Work and Pensions secretary and hardcore neoliberal Liz Kendall has decided that the biggest challenge facing those with the most profound mental illness is not being ready for work. To put this in context, the UK has one of the most under-resourced and poorly performing mental health systems in the developed world. So much so, that the majority of people affected by mental illness go untreated, while only those at the greatest risk to themselves and or others qualify for one of the few remaining places on a mental health hospital ward. Nevertheless, Kendall apparently believes that sending “job coaches” into mental health wards is an appropriate response.
Even accepting that, despite Treasury pressure to cut costs, this really is an attempt to help the millions of people affected by mental illness in the UK – a number that not unsurprisingly spiked in the wake of two years of unnecessary house arrests of young people – it is unlikely to have the desired effect, and risks making people’s health far worse. Because most people who are out of work with mental illness were previously in work with mental illness. And the very fact that they lost their employment is a measure of the atrocious lack of early interventions to prevent mild-moderate mental illness deteriorating. As a GP with an interest in mental health put it to me a couple of decades ago (when access to care was greater than today):
“We’re like emergency workers pulling drowning people out of a river, but we’re so busy that nobody has time to go upstream to see who or what is pushing them in.”
Thanks to the development of (relatively safe) anti-depressant and anti-anxiety drugs in the 1990s, most people affected by mental illness can at least get a modicum of support from general practice… with some surgeries offering limited access to counselling (although getting an appointment is increasingly difficult these days). But accessing specialist community mental health services is like something out of Catch 22, where most people are deemed “not ill enough” to qualify, even as the most ill are “too ill” for anything but hospitalisation. Contrast this to the approach taken to cancer, strokes, and heart disease, where speed is the essence because the earlier the intervention, the greater the chance of survival.
In practice, this means that mental health services, as configured, become just another failure on the road of someone’s journey from mental health to mental illness. Not because – as happens with physical illness – the disease itself deteriorates, but because mental illness is as much a life journey as a health journey. That is, as the GP mentioned above put it: “people have problems before they have diagnoses.” Some people may be more predisposed to developing mental illness – Paul Keedwell, for example, makes the compelling case for a genetic predisposition to depression, although others point to such things as childhood neglect or abuse, or just growing up in poverty (something else that is far more common today). Nevertheless, something must precipitate an episode of depression, such as a relationship breakdown or the loss of a job. And when these predisposing and precipitating factors come together, the unfortunate individual often suffers a life cascade – job (or income) loss often results in relationship breakdown, which very often leads to homelessness. And, predictably, mental illness – and periodic stays in mental health hospital wards – is high among homeless people… if only Ms Kendall’s “job coaches” had been available at the start of the journey – ideally while the victim was still working – rather than inflicting them at the nadir.
When I first began running the Welsh branch of Depression Alliance nearly quarter of a century ago, among my first actions was to survey the members and subscribers to uncover their main issues (and thus the issues that we, as a charity, ought to pursue). By far the biggest issue raised was the need for support to help people retain their jobs. It was from this result that I worked to develop what became the EU-funded Healthy Minds at Work project. The aim was simple enough – to develop a range of non-medical supports – including a telephone counselling and coaching service, self-management training programmes, and the broader Mental Health First Aid training for employers.
Sadly, this initiative began just as the Blair government was cosying up to American insurance-busters such as Unum Provident (which funded an occupational health department at Cardiff University around that time) with a focus on getting people back to work (or, more cynically, denying them benefits) rather than helping them stay in their old jobs to begin with. In part, this was due to the labour shortage in the UK in the mid-2000s (which is why the government opened the borders to migrants at that time) with disabled people – even those with mental illness, who face additional discrimination – seeming like an obvious pool of potential workers. And because almost all the funding went in this direction, job loss prevention was off the agenda… permanently.
Just months later, Lehman Brothers collapsed, taking several UK banks and a large portion of the previous job vacancies with it. In Cameron’s post-crash austerity Britain, demand for disabled workers fell, but the state sanctions placed on disabled workers remained. Blair’s hated Work Capacity Assessments became a means of denying thousands of people the income and support they needed, with people affected by mental illness being over-represented among those who killed themselves as a result. The performance-targeted Job coaching regime became a cat and mouse game in which there were never enough mice (jobs) for the cats (disabled people) to catch, but where the cats were punished for failing to catch the non-existent mice.
This is not, of course, to suggest that there shouldn’t be public support to assist those currently out of work due to ill-health. But a more targeted and comprehensive approach is surely warranted. Rather than wait until people are so ill that they need hospitalisation, focussing support on those with mild-moderate conditions would be more productive. Moreover, recognising that help finding work is just one of a plethora of support needs would avoid the casual sadism of a service which otherwise becomes just another means of cutting the Work and Pensions budget. Not least because job coaches themselves report a huge “knowledge gap” when it comes to supporting people with mental illness… something not really addressed by the DWP provision of Mental Health First Aid training, which barely scratches the surface of understanding the complexities of mental illness.
Someone entering the downward spiral into mental illness is likely to need support with health, education, and housing as well as help finding work. But most of all, they need a replacement for the income they lost after they – for one reason or another – lost the job they had been doing. But since those services are also upside down (targeting those with the most profound and complex problems) then all too often, finding and keeping a job is too difficult. In this respect, sending a job coach to sit next to their bed in an acute mental health ward is surely the ultimate insult.
Indeed, even if ministers and senior government officials convince themselves that job coaching – backed up by punitive sanctions – really is in the best interests of those they claim to be helping, the reality for the victims will more likely be akin to C.S. Lewis’s vision of Hell on Earth:
“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. They may be more likely to go to Heaven yet at the same time likelier to make a Hell of earth.”
Little wonder, perhaps, that so many people (as happened in similar circumstances in the 1930s) are opting for the (fascistic) robber barons in preference to the puritanical do-gooders whose mission seems to be to make life miserable for everyone else.The last working-class hero in England.
Clio the cat, ? July 1997 - 1 May 2016 Kira the cat, ? ? 2010 - 3 August 2018 Jasper the Ruffian cat ? ? ? - 4 November 2021
on October 30, 2024, 10:22 pm