Recovery in the Bin at #RCOT2018

Wow! What a day! Recovery in the Bin had their abstract accepted for a poster and short presentation at the Royal College of Occupational Therapists’ Conference in Belfast on the 12th of June 2018. We were very excited to be able to share our work at such a big and prestigious event.

This blog post is an opportunity to expand on our poster and presentation. It is also a resource for those who were unable to attend who may want to know a bit about us and our work. As it is for a wide range of audiences, we have included an Occupational Therapy Language Translator for those who are not familiar with the language used by occupational therapists – or maybe more appropriately – the way occupational therapists understand and use certain words : )

For in depth critiques on the notion of recovery, please feel free to browse the groups numerous blog posts.

Occupational Therapy Language Translator!

Occupation:

Most people associate the word occupation with the words, job, career or vocation.  Some associate it with the occupation of land by military force.

However, occupational therapists use the word occupation differently.  In its broadest sense, the word occupation can refer to anything that somebody occupies their time doing – literally anything! 

Occupational therapists typically split occupations into 3 main categories – Self-care, Work and Leisure.  Work does not necessarily mean paid work – it can mean voluntary work and other things classed as work, for example house work, caregiving, DIY.  Importantly, the definition should always be made by the person themselves – some people might think DIY is a leisure occupation etc…

What was the presentation about?

Slide1

We decided that the Unrecovery Star would be a good introduction to the groups philosophy and views on recovery – it is visual, and it has a catchy name!  Most importantly, we wanted to emphasise that our work is survivor and service user led, although we have members who are also health and social care professionals.

Why are Recovery in the Bin critical of recovery?

Slide2

Everyone working in mental health services has heard of the word recovery.  You cannot read a mental health policy without coming across the word on multiple occasions.

So what’s wrong with this? Isn’t recovery a good thing?

Unfortunately, since recovery has become mainstream and has been implemented across health and social care services, it no longer represents its original ethos that made it so popular.

It is no longer service user or survivor led, and it is no longer radical: Professionals typically lead or control the recovery process and the services in which a recovery approach is delivered.

Conversely, the notion of recovery originated from grassroots service user / survivor organisations, which placed emphasis on personal meaning and agency, in contrast to a traditional professional led approach.

The current power imbalance in service provision is incompatible with recovery’s origins.

The impact of Neoliberalism and Austerity

Recovery in the Bin is critical of the influence our socio-political environment (primarily neoliberalism and austerity) has had on recovery’s implementation, and peoples understanding of recovery.  Recovery’s original emphasis on what is personally meaningful has evolved to reflect neoliberalism’s overemphasis on personal responsibility and choice.

Services and working practices have changed to reflect this.  The premise that continued involvement or contact with services results in ‘dependency’ and a lack of ‘responsibility’ is widespread.  Discharge is the goal, whether recovered or not.

Neoliberalism’s emphasis on personal responsibility and choice, fails to acknowledge the social injustices inherent in a neoliberal society that prevent choice and minimise others’ and societies responsibilities.  Recovery in the Bin challenges neoliberalism’s individualism by advocating a collectivist approach.  It highlights society’s role in addressing social injustice and creating a socio-political environment that enables a meaningful recovery.

What is the Unrecovery star?

Slide3

The Unrecovery Star was developed through consensus based and participatory methods by Recovery in the Bin.  It visually depicts the socio-political barriers faced by people living with mental health conditions or distress, which inhibit recovery.  As such, it directly contrasts the individualised focus of the traditional ‘Recovery Star’: The Unrecovery Star does not place the responsibility and burden for recovery on the individual, rather, it situates recovery within the wider context of social change.

It is not a validated outcome tool. Instead, its purpose is to encourage clinicians to become aware of the way the recovery approach is implemented in practice, with an over emphasis on the individual as opposed to society. It promotes critical reflection on the recovery approach from a socio-political perspective.  It seeks to strengthen clinicians’ commitment to social justice

What implications does it have for occupational therapy?

  1. Holistic Practice:

Occupational Therapy Language Translator!

