Category: Mental Health

DWP is trying to co-opt GPs in forcing ill people into work

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Yesterday on Twitter, I posted one of my previous posts – Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died in which I discuss a letter addressed to a GP regarding a seriously ill patient. It said:

We have decided your patient is capable of work from and including January 10, 2016.

“This means you do not have to give your patient more medical certificates for employment and support allowance purposes unless they appeal against this decision.”

The patient, James Harrison, had been declared “fit for work” and the letter stated that he should not get further medical certificates. 

However, 10 months after the Department for Work and Pensions (DWP) contacted his doctor without telling him, he died, aged 55. James clearly wasn’t fit for work. 

The GP had stopped issuing medical certificates when the DWP told him to. It is completely unacceptable that James Harrison was left struggling without support, when he was clearly very ill. It is also unacceptable that James’ GP was given instructions from the state – that caused harm – without James’ knowledge. 

The certificates – so-called fit notes – demonstrate the government seems to have some difficulty in recognising that sometimes people get ‘sick’ and require support via the provision they have paid into.

Austerity: When the state takes money from the public and hands it out to millionaires

David Cameron, however, had other plans for the UK. He said: “We simply have to get to grips with the sicknote culture that means a short spell of sickness absence can far too easily become a gradual slide to a life of long-term benefit dependency.

“The new welfare bill – described as the biggest shake-up of the system since it was set up 60 years ago – is designed to say end the culture of the fit and healthy being able to refuse work being rewarded for staying at home.”

However, the statement isn’t coherent. He infers that people are recovering from a brief period of illness and then refusing to return to work. As we have learned at great human cost over the last few years, this legislation has destroyed the lives of thousands of people who are ill. It was always intended to take away support from those who need it most. That is evident in the Conservatives’ incoherent attempt at a justification narrative, propped up by the right wing media. 

It never seemed to have crossed Cameron’s mind that 1) people’s medical conditions may worsen, they may have a chronic or degenerative illness. Being chronically ill does not make a person ‘benefit dependent’, it simply makes them ill. 2) The public contributes to the treasury, which is in part a funding mechanism towards social security and other state provisions, via tax and national insurance. This is done on the understanding that the state ensures citizens can meet their basic survival needs. The Conservatives have clearly stated they have ‘other’ ideas on how our public funds should be spent, which does not include meeting the needs of the public.

The state is responsible for handling public funds. It is unacceptable that such contentious neoliberal ideology is being used by the Conservatives to dismantle state provision for those who need it most, while deliberately targeting the poorest citizens with austerity cuts. Meanwhile, millionaires are rewarded with generous tax cuts from the public purse. At the time when the welfare reform act was passed, millonaires were handed a tax cut of £107,000 each per year. This callous and unjustified approach to social administration is destroying people’s lives and has profoundly damaged our democracy and society, while seriously and systematically violating the human rights of the UK’s most marginalised groups.

It is very worrying that the clearly dangerous ESA65B form is a standardised response to GPs from the DWP following an assessment where someone has been found fit for work.  I discussed some of the raised issues further in another article from last year that I posted on Twitter yesterday – GPs told to consider making fit notes conditional on patients having appointment with work coach 

It’s even more worrying that the part clarifying ‘fit notes’ should continue if a person is appealing a ‘fit for work’ has been removed from the standard letter, and a line added that says: “In the course of any further consultations with […] we hope you will also encourage [the patient]in [their]efforts to return to, or start, work.” 

I always worry when the government uses the words “encourage”, “help” and “support” in the context of policies and political practices that affect disabled people. They are usually techniques of neutralisation – euphemisms for the actions embedded in punitive and harmful policies.

This growing practice of the state intruding in the confidential relationship between a GP and patient undermines trust, it damages the professionalism and clinical expertise of doctors and threatens the safety and wellbeing of patients. It shrinks the safe spaces for citizens to escape the increasingly oppressive practices of the government. It turns GPs into non-neutral agents of the state.

We know from the high rate of success at appeal for Employment and Support Allowance claims that the DWP’s decision making regarding ill and disabled people’s ‘work capability’ is truly atrocious and negligent, and there is absolutely no convincing empirical evidence that “work is a health outcome”. (See: Work as a health outcome, making work pay and other Conservative myths and magical thinking.)

Last year, jobcentre staff were forced to withdraw guidance that urged GPs in Leeds to use deceitful tactics to attempt to get people who are ill off social security support and into work. The shocking guidance asked doctors to send patients for a 45-minute session with a “Patient Coach” – without mentioning that the coach actually worked for the the DWP.

It was even suggested that GPs withhold sick notes unless patients agreed to attend an appointment with the work coach. 

This is a tactic many of us have previously warned of – the government attempting to co-opt doctors to police ill and disabled people, pushing them into work, regardless of whether or not it is appropriate or safe to do so. But it also indicates the direction of travel for healthcare in the UK. The government intend to make that provision conditional also. (See Tories propose nudge, big business AI initiative and ‘personal responsibility’ in place of adequate health care funding.)

The government is forcing people who are ill into either work or into poverty, and both  outcomes are absolutely ethically unacceptable, a violation of rights, authoritarian and very dangerous. Increasingly, poverty is being used as a weapon to coerce people into work. However, many jobs are not paying enough for people to meet their living costs, so it is no guarantee that work will alleviate poverty.

The government seems to think that citizenship rights ought to be entirely conditional on people being economically useful to the government.

If we fail to be so, we are being treated as disposable political commodities. But citizens are not a means to state imposed ends and ideological aims in wealthy so-called first world democracies. And democratic governments don’t generally impose ‘behavioural change’ techniques on citizens, or professionals, for that matter, in order to make them complicit in the abuse and oppression of marginalised groups. The state is increasingly policing and punishing the poorest citizens, leaving them completely isolated and without any reliable support whatsoever.

The ESA65B is a form of tyranny

On the DWP’s ESA65B GP’s letter template most recently placed on the government site, titled “Help us support your patient to return to or start work” it says: “We assessed [Title] [First name] [Surname] on and decided that [select] is capable of doing some work, but this might not be the same type of work [select] may have done before.

“We know most people are better off in work, so we are encouraging [Title] [First name] [Surname] to find out what type of work [select] may be able to do with [select] health condition or disability through focused support at [select] local Jobcentre Plus.

