New discriminatory regulations for PIP come into effect today

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A Department for Work and Pensions spokesperson has denied allegations that people with mental health conditions claiming Personal Independence Payment (PIP) are being treated differently to those with physical disabilities: “At the core of PIP’s design is the principle that mental health conditions should be given the same recognition as physical ones”, the spokesperson said.

“In fact, there are more people with mental health conditions receiving the higher rates of both PIP components than the DLA equivalents.

This Government is also investing more in mental health than ever before – spending more than £11 billion this year.”

However, following two independent tribunal rulings that the Department for Work and Pensions (DWP) should expand the scope and eligibility criteria of PIP, which helps both in-work and out-of work disabled people fund their additional living costs, the government is rushing in an “urgent change” to the law to prevent many people with mental health conditions being awarded the mobility component of PIP. The court held that people with conditions such as severe anxiety can qualify for the enhanced rate of the mobility component, on the basis of problems with “planning and following a journey”, or “going out”. 

The government’s new regulations will reverse the recent tribunal ruling and will mean that people with mental health conditions such as severe anxiety who can go outdoors, even if they need to have someone with them, are much less likely to get an award of even the standard rate of the PIP mobility component. The regulations also make changes to the way that the descriptors relating to taking medication are interpreted, again in response to a ruling by a tribunal in favour of disabled people.

The first tribunal said more points should be available in the “mobility” element for people who suffer “overwhelming psychological distress” when travelling alone. The second tribunal recommended more points in the “daily living” element for people who need help to take medication and monitor a health condition. 

It’s worth noting that the Coalition Government enshrined in law a commitment to parity of esteem for mental and physical health in the Health and Social Care Act 2012. In January 2014 it published the policy paper Closing the Gap: priorities for essential change in mental health (Department of Health, 2014), which sets out 25 priorities for change in how children and adults with mental health problems are supported and cared for. The limiting changes to PIP legislation does not reflect that commitment.  

PIP is defined by Capita, the private company employed by the government to carry out “functional assessments of disabled people as “a non means tested benefit for people with a long-term health condition or impairment, whether physical, sensory, mental, cognitive, intellectual, or any combination of these.” It is an essential financial support towards the extra costs that ill and disabled people face, to help them lead as socially and economically inclusive, active and independent lives as possible.

Who will be affected by the reversal of the tribunal rulings?

As I reported previously, from 16 March (today)  the law will be changed so that the phrase “For reasons other than psychological distress” will be added to the start of descriptors c, d and f in relation to “Planning and following journeys” on the PIP form. 

New guidelines circulated by the DWP instruct assessors to disregard the physical impact of mental illness, in relation to how the impairments affect a person’s mobility in completing a journey unaccompanied, which will effectively exclude them from eligibility to the higher mobility component of PIP.

This means that claimants with severe mental illness that impacts on their mobility will be refused the same level of financial support as people with physical disabilities.

It effectively means that people suffering with debilitating mental health conditions are to be denied equal access to the disability benefits system.

People with the following conditions are likely to be affected by the reversal of the independent tribunal’s ruling regarding PIP mobility awards, with conditions in the general category of “severe psychological distress”:

Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

A case study is included in the new guidance, which says: “Sukhi has sought an award under mobility descriptor 1f as she cannot follow the route of a familiar journey without another person.

However, the [decision maker] determines that because of the wording of mobility descriptor 1f (“for reasons other than psychological distress, cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid”), any problems following the route due to psychological distress are not relevant.”

PIP consists of two separate components – a daily living component and a mobility element – each paying a standard or enhanced rate, with the enhanced rate paying more than the lower rate. 

In response to the rulings, government have simply chosen to rewrite the law in a way that denies higher PIP payments for those claimants who would have benefited from the rulings, without consulting medical experts, disabled people, advocacy organisations and MPs – including the Work and Pensions parliamentary committee.

Responding to the new guidelines, Paul Farmer, chief executive of the mental health charity Mind, said: “The purpose of PIP is to cover the extra costs people incur because of a disability – decisions makers shouldn’t discriminate between disabilities on the basis of their cause, but decisions should be based on the impact of the disability.

People who struggle to leave the house without support may face the same costs whether their difficulties arise from, for example, a sensory disability or severe anxiety or other mental health problems.

Yet those making decisions about the level of support someone will receive will now be explicitly told to disregard those barriers if they are a result of someone’s mental health problem.”

He added: “This move undermines the Government’s commitment to look at disabled people as individuals, rather than labelling them by their condition, and completely goes against the Government’s commitment to putting mental health on an equal footing with physical health.

Meanwhile, the government’s own expert welfare advisors have said that the changes to PIP – affecting the mentally ill – should be delayed until they have been properly tested and “clearly understood”. 

The Social Security Advisory Committee (SSAC) said in their report that they are “particularly concerned” that overturning the tribunal’s ruling will cause confusion. They warn it is “not clear” how assessors will interpret the changes, raising concerns over a real possibility that claimants will not be “consistently treated”.

The committee have disputed ministers’ claims that emergency legislation must be rushed through today, suggesting the feared increase in costs has been “over-hyped”.

The government claimed the tribunal ruling would cost at least £3.7bn over the next five years – money which should go to “really disabled people who need it”, according to one minister.

The committees’ damning conclusions have sparked angry exchanges in the Commons, with some Tory MPs joining Labour and the Liberal Democrats in criticising the impact of the PIP regulations on some of the most vulnerable citizens.

However, Damian Green, the Work and Pensions Secretary, refused to allow MPs to vote on the changes – insisting that was “above my pay grade”.

Green also acknowledged “a handful of people” could now have their PIP payments cut, having been awarded higher sums in the last few months.

Debbie Abrahams, Labour’s Work and Pensions spokeswoman, said that contradicted repeated assurances – including by Theresa May – that no disabled people would lose money, with only new claimants affected.

And she said: “The Government’s decision to change the law on PIP is a clear example of the way people with mental health conditions are not given equal treatment.”

The SSAC have urged the DWP to consider “testing the proposed changes with health care professionals and decision makers to ensure the policy intent behind the regulation is clearly understood”.

They concluded: “The department should both (a) consult more widely with representative bodies and health care professionals; and (b) improve the estimate of likely impact before the changes are introduced.”

Answering an urgent question in parliament, Mr Green insisted the SSAC was “not challenging the decision” to tighten the criteria for PIP.

But he added: “We think there may be a handful of people whose appeals have gone through the courts in this very, very small period.”

While “that money will not be clawed back from them” they would receive lower PIP payments once those appeals were struck out by the new regulations.

In their recent Equality Analysis PIP assessment criteria document, the government concede that: “Since PIP is a benefit for people with a disability, impairment or long-term health condition, any changes will have a direct effect on disabled people. The vast majority of people receiving PIP are likely to be covered by the definition of “disability” in the Equality Act 2010.

By definition, therefore, the UT [upper tribunal] judgment results in higher payments to disabled people, and reversing its effect will prevent that and keep payments at the level originally intended. The difference in income will clearly make a real practical difference to most affected claimants, and (depending on factors such as their other resources) is capable of affecting their ability to be independently mobile, access services etc – all matters covered by the UN Convention on the Rights of Persons with Disabilities as set out at the start of this Analysis.”

