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How do we get mental wealth?

In his address to a Labour Party conference fringe event, Paul Atkinson examines the social and political forces at work in our society’s current approach to psychological distress and asks what we need from a new government to support and nourish the nation’s mental wealth.


For whatever reasons – reasons that I think are very important and need to be explored – the emotional and psychological difficulties of living in this society are becoming increasingly visible and alarming: in our families; in our schools and colleges; in our local communities; in the attention drawn to mental ill health by (social) media, charities and celebrities, as well as politicians and social policy makers.

Should we think of this growing attention to mental health and the emotional conditions of contemporary life as a sign of growing awareness of the pain and suffering that has always been with us, hidden away in the private closet of social stigma and shame? Or are we witnessing the symptoms of an increasingly dysfunctional, disturbed and disturbing political and social structure? However we interpret it, I think we can say that there is something very, very wrong. It has either always been wrong, or over the last two to three decades we have been getting something very wrong. Certainly both Tory and Labour governments have been getting something very wrong, and are continuing to get it wrong.

To my way of thinking, there is something very wrong with a political economy which simply carries on, blindly it seems, propagating and prioritising the same fundamentally alienating and corrosive values:

economic growth before all else;

the accumulation of status and worth through money, wealth and conspicuous consumption;

generating and acquiescing in deep inequalities of material wellbeing and of the opportunities to make creative, satisfying lives.

To my libertarian socialist mind, capitalism has always generated toxic side effects in its exploitation of people’s mental wealth – in the service of profit and the accumulation of the few. Neoliberal capitalism – its extractive and kleptocratic offspring – seems to be generating an accelerating pandemic of fear, insecurity and anxiety which is splintering and dividing us as communities and individuals.

So my message to the Labour Party is that we need a government that is prepared to redefine what society is for, who society is for. A government that acknowledges the priority of people’s emotional and spiritual lives, their relationships, their need to give and receive care, support and love from each other. We need a government that is prepared to put our mental wealth before our economic wealth.

Yes mental health services need more money, far more money and human resources. But better funding alone is not the answer.

I am not a mental health service user or survivor of the psychiatric system. I am not poor, black or gay. But let me give you an example from my professional world in which I can claim some small expertise by experience. Let me give an example of how more of the same as far as mental health funding is really not the answer; an example of how what seems like a major step for improving the nation’s mental health is turning out to be as much part of the problem as part of the answer.

In an article in the New York Times in July 2017, titled Englands Mental Health Experiment: No-Cost Talk Therapy, Benedict Carey – US journalistcelebrated as a globally inspiring initiative the UK’s programme of short courses of cognitive behavioural therapy (CBT) in every primary care service in England – the Improving access to Psychological Therapies (IAPT) programme:

‘England is in the midst of a unique national experiment, the worlds most ambitious effort to treat depression, anxiety and other common mental illnesses.’

Colleagues and I on the left of the psychotherapy profession groaned in despair.

In 2008, Richard Layard and David Clark persuaded the Blair government to roll out an ambitious programme of CBT, offering psychological therapy for one million referrals a year through GPs. Layard, an economist specialising in unemployment and welfare to workfare policies, argued that mental ill health was the primary burden on the welfare budget of unemployed people receiving Employment and Support Allowance, and psychological therapy provided by the state would pay for itself by getting people off benefits.

On the face of it, it has been a huge success. Its champions call it the ‘IAPT revolution’. Every CCG in England offers psychological therapy under IAPT. Roughly 1.3 million referrals (some self referrals) were made to IAPT last year. It claims a 45% recovery rate. People in therapy that otherwise would never see therapy.

In reality…

Despite its value to probably many thousands of clients, the reality of NHS psychological therapy is far from the rosy picture Benedict Carey or its champions paint:

At an operational level, IAPT is an assembly line mental health fix.

Of the 1.3 million referrals last year, one third actually finished a course of treatment. In the end, only 12% of all referrals “recover”.

Almost half of these received what is called low-intensity (LI) treatment – something most psychotherapists would not recognise as talking therapy. For example, the most successful LI “therapy” was through non-guided self-help books.

The average number of sessions for all IAPT treatments is nine. A fifth consist of just two sessions. Recovery rates are falling, and the number of patients returning for repeat treatment is growing.

Almost all state funded talking therapy is now CBT, which has replaced virtually all other kinds of psychotherapy previously available free on the NHS.

The gold-standard evidence base for IAPT, based on random control trials, is in fact an avalanche of statistics highly manipulated towards maintaining state funding. Waiting lists are growing. Recovery rates within more deprived areas of England are significantly lower than in wealthier communities.

Meanwhile, according to a recent report by the British Psychological Society, the mental health of IAPT therapists and psychological practitioners is suffering a monumental nose-dive – 50% suffering depression, anxiety and acute work stress.

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And yet, for the moment at least, there seems to be little recognition at government level that something is amiss – the programme is expanding. IAPT is doing an important political job. As far as I and my fellow campaigners are concerned, that political job looks like this:

First, IAPT has no brief, no money and no time to be thinking about the causes and meaning of the mental health issues it is managing. It deals with symptoms on an individual basis and aims to get people back into their everyday “normal” lives as quickly and cheaply as possible. As far as I can see it has no interest in the social model of mental health or in the influence it might have on getting government to think about the emotional impact of economic and social policy generally.