“In the course of any further consultations with [Title] [First name] [Surname] we hope you will also encourage [select] in [select] efforts to return to, or start, work

“Please do not give [Title] [First name] [Surname] any more fit notes relating to [select] disability/health condition for ESA purposes.

Minister for disabled people, Sarah Newton, responded to one of several Written Questions from Emma Dent Coad, saying: “The ESA65B letter is issued to GPs in every case where an ESA claimant has been found ‘fit for work’. This process was built into the IT system as part of the introduction of ESA in October 2008. 

“Following a Ministerial requirement by the Cabinet Secretary, which was endorsed by the Secretary of State for Work and Pensions, the content of the ESA65B letter has been improved in order to explain to GPs the type of support customers can expect to receive from their local Jobcentre, and to ask GPs to encourage customers in their efforts to return to work.” [My emphasis]. 

GPs are trained and tasked to objectively address health and wellbeing , they should not be co-opted as government ideologues.

The decision to change the letter template was made without any scrutiny from or consultation with parliament and the public. It’s worth reading the series of questions by Emma Dent Coad. Prompting accountable and transparent answers from Sarah Newton appears similar to an exercise in pulling teeth. The responses given display the arrogance, contempt and delusions of an authoritarian government.

When people become ill, they make an appointment with my GP, and not the secretary of state for work and pensions, and for very good reasons. People need support and treatment, not someone spouting ideologically orchestrated dangerous claptrap about how work is ‘good’ for them. It seems the notion of convalescence and recovery are incompatible with the government’s aim of “getting Britain working”.

Catastrophically inaccurate assessments within the DWP are the norm. The government are intentionally reducing access to essential support and services for ill and disabled people, and this ideological attack is causing material hardship, suffering, distress and sometimes, it is killing people. 

The contentious “fit for work” assessment is forcing severely ill people to look for work and sanctioning them if they’re exhausted, in too much pain to get out of bed, while delays in social security are forcing cancer patients to food banks, and the bedroom tax results in bed-bound ill and disabled people facing horrifying threats of eviction. 

These are the direct consequence of intentionally punitive government policies, which aim at enforcing ‘personal responsibility’ and ‘behavioural change’ on those citizens with the fewest choices.

Dan Carden’s letter to Amber Rudd

I was pleased to see Liverpool Walton MP Dan Carden’s letter to Amber Rudd (below) which addresses some of the concerns many of us have raised. He also notes that without a GP’s ‘fit note’, (the Conservative’s Orwellian rebrand of the sick note) it isn’t possible for people challenging Department for Work and Pensions (DWP) decisions to claim Employment and Support Allowance (ESA) in the interim period, until their appeal is heard at Tribunal. 

Indeed, people who have lodged an appeal against a wrongful decision have been blocked from claiming ESA while awaiting the hearing, due to the misleading letter routinely sent from the DWP to doctors. This prevents untold numbers of low-income claimants from accessing financial support while they wait for months on end to go to tribunal. 

Entitlement to ESA pending appeal is enshrined in the ESA Regulations to cover the whole of the period leading up the hearing. It is also possible to have the payment backdated to cover the Mandatory Review waiting period too – it can take over six weeks for the DWP to review their original decision, over which time people are left without welfare support.

However, ESA pending appeal is not paid automatically – people usually have to ask for it, and must provide fit notes from their GP, presenting these along with their appeal acknowledgment letter from the Tribunal Courts to their local Job Centre. The Job Centre should report back to the DWP who will arrange for ESA pending appeal to be paid.

It simply isn’t appropriate for the DWP to interfere in a GP’s professional and qualified judgement, especially given the high rate of successful ESA appeals, indicating just how poor the decisions issued by the DWP actually are concerning people’s capacity to work. 

Dan’s letter:

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Related

Jobcentre tells GP to stop issuing sick notes to patient assessed as ‘fit for work’ and he died.

Rogue company Unum’s profiteering hand in the government’s work, health and disability green paper

The new Work and Health Programme: government plan social experiments to “nudge” sick and disabled people into work

Tories propose nudge, big business AI initiative and ‘personal responsibility’ in place of adequate health care funding

 


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Twin brothers found hanging from tree in tragic suicide pact after benefits were cut

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Vulnerable twin brothers were found hanging from a tree in Greater Manchester within months of their social security support being axed by the Department for Work and Pensions (DWP), the Manchester Evening News reportsNeil and Paul Micklewright were found by someone walking their dog in Urmston on 31 July 2018.

Suicide notes were found in the brothers’ pockets, and similar longer notes were found “neatly laid out” on a table in their home. Police coroners officer David Wood told an inquest that when officers searched the brothers’ flat they found financial documents had been arranged in folders, the fridge and freezer had been emptied and defrosted, the fish tank had been emptied and cleaned, their clothes had been packed away in plastic bags, electrical appliances had been switched off, the batteries were removed from the smoke alarms and the beds had been stripped.

The two brothers, who are said to have “relied on each other most of the time”, were reported to have received £40,000 inheritance following the death of their mother which resulted in their benefits being stopped. However, it is also reported that neither brother had more than a few pounds in their bank accounts at the time of their deaths. Their sister Julie Gillaspy told an inquest that the twins were “too proud” to go back to claim social security and were suffering financial hardship in the months leading up to their death.

The inquest into the 52-year-old twins’ deaths heard that they were “gentle, kind and generous”, and had lived with their parents their entire lives.

 Gillaspy described the two men as “introverted,”  adding: “They were very close, sometimes to the exclusion of others.” She said that she had “struggled to understand” why her brothers took their own lives. 

The two suicide notes found in the pockets of the brothers and the two found left n their home were described by a coroner as “essentially identical”, and offered no real clue as to the reasons behind the apparent suicide pact, other than to say that they had “had enough”. 

But it was clear that the twins were vulnerable. “I think they struggled socially and I think it all just got on top of them”, Gillaspy said.

“They were very proud people who perhaps weren’t dealt the best hand in life.”

A post-mortem examination gave both brothers’ cause of death as hanging.

Wells said the brothers’ suicide pact “appeared to be a well-planned event”, he added: “All suicides are tragic but the death of two brothers in these circumstances is particularly tragic.”

