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

By @444blackcat

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.

The Invisible Prison – Panopticon Of The DWP

Invisible prison 1 art

One of the things I’m feeling a lot at the moment is the massive divide being successfully constructed between:

1. Those of us who are long-term dependent on state disability benefits to live.

2. The rest of society.

This is absolutely deliberate.

People who aren’t dealing with the DWP for disability benefits have no idea how traumatic and violent and all-encompassing it is. It is an ongoing trauma for a lot of us.

Pretty much everyone I know who, like me, relies on disability benefits for rent/food/bills/life money, has had multiple traumatic experiences. And that’s on top of the GIGANTIC amount of work that the assessment process involves: do to it successfully requires a lot of specialist knowledge, writing skills, capacity for loads of admin, having to contact people, arrange medical appoints which are a total waste of patient and NHS resources, attend horrific ‘assessments’ , try to find advocacy etc

And being forced to do this all to the tightest timescale possible.

We deal with a level of surveillance and arbitrary punishment that, rightly,
has been judged by multiple independent analyses to be a state driven deliberate breach of the human rights of disabled people who have the fucking gall to be poor and/or unable to work.

Loads of the techniques of psychological pressure were developed first in one of the home office/ foreign office/ DWP, and then exported to the others. Nice, huh?

If you’ve a strong stomach and/or are not directly affected, more on that here.

Nudging conformity and benefit sanctions: a state experiment in behaviour modification

Basically the gist of this is, in which we discover until recently there really was a controversial government department which researched and tested “behaviour modification techniques” for implementation in aggressive state policy:

“Conservative anti-welfare discourse excludes the structural context of unemployment and poverty from public conversation by transforming these social problems into individual pathologies of “welfare dependency” and “worklessness.”

The consequence is an escalating illogic of authoritarian policy measures which have at their core the intensification of punitive conditionality. These state interventions are justified by the construction and mediation of stigma, which is directed at already marginalised social groups that the policies target. The groups, which include sick and disabled people, people who are unemployed, are painted with a Malthusian brush, as a “burden on the state” and a drain on what are politically portrayed and publicly seen as scarce resources in an era of austerity.”

Political processes of scapegoating, stigmatisation and outgrouping have been amplified by a largely complicit UK corporate media. Examples of its work are all over the DWP. PREVENT. The whole Hostile Environment project. There’s plenty more, I’m sure.

Which is why I’m not exaggerating when I name this as state terrorism.

A bunch of disability and civil liberties activists/campaigners/lawyers discovered  the existence of the ‘nudge unit’.  So they made Freedom of Information requests to try and find out what the hell government money is being spent on.

Government solution? To privatise the department and turn it into an ‘institute’ to avoid scrutiny. And to drain more state cash into private pockets.

Anyway, back to us, trying to survive in an increasingly violent and reactionary society with the vast machinery of the  right wing state bearing down on us.

This shit and much more stuff like it = many of us are scared to leave the house, post any pictures of us looking happy on social media, be photographed at events/protests.

We’re cut off from participating in civil society.

Police force admits agreement to share information about protesters with DWP

It’s absolutely deliberate: the more surveillance, the more the DWP poke their nose and disclosure agreements into every area of our lives, the scarier it is to be out in the world even when we aren’t disabled by society.

And – for many of us – there are multiple other oppressions we’re dealing with too. Disability is inextricably entwined with race, class, gender, gender id, immigration status, sexuality and poverty.

Our lives are FUCKING HARD.

The surveillance/sanctions regime is a deliberate tactic to put extra pressure on already vulnerable people. It’s punishment for being vulnerable and in need. It’s also eugenics: it’s about disabled people being regarded as disposable/barely/not human. It’s an idea with deep roots in British society.

And they’re only just getting started. Looking at Bloody Boris’ fucking cabinet terrifies me, eg right now the DWP is trying to get its hooks into NHS files. The proposal is dressed up in fake nicey language but basically it would mean that if you claim disability benefits, you have no privacy or confidentiality during medical appointments. It would be horrific. I know that there’s a lot of pushback against this from loads of NHS groups, thank fuck.

I don’t have much hope, and I feel a lot of the time the clock is ticking on how long I can survive before they break me, or make me homeless again or otherwise fatally fuck me up. That worry never leaves me. Which is another reason for stopping dealing with them for now.

Because I realise now: I’ve become institutionalised. I live inside an invisible cage built by the DWP (and Social Scare, of course. Let’s not forget them. Bastards)

By institutionalised, I mean, for eg – I anticipate and strategise against DWP sanctions automatically whenever I think, open my mouth, and especially if I leave the house. Any time I think about doing anything out of the house that might improve my life, (eg an art class, or an event that a photographer is at) I freak out over whether it will trigger sanctions.

