Tag Archives: mental health

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)

 

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.

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

In part two of our conference report, Richard House reflects on an historic event


Psy Users and Professionals Join in Common Activist Cause: a report on a one-day conference in Bermondsey, London, 5 March 2016

An historic event

This historic conference, entitled ‘Welfare Reforms and Mental Health – Resisting Sanctions, Assessments and Psychological Coercion’, was jointly organised by the Mental Health Resistance Network (MHRN) and the Alliance for Counselling and Psychotherapy, with the aim of bringing together activists and campaigners, both mental health and claimant activists and psy professionals, with a view to resisting punitive Conservative Government’s welfare reforms.

We use the term ‘historic’ advisedly, because to our knowledge this is one of the first (if not the first) occasion/s where service users, survivors, clients, psy professionals and academics have come together without the usual, often stultifying ‘expert’/‘client’ hierarchies of power. Indeed, it has rapidly become evident to members of the Alliance in recent months that when it comes to activism, we professionals have a huge amount to learn from the users and survivors of the services that professionals provide. So there was a really tangible sense of equality between everyone present at this gathering – the kind of thing that over-professionalised elements of the therapy world would no doubt be appalled by, and would construct allegedly sound, self-serving theoretical rationales as to why such equality wouldn’t be good for users/clients! Our response to such balderdash probably isn’t printable in a public document of this kind; but we warmly welcome this, the latest foray into what an exciting ‘post-professional’ psy world might begin to look like.

The conference

The conference was ably introduced and chaired by Paula Peters of DPAC (Disabled People Against Cuts), and Paula introduced us to two magnificent and inspiring speakers: Paul Atkinson of the Alliance, and Denise McKenna of MHRN (both addresses are to be reproduced in the Humanistic Psychology journal Self & Society later this year; also see Denise’s address here).

“the politics of austerity and neoliberalism, and their noxious effects on those most susceptible to psychological distress and fragility in society”

Paul and Denise spoke incredibly movingly about the backdrop to just why we were all assembled here, each striking an admirable balance between ‘diagnosing’ the problem and the issues, and calls for action and effective mobilisation and resistance. The main focus was on the politics of austerity and neoliberalism, and their noxious effects on those most susceptible to psychological distress and fragility in society, especially poor and disabled people. Indeed, the state as abuser was a recurrent motif that ran through the whole event.

We then broke for a series of inspiring and richly diverse workshops – something for everyone – the only drawback seeming to be that everyone wanted to go to all of them! The following workshops comprised the event:

  • Welfare reform and psychological coercion – with Rob Stearn and Jay Watts
  • Recovery In The Bin (RITB) – 19 Principles
  • Organising to tackle professional bodies, charities, and DWP staff – with Paul Atkinson
  • Campaigning Priorities – with the Mental Health Resistance Network
  • Emotional support for Survivors and Activists
  • The Mental Wealth Foundation – with Roy Bard
  • Direct Action – with Andy Greene

It’s quite impossible to do justice in this short review to the range of vital themes identified and explored on the day. To name just a few raised in one of the workshops I attended:

  • the issue of how we might step up campaigning around the collusion of professional organisations and charities with the Department of Work and Pensions (DWP) and Work and Health initiatives on welfare to work;
  • the theme of why psychology and psychotherapy are being used by government-funded agencies to legitimate oppression;
  • Improving Access to Psychological Therapies (IAPT) promoting a CBT agenda designed to coerce people into being productive consumers rather than offering care; examples of how survivors and mental health workers organised together to opposing the cutting of a successful peer-led project in Liverpool;
  • how community psychologists are organising campaigns in Brighton and elsewhere in the country;
  • how we might use the local press alongside social media to by-pass the bias of official national media.

Each participant was able to attend two workshops in all and my sense was that the discussions were wide-ranging, with the synergy of users, psy professionals and academics producing a quality of discussion and sharing which was far more than the sum of its parts. This surely has to be just the start of something new, exciting and vitally important in the world of psy.

The evening social

As if the rich fare of the day wasn’t sufficient for us all, we were then treated in the evening to a stunningly excellent artistic cabaret of talented musicians and poets, with the likes of Edgar Broughton (he of the legendary 1970s prog rock Edgar Broughton Band), the amazing iconoclastic singer-songwriter Dave Russell, and the radical performance poet, Woman Of Bones Tara Fleur.

Two particular highlights were Dave Russell’s extraordinary cover of the Sex Pistols’ ‘Pretty Vacant’ (‘Beefheart meets Stockhausen’, as someone remarked at the time) and Tara Fleur’s poem ‘I.D.S.I.O.T’., in which she searingly exposes the outrage that is the government’s back-to-work regime for those with mental health issues; a poem that brings humour and hilarity, visceral passion, outrage and tragedy – all wrapped into one breathtaking bravura performance. A ‘John Cooper Clarke moment’, as one poster expressed it on YouTube. This 12-minute, must-watch poem is indeed now on YouTube – and we strongly urge all our supporters to circulate this link to all of their contacts – a poem that will hopefully become a key ideological port of call in the struggle against the appallingly iatrogenic back-to-work regime. It was certainly good to be reminded that talking-shops do have their limits, and that brilliant agitprop and political art can reach places that nothing else can.

