is purposefully conflating citizens’ widely varied needs with economic outcomes and diktats, which will isolate people from traditionally non-partisan networks of unconditional support, such as the health service, social services, community services and mental health services.

Services “speaking with one voice” will invariably make accessing support conditional, and further isolate marginalised social groups. It will damage trust between people needing support and professionals who are meant to deliver essential public services, rather than simply extending government dogma, prejudices and discrimination. And meeting ideologically designed targets.

As neoliberals, the Conservatives see the state as a means to reshape social institutions and social relationships hierarchically, based on a model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged and modified. Social groups that don’t conform to ideologically defined economic outcomes and politically defined norms are stigmatised and outgrouped. 

Othering and outgrouping have become common political practices, it seems.

The Work and Health Programme is a welfare-to-work programme for people with disabilities, mental health problems and for long-term unemployed people, due to be rolled out in the autumn. In the recent Work, Health and Disability green paper, the government mentioned new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” those people in the ESA Support Group – those assessed by their own doctors and the state as being unlikely to work in the near future – “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation.” 

Apparently these “conversations” were “co-designed” by the Behavioural Insights Team.

Democracy is based on a process of dialogue between the public and government, ensuring that the public are represented: that governments are responsive, shaping policies that address identified social needs.

However, policies increasingly reflect a behaviourist turn. They are no longer about reflecting citizens’ needs: they are increasingly about telling some citizens how to be. This has some profound implications for democracy.

Neoliberal policies increasingly extend behaviour modification techniques that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes through rewards or “consequences.” Rewards, such as tax cuts, are aimed at the wealthiest, whereas the most vulnerable citizens who are the poorest are simply presented with imposed cuts to their lifeline support as an “incentive” to not be poor. Taking money from the poorest is apparently “for their own good”.   

Defining human agency and rationality in terms of economic outcomes is extremely problematic. And dehumanising. Despite the alleged value-neutrality of behavioural economic theory and CBT, both have become invariably biased towards the status quo rather than progressive change and social justice.

Behavoural economics theory has permited policy-makers to indulge ideological impulses whilst presenting them as “objective science.” From a libertarian paternalist perspective, the problems of neoliberalism don’t lie in the market, or in growing inequality and poverty: neoliberalism isn’t flawed, nor are governments – we are. Governments and behavioural economists don’t make mistakes – only citizens do. No-one is nudging the nudgers. It’s assumed that their decision-making is infallible and they have no whopping cognitive biases of their own. 

“There’s no reason to think that markets always drive people to what’s good for them.” Richard Thaler.

There’s no reason whatsoever to think that markets are good for people at all. Let’s not confuse economics with psychology, or competitive individualism and economic Darwinism with collectivism and mutual aid. Behavioural economics may offer us titbit theories explaining individual consumer’s decision making, but it’s been rather unreliable in explaining socioeconomic and political contexts and complex systems such as financial crises, and of course behavioual economists don’t feel the same pressing need to explore the decision making and “cognitive bias” of the handful of people who cause those.

It wasn’t those with mental health problems currently claiming social security. They do much less damage to the economy, in fact IAPT means vulture capitalist private companies like G4S and trusts like Southern Care can turn a profit offering “support”. 

The current emphasis on quantitative methodology and standardisation has led to an overwhelming focus on measurement in IAPT settings. Mental health services are now dominated by IAPT, which focuses exclusively on “evidence-based” and short-term interventions for clients with particular diagnoses – mostly anxiety disorders and depression. Most workers in IAPT services offer CBT, often by minimally trained psychological wellbeing practitioners offering “low-intensity” interventions over few sessions.

Verificationism and standardisation leads to a focus on measurement in IAPT settings. CBT mutes the causes of distress, which do not reside “within” the individual: they are intersubjectively constructed, with cultural, socioeconomic and political dimensions. Furthermore, there is little room left for authentic dialogue – qualitative accounts of client’s experiences are not accommodated. In this context, CBT is authoritarian, rather than being prefigurative and genuinely dialogic.

Under the government’s plans, therapists from the IAPT programme are to support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses. 

