the free psychotherapy network

free psychotherapy for people on low incomes and benefits

Is work a health outcome?

For all NICE and IAPT’s insistence on an “evidence base” for policy and funding, there is no real evidence that work is in any general sense good for people with mental health difficulties, and especially those with more severe and enduring conditions. Under Tony Blair, the DWP commissioned a report from the Centre for Psychosocial and Disability Research, University of Cardiff to gather evidence for the assertion that work is good for you. Waddell and Burton’s report in 2006 has become the most quoted workfare authority on the efficacy of work for physical and mental health.[i] Paradoxically, it is extremely ambivalent about the efficacy of employment for people suffering mental health of difficulties:

The current review shows that work is not harmful to the psychiatric condition or mental health of people with severe mental illness although, conversely, it has no direct beneficial impact on their mental condition either. However, the balance of the indirect evidence is that it is beneficial for their overall well-being.

There is limited evidence about the impact of (return to) work on (people with) mild/moderate mental health problems, despite their epidemiological and social importance. However, there is much more evidence on ‘stress’, which may be the best modern exemplar of common mental health problems.

There are no objective or agreed criteria for the definition or measurement of stressors or stress responses, or for the diagnosis of any clinical syndrome of ‘stress’. These conceptual and methodological problems create considerable uncertainty about psychosocial hazards, about psychosocial harms, and about the relationship between them .[ii]

Equally, there is no good evidence to support the Royal College of Psychiatrists report claiming that “as many as 90% of workless people who use mental health services wish to work”.[iii] Again the sources of this assertion are based on distorted interpretations of evidence.[iv] Apart from anything else, it seems impossible to take at face value that if asked whether they want to work or not someone on benefits would be likely to say ‘no’ given the general prejudice against benefit claimants, and the punitive culture of the current workfare system.[v]

There is evidence, however, that welfare to work programmes simply do not work[vi]. In 2015, despite government claims to the contrary, it was clear that the coalition’s Work Programme, designed to get 45% of ESA claimants into work, had failed.[vii] It is being replaced by a much less ambitious Work and Health Programme from 2017.[viii] Attempts to introduce intensive Individual Placement and Support into the IAPT has had little success[ix], and likewise ‘employment support’ for depression and anxiety within the IAPT programme.[x]

And is it not extraordinary, in the era of the “bullshit jobs”[xi] of the neoliberal labour market with general precariarity[xii], zero-hour and part-time contracts, low wages, lack of trade unions and workers’ rights, and the relentless pace and repetitive monotony of most low-paid jobs, that such massive pressure is being brought to bear by the state on people who are the least likely to be able to sustain themselves in the mad house of modern working environments.[xiii] Despite one DWP minister’s enthusiasm for the gig-economy[xiv], Neoliberal labour markets are far more likely to be detrimental to all workers’ mental health than they are beneficial for those already suffering from psychological distress.[xv] A survey conducted by The Hoxby Collective has found that 33% of workers said they’d suffered from mental health issues as a direct result of working rigid hours.[xvi] Studies have also shown that moving from unemployment to bad employment is certainly not good for your mental health.[xvii] As we have seen, IAPT workers are themselves experiencing versions of David Graeber’s “bullshit”.

 


[i] Waddell G; Burton A (2006) Is work good for your health and well-being? London (UK): The Stationery Office. [Available from: http://www.gov.uk/ government/uploads/system/uploads/attachment_data/file/214326/hwwb-is-work-good-for-you.pdf]. For the influence of the report on government policy see www.gov.uk/government/collections/health-work-and-wellbeing-evidence-and-research and www.evidence.nhs.uk/Search?ps=250&q=waddell+and+burton&s=Date. On the background of the Centre for Psychosocial and Disability Research, and Waddell and Burton’s associations with the application of the biopsychosocial work capability test in the UK, see Stewart M. (2016) Cash Not Care: the planned demolition of the UK welfare state. New Generation Publishing: London. On the influence of Waddell and Burton on US welfare policy and campaigning, see https://talkpoverty.org/2018/01/19/no-forced-labor-not-good-health/

[ii] https://dpac.uk.net/2015/09/the-ids-files-better-off-in-work-idsfiles/

[iii] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212266/hwwb-mental-health-and-work.pdf p.17 https://www.theguardian.com/society/2007/nov/14/mentalhealth2

[iv] For example, one source for RCP report states: ‘Those users who were not already in paid employment… were asked if they were interested in work of any kind, including voluntary or supported work. They had the opportunity to respond positively (yes), more tentatively (maybe in the future), or negatively (no). Around half (47%) responded positively, and almost the same proportion (43%) had a tentative interest. 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. (p397). In fact, the same study found that only a quarter of the people who expressed a positive or tentative interest listed full time work as a long term goal. To add more tentative to positive to conclude that 90% wish to work is very misleading, especially when Secker and other authors go on to describe the kind of obstacles to work that concern service users. Compare a DWP survey of disabled working age benefit claimants in 2013. 56% of 1,349 respondents agreed that they wanted to work. Only 15% agreed that they were currently able to work. Only 23% agreed that having a job would be beneficial for their health. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224543/ihr_16_v2.pdf

[v] https://www.academia.edu/16700661/_Benefits_broods_The_cultural_and_political_crafting_of_anti-welfare_commonsense; https://themighty.com/2017/05/shame-depression-being-on-disability/; https://www.theguardian.com/society/2014/nov/05/work-programme-adviser-box-ticking-sanctioning-sick-people;

[vi] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212266/hwwb-mental-health-and-work.pdf p.17 https://www.theguardian.com/society/2007/nov/14/mentalhealth2

[vii] https://www.theguardian.com/politics/2015/sep/17/welfare-to-work-programme-failing-disabled-and-ill-jobseekers-say-charities & http://www.boycottworkfare.org/the-not-working-programme/

[viii] https://www.theguardian.com/politics/2017/jan/13/thousands-of-jobs-to-go-in-government-shakeout-of-welfare-to-work-sector

[ix] Ihttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/415177/IPS_in_IAPT_Report.pdf

[x] http://digital.nhs.uk/catalogue/PUB22110 p.11

[xi] https://libcom.org/library/phenomenon-bullshit-jobs-david-graeber. See also http://theconversation.com/when-it-comes-to-jobs-its-quality-not-quantity-that-matters-36490; https://www.weforum.org/agenda/2017/04/why-its-time-to-rethink-the-meaning-of-work/; https://www.independent.co.uk/news/business/news/uk-must-combat-insecure-unfulfilling-jobs-commit-to-good-work-economy-matthew-taylor-government-a7724786.html

[xii] https://hbr.org/2017/04/what-happens-at-home-when-people-cant-depend-on-stable-work

[xiii] https://www.rand.org/pubs/research_reports/RR2014.html

[xiv] https://www.independent.co.uk/news/uk/politics/dwp-gig-economy-damian-green-speech-holiday-minimum-wage-sick-pay-hours-a7421071.html

[xv] https://www.ft.com/content/6cb845b2-8682-11e7-bf50-e1c239b45787

[xvi] http://metro.co.uk/2017/10/10/world-mental-health-day-research-shows-that-presenteeism-is-strongly-linked-to-mental-health-issues-in-the-workplace-6988416/

[xvii] https://academic.oup.com/ije/advance-article/doi/10.1093/ije/dyx150/4079898