Holistic:

Occupational therapists use this word a lot.  It means that they look at the whole person, not just the ‘condition’ or difficulties a person may experience.  This includes their environment – physical, social etc, what’s important and meaningful to them – their values, their interests, their habits, what they enjoy doing and how they think and feel about themselves. 

As this blog was produced at short notice – this section will be updated to include examples of holistic practice!  Here’s an OT model of practice, which gives you an overview of what we mean by ‘holistic’.  This model does outline ‘Social and Economic Systems’ well.

RITB Holistic

Slide4

As a holistic profession, occupational therapy purports the dynamic interaction between a person, their occupations and their environment (Taylor 2017).

As a tool to aid critical reflection, the Unrecovery Star can be used to enhance holistic practice by increasing occupational therapists’ awareness of the socio-political environment and its impact on occupational participation and recovery.

This could include welfare reform, for example, the Bedroom Tax, cuts to Employment and Support Allowance and DLA / PIP, which may limit the amount of money someone may have to access and participate in meaningful occupations.   Cuts to local government funding have meant that many local libraries have shut, and community groups have ceased to exist.  This restricts people’s occupational opportunities and the freedom people have to make occupational choices.  Packages of care are being restricted and so are programmes of intervention.  Recurrent ESA and PIP assessments may have an on-going long-term impact on someone’s occupational identity as a person: emphasis on work and productivity can diminish the value people believe they have as occupational beings.

These broader aspects of the socio-political environment can and often remain hidden.  Standardised assessments may not be particularly attuned to picking up these wider, insidious influences on occupational performance.  Critically reflecting on the recovery star can facilitate this insight which can be used during the assessment process to inform realistic plans of intervention.  In addition, it can aid critical reflection on the service and organisational environment within which occupational therapists work.  In particular, this could include the socio-political environments’ impact on the way the recovery approach is implemented locally.

2. Occupational Justice:

Slide5

The Unrecovery Star’s emphasis on social justice closely aligns with the notion of occupational justice.  As Durocher et al (2014) states, “occupational justice extends the notion of social justice” (p421):  Just social structures are necessary when seeking occupational justice.  The Unrecovery star raises awareness of the particular social injustices people with mental health conditions experience, which must be addressed when seeking occupational justice.

Both occupational and social justice call for political action.  Given the socio-political injustices, including austerity and welfare reform, that people with mental health conditions and distress experience, it is time to find and embrace a political voice.  As a profession, occupational therapists can bring these injustices to the attention of decision makers and governments through policy, lobbying, activism, petitions and protest.

Without political action, occupational and social injustices cannot be changed on a large scale.

Talking about occupational justice…We’d like to draw occupational therapists’ attention to the United Nation’s Committee on the Rights of Persons with Disabilities Report.  Their concerns regarding the ability of people living with a disability to live independently and be included in their communities in the UK are outlined at the end of this blog and the full document can be accessed here: http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2FPPRiCAqhKb7yhspCUnZhK1jU66fLQJyHIkqMIT3RDaLiqzhH8tVNxhro6S657eVNwuqlzu0xvsQUehREyYEQD%2BldQaLP31QDpRcmG35KYFtgGyAN%2BaB7cyky7

To conclude…

Slide6

Post Presentation Questions (not word for word…relying on poor memory!):

Unrecovery can come across as quite a negative word. How would you respond to this challenge?

That’s a great question. Unrecovery should be seen as the same kind of ethos as ‘unconference’ or ‘antiuniversity’*. It’s about including the excluded, going back to the grassroots. Surprisingly, Recovery in the Bin is not actually opposed to ‘recovery’. What we want to bin Is the ‘Recovery Approach’ in the form it often takes in services that can be very far from Recovery’s original values: commitment to the service user and personal meaning.

*Unconference can be described as participant-driven meetings that try to avoid top down organisation, fees, sponsorship typical of conventional conferences. Antiuniversity is about free and inclusive learning events and as such challenges academic and class hierarchy that may exclude people who aren’t privileged in society.

How can Recovery in the Bin’s materials be used in a Recovery College?

