Welfare reform: chuck the nutter in the gutter


6:30 pm - January 4th 2009

by Laurie Penny    


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The tendency not to want to believe in mental illness festers across the Western world, and particularly in Britain, the nation that gave us Shakespeare, concentration camps and the stiff upper lip.

From the friends and families of sufferers to the upper echelons of government, the suspicion that mental health difficulties are forms of weakness – simple personality flaws that could be eradicated if more of these mentalists would jolly well buck up – informs policy and influences behaviour. We need to look this institutional prejudice in the face and call it what it is: outdated, destructive and desperately unhelpful.

The response of our government in boom times had been to quietly shunt the sick onto a government poverty package and tell us to be grateful. However, as incapacity levels continue to rise, the DWP’s new Work to Welfare policy threatens to shunt us just as quickly back to the jobcentre, telling us that we’re scroungers who were actually making it up all along. This comes in the teeth of a recession. Nice timing, Purnell.

Many of the 40% of Britain’s 2 million IB claimants who are unable to work due to mental health difficulties already have a few problems with paranoia. But, as the noted social theorist Kurt Cobain observed, that doesn’t necessarily mean that they’re not after you.

Because when any major political party talks about moving people off Incapacity Benefit, when they talk about instituting a system of interviews to ‘weed out’ benefit ‘scroungers’, we know that they’re talking about the mentally ill – those whose disabilities and challenges are most difficult to see and to quantify, often the poorest and most vulnerable members of society who have since Thatcher’s day been the first in the firing like when budget cuts needed to be made.

Employment law is one big area where the Disability Discrimination Act has so far failed to translate into action when it comes to the mentally ill. The argument goes something like this: it’s more risky and more costly for company x to hire person y if they suffer from a mental illness – after all, how is company x to know that that employee y won’t fall behind on their work, start slicing themselves up by the water-cooler or march into the office one day spraying slugs of hot lead death into co-workers and clients?

In fact: the mentally ill are statistically less likely to perpetrate violent crime, and far more likely to become victims of it.

But a subtler prejudice against minorities is inherent to the hypercapitalist machine – because yes, it is technically less costly for a firm to hire an individual who is entirely mentally well. By the same logic, it is also better business sense to hire someone who is neither physically disabled nor a female of childbearing age.

What happens when companies are allowed to set their own hiring policies purely on the basis of business sense is that a large amount of the nation’s talent remains untapped, and swathes of people who need to be in work more than almost anybody become dependent on the state. Individuals suffer, and the entire economic community suffers. Anti-discrimination legislation and hiring standards are not only essential for the advancement of true equality; they advance free nations both spirituality and economically.

What we need if we are to avert a genuine crisis both in employment and in public health is a radical restructuring of what it means to be a worker in the information age. It is also not enough just to whinge about current policy without suggesting viable alternatives.

So, what would a world with fewer stigmas against the mentally ill look like?

Fifty years ago, the idea of having ramps on public transport, in offices and public buildings in order to help the physically disabled participate in normal life would have sounded preposterous and wildly costly – now it is more or less accepted that the physically disabled have just as much drive to work and live as the rest of us, and should be aided in that goal. The same attitude needs to be applied across the board.

It would be a world in which flexible and part-time working is not only available but a respected and well-taken up practice required of all employers, in order to help the mentally disabled, the physically incapacitated and those with caring duties, including parents, to stay in appropriate work. It would be a world in which part-time work is supported by government benefits, allowing the hundreds of thousands of people with mental health difficulties who cannot cope with full-time work to participate more fully in the economic and cultural life of the nation.

It would be a world in which the many laudable grants, higher education places, work schemes and training projects set aside specifically for the physically disabled and other minorities are matched by similar schemes for the mentally and emotionally disadvantaged.

This is about socialism, but it isn’t just about socialism. It’s about creating a world that is fairer and more efficient, carrying every citizen with it. If the government really wants to leave no one behind – if it wants to move more of the mentally ill into rewarding, taxpaying work, rather than simply pare more fat from the already scrawny welfare state – we need to dare to dream of a society in which everyone can participate.

