Tag: Peter Kinderman

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?

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

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

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

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

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

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

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

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

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

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Happiness is a neoliberal warm gun: depopulating policy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The statement from Psychologists Against Austerity

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

You can read PAA’s full response here

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

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Related

The Psychological Impact of Austerity – Psychologists Against Austerity

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

The power of positive thinking is really political gaslighting


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

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