The Unrecovery Star could be used to discuss Recovery’s original values and give service users the opportunity to talk about how it may be being implemented in services. Perhaps it could be shared with participants as part of discussion about how to challenge professionals or colleagues or managers who may be implementing recovery in a way that departs from the original values of recovery. It could also be used to think about how society’s responsibilities and duties toward people influence an individuals recovery and personal values, goals and meaning^

^We also have a blog on Recovery Colleges. This hard hitting satire was meant to challenge. It had a very positive impact resulting in an editorial in a per reviewed journal, by the founders of Recovery College’s focusing on how colleges could return to their original principles when they drifted into the kind of practices satirised by RITB’s ‘Stepford Recovery College’ blog.

The United Nation’s Committee on the Rights of Persons with Disabilities Report. 

Living independently and being included in the community (art. 19)

44.The Committee is concerned about:

(a)The fact that the State party’s legislation fails to recognize living independently and being included in the community as a human right that enshrines individual autonomy, control and choice as intrinsic aspects of that right;

(b)Policies and measures that affect the ability to live independently in the community, such as the reduction in social protection schemes related to housing, household income and budgets for independent living, as well as the closure of the Independent Living Fund;

(c)The fact that responsibility for supporting independent living has been transferred to the devolved administrations and local authorities without providing appropriate and earmarked budget allocation;

(d)The fact that many persons with disabilities are still institutionalized and deprived of the right to live independently and be included within the community, when: (i) they lack the financial resources to afford personal assistance; (ii) local authorities are of the opinion that they can provide assistance within care homes; and (iii) the cost rationale constitutes the main parameter of an assessment;

(e)The lack of support services and accessible public facilities, including personal assistance, for persons with disabilities, regardless of sex, gender, age and other status, to live independently and be included in the community.

  1. The Committee recommends that the State party, in line with the Committee ’ s general comment No. 5 (2017) on living independently and being included in the community and the Committee ’ s report on its inquiry concerning the United Kingdom of Great Britain and Northern Ireland carried out under article 6 of the Optional Protocol to the Convention:

(a) Recognize the right to living independently and being included in the community as a subjective right, recognize the enforceability of all its elements, and adopt rights-based policies, regulations and guidelines to ensure implementation;

(b) Conduct periodic assessments in close consultation with organizations of persons with disabilities to address and prevent the negative effects of policy reforms through sufficiently funded and appropriate strategies in the area of social support and living independently;

(c) Provide adequate, sufficient earmarked funding to local authorities and administrations, including the devolved governments, to be able to continuously allocate adequate resources allowing persons with disabilities to live independently and be included in the community and to exercise their right to choose their place of residence and where and with whom to live;

(d) Set up a comprehensive plan, developed in close collaboration with organizations of persons with disabilities, aimed at the deinstitutionalization of persons with disabilities, and develop community-based independent living schemes through a holistic and cross-cutting approach, including education, childcare, transport, housing, employment and social security;

(e) Allocate sufficient resources to ensure that support services are available, accessible, affordable, acceptable, adaptable and are sensitive to different living conditions for all persons with disabilities in urban and rural areas.

Slide7

The Left Must Challenge The State’s Reduction Of Mental Health To Market Agendas

This interview first appeared in the Morning Star

Psychotherapist Paul Atkinson talks to Richard House about being a mental well-being activist and the daily difficulties faced by those on the therapeutic front line

Richard House [RH]: Paul, activism takes many forms – including ‘psy activism’ (my term) in the realm of mental health; and you’re one of the most committed psy activists I know. Can you say something, first, about what you see as the key commitments of a psy activist who also works professionally in the mental health field?

Paul Atkinson [PA]: For me as a psychotherapist, the key commitment is an ongoing awareness of the inevitable and complex power relationship between psy professionals and clients/service users. This applies to activism, and also to the consulting room itself. Psy professionals often claim an apolitical neutrality and an enhanced empathic sensitivity in their relationships with other people. Unless we’re willing to continually pay attention to the limits of our assumptions and experience, and keep learning from the people we’re working with, we’re likely to be projecting subtle, and not-so-subtle messages of knowing more than we know, of being a little (or a lot) more important than we are, and protecting ourselves with a whiff of authority that’s overbearing or condescending.