And what next?

All in all, then, this conference was a crucial and necessary staging-post on the way towards creating a critical mass in and around psy that can effectively resist the flagrant class attacks on poor and disabled people that the current government is perpetrating. The hope was also expressed that these events might become on ongoing forum of support for those working in and around ‘psy and the state’ – so watch this oppositional space! Certainly, as we write some strong post-conference initiatives are already underway. A dozen activist therapy and service user organisations are currently preparing an open letter to the main professional organisations, calling them out on their tacit support for the DWP’s welfare to work policies. A working group will be meeting to develop the Mental Wealth Foundation, an umbrella for radical mental health activism. We are developing groups of support and advocacy for people facing Work Capability Assessments. The working group for the next conference is forming. The day was also filmed, including face-to-face interviews with some key psy ‘movers and shakers’; and a film is currently being made which will soon be available on the Alliance, DPAC and MHRN websites.

And finally, we’d like to offer our heart-felt thanks to Gary, Mandy and Ilona at Wade Hall, Dickens Estate, Parker’s Row, Bermondsey for providing such a great venue for this event, for coping so wonderfully with the mushrooming number of attendees and for the wonderfully generous catering.

And once more to Paul Atkinson and Roy Bard for the tremendous work they put into organising this stunningly successful event.


See part three of our conference report here.

Go back to part one here.

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

On 5 March 2016 at a community centre in south London, mental-health activists, psy-practitioners and academics gathered for a day of consciousness-raising around welfare reforms and mental health.  In the first of four reports, we share the conference film Resisting Psychological Coercion, and Paul Atkinson looks at how this landmark event came about.


Kicking it off

Roy Bard of the Mental Health Resistance Network (MHRN) and I cooked up the conference. I’d called a meeting of lefty therapists to respond to the news last Spring that Osborne and co. planned to put IAPT therapists in Jobcentres. It seemed to me to be a golden opportunity to try and get us psych’s out of the bubble of our familiar concerns into the world of social class, poverty, welfare benefits, and mental and physical disability. The connection was being made for us by Ian Duncan Smith, George Osborne and, in fact, a next logical step in the recuperation of the psychological professions for neoliberal agendas. A few connections through Occupy St Paul’s prodded me to invite Disabled People Against Cuts (DPAC) and MHRN. I didn’t expect them to be interested, but they were.

Thirty of us met at the Jagonari Centre in Whitechapel. In true psych fashion we went round the group introducing ourselves. Someone – I think it was Roy – said, almost in desperation I discovered later, “Well, we’re doing an action at Streatham Jobcentre. You could join us”. We did. Mental health activists and therapists, and plenty of other campaigners, marched on Streatham Jobcentre in June and a few of us gatecrashed the MH hub’s opening do on the second floor. And then we went to the pub.

A view of the Alliance’s spanking new banner from the second floor of Streatham Jobcentre Plus, 26th June 2015
A view of the Alliance’s spanking new banner from the second floor of Streatham Jobcentre Plus, 26th June 2015

Six months and some relationship building later, with the Tories’ welfare to work and Health and Work policies mushrooming, I thought it might be time for another meeting to talk strategy on how psychs and mental health activists might work together with a bit more coherence. I was conscious all the time that it was my survivor partners who had all the brownie points. They were the activists. We were the Johnny-come-latelies who had basically been part of the problem for a very long time. I was thinking another meeting of twenty to thirty people. Activists were not too keen this time. “We are really busy. We’ve got a lot going on – our own conferences…” As it turns out they also had a major action brewing, at an Islington GP practice protesting at the introduction of DWP/Remploy/Maximus ‘employment coaches’ into six Islington surgeries. Roy, however, thought it was a good idea anyway and that it should be a ‘mini-conference’ – a daylong meeting with workshops… “Er, okay, me and Roy will organise a conference… er, alright then…”  So we did.

Roy had the contact with Gary at Wade Hall, the tenants and residents association hall for the Dickens Estate in Bermondsey. I loved it. A real community venue, hidden away in the middle of a housing estate. Gary really wanted us to use his hall. It turned out he is a lefty himself and has his own mental health connections. The hall could take 80 people without a sweat. He was immediately on about doing food for us. We were on about wheelchair access to the loos. There were grab rails in the women’s loo, but the doorway wasn’t wide enough. Gary thought the pub across the road had an accessible loo, or maybe the church hall down the road. And council workers had a building round the corner for storage and tea that had a disabled loo. He might be able to borrow the key. And by the way, Wade Hall had a licence and why didn’t we have a social in the evening – he would open the bar and if people paid a pound to become members for a year… I was busy fantasising about showing a DPAC activist in a wheelchair the way to the church hall somewhere down the road, probably in the rain, so they could have a piss.

“There is a serious hunger out there to do something about the horrific attacks on disabled people, on our welfare state, on our basic belief in social justice”

I eventually got the Eventbrite link up with a pretty cursory description of the conference and networks started to tweet. Thirty-six hours later the conference was full, and within a week nearly a hundred people were on the waiting list. There is a serious hunger out there to do something about the horrific attacks on disabled people, on our welfare state, on our basic belief in social justice and our values as a society generally.