Researchers and sociologists have identified several causes for rises in the rate of suicide in the United Kingdom; these include recent recessions, unemployment, austerity measures and loneliness. Research undertaken by Samaritans suggested that mental-health issues of middle-aged men and loss of masculine pride and identity are also major factors behind the high rate of suicide.

It is very difficult to establish a single cause of suicide, the reasons are often very complex. One of the thoughts that struck me when I wrote this is how inaccessible our social security system has become, especially for vulnerable people. One of the reasons for this is related to the stigma that has been attached to claiming support, which has happened at least in part because of utterly irresponsible political and media scapegoating narratives, as well as the government’s programme of punitive welfare policies. This made me very angry and also, terribly saddened, because those people who need support the most are being catastrophically let down by a dehumanising system.

There is no narrative from the inquest, as far as I know, that explains why the twin brothers had scarcely any money in their accounts to get by, given the reported circumstances of their inheritance. 

The Samaritans and other charities and campaign groups have called for a prioritisation of resources towards services aimed at suicide reduction and prevention. 

My own view is that unless we ensure people can meet their basic living needs as a society – such as ensuring that social security is accessible and covers the costs to secure food, fuel and shelter – citizens’ psychosocial needs will always be less of a priority, while they are struggling to survive. Abraham Maslow’s iconic hierarchy of human needs explains how psychological and social wellbeing is very much dependent on our physical wellbeing, and meeting survival needs. 

It is difficult to report on suicide. I try my best to do so responsibly and sensitively, while ensuring that the wider public are kept informed. It is important not to brush over the complex realities of suicide and its devastating impact on those left behind, and to also remain mindful of how an article is written, which may have potential consequences for others, including people who are vulnerable, or who identify with the persons who have died.

I know that researching and writing about suicide affects my own state of mind.

If you have been affected by this article, or if are experiencing distress and anxiety and don’t know who to talk to, the Samaritans (116 123) operate a 24-hour service available every day of the year. If you prefer to write down how you’re feeling, or if you’re worried about using the phone, or being overheard, you can email Samaritans at jo@samaritans.org

The Sanctuary (0300 003 7029 ) helps people who are struggling to cope – experiencing depression, anxiety, panic attacks or in crisis. You can call them between 8pm and 6am every night.

 


My work is unfunded and I don’t make any money from it. This is a pay as you like site. If you wish you can support me by making a one-off donation or a monthly contribution. This will help me continue to research and write independent, insightful and informative articles, and to continue to provide support others who are affected by the welfare ‘reforms’. 

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Amber Rudd’s masterclass in Doublespeak

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Yesterday, heartless Amber Rudd was accused of shrugging off ‘heartbreaking’ Universal Credit experiences and stories by suggesting they are about only “one or two” people. 

This is a government who tell us with a straight face that inflicting absolute poverty on the poorest citizens is somehow going to make them less poor. This ideological framework is also imposed upon people in low paid work, struggling to meet their basic living costs. So the government slogan “making work pay” is meaningless Orwellian tosh, as is the Conservative’s longstanding ‘culture of dependency’ thesis and ideological justification narrative for inflicting devastating cuts on those who can least manage to get by. 

The Work and Pensions Secretary made the outrageous comments after being confronted by the Mirror about flaws in Universal Credit.

For years many of us have published articles ranging from flaws in the social security system, affecting millions, to struggling readers who’ve been forced to food banks, as well as administrative ineptitude and bullying that has often had catastrophic consequences. The roll out of Universal Credit has caused hunger, destitution, deaths and suicides, let’s be frank and pay some attention to the empirical evidence, rather than expedient ideological soundbites.  

Amber Rudd told the Mirror: “Some of the criticisms that have come from various publications have been based on one or two particular individuals where the advice hasn’t worked for them.”

That statement flies in the face of empirical evidence. On this site alone there are MANY individual accounts of the harms arising as a result of Universal Credit. And to claim the reason for these harms is because “the advice hasn’t worked or them” is a serious and disgusting trivialisation of the psychological distress and trauma, the deaths, suicides, rising numbers of those facing hunger, hardship, and destitution that Universal Credit, combined with such systematic government denial and indifference, is causing.

She added: “But in the vast majority of cases, and I would urge everybody who hasn’t to take the opportunity to speak to work coaches, the sort of support that individuals get is a completely different approach to what they had previously.”

Yes. It’s not actually support. It’s a programme of discipline, coercion and punishment.

However it isn’t work coaches who have to live with the consequences of a system that was designed to be an increasingly standardised Conservative hostile environment. The government seem to believe that publicly funded public services should serve as a deterrent to people needing support from the public services they have paid into. 

What matters most is the accounts of citizens, which tell their experiences of the system, not of those administrating it. But citizens’ voices are being intentionally stifled, edited out and worse, their accounts are being re-written by politically expedient civil servants and government ministers. This presentation of ideological fictions and the use of gaslighting techniques is usually the preserve of totalitarian regimes, it’s not the behaviour one would expect of a democratic government in a so-called liberal society. 

Governments with such limited social intelligence don’t lie very convincingly, but they do tend to be hard faced and tenacious. The real horror is their utter indifference and lack of responsiveness: that they really don’t care. They continue to demand our suspension of belief and dizzying cognitive dissonance. The relationship between citizen and state is one of abuse, founded on gaslighting strategies.

Rudd added: “And it is delivered with professionalism and care and compassion.”

Sure. The kind of “professionalism, care and compassion” that leaves a terminally ill man without sufficient support to meet his most basic needs, or that leaves a pregnant mother in extreme hardship, homeless, and resulting in the loss of her unborn child. Or one that pushes people towards suicide.

There is very little empirical evidence of the “professionalism, care and compassion” that Rudd claims. Furthermore, the trivialisation and persistent denials of the harm, distress and extreme hardship that is being inflicted on people because of government policies are all utterly unacceptable behaviours from a government minister, reflecting a profound spite within policy design, a profound lack of political accountability and a profound indifference for the consequences of these behaviours on the lives of ordinary people.