Second, I think of IAPT as a partner of Big Pharma in the growing mental health/happiness industry. CBT with its tick-box inventories, like the mass consumption of anti-depressants, has grown rapidly since the end of the 1970s. They are both contemporaries of the neoliberal turn. IAPT therapy is essentially courses of positive thinking, encouraging you to take more responsibility for your states of mind and adapting a little more flexibly to the realities of the world you are in – including of course the world’s markets.

Third, like antidepressants and other psychotropic drugs, IAPT is administered from the top down, on the medical model of diagnosis and allocation of treatment by a health professional. While the client hopefully has a say in the content of a talking therapy session, she has little say in who she works with, in what kind of setting, with what kind of frame, for how long and so on. If you want a choice of psychotherapy approaches, if you want a therapeutic relationship that is on-going and open-ended, led by your own sense of need, pain and distress, then it’s private practice at £60 – £90 a session.

Fourth. IAPT is an NHS service, state funded and state led. Its basic brief is to get people back into the flow of a “normal” life as quickly and cheaply as possible. This has always included getting people back to work. From its inception, IAPT has occupied and helped create a space in which the government’s policies on mental health, employment and welfare meet up within the toxic framework of workfare, cutting welfare, maintaining a low wage labour market.

“psy professionals have allowed themselves to be drawn in to a system of psychocoercion”

What we as psy workers have been witnessing, as New Labour’s workfare iniatives have progressively developed into the Tories’ vicious – yes, murderous – attacks on people with mental and physical disabilities and on welfare provision generally, is that psychotherapists, psychologists, occupational therapists and mental health workers have been increasingly drawn in – and have allowed themselves to be drawn in – to a system of psychocoercion of people on welfare benefits, a system which glorifies work as the ultimate goal and obligation of citizenry.

As we know, the experience of many claimants with mental health difficulties is one of being terrorised by benefit cuts (whether in work or not), sanctions, fitness to work assessments, PIP, and now the further cuts of Universal Credit. For many, being driven off benefits is not into work: it is onto the streets, into the food banks, into an early grave through ill health, addiction, self harm and tragically, suicide.

The New Savoy Conference, IAPT bosses’ annual trade conference, welcomed with open arms the Tories’ welfare to work policies and the opportunities they offered for state funded therapy to get involved in “helping” people get off benefits and into work.

When George Osborne announced in his spring budget 2015 that he was co-locating teams of IAPT therapists in Jobcentres, that DWP employment coaches were going to be located in GP surgeries and at one point in food banks, finally some of us psy professionals woke up and realised our own professions were becoming agents of psychological terror. That our professions were allowing themselves to be drawn into the violence that is at the heart of the neoliberal project. We got together in 2015 and formed the campaigning alliance that organised this meeting.

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So, coming back to the question, what do we want from a radical Labour Party and Labour government to support and nourish the nation’s mental wealth?

Looking at this year’s Labour Manifesto:

Do I think it’s enough to talk about restoring Tory cuts to mental health services, putting more resources into attending to children and young people mental health, reasserting the need for parity of esteem with physical health, and offering a wider choice of therapy options under NICE guidelines?

Do I think it’s enough to restore Tory cuts to ESA, get rid of sanctions, the bedroom tax, WCA and PIP assessments, to talk about support and care for people who cannot work, and the social model of disability – or even Universal Basic Income?

Well, no.

Of course mental health services need more resources. The hypocrisy of every party declaring their distress at the lack of such services while doing bugger all except to cut funding further is shocking. The only way of understanding this is that mental illness is still regarded as a shameful, frightening shadow of our culture which politicians can get away with ignoring and attacking, as they do with welfare claimants.

Yes, we need more safe spaces for people with acute and severe mental health problems. We will continue to need more people with specialist trainings. And yes we need more talking therapy without a doubt.

But, FIRSTLY we need these services as part of a very different understanding of the kind of society and the kind of relationships that promote and support our mental wealth. Most of what gets called mental ill health is facilitated by the social, cultural and emotional conditions people are living in from day to day, and the conditions we have been in most of their lives.

We need housing policies, education and early years policies, transport policies, policies on working conditions, as well as health policies, that give the first priority to how people feel about themselves and their world, not to how they can be managed to maximise GDP.

And SECONDLY, absolutely crucially, if we are going to take seriously the priority of mental over material wealth at all, we need a society in which people feel that they not only have a say in how their world is developed and run; we need a society in which people feel they have THE say, the FIRST and LAST say, day to day, in how their world is organised.

Top down mental health services, administered by psychiatrists, psychologists, therapists, nurses and other professionals disempower and isolate individuals as mental health problems. To as high degree as possible these services need to be designed, managed and developed by service users and survivors. Professional services need to be in service, really in service, not driven by their own managerial ambitions, their profit making, or the fear of hanging on to an impossible job.

“Work remains the absolutely critical structure of social control in these capitalist societies of ours.”

