Coffee House

Mental health and benefits: ministers get the wrong end of the stick

13 July 2014

Every so often when ministers are considering a policy, they send a little kite up to see how it’s received. Sometimes it gets hit by a lightning bolt of fury from a party’s target voters, and is never heard of again. Sometimes it flutters about and no-one plays a blind bit of notice. And sometimes the kite gets rapturous applause. There seems to be a mixed response to the kite flown today that people with anxiety and depression could be forced to have a talking therapy such as cognitive behavioural therapy or risk losing their benefits.

On the one hand, it’s welcome that ministers want to help people with mental health conditions that can be managed so that someone can go back to work. Unemployment is hardly conducive to good self-esteem and strong mental health. On the other, it’s pretty darn difficult to force someone to take any treatment at all, not to mention unethical. Health Select Committee chair Sarah Wollaston doesn’t like it for that reason:

But there’s another point that’s worth considering, which is that talking therapies often have very long waiting lists. This policy would perhaps make more sense were talking therapies so readily available that anyone could ask for them and find themselves in a consulting room or talking to a therapist over the phone within days. But that is not the case, and is not anywhere near the case, either. Mind, the mental health charity, estimates that one in 10 patients waits longer than a year to receive psychological treatment. There is no suggestion in today’s kite that incorporating talking therapies as mandatory element of the work programme would include investment in increasing the availability of those treatments.

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If ministers don’t want quite so many people floating about on benefits who could, given the right support, return to work, or if they don’t want people who leave work because they have not been given the right support and their condition has deteriorated, might I humbly suggest that the thing to do is not to mandate access to that help, but ensure it is on offer in the first place? What is the point of pushing someone through a therapy that must have their consent and engagement to have even a cat’s chance of working when another person who is not claiming employment and support allowance but is desperate for treatment must wait? And why must policy be skewed so that it is only those whose illnesses mean they have left the workplace already who are prioritised for treatment?

This is one of the sillier remarks from a government source:

‘But there are loads of people who claim ESA who undergo no treatment whatsoever. It is bizarre. This is a real problem because we want people to get better.’

It is indeed bizarre that people on ESA are undergoing no treatment whatsoever, just as it is bizarre that people suffering from illnesses which can kill must wait over a year for treatment.

Recently health minister Norman Lamb – who has told the Telegraph that he opposes this benefits policy – admitted to Radio 4 that he couldn’t say when the government would be able to achieve parity of esteem between the way physical and mental health are treated by the NHS, even though this is a goal the government has set itself. Charles Walker, former chair of the all-party parliamentary group on mental health and an outspoken Conservative campaigner on this issue, recently wrote on Coffee House that the government’s rhetoric fails to match the reality.

Perhaps ministers could reel their kite in a little and have a good think about the reason so many people are languishing on benefits with mental health problems. It might not be because they’ve never been forced to take up a therapy. Instead, it might be because that therapy has never been available to them in the first place.

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  • I dont hate you

    The government seems bent on psychological treatments for everybody, wouldn’t have anything to do with American insurance companies by any chance ?

  • Tremulous

    The irony in all of this is there aren’t enough places where you can actually get this therapy. GPs would obviously send people to specialists if they could, but they can’t because they’re at the front-end of a rationing system. The last time I went to see a GP I was told the waiting list for counselling was OVER A YEAR! Not that counselling would have done any good in any case.

    So if the government also plan to increase spending on things like that by, say, 5 billion, they might save a few hundred million on benefits.

    I work by the way (it’s a struggle but hey, I can check-out any time I like).