In fact, former Universal Credit staff reveal call targets and ‘deflection scripts, which means staff having to block or deflect vulnerable claimants, telling them that they would not be paid, or would have to submit a new claim, or have a claim closed for missing a jobcentre appointment, or be sanctioned – a penalty fine for breaching benefit conditions – or go to the food bank.

One whistleblower said that her role often felt adversarial. She said: “It was more about getting the person off the phone, not helping.” That’s a very strange kind of “compassion.”

As researchers have concluded, Universal Credit is a complicated, dysfunctional and punitive’ system that makes people increasingly anxious, distressed, with some of the most vulnerable citizens in the UK being pushed to consider suicide, and it ‘simply doesn’t work.’ (See Universal Credit is a ‘serious threat to public health’ say public health researchersfor example).

devastating National Audit Office report last year about Universal Credit concluded that the DWP was institutionally defensive and prone to dismissing uncomfortable evidence of operational problems. Welfare secretary at the time, Esther McVey, felt the need to make a speech in July in which she promised that where problems arose in future the department would “put our hands up, [and] admit things might not be be going right”.

It’s also clear – in the words of the public accounts committee – that there is a “culture of indifference” within the DWP and wider government.

It’s time that government ministers started to listen to citizens’ voices, to service users – as well as campaigners, researchers, charities and the opposition Parties. And the United Nations – instead of presenting denials that policies are seriously harming people. But there is every indication that they won’t. 

Universal Credit’s malign effects are obvious to anyone who actually looks, and is willing to listen to the voices of those affected by this punitive, mean-spirited and fixated, theory-laden, ideologically driven, miserly provision, that was, at the end of the day, paid for by the very public who are claiming it.

Labour MP Maria Eagle flatly stated that Rudd’s comments are “not true” and are “out of touch”.

She said: “The entire design of the system puts people in debt and the benefit cuts accompanying its introduction have made it far worse.” 

Rudd was questioned by the Mirror after she said yesterday: “Maybe things that were  proposed previously weren’t effective or weren’t compassionate in the way that I want them to be.”

Mirror journalists asked if she could, ‘hand on heart’, say it was “compassionate” to double UC claimants this year, keep the two-child limit and keep the benefit freeze until 2020.

Rudd did not respond to the question, instead replying: “The overall product that is Universal Credit is absolutely compassionate.”

Product? That’s a very odd word to use for lifeline support – the public services that are our social insurance which people have paid into for those times when they need it. 

And using key words from a government strategic comms crib sheet – James Cleverly among others has also opted for the word ‘compassionate’ to describe the welfare ‘reforms’ – does not make those narratives the reality experienced by citizens who need to access support from public services. Saying it does not make it real. This is something the Conservatives seem to have overlooked – that their narratives don’t match people’s realities. That’s the problem with telling lies – the empirical evidence catches up with you sooner or later.

Starving people and leaving them in destitution is not ‘compassionate’. Using a publicly funded public service to deliver punitive and a blunt, coercive, authoritarian behavioural modification programme is not ‘compassionate’. These are the actions and narratives of a government dipping a toe into the realms of totalitarianism.

Rudd claimed that UC needs to be ‘improved’, including to make it fairer to woman, but also said it was a “vital reform delivering a fair and compassionate welfare system”, “by far the most important and crucial reform” and a “force for good”.

Yesterday, the high court concluded that the Universal Credit assessment is illegal. The first judicial review verdict of Universal Credit found that the cutting of severe disability premiums from those who had previously claimed ESA was discriminatory.  How many more legal changes will it take to make the government act with some decency and observe basic laws and human rights?

Ideological mythologies

Rudd went on to claim, somewhat incoherently, that the ‘old system’ was “broken”, “not a utopia that we should return to” and under Labour someone unemployed could receive “£100,000 housing benefit per year.”

The charity Fullfact submitted a freedom of information (FoI) request to the DWP in 2012, following the same claims from David Freud, among other Conservative minsters, that people claiming social security support were receiving £100,000 housing benefit per year. The figures in the response showed that over four out of every five Housing Benefit claims are below £100 per week (the equivalent of £5,200 per year) according to the September 2010 figures, while only 70 out of over 4.5 million recipients claimed over £1000 per week, around 0.001% of the total.

Even this is likely to overstate the number claiming £100,000 per year however, as a family would need to claim over £1,900 per week to hit this total. Previous FoI responses from the Department have suggested around five families were awarded this amount.

Ministers and the media repeatedly failed to highlight what is such a small number of the total, and printed screaming and misleading headlines that were inaccurate, without putting this into a wider context. While the evidence suggests that there are a small number of Housing Benefit claims of more than £100,000 per year –  around five – these cases are very much the exception rather than the rule. Focusing exclusively on these outliers without first putting them into context, where over 80% of claims are below £100 per week, has [intentionally] distorted the debate about welfare, aimed at de-empathising the public and providing a justification narrative for cuts.  

Other information drawn from the FoI request found that larger claims tended to come from larger families, and the average household size for people claiming over £40,000 was six. For more details, do check out the numbers in the request itself, which is available here.

People weren’t suffering profound distress, hunger, destitution, suicide ideation and dying because of the ‘old system’.

Perhaps ‘utopias’ are relative. What we are currently witnessing is not “compassionate” or a “force for the good”: it is the dystopic system of an authoritarian state inflicting punishment, discipline and coercion on our most vulnerable citizens.

It’s a state programme that dispossesses citizens, with catastrophic human costs, to fund the tax cuts demanded by a handful of powerful and wealthy vultures, who live lavishly within a culture of entitlement, while the rest of us are increasingly impoverished.

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Amber Rudd claims that Universal Credit is ‘compassionate’. She must have been taking lessons in Doublespeak again.

 

I originally published this as part of a larger article. 

 


My work is unfunded and I don’t make any money from it. This is a pay as you like site. If you wish you can support me by making a one-off donation or a monthly contribution. This will help me continue to research and write independent, insightful and informative articles, and to continue to provide support others who are affected by the welfare ‘reforms’. 

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A man ended his life when his ESA award was stopped, because he couldn’t find work

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Damien Lawler, who had a generous nature and a heart of gold. (Image: Karen Lawler)

Last year on 19 July, Karen Lawler found her son Damien, aged 34, dead at his flat in Newtown Court, Hull.