For how long are we going to carry on preaching and believing in the insanity of the capitalist work ethic? That your value as a citizen is dictated by having a job? That it is your obligation to society to be in waged work? Are we absolutely bonkers?

Only 13% of people worldwide actually like going to work, according to a Gallup poll conducted in the States and published in the Washington Post October 10th 2013. According to new research by the London School of Business and Finance, which interviewed 1,000 male and female professionals of different age groups from across the UK, an overwhelming 47% want to change jobs and more than one in five are looking to career hop in the next 12 months. And over 60% of people living in poverty in the UK are in working families.

Forcing people with mental health difficulties into work says it all. Work remains the absolutely critical structure of social control in these capitalist societies of ours. Those who cannot work are to be treated as pariahs. They are the worthless lazy dependent scroungers that everyone can hate and treat with contempt – along with the homeless, the poor, the food bank users and the immigrants.

How appalling do the conditions of work have to become for us to say STOP. Something is very, very wrong. Why on earth can a parent, and especially a mother of young children, not say I don’t want to work, I want to focus on bringing up my kids?

Why is it treated as a utopian fantasy that work should be enjoyable – ‘adult play’, the psychoanalyst Donald Winnicott wanted to call it – that work be defined in all sorts of ways but basically as creative effort?

What the hell is wrong with us?

Yes, let’s have trade union power, workers’ power established at the centre of everyone’s working life. But also let’s get rid of the workerism that’s embedded in traditional left visions of a transformed society. We need so much more than the dignity of labour defining what life is about.

So let me just end on this. No, I don’t think more of the same is at all good enough. Yes, I think Corbyn’s Labour Party is beginning to take seriously the possibility of a world transformed. But there is a long way to go before mental wealth becomes the real standard by which we measure society and our political economy.

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Alliance video: protest against New Savoy Conference of psy-organisations

The Mental Wealth Foundation, supported by The Alliance for Counselling and Psychotherapy, challenge attendees at the 2017 New Savoy Conference.

Why, despite some of the recent rhetoric, are the professional psychological organisations colluding with the Department of Work & Pensions view that being out of work is a pathology requiring treatment? Why support psycho-compulsion by working in environments in which those claiming benefits can be coerced into a distorted form of counselling and psychotherapy? Why support the emergence of State therapy?

OiOiSaveloy from Denis Postle on Vimeo.

Government Attack on Benefits Claimants: A Message from the Alliance

In response to the latest Government attack on benefits claimants with mental health and physical disabilities, the Alliance has written to the press and to the major psy-organisations, who we call upon to take a much more critical stance on these issues. See both letters below.


Letter to the Psy-Organisations

Dear Senior and Representative Colleagues,

The Alliance for Counselling and Psychotherapy is part of the Mental Wealth Alliance that has been engaging with most of the addressees of this e-mail. We have asked that you distance yourself from the DWP in an unmistakeable way and take up a much more combative and critical stance in relation to what is happening to ‘welfare’.

We assume that you are aware of the latest DWP issue referred to by the Daily Mirror and many other media outlets. If not: Tory ministers have rewritten the law to deny increased disability benefit payments to more than 150,000 people

The response we get is that your organisations are doing all that can be done and that there is no difference between your position and that of the Mental Wealth Alliance.

It is time to put your money where your mouth is and start to exert pressure on the DWP to operate in a more equitable, consistent and honest manner.

We believe that your various memberships are expecting this, and we urge you not to follow what is effectively, a collusive path. True, by muting protest you retain your access to the seats of power. But, in these circumstances, this is simply not the proper attitude to maintain.

Below, please find the letter sent by the Alliance for Counselling and Psychotherapy to the Daily Mirror and other newspapers. Will you take similar or analogous actions?

Yours sincerely,

Paul Atkinson and Professor Andrew Samuels (for the Alliance for Counselling and Psychotherapy)


Letter to National News Media

The Alliance for Counselling and Psychotherapy is a nationally recognised interest group of mental health professionals from diverse clinical and academic backgrounds. We were appalled to learn that last Friday, February 24th, without consultation or warning, the Government launched yet another vicious attack on the psychological, as well as financial resources of benefit claimants with mental health and physical disabilities (Tory ministers have rewritten the law to deny increased disability benefit payments to more than 150,000 people Daily Mirror, 24 Feb).

Emergency legislation has over-ridden the rulings of two tribunals that the Department for Work and Pensions (DWP) should expand the reach of Personal Independence Payments (PIP). At stake is mobility support for over 140,000 people who suffer “overwhelming psychological distress” when travelling alone, and more than 1,000 people who need help to take medication and monitor a health condition. The courts ruled both categories of support needed to be included in the PIP assessment of people’s needs. The DWP itself admits this will include for example those who have a learning disability, diabetes, epilepsy, anxiety or dementia.

In September 2016, Theresa May and her DWP ministers promised there would be no more welfare cuts on top of the string of draconian measures agreed last year as the final contribution of Cameron and Osborne’s campaign to punish those who cannot work. It seems her promise was another lie. With delicious irony, Disabilities Minister Penny Mordaunt said this latest move would “make sure we are giving support to those who need it most”. Meanwhile on Marr this Sunday, Tory party chairman Patrick McGloughlin responded to criticism of the emergency legislation by stating “as far as supporting disabled people in this country is concerned, we do very proudly”.

