Tag: Psychocoercion

Amnesty International express grave concerns about UK government’s outsourced ‘back to work therapy’

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THE BRIGHTON AND HOVE AMNESTY INTERNATIONAL GROUP NEWSLETTER.

January / February 2018. Page 4:

Mental Health and “Return to Work”

It’s not just the introduction of Universal Credit which is affecting the Human Rights of too many citizens of the UK. As part of the drive to force physically disabled people into work under the “Work and Health Programme” often via cursory “interviews” those facing mental health issues are being targeted as well.

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This is based on an article by Kitty S Jones. 

In 2016 she wrote: “Last April, more than 400 psychologists, counsellors and academics signed an open letter condemning the profoundly disturbing psychological implications of the government’s austerity and welfare reform measures. The group of professionals said that over the past five years the types of issues causing clients distress had shifted dramatically and now include increasing inequality, outright poverty and that people needing support because of structural problems, such as benefits claimants, are being subjected to a “new, intimidatory kind of disciplinary regime”. 

The signatories of the letter, published in The Guardian, express concern over chancellor George Osborne’s plans, laid out in the latest budget, to embed psychological therapy in a coercive back-to-work agenda. Osborne said the government will aim to give online CBT to 40,000 recipients of Jobseeker’s Allowance, Employment and Support Allowance, people on the Fit for Work programme, as well as putting therapists in more than 350 job centres. 

The letter stated that the government’s proposed policy of linking social security benefits to the receipt of “state therapy” is utterly unacceptable. The measure, casually described as “get to work therapy,” was discussed by George Osborne during his last budget (2015). 

The letter’s signatories, all of whom are experts in the field of mental health, have said such a measure is counter-productive, “anti-therapeutic,” damaging and professionally unethical. The intimidatory disciplinary regime facing benefits claimants would be made even worse by further unacceptable proposals outlined in the 2015 budget

The proposals are widely held to be profoundly anti-therapeutic, potentially very damaging and  professionally unethical. With such a narrow objective, the delivery will invariably be driven by an ideological agenda, politically motivated outcomes and meeting limited targets, rather than being focused on the wellbeing of individuals who need support and who may be vulnerable. 

A major concern that many of us have raised is regarding consent to participation, as, if benefit conditionality is attached to what ought to be a voluntary engagement, that undermines the fundamental principles of the right to physical and mental care. Such an approach would reduce psychologists to simply acting as agents of state control, enforcing compliance and conformity. 

That is not therapy: it’s psychopolitics and policy-making founded on a blunt behaviourism,  which is pro-status quo, imbued with Conservative values and prejudices. It’s an approach that does nothing whatsoever to improve public life or meet people’s needs.

The situation seems to be getting worse. Despite the recent Carillion fiasco over outsourcing public sector work other agencies have been given the contracts to deliver the Cognitive Behavioural Therapy component of the Return To Work programme. Of these, G4S (“We are saving the taxpayer £120 million a year in benefit savings.” Sean Williams – Welfare to Work, Managing Director, G4S.) have published the criteria for applicants as therapists to deliver “return-to-work” advice in Surrey, Sussex and Kent. 

The Role Description:

Manage a caseload of Customers and provide return-to-work advice and guidance regarding health issues. 

Targeted on the level, number and effectiveness of interventions in re-engaging Customers and Customer progression into work. 

Focus on practical techniques that enable them to manage their conditions to enter and sustain employment. 

Work with Customers on a one-to-one basis and in groups to provide support on a range of mental health conditions. 

Refer clients to relevant external health or specialist services as required. 

Conduct bio-psychosocial assessments via face-to-face and telephone-based interventions and produce tailored action plans to support Customers in line with contractual MSO. 

Deliver specific health for employment workshops and input into delivery models to support achievement of MSO.

Build relationships with key stakeholders including GP’s, employers and relevant NHS bodies. 

Identify and build relationships with other organisations that contribute to the successful delivery of the programme. 

Expected to contribute substantially to the development of the service. Including the routine collection, review and feedback of activity/data, ensuring that activity targets are adhered to.

Basic Requirements

Experience of delivering CBT. 

Evidence of understanding of Welfare to Work and the issues that unemployed people face.

Amnesty say: “Should this delicate and sensitive work be entrusted to the likes of G4S? It behoves us as, Human Rights activists, to be aware of the grave potential for Human Rights abuses in our country and to act to monitor non governmental agents such as G4S who have already got a very poor track record in Human Rights matters.” 

