Social Model – Recovery in the Bin

Mental Health Professionals Need To Help People With DWP Processes To Save Lives

I’m a AMHP an a MH social worker in an Adult Mental Health Social Care Team we used to be integrated with Health but the Care Act led to a split We have average caseloads of 40 people the vast majority entitled to state benefits ESA and/or PIP an repeatedly they have to prove that entitlement again and again. All workers need to consider the impact this has on people, not only the financial impact but the stress of having to share their personal lives with the DWP It’s an essential part of our job including if you’re a CPN OT or Lead Professional to make sure you help with forms or get someone who will, write supporting letters an make sure people know they can put your contact details on.

Please don’t think of this as a favour, more as an essential part of your role and yes nag the Consultant or GP to do their bit. I’ve never had a DWP worker complain there’s too much evidence. And to appeal perhaps to the selfish side of things. A person been denied benefits can easily lead to a crisis giving you more work an your organisation more costs We’re lucky enough to have a great CAB worker but they are overwhelmed but resources are online to make sure people get the points they need and deserve.

5 Ways To Help

By Tony Roberts. Former RMN and Public Health Specialist @FosterChangeUK

I used to work as a MH nurse for a CMHT. Occasionally, some patients were re-referred or dropped into crisis for an unknown reason. I had a colleague who always dismissively suggested that it was “just because their benefits are up for review”. Their cynical hypothesis was that the patient was manufacturing a “crisis” for the purpose of getting their benefits renewed. Once this objective was achieved, the patient “wouldn’t be seen again for two years” Our response, therefore, should be to ignore said “crisis” (air quotes were a common thing for this colleague). We should refuse to assist or write a letter, because that would be rewarding and perpetuating their manipulative behaviour.

I don’t think this is an uncommon view in MH services. It is a failure to see how much our mental health (and I do mean for all of us) hinges precariously on our financial stability. Some of us fortunately have a wider tolerance for financial upset – we may have savings, a generous credit limit or others we can lean on for help. But for many patients of mental health services – especially those dependent on welfare – this tolerance is a knife edge. Any slight change to their finances can have a catastrophic impact on their ability to live a humane and decent life. And it’s not hard to see why, if we choose to spend a few minutes thinking less cynically than my former colleague. Paying rent and bills is a pretty non negotiable chunk of income. From what is left, we have to prioritise. Hopefully, there is enough left to eat healthily, be able to get into town, heat the house when it’s cold, visit friends and relatives, watch some TV, have phone credit, get to appointments, and do things that make our lives more enjoyable – maybe odd treat, rewarding activities or a Netflix subscription.

But what if that financial stability is threatened by the Brown Envelope of Doom? What do we cut back? Do we downgrade our food? Cancel Netflix? Walk into town in the rain? Stop seeing the people we love? All the things that keep us well are under threat. And some people don’t even have those luxuries to cut back on. Reduced income threatens the essentials – bills, rent – risking eviction, arrears, homelessness. The stress of a benefit review cannot be underestimated. They threaten everything a patient has. Their entire life.

But what can we, as MH professionals do about it? Easy. Here are 5 things:

1 – Spend a few minutes of your time familiarising yourself with the DWP and review process.

2 -Talk to patients about their very real concerns. Find ways to mitigate the potential impact, help to take some of the distress from the process by planning contingencies.

3 – Talk to colleagues who know more than you – social workers, welfare rights etc who can give you and the patient advice.

4 – Offer to assist the patient through the process. It is hard enough to navigate as it is, without all the additional stress it causes. Give patients some spoons and take some of the load off them.

5 – Unlike my former colleague, write that letter of support. DWP letters often ask specifically about things like diagnosis, treatment, medical opinion etc. You may have views about the “validity” of such “constructs” That’s fine. But now is NOT the time for your philosophical views on psychiatry. Now is the time to sign a letter that means your patient won’t starve, be isolated, cold or desperate. Save your philosophy for Twitter. Sign the letter.

“A Call for Social Justice”: BME Mental Health Service User Led Manifesto

RITB are delighted to be able to share a recent keynote delivered by Raza Griffiths (above), lead author of the Kindred Minds Manifesto. Here’s what Raza said about the keynote:

I used the powerpoint as part of my opening keynote at a conference entitled “Psychological impacts of racial discrimination for both clients and practitioners”. The event was organised by practitioners from the British Psychological Society – which, as a professional body, has had a patchy history when it comes to addressing racism.

