The challenge to the government’s draconian welfare reforms are gathering momentum, and as part of this campaigners from across Merseyside and even as far afield as London gathered outside the annual BPS Clinical Psychology Conference at the Hilton Hotel, Liverpool on Wednesday 18th January. The British Psychological Society (BPS) is the professional body for UK psychologists and has been working with the government on aspects of its welfare reform programme.
Service users/survivors, mental health workers and clinicians from a range of groups including Psychologists Against Austerity (PAA), Mental Health Resistance Network, Disabled People Against Cuts, Social Work Action Network (SWAN) as well as trade unionists arrived bright and early at the venue to share our concerns with conference attendees. There is strong evidence of the detrimental impact of welfare reform on claimants with mental health needs so we are calling on the BPS to withdraw from all work with the Department of Work & Pensions (DWP) and join us in demanding the government end their harmful welfare reform programme.
Campaigners from a number of groups united to send a powerful message to the BPS leadership
As a result of our lobby, delegates informed us that welfare reform had become a major discussion point for attendees inside. Then as a result of this pressure a call came through to inform us that Peter Kinderman, president of the BPS, had invited us to address the conference the following day to explain our position and present our demands.
The next morning a group of campaigners representing the breadth of our alliance –service-users/survivors, a carer, and activists from North West Psychologists Against Austerity, Mental Health Resistance Network and SWAN – spoke to 300 psychologists at the first session of the conference. The group shared a strong message about the effects of welfare reform and called on the BPS to withdraw from all collaboration with the Department of Work & Pensions. In his response BPS president Peter Kinderman accepted some of our arguments but maintained that the BPS needs to continue to work with the DWP to get its perspectives heard. We reject this argument. We believe continued BPS involvement only lends credibility to the government, and BPS withdrawal would send a strong message about clinicians’ and service users’ concerns. We will continue to call for an end to all collaboration between the BPS and DWP.
Campaigners are invited onstage to address 300 psychologists at the BPS Conference
The DWP is an unethical body that is damaging the lives of claimants with mental health needs.
The statistics and evidence on the harmful impact of welfare reform are clear:
20,000 people with mental health difficulties had their benefits sanctioned in 2015
Following Work Capability Reassessment, there is a greater risk of suicides, self-reported mental health problems, and antidepressant prescribing (Barr et al, 2015)
2,380 people died shortly after being declared able to work between 2011 and 2014
Government & corporate collaborators are imposing psychological explanations for unemployment, together with mandatory activities intended to modify beliefs, attitude, disposition, or personality – this is being called psychocompulsion (Friedli & Stearn, 2015)
The United Nations “is deeply concerned about the various changes in the entitlements to, & cuts in, social benefits introduced by the Welfare Reform Act 2012 & the Welfare Reform & Work Act 2016”. The UN has called on the Government to: “Review the entitlement conditions & reverse the cuts in social security benefits introduced by” these Acts
However we believe that this action and the growing campaigns around the country are starting to make a difference on this issue. A number of clinical psychologists attending the conference told us that the lobby and ensuing discussions would help to strengthen their voices within the BPS to make the case against the organisation’s involvement with the DWP.
We believe that when service users/survivors, psychologists and other mental health workers come together we are stronger. We will keep building alliances to pressure the BPS to withdraw from involvement with the DWP and to bring an end to the government’s wider programme of welfare cuts, reforms and psychocompulsion. If you would like to get involved please email us on mhwelfarereform2016@gmail.com.
Mental Health Resistance Network; Disabled People Against Cuts; Recovery in the Bin; Boycott Workfare; The Survivors Trust; Alliance for Counselling and Psychotherapy; College of Psychoanalysts; Psychotherapists and Counsellors for Social Responsibility; Psychologists Against Austerity; Free Psychotherapy Network; Psychotherapists and Counsellors Union; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ Network; Critical Mental Health Nurses’ Network; National Health Action Party.
