Who Would Jesus Sanction?

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Recovery in the Bin has no religious affiliation but we feel an article by Bernadette Meaden (@BernaMeaden) is well worth bringing to people’s attention.

We came across this writing when it was shared in discussion about a tweet by Rob McDowall, Chair of Welfare Scotland (@robmcd85). Rob had received a shocking message from a person insisting the New Testament supports the DWP leaving people to starve, quoting 2 Thessalonians 3:10 ‘He who does not work neither shall he eat”. This was in response to Steve Topple’s article on a lady supported by Welfare Scotland who the DWP left ‘so starved she got an illness usually seen in concentration camps’.

Needless to say the selected quote does not support the interpretation this person gave it but the encounter highlights that there are always people who will seek to justify neglecting the poor, whether they turn to the Bible or economic myths like the ‘trickle down’ theory.

We hope this superb article by Bernadette Meaden will help provide a riposte to anyone mistakenly seeking to use the New Testament to justify mistreating those of us who are poor and subject to callous social policies-

How IDS measures up to Catholic Social Teaching
By Bernadette Meaden (Originally published by Ekklesia)

As Secretary of State for Work and Pensions, Iain Duncan Smith probably has more influence over the lives of the least fortunate members of society than any other person in the country. His decisions have a life-changing impact on poor, sick, and disabled people: the section of society that has least power and influence.

The DWP has the largest budget of all government departments and is a prime target for spending cuts. As a percentage of GDP, however, welfare spending is now much lower than it was in the 1980’s so the welfare ‘burden’ is not out of control.

As the man responsible for implementing cuts and reforms to welfare, Mr Duncan Smith is obviously dedicated to his job, turning down the post of Justice Secretary in the latest Cabinet reshuffle. Unusually for a member of the Cabinet, he is known for his religious beliefs, and even more unusually, for his Catholicism. This is interesting because through its social teaching, developed over more than a century through various Papal Encyclicals and other documents, the Catholic Church has had much to say on the issues Mr Duncan Smith is wrestling with every day. So it seems reasonable to look at how the Secretary of State’s policies compare with Catholic Social Teaching (CST).

CST really began in 1891 with Rerum Novarum, Pope Leo XIII’s Encyclical on Capital and Labour. It was an attempt by the Church to avert the violent social upheaval it feared would be the result of widespread poverty and the gross exploitation of workers. Although written to avert a revolution, its tone and ideas would be seen as extremely radical in today’s globalised, corporate world. This is how Pope Leo described conditions in his day:

“By degrees it has come to pass that working men have been surrendered, isolated and helpless, to the hardheartedness of employers and the greed of unchecked competition. The mischief has been increased by rapacious usury, which, although more than once condemned by the Church, is nevertheless, under a different guise, but with like injustice, still practiced by covetous and grasping men. To this must be added that the hiring of labour and the conduct of trade are concentrated in the hands of comparatively few; so that a small number of very rich men have been able to lay upon the teeming masses of the labouring poor a yoke little better than that of slavery itself.”

The Church promoted the dignity of labour, but recognised that having a job was not a blessing if it failed to pay what it considered a fair wage, one that allowed a man(sic) to maintain himself and his dependents in decency. Perhaps the modern equivalent would be the Living Wage.

As his own response to today’s problems, Duncan Smith established the Centre for Social Justice (CSJ), which has been influential on Conservative party policy. Many of the CSJ’s leading lights are known for their Christian beliefs and the think tank places a heavy emphasis on work as the route out of poverty. It pays much less attention to the plight of the working poor, and has said little about the fact that more than half of children living in poverty are in working households, and that growing numbers of working families depend on benefits to make ends meet.

Mr Duncan Smith has carried his belief in the primacy of work from the CSJ to the Department of Work and Pensions (DWP). Most of the DWP’s spending goes on state pensions and benefits for working people on low incomes. Out-of-work benefits and benefits for disabled people are a small percentage of the welfare budget, but they have arguably attracted a disproportionate amount of attention. Indeed
the DWP has been criticised for a less than careful use of statistics and language, portraying benefit claimants as workshy scroungers.

Sanctions (having benefits cut or suspended) have been introduced for those who do not fulfill the increasingly onerous conditions placed upon out of work claimants, and even sick and disabled people are now subject to these sanctions.

In 2010/11, 10,300 sanctions were applied to sick and disabled people on Employment Support Allowance.

Christian advocates of this tough approach often quote St Paul in 2 Thessalonians 3:10, “If any man will not work neither let him eat.”, but Catholic Social Teaching specifically refutes this. In Quadragesimo Anno, written in 1931 as the world suffered the effects of the Stock Market crash, Pope Pius XI stated “we must not pass over the unwarranted and unmerited appeal made by some to the Apostle when he said ‘If any man will not work neither let him eat.’ For the Apostle is passing judgment on those who are unwilling to work, although they can and ought to, and he admonishes us that we ought diligently to use our time and energies of body, and mind and not be a burden to others when we can provide for ourselves. But the Apostle in no wise teaches that labour is the sole title to a living or an income.