This is a government determined, come hell or high water, to strip welfare provision to the absolute bone, an ideological commitment it justifies in terms of the fiscal necessity of austerity savings and the therapeutic magic for all benefit claimants of getting themselves into work. As mental health professionals, we find it tragic and painful to be living through a period in which the social contract between the advantaged and the disadvantaged is under full-frontal attack.

More particularly, we find it shameful that our own professional bodies – psychotherapists, counsellors, psychologists and psychiatrists – continue to participate in the abuse of human rights and of their own ethical codes through their involvement in the psycho-compulsion of benefits complainants through the DWP’s workfare and Work and Health policies.

We call on the government to reverse its policies of welfare cuts as a minimum step to honouring Theresa May’s promises for a fairer deal for those struggling to cope to maintain any decent conditions of life. And we call upon our fellow ‘psy’ professionals to now insist on a withdrawal of all involvement in supporting the psychological coercion and punishment by the DWP of the most disadvantaged members of our society.

Yours sincerely,

Paul Atkinson and Professor Andrew Samuels (for the Alliance for Counselling and Psychotherapy)

 

Nothing about us without us? Are you bonkers?

In May this year, I joined members of the Mental Health Resistance Network at an event at the Old Vic. It was a panel debate on the state of mental health provision in the UK, one of their Voices Off events linked to the production of Harold Pinter’s The Caretaker. The original panel was Luciana Berger MP, Shadow Minister for Mental Health; Paul Farmer, CEO of Mind; and Simon Wessely President of the Royal College of Psychiatrists. MHRN members protested that there were no service user speakers, and eventually Peter Beresford and Alice Evans were invited onto the panel.

Inspired by the desperate lack of service user voices, mental health activists rapidly got together a zine to distribute at the meeting – a passionate collection of first-hand experiences of living on the sharp end of mental health disability in the UK. Jay Watts of the Alliance contributed a cartoon strip. I promised a short piece but couldn’t finish it for the deadline. Here it is – my belated contribution.

Read the full zine here


What’s wrong with people wanting to talk in public about other people’s mental health without including them in the conversation?

We psychotherapists definitely like to talk about our clients in the third person, though we don’t usually do it when they might be in the room. We do it behind their backs.

We like to exchange anecdotes about how difficult so and so is; about the terribly interesting unconscious meaning of what so and so said; about the clever little interpretation we were ‘able to offer’; about how narcissistic, borderline, dissociated, manic, aggressive, negative or just plain bonkers… so and so is.

So and so is not usually there when we speak about them, which is a good thing. If they were, we wouldn’t feel quite so free to show off how clever we are to our colleagues, or our students, or our partners and friends. We might feel a little inhibited, just a little caught out. A little wanting in ethical authenticity.

For the Mad Old Vic panel, the rationale for talking about, not talking with, is surely that three of the panel members have professional authority in the field.

A senior psychiatrist, the CEO of Mind, and the shadow Minister for Mental Health surely have something intelligent and authoritative to say about people who suffer psychologically. Could it be they have their own psychic pain somewhere tucked away inside them? Better not to ask. We are here to talk about people with mental health problems, not to talk about our own problems.

If you ask me, an awful lot of people are scared shitless by madness. Like they are terrified of poverty. Poverty and mental illness – handmaidens of hell. What they have in common is their contagion. You know, if you get too close the lurgy spreads from you to me. We psychotherapists are scared of this. We fend it off with the technologies of our trade, our magic words like ‘countertransference’ and ‘projection’ – spells we cast to keep the horrors at bay. They make it clear that it’s your problem not ours.

Sitting up there on their panel’s rostrum, I am hoping our trio of professional experts will be able to make a few basic facts clear.

First, that there has been a growing epidemic of mental ill-health in the UK from the 1980’s onward, as evidenced by the massive increase in anti-depressant prescriptions and the need for a huge expansion of primary care psychological therapies to millions of citizens. Thank goodness for pharmaceutics and CBT.

Second, that there is no connection between increasing mental ill-health and the introduction of neoliberal economic and social policies by Mrs Thatcher and Ronald Reagan, under the sway of ideologues like Hayek and Friedman. Atomising communities, destroying social housing, breaking the trade unions, deskilling labour, generating massive inequalities of wealth and income, increasing poverty, undermining social welfare provision, consistently cutting the mental health budget, creating a precariat of low pay, part-time, zero hour employment; overseeing a staggering increase in household debt, manufacturing a global financial crisis, following it up with austerity policies aimed at the least well-off, waging imperialist wars in the Middle East – all of this has no bearing on the mental health of the nation. It is NOT true that it is our society that’s sick.

In fact, third, psychological pain and distress is located in the individual. A good proportion of it is probably genetic and/or the embedded dysfunctionality of troubled families. A lot of it is negative thinking, laced with self-pity and dependence on a welfare culture. People need to strive more, skive less. With a judiciously administered balance of encouragement, nudge, threat, bribery and coercion most people will recover their capacity to join in our happy society.