Damien killed himself after struggling to find work and his social security support – Employment and Support Allowance (ESA) was due to be stopped. Known as ‘Damo’ to his family, he was found dead in his flateast Hull, flat with a suicide note in his hand.

In the note, he wrote that he felt like a “hindrance” and “couldn’t carry on anymore” after having no success for the numerous job applications he had made. He also wrote that his ESA was due to be cancelled, and he was so terrified about being put on Jobseeker’s Allowance he was experiencing “stupid” panic attacks.

He wrote: “I’m sorry for all the pain and heartache I’m leaving behind. I love you with all my heart but I can’t carry on anymore.”

Damien’s mother, Karen Lawler, spoke of her heartache and described her son as someone “with a heart of gold”.  She said: “He never had much money but he would always give his last penny or his last cigarette to a homeless person on the street. He always had a care for the homeless.” 

“He had a wicked sense of humour and a heart of gold. He would do anything for anybody.”

Lawler, who found her son after letting herself into his home on July 19, 2018, said her son had been suffering depression for a number of years, and said more needed to be done to support people with mental health issues.  She said: “Damo was just so tired and exhausted with it all.

“There was not enough support for him.

“There’s just nothing there. He’s not the only one. The recent cases with males in Hull is going sky high because they can’t cope anymore.”

An inquest on Tuesday heard Ms Lawler took her son to his GP in November 2013 after he deliberately self-harmed, using a Stanley knife to cut off his toe nails. He was prescribed with anti-depressants but his mental health difficulties took a turn for the worse in 2017.

During a visit to his GP in January 2018, Damien revealed he had thoughts of self-harm and suicide. He was advised to return to the surgery for further consultation, but he did not follow through with the appointments.

Many people who are ill and struggling find it very difficult to keep appointments, especially when they face difficulties accessing acute services for help. Many need immediate help to follow from the first appointment, because by that time, they are in crisis. But all too often, people in terrible distress, with suicide ideation, are being told they must attend yet another appointment.

This system sets up a bureaucratic wall, placing an all too often insurmountable barrier between citizens in the greatest need – those least ability to cope with navigating the wall – and the services and support they need to access. 

We must also question the decision to end Damien’s ESA award, when he was so clearly ill and unfit for work. We must challenge a system that leaves people feeling as if they are some kind of ‘burden’ simply because they are ill.  

“There needs to be something there if they do not turn up for any appointments,” said Ms Lawler.  “They cannot just discharge someone. They need to try and find out why they have not come to the appointment. Maybe contacting a next of kin or something.

She added: “I don’t know what the answer is and I don’t suppose there is an easy answer but something needs to be changed. Something has got to change in Hull, it really has.”

I agree. Something has to change. The social security and health care systems no longer function to meet fundamental human needs. Instead they have been redesigned to provide as little support as possible at the lowest costs, while a host of private companies make profits at citizens’ expense. 

The Coroner, James Hargan, returned a verdict of suicide.

If you need help

Please, please talk to someone.

Samaritans (116 123)
 samaritans.org operates a 24-hour service available every day of the year. If you prefer to write down how you’re feeling, or if you’re worried about being overheard on the phone, you can email Samaritans at jo@samaritans.org , write to Freepost RSRB-KKBY-CYJK, PO Box 9090, STIRLING, FK8 2SA and visit http://www.samaritans.org  find your nearest branch.

CALM (0800 58 58 58) thecalmzone.net has a helpline is for men who are down or have hit a wall for any reason, who need to talk or find information and support. They’re open 5pm to midnight, 365 days a year.

Childline (0800 1111 ) runs a helpline for children and young people in the UK. Calls are free and the number won’t show up on your phone bill. 

PAPYRUS (0800 068 41 41) is a voluntary organisation supporting teenagers and young adults who are feeling suicidal. 

Depression Alliance is a charity for people with depression. It doesn’t have a helpline, but offers a wide range of useful resources and links to other relevant information depressionalliance.org 

Students Against Depression is a website for students who are depressed, have a low mood or are having suicidal thoughts. Bullying UK is a website for both children and adults affected by bullying studentsagainstdepression.org

You can also contact me on this site any time, too. I’m a good and experienced listener. I can also signpost people to organisations that can help.

 



I don’t make any money from my work. I have a very limited income. But you can help if you like, by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others affected by the Conservative’s welfare ‘reforms’. The smallest amount is much appreciated – thank you.

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The controversial Mental Capacity Amendment Bill gets second reading in parliament

DoLs

Under the Conservative government, applications for the Deprivation of Liberty of citizens have soared. (Source: Court of Protection hub.

MPs debated the second reading of the Mental Capacity (Amendment) Bill in the House of Commons on Tuesday 18 December 2018.

The Bill amends the Mental Capacity Act 2005, which provides a statutory framework for people who lack capacity to make decisions for themselves. The Bill is based on the recommendations of the Law Commission report Mental Capacity and Deprivation of Liberty, which was published together with the Law Commission’s draft Bill in March 2017. 

I wrote an analysis of the Amendment Bill  back in October, outlining some serious concerns about the lack of safeguarding under the government’s proposals – Government changes to Mental Capacity Act threatens human rights of vulnerable citizens. 

Over the last eighteen months, the Law Commission – a statutory independent body created by the Law Commissions Act 1965 to keep the law of England and Wales under review and to recommend reform where it is needed – has been reviewing the framework that is called Deprivation of Liberty Safeguards (DoLs) which is put in place when a person who lacks capacity is placed in a care home.

Deprivation of Liberty, which is defined in part of the Mental Capacity Act 2005, is there to ensure that there are checks and balances for the person placed in care, that decisions are made in their best interest and that an independent advocate can be appointed to speak on their behalf in these decision making processes.

The Commission made recommendations to change the law, following public consultation. The recommendations included:

  • Enhanced rights to advocacy and periodic checks on the care or treatment arrangements for those most in need.
  • Greater prominence given to issues of the person’s human rights, and of whether a deprivation of their liberty is necessary and proportionate, at the stage at which arrangements are being devised.
  • Extending protections to all care settings, such as supported living and domestic settings, therefore removing the need for costly and impractical applications to the Court of Protection.
  • Widening the scope to cover 16 and 17 year olds and planned moves between settings.
  • Cutting unnecessary duplication by taking into account previous assessments, enabling authorisations to cover more than one setting and allowing renewals for those with long-term conditions.
  • Extending who is responsible for giving authorisations from councils to the NHS if in a hospital or NHS healthcare setting.
  • A simplified version of the best interests assessment, which emphasises that, in all cases, arrangements must be necessary and proportionate before they can be authorised.