“To each, therefore, must be given his own share of goods, and the distribution of created goods, which, as every discerning person knows, is labouring today under the gravest evils due to the huge disparity between the few exceedingly rich and the unnumbered propertyless, must be effectively called back to and brought into conformity with the norms of the common good, that is, social justice”.
(Quadragesimo Anno para 57/58)

This principle promoted by the Church, that everybody, simply by virtue of being human, and irrespective of work, has a right to a decent life, would appear to be a completely alien concept to Duncan Smith, the DWP and the CSJ. As sick and disabled people and the unemployed face increasing hardship, and feel increasingly stigmatised and pressured, his department really does seem to be wielding a sledgehammer to crack a rather fragile nut.

Another group of people that have attracted much adverse attention are Housing Benefit claimants, with David Cameron in his Conference speech portraying this as a lifestyle choice by people who won’t work but expect to get their own home at the taxpayers’ expense. This is completely at odds with the fact that over 90 per cent of new Housing Benefit claimants are working, but the DWP never seeks to correct this misconception.

Quadragesimo Anno gave an analysis of the imbalance of economic and political power which could have come straight from the Occupy movement. Speaking of a “despotic economic dictatorship” it says:

“This dictatorship is being most forcibly exercised by those who, since they hold the money and completely control it, control credit also and rule the lending of money. Hence they regulate the flow, so to speak, of the life-blood whereby the entire economic system lives, and have so firmly in their grasp the soul, as it were, of economic life that no one can breathe against their will.

“This concentration of power and might, the characteristic mark, as it were, of contemporary economic life, is the fruit that the unlimited freedom of struggle among competitors has of its own nature produced, and which lets only the strongest survive; and this is often the same as saying, those who fight the most violently, those who give least heed to their conscience.”

To restore social justice under such conditions is a herculean task, but Mr Duncan Smith seems to be confident that he is the person for the job, and Universal Credit, his great project, will be the way to do it. This will be his legacy, and his reputation will rest on it. It is intended to simplify the benefits system and ‘make work pay’.

But under Universal Credit, it is claimed that many more disabled people will be pushed into poverty.

There are some very disturbing features about the treatment of disabled people under Universal Credit. For instance, “A disabled person who uses a manual wheelchair and can self-propel this 50 metres will be treated as non-disabled and will no longer qualify for any extra support under Universal Credit”.

Of course it is important not to write disabled people off as incapable, but to ignore the difficulties and extra expense they face in trying to live with their disability is callous.

Chris Edwards, an economist and senior research associate at the University of East Anglia, has published “The Austerity War and the impoverishment of disabled people”, in which he finds that ‘over four years to 2015 the poorest 20 per cent of the 2.7 million households receiving disability benefits will lose 16 per cent of their cash income plus benefits-in-kind. This percentage loss is four times as big as the loss for the richest 20 per cent of households’.

Concern about this has led to the foundation of The Hardest Hit, a coalition of disabled people, their families and supporters, calling on the government, and particularly Mr. Duncan Smith, to reconsider their plans.

Despite everything the government says, all the figures suggest they really are balancing the budget on the backs of the poor, and Mr Duncan Smith is at the forefront of this approach. He seems to spend much of his considerable energy and intelligence on judging and trying to alter the behaviour of the poor, whilst maintaining, in the face of all the evidence, that the last thing the poor need is more money

Unlike the Church’s condemnation of a ‘despotic economic dictatorship’, one rarely hears anyone from the government questioning the morals or behaviour of the rich.

Perhaps this is the crucial difference between Mr Duncan Smith’s approach, and that of Catholic Social Teaching. The Church recognises that to achieve social justice, one must first establish economic justice, whereas the Secretary of State appears to reject this basic principle.

To be fair, many devout Catholics, perhaps the majority, are largely unaware of the thrust of the Church’s Social Teaching. If this is the case with Mr. Duncan Smith, one can hope that at some point he will take a moment to pause and consider his policies in the light of that teaching.

‘Choice’ and wrong turns in the world of private therapy

therapist tinder

Note: Many people cannot afford private therapy or are not able to successfully claim PIP. We understand this as does the author. If however you are in this position of having an income or a PIP award this offers some very useful experiences and lessons. For advice on Benefits see these resources Here

I am not a user of NHS mental health services but I choose to be a client seeing a private therapist on an open-ended basis. I have no private health insurance cover. I live in a housing association flat on an estate with its share of anti-social behaviour and police attendances. Until this new financial year my income as a single adult was low enough to qualify for Working Tax Credits. I am employed by the NHS and believe in care available to all regardless of wealth. I value my GP surgery immensely and their endless care provided without complaint. I don’t seek transformational change through private therapy but ‘life support.’

Due to the scarcity of long-term therapy on the NHS there are more people with enduring mental health issues finding we need to look to the private sector. I must admit that in 2012 I did receive a year’s psychological therapy from a psychologist in the local Community Mental Health Team (CMHT) before being discharged back to my GP, no doubt to the relief of that service which had ‘held’ me for ten years. I have since been re-referred to the CMHT during crises where the practitioners triaging the referral have been astonished to meet someone who has received individual therapy from their psychological services. I have been discharged immediately after these ‘assessments’, told to use the tools that I was given in that therapy. I am seen as having used up all of my chances with mental health services and can be turned away as a time waster. I have exhausted what psychology input used to be available but is now a rarity.

