Last year, Tory MP Gavin Barwell won a heap of praise from all shades of political colour for pushing parliamentary legislation to challenge mental health stigma.
Yet the disparity between the medical experts’ approach the complexities of mental health and the way politicians, job centres, fitness-for-work examiners, and other non-medical professionals approach this issue is still enormous, and no-one seems particularly fussed. Mental health stigma as experienced by Clarke Carlisle or Alistair Campbell, while important and terrible, is rather different than the stress, trauma, and in some cases suicides that are increasingly associated with work capability assessments and the removal of benefits for people with mental health problems.
Fast forward to July 2014 and we see that those same Tories have a brand-spanking new policy idea on what they deem “treatable” mental illnesses: for benefits to be taken away from claimants who “refuse” treatment for depression – and by treatment, the example they give is CBT.
Tory MP and former GP Sarah Wollaston has tweeted that the idea is a “no brainer” and is “doomed to fail.” She went on to add: “When I said it’s a no brainer I mean this unethical unworkable kite flying comes from someone with #NoBrain.” Hmm, I wonder who she means…
As a doctor, Wollaston understands medical ethics and the inherent problems in forced treatment better than some of her colleagues might. She also presumably understands illness, treatment, cure, and all the messy nuances that go alongside each.
Depression (which I’m focusing on here because it’s the main illness singled out as “treatable” by the “senior Tory” who is quoted in the Daily Telegraph about the policy idea) is complex and unpredictable. It can be sporadic, uncontrollable, sometimes fatal. Cognitive Behavioural Therapy works well for some people, some of the time, but it is not right for everybody and even when it “works”, it’s hardly a permanent cure – it’s more like just one way of mitigating some of the most painful symptoms that the illness brings. Politicians are not doctors.
But this policy idea isn’t just an ethical issue from a health perspective. It is yet another policy designed to “get people back to work” which focuses entirely on changing the attitude or behaviour of the potential employee, and changing nothing about employment practices. If you want people battling depression to work full time you need to put pressure on employers to actively challenge discrimination in their employment practices, and actively make sure their workplaces suitably accommodate people with depression.
The real irony of these proposals is that in many parts of the country, NHS mental health support and treatment is under-resourced, almost to a point of devastation. Many people are desperate for treatment and are made to wait months and months. Often when support does come, it’s in the form of group therapy, with strangers – hardly a safe environment. I have one friend who, despite being suicidal, had to stop attending his sessions the first time around because the social setting quite unsurprisingly triggered his anxiety – and because, well, who wants to discuss things like abuse, phobias, or sexual inadequacy with a bunch of strangers? Certainly not people who suffer from extreme social phobias and anxieties.
I can’t help but wonder how common it is to force people with physical conditions to share the details with strangers, in order to access support or treatment? I am thinking of the complexities of people’s lives and wondering how private, let alone how specialist, these forced CBT sessions will be? Could a rape survivor be forced to discuss their PTSD and depressive episodes with victim-blamers in the room? Could LGB sufferers of depression be forced to discuss their personal feelings of self-worth with homophobes? Could trans people suffering from depression be forced to talk about their experience of the world with transphobes?
And, perhaps the most ridiculous thing of all: this policy is ostensibly about saving money. Years ago the Mental Health Foundation published a great piece of research which showed that costs associated with mental health are overwhelmingly connected to lack of early support and poor preventative measures; a reluctance to invest in public health when it comes to our minds the way we do when it comes to, say, smoking or obesity.
Cuts to SEN specialists and teaching assistants in schools, cuts to local authority budgets, cuts to the police force, cuts to hospitals, cuts in social services, cuts in support for people with mental illnesses and for their carers, cuts in housing benefit all have a knock-on impact on how quickly mental health issues can be identified and addressed. The expense, says the Mental Health Foundation, comes when people reach their crisis point in a way which could have been mitigated or even avoided, had they been supported earlier on. The idea that the government has suddenly had a light bulb moment, after decimating the very services that help people manage or avoid their mental health crisis point, that, actually, support and treatment might also be a good idea, is quite frankly beyond satire.