Motherhood, mental illness and beyond

Recover or else?

This morning I read this news story with a mixture of exasperation, anger and fear. The British government, having already made life close to unbearable for disabled people, are now turning their attention to another extremely vulnerable group: those with mental illnesses. It seems that spending 15% of the welfare budget on the sick and disabled is unsustainable (but apparently spending 21% on low income workers and 42% on the elderly isn’t a problem). So government ministers have come up with the idiotic brilliant idea of forcing people with depression or anxiety to attend therapy, and stopping their benefits if they’re unable to.

In response to this article I dashed off several quick objections to this proposal:

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It’s proven very popular on Twitter, having been retweeted over 200 times now, but now I’d like to explain these points properly.

1) You can’t force people into therapy and then expect them to get anything out of it. Whether it’s cognitive behavioural therapy, talking therapy or anything else, the individual has to be willing and able to undergo what can often be a traumatic and upsetting experience. Forcing someone who isn’t ready to go through this would be highly counter-productive, exacerbating the problem and further alienating the ill person.

2) No-one will trust a therapist who they know is focused on declaring them fit to work, come what may. Just as you wouldn’t automatically trust someone you met on the street, you don’t automatically trust a therapist. A relationship has to be built, slowly and cautiously, and trust must be earned. If you know that the person you’re supposed to be baring your soul to isn’t focused on what’s best for you but only on telling the government that you can work, that trust will be non-existent. In addition, the basic principle underlying psychotherapy is that clients give voluntary (ie not forced), informed consent; would therapists even be allowed to treat patients who attended under duress?

3) In most areas there’s a long wait for talking therapies and CBT, often a year or more. Are the government going to conjure therapists out of a hat as though they’re well-qualified rabbits? When funding for mental health services have already been drastically cut, how can thousands more people be forced into a system that’s already bursting at the seams?

4) “We know that depression and anxiety are treatable conditions”. Wrong – they *can* be treatable conditions. There are all kinds of depression and anxiety and some of them are permanent. Whilst most of the time depression and anxiety can be transient illnesses, passing with the right treatment, for some they are merely manageable with treatment and don’t go away. Being forced to attend further therapy is only going to make these illnesses worse.

5) “Cognitive behavioural therapies work and they get people stable again”. Wrong again – they *can* work. For some people CBT is an utter waste of time, as I can attest. There is no panacea for depression and anxiety, no one-size-fits-all cure. If there was then we wouldn’t be having this discussion!

6) Most of the welfare budget actually goes to the working poor through tax credits. Instead of targeting the ill and vulnerable yet again, why not legislate for companies to pay a living wage instead of having to top up incomes via welfare? As I wrote at the start of this post, only 15% of the welfare budget is paid to those who are sick and/or disabled. Why aren’t the government ensuring workers are paid a proper living wage, instead of having to pay 21% to people who work but are paid so little that they’re still impoverished? It couldn’t possibly be because vulnerable groups are easier to target, could it? Or perhaps ministers have fooled themselves into believing their own “scroungers” rhetoric.

7) Oh and let’s not forget the billions of pounds lost through legal tax avoidance, why not close that loophole while they’re at it? The Telegraph article states that “Estimates based on government figures suggest the state spends up to £1.4 billion a year – more than £3.5 million per day – on ESA for these claimants with mental health issues”. But other government figures have shown that over £5.1 billion a year is lost through tax evasion. The government is targeting the vulnerable instead of those who think they’re too good to pay taxes.

Many ill and disabled people have died within 6 weeks of being declared fit to work by ATOS, the company contracted by the UK government to reduce disability payments. How many more will die if this ill-considered idea is actually put into practice? Sadly we may soon find out, as pilot schemes are being rolled out in the near future.

One last thing. You are only one illness, one accident, away from becoming disabled yourself. 1 in 4 people in the UK will have a mental illness at some point in their lifetime. Although this government’s barbaric policy of targeting the ill and vulnerable may not affect you today, there’s no guarantee that it won’t tomorrow.