Unfortunately, some problems still remain even though I had this one year’s therapy six years ago that should have converted me into a person who would never be distressed again. In 2014 I was granted some ‘top up’ sessions before being discharged and told that I wouldn’t be seen by the CMHT in future while I still had the ‘same presentation.’ I wasn’t able to explain to the mental health services then or now that the clumsy and final way in which I had been discharged exacerbated my difficulties, resulting in a sense of failure and tarnished ending.

With over seven years’ experience of seeking and receiving private therapy support I can share what I have learned here in case you also find you are abandoned by the NHS but don’t feel ready to go it alone yet. I appreciate that there will be many readers with counselling qualifications and years of practice who will find my account lacking. This will be subjective writing but that reflects how each unique individual will react differently to therapy and needs to find the right match of therapist. No therapist will be perfect, but where a therapist is open to thinking about walking in your shoes then there is potential.

I am conscious that for so many people private therapy is out of reach financially. The lowest price I ever paid for a therapy session was £40. I currently pay £90 a session but, as I will later explain, this experience has provided the best value. I receive Personal Independence Payment (PIP) which mostly covers the session fee. However, my first PIP claim has ended and I wait with trepidation as to whether I will be awarded PIP again. Though I am receiving weekly specialist psychology support, the DWP tend to only recognise medical evidence provided by an NHS service. I was turned down for PIP the first time I applied even though I provided a letter from a private counsellor who called herself a psychotherapist. The Atos report repeatedly stated that I received no specialist input. When I complained that most questions in the assessment were about what NHS services I accessed and not how my disability affected me, the written Atos response was that the DWP used secondary services as an indicator of severity. In practice, the DWP decision maker favours NHS or Atos evidence over that of a private psychologist even when that practitioner also does NHS work. If I lose PIP then my therapy will be at risk but I would still prioritise this investment over other living expenses.

Therapist Tinder

There are several online facilities to find a private therapist especially the BACP website and the Counselling Directory. Counsellors and therapists will pay to be included on these sites and can indicate the areas of counselling they deal with. I feel sceptical about the wide choice on the Counselling Directory where some, apparently newly qualified, counsellors will indicate they deal with all of the 93 categories listed. I doubt that a counsellor would have an interest in areas as diverse as Autism, Abortion, HIV, Personality Disorders, hearing voices and gambling. Since I object to my diagnosis of ‘borderline personality disorder’ I could make sure the therapist didn’t have an interest in this area by excluding that option, but then I may miss a practitioner who was critical of the label too. No therapist is likely to go public with a critical view of current mental health practice and so one profile is much like another. These bland profiles may say how the counsellor wants to help you to live a fuller life and will provide a safe space. There are photos of the practitioners, making the site feel like the therapists’ equivalent of Tinder.

There are some definite warning signs to look out for in profiles. I avoid therapists who are clearly looking to supervise trainees rather than troublesome clients and boast of their skills. A psychotherapist who comes up in my postcode search on the Counselling Directory describes himself as one of the leading psychotherapists in the field with a national and international reputation. He has written books on the erotic transference and countertransference within the therapeutic relationship, suggesting erotic feelings and fantasies can bring about transformation. Where a professional has a research interest or psychoanalytic focus then it is advisable to steer clear since they are likely to see you through their filter. I have negative experiences of therapeutic communities so would discount a therapist prepared to say he had worked in these places which would mean he had facilitated group cannibalism.

The fees of therapists may be another deciding factor. My experience is that psychologists charge a lot more than counsellors and psychotherapists, even outside London. A few years ago I worked close to a psychology practice where fees started at £130 for an associate psychologist. An assessment report by one of their psychologists would cost several hundred pounds. The average session fee for a counsellor or psychotherapist is usually £50-£60 though some offer sliding scale which may take it down to £40. There are charities such as local Mind associations where they offer free or subsidised counselling. Some employers provide an Employee Assistance Scheme though my experience is that these are call centres where any counselling offered amounts to six phone calls with someone who only gives their first name.

Most psychotherapists and counsellors operate a 50 minute hour. I have resented paying £1 for every minute and so £3 may go on a long pause or £10 on a pointless interpretation which I didn’t recognise. Given the high cost it is important that you find a therapist who allows you to direct the time and doesn’t impose a particular model on you that doesn’t make sense. I used to end sessions sooner than 50 minutes as I would worry so much about causing the therapist to overrun, though they kept looking at the clock so this was probably unnecessary. It has felt as though I was toxic and could only be handled carefully within the allowed slot before ceasing to exist once time was up.

With counsellors registered with the BACP you may want to look at whether they have worked to gain accreditation or senior accreditation. A person centred counsellor can be as skilled and able to deal with complicated issues as a psychotherapist. It can feel as though a psychotherapist’s training, with years of costly self-analysis, leads to them becoming less authentic as they are able to objectify and distance clients. There is a professional mystique around psychoanalysis and psychotherapy which now seems outdated. Don’t be afraid to ask the therapist about their qualifications and experiences. If they are defensive about this question then look for the door.