One of the particular characteristics of mental health politics, of course, is that what we call “mental ill-health” is very likely to be a response to the abuse or misuse of others’ power over us at different periods and settings in our lives. So the fact that so much service mental health provision is top-down – in the form of the politics of commissioning and funding, as well as the diagnostic and treatment decisions of psy professionals – is a fundamental issue for mental health activism. As far as possible, political activism around mental health must be shaped and led by service users and survivors. For psy professionals, trust can only be earned over time through action, alongside and in support of survivors. Obviously we professionals have plenty of political issues within our own working remits, around which we can take the lead. But we’re so much more powerful in our campaigns if we have allies campaigning with us who are on the receiving end of the dysfunctionality of the psy professions.

RH: There’s a lot there, Paul! Can you tell us how far away current mental health provision is from the “bottom-up” approach you’re advocating here? – and whether you think a radical-left government could really make a difference to that – and if so, how? magine Iyou’re the new minister for mental health and you have five years!…

PA: I think there are fantastic examples of grass-roots activity among service users. I’m thinking of people I’ve met from the Mental Health Resistance Network, Disabled People Against Cuts (DPAC – regularly featured in the Star, of course), Recovery in the Bin, Friends of East London Loonies, the National Survivor User Network, Kindred Minds, the Survivor Researcher Network and Making Waves, as well as hundreds of small user, refuser and survivor-run groups involved in peer support, political campaigning, the creative arts, in manifold ways of sharing and valuing each other’s lived experience. But the culture-gap that exists between these forms of local “activism” and mainstream top-down mental health services provided by the NHS, or by some of the big mental health charities like MIND, can be enormous, and often very toxic for people suffering psychological distress.

Do I think a radical-left government could really make a difference? The political transformation required to rethink mental ill-health as a function of society’s ill-health is profound. In a way, mental-health politics is at the heart of any real questioning of what kind of society we want to live in, how we want to relate and be related to, what and whom society’s for. The first three jobs of a radical minister for mental health should be: (1) To ask user groups and individuals all over the country what “mental illness” means to them, and what would be of help to them. Mean it, listen, and then carry on listening. If the Labour Party were serious about any kind of radical transformation of mental health policy, it should be doing this right now. Are they?… (2) Give people the material resources to support their basic needs without condition. (3) Ban all forms of coercion in the name of “treating” people’s psychological suffering/distress.

RH: That’s a resoundingly clear statement – and challenge – to Labour’s shadow health team, Paul: let’s hope they’re open to listening, both to your conspectus here and to the experience of those who desperately need to be listened to – and who, to date, rarely have been by the Establishment. I really like how you place your emphasis on political receptivity and user empowerment, rather than on top-down initiative-itis. I assume you’re less than impressed by current state therapy provision and its top-down nature?

PA: Well, NHS primary care therapy provision – Improving Access to Psychological Therapies (or IAPT) – is seriously top-down. It’s organised as a sort of factory-system or conveyor-belt of mental health treatment, offering on average six or so sessions of cognitive behavioural therapy (CBT), or perhaps mindfulness, relaxation, or online self-guided exercises – aimed really at getting people suffering from depression and/or anxiety back into the everyday reality of their lives under capitalism. What kind of therapy you get is decided for you through a diagnostic check-box interview which may be held on the phone, or even by computer. There’s very little room for “user choice”. Out of 1.4 million people referred last year, two-thirds either never entered or failed to finish a course of IAPT treatment. They simply disappear from the statistics. I’m afraid it’s hard not to feel that IAPT is more about providing cover for the mental ill-health of capitalism than it is responding to the psychological suffering of the people.

Beyond IAPT, I think all forms of therapy carry the danger of encouraging a way of thinking about one’s self and the world that’s imposed on clients, rather than evolving through a process of mutual exchange between a therapist and a client.

RH: That’s sobering stuff, Paul; but I suppose we shouldn’t be too surprised when (state) capitalism creates a form of therapy that’s cast in its own image. Finally, could you say something about the once-again mooted state regulation of the psy therapies, and why you think this would be harmful to the field and to the work of therapy?