We must question the ethics of linking receipt of welfare with “state therapy,” which, upon closer scrutiny, is not therapy at all. Linked to such a narrow outcome – getting a job – it amounts to little more than a blunt behaviour modification programme. The fact that the Conservatives have planned to make receipt of benefits contingent on participation in “treatment” also worryingly takes away the fundamental right of consent.

CBT facilitates the identification of “negative thinking patterns” and associated “problematic behaviours” and “challenges” them. This approach is at first glance a problem-solving approach, however, it’s 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. 

So we need to ask what are the circumstances that we expect people to accept stoically. Socioeconomic inequality? Precarity? 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?  

It’s all very well challenging people’s thoughts but for whom is CBT being used. For what purpose? It seems to me that this is about coercing those people on the wrong side of draconian government policy to accommodate that; to mute negative responses to negative situations. CBT in this context is not based on a genuinely liberational approach, nor is it based on democratic dialogue. It’s 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 tends to generate oversimplifications of the causes human distress. It’s not about helping people make better choices, it’s about coercing people to make the choices that policymakers want them to make. Those “choices” are based on enforced conformity to the ideological commitments of policymakers.

It’s assumed that the causes of unemployment are personal and attitudinal rather than sociopolitical or because of health barriers, 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.

There is also widely held assumption that working is good for mental health, and that being in employment indicates mental wellbeing. It’s well-established that poverty is strongly linked with a higher likelihood of being diagnosed with a mental illness. That does not mean working is therefore somehow “good” for mental health. Encouraging people to work should entail genuine support, it shouldn’t entail taking away their lifeline income as punishment “incentive” if they can’t work.

An adequate level of social security to meet people’s basic survival needs is not mutually exclusive from encouraging people to find a suitable job.

It’s worth noting that research indicates in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than “worklessness”, has the biggest detrimental impact on mental health. 

CBT does not address the socioeconomic and political context. It permits society to look the other way, whilst the government continue to present mental illness as an individual weakness or vulnerability, and a consequence of “worklessness” rather than a fairly predictable result of living a distressing, stigmatised, excluded existence and material deprivation in an increasingly unequal society.

Inequality and poverty arise because of ideology and policy-formulated socioeconomic circumstances, but the government have transformed established explanations into a project of constructing behavioural and cognitive problems as “medical diagnoses” for politically created socioeconomic problems. Austerity targets the poorest disproportionately for cuts to income and essential services, it’s one ideologically-driven political decision taken amongst alternative, effective and more humane choices.

Both nudge and CBT are being used to prop up austerity and reflect neoliberal managementspeak at its very worst. Neoliberal policies are causing profound damage, harm and distress to those they were never actually designed to “help”. Let’s not permit techniques of neutralisation: the use of rhetoric to obscure the real intention behind policies. It’s nothing less than political gaslighting.

The government’s profound antiwelfarist rhetoric indicates that there’s no genuine intention to support those people with mental health problems and others in need, despite their semantic thrifts and diversions.

Policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, all citizen’s accounts of the impacts of policies ought to matter. 

However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, partly because the government employs the widespread use of linguistic strategies and techniques of persuasion to intentionally divert us from the aims and consequences of their ideologically driven and increasingly dehumanising policies. Furthermore, policies have become increasingly detached from public interests and needs. 

For people with mental health problems, policies are being formulated to act upon them as if they are objects, rather than autonomous human subjects. Such a dehumanising approach has contributed significantly to a wider process of social outgrouping, increasing stigmatisation and ultimately, to further socioeconomic and mental health inequalities.

It’s the government that need to change their behaviour.

It’s us that need to make a stand against hegemonic neoliberal discourse and injustice.

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This article was written for a zine to mark the protest at the 10th annual New Savoy conference on 15 March in London #newsavoy2017. You can read the zine, with other people’s excellent contributions, here.

Also, see: New Savoy Protest against psycho-compulsion of MH claimants – 15th March 2017.

You can read about the background to the Mental Wealth Alliance and the New Savoy demo and lobby here.

You can watch the video here from Let Me Look TV: Protest at the 10th Annual New Savoy Conference 15 March 2017.