It goes on to say in the document: “However, this does not necessarily mean that the increased payments that would result from the judgment are a fair reflection of the costs faced by those affected, or represent a fair approach as between different groups of PIP claimants.” 

I think it’s much less likely that the government’s decision to subvert the ruling of the upper tribunal reflects any consideration of a fair reflection of costs faced by those affected, or a “fair approach” between different groups of PIP claimants. 

The purpose of Upper Tribunals

The government introduced the restrictive regulations after losing two cases at tribunals, showing an utter contempt for the UK judiciary system. However, the UK tribunal system is part of the national system of administrative justice. 

Administrative law is the body of law that governs the activities of administrative agencies of government. It is designed to independently review the decisions of governments, and as such, it provides protection and promotion of fundamental rights and freedoms for citizens.

The Upper Tribunal is a superior court of record, giving it equivalent status to the High Court and it can both set precedents and can enforce its decisions (and those of the First-tier Tribunal) without the need to ask the High Court or the Court of Session to intervene. It is also the first (and only) tribunal to have the power of judicial review. (The Conservatives have a historical dislike of judicial review. See for example: The real “constitutional crisis” is Chris Grayling’s despotic tendencies and his undermining of the Rule of Law.)

The Tribunals, Courts and Enforcement Act 2007 created a new unified structure for tribunals and recognises legally qualified members of tribunals as members of the judiciary of the United Kingdom who are guaranteed continued judicial independence. This means that the judiciary is kept discrete from other branches of government. That is so that courts are not subjected to improper influence from the other branches of government, or from private or partisan interests.

Judicial Independence is vital and important to the idea of separation of powers. The intent behind this concept is to prevent the concentration of political power and provide for checks and balances. It has been significantly influenced by judicial independence principles developed by international human rights constitutional documents. in the application of the European Convention on Human Rights in British law through the Human Rights Act 1998, which came into force in the UK in 2000.

The government’s new regulations are a particularly autocratic move, aimed at simply overturning two legal rulings that the government did not like, partly because their zealotry concerning their anti-welfarism and “small state” neoliberal ideology has been challenged. The regulations were ushered in and imposed so that they would not be subjected to parliamentary scrutiny and debate or democratic dialogue with disabled people or groups and organisations that support and advocate for those with disability. 

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Work and Pensions Secretary Damian Green

Related

Two EDMs have been tabled to stop Tory cuts to disability support, with cross-party endorsement


 

I don’t make any money from my work. I am disabled because of illness and have a very limited income. But 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. The smallest amount is much appreciated – thank you. 

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Disabled people are once again confronting the spectre of social isolation – Jane Campbell

 

Superficially the UK leads the world on disability rights, but colossal cuts are undermining the progress made over the last few decades
 
Lady Jane Campbell at her home in Surbiton, Surrey
Lady Jane Campbell served on the House of Lords select committee reviewing the impact of the Equality Act. Photograph: Martin Godwin for the Guardian

On Monday, disabled representatives from disability organisations across England, Scotland and Wales presented reports to the UN Committee on the Rights of Persons with Disabilities in Geneva. It is now eight years since the UK ratified the UNCRPD with cross-party support and this is the committee’s first full examination of the UK’s performance.

So how are we doing? The government is fond of claiming that the UK is a “world leader” on disability rights. Superficially, this claim remains fairly accurate. We have the most comprehensive and proactive equality law anywhere in the world; social care legislation and practice that embodies the principle of choice and control; a social security system that claims to recognise the extra costs of disability; and law and regulations to advance accessibility.

It is important to remind ourselves of what disabled people have achieved over the past 30-40 years of disability rights activism, as we have charted our journey from objects of care and charity to becoming active, contributing citizens. But any assessment of progress cannot be confined solely to what we now have, or where we were in the past. And judging by the UK’s direction of travel, the government’s claim of world leadership quickly unravels: we are seeing big cuts to services and watering down of rights and opportunities of disabled people. 

Last year, I served on the House of Lords select committee, reviewing the impact of the Equality Act on disabled people. We found that this government’s deregulatory zeal and spending cuts significantly undermined the intended effect of the act. Employment tribunal fees, legal aid cuts and loss of advice services have put the act’s protection beyond the reach of most disabled people. And colossal cuts to the Equality and Human Rights Commission’s budget have left the act under-promoted and unenforced.

The UK’s mental health and mental capacity laws fail to comply with the CRPD, which stipulates that disability cannot be grounds for denying people equal recognition before the law or for depriving people of their liberty. Yet in England, there has been a 10% rise in detention each year for the past two years. More than half of these cases related to people with dementia, and a significant minority to adults with learning disabilities. The sanctioned use of restraint, seclusion and anti-psychotic medication remains commonplace on mental health and learning disabilty wards, violating people’s rights to physical and mental integrity and to live free from torture, inhuman or degrading treatment.

NHS benchmarking data revealed that there were 9,600 uses of restraint during August 2015 in mental health wards in England, while the Learning Disability Census 2015 found that one-third of patients with a learning disability were subject to the use of restraint in 2015-16.

Unexpected deaths of mental health in-patients, or those cared for at home in England, are up by 21% yet, unlike deaths in police, prison or immigration detention, there is no system of independent investigation. Since 2011, hospitals in England have investigated just 222 out of 1,638 deaths of patients with learning disabilities. Among deaths they classed as unexpected, hospitals inquired into just over a third.

The Care Act fails to ensure disabled people’s right to independent living, and swingeing cuts in health, social care and benefits are eroding the availability of support and people’s right to exercise choice and control. Disabled people are confronting the spectre of re-institutionalisation as councils and clinical commissioning groups limit the amount they spend on individual packages of support

The UN disability rights committee has already reported on the negative impact of the UK’s measures to cut social security spending. Yet further disability benefit cuts continue to be implemented and the extension of punitive sanctions to those hitherto assessed as unable to work is being proposed on the back of declining investment in employment support.

“Nothing about us without us” is the international motto of the disability rights movement, but there is little evidence of disabled people being involved in policy development. The last 10 years have seen the proportion of public appointees with a self-declared disability halve in number, while helpful measures to support more disabled people into politics, such as the Access to Elected Office Fund, have been suspended in England.

Advancing the rights of disabled people requires good leadership to establish coherence and coordination in Whitehall, and in devolved and local government. The Office for Disability Issues was set up for this very task, but has become a shadow of its former self. But in Wales and Scotland, things are more positive, with the convention firmly embedded in policy and strategy. 

If the UK wants to maintain the mantle of world leader on disability rights, it must see the forthcoming examination as an opportunity to listen and take stock. If it fails to do so, current and future generations of disabled people face the slow, inexorable slide back towards social death once again.

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Research finds damaging mental health discrimination ‘built into’ Work Capability Assessment. Again.

Research conducted by academics at Edinburgh’s Heriot-Watt and Napier universities confirms what many of us already knew: that the government’s “fit for work” assessment is causing permanent damage to some people’s mental health, from which they are not recovering. 

