Monday 16 August 2010

Guest Post: Benefits Who?

This is a guest post from Blu.

Slowly but surely over the last few years, I've watched tolerance and understanding of mental health issues evaporate in the benefits system - not that there was much there to start with. The latest portfolio of idiots in power appear to view mental health as something that's guaranteed by the ability to earn money, and those whose mental health is poor need only to take the tablets, stop thinking about those damned problems, and just get on with earning already.

If only it were that easy, I'd currently be preparing for the start of a new teaching term whilst nursing my Seychelles tan and planning for a long weekend away in Singapore in October. I've got the qualifications. Schools are crying out for teachers. The pay is far more than any amount of DLA, ESA, IS or other benefits combined. So why don't I just 'pull myself together', 'get a grip' and 'stop scrounging'?

I have mental health issues. Big, f*ck-off issues. And yes, they prevent me from working. But I know, I'm making it all up, because mental health problems are easy to fake, aren't they? And what a great way to scrounge some benefit money whilst I'm at it! I should get up off my arse, stop making excuses and WORK, DAMMIT.

It's at this point that many people would go into detail as to why they can't work, and what caused them to be this way. I lost patience with justifying myself a long time ago. I shouldn't have to carry a potted medical history around with me to prove to all comers that yes, I am actually ill and deserving of benefits. It's nobody's business but my own. Unfortunately, in the current climate of ‘pick on the poor’ my right to privacy is winging its merry way out of the window, to be replaced by ‘work-focused interviews’, medicals by unqualified staff and financial compulsion (not forgetting the baying masses who believe what they read in the Daily Mail).
Treatment for my condition is my choice – or so I thought. So you can understand my ire when, after re-applying for DLA a couple of years ago, I received a letter stating that my benefit had been revised to a lower level...and when I called to ask why, I was told that the reason for this was because I wasn’t under the care of a hospital psychiatrist.

In other words, if you don’t take treatment, we’ll cut your money.

This was a new one on me. Having patiently explained on the multitude of DLA forms my reasons for not using the NHS psychiatric services – because they don’t listen to me, because they only want to give me tablets and not tangible help, because I never see the same member of staff twice, because having to explain your history and feelings week in and week out to a different person every time actually makes mental health issues worse, not better, and because I won’t make myself worse by being forced to talk about my history and feelings with someone I don’t know and who patently isn’t interested anyway – I’m told that my reasons are invalid, and I must receive NHS psychiatric care (subtext: or you’re either trying to stay ill, or you’re not really ill anyway and a psychiatrist would find you out).

I couldn’t quite believe it. But the (admittedly very helpful) lady on the other end of the phone at DLA Central confirmed that it was true – I couldn’t receive the level of DLA I’d been previously getting if I wasn’t seeing some sort of mental health professional. I noted that she’d softened from ‘hospital psychiatrist’ to ‘mental health professional’. I mentioned that I was currently attending the Rape Crisis Centre for counselling (which I had also included on the DLA forms). This, apparently, was enough. She filled in an appeal for me. My DLA was reinstated at the previous level, although no explanation was received as to why non-NHS counselling was ignored as ‘treatment’ in the first instance.

I thought it was a one-off. And then I read the mass of legalese that made up the newfangled ESA benefit small print. Lo and behold, the benefits office are now perfectly within their rights to remove a claimant’s benefits if said claimant refuses to take treatment ‘recommended by a healthcare professional’. Given that the government and benefits agencies seem to regard anyone who can spell ‘disability’ as a healthcare professional nowadays, that doesn’t bode well for the ongoing treatment of people with mental health issues, thinks I.

Why shouldn’t people with mental health issues be forced to take NHS psychiatric (or psychological) treatments? It’ll make them better, and able to go back to work, won’t it?

For a start off, no-one should be forced into medical treatments they don’t want, don’t consent to, or that may make their condition worse. Forcible medical treatment happened under regimes like Hitler’s and Stalin’s. It shouldn’t happen in a supposedly free country like the UK. That the basis for such compulsion is financial rather than ideological (although I’d dispute that the two were that much different) makes no odds. Forcing people in any way to take medical treatments that they don’t want is assault, pure and simple.

Added to that, there’s the way in which the NHS has been increasingly co-opted by the government in the last few years. CBT used to be absolutely impossible to get in the Midlands city where I used to live. A friend of mine who had a serious phobia spent years begging and pleading with various doctors and mental health services for CBT to be made available in the area, as it would’ve been the best thing to help her. It’s available now, of course – so available, in fact, that every wallah with any form of mental health issue (and a fair few physical ones too) is packed off to CBT. Hey, if it works for a phobia of buses, it must work for every other form of anxiety, right?