******

And with that, I’m going to go and exercise another of my dysfunctional coping mechanisms and have a little cigarette. I’d offer, but you wouldn’t want one. It’s fucking menthol *cackle*.

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About the author
Laurie Penny is a regular contributor to Liberal Conspiracy. She is a journalist, blogger and feminist activist. She is Features Assistant at the Morning Star, and blogs at Penny Red and for Red Pepper magazine.
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Reader comments


Well said, sister. I really hope your Utopia comes to pass, too, although I doubt it will. The medical check paperwork that you have to fill in when accepting a job today is almost more detailed that the friggn job application itself. Surely people today feel they must lie about their medical histories if they have had mental health issues, and just pray very hard that nobody ever does a proper check.

I’ve always found it interesting, too, when you talk to homeless people and/or guy sitting on the street, they always – ALWAYS – tell you at some point that they have serious mental health issues. I know it’s a cliche to interview homeless people, or people who are asking for change, etc, but I’ve done quite a bit of it and it always turns out that they have mental health problems that they’ve been in and out of treatment for. Always. Yet there they are, freezing and festering on the street.

I’d much rather my tax money went into supporting people who need the IB than bankers. Nobody every asked me, unfortunately.

2. Alisdair Cameron

Nice stuff, Laurie, but I seem to recall your saying on another thread (when I’d brought up MH, as I run an MH user project, etc) that you write for OneinFour magazine. Didn’t its last edition massively suck up to Purnell and co. I ask, because several user groups with whom I work, and various networks are (as a consequence) boycotting/not resubscribing…

AC: dude, you really want to read the last issue of One In Four – the lead article is about how Purnell admits that the government aren’t doing enough.

Also, on a wider note, the point of One In Four is that it’s a lifestyle magazine for people with mental health difficulties – it’s *not* about the politics of mental health. I wrote quite a lot of the last feature on welfare reform, much as I wanted to barnstormingly say ‘we’re all fucked!’, was geared towards how people with mental health difficulties can cope with the changes. It was about explaining what’s happening without scaremongering, nothing more, nothing less.

However – if, as you say, these user groups are boycotting, then we need to know how we’re letting them down. Feel free to pass on my work email address (laurie at socialspider dot com) or give me theirs, and I shall endeavour to respond personally in consultation with the editor.

4. the a&e charge nurse

The term mental illness is fraught with danger not least because it encompasses such a wide spectrum of conditions from schizophrenia to gambling addiction.

Yet leaving aside organic brain disorders like Huntingdons Chorea few, if any mental disorders have any PROVEN biological basis (lots of theories though).
The unsatisfactory position we have at the moment is that mental illness is something that is determined by a psychiatrist but without any biological evidence.
Needless to say there are studies which suggest that not even psychiatrists can always agree (amongst themselves) with the phenomena they are dealing with.

Take drug and alcohol dependence, are these really mental illnesses (as opposed to existential problems) – according to the Torygraph around 100,000 with drink/drug problems receive IB, a figure that has doubled in less than 10 years.
http://www.telegraph.co.uk/news/uknews/1531201/100%2COOO-drug-addicts-and-alcoholics-on-benefits.html

I understand that there are approx 2.6 mil claiming IB (at a cost of £12 billion, annually) – the figure 20 years ago was around 700,000 claimants.

Is modern life is making more people mentally ill or has the term mental illness become so ubiquitous that it is sometimes difficult to know what it is really meant to signify ?

‘Is modern life is making more people mentally ill or has the term mental illness become so ubiquitous that it is sometimes difficult to know what it is really meant to signify ?’

There’s more about this on my blog, but here’s a precis:

Yes, there are more people receiving IB now than there were a generation ago. No, this does not mean that all of the extra people are skivers who’d rather sit around watching Trisha and drinking milkshakes. The sweeping social change that has transformed society in the past fifty years has led to an increase in the numbers of those deemed unable to work due to mental illness for many reasons. Not only has society become more treacherous and unpredictable and the working world more stressful (especially in stonkingly pro-market, anti-worker countries which exempt themselves from working time directives) but more men and women are expected to hold down full-time jobs which are increasingly focused in the service, information and fourth-sector industries, meaning that it’s more important for these employees to be entirely mentally and emotionally on the ball. Simply put: as the labour market is changing and becoming more mentally and physically stressful, the mentally ill, whose care has been successively eroded by government after neoliberal government, are being left out in the cold..