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Comments on: "Recover or else?" (9)

  1. souhaiteunevie said:

    This post is exactly what I had wanted to put into words. It has enraged me so much. I have been in therapy 12 years, nearly 13 and have only been able to start working these last 10 months. Forcing someone into therapy expecting instant results is not only ethically wrong, it is highly unrealistic. Mental health is a mental health condition because it is persistant and the very nature of it means it won’t just “go away” because you are being forced to get better. The NHS mental health services have been drastically cut in recent years, how do they expect thousands of new people to acess these services suddenly when the average waiting time is over a year anyway. Stupid proposal. Angry doesn’t even cover it!
    Anyway, great post, I hope more and more people take note of things like this, and stop this governments betrayal of those most vulnerable.

  2. Oh what another shitty decision they’ve made. I truly hope the trials show this can not be rolled out on a national scale.
    You’ve written so well as to why this is a stupid idea, there’s no need to add anything else.

  3. Claire S said:

    I can also see where they’re coming from. It would be wonderful if there was some way to get people who want to work back into work, where they would be able to earn enough money for a decent life without having to compromise and rely on state benefits. However, it would also be wonderful if everyone who was supposed to pay into the system properly did so, and everyone who took out of the system was doing so for legitimate reasons. In both cases, it is the minority playing the system, and yet the majority is suffering for it. At present, the government seems to be concentrating more on the minority who are unfairly taking advantage of the benefit system, and far less on the minority who are unfairly taking advantage of the loopholes in the tax system. The tax system is likely to be easier to fix, as it takes stronger legislation, good accountancy, and good tax lawyers to assess and sort. As a country, we’re pretty good at training people to do such work. We just need to have the motivation.
    Attempting to assess people who have been claiming benefits for ill health (of any kind) while not deserving of them, is like sweeping a minefield the old-fashioned way: with highly training people, lots of time and patience, and an understanding of the terrain and the task at hand. There is no quick fix, no one-treatment-fits-all, and no guarantee that the methods used will actually work.
    I applaud the suggestion, as it actually attempts to help people rather than force them. But it shows a deplorable lack of understanding of the issues facing people of any degree of ill health, and even less of how to treat them.
    Thanks for the attempt, government; come back and try again once you’ve researched a bit more.

  4. I work in a mental health ward.The cuts are evident all around.They are often short staffed and even when there are staff they are from agencies rather than NHS so have little understanding of patient needs.Most of the patients have extreme types of depression,bipolar etc and are prone to self harm.
    The unit tries to get them out of there ASAP but the majority always come back as they are not getting the relevant support outside.
    You are right.CBT does not work if you are not ready as I too had this.I only got 6 sessions on the NHS which is not enough (that was after a 7 month wait).
    I am now in private therapy which has been ongoing for two years.
    and i am far from “fixed”.

  5. My psychiatrist was made redundant. Where will they get all the professionals from to “help” the mentally ill?

  6. I tried to get therapy through the NHS, but they couldn’t offer me appointments that worked around my busy work schedule. I didn’t want to give up work, as it was the only thing keeping me going. When I questioned it, I was told that ‘most people’ who were as unwell as I was wouldn’t be working and therefore could come in for appointments whenever was convenient for the therapists and if I ‘really wanted’ to get better I’d consider giving up work to attend appointments. I begged and borrowed and went private instead; I was fortunate that this was an option. If they had more resource to offer people appointments that fit in with a work schedule, maybe fewer people would have to give up work to start with.

  7. in general the worlds governments seem to be marginalizing the “un-fit” …

  8. I have to laugh at suggestions like this – two main reasons (though the ones you suggest are great)

    Does he have any idea how difficult it is to get ESA? If you have managed to get ESA and your primary diagnosis is depression then six sessions of CBT (or even 24 for that matter) would probably be as much use as telling someone who needs morphine that they can get an asprin.

    And the main one is that anyone who is on ESA because of mental health issues would actually be delighted to get access to the right treatment. The only reason they aren’t getting the right treatment for them right now is because it isn’t available!

    It baffles me why this mental giant isn’t considering the truly difficult questions of the day. Like why do burgers come in packs of four and burger buns in packs of six?

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