To:
British Association for Behavioural and Cognitive Psychotherapies
British Association for Counselling and Psychotherapy
British Psychoanalytic Council
British Psychological Society
United Kingdom Council for Psychotherapy
30th January 2017
MWA response to the psy professional bodies’ statement on benefit sanctions and mental health 30th November 2016
We welcome the call from the psychological therapy bodies for the government to suspend the use of sanctions by the DWP subject to the outcomes of an independent review of its welfare policies and their potential damage to the mental health of benefit claimants. Given the accumulation of evidence over many years of the material and psychological suffering inflicted on benefit claimants by workfare-based conditionality[2], it has been frankly shocking that the professional bodies directly concerned with the mental health of the nation have preferred to welcome and participate in workfare policies rather than publicly and vociferously dissociate themselves.
The timing of the statement is given to be the recent report on sanctions by the National Audit Office. Welcome as its report is, the NAO’s perspective on government policy is primarily monetary, not one of health, ethics and social justice. Its “vision is to help the nation spend wisely”. The choice of this timing represents realpolitik on the part of the professional bodies no doubt, as perhaps is the intention of the conditional statement: “The sanctions process may be detrimental to people’s mental health and wellbeing”. But surely as psychotherapists and counsellors we can do better to represent the overwhelming evidence of personal suffering on such a scale than point to poor returns on expenditure and an ambivalent proposal that sanctions may be detrimental to people’s mental health.
Sanctions are only one dimension, albeit at the sharp end, of a welfare regime based on the political assertion that people need to be coerced off benefits and “nudged” into work. The psychological pressure of WCA and PIP assessments, job search rules, work programmes on “good employee” behaviours and the regular cuts to welfare benefits generally are part and parcel of the psycho-compulsion of the DWP benefits regime.[3]
We dispute the government’s premise that work is a therapeutic priority for people suffering from mental health difficulties. The marshalling of evidence for this modern-day workhouse mentality lacks both substance and integrity. Work has become the ideological mantra for neoliberal welfare policies.
Obviously where people want to work and where employment possibilities exist that will support and nourish people’s mental health, then encouragement, training and professional support should be available. But why is there no acknowledgement of the hundreds of thousands of claimants with mental health difficulties who cannot work, whether they want to or not?[4] Where is the evidence that people with mental health difficulties are actually benefiting from what is now two decades of workfare conditionality in the UK? Where is the evidence that in our current labour market decent jobs exist that will nourish people’s mental health? And where is the evidence that psychological therapy for benefit claimants with long-term mental health disabilities succeeds in supporting them into decent jobs they want, can survive and maintain?
When the professional bodies say, “an estimated 86-90% of people with mental health conditions that are not in employment want to work”, they are supporting the proposition that getting into work is an overwhelmingly important and efficacious goal for this group of benefit claimants. It is not clear where this figure comes from and what it means.
A similar figure is quoted by The Royal College of Psychiatrists’ report on Mental Health and Work (2013)[5], making use of a Sheffield study by J. Secker and others (2001)[6]. In fact, Secker finds that of their sample of 149 unemployed service users, when asked if they were interested in work of any kind – including voluntary and supported work – “around half (47%) responded positively, and almost the same proportion (43%) had a tentative interest. Only 15 people (10%) had no interest in work”. At the same time, only 25% of respondents saw full-time employment as a long-term goal. 71% said that their preferred vocational assistance would be “help for mental health/keep current service”.[7]
This study does not translate into “86-90% of people with mental health conditions that are not in employment want to work”.[8] What it points to is the complex texture of attitudes, desires and fears around waged work that are the common experience of service users, alongside the harsh realities of the current labour market, the socio-economic environment generally, and the dire state of mental health services of all kinds more particularly.[9]
From our point of view, the professional bodies’ statement is a step in the right direction. It is a step that must now be followed through with active political pressure on the DWP and the Dept of Health to suspend sanctions and set up an independent review of their use, including the damage they inflict on people’s mental health. Parliament has already called for such a review.[10]
But more than this, the remit of such a review should include all aspects of conditionality in a benefits system that deploy psycho-compulsion through mandatory rules or through the more subtle imposition of behavioural norms which aim to override the claimant’s voice.