For this event, I looked primarily at the impact of racism on BME service users, drawing on my work in authoring “A Call for Social Justice” (2018). This is a manifesto written with contributions from 200 BME mental health service users, and spells out the changes they have said are needed to bring about a reduction in BME communities’ poor experiences within ‘mental health’.

The manifesto underlines the need for action against structural and institutionalised racism. It gives an overview of the current political climate and then identifies the changes in policy and practice across a range of interlinked life areas, including in education, policing and mental health, that BME service users have said will bring about an improvement in their mental wellbeing.

In mental health, this includes a move away from an exclusive focus on bio medical understandings of mental distress and towards support underpinned by a plurality of understandings of distress that BME communities can relate to; a move away from involuntary detention and treatment which are disproportionately used against BME communities; and foregrounding some of the good practice identified by the extensive writings of BME service user led initiatives over the years which are all too often ignored by campaigning groups and policy makers.

The conference took place on Friday 11th October 2019 at the De Vere Grand Connaught Rooms in Holborn, London

Links to the executive summary and full version of the manifesto can be found at the bottom of this webpage: https://www.nsun.org.uk/news/bme-mental-health-service-users-launch-manifesto

Positivity, Terrorism, & Neorecovery

The imperative to be positive, to have what is lauded in the workplace under neoliberal capitalism as a ‘Positive Mental Attitude (PMA)’, has seeped into every area of human life, and it is terroristic. The obligation to wrap up one’s distress in a gift box with a pretty ribbon, to mask the absolute horror show that can be bestowed upon some of us in the form of mental torment, is nothing less than a violence. As we have learned from those who are subject to racism and intersecting oppressions, it is what these things do to the psyche, the way they get under the skin, into the marrow, and woven into the very fabric of our selves, that does the most damage. It is a colonization of the mind.

The positive police have set up shop in every mental health service. We should write gratitude lists, mindfully eat raisins, HOPE (help other people every day), list our strengths on care plans, and think about where we might want to be in five-year’s-time when the next hour feels unsurvivable. My current care plan asks me to document my long term goals and how I will achieve them; the boxes to fill in read like an appraisal form, or something to put in a personal statement in which I try to convince someone I deserve a particular position. The form used to be about the difficulties we experience, what help we need – not an instruction to account for oneself and how we might materialise the things we want out of thin air, driven by pure (and probably literal) hunger for it.

I run a writing group for people who experience ‘psychosis’. Last week one of the members was trying to write something based on a prompt I gave them and said, apologetically, that she had nothing positive to write. I was a bit startled because I have never asked them to write in a particular way, and certainly not to write with their positive pants on. I said that the group wasn’t a space that demanded positivity, but was a space in which to be real with yourself and others, to the degree with which you are comfortable. Her reply? “That makes me want to cry”. Her response made me want to cry. And shout. What are we doing to people that we feel that unless we can speak positively we shouldn’t speak at all, particularly about the reality we experience? This violence rips words from throats; puts a sterile spin on the diverse range of human experiences; whittles us away to silt; isolates; individualises; and expects us to swallow patronising platitudes in the name of ‘recovery’ so that we may be deemed worthwhile (read: productive) subjects.

I don’t want to go all John Lennon on you, but imagine if we let people be. Imagine if we accepted that it isn’t wallowing and being resistant to treatment to be honest about how we feel? Imagine if we were willing to hold that space for people with care, and to sit alongside them in it. Imagine if we decolonised the narrative, stopped asking people to superficially cover wounds that need suturing and healing from the bottom up. Contrary to neoliberal propaganda, of which the recovery discourse is fast becoming a sacred part, this doesn’t cause people to be stuck in a sick role and too dependent (whatever that means given we are all dependent on others), but allows for the possibility of being seen, being accompanied, and possibly moving through it with help.

Interestingly, the group member I mentioned above, though speaking of her fears and upset of the previous two weeks, wrote a very positive poem. I am not convinced this is because she miraculously felt that way, but because the obligation to be positive has hijacked her from the inside. Violence isn’t always bloody.