Therapy approaches (whether you like them or not)

I don’t wish to generalise, but my experience of therapists is that their style and demeanour is influenced by their training and treatment modality. The therapist appears to believe entirely in their single modality. I find CBT therapists dogmatic in their promotion of CBT with an insistence on it being evidence based, making sure they give you ‘homework’ and that you do not look to them for support. Last year I made an appointment to see a CBT practising psychologist willing to offer five sessions of CBT before we reviewed progress. The first thing she said to me was: ‘this is a business arrangement’. She made me justify why I wanted therapy again when I had tried other therapies in the past which obviously hadn’t worked. When I voiced my sense of rejection by local services she said that they wouldn’t be able to see me as: “they only have capacity to see those who are in the severe and enduring mental illness group which isn’t you.” I didn’t go back to her as why would I want to pay someone who made me feel as bad as NHS services did at the time of discharging me.

I had tried CBT before privately for around six sessions. The psychologist again acted as though she didn’t really want to see me. She challenged me during the assessment when I asked if she was only at the clinic on Fridays. The relationship ended since I emailed her after I collapsed due to bleeding out from a self-harm injury on the way to A&E. When we met after this trauma, she said that she wasn’t there for support, this was time limited therapy and asked why I had contacted her about the incident. I felt very dismissed and distressed by this response after an episode where I had to be revived by paramedics since I had gone into medical shock. The attitude of CBT therapists is that they want you to cope on your own, which is a great aim but ignores the realities of people’s lives which may involve poverty, loneliness, trauma and loss.

Bad therapy

My worst and most extended spell of therapy was with a psychoanalytic therapist for 18 months. When I ended with NHS psychology services I did ask my CMHT psychologist if he could make any recommendations. He told me not to use Increased Access to Psychological Therapies (IAPT) as they were only trained to a certain level and would not be used to seeing someone who had been through as much as I had been. At first he refused to make any suggestion because he felt this was my wanting him to provide for me after we ended. Eventually he did suggest two names (one being the therapist who writes books on erotic transference already mentioned) who also did sessions for the CMHT. I did opt to see the therapist without the interest in erotic transference knowing that as a self-identifying asexual I wouldn’t appreciate that imposed focus. His website was inoffensive though there were no real selling points or personality there. On reflection I chose him in order to keep some connection with the CMHT and the psychologist who I had liked working with. I remember when we first spoke on the phone and this new psychotherapist said that he did have ‘vacancies’ and gave me an address for his ‘consulting rooms’. He practised at his home though we never called it that. Everything was impersonal, robotic and guarded. He once came to the door on crutches and wouldn’t say what had happened to incapacitate him.

The psychotherapist’s fee was £50 a session which I had to pay in arrears once a month. I was not allowed to pay him any sooner or later than a week after he handed me the slip of paper. The ‘invoice’ said ‘for professional services’ and he signed his initials along with the dates of the sessions. I then would take a cheque to him the following week which he received in silence. I was earning around £16,000 a year and wanted to pay him weekly to help with my budgeting. However, any mention of a change in payment arrangement was refuted and analysed; his theory was that I needed to hold onto the payment for him as this was similar to my unwillingness to contain my emotions. It was another ‘boundary’ in the relationship which I had to keep or face heavy discussion. I was not allowed to email him except about practical meeting arrangements. If I missed a session, no matter how much notice I gave or how ill I was, then I would have to pay for it. This is in line with other therapists I have seen where even giving many months’ notice of cancellation meant I still had to pay at least half ie £25 in order to keep open my ‘slot.’

The relationship with the psychotherapist was rocky though he told me to give it no less than a year. If I emailed him saying I wanted to end he would ask me to come to the next session to discuss it. I wasn’t able to end as it still would have felt like a rejection and treatment failure, mirroring the botched ending with the CMHT. I felt beholden to his clever but empty interpretations, for instance whether eating sandwiches as a child meant that I avoided them now or was my mother not breast feeding me a cause of my eating distress. I felt too passive at times to say the obvious ie ‘what rubbish.’ We kept returning to the relationship and what was happening in the room even when my mind was elsewhere since not all of my feelings were about him. It is hard to feel much about a therapist who is deliberately a blank page. He found everything I said ‘fascinating’ while offering no warmth, humanity or ability to be real in return. Therapy felt like an intellectual exercise and not a therapist acting as a witness or helping me deal with expressed difficulties.

It was clear that the psychotherapist always had to be in control. When I decided to apply for a lay position on a committee of the UKCP he saw this as a direct attack on him. I felt that he would welcome my interest in user involvement but he felt that I was going for a job with his regulatory body to gain power over him. When I asked if I could start his first session of the day ten minutes early in order to catch a bus to work he said he needed a week to think about the ramifications.

After paying the psychotherapist over £3,300 he terminated the therapy due to my self-harm. He had given me an ultimatum, in effect a contract not to self-harm. When I challenged how this would help he said I was ‘playing games’. He only reacted to the self-harm when I had let him know I had been to A&E. It felt as though he was safeguarding his reputation rather than thinking about what happened to me once I was completely unsupported. He told me that if I felt I couldn’t stop self-harming then I should go back to the NHS, which was the same CMHT he worked for. Unsurprisingly the CMHT rejected the referral and expected me to go back to seeing him or another therapist who I should find in an instant.

