Un-Critical Psychiatry

Un-Critical Psychiatry?

A paper just published in British Journal of Psychiatry Open has met with criticism and anger in some quarters. The paper, co-authored by Sebastião Viola and Joanna Moncrieff, prominent members of the Critical Psychiatry Network, analysed trends in claims for sickness benefits from 1995 to 2014 using data from the Department of Work and Pensions (http://bjpo.rcpsych.org/content/2/1/18 ). They examined changes in the prevalence of claims attributable to mental disorders compared with other major categories of medical condition and changes in long-term claims. They found that the number of people claiming benefits for more than 5 years had increased since 1995, largely because of a rise in long-term claims for mental disorders. In contrast, claims for other disorders such as musculo-skeletal conditions fell, with the result that mental disorders are the largest single medical cause of benefit claims, accounting for almost half of all claims in 2014.

Critical comments appeared on the Council for Evidence Based Psychiatry’s website (see http://cepuk.org/2016/01/25/new-study-shows-disability-claims-for-mental-disorders-in-uk-has-doubled-over-past-20-years/ ), where a link to the paper appeared, and on the anti-austerity critical mental health survivor Face Book page Recovery in the Bin (RitB). For example, one commentator notes that the paper ‘…isn’t helpful in the current climate where MH claimants are being targeted with impunity & the problems that people have are also rooted in the society they live in, as for “less stigma” [an argument developed in the paper] you have to be joking you really have taken your eye off the ball to state that.’ (my emphasis) A comment on Recovery in the Bin (RitB) observes that ‘…when social justice is at an all time low…all social support demands people are on meds at least on paper, and our govnt [sic] is targeting people with a mental illness dx [sic] who are claimants. They won’t look at this and think maybe we should fund different sorts of services, it will just be another stick to beat people with.’ A person with disabilities and mental health problems points out that ‘It seems that there is a campaign against the idea of people with mental health problems being classed as disabled under the Equality Act and therefore receiving ESA and PIP. Unfortunately it all seems to result from underlying stigma of mental health problems and the idea that we are not *really* unwell or disabled in the same way that people with more visible health conditions or illnesses may be.’ Another person comments that ‘An economist at the Kings fund said to me once pompously [sic]… the key to being able to provide more services (he meant health care) was to increase productivity in the economy. So I asked him “what if the things that increase productivity… longer hours and more work… are the things that make people sick?” He went glassy eyed and wandered off to spead [sic] more of his productivity gospel…’

These comments raise a number of questions. First, why was this study undertaken? The authors say that since the changes to the benefit system introduced by the last Labour government in 2008 there has been no systematic study of the impact of these changes, aimed at encouraging long-term benefit claimants back to work, in the UK. Indeed the paper’s opening sentence refers to the cost of benefit support for long-term sickness being an international concern.

The subjects of this study, those who experience long-term unemployment because of disabilities and mental health problems, are people who are despised, reviled and detested (see, for example http://www.theguardian.com/society/2012/feb/05/benefit-cuts-fuelling-abuse-disabled-people ). They are attacked in the tabloids and broadsheets, in so-called ‘poverty porn’ on television (see, for example Channel 4’s Benefits Street) and by leading politicians. Indeed, there is anecdotal evidence that welfare reforms are jeopardizing the mental health of claimants (see http://www.theguardian.com/society/2012/feb/05/benefit-cuts-fuelling-abuse-disabled-people )

This raises the question of power. The mighty, the privileged, and those who have a voice are seen to be bearing down on and pointing the fickle finger of morality at those who are powerless, under-privileged, and who are voiceless. I am certainly not accusing the authors of this paper of making moral judgements about the subjects of their study, but it is important to recognize that the wider context is one in which others are already doing so.

This raises another issue. The NHS has an extensive system of ethical checks and balances through Multi-centre and Local Research Ethics Committees, who scrutinize research on NHS patients to safeguard their interests and safety. There is however no reference in this paper to ethical scrutiny (there usually is in papers published in medical journals). The authors will doubtless argue that NHS ethical scrutiny was unnecessary because their data originated not from NHS sources but from the DWP (though a freedom of information request). If that’s so, then perhaps the NHS needs to consider extending its ethical scrutiny to such work.