PA: Obviously therapists want their work with clients to be accountable. The problem with state regulation is the state’s desire for psychotherapy. As we see in other fields like education, medicine, and the law, the neoliberal state is increasingly engaged in violently undermining and taking political control of professional practice whose values and traditions conflict with the interests of the market. Psychotherapy, especially in the independent sector, operates at its best as a sort of free association and open exploration of meaning between people, a process that fosters possibilities for individual and social transformation. In the hands of the state, it will gradually and inevitably be reduced into the service of market agendas.

Paul Atkinson is a psychotherapist in independent practice in London, and a member of the Free Psychotherapy Network. Richard House is a Corbynista activist living in Stroud.

Duty, by Dr Avon

One of the responsibilities of doctors (leading to great privilege in the form of good wages and social status) is to act as an informed, accurate and unbiased opinion about people’s access to welfare on the grounds of health problems. Another responsibility of the doctor is to act as an advocate for their patients so that they can access welfare they are entitled to by any reasonable interpretation of the requirements as well as to protect them from any adverse effects of the welfare system that they are vulnerable to. This responsibility can be discharged by communicating with the relevant welfare agencies by various means such as filling out forms, writing letters and direct communications by phone or email. In this blog I tend to use the term “patients” as a generic term used for people consulting a doctor.

Whilst the social model of “disability” is by far the most helpful in order to plan interventions to reduce adverse consequences of mental health problems (my crude understanding of this model is what barriers are there that prevent this person’s desired participation in society including access to their needs for food, shelter and security being met), access to benefits are based on a more medical model of medical condition (identified by diagnosis), associated impairments in functioning and resultant disability (lack of capability or restriction) and social disabling (subsequent disadvantage and lack of fulfilment of social roles such as work or independence without care).

A first point is that the diagnosis is usually insufficient and details need to be given about any resultant impairment. For many diagnostic constructs, the diagnostic criteria are used to identify the best-fitting diagnosis and are not in themselves the whole nature of the condition. To use a general medical example, myocardial infarctions (“heart attacks”) are often identified using a combination of cardiac muscle enzyme results, ECGs, typical descriptions of symptoms and so on but the myocardial infarction itself is a blockage in the blood supply to the heart muscle leading to death of cardiac muscle tissue and resultant complications. It is this blockage and resultant complications that leads to death and impairment in functioning but the diagnostic criteria are used to identify the condition and access to correct treatments and as a first step to other help such as benefits if unable to work afterwards.

Depression is more than just the listing of diagnostic criteria in diagnostic manuals (and in this case the criteria are not as clearly linked to an underlying cause as they are for myocardial infarction). It is this whole nature of depression that is important for the purposes of access to benefits – lethargy, the dread of any change in case it makes things worse, the loss of confidence, the self-doubt, anxiety, avoidance of social contact, poor concentration, thoughts of self-harm etc. The diagnostic construct means the person is more likely to have features associated with that construct that may make them eligible for benefits. It is then up to the doctor to spell out what these features are, what treatment they are receiving, whether they are receiving services such as inpatient or day patient or outpatient, what impairments in functioning result and/or what risks arise to the person or others and what nature of support is needed from others. For example, if someone has agoraphobia they will struggle to leave the house – one consequence is they will find it hard to keep a job. Someone with dementia may wander and get lost so need somebody supervising them. Somebody who is suicidal is a risk of death so will need support and watchful care.

There several papers I use to help me fill out these forms (see references, all open access but all last millennium) but care coordinators such as CPNs and social workers are much more aware of the intricacies and requirements of the system. CAB and welfare rights organisations can provide helpful guides to completing form.

The second point and one frequently made is that the benefits system suits physical health conditions better. It is much harder in mental health to demonstrate that the impairment in functioning is due to the condition – for the myocardial infarction there are tests both associated with diagnosing the condition as well as associated impairments in functioning. In mental health apart from some exemptions such as dementia the demonstration of impairment in functioning is often reliant on the “word” of a mental health professional – it is therefore necessary to fill in the forms requested by benefits agencies so that the doctor’s patient can prove their eligibility. The benefits agencies will weigh up the reports of impairments in functioning, the risks and need for support and care.