We again suggest that the psy professional bodies would benefit by widening their own conversations to include service users and the rank and file of their membership. They would also win more credibility as organisations with ethical and social values independent of the government’s policies of dismantlement of social security and the welfare state if they were willing to make transparent their currently private conversations with DWP.
[1] Mental Wealth Alliance (MWA), formerly the Mental Wealth Foundation, is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.
[2] Parliamentary committees, the national press, endless reports from charities, service user organisations, people with disabilities, claimants unions and workfare campaigners have been reporting the physical and psychological damage of ‘welfare reform’ and its tragic outcomes for a decade.
[4] In February 2015 over a million people claiming ESA under a MH diagnosis were in either the Support Group or WRAG. Over 70% of new applicants for ESA are found unfit for work
[6] Secker, J., Grove, B. & Seebohm, P. (2001) Challenging barriers to employment, training and education for mental health service users. The service users’ perspective. London: Institute for Applied Health & Social Policy, King’s College London.
[9] For example, some of this complexity is flagged by Blank, Harries and Reynolds (2012) The meaning and experience of work in the context of severe and enduring mental health problems: An interpretative phenomenological analysis Work: 47 45(3)“Stigma, the disclosure of a mental health problem and the symptoms of the mental health problem are frequently described, as well as feelings of hopelessness, seeing recovery as uncertain, and feeling a lack of encouragement from services. Difficulties in accessing occupational health services, having a disjointed work history, lack of work experience, age, lack of motivation and fears about competency, as well as the social benefits system and caring commitments, are also experienced as barriers to accessing employment for people with mental health problems.”
MARCH ON STREATHAM JOB CENTRE – FRIDAY 26TH JUNE, 1.30 pm
MEETING POINT: STREATHAM MEMORIAL GARDENS, STREATHAM HIGH ROAD/ STREATHAM COMMON NORTH, LONDON SW16
STREATHAM JOB CENTRE PLUS: CROWN HOUSE, STATION APPROACH, LONDON SW16 6HW
* A pilot project to bring CBT (Cognitive Behavioural Therapy) into Job Centres starts at Streatham Job Centre Plus in June 2015.
* In the same month, Lambeth “Living Well Hub” for Community Mental Health Services is due to open in the same building.
*Mental Health Resistance Network is unhappy with these developments which are part of the government’s brutal “back to work” agenda.
*Mental Health Resistance Network has called a demonstration which will march on Streatham Job Centre on Friday 26th June.
*Mental Health Resistance Network is circulating an open letter to relevant individuals, charities and professional organisations stating our position and asking them to join us in our condemnation for these developments.
Mental Health Resistance Network is organising a demonstration to take place at Streatham Job Centre Plus on Friday 26th June 2015, protesting against the opening there of Lambeth’s principal community mental health centre (“Living Well Network Hub”) the following Monday.
Streatham Job Centre also, from June 2015, hosts the first pilot of the DWP’s scheme to provide psychological therapies – specifically Cognitive Behavioural Therapy (CBT) – at Job Centres for people suspected of having mental health problems. This is the first of ten pilot schemes in advance of a national project planned to begin in January 2016.
We are calling on you/ your organisation to state your position on these issues, and we hope join us in our condemnation of these developments.
As mental health service users, we are extremely unhappy with these developments. We deplore the government’s brutal “back to work” agenda, which is a front for cutting disabled welfare benefits for the most vulnerable. Mental health service users are understandably terrified of Job Centres and the threat of losing their benefits through Sanctions, or degrading and unfit-for-purpose Work Capability Assessments. With the main point of access to Community Mental Health services in Lambeth on the 3rd floor of a Job Centre, many of us will feel too frightened to ask for the help and services we need, and lose contact with services altogether.
Mental health service users are already reporting higher levels of fear, anxiety and anguish as a result of the increasingly difficult welfare benefits system, which is linked to an increasing rate of suicides. This situation will be exacerbated by the new developments.
We should not be put under pressure to look for work unless we feel capable. The competitive, profit-driven and exploitative nature of the modern workplace is not suitable for people whose mental health is fragile. But the location of the Network Hub at Streatham Job Centre put us under such pressure if we try to use mental health services.