– Eleanor Higgins

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Unrecovery Artwork In The Wild

Gary Writes:- On Wednesday I was admitted to an acute psychiatric ward yet again, after attempting suicide. On Friday I decided to draw Recovery in the Bin’s Unrecovery Star as a way of explaining why I can’t ‘recover’ from my mental distress and how the Social Model of Madness is so often ignored by professionals working in mental health settings. Recovery, in my opinion, has become a buzzword in mental health settings. It’s not that I don’t want to recover, but it is the failure to realise the social, political and human rights issues that stop my recovery.

I began drawing the Unrecovery Star at the table in the communal area of the ward. Patients and staff were interested in what I was drawing and began to ask questions which I answered as best I could without too many personal details.

My named nurse asked to speak to me privately about my art work. I explained to her that mental health services seem to only focus on my ‘symptoms’ and diagnosis of ‘Borderline Personality Disorder’ with ‘psychosis’. The answer, especially when I am sectioned, seems to be to add more medication and the root causes of what led me to be in a locked ward are often not even discussed and ignored. In fact the staff often don’t have time to speak to me at all.

I told her that the despair that had led me to try to take my life had been caused by a variety of reasons. I am in debt as my ESA payments have been suspended pending a fraud investigation as I failed (again) to ask permission to get paid for permitted work. The ever decreasing welfare benefits I live on, the recent stressful events when applying for PIP, the face to face assessment, appealing the decision, and the enormous fear of soon having to apply for Universal Credit that I can’t even face. I told her that any loss in benefits could see me homeless once again. My Personal Budget which helps me to live in the community by employing a Personal Assistant is also due to be reviewed and I expect the budget to be reduced. The thought of having to try to detail and justify the struggles I face, to do even the most basic daily living tasks is horrendous.

I detailed the transphobia I face daily from my family and the nasty arguments I read on social media regarding transgender people. The fact that I am waiting for an appointment at the gender identity clinic and how I feel I don’t ‘fit’ into a female ward. Yet, I don’t ‘pass’ as a man and therefore would be afraid to be on a male ward. The fact that some staff and patients call me by my preferred name but use the wrong pronouns. That gender dysphoria is cripplingly distressing but that I have no support to talk about this.

I talked about the iatrogenic trauma I have endured for the last two and a half decades of being in secondary mental health services and during the many times I have been locked away. I likened it to the childhood physical, sexual and emotional abuse I was a victim of and how I can’t call myself a ‘survivor’ as I am in many ways still a victim of control, coercion, abuse, trauma and power by the very people who are supposed to be ‘helping and supporting’ me to ‘recover’.

I stuck the Unrecovery Star I had drawn on to my bedroom door and was surprised at the ongoing interest by staff and patients. Some staff have signed it in agreement and with messages of support. The other evening some of the patients asked me to explain more about the drawing and we had an in depth and respectful discussion with all opinions being taken into account and valued.

I’m seeing the Consultant Psychiatrist tomorrow during ward round and I will be taking my drawing to show him and to try to explain the circumstances that led to the desperate act that led me once again to be sectioned. I will ask the ward manager if I can leave my Unrecovery Star on the wall of the ward when I eventually get to leave.

Yes, people like me, need the hope of recovery. However, I believe people need to know that there are many issues that stop my recovery. That I am unrecovered. Society as a whole has to take responsibility for giving me hope of recovery. As I finish writing, I’ve just looked at my drawing of the Unrecovery Star on my bedroom door and I notice two more signatures from fellow patients.

I wonder how many lives could be saved if a robust “Social Model of Madness, Distress & Confusion” was universally adopted. I wonder if my brother may have been saved.

Open Letter To Some Of Those Attending The Global #DisabilitySummit #NowIsTheTime

Open Letter to some of those attending the Global Disability Summit

To:

Lenin Moreno, President of Ecuador

Gabriela Michetti, Vice President of Argentina

Sophie Morgan

20 July 2018

We are writing this open letter to you on behalf of Deaf and Disabled people across the UK concerning your involvement in the global disability summit being co-hosted by the UK government in London on 23 and 24 July.