Finally, we need to trust our psy experts up there on the podium, give them more money and more power. Let them get to work on this contagious epidemic of loneliness, depression, fear and anxiety. Trust the technologies of diagnosis, treatment and cure that are so successfully defining and dealing with the epidemic, offering each suffering individual recovery into happiness, optimism and the chance of being part of our hard-working family. Stop putting money into the welfare state, stop putting money into old fashioned care and treatment. Focus on building the innovative, practical recovery strategies that are quick, easy and cheap.

I suppose when we come down to it, talking with people is not very easy, and not very conclusive. All too often it turns out that, like you, people are really very complex and confusing human beings. Before long, talking with people at any depth over a decent period of time undoes your sense that you may know something more about being a successful person than they do. In fact, talking to people soon leads you to realise that you don’t really know very much at all, once you’ve been taken outside your comfort zone. Soon you are flying by the seat of your pants in that intersubjective realm that is so human and yet so disturbing. Most of us, quite rightly, get busy trying to establish anchors, to impose narratives of meanings that are familiar enough to our poor old egos and their ‘entitlements’.

Otherwise, this is exactly how the contagion gets going. Whose pain, love, fear and loss am I feeling? Yours or mine? When we begin to experience our differences, who is right, who is wrong? Why is it so bloody hard to be me and let you be you? What am I frightened of? Like the testimonials to lived experience in the zine, people move us and not necessarily into worlds we want to visit.

This is not the kind of experience that facilitates handy diagnosis, treatment regimes and evidence-based efficacy.

In an age when a tide of depression and anxiety is overwhelming us, when the loud and increasingly disingenuous promises of more resources for mental health services are outdone only by the savagery of regular service cuts, and when the rhetoric of a revolutionary expansion of psychological therapies is being swamped by mushrooming waiting lists, shorter courses of treatment and undertrained and underpaid workers – surely the very last thing we need are the voices of service users and survivors muddying the waters.

If we are not very careful, the conclusion that neoliberal society itself is a mental health disability afflicting all our citizens will be difficult to disguise.

Paul Atkinson

Andrew Samuels on Jobcentre Therapy and the Psy-Organisations

Letter submitted to Therapy Today (the BACP journal) but not published.


I’d like to respond to Catherine Jackson’s interesting article Colocation or collusion? How ethical are the Government’s proposals for closer working between IAPT services and Jobcentre Plus?’ (Therapy Today, April 2016, pp.8-9).

Catherine’s title suggests that the issue is generating heat and, at the end of this letter, I make a suggestion for a dialogical, relational next step.

What Catherine wrote illustrates the usual dilemma that the large professional organisations find themselves in with regard to Government policies – in this case, the many linkages between employment on the one hand and psychological therapies on the other. If bodies such as BACP, UKCP, BPC, BPS and BABCP are too robust in their criticism of Government policies, they will be labelled as ‘the awkward squad’ and ‘the usual suspects’. Doors in Whitehall close, requests for meetings go unanswered or evaded. That doesn’t serve the interests of the members. But what if they are too compliant, too accepting and even collusive with Government policy? What if the Big Five (as I call them) have inadvertently fallen into a role as being one of passing on reassurance to their memberships about the reassurance they themselves have received from the Department of Work and Pensions? That isn’t what members expect either.

I suspect that getting this particular balance right matters a lot to BACP members – it certainly did at the UKCP when I was Chair and the conundrum continues to be frequently discussed there. It is a really difficult balance to achieve. Be that as it may, Catherine’s article describes a significant new development in the field, in which 17 separate organisations have united to make the claim that the Big Five professional bodies referred to may need to do more to bring to the attention of their members what the overall thrust is of the linkages being made at many levels between employment and ‘mental health’. These 17 organisations include service user/survivor groups working alongside organised groups of professional counsellors, psychotherapists, psychologists, social workers, mental health nurses and academics. In all my 44 years as a therapist involved with public issues, I cannot remember anything like this happening before. It’s really important that BACP, in particular, with its deserved reputation for being the most outward-oriented of all the big professional bodies, clocks the significance of what has happened; I hope that the recognition of the importance of user-professional co-operation is not being too slow to arise. (See Note 1, below, for a roll call of the organisations concerned; the names tell their own story.)

In the public correspondence between the Big Five and the 17 organisations challenging them, there seems to be one point of agreement – at least in the abstract, at the level of principle. This is that therapy which has employment as a specific goal stated in advance is questionable from clinical and ethical standpoints. This is what the memberships of the Big Five believe, I think, and hence it is what they expect their leaderships to support.

But there is an increasing amount of ‘therapy-for-work’ being offered in Britain today and the Big Five know about it. Not least, their websites carry adverts whose job descriptions make it clear that the client’s employment is to be the clinical goal of the therapist that will be appointed. To be clear: the main issue here is not that our organisations carry the adverts. The thing is, now it has been pointed out, it is a little problematic to go on saying that this is not happening on the ground. The evidence is very close to hand. Or, to give a further and more general example, the New Savoy Conference, of which four of the Big Five are members, has been explicit that the stated clinical goal of psychological therapy should be employment. IAPTs, too, follow the same line, as Catherine mentions.