Perhaps your experience of CBT has been positive. I’m not doubting that it helps some people and some issues. But CBT is in no way the cure-all the government seems to crow that it is. I’m very wary of the way in which it’s being pushed on all people with mental health issues, because many mental health issues are caused by very real physical and societal problems. Changing the way the person with mental health issues thinks about these problems smacks of blaming (and silencing) the victim, rather than dealing with the problem. Of course, it’s cheaper that way – which is why, I suspect, CBT is being recommended for absolutely everything and its dog. Blame it on your head. Think differently. Get a grip. Get a job. It doesn’t take much to join the dots.

Outside of CBT, the waiting lists for psychiatric and psychological treatments are astronomical. You’ll need an assessment, which involves going through past history and current issues with someone whom you’ve never met before and may not ever see again. Unsurprisingly, this has the potential to leave people with mental health issues in serious crisis. Yet there’s no after-care – and if the current coalition government has its way, there’ll be precious little in the way of voluntary or charity-based support available either. If you manage to sit though the months of waiting to get a regular appointment with psychiatry or psychology, there’s no guarantee that you’ll see the same person twice (this seems to be the case especially in psychiatry) – and going through your history yet again with someone you don’t know or trust is at best not helpful, and at worst positively damaging. You might not want to take certain medications, based on potential side-effects. You might not want to talk about particular subjects. You might not want to go through any of this at all, as placing your very survival in the hands of someone you don’t know or trust is an incredibly vulnerable position to be in. Most people who don’t have mental health issues would find that uncomfortable. For someone like an abuse survivor, for example, such a situation may feel like the height of terror. But the benefits system doesn’t care if this negatively affects you. Whether or not it makes you better is besides the point – you have to show that you’re willing to ‘get over it’, shut up, take the tablets, IMPROVE, dammit, and WORK. Pretend that everything’s okay for someone else’s benefit, when it so obviously isn’t. I’ve been here before. And I’ve learnt through hard experience that the only way out is to shout – loudly – that the emperor is indeed in the nip.

All this DWP compulsion does is create more of a barrier to treatment for people with mental health issues, rather than less. I don’t want to talk to someone I don’t know about personal and uncomfortable things. I’m even less likely to want to talk to them if we both know that the only reason I’m there is to check up that I’m not faking, and that I’m trying to get better. I already know I can’t trust the DWP to take me seriously. Setting the NHS up for the same thing is a grave mistake – especially as the DWP’s medical ‘assessments’ take not one jot of notice of your NHS medical records anyway!

The current benefits ‘shake-up’ is designed to save money, pure and simple. People with mental health issues will be a prime target because they’re easy to dismiss. Our disabilities aren’t always visually obvious, and the government quite clearly thinks that this means we’re lying about having them. Conversely, if we do have them, then we’re evidently unable to think clearly and make our own decisions – therefore our views should be ignored. As people who are either lying or incapable, we can then be made to take treatments that will make us capable of being financially productive, and anyone who disagrees or can’t manage this is proven to be the very worst of benefit scrounging ungrateful scum.

Which leaves me wondering what will happen to those of us whose mental health conditions leave us, for whatever reason, outside of their glorious ‘Arbeit macht Frei’ future.


  1. Oh my God, are you me? I think you might actually be me! This is one of the many reasons I don't go to the pub any more - people don't want to hear the above every time they go out for a quiet drink. I had the "If you're not being treated you can't be ill" thing, despite explaining that being forced to do anything, even attend an appointment on time, knocked me back. And no, my experiences with CBT were not good either. "I'm upset because a psychopath deliberately systematically mentally destroyed me", "aww... don't be upset". Sod off. Ahem. Sorry. Your post has made my day, thank you.

    It's a funny thing. The general perception of psychotherapy is as something most people wouldn't want to submit themselves to, and yet apparently it's ok to force more vulnerable people onto the couch. Bizarre.

  2. "The current benefits ‘shake-up’ is designed to save money, pure and simple"
    Wrong - it's not about saving money, it's all about syphoning off tax payers money into the pockets of government cronies. Benefit reforms invariably involve giving hundreds of millions of pounds to private companies to attack the poorest and most vulnerable people in society. I suspect the £500 million Atos receive is more than they save the government by kicking seriously ill people off ESA. All the research shows that the various 'get the bastards back to work' schemes do not work, yet the government keeps throwing more and more money at the companies such as A4E that operate them. They do not save money - they cost money. Politicians are, without exception, liars and crooks.

  3. "it's not about saving money, it's all about syphoning off tax payers money into the pockets of government cronies... They do not save money - they cost money."

    Ah, but as long as the government can make a hypothetical Mr Hard-working Taxpayer And His Family *feel* like the cuts are saving them money, then it's all OK. Who cares that disability hate crime rates are rising and disabled people are being left to die in poverty, right?

    The mental health 'care' system in this country is a disgrace, and the ideological nature of the cuts is depressing. It's even more depressing that so many people don't recognise quite how ideologically-motivated these cuts are. Why are people with mental health problems always the first to experience cuts, and why are mental health services the 'Cinderella of the NHS'? Because, as the poster above says, it's easy to attack a target who by definition is going to find it much harder to fight back. What a mess of a vicious cycle.