We are strongly in favour of international support that improves the lives of Deaf and Disabled people across the world and welcome co-operation between States that lead to stronger human rights laws and protections. We particularly support the building of international solidarity and links directly between Deaf and Disabled People, our organisations and campaigns.

However, we have the following concerns regarding the July summit:

The role of the UK government in co-hosting the event. Following an unprecedented investigation carried out by the UN disability committee under the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD), the UK was found responsible for grave and systematic violations of Disabled people’s rights due to welfare reform. The findings of their investigation, published in November 2016, were and continue to be entirely dismissed by the UK government. In August 2017 the UK government was routinely examined under the UN CRPD and again the UN disability committee expressed their deep concerns regarding the UK government’s failure to understand the Convention, the impact of their policies and failure to recognise them. Again the UK government said they disagreed with the findings of the Committee. The involvement of the UK government in co-hosting the summit therefore undermines any aims of the summit linked to strengthening Deaf and Disabled people’s rights under the UN CRPD. Instead it provides a platform for them to showcase to other States how it is possible to get away with ignoring those rights when it comes to your own citizens.

The UK government’s use of its international work to cynically deflect from criticisms of their disability record in the UK. On a number of occasions when government ministers have been criticised for implementing policies with an adverse impact on Deaf and Disabled people, they have cited the poorer conditions of Disabled people in other countries. This represents a misunderstanding of the UN CRPD which is about the progressive realisation of rights. The UN disability committee have such concern about the situation in the UK because it represents a serious and dramatic retrogression of rights, described by the Chair as a ‘human catastrophe’. In deflecting attention from their record in the UK, the Government clearly intend to more easily continue their punitive policies targeted at Disabled people and the poorest members of society. There is now overwhelming evidence, evidence which the UN disability committee considered, that prove the brutal impacts of these policies. It would be a betrayal to all those suffering under them not to raise concerns about attempts such as use of the global summit to divert attention and opposition to those policies.

The suitability of the Government of Kenya as co-hosts given their abuse of the rights of LGBTQI+ people, many of whom develop lifelong impairments as a result. LGBTQI+ people in Kenya are routinely banished from their families, denied work and accommodation, imprisoned and persecuted. They face severe barriers to forming and maintaining relationships and to living as a couple, the ‘Right to Family Life’ that every human is promised. This results in widespread damage to their mental and physical health, creating impairments where none previously existed. This is reflected in the high level of asylum applications to the UK from LGBTQI+ asylum seekers from African countries.

Despite their experiences, the majority are then refused asylum in the UK and forcibly returned home, where many disappear or are murdered. Just this April, President Kenyatta said that LGBT rights are “not acceptable” and not “an issue of human rights”. The Kenyan Government has also claimed this is a non-issue for Kenyans, and no doubt would argue that it has nothing to do with the Summit. However, if you are Kenyan or Ugandan and are lesbian, gay, bisexual, trans, queer or intersex, it is an issue that completely dominates and dictates your life. For many Disabled people from Kenya, it is the reason they developed an impairment in the first place. Under the UN CRPD, the Kenyan government also has an obligation to protect the rights of disabled people who are LGBTQI+.
We appreciate that you may not have had this information when you agreed to involvement in the summit and would be happy to meet to discuss our concerns. Please do not hesitate to contact us with any questions or for further information.

Yours sincerely,

Disabled People Against Cuts dpac.uk.net

Sisters of Frida sisofrida.org

Alliance for Inclusive Education allfie.org.uk

Inclusion London inclusionlondon.org.uk

Mental Health Resistance Network mentalhealthresistance.org

Reclaiming Our Futures Alliance rofa.org.uk

Recovery in the Bin recoveryinthebin.org

Can you be disabled with a mental “illness”?

The idea of disability, when applied to blindness or an inability to walk, seems fairly straightforward – a simple recognition of difference. But its application to mental distress and psychological conditions seems much more vexed and controversial. This is so amongst both health professionals and the people to whom it might be applied. Why might that be?

Disability has a legal definition. In England, Wales and Scotland the Equality Act 2010 covers work, education, housing and the provision of goods or services. At least in theory, the Act protects people from being discriminated against because of certain protected characteristics such as gender, age or disability. To count as disabled you must show that your condition has a “substantial, adverse, and long-term effect on your normal day-to-day activities”. Many of us will feel we easily meet this condition.

