Using power wisely: why psychologists must engage with the DWP

In response to RITB’s request for professionals to get in touch, a clinical psychologist explains why they think it is vital for the profession to speak up and to get involved when it comes to dealing with the Department of Work and Pensions. They have chosen to remain anonymous to protect patient confidentiality.

Psychologists in the UK have been talking a lot about power of late. Here’s a statement that presumably we’ll all agree with: the Department of Work and Pensions (DWP) exerts a vast amount of power over people.

Many people who are engaged in therapy with a psychologist or other mental-health professional might be caught up in the DWP power dynamic. You might therefore expect those of us working in health and social care to be keenly aware of exactly what that means – just as, for instance, you’d expect us to be aware of comorbid health conditions, or of difficulties in someone’s social or relational context.

So here’s a question for my fellow professionals: are we aware? When someone sits in our clinic room and explains that they’re completely dependent on the DWP for ESA or PIP or Universal Credit – for every penny they get – do we take time to consider what that means for them? Do we include it in our carefully crafted, collaborative formulation? Or do we file it away, to be forgotten until the session that gets missed because even the bus fare that week proved too much? Do we understand what those different benefits are; how they work; what the complicated rules are around them; how those rules are imposed by the DWP and their appointed assessors?

Straight away as I write, examples from my own practice come to mind. The person struggling to recover from unimaginable trauma, terrified to visit the gym lest ‘fit to walk on a treadmill’ somehow equates to ‘fit to work’. The person living in a tiny rural village, summoned to a benefits review by way of a curt letter that showed no inkling at all that a journey to the city may be expensive, time-consuming and challenging to the point of being impossible (especially in the middle of winter). The person who told me they’d simply given up on the idea of claiming the benefits to which they were entitled, so crushing had they found the experience of being threatened with sanction for some minor transgression. There are many, many darker stories elsewhere [1].

This is not a benign system. It’s not even a neutral one. It might be argued that it is in fact a structurally violent one [2].

As a psychologist working in the UK, I am a member of a professional body which has – as is its wont – tiptoed gently around these issues [3]. Some individual psychologists have done much, much more [4, 5]. So what else can applied psychologists do, day to day, in our routine practice?

I would suggest that the answer involves doing exactly what we’re trained to do. We listen, we formulate, and we engage – gradually, persistently – to try to bring about positive, enduring change for the people with whom we are working. And if that means engaging with the DWP on their behalf, then let’s do it.

Listening, then, involves attending to exactly what people are telling us when they talk about benefits or the DWP. What position are they finding themselves in? What are they doing to cope with that? Are they asking for help; have they considered asking for help? Formulating includes – as always – considering people’s subjective experiences, not merely imposing our own understanding, which is sometimes vague and ill-informed. (This cuts both ways, of course: I’d never want to impose my own concerns about the system upon someone! But I’ll admit I’m struggling to think of a single person I’ve ever worked with who’s said: ‘I’m in receipt of benefits, and I have absolutely no concerns about my future financial security or dealings with DWP assessors.’)

As for engagement: that doesn’t have to be oppositional. As is so often the case, an open, curious stance is a good place to begin. If people are struggling with their dealings with the DWP – if they feel unsupported and afraid – how might we help with that struggle? Are we aware of local money-support services to whom we can signpost? Can we provide information to help people complete those uninviting forms? Can we put aside some time in a session to actually do the forms with them?

More pertinently, might we write a formal letter of support on their behalf? (The Westcountry Community Psychology guidance on letter-writing is invaluable here, and I am indebted to its authors [5].) Might we pick up the phone and make a call … or, as I still find anachronistically amusing, fax a copy of a letter, as the DWP sometimes request? (That has involved not just locating a fax machine but learning how to work it. Every day’s a school day.) Once we’ve done that, could we spare five minutes of our time to make another call and check the fax has been received? Yes, we can. All these little acts add up; all that persistence can pay off. Our engagement might be the thing that makes all the difference to what someone receives.

Of course, it’s easy to be put off. It’s incredibly easy to tell ourselves ‘this isn’t my job’ or ‘I haven’t got time’. But whose job is it? Every single time I engage with the DWP, on any level, there’s a point at which I feel my frustration rising in my throat; a point at which I find myself almost marvelling at the mercurial mechanisms of the system; a point at which I consider giving up. But if I’m experiencing all that – me, the empowered professional – then what on earth is someone who is suffering, struggling and distressed going to make of it all? So yes, of course I can make the time to make a call to pursue something that is potentially going to have a profound impact on a person’s psychological wellbeing.

As a clinical psychologist, I am operating in a highly privileged position. For better or for worse, I can persuade people to listen to me much more easily than I could when I didn’t have ‘Doctor’ in front of my name. To what end, then, do I want to use that power? If I can share it – use it to empower others, who don’t have the same privilege – that strikes me as a very worthwhile endeavour. On an individual level, that letter, that call – that fax! – from you as an empowered professional, one who is willing to take a stand on behalf of your patient, might be the intervention that changes everything.

I might also add that every single human being I’ve spoken to at the DWP has been decent and helpful – in surprising contrast to the tone of the brutal written communications that get sent out every day. Perhaps I’m being overly idealistic, but I do believe there’s a common humanity here, to which we might appeal.

And on a wider level, let’s engage too. Let’s get involved with policy. Let’s consider how we can use our collective voice. I imagine that if you’ve read this far you’re already aware of Psychologists for Social Change [6], but if not: well, you are now.

If we walk away from engagement with the DWP – if we hide behind woolly ideas of what’s our job and what’s someone else’s – I believe that we are failing the people with whom we work.

This matters. So let’s do what it takes.

Links
[1] https://www.theguardian.com/society/2016/may/13/suicides-of-benefit-claimants-reveal-dwp-flaws-says-inquiry
[2] https://en.wikipedia.org/wiki/Structural_violence
[3] https://www.bps.org.uk/news-and-policy/bps-calls-government-suspend-its-benefits-sanctions-system
[4] https://www.bps.org.uk/blogs/stephen-weatherhead/your-brain-benefits
[5] https://lindagask.files.wordpress.com/2018/01/med_evidence_wcp_guidance_final_14dec.pdf
[6] http://www.psychchange.org

RITB welfare resource listing:

Click to access benefit-assessments-e28093-exemption-to-protect-vulnerable-patients.pdf

Click to access Med_Evidence_WCP_Guidance_final_14dec.pdf

http://pipinfo.net

https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/pip/

http://www.benefitsandwork.co.uk

http://www.fightback4justice.co.uk

http://www.shop.cpag.org.uk/big-book-of-benefits-and-mental-health-2017-18

https://www.shop.cpag.org.uk/welfare-rights-books

https://www.disabilityrightsuk.org/shop/disability-rights-handbook-2017-2018