  4. I'm appalled that anyone with serious depression would ever be given CBT. "So, have you trioed NOT being clinically depressed?" very helpful. It strikes me as highly dangerous top force on anyone a therapy that is all about suppressing your thoughts and have to wonder how much trouble that stores up for later on even if there seems to be some initial 'improvement' in the eyes of people who measure these things in 'did it get them back in the office' terms alone. I was sent to do CBT for my ME and it was basically a joke. I'd certainly refuse if anyone suggested I do it to help with my depression.

  5. Thank you for writing this post.

    Mental Health support can be so, random. After struggling for years alone with agoraphobia and depression, with sporadic sessions of CBT or councilling, I finally got treatment which was helping me progress.

    For a year I saw a CPN who was CBT trained (once a week at first, then once a fortnight) and a support worker who did graduated exposure work with me who I saw once a week.

    Then the CPN changed jobs, her replacement wasn't CBT trained so I was referred to their group therapy department (the thinking was that I wouldn't need to wait months for CBT with a psychiatrist or similar). The group therapy folk put me into an anxiety group. I lost my support worker. There were 6 group sessions, then I was left with no support at all.

    Now I'm getting no treatment, and don't really want to go back to my GP to be referred back to the same people who let me down. I don't want to go through that process of having to try and trust and connect with strangers again.

    I may just be one patient to them. But to me, they were aometimes the only people I'd see other than my husband for weeks.

    I don't know how this will affect my DLA when I need to reapply.

  6. Excellent, excellent post.

  7. Excellent, excellent post. Well said!

  8. I just wish a politician would listen to this! It's so obvious really, and you articulate it fantastically. Please run for PM!
    With love,
    Reuben Walsh

  9. Wow, there must be a wide variety in the quality of CBT given to people because my experience is very different! CBT when done properly would *never* involve a therapist telling you 'don't be upset' or 'have you tried not being depressed', or try and blame the patient for their own condition. If people have genuinely had CBT therapists say these types of things then *please* complain to your PCT because they're frankly doing it very wrong (and giving it a bad reputation to boot)! I say this as someone who has both had CBT, and studied the method in depth as part of a psychology degree.

    CBT can be really effective when administered by someone who knows what they are doing. It is not about blaming the victim/patient. In fact it's the opposite, it's (partly) learning to stop blaming yourself and seeing yourself negatively. The only problem I've had with it is that I wasn't given enough of it, although what I had definitely helped. Indeed if I hadn't had CBT I wonder where I'd be now. It didn't cure me but it gave me the mental strength to carry on at a very difficult time.

  10. Thanks Anonymous (the last one!). I'm genuinely glad that you had such a good experience of CBT :) I suppose when it's pushed the whole time it's just a huge relief to come across someone else who's been hurt by it, so it's too easy to get snide :D.

    I too studied CBT as part of Psychology at university, and I have heard people say that it's not the school of therapy as much as the decent therapist that makes a difference. The thing is, CBT techniques are useful for people who aren't sure how to do that kind of thing already. Positive thinking and the like. The trouble is, positive thinking and good self-image always came very naturally to me (probably just a temperamental thing), and so when I didn't get anything out of CBT it was suggested that I just "keep trying" with things I'd been doing all my life anyway. I hadn't blamed myself for a second, but the lack of interest on the part of the therapist in talking about the causes of my illness made that waver, which I couldn't afford.

    A good example is low self-esteem. I've never suffered from that, but it was a big concern for the therapist I saw, presumably because various symptoms of my trauma looked like low self-esteem. So it's treated with positive thinking, when really what a lot of people need is for the therapist to just say "Christ, your life is sh*te, frankly I wouldn't blame you if you just wanted to lie down and die". Plenty of people who seek therapy have never had anyone talk to them about how wrong it was that they were beaten by their mother/bullied at school/raped/whatever. Thing is, on the NHS, there is next to no time devoted to figuring out which patients need that, and which need the opposite. I might CBT-bash when I'm reminded of all this, but it's really the way it's pushed onto people by the NHS that I'm angry about rather than the method itself, which clearly helps plenty of people.

    I have heard people very occasionally say that CBT has helped with reactive illness, but personally I wouldn't recommend it for anything that isn't organic.

  11. I've had 4 or 5 lots of CBT none of which have gotten very far, its not that i don't want to get better but its more like I know I need to change the way i think, but the way i used to think is still always there in my head waiting for the s@#t to hit the fan. I feel like CBT hasn't worked for me because it seems like its point is to trick/ brain wash people into a new way of thinking and I don't seem to have responded to that, I am not saying that for CBT to work you have to be gullible far from it, it just never worked for me. I also feel like a fake because my biggest trauma in life was my nan dying when i was younger, i've not been abused or attacked and I feel like me being depressed and anxious isn't warranted because I haven't suffered the same as everyone else with worse storys to tell.