Counsellors and psychotherapists, who bring psychological perspectives to bar on public affairs, will understand that the proposals to locate ‘therapy’ in job centres will have (and has already had) a profound emotional impact. Counsellors and psychotherapists all know that the line between ‘suggestion’ and ‘compulsion’ is a very difficult one to demarcate. Vulnerable people can and often do say ‘No’ to what they believe will damage them, no matter how well intended. But, as therapists, shouldn’t we be concerned at what a false compliance does to the emotional state of an individual going through a difficult time?

Returning to the suggestion I flagged up in my opening paragraph, how about BACP convening a Stakeholders’ Meeting at which these matters can be more deeply explored. The Big Five plus the 17 smaller organisations would be at the core of such a gathering. Whether the Department of Work and Pensions would attend is something to discuss.

Andrew Samuels

Professor of Analytical Psychology, University of Essex; former Chair, United Kingdom Council for Psychotherapy


Note 1

The organisations referred to are: Mental Wealth Foundation, 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, Critical Mental Health Nurses’ Network, Social Work Action Network (Mental Health Charter), National Unemployed Workers Combine, Merseyside County Association of Trades Union Councils, Scottish Unemployed Workers’ Network, National Health Action Party

Jobcentre Therapy: MWF exchange letters with the big Psy-Organisations

Following the Mental Wealth Foundation’s (MWF) letter to the five large psy-professions organisations, challenging their statement on jobcentre therapy and psycho-coercion, the organisations responded (see that response at the end of this blog).

The MWF replied on 12 April 2016, raising further issues and proposing a meeting for further dialogue. At the time of writing, this and other requests to meet face-to-face have gone unacknowledged.  Please read on for the full MWF reply…


From:

Mental Wealth Foundation

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; Critical Mental Health Nurses’ Network; Social Work Action Network (Mental Health Charter); National Unemployed Workers Combine; Merseyside County Association of Trades Union Councils; Scottish Unemployed Workers’ 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

Professional bodies scrutinise Government therapists in job centres plans

Thank you for your response of 24 March 2016. We would like to reiterate our invitation to a dialogue around these issues. We are a unique alliance of 17 diverse organisations, representing clients, therapists, campaigners and academics with a unique breadth and depth of perspective. We would very much like to share this wealth of experience and expertise with you; and to understand your position better. We think your members would expect you to meet with us, given the very diverse range of organisations that have united in order to communicate with you.

We appreciate your assurances that you oppose as unethical any coercion or sanctioning connected with psychological therapy’s contribution to the government’s workfare programmes. We also welcome your statement that “[you] do not believe the role of therapists should be to get people back to work”, and that the therapeutic value of employment is conditional both on individual circumstance and the nature of any particular employment and its environment.

At the same time, we are aware that as members of the New Savoy Partnership four of your organisations have welcomed recent workfare proposals, have initiated collaboration between DoH and DWP on Health and Work pilots, and have invited Lord Freud as Minister of Welfare Reform to open a number of your recent annual conferences. Your ‘Joint Pledge on Welfare’  states:

“We welcome the opportunity the Work Programme provides to support more people with mental health conditions into appropriate and sustainable employment.  Specifically, we will develop our expertise to help people with mental health conditions find, enter and remain in employment.” (emphasis added)

We cannot see how your position differs in any significant aspect from that of the DWP and you seem to have allowed yourselves to be drawn into becoming active partners in the government’s workfare policies. We believe – and we know many of your members agree – that the “psy” professions are being let down by our professional bodies going along with government aims and schemes, instead of using their professional knowledge together with service user experience to influence the proper provision of therapeutic services in more appropriate settings, for the benefit of clients and the profession. Clearly your views do in fact differ significantly from ours. Isn’t this something better explored at a meeting?

Over recent months, dozens of adverts for DWP financed mental health advisor and employment coach posts have invited applications from people accredited by you, including as we have already pointed out, those in Therapy Today. These job descriptions are explicit that the role is to get people off benefits and into work. Our concern remains that no action has been taken to inform or protect your members or their clients about involvement in work of this nature which breaches ethical practice.

The top-down nature of policymaking causes alienation and distrust of government workfare policies with a reliance on expert think-tank research, “evidence-based” reports, and a reluctance to engage in any real collaboration with either service users or practitioners.   We are offering you an opportunity to do something different. We believe it is within your role and responsibility, as national professional bodies representing psychological therapies, counselling and psychotherapy in the UK, to hold open an independent arena of public debate on issues of national policy.

We believe your collusion with the government is now threatening to undermine the ethical integrity of the “psy” professions among service user/survivors and professionals. A year ago, our joint letter to the Guardian signed by 440 psychologists, psychotherapists and counsellors raised the alarm about the probability of mandatory psychological therapy coming into being through the co-location of IAPT workers in Job Centres. A year on, the development of Health and Work projects under the DWP’s workfare banner is promoting more, not less fear, demoralisation, and distrust among the members of the organisations the MWF umbrella represents.