I listed some of G4S’ Human Rights abuses in my original article, which you can read in full here.

I have also written more than one article about my concerns regarding the related government claim that “work is a health outcome”, and about the political pathologising and stigmatising of people claiming social security.

Please read Amnesty’s newsletter, you can also sign up here, the national and international websites are listed at the foot of the newsletter.

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Mental Wealth Alliance response to the psy professional bodies’ statement on benefit sanctions and mental health

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The British Psychological Society (BPS) has responded jointly with other psychological bodies to call on the UK Government to suspend its cruel and degrading benefit sanctions regime.

The BPS say that the government should suspend its benefit sanctions system as it fails to get people back to work and damages their mental health. s

The professional bodies highlight evidence that sanctions, or the threat of sanctions (benefit cuts following a claimant’s failure to comply with jobcentre conditions, e.g. missing an appointment with their work coach) can result in destitution, hardship, widespread anxiety and feelings of disempowerment.

The call came in a joint response to the Government’s consultation, ‘Improving Lives’, from the British Psychological Society, the British Association of Counselling and Psychotherapy, the British Psychoanalytic Council, the British Association for Behavioural and Cognitive Psychotherapies and the UK Council for Psychotherapy.

Findings from the National Audit Office  show that there is limited evidence the sanctions system actually works, or is cost effective. The bodies argue that the Government needs to change focus from trying to make unemployment less attractive, to trying to make employment more attractive.

BPS President Professor Peter Kinderman said:

“We call for the benefits sanctions regime to be suspended until the completion of an independent review of their impact on people’s mental health and wellbeing

While there is evidence that the sanctions process is undermining mental health and wellbeing, there is no clear evidence that it leads to increased employment.  Vulnerable people with specific multiple and complex needs are being disproportionately affected by the increased use of sanctions.”

In order to improve mental health, the bodies have also called for:

  • Jobcentres to care about the quality of work they provide – citing evidence that bad jobs can be more damaging to mental health than unemployment.
  • The development of statutory support for creating psychologically healthy workplaces.
  • Increased mental health awareness training for jobcentre staff.
  • Review and reform of the work capability assessment (WCA), which may be psychologically damaging, and lacks clear evidence of reliability or effectiveness. 

The Mental Wealth Alliance have written a response to the collective statement on benefit sanctions and mental health:

Source: the free psychotherapy network

From:

Mental Wealth Alliance [1]

 Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; Critical Mental Health Nurses’ Network; National Health Action Party.

To:

British Association for Behavioural and Cognitive Psychotherapies

British Association for Counselling and Psychotherapy

British Psychoanalytic Council

British Psychological Society

United Kingdom Council for Psychotherapy

30th January 2017

MWA response to the psy professional bodies’ statement on benefit sanctions and mental health  30th November 2016

We welcome the call from the psychological therapy bodies for the government to suspend the use of sanctions by the DWP subject to the outcomes of an independent review of its welfare policies and their potential damage to the mental health of benefit claimants. Given the accumulation of evidence over many years of the material and psychological suffering inflicted on benefit claimants by workfare-based conditionality[2], it has been frankly shocking that the professional bodies directly concerned with the mental health of the nation have preferred to welcome and participate in workfare policies rather than publicly and vociferously dissociate themselves.

The timing of the statement is given to be the recent report on sanctions by the National Audit Office. Welcome as its report is, the NAO’s perspective on government policy is primarily monetary, not one of health, ethics and social justice. Its “vision is to help the nation spend wisely”.  The choice of this timing represents realpolitik on the part of the professional bodies no doubt, as perhaps is the intention of the conditional statement: “The sanctions process may be detrimental to people’s mental health and wellbeing”. But surely as psychotherapists and counsellors we can do better to represent the overwhelming evidence of personal suffering on such a scale than point to poor returns on expenditure and an ambivalent proposal that sanctions may be detrimental to people’s mental health.

Sanctions are only one dimension, albeit at the sharp end, of a welfare regime based on the political assertion that people need to be coerced off benefits and “nudged” into work. The psychological pressure of WCA and PIP assessments, job search rules, work programmes on “good employee” behaviours and the regular cuts to welfare benefits generally are part and parcel of the psycho-compulsion of the DWP benefits regime.[3]

We dispute the government’s premise that work is a therapeutic priority for people suffering from mental health difficulties. The marshalling of evidence for this modern-day workhouse mentality lacks both substance and integrity. Work has become the ideological mantra for neoliberal welfare policies.

