Compulsory treatment and benefit sanctions: stoking fear and prejudice for political ends

14 Jul

Benefits Street

Benefits Street arrived on the iPads of Telegraph readers on Saturday night. A story about scroungers refusing help to get back on their feet and the Conservative party’s proposed “tough love” solution provoked strong reactions. And that’s no surprise.

People with mental health problems who are unable to work and dependent on state support were led to believe that payments would be docked if they refused treatment. This would effectively make state-sanctioned treatment compulsory on pain of losing your only source of income. Telegraph readers were fed the line that people with common mental health problems were willfully refusing to engage with treatments almost guaranteed to succeed just so that they could lounge about at taxpayers’ expense; but reassured that the Tories had proposed a simple and cost-effective solution (sanctions and compulsory treatment) to get people back to work.

Although at first glance the story might follow a coherent line, at second glance it became clear there was more to it. None of the reasons for publishing the story (see below) had anything to do with the advice of mental health professionals nor with helping people with mental health problems back into paid work: people with mental health problems are being used as pawns in a game of politics.

The story could prove a useful example for journalism, behavioural science and politics tutors. But does that mean it is baseless and can be dismissed entirely? No. Even though, a few minutes ago, the Department of Health tweeted me a disclaimer – there were “no plans to make mental health treatment compulsory for people receiving Employment Support Allowance” – there is a real story behind the vile propaganda, namely the current and proposed pilots of new ways to provide back-to-work support (see below).

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Why was the story published? Kite flying, dog whistles, nudging and click bait

Political parties thinking about whether to make a potentially controversial policy official will occasionally send up a little kite: they’ll brief a journalist anonymously, typically for one of the Sunday papers, to see how the idea flies. If it is ridiculed or condemned by the public, the idea can simply be dropped. If it proves hugely popular, it can be embraced. In any case, there’ll be new information. Another reason for kite flying is to put an idea out there which could never be put into effect for good practical reasons but will nonetheless get enough coverage to plant an idea in the minds of relevant voters. Some call this dog whistle politics.

The proposed policy has all the hallmarks of a ludicrous back-of-the-envelope idea dreamed up by people with no experience of mental health or clinical practice (see below). In other words, it is utter tosh. Yet the idea has been planted, without it ever having to become a practical reality, that the government is tough on skivers and tough on the causes of skiving.

The government’s Behavioural Insights Team (or, as it is known colloquially, the Nudge Unit) looks at ways to subtly alter behaviour by “nudging” or encouraging us in the right direction. Here we can see the hallmarks of a “nudge” to people with mental health problems that it really would be in our very best interests to buck up and get back into work, because we will not get an easy ride on benefits. The proposed policy is a signal that, if we must insist on being dependent on social security in future, we should prepare ourselves to jump through further hoops. Though, for practical and ethical reasons (see below), it may not be this particular hoop, there will be new hoops nonetheless.

We can also see a “nudge” in the direction of “hard working families”: the public is being softened up for the introduction of further welfare benefits cuts to disabled people. Because, as the story makes clear, there are the deserving poor and the undeserving poor – the skivers – and what they need is “tough love”.

Newspapers aren’t impartial public information services: they’re there to sell advertising and papers. Facts and context don’t sell papers: controversy, fear and outrage are the sorts of things that do. We haven’t seen the original briefing note so it’s hard to tell where the line lies between what the “government source” said and how the journalist interpreted it. But, whatever the case, the story contains a potent cocktail of inflammatory statements which appear to seek to stoke up outrage at “lazy scroungers” lounging on benefits refusing treatment that is almost guaranteed to cure them. And that’s just perfect for selling newspapers and driving traffic to  your website and up its desirability to advertisers. In other words, a controversial story is “click bait”.

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How true, complete and accurate is the story?