The researchers say in their report that the Work Capability Assessment (WCA) experience “for many, caused a deterioration in people’s mental health which individuals did not recover from”.

The study comes at the same time as John Pring, journalist from the Disability News Service (DNS) has exposed private provider Maximus in their use of “brutal and dangerous” questions about suicide intention directed at people with mental health problems during their assessments. 

Dr Jay Watts, a clinical psychologist and academic, told DNS that people should only be asked about suicidal ideation by a trained mental health professional who can offer help, or someone in an “existing trusting relationship with the individual”.

Watts said that WCAs were “degrading and humiliating experiences for most if not all claimants” and were carried out in a space which was “not a trustworthy one”.

She said: “Individuals are required to parade their distress and feel compelled to answer intrusive questions (for the means to live relies on this).”

She went on to say: “To ask about suicide or self-harm in this context brings huge risks.”

She added that such questioning “can be suggestive if the environment is unsafe.”

She said that claimants were “battered with multiple questions about that which is most personal” in disability assessments and questioned about suicide while the assessors are “typing away” on their keyboards.

Watts concluded: “I have no doubt that questions on suicidal ideation, and the degrading manner in which they are asked, are one reason behind the suicide spike associated with the WCA process.”

The tragic case of Michael O’Sullivan, who killed himself after being found fit for work by the government’s disability assessors, has also cast a spotlight on the harmful consequences of the work capability assessment, particularly in relation to people with mental health problems. 

Though O’Sullivan’s suicide is the first to have been judged a direct consequence of being found fit for work, the DWP has conducted 49 internal reviews into benefit-related deaths since 2012, according to data released following freedom of information requests by the Disability News Service.

Of these, no fewer than 40 were conducted following the suicide, or apparent suicide, of a person claiming benefit. This is both profoundly shocking and entirely unsurprising. It is the wholly predictable result of a system designed and operated by people who appear to lack even the most basic understanding of the realities of living with mental illness.

Despite providing reports from three doctors, including his GP, stating that he had long-term depression and agoraphobia, and was unable to work, O’Sullivan was taken off employment support allowance (ESA) and placed on jobseeker’s allowance. The decision to find him fit for work was made after an assessment by a Department for Work and Pensions (DWP) doctor, a former orthopaedic surgeon, who did not factor in the views of any of the three doctors treating O’Sullivan.

Work capability assessments discriminate against people with mental health problems and should be “redesigned entirely”, according to Professor Abigail Marks from Heriot-Watt University’s Centre for Research on Work and Wellbeing. This recent study also established, through dozens of in-depth interviews of people who had been through the tests, that “in the worst cases, the WCA experience led to thoughts of suicide”. Mental health charities said the contents of the interviews “reflect what we hear from people every day”.

The researchers interviewed 30 people with existing mental health conditions who had taken the tests throughout 2016. The majority of subjects suffered from depression or anxiety, whilst a smaller number had more complex issues like bipolar disorder or borderline personality disorder. In addition, the team interviewed individuals from advocacy organisations, Citizens Advice Bureau and a former employee of Ingeus, one of the private Work Programme providers.

Marks said: “It is unacceptable that healthcare professionals who act as assessors for the WCA, for example, physiotherapists, nurses, occupational therapists are not fully qualified or trained to assess mental health conditions, yet they seem to be able to override participants’ own GPs, community psychiatric nurses, and therapists.

The WCA must be entirely redesigned, and focus on the potential barriers to work for both physical and mental health problems.”    

The report also highlighted that WCAs make non-Work Programme work experience, or other voluntary work, almost ‘impossible’ for people with mental health conditions. 

Dr Gavin Maclean, research assistant at Edinburgh Napier University, said: “Many of the participants in the study found the experience of the WCA so damaging that they stopped engaging in work-based activity and did not return to it.

This could further reduce their long-term employability and potentially increase their dependency on benefits.”

Dr Sue Cowan, assistant professor of psychology in the School of Social Sciences, said: “For people with severe and enduring mental health conditions, voluntary work may be as ‘good as it gets’, as one of our participants stated.

This does not mean a failure to obtain more. Rather, it is a recognition that an individual is making a choice, and the current system does not recognise or support that in any way.

The assumption that engaging in voluntary work means an individual is fit for employment should be scrapped; there has to be much greater flexibility about undertaking training while on ESA and much greater value must be placed on voluntary work and work-preparation activity.”

The qualitative study highlights in particular a lack of expertise in mental health problems among WCA assessors and advice from the WCA that was not consistent with what people going through the assessment had been told by their own GPs. In one case recorded in the study, a participant recounted a doctor “actually physically gasping” during an appeal because of the poor quality of evidence recorded by a WCA assessor. 

Some participants reported being in tears or having panic attacks during the tests, and others told the researchers that the assessments were “making me feel worse”.

The researchers said that the extreme stress having to deal with multiple stigmas of being unemployed and having a mental health condition became “self-reinforcing and self-perpetuating”, leading to the deterioration of peoples’ condition.

It says in the report: “Our research has reinforced the fact that people with mental health problems face more stigma and discrimination than those with physical health conditions and that this discrimination is built into the WCA.” 

Professor Marks, the lead author of the study, who is based at Heriot-Watt University, told the Independent that people who worked closely with such cases reported that deterioration in mental health conditions was an “almost universal” response to the tests.

Key causes of extreme stress were said to be a claimant’s fear of losing their lifeline income, the prolonged nature of tests, a lack of specialist mental health training amongst assessors, and the fact the test was “clearly geared towards people with physical disabilities.”

This said, many people with physical disabilities have also stated that the WCA experience has had an adverse effect on their mental health. 

Marks says: “A lot of the people we spoke to were in a position where they are preparing to go back to work before their assessment – they were doing training courses, community initiatives, or volunteering.” 

“They said that after the assessment, because the assessment had caused them so much stress, they were unable to go back and take part in those activities because their mental health had had such a deterioration.

“Talking to the advocacy workers, as well, they said it was almost universal that after people had gone through an assessment there was a significant decrease in their mental health.” 

In October last year the Government announced that it would stop repeat Work Capability Assessments for people with chronic conditions, characterising the repeat assessments it was scrapping as “unnecessary stress and bureaucracy”.

Mental health charity Mind said the WCA was clearly “not fit for purpose” and that its lengthy and costly appeals processes could well make matters worse.

“The findings of this report are concerning but sadly not surprising, as they reflect what we hear from people every day,” Ayaz Manji, the charity’s policy and campaigns officer, said.

“People with mental health problems tell us that the current fit-for-work test causes a great deal of additional anxiety. We know the assessors rarely have sufficient knowledge or expertise in mental health, meaning many people don’t get the right outcome and then have to go through a lengthy and costly appeals process. 

“The current approach is not fit for purpose and needs to be replaced by an open and honest conversation based on each person’s individual needs.”

Debbie Abrahams, the shadow work and pensions minister, said the study was more proof that the WCA “is not only unfit for purpose, but is causing harm to some disabled people”.