However, the Law Commission recognised that many people who need to be deprived of their liberty at home benefit from the loving support that close family can provide. These reforms, which aimed to widen protections to include care or treatment in the home, were designed to ensure that safeguards can be provided in a simple and unobtrusive manner, which minimises distress for family carers.

Importantly, the Commission also recommended a wider set of reforms which would improve decision making across the Mental Capacity Act. This is not just in relation to people deprived of liberty. All decision makers would be required to place greater weight on the person’s wishes and feelings when making decisions under the Act.

Care professionals would also be expected to confirm in writing that they have complied with the requirements of the Mental Capacity Act when making important decisions – such as moving a person into a care home or providing (or withholding) serious medical treatment. 

The government responded and put forward proposals for changing the Mental Capacity Act. However, though this new legislation has been worded carefully, its effect will be to risk the removal of key human rights; it also ignores the entire concept of best interests and has put decision making power over people’s liberty and rights in the hands of organisations and their managers with a commercial interest in decisions and outcomes.  

Any statutory scheme which permits the state to deprive someone of their liberty for the purpose of providing care and treatment must be comprehensible, with robust safeguards to ensure that human rights are observed. 

In July 2018, the government published the Mental Capacity (Amendment) Bill, which if passed into law, will reform the Deprivation of Liberty Safeguards (DoLS), and replace them with a scheme known as the Liberty Protection Safeguards (although the term is not used in the Bill itself).

The Bill draws on the Law Commission’s proposals for reforming DoLS, but generally does not address some of the wider Mental Capacity Act reforms that the Law Commission suggested. Proposed reforms around supported decision making and best interests are not included, for example, and these omissions are very controversial.

In a statement accompanying the proposals the government claims that £200m per year will be saved by local authorities under the new scheme, though the increased role of the NHS and independent sector providers will lead to increased costs elsewhere.

The new responsibilities being imposed on care homes, Clinical Commissioning Groups (CCGs) and hospitals will need some thought, resources and training.

Members of the House of Lords have already warned that the Bill to reform the law on deprivation of liberty does not adequately secure the rights of people subject to restrictive care arrangements. In Parliament’s first debate on the Mental Capacity (Amendment) Bill on 16 May this year, peers questioned several elements of the legislation. 

The Liberty Protection Safeguards are designed to provide a much less bureaucratic system than DoLS for authorising health and social care arrangements that involve a deprivation of liberty to which a person cannot consent.

The proposed Bill has been widely criticised because it contains insufficient safeguards and is not fit for purpose in its current form. It requires serious reconsideration and extensive revision.

The Law Society says that the Bill is not fit for purpose: “While agreeing that simplification is needed and acknowledging that there are resource constraints, these constraints are “insufficient justification for not implementing fully the safeguards recommended by the Law Commission.” 

Their Briefing also sets out six recommendations for change, reflecting what the authors feel should be the principles underpinning the new framework and why they are concerned that the Bill does not meet those principles, as it includes:

  • an already overly complex scheme being further complicated by a replacement scheme which instead of placing the cared-for person at the centre of the process, significantly dilutes and even removes the existing protections for them
  • the risk of increased burdens on local authorities who will bear ultimate responsibility for mistakes and poor implementation rather than building on the learning from the problems with DoLS and retaining those elements that have been effective whilst removing those which are unnecessary and bureaucratic
  • the cared-for person will not be at the centre of the process but side-lined with decisions being made without proper or even basic protections
  • the removal of the invaluable role of Best Interests Assessors and Relevant Person’s Representatives would leave vulnerable people without protection from unnecessary detention.

You can read the Law Society’s full Briefing here: Parliamentary briefing: Mental Capacity (Amendment) Bill – House of Lords committee stage (PDF 196kb).

I was pleased that the concerns I had raised in my original article were also voiced by MPs yesterday, though I remain very concerned that further safeguarding amendments to the Bill were unsuccessful.

SteveH
SteveH

comment mental Health billSee also:

Law Commission report: Mental Capacity and Deprivation of Liberty 

Watch Parliament TV: second reading of the Mental Capacity (Amendment) Bill

Transcripts of proceedings in the House of Commons Chamber are available in Hansard online.

 


I don’t make any money from my work. I am disabled because of illness and often struggle to get by. If you want to, you can help by making a donation to help me continue to research and write informative, insightful and independent articles, and to provide support to others.

 

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Government changes to Mental Health Capacity Act places human rights of disabled people in jeopardy

Picture

Under the Conservative government, applications for the Deprivation of Liberty of citizens have soared. (Source: Court of Protection hub.) 

Last month I wrote an article about the government’s under the radar proposed changes to the Mental Capacity Act, raising my concerns about how it threatens human rights – Government changes to Mental Capacity Act threatens human rights of vulnerable citizens.

Deprivation of Liberty, which is defined in part of the Mental Capacity Act 2005, is there to ensure that there are checks and balances for a person placed in care, that decisions are made in their best interest and that an independent advocate can be appointed to speak on their behalf in these decision making processes. The government asked the Law Commission to review the legal framework that is called Deprivation of Liberty Safeguards (DoLs) which is put in place when a person who lacks capacity is placed in a care home. The Commission made recommendations to change the law, following public consultation. 

However, the government has not included all of the recommendations in their Bill.

The new legislation has been worded carefully, and its effect will be to risk the removal of key human rights; it also ignores the entire concept of best interests and has put decision making power over people’s liberty and rights in the hands of organisations and their managers with a commercial interest in decisions and outcomes.  

Any statutory scheme which permits the state to deprive someone of their liberty for the purpose of providing care and treatment must be comprehensible, with robust safeguards to ensure that human rights are observed. However, the proposed Bill has been widely criticised because it contains insufficient safeguards and is not fit for purpose in its current form. It requires serious reconsideration and extensive revision.

The Law Society has issued a rather damning briefing on the Mental Capacity (Amendment) Bill 2018 that moved to a Lords committee stage in early September.