Please share.

Related

The power of positive thinking is really political gaslighting

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

A critique of the ‘Origins of Happiness’ study

A critique of Conservative notions of social research

Research finds damaging mental health discrimination ‘built into’ Work Capability Assessment. Again.

The Conservative approach to social research – that way madness lies


 

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Dying from inequality: socioeconomic disadvantage and suicidal behaviour – report from Samaritans

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As Samaritans release a report ahead of Wednesday’s Budget linking inequality with a higher risk of suicide, the charity is calling on the government, businesses, industry and sector leaders to be aware of the risks of suicide and to direct support to those with unstable employment, insecure housing, low income or in areas of socioeconomic deprivation.

The report, Dying from Inequality, produced in conjunction with leading researchers and academics, is far-reaching and highlights clear areas of risk to communities and individuals, including the closure and downsizing of businesses, those in manual, low-skilled employment, those facing unmanageable debt and those with poor housing conditions.

In today’s press release, Samaritans’ CEO Ruth Sutherland says, “Suicide is an inequality issue that we have known about for some time, this report says that’s not right, it’s not fair and it’s got to change. Most importantly this report sets out, for the first time, what needs to happen to save lives. Addressing inequality would remove the barriers to help and support where they are needed most and reduce the need for that support in the first place. Government, public services, employers, service providers, communities, family and friends all have a role in making sure help is relevant and accessible when it matters most.

“Everyone can feel overwhelmed at times in their life. People at risk of suicide may have employers, or they may seek help at job centres, or go to their GP. They may come into contact with national and local government agencies, perhaps on a daily basis. So, in the light of this report we are asking key people and organisations from across society, for example those working in housing, in businesses, medical staff, job centre managers, to all take action to make sure their service, their organisation, their community is doing all it can to promote mental health and prevent the tragedy of suicide. 

Samaritans has already started addressing the inequalities driving people to suicide, by making its helpline number free to call, by calling on Government for more frontline staff to be trained in suicide prevention in England and by campaigning for local authorities to have effective suicide prevention plans in place. Now, in response to the findings of this report, the next steps will involve instigating working groups, in different sectors, bringing together businesses and charities who can influence in the areas highlighted, in order to tackle this issue in a collaborative, systematic and effective way to ensure that fewer people die by suicide.”

Sutherland continues: “Each suicide statistic is a person. The employee on a zero hour’s contract is somebody’s parent or child. A person at risk of losing their home may be a sibling or a friend. And each one of them will leave others devastated, and potentially more disadvantaged too, if they take their own life. This is a call for us as individuals to care more and for organisations that can make a difference, to do so.”

She went on to say: “Living in poverty shouldn’t mean losing your life. Going through difficult times like losing your job or being in debt shouldn’t mean not wanting to live. But that is what’s happening in the UK and Ireland today. Suicide is killing the most disadvantaged and vulnerable people, devastating families and communities.”

Some key points from the report summary:

There is no single reason why people take their own lives. Suicide is a complex and multi-faceted behaviour, resulting from a wide range of psychological, social, economic and cultural risk factors which interact and increase an individual’s level of risk.

Socioeconomic disadvantage is a key risk factor for suicidal behaviour.

Socioeconomic disadvantage or living in an area of socioeconomic deprivation increases the risk of suicidal behaviour.

The research evidence was considered at three levels: societal, community and individual: 

Societal: political, economic and social policies related to, for example, economic change, employment, social support and the labour market; stigmatised attitudes towards people on the basis of their socioeconomic standing or their suicidal behaviour.

Community: the local economic, social, cultural and physical environment, including, for example, geographical location, job opportunities, service availability and accessibility, and home ownership.

Individual: demographic characteristics, such as gender and age; socioeconomic position, including occupational social class and type of employment; mental health; and health-related behaviours.

Suicide risk increases during periods of economic recession, particularly when recessions are associated with a steep rise in unemployment, and this risk remains high when crises end, especially for individuals whose economic circumstances do not improve. Countries with higher levels of per capita spending on active labour market programmes, and which have more generous unemployment benefits, experience lower recession-related rises in suicides.