She added: “That’s why I have committed Labour to scrapping these assessments completely and replacing them with a holistic, person-centred approach.”

As usual, a Department for Work and Pensions spokesperson dismissed the interviewees’ experiences as not “statistically significant”.

Apparently, qualitative data doesn’t count as “empirical evidence”, or contribute to it. Or put another way, if the government don’t want to count it, it doesn’t count.

The spokesperson said: “Only thirty people were interviewed for this report, which fails to acknowledge any of the significant improvements we have made to our assessments – particularly for people with mental health conditions.” 

“Last year alone at least 35,000 work capability assessments took place in Scotland to help ensure people get the right level of support that they need.”

In fact, 37 interviews were conducted for the study. Furthermore, there is much evidence outside of this study that supports the findings. Qualitative evidence often provides richer, more in-depth, detailed evidence than quantitative studies tend to permit. Yet the government insist that citizens’ own accounts are not important, regularly dismissing them as “anecdotal”.

The government have also failed to conduct a quantitative investigation into the established correlation between WCAs and a deterioration in mental health conditions.

In 2015, the “fit for work” tests, introduced to assess eligibility for disability benefit ESA, were again found to have caused relapses in patients with serious mental health conditions, Dr Jed Boarman, consultant with the Royal College of Psychiatrists, called for an  overhaul of the process.

Boardman, a consultant psychiatrist at the South London and Maudsley NHS trust, also said the WCA discriminates against those with mental health issues. 

Boardman, who treats patients with serious and long-term mental health problems, said: “People with severe long-term problems get very distressed about being assessed, probably because mistakes are made, because the process isn’t perfect, because they don’t feel they are being listened to in their interviews.

“You do see people relapsing as a consequence of getting distressed.”

His comments followed a study, published the previous month, that linked the WCA tests with an additional 590 suicides, increased mental health problems and hundreds of thousands of antidepressant prescriptions.

The study, published by the Journal of Epidemiology and Community Health, showed a correlation between worsening mental health and assessments under the WCA.

The Department for Work and Pensions described the study as “misleading.”

The study’s main author, Benjamin Barr, said it was crucial the DWP takes seriously concerns that WCAs are “severely damaging” mental health. He called on the department to release data it holds to researchers to allow further analysis of the health impact of the controversial test.

Boardman added: “Their primary criticism of our study is that we don’t have data specifically on people going through the WCA and consequent mental health problems,” said Barr, from the University of Liverpool. “They have data on who has died following the WCA and they could facilitate linkage of that data with health causes.”

Thousands of claimants have died after being found fit for work, according to statistics released in August 2015 by the DWP, following a freedom of information request and a determined and successful court appeal by Mike Sivier of Vox Political. Ministers insisted that the figures they have released could not be used to link claimant deaths to welfare reforms, but the government has refused to release figures that would make it possible to assess whether the death rate for people found fit for work is higher than normal.

Boardman and Mark’s concerns are echoed by psychologists and benefit advisers working with claimants, who say they have gathered a lot of qualitative evidence that WCAs cause much additional psychological distress for those with mental health issues.

Related

Maximus ‘admits’ using brutal and dangerous suicide questions – John Pring

Man leaves coroner letter as he fears Work Capability Assessment will kill him

Doctors bribed with 70-90k salaries to join Maximus and “endorse a political agenda regardless of how it affects patients.”

What you need to know about Atos

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

Dying from inequality: socioeconomic disadvantage and suicidal behaviour – report from Samaritans


I don’t make any money from my work. I am disabled because of illness and have a very limited income. The budget didn’t do me any favours at all.

But 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. The smallest amount is much appreciated – thank you.

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Generous welfare benefits increase the work ethic. The government is wrong about ‘perverse incentives’

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The UK establishment have intentionally created a scapegoating project. A dominant political and cultural narrative has targeted people needing social security support, constructing welfare folk devils and generating moral panic. This is to justify the dismantling of the welfare state, and to de-empathise the public to the plight of the poorest citizens. The government have misled the public, claiming social security provision leads to a “culture of dependency”. International research shows this is untrue.

Comparative research at an international level has undermined the government claim that the UK welfare state encourages “widespread cultures of dependency” and presents unemployed people with “perverse incentives”. 

study, which links welfare generosity and active labour market policies with increased employment commitment, was published in 2015. It has demonstrated that people are more likely to look for work if they live in a country where welfare provision is generous and relatively unconditional. Empirically, the research includes more recent data, from a larger number of European countries than previous studies.

The research also compared employment motivation in specific sub-sections of communities across countries: ethnic minorities, people in poor health, non-employed people and women, and adds depth to previous studies. It has been concluded that comprehensive welfare provision is increasingly seen as a productive force in society (Bonoli, 2012), that stimulates employment commitment (Esser, 2005) and supports individual inclusion and participation in society and the labour market, particularly among disadvantaged groups

Sociologists Dr Kjetil van der Wel and Dr Knut Halvorsen, from Oslo and Akershus University College, Norway, examined responses to the statement “I would enjoy having a paid job even if I did not need the money” presented to the interviewees for the European Social Survey in 2010.

In a paper published in the journal Work, employment and society, (published by the British Sociological Association and SAGE) titled The bigger the worse? A comparative study of the welfare state and employment commitment, sociologists compare the responses with the amount the country spent on welfare benefits and employment schemes, whilst taking into account the population differences between states.

The researchers found that the more a country paid to unemployed and disabled people, and invested in employment schemes, the more its population were likely to agree with the statement, whether employed or not.

They found that almost 80% of people in Norway, which pays the highest benefits of the 18 countries, agreed with the statement. By contrast in Estonia, one of least generous, only around 40% did. It’s also the case that the countries with the highest levels of financial support for those in need also have the highest employment rates, which challenges neoliberal antiwelfare narratives regarding so-called “perverse incentives” and their highly controversial and stigmatising “scrounger” rhetoric.

The UK was then considered average in terms of our generosity of benefit levels, and the percentage of subjects agreeing with the statement was almost 60%.  However, this research was carried out in 2010, prior to the radical changes to the UK social security system that happened with the Coalition Welfare Reform Act in 2012 and subsequent Conservative policies.

The researchers also found that government programmes which intervene in the labour market to support unemployed people in finding work made it more likely that those people agree that they wanted to work even if they didn’t need the money. In the countries with the most interventionist states, around 80% agreed with the statement and in the least around 45%. The UK’s response, though one of the least interventionist then (and is even less positively interventionist now), was around 60%.

In the article, the researchers say: “Many scholars and commentators fear that generous social benefits threaten the sustainability of the welfare state due to work norm erosion, disincentives to work and dependency cultures. 

A basic assumption is that if individuals can obtain sufficient levels of well-being – economic, social and psychological – from living off public benefits, compared to being employed, they would prefer the former. When a ‘critical mass’ of individuals receive public benefits rather than engaging in paid work, the norms regulating work and benefit behaviour will weaken, setting off a self-reinforcing process towards the ‘self-destruction’ of the welfare state. The more people are recipients of benefits, the less stigmatizing and costly in terms of social sanctions it is to apply for benefits.