What worries me most of all about this paper is its failure to contextualise the study politically. Here, I’m referring to the impact of government austerity policies on income and other forms of inequality. We know that the UK has the second highest levels of income inequality in the Global North, second only to the USA. We know that income inequality is very closely related to a broad spectrum of physical and mental health problems, indices of family and social dysfunction, and long-term unemployment. Yet there is no reference in the paper to austerity and inequality. Instead it argues tamely and unconvincingly that the increase in the proportion of benefit claimants with mental health problems arises from the success of anti-stigma campaigns making it more socially acceptable for claimants to admit to mental health problems. Yet they adduce no evidence to support this.

Maybe those of us who are critical of this study are mistaken. I’d like to imagine it’s the first in a series of well thought out papers from critical psychiatrists criticizing the benefits system, and that next the authors will turn their attention to the ideology of neoliberalism that many of us consider to be the principle author of inequality and the widespread social injustices that spring from this. Joanna Moncrieff’s work is rightly highly regarded. In the past she has demonstrated great integrity and courage by publishing important papers and books that challenge and question what in my view is the harmful dogma that masquerades as psychiatric theory. She has also published thoughtful critical papers on neoliberalism, biomedical psychiatry and the pharmaceutical industry in the past.

This paper is an aberration, but perhaps this is what happens when you try to publish your work in a mainstream psychiatric journal. The British Journal of Psychiatry would after all be most unlikely to publish a paper analyzing trends in benefit claims from people with mental health problems against the context of neoliberal austerity. But then consider the implications of this paper as it stands; how will it be interpreted by policy makers, politicians and government? This is another reason for more careful ethical scrutiny of research undertaken by NHS employees on NHS patients using data that has not originated from NHS sources. Sadly, in my opinion, it would appear to be a case of un-critical psychiatry.

© 2016 Philip Thomas

What disability benefit trends tell us about psychiatric treatments and the economy

joannamoncrieff / January 29, 2016

Sickness and disability benefits are a hot topic in the United Kingdom at the moment. The government’s new system means that everyone’s benefit entitlement is being reviewed, and this is causing huge stress and anxiety for many people, including my patients. Some people have suggested that for this reason, I should not have published the recent paper on trends in sickness and disability benefits that I published with a colleague, Sebastiao Viola (1, http://bjpo.rcpsych.org/content/2/1/18.) It was unethical and should not have been allowed, apparently (2, http://www.philipfthomas.com/index.php/blogs/28-un-critical-psychiatry), even though almost all the data is already in the public domain – on the Department for Work and Pensions’s website – in the name of transparency.

But we cannot simply ignore or suppress such a seismic shift in social trends. When I looked at benefit statistics in the 1990s, musculo-skeletal disorders (principally back pain) were overwhelmingly the biggest and fastest growing cause of receiving what were then called incapacity benefits, and cardiovascular disorders were the second most common cause in men. In 1994-1995, mental disorders accounted for just 20% of days on which benefits were claimed (3, http://jpubhealth.oxfordjournals.org/content/22/1/59.long).

Since that time, mental disorders have far outstripped all other types of medical conditions and become the leading cause of claiming sickness and disability benefits. While the number of people claiming benefits for other medical conditions fell by 35% between 1995 and 2014, the number of people claiming benefits for mental disorders more than doubled. In 2014, 47% of all claims for disability benefits – almost half- were made by people whose primary condition is a mental disorder. 1.1 million people in the UK, or 2.7% of the working age population, claim disability benefits due to a mental disorder (4). The costs to the individuals who are unable to support themselves, and to the society as a whole, are huge.

These figures are important for what they tell us about the success or otherwise of current approaches to helping people with common mental health problems, and for what they say about the economy, and the nature of modern work.

I started looking at disability benefits back in the 1990s in order to find some objective measure of the performance of people diagnosed with depression Depression and anxiety disorders account for the majority of disability claims by people with mental disorders. In 2014, almost half (44.2%) of disability benefits awarded to people with a mental disorder were for depression and two thirds were for depression or anxiety (66.8%) (1). These proportions have not changed much since the 1990s.