During the most recent recession (2008-09), there was a 0.54% increase in suicides for every 1% increase in indebtedness across 20 EU countries, including the UK and Ireland. Social and employment protection for the most vulnerable in society, and labour market programmes to help unemployed people find work, can reduce suicidal behaviour by reducing both the real and perceived risks of job insecurity and by increasing protective factors, such as social contact. In order to be effective, however, programmes must be meaningful to participants and felt to be non-stigmatising.

There is a strong association between area-level deprivation and suicidal behaviour: as area-level deprivation increases, so does suicidal behaviour. Suicide rates are two to three times higher in the most deprived neighbourhoods compared to the most affluent.

Admissions to hospital following self-harm are two times higher in the most deprived neighbourhoods compared to the most affluent. Multiple and large employer closures resulting in unemployment can increase stress in a local community, break down social connections and increase feelings of hopelessness and depression, all of which are recognised risk factors for suicidal behaviour.  

While the economic situation and policy approaches vary across the nations in which Samaritans operates, the link between socioeconomic disadvantage and increased risk of suicide is evident in all these nations. It is therefore essential that we understand why this link exists. We all need to address this inequality issue which is resulting in the tragic loss of lives.

Features of socioeconomic disadvantage include low income, unmanageable debt, poor housing conditions, lack of educational qualifications, unemployment and living in a socioeconomically deprived area. Individual Individuals experiencing socioeconomic disadvantage and adverse experiences, such as unemployment and unmanageable debt, are at increased risk of suicidal behaviour, particularly during periods of economic recession.

The risk of suicidal behaviour is increased among those experiencing job insecurity and downsizing or those engaged in non-traditional work situations, such as part-time, irregular and short-term contracts with various employers. The experience of being declared bankrupt, losing one’s home or not being able to repay debts to family and friends is not only stressful but can also feel humiliating. This can lead to an increased risk of suicidal behaviour.

The risk of suicidal behaviour increases when an individual faces negative life events, such as adversity, relationship breakdown, social isolation, or experiences stigma, emotional distress or poor mental health.

Socioeconomically disadvantaged individuals are more likely to experience ongoing stress and negative life events, thus increasing their risk of suicidal behaviour. In the UK, socioeconomically disadvantaged individuals are less likely to seek help for mental health problems than the more affluent, and are less likely to be referred to specialist mental health services following self-harm by GPs located in deprived areas.

Different welfare states have been shown to have different effects on social and health inequalities. High quality public service provision leads to a more cohesive society than policies based on means-testing which may generate social divisions. Given the link between inequalities and suicidal behaviour, labour market policy design can help improve wellbeing and reduce the risk of suicide.

Employment

Evidence on the association between working conditions, debt and suicide suggests that increased, involuntary part-time work, job insecurity and workplace downsizing are important risk factors for suicidal behaviour. It is not only unemployed people who are at increased risk. Employees who keep their jobs during a workplace downsizing may experience job insecurity and negative relationships with their peers, as well as stress from an increased workload. People who are self-employed can also be affected if demand for their business decreases. 

Unemployment benefits

Generous unemployment benefits and other types of social protection can reduce the risk of suicidal behaviour. Suicide rates tend to increase in countries which implement significant budget cuts, which was evident during the 2008-09 recession in some EU countries (Karanikolos et al., 2013). Unemployment benefits compensate for some of the income loss experienced from involuntary unemployment. Depending on the level of benefits, they should help ease financial worries that may lead to suicidal behaviour. However, means-tested benefits may actually contribute to suicidal behaviour, if recipients feel stigmatised, leading to feelings of shame, worthlessness, a loss of status, and a deterioration of mental health.

Employment protection

Strong employment protection should reduce real and perceived risks around job insecurity and unemployment, resulting in a positive impact on mental health. In contrast, weak employment protection is likely to increase real and perceived insecurity, and could lead to precarious forms of employment, such as temporary or zero-hours contracts, with adverse effects on mental health.