There are numerous problems with the story as reported, including:

  • The news coverage (initially in the Telegraph and subsequently in other news outlets) lacks analysis or context. For the main part, it repeats the same line, namely making a case for people with mental health problems to be sanctioned for refusing to engage with treatment. The news reports the proposed Tory policy, rather than the actual DWP/DoH pilot schemes (see below).
  • No acknowledgment that people in receipt of Employment Support Allowance already have to “prove they are depressed” (or whatever the reason for incapacity is) through the Work Capability Assessment. It’s not simply a case of saying “I’m unwell, give me money”.
  • There is a conflation of treatments for unwell people with JobCentre schemes currently on offer to people judged fit to work. That’s like conflating treatment received from doctors and nurses at the chemotherapy outpatient clinic and workshops at the JobCentre to help a cancer patient in remission to build confidence and return to the workforce. They are different things, but the news coverage blurs the lines.
  • There is no acknowledgment that diagnoses of depression and anxiety, which may be helpful descriptions or guidelines, are not uniform conditions to which uniform fixes can be applied. There is no acknowledgement that CBT is not appropriate nor effective for everyone. As Professor Louis Appleby says, even bacterial infections need treatment with different antibiotics.
  • No context is provided about benefits payments. Instead, people with mental health problems are presented as a drain on the economy when in fact we receive a minority of the welfare budget.
  • Misleading statements – frank factual inaccuracies – are being peddled about the treatability of depression and anxiety and about success rates for CBT. If CBT for depression and anxiety had a 90% success rate, that would be a wonderful thing. But it doesn’t. Even the government’s own IAPT services claim a success rate below half.
  • There is no acknowledgement that, with IAPT aiming to only treat 15% of need in England (and different circumstances applying elsewhere in the UK), it is pure fabrication to say that people are turning down treatment. Mental health services face devastating and ongoing cutbacks.
  • There is no discussion of the ethics for doctors or therapists of engaging in compulsory talking therapy.
  • There is no acknowledgement that talking therapy can be hard work for people. It is not nothing. It is not an easy option. It can be traumatic and upsetting. It can make people worse before it makes them better.
  • Incredibly, today the story took a further turn when it was reported that the government had refused to rule out compulsory drug treatment. It’s one thing compulsorily treating people who lack mental capacity (under the Mental Capacity Act) or people who are sectioned (under the Mental Health Act). (I have been compulsorily treated when sectioned and I can tell you I am not in favour.) But to compulsorily treat people – people who are not sectioned and who have capacity – for common mental health problems? Ridiculous. Does anyone really believe that people’s benefits will be docked if their weekly blood test at the JobCentre shows they haven’t taken their state-mandated pills? No. It’s utter tosh.

The proposals reported could never come into action: they are unethical and impractical. As the Department of Heath statement said this afternoon:

“There are no plans to make mental health treatment compulsory for people receiving Employment Support Allowance. Experiencing a mental health problem can be distressing and we want people to be able to seek treatment at the right time. We also want to help people to stay in work or return to work as part of their recovery, which is why we’re looking at options to offer more support.”

And it’s in the phrase, “we’re looking at options to offer more support” that the factual element to the story lies.

Reports say there are four trials either proposed or ongoing. The paper produced jointly for the Department for Work and Pensions and Department of Health by Rand Europe earlier in the year, Psychological Wellbeing and Work – Improving Service Provision and Outcomes, proposed trials of the following four policy options (see Part 5):

  • Policy option 1: Embed vocational support based on the principles of IPS in local IAPT or psychological therapy services
  • Policy option 2: Introduce group work approaches based on JOBS II in Jobcentre Plus
  • Policy option 3: Improving access to online assessments and interventions for common mental health problems
  • Policy option 4: Commission third-party organisations to provide a combination of psychological and employment related support to claimants

Each policy option is discussed in detail in the report and costed. They make for fascinating reading. It may well be that these are the pilots referred to by the government source. If so, they do have real implications for people with mental health problems, whether in receipt of welfare benefits or not.

This is a real story. .

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What is the fallout from the story and what may happen next?