However, other commentators suggested that because employment rates are higher in countries with generous welfare states, more people will have positive experience of work. People who receive generous benefits when out of work may feel more inclined to give something back to the state by striving hard to find work.

This article concludes that there are few signs that groups with traditionally weaker bonds to the labour market are less motivated to work if they live in generous and activating welfare states.

The notion that big welfare states are associated with widespread cultures of dependency, or other adverse consequences of poor short term incentives to work, receives little support.”

On the contrary, employment commitment was much higher in all the studied groups in bigger welfare states. Hence, this study’s findings support the welfare resources perspective over the welfare scepticism perspective.”

The UK government launched an unprecedented range of cuts on public services which happened between 2010 to 2015. However, the UK’s millionaires were awarded substantial tax cuts over that time period. George Osborne handed out a cut in tax that rewarded millionaires with £107, 000 each per year at the same time the welfare “reform” bill became policy.

The biggest percentage of cuts affected social security benefits and local government, which has adversely impacted on housing, local authority services and ultimately, on ordinary people in local communities. The cuts in social care and welfare fall disproportionately on two groups that overlap: people in poverty and disabled people. They fall hardest of all on people with the most severe disabilities, who need both benefits and social care.

Using an extremely divisive justification narrative peppered with words such as “workshy” and “scrounger”, and redefining what is “fair”, the government made out that UK tax payers were a discrete group from people needing welfare support, and that the latter group were a kind of economic free rider, sharing a “something for nothing culture”.  The government intentionally fostered resentment in employed people “paying taxes to carry the burden of those who won’t work”.

The Conservatives have persistently claimed that there are moral hazards and adverse behavioural consequences attached to providing poverty relief. This is a view shared by other neoliberal nation states, such as the US.

Policies represent perceptions and establish state instructions regarding how various social groups ought to be perceived and treated. They reflect how a government thinks society should be organised. They encode messages about how people ought to behave and how our individual degree of freedoms are defined, extended or restricted. Policies are always intentional acts that shape socioeconomic organisation.

The government have colonised left wing rhetoric, and conflated social justice and inclusion with work, making citizenship and human rights conditional, and contingent on a person’s economic productivity. They claimed to be “the party of workers”, yet the Conservatives have legislated more than once to undermine collective bargaining and trade unionism more generally. There has been a marked downward shift in wage levels and working conditions over the past six years, as well as drastic reductions in welfare support.

The word “reforms” is now a euphemism for cuts. Words like “support” and “help” are used as techniques of neutralisation, to divert people from the coercive, punitive and targeted elements of the “reforms”. These are semantic shifts of Orwellian proportions. 

The majority of unemployed people move in and out of work, indicating that policy, the economy and labour market conditions, rather than personal failings and dubious “cultures”, are the reason why people become unemployed. The tax payer/benefit claimant dichotomy is a false one. Everyone contributes to welfare, that is why national insurance was introduced: to pay for support provision that you may need in the future.

Furthermore, unemployed people pay taxes, and stealth taxes such as VAT contribute a significant amount to the Treasury. When social security benefits were originally calculated, they covered only the costs of food and fuel. It was assumed that people claiming support were exempt from council tax and paying rent. That is no longer the case, but benefit levels have not risen to adjust for this. 

The highest welfare spending has actually been on pensions, followed by in-work benefits. The latter subsidises employers paying low wages that don’t support families in meeting the costs of living. However, under the new Universal Credit, in-work support will be conditional and significantly reduced, especially for those families on low pay with children. 

The Conservative’s austerity cuts have disproportionally targeted the very people that a fair and civilised society should protect. This was justified partly by the global economic recession, though not everyone was expected to “live within their means” and contribute to reducing the national deficit. Remarkably, those that caused the recession appear to have got off free from obligation to contribute to the reduction of the debt, in a “low tax, low welfare society.”

The Conservative cuts were also justified by the perpetuation of a dominant neoliberal discourse based on small state ideology, antiwelfare myths and the purposeful creation of welfare folk devils and moral panic.

One consequence of the Conservative’s “reforms” has been the return of absolute poverty in the UK – some people cannot meet their basic needs and are going without adequate food and fuel. Many people have suffered distress, harm and some have died as a result of the government’s welfare regime. 

The Samaritan’s recent study – Dying from Inequality – links suicidal behaviours with socioeconomic deprivation. Their report says: “Suicide risk increases during periods of economic recession, particularly when recessions are associated with a steep rise in unemployment, and this risk remains high when crises end, especially for individuals whose economic circumstances do not improve. Countries with higher levels of per capita spending on active labour market programmes, and which have more generous unemployment benefits, experience lower recession-related rises in suicides.”

There is also a further extensive cost to human potential. As Abraham Maslow indicated, if people cannot meet their basic physical needs, they are not likely to fulfil psychosocial ones.

 christianity-and-social-justice-exploring-the-meaning-of-welfare-reform-29-638

Graphic courtesy of Dr Simon Duffy,  The Centre for Welfare Reform.

Related

A bad job is worse for your mental health than unemployment, say UK’s top psychologists

Dying from inequality: socioeconomic disadvantage and suicidal behaviour – report from Samaritans

The Minnesota Starvation Experiment provided empirical evidence that demonstrates clearly why welfare sanctions can’t possibly work as an “incentive” to “make work pay”


 

I don’t make any money from my work. I am disabled because of illness and have a very limited income. But 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. The smallest amount is much appreciated – thank you. 

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A bad job is worse for your mental health than unemployment, say UK’s top psychologists

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Last month, the following letter was sent to the Independent, titled The DWP must see that a bad job is worse for your mental health than unemployment:

“We, the UK’s leading bodies representing psychologists, psychotherapists, psychoanalysts, and counsellors, call on the Government to immediately suspend the benefits sanctions system. It fails to get people back to work and damages their mental health.

Findings from the National Audit Office (NAO) show limited evidence that the sanctions system actually works, or is cost effective.

But, even more worrying, we see evidence from NHS Health Scotland, the Centre for Welfare Conditionality hosted by the University of York, and others, which links sanctions to destitution, disempowerment, and increased rates of mental health problems. This is also emphasised in the recent Public Accounts Committee report, which states that the unexplained variations in the use of benefits sanctions are unacceptable and must be addressed.

Vulnerable people with multiple and complex needs, in particular, are disproportionately affected by the increased use of sanctions.

Therefore, we call on the Government to suspend the benefits sanctions regime and undertake an independent review of its impact on people’s mental health and wellbeing.

But suspending the sanctions system alone is not enough. We believe the Government also has to change its focus from making unemployment less attractive, to making employment more attractive – which means a wholesale review of the back to work system.

We want to see a range of policy changes to promote mental health and wellbeing. These include increased mental health awareness training for Jobcentre staff – and reform of the work capability assessment (WCA), which may be psychologically damaging, and lacks clear evidence of reliability or effectiveness.

We urge the Government to rethink the Jobcentre’s role from not only increasing employment, but also ensuring the quality of that employment, given that bad jobs can be more damaging to mental health than unemployment.