In the early 1990s, campaigns like the Defeat Depression Campaign publicised the message that large numbers of people were depressed without knowing it, and that they should go and get the new and wonderful antidepressants that had just come onto the market (the SSRIs of course!). Since that time, the use of antidepressants has increased four times! In England, prescriptions have risen over 10% a year since 1998 (4, http://bjp.rcpsych.org/content/200/5/393.long).

If antidepressants are effective, and people with depression are more likely to be prescribed them, then you would expect the consequences of depression to start to lessen. One of those consequences, according to government statistics, is being out of work. But what we see is quite the opposite: Increasing use of antidepressants correlates with increased numbers of people with depression who are out of work and claiming benefits, and increasingly on a long-term basis. And this is at a time when disability due to other medical conditions has fallen.

The idea that conditions like depression and anxiety can be quickly and effectively treated with medication or short courses of therapy that re-adjust your thinking is not borne out by the evidence. Rather than helping people improve their lives and get on their feet again, this approach seems to create ever rising numbers of people who are viewed, and may come to themselves, as chronically sick. Far from helping people towards a meaningful recovery, taking an antidepressant may simply be a daily reminder of the idea that you are permanenelty flawed.

One of the ways our current approach is wrong is that we are looking for the problem in the individual- inside the brain. Instead we need to ask what it is about our society that means that so many people feel too unhappy, worried or mentally frail to work. Having a ‘decent’ job is an incredibly important part of people’s lives, and most people want one. Research shows that even people with severe mental disorders would like to be in work, if they could (5,6). A good job is a source of satisfaction, purpose and camaraderie. People without work easily lose confidence and become socially isolated.

Fewer and fewer ‘decent’ jobs exist, however, especially at the unskilled end of the jobs market. Most jobs, even fairly menial ones, have become increasingly competitive and demanding, with performance targets and micro-management. I heard one radio journalist describe how he had attempted to apply for a job as a local petrol station attendant. He had to complete complex questionnaires designed to assess his levels of motivation and dedication, as if the application were for a high flying executive position. Despite his University education, he failed miserably to qualify, and wondered how anyone without a degree in management consultancy was able to get shortlisted.

Unskilled jobs have either gone altogether, or have become increasingly casualised. With the increase in agency work and zero-hours contracts, there are fewer jobs with paid sick leave and holidays. For these reasons, some analysts have referred to the problem of ‘disguised unemployment,’ indicating that many disability claimants are willing and able to work if suitable employment opportunities existed (7). But they need jobs that will accommodate the fact that they might not always be performing at 100% efficiency (like everyone, of course), and they might need to take time off occasionally. They need understanding employers, who respect and value their contribution, not agencies which can simply hire someone else.

Working in a highly pressured, insecure and competitive situation is bad for everyone. Rising disability benefits are a sign that we need to do something about modern employment conditions. We need to provide more opportunities to work in a supportive and accommodating environment. This is especially important for people with mental health problems, but it would benefit us all.

(1) Viola S, Moncrieff J. Claims for sickness and disability benefits owing to mental disorders in the UK: trends from 1995 to 2014. BJPsych Open 2016;2:18-24. http://bjpo.rcpsych.org/content/2/1/18
(2) http://www.philipfthomas.com/index.php/blogs/28-un-critical-psychiatry
(3) Moncrieff J, Pomerleau J. Trends in sickness benefits in Great Britain and the contribution of mental disorders. J Public Health Med 2000 Mar;22(1):59-67. http://jpubhealth.oxfordjournals.org/content/22/1/59.long
(4) Calculated using figures from ONS: http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk–england-and-wales–scotland-and-northern-ireland/mid-2014/sty—overview-of-the-uk-population.html, deducting population of Northern Ireland (since disability benefits data do not cover Northern Ireland), and assuming working age pop is 64% of population, as given by ONS data
(5) Ilyas S, Moncrieff J. Trends in prescriptions and costs of drugs for mental disorders in England, 1998-2010. Br J Psychiatry 2012 May;200(5):393-8. http://bjp.rcpsych.org/content/200/5/393.long
(6) Boycott N, Akhtar A, Schneider J. “Work is good for me”: views of mental health service users seeking work during the UK recession, a qualitative analysis. J Ment Health 2015 Apr;24(2):93-7. http://www.ncbi.nlm.nih.gov/pubmed/?term=boycott+and+akhtar
(7) Marwaha S, Johnson S. Views and experiences of employment among people with psychosis: a qualitative descriptive study. Int J Soc Psychiatry 2005 Dec;51(4):302-16. http://www.ncbi.nlm.nih.gov/pubmed/16400906
(8) Beatty C, Fothergill S, Macmillan R. A theory of employment, unemployment and sickness. Regional Studies 2000;34:617-30. http://www.tandfonline.com/doi/abs/10.1080/00343400050178429