Inexperienced workers with low skills are particularly vulnerable in such contexts, since they are most likely to be on contracts which are less well protected and more precarious. The risk of mental health problems is increased among those engaged in non-traditional work situations, such as part-time, irregular and short-term contracts with various employers, especially where there is little or no choice, as well as for those experiencing job insecurity and downsizing. Suicidal behaviour can be reduced amongst the most vulnerable in society through social and employment protection and labour market programmes. This will reduce the real and perceived risks of job insecurity and reduce stigma of unemployment.

Recommendations:

Individuals, communities and wider society can all play a part in reducing the risk of suicidal behaviour. Governments need to take a lead by placing a stronger emphasis on suicide prevention as an inequality issue.

National suicide prevention strategies need to target efforts towards the most vulnerable people and places, in order to reduce geographical inequalities in suicide. Effective cross-governmental approaches are required, with mental health services improved and protected.

Suicide prevention needs to be a government priority in welfare, education, housing and employment policies. Workplaces should have in place a suicide prevention plan, and provide better psychological support to all employees, especially those experiencing job insecurity or those affected by downsizing.

Poverty and debt need to be destigmatised so that individuals feel valued and able to access support without fear of being judged. Every local area should have a suicide prevention plan in place. This should include the development and maintenance of services that provide support to individuals experiencing socioeconomic disadvantage.

Staff and volunteers in services accessed by socioeconomically disadvantaged individuals or groups should receive specialist training in recognising, understanding and responding to individuals who are in distress and may be suicidal (even if they do not say they are feeling suicidal). People bereaved or affected by suicidal behaviour, and therefore at higher risk of suicide themselves, should be offered tailored psychological, practical and financial support particularly in disadvantaged communities.

It is well understood that adverse individual or family circumstances, such as relationship breakdown, unemployment or debt, can result in a higher risk of suicidal behaviour (Gunnell & Chang 2016). What is less well known is the potential impact of the place where people live (neighbourhood, city, region) on the likelihood of suicidal behaviour.

The public health evidence is clear: as area-level deprivation increases, so does suicidal behaviour. For both men and women, those living in the most deprived neighbourhoods are more likely to engage in suicidal behaviour; and every increase in area-level affluence results in a reduction in the risk of suicidal behaviour.

The health of people in a neighbourhood, town, region or country is the product of the demographic, behavioural, socioeconomic and other characteristics of the people who live there. Compositional factors that are likely to increase the risk of suicidal behaviour in areas of socioeconomic deprivation include (O’Reilly et al., 2008; Lorant et al., 2005): experiencing multiple negative life events, such as poor health, unemployment, poor living conditions feeling powerless, stigmatised, disrespected, social disconnectedness, such as social isolation, poor social support other features of social exclusion, such as poverty, and poor educational attainment.

People living in the most deprived areas are more likely to engage in suicidal behaviour. Suicide rates are two to three times higher in the most deprived neighbourhoods compared to the most affluent, and rates of hospitalised self-harm are also twice as high. Neighbourhoods that are the most deprived have worse health than those that are less deprived and this association follows a gradient: for each increase in deprivation, there is a decrease in health. Additional support for those living in deprived areas is needed to reduce geographical inequalities in health and the risk of suicidal behaviour.

Experiences of childhood adversity, negative life events, and the cumulative effects of stress are associated with feelings of entrapment and hopelessness and increase the risk of suicidal behaviour, especially among those who are socioeconomically disadvantaged.

Stressful life events and childhood adversity

Exposure to negative life events, particularly those involving loss, such as bereavement or a relationship breakdown, heightens the risk of suicidal behaviour. Socioeconomically disadvantaged individuals are more likely to experience such negative life events, and therefore more likely to engage in suicidal behaviour. Experiencing childhood adversity increases the likelihood that individuals will become socioeconomically disadvantaged in later life.

For example, unemployment is more likely among those who have adverse childhood experiences, particularly men who have experienced childhood sexual abuse. Stress response and allostatic load Ongoing exposure to stress and adversity may gradually reduce an individual’s biological stress regulation resources, leading to a cumulative physiological toll known as “allostatic load” (Seeman et al., 2010).