We now had a conference of anything up to 200; we had thought maybe 50. We wanted the day to be mainly workshops – short introductory plenary speakers, then down to work. What are we planning to do about the DWP’s violence, the coercion of welfare to work, the terror of Work Capability Assessments, of sanctions and conditionality rules? The hall might take 100 at a push, but how do we break out into workshop groups? We reckoned we needed three, preferably four workshop spaces. There were two at Wade Hall.

Wade Hall
Wade Hall

Gary raised his game. There was another hall we could hire for two workshop sessions fifteen minutes away. And there was a pub by the river that advertised free meeting space in its bar for local community groups – it was called The Winnicott (yes, that Winnicott). A mini-conference spread over a community ‘campus’ on three sites. Colleagues were saying, “Book a bigger venue”. They hadn’t met Gary. On the spot he phoned the other hall and negotiated a discounted rate. Later he walked us over to negotiate transitional space with The Winnicott.

So far, strangely easy. Eventbrite and social media opens a door with a crowd of people waiting to get in. Gary provides a Tardis-like venue with bells and whistles. Lucky, because apart from me most of the people who were going to make this event happen were suddenly a lot busier organising the Islington GP demo, timed for the day before the conference. We joked that key players may well still be in the nick on Saturday morning. We’d have to call in the reserves on the waiting list.

A small group of organisers – Paula, Denise, Andrea, Lynne and Jay – joined Roy and me. Over coffee at the BFI and a few emails, we sorted out the workshops, the administration and the domestics, talked about the videoing of the event, the process of the day and what we hoped might come out of it.

“The warmth and the gratitude from all sides for an opportunity to meet to talk political action on mental health and the attacks on the welfare state were palpable.”

I became a bit addicted to Eventbrite. All those names and email addresses. How many did I know? Hardly any. People started to get in touch to ask about travel directions, to apologise and cancel their tickets, to say they really wanted to come but were too late for a ticket, can I get them in. I got the sense that people were coming from all over the UK. We used the survey monkey link to ask everyone who they were – survivor, professional, campaigner; about access and dietary needs; permission to film and to contact after the conference. Fabulously, of the people who replied there were equal numbers of people who identified themselves as service user/survivors and professionals (some of course were both). From the numbers registering and the open enthusiasm of people getting in touch, it was quickly feeling like a really special event. The warmth and the gratitude from all sides for an opportunity to meet to talk political action on mental health and the attacks on the welfare state were palpable.

The Islington GP action on Friday 4th was a big success. A massive amount of careful planning had gone into it. The energy on the day was electric. In its closing phase, as we stood around ‘occupying’ Old Street roundabout in the rush hour, I wondered how on earth people were going to manage to get up next day and get a conference to happen. Surely it was going to be mainly down to me. At about 10 that evening, I began to get anxious. Were there enough chairs? I couldn’t remember what Gary had said. Was it totally mad to expect people to wander around Bermondsey – in the rain the forecast said – looking for a pub to have a one hour workshop? Did Denise and I have time at 10am, as arranged, to put up signage from Bermondsey station into the labyrinthine recesses of the Dickens Estate? Had I printed off the maps and the registration list, did I have enough pens? What about buckets for donations – aargh, no! At 4 on Saturday morning I woke up in a panic and emailed Gary to say we needed the hall open earlier than we’d arranged. Carol tried to get me back to bed. We just lay there wide awake like two anxious and excited new lovers, except not. “I’m going to bloody kill you later today, you nutcase! Do you want me to come over with you in the morning and help you get going?” Oh yes, please.

“These people want to be here, they want to be together. And they want to do something together.”

When we arrived at 9.30, Gary and Mandy were already rushing around. “We’ve been cacking it”, he said. I gave him a therapist’s understanding smile. “So has he”, said Carol, spotting my subterfuge. “He had us awake at 4 in the morning cacking it”. Mmmm.. always good to have you around, darling. Other people start to arrive. Chairs are put out in rows. Tony carries the PA system in from his camper van. Paula sets up the registration table. Denise and I set off with the plastic envelopes and cable ties. By 10.30 we have a few conference goers. They look good. Pretty happy despite the rain and the struggle to find Wade Hall. All sorts of people looking almost instantly at home and glad to meet each other. By kick-off at 11 we have maybe 40 people in the hall, less than half the number registered. “People don’t turn up to a free event, you know”. We hear this a lot in the Free Psychotherapy Network. “They don’t value the work if they don’t have to pay”. We hang on a bit. People are still piling in. By lunch, it’s going to be 90 or so.

But now, I’m relaxing. Paula’s in the chair. Denise and I will kick things off. It feels good; very, very good. These people want to be here, they want to be together. And they want to do something together.


See part two of our conference report – by Richard House – here.