A simple guide to avoid receiving a diagnosis of ‘personality disorder’.

This is a leaflet based on a discussion on personality disorder diagnoses that we had on the Facebook group. Thanks to the wonderful Dolly Sen for her designs.

The leaflet has been in Clinical Psychology Forum No 279, March 2016 , published by the British Psychology Society.

PD GuidePD Guide2PD Guide3PD Guide4

A simple guide to avoid receiving a diagnosis of ‘Personality”Disorder’.

Disclaimer: unfortunately our suggestions above are not foolproof and we’re not encouraging…

Recovery In The Bin (TM)

1) Try not to be female (for BPD).

2) Do not argue your point of view with the professionals.

RITB How not to get a diagnosis of PD Guide3) You cannot be seen to like some staff members more than others (this is SPLITTING behaviour).

4) Do not under any circumstances harm yourself. (This will more than likely be seen as a) manipulative b) attention seeking c) a communication of your distress caused by your underlying PD).

5) Do not make statements, which can be interpreted as black and white thinking. For example, the nurses all hate me. Try instead to make unrealistic, robot like, rational statements such as ‘Enid, Mary, Silvia, John, Mark and Boteng have all shown epic disdain at my presence on the ward, but an agency nurse once smiled at me in 1992.’

6) Do not admire or pin any hope to a professional who appears to understand the social context of your distress (this is idealization, my dear).

7) Do not complain about anything. Ever.

8) Try to avoid working with professionals who look a bit tired. If they eventually go off sick you will inevitably be blamed for this. (Of course, because you are a difficult patient).

9) Things you can talk about: how medication is helping you, mood swings (BUT only extreme ones that last long enough to fit within a diagnosis of bipolar, that’s an ok one as Stephen Fry made it a bit edgy), Do talk about how much the system is helping you, be eternally grateful to every professional you meet, tip your hat slightly to the side and say the words ‘thanking you kindly for your ‘help sir’.

10) Things you should not talk about: Abuse – of any kind, patterns in your relationships because of this abuse, existential dilemmas, perceived flaws in the system or anything to do with individual staff members.

11) You never ever; over/under eat, drink, exercise, and are never impulsive with sex, shopping, driving and you LOVE being alone.

12) If you are from cultures seen as “traditional”, never say you even think about sex unless you are in a proper family approved heterosexual marriage.

13) To avoid BPD diagnosis you must not point out that the psychiatric teams are blaming you for their own inadequacies, their ‘externalised locus of control’ and ‘refusal to take responsibility’.

14) Do not tell the psychiatrist you think you may have PTSD. (Don’t be stupid now, everyone knows only soldiers can get this, are you a soldier?).

15) Try somehow not to be addicted to medication you are forced to take. Prepare yourself to be accused of lacking in coping skills when addiction inevitably does happen.

16) Talk with enthusiasm at the idea of being abandoned. Relish the idea whether it’s real and/or imagined.

17) If you attempt suicide make sure you are successful or it will be deemed attention seeking.

18) If you do by chance happen to self harm, make sure it is a life threatening, Stephen King style canyon of a gash, anything less than this will be clinically defined as ‘superficial’ adding to the likelihood of the PD label being applied.

19) BPD diagnosis is a mirror to professionals’ behavior, described as the personal characteristics of the service user.

20) Never phone the crisis team and say you’d like another visit (tick box dependency issues).

21) Hide any teddy bears or suchlike when they come round to visit (“too childish”).