  • Jackthesmilingblack

    British education, particularly higher education essentially bans any adversarial style of debate in order to provide a ‘supportive environment’ for students. Educationalists determined that a strong argument is a form of mental intimidation. Criticising someone else’s ideas is readily interpreted as ego-tripping or insensitivity, while the very act of questioning another’s views can be construed as a personal insult. To the extent it has become unwise to state confidently that two and two make four because others may be of a different opinion.
    It seems that some Internet correspondents on these pages suffer from this fragile ego syndrome, and thus react badly when their opinions, facts or conjecture are questioned. How else can you explain the behaviour one particular contributor who over the past 10 years and in literally hundreds of messages, following me from the Times to the Telegraph to the Independent to the Guardian, and finally to the Spectator, insisting that I’m Japanese rather than British. This is a form of race hate, as the greatest insult the xenophobic racist bigot can bestow is to assign anyone they disagree with a different race and nationality. So if you want to write about mental health, may I suggest that charity begins at home.
    Jack, Japan Alps

  • Fraser Bailey

    This problem is easily solved by not allowing people with ‘depression’ or ‘mental health’ problems to claim benefits. How on earth we reached the point of paying people to wallow in such dubious and/or imagined conditions is beyond me.

    • Simon

      This is a completely crazy comment. Mild mental disorders can develop into much worse ones if not identified. It is far better that people acknowledge their is something wrong with the way they think about things, whether this is depression, anxiety (anxiety attacks are real and physical hence are not imagined), narcissism or psychopathic, than let them develop into something much worse.

    • Dave Cockayne

      Well it all started with the enclosure acts forcing people into cities to provide cheap labour for factories, an economic/empire collapse, mass unemployment, the abuse of the financial system to ramp up the price of housing and mass immigration on a scale never before seen in our history.

      If you want people with ‘mental issues’ to work, you need to find a way of getting employers to employ them instead of relying on floods of immigrants with better skills and no mental health issues. At the moment in Britain the welfare system has become so punitive that people are dying of starvation.

      In Britain, in the 21st century, people are dying of starvation.

      But you are probably right of course, mental health issues is just code for lazy scrounger, they are all faking it.

    • Mason Dixon, Autistic

      Do you mean excluding people with those conditions from claiming, or simply not having those conditions or the effects of them considered during the assessment for eligibility? Either way, far from solving any problems they create many more.

    • Neil Gardner

      There is nothing more depressing than being told by the some mental health lobby group that all one’s problems can be attributed to an allegedly medical condition, especially when the real causes of one’s emotional distress are so apparent. What we often see is a vicious circle of emotional distress (feeling unwanted, isolated, inferior etc.) and bad lifestyle choices (bad diet, booze, drugs. etc.), with one behaviour reinforcing the other. As a result ” mental health experts” attribute all sorts of odd behaviours to psychiatric labels rather than seeing how one life event led to another.
      There has undoubtedly been a huge rise in people diagnosed with a growing range of psychiatric labels and a growing number unable to work because of social challenges at work. I no longer believe more awareness raising is the solution. The only path is to compassionately guide people back into a meaningful life, without labels looking at the person and not a checklist of outwards behaviours.

    • I dont hate you

      obvious troll is obvious, and also probably a bit lonely..awwww

  • IanH

    This is an extension of a pilot, so presumably the pilots have shown good results. It is not improper to insist that people should consider therapy if they are in receipt of my tax money thank you very much.

    • HookesLaw

      Is that righht? The link just says it is a piot. Harman does not mention that her article. Mind you she is only a journalist. Nor does she seem to address the convenient ‘huge’ rise in people claiming benefits because of supposed anxiety.
      If such people have a condition, why are they not taking treatment already – and this only applies to people considered fit for work.

      (by the way what is ‘a talking treatment’?)

      • Simon

        The “work programme” has been a complete failure and over all has cost the tax payer much more than it has made the government in taxes. Ian Duncan Smith has been reprimanded on several occasions for stating incorrect/misleading figures in relation to the success rate of the work programme, also for situations where dead people were being sanctioned for not attending courses and such. I wouldn’t trust the current government on any of its claims about the effectiveness of the back to work programmes.

      • Mason Dixon, Autistic

        Try actually reading the article- people aren’t having treatment because the waiting lists are huge. There aren’t enough places for referrals and the government thinks the solution is to consider making it mandatory rather than making sure it’s available to begin with.