MWF Letter To Therapy Organisations – Jobcentre Therapy & Psychocompulsion


Mental Wealth Foundation (MWF) is a broad, inclusive coalition of professional, grassroots, academic and survivor campaigns and movements. We bear collective witness and support collective action in response to the destructive impact of the new paradigm in health, social care, welfare and employment. We oppose the individualisation and medicalisation of the social, political and material causes of hardship and distress, which are increasing as a result of austerity cuts to services and welfare and the unjust shift of responsibility onto people on low incomes and welfare benefits. Our recent conference focused on Welfare Reforms and Mental Health, Resisting the Impact of Sanctions, Assessments and Psychological Coercion.


21 March 2016

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

We write in response to your joint public statement of 7 March 2016 outlining the outcome of your meetings with the Government’s new Joint Health and Work Unit and your scrutiny of the Government’s plans to place therapists in job centres [1].

There is no indication that any consultation has taken place with members of your organisations with knowledge of these matters nor with service users, clients and their representative organisations. This lack of consultation and opportunity for wider reflection has contributed to your organisations departing from your own ethical structures and frameworks, and being seen as agents of harmful government policy [2]. It is by now generally accepted that the consequences of the DWP and government policy in this area are far reaching for physically and mentally disabled people on social security benefits. Inexplicably your organisations’ scrutiny of government plans has failed to recognise this.

“It is wrong for therapy organisations to buy into the unthinking praise for ‘work’…”

The joining of Government Health and Work Departments is not helpful, and current DWP policy intended to reduce the socio-economic causes of mental illness to the one simple fact of unemployment is clinically and intellectually ridiculous. The resulting policy promoting work as cure, which your organisations are now supporting, is offensive and dangerous. It is wrong for therapy organisations to buy into the unthinking praise for ‘work’ that often forms part of the rhetoric of governments.

While for some clients improving employment prospects may be an objective, for many others this is not the case and may be profoundly damaging. Indeed, for some people, their mental health problems may have begun because of work e.g. through experiences of bullying in the workplace. This one size fits all approach is simplistic. Premature return to work can result in loss of confidence and relapses affecting future ability to get back to work. This can also lead to prolonged periods without benefits and no income [3].

You state that plans must be aimed at improving mental health and wellbeing rather than as a means of getting people back to work. These are not the aims and objectives being expressed by the people who are implementing the programme right now, involving targeting ‘hard to help’ clients who are likely to be people with enduring physical or mental health difficulties. For example in the Islington pilot project Councillor Richard Watts has stated, “We think there is much more that health services can do to promote the idea of employment for people with health conditions.” In the Islington CCG Commissioners’ report in November calling for employment services in GP surgeries to reach ‘hard to help’ claimants, they state that, “to improve the system we need to…maximise the contribution of all local services to boost employment, making it a priority for health, housing, social care and training. We need to open up how we talk to people about employment, including asking healthcare professionals to have conversations about work with patients, as part of their recovery. We need to give professionals the information and tools to help them to do this.” [4]. For all clients, establishing a trusting relationship is the first priority, involving respecting their current needs, perspectives and autonomy.

“We fail to share your reassurance from the government that these punitive measures will not be pursued against clients”

Jobs advertised on the BACP website in November 2015 have the explicit aim of getting clients back to work and engaging with employment services e.g. “your role will include: producing tailored health action plans for each client, focusing on improving their health and moving them closer to work…generate health and wellbeing referrals to ensure continued engagement with employment advisers” [5]. Similarly G4S advertise jobs for BABCP accredited CBT practitioners with job roles including: “Targeted on the level, number and effectiveness of interventions in re-engaging Customers and Customer progression into work” [6].

We respectfully submit that information about these jobs was known to all of your organisations when you issued your joint statement. This inconsistency is seriously misleading.

We are glad that you oppose conditionality, coercion and sanctions. Clearly such punitive measures have no place in the therapeutic relationship. We fail to share your reassurance from the government that these measures will not be pursued against clients. DWP have repeatedly claimed that sanctions are a last resort and only happen in a tiny minority of cases. The reality is that millions of people have been sanctioned. In the twelve months to September 2015 alone, over 350,000 ESA and JSA claimants were sanctioned [7]. In the Employment Support Allowance Work Related Activity Group the majority of sanctions were of people who have been placed in the group specifically because they are experiencing mental health issues and research shows that benefit sanctions on people with mental health problems has increased by 600% [8].

“therapy may not be explicitly linked to conditions/sanctions but will feel so for many of its prospective clients”

It is not possible to consider this issue without considering the context of sanctions, cuts and persecution which is endemic in the current system. You fail to acknowledge that attending this proposed therapy may not be explicitly linked to conditions/sanctions but will feel so for many of its prospective clients who are on benefits. There is a structural power imbalance between job centre employees and those on benefits. With their income under threat, those on benefits will be especially susceptible to cues, suggestibility and positive reinforcement when attending job centres. Many on benefits have experienced oppressive power relations for much of their lives. Saying no in relation to an apparent free choice in this context is hugely difficult, especially when saying no has uncertain consequences [9] .