It can be possible to be trapped in a therapy relationship like this and I imagine it to resemble domestic abuse in some ways. You hope for change in yourself and for the therapist to actually like you. You keep going back only to get the same cold, controlling treatment again. Paying so much to a therapist who stopped seeing me since I was distressed enough to self harm felt abusive.

Still not found what I am looking for

Needless to say, there have been many other therapists I have seen who felt unsatisfactory. I have often had to wait in the rain for my time to knock on the door of the therapist, as arriving even two minutes early was breaking a boundary and forbidden anyway since they had no waiting room. At times I wondered why I was paying £50 to a therapist with a house which must cost close to a million pounds when I was going back to a flat with neighbour problems. I have seen two well meaning counsellors who, while lovely, just seemed to agree with me as their way of validating everything. This agreement then entrenched my sadness and led to a sense of going round in circles. One of the counsellors said things that felt trite or weird, like describing us as ‘the dynamic duo’ as a way of compensating for the fact that no-one else, including the GP, was interested.

I have tried the only NHS therapy available to everyone through IAPT. This experience, while free, felt rushed since the therapist kept saying: “you know we only have six sessions.” Ten minutes of each session was spent filling out a self-assessment questionnaire for my anxiety and depression scores. This exercise was about her outcomes monitoring and had no therapeutic purpose. I gave up after the first session since I knew that my scores were unlikely to improve within such an irritating and imposed format.

A good match

I do now see a psychologist who treats me as a fellow human being. There can be misunderstandings, as in any relationship, but we discuss and repair. She is relaxed about me emailing which is important to me given my anxiety means I sometimes have to communicate in that moment. While she does have vast secondary care experience of working with clients with a label of BPD she views the underlying complex trauma and understands the prevailing discrimination. I prefer the way that she can draw on many different therapeutic approaches rather than deciding we must do DBT, MBT, Stepps etc because that is what is in a NICE guideline for BPD. I don’t see her as part of the PD industry, another expert who will get me to mentalise even though we can never truly know what someone else is thinking about us. I like that I don’t know much about her personally, though I guess we are not far apart in age. She is intelligent but not over intellectual and I can talk to her about the most intimate or embarrassing problem without shame. Most of all I see how she really wants to help and see me free of mental torment, while avoiding any rescue attempt when I do sometimes self-harm. I see her in a clinic where she hires a room so have somewhere to wait if I want to stay out of the rain and cold weather before an appointment. She puts up with me being gloomy at times without demanding I think more positively as she hears the life circumstances that make this challenging. I can take everyday issues to her such as work obligations and family relationships, looking for new perspectives and coping strategies.

I have spent tens of thousands of pounds getting to this point, too much to just put down to bad experience. At best I helped the psychotherapist I saw for 18 months pay for holidays for his secret family when he took the whole of August off. But I also think that all of the misses make me appreciate my current therapeutic relationship more, I feel grateful that there is someone who ‘gets’ me and that I can still benefit from therapy. As my therapist she listens and learns from me, whereas the analytic profession will search for unseen and hidden meanings which would cost me more money but answer nothing. It feels interactive and equal, a gift of therapy and not another missed connection.
I would always want long-term therapy to be available on the NHS. In the new real world though I am using what is available to survive, stay in work, gain insights, practise self-compassion and acceptance of what can’t be changed.
This isn’t an advertisement for private therapy as I know it will continue to come down to affordability for most people. If you want CBT then don’t pay a penny to a private therapist but go to IAPT along with perhaps buying self-help books. Private therapy can though lead to a special relationship but this is far from automatic. So much choice in the private sector and personal vulnerabilities can certainly lead you down wrong paths.

Note: PIP is awarded on functional descriptors about how your condition/difficulty/impairment AFFECTS you. Saying on a form ‘I need PIP to Pay for Therapy’ will get you zero points, you must phrase all answers in the form of how you are affected and with reference to the legal descriptors, see Advice Links

The UK Government Has Been Killing Disabled People, A New Government Must Stop This And Make Things Right

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Ok, I wrote this a couple of weeks ago while thinking about the roundtable meeting with John McDonnell and saved it away, I think it needs putting out there now, because clearly even people supposedly aware of what is going on seem to not understand what it is like to be a target of government hostility. This is what a future new government needs to do to make things right and respect disabled people’s rights and lives and to move forward.

1. People have a form of trauma from their dealing with the DWP and contractors over the last decade, we are survivors of state sponsored abuse, that needs recognising and help given.

2. To that end there needs to be a formal state led process of truth and reconciliation and part of that will entail key senior command people face trial, thousands of lives have been taken here and that trauma cannot be dealt with without redress, forgiveness can only happen after an oppressor accepts what they have done and that it was wrong. There is no place for sanctions in a social security safety net. It should also be noted that professional bodies (General Medical Council, Nursing & Midwifery Council & Health and Care Professions Council) have sought to protect their members from complaints and remedying their institutional bias needs to be part of this process. The Coroner System also needs to be changed so the threshold of determining suicide and causes is no longer to a criminal standard and that coroners warnings to government about lethal effects of policy have statutory force and cannot be hidden or dismissed. As for Corporate Charities or Disability Rights UK, when push came to shove, they mostly failed us. If they want to share in this way forward they have to re-orient how they represent the people they supposedly are constituted to help.