The third point is that the benefits system can cause distress to people who are most vulnerable to this problems and increase their mental health problems and risks. Waiting for benefits with no income or savings leads to practical problems as lack of access to food and how to pay the rent multiplied many-fold if the patient has dependents like children. Assessments including reviews of eligibility are major existential threats to many patients on benefits. The lack of tests in mental health mean patients fear they will be disbelieved and the stress caused by these procedures can lead to relapses of mental health conditions and increased risks such as suicide. It is important that mental health services support their patients by completing these forms and if necessary direct contact with benefits agencies – by phone, letter or email – to point out these adverse and counter-productive effects so that patients are protected from these effects.

It is the duty of doctors to help their patients access benefits to which they are eligible, to provide accurate unbiased information as needed to benefits agencies and to help patients by interceding if they are suffering adverse effects from the procedures of the benefits agencies.

References

Disability and Incapacity Benefits – the role that doctors play. Maura Killoughery
https://www.cambridge.org/core/journals/psychiatric-bulletin/article/disability-and-incapacity-benefits/5F3F034CF0D64DC4A6117255701D7465

Incapacity Benefit. Phillip D. Marshall
https://www.cambridge.org/core/journals/psychiatric-bulletin/article/incapacity-benefit/EBD5705BFF05F942B59E69391601B5DA

Mental Health aspects of Incapacity Benefit. Laurence G. Measey
https://www.cambridge.org/core/journals/psychiatric-bulletin/article/mental-health-aspects-of-incapacity-benefit/81D0E6F7D6E4ECAC35E75F26F4ADD248


RITB recommends these essential resources for mental health
professionals:

https://newshoundsnewsround.files.wordpress.com/2017/12/benefit-assessments-e28093-exemption-to-protect-vulnerable-patients.pdf

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

https://www.benefitsandwork.co.uk

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

http://pipinfo.net

This is covered by a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License 88x31.png

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:

https://newshoundsnewsround.files.wordpress.com/2017/12/benefit-assessments-e28093-exemption-to-protect-vulnerable-patients.pdf

https://citizensadviceteignbridge.org.uk/wp-content/uploads/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

http://www.lawcentres.org.uk/about-law-centres/law-centres-on-google-maps/alphabetically

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Universal Basic Income, a neoliberal scam: discussion

A: Some of you know that the idea of a Guaranteed Basic Income is being mooted.

When I say I don’t support ‘it’, I have to be careful what I said. There are plenty of Marxists and others (Kathi Weeks, David Frayne, David Graeber, Thomas Piketty etc) who support a ‘wealth tax’ based Basic Income, that is a response to increasing automation replacing people’s work, and part of the move to have a decent wages (better than we have now), less hours, better employment rights etc. That is fine. This has my support, especially in ADDITION to the welfare state
But we are not being sold this. What we are being offered is a negative tax (Milton Friedmannesque) based Basic Income (not that dissimilar to Tax Credits, and bear in mind Universal Credit will be a similar version – don’t forget when the Tories backtracked on reducing Tax Credits it was because it was already passed in the House of commons as being cut in the introduction of Universal Credit). It will be less and cover for less accidental contingencies than the welfare state, it won’t be much more than JSA.
So in many ways the travesty that is being sold as Basic Income today is the equivalent of the Tories undermining Labour’s Living Wage pledge by renaming the Minimum Wage as a Living wage after keeping it low for five years and returning it to what it would have been had it risen with inflation, and called it a generous increase. It’s a pup!

One argument that I am looking at is the Job seeker’s Allowance thing. I know a fair few disabled people who fear losing their income due to this, but truth be told their ‘top up’ would most likely be replaced by a personalised agenda, like direct Payments, sounds good in theory, but actually is more focused and controlling and has greater possibility of sanction for not meeting audited outcomes and procrustean criteria.

But the one those who swallow the ‘hard working families’ propaganda agenda may find harder to swallow is the socialised unemployment insurance thing. Basically ‘waged’ and ‘salaried’ worker’s pay their NI because they have very little control over the eventualities of losing their jobs. A Basic Income would be in-work. Many families (at least) get tax credits already to top up their low wages, should they lose their job if BI replaces JSA they would be in the equivalent position of being without work just on tax credits, without JSA, that they pay NI for such an eventuality.