Attempts to coerce people into work are detrimental not only to their health but to their safety and, in many cases, present a risk to life. The extreme fear and distress caused by the current welfare reforms, including changes in disability benefits and the new Work Capability Assessments, is widely reported including instances that have led to suicide [10]. Therapy alongside this coercive system breaches the ethical principle of non-maleficence.

You state that there must be choice as to location of therapy. There is a clear danger in putting DWP representatives into GP surgeries, community centres and food banks that are seen as safe havens for people on low incomes and benefits. The presence of DWP compromises this. DWP/Maximus workers in the GP surgery, with access to medical records, will serve as a deterrent to people visiting their family doctor. The model currently in use in Islington allows Remploy/Maximus workers to access and write into GP records; this jeopardises any commitment to client privacy and confidentiality [11].

The choice of method of therapy is an illusion and therapists of all modalities are subject to the stresses of an unjust target driven culture [12]. We are concerned that under-qualified and inexperienced staff, such as job centre coaches, will be in a position to make referrals to Health and Work programs. This is exacerbated by the fact that referrals are likely to be to IAPT workers, many of whom themselves lack in-depth training and experience of severe mental health issues. Inappropriate referrals are increasingly likely in a target-driven culture.

“We call on you to cease your engagement with the Government Joint Work and Health Unit and instead hold a national stakeholder event”

We are not reassured that the feasibility trials planned by the government will contribute to knowledge and understanding and are not reassured by your echoing what government is saying. Instead you and government must listen to the voices of survivors who describe the reality of government plans on their lives and are fighting for services with a vision of humanity beyond work [13].

It is clear from your public statement that you have failed to critically examine and scrutinise the ongoing activities of the Government Joint Work and Health Unit. We call on you to cease your engagement with this unit and instead hold a national stakeholder event which is guaranteed to involve the participation of representative organisations for service users and therapists with direct knowledge of the area, as well as professional bodies like yours. There should be no government involvement in such an event. From it, a representative group can be selected that will adequately represent the views of service users and therapists to the appropriate government departments as well as to the opposition.

References

  1. http://www.bacp.co.uk/media/index.php?newsId=3906
  2. https://www.opendemocracy.net/ournhs/dr-lynne-friedli-robert-stern/why-we-re-opposed-to-jobs-on-prescription
  3. https://www.morningstaronline.co.uk/a-a3e3-Joblessness-branded-a-mental-illness#.VuKWT4SFDzI
  4. http://www.islingtonccg.nhs.uk/Downloads/CCG/BoardPapers/20151111/4.3%20Health%20and%20Employment%20Programme.pdf
  5. ‘Mental Health Advisor – Job Details’ Retrieved from http://www.bacp.co.uk/jobs/jobs.php November 21st, 2015. Available at: https://www.dropbox.com/s/a6p9mod1jb08dne/Mental%20Health%20Advisor%20-%20Job%20Details.docx?dl=0
  6. http://careers.g4s.com/jobs/Cognitive-Behavioural-Therapist_58526/6 crisis
  7. https://www.gov.uk/government/statistics/jobseekers-allowance-and-employment-and-support-allowance-sanctions-decisions-made-to-september-2015
  8. http://www.independent.co.uk/news/uk/politics/benefit-sanctions-against-people-with-mental-health-problems-up-by-600-per-cent-a6731971.html
  9. For a fuller discussion of these issues, see http://mh.bmj.com/content/41/1/40.full
  10. http://jech.bmj.com/content/early/2015/10/26/jech-2015-206209.full
  11. Para 4.3: http://democracy.islington.gov.uk/documents/s6740/Health%20and%20work%20-%20HWB%20update%20Jan%202016%20final.pdf; http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/gps-told-to-inform-patients-dwp-will-obtain-their-fit-note-records/20030820.article. See also http://files-eu.clickdimensions.com/hscicgovuk-amnje/files/emed3dpnlettertogppracticesv1.0.pdf?_cldee=Y29yYWwuam9uZXNAbmhzLm5ldA%3d%3d&urlid=0
  12. http://www.theguardian.com/healthcare-network/2016/feb/17/were-not-surprised-half-our-psychologist-colleagues-are-depressed
  13. http://recoveryinthebin.org/2016/03/10/welfare-reforms-and-mental-health-resisting-sanctions-assessments-and-psychological-coercion-by-denise-mckenna-mental-health-resistance-network-mhrn/

The Ethical Dilemmas of Back-To-Work Therapy

This dialogue is taken from an email conversation held in 2015 between Paul Atkinson and Andy Rogers and was inspired by the dilemma described in the vignette below.

An earlier version was published in the journal Self & Society – An International Journal for Humanistic Psychology , Vol 43, Issue 4, 2015. Subscribe to Self & Society here.


Izzy is a qualified psychodynamic counsellor, with a supplementary training in CBT. She has a small but growing private practice working from home and recently began a part-time job as a mental health advisor in a Well-Being Hub located above a Jobcentre Plus. She feels increasingly caught in a conflict of feelings and loyalties between the two settings of her working life.