22) Never refer to your psychiatrist’s affection for the DSM as ‘ideas of reference’…

23) When they suggest cutting back on support, appointments etc, pause and think and then say, “yes, that’s good, I feel I am ready to be more independent”.

24) Be attractive but not ‘coquettish’.

25) Do not at any point mention that you sometimes question who you are. You should know exactly who you are, be definite, unchanging about this (only people with PD ever question their identity

26) Do not change your hair colour too frequently. This will be interpreted as evidence of the above.

27) Always repeat when questioned that your attachment with your mother & father was always loving and supportive.

28) All depression, voice hearing and suicidality is ‘pseudo’ so please ensure the death certificate is recorded as ‘pseudo death’ and according to Joel Paris MD it was a ‘career’ so make sure your CV is updated posthumously.

29) Remember that inequality does not exist; it is your perception that is flawed.

30) Never, if you can manage it, express anger to MH professionals. Even when it’s understandable, genuine and valid!

31) The appropriate response following an OD to the question ‘how much did you take’ is ‘clearly not enough’. This is also likely to get you sectioned.

32) Never become a ‘skilled’ Service User. Understanding the games that nurses play will only get you described as ‘playing games’.

33) Your mental health team believes in its adequacy, despite all evidence. Do not do or say anything that threatens professionals’ fixed delusional beliefs, they may ‘decompensate’, becoming either coldly punitive and violent or weirdly smiley and dissociative, forcing you to have too much ‘service’ and then none at all.

34) Don’t ever ask a MH prof to ‘see you all the time and kiss your cuts better’ (as stated by a PD expert).

35) Act dumb as intelligence is viewed as a facet of PD (unlike psychosis where it’s assumed you’re less intelligent).

36) Failure to respond to medication or recover (or the CMHT needs to reduce numbers with discharges) means reclassification to PD.

Another Disclaimer: “You do not have the right to say anything without it being used against you. Anything you say can and will be used against you. You have the right to legal assistance. If you cannot afford legal assistance, you are buggered. Do you understand the rights I have just read to you? With these rights in mind, do you wish to engage in our therapeutic relationship?”

Critical articles:

http://fap.sagepub.com/content/15/4/483.extract

http://www.sistersinside.com.au/media/papermepstein.pdf

http://discursiveoftunbridgewells.blogspot.co.uk/…/bord…

http://pb.rcpsych.org/content/31/5/194.1

Shaw, C. & Proctor, G. (eds.) (2004) Women at the Margins: Special Issue on women and Borderline Personality Disorder. Asylum magazine 4(3).
Sulzer (2015) Does “difficult patient” status contribute to de facto demedicalization?

https://www.madinamerica.com/…/scarlet-label-close…/

http://www.haringey.gov.uk/equilibrium_magazine_issue_46…

page 23 ‘The most savage insult’  http://www.scie-socialcareonline.org.uk/…/a1CG0000000Gg…

Refs:

Between 3 and 4.07 mins “you want me to see you all the time and kiss your cuts >better”: https://www.youtube.com/watch?v=kasiSXppCVA

Joel Paris: Half in love with easeful death: https://drive.google.com/…/0B2o15rQwZLh7MlRjc2F…/view…

Linehan: https://www.nimh.nih.gov/news/media/2011/linehan.shtml For the research funding she had to choose between BPD and Major Depression as the named mental disorder – she chose BPD, the diagnosis was attached to fit the intervention for the funding. She wanted the most difficult & challenging patients. So who was in the control group?

http://www.rcpsych.ac.uk/pdf/Wilkinson%20Paul%20Sept14.pdf

NHS Choices discriminatory advice/liver transplants

Members of Recovery in the Bin have been writing to NHS Choices over their liver transplant page which stipulated that people dx with psychosis/bipolar wouldn’t receive new livers due to ability to follow the regime of follow-up appointments & immunosuppressant meds. Members challenged this and NHS Choices replied by the following:-

“Thank you for contacting us regarding the liver transplant topic on the NHS Choices website.

The section about mental health conditions you refer to is talking about the patient’s ability to follow the regime of follow-up appointments and immunosuppressant medication needed after a liver transplant.