Just look at Mind’s recent report on mental illness within parliament itself. Twenty-seven percent of MPs, Peers and their staff have personal experience of mental health difficulty, and one in three said work-based stigma and the expectation of a hostile reaction from the media and public prevented them from being open about mental health issues. This is a problem that touches everyone, and it isn’t going to go away if we collectively stick our fingers in our ears and sing a little song.

Statistically, whilst rates of severe mental conditions such as schizophrenia, bipolar disorder and other complaints which may have genetic components have remained stable, there does seem to have been a rise in the rates of depression, anxiety, compulstions and stress-related conditions. Many psychiatrists believe that some of the structures of modern life, including the modern workforce but also the wider implocations of industrialisation and social change, are partly to blame. That doesn’t mean that social change and industrialisation are bad: it simply means that we must accept mental illness as a challenge that cannot be overlooked in the modern age. It is our task as a generation to be equal to the pace of this change.

Laurie : Be careful when saying that mentally ill people aren’t any more likely than other people to be violent. There’s strong evidence that people with schizophrenia are – although the vast majority still don’t, the % who do is raised

http://www.ncbi.nlm.nih.gov/pubmed/12042226
http://www.ncbi.nlm.nih.gov/pubmed/11261644

Although drug abuse seems to be a much bigger risk.

The thing is, though, schizophrenia is not the same as depression which is not the same as anxiety problems… saying “the mentally ill are statistically less likely to perpetrate violent crime” is just as wrong as saying “the mentally ill are statistically MORE likely to perpetrate violent crime” – it depends on which mentally ill people you’re talking about.

Likewise, not giving someone a job because they’re spider-phobic or because they suffered from “mild depression” 10 years ago or because they were bulemic as a teenager and they’re now 30 would be a ridiculous decision (not least because a huge % of people would fit those criteria for a history of “mental illness”).

Not giving someone a job because they’re schizophrenic or severely bipolar is quite another thing. I’m sure there’s a case that such people should have special protection from discrimination, but it’s a difficult situation with arguments on both sides – it’s not at all *obvious* that they should, certainly not in the way that it’s obvious that ethnic & sexual minorities should have protection.

Likewise, rates of severe mental illness are not rising, rates of mild “mental illness” such as mild depression & anxiety may be (although it’s difficult to tell because people might just be more willing to admit to it nowadays) but I’m not sure they should be classed as illnesses.

If someone has schizophrenia, which is very highly genetic, and at the age of 18 they stop talking to people, spend all their time in their room and start to believe that ghosts are stealing their thoughts, I think most people would agree that they’re ill. (If not, get back to the 1960s, frankly.)

On the other hand if someone is otherwise fine but is having trouble sleeping because they’re worrying about the stresses of work, are they ill?

Maybe they are, but maybe they’re not, most people would probably say no (although most people might be wrong), and it’s a major question which current psychiatric diagnosis (DSM-IV) has just swept under the carpet.

8. Alisdair Cameron

Laurie, will be in touch on those groups: they’re not opposed to the mag per se, just feel that the benefit changes are already having a huge impact on lifestyle, and a ‘lifestyle’ mag could possibly have taken more of a stand.If you’re going to cover the subject of benefits, there’s no point being mealy-mouthed about things, as no other bugger is.