The Society says that the Bill is not fit for purpose: “While agreeing that simplification is needed and acknowledging that there are resource constraints, these constraints are “insufficient justification for not implementing fully the safeguards recommended by the Law Commission.”

Inclusion London have also raised grave concerns about this amendment Bill:

“Right now the government is pushing a new law through Parliament that will make it easier to deprive someone of their liberty if they are judged unable to make decisions for themselves. It could mean people are forced to live in care homes because it’s cheaper and easier for the local council even though it’s not what they want or need.

“It’s hugely important as many people as possible sign our petition. We need to let the government know there is widespread opposition to their proposals. Please sign our petition to help us change the bill:

38 Degrees Petition to protect the human rights of people receiving care and support

“In July 2018 the government introduced The Mental Capacity (Amendment) Bill in Parliament.  The Bill will amend the Mental Capacity Act 2005 (MCA).  It will affect the human rights of over 300,000 citizens in England and Wales with conditions including dementia, learning difficulties, autism and brain injuries, as well as their families and supporters”

Inclusion go on to say: “We recognise the existing system needs to change, but not in the way proposed by the Bill. We are very much concerned that the bill weakens the existing safeguards that people have and does nothing to ensure support and care is provided in a way that promotes and maximises Disabled people’s liberty. 

In fact the Bill will make it easier to deprive Disabled people of their liberty.  We are also concerned that there has been very little consultation with Disabled people who will be affected by the Bill.

“We are working together with People First Self Advocacy, other Deaf and Disabled People’s (DDPOs) Organisations, lawyers and academics to ensure the Bill is changed.

“We want as many DDPOs and self-advocacy groups as possible to get involved in this work.  Please let Inclusion London know if you are interested and we’ll keep you in the loop.

Read Inclusion London’s briefing about the Bill, it will tell you exactly what changes the government wants to make and what our main concerns are:

Briefing on Metal Health Capacity Amendment Bill

Easy read version: Briefing on Mental Health Capacity Amendment Bill- Easy Read

And please sign their important petition: 38 Degrees Petition to protect the human rights of people receiving care and support

 


 

Universal Credit is a ‘serious threat to public health’ say public health researchers

UC

Some citizens in the UK have ended up in an unprecedented and darkly absurd position of having to explain and prove over and over to a cruel and harmful government that their cruel and harmful policies are cruel and harmful.

Recent research has verified that Conservative welfare policies are damaging, yet the government simply denies this is the case.

New research conducted for Gateshead council highlights that Universal Credit, another cruel and harmful policy, is detrimental to peoples’ mental health, because it increases depression and anxiety. 

Public health researchers say that Universal credit has become a serious threat to public health after the study revealed that the stress of coping with the new benefits system had so profoundly affected peoples’ mental health that some considered suicide.

The researchers found overwhelmingly negative experiences among vulnerable citizens claiming Universal Credit, including high levels of anxiety and depression, as well as physical problems and social isolation, all of which was exacerbated by hunger and destitution.

The Gateshead study comes as the United Nation’s special rapporteur on extreme poverty and human rights, Philip Alston, prepares to publish a report of the impact of Conservative austerity in the UK. Alston has been collecting evidence and testimonies on the effects of the welfare reforms, council funding cuts, and Universal Credit during a two-week visit of the UK. 

This research is highly likely to raise fresh calls for the system’s rollout to be halted, or at the very least, paused to attempt to fix the fundamental design flaws and ensure adequate protections are in place for the most vulnerable people claiming it.

Approximately 750,000 chronically ill and disabled claimants are expected to transfer on to Universal Credit from 2019. Yet earlier this year, the first legal challenge against Universal Credit found that the government unlawfully discriminated against two men with severe disabilities who were required to claim the new benefit after moving into new local authority areas. Both saw their benefits dramatically reduced when they moved to a different Local Authority and were required to claim Universal Credit instead of Employment and Support Allowance.

The study findings are yet another indication of how unfit for purpose Universal Credit is. Six of the participants in the study reported that claiming Universal Credit had made them so depressed that they considered taking their own lives. The lead researcher, Mandy Cheetham, said the participant interviews were so distressing she undertook a suicide prevention course midway through the study.

The report says: “Universal Credit is not only failing to achieve its stated aim of moving people into employment, it is punishing people to such an extent that the mental health and wellbeing of claimants, their families and of [support] staff is being undermined.”

One participant told the researchers: “When you feel like ‘I can’t feed myself, I can’t pay my electric bill, I can’t pay my rent,’ well, all you can feel is the world collapsing around you. It does a lot of damage, physically and mentally … there were points where I did think about ending my life.”

An armed forces veteran said that helplessness and despair over Universal Credit had triggered insomnia and depression, for which he was taking medication. “Universal Credit was the straw that broke the camel’s back. It really did sort of drag me to a low position where I don’t want to be sort of thrown into again.”

Unsurprisingly, the report concludes that Universal Credit is actively creating poverty and destitution, and says it is not fit for purpose for many people with disabilities, mental illness or chronic health conditions. It calls for a radical overhaul of the system before the next phase of its rollout next year.

Alice Wiseman, the director of public health at Gateshead council, which commissioned the study, said: “I consider Universal Credit, in the context of wider austerity, as a threat to the public’s health.” She said many of her public health colleagues around the country shared her concerns.

Wiseman said that Universal Credit is “seriously undermining” efforts to prevent ill-health in one of the UK’s most deprived areas.

She added “This is not political, this is about the lives of vulnerable people in Gateshead. They are a group that should be protected but they haven’t been.”

The qualitative study of 33 people claiming Universal Credit and 37 welfare advice staff was carried out by Teesside and Newcastle university academics between April and October. It focused on those claimants with disabilities, mental illness and long-term health conditions, as well as homeless people, veterans and care leavers.

The respondents found that compared to the legacy benefits, Universal Credit is less accessible, remote, inflexible, demeaning and intrusive. It was less sensitive to claimants’ health and personal circumstances, the researchers said. This heightened peoples’ anxiety, sense of shame, guilt, and feelings of loss of dignity and control.