This should be backed up with the development of statutory support for creating psychologically healthy workplaces.

These policies would begin to take us towards a welfare and employment system that promotes mental health and wellbeing, rather than one that undermines and damages it.

Professor Peter Kinderman, President, British Psychological Society (BPS)

Martin Pollecoff, Chair, UK Council for Psychotherapy (UKCP)

Dr Andrew Reeves, Chair, British Association for Counselling and Psychotherapy (BACP)

Helen Morgan, Chair, British Psychoanalytic Council (BPC)

Steve Flatt, Trustee, British Association of Behavioural and Cognitive Psychotherapies (BABCP)”

“Making work pay” for whom?

pie wealth

It’s a draconian, crude behaviourist and armchair technocratic government that would claim to “make work pay” by decreasing social security support for the poorest members of society, rather than raising wages to meet the rising costs of living. This approach was justified by claims that poor people became “dependent” on benefits because the welfare state provides “perverse incentives” for people seeking employment. However, there is no empirical evidence of these claims. Keith Joseph, a leading New Right advocate of the welfare dependency theories, set out to try and establish evidence dependency during the Thatcher era, and failed. Both Thatcher and Joseph wanted to extend Victorian bourgeois values of thrift, self-reliance and charity among all classes.

Such an approach has benefitted no-one but wealthy employers motivated by a profit incentive, as people who are out of work or claiming disability related benefits have become increasingly desperate. These imposed conditions have created a reserve army of labour, which has subsequently served to devalue labour, and drive wages down. We now witness high levels of in-work poverty, too. The Victorian Poor Law principle of less eligibility had the same consequences, and also “made work pay.” It’s shameful that in 2017, the government still believe that it is somehow effective and appropriate to punish people into not being poor. Especially when the government’s own policies are constructing inequality and poverty.

Last week I wrote about the Samaritans report: Dying from inequality: socioeconomic disadvantage and suicidal behaviour, which strongly links socioeconomic disadvantage and inequality with psychological distress and suicidal behaviours. The report reiterates that countries with higher levels of per capita spending on active labour market programmes, and which have more generous unemployment benefits, experience lower recession-related rises in suicides.

Research has consistently found that in countries with a generous social safety net, poor employment (low pay, poor conditions, job insecurity short-term contracts), rather than unemployment, has the biggest detrimental impact on mental health. This is particularly true of neoliberal states with minimal and means tested welfare regimes. It seems health and wellbeing are contingent on the degree to which individuals, or families, can uphold a socially acceptable standard of living independently of market participation, and on the kind of social stratification  (socioeconomic hierarchies indicating levels of inequality) is fostered by social policies.

Furthermore, despite the government’s rhetoric on welfare “dependency”, and the alleged need for removing the “perverse incentives” from the social security system by imposing a harsh conditionality framework and a compliance regime – using punitive sanctions – and work capability assessments designed to preclude eligibility to disability benefits, research shows that generous social security regimes make people more likely to want to work, not less.

The government’s welfare “reforms” have already invited scathing international criticism because they have disproportionately targeted cuts at those with the least income. Furthermore, the government have systematically violated the human rights of those with mental and physical disabilities. In a highly critical UN report last year, following a lengthy inquiry, it says: “States parties should find an adequate balance between providing an adequate level of income security for persons with disabilities through social security schemes and supporting their labour inclusion. The two sets of measures should be seen as complementary rather than contradictory.”

However, the UK government have continued to conflate social justice and inclusion with punitive policies and cuts, aimed at coercing disabled people towards narrow employment outcomes that preferably bypass any form of genuine support and the social security system completely. 

See – UN’s highly critical report confirms UK government has systematically violated the human rights of disabled people.

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Kitty.

 


 

I don’t make any money from my work. I am disabled because of illness and have a very limited income. The budget didn’t do me any favours at all.

But 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. The smallest amount is much appreciated – thank you.

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A brief view of the budget

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He’s not very bright our chancellor, is he? Self-employed people face an increase in their National Insurance (NI) contributions as the Chancellor says he wants to “tackle the unfair burden on people in employment”. Presumably he means self employed people are not in employment. Yet they certainly aren’t included in unemployment figures, either. Last time I checked, employment means “the state of having paid work.”

That’s yet another broken manifesto pledge.

Gutto Bebb, Conservative Welsh minister, hit out at the proposals and called on the Government to “apologise.” Iain Duncan Smith added his voice to calls for a rethink of proposed changes to the National Insurance contributions after Hammond suggested that Brexit is responsible for the Government’s tax raid – conveniently mentioning Brexit for the first time regarding his budget. But he later denied that self-employed workers were paying the price for Brexit. Hard to keep up with what passes as the Conservative brand of reasoning and justification. It certainly makes me feel dizzy and nauseous, that’s for sure.

Hammond could have simply reduced the rate of NI that employees pay instead. He’s a bit of a wally. We did have a period of economic growth last year, second to only Germany, apparently. Good old Tories, eh?  Hurrah!

But I wonder who will benefit from that, assuming it’s really a growth in the economy? It won’t be disabled people claiming Personal Independence Payment (PIP) with severe psychological distress who can’t leave the house, that’s for sure. Or those suffering epilepsy, both types of diabetes and blackouts who need support with managing their treatments and monitoring their health conditions.

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A period of Orwellian growth. The economy is currently being propped up by increasing personal debt.  

All of these conditions in fact: Diabetes mellitus (category unknown), Diabetes mellitus Type 1 (insulin dependent), Diabetes mellitus Type 2 (non-insulin dependent), Diabetic neuropathy, Diabetic retinopathy, Disturbances of consciousness – Nonepileptic – Other / type not known, Drop attacks, Generalised seizures (with status epilepticus in last 12 months), Generalised seizures, (without status epilepticus in last 12 months), Narcolepsy, Non epileptic Attack disorder (pseudoseizures), Partial seizures (with status epilepticus in last 12 months), Partial seizures (without status epilepticus in last 12 months), Seizures – unclassified Dizziness – cause not specified, Stokes Adams attacks (cardiovascular syncope), Syncope – Other / type not known.

And these:  Mood disorders – Other / type not known, Psychotic disorders – Other / type not known, Schizophrenia, Schizoaffective disorder, Phobia – Social Panic disorder, Learning disability – Other / type not known, Generalized anxiety disorder, Agoraphobia, Alcohol misuse, Anxiety and depressive disorders – mixed Anxiety disorders – Other / type not known, Autism, Bipolar affective disorder (Hypomania / Mania), Cognitive disorder due to stroke, Cognitive disorders – Other / type not known, Dementia, Depressive disorder, Drug misuse, Stress reaction disorders – Other / type not known, Post-traumatic stress disorder (PTSD), Phobia – Specific Personality disorder, Obsessive compulsive disorder (OCD).

What kind of government cuts support for those needing help to manage medication, monitor a health condition, or both?

What kind of government cuts mobility support for people who can’t leave the house alone?

It seems that most people who are actually ill won’t be eligible for PIP. I wonder which people the government have in mind when they say “those in greatest need”?