Regarding the modern life making more people ill (or not) debate, I could go on for 10,000 words, but feel there are a number of strands to this:

a) As alluded to by the A&E charge nurse, definitions matter. It can be argued that the anti-stigma message, or at least the tactics used to date, while worthwhile, have had unintended consequences. The ‘normalisation’ agenda, or the depiction of all MH lying along the one spectrum does assist in reducing prejudice, but sometimes leads to the less-than-helpful assumption by the worried well/slightly sad etc that they understand severe and enduring MH problems and also to think that they have a MH problem. Some may, but when resources are definitely finite, I’d be wary of pathologising regular but upsetting emotions.
b)This very mild MH problem sector (if indeed we even dub it MH, and not some othery phrase like emotional resilience/wellbeing) is a bottomless pit of ‘need’: not need in a strict clinical sense, but folk want a service to stop their unhappiness. the nearest match in their eyes are the already stretched MH services, so that’s who they ask for help. Should MH services be dealing with such folk? I’d most certainly say no and focus resources on severe and enduring problems,others may disagree.
c) everyone knows the Tories in the 80s shoved people on to Incapacity to massage unemployment figures. The ‘diagnosis’ of depression was attached to folk for diverse and inconsistent reasons (again pathologising folk who shouldn’t be). Another cluster of MH users, who aren’t or at least who muddy the waters.
d) Layard, Dame Carol Black and Purnell & co. Not a MH specialist or (out) user among them, but they have set the tone for MH for the future. The money’s going to go on a CBT practitioner for every street corner, six sessions from someone who’s done a fortnight-long course, and if you’re not sorted then tough, that’s your lot, oh, and forget about benefits. I exaggerate but look at IAPT and tell me there’s not truth in there: underpinning it all is the worklessness agenda, and the need, explicit in Layard (an economist) to keep workers happy and in their drone-like minimum-wage drudgery, and off the sick.
You and I may (rightly) think that a sane response to being in a shitty, low-security, min-wage job, with a touch of bullying etc on top would be to feel unhappy. Not so, for layard and purnell, who do seem to subscribe to the work makes you happy doctrine, and that not liking work is a sign of mental ill-health. Utter bollocks, as it all depends on the type of work, doesn’t it, but there again, they’ve never done shitty jobs, have they.
e) this naturally leads on to the stick approach, whereby lots of genuine (severe and enduring) mental health service users will have their human rights impinged upon, because they’ll be pressured into woefully inadequate and unsuitable CBT, little else,or lose their benefits. Try asking for other talking treatments, or carrots instead of the stick. Add in compulsory Community treatment, all about things being done to the user, not with.

“b)This very mild MH problem sector (if indeed we even dub it MH, and not some othery phrase like emotional resilience/wellbeing) is a bottomless pit of ‘need’: not need in a strict clinical sense, but folk want a service to stop their unhappiness. the nearest match in their eyes are the already stretched MH services, so that’s who they ask for help. Should MH services be dealing with such folk? I’d most certainly say no and focus resources on severe and enduring problems,others may disagree.”

I’d say they’re the ones who should be seeing the new CBT-R-Us therapists.

‘The tendency not to want to believe in mental illness festers across the Western world’

With good reason .In this country unemployment figures are kept down by signing people off as incapacitated because they are bit miz ( sad face ) or have achy backs irritable bowels and anything not provably a lie . 2·6 million people are claiming incapacity benefit (up from 740,000 in 1983), even though by the Government’s own estimates more than one million of them are not remotely disabled. ( God knows what the truth is ! )
The upshot is that taxpayers are being defrauded and their justifiable fury is directed at the mentally ill in as much as that refers to Borderline Personality Disorder. You want to make this even worse ? Well good luck I think everyone is sick of being conned and we cannot afford it .
The sort of regime you are nebulously describing would require Swedish tax levels even if it were possible .This would mean its not worth getting out of bed with UK property prices and natural wealth per capita .I would stay in bed and develop emotional problems , it shouldn’t be hard I`d pretty much want to die in such a country anyway.
On mental health it is not clear that the vast sums wasted on therapy have ever done any good for anyone . Lets cut that . On the other hand I am in favour of getting the ill out of our prisons off the street and back into institutions that can cope . On the endless penumbra of emotional problems . I sympathise ( more than I can possibly say) but this is vast spectrum. Agraphobia and anxiety related problems can indeed be debilitating for example , on the other hand a lot of people just like droning on about themselves (Me for example ).Much of this is just a lot of cock. There is already a great deal of support but the problem is lack of diagnosis and treatment .