No mental health condition, including bipolar disorder, will automatically exclude someone from having a liver transplant – but an assessment will be necessary on an individual basis to determine whether the condition is severe enough that it might impact on their post-transplant care.

We only mention bipolar as an example because some studies have looked at this issue specifically.

However, after reconsidering our information, we have decided to remove the examples of mental health conditions from our liver transplant topic, as it’s more the severity that’s important, rather than the specific condition. By only giving a couple of examples, we think it could potentially be misleading.

Thanks again for bringing this matter to our attention. We hope this response has been helpful.

Best regards,

The NHS Choices Editorial Team”

Letter to Luciana Berger (Shadow Minister for Mental Health in England and Wales)

Dear Luciana Berger – Shadow Minister for Mental Health, England and Wales.

We are writing to you to raise our concerns and priorities for Governmental Mental Health care and provision in the UK. We enclose the first of a number of our “position statements” that we intend to send to you.

We are a User Led Mental Health Activist Facebook Group campaigning for Social Justice and Equality in MH care and practice, with a focus on critiquing and challenging mainstream ‘recovery’ ideology. At the time of writing our membership stands at 474 and this is growing by the day.

We believe ‘recovery’ has been colonised by MH services, commissioners and policy makers. We reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by marketisation, language, techniques and outcomes. Some of us will never feel “Recovered” living under these intolerable and inhumane social pressures.

We believe access to quality housing and disability benefits designed for mental health claimants would give people a stable and secure environment to raise their quality of life and health. This would enable efforts towards going back to study, work IF people choose / aspire to this. Allowing people to volunteer indefinitely and claim benefits if this improves their quality of life and MH – and recognise how valuable this work is to society.

Our first “position statement” is about the Welfare State and Social Housing.

We will cover the following issues: –

  • Work Capability Assessment (WCA)
  • Benefit Sanctions
  • Personal Independence Payment (PIP)
  • Employment
  • Voluntary Work
  • CBT in Job Centres
  • Social Housing & Homelessness

We look forward to hearing from you about the matters we have raised.

Yours Sincerely,

Recovery In The Bin

Copy: Jeremy Corbyn MP and Leader of Labour Party.
John McDonnell MP and Shadow Chancellor.
Owen Smith MP, Shadow Secretary of State for Work and Pensions.
Mental Health Resistance Network.
Social Workers Action Network (SWAN).
Psychologists Against Austerity.
Critical Mental Health Nursing Network (CMHNN).
Critical Psychiatry Network.
Disabled People Against Cuts (DPAC).
The Peoples Assembly.

Welfare State and Social Housing

Work Capability Assessments (WCA)

  • The Work Capability Assessments (WCA) for Employment Support Allowance (ESA) appear to be weighted in favour of those with physical disabilities, and often fails to take into account fluctuating conditions, common to mental distress, such as anxiety and depression.
  • A Service User initiated judicial review of WCA found that MH claimants were at a “substantial disadvantage”. (http://www.rethink.org/…/unfair…/wca-judicial-review-faq). To date the DWP has failed to take concrete steps to address that disadvantage.
  • Access to welfare advisors and advocacy workers has been severely reduced due to cuts to funding, services and the legal aid budget.
  • We are aware of a number of deaths related to the “reforms”, including recent reports that a coroner has ruled that the WCA contributed directly to the suicide of a claimant, and that steps need to be taken by the DWP to prevent further such incidents. (The Independent 20.9.2015).
  • We believe the WCA needs to be abolished as a matter of urgency.

Benefit Sanctions

  • Sanctions remove the very means of existence, and as a consequence the related death toll is rising.
  • Those in the ‘Work Related Activity Group’ face huge cuts to their benefits in the near future, even if they manage to avoid being sanctioned.

Personal Independence Payment (PIP)

  • PIP is not MH orientated and self-harm/suicide risk factors have been removed from criteria.
  • MH claimants struggle to obtain the necessary medical evidence because MH services are now short term, and once discharged no specialist reports can be secured.
  • Loss of DLA/PIP to MH claimants who are not in receipt of ESA because they’re doing some part-time work or self-employment will be rendered unable to continue working or plunged into poverty, being under immense pressure to work more hours, which could lead to mental distress and deterioration.