3. Long term the DWP is so institutionally dysfunctional it has no future in a civilised society, we need a new Ministry combining Social Security and Social Care closely allied to Health (if not also Health) DHSS, imagine such a thing! And firmly rooted in human rights and the social model. So not Universal Credit.

4. More directly about the future, there needs to be a transition plan so that the Friday morning when Labour walk into Downing Street, civil servants and government lawyers are tasked with ending the contracts with Atos, Capita & Maximus. On this we are happy to provide testimony to show all three are catastrophically in breach of their contacts and deserve no exit clause payments, in fact they deserve prosecutions. The assessments need to be paused, interim payments continued and an emergency process in place to deal with ongoing claims and new claims while new legislation is debated and passed, ideally seeing NHS professionals and the claimants own support network co-produce an assessed support plan that is the gateway to benefits. The era of the fear of the brown envelope must end immediately.

Unsupported Work To Provide For No Family – The Work Cure?

human value

“Work is good for you” is a mantra inflicted on everyone of working age including mental health service users. I don’t think the reality is straightforward and work can feel perilous when it is insecure, (zero hours contracts being the clearest example), low paid, low skilled with employers whose priority isn’t to ‘promote staff mental wellbeing’. I do work full-time though didn’t achieve regular paid work until I was 33 years of age. Please bear with me as I explain this statement since I feel I need to justify it in case anyone assumes I was lazy or went travelling the world.

When I was 18 I reluctantly dropped out of university with a weight below four and a half stone. I spent the next five years being refed and rehabilitated from Anorexia. At the age of 23 I tried to make a new start with a disabled person’s traineeship for a government funding body. My manager terminated this fixed-term contract after I disclosed in confidence that I was distressed and self-harming outside of work. My life then fell apart and the self-harm worsened with paracetamol overdoses. I was fortunate to meet a community psychiatric nurse who saw beyond the self-harm, encouraged my potential and need to stay busy. I volunteered at a local Citizens Advice for nine years during which time I was hospitalised for countless blood tranfusions and even sectioned on the psychiatric ward due to pressure from A&E medics for services to do something. In my early thirties, while still under the community mental health team, I came across an incredibly hard working, sound and enthusiastic vocational adviser, using the Individual Placement and Support model, who motivated me to finally contemplate a meaningful, appropriate and chosen job.

I believe the structure of work helps me now though work is inherently stressful. I never want to imply that I have done it and so should others with mental health issues. I have seen this bullying attitude amongst peer leaders who had chosen working in a supermarket or self-employed consultancy on mental health over claiming benefits which they saw as a mark of disgrace and welfare dependency. Some service users progress to working within mental health services in peer worker roles which are usually underpaid and undervalued by their NHS trusts. However, I decided to do administrative work away from mental health care, since I feel too much of my life has been lost to mental health already.

I have many friends who don’t work due to their mental health and I would always advocate for their need to be left alone by the Department of Work and Pensions (DWP) and the various organisations, which can include NHS trusts and mental health charities, acting as their agents. While the fear of being made to do ‘any’ job, if found fit for work, did propel me to act before I was forced, I don’t support this underlying threat tactic.

Apart from the benefits questions, I have been wondering whether there are unspoken disadvantages to being in work when you have ongoing mental health challenges. These disadvantages include health services seeing an employed person as recovered, the lack of support in the workplace, the inability to disclose less appealing diagnoses, for instance ‘personality disorders’, eating disorders or addictions, and the difficulty of accessing benefits support which enables you to keep working.

This week I attended a CCG organised ‘Coproduction’ workshop on local care and mental health using my annual leave so that I could speak freely. A consultant psychiatrist was the speaker representing the main mental health trust in this area. His presentation and words were: “only the most severely impaired should access secondary services.” I interrupted at this point to ask how he would define ‘severely impaired’ and if it could include people in work. The speaker said that it would not because: “they wouldn’t want to see us as they are out working providing for their families.” I pointed out that someone in work could still have a crisis, indeed could need hospital admission.  I felt a lone voice in a room of professionals where others probably agreed that all patients who can just about function should be discharged back to primary care to release capacity in the system, outing those who are the equivalent of bed blockers in hospital.

There are logistical difficulties of accessing mental health services if they decide you deserve an appointment when you work. Even the mental health services embedding in primary care operate during core work hours and may be in a town away from your place of work. Since I’m fully aware of the huge demand on specialist services, it does kind of make sense how services view someone working, even if signed off sick, as more able to fend for themselves. Perhaps there is also a mistaken belief by professionals that working is a curative therapy which then creates a lack of comprehension why someone, particularly with non-psychotic conditions, should become ill when in work. Services only want to see people short-term to work to Recovery model goals, so if you have achieved paid employment then this can in itself be regarded as marking the end of the treatment journey.