Some things have to be faced alone and the only answer is to take courage and keep buggering on.

PS Brown on skivers

In the 2000 Budget, Mr Brown rightly concluded: “The problem of Britain’s most deprived areas is not necessarily a lack of jobs – in almost every case, these areas sit alongside, and within travelling distance of, labour markets with high levels of vacancies.” In his pre-Budget report the following year, Mr Brown said: “[The] increase in the number of people on sickness and disability-related benefits cannot be explained by a general decline in the overall health of the population.”

Dayum, I’d kill for a ciggie right now. I LIKE Menthol – St Moritz by preference.

Newmania,

Merry Christmas, old boy.

Alas, my friend – you are still a tragedy.

Are you seriously describing schizophrenia, alcoholism as ‘a bit miz’? ZZZZzzzzzzzzz. The only people I know who got a big bailout for being a bit miz this year were your pals the bankers – socialism/welfare/IB for the rich and all that. That’s been enough to make me very depressed. Got to go back to work tomorrow, and am just hoping that there’ll still work to go back to, etc, and all because the private sector’s stuck its sticky hands in the till to an even greater extent than all these loathed people on benefits…

I have to bugger on, though…

schizophrenia, – Is an obvious example of a diagnosable condition m, one end of the spectrum. Are you suggesting companies should be obliged to employ schizophrenics ?A an illness it does not deserve treatment above and beyond any other.

alcoholism – Does not exist . The answer is stop drinking and the extent to which it is a medical problem is highly debatable , it probably covers a welter of social emotional and medical problems . How exactly are you going to start handing out jobs to drinkers . That’s really going to work isn’t it ….

your pals the bankers

That was New Labour`s fault and New Labour`s policy and I would have much slower and more cautious protecting the tax payer. Not me matey

14. the a&e charge nurse

At least one authority (Oliver James) has claimed that rising rates of mental illness are directly linked to materialism and consumer culture fostered by the likes of Thatcher & Blair in the UK, but also evident in other countries which increasingly treat its citizens like commodities.
http://www.independent.co.uk/arts-entertainment/books/reviews/affluenza-how-to-be-successful-and-stay-sane-by-oliver-james-436485.html

James terms the condition “affluenza” and warns the consequence of our current lifestyle (for many) is the the three A’s” – anomie, alienation and addiction – it goes without saying that the USA is the epicentre of this alleged phenomena ?

Yeah, but Oliver James is, how to put it… a gimp. He uses phrases like “the low serotonin society”.

I can’t believe the Fleet Foxes named one of their best songs after him 😛

Interesting article. However, as someone with physical disabilities I’d really love to know where all these supportive projects, and particularly employers are. Things like Access to Work, and the DDA sound great on paper, but in reality DDA is toothless and of little practical value as it places the onus on the individual to take action. Something that frankly most disabled people are too busy being disabled to be in a position to do. Unfortunately until that changes, which doesn’t look likely considering the UK haven’t even ratified the UN convention on disability rights yet as the government is far too busy trying to exclude all sorts of clauses.
Whilst I agree with your point that the welfare reforms will hit the mentally unwell hardest, in practice its simply not beneficial to split disability into different categories for this purpose. The idea that physical access requirements should be provided is far from being accepted by the majority other than in perhaps a vague conceptual way and we are decades away from physical access being available in the majority of places.
Unfortunately what is needed most is a shift in attitude and the hype about scrounging benefits claimants is doing a very good job of shifting that attitude in the wrong direction.

Mental illness is a tough one. Even schizophrenia which was taken to be the archetype diagnosable singular mental illness is on the verge of collapsing into a number of very different diagnoses. Bi-polar disorder/ manic depression appears to be the new archetype.