The Telegraph story and those that followed that parroted it without analysis has stoked prejudice against people with mental health problems and facilitated and encouraged discrimination. The tone of the piece is around benefits scroungers, presenting mental health issues as something other than genuine illness, as something people can get over with the right motivation – in this case, financial penalties for people with no other source of income.

It is no wonder people on twitter have expressed such fear and despair. When ill-health forces you to rely on social security payments to keep a roof over your head, when you desperately need treatment but are unable to get it due to cutbacks and waiting lists, then being blamed for your inability to work, being told your sole source of income will be docked and that you could be forced into treatment is supremely unwelcome. People with mental health problems are a vulnerable and discriminated-against minority. Being used cynically for political purposes in this way is sickening.

We will start to learn more about the pilots in due course. And there will be implications for people with mental health problems, whether or not they are in receipt of welfare benefits.

 

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Web links thumbnail

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Related links

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Mainstream media

Saturday 12th

Sunday 13th

Monday 14th

Tuesday 15th

  • Mental health benefit claims denied  – “Norman Lamb also told MPs there are no plans to force people to access therapy, adding pilot projects would seek to develop ways to ensure unemployed people with mental health problems receive help.” Press Association

 

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Mental health charities

  • Proposal to force people to undergo treatment is unacceptable“We are deeply concerned by the rumoured Government proposals to strip people of social security if they don’t undergo treatment for mental illness. We doubt that the Government would consider doing the same to people with diabetes if they didn’t take insulin, so why should people with mental illness be treated this way?”Rethink Mental Illness (Monday 14th July)

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Department of Health

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Blogosphere and commentators

Sunday 13th

Monday 14th

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Background reading

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Twitter comments and conversations

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17 Responses to “Compulsory treatment and benefit sanctions: stoking fear and prejudice for political ends”

  1. nearlydead 14 July 2014 at 7:06 pm #

    Reblogged this on nearlydead.

  2. Quinonostante 14 July 2014 at 9:19 pm #

    Reblogged this on Mentally Wealthy.

  3. Alisdair Cameron 15 July 2014 at 12:50 pm #

    Reblogged this on Launchpad: By and for mental health service users.

    • A.Sladdin 2 December 2014 at 9:43 pm #

      Thanks again Alisdair. I am currently working on the ‘sledge-hammer’ blog. .. . Disabled Persons Union? I hope it isn’t my idea, bit controversial. I hope all at Launchpad are getting on well and hope to see you all again, maybe early next year/

  4. stewilko 15 July 2014 at 3:17 pm #

    Reblogged this on stewilko's Blog and commented:
    Great article, “the nudge team”, this and the other stories i am reading concerning this governments us of psychological tactics is making me consider is there some links to those adopted within the dreadful 2nd world war.

  5. borderline 15 July 2014 at 8:56 pm #

    How is that gonna work I have mental health problems and my illness is untreatable the so called cbt won’t help me neither will medication as there is no meds out there for my illness so what is he gonna do with the likes of me and others that suffer with untreatable mh issues maybe the gas chambers

  6. Firestormm 21 July 2014 at 4:06 pm #

    Thank you. I thought this an excellent analysis and am grateful.

  7. argotina1 25 July 2014 at 3:46 pm #

    Reblogged this on Benefit tales.

  8. Mike Sivier 25 July 2014 at 9:12 pm #

    Reblogged this on Vox Political and commented:
    This is well worth reading, as it provides welcome information on the way politicians use the media to manipulate public opinion.

  9. A6er 25 July 2014 at 9:32 pm #

    Reblogged this on Britain Isn't Eating.

  10. aboriginalpress 25 July 2014 at 11:34 pm #

    Reblogged this on .