    • Simon

      How do you “insist” that ill people should take some form of medication?

      • Dave Cockayne

        We already do, it’s called being sectioned under the Mental Health Act.

        • Simon

          People are only sectioned if they are considered a danger to themselves or others your comment is irrelevant to this discussion. Actually I take back you have a point. Are you saying people who have been diagnosed but refuse to take treatment for mild to medium conditions should be sectioned?

          • Dave Cockayne

            I’m not suggesting that at all.

            You asked ‘how do you insist that ill people take medication?’

            I was pointing out that we already do this all the time to human beings that have been sectioned, using violence to force compliance. The only thing stopping the government extending this practice to lazy scroungers is the economic cost of managing the regime, not ethical questions about whether we should be doing it to people.

            • Simon

              In my opinion forcing anyone especially adults who most likely have a very good reason not to want to do something is unethical. I do not understand your reference to scroungers. This debate is about people who have been diagnosed as ill and the Conservatives attempts to use them as a resource.

              • Dave Cockayne

                I refer you to conservative rhetoric over the last thirty years, anyone that isn’t in work for any reason is a scrounger and should be killed off.

                As far as defining the debate goes the article was about talking therapy, not medication and making the point that their are lots of people who would potentially benefit from talking therapy but who can’t get therapy because the resources are not there. Unless the government is prepared to inject a massive amount of cash to provide the therapy the inevitable outcome of this policy will simply be to deny people benefits until they have completed a course of talking therapy while the waiting lists go from one year to five years.

                • Simon

                  I see where you are coming from. I would also like to know who is going to diagnose that ‘talking therapy’ is going to be of any use to the patient. Is everyone diagnosed with a mental health issue to be referred to a therapist? That will be really expensive also as in many cases it is not a problem that cant be rectified by therapy. Will thousands of people who are on or should be taking medication be ‘forced’ to speak to a therapist? This goes even further where Psychologists could see patients as a cash cow. ‘In the door quick chat, on you go’ £500 in pocket Also in reality you cannot really separate those that choose not to take medication and those that do. They still suffer from the same condition at varying levels, for instance an anxiety sufferer may not take medication for 5 years then the condition is triggered and suddenly comes back worse than ever and they have to take strong sedatives. Not only this but the brain degenerates over time, just like the body (I am not sure of these figures) but I wouldn’t be surprised if anxiety as a disorder was greater in the older generation than younger.

                • Tremulous

                  “talking therapy” is no good. At least it’s not good for men. It may work for women, who naturally are oriented towards doing that to resolve issues.

    • Mason Dixon, Autistic

      The pilot did not coerce or force anyone to have treatment. Also, did you manage to ignore just about every practical(as well as ethical) problem pointed out in the article?

    • Tremulous

      The thing about a pilot is it involves a limited number of people and hence a limited amount of service and treatment is provided for them. Roll it out across the country and waiting lists will balloon to absurd levels.

    • I dont hate you

      What about their tax money ??? Why do you assume people with health conditions have never paid tax ?
      You sound a little brain washed to me.

  • davidraynes

    It is also important to think about the causes or deeply aggravating factors in many of those with mental issues, that is drugs use, both illegal and legal. (Particularly cannabis & alcohol).

    Very important that government does not do anything to make that use & that damage, more likely.

  • greyhoundsaregreyt

    Excellent blog, Isabel. Thoughtful, balanced and considered. Of course the correct response to this government proposal is: Make treatment available so that people can get help before they lose their jobs, not after. As you say.

    Surely this is an area where more expenditure up front would save masses more further down the line.

    Mental health problems are a particular challenge to those wanting to return to work after long illness. No employer ever wants to know!