Because although it’s not likely, it does happen.

It’s a perfect panopticon. They fuck over just enough people to make all of us realistically terrified about it.

And it’s a deliberately and increasingly asymetric system.

Ie: getting the benefits takes huge amounts of work, and can take years. But the state can take them away in an instant.

There’s also the alienation: I deal with this monster that infests every area of my life. People who don’t deal with it mostly have absolutely no idea how hard our lives are. How we don’t go a week on social media without hearing about yet another death caused by the system we’re reliant on.

A system that is our right.

And it should be the right of anyone living here, btw. And isn’t anymore – that’s a whole other pile of DWP fuckery that’s been happening over the past decade or so.

Fuck borders and fuck nativist politics always.

But my one hope is that I see so many grassroots people/groups/organisations/communities doing mutual aid, advocacy, support, skill sharing etc. A lot of it is very informal and grassroots and it’s amazing. So you get people on random fb forums putting hours into helpful /detailed/informed responses to questions. You get people sharing often traumatic details of the assessment process because they care about someone else going through the same thing. It’s fucking amazing. But we shouldn’t fucking be going through this shit in the first place.

More specific stuff re the ”invisible cage’/panopticon:

CW: moar DWP ranting. Also, tho, theory.
Which isn’t actually fucking theory for me. It’s my daily life.

The DWP is absolutely a panopticon. I’m living in a fucking panopticon. Except it’s invisible. And specifically designed to marginalise already vulnerable people.

So most people don’t even know it exists. And often don’t believe you when you tell them. And it fucks you up so sometimes* you forget that you’re living in a panopticon and just blame/hate yourself.

I’m living in a panopticon in twenty fucking nineteen in a rich White Western country that likes to think of itself as:

1. Liberal (it isn’t. There are important  traditions of liberalism in this country. Traditions of radical internationalist anti colonial/anti racist socialism, communism, anarchism. Powerful histories of working class people of all races doing practical radical political work. And loads more. Britain’s dominant character as a ‘nation’ in general, in practice ends up  defaulting to English norms’ . Which prize conformism, hierarchy, subtle powerful coded signals.
Its all about us ‘knowing our place’.

Riz MC nails it in ‘Englistan’:
“God save the queen
Nah she ain’t mates with me
But she keeps my paper green
Plus we are neighbours see
On this little island
Where we’re all surviving
Politeness mixed with violence
This is England”

Track: Riz MC Englistan on Bandcamp
Lyrics: https://genius.com/Riz-mc-englistan-lyrics

2. Modern. Modernity isn’t inherently good – in English, it’s a category inseparable from white supremacy and capitalism and patriarchy and and and.

But my main issue is that the idea that the UK is modern is fucking laughable. UK = basically feudal neoliberal empire-hangover capitalism. Doesn’t that sound just GREAT?

If you think I’m exaggerating – bear in mind that our new Prime Minister is related to the royal family. In twenty fucking nineteen.

Thinking about the DWP as a panopticon also usefully reminds me that there’s a reason that a fucking White English public school-and-oxbridge man came up with with the panopticon. These same people still largely run the country OVER TWO HUNDRED YEARS LATER.

“Jeremy Bentham, an English philosopher and social theorist in the mid-1700s, invented a social control mechanism that would become a comprehensive symbol for modern authority and discipline in the western world: a prison system called the Panopticon.

The basic principle for the design, which Bentham first completed in 1785, was to monitor the maximum number of prisoners with the fewest possible guards and other security costs. The layout (which is depicted below) consists of a central tower for the guards, surrounded by a ring-shaped building of prison cells.

The building with the prisoners is only one cell thick, and every cell has one open side facing the central tower. This open side has bars over it, but is otherwise entirely exposed to the tower. The guards can thus see the entirety of any cell at any time, and the prisoners are always vulnerable and visible. Conversely, the tower is far enough from the cells and has sufficiently small windows that the prisoners cannot see the guards inside of it.

The sociological effect is that the prisoners are aware of the presence of authority at all times, even though they never know exactly when they are being observed. The authority changes from being a limited physical entity to being an internalized omniscience- the prisoners discipline themselves simply because someone might be watching, eliminating the need for more physical power to accomplish the same task. Just a few guards are able to maintain a very large number of prisoners this way. Arguably, there wouldn’t even need to be any guards in the tower at all.”