My experience of applying for Personal Independence Payment, once Disability Living Allowance ended, is that working counted against me. The medical report from my face to face assessment with a general nurse employed by Atos repeatedly said “in her social history she states that she works full-time with no specialist input.” While I scored 6 points these were on account of my eating disorder, thankfully being in a job doesn’t denote that I can eat three meals a day or prepare a simple cooked meal. The assumption made by the assessor and the DWP is that if you hold down a job then you can do all of the activity descriptors involved in daily living. I was turned down for PIP and had to challenge the decision. The short-term award I did get on mandatory reconsideration has meant that I have to go through this claiming process 18 months later, explaining all over again how I can be employed yet still find it difficult to engage with other people face to face.

If you do become more unwell while at work, whether caused by work stress or personal issues, then there may be no support to prevent your job loss. Large employers usually have an outsourced Occupational Health service but this tends to amount to advice for the employer about when the employee is likely to return to work. There is no advice directed towards the employee about how they can cope with work. The provider used by my current employer is OH Assist, which used to be a division of Atos, the private company which performs benefits assessments on behalf of the DWP. The assessment of the employee’s health and subsequent advice report is done through a brief telephone consultation. The Occupational Health Adviser may be a nurse or OT who has no mental health knowledge, leading to a short and generic report for the employer, which is more of a tick box exercise than a considered specialist opinion.  I have had to pay my private psychologist to write a report for my line manager in the hope that it may lead to reasonable adjustments and understanding of how to support me at work.

Many large employers do have an Employee Assistance Scheme (EAP) which is telephone based. My experience is that calls are short, possibly to target times of 10 minutes, unless you wish to access eight sessions of phone counselling. Since the EAP is also outsourced to a national company, there is no familiarity with the employer you work for and their policies. I was overpaid salary of thousands of pounds in error by my employer but had no way of sharing my pay slips with a phone adviser who would be someone different if I called again. The extent of the advice given during 10 minutes about my overpayment was that the employer should be ‘reasonable’. I experienced even greater stress when my employer then demanded in two threatening letters that I repay the total overpayment back in two months leaving me with a nil income for those months. In fact, the overpayment recovery deductions set amounted to more each month than I would have been paid. I had to use my annual leave to see a local Citizens Advice to figure out how to respond to the overpayment that wasn’t my fault though still needed full repayment.

Job retention support is non-existent despite the way that work is a policy priority in mental health and the Five Year Forward View.  I approached the Shaw Trust and was told that they weren’t commissioned to provide job retention and the only way they could help me was if I gave up my job to look for another. I have seen the Disability Employment Adviser at the Jobcentre and was given a leaflet for an NHS funded Improving Access to Psychological Therapies service offering six sessions of web chat and was told that Access to Work wouldn’t cover anything for mental health except taxi fares. After much internet searching, I found Remploy, funded by Access to Work, has a Mental Health Support Service. I self-referred to this service and understood that there would be six months of support. I later realised that the support was telephone based whereas I needed someone to come with me to meetings with senior managers at work. Remploy is in partnership with Maximus, which is another private company that provides benefits assessments for the DWP.

Two weeks after I self-referred, a Vocational Rehabilitation Consultant phoned me and offered the only face to face meeting I would have in six months apart from a 13 week review he said could be done in person or over the phone. He made clear that he was fitting me in on his way by train to another client. His office address is over 150 miles away from where I am based. During our meeting lasting half an hour, he asked my diagnosis and when I said it was ‘Borderline Personality Disorder’ he suggested that I was a ‘complex lady.’ He said that he had other clients with BPD but they did not self-harm and he knew how with BPD one day he may be my best friend and the next day my worst enemy. I tried to explain that I didn’t experience this perception and found such a stereotype offensive. He had emailed me a lot of leaflets produced by Mind in advance of this meeting and asked if I had read them yet. I was in crisis, attending A&E for wound repairs, so reading the leaflets was the last thing on my mind.

My personalised action plan from Remploy stated that the “reading resources were provided to help her better understand anxiety, depression and self-harm so that she can try to develop coping strategies to better manage her mental health.” He drafted a letter to my manager which I had to ask him not to send since it stated that she was the cause of my anxiety! When I gave feedback that the leaflets were too basic and his service didn’t meet my needs he replied in several emails saying:“We deal with individuals who have mild to moderate mental health difficulties who are already in employment and do not require intensive support. I feel you are not benefiting from the mental health support service (MHSS) which Remploy deliver as it provides a much lighter touch as I think you require a level of intensive support which is not designed into the MHSS as it is not designed for that purpose.”  He never suggested where this intensive support should come from. I still have to provide him with monthly updates until the end of the six month support period, even though I have withdrawn from the service.

My employer does have Mental Health First Aiders (MHFAs) who can be approached in the same way that an employee could ask for physical first aid if they had an accident. These MHFAs do have two days of training. I believe that staff with the right qualities training as MHFAs can be a helpful resource in the workplace though their role is to listen, signpost but not to give advice. However, it isn’t easy to approach MHFAs you know as colleagues. While the conversations are meant to be confidential I do have a doubt about whether I may regret being open if later interviewed for a promotion by a colleague who is also a MHFA and may see me in a different light. I have not managed to tell any of my colleagues about my diagnosis as I am sure it would damage my career prospects. There are so many negative articles online about BPD that a manager would only have to look at the wrong Walking on Eggshells type web page to form a judgement that the employee was a problem.