As survivors and witnesses of the impact of these developments, we are compelled to act against welfare to work policies and associated government-sanctioned psychological coercion which harms service users and professionals alike. You didn’t reply to our call to cease engagement with the Government Joint Work and Health Unit, and to hold a national event where all stakeholders views can be heard. We would like our campaign to include open debate with the professional bodies whose interests must surely include upholding the ethical values of psychological practice, for the sake of all.

We look forward to your response to our offer.

 


Appendix

Letter from psy-organisations to MWF, dated 24th March 2016:

Dear members of the Mental Wealth Foundation,

Thank you for your letter,

It might be useful if we started by clarifying a number of points that we have made repeatedly to the Department for Work and Pensions. We do not believe that anyone should be coerced into therapy and would denounce any coercion or sanctioning in relation to ‘job centre therapy’. As a result of ethical concerns raised last summer around coercion and sanctioning in relation to ‘job centre therapy’ we, as professional psychological therapy organisations, immediately contacted the Department for Work and Pensions. We were also acutely aware of, and remain acutely aware of, the wider context of sanctions and cuts.

Work is not always good for people’s mental health and wellbeing and we too recognize that poor quality, stressful and insecure employment can be detrimental and profoundly damaging. We also do not believe that employment should be viewed as a universally beneficial health outcome. At the same time, however, good employment can help people, by adding security and purpose to people’s lives, thus enhancing their mental well being. There should indeed not be a ‘one size fits all’ approach and we do not support a policy of work as cure.

We share the view that clients should have their current needs, perspective and autonomy respected but we also make it clear that we do not believe the role of therapists should be to get people back to work. Instead, we believe that the role of the therapist should always be to work with clients to help them resolve their mental health issues. We also do not believe people should receive psychological therapy in an environment where they feel uncomfortable and we do not believe client’s privacy should be compromised.

It is nevertheless important to recognise that access to psychological therapy remains restricted and people are suffering needlessly because of this. It is also the case that rates of mental health problems among people who are unemployed remain unacceptably high. There are likely to be a multitude of reasons for this, from loss of sense of purpose, to the stresses of the sanctions regime – and we wish to see all of these factors tackled. Improving voluntary access to psychological therapy for jobcentre clients is therefore a policy which deserves proper consideration and as organisations which represent psychological therapists, we recognise that the provision of appropriate, voluntary, therapy can play a role in alleviating distress.

The DWP has repeatedly told us that there will be no coercion involved or sanctioning of clients who do not wish to enter psychological therapy. It has also said that clients will have
a choice of where they can access their therapy. We have also secured a promise of a thorough evaluation of their planned small-scale co-location feasibility trial, which should provide a clear indication of whether people’s health and wellbeing is genuinely being improved in both the short and the long term. We suggest it is prudent to review these evaluations before prejudging a project that could provide genuine help to jobcentre clients who experience issues with their mental health.

We also note that your letter conflates different projects. Our organisations are concerned with the provision of therapy to jobcentre clients. We are mindful that other projects have
been initiated in regard to the co-location of work coaches in GPs surgeries, and that other organisations have engaged in scrutiny of these projects. We do not believe we are the most appropriate organisations to comment on those proposals, given they do not involve therapeutic coaches or psychological therapy – which is why our joint response made no mention of those plans.

We would also ask you to note that any past job adverts for positions outside of our organisations should in no way be regarded as the official opinion of any of our organisations individually or collectively.

Yours sincerely,

The British Association for Behavioural and Cognitive Psychotherapies
The British Association for Counselling and Psychotherapy
The British Psychoanalytic Council
The British Psychological Society
The UK Council for Psychotherapy

‘Welfare Reforms and Mental Health – Resisting Sanctions, Assessments and Psychological Coercion’. Conference Report – Part Three

In the final part of our report from the conference, Jay Watts and Nicola Saunders share their reflections on the day.


Jay Watts

I’ve slightly volunteered myself to write something about the ‘Welfare Reforms and Mental Health – Resisting Sanctions, Assessments and Psychological Coercion’ conference because it was, I think, the most exciting event I have been to in a twenty-year history as a mental health professional. Why?

First of all, thinking and planing the conference was a real collaboration, led by Paul Atkinson and Roy Bard. Some of us were lucky enough to hear reports back as they ventured off to territories unknown to find a space that would capture the ethos of the event – a place embedded in the community and activism, as Wade Hall turned out to be. I remember an email from Paul after one such trip, telling me of his delight at finding a local pub to use for small groups called ‘The Winnicott’, so named as the publican had done the one year introduction course to group analysis in the 1970s and been inspired! Here, the kind of embedding of therapy ideas in the community we really need!

“professionals lagging hopelessly behind”

When I arrived on the day, I was greeted with a hug by the marvellous Paula Peters, the kind of touching relations the day, I believe, fostered between those on the front line of disability activism, and us professionals lagging hopelessly behind. Hopelessly? Well, certainly not after the mutual feeding, planned actions, and passion of the day. The opening speeches by Paula, Denise, and Paul were inspiring – as others have written about. But perhaps the banter and respect between the three was as important as a model of what collaborative work might look like.