  11. beastrabban 27 July 2014 at 11:56 am #

    Reblogged this on Beastrabban’s Weblog and commented:
    This is an extremely detailed critique of the story floated in the Telegraph that ministers are considering sanctioning benefits claimants, who refuse to take their medicine. This is, of course, the Tories kite-flying, finding ways to further punish the weakest and most vulnerable members of society. The last thing it is about is actually helping people, as it is claimed. It is also about reinforcing prejudices, and presenting those with mental health problems as scroungers and malingerers, rather than people with genuinely difficult and challenging problems to their health.
    The article connects this story to the government’s ‘Nudge Unit’, which employs socio-psychological techniques to alter voters’ behaviour. Somebody once said that if you wanted to know what’s really going on, follow the money. It doesn’t always work – there have been any number of cases where businesses have followed a fad, only to get caught in a massive crash, from the South Sea Bubble to the Dot Com Bubble a few years ago. But in this case, it’s right. The Nudge Unit are a bunch of quacks peddling woo, and the business community knows it. The Unit was privatised to great fanfare a few months ago, and there were admiring columns written about them in papers like the Independent. However, one of the businesses that took them over is owned by the government, according to Private Eye, which revealed that private industry didn’t want to touch them with a barge pole. And with them floating quack, damaging policies like this, I can’t say I blame them.

  12. Lucy 28 July 2014 at 11:47 am #

    I first read about the planned pilots for this latest attempt to harm the mentally ill about 3 years ago. No one I spoke to believed it would be possible to bring in such draconian schemes because coercion to take up medical treatment is considered in law to be social control, and it’s illegal.

    I think this foul government or any other party who happens to get into power next May, will continue with these schemes. The loophole they are working on now, to get around the social control legal issue is the one where they redefine medical treatment/therapy as something other than medical treatment.

  13. A.Sladin 2 December 2014 at 9:18 pm #

    Has anyone else thought of founding the Disabled Persons Union? No? One man cannot achieve this. I think it would attract more members than Unison. I have read the above and found it hard work but nothing like the battle to be assessed for PIP or understand the transition from DLA to PIP. I currently have a claim being assessed for both? Unbelievable. I have been sent the wrong forms. I re-applied for DLA to be told I could not apply for that as it did not exist anymore in a letter accompanying the correct form for a PIP application. After the expiry of my existing award of course. Alongside this all my other benefits were stopped apparently by mistake. I await confirmation as to whether any evidence I submitted during the DLA application is relevant. I argue that it is, under these bizarre circumstances. I hope the almost inevitable appeal tribunal finds in my favour. That is if I live long enough to make it to the assessment. Currently the waiting time for assessment is 26 weeks or more. If a claimant dies during the processing of a claim, is any award paid to their estate? I am unable to find any mention of the implications of death during the claim processing.
    Perhaps the DWP, ATOS, Capita Health are too busy with other issues to consider their own woeful failings. It can’t just be me, can it? In a way I hope so. If there are others out there being as messed around with as I am, You have my sympathy. I have managed to include evidence that the application process for these benefits exacerbates some nervous conditions. I think that is enough for now. In case this becomes ‘un-threaded’ or escapes onto the wider web detached from its source or inspiration, it is a reply to damaging propaganda published about disabled benefit claimants.
    Best wishes to anyone who has to go through the flawed benefits claim system and I think it best to get all relevant evidence included in any claim. The assessors can only consider what they are made aware of.

Trackbacks/Pingbacks

  1. The Nine most terrifying words in the English Language are…. | Carer Watch's Blog - 15 July 2014

    […] copied from  mental health & mental healthcare blog […]

  2. Mid July bulletin of meetings,upcoming events etc in mental health and health and social care related stuff | Launchpad: By and for mental health service users - 16 July 2014

    […] that someone within a major political party can float such notions. A good read on this all is here. The whole benefits "reform" saga goes on, and doesn’t make happier reading as it […]

  3. Collaborating in coercion? A pivotal time for the psychotherapy profession | Sectioned - 27 June 2015

    […] Compulsory treatment and benefit sanctions: stoking fear and prejudice for political ends – My blog – 14 July 2014 […]

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