Employment

  • It’s a fact that 70% of working age adults with a mental health condition in England are unemployed (http://www.theguardian.com/…/cuts-threaten-mental-health-pr…).
  • There are approximately 700,000 vacancies and 2 million (possibly more if you count those who are sanctioned/on Workfare) applying for those 700,000 vacancies, therefore the maths don’t work here.
  • It’s evidenced that Workfare doesn’t work and only provides massive profits to private companies using public funds and plunges more people into sanctions/food banks.
  • MH claimants have been and are being targeted as the ‘low hanging fruit’ (their description) in the full knowledge that MH (and Learning Difficulties) has the lowest employment rates.
  • Temporary and zero contract hours shift work is evidenced as being bad for anyone’s mental (and physical) health, but this looks set to become more common for MH claimants who are at threat of sanction/workfare.

Voluntary Work

  • We often carry out highly valued long term voluntary work within Trusts, University’s and Charities, so chosen voluntary work (with appropriate evidence) needs to be considered as an additional outcome to employment, as for some people that’s the most ‘doable’, maintaining the best ‘stability’.
  • Voluntary work gives a person greater flexibility, and provides less pressure to work when s/he is not feeling up to it.
  • MH claimants have had benefit claims stopped/reviewed for doing voluntary work (even when organised by own MH Trust & MH professionals have had to intervene by advocating that it’s part of their treatment).

Cognitive Behavioural Therapy (CBT) in Jobcentres.

  • We do not support targeting MH conditions with CBT, where there is contradictory evidence that this therapy is effective, and its unproven in helping people back to work. https://www.gov.uk/…/attachment…/file/193382/812summ.pdf.
  • We believe getting back to work, especially after many years of unemployment, due to MH complexities, is unlikely to be resolved by a “quick fix” such as CBT.
  • Many of these initiatives are being piloted in Labour controlled authorities. For example, in June 2015, Service Users protested outside the Streatham Job Centre, which had been identified as a site for trialling the introduction of CBT inside Job centres.

Social Housing & Homelessness

  • Some Councils/Housing Associations are losing over 90% of their stock, and letting agencies/private landlords don’t want tenants on housing benefit. This is a significant factor with respect to the increasing levels of homelessness that should not be acceptable for any Government.
  • Very vulnerable mentally distressed people are ending up sleeping rough because of refusal to join groups in high support mental health housing, which means they have refused an offer of housing and are deemed voluntarily homeless.

 

 

Dear Recovery in the Bin Group,

Thank you so much for taking the time to get in touch with me.
Firstly, I want to apologise for the delay in getting back to you. Since my new role was recently announced I have been inundated with hundreds and hundreds of emails from people getting in touch to share their stories, and I want to get back to everyone individually.

I read your letter and your position statements with interest as I share many of the same concerns. The Labour Party has made a commitment to take a cross-departmental approach in addressing mental health challenges, and this is especially true when it comes to the impact of DWP policies on mental health. Many of the emails I have received since my appointment echo this.

Just before Christmas I opened Labour’s Opposition Day Speech on mental health, and highlighted a number of the things you mention in your letter, including capability assessments and benefit sanctions, and the fact that a majority of people on the Work Programme told Mind it made their mental health worse. You can watch it here.

I have also been using Parliamentary Questions to probe the Government’s policies, including on the services in Job Centres that you mentioned.
Currently, I am working with John Healey to ensure Labour’s policies on housing and homelessness are developed with mental health in mind.

The point you raised about volunteering having a detrimental impact on welfare claims is a concerning one, and something I plan to ask the Government to clarify their position.

My immediate priority is to hold ministers to account for their broken promises on mental health, and to speak up for people who are being let down. Thank you for sharing your ideas with me which I will feed in to the work I continue to do to hold the Government to account. We must work together to tackle taboos, challenge stigma, and redesign services to match the needs of so many people.

In the coming weeks and months I may circulate updates of what I have been doing in my shadow ministerial role on mental health. Please let me know if you would not like to be included in this mailing list.

Thank you again for getting in touch.

Very best wishes

Luciana