Experts agree that CBT does not work for everyone; that psychological therapies are ineffective if they are forced on people; and that they need to take place in safe, unthreatening environments. We do not think making people have CBT at Job Centres will make anyone magically “fit for work.” We are concerned that people will be Sanctioned (i.e. have their benefits stopped) if they do not co-operate with this “therapy” either out of principle or because they are not well enough. “BACK TO WORK THERAPY” IS NO THERAPY AT ALL!
Additionally, we are concerned that this amounts to an extension of the coercive powers of the 1983 Mental Health Act amended 2007. Whereas at present people can only be forced into “treatment” under in-patient Sections of this Act or by Community Treatment Orders, making welfare benefits and by extension housing conditional on agreeing to psychological treatment broadens the principle of compulsion.
We condemn the involvement of IAPT in this attempt to make people undergo “therapy” at Job Centres, which we believe goes against professional ethics. We are also unhappy that psychiatrists, occupational therapists, nurses, social workers and other mental health professionals are also expected to work at Streatham Job Centre, again compromising their professional ethics, and we call on individual staff and collective agencies representing them to publicly oppose this development.
Curing unemployment is a growth market for psychologists. Job Centres are becoming medical centres, claimants are becoming patients, and unemployment is being redefined as a psychological disorder.
Made-up ailments such as “psychological resistance to work” and “entrenched worklessness” feature in ministerial speeches and lucrative Department for Work and Pensions (DWP) contracts, without attracting a murmur of protest from professional psychologists.
Psychological explanations for unemployment – the failings of the maladjusted jobseeker – isolate, blame, and stigmatise unemployed people. They reinforce myths about “cultures of worklessness”; they obscure the realities of the UK labour market and the political choices that underpin it. The same is true of psychological prescriptions for treating unemployment.
Interventions
People claiming benefits are already subject to psycho-interventions through mandatory courses designed to promote “employability” and “job readiness”. And as we show in a new paper published in Medical Humanities, “positive psychology” is pervasive in Job Centres (the newly privatised Behavioural Insights Team has trained more than 20,000 Job Centre staff. A narrow set of approved psychological and personality traits are widely touted as essential to getting and keeping a job: confidence, optimism, positive, aspirational, motivated, and infinitely flexible.
Motivational “messaging” targets both staff and claimants, and is set to intensify. The 2015 budget sets out government plans to put therapists in job centres this summer. Online cognitive behavioural therapy will also be provided, in order to “improve employment outcomes” for claimants with mental health conditions. (Some of the many problems with these approaches have recently been discussed in The Conversation.)
The “change your attitude” message of positive psychology is enforced by unsolicited “positive thinking” emails sent to claimants, and in mandatory “employability” training courses promising to help with “self-esteem, self-confidence and motivation”.
Employability, workfare and sanctions
People on benefits are made to take part in various pointless and humiliating psychological group activities (like building paper clip towers to demonstrate team work), or take completely meaningless and unethical psychological tests to determine their “strengths”. But the goal is not a job with pay that you can live on. Instead, this is an intensive “change your attitude” programme, which – along with other forms of workfare – is designed to force people off benefits.
Workfare is a name for the different kinds of “work-for-your-benefits” schemes, exported from the US, which have spread to many rich democracies over the last two decades. In the UK, unemployed people are forced to work unpaid for a charity, business, or local authority in order to continue to be eligible for benefits (both Job Seekers’ Allowance and Employment and Support Allowance – the benefit paid to sick and disabled people).
Workfare also includes coaching, skills-building and motivational workshops, and schemes that are part training course, part unpaid work placement. Failure to take part in these schemes may result in harsher or more demanding workfare activities or benefit sanctions.
High Court ruled unpaid work schemes like Poundland’s were lawful. Pittaya Sroilong, CC BY
Sanctions amount, as David Webster has recently argued, to a “secret penal system”. Entrenched, arbitrary, and unaccountable, they deprive people of the money they need to eat and live. Workfare – backed by sanctions – also ensures a steady supply of free labour, replacing paid jobs, further depressing wages, and creating a claimant workforce without the legal status and rights normally given to workers. The unemployed person is a generator of income for everyone except themselves.