Oh, it’s the millionaires again. Phew! Silly me.

From the Equality Trust:

pie wealth

The poorest people lose out from the budget yet again, of course. The distribution of wealth won’t change, with many households in the lowest deciles being worse off. The graph above does not show the full extent of the difference between the richest and the rest of society. This is because the top 1% have incomes substantially higher than the rest of those in the top 10%. In 2012, the top 1% had an average income of £253,927 and the top 0.1% had an average income of £919,882.

If you earn a few hundred thousand, you are set to do rather well yet again from another Tory budget. It’s remarkable how those need it least always get the financial “incentive” isn’t it?  Carrots for the fat cats.  It’s the delux model of “incentives”.

Meanwhile those who need it most pay for those who need it least. Poor people get the budget premium “incentive”, which includes standing on the naughty step, and thinking about what you have not done.

The Tories like wielding a stout stick and giving out a good thrashing for those who dare to fall ill. 

And just to clarify, social justice, equality and inclusion are NOT the same thing as work. They should exist independently of someone’s employment status. Otherwise, “inclusion” takes an Orwellian turn to the far right. We know from history that work doesn’t really set us free. People “enjoying the security and dignity of work” does not entail ensuring those who can’t work or who lost their job are utterly insecure, hungry or destitute. 

The government’s “pledge” to increase adult social care funding is being paid for by increases in council tax, some of which will be paid by those previously exempted from council tax because they are sick, disabled or unemployed. Social security was originally calculated to meet only the cost of fuel and food on the assumption that people needing support would be exempt from rent and council tax. That no longer is the case.

The rises due to come into force from April will not be sufficient to avoid strapped for cash councils having to make deep cuts to essential services, including road repair, parks, children’s centres, leisure centres and libraries. All of this in a time of “economic growth”. It looks like austerity is to be a permanent feature of Conservative neoliberal policy-making.

For many families who are just about managing, the withdrawal of state support for those who are in low paid work is hardly an incentive to “make work pay”. Of course Hammond has ignored the scandal of in-work poverty. This is one of the other austerity measures that he has chosen to keep. Introducing sanctions for those claiming social security because their employers don’t pay them enough to live on is simply a big bully’s stick, which would be better aimed at exploitative and miserly big business employers. Fancy punishing people because profit driven businesses pay as little as possible. 

It’s all the same peevish and spiteful mentality as “making work pay.” Instead of ensuring workers get a decent rate of pay, like you’d think from the Tory claim, the truly nasty party cut benefits and decided to impose punishing conditions on people who need state support indiscriminately, regardless of the reason, instead.

That’s pure upper class prejudice and malice.

And greed. 

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Meet Brexit, by the way, he’s the big elephant in the room, Mr Hammond


 

I don’t make any money from my work. I am disabled because of illness  and have a very limited income. The budget didn’t do me any favours at all.

But 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. The smallest amount is much appreciated – thank you.

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IAPT is value-laden, non-prefigurative, non-dialogic, antidemocratic and reflects a political agenda

arnstein-ladder-citizenship-participation

Arnstein’s ladder of citizen participation and inclusion. It represents the redistribution of power that enables marginalised citizens, presently excluded from the political and economic processes, to be purposefully included in the future.

The government’s Work and Health Programme, due to be rolled out this autumn, involves a plan to integrate health and employment services, aligning the outcome frameworks of health services, Improving Access to Psychological Therapies (IAPT), Jobcentre Plus and the Work Programme.

But the government’s aim to prompt public services and commissioned providers to “speak with one voice” is founded on traditional Conservative prejudices about people who need support. This proposed multi-agency approach is reductive, rather than being about formulating expansive, coherent, comprehensive and importantly, responsive mental health provision.

What’s on offer is psychopolitics, not therapy. It’s about (re)defining the experience and reality of a marginalised social group to justify dismantling public services (especially welfare). In linking receipt of welfare with health services and state therapy, with the single politically intended outcome of employment, the government is purposefully conflating citizens’ widely varied needs with economic outcomes and diktats, which will isolate people from traditionally non-partisan networks of unconditional support, such as the health service, social services, community services and mental health services.

Services “speaking with one voice” will invariably make accessing support conditional, and further isolate marginalised social groups. It will damage trust between people needing support and professionals who are meant to deliver essential public services, rather than simply extending government dogma, prejudices and discrimination. And meeting ideologically designed targets.

As neoliberals, the Conservatives see the state as a means to reshape social institutions and social relationships hierarchically, based on a model of a competitive market place. This requires a highly invasive power and mechanisms of persuasion, manifested in an authoritarian turn. Public interests are conflated with narrow economic outcomes. Public behaviours are politically micromanaged and modified. Social groups that don’t conform to ideologically defined economic outcomes and politically defined norms are stigmatised and outgrouped. 

Othering and outgrouping have become common political practices, it seems.

The Work and Health Programme is a welfare-to-work programme for people with disabilities, mental health problems and for long-term unemployed people, due to be rolled out in the autumn. In the recent Work, Health and Disability green paper, the government mentioned new mandatory “health and work conversations” in which work coaches will use “specially designed techniques” to “help” those people in the ESA Support Group – those assessed by their own doctors and the state as being unlikely to work in the near future – “identify their health and work goals, draw out their strengths, make realistic plans, and build resilience and motivation.” 

Apparently these “conversations” were “co-designed” by the Behavioural Insights Team.

Democracy is based on a process of dialogue between the public and government, ensuring that the public are represented: that governments are responsive, shaping policies that address identified social needs.

However, policies increasingly reflect a behaviourist turn. They are no longer about reflecting citizens’ needs: they are increasingly about telling some citizens how to be. This has some profound implications for democracy.

Neoliberal policies increasingly extend behaviour modification techniques that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes through rewards or “consequences.” Rewards, such as tax cuts, are aimed at the wealthiest, whereas the most vulnerable citizens who are the poorest are simply presented with imposed cuts to their lifeline support as an “incentive” to not be poor. Taking money from the poorest is apparently “for their own good”.   

Defining human agency and rationality in terms of economic outcomes is extremely problematic. And dehumanising. Despite the alleged value-neutrality of behavioural economic theory and CBT, both have become invariably biased towards the status quo rather than progressive change and social justice.

Behavoural economics theory has permited policy-makers to indulge ideological impulses whilst presenting them as “objective science.” From a libertarian paternalist perspective, the problems of neoliberalism don’t lie in the market, or in growing inequality and poverty: neoliberalism isn’t flawed, nor are governments – we are. Governments and behavioural economists don’t make mistakes – only citizens do. No-one is nudging the nudgers. It’s assumed that their decision-making is infallible and they have no whopping cognitive biases of their own. 

“There’s no reason to think that markets always drive people to what’s good for them.” Richard Thaler.

There’s no reason whatsoever to think that markets are good for people at all. Let’s not confuse economics with psychology, or competitive individualism and economic Darwinism with collectivism and mutual aid. Behavioural economics may offer us titbit theories explaining individual consumer’s decision making, but it’s been rather unreliable in explaining socioeconomic and political contexts and complex systems such as financial crises, and of course behavioual economists don’t feel the same pressing need to explore the decision making and “cognitive bias” of the handful of people who cause those.