Her Hub clients are nearly all working class, on welfare benefits and from a variety of ethnic minority communities. Many are on medication and have patchy experience of work. Some have been sanctioned by the Jobcentre staff downstairs and have had to survive on reduced benefits for weeks or months. Via the Hub, she can offer a maximum of 12 weeks support. Meanwhile, her private clients are predominantly white and broadly middle-class, and she sees them once or sometimes twice a week for open-ended therapy on a sliding-scale of £15 to £55 per session.

She feels a profound ethical and social commitment to her Hub clients and the value of their work together, but is concerned she might be supporting an inadequate and potentially punitive system of mental health provision, on an hourly rate of about one sixth of her average private practice fee.


Andy Rogers: Can you say a little about your own work in and around the therapy field, Paul, and what first strikes you about Izzy’s situation and her ‘conflict of feelings and loyalties’?

Paul Atkinson: I have been involved with therapy and left libertarian politics since the early 1970s. I’ve worked in private practice as a Jungian analytical psychotherapist and supervisor since 1990, and chaired two training organisations along the way. As a member of the Alliance for Counselling & Psychotherapy and the analytic college of the UKCP I campaigned against state regulation and the ‘medicalisation’ of the therapeutic relationship. Most recently I have been working to undo the separation of psychological life and social and economic life, a separation through which psychotherapy has played its part in neoliberalism’s growing capture of subjectivity. I helped set up the Free Psychotherapy Network (FPN), and am working with mental health and welfare campaigners to oppose the Department for Work and Pensions’ (DWP) psychological coercion of benefits claimants.

Izzy’s situation and her ethical dilemmas feel very familiar. I think many therapists experience a tension between wanting to work with ordinary people in psychological difficulty through the public and voluntary sectors, and the potential freedoms, satisfactions and income of private practice and its largely white, middle-class clientele. Over the last two decades, these two worlds have become increasingly polarised – in parallel with most other trends in social cohesion and the distribution of resources. As we all know, most counselling and psychotherapy in the public and third sectors is now very short-term, instrumental and behavioural. In the self-employed private sector, open-ended work is the norm, but is affordable to the more well-off only.

My fantasy is that Izzy wants to build up her private practice but is experiencing a lot of anxiety about getting enough clients, setting herself up as a self-employed business and bearing in relative isolation the responsibility she feels for her private clients. The part-time job at the Hub gives her a reliable if modest income and places her in a team with a framework of guidelines, shared responsibility and focussed goals and outcome measures – alongside the satisfaction of working with people experiencing social and economic deprivation and considerable psychological suffering.

The trouble is her job at the Well-Being Hub places her right on the cutting edge of the most vicious campaign in post-war Britain of state violence against welfare claimants, and especially people on mental health disability benefits.

AR: So Izzy’s anxieties, comforts, conflicts and satisfactions aren’t just individual or interpersonal matters, but are in direct relationship with the push and pull of the political and socio-economic environment. Most starkly, she finds herself involved with a government policy that’s having a direct and devastating impact on some of the least powerful people in society.

What really stands out here to me is the mention of Izzy’s ‘profound ethical and social commitment’ to her Hub clients. This brings with it the dilemma of whether or not she can honour – or do justice to – that commitment in such an environment; or is it just too contaminated? How do we begin to answer that question?

PA: Well, there are surely conflicting ethical perspectives for Izzy to wrestle with, and as always the realms of ethics and politics are interwoven.

There is a broad ethical debate about the difference between working in the public and private sectors, a debate which has deepened with the replacement of most NHS talking therapy with the Improving Access to Psychological Therapies (IAPT) programme. As a private practitioner, I would say the primary scene of ethical action is the quantum flow of the intersubjective moment. The existential, let’s say ‘Levinasian’ space of interpersonal encounter is undoubtedly relevant to any institutional setting, but has become increasingly circumscribed by neoliberal utilitarianism and the devastations of austerity ideology. Private practice potentially offers more scope for ethical integrity, say in relation to respect for unconscious process, but it is slave to the market in its own way, and can hardly make more than a limited, individualised claim to serve social justice.

Many therapists in Izzy’s position would argue that something is better than nothing, that the value to her Hub clients of several hours of empathic attention, a taking seriously of their very personal experience of distress and an attempt to offer some kind of useful perspective on how to better live with that experience is primary in the ethical balance. The exponential growth of short-term, outcome oriented therapy over the last decade and more has appalled many practitioners, while others claim the ethical core of the relational encounter remains viable.

In general, I hesitate to make principled judgements on the ethics of someone’s work based on the restrictions of their setting and job description. A practitioner’s capacity for ethical work can overcome, or at least survive all sorts of environmental enclosure. The ethical environment of Izzy’s mental health Hub, however, has and is being deeply undermined under the Coalition and Tory governments, especially in relation to the increasing collaboration between the NHS and the DWP to get claimants suffering mental health issues off benefits and into work.

AR: What’s some of the recent political history around these developments?

PA: From the start, the IAPT scheme promised to pay for itself by reducing the welfare bill. Richard Layard was clear in his Depression Report 2006 that more people were claiming benefits with a mental health diagnosis than for any other reason, including unemployment.  Getting people off benefits and into work was to be a major outcome goal of IAPT provision.