“Michel Foucault, a French intellectual and critic, expanded the idea of the panopticon into a symbol of social control that extends into everyday life for all citizens, not just those in the prison system (Foucault 1970). He argues that social citizens always internalize authority, which is one source of power for prevailing norms and institutions. A driver, for example, might stop at a red light even when there are no other cars or police present. Even though there are not necessarily any repercussions, the police are an internalized authority- people tend to obey laws because those rules become self-imposed.”

* ie almost all the time.

A final thought:

The tories are trying to kill me.
And a LOT of other people.
And they’ve already killed so many.

Black people. Muslims. People of Colour.
Migrants, particularly guess what, black people, muslims, people of colour.
Disabled People. Mad people.
Trans* people
Queers
The ‘wrong kind’ of women.
Working class people

*

Think about what it’s like for those of us who tick most or all of these boxes.

Try to conceive of the firestorm that we’re living in.

quotes are from here Internalized Authority and the Prison of the Mind: Bentham and Foucault’s Panopticon

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I Won by Sam Ambreen

{CN for suicide, self harm, mental health}

13 months after my personal independence payments were cut, I won my 2nd tribunal. 13 months of crowdfunding my rent. 13 months of reducing my food intake, buying the cheaper brand, going without, and feeling humiliated but on Friday, a panel ruled in my favour. There was no objection from the DWP representative who, I could have sworn, was even crying at one point. I felt bad for scowling at her after that!

I self harmed 4 times during that period, when I absolutely could not comply with the measures I’ve worked at to protect myself. I dissociated more frequently. I got as far as buying the instruments I would need to end it. Drew up a plan. Resisted writing the suicide note because that would make it final, and only because the people around me pulled through when I shared my invasive thoughts (a thing I was only able to do because I’d been taught, by my first therapist). They reminded me I’d managed to survive this long because people wanted to help me. They made me think about the people who look to me for strength and how my demise would impact on them. I didn’t really care in that split second but when the feverish urges passed I felt a bit sheepish I’ll admit. People do take strength from my courage.

When the DWP cut me off and sent me their decision, they said they were not disputing the fact that I had these disabilities just whether or not I qualified for personal independence payments. 13 months on and I’ve just been told I do. So was it really necessary to put me through this? What is its purpose otherwise? Survival of the fittest? It’s not strictly true anymore though is it? I’m nowhere near the fittest but I have recourse; to advocates, to friends who work in the public sector and health professionals who actually listen. Perhaps this mum didn’t?

Even with all the support I have, I came the closest I ever have to ending it. I didn’t enjoy asking for help, again and again, I was isolated and lonely as a result. I might be an anarcho-communist but I still have the hardwiring of a society that celebrates charity as a virtue but not if you’re on the receiving end. The shame still lingers. I didn’t want to die, I felt I had no other choice.

Recently I read about a young woman called Holly Cowlam who took her own life when she was diagnosed with depression. Holly had been studying psychology and so had some understanding of mental health. I get the sense, because she knew her chances in life would be greatly affected, as they are in a society that demonises mental health, she felt she had no other option. I know what that’s like; the shame and hopelessness. I refused to acknowledge my own mental health for 20 years, telling myself I was stronger than those others who had succumbed. In the end, you can’t really prevent it. I am the sum total of all the violence and treachery inflicted on me but with the right support, and freedom, and protection, I know I can get better.

holly-cowlam

What I do not need, and could have really done without, was being treated like I’m making it up. As a repeat victim of sexual and domestic violence, gaslighting is a straight up trigger for my PTSD. Being treated like I am insignificant and somehow asking for more than what is my right, having paid into a system for many years and on an emergency tax code more often than not (I did a lot of temp work because I was sick even then only I wouldn’t admit it) eventually wore me down in a way my mental and physical conditions do not, because I believe I can overcome them (to an extent). I needed time and space to heal not to be hindered by a cruel and abusive process.

Advocates for humanity must ramp up the pressure on this government and demand justice for all those who’ve needlessly died in our country. The architects of social cleansing must be tried for their crimes against our humanity.

You can judge a country by the way it treats its animals/poor/prisoners/women/disabled folk.

Republished (23/02/19) by kind permission, Sam Ambreen blogs at Left At The Lights

If you need help dealing with the DWP see our Advice Links page.

Note: PIP application processes generally require disclosure of diagnoses, medication, and supporting evidence, making it significantly discriminatory and arduous for many people. Professionals are often uninformed about how best to help people, this is a good guide.

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Unrecovery Artwork In The Wild

RITB wild_edited-1

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’.

RITB wild_edited-2

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.

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.