Obviously where people want to work and where employment possibilities exist that will support and nourish people’s mental health, then encouragement, training and professional support should be available. But why is there no acknowledgement of the hundreds of thousands of claimants with mental health difficulties who cannot work, whether they want to or not?[4] Where is the evidence that people with mental health difficulties are actually benefiting from what is now two decades of workfare conditionality in the UK? Where is the evidence that in our current labour market decent jobs exist that will nourish people’s mental health? And where is the evidence that psychological therapy for benefit claimants with long-term mental health disabilities succeeds in supporting them into decent jobs they want, can survive and maintain?

When the professional bodies say, “an estimated 86-90% of people with mental health conditions that are not in employment want to work”, they are supporting the proposition that getting into work is an overwhelmingly important and efficacious goal for this group of benefit claimants. It is not clear where this figure comes from and what it means.

A similar figure is quoted by The Royal College of Psychiatrists’ report on Mental Health and Work (2013)[5], making use of a Sheffield study by J. Secker and others (2001)[6]. In fact, Secker finds that of their sample of 149 unemployed service users, when asked if they were interested in work of any kind – including voluntary and supported work –  “around half (47%) responded positively, and almost the same proportion (43%) had a tentative interest. Only 15 people (10%) had no interest in work”. At the same time, only 25% of respondents saw full-time employment as a long-term goal. 71% said that their preferred vocational assistance would be “help for mental health/keep current service”.[7]

This study does not translate into “86-90% of people with mental health conditions that are not in employment want to work”.[8] What it points to is the complex texture of attitudes, desires and fears around waged work that are the common experience of service users, alongside the harsh realities of the current labour market, the socio-economic environment generally, and the dire state of mental health services of all kinds more particularly.[9]

From our point of view, the professional bodies’ statement is a step in the right direction. It is a step that must now be followed through with active political pressure on the DWP and the Dept of Health to suspend sanctions and set up an independent review of their use, including the damage they inflict on people’s mental health.  Parliament has already called for such a review.[10]

But more than this, the remit of such a review should include all aspects of conditionality in a benefits system that deploy psycho-compulsion through mandatory rules or through the more subtle imposition of behavioural norms which aim to override the claimant’s voice.

We again suggest that the psy professional bodies would benefit by widening their own conversations to include service users and the rank and file of their membership. They would also win more credibility as organisations with ethical and social values independent of the government’s policies of dismantlement of social security and the welfare state if they were willing to make transparent their currently private conversations with DWP.

 


 

[1] Mental Wealth Alliance (MWA), formerly the Mental Wealth Foundation, is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.

[2] Parliamentary committees, the national press, endless reports from charities, service user organisations, people with disabilities, claimants unions and workfare campaigners have been reporting the physical and psychological damage of ‘welfare reform’ and its tragic outcomes for a decade.

[3] On psycho-compulsion and the benefits system see Friedli and Stearn http://mh.bmj.com/content/41/1/40.full and https://vimeo.com/157125824

[4] In February 2015 over a million people claiming ESA under a MH diagnosis were in either the Support Group or WRAG. Over 70% of new applicants for ESA are found unfit for work

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/470545/3307-2015.pdf

[5]https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212266/hwwb-mental-health-and-work.pdf p.17

[6] Secker, J., Grove, B. & Seebohm, P. (2001) Challenging barriers to employment, training and education for mental health service users. The service users’ perspective. London: Institute for Applied Health & Social Policy, King’s College London.

[7] Ibid, pp. 397-399

[8] Compare a DWP survey of disabled working age benefit claimants in 2013. 56% of 1,349 respondents agreed that they wanted to work. Only 15% agreed that they were currently able to work. Only 23% agreed that having a job would be beneficial for their health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224543/ihr_16_v2.pdf

[9] For example, some of this complexity is flagged by Blank, Harries and Reynolds (2012) The meaning and experience of work in the context of severe and enduring mental health problems: An interpretative phenomenological analysis Work: 47 45(3)    “Stigma, the disclosure of a mental health problem and the symptoms of the mental health problem are frequently described, as well as feelings of hopelessness, seeing recovery as uncertain, and feeling a lack of encouragement from services. Difficulties in accessing occupational health services, having a disjointed work history, lack of work experience, age, lack of motivation and fears about competency, as well as the social benefits system and caring commitments, are also experienced as barriers to accessing employment for people with mental health problems.”

[10] https://www.parliament.uk/business/committees/committees-a-z/commons-select/work-and-pensions-committee/news/benefit-sanctions-report

 


 

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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