At the same time, assessing “employability” and enforcing activities said to increase it is now a central function of workfare, stimulating the growth of a state-sanctioned, state-contracted industry heavily influenced by – and reliant upon – psychological “magic” .
“Employability” isn’t a set of skills or attributes required for a specific job or job offer (receptionist, bus driver, call centre operator, care worker). Rather, it is about personality and emotions: achieving a generic upbeat state; having the characteristics, attitudes and habits of “the sort of person who can get a job” – the familiar roll call of confidence, self esteem, motivation and aspiration so celebrated by the CBI, as they lament the absence of these “job ready” attributes in young people leaving school or university and identify “a positive attitude as the key foundation of employability”.
Attitudes to work
This means that “attitude to work” – boosted by confidence courses and assertiveness sheets – becomes a legitimate basis for deciding who is and who is not entitled to social security and a condition placed on receipt of benefits.
In the past, conditionality related to things like refusing to take a job after receiving three offers of work. This was hardly beyond criticism. Now, the supposed absence of positive affect can trigger some form of sanction. “Lack of work experience or motivation” is one of the criteria for being sent on a Community Work Placement – six months’ unpaid community service for 30 hours a week.
Esther McVey, former minister of state for employment, talked about targeting people who are “less mentally fit, bewildered, despondent”, and about the difference between those who are “apprehensive but willing” and those who are “reticent but disengaged”. While unfit claimants will be sent on “more intensive coaching”, those who are “optimistic” can be placed on less rigorous regimes. This is how the DWP will decide who is to be punished with “extra support” – 35 hours a week at a Job Centre.
Medical professionals as state enforcers
The 2015 Conservative manifesto stated that claimants who “refuse a recommended treatment” may have their benefits reduced. This attempt to co-opt medical professionals as state enforcers is what led to the first protest by psychologists. However, while campaigns such as Psychologists Against Austerity have focused on the psychological impact of welfare reform, there has been little mention of psychology’s central role in disciplining and punishing people claiming benefits, or of the ethics of psychological conditionality.
Notwithstanding the UK’s low pay, no pay economy featuring a growing number of precarious, exploitative and part-time jobs, what employers want is “enthusiasm” and workfare is designed to ensure they get it. The “engage” training module will help job seekers achieve “a mindset that appeals to employers, assertiveness, confidence, understanding the benefits of work, motivation and coping with low mood”. In the Job Centre and at the premises of private training providers these positive psychological imperatives – frequently laughable in themselves – are plugged into a violent and coercive sanctions regime.
Substituting outcomes
The frameworks used for DWP evaluations of workfare schemes overwhelmingly focus on their psychological benefits. The explanation psychology offers, the treatment it delivers and legitimates, and the kinds of outcome it recognises, are also specified in DWP contracts worth hundreds of thousands of pounds (Focus the Mind, Achieve your Potential, Engage for Success). A programme for JSA/ESA claimants older than 50 even aims to persuade people that age discrimination doesn’t exist.
These developments raise important questions about the ethics of extending state surveillance – and state-contracted surveillance – to psychological characteristics. Psychology can offer a powerful critical perspective on these kinds of compulsion. But pressing issues of accountability and complicity have not been addressed by professional psychological bodies, in spite of persistent lobbying from anti-workfare campaigners. Boycott Workfare says that BACP – which sets standards for therapeutic practice – has been silent, and that they are still waiting for a statement from the British Psychological Society (BPS). Far from addressing the validity or ethics of assessing claimants for “psychological resistance to work”, BPS put out a press release noting that tests should be undertaken by qualified staff.
Psychological coercion and manipulation are part of the day-to-day experience of claiming benefits. It is time the profession took a stand against them.
Co-author Lynne Friedli is a researcher with Hubbub, an interdisciplinary project of scientists, public health experts, clinicians and humanists funded by the Wellcome Trust and run from Durham University, with support from the Max Planck Institutes and the University of York.
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