From 2010, DWP welfare policies have become increasingly punitive towards anyone claiming social security benefits, and the pressure to get claimants off benefits has created a toxic environment of fear and coercion, fuelled by a massive increase in benefit sanctions, work preparation courses and compulsory workfare.  The number of claimants sanctioned doubled within a year of new rules introduced in 2012.  Thousands of people with mental and physical disabilities have been subjected to repeated rounds of Work Capacity Assessments and declared fit for work. Deaths through suicide or other causes associated with people being sanctioned or declared fit for work have climbed.  On October 14th 2015, responding to an approach from Disabled People Against Cuts, the UN launched its first ever investigation in a developed economy into the effects of UK welfare cuts on people with disabilities.

Following the Rand Report of 2009 on the value of work as a treatment for mental health sufferers and its recommendations for the joint Department of Health/DWP piloting of a number of return-to-work programmes offering psychological therapies and well-being courses to benefit claimants, return-to-work therapy has begun to dominate the discourse of ‘treatment’ approaches for mental health service users on benefits.  In his 2015 spring budget statement, George Osborne announced the ‘co-location’ of IAPT teams in 350 Jobcentres around the country. The Conservative Manifesto a month later suggested compulsory treatment for benefit claimants with obesity and substance misuse issues.  As I write, Ian Duncan Smith is putting job advisors in food banks.

I want to ask Izzy what she thinks about the ethics of mental health work located in the same building as a Jobcentre Plus? What does she think about working with clients, many of whom will be claiming benefits and will be subjected to a regime of sanctions, workfare, fit-to-work assessments and so on? Does she not think that her work is becoming profoundly contaminated by a “get to work” ideology that is a major source of distress, anxiety, fear and humiliation for many of her clients?

Part of the response from the Hub’s management will be that their work and the DWP’s work are separate, that sharing a building does not mean that they are collaborating in any way, that any course of treatment or support they are offering is strictly by the informed consent of the client, and in so many cases their clients want to work – in fact are desperate to get out into the world of work and all the benefits of self-respect, feeling useful and having a bit more money a job brings.¹

But what does Izzy think as a therapist?

AR: I wonder whether part of the difficulty here is that a practitioner such as Izzy might ‘think as a therapist’ a bit too much! That her commitment to therapeutic process and the assumed value of therapy discourse and practice, and its associated conventions (we sit in this room and we talk in this way about you etc.) might narrow her field of vision when trying to see a way through her dilemma.

Perhaps Izzy and the rest of us need to think more like sociologists or political theorists, or at least apply our critical faculties not just to what happens ‘in the room’ but to the relationships and structures beyond. Interestingly, this seems almost fashionable to say at the moment, which is rather incongruous with our field’s ever more cosy relationship with the State!

Yet even with a fairly conventional therapist hat on, it’s pretty clear that a coercive context (or a physical location and referral  process that directly links therapy with coercive practices nearby) will influence what is going on in the therapy relationally, however noble our intentions to provide a facilitative space for personal exploration.

PA: I imagine all therapists recognise that work is an important issue for most people, whether they are in paid work or not. Work and family are probably still the primary sources of meaning, identity and social connection for most of us. Everyone needs the means of keeping body and soul together, and we live in a society that puts a high value on individuals and families taking responsibility for those needs, mainly through paid work. What is going on for a client in relation to work and money is going be an important arena of therapeutic endeavour, and an endeavour which forcefully brings the world into the room with the client and the therapist.

Obviously, not everyone can work, wants to work or needs to work. Having a job is not a goal of psychotherapy.²  If there is a therapeutic desire around the issue of work, it is surely to explore and open out what work means to someone. The individual complexity of those meanings, as every therapist knows, can be dense, contradictory and fascinating. Ideally, the ethics of the profession call for as open an exploration as possible of the meanings both the client and the therapist associate with work.

If I were offering Izzy supervision for her Hub work, we would inevitably be thinking together about the restrictions of the setting for exploring what things mean to her clients – including work. I have no doubt she will be seeing people who want to work, have a history of difficulties finding and holding down a job, and perhaps find it hard to identify and articulate what kinds of working conditions would be best for them and so on. Izzy and her colleagues in occupational therapy, confidence training and practical support may well do a great job supporting these people, including offering some insight into the clients’ difficulties around work.

“It is impossible to imagine how the toxicity of the DWP culture would not undermine and contaminate Izzy’s hope”

But she will also be seeing people for whom the whole process of being in work or looking for work has been a traumatic nightmare alongside coping with combinations of housing problems; bouts of depression; panic attacks; family breakdown; single parenthood; low wages and benefit claiming; excruciating feelings of uselessness, failure and despair; domestic violence; physical disability; caring for dependents; self-harm; substance misuse; psychosis. Many people with this kind of experience of emotional and social problems will be on benefits and will be in the hands of the DWP regime in the Jobcentre Plus downstairs from her Well-Being Hub.

It is impossible to imagine how the toxicity of the DWP culture would not undermine and contaminate Izzy’s hope to offer a space in which someone’s feelings and associations about work or anything else can be explored.  How in these circumstances can anything approaching an ethical frame for counselling or psychotherapy be tenable? On the contrary, return-to-work and any real therapy will be at loggerheads.