At 11:00, Rob Stearn and I set off to run our workshop on ‘psychocompulsion’ with about thirty survivors, professionals, and the undefinable. This was both an honour, and a bit of a blow as it meant missing out on other workshops being run at the same time. One of our group – Liz Hughes – has written beautifully about the themes of our conversations so I won’t repeat this. But let me add that I was most taken by the emotional honesty of our grouping, many of whom were suffering that very day with insistent forms and letters from the DWP who just won’t let go of the persecution.

One of the main feedbacks of the day was how nice it was to have a warm lunch ready, so we could talk together and not splinter off to find local amendments. Steaming plate of soup in hand, we settled in to share stories, greet new friends, make new connections. It was especially nice to meet in person many of the twitter activists – we who have shared so many passions, disappointments and hope whilst missing the embodied experience of one another.

“There is a moment in all this, a moment we are in, a moment of potential profound change in how we work together, and the social power we can thus wield”

Afternoon now, I found myself in Roy Bard’s workshop on ‘Mental Wealth’, after the now normal flurry of wondering how I could be in four separate workshops at one time. Roy proposed a new consortium of organisations – survivor, professional, academic, activist – to fight together to challenge the current organisational structures that exist, so deeply in the pocket of the establishment, desperate for crumbs of prestige and funding at the cost of a true ethics. As a group, we held vastly different ideas of what was going wrong, what needs to be done. But out of our dialogue, a tapestry began to be sewn of what the next stage of our activism might look like. And lo and behold, even in the weeks since the conference, the new ‘Mental Wealth’ consortium has bought together very diverse organisations in our first action – a statement to the professional organisations piercing through the ‘reassurance’ of a recent professionals’ press statement saying any link between therapy, job centres and benefits will be ethical.

There is a moment in all this, a moment we are in, a moment of potential profound change in how we work together, and the social power we can thus wield. The conference inspired me most, I believe, because it was one of the first spaces I have been in where the personal, professional and political were taken equally seriously with survivors, professionals and activists present in equal numbers as equals. As someone who has been under psychiatric services in my day, been on disability, but got to get out, this is the only way of being that makes sense to me, that brings it all together.

“We felt mobilised, emboldened, fierce”

After this nourishment, it was with hearts lifted that we reconnected as a larger group for workshop feedbacks, final comments and questions. We felt mobilised, emboldened, fierce. But dotted in amongst this spirit were comments reminding us again and again of the lost lives, anguished realities, and impossible-to-bear poverties the welfare state has inflicted upon us. These comments bought tears to me eyes.

As the formal parts of the day closed – to make way for dance, poetry and music – all of us professionals – I feel – were left with both a renewed horror in what our theories have been used to legitimise, and a profound sense that this event gave us a glimmer that something different was, is, possible. That a different way of being together, supporting each other, fighting for each other is not only conceivable, but the only ethical way to go forward as individuals, professionals and friends.

In solidarity – Jay.


Nicola Saunders

I was late after getting lost but fortunately bumped into Andy, a colleague from the Free Psychotherapy Network, and others talking about how good the opening speakers were, whilst walking to the Winnicott pub for the psy-compulsion workshop – I joined them. We were a mix of survivors, service users, students, psychotherapy trainees and psy professionals. The workshop began with an introduction from Jay and Rob from Boycott Workfare.

After a short silence the group discussion was started by a person who had been forced to stop work because of ill health.   After being told they couldn’t work again and coming to terms with the impact of that on their life, they were told they were ‘fit to work’ at a medical assessment. Looking for work and not being employed because of their illness, they had met Rob and joined Boycott Workfare and the campaign to inform and influence charities from joining workfare.

“The person sitting next to me spoke about not wanting this to be like other meetings where ‘we just talk’.”

A ‘mental health advocate’ had travelled from outside London, spoke next, wanting to be at the conference but frustrated at finding themselves on the waiting list, decided to take the risk after speaking to Paul and ‘came anyway’. Much of their job is now supporting people to engage with the benefits system in order that they receive the benefits they are entitled to. They were very pleased to be there and be with people who want to do something about what is happening.

The person sitting next to me spoke about their not wanting this to be like the other meetings they have been to where ‘we just talk’. Following a discussion on how do psy-professionals engage with other professionals who take up jobs in job centres, they suggested we ask to speak on their training courses and explain to them what happens to the people they see when they do these jobs.

After lunch I went to the Mental Wealth workshop where there was a wide and diverse range of views and critiques of neo-liberalism. It felt to me at times that that there was such a wide a range of views being expressed, that it might prove too difficult to find a consensus, and a big enough campaigning umbrella for all to come together under. I wondered if it might have been helpful for the Mental Wealth and Direct Action workshops to have come together at this point!

Gradually though the campaign to save mental health day services in Liverpool was spoken about. Service users, social workers and academics coming together to defend day support from local authority cuts – and winning. Local defend council housing campaigns were mentioned – 1 in 4 people living on the street have a mental health problem (St Mungo’s: 2016). There was a suggestion for a way of collecting details of the many campaign groups in order that learning and resources can be shared.   And on the Monday after the conference the beginning of the writing of the joint public statement on psychocompulsion under the Mental Wealth umbrella began. I’m sure all in the workshop would have approved.

Nicola

Go back to part one and part two of our report.