It wasn’t those with mental health problems currently claiming social security. They do much less damage to the economy, in fact IAPT means vulture capitalist private companies like G4S and trusts like Southern Care can turn a profit offering “support”. 

The current emphasis on quantitative methodology and standardisation has led to an overwhelming focus on measurement in IAPT settings. Mental health services are now dominated by IAPT, which focuses exclusively on “evidence-based” and short-term interventions for clients with particular diagnoses – mostly anxiety disorders and depression. Most workers in IAPT services offer CBT, often by minimally trained psychological wellbeing practitioners offering “low-intensity” interventions over few sessions.

Verificationism and standardisation leads to a focus on measurement in IAPT settings. CBT mutes the causes of distress, which do not reside “within” the individual: they are intersubjectively constructed, with cultural, socioeconomic and political dimensions. Furthermore, there is little room left for authentic dialogue – qualitative accounts of client’s experiences are not accommodated. In this context, CBT is authoritarian, rather than being prefigurative and genuinely dialogic.

Under the government’s plans, therapists from the IAPT programme are to support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses. 

We must question the ethics of linking receipt of welfare with “state therapy,” which, upon closer scrutiny, is not therapy at all. Linked to such a narrow outcome – getting a job – it amounts to little more than a blunt behaviour modification programme. The fact that the Conservatives have planned to make receipt of benefits contingent on participation in “treatment” also worryingly takes away the fundamental right of consent.

CBT facilitates the identification of “negative thinking patterns” and associated “problematic behaviours” and “challenges” them. This approach is at first glance a problem-solving approach, however, it’s of course premised on the assumption that interpreting situations “negatively” is a bad thing, and that thinking positively about bad events is beneficial.

The onus is on the individual to adapt by perceiving their circumstances in a stoical and purely “rational” way. 

So we need to ask what are the circumstances that we expect people to accept stoically. Socioeconomic inequality? Precarity? Absolute poverty? Sanctions? Work fare? Being forced to accept very poorly paid work, abysmal working conditions and no security? The loss of social support, public services and essential safety nets? Starvation and destitution?  

It’s all very well challenging people’s thoughts but for whom is CBT being used. For what purpose? It seems to me that this is about coercing those people on the wrong side of draconian government policy to accommodate that; to mute negative responses to negative situations. CBT in this context is not based on a genuinely liberational approach, nor is it based on democratic dialogue. It’s about modifying and controlling behaviour, particularly when it’s aimed at such narrow, politically defined and specific economic outcomes, which extend and perpetuate inequality. In this context, CBT becomes state “therapy” used only as an ideological prop for neoliberalism.

CBT tends to generate oversimplifications of the causes human distress. It’s not about helping people make better choices, it’s about coercing people to make the choices that policymakers want them to make. Those “choices” are based on enforced conformity to the ideological commitments of policymakers.

It’s assumed that the causes of unemployment are personal and attitudinal rather than sociopolitical or because of health barriers, and that particular assumption authorises intrusive state interventions that encode a Conservative moral framework, which places responsibility on the individual, who is characterised as “faulty” in some way. The deeply flawed political/economic system that entrenches inequality isn’t challenged at all: its victims are discredited and stigmatised instead.

Yet historically (and empirically), it has been widely accepted that poverty significantly increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics and circumstances (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, requires engagement with this complexity.

There is also widely held assumption that working is good for mental health, and that being in employment indicates mental wellbeing. It’s well-established that poverty is strongly linked with a higher likelihood of being diagnosed with a mental illness. That does not mean working is therefore somehow “good” for mental health. Encouraging people to work should entail genuine support, it shouldn’t entail taking away their lifeline income as punishment “incentive” if they can’t work.

An adequate level of social security to meet people’s basic survival needs is not mutually exclusive from encouraging people to find a suitable job.

It’s worth noting that research indicates in countries with an adequate social safety net, poor employment (low pay, short-term contracts), rather than “worklessness”, has the biggest detrimental impact on mental health. 

CBT does not address the socioeconomic and political context. It permits society to look the other way, whilst the government continue to present mental illness as an individual weakness or vulnerability, and a consequence of “worklessness” rather than a fairly predictable result of living a distressing, stigmatised, excluded existence and material deprivation in an increasingly unequal society.

Inequality and poverty arise because of ideology and policy-formulated socioeconomic circumstances, but the government have transformed established explanations into a project of constructing behavioural and cognitive problems as “medical diagnoses” for politically created socioeconomic problems. Austerity targets the poorest disproportionately for cuts to income and essential services, it’s one ideologically-driven political decision taken amongst alternative, effective and more humane choices.

Both nudge and CBT are being used to prop up austerity and reflect neoliberal managementspeak at its very worst. Neoliberal policies are causing profound damage, harm and distress to those they were never actually designed to “help”. Let’s not permit techniques of neutralisation: the use of rhetoric to obscure the real intention behind policies. It’s nothing less than political gaslighting.

The government’s profound antiwelfarist rhetoric indicates that there’s no genuine intention to support those people with mental health problems and others in need, despite their semantic thrifts and diversions.

Policies are expressed political intentions regarding how our society is organised and governed. They have calculated social and economic aims and consequences. In democratic societies, all citizen’s accounts of the impacts of policies ought to matter. 

However, in the UK, the way that policies are justified is being increasingly detached from their aims and consequences, partly because democratic processes and basic human rights are being disassembled or side-stepped, partly because the government employs the widespread use of linguistic strategies and techniques of persuasion to intentionally divert us from the aims and consequences of their ideologically driven and increasingly dehumanising policies. Furthermore, policies have become increasingly detached from public interests and needs. 

For people with mental health problems, policies are being formulated to act upon them as if they are objects, rather than autonomous human subjects. Such a dehumanising approach has contributed significantly to a wider process of social outgrouping, increasing stigmatisation and ultimately, to further socioeconomic and mental health inequalities.

It’s the government that need to change their behaviour.

It’s us that need to make a stand against hegemonic neoliberal discourse and injustice.

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This article was written for a zine to mark the protest at the 10th annual New Savoy conference on 15 March in London #newsavoy2017. You can read the zine, with other people’s excellent contributions, here.

Also, see: New Savoy Protest against psycho-compulsion of MH claimants – 15th March 2017.

You can read about the background to the Mental Wealth Alliance and the New Savoy demo and lobby here.

You can watch the video here from Let Me Look TV: Protest at the 10th Annual New Savoy Conference 15 March 2017.

Please share.

Related

The power of positive thinking is really political gaslighting

The importance of citizen’s qualitative accounts in democratic inclusion and political participation

A critique of the ‘Origins of Happiness’ study

A critique of Conservative notions of social research

Research finds damaging mental health discrimination ‘built into’ Work Capability Assessment. Again.

The Conservative approach to social research – that way madness lies


 

I don’t make any money from my work. I am disabled because of illness and have a very limited income. The budget didn’t do me any favours at all.

But 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. The smallest amount is much appreciated – thank you.

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