Socioeconomic disadvantage itself is a stressor linked to increased allostatic load, but it may also influence allostatic load indirectly by increasing the likelihood of individuals experiencing childhood adversity and other stressful life events. Increased allostatic load brought about by the chronic and acute stresses associated with socioeconomic disadvantage may contribute to suicidal behaviour.

Socioeconomic disadvantage, from a psychological perspective, makes a major contribution to the occurrence of suicidal behaviour.

 

You can read the full summary report here

The full version of the report will be available on 10th March

 


 

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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Heartless PIP Cuts Latest, ESA WRAG Cut Regulations Published – Benefits and Work

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I got the following email from Benefits and Work:

Dear Sue,

Even by this government’s standards it’s a shockingly cruel move.

Last month a tribunal of judges ruled that claimants with mental health conditions such as severe anxiety have a right to claim even the higher rate of PIP for help with going outdoors.

It was a decision that put an end to years of the DWP deliberately misinterpreting the law. It meant that many thousands of people with serious mental health conditions finally had a chance to gain a little bit more independence.

So the government acted with remarkable speed.

Bypassing the social security advisory committee, who are supposed to get the chance to comment on all changes to social security law, they published a statutory instrument that will reverse the judges’ decision.

In an effort to justify overturning the judges’ ruling, Tory policy supremo George Freeman mocked as “bizarre” the idea that claimants with mental health conditions should be eligible for PIP. Instead, he said, PIP should only be for “the really disabled people who need it.”

The changes will apply to all claims made from 16 March, 2017.

Just a few days ago we had the following feedback by email.

“Just wanted to say thank you so much for your amazing site! I have used your advice over the years for my son’s DLA applications with great success, have now had his PIP awarded for enhanced care, and after mandatory reconsideration, got the award for mobility as well (thanks to your advice about the tribunal rulings on this for people with a mental health issue).”

Unless attempts by the Lib Dems and Labour to overturn the statutory instrument are successful, and that seems a very long shot, we won’t be seeing many more emails like that.

ESA CUTS REGULATIONS FINALLY PUBLISHED
The DWP have finally published regulations removing the work-related activity component of employment and support allowance (ESA) for new claims.

New ESA claimants in the work-related activity group who are aged 25 or over will receive only £73.10 a week. They will not receive the additional £29.05 component that current claimants receive.

Similar regulations apply to universal credit claimants who have limited capability for work.

Claimants who made a claim for ESA before 3 April, or who are deemed to have made a claim before that date, as well as claimants who are still waiting to be transferred from incapacity benefits to ESA, will not be affected.

Claimants who qualify for the support group are not affected by the changes.

TRIBUNAL CHANGES
Sir Ernest Ryder, the Senior President of Tribunals, has confirmed that benefits claimants will be the Guinea pigs for changes to appeal tribunals due to begin in September 2017. From that date social security tribunals will move more and more online.

You can look forward to attempting to upload your personal data to the cloud, getting emails from tribunal clerks or judges which hopefully won’t disappear into your spam folder and to having a hearing – if you get one at all – via Skype or telephone.

We’ll keep you informed, and our appeals guides updated, as we learn more.

HAVE YOU BEEN ASKED TO JOIN THE DWP’S CLAIMANT PANEL?
DWP minister Penny Mordaunt told the Commons last week, in relation to PIP and ESA, that:

“One thing I have done to ensure that we get more timely information about where things are going wrong and where standards are not being maintained is to establish a claimant user rep panel, which will go live in the next few weeks. It will be rolled out on a very large scale across the country.”

We’re very keen to hear from anyone who has been invited to join this, until now, completely unknown body. Please contact us if you have.

HOME MEDICALS SURVEY
Many thanks to everyone who took part in our survey on PIP and ESA home medicals. We had almost 2,000 responses. There were a lot more additional comments than we had expected, so we’re making sure we go through them all before we publish our findings, which we plan to do in a fortnight.

Good luck,

Steve Donnison

Related

Two EDMs have been tabled to stop Tory cuts to disability support, with cross-party endorsement

Tory MP says PIP should only go to ‘really disabled’ people, not those with anxiety ‘taking pills at home’

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

Lords table motion to kill new Tory restrictions on PIP

 


 

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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