The Universal Credit system itself was described by those claiming it as dysfunctional and prone to administrative error. People experienced the system as “hostile, punitive and difficult to navigate,” and struggled to cope with payment delays that left them in debt, unable to eat regularly, and reliant on food banks.

The government claimed that people making a new claim are expected to wait five weeks for a first payment. That’s a long time to wait with no money for basic living requirements. However, the average wait for participants on the study was seven and a half weeks, with some waiting as long as three months. Researchers were told of respondents who were so desperate and broke they turned to begging or shoplifting.

Wiseman made a point that many campaigners have made, and said that alongside the human costs, universal credit was placing extra burdens on NHS and social care, as well as charities such as food banks. It also affected the wellbeing of advice staff, who reported high stress levels and burnout from dealing with the fallout on those claiming the benefit.

Guy Pilkington, a GP in Newcastle said that the benefits system had always been tough, but under Universal Credit, those claiming faced a higher risk of destitution.

“For me the biggest [change] is the ease with which claimants can fall into a Victorian-style system that allows you to starve. That’s really shocking, and that’s new,” he said.

A spokesperson for the Department for Work and Pensions (DWP) said: “This survey of 33 claimants doesn’t match the broader experience of more than 9,000 people receiving Universal Credit in Gateshead, who are taking advantage of its flexibility and personalised support to find work.

“We have just announced a £4.5bn package of support so people can earn £1,000 more before their credit payment begins to be reduced, and we are providing an additional two weeks’ payments for people being moved from the old system.”

That will still leave people with nothing to live on or to cover their rent for at least three weeks. The study focused on those less likely to be able to work – people with disabilities, mental illness or chronic health conditions. The DWP failed to recognise that this group have different needs and experiences than the broader population, which leave them much more likely to become vulnerable when they cannot meet their needs.

Vulnerable people are suffering great harm and dying because of this government’s policies. It is not appropriate to attempt to compare those peoples’ experiences with some larger group who have not died or have not yet experienced those harms. Where is the empirical evidence of these claims, anyway? Where is the DWP’s study report?

Callousness and indifference to the suffering and needs of disadvantaged citizens – disadvantaged because of discriminatory policies – has become so normalised to this government that they no longer see or care how utterly repugnant and dangerous it is.

The DWP are not ‘providing’ anything. Social security is a publicly funded safety net, paid for by the public FOR the public. It’s a reasonable expectation that citizens, most of who have worked and contributed towards welfare provision, should be able to access a system of support when they experience difficulties – that is what social security was designed to provide, so that no one in the UK need to face absolute poverty. It’s supposed to be there so that everyone can meet their basic survival needs.

What people in their time of need find instead is a system that has been redesigned to administer punishments, shame and psychological abuse. What kind of government kicks people hard when they are already down?

Imagine what that level of state abuse does to a person psychologically. 

Techniques of neutralisation and gaslighting 

The government’s denial and indifference to the needs of others are part of a wider, deplorable gaslighting strategy, which strongly implies that the cruel and harmful policy consequences are actually intended and deliberately inflicted.

I once compared the relationship between marginalised social groups, such as the disabled community, and the state with being in an abusive relationship from which you cannot escape. 

The Conservatives have persistently claimed, contrary to the ever-mounting evidence, that there is no ‘causal link’ between their punitive welfare policies and social harm, such as increases in premature deaths, suicides, distress, poverty, destitution, physiological and psychological harm.

The denials are grounded in techniques of neutralisationaimed at discrediting citizens’ accounts of their own experience. Cruel and harmful policies are described as “support”, “help” and “incentivising behavioural change”, for example.

Techniques of neutralisation provide simple and powerful rationales for why some people violate society’s norms, and they are used to explain to perpetrators and others why it was “okay” to act immorally. Matza and Sykes identified five separate techniques of neutralisation:

1) Denial of responsibility. (Saying repeatedly “There is no causal link established between policy and harm”, for example)

2) Denial of injury.  (Claiming that any abuse causing injury is somehow ultimately in the person’s ‘best interests’. Claiming that any evidence presented of injury is ‘just anecdotal evidence’, and dismissing it, for example).

3) Blaming the victim. (Saying people are ‘scroungers’, ‘parked on benefits’, ‘cognitively biased’, part of a ‘something for nothing culture’, and “we need to ‘change their behaviours’,”for example)

4) Condemning the condemners. (Calling those who challenge the government ‘scaremongers’, or implying they are liars, for example)

5) Appealing to a higher loyalty. (The ‘tax payer’, the ‘national interest’, the economy, ‘the best interests of the individual’. 

Within an abusive relationship, this kind of constant denial – gaslighting – blurs normative boundaries, and what we once deemed unacceptable somehow becomes an everyday event. But gaslighting is a strategy of abuse that is carefully calculated to discredit your account, and to manipulate you into doubting your own perceptions, accounts and experiences. 

The government have normalised cruelty and have fostered an abusive relationship with some of the poorest citizens – those historically most vulnerable to political abuse. That abusive relationship reflects a profoundly authoritarian imbalance of power and traditional Conservative prejudice, contempt and malice towards the most systematically disadvantaged citizens.

Watch Sarah Newton use techniques of neutralisation to discredit the robustly evidenced account of the United Nations, opposition shadow ministers and ultimately, the accounts of the citizens who they represent – many of whom submitted evidence of the harm they have experienced because of government policy to the United Nations.

If you have experienced any of the issues discussed here, or if you are feeling low or distressed for any reason, please talk to someone. The Samaritans can be contacted on 116 123 or email jo@samaritans.org. 

Update Philip Alston, the UN special rapporteur on extreme poverty and human rights, has published his report following his visit to the UK . In it, he also discusses a government ‘denial.’  

He says: “The Government has remained determinedly in a state of denial. Even while devolved authorities in Scotland and Northern Ireland are frantically trying to devise ways to ‘mitigate’, or in other words counteract, at least the worst features of the Government’s benefits policy, Ministers insisted to me that all is well and running according to plan. 

“Some tweaks to basic policy have reluctantly been made, but there has been a determined resistance to change in response to the many problems which so many people at all levels have brought to my attention.”

You can read the report in full here: https://www.ohchr.org/Documents/Issues/Poverty/EOM_GB_16Nov2018.pdf

I will write an analysis of the report in due course.

 



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