In several places of work I have heard colleagues use what they call ‘gallows humour’ about customers, such as saying those who self-harm seek attention, that it was a waste of resources that an ambulance helicopter was called out for a resident who had taken an overdose and that they wished one of their clients would get run over by a car as he served no useful purpose as a drug addict. I still hear where clients are called ‘manipulative’ as though this is definitive. Even though the colleagues are not talking about me, I start wondering what statements they would make if they knew that I was a frequent user of A&E, covered in scars under my long sleeved shirts and trousers. I want to educate them on the distress behind mental health issues but don’t want to reveal too much about my own history that they either feel sorry for me or form a different opinion other than one based on my strong work ethic.

There is the isolation of being single and in work (I have no family to provide for despite what was suggested by the speaker at the workshop). I have no-one to turn to after a long day in the office where I may have experienced conflict, stress or bad news, for instance there is an imminent restructure. It takes me several hours in the morning to psych myself up to go to work and once home I have no energy left. I eat something simple like cereal, having snacked for most of the day due to my anxiety, I then phone my surviving elderly parent and go to bed. The events at work and whether I said the right thing or have forgotten any task go round in my mind inhibiting sleep. I know that the next work day offers more of the same routine, perceived criticism, uncertainty and self -doubt. Working has created distance from a few friends who think that it is alright for me now I have work and don’t have to worry about work capability assessments. Government policy pitches disabled people against each other. We compare ourselves and who needs the rationed resources more since benefits and services were cut as part of austerity measures. I also feel I have no energy to talk to these friends about their encounters with mental health services when I just need total rest after forced company in the office. I don’t feel like using the computer or answering the phone since I fear I will have no resources left to go into work again.

I often feel like a disaster survivor unable to tell my colleagues what has happened to me through iatrogenic and personal traumas. My world is clearly not theirs. I share in their news of families, childcare arrangements, children’s exam results and their own career promotions. I don’t say how unhappy and empty I feel inside or that I won’t see anyone over the weekend as otherwise I wouldn’t recover to see them again on Monday.

If work is good for you, it should be good to you as well. Work needs to be with a supportive employer, have a benefits package with well funded employee wellbeing resources, open minded colleagues and local NHS and voluntary sector services that don’t exclude the ‘high functioning.’ There should be a raft of supports that are concerned about job retention and not just a job placement, job done approach. Voluntary work should be valued as a meaningful and important part of life for those whose mental health condition means they shouldn’t be pressurised into work to targets or to keep the welfare bill down. We need to work together as allies, those in and out of work, to make sure our voices are heard and that work is chosen, decently paid, healthy and fair.

Esther McVey and the Samaritans: Psychologists for Social Change and Recovery in the Bin respond

Psychologists for Social Change and Recovery in the Bin response to news of Esther McVey, Secretary of State for Work and Pensions’, position on the Samaritans’ Advisory board.

As a group of psychologists (Psychologists for Social Change) and service users (Recovery in the Bin) we are deeply concerned at news that Esther McVey has a role on Samaritans’ advisory board and believe that holding this along with her position as secretary of state constitutes a conflict of interest.

We think a position advising the Samaritans is incompatible with the beliefs she has been shown to hold based on her record in government. Esther McVey is a conservative government minister with a long record of voting and working to reduce support for those requiring welfare benefits. She has consistently voted against any increases in welfare benefits, including for people who are unable to work through illness and disability and, over a three year period, supported a reduction in total welfare spending 29 times. In addition she has consistently voted to reduce housing benefit for those social tenants deemed to have excess bedrooms (‘the bedroom tax’).

People experiencing financial difficulties are at an increased risk of developing mental health problems (Kiely et al., 2015), being associated with self-harm (Barnes et al., 2016) and depression (Mirowosky & Ross, 2001). Increases in suicide rates have also been associated with times of economic crises (Branas et al., 2015). As such the Samaritans have become something of a lifeline for people suffering the consequences of the reduction and removal of crucial welfare support. It is frequently recommended by stretched Mental Health Services for whom crisis services may be minimal or non-existent, meaning the Samaritans can sometimes be the last resort for people who may feel suicidal.

Representatives of Recovery in the Bin, a group of mental health service users, have described this as an issue of trust and respect, experiencing her decisions and their consequences as abusive and detrimental to their mental and physical health. They drew attention to the fact that the United Nations have found the UK government and particularly the DWP guilty of ‘grave & systemic’ human rights abuses which have caused a ‘human catastrophe’ for disabled people. Therefore they state it is wrong to have a human rights abuser on a charity board, especially when that charity is supposed to help people who are harmed by her decisions.

Representatives from Recovery in the Bin noted that benefit cuts are a leading cause of crisis for mental health service users. Service users and more who are now discharged through service cuts feel betrayed by the Dept of Work and Pensions who have been shown to disproportionately discriminate against mental health claimants as court cases demonstrate. They are also the sole group targeted for employment as a “health outcome” which amounts to sanctions, workfare and removal of benefits.The insertion of Job Centre Plus into libraries and GP surgeries leave service users feeling that there are virtually no safe spaces left from the very government department they are affected by. Some will not not feel able to use the Samaritans until this additional imposition is rectified by the removal of Esther McVey.