Motherhood, mental illness and beyond

Posts tagged ‘disability’

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.

Is this year’s theme for Mental Health Awareness Week a bit of an own goal?

This week is Mental Health Awareness Week in the UK. Each year a different theme is chosen and this year the Mental Health Foundation have chosen physical activity. Their website says that “This year’s Mental Health Awareness Week aims to shift our motivation for physical activity to something we choose to do to increase our wellbeing”.

This makes sense, as it has become conventional thinking in recent years that exercise and other physical activity can increase the production of endorphins in the brain. And of course exercise doesn’t necessarily mean a 5 mile run – as this helpful page from the MHF website explains physical activity can include housework, gardening, going for a walk etc.

Unfortunately this theme for the week doesn’t seem to have been properly thought through. For a start the message being promoted through social media already seems to have shifted from ‘choosing to do physical activity to increase wellbeing’ to ‘exercise will help your mental health problems’. The Twitter hashtag #letsgetphysical is being used to enthuse about the benefits of gym visits rather than gardening. This isn’t the fault of the MHF of course, but it could have been foreseen and it isn’t helped by the MHF’s use of the the quote “It is exercise alone that supports the spirits, and keep the mind in vigor” (Marcus Tullius Cicero) in their leaflet about physical activity.

Another problem with having physical activity as the week’s theme is that there are many people who have both mental illness and physical disabilities. Whilst a lot of these people will be able to undertake some form of physical activity there will be a significant number who can’t. And what of those whose mental illness is severe enough that they struggle to get out of bed, let alone go for a walk? As I understand it the idea that physical activity can help mental health only seems to apply to relatively mild conditions.

In fact, increased physical activity can actually have a detrimental effect on some people with mental illnesses. Those with ‘invisible’ disabilities such as CFS and fibromyalgia may well find that increased physical activity increases their fatigue which could put them at greater risk of depression. Speaking as someone who struggles to walk for more than a few minutes and at times finds it impossible to do any kind of housework, being repeatedly told that I need to increase my levels of activity is unhelpful as it makes me reflect on my increasing loss of mobility and lowers my mood. Those who suffer from eating disorders may also find this advice counter-productive, if not downright dangerous.

Some have already complained that this focus on physical activity as a kind of panacea for mental illness is almost akin to victim-blaming. There are already tweets under the #letsgetphysical hashtag asking why, if exercise is so good for mental health, sufferers wouldn’t get off their backsides and just do it? (Note again the confusion between exercise and physical activity). The implication seems to be that those who aren’t out pounding the pavements in order to beat their mental illness obviously don’t want to get better. This is damaging.

The final problem I want to discuss is that for some people exercise and other physical activity simply isn’t that effective. Some years ago I was enrolled in an ‘exercise prescription’ programme where I was able to use a local gym and go to classes for a pound a time. It was good and I enjoyed it – but it did nothing to help my crippling depression. For me, medication and a great support network are the most effective form of treatment and I know I’m not alone.

I’m not saying that the MHF shouldn’t have chosen this as their theme for Mental Health Awareness Week; it’s obviously quite successful in getting people talking and I’m sure there are many who will be helped by the message. However those who cannot partake in physical activity and those for whom it is a risky or ineffective treatment are being ignored and excluded by the very organisations that are supposed to support them.

Oh and one last thing. The #letsgetphysical hashtag means that I’ve been humming Olivia Newton-John for the last 36 hours. Not cool, MHF. Not cool.

But you don’t seem the type…

Friends are often surprised when I mention my mental health problems. To me it feels as though I’m walking around with a brand on my forehead, marking me as separate from all the ‘normal’ people. But others never seem to see me this way; typical responses include “But you’re so cheery!”, “I would never have guessed” and my personal favourite “But you don’t seem the type!”.

Then once it’s out in the open a lot of people never mention it again. Which is good in a way, because it hasn’t affected our relationship. But it also means that I don’t know what that person is thinking – whether they are comfortable around me still or whether they’re just going through the motions, waiting for me to  ‘go mental’.

In contrast to this are the reactions I get to my physical disability. I have degenerative disc disorder and frequently need to use a walking stick. I get a lot of sympathy and friendly interest from strangers as well as friends. No-one has ever told me that I “don’t seem the type” to have a physical condition, although as a woman in my thirties using a walking stick I do sometimes get odd looks. 🙂

So what’s the difference? Stigma, misconceptions and ignorance. One in four people will suffer a mental health problem at some point yet it is still taboo; people talk about mental illness in hushed tones and using euphemisms. Depression is often seen as a sign of weakness and thanks to misconceptions and inaccurate media portrayals many people are scared by illnesses like bipolar disorder or schizophrenia.

A physical injury or illness is usually more obvious than a mental illness and more easily understood. Because of the taboos surrounding mental illness quite often people don’t understand what it can be like. You can understand what it would be like to have a broken leg, right? Can you understand how it would be to have depression so badly that it’s impossible to get out of bed or speak to people?

Mental illness is often viewed as a sign of weakness, that if the sufferer merely pulled themselves together they would be fine. But no-one thinks this way about physical illnesses because it would be ridiculous. No-one tells a diabetic to stop taking insulin and yet people taking anti-depressants are often encouraged by friends and family to stop.

Is there a point to this rambling ranty post? Yes, a very simple one. If someone tells you that they or someone they know is suffering from a mental illness, please pause before you react. Think, would you react this way to news of a physical illness? Having a mental illness can be incredibly isolating and a lot of sufferers feel ashamed – together we can change that.

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