So it’s a way of explaining that people lose the ‘unemployment’ contingency aspect of NI, given that wages will adjust around whatever figure BI would be.

B: So it’s perhaps not surprising that a section of the super wealthy elite favour reducing the problem created by the escalating wealth divide, as Dugger says “It’s a reason most of them give money to good causes”. This future is the warehousing strategy of introducing a Universal Basic Income (UBI) for those lucky enough to be born in the already industrialised zones where most of the super rich live. When the need for our labour ends rather than leaving us to starve (and perhaps rob them if not revolt) the elite want to give us enough of an income to survive on. UBI would involve every citizen or resident (and that distinction is important) being given a regular unconditional sum of money in addition to any income received from elsewhere. In most forms of UBI this is enough money to look after essential needs including housing and healthcare.

This warehousing may appear more attractive to some of us but it also moves us inside the borders of fear. It inevitably involves escalating the slamming of the door on those trapped outside because of where they happened to be born. Thousands of people have died trying to cross the EU borders this year without the magic of the right passport. Even as I type this I’ve received a new notification that dozens of bodies of the drowned have just been found along the coast of Libya, another ship must have gone down.

UBI would also do little against the other looming disasters related to growth and pollution, in particular climate change. It would have some impact as the super wealthy would be slightly less powerful so environmental protection laws would be stronger but capitalism and its need for incessant growth would survive and continue to deepen that crisis. UBI has also become a cover in many countries for the final abolition of the welfare state as parties say they will fund it by abolishing entitlement to services which people will then have to buy.

In countries like Ireland where a welfare system exists mainstream parties have started to talk about UBI as a way of eliminating bureaucracy and introducing market competition. In practise that translated into eliminating yet more jobs – in the public sector – and replacing only some of them with what would be much more insecure private sector jobs. UBI was even favourably put forward – as ‘negative taxation’ – by Milton Friedman, the chief economist promoting neoliberalism who also advised Pinochet on the post-coup destruction of workers’ gains in Chile.

http://anarchism.pageabode.com/andrewnflood/three-futures-barbarism-ubi-warehousing-anarchism

C: I’m always suspicious now when things are mooted as ways to reduce or eliminate bureaucracy. Personal budgets/direct payments/UC were all trumpeted as reducing bureaucracy, simplifying the process, giving service users more choice and more control over their lives. More like a sneaky way to strengthen the independence is everything narrative while simultaneously cutting costs and therefore the necessary funding for everyone to be able to live independently.


UBI references:

https://recoveryinthebin.org/2017/09/04/ubi-the-good-the-bad-and-the-ugly/

https://recoveryinthebin.org/2017/06/25/the-neoliberal-writing-on-the-wall-ontarios-basic-income-experiment/

https://ocaptoronto.wordpress.com/2017/04/12/what-basic-income-means-for-disabled-people/

http://www.telesurtv.net/english/opinion/Basic-Income-as-a-Neoliberal-Weapon-20170217-0009.html

http://www.socialistproject.ca/bullet/1350.php#continue

https://www.jacobinmag.com/2017/01/ubi-finland-centre-party-unemployment-jobs/

https://www.opendemocracy.net/neweconomics/universal-basic-income-is-a-neoliberal-plot-to-make-you-poorer/

https://www.jacobinmag.com/2016/01/universal-basic-income-switzerland-finland-milton-friedman-kathi-weeks/

https://jacobinmag.com/2017/12/universal-basic-income-inequality-work

https://londongreenleft.blogspot.co.uk/2017/11/universal-basic-income-too-basic-not.html

https://www.policyalternatives.ca/publications/monitor/redistribution-through-basic-income

https://dpac.uk.net/2017/09/why-dpac-has-concerns-about-a-neo-liberal-basic-income/

https://www.jrf.org.uk/blog/universal-basic-income-not-answer-poverty

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When Staff Train Each Other: What Can Go Wrong?

There are myths presented at a Tees, Esk and Wear training session for a mixed group of staff. We have tried to provide some insight into the reality behind the myths.