What should Izzy do? This is where your question comes in, Andy. ‘Do we therapists need to think more like sociologists or political theorists, or at least apply our critical faculties not just to what happens ‘in the room’ but to the relationships and structures beyond?’ Yes of course, but what does that mean? Thinking critically about the interplay of the social, political and psychological dimensions of a person’s life, and working within that interplay as a therapist are not necessarily the same thing.

Most of our trainings will include reading and thinking about ‘social diversity, inequality and social justice’. Some make a lot of post-modern critical thinking. There is a growing literature on psychotherapy and politics.  A therapist’s background in terms of class, race, gender, sexual orientation and life experience generally is likely to have a crucial influence on how socially-minded they are and therefore how social and political understandings get into their work. In reality, though, I think the psychodynamics of social difference remain primitive everywhere. Among therapists – because of the intensity and depth of the encounter – fear of difference and associated defensive strategies can be especially powerful. For example, thinking of Izzy, how much thought do we give to our fear of poverty and the poor?

“As a profession, we are more part of the problem of neoliberal capitalism than we are part of the solution. “

At the same time, the separation of the psychological from the socio-economic is at the foundation of psychotherapy and counselling. As a profession, we are more part of the problem of neoliberal capitalism than we are part of the solution. Psychotherapy’s creation and marketing of the intra-psychic individual, like Big Pharma’s creation of the depressed and anxious brain, represent very successful enclosures of lived experience as marketable solutions for the failing denizens of “modern life and its challenges”.

Izzy has some kind of political take on her work, expressed as an ethical tension within her. I would encourage her to experience this ethical discomfort as a guide in her development as a person, a citizen and a therapist. I would want her to allow the unfolding of her discomfort and her effort to work, think and live with its nagging voice to become a passion in her life. Where it takes her is not really the point.

She may think that the ethical environment of her Hub work is too toxic to bear, and leave as soon as she can. Many newly qualified therapists who take up work in the public or voluntary sector and find themselves doing very short term, regulated, outcome-driven therapy can’t stick it for long. It is not what they have trained to do and can accept as real therapy. A recent blog on the Critical Mental Health Nurses Network tells the moving story of a student nurse who decided to leave his training in the face of what he discovered to be the political context of the profession: ‘In short, I felt more like a prison guard than a nurse. Mental health nursing is much more of an authoritarian role – which made me feel more like I was more part of the problem than the solution.’

Izzy may feel she wants the experience of working with and getting to understand the experience of the people she meets in the Hub work – people she is unlikely to meet in private practice. With a growing awareness of how the politics of mental health operate, she may want to explore how to find trust between herself and service users, how she might begin to challenge the Hub’s ethos, and get involved in arguing for changes in the service and in the DWP policies whose impact she is experiencing first hand. She may find herself in deepening conflict with her employers, looking for support from sympathetic colleagues and her union. She may end up losing her job. But in the process she will deepen her understanding of the politics of mental health and of how to work more creatively with people who want positive change.³

But as I say, where it actually takes her is not really the point.


References

  1. In June 2015, the Mental Health Resistance Network and a number of claimants’ organisations and psy-professionals protested at the location of a Well-Being Hub being located above a Jobcentre Plus in Streatham: http://www.swlondoner.co.uk/protesters-rally-against-streatham-jobcentre-forcing-unemployed-people-into-mental-health-treatment/. The Hub staff and representatives of the protesters met a few months later to talk about issues raised.
  2. The moral power of work in our wealthy society is unrelenting. However meaningless, under-paid and demeaning, with a labour market increasingly dominated by ‘voluntary’ and unpaid, low-paid, part-time, zero-hour contract and desperate self-employment work, we are to obey a moral duty to want to work. Benefit claimants are regularly declared to be scroungers, cheats and liars. On the debilitating influence of the current ethos of work, see: http://www.theguardian.com/commentisfree/2015/aug/25/work-cure-disability-benefits-sickness and for a refreshing rebuttal of the return-to-work philosophy, see http://freepsychotherapynetwork.com/2015/03/05/middle-class-solutions-to-working-class-problems-is-why-charities-like-mind-keep-getting-it-so-wrong/
  3. For the beginnings of a discussion in Therapy Today on the ethics of return-to-work therapy and how practitioners might respond see: http://www.therapytoday.net/article/show/4899/should-counsellors-work-with-workfare/ and http://www.therapytoday.net/article/show/4968/counsellors-helping-the-unemployed/

About the authors

Andy Rogers trained at the University of East Anglia in the late 1990s and has worked in and written about the therapy field ever since. He now coordinates a counselling service in a large college of further and higher education and is an active participant in the Alliance for Counselling & Psychotherapy.

Paul Atkinson is a Jungian psychotherapist in private practice in London. Political activism has flushed him out of his consulting room over the last few years, nicely timed to coincide with his state pension and the arrival of grandchildren. He is a member of the Alliance for Counselling & Psychotherapy, and has been centrally involved in setting up the Free Psychotherapy Network.