Also, to take either the left (everyone’s a victim!) or right (everyone’s a scrounger!) is a dangerous line to take. I spoke with a psychiatrist in charge on one district about a year ago, who has treated mentally ill people all his life. He described a staggering increase in people turning up on his list who were not in an identifiable way mentally ill by any medical standards, but were generally a bit useless, a bit unhappy or just had a tendency to be unnecessarily violent or unsociable. So far as he could tell, despite them having nothing specifically wrong with them, they had just never been expected to take any responsiblity for their actions. I suppose one might describe these people as having ‘social problems’ but they are certainly now turning up on incapacity benefit, and they are starting to give people with real mental health problems a bad name.

19. Simon Canning

i can tell wobegone and others have never suffered mental illness….

i just love all the inexperienced views.

20. Simon Canning

to further that….

anti-stigma campaigning, including minds own, completely explains that very few people with serious mental illnesses actually look mad.

so any comments about requiring this visual nature are obviously unresearched, based on an inexperienced viewpoint and based around that rather typical “burn the witch” reaction that many like to have….

i would love to explain what it’s like to go through hell only to be told by a psych that nothing is wrong.

dissmissiveness is this systems game. anyone who disagrees is to be terminated.
or so it would seem.

21. the a&e charge nurse

Quite, Woobegone, a large pinch of salt is required whenever the ubiquitous Mr James crops up – I mentioned his stuff simply because of the apparent epidemic in mental distress that James attributes primarily to certain kinds of social conditions.

The so-called ‘sick society’ is not a new idea of course – and different groups do seem to react differently to stress.
Take doctors and nurses, nurses throw far more ‘sickies’ than their medical counterparts – why is that ?
Various theories have been put forward, including lower status, less control in the workplace, mostly female workforce (and hence hidden agendas like child care issues, etc, etc).

I do think it isimportant NOT to penalise those with serious mental health problems (like schizophrenia) because of an upturn in claimants – bendy girl is absolutely correct to point out that ATTITUDE is an incredibly important element when it comes to offering a humane form of assessment.

22. Alisdair Cameron

Are you psychic then Simon, because I know for a fact, that at least three of the above contributors have been in-patients (inc. myself, FWIW)

Simon,

Real, severe mental illness is probably the worst thing that can happen to someone. It’s at least as devastating as fatal physical illness, worse in many cases.

However, this doesn’t mean that everyone who is currently described as “mentally ill” is actually severely ill. 1 in 4 people are not, in any meaningful sense, mentally ill. Society would collapse if that were really the case.

Sincerely,
Woobegone
(citalopram 60mg/day for depression)
(author of academic papers on depression)
(doesn’t make assumptions about people he’s never met)

I’m surprised why the mentally healthy are the ones ranting about the not ill enough benefit scroungers. It actually should be the really ill that are the most offended and affected by the huge level of scrounging going on. I cannot for one second believe that the huge numbers of Mentally ill IB are real – unless there is something really wrong with London tap water. For me, the main cause of mental illness in the UK is boredom – it certainly drives me crazy.

PS – Woobegone, you don’t have to be depressed to antidepressants – you just need a good relationship wih a GP – and most of them are really friendly. Nevertheless, I hope you’re in a seretonin rich mood – and that it lasts a long time;)

Lilliput

25. trust me I'm a doctor

I am trying and failing to succeed with my vocational services guided volunteering get back to work plan… I really wanted it to work but BANG! suicidal again. I don’t choose this!

I HATE ALL THESE PEOPLE WHO TALK ABOUT WELLNESS RECOVERY ACTION PLANS AND EMPOWERMENT AND SUCCESSFUL MENTALLY ILL PEOPLE.

it is bullcrap.
pendulum, MDF, rethink, all these people are saying the same thing…..that with some support and therapy and the right meds everybody can cope and be successful and (more to the point) taxpayers. I don’t think these organisations help us in the long run. Yes, some people can get better, manage their condition, but some can’t. And all these organisations do is persuade the public that everyone can get well, the public end up getting more and more of a must try harder, pull your socks up attitude. Manage on your own, don’t be lazy, get it together, get a work ethic and stop scrounging.

Empowerment is not only a repulsive buzzword but also a sly way of turning people against an expensive group of needy people.


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