There are several ways of looking at disability.

In the medical model, something is wrong with your “body” (and by extension, your “mind”). You have a mental “illness” or “impairment” which disables you from reaching your full potential.

In the social model, something is wrong with your society, and the arrangements it has made for you. Society is what disables you from reaching your full potential. This model does not necessarily value one kind of life over another, treats people as inherently diverse and allows for a variety of attitudes to our condition. (Although many of us are indeed in distress and desperate for a way out, others accept the way we are and do not necessarily want to be “cured” of anything!).

In the case of mental distress and “ill health” both these models are under attack from a third, neo-liberal recovery model.

For some years now, Government policy in the UK has been dominated by “Austerity”: a programme of reductions to public spending and removal of any constraints on business which interfere with making a profit. Profit is assumed to be the highest good and nobody has any “right” to payments from public funds, not even if they contributed the money via taxes and national insurance in the first place. Austerity lies behind the “Hostile Climate” experienced by the poor in general and by some groups in particular (refugees/asylum seekers, members of ethnic minorities and disabled people – above all, those whose continued existence might involve a cost on the public purse).

Neatly fitting into this context, the Recovery model firmly rejects any concept of permanent or long-term psychological impairment or difference and concentrates on finding quick, cheap fixes which get people back to work. It’s important to clarify what kind of work. Ideally full-time and paid, it certainly doesn’t mean work which provides you with enough to live on, or which is socially useful or “meaningful” in some way. The defining feature is that it must make a profit for somebody else – preferably a large employer.

In this model lack of effort (and too much help from family or society) is what disables you from reaching your full potential. Psychological disability becomes essentially a moral question, much as it was back in the days of demon-possession and sin. Although by no means all NHS mental health professionals agree with this view, most in the UK have had to deal with it one way or another. Many feel obliged to pressure people to “recover” in these terms, as rapidly as possible.

So given that the Equality Act gives disabled people rights and a protected status, why might we be reluctant to call ourselves “disabled”?

We may feel we have no right to claim the label, and feel embarrassed at the need for support it seems to imply. (It took a GP’s recognition that her condition was long-term before the writer felt she had permission to use it, for example.) This is of course nonsense in a social animal like homo sapiens whose daily survival depends on the support of others, but in a society dominated by neo-liberal ideas, “independence” can sometimes feel like a necessary condition for self-respect and dignity.

We may associate it with hopelessness, rejection, degradation and despair. Lurking just behind the shoulder of many of us (especially those aged 50+) is the nightmarish spectre of the old “hospitals” where the mentally “ill” (such as unmarried mothers, or those who had accused powerful people of abuse) the learning disabled and the physically disabled alike were incarcerated, lobotomised, electroshocked, raped, abused and/or abandoned and forgotten for ever. (Because of this, for some of us it took a significant act of courage to “come out” to the NHS as “mentally ill” in the first place.)

In the Hostile Climate, where disabled people face routine hostility, harassment and physical attack, it may be genuinely dangerous. Bullying and abuse from others often makes our psychological distress worse. It may even place us in immediate physical danger.

So why might we want to use the term “disabled”?

Many of us fit the definition in the Equality Act, and we may want to claim the legal rights it gives us. Especially if we are in paid employment, we (or our union representatives) may be able to insist that our employers make reasonable adjustments to enable us to continue working on equal terms to our workmates. (I am assured by Unison colleagues that this still can and does happen on occasion, especially in what remains of the public sector.)

It may help others take our condition seriously, and to accept that we’re in there for the duration. It may help to prevent idiocies like telling the severely depressed to cheer up, or trauma victims that there is “nothing to worry about”.

It may help us to insist on our human dignity. It may help us to make common cause with others who face different problems, but the same oppressor. It may help us to build solidarity. It may help us to take ourselves seriously. I like this quote from one of our members, ‘I am disabled due to my emotional distress, adversity, finances and society. Proud to call myself disabled!’

Rita Binns

https://www.jrf.org.uk/report/towards-social-model-madness-and-distress-exploring-what-service-users-say

https://www.gmcdp.com/beliefs-values-aims/social-model

http://www.centreforwelfarereform.org/library/by-az/reclaiming-chronic-illness.html

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