Screenshot 2018-05-03 22.38.46

MYTH: A common dynamic with complex clients is that they often find it difficult to accept or feel helped by care yet at the same time desperately seek it and demand more and more.
REALITY: Some MH Professionals offer poor quality care. They are often so poorly trained, insightless and socialised into poor standards that they have no idea how incompetent they are. ‘Complex’ clients are usually people who have a level of professionalism and expectations that are outside the competence of the average mental health worker.

MYTH: Relationship patterns of childhood are repeated in relationship with the people trying to care for them
REALITY: Even the most mature person will apply previous relationship learning to new relationships. This applies to MH professionals and clients. Many MH professionals have their own problems and may be replaying dynamics where they were carers for parents or relatives. Clients who don’t provide staff with admiration, comfort reassurance and a sense of control can experience hostile and retaliatory reactions. This is why clients with an attitude of ‘doctor knows best’ tend to be so popular with health professionals.

MYTH: Staff can find themselves in a rescuing position, giving more and more – but are still accused of not caring enough.
REALITY: MH services are underfunded and under resourced. People with severe illnesses that should have intense community support are considered to receive a lot of support if they see a key worker for 1 hour a week – that’s 1/168 hours. Most clients have even less input. Rather than owning this many staff accuse patients of being overly demanding and perceive them as taking up their time. When staff position themselves as victims doing all they can to rescue and care for an accusatory client they really are losing the plot and failing to see the situation objectively: they feel overworked and patients are rightly identifying insufficient services.

MYTH: Well-intention ideal caring/rescue generates unrealistic expectations, becomes unsustainable (both personally and financially) and inevitably leads to failure
REALITY: Ideal caring is a fiction in current MH services and austerity UK. There is no possibility that staff will be providing this. Describing optimal care as ‘rescue’ is demeaning towards clients and insulting to those staff who are kind and deliver high standards. Research shows that good quality care is the type of care most likely to result in positive outcomes. Ineffective care from poorly trained staff with weak personal attributes who believe they are providing good care but lack the self-awareness to identify their personal, and training, needs and subsequently feel overwhelmed, burnt-out and then seek to blame clients, never helped anyone.

Screenshot 2018-05-03 22.38.26

MYTH: Some staff can feel caught in a dilemma – whether to be “abused” or reject the client.
REALITY: Some staff are caught in a situation where they lack skills and personal insight and their managers and Trust leadership provide poor role models, support and supervision. Some staff, due to their inability to recognise their own skills gaps perceive clients accurate identification of care failings as personal criticism. Lacking any self-awareness and not open to accept the clients feedback about the standard of care they deliver, they experience the feedback as abusive. Blaming someone else rather than accepting one’s own failings is not restricted to psychiatric nurses but due to MH professionals role and power it is particularly harmful.

MYTH: Attempts to help are apparently sabotaged by the client leaving workers feeling worthless, neglected or victimised
REALITY: Workers impose tick box solutions on clients that are totally unsuitable. They will also claim they’ve involved a client when they may have not listened well to a client at all. When a worker imposes an inappropriate solution on a client it isn’t likely to work. Anger and resentment by NHS professionals toward patients who don’t respond gratefully to ineffective advice and solutions imposed on them is inappropriate. It is also important workers don’t respond with dramatic accusations of ‘sabotage’ when an intervention is ineffective – maybe the clients needs and barriers have not been addressed, or have been discounted.

MYTH: Splitting and interdisciplinary conflict, failure to support each other within the ‘team’. Stress. Burn-out.
REALITY: The concept of splitting was originally about how the most vulnerable patients could be caught up in the dynamics of weak, fractious teams. Overtime, and unsurprisingly given the problematic staff in such teams, splitting has come to be a phenomena blamed on the patient. In family therapy dynamics like this where dysfunctional parents blame the child would be called ‘scapegoating’.

MYTH: Use of language such as ‘it’s just behaviour’ or ‘it’s manipulative’ (experienced as blaming or abusive)
REALITY: Use of language like this by NHS professionals toward the patients they have a duty of care toward IS abusive. Such beliefs about patients are the result of ignorance, prejudice and stigma.

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