  • Simon

    Hmmm, this appears to be another ridiculous (and unrealistic) attempt by the Conservatives to force as many people to work as they can, ignoring the implications and outcomes of such ideals and without taking individuals circumstances into account. Many people who suffer from mental health conditions suffer their affliction sporadically. That is to say they have no control over when and for how long the illness strikes and lasts. An example would be this; someone is forced to work on a checkout in a supermarket and through no fault of their own (as they are ill) they get so stressed out that they start snapping at customers and colleagues. Obviously this is not acceptable and the supermarket sacks them.
    If it is a chemical imbalance in the brain, what is the solution to this “talking about it”? in these cases talking is pointless, the only solution is medication.

    Does the Government have the right to say you have to take this or that type of medication so that you are fit to work? Or going even further could they not suggest some type of brain surgery to “cut out the problem”? It is no use saying that these things will not happen for as we have learnt, as soon as you give people the power to do something they do, as seen by the benefits sanctions scandal where people are being sanctioned by Jobcentre staff, when they shouldn’t be. The only people who are qualified (and psychology is not an exact science) to judge if someone is fit for work are their local GP’s and Psychology experts. A therapist will tell you there is no way they can evaluate a patients mental condition in a short period of time it takes months and in some cases years (this treatment/diagnosis process is also mega expensive). Cost being a factor I am sure will be included into calculations of the effectiveness of the proposed process over the actual “wellbeng” of the people they are claiming to help.
    Also anxiety is caused by stress, how is threating people who suffer from anxiety with sanctions, or indeed any type of threat at all, going to lower their stress? You would effectively be creating the exact problem you are attempting to solve and as mentioned were does this actually lead, forced medication and treatments? This is 2014 and as a society we have worked towards a society were the vulnerable and ill are supported, indeed these are virtues we export around the world. This appears to be another attempt by the Conservatives to create an even more unequal society were everyone looks after themselves and screw everybody else. Also if you attempt to complain about it you will be ignored by the media and potentially have water cannons fired at you. I for one am sick to death of the Con-Dem liars as are millions of others.

    • Andy

      So how are you ‘nurturing’ people by allowing them to rot on the scrap heap ? There is nothing wrong with people working. There is nothing wrong with the unskilled retraining and finding employment. There is actually nothing wrong with those with depression doing something useful rather than sitting at home deteriorating by the day. But of course mass immigration has robbed many of jobs they could have done but provided the likes of you with cheap cleaners and plumbers. Many of us are sick to death of the Fascist Left liars.

      • Simon

        I have no idea what you are on about? If these people have been declared unfit for work by experts why is the government attempting to redesign the system to force them into some kind of work? They are clearly unfit and in reality would only be a liability. Are you suggesting that these people who have been declared ill are somehow pretending?

        • HookesLaw

          The link says many people ae not having treatment – so how can it be they have been ‘declared unfit by experts’.

          • Simon

            There could be many reasons some one is diagnosed with a mental disorder but is not receiving treatment the most obvious being that we do not actually know how the brain works! This is that a patient may have been on treatment that had no effect so it was withdrawn. Also some people will refuse treatment and rightfully so, this could be for religious reasons, or a distrust of the treatment they are allocated. Not only this but as Isabel points out in her article the mental health side if the NHS is massively underfunded hence in many areas treatment will not be available. In many cases people in work who have mental health problems cannot receive treatment.

            • Dave Cockayne

              Alternatively of course it could be because the government slashed budgets for social care so there is no money to pay for treatment?

          • Mason Dixon, Autistic

            Do you really not follow the topic in the news? All ESA claimants are referred after 3 months for an assessment by Atos(currently withdrawing from the contract after all the publicity you apparently missed) who then administer the Mickey Mouse WCA test. They are not there to recommend or supply any treatment, otherwise the claimant would be classed as a patient and then the assessor would have a duty of care as a physician towards them. Hard to kick sick and disabled people off benefit if you have to actually consider the consequences for them.

    • HookesLaw

      ‘forcing’ people to work. Shocking notion.

      • Simon

        Forcing people to work for nothing is shocking as highlighted by the fact the judiciary have stated so.

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